Radiology MOC

Abstract Objective  Anterior cruciate ligament tears are frequent and if not diagnosed may lead to relevant patient disability. Magnetic resonance imaging is the method of choice for the non-invasive diagnosis of these tears. Despite the high performance of this method some cases are challenging and the criteria described in the literature are not sufficient to reach a diagnosis. We propose a systematic method for the evaluation of anterior cruciate ligament tears based on the aspect of its distal portion. Materials and methods  Magnetic resonance studies of 132 knees were evaluated in correlation with arthroscopy. The performance of the proposed method was compared with that of classic imaging signs of anterior cruciate ligament tear. The impact of image quality and reader expertise on the proposed method and the classic signs of tear were taken into account. Results  This method had a sensitivity and specificity of 91.1% and 82.9% for the detection of abnormal ACLs. The interobserver agreement (kappa) of the proposed method was significantly higher than that of the classic signs at all levels of expertise (0.89 vs 0.76). This method was not influenced by image quality. Distal ACL analysis identified more partial tears and synovialization (granulation scar tissue) than the conventional method (71% vs 58.5% for partial tears and 83.5% vs 58.5% for synovialization). Conclusion  The proposed classification has a high performance and reproducibility for the identification of abnormal anterior cruciate ligament. The results were influenced neither by the level of expertise of the readers nor by the image quality.

• Content Type Journal Article
• Category Scientific Article
• Pages 1-10
• DOI 10.1007/s00256-012-1363-z
• Authors
  • G. Oldrini, Service d’imagerie Guilloz, CHU Nancy, Av De Lattre de Tassigny, 54000 Nancy, France
  • P. Gondim Teixeira, Service d’imagerie Guilloz, CHU Nancy, Av De Lattre de Tassigny, 54000 Nancy, France
  • A. Chanson, Service d’imagerie Guilloz, CHU Nancy, Av De Lattre de Tassigny, 54000 Nancy, France
  • M. L. Erpelding, Service Epidémiologie et Evaluation Cliniques, CHU Nancy, Hôpitaux de Brabois Allée du Morvan, 54500 Vandoeuvre-lès-Nancy, France
  • B. Osemont, Service d’imagerie Guilloz, CHU Nancy, Av De Lattre de Tassigny, 54000 Nancy, France
  • M. Louis, Service d’imagerie Guilloz, CHU Nancy, Av De Lattre de Tassigny, 54000 Nancy, France
  • A. Blum, Service d’imagerie Guilloz, CHU Nancy, Av De Lattre de Tassigny, 54000 Nancy, France

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract  We describe a case of medial clavicular physeal separation with posterior displacement of the metaphysis in a 13-year-old girl, focusing on the role played by ultrasound in the diagnosis, planning of treatment and post-reduction follow-up. On clinical examination and conventional radiography, the injury is essentially indistinguishable from a sternoclavicular dislocation or a fracture of the medial aspect of the clavicle; however, the pathogenesis is different, consisting in medial physeal separation and ‘degloving’ of the inner cancellous bone of the metaphysis from the surrounding periosteal collar with posterior metaphyseal dislocation. In our case, attempted closed reduction failed, and the injury required open reduction with relocation of the clavicle into the periosteal sleeve followed by suturing of the periosteal tear.

• Content Type Journal Article
• Category Case Report
• Pages 1-4
• DOI 10.1007/s00256-011-1357-2
• Authors
  • A. Deganello, King’s College Hospital, London, UK
  • L. Meacock, King’s College Hospital, London, UK
  • A. Tavakkolizadeh, King’s College Hospital, London, UK
  • J. Sinha, King’s College Hospital, London, UK
  • D. A. Elias, King’s College Hospital, London, UK

