Quadratus femoris muscle edema in children.

OBJECTIVE: To assess the prevalence and clinical relevance of quadratus femoris muscle edema (QFME) in pediatric pelvic MRI. MATERIALS AND METHODS: The axial T2-W with fat saturation sequence of pelvic/hip MRI examinations of pediatric patients (≤ 18 years) and a control group of young adults aged 19-45 years was retrospectively and independently evaluated by two musculoskeletal radiologists for the presence of QFME in each hip. Demographics, indication for imaging studies, and pain location were documented. The prevalence of QFME was compared between the groups on a patient level and on a hip level. RESULTS: The study group included 119 children (164 MRI examinations; F:M 1:1.08, mean age 11.4 ± 3.6 years), and 120 young adults, > 18, < 45 years old, served as controls (F:M 1:0.9, mean age 33.7 ± 6.4 years). QFME was significantly more prevalent among the study compared to the control group, both on a patient level (15% and 4.2%, respectively, p < 0.05) and on a hip level (12.1% and 2.5%, respectively, p < 0.05). This significant difference was also seen in the subgroup of MRI studies performed for orthopedic indications but not for non-orthopedic indications. There was no correlation between the side of localized pain and the side with QFME. CONCLUSION: QFME is significantly more prevalent in pediatric patients compared to adults under 45 years old, especially in subjects scanned for orthopedic indications. The clinical relevance of QFME in children and adolescents is unclear.

The frequency of sacroiliitis on MRI in subjects over 55 years of age.

OBJECTIVE: To evaluate the frequency of sacroiliitis in older subjects. MATERIALS AND METHODS: Consecutive MRI examinations of the sacroiliac joints (SIJs) performed for suspected sacroiliitis (2005-2019) in patients ≥ 18 years were retrospectively evaluated for the presence of active/structural lesions and were categorized for the presence/absence of sacroiliitis. Clinical and imaging parameters were compared between subjects with sacroiliitis according to age groups < 40 years, 40-55, and > 55 years. Clinical parameters including inflammatory back pain (IBP) and other spondyloarthritis (SpA) features were retrieved from the medical records. RESULTS: A total of 431 patients with SIJs MRI were evaluated: median age, 44 [IQR 35-54]; female:male 267(62%):164(38%). Sacroiliitis was diagnosed in 89 (20.6%) subjects-median age, 41 years [IQR 32-54], 52% females- and was equally prevalent among the different age groups: > 40 years old, 23.6%; 40-55, 20%; and > 55 years old, 17%, p = 0.43, with active/structural lesions equally dispersed. Older patients (> 55) started suffering from back pain at an older age and had a longer delay in diagnosis. Gender distribution, the presence of IBP, and other SpA features were no different in patients < 45 and > 55 years of age. CONCLUSIONS: The frequency of sacroiliitis on SIJs-MRI in subjects > 55 years is similar to its frequency in younger subjects and is associated with the same type and magnitude of active and structural MRI lesions. Clinical parameters such as IBP and additional SpA features are similarly prevalent in older and younger subjects suggesting they suffer from the same disease and differing only in age of presentation.

The prevalence of sacroiliitis on abdominal MRI examinations of patients with Takayasu arteritis.

BACKGROUND: Takayasu arteritis (TA), a systemic large-vessel vasculitis, was reported to have high incidence of spondyloarthropathy. PURPOSE: To evaluate the prevalence of inflammatory sacroiliitis in patients with TA that underwent abdominal/pelvic magnetic resonance imaging (MRI) examinations as part of their vasculitis work-up. MATERIAL AND METHODS: Consecutive abdominal/pelvic MRI examinations of 34 patients with TA fulfilling the 1990 ACR criteria and 34 age- and gender-matched controls performed between 2008 and 2020 were retrospectively reviewed for the presence sacroiliitis. The presence of active and structural lesions was scored twice (with a one-month interval between reads) by one reader. Structural lesions were also evaluated on computed tomography, when available, and correlated to MRI findings. Clinical data were extracted from the patients' clinical files. MRI scores were compared between the study and control groups and correlated with the clinical data. RESULTS: Sacroiliitis was evident in 11.7% of the TA group examinations compared to 0.3% in the control group (P = 0.6). Participants with TA had significantly more erosions and fat deposition compared to the control group (Study: 0.01/0.03, Control: 0/0, P = 0.03/0.003, respectively). However, mean sacroiliitis score was not significantly different (Study: 1.06, Control: 0.78, P = 0.015). Of the four patients with TA and sacroiliitis, 3 (75%) had a diagnosis of inflammatory bowel disease (IBD). CONCLUSION: Sacroiliitis was detected in 11.7% of abdominal MRI examinations of patients with TA, 75% of which had associated IBD, suggesting that both IBD and sacroiliitis should be routinely screened in the TA population as their presence may influence treatment decisions.

