Objective. To establish by means of ultrasound and magnetic resonance imaging (MRI) the role of tenosynovitis and arthritis in determining the "sausagelike" aspect of finger dactylitis and to compare the results of the 2 examinations.Methods. Twelve dactylitic fingers and their corresponding normal contralateral fingers belonging to 10 patients who met the Amor criteria for the diagnosis of seronegative spondylarthropathy (SpA) were studied by ultrasonography and MRI.Resuh. MRI revealed a significant increase in the volar bone-to-skin distance in dactylitic fingers with respect to that of the normal contralateral fingers (P < 0.001). This increase was due to distension of the flexor synovial sheaths (P < 0,00001) by fluid collection.Peritendinous soft tissues were not involved, since these were Found to be significantly thicker in the normal fingers (I' < 0.05). OF the 36 joints of the 12 dactylitic fingers, only 1 showed capsule distension. Using MRI as the "gold standard," ultrasonography showed a 100% sensitivity and specificity for flexor tenosynovitis, but lacked sensitivity for joint involvement because it failed to reveal joint capsule distension in the only joint involved. Similarly, physical examination showed a 100% sensitivity and specificity For flexor sheath involvement.
ObjectiveTo assess the impact that examiner experience has on the reproducibility and
accuracy of computed tomography (CT) enterography in the detection of
radiological signs in patients with Crohn's disease.Materials and MethodsThis was a retrospective, cross-sectional observational study involving the
analysis of CT enterography scans of 20 patients with Crohn's disease. The
exams were analyzed independently by two radiologists in their last year of
residence (duo I) and by two abdominal imaging specialists (duo II). The
interobserver agreement of each pair of examiners in identifying the main
radiological signs was calculated with the kappa test. The accuracy of the
examiners with less experience was quantified by using the consensus among
three experienced examiners as a reference.ResultsDuo I and duo II obtained a similar interobserver agreement, with a moderate
to good correlation, for mural hyperenhancement, parietal thickening, mural
stratification, fat densification, and comb sign (kappa: 0.45-0.64). The
less experienced examiners showed an accuracy > 80% for all signs, except
for lymph nodes and fistula, for which it ranged from 60% to 75%.ConclusionLess experienced examiners have a tendency to present a level of
interobserver agreement similar to that of experienced examiners in
evaluating Crohn's disease through CT enterography, as well as showing
satisfactory accuracy in identifying most radiological signs of the
disease.
The case of a patient with seronegative spondyloarthropathy showing oligoarthritis of the hand together with large pitting oedema is reported. Unlike the patients with late onset peripheral spondyloarthropathy described by Dubost and Sauvezie who show minimal involvement of the axial skeleton, the patient has been suffering from AS for about twenty years.
We describe a 30-year-old woman with syringomyelia, who developed recurrent painless whitlows of the left hand that led to amputation of the terminal phalanx of the 4th finger and considerable shortening of the terminal phalanges of the 1st, 2nd, 3rd and 5th fingers. A roentgenogram of the left hand showed a complete resorption of the terminal phalanges of the 3rd, 4th and 5th fingers and partial resorption of the terminal phalanx of the 2nd finger. Although the defective sensory function undoubtedly contributes to the development of bone resorption by facilitating mechanical repetitive injuries and infections, impaired vasomotor function possibly plays an equally important role.
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