Recent journal articles from the members of the department




Tudor Hughes

Rugby related cervical spine injuries.

19. Chinese J. Radiology 2000;25(1):7-12

        MR Imaging of Soft Tissue Neoplasm after Treatment with Surgery and Radiation Therapy.

            Pang A, Hughes T.

18. Stroke. 2000 Aug;31(8):1997-2001.  
Brain stem stroke causing baroreflex failure and paroxysmal hypertension.

Phillips AM, Jardine DL, Parkin PJ, Hughes T, Ikram H.

Department of General Medicine, Christchurch Hospital, New Zealand,

BACKGROUND: Paroxysmal neurogenic hypertension has been associated with a variety of diseases affecting the brain stem but has only rarely been reported after brain stem stroke. The mechanism is thought to involve increased sympathetic activity and baroreflex dysfunction. We undertook microneurographic recordings of muscle sympathetic nerve activity (MNSA) during beat-to-beat blood pressure (BP) monitoring to investigate this hypothesis. CASE DESCRIPTION: We investigated a 75-year-old woman who developed paroxysmal hypertension (BP 220/110 mm Hg) after a large left-sided medullary infarct. The paroxysms were triggered by changes in posture and were accompanied by tachycardia, diaphoresis, and headache. Serum catecholamines were substantially increased (norepinephrine level, 23.9 nmol/L 9 days after stroke; normal level, <3.8 nmol/L), and heart rate variability, measured by spectral analysis, was decreased in both low- and high-frequency domains (0.04 and 0.06 ms(2), respectively; normal level, 0.14+/-0.02 ms(2)). MNSA was increased in frequency (61 bursts per minute; normal level, 34+/-18 bursts per minute), and the burst amplitude was not inversely related to diastolic BP. BP and MNSA responses to cold pressor and isometric handgrip stimuli were intact. CONCLUSIONS: Extensive unilateral infarction of the brain stem in the region of the nucleus tractus solitarius may result in partial baroreflex dysfunction, increased sympathetic activity, and neurogenic paroxysmal hypertension.

PMID: 10926969 [PubMed - indexed for MEDLINE]


17. Australas Radiol. 2000 Nov;44(4):412-6. Related Articles, Links
Magnetic resonance imaging of lipoma and liposarcoma: potential of short tau inversion recovery as a technique of fat suppression.

Pang AK, Hughes T.

Department of Radiology, Christchurch Public Hospital, New Zealand.

The present limited retrospective study was performed to assess MR imaging of lipomatous tumours of the musculoskeletal system and to evaluate the potential of the T2 short tau inversion-recovery (STIR) technique for differentiating lipomas from liposarcomas. Magnetic resonance imaging of 12 patients with lipomatous tumours of the musculoskeletal system (eight benign lipomas, three well-differentiated liposarcomas and one myxoid liposarcoma) were reviewed. Benign lipomas were usually superficial and showed homogeneity on T1- and T2-weighted spin echo sequences. Full suppression at T2 STIR was readily demonstrated. In contrast, the liposarcomas in the present series were all deep-seated. Two well-differentiated liposaromas showed homogeneity at long and short relaxation time (TR) but failed to show complete suppression at T2 STIR. One case of well-differentiated liposarcoma (dedifferentiated liposarcoma) and one of myxoid liposarcoma showed mild and moderate heterogeneity at T1 and T2, respectively, and posed no difficulty in being diagnosed correctly. In conclusion, short and long TR in combination with T2 STIR show promise in differentiating benign from malignant lipomatous tumours of the musculoskeletal system, when taken in combination with the position of the tumour.

PMID: 11103539 [PubMed - indexed for MEDLINE]


16. QJM. 1997 May;90(5):359-66. Related Articles, Links
Acute bone-marrow oedema in cyclosporin-treated renal transplant recipients.

Jagose JT, Bailey RR, Hughes TH.

Department of Nephrology, Christchurch Hospital, New Zealand.

Transient musculoskeletal pain may occur in renal transplant patients on cyclosporin (CyA). Of 28 consecutive patients transplanted in this unit between 20 January 1995 and 2 May 1996, eight (two published elsewhere) developed this problem. Before transplantation, three of the patients had received prednisone intermittently or continuously for 15, 5 and 2 years, for asthma, crescentic GN and SLE, respectively. All patients had normal hand radiographs prior to transplantation. Five developed acute rejection following transplantation requiring treatment with methylprednisolone; one also required OKT3 (7 days). Weight-bearing joints of the lower limbs became affected at 3-40 weeks (mean 14) following transplantation. MRI changes (T1-, T2-weighted and STIR images) were consistent with acute bone-marrow oedema. Bone scintigrams showed enhanced tracer uptake in affected joints. A spontaneous complete remission occurred in five patients within 4-16 weeks, and this was supported by serial imaging. The other patient underwent core decompression of the femoral heads with relief of symptoms, but MRI showed bilateral avascular necrosis (AVN) of the femoral heads. MRI proved useful in detecting acute bone-marrow oedema and its possible progression to AVN. The former may be either a distinct entity or a forerunner of AVN.

PMID: 9205672 [PubMed - indexed for MEDLINE]


15. Sports Exercise and Injury 1996:2;141-151.

        Imaging in Paediatric sports injuries.

          Hughes TH.


14.  Skeletal Radiol. 1995 Jan;24(1):7-12.  

Pigmented villonodular synovitis: MRI characteristics.

Hughes TH, Sartoris DJ, Schweitzer ME, Resnick DL.

Department of Radiology, University of California, San Diego, USA.

The magnetic resonance imaging (MRI) scans of 26 patients with histopathologically proven pigmented villonodular synovitis (PVNS), involving joints but excluding tendon sheaths, were reviewed retrospectively. The purpose of this study is to define the spectrum and frequency of MRI characteristics for PVNS using conventional spin echo (in two cases before and after intravenous administration of gadopentate dimeglumine) and also gradient echo techniques. A cystic variety is presented, the MRI appearances of which have not been found in a review of the literature.