Ultrasound Tissue Characterization (UTC) of the Achilles Tendon in Pre- and Post-Pubertal Dancers.

This study examined whether maturation status, body physique, and the impact of training are related to the development of Achilles tendon structure in young dancers. Seventy-one pre- and post-menarche dancers (12 to 15 years of age) were recruited. The Achilles tendon of each dancer was examined via ultrasonography tissue characterization (UTC) imaging. The cross-sectional area (CSA) and the fibrillar structure (echo types I to IV) were measured. The participants were screened for anthropometric parameters (weight, height, and leg length) with body mass index (BMI) and BMI percentile calculated; for hours and impact of training; for Tanner pubertal maturation; and for pain in their Achilles tendon (VAS scale). In addition, age and age at onset of menarche were documented. Tendon structure was found to differ between pre- and post-menarche dancers. Post-menarche dancers had a significantly lower percentage of echo type I fibers and a significantly higher percentage of echo type II, III, and IV fibers, with a greater CSA compared to pre-menarche dancers. The tendon structure was found to be correlated with BMI percentile, but no correlations were found with chronologic age or the impact of dance training. Furthermore, ANCOVA showed that BMI had a statistically significant effect on fiber types II and III (p < 0.005) and that the effect of menarche was significant, meaning that pre-menarche dancers had a lower BMI compared with those who were post-menarche. It is concluded that pre- and post-menarche dancers had developed different patterns of Achilles tendon fiber structure. Body mass index was found to be the most significant factor influencing the different tendon structures in young pubertal dancers.

Whole Spine CT Scan for the Detection of Acute Spinal Fractures in Diffuse Idiopathic Skeletal Hyperostosis Patients Who Sustained Low-energy Trauma.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to evaluate the role and value of whole-spine computerized tomography (WSCT) versus radiographs and targeted CT to tender spinal regions in patients with diffuse idiopathic skeletal hyperostosis (DISH) after low-energy trauma. SUMMARY OF BACKGROUND DATA: Subjects with DISH are prone to spinal fractures even after low-impact trauma due to a rigid spinal structure. METHODS: One-hundred forty-seven subjects (average age: 83 years, M:F 64/83) with verified DISH (Resnick and Niwayama radiographic criteria) on WSCT who were admitted to the emergency room (ER) after low-energy trauma and for whom there were radiographs of at least the thoracic and lumbar spine were evaluated for the presence of acute spinal fractures on both radiographs and WSCT. Agreement between fracture location and spinal tenderness location (cervical, thoracic, or lumbar) as reported in the medical record was evaluated. RESULTS: Significantly more acute fractures were detected on WSCT compared to radiographs (55 and 32, P < 0.00001, respectively). The site of tenderness was not indicative of the fractured spinal segment in 57% of all acute fractures (seven cervical, 15 thoracic, and 16 lumbar). No fracture was detected on WSCT in 10 subjects with an unspecified pain location. Multilevel distant fractures were detected in two patients with a specified pain location to only one of the fractures. CONCLUSION: WSCT in DISH subjects after low-impact trauma is mandatory due to the high prevalence of acute fractures and the low specificity for fracture detection on radiographs. A targeted CT approach to the tender spinal segment proved to be inadequate and would have missed 57% of the acute single fractures with incompatible spinal tenderness location. These results support the significant role of WSCT in the ER setting for detecting and pinpointing the spinal fracture site of DISH subjects who present with low-impact trauma. LEVEL OF EVIDENCE: 3.

