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Imaging of painful scoliosis.

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Scoliosis is defined as a lateral deviation of the spine from the normal plumb line. Commonly, there is a rotational component and deviation also in the sagittal plane (kyphosis or hyperlordosis). When scoliosis presents in adults, it is often painful. In contrast, back pain in a child is considered rare, and serious underlying pathology should be excluded, particularly since idiopathic scoliosis is typically painless. A painful scoliosis in a child or adolescent, especially if the patient has a left-sided curve, should be examined thoroughly. The aim of this review is to illustrate the causes of a painful scoliosis in children, adolescents and adults.

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脊柱侧弯的定义是横向偏差脊柱正常铅垂线。通常，有一个旋转组件和偏差也在矢状面（后凸畸形或hyperlordosis ）。当脊柱侧弯提出的成年人，往往是痛苦的。与此相反，背痛的一个孩子被认为是罕见的，严重的基本病理应排除在外，尤其是因为特发性脊柱侧凸通常是无痛的。一个痛苦的脊柱侧弯的儿童或青少年，尤其是如果病人有左侧曲线，应该彻底审查。这样做的目的是要说明审查的原因，一个痛苦的脊柱侧弯在儿童，青少年和成年人。

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AIM: The aim of the study is to assess the feasibility of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and staging of multiple myeloma and compare to skeletal survey (SS), using bone marrow biopsy and whole-body magnetic resonance imaging (WBMRI; where available) as gold standard. MATERIALS AND METHODS: Patients referred over an 18-month period for investigation of suspected multiple myeloma or restaging of myeloma were randomized to undergo one of two WBLDCT protocols using high kVp, low mAs technique (140 kVp, 14 mAs; or 140 kVp, 25 mAs). Recent WBMRI scans were reviewed in 23 cases. Each imaging modality was assessed by two radiologists in consensus and scored from 0-3 (0 = normal, 1 = 1-4 lesions, 2 = 5-20 lesions, 3 >/= 20 lesions/diffuse disease) in ten anatomical areas. Overall stage of disease, image quality score, and the degree of confidence of diagnosis were recorded. Diagnostic accuracy of skeletal survey and WBLDCT were determined using a gold standard of bone marrow biopsy and distribution of disease was compared to WBMRI. RESULTS: Thirty-nine patients were evaluated. WBLDCT identified more osteolytic lesions than skeletal survey with a greater degree of diagnostic confidence and led to restaging in 18 instances (16 upstaged, two downstaged). In those with recent WBMRI, distribution of disease on WBLDCT showed superior correlation with WBMRI when compared with SS. Overall reader impression of stage on WBLDCT showed significant correlation with WBMRI (kappa = 0.454, p < 0.05). WBLDCT provided complementary information to WBMRI in nine patients with normal marrow signal following treatment response, but which were shown to have diffuse residual cortical abnormalities on CT. CONCLUSION: WBLDCT at effective doses lower than previously reported, is superior to SS at detecting osteolytic lesions and at determining overall stage of multiple myeloma, and provides complementary information to WBMRI.

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OBJECTIVE: The objective of this study was to assess the utility of MRI in diagnosing injury to the first interosseous cuneometatarsal (Lisfranc) ligament and to additionally determine the associated patterns of traumatic soft tissue and osseous injury. MATERIALS AND METHODS: Fifteen patients (16 feet) who were referred for MRI evaluation of the Lisfranc ligament, and had operative exploration or examination under anesthesia, were included for analysis. Standard non-contrast MRI foot imaging was performed in all cases. Evaluation of the following components was performed: the dorsal and plantar bundles of the Lisfranc ligament, the plantar tarsal metatarsal ligaments, soft tissue edema and fluid, and bone marrow edema and fractures. Surgical reports were regarded as the reference standard in all cases. RESULTS: Seven of 10 cases of grade 3 Lisfranc ligament injuries at surgery were correctly graded at MRI. No cases of surgically proven complete Lisfranc ligament tears (grade 3) were interpreted as normal at MRI. All Lisfranc ligament sprains (grade 2 or 3) at surgery were detected at MRI. Two of six cases reported as grade 1 injuries at MRI were normal at surgery. No cases of surgically proven normal or sprained Lisfranc ligaments were interpreted as grade 3 tears on MRI. Four of six of our cases of normal or sprained Lisfranc ligaments demonstrated fractures; while the minority of complete Lisfranc ligament tears (3/10) contained fractures. CONCLUSION: MRI is reasonably accurate at detecting traumatic injury to the Lisfranc ligament. However, in clinically suspected cases of traumatic Lisfranc ligament injury, true positive rate for sprain is low.