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract Objective  The purpose of our study was to determine if cysts in and adjacent to the lesser tuberosity are associated with rotator cuff pathology found at arthroscopy. Materials and methods  A retrospective review was undertaken of the magnetic resonance (MR) imaging of 286 consecutive arthroscopic procedures performed by a single orthopedic shoulder surgeon from February 2001 to June 2009. Images of the shoulders were reviewed by an experienced fellowship-trained musculoskeletal radiologist, reader 1, and a musculoskeletal fellow, reader 2, for the presence and location of lesser tuberosity cysts. Cysts were grouped by their location into those within the lesser tuberosity and those adjacent to the lesser tuberosity. Interreader agreement was calculated using kappa values. Results  A total of 26 patients (17 men, 9 women; age range 14–84 years; mean of 61 years) had cysts in or adjacent to the lesser tuberosity. For reader 1, patients with cysts located in the lesser tuberosity were found to be significantly older (p = 0.03) and more likely to have subscapularis tendon tears (p = 0.02) than patients with cysts located adjacent to the tuberosity. No significant difference in any category between patients with a cyst located in the lesser tuberosity and those adjacent to the tuberosity was identified for reader 2. Interreader agreement of imaging findings ranged from fair to near perfect agreement. Conclusion  Cysts located in the lesser tuberosity at the insertion of the subscapularis tendon are suggestive of subscapularis tendon pathology and may occur in older individuals.

• Content Type Journal Article
• Category Scientific Article
• Pages 1-6
• DOI 10.1007/s00256-012-1366-9
• Authors
  • Robert D. Wissman, Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45267-0761, USA
  • Jerrell Ingalls, Desert Radiologists, 2020 Palomino Lane Suite 100, Las Vegas, NV 89106, USA
  • Daniel Hendry, Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45267-0761, USA
  • Dan Gorman, Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45267-0761, USA
  • Keith Kenter, Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45267-0761, USA

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract Objective  To retrospectively evaluate the incidence and clinical impact of local polymethylmethacrylate (PMMA) leaks and pulmonary cement embolisms occurring under CT fluoroscopy-guided vertebroplasty of symptomatic malignant vertebral osteolyses. Materials and methods  From December 2001 to June 2009, 202 cancer patients (116 women, 86 men; age 63.2 ± 8.6 years) with painful malignant vertebral osteolyses underwent vertebroplasty, with or without vertebral compression fracture. A total of 331 vertebrae were treated in 231 sessions under CT fluoroscopy guidance (120kV; 10–25mA; single slice, 4-, 16-, and 128-row CT). In the pre-vertebroplasty CT, the following items were assessed: osteolytic destruction (0, ≤25, ≤50, ≤75, or ≤100%) of vertebral cross-sectional area, posterior wall, and circumference; presence of perivertebral and degree of epidural (no, mild, moderate) soft tissue involvement. Local PMMA leaks were analyzed using the post-vertebroplasty CT. Pulmonary cement embolisms were evaluated in all patients having undergone radiography (CR; n = 53) or CT (n = 88) of the chest after vertebroplasty due to their underlying disease. Patient charts were reviewed regarding adverse events. Results  Of 331 treated vertebrae, 32, 20.2, and 15.7% showed more than 50% osteolytic involvement of the vertebral cross-sectional area, posterior wall, and circumference, respectively. Mild or moderate epidural involvement was seen in 13.0 and 8.4%. Local PMMA leakage rate was 58.6% (194 of 331 vertebrae). Pulmonary cement embolisms (segmental, n = 10; central, n = 1) were seen after 7.8% of the procedures with follow-up imaging of the chest. No major complications occurred within a 30-day period after vertebroplasty. Conclusion  Vertebroplasty of spinal malignancy can be safely performed under CT fluoroscopy guidance even in patients with substantial osteolytic involvement. In our patient collective, PMMA leaks and pulmonary cement embolisms visualized in post-procedural radiography and CT images had no clinical impact.

• Content Type Journal Article
• Category Scientific Article
• Pages 1-10
• DOI 10.1007/s00256-012-1365-x
• Authors
  • Christoph G. Trumm, Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany
  • Anne Pahl, Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany
  • Thomas K. Helmberger, Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, Klinikum Bogenhausen, Englschalkinger Strasse 77, 81925 München, Germany
  • Tobias F. Jakobs, Department of Radiology, Krankenhaus Barmherzige Brüder München, Romanstr. 93, 80639 München, Germany
  • Christoph J. Zech, Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany
  • Robert Stahl, Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany
  • Philipp M. Paprottka, Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany
  • Torleif A. Sandner, Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany
  • Maximilian F. Reiser, Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany
  • Ralf-Thorsten Hoffmann, Department and Policlinics of Diagnostic Radiology, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307 Dresden, Germany

