Available on iTunes. Add Comment 1. The tumor is considered to be aggressive and requires surgery if one of the following criteria is present: cortical destruction, Moth-eaten or permeative osteolysis, spontaneous pathologic fracture, periosteal reaction, edema surrounding the tumor on MR images, and soft tissue mass. Tumor biopsy followed by complete intralesional treatment is indicated. 2. The tumor is classified as active if two of the following active criteria are present: pain related to the tumor, endosteal scalloping superior to two-thirds of the cortical thickness, extent of endosteal scalloping superior to two-thirds of the lesion length, cortical thickening and enlargement of the medullary cavity. Tumor biopsy or excision is indicated. 3. The tumor is classified as possibly active if one of the previous active criteria is present. In such cases, bone scintigraphy and dynamic-enhanced MR imaging should be obtained. Radionuclide uptake superior to the anterior iliac crest at bone scintigraphy and early and exponential enhancement at dynamic-enhanced MR are considered as two additional active criteria. After these two examinations, if only one criterion is still present, the lesion can be regarded as possibly quiescent, and the following monitoring is suggested: first follow-up at three to six months and then once a year. Otherwise, if two or more active criteria are present, biopsy is recommended. 4. The tumor is considered quiescent and does not require surgery if no active or aggressive criterion is present. A radiological follow-up can be proposed. Taken from: Eur J Radiol. 2011 Jan;77(1):6-12. When should we biopsy a solitary central cartilaginous tumor of long bones? Literature review and management proposal.Parlier-Cuau C, Bousson V, Ogilvie CM, Lackman RD, Laredo JD. Medial ankle pain 06/07/2011
Pain medial ankle.   There's oedema in the deep deltoid ligament fibres, associated with mild thickening of the anterior talofibular ligament. Nodular thickening on the articular surface of the ATFL is suggestive of a meniscoid lesion. The appearance is typical for a lot of ankle inversion injuries. The patient "rolls" his ankle. The medial aspect of the talus abuts the distal tibia, and the lateral side is stretched. This results in anterior talofibular ligament tear, and fluid in the anterolateral gutter. Cystic Pancreatic Nodules- imaging 09/30/2010
Nice review article in the Singapore Medical Journal (link here). I've made a mind map of it as well. 
Midfoot pain 12/04/2009
 OK- messing up the images with colour overlays. There is a thickened and oedematous Lisfranc ligament (1st intermetarsal space) consistent with Lisfranc ligament sprain/partial tear. Note mild widening of the Lisfranc joint. The Lisfranc joint injury spans a spectrum from strain to frank dislocation. We've talked about it here before. The Lisfranc ligament is also called the first intermetatarsal ligament and bridges the medial cuneiform with the base of the 2nd metatarsal. The other metatarsals are connected by intermetatarsal ligaments which are transverse in orientation. The 1st intermetarsal joint has no transverse ligament. This effectively jams the base of the 2nd metatarsal into the cuneiform on weight-bearing (a keystone effect). Lisfranc injuries manifest as a step off at the base of the 2nd metatarsal relative to the cuneiforms. Patients also cannot tip-toe due to pain. Ankle pain 11/13/2009
Chronic ankle pain. Sagittal PD fat sat and coronal PD.   Nice example of osteochondral injury involving the cartilage tidemark. There are multiple subchondral cysts, and bone oedema. This is quite classic of inversion injuries, with impaction injury between the talus and distal tibia. The important thing, of course, is to make sure that there is no detached osteochondral fragment. For that, follow the cartilage lining from end to end, and the overlying cortex. Make sure there are no cortical disruptions. Not something to snuff at 10/31/2009
 MR images demonstrating a fracture of the scaphoid waist. The important thing is as Dr Hollis Potter says, "You can't move protons in it on the PD sequence- it means it's dead bone". There's also widening of the scapholunate joint. So, from first consult to confirmation of diagnosis there can be a delay as initial scaphoid fractures can be radiographically occult. There is institutional variation in practice: some places use nuclear bone scan, and some use repeat radiography, and some use MRI. I prefer to image gently with MRI. What about you? Andy Groves at Cambridge has a very nice paper demonstrating this variation in pratice in the UK. Paper available here. Sit on it. 10/28/2009
Swelling left side of buttock- 6 months' duration. Sagittal T1, Sagittal PD, Axial T1 and Axial T2 fat sat.   There is a loculated fluid collection with septation, and multiple fluid levels (see axial T2 fat sat image). It's adjacent to the left ischial tuberosity. There's a thick rim around the lesion. Ischial bursitis: also called weaver's bottom Name that structure! 10/17/2009
Let's play Name That Structure!  Write in with your answers! All that glitters... 10/16/2009
Have a look at the images below. Shoulder pain.   Got your diagnosis? Good. Now look at the following image- taken a few weeks before the ultrasound above So- still think it's calcific tendinitis? The patient suffered an anterior dislocation previously. See the defect on the inferior glenoid rim on the radiograph above? That's a bony Bankart. And if you go up to the fragment shown above, it does look suspiciously like a piece from the glenoid defect. It's too well-circumscribed and well demarcated. Also, with such a large calcific fragment, shouldn't there be more swelling of the tendon? So, knowing what you now know, it's likely the bone fragment from the bony Bankart displaced up into the supraspinatus tendon! Take home message: if it's too sharp, look again. Calcific tendinosis is fluffy. | About Us
We are doctors interested in imaging of spine, sports injuries, arthritides, and interventions to diagnose and treat painful musculoskeletal conditions. ArchivesJune 2011 CategoriesAll | ||
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