RESUMO
PURPOSE: To compare the contribution of various radiographic projections in the evaluation of impingement syndrome and rotator cuff tears. Materials and method. We realized a prospective study in 53 patients with suspected rotator cuff tear, evaluated by plain radiographs and arthrography (gold standard). 31 patients were men and 22 were women (mean age 51 years). In all patients, anteroposterior radiograph, strict anteroposterior straight-beam decubitus view and anteroposterior radiograph during Leclercq's maneuver of the affected shoulder were obtained. The population was divided into three groups: group 1: normal arthrography (n=19), group 2: isolated supraspinatus tendon tear (n=23), group 3: rupture of the supraspinatus and infraspinatus tendons (n=11). The acromio-humeral space was measured on all these views and differences between the three groups were statistically analyzed. RESULTS: There is a significant statistical difference between the height of the acromio-humeral space found in patients with isolated tear of the supraspinatus tendon and those with a tear extending to the infraspinatus tendon (p=0.0001). The ROC methodology showed a better accuracy of the strict anteroposterior straight-beam decubitus view in cases of wide ruptures of the rotator cuff, and this for a selected threshold value of 6 mm. CONCLUSION: Strict anteroposterior straight-beam decubitus view, seems to be easy to realize, cheap, reproducible and very powerful in the preoperative assessment of patients with suspected rotator cuff tendon tear. It allows an excellent visualization of the acromioclavicular joint.
Assuntos
Lesões do Manguito Rotador , Manguito Rotador/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Postura , Estudos Prospectivos , Radiografia/métodosRESUMO
PURPOSE: We studied 11 healthy subjects were evaluated using cine MR imaging comparing HASTE and gradient echo sequences. Materials and methods :HASTE is a high-speed turbo-spin echo T2-weighted sequence. All examinations were performed using dynamic MRI using a simple process allowing acquisition of images at different stages during flexion and extension. The cine MR evaluation was obtained by rebuilding a cine-loop sequence. RESULTS: HASTE sequence provides a myelographic effect of the cervical spine. The size, the pattern and the movements of the cervical spine, the spinal cord, as well as the functional reserve of cerebro-spinal fluid are analysable. CONCLUSION: Because of its very high speed, HASTE sequence is particularly useful for cine MR imaging.
Assuntos
Vértebras Cervicais/anatomia & histologia , Imagem Cinética por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/métodos , Canal Medular/anatomia & histologia , Adulto , Articulação Atlantoaxial/anatomia & histologia , Vértebra Cervical Áxis/anatomia & histologia , Líquido Cefalorraquidiano , Atlas Cervical/anatomia & histologia , Estudos de Coortes , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Movimento , Medula Espinal/fisiologiaRESUMO
PURPOSE: To evaluate the contribution of principal imaging techniques in diagnosis and treatment in adhesive capsulitis of the shoulder. MATERIALS AND METHODS: In 20 patients presenting adhesive capsulitis of shoulder since mean of 6,7 months, the following examinations were performed: radiographies, angioscintigraphy, MRI as well as an opaque arthrography and a bursography associated with corticosteroid injection. Patients were followed during one year. RESULTS: The opaque arthrography was to affirm the adhesive capsulitis for the inclusion of the patients. Radiographies (patchy demineralization) and scintigraphy (hyperfixation) were often pathological. In MRI, T1 fat-saturated sequences after contrast injection almost always showed enhancement of the articular capsula, the synovia, the miscellaneous bone or the sub-acromial bursa. The latter was often modified and retracted at bursography. In 19 of 20 cases, a functional improvement was observed after the opacifications. CONCLUSION: Therapeutic effect of both arthrography and bursography is almost proved. Post contrast MRI confirms presence of vascular troubles in all the shoulder structures even at this advanced stage.
