Recent journal articles from the members of the department
Rugby related cervical spine injuries.
19. Chinese J. Radiology 2000;25(1):7-12
MR Imaging of
Soft Tissue Neoplasm after Treatment with Surgery and Radiation Therapy.
Pang A, Hughes T.
|18. Stroke. 2000 Aug;31(8):1997-2001.
Brain stem stroke causing baroreflex failure and paroxysmal
Phillips AM, Jardine DL, Parkin PJ, Hughes T, Ikram H.
Department of General Medicine, Christchurch Hospital, New Zealand,
BACKGROUND: Paroxysmal neurogenic hypertension has been associated with a
variety of diseases affecting the brain stem but has only rarely been reported
after brain stem stroke. The mechanism is thought to involve increased
sympathetic activity and baroreflex dysfunction. We undertook microneurographic
recordings of muscle sympathetic nerve activity (MNSA) during beat-to-beat blood
pressure (BP) monitoring to investigate this hypothesis. CASE DESCRIPTION: We
investigated a 75-year-old woman who developed paroxysmal hypertension (BP
220/110 mm Hg) after a large left-sided medullary infarct. The paroxysms were
triggered by changes in posture and were accompanied by tachycardia,
diaphoresis, and headache. Serum catecholamines were substantially increased
(norepinephrine level, 23.9 nmol/L 9 days after stroke; normal level, <3.8 nmol/L),
and heart rate variability, measured by spectral analysis, was decreased in both
low- and high-frequency domains (0.04 and 0.06 ms(2), respectively; normal
level, 0.14+/-0.02 ms(2)). MNSA was increased in frequency (61 bursts per
minute; normal level, 34+/-18 bursts per minute), and the burst amplitude was
not inversely related to diastolic BP. BP and MNSA responses to cold pressor and
isometric handgrip stimuli were intact. CONCLUSIONS: Extensive unilateral
infarction of the brain stem in the region of the nucleus tractus solitarius may
result in partial baroreflex dysfunction, increased sympathetic activity, and
neurogenic paroxysmal hypertension.
PMID: 10926969 [PubMed - indexed for MEDLINE]
Magnetic resonance imaging of lipoma and liposarcoma:
potential of short tau inversion recovery as a technique of fat suppression.
Pang AK, Hughes T.
Department of Radiology, Christchurch Public Hospital, New Zealand.
The present limited retrospective study was performed to assess MR imaging of
lipomatous tumours of the musculoskeletal system and to evaluate the potential
of the T2 short tau inversion-recovery (STIR) technique for differentiating
lipomas from liposarcomas. Magnetic resonance imaging of 12 patients with
lipomatous tumours of the musculoskeletal system (eight benign lipomas, three
well-differentiated liposarcomas and one myxoid liposarcoma) were reviewed.
Benign lipomas were usually superficial and showed homogeneity on T1- and
T2-weighted spin echo sequences. Full suppression at T2 STIR was readily
demonstrated. In contrast, the liposarcomas in the present series were all
deep-seated. Two well-differentiated liposaromas showed homogeneity at long and
short relaxation time (TR) but failed to show complete suppression at T2 STIR.
One case of well-differentiated liposarcoma (dedifferentiated liposarcoma) and
one of myxoid liposarcoma showed mild and moderate heterogeneity at T1 and T2,
respectively, and posed no difficulty in being diagnosed correctly. In
conclusion, short and long TR in combination with T2 STIR show promise in
differentiating benign from malignant lipomatous tumours of the musculoskeletal
system, when taken in combination with the position of the tumour.
PMID: 11103539 [PubMed - indexed for MEDLINE]
Acute bone-marrow oedema in cyclosporin-treated renal
Jagose JT, Bailey RR, Hughes TH.
Department of Nephrology, Christchurch Hospital, New Zealand.
Transient musculoskeletal pain may occur in renal transplant patients on
cyclosporin (CyA). Of 28 consecutive patients transplanted in this unit between
20 January 1995 and 2 May 1996, eight (two published elsewhere) developed this
problem. Before transplantation, three of the patients had received prednisone
intermittently or continuously for 15, 5 and 2 years, for asthma, crescentic GN
and SLE, respectively. All patients had normal hand radiographs prior to
transplantation. Five developed acute rejection following transplantation
requiring treatment with methylprednisolone; one also required OKT3 (7 days).
Weight-bearing joints of the lower limbs became affected at 3-40 weeks (mean 14)
following transplantation. MRI changes (T1-, T2-weighted and STIR images) were
consistent with acute bone-marrow oedema. Bone scintigrams showed enhanced
tracer uptake in affected joints. A spontaneous complete remission occurred in
five patients within 4-16 weeks, and this was supported by serial imaging. The
other patient underwent core decompression of the femoral heads with relief of
symptoms, but MRI showed bilateral avascular necrosis (AVN) of the femoral
heads. MRI proved useful in detecting acute bone-marrow oedema and its possible
progression to AVN. The former may be either a distinct entity or a forerunner
PMID: 9205672 [PubMed - indexed for MEDLINE]
15. Sports Exercise and Injury 1996:2;141-151.
Paediatric sports injuries.
|14. Skeletal Radiol. 1995 Jan;24(1):7-12.
Pigmented villonodular synovitis: MRI characteristics.
Hughes TH, Sartoris DJ, Schweitzer ME, Resnick DL.
Department of Radiology, University of California, San Diego, USA.