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目的：本研究的目的是评估的效用损伤MRI诊断的第一间cuneometatarsal （跖跗关节）韧带和另外确定相关格局创伤性软组织和骨损伤。材料与方法： 15例（ 16英尺）谁被称为磁共振成像评价跖跗关节韧带拉伤，并手术探查或考试麻醉下，被列入分析。标准的非对比磁共振成像脚是在所有情况。评价以下内容进行：背和足底捆绑的跖跗关节韧带，跖跗跖骨韧带，软组织水肿和液体，和骨髓水肿和骨折。手术报告被视为参考标准在所有情况下。结果： 7 10例三级跖跗关节韧带损伤的手术是在正确的MRI分级。没有证明的情况下完成手术跖跗关节韧带眼泪（三级）被解释为正常的MRI 。所有跖跗关节韧带扭伤（二级或3 ）在手术时发现的MRI 。两个6例报告为1级损伤的MRI是正常的手术。没有发生手术证明正常或跖跗关节韧带扭伤解释为三级眼泪的MRI 。四年六个月我们例正常或跖跗关节韧带扭伤表明骨折;而少数完整的跖跗关节韧带的眼泪（ 3 / 10 ）载有骨折。结论： MRI是相当准确的检测外伤的跖跗关节韧带。然而，在临床上怀疑例创伤性跖跗关节韧带损伤，真正的阳性率为扭伤低。

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OBJECTIVE: The objective of this study was to describe the magnetic resonance imaging (MRI) features of tuberculosis (TB) of the knee joint. MATERIALS AND METHODS: The MRI features in 15 patients with TB of the knee, as confirmed by histology of the biopsied joint synovium, were reviewed retrospectively. The images were assessed for intra-articular and peri-articular abnormalities. RESULTS: All patients had florid synovial proliferation. The proliferating synovium showed intermediate to low T2 signal intensity. In the patients who were administered intravenous contrast, the hypertrophic synovium was intensely enhancing. Marrow edema (n = 9), osteomyelitis (n = 4), cortical erosions (n = 5), myositis (n = 6), cellulitis (n = 2), abscesses (n = 3), and skin ulceration/sinus formation (n = 2) were seen in the adjacent bone and soft tissue. CONCLUSION: Synovial proliferation associated with tuberculous arthritis is typically hypointense on T2-weighted images. This appearance, in conjunction with other peri-articular MRI features described, can help in distinguishing TB arthritis from other proliferating synovial arthropathies.

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目的：本研究的目的是描述磁共振成像（ MRI ）特点肺结核（ TB ）的膝关节。材料与方法： MRI表现15例膝关节结核，病理证实的滑膜活检联合，进行回顾性分析。这些照片被评估关节内和周围的关节畸形。结果：所有患者均有炽滑膜扩散。增殖滑膜表明中间低时刻信号强度。患者谁的管理静脉相反，肥厚性滑膜是激烈的提高。骨髓水肿（ 9例），骨髓炎（ 4例），皮质糜烂（ 5例），肌炎（ 6例），蜂窝组织炎（ 2例），脓肿（ 3例），皮肤溃疡/窦形成（ 2例）出现在邻近的骨与软组织。结论：增殖与滑膜结核性关节炎通常是低的T2加权图像。这外观，与其他周边关节MRI特点描述，可以帮助区分结核性关节炎其他增殖滑膜arthropathies 。

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OBJECTIVES: The goal of our study was to determine the usefulness of percutaneous abscess drainage under guidance of computed tomography (CT) fluoroscopy. MATERIALS AND METHODS: Our subjects were 21 patients (seven women, 14 men; mean age 64 years; age range 30-87 years) who had undergone percutaneous drainage of 26 psoas abscess lesions under CT fluoroscopic guidance between May 2001 and January 2008. Drainage methods involved a needle puncture, insertion of a guidewire, serial dilations, and the exchange of the needle with a drainage tube. The procedures were guided by use of a helical CT scanner that provided real-time fluoroscopic reconstruction. RESULTS: Percutaneous drainage under real-time CT fluoroscopic guidance was successfully performed in every procedure. Use of real-time CT fluoroscopy allowed rapid assessment of needle, guidewire, and catheter placement. No patient had serious complications related to the drainage procedure. The mean procedure time required to drain one lesion was 35.6 +/- 13.6 min. Mean period after the drainage procedure until complete disappearance of the abscess as confirmed by CT was 12.4 +/- 10.0 days (range 3-46 days). CONCLUSION: CT fluoroscopy is useful in achieving accurate and safe drainage of abnormal psoas fluid collections.

