No abstract

Sixty-two patients with seropositive rheumatoid arthritis (RA) were evaluated radiographically for distal interphalangeal (DIP) joint involvement and were compared with 50 age-and sex-matched control subjects. The frequency of DIP erosions was 37% ip the patients versus 14% in the controls; these erosions were mild and were not related to disease duration. Erosions elsewhere in the hand and wrist were of all degrees of severity and were related in part to disease duration. Osteophytes occurred frequently in both the RA group (71 %) and the control group (60%). However, joint space narrowing occurred more frequently in RA patients (77%) than in the controls (46%) (P < 0.009). The findings from this study suggest that in RA patients, DIP erosions occur frequently, do not occur in isolation, and are not simply a marker for severe global erosive disease in the hand and wrist. The high frequency of osteophytosis and joint space narrowing in both groups probably represents the overlap of osteoarthritis and RA that occurs in many patients.Bone erosions of the proximal interphalangeal (PIP), metacarpophalangeal (MCP), and carpal articuFrom the Departments of Radiology and Rheumatology,

A comprehensive imaging and pathologic investigation utilizing patients and cadaver material was performed in order to identify the normal trabecular pattern of the proximal femur and to assess alterations in this pattern in various disorders. Patients and specimens were studied with computed tomography (CT), including three-dimensional CT image reconstruction in selected cases and plain film radiography. The CT imaging of the proximal femur provides insight into the dynamic state of bone in this region. Despite limited resolution, three-dimensional CT image reconstruction is capable of portraying the concentration and orientation of major trabeculae in the proximal femur. Increased trabecular spacing occurs in osteoporosis and is well depicted by CT. Proliferation and thickening of the most superior subchondral primary compressive trabeculae is an early sign of osteoarthritis. In the region of the calcar femorale, crossing trabeculae, similar to the appearance of an enchondroma or bone infarct, have been described in osteoporosis and osteoarthritis and probably represent unmasking of normally present reinforcing trabeculae. In ischemic necrosis, CT should be considered a useful modality for detection of early or mild alterations and may be valuable in treatment planning.

No abstract

Although foramina in the scapula are a rare occurrence, they produce radiolucent defects that simulate those related to skeletal metastasis or multiple myeloma. In order to define the typical location and appearance of these foramina, we initiated a radiographic and pathologic examination of macerated modern and ancient scapulae. Of 93 macerated scapulae that were examined, foramina were observed in 27 specimens (29%). These occurred at four sites: at the superior border of the bone at its junction with the coracoid process, caused by ossification of the superior transverse ligament (21 specimens); in the body of the bone inferior to the scapular spine, resulting from a disturbance in ossification during fetal development (five specimens); in the superior fossa, as a clasp-like defect (one specimen); and, at the superomedial border above the scapular spine (one specimen). The radiographic features of these foramina were compared to those produced by normal vascular channels, anatomic thinning of the bone, and skeletal metastasis or multiple myeloma. Knowledge of the typical appearance and site of scapular foramina assures accurate diagnosis.