Publications of Nancy M Major
%% Papers Published
@article{fds133621,
Author = {GA Toomayan and F Robertson and NM Major and BE Brigman},
Title = {Upper extremity compartmental anatomy: clinical relevance to
radiologists.},
Journal = {Skeletal radiology, Germany},
Volume = {35},
Number = {4},
Pages = {195-201},
Year = {2006},
Month = {April},
ISSN = {0364-2348},
Keywords = {Bone Neoplasms • Humans • Magnetic Resonance
Imaging • Soft Tissue Neoplasms • Upper Extremity
• anatomy & histology • pathology •
radiography • radiography* • surgery},
Abstract = {Malignant tumors of the upper extremity are uncommon, and
their care should be referred to specialized facilities with
experience treating these lesions. The Musculoskeletal Tumor
Society (MSTS) staging system is used by the surgeon to
determine appropriate surgical management, assess prognosis,
and communicate with other healthcare providers. Magnetic
resonance imaging (MRI) is employed pre-operatively to
identify a lesion's compartment of origin, determine extent
of spread, and plan biopsy and resection approaches.
Involvement of neurovascular structures may result in
devastating loss of upper extremity function, requiring
amputation. Violation of high-resistance compartmental
barriers necessitates more extensive surgical resection.
Biopsy may be performed by the radiologist using imaging
guidance. Knowledge of compartmental anatomy allows the
radiologist or surgeon to use an easily excisable biopsy
approach and prevent iatrogenic spread to unaffected
compartments. Case examples are presented to illustrate the
importance of compartmental anatomy in the management of
benign and malignant upper extremity tumors.},
Key = {fds133621}
}
@article{fds133622,
Author = {TP Sundberg and GA Toomayan and NM Major},
Title = {Evaluation of the acetabular labrum at 3.0-T MR imaging
compared with 1.5-T MR arthrography: preliminary
experience.},
Journal = {Radiology, United States},
Volume = {238},
Number = {2},
Pages = {706-11},
Year = {2006},
Month = {February},
ISSN = {0033-8419},
Keywords = {Acetabulum • Adult • Arthralgia •
Arthrography • Female • Hip Joint • Humans
• Joint Diseases • Magnetic Resonance Imaging*
• Male • Prospective Studies • etiology
• methods • methods* • pathology •
pathology*},
Abstract = {Institutional review board approval and informed consent
were obtained for this HIPAA-compliant study. The purpose of
this study was to prospectively compare imaging of the
acetabular labrum with 3.0-T magnetic resonance (MR) imaging
and 1.5-T MR arthrography. Eight patients (four male, four
female; mean age, 38 years) with hip pain suspicious for
labral disease were examined at both MR arthrography and MR
imaging. Presence of labral lesions, paralabral cysts,
articular cartilage lesions, subchondral cysts, osteophytes,
and synovial herniation pits was recorded. There was
arthroscopic correlation of findings in five patients. MR
imaging depicted four surgically confirmed labral tears that
were identified at MR arthrography, as well as one that was
not visualized at MR arthrography. MR imaging helped
identify all other pathologic conditions that were diagnosed
at MR arthrography and helped identify one additional
surgically confirmed focal articular cartilage lesion. These
results provide encouraging support for evaluation with
3.0-T MR imaging over 1.5-T MR arthrography.},
Key = {fds133622}
}
@article{fds133625,
Author = {GA Toomayan and WR Holman and NM Major and SM Kozlowicz and TP
Vail},
Title = {Sensitivity of MR arthrography in the evaluation of
acetabular labral tears.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {186},
Number = {2},
Pages = {449-53},
Year = {2006},
Month = {February},
ISSN = {0361-803X},
Keywords = {Acetabulum • Adolescent • Adult • Arthroscopy
• Cartilage, Articular • Chi-Square Distribution
• Contrast Media • Female • Gadolinium DTPA
• Humans • Magnetic Resonance Imaging • Male
• Middle Aged • Retrospective Studies •
Sensitivity and Specificity • diagnostic use •
injuries* • methods*},
Abstract = {OBJECTIVE: MRI has historically provided suboptimal
visualization of tears of the acetabular labrum.
Degenerative fraying and underlying cartilage abnormalities
can often mimic tears of the labrum on conventional MRI.
Administration of intraarticular gadolinium enhances the MRI
appearance of the labrum to improve detection of labral
abnormalities. This study examined the improved diagnostic
sensitivity of MR arthrography compared with conventional
MRI and the importance of confining the study to a small
field of view. MATERIALS AND METHODS: Fifty-one hips were
imaged in 48 patients. Fourteen hips underwent conventional
MRI with a large field of view (30-38 cm). Seven hips
underwent conventional MRI with a small field of view (14-20
cm). Thirty hips underwent MR arthrography with a small
field of view (14-20 cm). Labral tears were diagnosed when
contrast material was identified within the labrum or
between the labrum and the acetabulum, when a displaced
fragment was noted, or when a paralabral cyst was
identified. All study results were compared with findings at
the time of hip arthroscopy. RESULTS: Conventional MRI with
a large field of view was 8% sensitive in detecting labral
tears compared with findings at the time of arthroscopy.
Diagnostic sensitivity was improved to 25% with a small
field of view. MR arthrography with a small field of view
was 92% sensitive in detecting labral tears. CONCLUSION: A
combination of MR arthrography and a small field of view is
more sensitive in detecting labral abnormalities than is
conventional MRI with either a large or a small field of
view.},
Key = {fds133625}
}
@article{fds133629,
Author = {EL Giaroli and NM Major and DE Lemley and J Lee},
Title = {Coracohumeral interval imaging in subcoracoid impingement
syndrome on MRI.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {186},
Number = {1},
Pages = {242-6},
Year = {2006},
Month = {January},
ISSN = {0361-803X},
Keywords = {Adolescent • Adult • Female • Humans •
Humerus • Magnetic Resonance Imaging* • Male
• Middle Aged • ROC Curve • Retrospective
Studies • Scapula • Sensitivity and Specificity
• Sex Factors • Shoulder Impingement Syndrome
• Shoulder Joint • anatomy & histology •
anatomy & histology* • diagnosis*},
Abstract = {OBJECTIVE: The coracohumeral interval previously has been
described as predictive of subcoracoid impingement on
dynamic screening. The purpose of this study was to
determine whether a coracohumeral interval acquired from
routinely performed MRI can reliably diagnose subcoracoid
impingement. MATERIALS AND METHODS: Preoperative MRI
examinations of 19 patients (16 males, three females) with
subsequent surgical confirmation of subcoracoid impingement
were reviewed retrospectively and compared with MRI studies
of 41 control subjects (22 males, 19 females). Axial and
oblique sagittal coracohumeral interval measurements were
taken. The morphology of the coracoid process and lesser
tuberosity was assessed. Postanalysis application of the
data to two smaller groups of patients was performed. The
first group consisted of nine subjects (three males, six
females) for whom subcoracoid impingement was diagnosed
prospectively on the basis of abnormalities found by MRI.
The second group consisted of seven patients (two males,
five females) who were referred for MRI evaluation because
of clinically suspected subcoracoid impingement. RESULTS:
The average coracohumeral interval for females was 3 mm
smaller than that for males. Using sex-adjusted data, we
found a statistically significant difference between
individuals with or without subcoracoid impingement in the
axial coracohumeral interval (p = 0.01). This value,
however, was poorly predictive (area under the receiver
operating characteristic curve, 0.73). An 11.5-mm axial
coracohumeral interval had 84% sensitivity but only 44%
specificity. A 10.5-mm axial coracohumeral interval had 79%
sensitivity and 59% specificity. The shoulder morphologic
features assessed and intraarticular contrast use were not
statistically significantly related to the coracohumeral
interval. In postanalysis application of data, in the group
of nine subjects without clinical diagnosis of subcoracoid
impingement, all prospective MRI subcoracoid impingement
diagnoses were falsely positive. However, if subcoracoid
impingement was the referring diagnosis, prospective MRI
evaluation more often was correct (n = 7 [three
true-negatives, two true-positives, two false-negatives]).
CONCLUSION: A sex-adjusted coracohumeral interval of
10.5-11.5 mm, although statistically significantly related
to subcoracoid impingement, is poorly predictive of this
diagnosis when acquired via routinely performed MRI.