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract Objective  To compare the positions of the trochlear groove (TG) line and the vertical midline of the pericondylar rectangle on axial computed tomography (CT). Materials and methods  A retrospective pilot study was conducted in February and March 2011 comprising 14 knees in 9 consecutive patients with patellofemoral pain, a normal trochlear angle (124°–145°), and no medical record of prior knee surgery. After the axial CT image displaying the center of the trochlear groove (“reference cut”) with a normal trochlear angle was identified, the pericondylar rectangle was drawn and located in the first quadrant of the Cartesian rectangular coordinate system. The x-coordinates of the vertical lines passing through the most posterior point of the trochlear groove (TG line) and the midpoints of the horizontal sides of the pericondylar rectangle (vertical midline) were obtained at 2-week intervals and statistically analyzed as matched pairs for differences (Wilcoxon signed rank test), agreements (Bland–Altman plot, intraclass correlation coefficient [ICC]) and relative variations (coefficient of variation [CV]). Results  There were no statistically significant differences between matched pairs (2-tailed p from 0.583 to 0.641) whereas the agreements were substantial (bias = −0.37 and −0.45 respectively, ICC = 0.688 and 0.670 respectively) to almost perfect for duplicate measurements (bias = 0.11 and 0.04 respectively, ICC = 0.975 and 0.998 respectively), with much less relative variation with regard to the vertical midline (CV = 1.22% to CV = 0.34% respectively). Conclusion  The positions of the TG line and the vertical midline of the pericondylar rectangle on axial CT were identical. The latter was identified regardless of trochlear morphology.

• Content Type Journal Article
• Category Scientific Article
• Pages 1-6
• DOI 10.1007/s00256-011-1346-5
• Authors
  • Dinko Nizić, Clinical Institute of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Kišpatićeva 12, 10000 Zagreb, Croatia

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract Objective  We used caudal epidurography to compare the spread of contrast medium when the needle was inserted toward the affected side in patients with unilateral radiculopathy undergoing caudal steroid injection. Materials and methods  We enrolled 24 patients with unilateral radiculopathy. A block needle was positioned toward the affected side in the sacral epidural space. After 5 mL of iodinated contrast medium was injected, a standardized anteroposterior view was imaged. Using Adobe Photoshop software, contrast medium spread was assessed by counting pixels within the areas spread on the affected side and on the opposite side, and the pixel counts of the two sides were compared. Spinal nerve root filling was also assessed. Results  The pixel count within the area of contrast medium spread on the side with the needle was significantly greater than that of the opposite side (mean [SD] 41,368.6 [13,143.1] vs 15,165.3 (10,698.1), P < 0.001]. However, 13.6% of the study patients had greater spread on the opposite side. The rates of L5 and S1 nerve root filling in the affected side were 18.2% and 36.4% respectively. Conclusions  When a needle was intentionally inserted toward the side with radiculopathy, the spread of contrast medium and number of delineated roots tended to be greater on the side with the needle, compared with those on the opposite side. However, the pattern of contrast medium spread in the sacral epidural space varied and some patients even had greater spread on the opposite side.

• Content Type Journal Article
• Category Technical Report
• Pages 1-6
• DOI 10.1007/s00256-011-1354-5
• Authors
  • Jae Hoon Lee, Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea
  • Duck Mi Yoon, Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea
  • Tae Dong Kwon, Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea
  • Kyung Bong Yoon, Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract Objective  We noted a large amount of intravenous gas during balloon kyphoplasty on CT imaging. Formal assessment to understand the extent, possible causes and implications was undertaken. Materials and methods  Ten consecutive cases of balloon kyphoplasty were performed under general anaesthesia in the prone position, on a single vertebral level using a two-step technique under combined fluoroscopic and CT guidance. CT of the affected vertebra was performed before, after, and intermittently during the procedure. In 2 cases delayed CT was carried out in the supine position. Results  Gas was seen on CT imaging, but not on conventional fluoroscopy. The gas is most likely to be air introduced during the procedure and was seen in the epidural and paravertebral venous plexus, posterior intercostal veins, renal veins, IVC and azygos vein. The average measured volume of gas seen on the post-procedure CT imaging was 1.07 mL, range 0.16–3.97 mL. There was no correlation of the measured amount of gas to the procedure duration or location, the use of a curette or the injected cement volume. Delayed CT in the supine position no longer showed air in the local venous system. Conclusions  Balloon kyphoplasty is associated with the fluoroscopically invisible introduction of air into the vertebral and paravertebral veins and deep systemic veins and is likely to be much more extensive than identified on CT imaging. There is potential for serious air embolism in kyphoplasty and if there is a sudden deterioration in patient condition during the procedure the possibility of this complication needs to be considered.

