All projects

Enostosis, Hyperostosis, and Periostitis
Dennis K. Bielecki, MD
Certain disorders are associated with localized or generalized cortical hyperostosis or periostitis. These include enostoses (bone islands), osteomas with or without associated Gardner’s syndrome, osteopoikilosis, osteopathia striata, melorheostosis, pachydermoperiostosis, secondary hypertrophic osteoarthropathy, vascular insufficiency, infantile cortical hyperostosis, hyperostosis frontalis interna, diffuse idiopathic skeletal hyperostosis, sternocostoclavicular hyperostosis, fluorosis, plasma cell dyscrasias, neurofibromatosis, and several rare or poorly defined syndromes. The changes must be distinguished from the periostitis that occurs as a response to an adjacent osseous process (neoplasm, infection, trauma) and from hyperostosis accompanying other congenital disorders. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Tuberous Sclerosis, Neurofibromatosis, and Fibrous Dysplasia
Dennis K. Bielecki, MD
Tuberous sclerosis is a widespread aberration that begins during embryonic life and may involve all germ layers. Its classic clinical triad consists of epileptic seizures, mental retardation, and skin lesions. Neurofibromatosis, previously characterized by the classic clinical triad of cutaneous lesions, mental deficiency, and skeletal deformities, has now been reclassified into several subtypes. Fibrous dysplasia is a disorder of unknown cause in which the skeleton is a prominent target tissue. A variety of endocrine abnormalities, including McCune-Albright syndrome, may accompany the osseous abnormalities. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Muscle Disorders
Dennis K. Bielecki, MD
This chapter reviews the fundamental elements in interpreting imaging examinations of the neuromuscular system: normal anatomy, imaging techniques, and pathologic conditions. Knowledge of anatomy and of the capabilities of the various techniques is a prerequisite for correctly interpreting the pathologic changes displayed. Imaging examinations also have an impact on patient care by providing meaningful information about the location, extent, severity, and activity of muscular disorders. Further, the muscular abnormalities detected on imaging examinations—some specific and some nonspecific—can be used to plan treatment, predict prognosis, guide invasive procedures, and assess therapeutic response. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Additional Congenital or Heritable Anomalies and Syndromes
Dennis K. Bielecki, MD
There are many congenital and inherited disorders of the skeleton, and these disorders have varied clinical and radiographic manifestations. In some instances, the radiographic features are entirely specific, whereas in others, they must be interpreted with knowledge of the clinical abnormalities to arrive at a correct diagnosis. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Osteochondrodysplasias, Dysostoses, Chromosomal Aberrations, Mucopolysaccharidoses, and Mucolipidoses
Dennis K. Bielecki, MD
The number of skeletal dysplasias is large and continues to increase. Nomenclature is complex and not agreed on. Only the more important dysplasias are covered in this chapter; certain other conditions, such as fibrous dysplasia, osteogenesis imperfecta, and melorheostosis, are discussed elsewhere in this book. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Heritable Diseases of Connective Tissue, Epiphyseal Dysplasias, and Related Conditions
Dennis K. Bielecki, MD
Included in this chapter are diseases of connective tissue synthesis and disorders of epiphyses. The radiographic changes are diverse, ranging from joint incongruity with secondary degeneration to soft tissue calcification or ossification with or without osseous overgrowth. Although there are clinical and laboratory features in some of these diseases that provide important clues to the correct diagnosis, an awareness of the radiographic alterations allows early and appropriate assessment in cases in which the diagnosis is more obscure. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Tumors and Tumor-Like Lesions of Soft Tissues
Dennis K. Bielecki, MD
The number of tumors and tumor-like lesions of soft tissues is impressive. Routine radiography is relatively insensitive in their detection, and it does not allow a specific diagnosis in most cases. Ultrasonography, computed tomography, scintigraphy, and magnetic resonance imaging are diagnostic methods with greater sensitivity for the detection of soft tissue masses, although in many instances, the specific cause of the mass remains elusive. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Tumors and Tumor-Like Lesions of Bone: Imaging and Pathology of Specific Lesions