PMID: 7709261 [PubMed - indexed for MEDLINE]


13.  Clin Orthop. 1994 Nov;(308):50-3.  

Imaging in bone lengthening. A review.

Hughes TH, Maffulli N, Green V, Fixsen JA.

Department of Radiology, University College Hospital, London, England.

Limb lengthening using callotasis needs careful preoperative planning and great care during the lengthening period. The most common method used to monitor limb lengthening is plain radiography, but the time of frame removal is still left to the judgment of the surgeon. This paper reviews some of the methods used experimentally and clinically to monitor the process, outlining their possible advantages and disadvantages for application in routine clinical practice. Considering availability, cost, and safety, an imaging protocol could involve preoperative assessment with computed tomography scan; immediate postoperative anteroposterior (AP) and lateral radiographs; weekly ultrasound scanning for the 1st 8 weeks; and monthly AP and lateral radiographs during the lengthening phase and if there is any clinical suspicion of complication during the consolidation phase. If available, dual energy bone densitometry can be performed every 2 to 4 weeks from 8 weeks, until removal of the fixator.

Publication Types:

PMID: 7955700 [PubMed - indexed for MEDLINE]


12.  Acta Radiol. 1994 Nov;35(6):555-9.  

Radiographic features of limb lengthening in children.

Minty I, Maffulli N, Hughes TH, Shaw DG, Fixsen JA.

Department of Radiology, Hospital for Sick Children, London, U.K.

We report our experience in radiographic imaging in limb lengthening procedures using callotasis for limb lengthening discrepancy with the Orthofix dynamic monoaxial external fixator. Seventeen patients (average age at operation 10.8 years) completed 22 bone segments (7 femora, 11 tibiae, 4 ulnae) lengthening procedures. The average time for formation of good medullary bridging was over 6 months. The commonest radiographic abnormality was a periosteal reaction around the pin sites seen in 14 patients, while evidence of pin loosening was present in 10. All patients with pin loosening also showed periosteal reaction which pre-dated the loosening in 5 of 12 patients by an average of 47 days. Angulation was detected in 9 patients in the a.p. plane, and in 6 in the lateral plane. Six patients developed a ragged radiolucent region through the newly forming bone at an average of 95 days from the corticotomy but with uneventful healing.

PMID: 7946677 [PubMed - indexed for MEDLINE]
11. Skeletal Radiol. 1995 Jul;24(5):367-70.  

Melorheostosis with an ossified soft tissue mass: MR features.

Yu JS, Resnick D, Vaughan LM, Haghighi P, Hughes T.

Department of Radiology, University of California, San Diego, USA.

PMID: 7570158 [PubMed - indexed for MEDLINE]



10. The Journal of Musculoskeletal Medicine 1993 (Aug.);61-63

        Musculoskeletal Radiology Quiz - Fight bite.

          Yu JS, Hughes TH, Resnick D.



9. Journal of the Southern Orthopaedic Association. 1993(Fall):2;173-184.

        Imaging of Osteoporosis. Feature article.

          Hughes T.H., Yu J.S. and Sartoris D.J.



8.   Radiography today 1993 Feb;59 (669):14-15

        The role of ultrasound in bone lengthening imaging.

          Green V, Maffulli N, Hughes T.



7.  Tuber Lung Dis. 1992 Dec;73(6):392-5.  

Spinal infection by Mycobacterium xenopi in a non-immunosuppressed patient.

Rahman MA, Phongsathorn V, Hughes T, Bielawska C.

Department of Rheumatology, Royal Free Hospital, London, UK.

A previously fit 77-year-old woman was found to have a paravertebral abscess. This was aspirated, yielding Mycobacterium xenopi, but no other pathogens. Antituberculosis chemotherapy with four first-line agents was commenced, with some response but continuing pain. Reports of extrapulmonary M. xenopi infections are rare. Most previous cases have involved immunosuppressed patients. This is the first reported case of spinal M. xenopi infection in a non-immunosuppressed patient, but radiological evidence suggests that previous tuberculous infection may have damaged the lumbar vertebrae, rendering them susceptible to infection by M. xenopi.

PMID: 1292722 [PubMed - indexed for MEDLINE]


6.  J R Soc Med. 1993 Jan;86(1):18-20.  

Ultrasonographic appearance of regenerate bone in limb lengthening.

Hughes TH, Maffulli N, Fixsen JA.

Department of Radiology, Hospital for Sick Children, London.

The appearance of regenerate bone during the process of limb lengthening using a mono-axial device was studied using radiographs and ultrasound scanning in nine patients. The corticotomy site initially appeared as a sonolucent area. Poorly organized echogenic foci were detectable 2 weeks after the distraction was begun. After 4 weeks, these areas became aligned. At 7-8 weeks, a clear impression of a new cortical margin was seen. The formation of a medullary canal started at this point, progressing to a radiographically evident canal. Ultrasound scanning can reduce considerably exposure to ionising radiation in patients undergoing limb lengthening. Accurate measurements are possible in the early stages, and ossification can be monitored. Axial deviation can be seen but not evaluated. The maturity of the regenerate bone still has to be assessed clinically.

PMID: 8423567 [PubMed - indexed for MEDLINE]


5.  Br J Urol. 1992 Jun;69(6):629-32.  

Pre-operative assessment of Peyronie's disease using colour Doppler sonography.

Ralph DJ, Hughes TH, Lees WR, Pryor JP.

St Peter's Hospital, Department of Radiology, London.

Colour Doppler ultrasonography was used to assess 39 patients with Peyronie's disease with a suspected organic cause for their impotence. In 20 patients who complained of a uniform loss of erection, the impotence was likely to be functional in origin (90%) or occasionally venogenic (10%), the penile arterial blood flow being normal. However, patients who complained of distal flaccidity were likely to have an organic cause for their impotence (68%). This was due to proximal arterial disease (10%), plaque involvement of the distal vessels (37%), veno-occlusive dysfunction (5%) or to the soft glans syndrome (16%).

