Sagittal splitting laminoplasty for spinal canal enlargement for ossification of the spinal ligaments (OPLL and OLF)

Patients have been followed up radiologically after sagittal splitting laminoplasty (SSL) for ossification of the posterior longitudinal ligament (OPLL) and ligamentum flavum. The enlarged spinal canal was maintained satisfactorily in all the cases, and the posterior spinal elements were also almost completely restored. In most cases, the range of the vertebral motion was good with more than 50% of the preoperative status. Postoperative instability of the vertebral column was not identified in any case. Mild cervical kyphosis was noted in 6% of cervical OPLL patients. There were no patients with neurological deterioration. Using SSL, reconstruction and restoration of the posterior spinal elements and retention of the enlarged spinal canal were accomplished safely and adequately.

Evaluation of patients with low back pain: a need for a standardized approach (radiologist's view)

Magnetic resonance (MR) imaging has been recognized as a modality of choice in the evaluation of the spine. However, morphological abnormalities demonstrated by MR imaging do not always reflect low back pain (LBP). MR imaging should be interpreted with consideration of full clinical signs, symptoms, and other relevant background. At the same time, MR findings potentially relevant to LBP, such as morphological abnormalities of the disc, presence or absence of high intensity zone, abnormalities of the end plate and adjacent marrow signal, degree of nerve root compression, and degeneration of the facet joint, should be described without omission.

Osteoarticular tuberculosis

The radiological features of osteoarticular tuberculosis are quite variable. The rareness of AIDS-associated tuberculosis and relatively mild course and imaging features may be the common feature of osteoarticular tuberculosis in Japan. Imaging features are generally similar to other low-grade infections, and liberal (often incomplete) use of antibiotics for the treatment of pyogenic infection may also make the differential diagnosis difficult on many occasions.

Virtual CT endoscopy of ossicles in the middle ear

The purpose of this study is to evaluate how virtual computed tomography (CT) endoscopy may help in assessing ossicles in the middle ear. Our series consisted of 96 ears of 68 consecutive patients with conducting hearing loss. All examinations were performed with a high-resolution spiral CT using axial and direct coronal planes of the temporal bone. Perspective virtual endoscopy was processed using the virtual endoscopic software. Superstructure of the stapes was difficult to evaluate on the virtual endoscopy; however, virtual endoscopy of the middle ear provides further information on the pathological conditions including congenital anomaly, posttraumatic, and inflammatory processes.

Primary leiomyosarcoma with the invasion into the intertrabecular space of bone: a case report and the review of the literatures

Primary leiomyosarcoma of bone is very rare. Most of reported cases were osteolytic. We report a primary leiomyosarcoma arising from the neck of the femur of a 43-year-old woman who had no remarkable abnormalities on plain radiographs. Magnetic resonance imaging (MRI) clearly depicted the lesion. Biopsy revealed it leiomyosarcoma. Gynecological and gastrointestinal examinations ruled out metastatic leiomyosarcoma. Wide excision of the tumor was performed and followed by endoprosthetic replacement of the proximal femur. Microscopic examination revealed tumor cells infiltrating into the intertrabecular space.

Elevated levels of oxidized low density lipoprotein show a positive relationship with the severity of acute coronary syndromes

BACKGROUND

There is accumulating data that acute coronary syndromes relate to recent onset activation of inflammation affecting atherosclerotic plaques. Increased blood levels of oxidized low density lipoprotein (ox-LDL) could play a role in these circumstances.

METHODS AND RESULTS

Ox-LDL levels were measured in 135 patients with acute myocardial infarction (AMI; n=45), unstable angina pectoris (UAP; n=45), and stable angina pectoris (SAP; n=45) and in 46 control subjects using a sandwich ELISA method. In addition, 33 atherectomy specimens obtained from a different cohort of patients with SAP (n=10) and UAP (n=23) were studied immunohistochemically for ox-LDL. In AMI patients, ox-LDL levels were significantly higher than in patients with UAP (P<0.0005) or SAP (P<0.0001) or in controls (P<0.0001) (AMI, 1.95+/-1.42 ng/5 microgram LDL protein; UAP, 1.19+/-0.74 ng/5 microgram LDL protein; SAP, 0.89+/-0.48 ng/5 microgram LDL protein; control, 0.58+/-0.23 ng/5 microgram LDL protein). Serum levels of total, HDL, and LDL cholesterol did not differ among these patient groups. In the atherectomy specimens, the surface area containing ox-LDL-positive macrophages was significantly higher in patients with UAP than in those with SAP (P<0.0001).