Dennis K. Bielecki, MD
Many tumors and tumor-like lesions may involve bone. Accurate diagnosis of these lesions requires close cooperation among the orthopedic surgeon, radiologist, and pathologist. The patient’s age and the site of skeletal localization are fundamental to the proper interpretation of the abnormalities detected by routine radiography and specialized imaging techniques. In many instances, however, a single diagnosis cannot be offered on the basis of such abnormalities, and careful histologic and, more recently, immunohistochemical analyses are required. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Tumors and Tumor-Like Lesions of Bone: Radiographic Principles
Dennis K. Bielecki, MD
Conventional radiographic techniques are of fundamental importance in the analysis of bone tumors and tumor-like lesions. Morphologic characteristics provide important diagnostic information regarding the aggressive or nonaggressive behavior of the lesion. These, when combined with information related to the site or distribution of skeletal involvement, allow the formulation of a single diagnostic choice or several choices that are most likely in any patient. The addition of clinical information, including the age of the patient, information derived from other imaging techniques, and, in some cases, histologic data, is also essential. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Osteochondroses
Dennis K. Bielecki, MD
The osteochondroses are a heterogeneous group of disorders that are usually characterized by fragmentation and sclerosis of an epiphyseal or apophyseal center in an immature skeleton. Reossification and reconstitution of osseous contour may be evident in some cases. These disorders can be divided into three major categories: (1) conditions characterized by primary or secondary osteonecrosis; (2) conditions related to trauma or abnormal stress, without evidence of osteonecrosis; and (3) conditions that represent variations in normal patterns of ossification. In some cases, a definite pathogenesis cannot be identified. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Osteonecrosis: Pathogenesis, Diagnostic Techniques, Specific Situations, and Complications
Dennis K. Bielecki, MD
Osteonecrosis can accompany many diverse disease processes, such as trauma, hemoglobinopathy, exogenous or endogenous hypercortisolism, alcoholism, pancreatitis, dysbaric conditions, and Gaucher’s disease. It may also become evident without any recognizable disease or event (primary, or spontaneous, osteonecrosis). Post-traumatic osteonecrosis is most frequent in the femoral and humeral heads, scaphoid, and talus, although other sites may be affected. Dysbaric osteonecrosis can produce widespread skeletal alterations of the epiphyseal, metaphyseal, or diaphyseal segments of tubular bones. Spontaneous osteonecrosis is most commonly recognized about the hip and knee. Possible complications of bone necrosis are secondary degenerative joint disease, formation of intra-articular osseous and cartilaginous bodies, septic arthritis, pathologic fracture, and cystic or sarcomatous transformation. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Heavy Metal Poisoning and Deficiency
Dennis K. Bielecki, MD
In some cases of heavy metal poisoning, radiodense lines or bands may appear in the metaphyses of tubular bones and within flat or irregular bones. The resulting radiographic findings, which are characteristically observed in lead, phosphorus, and bismuth poisoning, must be differentiated from normal variants, stress lines of Park or Harris, and changes in various metabolic, endocrine, and infectious disorders. Significant radiographic abnormalities are also observed in the aluminum accumulation that accompanies dialysis and in nutritional or inherited deficiencies of copper. Finally, metal debris (metallosis) may complicate joint surgery. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Disorders Due to Medications and Other Chemical Agents
Dennis K. Bielecki, MD
A survey of the musculoskeletal manifestations associated with certain medications and chemical substances indicates that in some cases the therapeutic regimen may be more detrimental than the disease. A variety of teratogenic drugs can lead to significant fetal anomalies. Corticosteroids and other anti-inflammatory agents can produce osteoporosis, osteonecrosis, and neuropathic-like alterations. Osteosclerosis, periostitis, osseous excrescences, ligamentous calcification, and dental abnormalities can accompany fluorosis. Injection of dopamine and related substances may lead to gangrene, requiring amputation, whereas soft tissue calcification may appear after calcium gluconate injection or ingestion of milk and alkali. New bone formation is seen in some patients receiving prostaglandins or isotretinoin. Quinolones may produce tendinosis and tendon rupture. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Radiation Changes