The magnetic resonance imaging (MRI) scans of 26 patients with
histopathologically proven pigmented villonodular synovitis (PVNS), involving
joints but excluding tendon sheaths, were reviewed retrospectively. The
purpose of this study is to define the spectrum and frequency of MRI
characteristics for PVNS using conventional spin echo (in two cases before and
after intravenous administration of gadopentate dimeglumine) and also gradient
echo techniques. A cystic variety is presented, the MRI appearances of which
have not been found in a review of the literature.
PMID: 7709261 [PubMed - indexed for MEDLINE]
|13. Clin Orthop. 1994 Nov;(308):50-3.
Imaging in bone lengthening. A review.
Hughes TH, Maffulli N, Green V, Fixsen JA.
Department of Radiology, University College Hospital, London, England.
Limb lengthening using callotasis needs careful preoperative planning and
great care during the lengthening period. The most common method used to
monitor limb lengthening is plain radiography, but the time of frame removal
is still left to the judgment of the surgeon. This paper reviews some of the
methods used experimentally and clinically to monitor the process, outlining
their possible advantages and disadvantages for application in routine
clinical practice. Considering availability, cost, and safety, an imaging
protocol could involve preoperative assessment with computed tomography scan;
immediate postoperative anteroposterior (AP) and lateral radiographs; weekly
ultrasound scanning for the 1st 8 weeks; and monthly AP and lateral
radiographs during the lengthening phase and if there is any clinical
suspicion of complication during the consolidation phase. If available, dual
energy bone densitometry can be performed every 2 to 4 weeks from 8 weeks,
until removal of the fixator.
PMID: 7955700 [PubMed - indexed for MEDLINE]
|12. Acta Radiol. 1994 Nov;35(6):555-9.
Radiographic features of limb lengthening in children.
Minty I, Maffulli N, Hughes TH, Shaw DG, Fixsen JA.
Department of Radiology, Hospital for Sick Children, London, U.K.
We report our experience in radiographic imaging in limb lengthening
procedures using callotasis for limb lengthening discrepancy with the Orthofix
dynamic monoaxial external fixator. Seventeen patients (average age at
operation 10.8 years) completed 22 bone segments (7 femora, 11 tibiae, 4
ulnae) lengthening procedures. The average time for formation of good
medullary bridging was over 6 months. The commonest radiographic abnormality
was a periosteal reaction around the pin sites seen in 14 patients, while
evidence of pin loosening was present in 10. All patients with pin loosening
also showed periosteal reaction which pre-dated the loosening in 5 of 12
patients by an average of 47 days. Angulation was detected in 9 patients in
the a.p. plane, and in 6 in the lateral plane. Six patients developed a ragged
radiolucent region through the newly forming bone at an average of 95 days
from the corticotomy but with uneventful healing.
PMID: 7946677 [PubMed - indexed for MEDLINE]
|11. Skeletal Radiol. 1995 Jul;24(5):367-70.
Melorheostosis with an ossified soft tissue mass: MR
Yu JS, Resnick D, Vaughan LM, Haghighi P, Hughes T.
Department of Radiology, University of California, San Diego, USA.
PMID: 7570158 [PubMed - indexed for MEDLINE]
10. The Journal of Musculoskeletal Medicine 1993 (Aug.);61-63
Radiology Quiz - Fight bite.
Yu JS, Hughes TH,
9. Journal of the Southern Orthopaedic Association. 1993(Fall):2;173-184.
Osteoporosis. Feature article.
Hughes T.H., Yu J.S.
and Sartoris D.J.
8. Radiography today 1993 Feb;59 (669):14-15
The role of
ultrasound in bone lengthening imaging.
Green V, Maffulli
N, Hughes T.
|7. Tuber Lung Dis. 1992 Dec;73(6):392-5.
Spinal infection by Mycobacterium xenopi in a
Rahman MA, Phongsathorn V, Hughes T, Bielawska C.
Department of Rheumatology, Royal Free Hospital, London, UK.
A previously fit 77-year-old woman was found to have a paravertebral abscess.
This was aspirated, yielding Mycobacterium xenopi, but no other pathogens.
Antituberculosis chemotherapy with four first-line agents was commenced, with
some response but continuing pain. Reports of extrapulmonary M. xenopi
infections are rare. Most previous cases have involved immunosuppressed
patients. This is the first reported case of spinal M. xenopi infection in a
non-immunosuppressed patient, but radiological evidence suggests that previous
tuberculous infection may have damaged the lumbar vertebrae, rendering them
susceptible to infection by M. xenopi.
PMID: 1292722 [PubMed - indexed for MEDLINE]
|6. J R Soc Med. 1993 Jan;86(1):18-20.
Ultrasonographic appearance of regenerate bone in limb
Hughes TH, Maffulli N, Fixsen JA.
Department of Radiology, Hospital for Sick Children, London.
The appearance of regenerate bone during the process of limb lengthening using
a mono-axial device was studied using radiographs and ultrasound scanning in
nine patients. The corticotomy site initially appeared as a sonolucent area.
Poorly organized echogenic foci were detectable 2 weeks after the distraction
was begun. After 4 weeks, these areas became aligned. At 7-8 weeks, a clear
impression of a new cortical margin was seen. The formation of a medullary
canal started at this point, progressing to a radiographically evident canal.
Ultrasound scanning can reduce considerably exposure to ionising radiation in
patients undergoing limb lengthening. Accurate measurements are possible in
the early stages, and ossification can be monitored. Axial deviation can be
seen but not evaluated. The maturity of the regenerate bone still has to be
PMID: 8423567 [PubMed - indexed for MEDLINE]
|5. Br J Urol. 1992 Jun;69(6):629-32.
Pre-operative assessment of Peyronie's disease using colour
Ralph DJ, Hughes TH, Lees WR, Pryor JP.
