Treatment of intermetatarsal Morton's neuroma with alcohol injection under US guide: 10-month follow-up

Mortons neuroma (MN) is a frequent cause of metatarsalgia. The aim of our study was to evaluate the efficacy of neuroma alcohol-sclerosing therapy (NAST) under US guide in MN after a 10-month follow-up. Forty intermetatarsal neuromas underwent alcohol-sclerosing therapy after sonographic evaluation of their dimensions and echotexture. After subcutaneous anesthesia, a sclerosing solution composed of anesthetic (carbocaine-adrenaline 70%) and ethylic alcohol (30%) was injected inside the mass under US guidance. The procedure was repeated at intervals of 15 days until the resolution of the symptoms. A total or partial symptomatic relief was obtained in 36 cases (90%). No procedure-related complications were observed. Transitory plantar pain, due to the flogistic reaction induced by the sclerosing solution, occurred in 6 cases (15%). The 10-month follow-up revealed a 20-30% mass volume reduction and an adiposus-like change in echotexture. In the 4 cases (10%) of therapeutic failure, the preliminary sonography demonstrated a hypoechoic echotexture with a strong US beam attenuation corresponding to a highly fibrous neuroma after surgical resection. The NAST is a feasible and cost-efficient procedure with high rates of therapeutic success

The Value of secondary MRI signs of an ACL lesion : comparison with arthroscopy

Primary MRI signs are sometimes insufficient for the diagnosis of anterior cruciate ligament (ACL) tears and the observation of secondary signs (impingement of the tibial plateau, augmented PCL curvature, anterior tibia] dislocation) may be of great assistance. This paper assesses the sensitivity and specificity of the primary and secondary MRI signs in the light of the arthroscopic findings in 50 patients with suspected ACL damage. MR imaging was conducted with specific surface coils and weighted T1 and T2 spin echo and gradient echo sequences. Sensitivity and specificity for the primary signs were 94% and 92%. The corresponding values for the secondary signs were: impingement 88% and 100%; augmented PCL curvature 70% and 89%; anterior dislocation 31% and 98%. These results indicate that MRI diagnosis of ACL tears based on primary signs (morphology and signal intensity) is more sensitive and specific. Diagnostic accuracy can be considerably improved in doubtful cases by resorting to the highly specific secondary signs. (C) 2001, Editrice Kurtis

Hepatic artery pseudoaneurysm in von Willebrand's disease. Eur Radiol. 2003 Aug;13(8):1913-5. Epub 2002 Sep 3

We report a case of hepatic artery pseudoaneurysm which occurred in a patient with von Willebrand's disease. The patient presented with upper abdominal pain and diagnosis was made by US and CT examinations. This case emphasizes the possible association between an established coagulation disorder and pseudoaneurysm. The patient was successfully treated by coil embolizatio

Pyriformis muscle syndrome: CT/MR findings in the percutaneous therapy with botulinic toxin [Sindrome del musculo piriforme: Diagnostica integrata TC/RM nella terapia percutanea con tossina botulinica]

Purpose. The aim of our study was to evaluate the diagnostic capabilities of computed tomography (CT) and magnetic resonance (MR) imaging in pyriformis syndrome (PS) and the long-term outcomes of CT-guided percutaneous treatment with botulinum. PS is a cause of sciatica and disability. The pain is usually increased by muscular contraction, palpation or prolonged sitting. Materials and methods. Thirty-four patients suffering from PS, suspected on the basis of clinical and electrophysiological criteria and after imaging examinations had excluded other causes of sciatic pain, had positive lidocaine tests and were treated by intramuscular injection of botulinum toxin type A (BTX-A) under CT guidance. MR sequences was performed in nine patients before treatment and after three months to evaluate the extent of muscle denervation. Results. In 30 cases relief of symptoms was obtained after 5-7 days. In four patients insufficient pain relief warranted a second percutaneous treatment which proved clinically successful. No complications or side effects were recorded after BTX-A injection. The MR examination demonstrated a change in signal intensity of the muscle in seven patients due to denervation, whereas in the remaining two cases only atrophy was detected. Larger series are necessary to confirm these preliminary results. Conclusions. CT-guided BTX-A injection in the pyriformis muscle is an emergent and feasible technique that appears to yield excellent local therapeutic effects without the risk of imprecise injection