Adam Mitchell

Fortius clinic · Radiology

Background Previous research in sport populations has demonstrated that abnormal magnetic resonance imaging (MRI) findings may be present in individuals without symptoms or known pathology. Extending this understanding to ballet, particularly in relation to the foot and ankle, is important to guide medical advice given to dancers. Purpose To asses...

Purpose: Lateral ligament ankle sprains are common and the anatomy on imaging studies is vital for accurate diagnosis. The lateral fibulotalocalcaneal ligament (LFTCL) complex consists of the inferior fascicle of the anterior talofibular ligament (ATFL) which is connected by arciform fibres with the calcaneofibular ligament (CFL). The superior fasc...

Objectives: To assess how pars interarticularis fracture characteristics on T1-VIBE and STIR MRI relate to healing and identify anatomical parameters that may impact healing. Materials and methods: A retrospective review of an MRI series of lumbar pars interarticularis injuries in elite athletes over a 3-year period. Fracture configurations, sig...

Abstract Objective: The effect of population screening for abdominal aortic aneurysm (AAA) disease on morbidity and mortality has been comprehensively studied and reported. However, the effect of early AAA detection on suitability for endovascular aneurysm repair (EVAR) remains unknown. Considering the importance of such an effect on future health...

PurposeLateral ligament ankle sprains are common and the anatomy on imaging studies is vital for accurate diagnosis. The lateral fibulotalocalcaneal ligament (LFTCL) complex consists of the inferior fascicle of the anterior talofibular ligament (ATFL) which is connected by arciform fibres with the calcaneofibular ligament (CFL). The superior fascic...

Background Understanding common MRI findings may allow clinicians to appreciate the sport-specific effects on the lumbar spine, and to discern clinically significant pathology. Prevalence data regarding radiological abnormalities seen during the surveillance of asymptomatic elite footballers is, therefore, important to help understand injury mechan...

Human Anatomy

ACL ancillary injuries

Background Understanding common MRI findings may allow clinicians to appreciate the sport-specific effects on the lumbar spine, and to discern clinically significant pathology. Prevalence data regarding radiological abnormalities seen during the surveillance of asymptomatic elite footballers is, therefore, important to help understand injury mechan...

Purpose Medial menisco-capsular separations (ramp lesions) are typically found in association with anterior cruciate ligament (ACL) deficiency. They are frequently missed preoperatively due to low MRI sensitivity. The purpose of this article was to describe demographic and anatomical risk factors for ramp lesions, and to identify concomitant lesion...

Inversion injuries of the ankle are a very frequent injury with relevant socioeconomic impact. Thus, the adequate imaging complementary diagnostic tools is very important in order to achieve the most cost-effective adequate assessment. The two main goals of imaging are the study of ligament’s status as well as combined lesions with clinical implica...

PurposeThe anterolateral soft tissue envelope of the knee is frequently injured at the time of ACL rupture. This study aims to investigate the MRI injury patterns to the Anterolateral complex and their associations in patients with acute 'isolated ligament' ACL ruptures.Methods Professional athletes who underwent ACL reconstruction for complete ACL...

Purpose In anterior cruciate ligament (ACL) injuries, concomitant damage to peripheral soft tissues is associated with increased rotatory instability of the knee. The purpose of this study was to investigate the incidence and patterns of medial collateral ligament complex injuries in patients with clinically ‘isolated’ ACL ruptures. Methods Patien...

PurposeThe purpose of the study is to review the MRI findings in a cohort of athletes who sustained acute traumatic avulsions of the adductor longus fibrocartilaginous entheses, and to investigate related injuries namely the pyramidalis–anterior pubic ligament–adductor longus complex (PLAC). Associated muscle and soft tissue injuries were also asse...

The peroneus quartus is one of a variety of described accessory peroneal muscles, most commonly an incidental finding on MRI or ultrasound of the ankle. We present the only described case in the literature of a peroneus quartus tendon rupture in a professional rugby player as well as the MRI findings.

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartil...

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within carti...

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartil...

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within carti...

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within carti...

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within carti...

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within carti...

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within carti...

