Skeletal Radiology

To evaluate the efficacy of MRI in classifying PFFD and to compare MRI to radiographic classification of PFFD. Radiographic and MRI classification of the cases was performed utilizing the Amstutz classification system. Retrospective evaluation of radiographs and MRI exams in nine hips of eight patients with proximal focal femoral deficiency was performed by two radiologists. The cases were classified by radiographs as Amstutz 1: n=3, Amstutz 3: n=3, Amstutz 4: n=1 and Amstutz 5: n=2. The classifications based on MRI were Amstutz 1: n=6, Amstutz 2: n=1, Amstutz 3: n=0, Amstutz 4: n=2 and Amstutz 5: n=0. Three hips demonstrated complete agreement. There were six discordant hips. In two of the discordant cases, follow-up radiographs of 6 months or greater intervals were available and helped to confirm MRI findings. Errors in radiographic evaluation consisted of overestimating the degree of deficiency. MRI is more accurate than radiographic evaluation for the classification of PFFD, particularly early on, prior to the ossification of cartilaginous components in the femurs. Since radiographic evaluation tends to overestimate the degree of deficiency, MRI is a more definitive modality for evaluation of PFFD.

The relationship of the posterior aspects of the atlas and the axis were studied in 100 normal adult volunteers. The ratio of the height of the atlantal spinolaminar line to the atlantoaxial interspinous distance was found to be remarkably constant and was less than 2.0 in all men and women. This ratio should prove helpful in detecting hyperflexion injuries isolated to the atlantoaxial level.

A destructive spondyloarthropathy is reported in four patients undergoing maintenance hemodialysis for chronic renal disease. In a separate investigation a controlled, prospective radiographic study of the cervical spine revealed this spondyloarthropathy in 4 (15%) of 26 long-term dialysis patients. A single disc level was involved in three patients, and two disc levels were involved in one patient. This spondyloarthropathy correlated with the duration of dialysis but not with the radiographic evidence of renal osteodystrophy or severity of laboratory abnormalities associated with hyperparathyroidism. Three of these four patients also had discovertebral erosions or destruction involving the lumbar spine. Cervical spine flexion views revealed evidence of ligamentous laxity or instability in three (12%) dialysis patients, all with vertebral resorption and disc space narrowing. It is postulated that this instability may contribute to the development of cervical discovertebral lesions or be a secondary manifestation of disc destruction.

To quantitatively evaluate vertebral bone marrow fat content and investigate its association with osteoporosis with chemical-shift magnetic resonance imaging (CS-MRI). Fifty-six female patients (age range 50–65 years) with varying bone mineral densities as documented with dual x-ray absorptiometry (DXA) were prospectively included in the study. According to the DXA results, the patients were grouped as normal bone density, osteopenic, or osteoporotic. In order to calculate fat content, the lumbar region was visualized in the sagittal plane by CS-MRI sequence. “Region of interest” (ROI)s were placed within L3 vertebral bodies and air (our reference point) at different time points by different radiologists. Fat content was calculated through “signal intensity (SI) suppression rate” and “SI Index”. The quantitative values were compared statistically with those obtained from DXA examinations. Kruskal–Wallis, and Mann–Whitney U tests were used for comparisons between groups. The reliability of the measurements performed by two radiologists was evaluated with the “intraclass correlation coefficient”. This study was approved by an institutional review board and all participants provided informed consent to participate in the study. Eighteen subjects with normal bone density (mean T score, 0.39 ± 1.3 [standard deviation]), 20 subjects with osteopenia (mean T score, –1.79 ± 0.38), and 18 subjects with osteoporosis (mean T score, –3 ± 0.5) were determined according to DXA results. The median age was 55.9 (age range 50–64 years) in the normal group, 55.5 (age range 50–64 years) in the osteopenic group, and 55.1 (age range 50–65 years) in the osteoporotic group (p = 0.872). In the CS-MRI examination, the values of “SI suppression ratio” and “SI Index” (median [min:max]) were calculated by the first and second reader, independently. There was no statistically significant difference between the groups with regard to vertebral bone marrow fat content (p > 0.05). According to the “intraclass correlation coefficient”, the measurements were reliable (0.55 and 0.60). Vertebral bone marrow fat content calculated with CS-MRI is not a reliable parameter for predicting bone mineral density in female patients aged between 50 and 65 years.

Since 1971 surgical management of musculoskeletal tumors has changed dramatically. In 1971 less than one-fourth of patients with a malignant tumor had limb salvage surgery, the remainder having an amputation. Amputations were also sometimes done for recurrent benign tumors. Since then amputation has become unusual for malignant disease and is virtually never done for benign tumors. The changes have been made possible because of advances in anesthesiology, surgery, radiology, medical oncology, and radiation oncology.

Six cases of amateur athletes who have severe atypical degenerative joint disease (DJD) are presented; their histories suggest that chronic, repetitive trauma was causative in the development of their arthropathy. Although many examples of this process have been reported in professional athletes, it has not been reported in amateurs. As participation in athletic activities increases we can, perhaps, expect to see more of this type of DJD in the future.

This review describes a range of shoulder injuries experienced by baseball pitchers. It is estimated that more than 57% of pitchers suffer some form of shoulder injury during a playing season. Knowledge of the overhead throwing cycle is crucial for our understanding of these shoulder injuries. Baseball pitchers are prone to rotator cuff tears from tensile overload and impingement. Glenoid labrum degeneration or tears are also common, due to overuse syndrome (micro-instability), internal impingement and microtrauma. An understanding of the lesions involved in overhead throwing is crucial in baseball pitchers, as long-term disability can result from these injuries, sometimes with severe financial consequences to the player.