Subcoracoid impingement is primarily a clinical diagnosis
that may be supported, but not established, by this
means.},
Key = {fds133629}
}
@article{fds133630,
Author = {NM Major},
Title = {Role of MRI in prevention of metatarsal stress fractures in
collegiate basketball players.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {186},
Number = {1},
Pages = {255-8},
Year = {2006},
Month = {January},
ISSN = {0361-803X},
Keywords = {Adolescent • Adult • Basketball • Bone Marrow
Diseases • Edema • Fractures, Stress • Humans
• Magnetic Resonance Imaging • Male •
Metatarsal Bones • diagnosis* • injuries* •
methods* • prevention & control*},
Abstract = {OBJECTIVE: Metatarsal stress fractures are common and
represent debilitating and potentially season-ending
injuries for basketball players. Bone marrow edema is
readily visualized on MRI and can be a sign of stress
changes. Twenty-six asymptomatic male National Collegiate
Athletic Association basketball players were imaged before
the 2003-2004 season and 14 players were reimaged after the
conclusion of the season with a screening study of long- and
short-axis fat-suppressed T2-weighted images (TR/effective
TE, 3,500/56) to identify bone marrow edema in the
metatarsals. CONCLUSION: Six (12%) of 52 feet showed a
signal indicating bone marrow edema in the metatarsals. MRI
depicts bone marrow edema in the feet before a fracture
becomes evident. Identification of this edema may reveal
stress changes, allowing early treatment and prevention of
debilitating stress fractures.},
Key = {fds133630}
}
@article{fds133623,
Author = {EL Giaroli and NM Major and LD Higgins},
Title = {MRI of internal impingement of the shoulder.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {185},
Number = {4},
Pages = {925-9},
Year = {2005},
Month = {October},
ISSN = {0361-803X},
Keywords = {Adolescent • Adult • Arthroscopy • Athletic
Injuries • Female • Humans • Magnetic
Resonance Imaging • Male • Prospective Studies
• Retrospective Studies • Shoulder Impingement
Syndrome • methods* • pathology*},
Abstract = {OBJECTIVE: Internal impingement is a condition that occurs
in athletes in which the shoulder is put in extreme
abduction and external rotation during overhead movements.
During this motion, the posterior fibers of the
supraspinatus tendon, anterior fibers of the infraspinatus
tendon, or both can get impinged between the humeral head
and the posterior glenoid. The purpose of this study was to
evaluate the ability of MRI to show the findings of internal
impingement of the shoulder. CONCLUSION: As opposed to our
six patients with clinically and surgically diagnosed
internal impingement, the control patients had isolated
pathology in the rotator cuff, labrum, or humeral head. We
found that the constellation of findings of undersurface
tears of the supraspinatus or infraspinatus tendon and
cystic changes in the posterior aspect of the humeral head
associated with posterosuperior labral pathology is a
consistent finding diagnostic of internal
impingement.},
Key = {fds133623}
}
@article{fds133626,
Author = {GB Blackmon and NM Major and CA Helms},
Title = {Comparison of fast spin-echo versus conventional spin-echo
MRI for evaluating meniscal tears.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {184},
Number = {6},
Pages = {1740-3},
Year = {2005},
Month = {June},
ISSN = {0361-803X},
Keywords = {Adult • Case-Control Studies • Female •
Humans • Magnetic Resonance Imaging • Male •
Menisci, Tibial • Sensitivity and Specificity •
injuries* • methods*},
Abstract = {OBJECTIVE: We compare sensitivities of conventional
spin-echo and fast spin-echo sequences in the evaluation of
meniscal tears. Furthermore, we reevaluate the results from
prior studies comparing these two sequences to understand
why there are differing conclusions regarding the efficacy
of fast spin-echo sequences as a commensurate replacement
for conventional spin-echo sequences. MATERIALS AND METHODS:
We used records from a control group of 64 patients (128
menisci) who had undergone arthroscopy to determine the
sensitivity of conventional spin-echo sequences for
detecting meniscal tears. Two hundred sixteen consecutive
patients (432 menisci) were then imaged using conventional
spin-echo and fast spin-echo sequences to evaluate for
meniscal tears. Both sequences were proton density-weighted
with fat suppression. RESULTS: Of the 432 menisci, 170 tears
were detected on conventional spin-echo imaging. Only 128
tears were detected on the fast spin-echo sequence. The
sensitivities of conventional spin-echo and fast spin-echo
imaging were found to be 93% and 80%, respectively. In
addition, findings from conventional spin-echo and fast
spin-echo sequences were discordant for 72 menisci (17%, p <
0.01). CONCLUSION: The sensitivities of conventional
spin-echo and fast spin-echo imaging for detecting meniscal
tears have been shown to be greater than 90% and
approximately 80%, respectively. However, some authors
advocate substituting conventional spin-echo imaging with
fast spin-echo imaging. We urge the abandonment of fast
spin-echo imaging for evaluating meniscal tears because a
loss of greater than 10% in sensitivity is
unacceptable.},
Key = {fds133626}
}
@article{fds133628,
Author = {GA Toomayan and F Robertson and NM Major},
Title = {Lower extremity compartmental anatomy: clinical relevance to
radiologists.},
Journal = {Skeletal radiology, Germany},
Volume = {34},
Number = {6},
Pages = {307-13},
Year = {2005},
Month = {June},
ISSN = {0364-2348},
Keywords = {Adult • Aged • Biopsy • Bone Neoplasms •
Female • Humans • Lower Extremity • Male
• Middle Aged • Muscle Neoplasms •
Musculoskeletal Diseases • Neoplasm Seeding •
Neoplasm Staging • Tomography, X-Ray Computed •
anatomy & histology* • diagnosis* • methods •
pathology • radiography*},
Abstract = {A thorough understanding of compartmental anatomy is
necessary for the radiologist participating in the care of a
patient with a lower extremity musculoskeletal malignancy.
Localization of tumor to compartment of origin and
identification of extracompartmental spread preoperatively
are needed to correctly stage a tumor and determine the
appropriate surgical management. An understanding of the
locations of fascial boundaries, extracompartmental tissues,
and neurovascular structures of the thigh and lower leg
facilitates this diagnostic process. For the radiologist
planning to biopsy a suspicious musculoskeletal lesion,
consultation with the referring orthopaedic surgeon is
recommended in order to jointly select an appropriate
percutaneous biopsy approach. Adequate preprocedural
planning ensures selection of an approach which prevents
iatrogenic tumor spread beyond the compartment of origin,
protects neurovascular structures, and allows complete
resection of the biopsy tract and scar at the time of
surgical resection without jeopardizing a potential
limb-sparing procedure. Cross-sectional anatomic review and
case examples demonstrate the importance of a detailed
understanding of compartmental anatomy when approaching the
patient with a lower extremity musculoskeletal
tumor.},
Key = {fds133628}
}
@article{fds133620,
Author = {KR Lindauer and NM Major and DP Rougier-Chapman and CA
Helms},
Title = {MR imaging appearance of 180-360 degrees labral tears of the
shoulder.},
Journal = {Skeletal radiology, Germany},
Volume = {34},
Number = {2},
Pages = {74-9},
Year = {2005},
Month = {February},
ISSN = {0364-2348},
Keywords = {Adolescent • Adult • Arthroscopy • Female
• Humans • Magnetic Resonance Imaging* • Male
• Middle Aged • Retrospective Studies •
Shoulder • Treatment Outcome • injuries* •
radiography* • surgery},
Abstract = {Glenoid labral tears exceeding 180 degrees are an uncommon
entity in which characteristic clinical and MR imaging
features can lead to a more accurate preoperative diagnosis.
We provide a description of glenoid labral tears that exceed
180 degrees, and their characteristic magnetic resonance
imaging features. In the young, heavily muscled male
athlete, the identification of multiple sites of labral
pathology and isolated, extensive posterior labral injuries
are features that should raise suspicion for labral tears
that exceed 180 degrees.},
Key = {fds133620}
}
@article{fds133618,
Author = {RS Bikkina and CA Tujo and AB Schraner and NM Major},
Title = {The "floating" meniscus: MRI in knee trauma and implications
for surgery.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {184},
Number = {1},
Pages = {200-4},
Year = {2005},
Month = {January},
ISSN = {0361-803X},
Keywords = {Adolescent • Adult • Female • Humans •
Knee Injuries • Magnetic Resonance Imaging* • Male
• Menisci, Tibial • Middle Aged •
Retrospective Studies • diagnosis* • injuries*
• surgery},
Abstract = {OBJECTIVE: We describe 21 cases involving meniscal injury in
which the meniscus appears free-floating on MRI of the knee.