St Peter's Hospital, Department of Radiology, London.
Colour Doppler ultrasonography was used to assess 39 patients with Peyronie's
disease with a suspected organic cause for their impotence. In 20 patients who
complained of a uniform loss of erection, the impotence was likely to be
functional in origin (90%) or occasionally venogenic (10%), the penile arterial
blood flow being normal. However, patients who complained of distal flaccidity
were likely to have an organic cause for their impotence (68%). This was due to
proximal arterial disease (10%), plaque involvement of the distal vessels (37%),
veno-occlusive dysfunction (5%) or to the soft glans syndrome (16%).
PMID: 1638347 [PubMed - indexed for MEDLINE]
|4. J Bone Joint Surg Br. 1992 Jan;74(1):130-2.
Ultrasonographic monitoring of limb lengthening.
Maffulli N, Hughes T, Fixsen JA.
Hospitals for Sick Children, London, England.
Limb lengthening in nine patients was monitored by radiographs and by ultrasound
scans. The distraction gap appeared as a sonolucent area within which echogenic
foci developed soon after distraction commenced. By seven weeks a new cortex was
detected, and medullary canal began to develop between seven and eight weeks.
Ultrasound scanning can be used to measure distraction, but it was not as useful
as radiographs in detecting angulation. Its use in patients undergoing limb
lengthening could reduce their exposure to radiation.
PMID: 1732241 [PubMed - indexed for MEDLINE]
|3. Br J Radiol. 1991 Jul;64(763):633-6.
Intracranial chondrosarcoma in a patient with Ollier's
Clifton AG, Kendall BE, Crockard HA, Hughes TH.
National Hospitals for Nervous Diseases, London, UK.
PMID: 1873666 [PubMed - indexed for MEDLINE]
|2. Br J Radiol. 1991 Apr;64(760):314-7.
The most advantageous timing of external ureteric
compression during intravenous urography.
Hughes TH, Hine AL.
Department of Radiology, Central Middlesex Hospital, London, UK.
The objective of this study was to ascertain the most advantageous time during
an intravenous urogram to apply external ureteric compression to gain the
greatest calyceal distension. This was a prospective randomized trial of 60
patients, divided into three equal groups with compression applied immediately
after injection, at 5 minutes and after the 5 minutes film had been viewed.
Patients with the usual criteria for avoiding compression were excluded. A
statistically significant improvement in calyceal distension occurred when
compression was applied at 5 minutes compared with that applied after the 5
minute film had been viewed. No improvement was seen when the compression was
applied immediately after injection. We recommend that external ureteric
compression should be applied immediately after the 5 minute film.
- Clinical Trial
- Randomized Controlled Trial
PMID: 2025770 [PubMed - indexed for MEDLINE]
1. British Journal of Radiology 1990;63:723.
A new positioning
technique for barium enemas.
Musculoskeletal Section Publishing From July 2002 – June 2003
1. Pfirrmann CWA, Theumann NH, Chung
CB, Trudell DJ, Resnick D. The
hamatolunate facet: characterization and
association with cartilage lesions-
magnetic resonance arthography and
anatomic correlation in cadaveric wrists.
Skeletal Radiology 2002; 31:451-456.
2. Delgado G, Chung CB, Lektrakul
N, Azocar P, Botte MJ, Coria D, Bosch E,
Resnick D. "Tennis leg": a clinical
study in 141 and anatomic investigation of four cadavers with MR imaging
and ultrasonography. Radiology 2002; 224: 112-119.
3. Abreu MR, Chung CB, Mendes L,
Mohana-Borges A, Resnick D. Plantar
calcaneal enthesophytes: new observations
regarding sites of origin based on
radiographs, MR imaging, anatomic, and
paleopathologic analysis. Skeletal
Radiology 2003; 32 (1): 13-21.
4. Antonio GE, Cho HJ, Chung CB,
Trudell DJ, Resnick D. MR imaging appearance
and classification of acromioclavicular
joint injury. AJR 2003; 180 (4): 1103-1110.
5. Theumann NH, Pfirrmann CW, Antonio GE,
Chung CB, Gilula LA, Trudell DJ,
Resnick D. Extrinsic carpal ligaments:
normal MR arthrographic appearance in
cadavers. Radiology 2003; 226 (1):
6. Mohana-Borges A, Theumann N, Pfirrmann,
Chung CB, Resnick D, Trudell D.
MR imaging of the lesser
metatarsaophalangeal joints with standard MR, MR
arthrography and MR bursography: initial
results in 48 cadaveric joints.
Radiology 2003; 227: 175-182.
7. Papakonstantinou O, Chung CB,
Chanchairujira K, Resnick D.
Complications of anterior cruciate
ligament reconstruction: MR imaging.
European Radiology 2002. In Press. Published
online 3 September 2002.
8. Chung CB, Mohana-Borges A,
Tophaceous gout in an amputation stump in
a patient with chronic myelogenous
leukemia. Skeletal Radiol. 2003; (Epub
ahead of print).
9. Chung CB, Kim HJ.
Sports injuries of the elbow. Magn Reson
Imaging Clin N Am. 2003; 11: 239
10. Chung CB, Resnick D.
Monitoring the pathologic changes of
rheumatoid arthritis: role of conventional and advanced imaging methods.
Arthritis and Rheumatism.
11. Mohana-Borges A, Chung CB,
MR imaging and MR arthrographic
evaluation of the postoperative shoulder: spectrum of normal and abnormal
12. Mohana-Borges A, Chung CB,
Superior labrum anterior and posterior
(SLAP) tear: classification and diagnosis on MR imaging and MR
Kallas KM, Vaughan L, Haghighi P, Resnick
Hibernoma of the left axilla; a case report
and review of MR imaging.