PMID: 1638347 [PubMed - indexed for MEDLINE]


4.  J Bone Joint Surg Br. 1992 Jan;74(1):130-2.  


Ultrasonographic monitoring of limb lengthening.

Maffulli N, Hughes T, Fixsen JA.

Hospitals for Sick Children, London, England.

Limb lengthening in nine patients was monitored by radiographs and by ultrasound scans. The distraction gap appeared as a sonolucent area within which echogenic foci developed soon after distraction commenced. By seven weeks a new cortex was detected, and medullary canal began to develop between seven and eight weeks. Ultrasound scanning can be used to measure distraction, but it was not as useful as radiographs in detecting angulation. Its use in patients undergoing limb lengthening could reduce their exposure to radiation.

PMID: 1732241 [PubMed - indexed for MEDLINE]


3.  Br J Radiol. 1991 Jul;64(763):633-6.  

Intracranial chondrosarcoma in a patient with Ollier's disease.

Clifton AG, Kendall BE, Crockard HA, Hughes TH.

National Hospitals for Nervous Diseases, London, UK.

PMID: 1873666 [PubMed - indexed for MEDLINE]


2.  Br J Radiol. 1991 Apr;64(760):314-7.  

The most advantageous timing of external ureteric compression during intravenous urography.

Hughes TH, Hine AL.

Department of Radiology, Central Middlesex Hospital, London, UK.

The objective of this study was to ascertain the most advantageous time during an intravenous urogram to apply external ureteric compression to gain the greatest calyceal distension. This was a prospective randomized trial of 60 patients, divided into three equal groups with compression applied immediately after injection, at 5 minutes and after the 5 minutes film had been viewed. Patients with the usual criteria for avoiding compression were excluded. A statistically significant improvement in calyceal distension occurred when compression was applied at 5 minutes compared with that applied after the 5 minute film had been viewed. No improvement was seen when the compression was applied immediately after injection. We recommend that external ureteric compression should be applied immediately after the 5 minute film.

Publication Types:

PMID: 2025770 [PubMed - indexed for MEDLINE]


1. British Journal of Radiology 1990;63:723.

        A new positioning technique for barium enemas.

          Hughes TH.


Christine Chung

Musculoskeletal Section Publishing From July 2002 June 2003


1. Pfirrmann CWA, Theumann NH, Chung CB, Trudell DJ, Resnick D. The

hamatolunate facet: characterization and association with cartilage lesions-

magnetic resonance arthography and anatomic correlation in cadaveric wrists.

Skeletal Radiology 2002; 31:451-456.


2. Delgado G, Chung CB, Lektrakul N, Azocar P, Botte MJ, Coria D, Bosch E,

Resnick D. "Tennis leg": a clinical study in 141 and anatomic investigation of four cadavers with MR imaging and ultrasonography. Radiology 2002; 224: 112-119.


3. Abreu MR, Chung CB, Mendes L, Mohana-Borges A, Resnick D. Plantar

calcaneal enthesophytes: new observations regarding sites of origin based on

radiographs, MR imaging, anatomic, and paleopathologic analysis. Skeletal

Radiology 2003; 32 (1): 13-21.


4. Antonio GE, Cho HJ, Chung CB, Trudell DJ, Resnick D. MR imaging appearance

and classification of acromioclavicular joint injury. AJR 2003; 180 (4): 1103-1110.


5. Theumann NH, Pfirrmann CW, Antonio GE, Chung CB, Gilula LA, Trudell DJ,

Resnick D. Extrinsic carpal ligaments: normal MR arthrographic appearance in

cadavers. Radiology 2003; 226 (1): 171-179.


6. Mohana-Borges A, Theumann N, Pfirrmann, Chung CB, Resnick D, Trudell D.

MR imaging of the lesser metatarsaophalangeal joints with standard MR, MR

arthrography and MR bursography: initial results in 48 cadaveric joints.

Radiology 2003; 227: 175-182.


7. Papakonstantinou O, Chung CB, Chanchairujira K, Resnick D.

Complications of anterior cruciate ligament reconstruction: MR imaging.

European Radiology 2002. In Press. Published online 3 September 2002.


8. Chung CB, Mohana-Borges A, Pathria M.

Tophaceous gout in an amputation stump in a patient with chronic myelogenous

leukemia. Skeletal Radiol. 2003; (Epub ahead of print).


9. Chung CB, Kim HJ.

Sports injuries of the elbow. Magn Reson Imaging Clin N Am. 2003; 11: 239



10. Chung CB, Resnick D.

Monitoring the pathologic changes of rheumatoid arthritis: role of conventional and advanced imaging methods. Arthritis and Rheumatism.


11. Mohana-Borges A, Chung CB, Resnick D.

MR imaging and MR arthrographic evaluation of the postoperative shoulder: spectrum of normal and abnormal findings. RadioGraphics.


12. Mohana-Borges A, Chung CB, Resnick D.

Superior labrum anterior and posterior (SLAP) tear: classification and diagnosis on MR imaging and MR arthrography. AJR.


  1. Kallas KM, Vaughan L, Haghighi P, Resnick D.

    Hibernoma of the left axilla; a case report and review of MR imaging.

    Skeletal Radiology 2003 May;32(5):290-4. Epub 2002 Aug 21.


  2. Munishi M, Pretterklieber ML, Kwak S, Antonio GE, Trudell DJ,

    Resnick D.

    MR imaging, MR arthography, and specimen correlation of the

    posterolateral corner of the knee: an anatomic study. AJR Am J Roentgenol.

    2003 Apr;180(4):1095-101.


  3. Theodorou DJ, Theodorou SJ, Kakitsubata Y, Botte MJ, Resnick D.

    Fractures of proximal portion of fifth metatarsal bone: anatomic and

    imaging evidence of a pathogenesis of avulsion of the plantar aponeurosis

    and the short peroneal muscle tendon. Radiology. 2003 Mar;226(3):857-65.