Dennis K. Bielecki, MD
The effects of radiation on bone occur as a result of accidental exposure (e.g., radium dial workers) and of diagnostic (e.g., Thorotrast) and therapeutic procedures. Radiation therapy may affect bone growth, cause osseous necrosis, and induce neoplasia. Fortunately, these complications have decreased in frequency owing to advances in the methods of providing such therapy and to the use of both radiation and chemotherapy. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Thermal and Electrical Injuries
Dennis K. Bielecki, MD
The radiographic features of the skeleton after thermal and electrical injuries are varied. In many cases, they are not specific and must be interpreted with knowledge of the mechanism of injury. Of particular interest are the appearance of epiphyseal abnormalities in frostbite, periarticular calcification and ossification after thermal burns, and pathologic fractures associated with electrocution. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Physical Injury: Extraspinal Sites
Dennis K. Bielecki, MD
Routine radiographic findings are emphasized in this chapter, although reference is made to the assessment of such injuries with other methods such as computed tomography and magnetic resonance imaging. Both these techniques are fundamental to the evaluation of internal derangements of joints. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Physical Injury: Concepts and Terminology
Dennis K. Bielecki, MD
In addition to such complications as reflex sympathetic dystrophy, osteolysis, osteonecrosis, many of the osteochondroses, neuropathic osteoarthropathy, heterotopic bone formation, and infection, physical trauma may lead to a variety of radiographic abnormalities. The radiographic characteristics of fractures in the various skeletal sites are explained on the basis of biomechanical principles. Special types of injuries include pathologic, stress, greenstick, torus, bowing, and transchondral fractures; trabecular microfractures; and osseous infractions accompanying subluxations and dislocations. The precise cause of osteochondritis dissecans is not clear, but trauma is suspected. Trauma to synovial joints may lead to synovitis, hemarthrosis, and lipohemarthrosis; trauma to symphyses may result in intraosseous cartilaginous displacement (cartilaginous nodes); trauma to synchondroses may cause variable patterns of acute or chronic growth plate injury; and trauma to supporting structures, syndesmoses, and entheses may lead to tendinous and ligamentous laceration and disruption, avulsion, and diastasis. A variety of skeletal muscle alterations are related to physiologic stress and acute or chronic injury. Characteristic skeletal abnormalities also appear in abused children. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Osteomyelitis, Septic Arthritis, and Soft Tissue Infection: Axial Skeleton
Dennis K. Bielecki, MD
The routes of contamination of the spine, the sacroiliac joint, and other axial skeletal sites are identical to those of the appendicular skeleton. In the spine, early loss of intervertebral disc space is characteristic of pyogenic infection and is associated with lysis and sclerosis of neighbouring bone. These findings can simulate those of other disorders, such as rheumatoid arthritis, intervertebral (osteo)chondrosis, and conditions complicated by cartilaginous node formation. Sacroiliac joint infection is typically unilateral in distribution, a feature that allows its differentiation from many other articular processes. Additional locations in the axial skeleton are not uncommonly infected in intravenous drug abusers and in patients after trauma, surgery, or diagnostic and therapeutic procedures. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Osteomyelitis, Septic Arthritis, and Soft Tissue Infection: Mechanisms and Situations
Dennis K. Bielecki, MD