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within carti...

Background: Treatment guidelines for cartilage lesions of the talus have been based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions on key topics regarding cartilage lesions of the talus. The purpose of this consensus article is...

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within carti...

Purpose Adductor longus injuries are complex. The conflict between views in the recent literature and various nineteenth-century anatomy books regarding symphyseal and perisymphyseal anatomy can lead to difficulties in MRI interpretation and treatment decisions. The aim of the study is to systematically investigate the pyramidalis muscle and its an...

Background: Subcircumferential periosteal edema above the ankle joint is frequently present on magnetic resonance imaging (MRI) with syndesmosis injuries but has not been previously reported. Fluid height within the interosseous membrane also has not previously been shown to be associated with syndesmosis injury severity. Purpose: To investigate...

anatomy for radiology

Background and purpose Operative findings during revision of metal-on-metal hip arthroplasty (MOMHA) vary widely and can involve massive soft tissue and bone disruption. As a result, planning of theater time and resources is difficult, surgery is challenging, and outcomes are often poor. We describe our experience with revision of MOMHA and provide...

Acute anterior glenohumeral dislocation (figure 1). The plain radiographs show an anterior glenohumeral dislocation (figure 1). The MR arthrographic image (figure 2) taken 2 years after dislocation of the glenohumeral joint shows a displaced thickened antero-inferior glenoid labrum or Bankart lesion. The presence of the subscapularis tendon anter...

This expanded new, full colour edition of the classic Applied Radiological Anatomy is an exhaustive yet practical imaging resource of every organ system using all diagnostic modalities. Every illustration has been replaced, providing the most accurate and up-to-date radiographic scans available. Features of the second edition: • Completely new radi...

The treatment of osteochondral lesions, especially those with a cystic component or those that have failed the standard arthroscopic procedures can be challenging. Synthetic grafts have several potential advantages over other second line treatments including the fact that only one operation is required and no other joint is violated. We report the...

Injuries to muscle in the elite athlete are common and may be responsible for prolonged periods of loss of competitive activity. The implications for the athlete and his/her coach and team may be catastrophic if the injury occurs at a critical time in the athlete's diary. Imaging now plays a crucial role in diagnosis, prognostication and management...

Introduction: Many papers have been published recently on the subject of pseudotumors surrounding metal-on-metal hip resurfacing and replacement prostheses. These pseudotumors are sterile, inflammatory lesions within the periprosthetic tissues and have been variously termed masses, cysts, bursae, collections, or aseptic lymphocyte-dominated vascul...

A 47-year-old woman presented with a disabling fixed flexion deformity of the knee and an equinus deformity of the ankle following treatment in a cast for a minor flexion deformity following a tibial plateau fracture. Two years later, the cause was identified as an isolated ischaemic contracture involving the medial head of gastrocnemius. She made...

Muscle-sparing perforator free flap breast reconstruction with the use of an inferior epigastric or gluteal perforating artery to create a vascular pedicle is increasingly popular because it obviates breast implants and results in lower donor site morbidity than breast reconstruction with myocutaneous flaps. The tissue harvesting procedure for a pe...

Multiligament injury of the knee, which may include joint dislocation, is a severe injury that can devastate knee function. It usually results in rupture of three of the four major stabilizing ligaments of the knee, but occasionally only two of the ligaments are torn. Evaluation and management is made more complex due to associated articular and me...

Minimally-invasive treatments for chronic Achilles tendinopathy may prevent the need for surgery when conservative methods have failed. Whilst injections have traditionally been used to manage symptoms, recently described therapies may also have disease-modifying potential. Ultrasound provides the ability to guide therapeutic interventions, ensurin...

The treatment of internal iliac artery aneurysms is aimed at the prevention of rupture. Traditionally, this is undertaken surgically; however, endovascular techniques are an acceptable alternative and these techniques are also not without complication. Herein, the authors describe the endovascular treatment of two patients with internal iliac aneur...

Metal artifact reduction sequence magnetic resonance imaging findings are reported in a prospective series of 31 patients with unexplained painful metal-on-metal (MOM) hips. The abnormalities identified were fluid collection (20 patients), solid mass (2 patients), moderate to severe muscle atrophy (23 patients), and muscle edema (8 patients). In co...