In these cases, the meniscus is completely surrounded by
fluid. Correlation with surgical reports shows that the
"floating" meniscus corresponds to a meniscal avulsion or
detachment from the tibial plateau with an associated
disruption of the meniscotibial coronary ligaments, which
attach the meniscus to the tibia, allowing fluid to
encompass the meniscus. A floating meniscus on MRI may
represent a new specific finding for an uncommon form of
meniscal injury known as meniscal avulsion. CONCLUSION: The
presence of a floating meniscus on MRI is a result of
significant trauma to the knee leading to meniscal avulsion
and is often associated with significant ligamentous injury.
Alerting the surgeon to the presence of a meniscal avulsion
facilitates appropriate surgical planning with meniscal
reattachment to the tibial plateau.},
Key = {fds133618}
}
@article{fds133624,
Author = {SM Jackson and NM Major},
Title = {Pathologic conditions mimicking osteonecrosis.},
Journal = {The Orthopedic clinics of North America, United
States},
Volume = {35},
Number = {3},
Pages = {315-20, ix},
Year = {2004},
Month = {July},
ISSN = {0030-5898},
Keywords = {Bone Cysts • Diagnosis, Differential • Female
• Femur Head Necrosis • Hip Joint • Humans
• Magnetic Resonance Imaging • Male •
Osteoarthritis, Hip • Osteoporosis • Risk
Assessment • diagnosis • pathology*},
Abstract = {MRI has become increasingly helpful in establishing an early
diagnosis of avascular necrosis(AVN). AVN often demonstrates
a classic pattern on MRI; findings earlier in the course of
the disease are less specific. Many pitfalls can complicate
interpretation, and a number of pathologic conditions can
share features of early AVN on MRI and plain
radiographs.These entities should be distinguished from AVN,
because treatment and prognosis may differ
significantly.},
Key = {fds133624}
}
@article{fds133619,
Author = {CJ Barnes and LD Higgins and NM Major and CJ Basamania},
Title = {Magnetic resonance imaging of the coracoclavicular
ligaments: its role in defining pathoanatomy at the
acromioclavicular joint.},
Journal = {Journal of surgical orthopaedic advances, United
States},
Volume = {13},
Number = {2},
Pages = {69-75},
Year = {2004},
ISSN = {1548-825X},
Keywords = {Acromioclavicular Joint • Adult • Humans •
Joint Instability • Ligaments, Articular •
Magnetic Resonance Imaging • Male • Wounds and
Injuries • classification • pathology* •
radiography},
Abstract = {Four patients with acromioclavicular joint injuries (one
type II, two type III, one type V), two patients without
acromioclavicular joint injury, and a fresh-frozen cadaver
underwent magnetic resonance imaging (MRI) and plain
radiographs. The normal conoid and trapezoid ligaments were
easily identified in the cadaver and the two uninjured
patients. Magnetic resonance imaging revealed disruption of
both coraclavicular ligaments in the three patients with
type II and type III injuries. However, the patient with the
type V injury had disruption of the trapezoid ligament
alone. Thus, the grade of injury, as determined by the
change in the coracoclavicular interval onplain radiography
and defined by the Rockwood classification system, failed to
correlate with the pathoanatomy seen on MRI in two of the
four injured patients. These findings suggest that
improvements in the classification of these injuries may be
necessary.},
Key = {fds133619}
}
@article{fds133603,
Author = {DG Trembath and R Dash and NM Major and LG Dodd},
Title = {Cytopathology of mesenchymal chondrosarcomas: a report and
comparison of four patients.},
Journal = {Cancer, United States},
Volume = {99},
Number = {4},
Pages = {211-6},
Year = {2003},
Month = {August},
ISSN = {0008-543X},
Keywords = {Adolescent • Adult • Biopsy, Needle • Bone
Neoplasms • Chondrosarcoma, Mesenchymal • Female
• Humans • Male • Middle Aged • Neoplasm
Metastasis • Prognosis • pathology* •
secondary*},
Abstract = {BACKGROUND: Mesenchymal chondrosarcoma (MC) is an infrequent
neoplasm, representing approximately 1% of all
chondrosarcomas. Cytologic descriptions of MCs have been
confined to rare case reports. In the current report, the
authors describe their experience with the cytologic
features of four MCs: two primary tumors and two metastatic
lesions. METHODS: Four patients were diagnosed with MC at
the authors' institution from 1994 to 2002. Three of four
patients underwent fine-needle aspiration (FNA) biopsy as
part of their diagnosis; in the fourth patient, imprint
cytology was performed. Each tumor also received histologic
confirmation. RESULTS: The patients studied included three
females and one male. In three patients, the tumor presented
initially as a soft tissue mass; whereas, in the remaining
patient, the MC presented in the tibia. FNA results
demonstrated small, oval-to-spindled cells with high
nuclear-to-cytoplasmic ratios. Cells occurred singly and in
clumps in a background of basophilic extracellular matrix.
Histologic examination of each lesion demonstrated biphasic
tumors, including focal areas of relatively mature cartilage
formation as well as a small cell population. CONCLUSIONS:
MC is a rare soft tissue tumor that occurs frequently in
extraskeletal locations. FNA of these tumors can be
diagnostic if the tumor is sampled appropriately and of
critical features, such as the background extracellular
matrix, are recognized. Given the propensity of these tumors
to metastasize and the poor prognosis of patients with MC,
early identification by FNA biopsy may allow earlier, more
aggressive interventions.},
Key = {fds133603}
}
@article{fds133588,
Author = {EN Vinson and NM Major},
Title = {MR imaging of ankylosing spondylitis.},
Journal = {Seminars in musculoskeletal radiology, United
States},
Volume = {7},
Number = {2},
Pages = {103-13},
Year = {2003},
Month = {June},
ISSN = {1089-7860},
Keywords = {Bone and Bones • Humans • Magnetic Resonance
Imaging* • Spondylitis, Ankylosing • diagnosis*
• pathology • physiopathology},
Abstract = {Ankylosing spondylitis (AS) is one of a group of disorders
characterized by association with HLA-B27 histocompatibility
complex, seronegativity for rheumatoid factor, and
propensity for inflammation at entheses, synovial
articulations, and cartilaginous articulations. The
radiographic hallmark of the disease is ankylosis, and the
principle sites of involvement are the sacroiliac joints and
spine, with less frequent involvement of other joints,
including the pubic symphysis, hips, shoulders, knees,
hands, feet, and sternoclavicular, acromioclavicular,
sternomanubrial, and temporomandibular joints. Following a
brief discussion of the basic pathophysiology and typical
clinical findings of AS, we describe the typical magnetic
resonance imaging features of the disease as it is manifests
in the axial skeleton. Finally, a brief mention of special
considerations in the radiographic evaluation of the AS
patient in the setting of trauma is made.},
Key = {fds133588}
}
@article{fds133608,
Author = {RL Cothran and PM McGuire and CA Helms and NM Major and DE
Attarian},
Title = {MR imaging of infrapatellar plica injury.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {180},
Number = {5},
Pages = {1443-7},
Year = {2003},
Month = {May},
ISSN = {0361-803X},
Keywords = {Adolescent • Adult • Female • Humans •
Magnetic Resonance Imaging* • Male • Patella*
• Retrospective Studies • Synovial Membrane •
injuries* • pathology*},
Abstract = {OBJECTIVE: Injury to the infrapatellar plica (ligamentum
mucosum) has not been previously described in the radiology
literature to our knowledge. This article shows the MR
imaging appearance of injury to the infrapatellar plica.
