Radiology

Schumacher, Timothy M.; Genant, Harry K.; Kellet, Michael J.; Mall, Jay C.; Fye, Kenneth H.

doi: 10.1148/126.2.289pmid: 622470

The association between histo-compatibility antigens and disease is reviewed, in particular that between HLA-B27 and spondylitic disorders, i.e. , ankylosing spondylitis, Reiter's arthritis, psoriatic arthritis, and ankylosing hyperostosis. We determined whether the presence of HLA-B27 predicted specific radiographic findings, and, conversely, whether specific radiographic changes predicted antigenic status. The prevalences of the HLA-B27 antigen in our patients were: ankylosing spondylitis, 100%; Reiter's arthritis, 93%; psoriatic arthritis, 55%; and ankylosing hyperostosis, 12%. The only specific radiographic finding associated with B27 positivity was severe spondylitis in psoriasis. Index terms (Ankylosing spondylitis, 30.740) Antigens Immunity (Psoriatic arthritis, 48.720) Reiter's syndrome, 48.730 Spine, ankylosis, arthritis

Sebes, Jeno I.; Nasrallah, Nabil S.; Rabinowitz, Jack G.; Masi, Alfonse T.

doi: 10.1148/126.2.299pmid: 622471

HLA typing for B27 antigen is a helpful diagnostic aid in the classification of peripheral arthritis patients (especially young patients) who are rheumatoid factor negative. We studied 109 patients with seronegative peripheral arthritis belonging to various clinical categories; 23% proved to be B27 positive in comparison to 7 % of normal controls. In spite of a paucity of spinal manifestations there was a high prevalence of sacroiliitis (83%) in the B27 positive peripheral arthritis patients as opposed to only 21 % in those without B27 antigen. HLA-B27 typing and radiographs of the sacroiliac joints are important differential tests. Index terms Antigens Arthritis, rheumatoid Immunity Sacroiliac joint (Sacroiliac joint, Reiters syndrome, 337.730) (Sacroiliac joint, ankylosing spondylitis, 337.740) Copyrighted 1978 by the Radiological Society of North America, Inc.

Latchaw, Richard E.; Meyer, George W.

doi: 10.1148/126.2.303pmid: 622472

The authors report the first known case of atlanto-axial subluxation in Reiter arthritis. The type of analysis, including radiographic and laboratory examinations, required for a diagnosis of atypical Reiter disease is an important feature of the case. Index terms Arthritis (Atlantoaxial subluxation, 31.4211) (Cervical spine, Reiter's syndrome, 31.730) Reiter syndrome (Skeletal system, Reiter's syndrome, 48.730)

Milgram, James W.

doi: 10.1148/126.2.305pmid: 622473

The specimens from 50 operated cases of osteochondritis dissecans of the distal femur were analyzed histopathologically. Radiodensity of the specimens of osteochondritis dissecans was due to ( a ) attached subchondral bone, ( b ) degenerative secondary calcification of articular cartilage, ( c ) revascularization with new bone, and, in the free bodies, ( d ) calcification in new surface layers of cartilage and bone. The pathological findings in the specimens suggested an etiology from trauma rather than avascular necrosis. Half of the specimens of osteochondritis dissecans contained no subchondral bone but only articular cartilage. It was postulated that the relationship of the attached lesions to the intercondylar notch of the femur, which permitted a partially retained blood supply, created a spectrum of different histopathological changes in the subchondral bone of those specimens with attached bone. Index terms (Distal femur, aseptic necrosis, 451.440) Femur Osteochondritis, dissecans Copyrighted 1978 by the Radiological Society of North America, Inc.

Weissman, Barbara N.; Rappoport, Arnold S.; Sosman, J. Leland; Schur, Peter H.

doi: 10.1148/126.2.313pmid: 622474

Hand radiographs of 59 patients with systemic lupus erythematosus (SLE) were examined. Thirty-four revealed radiographic abnormalities, most commonly periarticular soft-tissue swelling or demineralization. Alignment abnormalities, acral sclerosis, avascular necrosis, soft-tissue calcification and terminal tuft resorption were also seen. All patients with periarticular calcification or terminal tuft resorption had Raynaud's phenomenon. Clinical indicators of disease activity (including low serum complement levels) did not correlate with the presence or severity of radiographic abnormalities. Patients with abnormal radiographs generally were older at the time of diagnosis than those with normal studies. Index terms Joints, diseases Lupus erythematosus Raynaud's disease (Wrist and hand, lupus erythematosus, 43.1612)

