SAPHO syndrome masquerading as metastatic bone disease.

A 46-year-old woman who had had a right mastectomy for breast carcinoma a month before underwent bone scintigraphy. The examination revealed multiple pelvic, vertebral and sternal hot spots suggestive of bone metastases. Standard X-rays and CT confirmed the presence of bony lesions but they were not typical of bone metastases. As the radiographic appearance was reminiscent of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), bone biopsies were performed. Histology showed fibrosis and hyperostosis but no tumour cells. On further questioning, the patient revealed she had had palmar pustulosis and sacroiliitis some years earlier. The purpose of the case report is to show that accurate diagnosis of SAPHO syndrome requires careful clinical and radiological examinations.

The hamatolunate facet: characterization and association with cartilage lesions--magnetic resonance arthrography and anatomic correlation in cadaveric wrists.

The objective of this study was to characterize the appearance of the hamatolunate facet using high-resolution magnetic resonance (MR) arthrography in cadavers and to correlate the presence of this anatomic variant with the presence of osteoarthritis in the wrist. High-resolution MR images of 22 cadaveric wrist specimens were obtained after tri-compartmental arthrography. Two readers in consensus analyzed the MR images and recoded the presence or absence of a hamatolunate facet. Geometric characteristics and cartilage and ligament integrity were analyzed. A third reader, who was blinded to the purpose of the study, recorded cartilage lesions of all the bones of the proximal and distal carpal rows. A hamatolunate facet was present in 11 of 22 wrists (50%). The mean coronal size of the lunate facet at the lunate (type II lunate) was 4.5 mm (range, 2-6 mm). The highest frequencies of cartilage lesions were seen in the scapho-trapezio-trapezoid joint (45.5%) and at the proximal pole of the hamate (54.4% and 40.9% for consensus reading/blinded reading, respectively). In cases with a hamatolunate facet, the frequency of cartilage lesions in the proximal pole of the hamate was 81.8% and 63.6% versus 27.3% and 18.2% without such a facet (chi-squared, P=0.01/ P=0.03). No correlation of the presence of a hamatolunate facet with interosseous ligament tears or lesions of the triangular fibrocartilage was seen. In conclusion, the hamatolunate facet is a very common anatomic variant. The presence of a hamatolunate facet is associated with cartilage damage in the proximal pole of the hamate.

Traumatic injuries: imaging of pelvic fractures.

Pelvic trauma includes a great variety of very polymorphous lesions, differing from each other by their anatomical aspect, their context and therapeutic implication: In order to be efficient, the radiologist first has to know diagnostic value of each radiological technique, in order to suggest the investigation strategy appropriate to any clinical situation. Then, he must be able to accurately describe fractures and to include them into a classification in agreement with the clinician. Pelvic fractures form a polymorphous group. In the isolated acetabular fractures, function is mainly at stake. Radiological assessment relies upon good-quality plain films completed by CT imaging in fine slices with multiplanar reconstruction. Letournel's classification remains the reference standard. Management consists mainly of re-establishing a joint congruence to prevent early coxarthrosis. Pelvic fractures often occur in violent trauma and are associated with visceral lesions, putting vital prognosis at stake. Radiological assessment must be included in multidisciplinary management and CT imaging stands for the most complete and least time-consuming device, allowing for investigation of both visceral and osseous lesions. In case of hemodynamic shock, external fracture stabilization and embolization of pelvic bleeding are preponderant. Tile/Association for Osteosynthesis classification is the most used presently. It allows good description of mechanisms and lesions and more adapted management.

Greater trochanter of the hip: attachment of the abductor mechanism and a complex of three bursae--MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers.

PURPOSE: To evaluate trochanteric anatomy with magnetic resonance (MR) imaging, bursography, MR bursography, and anatomic analysis. MATERIALS AND METHODS: T1-weighted and fat-saturated T2-weighted (transverse, sagittal, coronal, and coronal oblique planes) MR imaging of the greater trochanter was performed in 10 cadaveric hips and 12 hips of asymptomatic volunteers. Three bursae comprising the trochanteric bursa complex were injected, and conventional radiography and MR imaging were performed. The specimens were sectioned for anatomic analysis, corresponding to the MR imaging planes. Tendon attachments and bursal localization were related to the facets of the greater trochanter. RESULTS: The bony surface of the greater trochanter consists of four facets: anterior, lateral, posterior, and superoposterior. The gluteus medius muscle attaches to the superoposterior and lateral facets. The gluteus minimus muscle attaches to the anterior facet. The trochanteric bursa covered the posterior facet and the lateral insertion of the gluteus medius muscle. The subgluteus medius bursa was located in the superior part of the lateral facet, underneath the gluteus medius tendon. The subgluteus minimus bursa lies in the area of the anterior facet, underneath the gluteus minimus tendon, medial and cranial to its insertion, and extends medially covering the distal anterior part of the hip joint capsule. The trochanteric bursa is delineated with fat on both sides and can be seen on transverse nonenhanced T1-weighted images as a fine line curving around the posterior part of the trochanter. CONCLUSION: MR imaging and bursography provide detailed information about the anatomy of tendinous attachments of the abductor muscles and the bursal complex of the greater trochanter.

Intermetatarsal spaces: analysis with MR bursography, anatomic correlation, and histopathology in cadavers.

