An approach to the teaching of radiographic interpretation of bony lesions

Abstract We report two cases of unusual extraneural metastasis in patients with embryonal tumors without central nervous system disease progression and prolonged survival. The first patient presented at 16 years of age with atypical teratoid rhabdoid tumor of the cervical spine. The tumor was confirmed to have loss of INI1, SMARCB1 deletion of exons 1–3, and heterozygous deletion of 22q11.2. The patient received treatment initially per ACNS0333 with high dose chemotherapy and tandem autologous transplants. The patient developed a biopsy-confirmed liver metastasis six months from diagnosis and, subsequently, had disease progression including liver metastases, bony lesions, muscle involvement, and lung nodules. Two and a half years from diagnosis the patient has still not had a relapse in the CNS. The second patient presented with medulloblastoma isolated to the posterior fossa at 11 years of age and was treated on SJMB03 protocol with craniospinal irradiation and high dose chemotherapy. He had his first recurrence in the temporal lobe three years post treatment. He had multiple recurrences in the brain over the next five years treated with re-resections, adjuvant chemotherapy, and gamma knife radiotherapy. He then developed cervical lymphadenopathy, bony lesions, liver lesions, and lung nodules. Cervical lymph node biopsy confirmed medulloblastoma. Next generation sequencing from recurrent tumor showed somatic mutations in p53, KDM6A, and PPP2R1A. Fourteen years from treatment, he has now developed a temporal lobe lesion. These cases are notable for prolonged survival despite widely metastatic disease and genomics predicting poor prognosis as well as metastatic disease disproportionate to CNS disease.

Download Full-text

Clinical and radiographic interpretation of facial fractures

Journal of Oral and Maxillofacial Surgery ◽

10.1016/0278-2391(82)90194-x ◽

1982 ◽

Vol 40 (12) ◽

pp. 830

Keyword(s):

Facial Fractures ◽

Radiographic Interpretation

Download Full-text

Short Observation Period and Aggressive Discharge of Patients With Head Injury and Serial CT Scans

The American Surgeon ◽

10.1177/00031348211063539 ◽

2021 ◽

pp. 000313482110635

Author(s):

Jordan Perkins ◽

Jacob Shreffler ◽

Danielle Kamenec ◽

Alexandra Bequer ◽

Corey Ziemba ◽

...

Keyword(s):

Ct Scanning ◽

Ct Scans ◽

New Findings ◽

Serial Ct ◽

Radiographic Interpretation ◽

Evidence Based Guidelines ◽

Head Computed Tomography ◽

Repeat Imaging ◽

Observation Period ◽

Negative Conversion

Background: Many patients undergo two head computed tomography (CT) scans after mild traumatic brain injury (TBI). Radiographic progression without clinical deterioration does not usually alter management. Evidence-based guidelines offer potential for limited repeat imaging and safe discharge. This study characterizes patients who had two head CTs in the Emergency Department (ED), determines the change between initial and repeat CTs, and describes timing of repeat scans. Methods: This retrospective series includes all patients with head CTs during the same ED visit at an urban trauma center between May 1st, 2016 and April 30th, 2018. Radiographic interpretation was coded as positive, negative, or equivocal. Results: Of 241 subjects, the number of positive, negative, and equivocal initial CT results were 154, 50, and 37, respectively. On repeat CT, 190 (78.8%) interpretations were congruent with the original scan. Out of the 21.2% of repeat scans that diverged from the original read, 14 (5.8%) showed positive to negative conversion, 1 (.4%) showed positive to equivocal conversion, 2 (.88%) showed negative to positive conversion, 20 (8.3%) showed equivocal to negative conversion, and 14 (5.8%) showed equivocal to positive conversion. Average time between scans was 4.4 hours, and median length of stay was 10.2 hours. Conclusions: In this retrospective review, most repeat CT scans had no new findings. A small percentage converted to positive, rarely altering clinical management. This study demonstrates the need for continued prospective research to update clinical guidelines that could reduce admission and serial CT scanning for mild TBI.

Download Full-text

Diagnosis of invasive cervical resorption by using cone beam computed tomography: report of two cases

Brazilian Dental Journal ◽

10.1590/s0103-64402012000500023 ◽

2012 ◽

Vol 23 (5) ◽

pp. 602-607 ◽

Cited By ~ 10

Author(s):

Karla de Faria Vasconcelos ◽

Yuri Nejaim ◽

Francisco Haiter Neto ◽

Frab Norberto Bóscolo

Keyword(s):

Computed Tomography ◽

Differential Diagnosis ◽

Cone Beam Computed Tomography ◽

Root Canal ◽

Root Resorption ◽

Imaging Modality ◽

Relevant Information ◽

Cone Beam ◽

Short Period ◽

Radiographic Interpretation

A radiographic interpretation is essential to the diagnosis of invasive cervical resorption (ICR) and the difficulty in distinguishing this lesion from internal root resorption has been highlighted in the literature. This paper reports the use of cone beam computed tomography (CBCT) in the diagnosis of ICR. The cases reports describe how CBCT can be used to make a differential diagnosis and also show that the use of this technology can provide relevant information on the location and nature of root resorption, which conventional radiographs cannot. As a result, the root canal treatment was not initially considered. The patients will be monitored and will undergo a scan after a short period of time to detect any small changes. It was observed that both cases benefited from CBCT in the diagnosis of ICR, because this imaging modality determined the real extent of resorption and possible points of communication with the periodontal space.