CONCLUSIONS

This study demonstrates that ox-LDL levels show a significant positive correlation with the severity of acute coronary syndromes and that the more severe lesions also contain a significantly higher percentage of ox-LDL-positive macrophages. These observations suggest that increased levels of ox-LDL relate to plaque instability in human coronary atherosclerotic lesions.

Disorganised unilateral cerebellar folia: a mild form of cerebellar cortical dysplasia?

We describe MRI findings in two patients with disorganised foliation of one cerebellar hemisphere, with folia running vertically rather than horizontally. The thickness of individual folia and corticomedullary interdigitations were normal. These patients have no cerebellar neurological deficit. This rare abnormality is probably a maldevelopment of the hemispheric part of the posterior lobe of the developing cerebellum, and no clinical significance can be elicited.

[Diagnostic imaging in the congenital and developmental disorders: before and after advancement of molecular genetics]

In this review, a general approach to the congenital and genetic disorders is presented. Differentiation between deformation and malformation is practically important to triage congenial or developmental abnormalities. The disease distribution along arterial supply or sclerotome is more suggestive of developmental or acquired disorder, either in utero or in early infancy. Newly developed genetic analysis of bone dysplasia is an important subject, and this review focuses on collagen abnormalities, systemic disorders associated with neoplasms and receptor disorders. Owing to the progress of molecular genetics and gene therapy, the approach to hereditary conditions will dramatically change. Although most of these diseases are relatively uncommon, the role of diagnostic radiologist may become more important for early institution of treatment planning and estimating prognosis.

Cervical spine injury in the elderly: imaging features

An increase in the elderly population has resulted in an increased incidence of cervical spine injury in this group. No specific type of cervical spine trauma is seen in the elderly, although dens fractures are reported to be common. Hyperextension injuries due to falling and the resultant central cord syndrome in the mid and lower cervical segments due to decreased elasticity as a result of spondylosis may be also characteristic. The imaging features of cervical spine injury are often modified by associated spondylosis deformans, DISH and other systemic disorders. The value of MR imaging in such cases is emphasized.

Superselective continuous arterial infusion chemotherapy through the superficial temporal artery for oral cavity tumors

BACKGROUND AND PURPOSE

High-dose intraarterial chemotherapy with repeated one-shot infusion may be useful for treating head and neck tumors. We evaluated the efficacy of superselective continuous arterial infusion chemotherapy administered via a coaxial catheter system and compared the results with those of subselective catheterization for treatment of oral cavity tumors.

METHODS

Forty-nine consecutive patients with tumors of the oral cavity (clinical stage I, 12 cases; stage II, 19 cases; stage III, six cases; stage IV, 12 cases) were treated by arterial infusion chemotherapy. After a guiding catheter was advanced into the superficial temporal artery, superselective catheterization was performed using a coaxial system microcatheter. Superselective catheterization was accomplished in 34 cases, and was unsuccessful in 15, owing to difficulties in performing catheterization or to multiple feeding arteries. In the latter cases, the tip of the catheter was placed near the origin of the feeding arteries (subselective catheterization).

RESULTS

Thirty (88%) of 34 patients had a complete response to superselective arterial infusion chemotherapy and two (6%) had a partial response. Twelve (80%) of 15 patients had a complete response to subselective arterial infusion chemotherapy and three (20%) had a partial response. Local recurrence was more frequent after subselective treatment (13%) than after superselective (6%) treatment.

CONCLUSION

Superselective continuous arterial infusion chemotherapy may be suitable for local control of oral cavity tumors, with a low rate of recurrence.

Intraosseous neurilemmoma of the mandible

We report a rare case of intraosseous neurilemmoma of the mandible, with an emphasis on radiographic findings. The tumor, located mainly in the premolar region, presented as an expansive, unilocular, well-defined, radiolucent lesion on plain radiography. No dilatation of the mandibular canal was identified. MR imaging helped to identify the solid nature of the tumor. A biopsy was necessary to make the final diagnosis because of the relatively nonspecific nature of the lesion.

