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A tailgut cyst (retrorectal cystic hamartoma) is an uncommon lesion that develops in the presacral (retrorectal) space. Malignant change in a tailgut cyst is extremely rare and presents as a soft tissue (presacral) or bone (sacral)... more
A tailgut cyst (retrorectal cystic hamartoma) is an uncommon lesion that develops in the presacral (retrorectal) space. Malignant change in a tailgut cyst is extremely rare and presents as a soft tissue (presacral) or bone (sacral) neoplasm. We report a case of tailgut cyst in which a neuroendocrine tumor developed in a 25-year-old female. Computed tomography and magnetic resonance imaging scans revealed a sacrococcygeal malformation with absent left S4 and S5 and a partly cystic lesion within the right presacral space. Histologically, the lesion contained cystic and solid elements. The cysts were lined by columnar and stratified squamous epithelial cells with underlying patchy smooth muscle. The solid element was a partly necrotic neuroendocrine tumor composed mainly of ribbons of tumor cells, which showed mitotic activity and expressed cytokeratin, chromogranin, and synaptophysin. Histologically, tailgut cysts are lined by epithelium and contain scattered smooth muscle bundles in ...
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In recent years significant advances have been made in imaging techniques. Dual-energy computed tomography has revolutionized the ability to detect and quantify gout. The key ultrasound features of gout have been defined. Magnetic... more
In recent years significant advances have been made in imaging techniques. Dual-energy computed tomography has revolutionized the ability to detect and quantify gout. The key ultrasound features of gout have been defined. Magnetic resonance imaging is an excellent modality for demonstrating the extent and severity of crystal arthropathies, but the findings may be nonspecific. This article summarizes the use of advanced imaging techniques in the diagnosis and assessment of gout and other crystal arthropathies.
The syndromes synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) and chronic recurrent multifocal osteomyelitis (CRMO) constitute a group of chronic relapsing inflammatory osteoarticular disorders with frequently associated... more
The syndromes synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) and chronic recurrent multifocal osteomyelitis (CRMO) constitute a group of chronic relapsing inflammatory osteoarticular disorders with frequently associated skin eruptions such as palmoplantar pustulosis and acne conglobata and rather characteristic imaging features in the form of osteitis and/or hyperostosis. CRMO predominantly occurs in children/adolescents and SAPHO in adults. Any skeletal site can be involved, and the imaging appearances vary, depending on the patient's age and the stage/age of the lesion. The diagnosis may be difficult if there is no skin disease, but attention to characteristic imaging appearances may help avoid misdiagnosis (e.g., infection and tumor) and thereby unnecessary invasive procedures as well as facilitating early diagnosis and appropriate treatment. This article provides an overview of the radiologic appearances of SAPHO/CRMO and relevant pathogenetic, clinical, and...
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... Teh, consultant radiologist 1,; Tony Berendt, consultant physician 2,; Benjamin A Lipsky, professor of medicine3. 1 Radiology Department, Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD; 2 Bone Infection Unit, Nuffield... more
... Teh, consultant radiologist 1,; Tony Berendt, consultant physician 2,; Benjamin A Lipsky, professor of medicine3. 1 Radiology Department, Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD; 2 Bone Infection Unit, Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD ...
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Pigmented villonodular synovitis is an uncommon benign neoplastic process that affects synovial-lined joints, bursae and tendon sheaths. We describe polyarticular extension of pigmented villonodular synovitis across joints secondary to... more
Pigmented villonodular synovitis is an uncommon benign neoplastic process that affects synovial-lined joints, bursae and tendon sheaths. We describe polyarticular extension of pigmented villonodular synovitis across joints secondary to pigmented villonodular tenosynovitis. Given that treatment is required to prevent progressive destruction of the involved joint, tendon or bursa, radiologists must be vigilant for diffuse polyarticular or extrasynovial involvement to optimize patient care and initiate appropriate therapy.
