SUBJECTS AND METHODS. Two hundred eighteen patients with single or recurrent anterior shoulder dislocation underwent shoulder CT examination. Fifteen patients had bilateral dislocation. Prevalence and severity of glenoid bone loss and glenoid fracture were assessed. CT examinations of 56 control subjects without shoulder dislocation were evaluated for glenoid contour and side-to-side variation in glenoid width.

RESULTS. Glenoid bone loss was present in 27 (41%) of 66 patients with first-time unilateral dislocation and 118 (86%) of 137 patients with recurrent unilateral dislocation. Glenoid bone loss ranged from –0.3% to –33% (mean, –10.8% ± 7.9%). Seventy-four (51%) of 145 patients had ≤ 10% glenoid bone loss, 54 (37%) had between 10% and 20%, eight (6%) had between 20% and 25% glenoid bone loss, and nine (6%) had ≥ 25% glenoid bone loss. Glenoid rim fractures were present in 49 (21%) of 233 dislocated shoulders. The number of dislocations correlated moderately with the severity of glenoid bone loss (r = 0.56). The normal side-to-side glenoid width variation was small (0.46 ± 0.81 mm).

CONCLUSION. Glenoid bone loss is common in anterior shoulder dislocation. It is probably multifactorial in origin, is usually mild in degree, and has a maximum observed severity of –33%. Dislocation frequency cannot accurately predict the degree of bone loss.

MATERIALS AND METHODS. Monosegmental lumbar spondylodesis with autologous iliac crest graft or solvent-preserved bovine cancellous bone was performed on seven sheep. The fused spinal segments were explanted after 24 weeks and examined with clinical 64-MDCT, high-resolution peripheral quantitative CT, and contact radiography. In 2D views, the area of the disk space bridged by bone was assessed, and the grafts were examined for fractures.

RESULTS. In three of seven sheep, clinical CT erroneously showed stable consolidation, whereas contact radiography revealed a clearly visible graft fracture, as did high-resolution peripheral quantitative CT. There was a statistically significant difference (p = 0.038) between bone volume assessed with clinical CT and that assessed with contact radiography. There was an almost significant difference (p = 0.053) between volumes assessed with high-resolution peripheral quantitative CT and clinical MDCT.

CONCLUSION. High-resolution peripheral quantitative CT, a technique approved for clinical use, has higher resolution in imaging of bone structure than does 64-MDCT. Our results show that high-resolution peripheral quantitative CT is superior to 64-MDCT in assessing osseous implant integration after anterior spondylodesis. The specimen size limit, however, prohibits in vivo use of this method in evaluation of the human spine. Our results suggest that in clinical practice, persisting symptoms despite radiologic findings of consolidated spondylodesis may be related to graft failure, which cannot be detected with clinically available methods.

MATERIALS AND METHODS. At 1.5 T, 50 consecutive patients' hips were evaluated on sets of oblique axial images. Two musculoskeletal radiologists recorded their subjective opinion as to the alpha angle using a confidence scale of 1–5. Direct mathematic measurement of the alpha angle was done by a third independent observer and correlated with the subjective results. Correlations between the subjective and measured angles and interobserver variation were calculated.

RESULTS. Statistically, significant variability was seen in the subjective assessment of the alpha angle. When the alpha angle was > 55°, the area under the receiver operating characteristic curve (AUC) was 0.606, indicating that visual assessment is a poor predictor of a wide alpha angle. Even in patients with a measured normal alpha angle (< 55°), slightly fewer than half were subjectively thought to possibly, likely, or definitely have abnormal angles. Similarly, more than half of the abnormal cases (alpha angles > 55°) were subjectively thought to possibly or probably be normal.

CONCLUSION. Subjective assessment of alpha angles is suboptimal unless one is quite confident of a bone abnormality.

SUBJECTS AND METHODS. In this prospective study, neurosclerosis was performed on 82 patients by means of high-resolution sonographically guided injection of up to 0.8 mL of 80% phenol solution according to a standardized protocol.

