The purpose of this study was to evaluate whole-body magnetic resonance imaging (MRI) of cadavers as an adjunct to autopsy. Eight consecutive patients underwent both whole-body MRI and autopsy [either conventional (six), limited (one), or percutaneous (one)] within 24 hours of death. Comparison was made of major and minor abnormalities and predicted cause of death recorded by independent readers at both MRI and autopsy. Major discrepancies between the recorded primary cause of death at imaging and autopsy occurred in five (5) patients. These included a myocardial infarction found at autopsy alone, bowel infarction and portal venous gas found at MRI alone, and aortic dissection and occipital infarct found at MRI alone in a patient on whom only limited autopsy was performed. Postmortem MRI may represent a useful adjunct to autopsy, particularly in patients in whom autopsy is limited due to patient/family consent, inoculation risks, and ethnic doctrines.

Objective. This study was undertaken to analyse the diffusion characteristics of synovial fluid in degenerative and inflammatory arthropathies.

This study was undertaken to assess the utility of whole-body turbo short tau inversion recovery (STIR) magnetic resonance imaging (MRI) to detect metastases to liver, brain, and bone as a single examination in women with breast cancer. Seventeen patients with biopsy-proven breast cancer and suspected metastatic disease attending over a 12-month period referred for both conventional imaging and whole-body MRI were included in the study. Three patients were found to be free of metastases at both conventional and MR imaging, Appendicular or axial skeletal metastases were identified in 11 of 17 patients, with correlation between findings at whole-body MRI and scintigraphy in 15 of the 17 patients. Five patients had evidence of hepatic metastases on whole-body MRI, of which metastases were identified in only three patients at CT despite contrast enhancement, Four patients had brain abnormalities (metastases in three patients, meningioma in one patient) detected on both whole-body and dedicated brain MRI. Preliminary clinical experience suggests that turbo STIR whole-body MRI: may represent a convenient and cost-effective method of total body screening for metastases In patients with breast carcinoma. (C) 2000 Wiley-Liss. Inc.

OBJECTIVEThis study was undertaken to analyze diffusion characteristics of normal and posttraumatic bone marrow.MATERIALS AND METHODSFifty consecutive patients with knee pain underwent both conventional and diffusion-weighted MR imaging (b values, 0-980 sec/mm2). Diffusion maps derived from source data were analyzed on a workstation using region-of-interest techniques. Apparent diffusion values recorded in normal marrow were compared with values recorded in abnormal posttraumatic bone marrow (square centimeters per second).RESULTSNormal bone marrow identified in 35 patients showed minimal diffusion, with a mean value of 0.15x10(-5) cm2/sec. Bone marrow in 15 patients sustaining direct traumatic injury (21 bone bruises) showed markedly increased diffusion, with a mean value of 0.8x10(-5) cm2/sec (range, 0.4-1.3 cm2/sec).CONCLUSIONMarrow injury after trauma with trabecular damage allows increased movement or diffusion of interstitial water relative to normal marrow. The magnitude of diffusion change appears to reflect the severity of marrow injury.

Comparison of conventional and turbo spin-echo T1-weighted MR imaging in acute knee trauma.S Eustace, P Hentzen, J Adams, K Harper and H JaraAudio Available | Share

PURPOSE:To evaluate pediatric growth plate injuries with conventional radiographs and magnetic resonance imaging (MRI). To review potential clinical impact of MRI on subsequent patient management and outcome.METHODS:Fourteen patients with known or suspected growth plate injury were studied. Each patient underwent imaging by conventional radiography and MRI within 2 weeks of injury. Findings on conventional radiographs and on MR images were compared and then correlated with subsequent management and outcome at a mean of 12 months.RESULTS:Direct visualization of cartilage afforded by MRI improved evaluation of growth plate injury in each case. MRI changed Salter Harris classification or staging in 2 of 9 patients with fractures visualized on conventional radiographs, allowed the detection of radiographically occult fractures in 5 of 14 cases, and resulted in a physical change in management in 5 of the 14 patients studied.CONCLUSION:MRI has an important role in the evaluation of acute pediatric growth plate injury, particularly when diagnostic uncertainty persists following the evaluation of conventional radiographs. MRI allows detection of occult fractures, may alter Salter Harris staging, and in the reported study it frequently resulted in a change in patient management.

This brief report outlines the novel use of whole body coronal turbo short tau inversion recovery (STIR) imaging to localize a primary tumor in patients with known metastatic disease without a previously identified source.

The bicipito-radial bursa, which lies at the biceps tendon insertion on the radial tuberosity, is a rare site of chronic bursitis. We describe the clinical, radiological, and pathological findings in a case complicated by multiple rice body formation. In so doing, we describe MR appearances that allow discrimination of this entity from both synovial chondromatosis and pigmented villonodular synovitis.

A comparison of conventional spin-echo and turbo spin-echo imaging of soft tissues adjacent to orthopedic hardware.S Eustace, H Jara, R Goldberg, H Fenlon, M Mason, E R Melhem and E K YucelAudio Available | Share

