A study on evaluation of knee osteoarthritis with MRI and comparing it with CT scan, high resolution USG and conventional radiography

Background: Knee osteo-arthritis is widely prevalent in the elderly population in our society and associated with significant morbidity and poor quality of life. Early diagnosis of the condition can enable timely and proper care for the patients. Magnetic Resonance Imaging, CT Scan, Ultrasonography and plain radiography are the different modalities of imaging that are commonly used for detection and diagnosis of knee osteo-arthritis. Aims and Objectives: To find out the early osteoarthritic changes of knee by Magnetic Resonance Imaging and compare those findings with conventional radiography, high frequency USG and CT scan findings. Materials and Methods: Patients suffering from knee osteoarthritis (OA) as per American College of Rheumatology guideline criteria (n=56) underwent imaging of the knee using plain radiography, ultrasonography, CT scan and MRI. The imaging findings studied in the patients were joint space narrowing (JSN), meniscal abnormality, Baker’s cyst, cruciate ligament abnormality, knee effusion, subchondral cyst, and loose bodies. A comparison between radiography, CT scan and USG was done for the imaging findings with MRI as the reference standard. Z-test of proportionality was used to find statistically significant difference for the three imaging modalities. A P<0.05 was deemed statistically significant. Results: The mean age of the patients was 61 years (38 males). The tibiofemoral compartment was most commonly affected. CT scan was more sensitive than radiography in detecting sub-chondral cyst (P=0.018) and loose bodies (P=0.004). USG and MRI were equally sensitive in detecting knee effusion (P=0.22) and synovial thickening (P=0.10). CT scan and MRI were equally sensitive in detecting subchondral cyst (P=1.00) and loose bodies (P=0.22). Conclusion: While CT imaging was more sensitive for detection of subchondral cysts and loose bodies than conventional radiography, it was as sensitive as MRI in detecting these findings in the study group. Additional study is warranted to assess diagnostic performance of CT scan and MRI in the diagnosis and progression of knee OA.

Trends in public sector radiological usage in the Western Cape Province, South Africa: 2009–2019

Background: Although global use of medical imaging has increased significantly, little is known about utilisation trends in low- and middle-income countries (LMICs).Objectives: To evaluate changes over a decade in public sector diagnostic imaging utilisation at provincial level in a middle-income country.Method: A retrospective analysis of medical imaging utilisation in the Western Cape Province of South Africa in 2009 and 2019. Use of conventional radiography, ultrasonography (US), fluoroscopy, CT, MRI, digital subtraction angiography (DSA) and whole-body digital radiography was assessed by total studies and studies/103 people, for the whole province, the rural and metropolitan areas. Mammography utilisation was calculated for every 103 females aged 40–70 years.Results: The provincial population and total imaging investigations increased by 25% and 32%, respectively, whilst studies/103 people increased by 5.5% (256 vs 270/103), with marked variation by modality. Provincial US, CT and MRI utilisation/103 people increased by 111% (20 vs 43/103), 78% (10 vs 18/103) and 32% (1.9 vs 2.5/103) respectively, whilst use of fluoroscopy (3.6 vs 3.7/103) and mammography (14.2 vs 15.9/103 women aged 40–70 years) was steady and plain radiography decreased by 20% (216 vs 196/103). For CT, mammography and fluoroscopy, percentage utilisation increases/103 people were higher in the rural than metropolitan areas.Conclusion: Population growth is the main driver of overall imaging utilisation in our setting. The relatively constant imaging workload per 1000 people, albeit with increasing ultrasound, CT and MR utilisation, and decreasing use of plain radiography, reflects improved provincial imaging infrastructure, and appropriate use of available resources.

Comment to: The utility of ultrasound examination in cubital tunnel syndrome caused by heterotopic ossification

Ultrasound (US) could visualize the pathological anatomy of HO and the enlargement site and compression location of the nerve in the cubital tunnel [1]. We read with great interest the article of Jačisko et al[2]. In addition, we report rare US images of HO in direct contact with the swollen ulnar nerve in the cubital tunnel that was not detected by plain radiography. A 60-year-old female presented with a six-month history of elbow pain. Her pain was located at the medial side of the right elbow joint and accompanied by numbness of the fifth finger. She had a history of excessive manual labor due to her occupation as a gardener over the past few decades. The numbness began with the fifth finger initially and gradually extended toward the medial side of the elbow joint. US images showed hyperechoic masses causing acoustic shadowing, in direct contact with the ulnar nerve in the cubital tunnel. The HO seems to be related to compression of the ulnar nerve. The ulnar nerve was swollen (Figure 1-a, b). The maximal cross-sectional-area was 0.10 cm2. Plain elbow radiographs demonstrated osteophyte formation in the coronoid process of the ulna, the coronoid fossa of the humerus, and in the radial head (Figure 1-c). Radiographic imaging showed no heterotopic bone formation in the soft tissues surrounding the medial side of the right elbow. We performed US-guided perineural injection with a mixture of 1 cc of 10 mg triamcinolone and 3 cc of 0.2 % ropivacaine. Her pain and numbness gradually diminished with no adverse effects. Her pain reduced by 70% after two weeks, with pain improvement sustained for 6 months after the injection. Jačisko et al[2]have presented some diagnostic US imaging on neuropathy caused by HO located close to the ulnar nerve in the cubital tunnel. Especially, this case showed definite heterotopic bone formation in the soft tissue surrounding the medial side of the elbow on plain radiography. The classic sonographic patterns of HO were defined by the presence of central hypoechoic area surrounded by foci of calcification [3, 4]. The distortion of normal soft tissue and the formation of hypoechoic areas, with or without foci of calcification can also be shown as early signs[3, 4]. The use of US for HO is highly sensitive and provides an earlier diagnosis compared with other radiologic modalities [3-5]. It can be an effective treatment strategy and may improve the prognosis of neuropathy. We highlight that US evaluation can provide early diagnostic information about ulnar nerve morphology and various HO formations even if plane radiographs did not show heterotopic bone formation in the soft tissues surrounding the medial side of the elbow.