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目标：我们的研究目标是确定的效用皮脓肿引流的指导下，计算机断层扫描（ CT ）透视。材料与方法：我们的主题分别为21例（ 7名妇女， 14名男性，平均年龄64岁，年龄范围30-87岁）谁进行了经皮引流26腰肌脓肿病灶的CT透视导向下至2001年5月和2008年1月。排水方法涉及针，插入导，串行dilations和交换针与引流管。该程序的指导下使用螺旋CT扫描仪，提供实时透视重建。结果：经皮引流根据实时的CT透视导向，成功地完成每一个程序。使用实时CT透视允许快速评估针，导线，导管位置。没有病人有严重的并发症有关的排水程序。平均程序所需的时间流失一个病变为35.6 + / - 13.6分。意味着以后期间的排水程序，直至完全消失的脓肿经CT证实为12.4 + / - 10.0天（范围3-46天）。结论： CT透视是有助于实现准确和安全的排水异常腰肌流体集合。

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Percutaneous osteoplasty (POP) as a technical extension of percutaneous vertebroplasty has been used as a treatment for osteolytic lesions in weight-bearing bones besides the vertebrae, and has demonstrated beneficial outcomes in terms of pain relief and functional improvement. However, its efficacy in non-weight-bearing bones is not well known. Herein, we present the case of a patient with an osteolytic lesion from multiple myeloma in the sternum, a non-weight-bearing bone, who obtained sustained pain relief and improvement of life quality after POP. These data suggest that POP may be an alternative treatment for osteolytic lesions in non-weight-bearing bones.

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经osteoplasty （持久性有机污染物）作为技术推广的经皮椎体成形术已被用作治疗溶骨性病变的负重骨骼除了椎骨，并显示了有益的结果而言，缓解疼痛和功能改善。但是，其疗效在非负重骨不是众所周知的。在此，我们目前的情况下，病人的溶骨性病变的多发性骨髓瘤的胸骨，非负重骨，谁获得持续的疼痛缓解和改善生活质量后的POP 。这些数据表明，持久性有机污染物可能是一种替代治疗溶骨性病变的非负重骨。

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Amyloidosis is a heterogeneous group of disorders characterized by extracellular deposition of unique protein fibrils. Amyloidosis may be hereditary or acquired, and the deposits may be focal, localized, or systemic in distribution. The least common presentation of an amyloid deposition is as a discrete mass called amyloidoma or amyloid tumor. Although described at various body sites, soft-tissue amyloidoma in an extremity is exceedingly rare. We report such a case of a large amyloidoma in the thigh, which simulated a soft-tissue sarcoma. In spite of attaining a very large size over a course of more than 20 years, the clinical course and the histology of this lesion were benign. Awareness of this entity will allow this rare diagnosis to be considered, prevent confusion with malignant disease, and allow appropriate management and patient reassurance. A review of literature on soft-tissue amyloidomas of extremities is also being presented.

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淀粉样变性病是一种异质性疾病集团的特点是独特的胞外蛋白沉积的纤维。可能是遗传性淀粉样变或后天，和存款可协调，局部或全身分布。最常见的表述是一种淀粉样蛋白沉积的离散质量要求amyloidoma或淀粉样肿瘤。虽然在不同的机构介绍的网站，软组织amyloidoma在下肢是极其罕见的。我们报告这种情况下，一个大amyloidoma的大腿，模拟软组织肉瘤。尽管实现一个非常大的规模过程中超过20年，临床过程和组织学的这个病灶为良性。认识到这个实体将让这难得的诊断加以考虑，防止混乱，恶性疾病，并允许适当的管理和病人放心。审查的文献软组织amyloidomas四肢也被提出。

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We report two siblings aged 11 and 7 years, respectively, who presented with the clinical and radiographic features of opsismodysplasia (non-lethal type). 3D computed tomography scans of the craniocervical region revealed a split atlas and os odontoideum in both siblings. To the best of our knowledge, this is the first clinical report detailing craniocervical malformations in two siblings with opsismodysplasia.

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我们提出的两个哥哥11岁和7岁，分别提交了谁的临床和影像学表现opsismodysplasia （非致命型）。三维计算机断层扫描的颅地区发现了分裂Atlas和全部odontoideum在兄弟姐妹。据我们所知，这是第一次临床报告，详细说明颅颈畸形的两个哥哥与opsismodysplasia 。

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A 32-year-old woman with bilateral hip chondrolysis diagnosed 2 years following allogeneic liver transplantation is described. Severe osteoarthritis was demonstrated on physical examination, serial radiographs and magnetic resonance imaging. Only four cases of chondrolysis in solid organ recipients have been described in the literature.

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一名32岁女子与双边髋chondrolysis诊断二年以下同种异体肝移植的方法。严重的骨性关节炎表现出的身体检查，串行线和磁共振成像。只有4例chondrolysis固体器官接受者已说明了文献中。

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