  4. Kakitsubata Y, Theodorou DJ, Theodorou SJ, Trudell D, Clopton PL, Donich AS, Lektrakul N, Resnick D.

    Magnetic resonance discograpgy in cadavers: tears of the annulus fibrosus.

    Clin Orthop. 2003 Feb;(407):228-40.


  5. Huang GS, Yu JS, Munshi M, Chan WP, Lee CH, Chen CY, Resnick D.

    Avulsion fracture of the head of the fibula (the "arcuate" sign): MR imaging

    findings predictive of injuries to the posterolateral ligaments and posrerior

    cruciate ligament. AJR AM J Roentgenol. 2003 Feb; 180(2):381-7.


  6. Gerling MC, Pfirrmann CW, Farooki S, Kim C, Boyd GJ, Aronoff MD, Feng SA, Jacobson JA, resnick D, Brage ME.

    Posterior tibialis tendon tears: comparison of the diagnostic efficacy of

    magnetic resonance imaging and ultrasonography for the detection of

    surgically created longitudinal tears in cadavers. Invest Radiol. 2003



  7. Kakitsubata Y, Theodorou DJ, Theodorou SJ, Tamura S, Nabeshima K, Trudell D, Clopton PL, Resnick D.

    Cartilaginous endplates of the spine: MRI with anatomic correlation in

    cadavers. J Comput Assist Tomogr. 2002 Nov-Dec;26(6):933-40.


  8. Theumann NH, Pfirrmann CW, Mohana Borges AV, Trudell DJ, Resnick D.

    Metatarsophalangeal joint of the great toe: normal MR, MR arthographic,

    and MR bursographic findings in cadavers. J Comput Assist Tomogr. 2002



  9. Theodorou DJ, Theodorou SJ, Resnick D.

Imaging in dialysis spondyloarthropathy. Semin Dial. 2002 Jul

Aug;15(4):290-6. Review.


1: Radiology 2001 Nov;221(2):478-484  

Intermetatarsal Spaces: Analysis with MR Bursography, Anatomic Correlation, and Histopathology in Cadavers.

Theumann NH, Pfirrmann CW, Chung CB, Mohana-Borges AV, Haghighi P, Trudell DJ, Resnick D.

Departments of Radiology (N.H.T., C.W.A.P., C.B.C., A.V.R.M.B., D.J.T., D.R.) and Pathology (P.H.), Veterans Administration Medical Center, San Diego, Calif.

PURPOSE: To describe the normal magnetic resonance (MR) imaging-depicted anatomy of the intermetatarsal spaces, with emphasis on the MR imaging appearance of the intermetatarsal bursae, and to correlate the MR findings with those seen in anatomic sections and at histopathologic analysis. MATERIALS AND METHODS: Conventional radiography and pre- and postcontrast T1-weighted and fat-saturated T1-weighted spin-echo MR imaging were performed in 32 intermetatarsal spaces in eight human cadaveric feet. The cadaveric specimens were sectioned in planes corresponding to those at MR imaging for anatomic correlation. The intermetatarsal space anatomy was analyzed. Histopathologic examinations of the bursae were performed. RESULTS: The intermetatarsal spaces were located in the forefoot between two metatarsal heads, below and above the deep transverse metatarsal ligament (DTML) that separated the spaces into two levels. The superior level contained the synovial bursa, the plantar and dorsal interosseous muscles and tendons, and the collateral ligament complexes of the metatarsophalangeal joints. The inferior level contained lumbrical muscles and neurovascular bundles. The bursae extended distally to the DTML in the second and third spaces close to the neurovascular bundles and did not extend beyond the DTML in the first and fourth spaces. In the first intermetatarsal space, the bursa had a specific appearance as it coursed along the adductor hallucis tendon as a tendon sheath. Histopathologic examination of the bursae revealed a single layer of attenuated cells. CONCLUSION: MR bursography provided detailed information about the intermetatarsal anatomy, especially the intermetatarsal bursae.

PMID: 11687693 [PubMed - as supplied by publisher]


2: Radiology 2001 Nov;221(2):469-477  
Greater Trochanter of the Hip: Attachment of the Abductor Mechanism and a Complex of Three Bursae MR Imaging and MR Bursography in Cadavers and MR Imaging in Asymptomatic Volunteers.

Pfirrmann CW, Chung CB, Theumann NH, Trudell DJ, Resnick D.

Department of Radiology, Veterans Administration Medical Center, San Diego, Calif. Received October 9, 2000.

PURPOSE: To evaluate trochanteric anatomy with magnetic resonance (MR) imaging, bursography, MR bursography, and anatomic analysis. MATERIALS AND METHODS: T1-weighted and fat-saturated T2-weighted (transverse, sagittal, coronal, and coronal oblique planes) MR imaging of the greater trochanter was performed in 10 cadaveric hips and 12 hips of asymptomatic volunteers. Three bursae comprising the trochanteric bursa complex were injected, and conventional radiography and MR imaging were performed. The specimens were sectioned for anatomic analysis, corresponding to the MR imaging planes. Tendon attachments and bursal localization were related to the facets of the greater trochanter. RESULTS: The bony surface of the greater trochanter consists of four facets: anterior, lateral, posterior, and superoposterior. The gluteus medius muscle attaches to the superoposterior and lateral facets. The gluteus minimus muscle attaches to the anterior facet. The trochanteric bursa covered the posterior facet and the lateral insertion of the gluteus medius muscle. The subgluteus medius bursa was located in the superior part of the lateral facet, underneath the gluteus medius tendon. The subgluteus minimus bursa lies in the area of the anterior facet, underneath the gluteus minimus tendon, medial and cranial to its insertion, and extends medially covering the distal anterior part of the hip joint capsule. The trochanteric bursa is delineated with fat on both sides and can be seen on transverse nonenhanced T1-weighted images as a fine line curving around the posterior part of the trochanter. CONCLUSION: MR imaging and bursography provide detailed information about the anatomy of tendinous attachments of the abductor muscles and the bursal complex of the greater trochanter.

