RESUMO
Isotope bone scans have been used for a number of years to assess growth activity in the mandibular condyle in patients who present with facial asymmetry. The aim is to distinguish normal bone growth within the condyle from increased activity that may be the cause of the asymmetry. Previous studies have, however, relied only on planar images. SPECT (single photon emission computed tomography) has been used with quantitative assessments of one mandibular condyle to clivus or lumbar spine, but we have compared one condyle with the other, which is more sensitive and accurate in detecting abnormal activity. A relative percentage uptake of 55% or more in the affected mandibular condyle is considered to be abnormal, and this has been validated by comparison with an age-matched control group. We have used SPECT as an aid to diagnosis and treatment in 18 patients with asymmetrical growth and have constructed a therapeutic algorithm to aid the treatment of these patients.
Assuntos
Côndilo Mandibular/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Fossa Craniana Posterior/diagnóstico por imagem , Assimetria Facial/complicações , Assimetria Facial/diagnóstico por imagem , Assimetria Facial/fisiopatologia , Assimetria Facial/cirurgia , Feminino , Seguimentos , Humanos , Hiperplasia , Vértebras Lombares/diagnóstico por imagem , Masculino , Má Oclusão/etiologia , Má Oclusão/cirurgia , Côndilo Mandibular/crescimento & desenvolvimento , Côndilo Mandibular/patologia , Côndilo Mandibular/cirurgia , Osteotomia , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Medronato de Tecnécio Tc 99mRESUMO
Schmorl's nodes, the result of previous intraosseous disc herniation (IODH), are a common incidental finding on plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). Acute IODH can, however, cause severe back pain, and the radiological features may also lead to inappropriate suspicion of malignancy or infection. We present eight cases of acute IODH in order to illustrate how the correct diagnosis can be made by MRI. In six cases isotope bone scintigraphy had been performed, demonstrating focal increased activity at the site of IODH. MRI can reinforce the concern about serious underlying pathology by the demonstration of marrow oedema, which may be localized around the disc herniation or extensive, extending throughout the vertebral body and into the pedicles. The key to the correct diagnosis is the recognition of the endplate defect and disc herniation. In three cases the diagnosis may have been possible from plain radiographs in which disc calcification visible on previous radiographs had migrated into an intraosseous location.
Assuntos
Deslocamento do Disco Intervertebral/diagnóstico , Doença Aguda , Adolescente , Dor nas Costas/etiologia , Doenças da Medula Óssea/diagnóstico , Edema/diagnóstico , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/complicações , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Diagnostic uncertainty concerning the nature of an enlarging inguinal mass in an elderly male with a short history of hip pain was resolved by a combination of ultrasound and magnetic resonance imaging (MRI). Subsequent investigations showed that the enlarged iliopsoas bursa, which contained a number of atypical cells, was an unusual presenting feature of a destructive metastatic lesion in the right hip.