A comparison between radiographic and sonographic assessment of hand and wrist bones for the estimation of skeletal age in the child patient.

AIM: The purpose of this study was to examine, with a sonographic investigation, the hand and wrist bones of a group of young patients and to compare the results with those obtained with a classical radiographic assessment. MATERIALS AND METHODS: Some 25 subjects, 9-18 years of age, who presented problems concerning their short stature or precocious puberty, were evaluated. Each subject was examined by a standard radiographic assessment and by a sonographic investigation with real-time imaging. Sonographic examination was performed on the metacarpus-phalanx articulation of the first finger in order to locate the sesamoid bone. Sonographic examination was also performed on the second and third phalanxes of the third finger and on the distal portion of the radius to evaluate the characteristics of growth cartilage in the area. RESULTS AND STATISTICS: In all the cases where a sesamoid bone was present, this was correctly identified by the sonogram, even up to the initial appearance of its ossification nucleus. Sensitivity, specificity, and diagnostic accuracy were all 100%. The capping phenomenon seen in radiographs was not detected by sonographic investigation in any of the cases. Sonographic evaluation of the fertile cartilage of the third finger distal phalanx demonstrated a sensitivity of 89%, a specificity of 100% and a diagnostic accuracy of 92%. Sonographic evaluation of the radius cartilage showed a sensitivity of 95%, a specificity of 100% and a diagnostic accuracy of 96%. CONCLUSION: Sonographic evaluation of hand and wrist bones cannot accurately reproduce the results of the classical radiographic evaluation. However, the sonographic investigation may be useful, when integrated in a radiographic investigation.

[Usefulness of opposed-phase gradient-echo technique in the diagnosis of occult lesions of the knee and comparison with traditional T1-weight sequences (in-phase)]. / Utilità della tecnica Gradient-Echo in opposizione di fase nel rilievo delle lesioni occulte del ginocchio e confronto con le sequenze T1-pesate tradizionali (in fase).

PURPOSE: To investigate the usefulness of opposed-phase gradient-echo (GRE) technique in detecting occult posttraumatic bone injuries in the knee. Occult injuries account for pain and, if not properly treated, may progress to severe chondral and bone damage. An early diagnosis provided by MRI can help avoid interventional procedures. MATERIAL AND METHODS: We submitted to MRI of the knee 51 patients (32 men and 19 women) with negative plain radiographic findings and at least one traumatic bone injury at MRI. MR examinations were performed with a 0.5 T unit and included a conventional SE or GRE T1-weighted sequence and an opposed phase GRE sequence on the coronal or sagittal plane (2-3 minutes acquisition). To assess the lesion number and conspicuity, images were retrospectively reviewed by two readers. Injury conspicuity was graded as: 0 (poorly visible), 1 (visible), and 2 (well visible). Marrow-to-injury signal intensity ratio was calculated in 30 patients: a ROI was positioned in the site of highest signal intensity and adjacent bone marrow and the ratio analyzed with Student's "t"-test. RESULTS: In-phase and out-of-phase images showed 71 injuries in 51 patients. Conventional (in-phase) imaging missed 6/71 lesions. Injury conspicuity on out-of-phase images was of grade 2 in 58 cases (81.6%) and of grade 1 in 13 cases (18.3%), versus 23 (32.3%) and 42 (59.1%), respectively, on conventional images. Injury conspicuity was graded as 0 in 6 cases (8.4%) on conventional images. Quantitative analysis of marrow-to-injury signal intensity ratio showed higher values for out-of-phase GRE than conventional images. CONCLUSION: Opposed-phase GRE are quick sequences available on all MR systems which appear superior to conventional T1-weighted images in detecting occult injuries in the knee. Injuries are more conspicuous because their signal intensity is lower due to the simultaneous presence of fat and water protons, which is typical of bone trauma, GRE sequences make a useful and rapid complement to T1-/T2-weighted fat saturation acquisitions in the study of the post-traumatic knee.

[Osteochondral lesions of the humeral head: the usefulness of echographic study]. / Lesioni osteocondrali della testa omerale: utilità dello studio ecografico.