A 56-year-old Caucasian female underwent left thoraco-abdominal radical nephrectomy with excision of the regional lymph nodes for a 10 × 11 cm mass in the upper pole of the left kidney. Histology confirmed a Fuhrman grade 4 clear cell renal carcinoma, pT2 NoMx, with microscopic venous invasion. All 11 lymph nodes were negative for metastatic diseas...

The use of ultrasound in the diagnosis and management of disorders of the tendo Achillis is discussed. Some of the pathological processes which occur in Achilles tendinopathy can be identified by ultrasound, which may also be used to direct local treatment.

Level of Evidence: V, Expert Opinion

We carried out metal artefact-reduction MRI, three-dimensional CT measurement of the position of the component and inductively-coupled plasma mass spectrometry analysis of cobalt and chromium levels in whole blood on 26 patients with unexplained pain following metal-on-metal resurfacing arthroplasty. MRI showed periprosthetic lesions around 16 hips...

This pictorial essay describes the role of musculoskeletal ultrasound (MSUS) in the investigation of common problems involving the knee. The aim is to highlight the usefulness of MSUS as a relatively inexpensive and portable imaging technique for evaluating a wide range of traumatic and non-traumatic conditions.

Ultrasound (US) is increasingly used for the assessment of periarticular structures of the knee and is frequently used in conjunction with magnetic resonance imaging and plain radiography. This pictorial essay describes a step-by-step approach for the ultrasonic examination of the knee and illustrates the normal anatomical structures which can be d...

Lipoma arborescens is a rare benign fat-containing synovial proliferative lesion that is typically known to affect the knee joint in adults. We present the first case of lipoma arborescens of the ankle joint in an adult patient with involvement of the intra-articular synovium as well as the synovial sheath of the tendons around the ankle. The MRI f...

We present a case of a pseudoaneurysm within the lumbar musculature. This occurred following a computed tomography (CT)-guided vertebral biopsy in a 79-year-old male patient and was successfully treated with percutaneous ultrasound-guided thrombin injection. The patient initially presented with severe back pain. The plain radiographs and Magnetic r...

Applied Radiological Anatomy for Medical Students, first published in 2007, is the definitive atlas of human anatomy, utilizing the complete range of imaging modalities to describe normal anatomy and radiological findings. Initial chapters describe all imaging techniques and introduce the principles of image interpretation. These are followed by co...

Applied Radiological Anatomy for Medical Students, first published in 2007, is the definitive atlas of human anatomy, utilizing the complete range of imaging modalities to describe normal anatomy and radiological findings. Initial chapters describe all imaging techniques and introduce the principles of image interpretation. These are followed by co...

Gestational trophoblastic neoplasia (GTN) encompasses a broad spectrum of placental lesions from the pre-malignant hydatidiform mole (complete and partial) through to the malignant invasive mole, choriocarcinoma and rare placental site trophoblastic tumour (PSTT). Ultrasound remains the radiological investigation of choice for initial diagnosis, an...

To determine the potential clinical efficacy of combination antibiotic therapy in treating rheumatoid arthritis (RA). Twenty-one patients with active RA despite second-line treatment were randomized to receive either combination antibiotic therapy (treatment group, n = 11) or no additional therapy (control group, n = 10). Antibiotic therapy was giv...

The effect of population screening for abdominal aortic aneurysm (AAA) disease on morbidity and mortality has been comprehensively studied and reported. However, the effect of early AAA detection on suitability for endovascular aneurysm repair (EVAR) remains unknown. Considering the importance of such an effect on future health economics, we sought...

LEARNING OBJECTIVES 1. To understand the spectrum of Gestational Trophoblastic Disorders. 2. To review the US and MRI appearances of Gestational Trophoblastic Tumours. 3. To understand the value of Doppler indices of the uterine arteries as a prognostic indicator and the complementary role of MRI ABSTRACT Gestational trophoblastic disease (GTD) re...