RESULTS. During treatment all patients had marked improvement in terms of reduction of pain measured with a visual analog scale. Twelve (15%) of the subjects were pain free after one to three treatments, nine of the 12 achieving relief with the initial instillation. At 6-month follow-up evaluation, 52 patients assessed their present pain quantity with a simplified three-step score. Twenty (38%) of the 52 patients reported almost unnoticeable pain, and 33 (64%) reported pain equal to the minimum reached during therapy. In 18 (35%) of the 52 patients, the incidence of painful periods had markedly decreased. The neurosclerosis procedure had a low complication rate (5% rate of minor complications, 1.3% rate of major complications).

CONCLUSION. The high-resolution sonographically guided neurosclerosis procedure had a significantly better outcome than other documented treatments. Sonographically guided neurosclerosis should be included in the management of chronic phantom limb and stump pain.

CONCLUSION. We provide important guidelines and key examples that will help readers perform percutaneous needle bone biopsy safely.

SUBJECTS AND METHODS. Forty-one patients with histologically confirmed myeloma were prospectively examined with a whole-body MDCT protocol and whole-body MRI on a 1.5-T system. The MRI protocol consisted of T1-weighted spin-echo and STIR sequences. For data analysis, the entire skeleton was divided into 61 regions per patient. Image evaluation was performed in a consensus reading by two radiologists blinded to the patients' history, with separate evaluation of each technique. The patients were staged by MRI and MDCT data separately according to the Durie and Salmon PLUS staging system.

RESULTS. On MRI, 15 patients showed no involvement. In 26 patients, 975 regions were affected: 21 patients were stage I, two were stage II, and 18 were stage III. On MDCT, 19 patients showed no involvement. In 22 patients, 462 regions were affected. For the detection rate, MRI was statistically superior to MDCT (p < 0.001, Wilcoxon's signed rank test). According to MDCT, 25 patients were stage I, seven were stage II, and nine were stage III. In 21 patients with involvement detected on both methods, MRI showed more extensive disease than MDCT. Eleven patients were understaged with MDCT compared with MRI, which was statistically significant (p < 0.001, chi-square test).

CONCLUSION. Whole-body MDCT leads to a significantly lower detection rate and staging in patients with multiple myeloma.

SUBJECTS AND METHODS. Forty-five shoulders in 39 patients who had undergone shoulder MRI for the assessment of rotator cuff disease were evaluated blindly with sonography. Supraspinatus muscle atrophy was quantitatively assessed by calculating the occupation ratio (cross-sectional surface area of the supraspinatus muscle belly divided by that of its fossa). This was done by reproducing on sonography the equivalent of the "Y" view on MRI. Fatty infiltration was assessed by evaluating supraspinatus muscle echogenicity compared with that of the trapezius muscle and pennate pattern. The occupation ratio and fatty infiltration of the supraspinatus muscle on sonography were compared with these findings on MRI.

RESULTS. Occupation ratios calculated on sonography images ranged from 0.07 (severe atrophy) to 0.81 (normal) and correlated with the ratios calculated on MRI (R = 0.90; 95% CI, 0.83–0.95). All 20 shoulders with no fatty infiltration on MRI had normal echogenicity and a pennate pattern on sonography. Eight of the 10 shoulders with mild fatty infiltration on MRI had an effaced pennate pattern and mild hyperechogenicity on sonography. In 13 of the 15 shoulders with moderate to severe fatty infiltration on MRI, the pennate pattern was absent and marked hyperechogenicity was present on sonography.

CONCLUSION. Our study suggests that there is a good correlation between sonography and MRI for the assessment of supraspinatus muscle atrophy and fatty infiltration.

CONCLUSION. Postoperative evaluation of the total ankle arthroplasty necessitates a familiarity with the various designs currently in use. Radiography serves as an integral component in the postoperative evaluation of such devices, with CT offering further characterization of radiographic abnormalities.

CONCLUSION. Hip MR arthrography with leg traction is a technically feasible and safe procedure that improves visualization of the femoral and acetabular cartilage surfaces.