Skeletal Radiology 2003 May;32(5):290-4.
Epub 2002 Aug 21.
Munishi M, Pretterklieber ML, Kwak S,
Antonio GE, Trudell DJ,
MR imaging, MR arthography, and specimen
correlation of the
posterolateral corner of the knee: an
anatomic study. AJR Am J Roentgenol.
Theodorou DJ, Theodorou SJ, Kakitsubata Y,
Botte MJ, Resnick D.
Fractures of proximal portion of fifth
metatarsal bone: anatomic and
imaging evidence of a pathogenesis of
avulsion of the plantar aponeurosis
and the short peroneal muscle tendon.
Radiology. 2003 Mar;226(3):857-65.
Kakitsubata Y, Theodorou DJ, Theodorou SJ,
Trudell D, Clopton PL, Donich AS, Lektrakul N, Resnick D.
Magnetic resonance discograpgy in cadavers:
tears of the annulus fibrosus.
Clin Orthop. 2003 Feb;(407):228-40.
Huang GS, Yu JS, Munshi M, Chan WP, Lee CH,
Chen CY, Resnick D.
Avulsion fracture of the head of the fibula
(the "arcuate" sign): MR imaging
findings predictive of injuries to the
posterolateral ligaments and posrerior
cruciate ligament. AJR AM J Roentgenol.
2003 Feb; 180(2):381-7.
Gerling MC, Pfirrmann CW, Farooki S, Kim C,
Boyd GJ, Aronoff MD, Feng SA, Jacobson JA, resnick D, Brage ME.
Posterior tibialis tendon tears: comparison
of the diagnostic efficacy of
magnetic resonance imaging and
ultrasonography for the detection of
surgically created longitudinal tears in
cadavers. Invest Radiol. 2003
Kakitsubata Y, Theodorou DJ, Theodorou SJ,
Tamura S, Nabeshima K, Trudell D, Clopton PL, Resnick D.
Cartilaginous endplates of the spine: MRI
with anatomic correlation in
cadavers. J Comput Assist Tomogr. 2002
Theumann NH, Pfirrmann CW, Mohana Borges
AV, Trudell DJ, Resnick D.
Metatarsophalangeal joint of the great toe:
normal MR, MR arthographic,
and MR bursographic findings in cadavers. J
Comput Assist Tomogr. 2002
Theodorou DJ, Theodorou SJ, Resnick D.
Imaging in dialysis spondyloarthropathy.
Semin Dial. 2002 Jul –
|1: Radiology 2001
Intermetatarsal Spaces: Analysis with MR Bursography,
Anatomic Correlation, and Histopathology in Cadavers.
Theumann NH, Pfirrmann CW, Chung CB, Mohana-Borges AV, Haghighi P, Trudell
DJ, Resnick D.
Departments of Radiology (N.H.T., C.W.A.P., C.B.C., A.V.R.M.B., D.J.T., D.R.)
and Pathology (P.H.), Veterans Administration Medical Center, San Diego,
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.
PMID: 11687693 [PubMed - as supplied by publisher]
|2: Radiology 2001
- 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.
Pfirrmann CW, Chung CB, Theumann NH, Trudell DJ, Resnick D.
Department of Radiology, Veterans Administration Medical Center, San Diego,
Calif. Received October 9, 2000.
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.
PMID: 11687692 [PubMed - as supplied by publisher]
|3: Radiology 2001
- Cervical Spine: Postmortem Assessment of Accident Injuries Comparison of
Radiographic, MR Imaging, Anatomic, and Pathologic Findings.
Stabler A, Eck J, Penning R, Milz SP, Bartl R, Resnick D, Reiser M.
Department of Clinical Radiology (A.S., J.E., M.R.) and Clinic of Internal
Medicine III (R.B.), University Hospital Ludwig-Maximilians-University Munich,
Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
PURPOSE: To assess the ability of postmortem radiography and magnetic
resonance (MR) imaging to depict occult cervical spine injuries as compared
with anatomic and pathologic findings. MATERIALS AND METHODS: The cervical
spines of 10 adult accident victims underwent radiography and MR imaging, with
T1-weighted, fast spin-echo T2-weighted, and four gradient-echo pulse
sequences. The frozen specimens were cut into 3-mm-thick slices (sagittal
plane) and photographed, and microfocus radiographs were obtained. Imaging
findings were compared with the anatomic and pathologic findings. RESULTS:
Eight of the 10 specimens had 28 posttraumatic lesions: three fractures (two
missed at the initial MR imaging reading), 10 facet joint capsule lesions with
bleeding, five soft-tissue and ligament lesions, eight disk lesions, and two
spinal cord lesions. Radiography depicted one lesion (4%). Two partial
ruptures of the anterior annulus fibrosus were depicted at only MR imaging.
Initially, 11 of 28 lesions were detected on MR images; retrospectively, 17 of
28 lesions were correlated with anatomic findings. CONCLUSION: Soft-tissue and
intervertebral disk and ligament injuries account for 89% (25 of 28) of
posttraumatic cervical spine lesions detected on postmortem images. Occult
lesions, including apophyseal joint injuries, were found in clinically
noninjured cervical spines. MR imaging was limited in the depiction of
discrete lesions when T1-weighted non-fat-saturated, fast spin-echo
T2-weighted, and gradient-echo pulse sequences were used.
PMID: 11687673 [PubMed - as supplied by publisher]
|4: Clin Orthop 2001
- Cartilage imaging techniques: current clinical applications and state of
the art imaging.
Chung CB, Frank LR, Resnick D.