Intracranial low-grade chondrosarcoma with hyperostosis of the skull: a case report

We describe a case of intracranial chondrosarcoma in a 46-year-old woman. The preoperative diagnosis was meningioma as plain radiography and computed tomography of the head revealed a tumor with discrete calcifications predominantly in the right frontoparietal region and hyperostosis of the inner table of the skull overlying the tumor. However, the tumor was histologically composed of cartilaginous tissue without meningiomatous differentiation and the final diagnosis was a low-grade chondrosarcoma based on its histological appearance and size, together with the radiologic images. Intracranial chondrosarcoma occurring above the skull base is extremely rare and 19 cases were found in our literature review. Intracranial chondrosarcoma showing hyperostosis of the skull has not been reported in the cases. The discussion includes its differential diagnosis, origin, and clinical behavior.

Angiosarcoma associated with chronic lymphedema (Stewart-Treves syndrome) of the leg: MR imaging

Magnetic resonance (MR) imaging findings of two patients with Stewart-Treves syndrome are presented. MR imaging showed edematous changes in the subcutaneous fat and skin masses that proved to be angiosarcomas. MR signal intensity of the tumor was low compared with fat on T1-weighted images and intermediate and heterogeneous on T2-weighted images. In one patient, administration of intravenous Gd-DTPA showed marked enhancement in the early phase, which persisted until the delayed phase. These finding on dynamic MR imaging may reflect the abundant vascular spaces seen in these tumors.

Pasteurized intercalary autogenous bone graft: radiographic and scintigraphic features

OBJECTIVE

Pasteurized autogenous bone graft sterilized at a low temperature (60 degrees C) is one option for reconstruction after resection of bone and soft tissue tumors. The purpose of this investigation was to assess the normal and abnormal radiographic and scintigraphic findings of pasteurized intercalary autogenous bone graft after resection of bone and soft tissue sarcomas.

DESIGN

This was a retrospective evaluation of the radiography and bone scintigraphy findings in patients after treatment of bone and soft tissue sarcomas using an intercalary pasteurized autogenous bone graft.

PATIENTS

Among 10 consecutive patients, eight had intercalary grafts, and they constitute the subjects of this study. All available radiography and bone scintigraphy findings were reviewed for the healing process and the possibility of complications.

RESULTS AND CONCLUSIONS

Healing and incorporation of the graft were observed in five patients during the follow-up, but the other three did not heal satisfactorily. Rapid incorporation of pasteurized autogenous bone graft can be demonstrated by means of radiography and bone scintigraphy.

Virtual CT endoscopy in determining safe surgical entrance points for paranasal mucoceles

The goal of this work was to evaluate virtual CT endoscopy for determining safe surgical entrance points for paranasal mucoceles. Twelve mucoceles in 11 cases were scanned with helical CT, and multiplanar reconstruction (MPR) and virtual endoscopic images were obtained. After a safe surgical entrance point was determined by MPR images, the entrance point was specified on the virtual endoscopic images. The combination of virtual endoscopic images and MPR images is a suitable method for determining a safe surgical entrance point for simple mucoceles.

[Simultaneous query and retrieve from multiple DICOM image archives using a proxy server]

PURPOSE

DICOM clients could not access more than one archive simultaneously in the previous PACS systems. We developed a proxy server which makes it possible for clients to query and retrieve images from multivendor DICOM archives simultaneously.

METHODS

We used a Web server that supports the DICOM query and retrieve(Q/R) service class as a proxy server. This system consisted of two DICOM servers and six DICOM clients of different vendors in the Radiology Department. Through Web browsers on the clients, requests for Q/R were transmitted to the proxy server by hypertext transfer protocol. The proxy server communicated with DICOM servers by DICOM Q/R Service Class(C-FIND, C-MOVE), and then DICOM servers directly transmitted images to DICOM clients by DICOM Storage Service Class(C-STORE).

RESULTS

DICOM clients could transmit Q/R requests to two DICOM servers simultaneously via the proxy server and receive requested images promptly. Confirmation of conformance among the proxy server, DICOM archives, and DICOM clients became much easier than previously.

CONCLUSION

A Web server working as a proxy server of the DICOM Q/R Service Class is an effective solution for allowing DICOM clients to communicate with multiple DICOM archives.

