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Objective: This study evaluated the diagnostic accuracy of high-spatial-resolution sonography in the diagnosis of occult fractures of the waist of the scaphoid., Subjects and Methods: Sonography of the scaphoid bone with a 12-MHz transducer was performed in 54 patients with clinically suspected scaphoid fracture and normal findings on initial radiographs, including specific scaphoid images. Three levels of clinical suspicion were considered: high (20%), moderate (30%), and low (50%). Attention was paid to the continuity of the scaphoid cortex and to the surrounding soft tissues (i.e., hemarthrosis or hematoma). Data from early sonograms were then compared with the results of radiography repeated 10-14 days after the initial trauma. In cases of persistent suspicion despite normal findings on follow-up radiographs, the presence of fracture was evaluated on CT (four patients), MR imaging (one patient), or bone scanning (one patient)., Results: Follow-up examinations proved fracture of the scaphoid waist in five patients. In all patients, diagnosis of fracture was suspected on initial sonograms showing cortical disruption associated with soft-tissue abnormalities. There was one false-positive finding and no false-negative results. Using cortical disruption as a diagnostic criterion, we found the sensitivity, specificity, and accuracy of high-resolution sonography for the depiction of scaphoid fracture to be 100%, 98%, and 98%, respectively. Using soft-tissue abnormalities alone as a criterion, we found the sensitivity, specificity, and accuracy of high-resolution sonography to be 100%, 65%, and 68%, respectively. The overall prevalence of occult fracture was 9%, ranging from 3.7% for low suspicion to 27% for high suspicion of fracture., Conclusion: High-resolution sonography is a reliable and accurate method of evaluating occult fractures of the scaphoid waist. Cortical disruption is the diagnostic key. Soft-tissue abnormalities alone lack specificity.

Objective: We describe the imaging findings of an unusual type of Schmorl's node appearing as giant cystlike lesion of the vertebral bodies., Conclusion: Giant cystic Schmorl's nodes are unusual entities; their radiologic appearance differs dramatically from the classic description and is diagnostically challenging. However, the appearance of these nodes on conventional radiographs and especially on MR images is characteristic. Knowledge of this entity would help to eliminate unnecessary invasive diagnostic or therapeutic procedures.

Objective: This article describes the appearance of the anterolateral recess of the posttraumatic ankle on CT arthrography and clearly shows the benefit of this technique in the diagnosis of soft-tissue impingement., Materials and Methods: The study was carried out on 44 patients examined by CT arthrography and arthroscopy for chronic, posttraumatic ankle pain. The analysis principally concerned the lateral compartment--in particular, the synovial regularity and the cartilage of the talar dome., Results: Four CT patterns were identified: type 0, uniform filling of the recess with clear limits; type I, intraarticular linear structure outlined by contrast agent; type II, nodular formation in the lateral groove; and type III, irregular appearance of the edges of the lateral groove. Ninety-one percent (10/11) of type II patterns were characterized as meniscoid lesions by arthroscopic examination, 100% (14/14) of type III patterns corresponded to an abundant fibrous reaction, and arthroscopic findings were normal for 100% (2/2) of type 0 patterns and 88% (15/17) of type I patterns. The latter was thus considered as a normal variant outlining the accessory anterior inferior tibiofibular ligament. Type II and III lesions were statistically associated (p = .001) with a chondropathy when time from initial trauma was greater than 22 months., Conclusion: CT arthrography provides evidence of anterolateral soft-tissue impingement--in particular, in type II or III patterns. These lesions are statistically associated with a chondropathy.