The importance of radiographic evaluation of the scapholunate space, which should not be wider than 2 mm, has been well established in cases of wrist injury. Unfortunately, the assessment of this space is not accurately determined with routine posteroanterior (PA) radiographs, because the scaphoid and lunate bones often overlap. Moreover, the exact portion of the scapholunate space that should be measured has never been clearly defined. Nine wrists with a scapholunate space no wider than 2 mm and without chondrocalcinosis were studied by means of plain routine views and special projections, transaxial and coronal computed tomographic scans, and dissection to determine the precise orientation and anatomy of this space. A PA radiograph with 10 degrees of tube angulation from the ulna toward the radius best demonstrated the scapholunate space. This space should be measured at the level of the midportion of the flat lateral facet of the scaphoid.
Necrosis of fatty bone marrow, caused by lipolytic enzymes, is a rare complication of several pancreatic disorders. A 44-year-old man with polyarthritis, subcutaneous nodules, and osteolysis associated with alcoholic pancreatitis underwent magnetic resonance (MR) imaging of the knees. In the marrow of the distal femur and proximal tibia, the images showed multiple foci of abnormal signal intensity compatible with the diagnosis of fat necrosis secondary to acute pancreatitis. Because MR imaging can depict abnormalities in fatty marrow that seem to precede necrosis, this modality may add early diagnostic information.
To provide further understanding of the magnetic resonance (MR) signal intensities in the triangular fibrocartilage (TFC) and interosseous ligaments of the wrist, the authors performed MR imaging with gross pathologic and histologic analysis in 10 cadaveric wrists. Spin-echo T1- and T2-weighted coronal images were obtained, and 3-mm coronal sections of the specimens were then made that correlated precisely with the MR images. Normal portions of the TFC showed asymmetrical bow tie-like low signal intensity, except near the radial and ulnar attachments. Degeneration of the TFC, present in all cases, was more severe on the proximal surface and was characterized by high signal intensity on T1-weighted images and less high signal intensity on T2-weighted images. These findings differed from those in TFC perforation, which showed high signal intensity on T2-weighted images. Similar signal intensity characteristics could allow differentiation of degeneration and perforation of the scapholunate and lunotriquetral ligaments. These findings suggest that in vivo MR imaging may accurately delineate degeneration and perforation of the TFC and intercarpal ligaments.
Although the radiologic manifestations of degenerative disease of the knee have been investigated, the distribution of marginal and central osteophytes has not been defined. This study included (a) 50 consecutive patients with osteoarthritis of the knee in whom routine and specialized projections were obtained prospectively, (b) 25 patients with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease whose knee radiographs were retrospectively reviewed, and (c) four cadaveric knees that were dissected to assess pertinent anatomy. In this study the importance of the tunnel view in the evaluation of osteoarthritis and CPPD crystal deposition disease is demonstrated, the distribution of and the relationship between marginal and central osteophytes are discussed, and two new radiologic signs are described. As both marginal and central osteophytes may simulate intraarticular bodies, the recognition of these outgrowths is of clinical importance.
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