CONCLUSION: Injury to the infrapatellar plica is uncommon
but should be considered as a potential source of knee pain,
especially if no other evidence indicates internal
derangement. MR imaging can reveal a typical appearance for
infrapatellar plica injury.},
Key = {fds133608}
}
@article{fds133609,
Author = {NM Major and MC Banks},
Title = {MR imaging of complications of loose surgical tacks in the
shoulder.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {180},
Number = {2},
Pages = {377-80},
Year = {2003},
Month = {February},
ISSN = {0361-803X},
Keywords = {Adolescent • Adult • Arthroscopy • Diagnosis,
Differential • Foreign Bodies • Humans •
Ligaments, Articular • Magnetic Resonance Imaging*
• Male • Middle Aged • Polyglycolic Acid
• Postoperative Complications • Shoulder Joint*
• Shoulder Pain • Surgical Instruments* •
Synovitis • complications • diagnosis •
diagnosis* • etiology • pathology •
surgery},
Abstract = {OBJECTIVE: Loose surgical tacks in the shoulder joint are a
potential cause of new-onset shoulder pain after
arthroscopic repair of an anterior-to-posterior lesion of
the superior labrum. We report the MR imaging appearance of
loose surgical tacks in this anatomic location. CONCLUSION:
MR imaging is valuable in the evaluation of postoperative
shoulder pain. Synovitis is a commonly considered clinical
diagnosis; our report illustrates that loose tacks are
another potential complication after shoulder
surgery},
Key = {fds133609}
}
@article{fds133594,
Author = {NM Major and LN Beard and CA Helms},
Title = {Accuracy of MR imaging of the knee in adolescents.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {180},
Number = {1},
Pages = {17-9},
Year = {2003},
Month = {January},
ISSN = {0361-803X},
Keywords = {Adolescent • Anterior Cruciate Ligament • Child
• Female • Humans • Knee Injuries • Knee
Joint • Magnetic Resonance Imaging* • Male •
Menisci, Tibial • Posterior Cruciate Ligament •
Retrospective Studies • Sensitivity and Specificity
• diagnosis* • injuries • pathology •
pathology*},
Abstract = {OBJECTIVE: A report in the orthopedics literature states
that MR imaging for internal derangement of the knee has a
lower accuracy in adolescents than in adults and may even
provide spurious information that alters clinical
management. This assertion has not been specifically
addressed in the radiology literature. The purpose of our
study was to determine the accuracy of MR imaging in
adolescents with regard to injury of the cruciate ligaments
and menisci. MATERIALS AND METHODS: A database search of our
institution's records from January 1998 to July 2000 yielded
2140 MR examinations of the knee, all of which had been
performed with a standard knee protocol on a 1.5-T magnet.
Of these 2140 examinations, 156 included patients younger
than 18 years. Fifty-nine of these patients underwent
surgery, and the orthopedic surgeons' operative reports were
used as the gold standard with which the MR imaging results
were compared. Thirty-four boys and 25 girls who ranged in
age from 11 to 17 years (mean age, 15 years) were examined.
The clinical notes for the remaining 97 patients were
evaluated for information about management and clinical
improvement. RESULTS: The sensitivity and specificity values
for MR imaging of the menisci and cruciate ligaments in
adolescents were as follows: medial meniscus, 92%
sensitivity and 87% specificity; lateral meniscus, 93%
sensitivity and 95% specificity; anterior cruciate ligament,
100% sensitivity and 100% specificity; and posterior
cruciate ligament, 0% sensitivity and 100% specificity.
CONCLUSION: Our data suggest that MR imaging of the knee in
adolescents is sensitive, specific, and accurate.},
Key = {fds133594}
}
@article{fds133610,
Author = {NM Major and CA Helms},
Title = {MR imaging of the knee: findings in asymptomatic collegiate
basketball players.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {179},
Number = {3},
Pages = {641-4},
Year = {2002},
Month = {September},
ISSN = {0361-803X},
Keywords = {Adult • Basketball • Data Collection • Female
• Humans • Knee Injuries • Knee Joint •
Ligaments, Articular • Magnetic Resonance Imaging*
• Male • Tendon Injuries • Tendons •
abnormalities • abnormalities* • injuries •
injuries* • pathology • pathology*},
Abstract = {OBJECTIVE: The purpose of our study was to evaluate the
knees of asymptomatic high-level collegiate basketball
players before the beginning of the basketball season to
gain an understanding of nonclinical findings in this
patient population. SUBJECTS AND METHODS: Bilateral knee MR
imaging examinations of 17 varsity basketball players (12
men and five women) were performed before basketball season
began. All of the subjects were imaged on a 1.5-T magnet.
The MR imaging studies were reviewed by two musculoskeletal
radiologists. Structures analyzed were the menisci,
ligaments, cartilage, plicae, and bone marrow. The presence
of a joint effusion was also noted. RESULTS: Fourteen (41%)
of the 34 knees had bone marrow edema, eight (24%) showed
signal in the patellar tendon, and 14 (41%) had abnormal
cartilage signal or a focal abnormality. Twelve (35%) of the
34 knees showed a joint effusion. Two knees (6%) showed
abnormal signal along the infrapatellar plica. Four knees
(12%) were noted to have a discoid meniscus. CONCLUSION: An
MR examination of the knees of high-level collegiate
basketball players may show changes unique to this
population. The changes seen on MR imaging in these athletes
may be asymptomatic abnormalities. For instance, changes
suggestive of patellar tendinopathy were identified in these
asymptomatic subjects.},
Key = {fds133610}
}
@article{fds133595,
Author = {LG Dodd and NM Major},
Title = {Fine-needle aspiration cytology of articular and
periarticular lesions.},
Journal = {Cancer, United States},
Volume = {96},
Number = {3},
Pages = {157-65},
Year = {2002},
Month = {June},
ISSN = {0008-543X},
Keywords = {Arthritis, Rheumatoid • Biopsy, Needle •
Chondromatosis, Synovial • Chondrosarcoma •
Ganglia • Gout • Humans • Joints •
Sarcoma • Synovitis, Pigmented Villonodular •
pathology • pathology*},
Abstract = {BACKGROUND: The cytologic diagnosis of joint and articular
surface-based lesions traditionally has been accomplished by
examination of fluids or effusions. Although exfoliative
cytology remains an accurate diagnostic test, not all
joint-based lesions will produce effusions that are amenable
to this type of examination. Fine-needle aspiration (FNA)
represents an excellent alternative to traditional cytologic
or histologic methods of diagnosis in joint
pathology.METHODS: The authors reviewed FNA materials for
the period 1992-2001 from lesions of joint spaces and
periarticular soft tissues. All diagnoses based on cytologic
materials that were included in this study were confirmed
with histologic follow-up. Cytologic and histologic
materials were prepared using standard methods.RESULTS: The
authors found six relatively common lesions that were
amenable to diagnosis by FNA. These included rheumatoid
nodule, gouty tophi, ganglion cysts, pigmented villonodular
synovitis, synovial chondromatosis, and synovial sarcoma.
There are potential pitfalls in discriminating gout from
pseudogout and synovial chondromatosis from
chondrosarcoma.CONCLUSIONS: In most instances,
mass-producing lesions of the joint space or the
periarticular soft tissues can be diagnosed successfully by
FNA. The common lesions are easily recognizable and are
cytologically distinctive.},
Key = {fds133595}
}
@article{fds133605,
Author = {CJ Weaver and NM Major and WE Garrett and JE Urbaniak},
Title = {Femoral head osteochondral lesions in painful hips of
athletes: MR imaging findings.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {178},
Number = {4},
Pages = {973-7},
Year = {2002},
Month = {April},
ISSN = {0361-803X},
Keywords = {Adolescent • Adult • Athletic Injuries • Bone
Marrow • Cartilage, Articular • Cumulative Trauma
Disorders • Female • Femur Head • Hip
Injuries • Hip Joint • Humans • Magnetic
Resonance Imaging* • Male • Osteochondritis •
Pain • Retrospective Studies • diagnosis •
diagnosis* • etiology • pathology •
pathology* • radiography},
Abstract = {OBJECTIVE: This study describes the MR imaging findings of
focal osteochondral lesions found in the hips of 11 athletes
with persistent pain and normal findings on radiographs.
CONCLUSION: Osteochondral lesions of the femoral head are
seen on MR imaging as focal, medial areas of high
T2-weighted and low T1-weighted signals and should be
considered as a possible cause of persistent hip or groin
pain in young, high-level athletes because the institution
of appropriate treatment may help to prevent late
degenerative sequelae.},
Key = {fds133605}
}
@article{fds133596,
Author = {NM Major and ST Crawford},
Title = {Elbow effusions in trauma in adults and children: is there
an occult fracture?},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {178},
Number = {2},
Pages = {413-8},
Year = {2002},
Month = {February},
ISSN = {0361-803X},
Keywords = {Adolescent • Adult • Aged • Aged, 80 and over
• Body Fluids* • Child • Child, Preschool
• Elbow Joint • Female • Fractures, Closed
• Humans • Joint Diseases • Magnetic
Resonance Imaging • Male • Middle Aged •
Prospective Studies • complications* • etiology
• injuries* • pathology},
Abstract = {OBJECTIVE: The purpose of this study was to evaluate whether
a detectable abnormality was present on MR imaging without a
visible fracture on conventional radiography in the setting
of trauma. A recent retrospective study based on the
presence or absence of periosteal reaction on follow-up
radiographs concluded that fractures were not always
present. The discrepancies in the literature over the
usefulness of joint effusions as an indicator of fracture
caused us to evaluate whether fractures were present more
often than identified by conventional radiography. To do
this, we used MR imaging. MATERIALS AND METHODS: Thirteen
consecutive patients (age range, 4-80 years; seven children
and six adults), whose post-trauma elbow radiographs showed
an effusion but no fracture, underwent screening MR imaging.
