Occasionally, vertebral body lesions are encountered that are ill suited to the standard posterolateral approach to biopsy. The authors used a transpedicular approach to spine biopsy in six such cases. The authors suggest that this approach be used when the location of the lesion does not allow easy access by means of the posterolateral approach.
The radiological diagnosis of Paget's disease of bone is usually straightforward because most cases conform to well-established classic descriptions. Diagnosis becomes more difficult, however, when radiological appearances are not typical or other disease processes mask or alter the behavior of Paget's disease. Examples are presented to illustrate four categories of unusual radiological presentation of Paget's disease: (1) unusual disease progression, (2) massive post-immobilization lysis, (3) metastatic spread to pagetic bone, and (4) vertebral end-plate destruction that mimics infection.
Spin echo T1- and T2-weighted images and intravenously administered gadopentetate dimeglumine-enhanced T1-weighted images were obtained in 4 normal volunteers and 11 patients (11 joints) with painful, intermittent, or persistent joint swelling of unknown etiology. These studies were retrospectively reviewed to assess the benefits of contrast-enhanced magnetic resonance imaging (MRI) in evaluating the synovium. Normal synovium and joint fluid showed no visually apparent enhancement on images obtained immediately after intravenous injection of gadopentetate dimeglumine. Abnormal synovium enhanced significantly, allowing the precise identification of equivocal or unsuspected synovial disease processes. These results suggest that, in selected cases, enhanced MRI can be a useful adjunct in the evaluation of suspected synovial disease processes.
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