Rheumatoid arthritis (RA) is a chronic systemic disease of unknown origin that predominantly involves synovial tissue. RA affects 0.5%-1.0% of the global population, with females affected more frequently than males. Early diagnosis and initiation of proper therapy help modify the course of the disease and reduce the degree of severe late sequelae. Radiology plays a key role in diagnosis and management of RA. Currently, magnetic resonance imaging is the best imaging modality because it depicts soft-tissue changes and damage to cartilage and bone even better and at an earlier stage than does computed tomography. Ultrasound and conventional radiography are more readily available but cannot show the entire spectrum of the disease. Diagnosis and differential diagnosis are achieved by identifying certain radiologic parameters, which are also used for grading purposes. The disease does not follow a linear course, especially with the early initiation of potent therapy. Knowledge of the imaging findings enables the radiologist to accurately select the most helpful imaging technique. Familiarity with the pathophysiologic mechanisms of RA, the imaging findings, and the grading systems and a basic knowledge of therapeutic regimens are prerequisites for a tailored diagnostic approach by the radiologist.

Vascular injuries in lumbar disk surgery, although rare, are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important that surgeons and radiologists be aware of these potentially fatal complications and develop an appropriate symptom-based diagnostic paradigm. We reviewed 8099 consecutive cases of lumbar disk surgery, performed over a 14-year period at a single institution, for postoperative vascular complications. We identified four patients (0.05%) with lumbar disk surgery-related vascular complications: intraoperative lacerations of the abdominal aorta and median sacral artery, an arteriovenous fistula between the left common iliac artery and vein detected 19 days postdiskectomy, and a partially thrombosed aortic aneurysm with an arteriovenous fistula between the aneurysm and the inferior vena cava, diagnosed 11 months after surgery. The majority of cases in the literature of vascular injury in lumbar disk surgery were reported prior to 1965. Diagnostic approaches described in that period do not reflect the great range of diagnostic techniques available today. Angiography remains the gold standard for diagnosis and guidance as to surgical repair. However, a high index of suspicion based on clinical signs and/or the use of sonography or CT is important in the detection of these complications.

Transient irradiation-induced increase in tumor capillary permeability to cisplatin can be quantified with MMCM-enhanced MR imaging.

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The purpose of this study was to compare a new MR macromolecular contrast medium (MMCM), gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-24-cascade-polymer, to a well-studied prototype MMCM, for the potential of distinguishing tissues of varying endothelial permeability. Three tissue models of varying capillary permeability were studied in a total of 46 rats: normal myocardium (normal capillaries), subcutaneously implanted adenocarcinoma (mild capillary leak), and reperfused infarcted myocardium (high capillary leak). TI-weighted MRI was performed before and dynamically after injection of either albumin-(Gd-DTPA)30 or the cascade polymer (each .02 mmol gadolinium [Gd] per kg). Data analysis based on a two-compartment kinetic model yielded estimates of fractional blood volume (BV) (percentage) and fractional leak rate (FLR) (1 per hour). Permeability to the cascade polymer as reflected in FLR was considerable in normal myocardium (8.24 per hour), of similar value in tumors (8.55 per hour), but significantly greater in infarcted myocardium (39.17 per hour, P < .01) versus normal myocardium. The larger albumin-(Gd-DTPA)30 demonstrated minimal extravasation in normal myocardium (FLR .33 per hour); FLR in tumors was 100% higher (.66 per hour, P < .002) and FLR in reperfused capillaries was significantly greater (7.94 per hour, P < .001). Based on capillary permeability measurements, the cascade polymer may have limited utility for detection of mildly increased microvascular permeabilities. For severe tissue injury, the cascade polymer can resolve abnormal microvascular integrity.

Although the exact pathogenesis of central pontine myelinolysis (CPM) is unknown, correction of hyponatremia, thyreotropin releasing hormone, plasmapheresis, and corticosteroids seem to be effective. Assuming intravenous immunoglobulins (IVIG) to also be effective in CPM, 0.4 g/kg body weight/d immunoglobulins were applied to a 48-year-old patient who developed CPM with double vision, dysarthria, dysphagia, and left-sided hemiparesis 3 weeks after spontaneous normalization of hyponatremia. After 5 days of IVIG, his symptoms markedly improved, confirmed by improvement in the Norris score (42%), Frenchay score (19%), Kurtzke score (20%), Disability score (54%), vital capacity (26%), and peak torque (69%). The promising clinical effect of IVIG was assumed to be caused by the reduction of myelinotoxic substances, the development of antimyelin antibodies, and the promotion of remyelination. In conclusion, IVIG appear to be a promising therapeutic option in CPM.

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The temporomandibular joint (TMJ) is a common site of complaint. Clicking sounds and pain are indicators of a frequent condition called internal derangement, most often affecting females. As a general term, internal derangement describes a structural abnormality within an articulation. The internal derangement of the TMJ is a specific term defined as an abnormal positional and functional relationship between the disk and articulating surfaces. Imaging of the joint is an important element in the diagnostic work-up. Trauma and inflammatory arthritis account for most of the other TMJ problems. A thorough understanding of joint anatomy and normal function is a prerequisite for perceiving abnormalities and making the correct diagnosis. The authors elucidate joint anatomy, correlating cadaveric specimen and anatomic slices with conventional and cross-sectional imaging studies. TMJ biomechanics are illustrated with schematics and animations, and an overview of imaging strategies and techniques is presented. Common abnormalities are described and illustrated, and a brief discussion of therapeutic options is included.