Faculty Bibliography

Magnetic resonance (MR) imaging of the wrist was performed in 35 patients with specific complaints of pain and soft-tissue swelling in the medial side of the wrist. Twenty of the 35 subsequently underwent surgery. In 14 of the patients who underwent surgery, a diagnosis of triangular fibrocartilage (TFC) tear was made at MR imaging; in 13 of the 14 the tear was confirmed by surgical findings. In the six patients with an MR diagnosis of an intact TFC, surgical findings confirmed the diagnosis. These patients were operated on for an abnormality in the vicinity of the TFC (avascular necrosis, ganglion cyst, xanthoma). On the basis of findings from the 20 patients with surgical correlation, the accuracy of MR imaging in the detection of TFC tears was 95%. MR imaging is a valuable noninvasive method in the study of pathologic conditions of the TFC

Sixty professional and recreational athletes underwent CT arthrography of the shoulder for evaluation of suspected shoulder joint derangement. These athletes, 46 males and 14 females ranging in age from 15 to 60 years (mean, 32 years), all had persistent pain that interfered with their sports activity and was resistant to conservative treatment. Seventeen patients had shoulder instability based on clinical manifestations and CT arthrographic findings. An additional five patients, also based on clinical manifestations and CT arthrographic findings, were considered to have an unobtrusive degree of anterior joint laxity. Patients with anterior instability (20 cases) all had an anteroinferior tear or detachment of the glenoid labrum, as well as some violation of the insertion of the joint capsule onto the scapula. Those with posterior instability (two cases) had a combination of labral and capsular tears. Two other major patterns of labral tears, both unaffiliated with shoulder instability, were identified. These included total or partial detachment of superior segments of the labrum, and anterior labral tears at the midglenoid level. Moreover, various degrees of labral attenuation (or, less often, enlargement), osteophyte formation, and alterations in articular cartilage were observed. Surgical correlation was obtained in 25 patients, with 95% accuracy of CT arthrographic findings. CT arthrography is a minimally invasive and highly accurate technique for investigation of glenohumeral derangement. Specifically, the extent of pathologic changes associated with instability can be determined and differentiated from other intraarticular causes of incapacity, such as labral tears caused by throwing, or degenerative changes

Sacral insufficiency fracture due to bone atrophy may develop as a complication of irradiation of pelvic malignancies. Pain is the presenting symptom and the clinical diagnoses most often considered are recurrence of the original malignancy and metastatic disease. Computed tomography provides the most specific information helpful for the detection of these fractures and for exclusion of recurrent malignancy

Computed tomography was performed in 100 patients for additional evaluation of suspected skeletal metastases following radionuclide bone scanning in 86 patients and conventional radiography in all. A retrospective review of these cases revealed that the majority (78%) involved the spine and pelvis. Computed tomography contributed to the diagnosis of a malignancy by revealing a definite destructive lesion of bone in 27 patients who had an abnormal radionuclide bone scan, a normal or inconclusive radiograph, or both. It excluded a malignant lesion in 19 patients. In 38 patients, computed tomography provided additional information that contributed to such aspects of patient care as obtaining tissue diagnosis, determining the extent of lesions, and evaluating the response to treatment. False diagnoses were made in two patients. Detection by computed tomography of a skeletal lesion and histologic documentation, frequently by computed tomography-guided percutaneous needle aspiration biopsy, greatly curtailed an otherwise extensive search for the primary site. Furthermore, this information altered the treatment plan by obviating the need for radical resection or biopsy of the primary tumor and by directing the choice of an appropriate chemotherapeutic regimen

Computed tomography (CT) of the lumbar spine without and with intravenous administration of contrast medium was performed in 143 consecutive patients who had previously had spine surgery for disk herniation and had persistent or recurrent symptoms. Fifty-two patients underwent surgical reexploration. It was possible to make the diagnosis of normal postoperative status, disk herniation, or scarring in 31 (60%) of the 52 patients with the use of CT scans without intravenous contrast medium. CT with intravenous contrast enhancement was useful in 12 of the remaining patients (23%). Enhancement of the margins of a herniated disk occurred in 37 (71%) of the patients. There was near-homogeneous enhancement of postoperative scarring in 34 (65%) patients. Intravenous contrast medium was particularly helpful when disk herniation and scarring were both present, by delineating the margins of a herniated disk and enhancing the entire substance of the scar. In symptomatic postoperative patients, CT of the lumbar spine without intravenous contrast medium should be performed initially. If a definitive diagnosis is not established, CT with intravenous contrast enhancement should be considered

Forty-three professional and amateur athletes with persistent shoulder pain that interfered with their sports activities were evaluated by computed tomographic (CT) arthrography. In 19 patients, glenohumeral instability (14 anterior, two posterior, three multidirectional) was diagnosed with CT arthrography based on the simultaneous presence of labral and capsular lesions. The findings were crucial in establishing the diagnosis of instability in six patients in whom the condition was not suggested or could not be confirmed clinically. Another significant injury consisted of labral lesions not associated with glenohumeral instability. These tears often involved the anterior and parasuperior segments of this structure. Other, less frequently detected lesions included segmental labral enlargement and several labra with abnormal orientation (everted labrum). Early onset of degenerative disease was present in many athletes, especially those with a long history of sports activity. CT arthrographic findings were correlated with arthroscopic or surgical results in 19 patients

Quantitative computerized tomography (QCT) of vertebral bodies could reveal metastatic spread of prostatic cancer before such lesions are seen with standard examinations. Focal increase in the density of the spongious bone in face of normal bone scan and serum acid phosphatase is suggestive of metastasis, but certitude is gained only if further increase in density or structural bone changes are demonstrated on follow-up studies. QCT also may provide an objective measurement of tumor response to therapy