Rajat Chowdhury’s research while affiliated with Oxford University Hospitals NHS Trust and other places

Objectives Scaphoid injuries occult on plain radiography often require further imaging for definitive diagnosis. We investigate the utility of dual-energy computed tomography (DECT) for the detection of acute bone marrow oedema and fracture of scaphoid compared to MRI. Materials and methods Twenty patients who presented acutely (without prior injury) to the emergency department with clinically suspected occult scaphoid fracture and had MRI of the wrist were prospectively recruited to have DECT (GE Revolution CT). Material decomposition images of the water-calcium base pair were generated and assessed in conjunction with the monochromatic images to permit correlation of marrow signal changes with any cortical disruption for fracture confirmation. The assessment was performed by two musculoskeletal radiologists blinded from MRI results. The statistical difference of MRI and reviewers’ detection of acute bone oedema (1 = present, 0 = absent) was performed using the Friedman test (SPSS v.16). Results MRI showed acute scaphoid fracture and/or bone marrow oedema in 14/20 patients of which 6 also had cortical disruption. On DECT, reviewer A identified oedema in 13 and cortical disruption in 10 patients while reviewer B identified oedema in 10 and cortical disruption in seven of the 14 MRI positive patients. No statistically significant difference in oedema detection on MRI and reviewers of DECT ( p value 0.61) but DECT was more sensitive at detecting cortical disruption. Conclusion DECT has the capability to detect acute scaphoid oedema in addition to cortical fractures. However, compared to MRI, DECT has lower contrast resolution and less sensitive in the detection of mild oedema. Key Points • Dual-energy CT is able to detect acute traumatic scaphoid marrow oedema. • Dual-energy CT has greater detection rate of scaphoid fractures than MRI. • Dual-energy CT is an alternative to MRI for occult scaphoid injury.

Ectopic breast tissue (EBT) is an uncommon entity that occurs in about 6% of the population, more frequently in Asian people. It manifests as a nonspecific soft tissue mass that can develop in any location along the “milk-line,” with the axilla being the most frequently reported location. As with normal breast tissue, both benign and malignant processes can arise from EBT. Therefore, imaging plays an important role in the adequate assessment of these soft tissue lesions, characterizing its shape, borders, internal components, and vascularity, as well as its relationship with the deep fascia and adjacent structures. Here we present a case of a 33-year-old female Indian patient with an 8 cm soft tissue mass in the upper left abdominal quadrant with a recent increase in size. Clinical and imagiological evaluation were nonspecific but established the nonaggressive behavior of the lesion. To ultimately exclude malignancy, an ultrasound-guided biopsy was performed providing the histological diagnosis of EBT. This case report illustrates the value of clinical, radiological, and histological correlation in the approach of indeterminate soft-tissue tumors, with special focus on lesions in close proximity to the native breasts, where EBT should not be forgotten amongst differentials.

Objective To delineate the spectrum of traumatic knee injuries associated with injury of the anterolateral ligament of the knee (ALL).Materials and methodsA retrospective review of 200 MRI scans undertaken for acute knee trauma was performed. In each scan, the ALL was scored as normal, sprained or torn. The menisci, ligaments and tendons of each knee were also assessed.ResultsThe mean age was 27.4 years (range, 9–69 years), and 71.5% (n = 143) of the patients were male. The anterolateral ligament (ALL) was graded as ruptured in 17 cases (8.5%), sprained in 58 cases (29%), normal in 116 cases (58%) and not visible in 9 cases (4.5%). Of cases with injury of the ALL (n = 75), there was associated injury of the anterior cruciate ligament (ACL) in 61 cases, medial collateral ligament (MCL) in 51 cases, popliteofibular ligament (PFL) in 29 cases, medial meniscus in 29 cases, lateral meniscus in 24 cases, lateral collateral ligament in 9 cases, posterior cruciate ligament in 8 cases, biceps femoris in 5 cases, popliteus tendon in 4 cases and fluid or oedema was seen adjacent to the iliotibial band in 59 cases. No cases of isolated ALL injury were seen.ConclusionsALL injury is not uncommon in acute knee trauma and is typically associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, medial collateral ligament injury, meniscal tears and injury to the popliteofibular ligament.

[This corrects the article DOI: 10.1016/j.radcr.2020.02.028.].

Purpose: To delineate the spectrum of traumatic knee injuries associated with injury of the anterolateral ligament of the knee (ALL). Materials and Methods: A retrospective review of 200 consecutive MRI scans undertaken for acute knee trauma was performed. Scans were excluded if there was a history of injury over 4 weeks from the time of the scan, septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artifact. In each scan, the ALL was scored as normal, sprained or torn. The menisci, ligaments, and tendons of each knee were also assessed. Results: The mean age was 27.4 years (range, 9–69 years) and 71.5% (n = 143) of the patients were male. The anterolateral ligament (ALL) was graded as ruptured in 17 cases (8.5%), sprained 58 cases (29%), normal in 116 cases (58%) and not visible in 9 cases (4.5%). Of cases with injury of the ALL (n = 75), there was associated injury of the anterior cruciate ligament (ACL) in 60 cases (p = 0.0001), medical collateral ligament (MCL) in 50 cases (p = 0.0001), popliteofibular ligament (PFL) in 28 cases (p = 0.0001), medial meniscus in 28 cases (p = 0.0007), lateral meniscus in 24 cases (p = 0.0002), lateral collateral ligament in 9 cases (p = 0.0007), posterior cruciate ligament in 8 cases (p = 0.2899), biceps femoris in 5 cases (p = 0.0068), popliteus tendon in 4 cases (p = 0.0667) and fluid or oedema was seen adjacent to the iliotibial band in 49 cases (p = 0.0001). Traumatic marrow oedema was identified in 68 cases of ALL injury (p = 0.0001). No cases of isolated ALL injury were seen. Conclusion: ALL injury is not uncommon in acute knee trauma and is typically associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, me- dial collateral ligament injury, meniscal tears and injury to other structures within the posterolateral corner, particularly the popliteofibular ligament.