• Content Type Journal Article
• Category Scientific Article
• Pages 1-6
• DOI 10.1007/s00256-011-1348-3
• Authors
  • Bernhard J. Tins, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Twmpath Lane, Oswestry, Shropshire SY10 7AG, UK
  • Victor N. Cassar-Pullicino, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Twmpath Lane, Oswestry, Shropshire SY10 7AG, UK
  • Radhesh Lalam, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Twmpath Lane, Oswestry, Shropshire SY10 7AG, UK
  • Mike Haddaway, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Twmpath Lane, Oswestry, Shropshire SY10 7AG, UK

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Painless groin mass and multiple erythematous to violaceous skin lesions: diagnosis and discussion

• Content Type Journal Article
• Category Test Yourself: Answer
• Pages 1-2
• DOI 10.1007/s00256-011-1352-7
• Authors
  • Cristina Méndez Díaz, Department of Radiology, Complejo Hospitalario Universitario A Coruña (CHUAC), Xubias de Arriba 84, 15006 A Coruña, Spain
  • Rafaela Soler Fernández, Department of Radiology, Complejo Hospitalario Universitario A Coruña (CHUAC), Xubias de Arriba 84, 15006 A Coruña, Spain
  • Esther Rodríguez García, Department of Radiology, Complejo Hospitalario Universitario A Coruña (CHUAC), Xubias de Arriba 84, 15006 A Coruña, Spain
  • Carmen Delgado Sotorrío, Department of Pathology, Complejo Hospitalario Universitario A Coruña (CHUAC), Xubias de Arriba 84, 15006 A Coruña, Spain

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract Objective  Quantitative MR imaging techniques of degenerative cartilage have been reported as useful indicators of degenerative changes in cartilage extracellular matrix, which consists of proteoglycans, collagen, non-collagenous proteins, and water. Apparent diffusion coefficient (ADC) mapping of cartilage has been shown to correlate mainly with the water content of the cartilage. As the water content of the cartilage in turn correlates with its viscoelasticity, which directly affects the mechanical strength of articular cartilage, ADC can serve as a potentially useful indicator of the mechanical strength of cartilage. The aim of this study was to investigate the correlation between ADC and viscoelasticity as measured by indentation testing. Materials and methods  Fresh porcine knee joints (n = 20, age 6 months) were obtained from a local abattoir. ADC of porcine knee cartilage was measured using a 3-Tesla MRI. Indentation testing was performed on an electromechanical precision-controlled system, and viscosity coefficient and relaxation time were measured as additional indicators of the viscoelasticity of cartilage. The relationship between ADC and viscosity coefficient as well as that between ADC and relaxation time were assessed. Results  ADC was correlated with relaxation time and viscosity coefficient (R2 = 0.75 and 0.69, respectively, p < 0.01). The mean relaxation time values in the weight-bearing and non-weight-bearing regions were 0.61 ± 0.17 ms and 0.14 ± 0.08 ms, respectively. Conclusions  This study found a moderate correlation between ADC and viscoelasticity in the superficial articular cartilage. Both molecular diffusion and viscoelasticity were higher in weight bearing than non-weight-bearing articular cartilage areas.

• Content Type Journal Article
• Category Scientific Article
• Pages 1-6
• DOI 10.1007/s00256-011-1340-y
• Authors
  • T. Aoki, Department of Radiological Science, Graduate School of Human Health Science, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, Japan
  • A. Watanabe, Department of Orthopedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japan
  • N. Nitta, Human Technology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 1-2-1 Namiki, Tsukuba, Ibaraki, Japan
  • T. Numano, Faculty of Health Sciences School of Radiological Science, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, Japan
  • M. Fukushi, Faculty of Health Sciences School of Radiological Science, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, Japan
  • M. Niitsu, Department of Radiology, Saitama Medical University Hospital, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama, Japan

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Painless groin mass and multiple erythematous to violaceous skin lesions