New Evaluation Method for Bone Formation around a Fully Hydroxyapatite-Coated Stem Using Digital Tomosynthesis: A Retrospective Cross-Sectional Study

Digital tomosynthesis (DTS) is a new imaging technique derived from radiography, and its usefulness has been gradually reported in the field of orthopedic diagnosis in recent years. A fully hydroxyapatite (HA)-coated stem, which is used for total hip arthroplasty (THA), is a type of cementless stem that has been widely used recently and reported to have good results. However, stem loosening on plain radiographs is difficult to determine in some cases due to cancellous condensation around the stem. In this retrospective cross-sectional study, we compared the results of plain radiography versus DTS to evaluate the imaging findings after THA using a fully HA-coated stem. Twenty joints each in the 3 y and 1 y postoperative groups underwent plain radiography and DTS. On DTS, bone formation around the stem was confirmed in all cases; however, this formation was not reproducible on plain radiography, and there were cases in which the reaction could not be confirmed or cases with cancellous condensation resembling reactive lines. This reaction was not reproducible on plain radiographs, and in some cases, the reaction could not be confirmed, or there were cases with cancellous condensation that resembled reactive lines. Therefore, DTS was useful in the diagnosis of bone formation around the implant.

Brodie Abscess

Brodie abscess is a relatively rare subacute form of osteomyelitis that is difficult to diagnose due to its insidious onset and limited initial systemic response. We present a case of Brodie abscess in a person with knee pain, swelling and antalgic gait. Diagnosis was made initially using plain radiography, this was supported by magnetic resonance imaging and confirmed on bacterial culture of the surgical samples.

Middle lobe syndrome: a clinical case

The term of middle lobe syndrome refers to abnormal processes that lead to the fact that due to external pressure and changes in the state of tissues, the airways are narrowed. Plain radiography in two projections is the basic method of radiological examination of patients with suspected "pneumonia" of the middle lobe. The disease develops in 6% of people with lung disorders. Middle lobe syndrome is an inconclusive clinical and radiological diagnosis. It requires clarification of the abnormal process

A New Anatomic Variant of T14 Vertebra: A Unique Case Report

The most common morphologic design of the spine comprises of 24 presacral mobile segments allocated to 7 non–rib-bearing cervical, 12 ribbearing thoracic, and 5 non-rib-bearing lumbar vertebrae. However, there are significant variations in the number of thoracic and lumbar segments. The authors presented a case of a 65-year-old female with back pain radiating to hips and legs. Plain radiography and magnetic resonance imaging (MRI) of the whole spine revealed fourteen thoracic vertebrae and bilateral ribs, which were found incidentally on preoperative investigation. To the authors’ knowledge, it has never been referenced in the literature. Keywords: Spine variation; T14 vertebra; Supernumerary thoracic ribs; Transitional vertebra

Non secretory myeloma in young man mimicking the Gorham disease: case report and the literature review

Multiple myeloma is a neoplasm of plasma cells affecting mostly the elderly with incidence peaks between 60 and 70 years. This disease is exceedingly rare in younger people, especially in adults under 30-year-old. Non-secretory multiple myeloma accounts for 1–5% of all cases of multiple myeloma. It is also a rare condition in young adult patients, and only six cases have been reported [1]. We herein describe a rare case of non-secretory myeloma in a 22- year-old male, explaining from chest wall pain, without general manifestation. Plain radiography and CT scans revealed diffuse osteolytic lesion mimicking the Gorham disease. A bone marrow biopsy was conducted, revealing the diagnosis of myeloma.

Migratory Foreign Body Presenting with Thyroid Abscess

Introduction The most common complication following accidental ingestion of a foreign body is entrapment in the upper digestive tract. Spontaneous penetration of a foreign body through the upper digestive tract and migration into the soft tissues of the neck is very uncommon. Consequences from such migratory foreign body can be serious and potentially fatal. Case Report Thirty six years old female presented with history of accidental ingestion of an unknown foreign body 3 days back. Clinical examination, plain radiography, hypopharyngoscopy and oesophagoscopy failed to find out the foreign body. Thereafter the patient developed thyroid abscess which was confirmed by computed tomography. Surprisingly we discovered the foreign body during surgical exploration of neck. Conclusion In a case of accidental ingestion of foreign body, even if initial evaluation with endoscopy and plain radiography are negative, the patient should be followed closely until resolution of symptoms. A high index of suspicion of migration of foreign body should be maintained. Retrieval of migratory foreign body needs surgical expertise and experience.