RESULTS: All patients showed bone marrow edema. Four of the
seven children had fractures on screening MR imaging, and
all adults had some identifiable fractures. CONCLUSION:
Preliminary data using screening MR imaging suggests that an
occult fracture usually is present in the setting of
effusion without radiographically visualized
fracture.},
Key = {fds133596}
}
@article{fds133589,
Author = {TA Dorsay and NM Major and CA Helms},
Title = {Cost-effectiveness of immediate MR imaging versus
traditional follow-up for revealing radiographically occult
scaphoid fractures.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {177},
Number = {6},
Pages = {1257-63},
Year = {2001},
Month = {December},
ISSN = {0361-803X},
Keywords = {Adolescent • Adult • Cost-Benefit Analysis •
Female • Follow-Up Studies • Fractures, Bone
• Humans • Magnetic Resonance Imaging • Male
• Predictive Value of Tests • Scaphoid Bone •
Time Factors • economics* • pathology*},
Abstract = {OBJECTIVE: For suspected scaphoid fractures with no
radiographic evidence of fracture, treating symptoms with
immobilization and radiographic follow-up has long been the
standard of care. Modified MR imaging of the wrist is
offered at our institution in screening for radiographically
occult scaphoid fractures at the time of initial
presentation to the emergency department. We show the
advantages and comparative costs of this modified protocol
versus a traditional protocol. MATERIALS AND METHODS: Our
modified protocol consists of coronal thin-section
T1-weighted and fast spin-echo T2-weighted MR images with
fat saturation. A review of the literature was performed to
assess the accuracy of clinical examination, radiography,
and other modalities in the evaluation of scaphoid fractures
of the wrist. Charges for this procedure are compared with
charges for traditional follow-up. RESULTS: Three of four
patients with positive results at clinical examination and
negative findings on initial radiographs will be needlessly
immobilized and monitored. The charges to the patient at our
institution for screening MR imaging of the wrist are $770.
The total charges to the patient with the traditional
protocol, which would not be necessary with screening MR
imaging, are $677 or more if a diagnosis is not made at this
time. Bone scanning or routine MR imaging is often
eventually used. CONCLUSION: Cost analysis at our
institution suggests the two protocols are nearly equivalent
from a financial standpoint. The loss of productivity for
patients who are unnecessarily in casts or splints may be
substantial. Screening MR imaging of the wrist in this
setting is becoming accepted at our institution in a manner
similar to screening MR imaging of the hip.},
Key = {fds133589}
}
@article{fds133591,
Author = {RL Cothran and NM Major and CA Helms and LD Higgins},
Title = {MR imaging of meniscal contusion in the knee.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {177},
Number = {5},
Pages = {1189-92},
Year = {2001},
Month = {November},
ISSN = {0361-803X},
Keywords = {Adult • Anterior Cruciate Ligament • Arthroscopy
• Contusions • Diagnosis, Differential •
Female • Humans • Knee Injuries • Magnetic
Resonance Imaging* • Male • Menisci, Tibial •
Quality Assurance, Health Care • Sensitivity and
Specificity • diagnosis* • injuries •
injuries* • pathology • surgery},
Abstract = {OBJECTIVE: We describe focal abnormal signal of the meniscus
in the knees of six patients who had a history of acute
trauma to the knee. This signal abuts the articular surface
of the meniscus on MR imaging but does not meet criteria for
a meniscal tear or degeneration. CONCLUSION: Acute trauma to
the knee may cause an abnormal signal in the meniscus that
does not meet the previously described criteria for a
meniscal tear or an intrasubstance degeneration. This
abnormal signal could be misinterpreted as a tear because of
its contact with the articular surface; this signal is seen
most often in our series in the setting of an anterior
cruciate ligament tear with adjacent bone contusions. We
suggest that this signal may be due to a contusion of the
meniscus and that the signal may resolve over time in some
patients.},
Key = {fds133591}
}
@article{fds133597,
Author = {NM Major},
Title = {Imaging of the subcoracoid bursa.},
Journal = {AJR. American journal of roentgenology, United
States},
Volume = {176},
Number = {3},
Pages = {812-3},
Year = {2001},
Month = {March},
ISSN = {0361-803X},
Keywords = {Bursa, Synovial • Humans • Magnetic Resonance
Imaging • Rotator Cuff • Shoulder Pain* •
etiology • injuries* • pathology*},
Key = {fds133597}
}
@article{fds133613,
Author = {S Bonsell and AW Pearsall and RJ Heitman and CA Helms and NM Major and KP
Speer},
Title = {The relationship of age, gender, and degenerative changes
observed on radiographs of the shoulder in asymptomatic
individuals.},
Journal = {The Journal of bone and joint surgery. British volume,
England},
Volume = {82},
Number = {8},
Pages = {1135-9},
Year = {2000},
Month = {November},
ISSN = {0301-620X},
Keywords = {Acromioclavicular Joint* • Adult • Age Factors
• Aged • Aged, 80 and over • Aging •
Arthritis • Bias (Epidemiology) • Chi-Square
Distribution • Diagnosis, Differential • Female
• Humans • Logistic Models • Male •
Middle Aged • Predictive Value of Tests •
Reference Values • Rotator Cuff • Severity of
Illness Index • Sex Characteristics • Shoulder
Impingement Syndrome • Shoulder Joint* •
Single-Blind Method • classification • etiology
• injuries* • pathology* • physiopathology
• radiography*},
Abstract = {Radiographs of the shoulders of 84 asymptomatic individuals
aged between 40 and 83 years were evaluated to determine
changes in 23 specific areas. Two fellowship-trained
orthopaedic radiologists graded each area on a scale of 0 to
II (normal 0, mild changes I, advanced changes II). Logistic
regression analysis indicated age to be a significant
predictor of change (p < 0.05) for sclerosis of the medial
acromion and lateral clavicle, the presence of subchondral
cysts in the acromion, formation of osteophytes at the
inferior acromion and clavicle, and narrowing and
degeneration of the acromioclavicular joint. Gender was not
a significant predictor (p > 0.05) for radiological changes.