• Content Type Journal Article
• Category Test Yourself: Question
• Pages 1-2
• DOI 10.1007/s00256-011-1351-8
• Authors
  • Cristina Méndez Díaz, Department of Radiology, Complejo Hospitalario Universitario A Coruña (CHUAC), Xubias de Arriba 84, 15006 A Coruña, Spain
  • Rafaela Soler Fernández, Department of Radiology, Complejo Hospitalario Universitario A Coruña (CHUAC), Xubias de Arriba 84, 15006 A Coruña, Spain
  • Esther Rodríguez García, Department of Radiology, Complejo Hospitalario Universitario A Coruña (CHUAC), Xubias de Arriba 84, 15006 A Coruña, Spain
  • Carmen Delgado Sotorrío, Department of Pathology, Complejo Hospitalario Universitario A Coruña (CHUAC), Xubias de Arriba 84, 15006 A Coruña, Spain

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract Objectives  The aim of this work was to assess the performance of facet joint and nerve root infiltrations under computed tomography guidance for the management of low back pain and to investigate the complications and patient tolerance. Materials and methods  The study was board-certified and informed consent was obtained from all patients. In 1 year, 86 consecutive patients (47 male, 39 female, age range 47–87 years, mean age 63) with low back pain for more than 2 years were included. All patients were clinically examined and had cross-sectional imaging performed before the procedure. Fifty-five facet joint infiltrations and 31 nerve blocks were performed under computed tomography guidance. All patients completed two valid pain questionnaires before and 3 months after the procedures. At the same time, they were clinically examined by the referring Orthopaedic Surgeon. The pain response was assessed by comparing the scores of the questionnaires. The improvement in clinical examination findings was assessed as well. Results  In patients who underwent facet joint infiltrations, long-term pain improvement was achieved in 79% and in those with nerve blocks in 85%. Immediate pain relief was demonstrated in 83% of patients with nerve infiltrations. No complications were observed. All procedures were very well tolerated by patients. Conclusions  Facet joint and nerve infiltrations under computed tomography guidance constitute an accurate and safe method that could be used to relieve low back pain and minimize the risk of disability.

• Content Type Journal Article
• Category Scientific Article
• Pages 1-5
• DOI 10.1007/s00256-011-1353-6
• Authors
  • Anastasia Fotiadou, Hinchingbrooke Hospital NHS Trust, Huntingdon, PE29 6NT Cambridgeshire, UK
  • Andrew Wojcik, Hinchingbrooke Hospital NHS Trust, Huntingdon, PE29 6NT Cambridgeshire, UK
  • Antony Shaju, Hinchingbrooke Hospital NHS Trust, Huntingdon, PE29 6NT Cambridgeshire, UK

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Browser’s notes

• Content Type Journal Article
• Category Browser’s Notes
• Pages 363-363
• DOI 10.1007/s00256-011-1344-7

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348
• Journal Volume Volume 41
• Journal Issue Volume 41, Number 3

Abstract  Scurvy is a lethal but treatable disease that is rare in industrialized countries. Caused by vitamin C deficiency, it is most prevalent in persons of low socioeconomic status and smokers. Low levels of circulating vitamin C result in poor collagen fiber formation that, in turn, leads to demineralized bones, microfractures, and poor healing. Here we report a case of scurvy in a 5-year-old boy with normal radiographs in whom initial concern for leukemia based upon magnetic resonance imaging and clinical presentation led to a bone marrow biopsy revealing gelatinous transformation.

• Content Type Journal Article
• Category Case Report
• Pages 357-360
• DOI 10.1007/s00256-011-1350-9
• Authors
  • Christopher M. Brennan, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA 22908, USA
  • Kristen A. Atkins, Department of Pathology, University of Virginia Health System, Charlottesville, VA 22908, USA
  • Colleen H. Druzgal, Department of Pediatrics, University of Virginia Health System, Charlottesville, VA 22908, USA
  • Cree M. Gaskin, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA 22908, USA

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348
• Journal Volume Volume 41
• Journal Issue Volume 41, Number 3