Research Interests: Computed Tomography, Chronic Fatigue Syndrome, Morphometry, Pathophysiology, Cortisol, and 15 moreHumans, Female, Male, Exploration, Disease Control, Middle Aged, Atrophy, Adult, Adrenocorticotropic Hormone, Adrenal Gland, Healthy Subjects, Adrenal glands, Psychology and Cognitive Sciences, hydrocortisone, and Medical and Health Sciences
Research Interests: Ultrasound, Biopsy, Humans, Transducers, Female, and 5 moreClinical Sciences, Adult, Hand, Wrist, and Needles
ABSTRACT Background: Both CT and fluoroscopically guided biopsies may be performed for suspected infective spondylodiscitis or malignancy. Fluoroscopically guided biopsies reduce both radiation exposure & costs. We determined the... more
ABSTRACT Background: Both CT and fluoroscopically guided biopsies may be performed for suspected infective spondylodiscitis or malignancy. Fluoroscopically guided biopsies reduce both radiation exposure & costs. We determined the efficacy of percutaneous fluoroscopically-guided spinal biopsy (FGSB) compared with the published literature on CT guidance. Methods: We used prospectively maintained procedure log books to identify all patients who had percutaneous FGSB between 1999 & 2007. We reviewed case records retrospectively to assign the diagnosis of infective spondylodiscitis, tumour or degenerative disc disease based on clinical, microbiological & histopathological data. Results: We identified 77 biopsies in 75 patients (41 male, 34 female). Median age was 60 (range 21-84). Biopsies were performed between the T6 body & L5/S1 disc level, with no biopsy related complications. In 33 (44%) and 27 (36%) the diagnosis of infective spondylodiscitis & tumour respectively was made by a single FGSB procedure. In 14(18.7%) degenerative disc disease was diagnosed & confirmed by follow-up. In one case an open biopsy was required after a false negative percutaneous biopsy. Of the 33 infective spondylodiscitis cases 24 (73%) were culture-positive (see table) & 6 later required surgical decompression. Conclusions: Percutaneous FGSB combines low-risk diagnostic accuracy with reduced costs & radiation dosage compared to CT. The diagnostic yield is at least equivalent to the published experience with CT guided biopsy & reliably diagnoses infective causes. Diagnoses in 77 Percutaneous Fluoroscopically Guided Spinal Biopsies (FGSB) Diagnosis Number Specific pathogen Number Infection 33 Staphylococci 11 Streptococci 7 Enterobacteriaciae 2 Anaerobes 2 Mycobacteria 2 Culture-negative 9 Tumour 27 - - Degenerative disc disease 14 - -
Research Interests: Humans, Knee, Male, Magnetic Resonance, Connective tissue, and 15 moreOSTEOMALACIA, Musculoskeletal pain, Fibroblast Growth Factor, Calcitriol, Alkaline phosphatase, Clinical Sciences, European, Middle Aged, Phosphates, Biological markers, Paraneoplastic Syndromes, Hypophosphatemia, Glomerular Filtration Rate, Magnetic resonance image, and Paediatrics and reproductive medicine
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To assess whether there is a significant difference in the ischiofemoral space in patients with multiple hereditary exostoses affecting the proximal femora compared to normal patients. Ischiofemoral impingement is an increasingly... more
To assess whether there is a significant difference in the ischiofemoral space in patients with multiple hereditary exostoses affecting the proximal femora compared to normal patients. Ischiofemoral impingement is an increasingly recognized cause of hip and buttock pain. This causes narrowing of the ischiofemoral space resulting in an abnormal quadratus femoris muscle. We performed a retrospective search for individuals with MHE with proximal femoral involvement on pelvic MRI over a 7-year period (2006-2013). Suitable patients were age- and sex-matched with a control group. The minimum ischiofemoral space (MIFS) was recorded in each hip, as was the presence of edema and atrophy of quadratus femoris and concomitant hip osteoarthrosis. MRI features suggestive of ischiofemoral impingement were defined as MIFS less than 10 mm or an abnormal quadratus femoris muscle. Twenty-one hips in 11 individuals with MHE were included in the study. A total of 42 hips were analyzed. The mean age was 37 years (range, 13-72 years) and 55% were male. There was a significant difference (p < 0.05) in the MIHS in individuals with MHE (mean, 10.7 mm, range, 0-21 mm) compared to a control group (mean, 18.1 mm, range, 10.5-26.5 mm). MRI features suggestive of ischiofemoral impingement were seen in 13/21 (62%) hips in the MHE group and 0/21 (0%) in the control group. The reduced ischiofemoral space and associated quadratus femoris abnormalities in patients with MHE involving the proximal femora may account for hip/buttock symptoms in the absence of significant degenerative change.