Assuntos
Bursite/diagnóstico , Diagnóstico por Imagem , Articulação do Ombro/patologia , Adulto , Idoso , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Artrografia , Bursite/diagnóstico por imagem , Bursite/tratamento farmacológico , Meios de Contraste , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Cápsula Articular/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Parametasona/administração & dosagem , Parametasona/uso terapêutico , Estudos Prospectivos , Cintilografia , Compostos Radiofarmacêuticos , Articulação do Ombro/efeitos dos fármacos , Membrana Sinovial/patologiaRESUMO
Diffuse esophageal leiomyomatosis is a rare disorder which may be found in association with leiomyomas in other locations or with other disorders. We report two cases in men, one with associated tracheobronchial involvement, which illustrate the value of imaging in differentiating this entity from other causes of dysphagia and in establishing a diagnosis.
Assuntos
Neoplasias Esofágicas/diagnóstico , Leiomiomatose/diagnóstico , Adulto , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
The aim of this study was to assess if a liver capsular retraction is a specific CT sign in malignant hepatic tumors. The authors reviewed retrospectively 320 hepatic CT scans obtained in 300 patients during a 3-year period. These patients presented with benign (n = 64) or malignant (n = 236) hepatic tumors. In 7 patients we found retraction of the capsule surrounding the tumor. All these tumors were histologically proven as malignant lesions: 4 metastases (none being chemically treated), 2 peripheral cholangiocarcinomas, and 1 epithelioid hemangioendothelioma. The prevalence of this sign was 2.18% (7 of 320) in this series. This capsular retraction pattern has never been found in hepato-cellular carcinomas (no fibrolamellar in this series) and benign lesions. Liver capsular retraction is an uncommon but specific (100%) sign in malignant hepatic tumors; however, a larger and prospective series is needed.
Assuntos
Neoplasias Hepáticas/diagnóstico por imagem , Fígado/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Humanos , Hepatopatias/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To reevaluate at medium term the results of computed tomography (CT)-guided percutaneous resection of osteoid osteomas. MATERIALS AND METHODS: Thirty-eight patients who had undergone treatment by means of this technique were reexamined with a mean follow-up of 3.7 years. The short- and medium-term clinical course and histologic features of the resection specimens were analyzed. RESULTS: The bone fragment could be analyzed in all cases, and the diagnosis of osteoid osteoma was confirmed in 28 patients (74%). A different diagnosis was made in six patients: mucoid cyst, subchondral arthritic geode, fibrous dysplastic lesion, focal osteochondritis, or focal chronic osteomyelitis. Cure was obtained in 32 patients (84%), whatever the cause. Complications, generally minor and transient, were observed in nine patients (24%). The most severe complications were two femoral fractures and one focal chronic osteomyelitis due to Staphylococcus aureus infection. CONCLUSION: The results of this study confirm the efficacy of percutaneous resection of osteoid osteomas and the possibility of using this method for successful treatment of other small bone lesions.
Assuntos
Neoplasias Ósseas/cirurgia , Endoscópios , Osteoma Osteoide/cirurgia , Tomografia Computadorizada por Raios X/instrumentação , Adolescente , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Osso e Ossos/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/patologia , Complicações Pós-Operatórias/etiologia , Instrumentos Cirúrgicos , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the mid-term outcome following CT-guided percutaneous resection of osteoid osteoma. MATERIALS AND METHODS: 38 patients who had been treated by CT-guided percutaneous resection were included. The mean follow-up of 3.7 years. Early and mid-term outcome and histology were analyzed. RESULTS: Histological samples were adequate in 92% of cases and a diagnosis of osteoid osteoma was confirmed in 73.7% of cases. In 6 cases, the lesion was not an osteoid osteoma: 2 mucoid cysts, 1 benign fibrous dysplasia, 1 fibromucoid lesion, 1 focal osteochondritis, 1 osteomyelitis. Cure was achieved in 84.2% of patients. Minor transient complications occurred in 23.7% of cases. The most serious complications included: 1 intramuscular hematoma, 2 femoral fractures, and 1 case of S. aureus osteomyelitis. CONCLUSION: This study confirms that CT-guided percutaneous resection of osteoid osteomas is effective and shows that other small lesions can also be treated using this technique.
