Making a Diagnosis of Osteochondritis Dissecans with Sonography
Abstract & Commentary
Synopsis: Sonography can be used to make a diagnosis of osteochondritis dissecans of the humeral capitellum and can classify a lesion as nondisplaced and either stable or unstable. MR is recommended to assess the stability of lesions precisely.
Source: Takahara M, et al. Sonographic assessment of osteochondritis dissecans of the humeral capitellum. AJR Am J Roentgenol 2000;174:411-415.
Conventional radiography understages osteochondritis dissecans; therefore, radiography with the elbow in 45° of flexion is suggested to allow clearer visualization of osteochondritis dissecans of the capitellum. This study was performed to address whether sonography enables the observer to distinguish between stable and unstable lesions.
Twenty-seven subjects with osteochondritis dissecans of the capitellum were assessed with anteroposterior extended, anteroposterior in 45° of flexion, and lateral views. Sonography of the capitellum was obtained in two directions: anterior and posterior longitudinal views.
Radiography showed that 10 lesions were stable and 17 were unstable. Sonography showed eight stable and 19 unstable leasions. Magnetic resonance (MR) showed three stable and seven unstable lesions. Sonography and radiography agreed in 23 cases and disagreed in four. Surgical findings confirmed 13 of the 15 radiographic assessments and revealed that two radiographic assessments had been underestimations. In these two lesions, sonography revealed the lesions were unstable and the finding was confirmed with MR and surgery. Thus, although assessment with AP radiographs with the elbow in 45° of flexion is useful, additional use of sonography and MR imaging is helpful to avoid underestimating the severity of osteochondritis dissecans of the capitellum.
Comment by Beverly P. Wood, MD
Sonography is useful in evaluating osteochondritis dissecans of the elbow as a dynamic study and one that is sensitive in visualizing subchondral bone and articular cartilage simultaneously. Sonography should identify unstable lesions, but apparently did not always indicate instability or complications such as synovitis or contracture. MR imaging was needed to obtain more information about lesions.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content