A thorough understanding of regional anatomy is fundamental to the accurate interpretation of clinical, radiographic, and pathologic characteristics of infections of bone, joint, and soft tissue. In most persons with such infections, a specific mechanism of contamination can be recognized; infection may be derived from hematogenous seeding, spread from a contiguous source, direct implantation, or operative contamination. The radiographic findings of osteomyelitis (including abscess, involucrum, and sequestration), septic arthritis (including joint space loss and marginal and central osseous erosions), and soft tissue suppuration (including swelling, radiolucent streaks, and periostitis) are generally delayed for a variable period after the clinical onset of infection. Other diagnostic techniques, including scintigraphy and magnetic resonance imaging, allow an accurate diagnosis at an earlier stage of the process. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Bleeding Disorders
Dennis K. Bielecki, MD
The skeletal abnormalities associated with hemophilia and other bleeding diatheses are characteristic. They result from hemorrhage in soft tissue, muscle, and subperiosteal, intraosseous, and intra-articular locations. In involved joints, typical findings are radiodense effusions, regional or periarticular osteoporosis, subchondral bony erosions and cysts, and joint space narrowing. Hyperemia may lead to epiphyseal overgrowth in a child affected by these disorders. Tumor-like lesions are occasionally encountered that are due to massive subperiosteal, osseous, or soft tissue hemorrhage, with erosion and distortion of adjacent bone. Hemosiderin deposition in any of these disorders leads to characteristic findings on magnetic resonance imaging. The differential diagnosis is usually not difficult when both clinical and imaging features are studied. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Lipidoses, Histiocytoses, and Hyperlipoproteinemias
Dennis K. Bielecki, MD
Musculoskeletal findings are a significant part of the lipidoses, histiocytoses, and hyperlipoproteinemias. In Gaucher’s disease, cellular accumulation in the bone marrow leads to replacement of trabeculae, endosteal erosion of the cortex, cortical thinning, lytic defects, and fractures. Osteonecrosis and modelling deformities of the long bones are characteristic. The findings in Niemann-Pick disease may resemble those of Gaucher’s disease, although osteonecrosis is not encountered. This latter abnormality is detected in Fabry’s disease. Multicentric reticulohistiocytosis is characterized by the proliferation of histiocytes in various tissues. Skeletal involvement can lead to a symmetrical destructive polyarthritis with a predilection for the interphalangeal joints of the hands and feet, early and severe abnormalities of the atlantoaxial joints, and changes in other articulations of the appendicular skeleton. The Langerhans cell histiocytoses consist of three disorders: eosinophilic granuloma, Hand-Schüller-Christian disease, and Letterer-Siwe disease. Although these disorders share numerous radiographic and pathologic features, their classic clinical characteristics allow their separation into discrete entities. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Paget’s Disease
Dennis K. Bielecki, MD
Paget’s disease is a common disorder of middle-aged and elderly patients that is characterized by excessive and abnormal remodelling of bone. Its radiographic features are virtually diagnostic and include an initial osteolytic phase, most common in the skull and tubular bones, and a subsequent osteosclerotic phase, particularly in the axial skeleton. An enlarged bone with increased radiodensity and an accentuated trabecular pattern is typical. Involvement of specific sites leads to characteristic radiographic signs, including the “cotton-wool” cranial vault and the “picture-frame” vertebral body. Complications associated with Paget’s disease are insufficiency fractures, neurologic symptoms and signs, skeletal deformities, neoplasms, and articular alterations. The most important articular abnormality associated with this disorder is degenerative joint disease, particularly in the hip and knee. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Temporomandibular Joint
Dennis K. Bielecki, MD
Temporomandibular joint (TMJ) pain and dysfunction are important clinical problems. Many of these disorders have long been misunderstood or ignored by physicians, who for years had little interest in or opportunity to learn about them. In the past 15 or 20 years, however, radiologists have had a major role in the diagnosis of TMJ disorders because of the explosion of new imaging methods. Foremost among these methods are arthrography, computed tomography (CT), and, more recently, magnetic resonance (MR) imaging. The impact of these imaging techniques on the diagnosis of TMJ disorders is undeniable. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Other Crystal-Induced Diseases
Dennis K. Bielecki, MD