Assuntos
Neoplasias Ósseas/cirurgia , Osteoma Osteoide/cirurgia , Radiografia Intervencionista , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Cistos Ósseos/diagnóstico por imagem , Cistos Ósseos/patologia , Cistos Ósseos/cirurgia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Criança , Pré-Escolar , Feminino , Fraturas do Fêmur/etiologia , Displasia Fibrosa Óssea/diagnóstico por imagem , Displasia Fibrosa Óssea/patologia , Displasia Fibrosa Óssea/cirurgia , Seguimentos , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mucocele/diagnóstico por imagem , Mucocele/patologia , Mucocele/cirurgia , Doenças Musculares/etiologia , Osteocondrite/diagnóstico por imagem , Osteocondrite/patologia , Osteocondrite/cirurgia , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/patologia , Osteomielite/diagnóstico por imagem , Osteomielite/microbiologia , Osteomielite/patologia , Osteomielite/cirurgia , Complicações Pós-Operatórias , Infecções Estafilocócicas , Infecção da Ferida Cirúrgica/etiologia , Resultado do TratamentoRESUMO
The authors report 42 cases of symptomatic pulmonary aspergilloma treated by intracavitary percutaneous injections of Amphotericine paste. These patients were not considered as operable. The aspergillomas complicated tuberculosis sequels and pulmonary fibrosis. Surgery was contraindicated in these patients on account of severe respiratory failure. The authors specify the technique for the preparation of the paste and for the type of percutaneous injection under CT guidance; the aim being to obtain complete filling of the cavity and creating an "anaerobic" environment for the aspergillus. The contribution of this technique for the non-surgical treatment of patients appears interesting but should be carried on a larger series to identify the exact indications and the interaction with other treatments (drugs and surgery).
Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Pneumopatias Fúngicas/tratamento farmacológico , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Injeções Intralesionais , Pneumopatias Fúngicas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , PomadasRESUMO
We report three cases of synovial sarcoma strictly located in the muscles. Synovial sarcoma generally arises in the vicinity of joints, tendon sheaths, bursae, fascia, and ligaments. Strictly intramuscular locations are not well known and not described in the literature to our knowledge although they seem to be frequent. The different characteristics on the radiographic examinations are non specific, and this location may be misleading. MRI is considered the procedure of choice for staging this tumor and to visualize soft tissues and bone invasion. CT scans may be useful in detecting more specific small calcifications.
Assuntos
Neoplasias Musculares/diagnóstico , Sarcoma Sinovial/diagnóstico , Adulto , Idoso , Biópsia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Musculares/cirurgia , Estadiamento de Neoplasias/métodos , Radioterapia Adjuvante , Sarcoma Sinovial/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Mediastinal pseudotumors are present in less than 5% of patients with long-standing portal hypertension. These pseudotumors may be caused by para-esophageal collateral vessels or greatly dilated azygos or hemiazygos veins. Enhanced CT seems to be the best tool for the diagnosis and in evaluating the overall status of portosystemic collateral vessels. In this case report, MRI ruled out tissular mass by showing vascular signal.
Assuntos
Veia Ázigos , Varizes Esofágicas e Gástricas/diagnóstico , Doenças do Mediastino/diagnóstico , Varizes/diagnóstico , Idoso , Circulação Colateral , Diagnóstico Diferencial , Varizes Esofágicas e Gástricas/etiologia , Feminino , Hepatite C/complicações , Humanos , Cirrose Hepática/complicações , Imageamento por Ressonância Magnética , Doenças do Mediastino/etiologia , Sistema Porta , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Varizes/etiologiaRESUMO
Mediastinal masses represent a vast group of tumours and pseudo-tumours which can involve the various compartments of the mediastinum. The authors propose a radiologic diagnostic approach starting from the plain thoracic radiograph with study of the mediastinal lines and oesophageal transit and going on to the classifications made possible by modern CT and MR imaging. The proposed diagnostic procedure is based on nine mediastinal lines and two 'threads of Ariadne' which are the compartments where the masses are located and their behaviour at CT (densitometry before and after administration of an iodinated bolus) and at MRI (T1, T2, gadolinium-enhanced T1-weighted sequences). The definitive aetiological diagnosis may be established by surgery, but also in certain cases by percutaneous needle biopsy.