PMID: 11687692 [PubMed - as supplied by publisher]


3: Radiology 2001 Nov;221(2):340-346  
Cervical Spine: Postmortem Assessment of Accident Injuries Comparison of Radiographic, MR Imaging, Anatomic, and Pathologic Findings.

Stabler A, Eck J, Penning R, Milz SP, Bartl R, Resnick D, Reiser M.

Department of Clinical Radiology (A.S., J.E., M.R.) and Clinic of Internal Medicine III (R.B.), University Hospital Ludwig-Maximilians-University Munich, Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.

PURPOSE: To assess the ability of postmortem radiography and magnetic resonance (MR) imaging to depict occult cervical spine injuries as compared with anatomic and pathologic findings. MATERIALS AND METHODS: The cervical spines of 10 adult accident victims underwent radiography and MR imaging, with T1-weighted, fast spin-echo T2-weighted, and four gradient-echo pulse sequences. The frozen specimens were cut into 3-mm-thick slices (sagittal plane) and photographed, and microfocus radiographs were obtained. Imaging findings were compared with the anatomic and pathologic findings. RESULTS: Eight of the 10 specimens had 28 posttraumatic lesions: three fractures (two missed at the initial MR imaging reading), 10 facet joint capsule lesions with bleeding, five soft-tissue and ligament lesions, eight disk lesions, and two spinal cord lesions. Radiography depicted one lesion (4%). Two partial ruptures of the anterior annulus fibrosus were depicted at only MR imaging. Initially, 11 of 28 lesions were detected on MR images; retrospectively, 17 of 28 lesions were correlated with anatomic findings. CONCLUSION: Soft-tissue and intervertebral disk and ligament injuries account for 89% (25 of 28) of posttraumatic cervical spine lesions detected on postmortem images. Occult lesions, including apophyseal joint injuries, were found in clinically noninjured cervical spines. MR imaging was limited in the depiction of discrete lesions when T1-weighted non-fat-saturated, fast spin-echo T2-weighted, and gradient-echo pulse sequences were used.

PMID: 11687673 [PubMed - as supplied by publisher]


4: Clin Orthop 2001 Oct;(391 Suppl):S370-8  
Cartilage imaging techniques: current clinical applications and state of the art imaging.

Chung CB, Frank LR, Resnick D.

Department of Radiology, UCSD and VA San Diego Healthcare System, La Jolla, CA, USA.

The high incidence of cartilage lesions, coupled with the recent advances for their surgical and nonsurgical treatment, have necessitated the development of techniques for accurate diagnosis and monitoring of these lesions. Although arthroscopy has been the standard for cartilage evaluation, magnetic resonance imaging has emerged as the imaging method of choice, allowing analysis of its infrastructure and surface abnormalities. The authors will focus on current clinical applications for articular cartilage analysis and advances and the future direction of the imaging of articular cartilage.

PMID: 11603720 [PubMed - in process]


5: Clin Orthop 2001 Oct;(391 Suppl):S116-23  
In vivo changes after mechanical injury.

Colwell CW Jr, D'Lima DD, Hoenecke HR, Fronek J, Pulido P, Morris BA, Chung C, Resnick D, Lotz M.

Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA 92037, USA.

Chondrocytes undergo apoptosis in response to mechanical injury in vitro. The current clinical study correlates arthroscopic and magnetic resonance imaging results with biopsy specimens of cartilage from patients with knee injury. Twenty patients were evaluated at a mean 2.7 months after acute knee injury. The mean age of the patients was 32 years and the mean weight was 83 kg. Cartilage lesions were graded separately on magnetic resonance images and arthroscopy in a blinded manner. During arthroscopy, a 1.8 mm diameter biopsy specimen was obtained from the edge of cartilage lesion. The biopsy specimen underwent histologic examination by safranin O staining and detection of chondrocyte apoptosis by the presence of deoxyribonucleic acid fragmentation. There was a positive correlation in 50% (10 of 20) when the presence or absence of cartilage lesions by magnetic resonance imaging was correlated with arthroscopy. All cases of partial thickness or full-thickness cartilage loss that were seen by arthroscopy also were detected by magnetic resonance images. Apoptotic cells were significantly more numerous in biopsy specimens from lesions compared with control biopsy specimens. The findings of reduced cell viability attributable to apoptosis may have profound implications for cartilage repair. This opens potential therapeutic avenues for the treatment of posttraumatic cartilage lesions through apoptosis prevention.

PMID: 11603696 [PubMed - in process]


6: Invest Radiol 2001 Oct;36(10):612-8  
Assessment of the position of the distal portion of the ulna in lateral projection radiographs of the wrist: analysis of the influence of pronation-supination and flexion-extension on the pisoscaphoid and the ulnotriquetral distances: a cadaver study.

Ertl-Wagner BB, Stabler A, Brossmann J, Trudell D, Resnick D.

Institute of Clinical Radiology, Klinikum Grosshadern, University of Munich, Munich, Germany, and the Department of Radiology, Veterans Administration Medical Center, San Diego, California.

Ertl-Wagner BB, Stabler A, Brossmann J, et al. Assessment of the position of the distal portion of the ulna in lateral projection radiographs of the wrist: Analysis of the influence of pronation-supination and flexion-extension on the pisoscaphoid and the ulnotriquetral distances: A cadaver study. Invest Radiol 2001;36:612-618.RATIONALE AND OBJECTIVES: Accurate assessment of the distal radioulnar joint is of paramount importance for the detection of possible dislocation or subluxation. Using a cadaveric model, the authors attempted to establish a quantitative method that would allow identification of normal and abnormal distal radioulnar joint anatomy on well-positioned and rotated conventional radiographs. METHODS: Four cadaveric wrists, in which subsequent sectioning confirmed the absence of disease, and one cadaveric wrist with a circumscribed lesion of the triangular fibrocartilaginous complex were studied. Defined movements in flexion and extension (+/- 10 degrees, 20 degrees, 30 degrees ) and in pronation and supination (+/- 10 degrees, 20 degrees, 30 degrees ) as well as combined flexion/extension and pronation/supination were performed. The ulnotriquetral and the pisoscaphoid distances were assessed in each position. Correlation with cryosections was achieved. RESULTS: A strong linear correlation between the degree of pronation or supination and the pisoscaphoid and ulnotriquetral distances was noted. Flexion and extension produced no significant effect on the pisoscaphoid distance, but a defined shift of the ulnotriquetral distance occurred with increasing flexion and extension. CONCLUSIONS: If all parameters are taken into account, this correlation aids in estimating the degree of possible malpositioning of the wrist during radiography and the degree of subluxation of the distal radioulnar joint. Tabular data with parameters to correct for instances of malrotated images and to estimate the extent of dislocation or malrotation of the distal radioulnar joint are provided.