Student's t-test determined significance (p < 0.05) between
age and the presence of medial acromial and lateral
clavicular sclerosis, subchondral acromial cysts, inferior
acromial and clavicular osteophytes, and degeneration of the
acromioclavicular joint. Radiological analysis in conditions
such as subacromial impingement, pathology of the rotator
cuff, and acromioclavicular degeneration should be
interpreted in the context of the symptoms and normal
age-related changes.},
Key = {fds133613}
}
@article{fds133592,
Author = {NM Major and CA Helms and WJ Richardson},
Title = {The "mini brain": plasmacytoma in a vertebral body on MR
imaging.},
Journal = {AJR. American journal of roentgenology, UNITED
STATES},
Volume = {175},
Number = {1},
Pages = {261-3},
Year = {2000},
Month = {July},
ISSN = {0361-803X},
Keywords = {Adult • Aged • Female • Humans •
Magnetic Resonance Imaging* • Male • Middle Aged
• Plasmacytoma • Spinal Cord Neoplasms •
pathology*},
Abstract = {OBJECTIVE: Patients with solitary plasmacytoma in the spine
frequently require a biopsy for diagnosis of their
condition. We report an appearance of plasmacytoma in the
spine, which is sufficiently pathognomonic to obviate
biopsy. CONCLUSION: Identification of a "mini brain" in an
expansile lesion in the spine is characteristic of
plasmacytoma. It is important that radiologists note this
characteristic because biopsy can be avoided in patients
with this appearance. Although biopsy might still be
required at many institutions, at our institution, surgeons
find this appearance sufficiently pathognomonic to bypass
biopsy and start treatment.},
Key = {fds133592}
}
@article{fds133617,
Author = {NM Major and CA Helms and RC Fritz and KP Speer},
Title = {The MR imaging appearance of longitudinal split tears of the
peroneus brevis tendon.},
Journal = {Foot & ankle international / American Orthopaedic Foot and
Ankle Society [and] Swiss Foot and Ankle Society, UNITED
STATES},
Volume = {21},
Number = {6},
Pages = {514-9},
Year = {2000},
Month = {June},
ISSN = {1071-1007},
Keywords = {Adolescent • Adult • Aged • Ankle Injuries
• Ankle* • Female • Humans • Magnetic
Resonance Imaging* • Male • Middle Aged •
Retrospective Studies • Rupture • Tendon Injuries
• Tendons • complications • diagnosis* •
pathology*},
Abstract = {PURPOSE: Longitudinal split tears of the peroneus brevis
tendon have been increasingly reported as a source of
lateral ankle pain and disability. MR imaging is useful in
identifying the appearance of longitudinal split tears of
the peroneus brevis tendon to differentiate this entity from
other causes of chronic lateral ankle pain. We observed
variations in anatomy associated with these tears. MATERIALS
AND METHODS: Twenty-two patients (eleven males, eleven
females) were identified as having longitudinal split tears
of the peroneus brevis tendon. These cases were reviewed
retrospectively to evaluate for the following: shape of the
peroneus brevis tendon, high signal in the peroneus brevis
tendon, tendon subluxation, appearance of the superior
peroneal retinaculum, presence of osseous changes in the
ankle, lateral ankle ligaments, presence of a bony fibular
spur, flattening of the peroneal groove of the fibula and
presence of a peroneus quartus. A control group consisted of
twenty ankles imaged for reasons other than lateral ankle
pain. The same structures were assessed in this group. A
Fisher's exact P-value was used to determine the
significance of each finding in the two groups. RESULTS:
Statistically significant associated findings were chevron
shaped tendon (p = .0001), high signal in the peroneus
brevis (p = .0017), bony changes (p = .0001), flat peroneal
groove (p = .0001), abnormal lateral ligaments (p = .0004),
and lateral fibular spur (p = .0006). CONCLUSIONS: MR
imaging is useful in differentiating longitudinal split
tears of the peroneus brevis tendon from other lateral ankle
disorders. It can show the extent of the abnormality in the
tendon and the associated findings of soft tissue and/or
bone variations which must be addressed at the time of
surgery.},
Key = {fds133617}
}
@article{fds133615,
Author = {NM Major and CA Helms},
Title = {Sacral stress fractures in long-distance
runners.},
Journal = {AJR. American journal of roentgenology, UNITED
STATES},
Volume = {174},
Number = {3},
Pages = {727-9},
Year = {2000},
Month = {March},
ISSN = {0361-803X},
Keywords = {Adolescent • Adult • Athletic Injuries •
Diagnosis, Differential • Female • Fractures,
Stress • Humans • Male • Middle Aged •
Running • Sacrum • Sciatica • Spinal
Fractures • diagnosis • diagnosis* •
injuries* • pathology},
Abstract = {OBJECTIVE: Sacral stress fractures in athletes are rare but
important to recognize because the symptoms often mimic
sciatica and can lead to delay in diagnosis and treatment.
The radiographic findings are characteristic and can
facilitate early diagnosis and lead to appropriate
treatment. CONCLUSION: The clinical presentation of runners
with sacral stress fractures can mimic disk disease.
However, stress fractures in athletes, especially
long-distance runners, must be treated differently. The
imaging characteristics appear as linear abnormal signal
intensity paralleling the sacroiliac joint on MR imaging and
linear sclerosis with cortical disruption on CT. Imaging
with bone scintigraphy shows increased uptake that parallels
the sacroiliac joint.},
Key = {fds133615}
}
@article{fds133616,
Author = {BK Brodwater and NM Major and RD Goldner and LJ Layfield},
Title = {Macrodystrophia lipomatosa with associated fibrolipomatous
hamartoma of the median nerve.},
Journal = {Pediatric surgery international, GERMANY},
Volume = {16},
Number = {3},
Pages = {216-8},
Year = {2000},
ISSN = {0179-0358},
Keywords = {Child, Preschool • Fingers • Gigantism •
Hamartoma • Humans • Male • Median Nerve*
• Peripheral Nervous System Diseases •
abnormalities* • complications* •
surgery},
Abstract = {Macrodystrophia lipomatosa (MDL) is a rare disease typically
causing localized gigantism and is often associated with a
fibrolipomatous hamartoma (FH) of the median or plantar
nerve. A previously unreported case of MDL with associated
FH of the median nerve is presented.},
Key = {fds133616}
}
@article{fds133590,
Author = {NM Major},
Title = {MR imaging after therapeutic injection of the subacromial
bursa.},
Journal = {Skeletal radiology, GERMANY},
Volume = {28},
Number = {11},
Pages = {628-31},
Year = {1999},
Month = {November},
ISSN = {0364-2348},
Keywords = {Acromion • Adult • Anesthetics, Local •
Bursa, Synovial • Cartilage, Articular • Female
• Humans • Injections, Intra-Articular •
Lidocaine • Male • Prospective Studies •
Rotator Cuff • Shoulder Impingement Syndrome •
Shoulder Joint • Synovial Membrane •
administration & dosage* • diagnosis* • drug
therapy • pathology* • therapeutic
use},
Abstract = {OBJECTIVE: As a therapeutic injection into the subacromial
bursa (SAB) is commonly performed for impingement syndrome,
it is important to know whether this fluid can be retained
for a period of time and cause confusion with a pathologic
collection of fluid. This study identifies and describes the
appearance of recent subacromial injection using MR imaging,
and the appearance of a potential complication. DESIGN AND
PATIENTS: Fourteen asymptomatic shoulders were studied with
MR imaging using fast spin echo T2-weighted imaging (1.5 T)
prior to injection with 7 cm(3) of xylocaine. Four shoulders
had subacromial fluid and were eliminated from the study.
The remaining 10 (9 men, 1 woman; age range 27-36 years,
average age 33 years) were then re-imaged immediately, and
at 6, 12 and 24 h after the injection or until fluid
resolved. Each set of images was reviewed for the presence
of fluid in the SAB and for additional abnormalities.
RESULTS: Fluid was identified in all subjects in the SAB in
the immediate, 6 and 12 h post-injection images. At 24 h,
fluid was not identified within the SAB in eight of 10
patients. In one patient fluid resolved in 48 h. The other
continued to demonstrate fluid in the SAB and in the joint
as well as abnormal signal in the infraspinatus muscle from
a presumed myositis. Imaging was performed up to 10 days
after the injection in this patient. CONCLUSIONS: It is
known that fluid identified in the SAB without evidence of a
cuff tear may be due to bursitis. However, if MR imaging is
performed within 24 h of injection, the presence of the
fluid may be iatrogenic. In addition, the history of recent
therapeutic injection is very important as complications
such as myositis can occur as a result of the injection.
Knowledge of injection prior to imaging is vital for
accurate interpretation of MR shoulder examinations.},
Key = {fds133590}
}
@article{fds133593,
Author = {NM Major and CA Helms and WJ Richardson},
Title = {MR imaging of fibrocartilaginous masses arising on the
margins of spondylolysis defects.},
Journal = {AJR. American journal of roentgenology, UNITED
STATES},
Volume = {173},
Number = {3},
Pages = {673-6},
Year = {1999},
Month = {September},
ISSN = {0361-803X},
Keywords = {Adult • Aged • Female • Humans • Lumbar
Vertebrae • Magnetic Resonance Imaging* • Male
• Middle Aged • Spondylolysis •
pathology*},
Abstract = {OBJECTIVE: Spondylolysis is reported in up to 7% of the
population. An uncommon process that can accompany a pars
interarticularis defect is a fibrocartilaginous mass, which
can cause impression on the nerve roots and thecal sac.
Recognition is important so that the presence may be
addressed at the time of surgery. This report describes the
MR imaging appearance and clinical significance of a
fibrocartilaginous mass in association with spondylolysis.