Differences Between Long Distance Road Runners and Trail Runners in Achilles Tendon Structure and Jumping and Balance Performance.

BACKGROUND: Load and joint kinematics change with differences in running surface. Running regularly on trails compared to roads might influence the load on the Achilles tendon and its adaptations, along with other factors such as balance, strength, and proprioception. OBJECTIVE: To investigate Achilles tendon structure and functional tests in road and trail runners. DESIGN: Cross-sectional study. SETTING: Laboratory, sport sciences college. PARTICIPANTS: The study included 26 road and 17 trail runners who run at least three times per week with a minimum of 20 km per week and who participated in running competitions over the preceding 2 years. METHODS: Each participant was examined for Achilles tendon structure (via ultrasound tissue characterization [UTC] imaging) and underwent functional tests in addition to completing a demographic questionnaire. MAIN OUTCOME MEASUREMENTS: The percentages of echo types I, II, III, and IV (degree of structural homogeneity) within the tendon, tendon length and width, tendon cross-sectional area (via UTC imaging); Ankle inversion movement discrimination ability (via Active Movement Extent Discrimination Apparatus device); dynamic postural balance (via Y balance test); jumping performance (by Triple hop distance test); and Hip muscle abduction muscle strength (by hand-held dynamometry). RESULTS: Percentage of echo type I was significantly lower while echo type II was higher in the road group compared with the trail group (67.3% type I and 28.9% type II in the road group compared with 74.1% type I and 22.1% type II in the trail group, P < .001). No differences between genders were found and no significant differences between groups were found for the other tests. CONCLUSION: Tendon integrity as examined with UTC is different between road and trail runners. This suggests an influence of running surface on Achilles tendon structure. This difference was not reflected in other tests, thus the influence of tendon structure on function needs further examination.

Enthesopathy of the anterior chest wall joints in patients with diffuse idiopathic skeletal hyperostosis (DISH): a retrospective analysis of computed tomography scans.

PURPOSE: To evaluate and characterize anterior chest wall (ACW) joint's enthesopathy on CT scans in patients with DISH compared with age- and gender-matched control group. MATERIAL AND METHODS: Retrospective evaluation for enthesopathy features of ACW joints-sterno-clavicular (SCJ), manubrio-sternal (MSJ), costo-sternal 1-7 (CSJ)-on chest CT scans of subjects with DISH (Resnick criteria) and of age- and gender-matched control subjects was performed. 183 subjects (DISH: 92, control: 91); male:female: 126:57, average age: 71.7 years (range 50-94) were evaluated. Total enthesopathy scores per subjects and per each joint were compared. RESULTS: Total enthesopathy score of ACW joints was significantly higher among DISH compared to controls (64.03 ± 15.1, 50.47 ± 12.4, p < 0.001). At joint level, SCJ and CSJ enthesopathy, but not MSJ was significantly more prevalent in DISH compared to controls. CONCLUSION: ACW joints' enthesopathy as seen on CT scans, an entity not included in the Resnick classification criteria, is common among DISH subjects. The difference between SCJ and CSJ prevalence compared to MSJ may result from different joint type. ACW joints' enthesopathy may be considered to be included in future modified radiographic criteria for DISH.

Patellofemoral pain, body morphology and alignment in female pubertal dancers: One-year follow-up.

The aim of this study was to assess changes in body morphology, anatomical alignment and prevalence of patellofemoral pain (PFP) in young female dancers along one year of pubertal growth, and to identify the risk factors related to PFP in these young dancers. Both legs of 60 dancers were evaluated during grade 7 and again after 1-year. At each of these points in time, the dancers were interviewed concerning their background, and anthropometric measurements, lower-limb physical examinations and knee ultrasound scans were performed. Morphological parameters changed significantly from baseline to follow-up. PFP was found in 53.3% of the dancers' knees at baseline. At follow-up, 55.4% of the asymptomatic knees at baseline developed PFP, and only 9.4% of the symptomatic knees at baseline recovered. Lower BMI was identified among dancers who developed PFP during follow-up compared with dancers with no PFP, either at baseline or at follow-up. A positive grinding and positive Patellar Inhibition Test (PIT) were found to be risk factors for PFP at follow-up. A high prevalence of young dancers suffered PFP, from injuries they sustained mostly during the 1-year of dance practice. Parameters predisposing the dancers to PFP should be identified at early stages of dance class.