Department of Radiology, UCSD and VA San Diego Healthcare System, La Jolla,
The high incidence of cartilage lesions, coupled with the recent advances for
their surgical and nonsurgical treatment, have necessitated the development of
techniques for accurate diagnosis and monitoring of these lesions. Although
arthroscopy has been the standard for cartilage evaluation, magnetic resonance
imaging has emerged as the imaging method of choice, allowing analysis of its
infrastructure and surface abnormalities. The authors will focus on current
clinical applications for articular cartilage analysis and advances and the
future direction of the imaging of articular cartilage.
PMID: 11603720 [PubMed - in process]
|5: Clin Orthop 2001
- In vivo changes after mechanical injury.
Colwell CW Jr, D'Lima DD, Hoenecke HR, Fronek J, Pulido P, Morris BA, Chung
C, Resnick D, Lotz M.
Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA 92037, USA.
Chondrocytes undergo apoptosis in response to mechanical injury in vitro. The
current clinical study correlates arthroscopic and magnetic resonance imaging
results with biopsy specimens of cartilage from patients with knee injury.
Twenty patients were evaluated at a mean 2.7 months after acute knee injury.
The mean age of the patients was 32 years and the mean weight was 83 kg.
Cartilage lesions were graded separately on magnetic resonance images and
arthroscopy in a blinded manner. During arthroscopy, a 1.8 mm diameter biopsy
specimen was obtained from the edge of cartilage lesion. The biopsy specimen
underwent histologic examination by safranin O staining and detection of
chondrocyte apoptosis by the presence of deoxyribonucleic acid fragmentation.
There was a positive correlation in 50% (10 of 20) when the presence or
absence of cartilage lesions by magnetic resonance imaging was correlated with
arthroscopy. All cases of partial thickness or full-thickness cartilage loss
that were seen by arthroscopy also were detected by magnetic resonance images.
Apoptotic cells were significantly more numerous in biopsy specimens from
lesions compared with control biopsy specimens. The findings of reduced cell
viability attributable to apoptosis may have profound implications for
cartilage repair. This opens potential therapeutic avenues for the treatment
of posttraumatic cartilage lesions through apoptosis prevention.
PMID: 11603696 [PubMed - in process]
|6: Invest Radiol 2001
- Assessment of the position of the distal portion of the ulna in lateral
projection radiographs of the wrist: analysis of the influence of
pronation-supination and flexion-extension on the pisoscaphoid and the
ulnotriquetral distances: a cadaver study.
Ertl-Wagner BB, Stabler A, Brossmann J, Trudell D, Resnick D.
Institute of Clinical Radiology, Klinikum Grosshadern, University of Munich,
Munich, Germany, and the Department of Radiology, Veterans Administration
Medical Center, San Diego, California.
Ertl-Wagner BB, Stabler A, Brossmann J, et al. Assessment of the position of
the distal portion of the ulna in lateral projection radiographs of the wrist:
Analysis of the influence of pronation-supination and flexion-extension on the
pisoscaphoid and the ulnotriquetral distances: A cadaver study. Invest Radiol
2001;36:612-618.RATIONALE AND OBJECTIVES: Accurate assessment of the distal
radioulnar joint is of paramount importance for the detection of possible
dislocation or subluxation. Using a cadaveric model, the authors attempted to
establish a quantitative method that would allow identification of normal and
abnormal distal radioulnar joint anatomy on well-positioned and rotated
conventional radiographs. METHODS: Four cadaveric wrists, in which subsequent
sectioning confirmed the absence of disease, and one cadaveric wrist with a
circumscribed lesion of the triangular fibrocartilaginous complex were
studied. Defined movements in flexion and extension (+/- 10 degrees, 20
degrees, 30 degrees ) and in pronation and supination (+/- 10 degrees, 20
degrees, 30 degrees ) as well as combined flexion/extension and pronation/supination
were performed. The ulnotriquetral and the pisoscaphoid distances were
assessed in each position. Correlation with cryosections was achieved.
RESULTS: A strong linear correlation between the degree of pronation or
supination and the pisoscaphoid and ulnotriquetral distances was noted.
Flexion and extension produced no significant effect on the pisoscaphoid
distance, but a defined shift of the ulnotriquetral distance occurred with
increasing flexion and extension. CONCLUSIONS: If all parameters are taken
into account, this correlation aids in estimating the degree of possible
malpositioning of the wrist during radiography and the degree of subluxation
of the distal radioulnar joint. Tabular data with parameters to correct for
instances of malrotated images and to estimate the extent of dislocation or
malrotation of the distal radioulnar joint are provided.
PMID: 11577272 [PubMed - in process]
|7: Clin Imaging 2001
- A huge osteoblastoma with aneurysmal bone cyst in skull base.
Wang YC, Huang JS, Wu CJ, Jeng CM, Fan JK, Resnick D.
Department of Radiology, Cathay General Hospital, Taipei, Taiwan, ROC.
We reported a case of a huge osteoblastoma in the skull base of a young girl
who had developed blindness in her right eye 1 year prior to examination. CT
showed a large expansile bony lesion with eggshell margin over the skull base.
MR imaging showed mixed solid and cystic parts with multiple fluid-fluid
levels in the lesion. The optic chiasma and bilateral optic nerves were
severely compressed by the tumor.
PMID: 11566084 [PubMed - indexed for MEDLINE]
|8: Skeletal Radiol
- Pigmented villonodular synovitis of the hip presenting as a
Kallas KM, Vaughan L, Haghighi P, Resnick D.