PMID: 11577272 [PubMed - in process]
7: Clin Imaging 2001 Jul-Aug;25(4):247-50  
A huge osteoblastoma with aneurysmal bone cyst in skull base.

Wang YC, Huang JS, Wu CJ, Jeng CM, Fan JK, Resnick D.

Department of Radiology, Cathay General Hospital, Taipei, Taiwan, ROC.

We reported a case of a huge osteoblastoma in the skull base of a young girl who had developed blindness in her right eye 1 year prior to examination. CT showed a large expansile bony lesion with eggshell margin over the skull base. MR imaging showed mixed solid and cystic parts with multiple fluid-fluid levels in the lesion. The optic chiasma and bilateral optic nerves were severely compressed by the tumor.

PMID: 11566084 [PubMed - indexed for MEDLINE]


8: Skeletal Radiol 2001 Aug;30(8):469-74


Pigmented villonodular synovitis of the hip presenting as a retroperitoneal mass.

Kallas KM, Vaughan L, Haghighi P, Resnick D.

Center for Diagnostic Imaging, 148 Second Street South, Waite Park, MN 56387, USA.

We present an unusual case of diffuse pigmented villonodular synovitis (PVNS) of the hip presenting as a large retroperitoneal mass in an asymptomatic 39-year-old man. Initial imaging characteristics and findings on core needle biopsy suggested soft tissue sarcoma. However, incisional biopsy showed findings of PVNS. The patient underwent radical synovectomy and total joint replacement, with no change in the large retroperitoneal component after 15 months of follow-up.

PMID: 11479754 [PubMed - indexed for MEDLINE]


9: Spine 2001 Jul 1;26(13):E287-93  

In vivo changes in the neuroforaminal size at flexion-extension and axial rotation of the cervical spine in healthy persons examined using kinematic magnetic resonance imaging.

Muhle C, Resnick D, Ahn JM, Sudmeyer M, Heller M.

Department of RadiologyChristian-Albrechts-University KielArnold-Heller-Str. 924105 KielGermany.

STUDY DESIGN: In vivo flexion-extension and axial rotation magnetic resonance imaging (MRI) studies of the cervical spine were performed inside a positioning device. OBJECTIVE: To determine the functional changes of neuroforaminal size that occur during flexion-extension and axial rotation of the cervical spine in healthy persons. SUMMARY OF BACKGROUND DATA: Kinematic MRI studies of the cervical spine were performed to obtain detailed information about the functional changes that occur in neuroforaminal size during flexion-extention and axial rotation. The results were compared with published data of in vitro functional flexion-extension and axial rotation studies of the cervical spine. METHODS: Inside a positioning device, the cervical spines of 30 healthy persons were examined in a whole-body magnetic resonance scanner from 40 degrees of flexion to 30 degrees of extension at nine different angle positions. In addition, axial rotation was performed at neutral position (0 degrees ) and at 20 degrees and 40 degrees of axial rotation to both sides. The images were analyzed with respect to the neuroforaminal size at each position using a reformatted 3D-FISP sequence. RESULTS: At flexion, widening of the neuroforaminal size of up to 31% (compared with neutral position, 0 degrees ) was observed. Conversely, at extension a decrease in the size of the neuroforamen of up to 20% was recognized. At 20 degrees and 40 degrees of ipsilateral rotation of the head, a reduction in the neuroforaminal size of up to 15% and 23%, respectively, compared with the neutral position was noted. In contrast, a widening of the foraminal size was recognized on the contralateral side of 9% and 20% at 20 degrees and 40 degrees rotation. Statistically significant differences (p <== 0.05) were found in the neuroforaminal size between different degrees of flexion and extension and in addition for axial rotation compared to neutral position (0 degrees ). CONCLUSION: Compared with the results of previous biomechanical studies of human cadaver cervical spines, kinematic MRI provides additional noninvasive data concerning the physiological changes of the neuroforaminal size during flexion-extension and axial rotation in healthy individuals.

PMID: 11458168 [PubMed - indexed for MEDLINE]


10: Clin Imaging 2001 Jan-Feb;25(1):60-5  
Osteonecrosis of the patella: imaging features.

Theodorou DJ, Theodorou SJ, Farooki S, Kakitsubata Y, Resnick D.

Department of Radiology, School of Medicine, University of California, San Diego Medical Center, San Diego, CA 92103, USA.

Osteonecrosis of the patella, although uncommon, has become important to recognize because it can be a cause of pain in the knee. We describe the imaging manifestations of nontraumatic osteonecrosis of the patella in seven clinical cases. The lesions uniformly involved the superior aspect of the patella. Conventional radiography displayed increased radiodensity, subchondral radiolucent areas, and typical demarcation line surrounding the ischemic region. MR imaging and bone scintigraphy demonstrated the characteristic features of osteonecrosis. Recognition of the imaging findings of osteonecrosis involving the patella can preclude misdiagnosis and may obviate unproductive invasive diagnostic procedures.

PMID: 11435043 [PubMed - indexed for MEDLINE]


11: Radiology 2001 Jul;220(1):225-30  

Intramedullary osteosclerosis: imaging features in nine patients.