The association between menarche, intensity of training and passive joint ROM in young pre-professional female dancers: A longitudinal follow-up study.

OBJECTIVES: To determine the association between the status of menarche (yes/no), the intensity of training and the potential to improve passive joint range of motion (ROM) over a 12-month period of dance training. DESIGN: Prospective cohort study. SETTING: Dance studio. PARTICIPANTS: Fifty-nine female dancers aged 12.8 ±â€¯0.5. MAIN OUTCOME MEASURES: The dancers were asked about their dance intensity and screened for anthropometric parameters and passive joint ROM in Grades 7 and 8. RESULTS: Along the 12 months of dance training, we found significantly increased ankle-foot en-pointe, hip abduction, and hip external rotation (ER); significantly decreased hip internal rotation (IR); and significant increased hip ER:IR ratio. In Grade 7, 26 dancers (44.1%) reached menarche (Yes menarche); in Grade 8 an additional 23 dancers (39.0%) reached menarche (No/Yes menarche); and 10 dancers (16.9%) had not reached menarche (No menarche). MANOVA (mixed models) with repeated measures to compare joint ROM between the three menarche groups (Yes; No/Yes; No), with h/week dance practice as a co-variant, showed that hip ER, ankle-foot en-pointe, and ER:IR were significantly correlated with h/week in all three menarche groups. CONCLUSIONS: Most passive joint ROM can be improved over 12 months of dancing around the age onset of menarche. H/week of dance practice is a main factor contributing to improved hip ER, ankle-foot en-pointe and ER/IR ratio.

Ultrasonography and clinical examination of knee injuries in pre- and post- menarche dancers.

This study aimed at evaluating whether the prevalence of knee injuries and morphological features are different among pre-and-post menarche dancers; Sixty-seven pre-and-post menarche dancers were screened for anthropometric parameters; knee laxity; patella femoral pain syndrome (PFPS), pathologies and anatomical structure of the knees. Both groups showed a high and similar prevalence of PFPS. The post-menarche dancers produced a significantly higher rate of Tanner stages 3-4 (p = .010), greater weight (p < .001) higher BMI (p = .003); and, higher prevalence of MCL pathology, pes planus, and scoliosis compared with pre-menarche dancers (p < .05). The pre-menarche dancers started dance practice earlier (p = .008); and, showed significantly higher prevalence of lateral laxity, patellar laxity, positive Lachman test and positive Drawer test compared with post-menarche dancers (p < .05). Interactions (menarche yes/no by PFPS no/one leg/both legs) were found for BMI (p = .044; η2 = .187), trochlear cartilage thickness (p = .020; η2 = 0.121) and tip of patella - trochlear groove distance (p = .024; η2 = .150). Pre-and-post-menarche female dancers demonstrated similar prevalence of knee injuries, with different body morphology.

Degenerative changes of the thoracic spine do exist in patients with diffuse idiopathic skeletal hyperostosis: a detailed thoracic spine CT analysis.

