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Purpose: To illustrate the variety of posterior cruciate ligament (PCL) injuries and assess the type and frequency of associated knee injuries., Materials and Methods: In a retrospective review of 1,950 magnetic resonance (MR) examinations of the knee, 47 patients with MR imaging findings of PCL injury were identified. In 24 patients, the findings on MR images were correlated with athroscopic findings (n = 14) or findings at physical examination (n = 10). Patterns of associated injuries were described and tabulated., Results: Twenty-one patients (45%) had complete PCL tears; 22 patients (47%), partial tears; and four patients (9%), bone avulsion. Associated injuries were seen in 34 patients (72%). Patterns of injuries differed from those seen in anterior cruciate ligament injury and correlated with the mechanism of trauma., Conclusion: MR imaging proved accurate in assessment of the PCL in patients with clinical correlation and demonstrated patterns of associated injury that may affect management strategy.

The bone scans and radiographs of 27 patients with solitary or multiple cortical bone metastases were retrospectively studied. Thirty-six cortical metastases were identified in 32 appendicular long bones. Origin of the tumors included lung, breast, kidney, pancreas, larynx, uterus, and site unknown. Cortical metastases have hitherto been reported as individual cases or in small numbers. The large number reported herein suggests that the occurrence of these lesions may be more common than previously expected. A cortical metastasis was the only evidence of metastatic disease in eight of the 27 patients.

Pressure sores occur frequently in patients with spinal cord injuries and require radiographic evaluation for adequate management. Plain radiography, computed tomography, direct magnification radiography, sinography, and ultrasonography were used to evaluate 218 pressures sores. The role of each of these modalities in the management of patients with pressure sores is defined, and recommendations for their use are made.

Radiographic and clinical evaluation of the relative severity of wrist versus hand involvement in 101 patients with rheumatoid arthritis revealed more severe changes in the wrists in 60%, equal involvement in wrists and hands in 37%, and more severe changes in the hands in 3%. There were severe changes in the wrists but little or no bone or joint change in the metacarpophalangeal and proximal interphalangeal joints in 43 (21%) of the 202 extremities studied. Serial examinations showed that, in time, the hand changes tended to overtake those in the wrist. Appreciation of this progression of wrist and hand changes can help the physician avoid diagnostic difficulties in a significant percentage of patients.

Over a one-year period, 206 patients with suspected pulmonary embolism received gamma camera perfusion lung images on an emergency 24 hr. basis. Clinical diagnosis listed pulmonary embolism in 37 of 39 patients whose images showed a high probability of it, in 28 of 69 whose images were abnormal but rated uncertain probability, and 5 of 98 with normal images. Retrospective clinical evaluation indicated 89 of the emergency images to be considered important, 95 contributory, and 22 not helpful in clinical management. As a result of the images, 80 patients were placed on heparin therapy of 198 considered for it, and 22 of 29 patients referred for hospital admission were placed on an outpatient basis. Delay in obtaining lung images creates the possibility of diagnostic uncertainty in interpreting the image.

Sequential whole-body scans with both 67Ga-citrate and 111In-bleomycin were performed for 14 patients undergoing staging for Hodgkin's disease or other lymphomas. A comparison or these scans gave a sensitivity in detecting the pathologically-proved tumor sites of 84% for 67Ga-citrate and only 56% for 111In-bleomycin. In 12 patients, the gallium scan demonstrated the lesions more clearly; in the others, the uptake of the two radionuclides was equal. In no case was a clinically diagnosed or histologically proved lesion identified by 111In-bleomycin that was not also demonstrated by 67Ga-citrate. 111In-bleomycin does not complement the 67Ga-citrate scan in the scintigraphic evaluation of lymphomas.

The results of plain film radiography and arthrography in diagnosing loosening of a prosthetic component after total hip arthroplasty were correlated with surgical findings in 31 patients who required surgery because of hip pain. The accuracy of arthrography in diagnosing component loosening using 5 ml of contrast material was 51%, and the accuracy of plain radiography was 69%. An accuracy of 92% was achieved using a modified arthrographic technique in which the pressure in the joint was recorded after injection of contrast material and while the patient walked to ensure that it was comparable with the pressure that caused the patient's pain prior to the study. Three per cent of the arthrographic studies using this technique were false negative and 5% were false positive.

Of 358 antegrade voiding urethrograms obtained in 200 males with spinal cord injury, the urethra was satisfactorily shown by 154 (77%), permitting evaluation of alterations related to cord damage, surgery, or iatrogenic trauma. In 105 cases the neurogenic urethra was normal, demonstrated only minor distension, or had a patulous appearance, in contrast to urinary tract changes such as a markedly neurogenic bladder, vesicoureteral reflux, and bladder calculi. In 49 patients, abnormalities included (a) changes related to surgical alleviation of sphincter dyssynergia; (b) iatrogenic changes such as diverticula strictures, undermining of the external sphincter ("spiral sign"), and intravasation of contrast material; and (c) pressure necrosis of the urethra. Some changes need no special treatment; others, such as pressure necrosis, require early recognition and prompt therapy.