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Back to From The Podium
ARRS Meeting 2001 -> April 30th
101st American Roentgen Ray Society Meeting: April 30th
reported by Joseph Gagliardi, M.D.
Today I sat in on Scientific Paper Presentation Session 1, Musculoskeletal 1: Trauma. Thomas L. Pope, Jr., M.D. gave the keynote address regarding MR imaging features of patellar dislocation/relocation. Of note during his discussion was that approximately 50-70% of patients with this problem are incorrectly diagnosed. Patients often don't know that they have suffered this injury, thus it is the radiologist who frequently makes the diagnosis. Unfortunately, even after diagnosis and correction, about 15% of patients will experience a recurrance.
Papers Presented
1. Does Muscle Damage Cause Heterotopic Ossification in Spinal Cord Injury?
J. Fleckenstein and colleagues from the University of Texas Southwestern Medical Center examined 14 paraplegic patients with both three phase radionuclide imaging and MR on a 1.5 Tesla magnet. The premise was that MR imaging might be able to detect early heterotopic ossification, thus allowing early diagnosis and possible intervention. Unfortunately, the results showed that multiple muscles demonstrated abnormal signals with MR imaging such that this is not a reliable indicator for predicting heterotopic ossification.
2. Prevalence of Occult Radius Fracture on MRI in Patients with Clinically Suspected Scaphoid Fracture: Predictive Value of Radiographic Fat Pad Signs
C. Pierre-Jerome and colleagues from Rochester University Medical Center reviewed 28 acute trauma patients (less than 1 week from initial injury, mean age = 36 years) with routine three-view radiographs and MR imaging on a .2 Tesla magnet (T-1 spin echo and STIR sequences). They found that 18 of the 28 patients had a positive fat pad sign with an occult radius fracture. Furthermore, they reported that marrow edema was present in the radius on MR images in 25 of the 28 patients. The conclusion of this paper is that a painful snuff box on physical exam and a positive pronator fat pad on radiographs can be a predictor of occult radius fracture. Furthermore, MR imaging is reliable in detecting these fractures.
3. Pattern of Injuries Seen on MRI Studies of Patients Examined for Occult Hip Fractures
M. Oka and colleagues from the University of Rochester School of Medicine and Dentistry reviewed images from 76 MR hip studies on patients (mean age = 67 years) to examine what type of bone and soft tissue injury can mimic hip fractures. These investigators noted that the most common muscle group injured was the external rotators and the single most common muscle injured was the obturator externus muscle. An additional mimic also noted was fractures of the obturator ring.
4. Femoral Head Osteochondral Lesions in the Painful Hips of Young Athletes: MR Findings of Three Patients
C. Weaver and colleagues from Duke University Medical Center noted that focal abnormal signal can be found in the anterior medial femoral head with overlying cartilage irregularity following trauma in young (mean age = 24 years) high-level athletes with normal radiographs. These lesions are similar to other osteochondral lesions found elsewhere in the skeleton. MR imaging allows an early diagnosis and treatment, thus preventing development of progression to osteoarthritic change.
Paper number 5 was withdrawn and replaced by an interesting presentation by N. Major (Duke University Medical Center) entitled: MR Imaging in Asymptomatic Varsity Basketball Players in the Post Season. This paper noted that although none of the athletes had meniscal or ligament injuries present, many had bone contusions and abnormal cartilage findings.
I was unfortunately unable to sit in on the other musculoskeletal paper section today as the Categorical Course was scheduled at the same time.
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