Newberg, Arthur H.; Greenstein, Robert

doi: 10.1148/126.2.319pmid: 622475

Thorough radiographic evaluation of tibial plateau fractures is necessary in order to determine the extent and type of injury. Routine anteroposterior and lateral radiographs should be supplemented by oblique and horizontal beam lateral views. Tomography most accurately delineates fracture anatomy and thus plays a key role in planning treatment; the surgical approach is determined by the tomographic localization of the fracture fragments. The radiologist's understanding of tibial plateau fractures aids the orthopedic surgeon in the management of these patients. Index terms Knee, arthrography Knee, wounds and injuries (Proximal tibia, epiphyseal fracture, 454.414) Tibia

Fredensborg, Nis; Nilsson, Bo E.

doi: 10.1148/126.2.325pmid: 622476

The hip joint space in standard anteroposterior images of 120 normal subjects was measured with the aid of a special transparent pattern. The normal value was slightly over 4 mm, scattered between 3 and 5 mm, except for elderly men in whom values of 6 mm or more may be normal. The lower borderline value does not change with age, nor is there any change in the average joint space with age except in men in whom it increases slightly. A narrow joint space in an elderly patient should not be expected simply because the patient is old. The measuring technique is useful in population studies. In individual cases a simple measurement with a ruler serves the same purpose if the outline of the acetabular roof is well-defined on the images. Index terms Hip, diseases (Hip joint, anatomical detail, 44.920) (Hip joint, mensuration technique, 44.123) (Hip joint, normal variant, 44130) Joints

Johnson, A. Chandrahasan; Reddy, Rajaram; Johnson, Satyabama; James, A. Everette

doi: 10.1148/126.2.327pmid: 622477

Bilateral lower limb angiography was performed on 58 patients with leprosy and compared with bilateral lower limb angiography performed on 63 non-leprosy patients. The vessels in leprosy were narrow and constricted. Decreased blood flow through arteries in the distal third of the lower limb was present. Abnormal AV fistula formation in the thigh and calf muscles and in trophic ulcers of the feet was also seen. Deep inflammatory granulomatous reaction surrounding the arteries as a result of leprosy is a possible explanation for these angiographic findings and is felt to be related to trophic ulceration. These findings were specific for leprosy, precede clinical manifestations, and are helpful in management. Index terms Blood, flow dynamics Blood vessels Leprosy Malformations, arteriovenous (Skeletal system, leprosy, 48.2032)

Goldman, Amy Beth; Lane, Joseph M.; Salvati, Eduardo

doi: 10.1148/126.2.333pmid: 622478

Three adolescents with bilateral slipped capital femoral epiphyses complicating renal disease are presented. In one case, the severity of the deformities necessitated bilateral total hip replacement. Pathological specimens were available for evaluation. In all 3 cases, epiphysiolysis was accompanied by severe subperiosteal reabsorption along the medial aspect of the femoral neck, widening of the cartilaginous growth plate, and coxa vara. The radiographic diagnosis of a minimally displaced femoral epiphysis may precede the clinical symptoms. Early recognition of this complication is important, since the treatment of choice is prophylactic surgical stabilization before disabling deformities occur. Index terms Bones, primary metabolic abnormalities Epiphyses (Hip, pelvis, slipped femoral capital epiphysis, 44.4146 Kidneys, failure (Skeletal system, renal osteodystrophy, 48.573)

Rothberg, Murray; Bastidas, Jefferson; Mattey, William E.; Bernas, Elviro

doi: 10.1148/126.2.341pmid: 622479

Only 13 cases of adrenal hemangiomas have been reported, none studied angiographically. Two additional cases, evaluated preoperatively, are presented. The radiographic finding of phleboliths, when present, with the characteristic angiographic appearance of hemangiomas, allows the radiologist to correctly diagnose this benign tumor preoperatively, and where surgical risk is high, prevent a serious operative procedure. Index terms (Adrenal, benign mesenchymal neoplasm, 86.318) Adrenals, angiography Adrenals, neoplasms Angioma