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SummaryAn objective radiographic study of erosions, fractures, and periarticular and vascular calcification was made in a series of 135 patients over 10 years of maintenance haemodialysis therapy. The four lesions progressed at different rates, consistent with variation in the response of tissues to a changing biochemical milieu and deficiency in vitamin D metabolites. The half time for development of individual radiographic signs was 3-4 years for vascular calcification, 9 years for fractures, 16 years for periarticular calcification, and 22-9 years for erosions. Calcification of the dorsalis pedis artery seen as a developing ring or tube was an early and valuable sign of disturbed calcium metabolism. In these patients renal osteodystrophy is a chronic condition with a prolonged time course.

SummaryA study of 150 patients undergoing haemodialysis has shown that age had a striking effect on the radiological presentation of renal bone disease, erosions being common in the young and uncommon in older patients and vascular calcification showing opposite trends to this. Men aged 20 to 59 years had a greater tendency to develop erosions than did women in this age range. Examination of a group of 53 patients over a period of five years showed that the half time for the development of vascular calcification was 4'6 years, erosions 26-7 years, and fractures 6-9 years. Nine out of 16 polycystic patients matched for age and sex with 50 controls did not develop erosions and had consistently less vascular calcification than the controls when examined over a six-year period.

The radiological investigation of neurosarcoidosis is discussed in relation to a series of 32 patients presenting to a neurological hospital. Cranial computed axial tomography, performed in 13 of these cases, was the most frequently positive procedure (77%). The indications for air studies are now limited but in cases with nerve or chiasmal syndromes and negative CAT they may show small mass lesions, or incomplete filling of basal cisterns due to granulomatous infiltration or fibrosis. Sarcoid masses are avascular and angiography is only useful for exclusion of incidental tumours with pathological circulation. Cord syndromes were present in eight cases, but myelography was only indicated in five of these and was normal in three. The cord may be involved by intra-medullary granulomas or meningeal infiltration causing arachnoiditis, both of which cause myelographic abnormalities though these are not specific for sarcoidosis.

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In a group of 121 adult patients with end-stage chronic renal failure who had been undergoing maintenance haemodialysis for up to 10 years a number of biochemical variables have been measured and related to a set of objective radiological changes in the same patients. The changes in plasma calcium, magnesium, phosphate, total protein, and albumin concentration did not distinguish the patients who were grouped on a radiological basis. Plasma alkaline phosphatase activity increased with the severity of the radiological findings but did not provide a sensitive discriminatory index between the different radiological groups. Plasma hydroxyproline concentration was found to be more sensitive than plasma alkaline phosphatase activity in detecting a radiological abnormality in some of the patients.

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