Abstract Purpose  To assess the capability of a commercial sonoelastography system to detect small tendon lesions by quantitative analysis of elastogram profiles. Materials and methods  Strips of equine digital flexor tendons were used to model small human tendons. Two tendons were examined. From each tendon, six unmodified tendon strips (controls) and six tendon strips with a central defect of the same tendons were compared. The tendon strips were placed under a physiological tensile strain of 5%. Sonoelastographic visualization of the strain profile was performed. Regions of interest (ROI) were defined left and right of the tendon defects. Average tissue strains in these ROI were compared with tissue strain in controls. Results  In the first series of experiments, there was a significant (p = 0.011) difference in the strain profile in regions proximal and distal to the tendon lesions compared with the respective tendon areas in the control tendon strips. In a second series of experiments, similar trends were observed, but the differences were not significant (p = 0.824). Conclusion  Even under carefully controlled experimental conditions using computational post-processing of sonoelastograms, tendon lesions could only be partially detected within elastograms from a clinical sonoelastography system. The ability to detect differences in some strain profiles indicates that tensile sonoelastography has the potential to identify small tendon lesions (such as those in the hand), but that substantial improvements with respect to quantitative analysis are required to make such measures diagnostically relevant.

• Content Type Journal Article
• Category Scientific Article
• Pages 1-7
• DOI 10.1007/s00256-011-1349-2
• Authors
  • Aline R. Buck, Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland
  • Nina Verstraete, Department of Mechanical Engineering, ETH Zurich, Zurich, Switzerland
  • Yufei Li, Department of Mechanical Engineering, ETH Zurich, Zurich, Switzerland
  • Andreas Schweizer, Department of Orthopedic Surgery, Orthopedic University Hospital Balgrist, Zurich, Switzerland
  • Jess G. Snedeker, Department of Mechanical Engineering, ETH Zurich, Zurich, Switzerland
  • Florian M. Buck, Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland

• Journal Skeletal Radiology
• Online ISSN 1432-2161
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Abstract Objective  The aim of this work was to compare the prevalence of cyclops lesions after anterior cruciate ligament reconstruction (ACLR) using the single-bundle and remnant bundle preservation techniques. Materials and methods  One hundred consecutive patients, who had undergone postoperative MRI of the knee followed by arthroscopic ACLR with the remnant bundle preservation technique (R) between February 2007 and August 2010, were enrolled in this study. Thirty-six consecutive patients who underwent ACLR using the single-bundle technique (S) were also included in this study as a control group. The MR findings were scored based on the presence of pre-ACL graft lesion as 0, 1, 2, or 3 on the sagittal images. The sixty-one specimens by second-look surgery (20 in S, 41 in R) were pathologically examined. Results  The numbers of patients with scores of 0, 1, 2, and 3 were 1, 18, 14, and 3 in group S and 4, 60, 29, and 7, in group R, respectively. Of the 61 patients who underwent second-look surgery (20 in S, 41 in R), eight had a cyclops lesion (three in group S and five in group R). The prevalence of cyclops lesion was not significantly different in group R and group S (p = 0.761). Conclusions  The prevalence of a cyclops lesion was similar in both groups.

• Content Type Journal Article
• Category Scientific Article
• Pages 1-6
• DOI 10.1007/s00256-011-1347-4
• Authors
  • Jihoon Cha, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea 135-710
  • Sang-Hee Choi, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea 135-710
  • Jong Won Kwon, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea 135-710
  • Sang-Hak Lee, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • Jin Hwan Ahn, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract  Deep fibromatoses, or desmoid tumors, arise from connective tissue. Imaging can frequently suggest the diagnosis of these aggressive, benign neoplasms. Cross-sectional imaging commonly demonstrates an enhancing solid mass that resembles scar tissue, typically without osseous involvement. We report a case of an extra-abdominal desmoid tumor involving the teres minor muscle in a symptomatic 42-year-old woman with unusual features of medullary involvement and negative nuclear beta-catenin staining.

• Content Type Journal Article
• Category Case Report
• Pages 1-5
• DOI 10.1007/s00256-011-1336-7
• Authors
  • Yaseen Oweis, Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
  • David R. Lucas, Division of Surgical Pathology, Department of Pathology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
  • Catherine J. Brandon, Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
  • Gandikota Girish, Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
  • Jon A. Jacobson, Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
  • David P. Fessell, Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract  The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner’s disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis.

