Hand radiological damage in systemic sclerosis: comparison with a control group and clinical and functional correlations.

OBJECTIVE: To define the burden of hand radiological damage in systemic sclerosis (SSc) patients, compared with a control group. METHODS: Both hands of 167 SSc patients and 168 hands (82 right and 86 left) of age- and gender-matched controls were imaged by conventional radiograph. Two musculoskeletal radiologists semiquantitatively scored the following lesions: tuft acro-osteolysis, tuft calcinosis, joint space narrowings, marginal erosions, surface erosions, collapse arthropathies, periarticular calcifications, and juxta-articular osteoporosis, at the following areas: tufts, distal interphalangeal, proximal interphalangeal, metacarpophalangeal, carpal, and first carpometacarpal joints. Clinical and functional characteristics of the 167 SSc patients were obtained from the Belgian Systemic Sclerosis Cohort database. RESULTS: Tuft acro-osteolysis and calcinosis were the most common findings observed in SSc patients and were almost absent in controls. SSc patients displaying tuft acro-osteolysis/calcinosis suffered from more severe disease. Arthropathies were infrequently detected and mainly consisted of a mixture of osteoarthritis-related changes (joint space narrowing and surface erosions)-also observed in controls-and of 2 types of rare SSc-associated arthropathies: a rheumatoid arthritis-like pattern, characterized by marginal erosions (n = 7 patients), and a collapse arthropathy (n = 6 patients), characterized by pressure erosions and joint subluxation. CONCLUSIONS: Although a rheumatoid arthritis-like or a collapse arthropathy can be observed in SSc patients, arthropathies are less common than previously reported.

Bone marrow edema of the femoral head and transient osteoporosis of the hip.

The current article of this issue aims at defining the generic term of bone marrow edema of the femoral head as seen at MR imaging. It must be kept in mind that this syndrome should be regarded, not as a specific diagnosis, but rather as a sign of an ongoing abnormal process that involves the femoral head and/or the hip joint. We aim at emphasizing the role of the radiologists in making a specific diagnosis, starting from a non-specific finding on T1-weighted images and by focusing on ancillary findings on T2-weighted SE or fat-saturated proton-density weighted MR images.

Multidetector spiral CT arthrography of the shoulder. Clinical applications and limits, with MR arthrography and arthroscopic correlations.

Although MR imaging and MR arthrography are the first choice modalities for shoulder imaging, CT arthrography (CTA) may be used successfully to address many clinical questions. The advent of submillimeter multiple detector CT technology and subsequent excellent three-plane resolution has considerably increased the quality of CTA examinations and has propelled this technique to the forefront in a growing number of indications. The combined use of iodinated contrast material for fluoroscopic confirmation of the articular position of the needle before injection of gadolinium chelates for MR arthrography offers the unique opportunity to compare CTA and MRA findings in carefully selected cases. This paper illustrates capabilities and limits of CTA for the study of rotator cuff tears, shoulder instability, cartilage lesions, anatomical variants and abnormalities of the glenoid labrum, with correlations to MR arthrography and surgical findings.