Spot Diagnosis

High-resolution MRI lymphangiography

A new technical innovation from Germany, by Lohrmann C et al, in the August issue of the AJR, shows how we can perform high-resolution MRI lymphangiography using gadodiamide (Omniscan), by injecting it into the web-spaces of the toes and imaging approximately 45-60 minutes later. The lymphatic vessels are very well seen and patients with lymphedema can thus be imaged.

Considering that traditional lymphangiography is so difficult nowadays to perform, especially due to the lack of availability of Lipiodol, this should be an attactive technique to use.

Giant cell tumor

This is a 20-years old lady whose knee radiograph shows a well-defined, expansile osteolytic lesion involving the epiphysis and metaphysis of the lower end of the femur, extending upto the articular surface, with subtle trabeculations. The zone of transition is narrow, as would be expected in benign lesions.

This appearance is highly suggestive of a giant cell tumor.

Solitary pulmonary nodule lecture

1. Slides 1-3

2. Slides 4-6

Solitary pulmonary nodule lecture - Slides 1-3

The Tom Cruise effect

Scanman on personal fetal Dopplers, etc

Radiology Ground Rounds - III

The third radiology grand rounds are up.

Radiofrequency ablation (RFA) of osteoid osteoma

This is a 15-years old boy with a posterior tibial mid-diaphyseal osteoid osteoma. A radiofrequency ablation (RFA) procedure was performed.

The approach was through the anterior cortex to avoid potential injury to other structures with posterior or lateral approaches. The electrode was placed in the lesion (Figs. 1, 2) and the ablation was performed at 90 deg C for 5 minutes.

A repeat MRI performed a week later shows the tract well (Fig. 3) as well as the zone of ablation (arrow).

RFA is the method of choice for treating osteoid osteomas. The results compare very favorably with surgery, but with hardly any associated morbidity. Since the procedure is performed under deep sedation in an OPD /day care setting, the patient is ready to resume a normal routine within 24 hours.