Styloid Process Elongation on Cervical Spine Computed Tomography is Associated with the Enthesopathy-Related Diseases of Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis.

BACKGROUND: Enthesopathy may lead to calcification of the stylohyoid ligament and can cause elongation of the styloid process (SP). OBJECTIVES: To evaluate whether SP elongation is associated with two common enthesitis-related diseases: ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). METHODS: Cervical spine computed tomography (CT) examinations of patients with DISH (n=64, Resnick criteria), AS (n=24, New York criteria) and a controls (no radiological signs of DISH or AS, n=54) were retrospectively evaluated. The DISH group was further divided into patients with and without cervical DISH. The length of right and left SP was measured independently by two readers on coronal and sagittal curved reformats. The average right and left styloid length and average length per person were compared among the groups. RESULTS: Demographic characteristics were similar between the DISH and control groups (average age 68.2 ± 15.7, 69.2 ± 12.7 years, male:female ratio 48:16 and 35:19, respectively, P > 0.05), whereas age was significantly lower (average age: 53 ± 15 years, P < 0.0001) in the AS group, which was also composed mainly of men. The AS and DISH groups had significantly longer SP compared to controls (AS 37.9 ± 9.6 mm, DISH 34.4 ± 9 mm, control 30.3 ± 10.1 mm, P < 0.05). There was no correlation between age and SP length. Inter-reader reliability of SP measurements was excellent in all groups (ICC = 0.998, P < 0.0001). CONCLUSIONS: SP elongation is associated with both AS and DISH substantiating the enthesopathy-related pathophysiology of this finding.

Radiographic features of intracorporeally smuggled liquid cocaine.

PURPOSE: The radiological features of intracorporeally smuggled cocaine powder are well-established. Liquid cocaine is a novel method for intracorporeal drug smuggling. We describe radiological features of liquid cocaine on abdominal plain films and computerized tomographic (CT) scans and compare them to those of cocaine powder. METHODS: Twenty-five suspected cocaine smugglers (13 males, 12 females, average age 38 years) underwent abdominal plain film radiography for drug detection between 2010 and 2014. Ten of them also underwent a CT scan. Eight were found to be smuggling cocaine powder and 17 were found to be smuggling liquid cocaine. We identified two new imaging characteristics unique to intracorporeal liquid cocaine on both plain films and CT scans, and compared them to the radiological features of cocaine powder. RESULTS: The radiological features of intraabdominal liquid cocaine packets on plain abdominal films (n = 17) were similar in opacity to bowel content and had an irregular shape that conformed to the intestinal contour. We identified what we termed "thin lucent lines" that were created by gas trapped between the packets. Four CT scans revealed that liquid cocaine was hyperdense compared to bowel content, that the packets had irregular shapes, and that the gas trapped between the packets formed a "jigsaw" pattern, a heretofore non-described finding that was present in all four scans. CONCLUSIONS: Liquid cocaine has several unique imaging features that assist its detection on abdominal plain film. A CT scan can assist detection in inconclusive cases by demonstrating hyperdense irregular packets of liquid cocaine and a "jigsaw" pattern of gas between them.

Central nervous system involvement in systemic lupus erythematosus: an imaging challenge.

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder involving multiple organs. One of the main sites of SLE morbidity is the central nervous system (CNS), specifically the brain. In this article we review several imaging modalities used for CNS examination in SLE patients. These modalities are categorized as morphological and functional. Special attention is given to magnetic resonance imaging (MRI) and its specific sequences such as diffusion-weighted imaging (DWI), diffuse tensor imaging (DTI) and magnetic resonance spectroscopy (MRS). These modalities allow us to better understand CNS involvement in SLE patients, its pathophysiology and consequences.

Common sites and etiologies of residents' misinterpretation of head CT scans in the emergency department of a level I trauma center.

BACKGROUND: Misinterpretation of head computerized tomographic (CT) scans by radiology residents in the emergency department (ED) can result in delayed and even erroneous radiology diagnoses. Better knowledge of pitfalls and environmental factors may decrease the occurrence of these errors. OBJECTIVES: To evaluate common misinterpretations of head CT scans by radiology residents in a level I trauma center ED. METHODS: We studied 955 head CT scans of patients admitted to our ED from January 2010 to May 2011. They were reviewed separately by two senior neuroradiologists and graded as being unimportant (score of 1), important but not requiring emergent treatment (score of 2), and important requiring urgent treatment (score of 3). We recorded the time of day the examination was performed, the year of residency, the site, subsite and side of the lesion, the pathology, the anatomical mistake, false-positive findings, and the attending neuroradiologists' score. RESULTS: A total of 955 examinations were interpreted of which 398 had misinterpreted findings that were entered into the database, with the possibility of multiple errors per examination. The overall misinterpretation rate was 41%. The most commonly missed pathologies were chronic infarcts, hypodense lesions, and mucosal thickening in the paranasal sinuses. The most common sites for misdiagnosis were brain lobes, sinuses and deep brain structures. The highest percentage of misinterpretation occurred between 2.30 p.m. and 8 p.m. and the lowest between midnight and 8 a.m. (P < 0.05). The overall percentage of errors involving pathologies with a score of 3 by at least one of the neuroradiologists was 4.7%. Third-year residents had an overall higher error rate and first-year residents had significantly more false-positive misinterpretations compared to the other residents. CONCLUSIONS: The percentage of errors made by our residents in cases that required urgent treatment was comparable to the published data. We believe that the intense workload of radiology residents contributes to their misinterpretation of head CT findings.

A volcanic explosion of autoantibodies in systemic lupus erythematosus: a diversity of 180 different antibodies found in SLE patients.

Recent research in systemic lupus erythematosus (SLE) yielded new antigens and antibodies in SLE patients. We describe the various autoantibodies that can be detected in patients with SLE. A literature review, using the terms "autoantibody" and "systemic lupus erythematosus", was conducted to search for articles on autoantibodies in SLE, their target antigens, association with disease activity and other clinical manifestations. One hundred and eighty autoantibodies were so far described in SLE patients. These include autoantibodies that target nuclear antigens, cytoplasmic antigens, cell membrane antigens, phospholipid-associated antigens, blood cells, endothelial cells, and nervous system antigens, plasma proteins, matrix proteins, and miscellaneous antigens. The target of an autoantibody, the autoantigen properties, autoantibody frequencies in SLE, as well as clinical associations, and correlation with disease activity are described for all 180 autoantibodies. SLE is so far the autoimmune disease with the largest number of detectable autoantibodies. Their production could be antigen-driven, the result of a polyclonal B cell activation, impaired apoptotic pathways, or the outcome of an idiotypic network dysregulation.