Other crystals besides monosodium urate, calcium pyrophosphate dihydrate (CPPD), and calcium hydroxyapatite crystals can lead to soft tissue, articular, and osseous abnormalities. Cholesterol crystals are identified in patients with rheumatoid arthritis, as well as osteoarthritis; they appear to reflect local rather than systemic alterations and may be responsible for low-grade synovial inflammation. When corticosteroid preparations are injected into joints, there is a mild synovial inflammatory response. Accumulation of calcium oxalate crystals is seen in both primary and secondary oxalosis, the latter most typically occurring as a complication of chronic renal disease. Destructive lesions of the metaphyseal regions of tubular bones, discovertebral regions, and sometimes joints become apparent. Cystine, haemoglobin, and Charcot-Leyden crystals can also accumulate in bones or joints, although the precise relationship between such accumulation and structural abnormality is not known. Xanthine and hypoxanthine crystals may be deposited in muscles. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Calcium Pyrophosphate Dihydrate Crystal Deposition Disease
Dennis K. Bielecki, MD
Until recently, calcium pyrophosphate dihydrate (CPPD) crystal deposition disease was a commonly overlooked condition. In the past 3 decades, considerable attention to its various clinical and radiographic manifestations has increased physicians’ awareness of this disorder. Chondrocalcinosis can no longer be considered the only significant radiographic feature of CPPD crystal deposition disease. An equally characteristic radiographic finding is the presence of other intra-articular and periarticular calcifications and structural joint damage. The pattern and distribution of structural joint damage (pyrophosphate arthropathy) are especially distinctive and can be differentiated from the features of degenerative joint disease to allow an accurate diagnosis of CPPD crystal deposition disease even in the absence of chondrocalcinosis. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Calcification and Ossification of the Posterior Spinal Ligaments and Tissues
Dennis K. Bielecki, MD
Calcification and ossification affect a variety of posterior spinal ligaments and tissues. Ossification of the posterior longitudinal ligament is a characteristic disorder of the spine that may be associated with significant neurologic findings. Its radiographic appearance is diagnostic and consists of a linear band of ossification along the posterior margin of the vertebral bodies and intervertebral discs, particularly in the cervical spine. Arachnoiditis ossificans is a rare condition that leads to extensive ossification in the arachnoid membrane, especially in the thoracic spine, and it produces significant symptoms and signs. Osseous proliferation at the cephalad and caudad attachments of the ligamentum flavum is a frequent finding that is generally of no significance. When extensive, however, such ossification in the thoracic spine leads to neurologic manifestations and is accompanied by involvement of nearby tissues and ligaments and, in some cases, diffuse idiopathic skeletal hyperostosis. Calcification in the ligamentum flavum is usually observed in the cervical spine and is associated with calcium hydroxyapatite crystal deposition or, more infrequently, calcium pyrophosphate dihydrate crystal accumulation. A nodular radiodense collection is the typical radiographic abnormality. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Diffuse Idiopathic Skeletal Hyperostosis
Dennis K. Bielecki, MD
The clinical, radiographic, and pathologic features of diffuse idiopathic skeletal hyperostosis (DISH) distinguish it from ankylosing spondylitis, spondylitic variants, acromegaly, hypoparathyroidism, hypervitaminosis A, Ochronosis, and fluorosis. Although there is a general tendency to attribute the peculiar pattern of spinal abnormality in DISH to “degenerative” or “discogenic” alterations, this is misleading. DISH differs considerably from intervertebral (osteo)chondrosis, which is the typical degenerative disease of the nucleus pulposus. DISH most resembles spondylosis deformans, although both qualitative and quantitative differences exist between the two entities. Spondylosis deformans is associated with spinal osteophytosis, and the pathogenesis of these outgrowths probably relates to changes in the anulus fibrosus. Disc protrusion followed by traction osteophytes appears to be the sequence of events in spondylosis deformans. These findings are identical to those occurring as part of the spinal abnormalities of DISH (type II). Spinal ligament calcification and ossification occur in DISH but are not a prominent feature of spondylosis deformans, and an enthesopathy is observed where the anterior longitudinal ligament attaches to the periosteal surface of the vertebral body. These findings could represent true qualitative differences between the two disorders. DISH may represent an ossifying diathesis that causes excessive bone formation at skeletal sites subject to normal or abnormal stress. These sites are generally found at points of tendon and ligament attachment to bone, in both the axial and extra-axial skeletons. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Degenerative Diseases of Extraspinal Locations