MATERIALS AND METHODS: We reviewed data regarding 336
patients who had lumbar spine imaging at our institution
during a 12-month period. Contiguous axial and sagittal MR
imaging using T1-weighted and fast spin-echo T2-weighted
sequences was used. Images were evaluated for a mass of
tissue surrounding the pars defect with MR characteristics
of cartilaginous and fibrous low signal intensity on
T1-weighted images and low to intermediate signal intensity
on T2-weighted images. The position of the
fibrocartilaginous mass and its relation to the thecal sac
were noted. Surgical correlation between those patients with
a fibrocartilaginous mass and those without was examined.
RESULTS: Twenty-nine (8.6%) of 336 patients were identified
as having a pars interarticularis defect. A
fibrocartilaginous mass was present in 26 (90%) of 29
patients. Six (21%) of the 29 patients had a mass effect on
the thecal sac. Of the remaining 23 patients, 20 had a
fibrocartilaginous mass external to the thecal sac, and
three did not show any fibrocartilaginous mass. Histologic
analysis in one patient confirmed the fibrous and
cartilaginous nature of the lesion at the pars defect.
CONCLUSION: A fibrocartilaginous mass was present in 90% of
the patients with spondylolysis. Mass effect on the thecal
sac that required surgery was identified in 21% of the
patients with spondylolysis. Awareness of this mass and
proper imaging protocols will enable the radiologist to
preoperatively alert the surgeon to its presence.},
Key = {fds133593}
}
@article{fds133611,
Author = {AB Schraner and NM Major},
Title = {MR imaging of the subcoracoid bursa.},
Journal = {AJR. American journal of roentgenology, UNITED
STATES},
Volume = {172},
Number = {6},
Pages = {1567-71},
Year = {1999},
Month = {June},
ISSN = {0361-803X},
Keywords = {Adolescent • Adult • Aged • Bursa, Synovial
• Female • Humans • Magnetic Resonance
Imaging* • Male • Middle Aged • Retrospective
Studies • Shoulder • Shoulder Pain •
diagnosis • etiology • instrumentation •
pathology*},
Abstract = {OBJECTIVE: The subcoracoid bursa, a bursa anterior to the
shoulder joint, can be identified on MR images. Awareness of
the MR appearance and location of this bursa, which can
connect with the subacromial-subdeltoid bursa, enables
appropriate diagnosis in patients with shoulder pain.
MATERIALS AND METHODS: Dictated reports involving all MR
imaging of the shoulder (n = 1545) performed at our
institution from June 1993 to February 1998 were reviewed
from computer archives. Films were reviewed in 16 cases
describing a subcoracoid bursa; in nine MR imaging correctly
revealed this bursa, whereas in seven MR imaging revealed
the subscapular recess, an outpouching of the glenohumeral
joint often confused with the subcoracoid bursa. RESULTS: Of
the 1545 shoulders examined, MR imaging revealed the
subcoracoid bursa in nine (0.6%) patients. Two cases from a
teaching file were also included, for a total of 11 cases.
In five (45%) of the 11 cases, the subcoracoid bursa
contained a small amount of fluid (<1 cm in largest diameter
on sagittal images). In the remaining six cases (55%), the
subcoracoid bursa contained a moderate (1-2 cm in largest
diameter) or a large amount (>2 cm in largest diameter) of
fluid. Of the 11 cases, six (55%) also showed connection
with the subacromial-subdeltoid bursa. CONCLUSION: It is
important to correctly identify the subcoracoid bursa on MR
imaging because it is believed to cause isolated shoulder
pain. Fluid in the subcoracoid bursa can also communicate
with the subacromial-subdeltoid bursa.},
Key = {fds133611}
}
@article{fds133607,
Author = {NM Major and CA Helms},
Title = {Pelvic stress injuries: the relationship between osteitis
pubis (symphysis pubis stress injury) and sacroiliac
abnormalities in athletes.},
Journal = {Skeletal radiology, GERMANY},
Volume = {26},
Number = {12},
Pages = {711-7},
Year = {1997},
Month = {December},
ISSN = {0364-2348},
Keywords = {Adolescent • Adult • Aged • Diagnosis,
Differential • Female • Fractures, Stress •
Humans • Magnetic Resonance Imaging • Male •
Middle Aged • Osteitis • Pelvic Bones •
Prospective Studies • Pubic Bone • Sacroiliac
Joint • Spinal Osteophytosis • Sports •
Tomography, X-Ray Computed • abnormalities* •
complications • complications* • diagnosis •
diagnosis* • etiology • injuries • injuries*
• pathology • radiography • radionuclide
imaging},
Abstract = {OBJECTIVE: To demonstrate with radiographic imaging the
association between pubic stress injury and sacroiliac
abnormalities in athletes. DESIGN AND PATIENTS: Eleven
athletes (9 men and 2 women), comprising seven male
long-distance runners, one male soccer player, one male and
two female basketball players, were imaged with plain films
for complaints of pubic symphysis pain, sciatica, groin
pain, or a combination of these complaints. In addition to
the plain films, four patients were imaged with CT, two
patients had MR imaging, and a bone scan was performed in
three patients. Anteroposterior plain films of the pelvis of
20 patients without back pain or pubic pain were evaluated
for comparison as a control group (ages 18-72 years, average
49 years; 11 women and 9 men). RESULTS: All athletes showed
plain film evidence of either sclerosis, erosions or offset
at the pubic symphysis. Four had avulsion of cortical bone
at the site of insertion of the gracilis tendon. Four
patients demonstrated sacroiliac joint abnormalities on
plain films consisting of sclerosis, erosions and
osteophytes, and in one of these athletes, bilateral
sacroiliac changes are present. Two patients with normal
sacroiliac joints on plain films had a bone scan showing
increased radionuclide uptake bilaterally at the sacroiliac
joints. One patient with both plain film and CT evidence of
sacroiliac abnormalities had an MR examination showing
abnormal signal at both sacroiliac joints and at the pubic
symphysis. A sacral stress fracture was found on CT in one
patient with complaints of sciatica. In the control group,
six patients, all over the age of 55 years, had mild
sclerosis of the symphysis, but no plain film evidence of
sacroiliac abnormalities. CONCLUSION: We have found a group
of athletes in whom stress injuries to the pubic symphysis
are associated with changes in the sacroiliac joint as
demonstrated by degenerative changes or in the sacrum as
manifested as a sacral stress fracture. These findings are
probably due to abnormal stresses across the pelvic ring
structure that lead to a second abnormality in the pelvic
ring. The abnormality in the sacrum is not always well seen
with conventional imaging. Recognition of the association of
stress injury of the symphysis with back pain is important
in that it can help avoid inappropriate studies and
diagnostic confusion.},
Key = {fds133607}
}
@article{fds133587,
Author = {NM Major and J Tehranzadeh},
Title = {Musculoskeletal manifestations of AIDS.},
Journal = {Radiologic clinics of North America, UNITED
STATES},
Volume = {35},
Number = {5},
Pages = {1167-89},
Year = {1997},
Month = {September},
ISSN = {0033-8389},
Keywords = {AIDS-Related Opportunistic Infections • Arthritis
• Bacterial Infections • Bone Diseases • Bone
Marrow Diseases • Bone Neoplasms • Humans •
Lymphoma, AIDS-Related • Muscle Neoplasms •
Muscular Diseases • Myositis • Osteoarthropathy,
Secondary Hypertrophic • Osteomyelitis •
Osteonecrosis • Reflex Sympathetic Dystrophy •
Sarcoma, Kaposi • diagnosis • diagnosis*},
Abstract = {Musculoskeletal manifestations in the HIV- and AIDS-infected
patient are not as common as in other organ systems. A
variety of musculoskeletal abnormalities are discussed in
this article, including infection, arthritis, and neoplasms.