Download Full-text

All-endoscopic management of benign bone lesions; a case series of 26 cases with minimum of 2 years follow-up

SICOT-J ◽

10.1051/sicotj/2018041 ◽

2018 ◽

Vol 4 ◽

pp. 50 ◽

Cited By ~ 1

Author(s):

Hazem A. Farouk ◽

Mostafa Saladin ◽

Wessam Abu Senna ◽

Walid Ebeid

Keyword(s):

Proximal Femur ◽

Aneurysmal Bone Cyst ◽

Proximal Tibia ◽

Bone Cyst ◽

Oncologic Outcome ◽

Functional Scores ◽

Bony Lesions ◽

Anatomic Locations ◽

Endoscopic Curettage

Purpose: Assessment of the functional and oncologic outcomes regarding endoscopic curettage of different benign bone tumor types within variable anatomic locations. Patients and methods: During the period between February 2012 and December 2016, 26 patients with symptomatic intra-osseous benign bony lesions were included. The age ranged from 3 up to 49 years (mean 20), of 14 females and 12 males. The follow-up duration ranged from 26 up to 58 months (mean 41). Functional scoring was done according to the Revised Musculoskeletal Tumour Society Rating Scale. Anatomic locations of the lesions included: 6 cases in the proximal tibia, 6 cases in the distal femur, 4 cases in the calcaneus, 3 cases in the proximal humerus, 3 cases in the distal tibia, 2 cases in the talus, 1 case in the proximal femur, and 1 case in the distal fibula. The procedure used 4 mm 30° scope for endoscopy, and high speed burrs 3.5–5 mm for extended curettage. Autogenous bone grafting was done in 5 cases, and adjuvant material (polymethylmethacrylate) was needed in 7 cases. Results: After exclusion of one case that was lost in the follow-up, the remaining 25 cases showed full functional recovery at a period of 8–12 weeks, and improved mean functional scores from 20.2 to 28.6/30 post-operatively, with p value <0.001 which was considered as a statistically significant result. The oncologic outcome showed 24 cases with adequate healing, while 1 case developed recurrence (aneurysmal bone cyst in the proximal tibia) for which, an open revision surgery was performed. Intra-operative fracture occurred in another case with aneurysmal bone cyst of the proximal femur, which was fixed by flexible nails with complete healing. Conclusion: Endoscopic curettage of different types of intra-osseous benign bony lesions proved to be an effective treatment modality with promising oncologic outcome, improved functional scores, and fast functional recovery.

Download Full-text

Does the innate relative size of the humeral head and glenoid affect the risk of anterior shoulder instability?

Shoulder & Elbow ◽

10.1177/1758573218805099 ◽

2018 ◽

Vol 11 (6) ◽

pp. 424-429

Author(s):

NW Willigenburg ◽

RA Bouma ◽

VAB Scholtes ◽

VPM van der Hulst ◽

DFP van Deurzen ◽

...

Keyword(s):

Shoulder Instability ◽

Humeral Head ◽

Relative Size ◽

Ct Scans ◽

Anterior Shoulder Instability ◽

Multivariate Logistic Regression ◽

Recurrent Instability ◽

Bony Lesions ◽

Joint Contact ◽

And Gender

Background Bony lesions after shoulder dislocation reduce the joint contact area and increase the risk of recurrent instability. It is unknown whether the innate relative sizes of the humeral head and glenoid may predispose patients to shoulder instability. This study evaluated whether anterior shoulder instability is associated with a larger innate humeral head/glenoid ratio (IHGR). Methods We evaluated CT scans of 40 shoulders with anterior shoulder instability and 48 controls. We measured axial humeral head diameter and glenoid diameter following native contours, discarding any bony lesions, and calculated IHGR by dividing both diameters. Multivariate logistic regression determined whether the IHGR, corrected for age and gender as potential confounders, was associated with anterior shoulder instability. Results Mean IHGR was 1.48 ± 0.23 in the group with anterior shoulder instability and 1.42 ± 0.20 in the group without anterior shoulder instability. Measurements for axial humeral head and axial glenoid diameters demonstrated excellent intra-rater reliability (ICC range: 0.94–0.95). IHGR was not significantly associated with anterior shoulder instability (OR = 1.105, 95%CI = 0.118–10.339, p = 0.930). Discussion The innate ratio of humeral head and glenoid diameters was not significantly associated with anterior shoulder instability in this retrospective sample of 88 shoulder CT scans.

Download Full-text

Type B Idiopathic Bone Defect of Mandible: An Etiopathogenic Dilemma

Case Reports in Dentistry ◽

10.1155/2012/482758 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Aakarsh V. Jhamb ◽

Parul A. Jhamb ◽

Aparna Dave ◽

Vishwa Prakash Shetty

Keyword(s):

Bone Defect ◽

Type A ◽

Bone Defects ◽

Long Bones ◽

Type B ◽

Jaw Bones ◽

Pathologic Lesions ◽

Malignant Lesions ◽

Radiographic Interpretation

Etiopathogenesis of the pathologic lesions forms the basis for formulation of appropriate intervention and further prevention. There is still a vast unknown field that has to be explored to know the causative reason behind certain benign & malignant lesions. Idiopathic bone defects are nonodontogenic pseudocystic cavities that are seen in the long bones & jaw bones. Radiographic interpretation is at times inadequate in diagnosis of odontogenic & nonodontogenic radiolucent lesions involving jaw bones. Histopathology has different criteria to segregate this lesion. In this paper, we discuss a case of type B histopathological variant of idiopathic bone defect that may suggest an alternative pathogenesis from type A variant.

Download Full-text