PURPOSE: In the cranial humeral end, osteochondral injuries localize in a circular crown including part of the humeral head and part of the major and minor tuberosities. Since this region is easy to depict with US, we investigated the potentials of this technique in detecting osteochondral injuries. MATERIALS AND METHODS: Seventy-five osteochondral injuries found at 492 US examinations performed in 12 months with a 7.5 MHz linear probe were retrospectively reviewed. Clinical history taking was focused on the following: a) previous trauma or b) luxation-instability and c) if the patient was a sportsman devoted to activities requiring forced abduction-external rotation or adduction-internal rotation. Since the site of the head's humeral injury is an important clue for diagnosis, we subdivided the humeral circle into four ideal quadrants by two perpendicular lines with the main line passing through the bicipital groove. Then, each injury was ascribed to a quadrant. All patients were also submitted to radiography (at least two films) and to MRI; CT was performed in 12 patients. Ten patients underwent surgery. RESULTS: We found 34 Hill-Sachs lesions, 15 traumas, 9 arthrotic lesions, 7 cases of anterointernal and 4 of posterosuperior impingement, 4 cases of infraspinatus enthesopathy and 2 erosions due to perihumeral calcifications. In our experience, US was an accurate tool in the identification of humeral head conditions, which were confirmed at CT and/or MRI in all patients (no false positives). As for the injury nature, US diagnosis was confirmed in all Hill-Sachs lesions (34/34 cases), traumas (15/15 cases) and 50% of the cases of posterosuperior impingement (2/4 cases). These conditions made up about 2/3 of the whole cases (51/75 cases). US failed to establish the injury nature in the 9 arthrotic lesions, 7 cases of anterointernal impingement, 4 cases of infraspinatus enthesopathy and 2 erosions due to perihumeral calcifications. CONCLUSIONS: US can be suggested as the method of choice in the study of the osteochondral lining of the humeral head.

[Anterolateral fibrous impingement of the ankle. Report of 14 cases]. / Conflitto fibroso antero-laterale della caviglia. Descrizione di 14 casi.

PURPOSE: Anterolateral fibrous impingement of the ankle is one of the causes of post-traumatic pain in the foot. We investigated the comparative accuracy of US and MRI in this condition. MATERIAL AND METHODS: Fourteen patients were submitted to arthroscopy, plain radiography, US and MRI of the foot. The patients, all sportsmen, had a clinical history of sprains; the major symptoms were pain, swelling and clicking on foot dorsiflexion. RESULTS: US showed anterior talofibular ligament changes in all patients and mid-low-echogenicity synovial tissue filling the lateral malleolar gutter. MRI demonstrated a small mass of synovial tissue in the gutter in 8 patients, with mid-low signal intensity before Gd-DTPA and mid-low contrast enhancement after contrast administration and no abnormal findings in 6 patients. Arthroscopy showed a small firm mass of proliferative synovium in the lateral malleolar gutter in all patients. CONCLUSIONS: Fibrous impingement must be suspected in the sportsmen presenting typical symptoms after ankle trauma. US is poorly accurate in diagnosing this condition. MRI shows a small synovial mass in the lateral malleolar gutter in more than half the patients, but aspecific MR findings do not rule impingement our MR images must be acquired along the proper planes and with Gd-DTPA administration.

[Short stature due to a partial idiopathic deficiency of the growth hormone. The role of the TW2 method in assessing treatment with r-hGH]. / Ipostaturalità da deficit idiopatico parziale di ormone della crescita. Il ruolo del metodo TW2 nella valutazione del trattamento con r-hGH.

The Tanner-Whitehouse 2 (TW2) method to assess skeletal maturation (reviewed by Nicoletti for the Italian population) was used to study, from January, 1991, to December, 1994, a series of 26 Italian patients. The patients, 18 men (69.3%) and 8 women (30.7%), came from inhomogeneous family stocks and were all affected with short stature due to partial idiopathic GH deficiency; they were treated with replacement therapy with the biosynthetic recombinant human growth hormone (r-hGH). Each patient underwent 3 wrist and left hand radiographs, the first one made on the basis of medical and endocrinologic assessment. The patients were reexamined after one and two years of treatment with the analysis of stature growth and of the skeletal maturation of hand bones. At one year, the average chronological age of our patients was 12.42 year (range: 9.4-15.2 years), their average bone age was 11.13 years (range: 6.5-14 years) and their average height was 137.81 cm (range: 117-155.5 cm). The patients were then retrospectively examined on the basis of bone maturation and final height, at the end of two years' therapy. At the end of treatment, height was above the third percentile in all patients and therefore within the expected personal target on the basis of genetic stature. The TW2 indexes of bone maturation, after one year of treatment, had increased by 44.84% (range: 27-77%) of the total maturation increase at two years. Moreover, after one year of treatment, average stature increase was 55.81% (range: 42-72%) of the total stature increase at two years. After two years of treatment, TW2 indexes showed an average 55.16% increase in bone maturation (range: 23-73%) of total maturation and average stature increase was 44.19% (range: 28-56%) of the total stature increase. Our results confirmed that skeletal growth and bone maturation are two distinct processes. Particularly, we noted that, while after one year of r-hGH therapy skeletal growth (especially in the long bones) prevails over bone maturation, after two years maturation prevails. In conclusion, our experience confirms the TW2 method as a simple and highly informative method which can be used in any radiologic center.