Faculty Bibliography

The clinical presentation of acute calcific tendinitis can be quite dramatic. This report describes a patient with this entity who had calcification in an unusual area, accompanied by abnormalities seen on radiography and magnetic resonance imaging. Clinical aspects of acute calcific tendinitis are also reviewed. With recognition of this entity, treatment can be initiated promptly, with dramatic resolution

OBJECTIVE: MR imaging is not routinely used for evaluation of tophaceous gout. However, gout may present clinically in an atypical, unusual, or confusing manner. A gouty tophus occasionally mimics an infectious or neoplastic process, and MR imaging may be obtained under these circumstances. The purpose of this study was to determine the MR imaging characteristics of intraosseous and soft-tissue tophi. MATERIALS AND METHODS: We identified 13 MR imaging examinations performed during a 27-month period on nine patients with gouty arthritis. All were men 42-70 years old. T1-, proton density-, and T2-weighted spin-echo MR images were obtained for all the examinations. Nine examinations included contrast-enhanced MR images. The findings were then evaluated, as were the corresponding radiographs. RESULTS: Five patients presented with articular involvement, three patients with an isolated soft-tissue mass, and one patient with persistent soft-tissue swelling. The duration of symptoms ranged from 3 months to more than 20 years. Nearly all the tophi were of intermediate signal intensity on T1-weighted images. On T2-weighted images, three sites revealed an overall increase in the signal intensity of the tophi, whereas 10 studies showed a heterogeneous decrease in signal intensity. All but one tophus showed homogeneous enhancement. Erosion of adjacent bone, synovial pannus, joint effusion, soft-tissue edema, and bone marrow edema were common associated findings. CONCLUSION: The MR appearance of tophi in patients with tophaceous gout is constant on T1- but quite variable on T2-weighted images. This variability in signal intensity could be related to calcium within a tophus. Tophaceous gout should be considered in the differential diagnosis when a mass reveals heterogeneously low to intermediate signal intensity, particularly if the adjacent bone shows typical erosive changes or if other joints are involved. When faced with this situation, radiologists may find it helpful to obtain a further clinical history and recommend evaluating the patient's serum urate level

MR imaging is an accurate, noninvasive, and cost-effective method for the evaluation of acute knee ligament injuries and in the examination of the postoperative knee. Understanding the normal anatomy and the pertinent clinical aspects of knee injuries is a prerequisite for accurate interpretation of MR imaging studies. The increasing popularity of ACL reconstruction following disruption of this ligament requires knowledge of the various surgical techniques and their MR imaging appearance as well as the appearance of possible complications

PURPOSE: To determine the accuracy of magnetic resonance (MR) imaging and MR arthrography in the detection and staging of lesions of the acetabular labrum. MATERIALS AND METHODS: Fifty-seven hips of 56 patients with chronic hip pain and a strong clinical suspicion of labral lesions were examined with a three-dimensional gradient-echo sequence in the coronal oblique and sagittal oblique projections before and after the intraarticular injection of gadopentetate dimeglumine. The labra were evaluated on the basis of morphology, signal intensity, the presence or absence of a tear, and their attachment to the acetabulum. Twenty-two of the hips underwent surgical intervention, and 35 hips were treated conservatively. RESULTS: Twenty of the 22 labra with surgical proof were staged accurately with MR arthrography. On the conventional MR images, only eight of the 22 labra were staged correctly. Whereas the sensitivity of MR arthrography was 90% and its accuracy was 91%, the sensitivity of MR imaging was 30% and its accuracy was 36%, compared with surgical findings. CONCLUSION: MR arthrography enables accurate detection and staging of lesions of the acetabular labrum and appears to be indicated in the assessment of chronic hip pain in patients with a strong suspicion of labral lesions