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This pictorial review illustrates the ultrasound appearances of pathological conditions affecting muscle with particular emphasis on extended field-of-view imaging.
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Pathological conditions affecting the musculoskeletal system often result in alterations of regional blood flow. The assessment of a Doppler signal in inflammatory or infective processes complements the grayscale findings, helping to... more
Pathological conditions affecting the musculoskeletal system often result in alterations of regional blood flow. The assessment of a Doppler signal in inflammatory or infective processes complements the grayscale findings, helping to evaluate the severity of disease. Doppler imaging can also be used to determine therapeutic response or help guide injections. In addition, Doppler interrogation enables vascular characterization of solid masses. The presence of a Doppler signal can also help differentiate solid from cystic lesions. This article reviews the wide range of applications for Doppler imaging of the musculoskeletal system.
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Research Interests: Magnetic Resonance Imaging, Adolescent, Anterior Cruciate Ligament, Humans, Child, and 15 moreFemale, Male, Clinical Sciences, Aged, Middle Aged, Observer Variation, Adult, Knee injuries, Retrospective Studies, Cross Sectional Studies, Knee Joint, Tendons, Severity of Illness Index, Acute Disease, and Joint diseases
Research Interests: Treatment Outcome, Humans, Shoulder, Female, Male, and 6 moreClinical Sciences, Aged, Middle Aged, Adult, Fluid Therapy, and Dilatation
Research Interests: Computed Tomography, Chronic Fatigue Syndrome, Morphometry, Pathophysiology, Cortisol, and 15 moreHumans, Female, Male, Exploration, Disease Control, Middle Aged, Atrophy, Adult, Adrenocorticotropic Hormone, Adrenal Gland, Healthy Subjects, Adrenal glands, Psychology and Cognitive Sciences, hydrocortisone, and Medical and Health Sciences
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Investigation of paediatric skeletal trauma requires careful consideration of not only the site of injury, but the proposed mechanism of trauma and the age of the child. Ultrasound is increasingly being used to detect and delineate... more
Investigation of paediatric skeletal trauma requires careful consideration of not only the site of injury, but the proposed mechanism of trauma and the age of the child. Ultrasound is increasingly being used to detect and delineate musculoskeletal injury, either as the primary imaging modality or as an adjunct to other modalities, particularly magnetic resonance imaging (MRI). The advent of high
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Stress fractures are an uncommon but important source of pain and disability in young athletes. The presentation and differential diagnosis of stress fractures in young athletes differs from that of older athletes. This pictorial review... more
Stress fractures are an uncommon but important source of pain and disability in young athletes. The presentation and differential diagnosis of stress fractures in young athletes differs from that of older athletes. This pictorial review outlines the pathogenesis and imaging features of stress fractures. Other pathologies that can mimic stress fractures and the advantages of the use of magnetic resonance imaging will be discussed. An imaging algorithm for a suspected stress fracture is suggested.
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Research Interests: Foot and Ankle Surgery, Football, Humans, Female, Male, and 7 moreClinical Sciences, Middle Aged, Adult, Calcaneus, Prognosis, Flatfoot, and Tendons
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Research Interests: Ultrasound, Biopsy, Humans, Transducers, Female, and 5 moreClinical Sciences, Adult, Hand, Wrist, and Needles
Oncogenic osteomalacia (OOM) is characterised by tumour production of fibroblast growth factor 23 (FGF23) that results in hypophosphataemia and renal phosphate wasting, reduced 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) synthesis and... more
Oncogenic osteomalacia (OOM) is characterised by tumour production of fibroblast growth factor 23 (FGF23) that results in hypophosphataemia and renal phosphate wasting, reduced 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) synthesis and osteomalacia. Here, we demonstrate the roles of serum FGF23 and 1,25(OH)2D3, together with the lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1), as biomarkers for OOM. A previously well 52-year-old man presented with a 2-year history of generalised musculoskeletal pain and proximal myopathy. He had hypophosphataemia, elevated serum alkaline phosphatase activity, low serum 1,25(OH)2D3 and a reduced tubular maximum of phosphate/glomerular filtration rate. These findings indicated a diagnosis of OOM, but magnetic resonance imaging (MRI) and octreotide scintigraphy did not identify any tumours. Treatment with oral phosphate and calcitriol resolved the symptoms and biochemical abnormalities within 6 months. Four years later, he relapsed whilst on trea...