Objective: The aim of this study was to determine the incidence and etiology of pulmonary artery pseudoaneurysms in patients undergoing bronchial angiography for massive hemoptysis and to assess patient outcome after the embolization of these pseudoaneurysms. Conclusion: Peripheral pulmonary artery pseudoaneurysms occur in up to 11% of patients...

Venous access catheters are employed for a wide variety of reasons. On removal of the catheter, the subcutaneous catheter cuff can be difficult to extract; retention of the cuff has recognized complications. We describe a simple ultrasound technique that assists in the identification of the cuff within the subcutaneous tissues, simplifying subseque...

The aim of this study was to assess the efficacy and durability of infra-inguinal PTA in patients with CLI, in terms of clinical outcome. Retrospective study of 50 consecutive patients with CLI that were exclusively treated by infra-inguinal PTA. The indications for intervention were rest pain in seven (14%) patients, non-healing ulcers in 27 (54%)...

To retrospectively evaluate embolotherapy of bleeding residual uterine vascular malformations in patients with gestational trophoblastic tumors. Fourteen patients were treated over the past 20 years. Embolizations were performed with a common femoral artery approach. Duplex ultrasonography was performed before and after embolization to document the...

Significant changes have occurred in the treatment of renal artery disease over the past few years. Although excellent clinical results can be obtained with surgery, percutaneous transluminal renal angioplasty has proved similarly efficacious and is now the treatment of choice for nonostial atherosclerotic stenoses and fibromuscular dysplasia. The...

Research for infectious agents in the etiology of atherosclerosis has identified Chlamydia pneumoniae as a possible candidate. While there is evidence of an association between presence of this microorganism and atherosclerosis, it is unclear whether infection has a genuinely etiologic role in this disease, whether its presence influences clinical...

Endoluminal treatment is being increasingly used for carotid artery disease. The aim of this study was to compare the stroke and death risk within 30 days of endovascular treatment or endarterectomy for symptomatic carotid artery disease. systematic comparison of the 30-day outcome of angioplasty with or without stenting and endarterectomy for symp...

Porto-portal varices are commonly seen in patients with segmental extra-hepatic portal hypertension and develop to provide a collateral circulation around an area of portal venous obstruction. It is not well recognized that such communications may also develop across surgical anastomoses and be the source of gastrointestinal haemorrhage. The possib...

A W Mitchell, J Jackson. Transanastomotic porto-portal varices in patients with gastrointestinal haemorrhage. Clin Rad. 2000; 55: 207-211.

The purpose of this study was to assess the sensitivity of angiography in revealing the vitellointestinal artery or other arteriographic abnormalities in patients in whom surgery subsequently proved Meckel's diverticulum. From the 36 patients who had undergone a Meckel's diverticulectomy between 1980 and 1997 at Hammersmith Hospital or a referring...

A.W Mitchell, J. Spencer, D.J Allison, J.E. Jackson. Meckel's diverticulum; angiographic findings in 16 patients. AJR. 1998; 170: 1329-1333

This article discusses different embolization techniques in the management of patients who have suffered vascular trauma. The authors separate embolization of "non-vital" traumatized vessels and "vital" vessels. The embolization technique in the latter has proven to be more difficult because occlusion of these embolization vessels could jeopardize...

Sarcoidosis is a multisystem granulomatous disease of unknown aetiology. The role of radiology is not only to support the clinical diagnosis but also as an adjunct to monitor the course and progression of the disease. The cornerstone of radiological assessment is the plain radiograph, however newer imaging methods are producing more information in...

The case described is of a primary liver cell carcinoma (PLCC), which was initially misdiagnosed as hepatic hydatid disease. The computed tomographic appearances of hepatic hydatid disease are often characteristic although not specific. When supported by the clinical findings, however, they will probably not be confused with other liver masses. In...

Having attended the presentation by Taylor et al, given at the British Institute of Radiology' s annual meeting of May 1993, which discussed the use of the Amplatz gooseneck snare [1], we would like to describe a method for repositioning Hickman lines which may be useful when the usual techniques are unsuccessful. In many centres Hickman lines are...