Chanchairujira K, Chung CB, Lai YM, Haghighi P, Resnick D.

Departments of Radiology, Veterans Affairs Medical Center, University of California-San Diego, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.

PURPOSE: To determine the conventional radiographic, computed tomographic (CT), magnetic resonance (MR) imaging, scintigraphic, and histologic features of intramedullary osteosclerosis and to review the clinical features. MATERIALS AND METHODS: Nine female patients with leg pain and imaging features indicative of intramedullary sclerosis were seen during a 25-year period. None of the patients had a history of trauma or infection, familial bone disease, or related abnormal laboratory findings. Imaging studies included radiography (n = 9), CT (n = 4), MR imaging (n = 5), and skeletal scintigraphy (n = 5). Histologic correlation was available in five patients. RESULTS: Sixteen bone lesions (midtibia, n = 14; distal fibula, n = 1; and proximal femur, n = 1) were evident. Both lower extremities were involved in seven patients, and a single extremity was involved in two. Intramedullary sclerosis was present, as was cortical thickening, mainly in the diaphysis of the long bones, without extensive periosteal reaction or soft-tissue involvement. Findings at bone scintigraphy were positive in all lesions. Histologic analysis showed nonspecific changes of markedly sclerotic bone with a variable degree of mineralization and maturity. CONCLUSION: Intramedullary osteosclerosis is a distinct disorder that typically affects the diaphysis of one or both tibiae in women. Characteristic imaging findings, when coupled with clinical information, allow precise diagnosis.

PMID: 11426002 [PubMed - indexed for MEDLINE]


12: AJR Am J Roentgenol 2001 Jul;177(1):217-9  

MR arthrography of the glenohumeral joint: a tailored approach.

Chung CB, Dwek JR, Feng S, Resnick D.

Department of Radiology, Musculoskeletal Division, University of California, San Diego, and Veterans Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.

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.

PMID: 11418432 [PubMed - indexed for MEDLINE]


13: Skeletal Radiol 2001 May;30(5):278-81  
Pelvic instability after bone graft harvesting from posterior iliac crest: report of nine patients.

Chan K, Resnick D, Pathria M, Jacobson J.

Department of Radiology, School of Medicine, University of California, San Diego Medical Center, 92103-1990, USA.

OBJECTIVE: To report the imaging findings in nine patients who developed pelvic instability after bone graft harvest from the posterior aspect of the iliac crest. DESIGN AND PATIENTS: A retrospective study was performed of the imaging studies of nine patients who developed pelvic pain after autologous bone graft was harvested from the posterior aspect of the ilium for spinal arthrodesis. Plain films, bone scans, and CT and MR examinations of the pelvis were reviewed. Pertinent aspects of the clinical history of these patients were noted, including age, gender and clinical symptoms. RESULTS: The age of the patients ranged from 52 to 77 years (average 69 years) and all were women. The bone graft had been derived from the posterior aspect of the iliac crest about the sacroiliac joint. All patients subsequently developed subluxation of the pubic symphysis. Eight patients had additional insufficiency fractures of the iliac crest adjacent to the bone graft donor site, and five patients also revealed subluxation of the sacroiliac joint. Two had insufficiency fractures of the sacrum and one had an additional fracture of the pubic ramus. CONCLUSIONS: Pelvic instability is a potential complication of bone graft harvesting from the posterior aspect of the iliac crest. The pelvic instability is manifested by insufficiency fractures of the ilium and subluxation of the sacroiliac joints and pubic symphysis.

PMID: 11407719 [PubMed - in process]


14: Radiology 2001 Jun;219(3):802-10  
Tarsal sinus: arthrographic, MR imaging, MR arthrographic, and pathologic findings in cadavers and retrospective study data in patients with sinus tarsi syndrome.

Lektrakul N, Chung CB, Lai Ym, Theodorou DJ, Yu J, Haghighi P, Trudell D, Resnick D.

Department of Radiology, Veterans Affairs San Diego Healthcare System, University of California, San Diego, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.

PURPOSE: To evaluate the tarsal sinus by using different imaging techniques and specialized planes. MATERIALS AND METHODS: Magnetic resonance (MR) imaging of the tarsal sinus was performed in 10 cadavers. Conventional arthrography of the anterior and posterior subtalar joints was then performed. Tarsal sinus ligaments were evaluated further on initial and reconstructed MR arthrograms along and perpendicular to their axes. Pathologic correlation was performed in five specimens suspected of having tarsal sinus lesions on the basis of initial imaging findings. In 37 patients with a clinical diagnosis of sinus tarsi syndrome, MR images of the ankle were obtained before and after intravenous gadolinium-based contrast material administration and were reviewed to verify the integrity of the tarsal sinus ligaments. RESULTS: Two complete and three partial cervical ligament (CL) tears and one complete interosseous talocalcaneal ligament (ITCL) tear were diagnosed with MR imaging. Only one complete and one partial CL tear were seen after evaluation of both initial and reconstructed MR arthrograms and confirmed with pathologic correlation. In 18 patients, the diagnosis was confirmed at MR imaging, which depicted ITCL and CL tears in 11 patients, isolated CL tears in three patients, ganglia in three patients, and pigmented villonodular synovitis in one patient. CONCLUSION: Cadaveric study results indicate that initial and reconstructed MR arthrograms along and perpendicular to the ligament axes are potentially useful for further evaluation of individual tarsal sinus structures.

PMID: 11376274 [PubMed - indexed for MEDLINE]


15: Clin Imaging 2000 Nov-Dec;24(6):381-3  
Subperiosteal lipoma: a case report.

Blair TR, Resnick D.

Department of Radiology, Veterans Affairs Medical Center, and University of California San Diego, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.

Lipomas are the most common benign mesenchymal tumor. They can occur in various locations such as subcutaneous tissue, muscle, nerve, synovium, different periosteal layers, and bone [Diagnosis of bone and joint disorders. 3rd ed. Philadelphia: Saunders, 1995. p. 3814, 3947; Skeletal Radiol 27 (1998) 375]. To our knowledge, however, lipomas arising in a subperiosteal location have not been described previously. We present a patient with two subperiosteal lipomas of the femur.