Research Interests: Humans, Knee, Male, Magnetic Resonance, Connective tissue, and 15 moreOSTEOMALACIA, Musculoskeletal pain, Fibroblast Growth Factor, Calcitriol, Alkaline phosphatase, Clinical Sciences, European, Middle Aged, Phosphates, Biological markers, Paraneoplastic Syndromes, Hypophosphatemia, Glomerular Filtration Rate, Magnetic resonance image, and Paediatrics and reproductive medicine
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The International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the... more
The International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the diagnosis of diabetic foot osteomyelitis (DFO) for research purposes, and undertook a systematic review of the evidence relating to treatment. The consensus diagnostic scheme was based on expert opinion; the systematic review was based on a search for reports of the effectiveness of treatment for DFO published prior to December 2006. The panel reached consensus on a proposed scheme that assesses the probability of DFO, based on clinical findings and the results of imaging and laboratory investigations. The literature review identified 1168 papers, 19 of which fulfilled criteria for detailed data extraction. No significant differences in outcome were associated with any particular treatment strategy. There was no evidence that surgical debridement of the infected bone is routinely necessary. Culture and sensitivity of isolates from bone biopsy may assist in selecting properly targeted antibiotic regimens, but empirical regimens should include agents active against staphylococci, administered either intravenously or orally (with a highly bioavailable agent). There are no data to support the superiority of any particular route of delivery of systemic antibiotics or to inform the optimal duration of antibiotic therapy. No available evidence supports the use of any adjunctive therapies, such as hyperbaric oxygen, granulocyte-colony stimulating factor or larvae. We have proposed a scheme for diagnosing DFO for research purposes. Data to inform treatment choices in DFO are limited, and further research is urgently needed.
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The aim of this study was to compare the distribution of injuries between patients who have fallen and those who have jumped from a height, and to relate the mechanism of injury to the fractures sustained. Three hundred and ninety-nine... more
The aim of this study was to compare the distribution of injuries between patients who have fallen and those who have jumped from a height, and to relate the mechanism of injury to the fractures sustained. Three hundred and ninety-nine patients, admitted via Helicopter Emergency Medical Service (HEMS), classified as either having fallen or jumped from a height were included in the study. The radiographs from the primary survey, together with radiographs of specific injury sites were analysed. The distribution of injury was compared in the two groups. Of the 399 patients, 342 were fallers and 57 were jumpers. Jumpers had a higher Injury Severity Score (ISS), death rate and number of fractures per person. Jumpers sustained more rib fractures (particularly on the right), pelvic and lower limb fractures but fewer skull fractures. Jumpers tend to sustain different injuries to fallers. It is proposed that jumpers have a tendency to land feet-first and then try to break their falls on their dominant side, sustaining more right-sided rib fractures in the process. The patterns of injury that have emerged from this study have important implications for evaluating skeletal injuries in those who jump or fall from a height.
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Research Interests: Software Development, Rheumatoid Arthritis, Humans, Female, Male, and 15 moreClinical Sciences, Aged, Middle Aged, C reactive protein, Blood Flow, Clinical Assessment, Disease Activity, Erythrocyte Sedimentation Rate, Synovitis, Reliability Assessment, power Doppler, Area of Interest, Functional Disability, Software Package, and Synovial membrane
The aim of this review is to illustrate the magnetic resonance imaging features that can help differentiate osteomyelitis from neuropathic osteoarthropathy in the foot.
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... Teh, consultant radiologist 1,; Tony Berendt, consultant physician 2,; Benjamin A Lipsky, professor of medicine3. 1 Radiology Department, Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD; 2 Bone Infection Unit, Nuffield... more
... Teh, consultant radiologist 1,; Tony Berendt, consultant physician 2,; Benjamin A Lipsky, professor of medicine3. 1 Radiology Department, Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD; 2 Bone Infection Unit, Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD ...