Magnetic resonance imaging is an excellent technique for imaging the tendons and the ligaments of the ankle. Owing to the advantage of detailed demonstration of soft-tissue structures and capability for multiplanar demonstration of the ankle ligaments and tendons, MRI has been increasingly used in the evaluation of the ligamentous and the tendon injuries of the ankle. Knowledge of normal anatomy and of MRI appearances are essential to recognize pathological appearances. In this pictorial essay, the first of a three part series, we review the normal MRI appearances of the ankle tendons and ligaments. The anterior, lateral and medial tendon groups, the Achilles tendon and the lateral, the syndesmotic and the medial ligament groups are described and illustrated. Anatomy of the sinus tarsi is also described. Tendon and ligament pathology will be illustrated in the second part of the series, and imaging approach to ankle injuries will be outlined in the final part of this series.
High-risk skin cancer arising on the upper limb or trunk can cause axillary nodal metastases. Previous studies have shown that axillary radiotherapy improves regional control. There is little published work on technique. Technique standardization is important in quality assurance and comparison of results especially for trials. Our technique, planned with CT assistance, is presented. To assess efficacy, an audit of patients treated in our institution over a 15-month period was conducted. Of 24 patients treated, 13 were treated with radical intent, 11 with this technique. With a follow up of over 2 years, the technique had more than a 90% (10/11) regional control in this radical group. Both of the radical patients who were not treated according to the technique had regional failure. One case of late toxicity was found, of asymptomatic lymphoedema in a radically treated patient. This technique for axillary radiotherapy for regional control of skin cancer is acceptable in terms of disease control and toxicity as validated by audit at 2 years.
Significant time, staff and equipment is required to run an effective breast MRI screening programme and this must be considered by future service providers.
To describe the technical radiological aspects of isolated limb infusion (ILI) to assist those procedural radiologists who carry out ILI on an occasional only basis and to inform the Australian radiologist community about this deserving but relatively little known radiological procedure. Retrospective audit of radiological catheter placement for 23 lower limb ILI procedures carried out for 16 patients with locally recurrent melanoma over 2 years (January 2002 to December 2003). Arterial and venous catheter placement, although sometimes difficult, was successful in all but four occasions. Unfavourable vascular anatomy was the main reason for failure. If approached systematically and with the knowledge of the patient's vascular anatomy, the outcome will be satisfactory in the hands of the generalist. Knowing the common technical pitfalls will certainly assist. Isolated limb infusion deserves to be more widely known in the radiological and surgical communities.
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