The authors assessed the use of magnetic resonance imaging in differentiating lymphedema, phlebedema, and lipedema of the lower limb. They examined 14 patients: five with lipedema, five with lymphedema, and four with phlebedema. T1- and T2-weighted transaxial sequences were performed before administration of gadolinium tetraazacyclododecane-tetraacetic acid (DOTA) and T1-weighted spin-echo sequences were performed after administration of Gd-DOTA in each patient. Images of patients with lipedema showed homogeneously enlarged subcutaneous layers, with no increase in signal intensity at T2-weighted imaging or after Gd-DOTA administration. Patients with phlebedema had areas containing increased amounts of fluid within muscle and subcutaneous fat. In lymphedema, a honeycomb pattern above the fascia between muscle and subcutis was observed, with a marked increase in signal intensity at T2-weighted imaging. After Gd-DOTA administration, there was only a slight increase in signal intensity in the subcutis in lymphedema and phlebedema and a moderate increase in signal intensity in muscle in phlebedema.

SUMMARYThis is the first controlled study of the frequency of back pain in a European Caucasian population with diffuse idiopathic skeletal hyperostosis (DISH).Elderly patients admitted to hospital for reasons other than back pain were assessed for the presence of spinal DISH using the routine lateral chest radiograph films. A total of 106 probands (82 males, 24 females) with a mean age of 70 years fulfilled the criteria for DISH as defined previously. One hundred and seventyeight patients (117 males, 61 females) not meeting these criteria were used as controls. The prevalence of back pain was assessed by a blinded interviewer using a structured questionnaire. Our primary hypothesis was that spinal DISH positive probands had not had back pain more often than controls. This controlled study showed no statistically significant difference in pain frequency between spinal DISH positive probands and controls at any spinal level.We conclude that back pain does not occur more often in radiographically defined DISH positive probands than in controls. The radiological finding of spinal DISH, as far as it does not lead to stenosis of the spinal canal or dysphagia, thus seems to be a finding without clinical relevance.

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A total of 11 cases of untreated carcinoma of the rectosigmoid colon and 56 cases of recurrent rectosigmoid carcinoma have been investigated by computed tomography. A tumor size of more than 2 cm in diameter is easily demonstrated within the rectosigmoid wall. Invasion of the pararectal fatty planes and the neighboring structures and organs is conclusively diagnosed when obliteration of the demarcating fat planes is demonstrated. Enlargement of the regional lymph nodes of more than 15 mm diameter indicates malignant metastatic spread. Local malignant recurrence following complete resection of the rectum is recognized when the tumor size has reached 2 cm or more. Fine-needle aspiration biopsy may be necessary to conclusively identify malignant tissue within the postoperative cavity.