PURPOSE: To describe the normal magnetic resonance (MR) imaging-depicted anatomy of the intermetatarsal spaces, with emphasis on the MR imaging appearance of the intermetatarsal bursae, and to correlate the MR findings with those seen in anatomic sections and at histopathologic analysis. MATERIALS AND METHODS: Conventional radiography and pre- and postcontrast T1-weighted and fat-saturated T1-weighted spin-echo MR imaging were performed in 32 intermetatarsal spaces in eight human cadaveric feet. The cadaveric specimens were sectioned in planes corresponding to those at MR imaging for anatomic correlation. The intermetatarsal space anatomy was analyzed. Histopathologic examinations of the bursae were performed. RESULTS: The intermetatarsal spaces were located in the forefoot between two metatarsal heads, below and above the deep transverse metatarsal ligament (DTML) that separated the spaces into two levels. The superior level contained the synovial bursa, the plantar and dorsal interosseous muscles and tendons, and the collateral ligament complexes of the metatarsophalangeal joints. The inferior level contained lumbrical muscles and neurovascular bundles. The bursae extended distally to the DTML in the second and third spaces close to the neurovascular bundles and did not extend beyond the DTML in the first and fourth spaces. In the first intermetatarsal space, the bursa had a specific appearance as it coursed along the adductor hallucis tendon as a tendon sheath. Histopathologic examination of the bursae revealed a single layer of attenuated cells. CONCLUSION: MR bursography provided detailed information about the intermetatarsal anatomy, especially the intermetatarsal bursae.

Hemangiomas of the fingers: MR imaging evaluation.

PURPOSE: To report the magnetic resonance (MR) imaging features of finger hemangiomas. MATERIALS AND METHODS: Sixteen patients clinically suspected of having hemangioma of the finger underwent 1.5-T MR imaging with a customized local gradient coil. The location, size, margins, signal intensity, and enhancement patterns of the lesions were noted. In accordance with the literature on MR imaging of deep hemangiomas, the authors' findings could be divided into those with typical features-that is, high signal intensity at T1- and T2-weighted imaging, lobulated appearance, strong enhancement, and heterogeneous pattern with flow void artifacts-and those with atypical features. The reference standard was surgery (n = 12) or clinical outcome (n = 4). RESULTS: One posttraumatic hematoma was excluded. Most lesions were in the fingertip (n = 10), with involvement of the nail bed and/or the pulp (n = 5). Hemangiomas were classified as typical in ten cases and atypical in five. The mean size of typical lesions was larger than that of atypical lesions. The unique imaging features of atypical hemangiomas included a masslike appearance, which was either homogeneous with diffuse enhancement-suggestive of hypervascularity (n = 2)-or heterogeneous with poor enhancement (n = 3). CONCLUSION: MR imaging characteristics of finger hemangiomas can be classified as typical or atypical. Knowledge of both patterns can be helpful in the distinction of soft-tissue abnormalities at this location.

What happens to the triangular fibrocartilage complex during pronation and supination of the forearm? Analysis of its morphology and diagnostic assessment with MR arthrography.

OBJECTIVE: To evaluate the dynamic morphologic changes of the triangular fibrocartilage complex (TFCC) during pronation and supination of the forearm using high-resolution MR arthrography in cadavers and to evaluate the impact of these changes on the diagnostic assessment of the normal and abnormal TFCC. DESIGN AND SPECIMENS: High-resolution MR arthrography of 10 wrists of cadaveric specimens was obtained in maximum pronation, in the neutral position, and in maximum supination of the forearm. The structures of the TFCC were evaluated by two musculoskeletal radiologists and correlated with anatomic sections. The position of the forearm that allowed the best visualization of normal structures and lesions of the TFCC was determined. RESULTS: The shape and extent of the articular disc as well as the radial portions of the radioulnar ligaments did not change with pronation and supination. The articular disc was horizontal in the neutral position and tilted more distally to align with the proximal carpal row in pronation and supination. The fibers of the ulnar part of the radioulnar ligaments (ulnar attachment of the articular disc) revealed the most significant changes: their orientation was coronal in the neutral position and sagittal in positions of pronation and supination. The ulnomeniscal homologue was largest in the neutral position and was reduced in size during pronation and supination. The extensor carpi ulnaris tendon was centered in its groove in the neutral position and pronation. In supination this tendon revealed subluxation from this groove. The dorsal capsule of the distal radioulnar joint was taut in pronation, and the palmar capsule was taut in supination. The preferred forearm position for analysis of most of the structures of the TFCC was the neutral position, followed by the pronated position. The neutral position was rated best for the detection of ulnar and radial detachments of the TFCC, followed by the pronated position, except for two central perforations of the TFCC which were best seen with supination. CONCLUSION: The articular disc and the surrounding radial portions of the radioulnar ligaments form a rigid, unified complex with the radius without change in their shape in positions of pronation and supination of the forearm, while the ulnar attachment of the TFCC shows important dynamic changes. The neutral forearm position is the best position to analyze both the normal and the abnormal TFCC.

Radiation doses delivered to radiologists during contrast-enhanced helical-CT examinations.

This work monitors the radiation doses to a radiologist during supervision of automatic contrast media injections during helical-CT examinations of the chest and abdomen. Forty consecutive standard helical-CT examinations of adult's chest and/or abdomen were monitored with five dosimeters worn by the radiologist supervising the entire injection with the hand on the injection site. Mean doses per examination measured at chest, thyroid gland, and hand levels were 11, 16, and 130 microGy, respectively, during chest examinations, and 5, 7, and 55 microGy during abdominal examinations. According to the high number of CT examinations performed, wearing lead apron, special lead glove protection, and thyroid shield is highly recommended.