OBJECTIVE:To compare the evaluation of fractures of the distal radius with MRI and conventional radiographs. To demonstrate the ability of MRI to detect unsuspected soft tissue derangement accompanying this common injury.DESIGN AND PATIENTS:Twenty-one consecutive inpatients admitted following fracture of the distal radius underwent preoperative evaluation with both conventional radiographs and MRI. In each case, analysis was made of both the osseous and soft tissue injury. MRI findings were compared with those identified on conventional radiographs and at subsequent surgical fixation.RESULTS:Of 21 patients with fractures of the distal radius, 20 had extension to the radiocarpal articulation, 14 had distal radio-ulnar joint extension and 5 had avulsion of the ulnar styloid. Occult carpal bone fractures accompanying fracture of the distal radius were identified in two patients: one of the capitate and the other of the second metacarpal base. Ten patients (48%) had associated soft tissue injury: six patients had scapholunate ligament rupture, two patients had disruption of the triangular fibrocartilage, one patient had extensor carpi ulnaris tenosynovitis and one patient had a tear of a dorsal radiocarpal ligament. Of five patients with ulnar styloid avulsions, none had evidence of triangular fibrocartilage tears.CONCLUSION:MRI affords better evaluation of osseous injury accompanying distal radial fractures than conventional radiographs. Intra-articular soft tissue injury accompanies distal radial fractures in almost 50% of cases. Scapholunate ligament disruption commonly accompanies intraarticular fracture through the lunate facet of the distal radius. Fracture of the ulnar styloid is infrequently associated with tear of the triangular fibrocartilage.

This study was undertaken to describe 'isolated' osteoarthritis of the scaphotrapeziotrapezoid articulation in six patients with chronic scapholunate ligament disruption. Each patient included for study had scapholunate ligament disruption with secondary dorsal intercalated segmental instability. Secondary volar tilt of the scaphoid appeared to be limited in each case by impaction and development of osteoarthritis at the scaphotrapeziotrapezoid articulation. Isolated osteoarthritis at the scaphotrapeziotrapezoid articulation may accompany chronic scapholunate ligament disruption, its identification should trigger a search for associated scapholunate ligament disruption in the absence of a known systemic arthropathy.

This article reviews contemporary evaluation of hip prostheses, emphasizing both the accepted use of conventional radiographs, arthrograms, and scintigraphy, as well as the evolving use of CT and MR imaging in evaluating suspected complications. Developments in CT postprocessing and MR pulse sequence design now allow successful imaging of soft tissues adjacent to hardware components.

This article outlines the imaging role of MR imaging in evaluating acute orthopedic trauma to the extremities. MR imaging is compared, where possible, with CT scan, scintigraphy, and ultrasound. The article specifically explores the role of MR imaging in evaluating soft tissue injury accompanying fracture, emphasizes an established role in occult fracture detection, reviews the role of MR imaging in evaluating neurovascular integrity following fracture, and underscores the utility of MR imaging in evaluating trauma to the growth plate.

MR imaging of a dedifferentiated chondrosarcoma of the humerus is presented and correlated with gross and microscopic histology from the surgical specimen. The classification of chondrosarcoma and specific MR signal characteristics that suggest dedifferentiation are discussed.

OBJECTIVE This study was undertaken to compare whole-body turbo short inversion time inversion recovery MR imaging and 99mTc-methylene diphosphonate planar scintigraphy in the examination of patients with suspected skeletal metastases. SUBJECTS AND METHODS Twenty-five patients with known or suspected skeletal metastatic disease underwent both whole-body turbo short inversion time inversion recovery MR imaging and whole-body 99mTc-methylene diphosphonate scintigraphy. RESULTS MR imaging revealed metastases at 57 of 175 possible sites (sensitivity, 96.5%, specificity, 100%; positive predictive value, 100%). Scintigraphy revealed metastases at 43 of 175 possible sites (sensitivity, 72%; specificity, 98%; positive predictive value, 95%) (McNemar test, 0.01; p = .016). Discrepancies in skeletal evaluation by whole-body MR imaging and scintigraphy were observed in six (24%) of 25 patients. Soft-tissue abnormalities were identified in 13 (52%) of 25 patients with MR imaging alone. CONCLUSION Preliminary results suggest that whole-body MR imaging is an effective method of examining patients with suspected skeletal metastases, with better sensitivity than conventional planar 99mTc-methylene diphosphonate scintigraphy.

This pictorial review outlines the current role of MR imaging in evaluating fractures of the upper limb.Although it is accepted that in most cases, review of plain film radiographs affords adequate clinical information allowing optimum patient management, occasionally patients present with symptoms relating to either an undetected occult fracture (Fig. 1 a,b,c) [1] or relating to the associated soft tissue injury.In this review, we briefly describe the potential of MR imaging to provide additional clinically useful information in patients with direct osseous injury.Specifically, we highlight its role in evaluating intra-articular fractures often associated with cartilage, ligament or neurovascular injury in the adjacent soft tissues.

OBJECTIVE:This study was undertaken to demonstrate a shift in tendon alignment at the first metatarsophalangeal joint in patients with hallux valgus by means of magnetic resonance imaging.DESIGN:Ten normal feet and 20 feet with the hallux valgus deformity conforming to conventional clinical and radiographic criteria were prospectively studied using magnetic resonance imaging. Correlation was made between tendon position at the first metatarsophalangeal joint and the severity of the hallux valgus deformity.RESULTS:There is a significant shift in tendon position at the first metatarsophalangeal joint of patients with hallux valgus. The insertion of the abductor hallucis tendon is markedly plantarward and the flexor and extensor tendons bowstring at the first metatarsophalangeal joint compared with patients without the deformity. The severity of the tendon shift correlates with the hallux valgus angle and clinical severity of the hallux valgus deformity in each case.CONCLUSION:Patients with hallux valgus have a significant tendon shift at the first metatarsophalangeal joint which appears to contribute to development of the deformity.

We present the MR appearances of three patients with biopsy-proven primary lymphoma of skeletal muscle. In each case lymphoma resulted in bulky expansion of the involved muscle, homogeneously isointense to skeletal muscle on T1-weighted images, homogeneously hyperintense to skeletal muscle on T2-weighted images and diffusely enhancing following intravenous administration of gadopentate dimeglumine.