Background Degenerative intervertebral disease (DID) is an exclusion criterion in the Resnick and Niwayama radiographic classification for diffuse idiopathic skeletal hyperostosis (DISH). However, although DID was previously described in DISH, no systematic computed tomography (CT) analysis has been reported so far. Purpose To assess for the presence and prevalence of such changes on CT examinations of the thoracic spine of individuals with DISH. Material and Methods Intervertebral space (D1-L1) on chest CT examinations of DISH patients was retrospectively evaluated for the presence of DID. Parameters evaluated were disc space height, disc protrusion, subchondral cysts/sclerosis, Schmorl nodes, vacuum phenomenon, and posterior elements including costovertebral and facet joints. Parameters were compared with two age- and gender-matched control groups of individuals whose entire spine CT lacked evidence of DISH (Control 1 individuals < 2 flowing osteophytes, Control 2 individuals < 4 and ≥ 2 flowing osteophytes). Results A total of 158 participants (DISH/Control 1/Control 2 = 54/54/50; 106 men, 52 women; average age = 70.6 years) were evaluated. Average intervertebral disc height was significantly lower in the DISH group compared with both control groups (DISH/Control 1/Control 2 = 4.55/5.13/5.01 mm, P < 0.001). Costovertebral degenerative changes were more prevalent in DISH patients ( P < 0.05) and, except for vacuum phenomenon (more prevalent in controls), other DID changes were as prevalent in DISH as in controls. Conclusion The presence of degenerative intervertebral changes on thoracic CT should not deter from diagnosing DISH. Thus, the radiographic Resnick and Niwayama DISH criteria cannot be directly adapted to CT.

Ultrasonography findings and physical examination outcomes in dancers with and without patellofemoral pain.

OBJECTIVES: To identify whether a physical examination for patello-femoral pain (PFP) is related to ultrasonography findings at the knee, and to identify possible factors related to PFP in young dancers. METHODS: Sixty-seven young female dancers (7th grade, aged 12.8 ± 0.5) from three schools with identical special dance programs were included in the study. All the dancers were interviewed for demographic details, dance background, and training intensity; were evaluated for anthropometric measurements; underwent physical examination of both knees for PFP and for knee range of motion (ROM); and, had ultrasonography assessment for pathologies and of anatomical parts of their knees. RESULTS: PFP was found in 54.5% of the 134 knees physically examined. In ultrasonography assessment, infra-articular effusion was found in 46.2% of the knees examined. H/week of dance practice was significantly higher among dancers with PFP (in both knees) compared with dancers with no PFP (p < .05). Knees with PFP had a significantly higher prevalence of intra articular effusion (p = .018) and higher prevalence of genu-recurvatum (p = .042). Knees with PFP had significantly greater growth plate width-anterior tibial tuberosity (p = .022) and a greater bony trochlear groove angle (p = .048). CONCLUSION: This study describes the relationship between physical examination for PFP and the sonographic findings, and the factors related to knee injuries. The results showed a high prevalence of PFP and intra articular knee effusion among young dancers at the age of 12-13 years; and, that the number of hours of practice and anatomical structure are related to PFP. Our results should alert physicians, physiotherapists, athletic trainers and dance teachers to the need for devising modifications of training and injury prevention strategies from a young age (<12 years old).

Magnetic resonance enterography in pregnant women with Crohn's disease: case series and literature review.

BACKGROUND: Evaluation of pregnant women with known or suspected Crohn's disease (CD) remains a challenge. Magnetic Resonance Enterography (MRE) is a promising diagnostic tool in these patients; however, the clinical data on MRE utilization in pregnancy is scarce. The aim of the study was to describe the experience with MRE in pregnant CD patients in a tertiary referral center. METHODS: We retrospectively reviewed MRE studies performed in pregnant women with known or suspected CD that were performed between January 2007 and November 2012. Imaging findings, clinical management and outcome were extracted from patient's file and electronic records. Image quality was evaluated. RESULTS: Ten studies of 9 patients were included. MRE protocol was modified to maximize maternal and fetal safety, and intravenous gadolinium was not used. In 7 patients, CD diagnosis was previously established; six were admitted with clinical symptoms consistent with CD exacerbation, and an additional patient with a recurrent groin abscess without apparent luminal symptoms. In all seven patients, imaging features consistent with active CD were detected; new penetrating complications were detected in 4 patients. Two patients underwent MRE for suspected CD which was not comforted by study results. The clinical management was significantly impacted by MRE results in all positive cases. The image quality of the fast MRE sequences obtained without gadolinium was satisfactory and allowed meaningful interpretation. CONCLUSION: MRE with an adapted protocol for pregnancy is a reliable imaging modality to manage in pregnant women with known or suspected CD.