Center for Diagnostic Imaging, 148 Second Street South, Waite Park, MN 56387,
We present an unusual case of diffuse pigmented villonodular synovitis (PVNS)
of the hip presenting as a large retroperitoneal mass in an asymptomatic
39-year-old man. Initial imaging characteristics and findings on core needle
biopsy suggested soft tissue sarcoma. However, incisional biopsy showed
findings of PVNS. The patient underwent radical synovectomy and total joint
replacement, with no change in the large retroperitoneal component after 15
months of follow-up.
PMID: 11479754 [PubMed - indexed for MEDLINE]
|9: Spine 2001 Jul
In vivo changes in the neuroforaminal size at
flexion-extension and axial rotation of the cervical spine in healthy persons
examined using kinematic magnetic resonance imaging.
Muhle C, Resnick D, Ahn JM, Sudmeyer M, Heller M.
Department of RadiologyChristian-Albrechts-University KielArnold-Heller-Str.
924105 KielGermany. email@example.com
STUDY DESIGN: In vivo flexion-extension and axial rotation magnetic resonance
imaging (MRI) studies of the cervical spine were performed inside a
positioning device. OBJECTIVE: To determine the functional changes of
neuroforaminal size that occur during flexion-extension and axial rotation of
the cervical spine in healthy persons. SUMMARY OF BACKGROUND DATA: Kinematic
MRI studies of the cervical spine were performed to obtain detailed
information about the functional changes that occur in neuroforaminal size
during flexion-extention and axial rotation. The results were compared with
published data of in vitro functional flexion-extension and axial rotation
studies of the cervical spine. METHODS: Inside a positioning device, the
cervical spines of 30 healthy persons were examined in a whole-body magnetic
resonance scanner from 40 degrees of flexion to 30 degrees of extension at
nine different angle positions. In addition, axial rotation was performed at
neutral position (0 degrees ) and at 20 degrees and 40 degrees of axial
rotation to both sides. The images were analyzed with respect to the
neuroforaminal size at each position using a reformatted 3D-FISP sequence.
RESULTS: At flexion, widening of the neuroforaminal size of up to 31%
(compared with neutral position, 0 degrees ) was observed. Conversely, at
extension a decrease in the size of the neuroforamen of up to 20% was
recognized. At 20 degrees and 40 degrees of ipsilateral rotation of the head,
a reduction in the neuroforaminal size of up to 15% and 23%, respectively,
compared with the neutral position was noted. In contrast, a widening of the
foraminal size was recognized on the contralateral side of 9% and 20% at 20
degrees and 40 degrees rotation. Statistically significant differences (p <==
0.05) were found in the neuroforaminal size between different degrees of
flexion and extension and in addition for axial rotation compared to neutral
position (0 degrees ). CONCLUSION: Compared with the results of previous
biomechanical studies of human cadaver cervical spines, kinematic MRI provides
additional noninvasive data concerning the physiological changes of the
neuroforaminal size during flexion-extension and axial rotation in healthy
PMID: 11458168 [PubMed - indexed for MEDLINE]
|10: Clin Imaging 2001
- Osteonecrosis of the patella: imaging features.
Theodorou DJ, Theodorou SJ, Farooki S, Kakitsubata Y, Resnick D.
Department of Radiology, School of Medicine, University of California, San
Diego Medical Center, San Diego, CA 92103, USA. firstname.lastname@example.org
Osteonecrosis of the patella, although uncommon, has become important to
recognize because it can be a cause of pain in the knee. We describe the
imaging manifestations of nontraumatic osteonecrosis of the patella in seven
clinical cases. The lesions uniformly involved the superior aspect of the
patella. Conventional radiography displayed increased radiodensity,
subchondral radiolucent areas, and typical demarcation line surrounding the
ischemic region. MR imaging and bone scintigraphy demonstrated the
characteristic features of osteonecrosis. Recognition of the imaging findings
of osteonecrosis involving the patella can preclude misdiagnosis and may
obviate unproductive invasive diagnostic procedures.
PMID: 11435043 [PubMed - indexed for MEDLINE]
|11: Radiology 2001
Intramedullary osteosclerosis: imaging features in nine
Chanchairujira K, Chung CB, Lai YM, Haghighi P, Resnick D.
Departments of Radiology, Veterans Affairs Medical Center, University of
California-San Diego, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.
PURPOSE: To determine the conventional radiographic, computed tomographic
(CT), magnetic resonance (MR) imaging, scintigraphic, and histologic features
of intramedullary osteosclerosis and to review the clinical features.
MATERIALS AND METHODS: Nine female patients with leg pain and imaging features
indicative of intramedullary sclerosis were seen during a 25-year period. None
of the patients had a history of trauma or infection, familial bone disease,
or related abnormal laboratory findings. Imaging studies included radiography
(n = 9), CT (n = 4), MR imaging (n = 5), and skeletal scintigraphy (n = 5).
Histologic correlation was available in five patients. RESULTS: Sixteen bone
lesions (midtibia, n = 14; distal fibula, n = 1; and proximal femur, n = 1)
were evident. Both lower extremities were involved in seven patients, and a
single extremity was involved in two. Intramedullary sclerosis was present, as
was cortical thickening, mainly in the diaphysis of the long bones, without
extensive periosteal reaction or soft-tissue involvement. Findings at bone
scintigraphy were positive in all lesions. Histologic analysis showed
nonspecific changes of markedly sclerotic bone with a variable degree of
mineralization and maturity. CONCLUSION: Intramedullary osteosclerosis is a
distinct disorder that typically affects the diaphysis of one or both tibiae
in women. Characteristic imaging findings, when coupled with clinical
information, allow precise diagnosis.
