This study assessed the reliability of bone age determination in normal central European children using the Greulich and Pyle method and determined the effects of readers' experience on the measured bone ages. Plain hand radiographs of 47 children (aged 2 months to 18.8 years) with normal growth were analysed by four radiologists (two experienced paediatric radiologists and two radiology residents). The readers were blinded to the age of the children. The images were re-read by the same readers 2 months later. The mean intraobserver and interobserver variations were lower for experienced readers than for radiology residents. However, these differences were not statistically significant at the 5% level. The difference between the chronological age and the measured bone age was -1.5 +/- 7.6 months (p = 0.20) for the experienced readers and 2.7 +/- 10.3 months (p = 0.09) for the radiology residents. The differences between the measured bone age and chronological age were statistically significant (p = 0.04) for only one of the two radiology residents. Although the measurements by all four readers underestimated the chronological age, the differences between chronological age and bone age were within the normal variations of skeletal maturation as reported by Greulich and Pyle. Our data suggest that the reliability of bone age measurements increases with experience and that the Greulich and Pyle method may be used for central European children.
The purpose of the study was to determine the frequency of associated MR imaging findings in patients with symptomatic lumbar intraspinal synovial cysts, and to correlate MR with surgical findings. MR imaging studies of 18 patients with surgically and histopathologically proven lumbar intraspinal synovial cysts were retrospectively analyzed and correlated with surgical findings. The diameters of the synovial cysts ranged from 10 mm to 28 mm, with a mean of 16 mm. A nonhemorrhagic cyst was found in 15 patients (83%), and a hemorrhagic cyst in three patients (17%). Degenerative spondylolisthesis was found in six patients (33%) at the level of the synovial cyst, with displacement ranging from 3 to 5 mm, mean 4 mm. Surgery revealed instability and hypermobility of the facet joint at the level of the synovial cyst in all patients with degenerative spondylolisthesis, and in five additional patients. Symptomatic synovial cysts of the lumbar spine were associated with degenerative spondylolisthesis in six of 18 patients (33%) and with instability of the facet joint in 11 (61%). These findings may support the theory that increased segmental motion plays a role in the pathogenesis of synovial cysts.
Metastasising chordomas are extremely rare and only four cases with drop metastases have been reported. We report a patient with an intracranial chondroid chordoma, typically involving the clivus, treated by repeated resection, percutaneous transluminal embolisation and radiosurgery. During follow-up with MRI asymptomatic intradural drop metastases were observed throughout the spine, with transgression of the intervertebral foramen, forming a "dumbbell".
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