Macrodystrophia lipomatosa: CT and MR findings

Macrodystrophia lipomatosa is a congenital macrodactyly characterized by proliferation of all mesenchymal components, particularly fibroadipose tissue. We report imaging features of two such patients. MR imaging and CT scanning demonstrated proliferation of fatty tissue in the territory of the median nerve in the hands and forearms, characteristic of macrodystrophia lipomatosa.

[Does reperfusion therapy reduce complications in acute inferior myocardial infarction?]

Both right ventricular infarction and complete atrioventricular block were frequently seen in patients with acute inferior myocardial infarction before the introduction of reperfusion therapy (RT). However, the effect of reperfusion therapy on these 2 complications is not well known. To evaluate the effect of reperfusion therapy in them, we retrospectively studied the in-hospital outcome of 103 consecutive patients with acute inferior myocardial infarction within 72 hr after the onset, 23 with right ventricular infarction and 36 with complete atrioventricular block. Patients were divided into 2 groups: RT group (n = 63) in which Thrombolysis in Myocardial Infarction (TIMI) III flow was obtained by reperfusion therapy within 24 hr after the onset, and the non-RT group (n = 40) in which TIMI III flow was not obtained or did not receive reperfusion therapy. Patients with right ventricular infarction in the RT group had a larger proportion of proximal occlusion of the right coronary artery and the absence of preinfarction angina. There were no effects of perfusion on complete atrioventricular block. In 23 patients with right ventricular infarction and 36 patients with complete atrioventricular block, in-hospital stay, duration of using temporary pacing and Swan-Ganz catheter were shorter in the RT group than the non-RT group. Reperfusion therapy does not decrease the incidence of both complications. However, successful reperfusion therapy results in a rapid improvement in hemodynamic instability and atrioventricular conduction injury, and early hospital discharge. Preinfarction angina may be associated with a protective effect against the development of these 2 complications.

Nutrient canal of the fibula

OBJECTIVE

To investigate the radiological features of the nutrient canal in the fibula.

DESIGN AND PATIENTS

One hundred and seventy-nine dried fibulae were studied regarding the type, number, location, and direction of the nutrient canal. They were classified into a usual type (type I: a radiolucent line confined to the cortex) and an atypical type (type II: a radiolucent line extending beyond the cortex).

RESULTS

Among the total of 230 nutrient canals seen on radiography, 197 (86%) were type I and 33 (14%) were type II. On CT scans, the ossified rim of the canal extended into the medullary cavity in type II canals. The most common site was the posteromedial aspect in both type I and type II canals. Type II canals were significantly more common in fibulae with two or three nutrient canals. The frequency of the upward direction was more common in type II canals.

CONCLUSION

Nutrient canals with extension of the ossified rim into the medullary canal are the cause of linear lucency that may simulate a fracture. Their features are slightly different from those of usual canals.

Fibrous dysplasia arising from the calcaneus

A case of an 18-year-old woman with fibrous dysplasia arising in the calcaneus, which is extremely rare, is reported, with the emphasis placed on differential diagnosis from low-grade central osteosarcoma. She had a severe pain in her left ankle after sprain. Plain radiographs showed a radiolucent lesion measuring 6.3 x 2.5 cm with a sclerotic margin in the left calcaneus. CT scans showed a well-defined lytic lesion with disruption of the lateral cortex and an ossification or calcification in its center. On MR imaging, the lesion had isointensities and high intensities on T1 and T2 weighted images, respectively, but its central portions showed lower intensities both on T1 and T2 weighted images. The lesion was enhanced with gadolinium except for the central portions. The specimen obtained by open biopsy consisted of fibrous tissue and foci of irregular woven bone. None of the nuclear atypia, mitoses, longitudinal stream of bone or invasive nature of growth was detected. The diagnosis of fibrous dysplasia was histologically made. The lesion was curetted and packed with autogenous bone chips. No evidence of recurrence was noted postoperatively.

Spondylolysis of the upper lumbar spine. Radiological features

To elucidate the radiological features of spondylolysis of the three upper lumbar vertebrae, review of radiology reports during an 8-year period was performed. Among 17 levels of defects in 14 patients, nine were unilateral. Among 25 defects, nine had an atypical course. In eight of nine atypical defects, the direction was vertical at the inferolateral aspect, and horizontal at the superomedial aspect. The spondylolysis of the upper lumbar spine is often unilateral and the course of the defect is frequently atypical.