PMID: 11426002 [PubMed - indexed for MEDLINE]
|12: AJR Am J
Roentgenol 2001 Jul;177(1):217-9
MR arthrography of the glenohumeral joint: a tailored
Chung CB, Dwek JR, Feng S, Resnick D.
Department of Radiology, Musculoskeletal Division, University of California,
San Diego, and Veterans Healthcare System, 3350 La Jolla Village Dr., San
Diego, CA 92161, USA.
OBJECTIVE: The purpose of this study was to anatomically confirm that anterior
shoulder injection could result in penetration of the anterior stabilizing
structures of the glenohumeral joint and to advocate the use of a tailored
approach to MR arthrography based on presenting symptoms. CONCLUSION: A
tailored approach to MR arthrography may be a useful way to isolate expected
pathology in the shoulder and limit confounding findings related to the
performance of the procedure.
PMID: 11418432 [PubMed - indexed for MEDLINE]
|13: Skeletal Radiol
- Pelvic instability after bone graft harvesting from posterior iliac crest:
report of nine patients.
Chan K, Resnick D, Pathria M, Jacobson J.
Department of Radiology, School of Medicine, University of California, San
Diego Medical Center, 92103-1990, USA.
OBJECTIVE: To report the imaging findings in nine patients who developed
pelvic instability after bone graft harvest from the posterior aspect of the
iliac crest. DESIGN AND PATIENTS: A retrospective study was performed of the
imaging studies of nine patients who developed pelvic pain after autologous
bone graft was harvested from the posterior aspect of the ilium for spinal
arthrodesis. Plain films, bone scans, and CT and MR examinations of the pelvis
were reviewed. Pertinent aspects of the clinical history of these patients
were noted, including age, gender and clinical symptoms. RESULTS: The age of
the patients ranged from 52 to 77 years (average 69 years) and all were women.
The bone graft had been derived from the posterior aspect of the iliac crest
about the sacroiliac joint. All patients subsequently developed subluxation of
the pubic symphysis. Eight patients had additional insufficiency fractures of
the iliac crest adjacent to the bone graft donor site, and five patients also
revealed subluxation of the sacroiliac joint. Two had insufficiency fractures
of the sacrum and one had an additional fracture of the pubic ramus.
CONCLUSIONS: Pelvic instability is a potential complication of bone graft
harvesting from the posterior aspect of the iliac crest. The pelvic
instability is manifested by insufficiency fractures of the ilium and
subluxation of the sacroiliac joints and pubic symphysis.
PMID: 11407719 [PubMed - in process]
|14: Radiology 2001
- Tarsal sinus: arthrographic, MR imaging, MR arthrographic, and pathologic
findings in cadavers and retrospective study data in patients with sinus tarsi
Lektrakul N, Chung CB, Lai Ym, Theodorou DJ, Yu J, Haghighi P, Trudell D,
Department of Radiology, Veterans Affairs San Diego Healthcare System,
University of California, San Diego, 3350 La Jolla Village Dr, San Diego, CA
PURPOSE: To evaluate the tarsal sinus by using different imaging techniques
and specialized planes. MATERIALS AND METHODS: Magnetic resonance (MR) imaging
of the tarsal sinus was performed in 10 cadavers. Conventional arthrography of
the anterior and posterior subtalar joints was then performed. Tarsal sinus
ligaments were evaluated further on initial and reconstructed MR arthrograms
along and perpendicular to their axes. Pathologic correlation was performed in
five specimens suspected of having tarsal sinus lesions on the basis of
initial imaging findings. In 37 patients with a clinical diagnosis of sinus
tarsi syndrome, MR images of the ankle were obtained before and after
intravenous gadolinium-based contrast material administration and were
reviewed to verify the integrity of the tarsal sinus ligaments. RESULTS: Two
complete and three partial cervical ligament (CL) tears and one complete
interosseous talocalcaneal ligament (ITCL) tear were diagnosed with MR
imaging. Only one complete and one partial CL tear were seen after evaluation
of both initial and reconstructed MR arthrograms and confirmed with pathologic
correlation. In 18 patients, the diagnosis was confirmed at MR imaging, which
depicted ITCL and CL tears in 11 patients, isolated CL tears in three
patients, ganglia in three patients, and pigmented villonodular synovitis in
one patient. CONCLUSION: Cadaveric study results indicate that initial and
reconstructed MR arthrograms along and perpendicular to the ligament axes are
potentially useful for further evaluation of individual tarsal sinus
PMID: 11376274 [PubMed - indexed for MEDLINE]
|15: Clin Imaging 2000
- Subperiosteal lipoma: a case report.
Blair TR, Resnick D.
Department of Radiology, Veterans Affairs Medical Center, and University of
California San Diego, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
Lipomas are the most common benign mesenchymal tumor. They can occur in
various locations such as subcutaneous tissue, muscle, nerve, synovium,
different periosteal layers, and bone [Diagnosis of bone and joint disorders.
3rd ed. Philadelphia: Saunders, 1995. p. 3814, 3947; Skeletal Radiol 27 (1998)
375]. To our knowledge, however, lipomas arising in a subperiosteal location
have not been described previously. We present a patient with two
subperiosteal lipomas of the femur.
PMID: 11368942 [PubMed - indexed for MEDLINE]
|16: J Comput Assist
Tomogr 2001 May-Jun;25(3):412-6
- MRI of the medial and lateral plantar nerves.
Farooki S, Theodorou DJ, Sokoloff RM, Theodorou SJ, Trudell DJ, Resnick D.
Department of Radiology, Veterans Affairs San Diego Healthcare System and
University of California San Diego School of Medicine, USA.