Assuntos
Doenças do Mediastino/diagnóstico , Neoplasias do Mediastino/diagnóstico , Absorciometria de Fóton , Biópsia por Agulha , Meios de Contraste , Esôfago/diagnóstico por imagem , Esôfago/patologia , Gadolínio , Humanos , Iodetos , Imageamento por Ressonância Magnética , Doenças do Mediastino/classificação , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/patologia , Doenças do Mediastino/cirurgia , Neoplasias do Mediastino/classificação , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Mediastino/diagnóstico por imagem , Mediastino/patologia , Radiografia Intervencionista , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
Synovial cysts are far less common at the hip than at the knee and usually occur in patients whose hip cavity communicates with the iliopsoas bursa. We report 12 cases of enlargement of the iliopsoas bursa, nine men and three women, with a mean age of 48 years. The six patients with septic bursitis had severe symptoms similar to those seen in septic arthritis of the hip. Chronic pain with or without a palpable inguinal swelling was the main symptom in the six remaining patients, some of whom had compression of neighboring structures making the diagnosis more difficult. Ultrasonography is the best first-line investigation in patients with an inguinal swelling. Computed arthrotomography with examination of the synovial fluid or magnetic resonance imaging should be performed as a confirmatory diagnostic test. Our series provides evidence of the efficacy of appropriate antimicrobial therapy in septic cases and of corticosteroid injections into the bursa or hip cavity in nonseptic cases.
Assuntos
Bursite/patologia , Ílio/patologia , Abscesso do Psoas/patologia , Músculos Psoas/patologia , Adulto , Idoso , Artrite Infecciosa/patologia , Bursite/diagnóstico por imagem , Feminino , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Humanos , Ílio/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/patologia , Abscesso do Psoas/diagnóstico por imagem , Músculos Psoas/diagnóstico por imagem , Cisto Sinovial/patologia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
OBJECTIVE: To demonstrate the therapeutic value of subacromial bursography (with a steroid injection) in adhesive capsulitis of the shoulder inadequately improved by arthrographic glenohumeral distension with steroid injection. METHOD: Twenty cases of adhesive capsulitis documented by glenohumeral arthrography were studied prospectively. A steroid was injected during distension arthrography, which was followed by physical therapy. Subacromial bursography without steroid injection was done routinely for diagnostic purposes. Constant's simplified score and range of motion were determined in each patient at baseline and after one, three, six and 12 months. Patients who were inadequately improved after one to three months underwent repeat subacromial bursography with steroid injection, followed by physical therapy. RESULTS: Of the 20 patients, 13 were noticeably improved 1.7 months on average after the distension arthrography. Of the remaining seven patients, six were improved 0.7 months on average after the bursography with steroid injection. CONCLUSION: Glenohumeral distension arthrography with steroid injection followed by physical therapy is effective in expediting the spontaneously favorable outcome of adhesive capsulitis and also allows to confirm the diagnosis. However, the subacromial bursa is almost consistently involved. Subacromial bursography with steroid injection can be useful in cases that fail to respond to conventional therapy.
Assuntos
Artrografia , Bolsa Sinovial/diagnóstico por imagem , Bursite/tratamento farmacológico , Bursite/radioterapia , Articulação do Ombro/diagnóstico por imagem , Adulto , Idoso , Bolsa Sinovial/efeitos dos fármacos , Terapia Combinada , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Manipulação Ortopédica , Pessoa de Meia-Idade , Parametasona/uso terapêutico , Amplitude de Movimento Articular/efeitos dos fármacos , Ruptura , Articulação do Ombro/efeitos dos fármacos , Sinovectomia , Resultado do TratamentoRESUMO
OBJECTIVE: To treat symptomatic pulmonary aspergilloma in patients who were not considered to be operable. MATERIAL AND METHODS: Forty patients were treated by CT-guided percutaneous injection of amphotericin paste, the aim being to fill the cavity completely and create an anaerobic environment for the aspergillus. The aspergillomas had developed after bacillary infection and pulmonary fibrosis. Surgery was contra-indicated in these patients because of severe respiratory failure. The authors detail the method of preparation of the paste and the technique of percutaneous injection. RESULTS: Hemoptysis ceased in all 40 patients, with a follow-up ranging from 6 to 28 months; six patients were also treated with bronchial embolization. In 26 patients, the aspergilloma disappeared and serum tests for aspergillus became negative. Complete disappearance of both the aspergilloma and the cavity was obtained in three patients. CONCLUSION: This technique appears to be a valuable contribution to non-surgical treatment of inoperable patients with pulmonary aspergilloma, but study should be continued in a larger series to define the exact indications and the interaction with other treatments which have recently been introduced.
Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Aspergilose/tratamento farmacológico , Pneumopatias Fúngicas/tratamento farmacológico , Tomografia Computadorizada por Raios X , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Aspergilose/diagnóstico por imagem , Feminino , Humanos , Pneumopatias Fúngicas/diagnóstico por imagem , Masculino , Pomadas , Cuidados Paliativos/métodosRESUMO
We report a rare case of colonic gallstone obstruction in a patient with cholecystocolic fistula. Diagnosis of this condition is usually difficult and only achieved at surgery. We review the radiological findings, particularly the CT findings, helpful for diagnosis: ectopic gallstone, biliary gas and fistula. Early preoperative diagnosis could reduce morbidity and mortality. Treatment is surgical with enterolithotomy. There is some controversy over the need to repair the fistula.
Assuntos
Colelitíase/complicações , Doenças do Colo/etiologia , Obstrução Intestinal/etiologia , Idoso , Idoso de 80 Anos ou mais , Fístula Biliar/complicações , Fístula Biliar/diagnóstico por imagem , Colelitíase/diagnóstico por imagem , Colelitíase/cirurgia , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/cirurgia , Meios de Contraste , Feminino , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/diagnóstico por imagem , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The authors report one case of a relatively common benign tumor, hemangioma, although in an uncommon location, intra-muscular. The radiological exploration, principally MR imaging has a great interest to specify the diagnosis and the regional extension. Intramuscular hemangioma appears with a relatively low signal intensity on T1-weighted images, but demonstrates a clear delineation of the extent of the lesion on T2-weighted images, because of high contrast between hemangiomas and surrounding muscle. The informations obtained with MR imaging may be valuable clinically in planning surgical resection.
Assuntos
Hemangioma/diagnóstico , Imageamento por Ressonância Magnética , Neoplasias Musculares/diagnóstico , Adolescente , Hemangioma/patologia , Humanos , Masculino , Neoplasias Musculares/patologia , Invasividade Neoplásica , Coxa da PernaRESUMO
Vascular catheterization techniques were used in bones to allow access to the entire medullary cavity through a minimal percutaneous approach. The study was carried out on human and animal anatomical specimens and in living sheep. After oblique penetration at an angle of approximately 40û to the surface of the cortical bone, we attempted to pass in the bone shaft using various types of guides and catheters. Different types of instrumentation currently available were compared for ease of advancement in the shaft and quantity of bone marrow that could be aspirated. Once the metaphysis was reached, a variety of techniques were studied to penetrate the cancellous bone and to introduce a catheter. A percutaneous approach to any part of a long bone through a cortical pathway from a remote entry site is feasible in certain diagnostic or therapeutic indications, when direct approach to pathological sites in long bones is dangerous or impossible.
RESUMO
OBJECTIVE: We performed this study to define the normal patterns of the glenohumeral joint with kinematic MR imaging in healthy volunteers. SUBJECTS AND METHODS: Twenty healthy volunteers (39 shoulders) were studied with a 1.5-T imager. Successive fast low-angle shot images (75/11 [TR/TE], 15 degrees flip angle) were obtained in the axial plane from full internal to full external rotation at the superior, middle, and inferior glenoid levels. RESULTS: The free margin of the anterior labrum was seen to be slightly mobile and its base was always fixed. The anterior labrum showed changes in shape and signal intensity during internal rotation (54%). The posterior labrum remained motionless in 97% of patients and no shape or signal-intensity changes were noted during internal rotation. The anterior joint capsule was taut during external and internal rotation, exhibited a slack pattern in 51% of patients, and a folded pattern in 14% of patients. CONCLUSION: Kinematic MR imaging, which permits dynamic evaluation of the various anatomic components that may be involved in shoulder instability, also provides information on the labrocapsular ligamentous complex.