PMID: 11368942 [PubMed - indexed for MEDLINE]


16: J Comput Assist Tomogr 2001 May-Jun;25(3):412-6  
MRI of the medial and lateral plantar nerves.

Farooki S, Theodorou DJ, Sokoloff RM, Theodorou SJ, Trudell DJ, Resnick D.

Department of Radiology, Veterans Affairs San Diego Healthcare System and University of California San Diego School of Medicine, USA.

PURPOSE: The purpose of this work was to demonstrate nerve anatomy of the medial plantar (MP) and lateral plantar (LP) nerves and the first branch of the lateral plantar (FBLP) nerve as depicted with MRI. METHOD: High resolution MRI of the heel was performed with a standard transmit-receive extremity coil in six human cadaveric specimens using sagittal, axial, and coronal T1-weighted spin echo images. The specimens were then sectioned in the axial and coronal planes. RESULTS: MRI depicted the MP and LP nerves arising from the posterior tibial (PT) nerve. Assessment of the anatomic course and trifurcation of the PT nerve into the plantar nerves and the FBLP nerve was best seen in the sagittal plane. Various portions of these nerves were visualized also in the axial and coronal imaging planes. CONCLUSION: MRI may demonstrate the origin, course, and branching of nerves in the heel and can provide a means for assessment of the patient presenting with chronic heel pain and suspected entrapment neuropathy.

PMID: 11351192 [PubMed - indexed for MEDLINE]


17: Radiology 2001 May;219(2):381-6  
Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion.

Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, Resnick D.

Department of Radiology, Veterans Affairs Medical Center, University of California, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.

PURPOSE: To demonstrate the normal anatomy of the stabilizing structures of the lateral aspect of the knee and to investigate pathogenesis of the Segond fracture, with emphasis on the iliotibial tract (ITT) and anterior oblique band (AOB) of the fibular collateral ligament. MATERIALS AND METHODS: Dissection of the region of the AOB, ITT, and lateral capsular ligament was performed in three cadaveric knees, with placement of gadopentetate dimeglumine-filled tubes along their course and tibial insertions. These knees, in addition to three nondissected knees, were studied with magnetic resonance (MR) imaging by using standard and specialized oblique planes. Specimen sectioning provided anatomic correlation. Retrospective review of radiographs and MR images in 17 patients with acute Segond fractures was performed, and the relationship between the fragment and the demonstrated lateral supporting structures of the knee was noted. RESULTS: Anatomic dissection and MR imaging of the cadaveric knees demonstrated a broad tibial insertion of the ITT, with fibers extending posterior to the Gerdy tubercle. A firm band of tissue, the AOB, extended from the fibular collateral ligament to the midportion of the lateral tibia, the typical site of a Segond fracture. The lateral capsular ligament proved to be a mere thickening of the capsule, inserting at the lateral tibia. Clinical analysis of acute Segond fractures confirmed the frequent attachment of the ITT and AOB to the avulsed fragment. CONCLUSION: Anatomic and clinical findings suggest that fibers of the ITT and AOB are important factors in the pathogenesis of the Segond fracture.

PMID: 11323461 [PubMed - indexed for MEDLINE]


18: Radiology 2001 May;219(2):368-74  
Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1,650 spinal levels in 100 cadavers.

Pfirrmann CW, Resnick D.

Department of Radiology, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.

PURPOSE: To investigate the frequency and characteristics of Schmorl nodes in an elderly population and to correlate these findings with degenerative spinal changes. MATERIALS AND METHODS: Cadaveric thoracic and lumbar spines were removed at autopsy (mean age at death, 68.2 years; range, 43-93 years). Parasagittal sections of approximately 5-mm thickness were obtained and radiographed. At each of 3,300 endplates from T1 to L5, the presence of Schmorl nodes was noted. Vertebral endplate contour was analyzed, and abnormalities of the discovertebral junction were noted. The height of each interspace was measured, and the presence or absence of vacuum phenomena and spondylosis was recorded. RESULTS: Schmorl nodes were found in 58 specimens and were multiple in 41. Of 3,300 vertebral endplates, 225 revealed Schmorl nodes: 88 cranial and 137 caudal. More than 182 were between T7 and L2. Schmorl nodes correlated with disk space loss (P <.001) but not with evidence of advanced disk degeneration: marked disk space loss (P =.53), vacuum phenomena (P =.82), or discogenic sclerosis or erosion (P =.35). Schmorl nodes were associated with claw (P <.001) but not traction (P =.72) osteophytes. Straight (P <.001) and fractured (P <.001) vertebral endplates were associated with Schmorl nodes. CONCLUSION: Schmorl nodes are common in the spines in an elderly population, with a frequency similar to that in a younger population. Schmorl nodes are associated with moderate but not advanced degenerative changes. Geometric observations regarding the vertebral endplates support the concept that Schmorl nodes are caused by an abnormality of the discovertebral junction.

PMID: 11323459 [PubMed - indexed for MEDLINE]


19: Ann Thorac Surg 2001 Apr;71(4):1338-41  
Dysphagia caused by a fetus-in-fetu in a 27-year-old man.

Massad MG, Kong L, Benedetti E, Resnick D, Ghosh L, Geha AS, Abcarian H.

Department of Surgery, The University of Illinois at Chicago, 60612, USA.

Mechanical obstruction of the distal esophagus by a fetus-in-fetu is an extremely rare condition that has not been previously reported. We present the case of a 27-year-old man who presented with dysphagia caused by fetus-in-fetu contained within a retroperitoneal cystic cavity. The tumor, noticed since childhood, did not cause any symptoms until a year before presentation when symptoms of dysphagia developed. We propose including this entity in the differential diagnosis of a retroperitoneal mass.

PMID: 11308184 [PubMed - indexed for MEDLINE]