• Content Type Journal Article
• Category Review Article
• Pages 1-18
• DOI 10.1007/s00256-011-1343-8
• Authors
  • Nikhil A. Kotnis, Departments of Radiology, McMaster University, Hamilton, ON, Canada
  • Mary M. Chiavaras, Departments of Radiology, McMaster University, Hamilton, ON, Canada
  • Srinivasan Harish, Departments of Radiology, McMaster University, Hamilton, ON, Canada

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Right hip pain in a 20-year-old epee fencer

• Content Type Journal Article
• Category Test Yourself: Question
• Pages 339-339
• DOI 10.1007/s00256-011-1314-0
• Authors
  • Catherine N. Petchprapa, Department of Radiology, NYU Langone Medical Center - Hospital for Joint Diseases, 6th floor, 301 East 17th Street, New York, NY 10003, USA
  • Jenny T. Bencardino, Department of Radiology, NYU Langone Medical Center - Hospital for Joint Diseases, 6th floor, 301 East 17th Street, New York, NY 10003, USA
  • Robert J. Meislin, Department of Orthopedics, NYU Langone Medical Center - Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348
• Journal Volume Volume 41
• Journal Issue Volume 41, Number 3

Abstract  Vascular injury following hip resurfacing arthroplasty is rare: we present a case of profunda femoris pseudoaneurysm complicating hip resurfacing arthroplasty performed via an anterolateral approach. Over recent years, it has been recognized that an adverse reaction to metal debris from metal-on-metal arthroplasties can also result in the development of cystic masses around the hip. This case highlights a potential rare differential diagnosis that needs to be considered when imaging cystic mass lesions around the postoperative hip. Imaging can provide a definitive diagnosis if this entity is considered and its appearances recognized, resulting in appropriate management of this potentially limb- and life-threatening complication.

• Content Type Journal Article
• Category Case Report
• Pages 1-4
• DOI 10.1007/s00256-011-1341-x
• Authors
  • M. S. Thomas, Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP UK
  • J. N. O’Hara, Department of Orthopaedic Surgery, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP UK
  • A. M. Davies, Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP UK
  • Steven L. J. James, Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP UK

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract Objective  To develop and characterize the MR properties of a synthetic model for cartilage extra-cellular matrix using hydrogels and to determine the concentration dependence of spin–lattice (T1) and spin-spin (T2) relaxation times of hydrogels and their glycosaminoglycan and collagen components in the presence and absence of gadopentetate dimeglumine (Gd-DTPA) for use in dGEMRIC. Materials and methods  T1 and T2 measurements were made at 3 Tesla on a range of gelatin (i.e., collagen) and hyaluronan (i.e., glycosaminoglycan) solutions (6.25–100 g/l), alone, together in a composite, and as dityramine-bridged hydrogels. Relaxivity was calculated as a function of macromolecular concentration. Results  Even at the highest concentrations, gelatin and hyaluronan solutions had T1 and T2 values significantly larger than those reported for cartilage. Only composite hydrogels with gelatin and hyaluronan concentrations naturally found in cartilage resulted in T1 values, but not T2 values, representative of cartilage. Relaxivities were slightly dependent on both hyaluronan concentration (R1 = 0.0027 l g–1 s–1; R2 = 0.025 l g–1 s–1) and gelatin concentration (R1 = 0.0032 l g–1 s–1; R2 = 0.020 l g–1 s–1) alone and as a composite (R1 = 0.0068 l g–1 s–1; R2 = 0.101 l g–1 s–1). Gd-DTPA relaxivities were dependent upon macromolecular concentration and varied by 14–32% (R1 = 4.24 to 5.55 mM–1 s–1; R2 = 4.60 to 6.27 mM–1 s–1) over the range of cartilage biochemistry. Conclusions  Without the contrast agent, hyaluronan and gelatin, alone or in a composite, have a very small impact on the relaxivities of the model system. The impact on R1 was approximately tenfold less than on R2. In contrast, macromolecular concentrations above 50 g/l significantly impacted Gd-DTPA relaxivity and should be accounted for when measuring the glycosaminoglycan content of cartilage in vivo using dGEMRIC.

• Content Type Journal Article
• Category Technical Report
• Pages 1-9
• DOI 10.1007/s00256-011-1331-z
• Authors
  • Ediuska Laurens, Department of Biomedical Engineering, The Cleveland Clinic, Cleveland, OH, USA
  • Erika Schneider, Imaging Institute, The Cleveland Clinic, 9500 Euclid Avenue, HB6, Cleveland, OH 44195, USA
  • Carl S. Winalski, Department of Biomedical Engineering, The Cleveland Clinic, Cleveland, OH, USA
  • Anthony Calabro, Department of Biomedical Engineering, The Cleveland Clinic, Cleveland, OH, USA

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348