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ABSTRACT: 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.
American Journal of Roentgenology 08/2001; 177(1):217-9. · 2.78 Impact Factor
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ABSTRACT: The purpose of this work was to establish the optimal means of evaluation of the rotator cuff interval (RCI) and rotator interval capsule and demonstrate normal anatomy of the RCI using MR imaging and MR arthrography.
MR arthrography was performed in 32 cadaveric shoulders. In 20 cases, MR imaging was completed prior to arthrography. Pre- and postarthrography studies included standard imaging planes. Images were evaluated by the consensus of two musculoskeletal radiologists with attention to the RCI, rotator interval capsule (measurements on postarthrographic studies), and crossing structures. In five cases, specialized imaging planes were performed after arthrography.
The RCI, rotator interval capsule, and crossing structures were best evaluated by MR arthrography. The anteroposterior dimension of the rotator interval capsule could be best depicted on postarthrogram images.
MR arthrography, with both standard and specialized imaging planes, is a useful way to evaluate the RCI, the rotator interval capsule, and its crossing structures.
Journal of Computer Assisted Tomography 08/2000; 24(5):738-43. · 1.22 Impact Factor
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ABSTRACT: We assessed the role of cervical spine flexion-extension radiographs in the acute evaluation of pediatric trauma patients.
We performed a retrospective review of all pediatric trauma patients who underwent static cervical spine radiography followed by flexion-extension radiography during a 22-month period. We reviewed the mechanism of injury, physical examination findings, and patient age, and tabulated the results of initial and follow-up imaging studies.
Two hundred forty seven children (age range, 1.6-18 years; mean age, 11.5 years) with a history of trauma underwent cervical spine radiography followed by flexion-extension radiography. Static cervical spine radiographs revealed normal findings in 224 patients (91%). Flexion-extension radiographs revealed normal findings for all patients with normal findings on cervical spine radiographs. Of 23 children (9%) with abnormal findings on static cervical spine radiographs, seven (30%) had congenital abnormalities visible on flexion-extension radiographs; 10 (43%) had traumatic injuries including fracture, subluxation, or soft-tissue swelling; two (9%) had instability; and six (26%) had questionable abnormalities that were noted on static cervical spine radiographs. In four patients (66%) with abnormal findings on static cervical spine radiographs, flexion-extension radiographs were helpful in ruling out abnormality.
In children with a history of trauma and normal findings on static cervical spine radiographs, additional flexion-extension radiographs are of questionable use.
American Journal of Roentgenology 07/2000; 174(6):1617-9. · 2.78 Impact Factor
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ABSTRACT: We describe a new fluoroscopic sign to aid in the diagnosis of an obstructing duodenal web and its attachment site.
During an upper GI series of a neonate, a nasogastric tube was passed into an obstructed duodenum and barium injected. The tube, pressing on an obstructing web, caused dimpling of the duodenal contour at the attachment point of the web to the duodenal wall. The same maneuver at surgery caused identical dimpling.
While the maneuver is described in surgical textbooks, there has been no radiologic correlate. The "duodenal dimple" is a new fluoroscopic sign of a duodenal web and its attachment point to the duodenal wall.
Pediatric Radiology 07/1999; 29(6):467-8. · 1.67 Impact Factor
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ABSTRACT: We have studied how gadolinium enhancement of T1-weighted MR images affects the expected normal differences in signal intensity between metaphyseal hematopoietic and epiphyseal fatty marrow. We have also analyzed how enhancement affects the expected normal changes in the MR images of the marrow due to fatty conversion.
We analyzed gadolinium-enhanced MR images of normal distal femurs in 18 immature rabbits that were 5-11 weeks old and of normal proximal femurs in 18 infants, children, and young adults who were 2 months to 21 years old. In all subjects, we studied the change with age in signal intensity and enhancement ratio of the epiphyseal and metaphyseal marrow. In the rabbits, marrow composition and transformation were histologically verified.
On unenhanced T1-weighted MR images of the rabbits and of the infants, children, and young adults, epiphyseal signal intensity always exceeded metaphyseal signal intensity; however, the enhancement ratio was always greater in the metaphysis. The signal intensity in metaphyseal and epiphyseal marrow on unenhanced MR images increased with age. However, enhancement ratios decreased with age in both areas. In the rabbits, histologic studies showed more fatty marrow in the epiphysis than in the corresponding metaphysis and an age-related increase in marrow fat at both sites.
In the marrow of the extremities, gadolinium enhancement is greater in the (hematopoietic) metaphysis than in the (fatty) epiphysis. In both areas, enhancement decreases as the marrow becomes more fatty. On T1-weighted images, administration of a gadolinium-containing contrast agent reduces the normal contrast between hematopoietic and fatty marrow and obscures the changes in marrow signal intensity due to fatty conversion.
American Journal of Roentgenology 08/1997; 169(1):191-6. · 2.78 Impact Factor
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ABSTRACT: To determine if gadolinium-enhanced MR imaging can detect early reversible ischemia of the capital femoral epiphysis and physis induced by hip hyperabduction in piglets.
Thirteen 1- to 3-week-old piglets were placed in maximal bilateral hip abduction and then studied with dynamic gadolinium-enhanced MR imaging 1-6 hr later to assess ischemia of the 26 femoral heads. The piglets were then allowed to ambulate freely for 1 or 7 days and reimaged in neutral position to assess reperfusion. We evaluated enhancement on MR images and compared them with histologic findings.
Decreased or absent enhancement, interpreted as ischemia, developed after maximal hip abduction in all 26 cartilaginous epiphyses and 85% of the 26 physes. The most frequently seen abnormality was a sharply marginated, nonenhancing area in the anterior part of the femoral head. A smaller area of decreased enhancement developed in the posterior part of the femoral head adjacent to the acetabular rim. The secondary center of ossification was ischemic in 10 (56%) of the 18 hips after 1 hr of abduction and in all 8 hips after 4 or 6 hr (p = .02). The overall severity of ischemia was greater with longer abduction times (p < .001) and greater degrees of abduction (p < .01). Reperfusion was complete in two (17%) of the 12 hips after 1 day of ambulation and in all 10 (100%) after 1 week of ambulation.
Enhanced MR imaging detects early ischemia of the epiphyseal and physeal cartilage and the epiphyseal marrow. In piglets, ischemia due to maximal abduction is reversible if corrected within 6 hr.
American Journal of Roentgenology 04/1996; 166(4):879-87. · 2.78 Impact Factor
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ABSTRACT: A 2-month-old infant with fever and a chest mass is presented. Imaging evaluation, differential and final pathological diagnosis are discussed.
Pediatric Radiology 02/1996; 26(2):165-7. · 1.67 Impact Factor