Dennis K. Bielecki, MD
Degenerative joint disease is widespread and common. In synovial joints, the process is termed osteoarthritis. At these sites, abnormalities predominate in the cartilaginous and osseous tissues, whereas alterations in the synovial membrane generally are mild. Typical findings include joint space loss, eburnation, cyst formation, and osteophytosis. Subluxation, malalignment, fibrous ankylosis, and intra-articular osseous and cartilaginous bodies may complicate osteoarthritis. The most common sites of extraspinal osteoarthritis are the interphalangeal and metacarpophalangeal joints of the hand, first carpometacarpal and trapezioscaphoid areas of the wrist, acromioclavicular and sternoclavicular articulations, hip, knee, and tarsometatarsal and metatarsophalangeal joints of the great toe. At each of these sites, radiographic features of the disease are sufficiently characteristic to allow their differentiation from the features of other articular disorders. Two special varieties of osteoarthritis have been described, although their existence as discrete entities is not universally accepted. Generalized osteoarthritis may be a particular form of degenerative joint disease in which multiple articulations are affected. Inflammatory (erosive) osteoarthritis is associated with clinical and pathologic features of joint inflammation. Although its distribution is virtually identical to that of noninflammatory digital osteoarthritis, certain radiographic features, such as erosions and intra-articular bony ankylosis, appear to be more typical of inflammatory osteoarthritis. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Polyarteritis Nodosa and Other Vasculitides
Dennis K. Bielecki, MD
Vasculitis occurs in a number of disorders and may be associated with musculoskeletal manifestations. Although arteriography can reveal characteristic alterations in these disorders, radiographic abnormalities are unimpressive. In polyarteritis nodosa, periosteal bone formation may be seen, particularly in the lower extremity. Articular abnormalities in giant cell (temporal) arteritis relate to its association with polymyalgia rheumatica and include soft tissue swelling and osteoporosis. In Henoch-Schönlein purpura and erythema nodosum, joint effusions are the only characteristic radiographic abnormality. Cryoglobulinemia is occasionally accompanied by cystic and erosive lesions of bone in both the axial and the appendicular skeletons. The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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Systemic Lupus Erythematosus
Dennis K. Bielecki, MD
Musculoskeletal abnormalities represent a significant part of the clinical and radiographic picture of systemic lupus erythematosus. These abnormalities include myositis, symmetrical polyarthritis, deforming nonerosive arthropathy, spontaneous rupture of tendons, osteonecrosis, soft tissue calcification, osteomyelitis and septic arthritis, and terminal phalangeal sclerosis and erosion. Many of these abnormalities resemble the changes that occur in other collagen vascular disorders and rheumatoid arthritis. In addition, findings of systemic lupus erythematosus may be combined with those of other collagen vascular diseases in various overlap syndromes and in mixed connective tissue disease, and they may also be evident The candidate will learn the mechanics of putting together an electronic poster presentation in lecture type format. This will be an official peer-reviewed publication. The publication will be a favorable addition to the candidate's CV. The candidate will be the first author, and I am the second author. A candidate is not limited to completing one project. He/she can do as many as they like! (There are always topics to teach about) The candidate, myself, King's College Hospital Department of Radiology and King's College all benefit from this publication.
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