PURPOSE: The purpose of this work was to demonstrate nerve anatomy of the
medial plantar (MP) and lateral plantar (LP) nerves and the first branch of
the lateral plantar (FBLP) nerve as depicted with MRI. METHOD: High resolution
MRI of the heel was performed with a standard transmit-receive extremity coil
in six human cadaveric specimens using sagittal, axial, and coronal
T1-weighted spin echo images. The specimens were then sectioned in the axial
and coronal planes. RESULTS: MRI depicted the MP and LP nerves arising from
the posterior tibial (PT) nerve. Assessment of the anatomic course and
trifurcation of the PT nerve into the plantar nerves and the FBLP nerve was
best seen in the sagittal plane. Various portions of these nerves were
visualized also in the axial and coronal imaging planes. CONCLUSION: MRI may
demonstrate the origin, course, and branching of nerves in the heel and can
provide a means for assessment of the patient presenting with chronic heel
pain and suspected entrapment neuropathy.
PMID: 11351192 [PubMed - indexed for MEDLINE]
|17: Radiology 2001
- Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of
an iliotibial tract or anterior oblique band avulsion.
Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, Resnick D.
Department of Radiology, Veterans Affairs Medical Center, University of
California, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.
PURPOSE: To demonstrate the normal anatomy of the stabilizing structures of
the lateral aspect of the knee and to investigate pathogenesis of the Segond
fracture, with emphasis on the iliotibial tract (ITT) and anterior oblique
band (AOB) of the fibular collateral ligament. MATERIALS AND METHODS:
Dissection of the region of the AOB, ITT, and lateral capsular ligament was
performed in three cadaveric knees, with placement of gadopentetate
dimeglumine-filled tubes along their course and tibial insertions. These
knees, in addition to three nondissected knees, were studied with magnetic
resonance (MR) imaging by using standard and specialized oblique planes.
Specimen sectioning provided anatomic correlation. Retrospective review of
radiographs and MR images in 17 patients with acute Segond fractures was
performed, and the relationship between the fragment and the demonstrated
lateral supporting structures of the knee was noted. RESULTS: Anatomic
dissection and MR imaging of the cadaveric knees demonstrated a broad tibial
insertion of the ITT, with fibers extending posterior to the Gerdy tubercle. A
firm band of tissue, the AOB, extended from the fibular collateral ligament to
the midportion of the lateral tibia, the typical site of a Segond fracture.
The lateral capsular ligament proved to be a mere thickening of the capsule,
inserting at the lateral tibia. Clinical analysis of acute Segond fractures
confirmed the frequent attachment of the ITT and AOB to the avulsed fragment.
CONCLUSION: Anatomic and clinical findings suggest that fibers of the ITT and
AOB are important factors in the pathogenesis of the Segond fracture.
PMID: 11323461 [PubMed - indexed for MEDLINE]
|18: Radiology 2001
- Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic
study of prevalence, characterization, and correlation with degenerative
changes of 1,650 spinal levels in 100 cadavers.
Pfirrmann CW, Resnick D.
Department of Radiology, Veterans Affairs San Diego Healthcare System, 3350 La
Jolla Village Dr, San Diego, CA 92161, USA.
PURPOSE: To investigate the frequency and characteristics of Schmorl nodes in
an elderly population and to correlate these findings with degenerative spinal
changes. MATERIALS AND METHODS: Cadaveric thoracic and lumbar spines were
removed at autopsy (mean age at death, 68.2 years; range, 43-93 years).
Parasagittal sections of approximately 5-mm thickness were obtained and
radiographed. At each of 3,300 endplates from T1 to L5, the presence of
Schmorl nodes was noted. Vertebral endplate contour was analyzed, and
abnormalities of the discovertebral junction were noted. The height of each
interspace was measured, and the presence or absence of vacuum phenomena and
spondylosis was recorded. RESULTS: Schmorl nodes were found in 58 specimens
and were multiple in 41. Of 3,300 vertebral endplates, 225 revealed Schmorl
nodes: 88 cranial and 137 caudal. More than 182 were between T7 and L2.
Schmorl nodes correlated with disk space loss (P <.001) but not with evidence
of advanced disk degeneration: marked disk space loss (P =.53), vacuum
phenomena (P =.82), or discogenic sclerosis or erosion (P =.35). Schmorl nodes
were associated with claw (P <.001) but not traction (P =.72) osteophytes.
Straight (P <.001) and fractured (P <.001) vertebral endplates were associated
with Schmorl nodes. CONCLUSION: Schmorl nodes are common in the spines in an
elderly population, with a frequency similar to that in a younger population.
Schmorl nodes are associated with moderate but not advanced degenerative
changes. Geometric observations regarding the vertebral endplates support the
concept that Schmorl nodes are caused by an abnormality of the discovertebral
PMID: 11323459 [PubMed - indexed for MEDLINE]
|19: Ann Thorac Surg
- Dysphagia caused by a fetus-in-fetu in a 27-year-old man.
Massad MG, Kong L, Benedetti E, Resnick D, Ghosh L, Geha AS, Abcarian H.
Department of Surgery, The University of Illinois at Chicago, 60612, USA.
Mechanical obstruction of the distal esophagus by a fetus-in-fetu is an
extremely rare condition that has not been previously reported. We present the
case of a 27-year-old man who presented with dysphagia caused by fetus-in-fetu
contained within a retroperitoneal cystic cavity. The tumor, noticed since
childhood, did not cause any symptoms until a year before presentation when
symptoms of dysphagia developed. We propose including this entity in the
differential diagnosis of a retroperitoneal mass.
PMID: 11308184 [PubMed - indexed for MEDLINE]