A brief discussion of miscellaneous conditions, such as
avascular necrosis, hypertrophic osteoarthropathy, reflex
sympathetic dystrophy, and bone marrows abnormalities is
also included.},
Key = {fds133587}
}
@article{fds133586,
Author = {NM Major and CA Helms},
Title = {Idiopathic transient osteoporosis of the
hip.},
Journal = {Arthritis and rheumatism, UNITED STATES},
Volume = {40},
Number = {6},
Pages = {1178-9},
Year = {1997},
Month = {June},
ISSN = {0004-3591},
Keywords = {Diagnosis, Differential • Hip • Humans • Male
• Middle Aged • Osteonecrosis • Osteoporosis
• etiology* • radiography*},
Key = {fds133586}
}
@article{fds133600,
Title = {Major NM, Helms CA. Idiopathic transient osteoporosis of the
hip. Radiologic Vignettes. Arthritis and Rheumatism
1997;40:1178-1179},
Year = {1997},
Key = {fds133600}
}
@article{fds133601,
Title = {Major NM, Helms CA. Pelvic stress injuries. the relationship
between osteitis pubis (symphysis pubis stress injury) and
sacroiliac abnormalities in athletes. Skeletal Radiology
1997;26:711-717},
Year = {1997},
Key = {fds133601}
}
@article{fds133606,
Author = {NM Major and CA Helms},
Title = {Absence or interruption of the supra-acetabular line: a
subtle plain film indicator of hip pathology.},
Journal = {Skeletal radiology, GERMANY},
Volume = {25},
Number = {6},
Pages = {525-9},
Year = {1996},
Month = {August},
ISSN = {0364-2348},
Keywords = {Acetabulum • Female • Hip Joint • Humans
• Joint Diseases • Magnetic Resonance Imaging
• Male • Middle Aged • Neoplasms •
pathology • radiography • radiography*},
Abstract = {OBJECTIVE: To show that absence or interruption of the
supra-acetabular line is a subtle plain film indicator of
pathology in the acetabulum. DESIGN: Nineteen hips from 17
patients with known disease processes involving the
acetabulum as demonstrated by subsequent magnetic resonance
imaging, bone scan or plain film follow-up were evaluated
with antero-posterior (AP) plain films of the pelvis. Three
additional cases were diagnosed prospectively using
interruption of the supra-acetabular line as the criterion
for inclusion. Fifty AP plain films of the pelvis in
patients without hip pain were examined prospectively to
determine normal imaging criteria. RESULTS AND CONCLUSIONS:
The normal supra-acetabular line measures 2-3 mm in
thickness superiorly and is a thin sclerotic line in the
medial aspect. In all 22 hips (with pathology) in this
series, the line was interrupted or absent. Loss or
interruption of the supra-acetabular line may thus be a
subtle pain film indicator of a disease process involving
the acetabulum. This plain film sign has not previously been
reported.},
Key = {fds133606}
}
@article{fds133585,
Title = {Major NM, Helms CA. Absence or Interruption of the
Supra-acetabular Line: A Subtle Plain Film Indicator of Hip
Pathology. Skeletal Radiology 1996; 25: 525-529.},
Year = {1996},
Key = {fds133585}
}
@article{fds133604,
Author = {CA Helms and NM Major},
Title = {Proper protocols key to CT of lumbar spine.},
Journal = {Diagnostic imaging, UNITED STATES},
Volume = {16},
Number = {11},
Pages = {118-21},
Year = {1994},
Month = {November},
ISSN = {0194-2514},
Keywords = {Humans • Intervertebral Disk Displacement • Lumbar
Vertebrae • Magnetic Resonance Imaging • Spinal
Stenosis • Spondylolysis • Tomography, X-Ray
Computed • diagnosis • methods* • pathology
• radiography*},
Abstract = {MRI is clearly superior to CT in imaging the lumbar spine
for evaluation of the postoperative back. The one area in
which CT has been shown to be superior to MRI in the lumbar
spine is in diagnosing spondylolysis. Pars defects can be
very difficult to appreciate with MRI, yet are easily seen
with CT. Other than spondylolysis, the postoperative spine,
and bone marrow imaging, CT and MRI appear to be
diagnostically equivalent.},
Key = {fds133604}
}
@article{fds133602,
Author = {NM Major and CA Helms and HK Genant},
Title = {Calcification demonstrated as high signal intensity on
T1-weighted MR images of the disks of the lumbar
spine.},
Journal = {Radiology, UNITED STATES},
Volume = {189},
Number = {2},
Pages = {494-6},
Year = {1993},
Month = {November},
ISSN = {0033-8419},
Keywords = {Adult • Aged • Aged, 80 and over • Calcinosis
• Female • Humans • Intervertebral Disk
• Intervertebral Disk Displacement • Low Back Pain
• Lumbar Vertebrae • Magnetic Resonance Imaging*
• Male • Middle Aged • Spinal Diseases •
Tomography, X-Ray Computed • diagnosis •
diagnosis* • methods • pathology* •
radiography},
Abstract = {PURPOSE: To report that calcification of lumbar disks may
not show the usual low signal intensity on T1-weighted
magnetic resonance (MR) images. MATERIALS AND METHODS: The
authors present five cases of high signal intensity on
T1-weighted MR images of a lumbar disk that reflect the
presence of calcium deposition. RESULTS: In four cases there
was conventional radiographic confirmation and in one case
there was computed tomographic confirmation of the disk
calcification, which corresponded to the high signal
intensity seen on the MR studies. One patient had undergone
surgical removal of a partially calcified protruding disk.
CONCLUSION: Lumbar disk calcification can vary in signal
intensity from low to high on T1-weighted MR
images.},
Key = {fds133602}
}
@article{fds133614,
Author = {CA Helms and NM Major},
Title = {Rapid triple-compartment wrist arthrography with diluted
contrast medium.},
Journal = {Canadian Association of Radiologists journal = Journal
l'Association canadienne des radiologistes,
CANADA},
Volume = {44},
Number = {3},
Pages = {227-9},
Year = {1993},
Month = {June},
ISSN = {0846-5371},
Keywords = {Diatrizoate • Humans • Injections, Intra-Articular
• Methods • Wrist Joint • administration &
dosage • diagnostic use* • radiography*},
Abstract = {Triple-compartment wrist arthrography is currently
considered the optimal technique for evaluating carpal
instability, because injection of contrast agent into the
radiocarpal joint alone can fail to reveal ligamentous
disruption due to a ball-valve tear. Unfortunately,
triple-compartment arthrography can be time consuming for
both the patient and the radiologist. This report describes
a technique for rapid triple-compartment wrist arthrography
with standard (as opposed to digital subtraction)
fluoroscopy. This technique reduces the time necessary to
perform the study to 30 to 45 minutes without sacrificing
diagnostic accuracy.},
Key = {fds133614}
}
@article{fds133598,
Title = {Helms CA, Major NM. Rapid Triple compartment wrist
arthrography using diluted contrast medium. Jour of Canadian
Assoc Radiol 1993; 44; 227-229.},
Year = {1993},
Key = {fds133598}
}
@article{fds133599,
Title = {Major NM, Helms CA, Genant HK. Calcification demonstrated as
high signal on T1-weighted MR images in the discs of the
lumbar spine. Radiology 1993; 189: 494-496.},
Year = {1993},
Key = {fds133599}
}
@article{fds133627,
Author = {RW Coonrad and TF Roush and NM Major and CJ Basamania},
Title = {The drop sign, a radiographic warning sign of elbow
instability.},
Journal = {Journal of shoulder and elbow surgery / American Shoulder
and Elbow Surgeons ... [et al.], United States},
Volume = {14},
Number = {3},
Pages = {312-7},
ISSN = {1058-2746},
Keywords = {Dislocations • Elbow Joint • Humans • Humerus
• Joint Instability • Ulna • injuries* •
physiopathology • radiography* •
surgery*},
Abstract = {Persistent instability or redislocation is uncommon but of
significant concern in treating elbow dislocations. Finding
an objective, static radiographic sign that might correlate
with the presence of instability was the purpose of this
study. Pre- and post-reduction radiographs of 10 consecutive
simple and complete adult elbow dislocations were reviewed
and compared with radiographs of 20 consecutive adult elbows
without any trauma history. A statistically significant
measured increase in static ulnohumeral distance was noted
on the routine unstressed post-reduction lateral radiographs
of patients sustaining dislocation. We have termed this
increased distance the drop sign. It differs from the
radiographic ulnohumeral separation noted during
O'Driscoll's test for posterolateral rotary instability,
which is present only with axial compression. The drop sign
becomes concerning only if persistent after the first
reduction radiograph and may be a warning sign of the
presence of instability.},
Key = {fds133627}
}
@article{fds133612,
Author = {NM Major},
Title = {Magnetic resonance imaging of the elbow.},
Journal = {Current problems in diagnostic radiology, UNITED
STATES},
Volume = {29},
Number = {1},
Pages = {27-40},
ISSN = {0363-0188},
Keywords = {Arthritis, Rheumatoid • Bone Neoplasms • Elbow
• Humans • Magnetic Resonance Imaging* •
Sarcoma • anatomy & histology* • diagnosis •
injuries • physiopathology},
Key = {fds133612}
}