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1.
Semin Musculoskelet Radiol ; 26(6): 656-669, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36791735

RESUMO

We suggest a similar approach to evaluating osteochondral lesions of the talar dome both pre- and postoperatively. This review addresses the etiology, natural history, and treatment of talar dome osteochondral lesions with an emphasis on imaging appearances. High-resolution magnetic resonance imaging, ideally combining a small field-of-view surface coil with ankle traction, optimizes visibility of most of the clinically relevant features both pre- and postoperatively.


Assuntos
Tálus , Humanos , Tálus/diagnóstico por imagem , Tálus/cirurgia , Tálus/patologia , Imageamento por Ressonância Magnética/métodos , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia
2.
AJR Am J Roentgenol ; 216(2): 464-470, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33236948

RESUMO

OBJECTIVE. The purpose of this study was to study changes in the median nerve, retinaculum, and carpal tunnel on MRI after successful endoscopic carpal tunnel release (ECTR). SUBJECTS AND METHODS. In this prospective study, 35 wrists in 32 patients (five men, 27 women; mean age, 56.7 ± 6.8 [SD] years) with nerve conduction test-confirmed primary carpal tunnel syndrome were evaluated from May 2013 to September 2016. Clinical scores ranging from 0 to 4 (no improvement to symptoms completely resolved) and MRI morphologic features of median nerve and carpal tunnel were evaluated at baseline and 3 and 12 months after ECTR. The paired t test was used to compare MRI parameters before and after ECTR and their relationships to clinical improvement scores. RESULTS. All patients' conditions improved after ECTR with mean clinical improvement scores of 2.94 ± 1.0 at 3 months and 3.49 ± 0.56 at 12 months. Although median nerve swelling did decrease proximally, the nerve remained swollen (> 15 mm2) and flattened in all areas, even 12 months after ECTR. Additional changes occurred in median nerve caliber-change ratio, relative signal intensity, and carpal tunnel cross-sectional area. A retinacular gap was present in 33 (94%) wrists 3 months and six (17%) wrists 12 months after ECTR, and increased retinacular bowing persisted. CONCLUSION. After ECTR, undue swelling and flattening of the median nerve persist as long as 12 months after surgery, even in patients with a good surgical outcome. One should be wary of using these MRI findings as signs of persistent neural compression. The retinaculum reforms in most patients within 12 months of surgery but with a more bowed configuration.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Endoscopia , Imageamento por Ressonância Magnética , Ossos do Carpo/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Ligamentos Articulares/diagnóstico por imagem , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Fatores de Tempo
3.
Semin Musculoskelet Radiol ; 25(5): 646-651, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34861709

RESUMO

This paper is designed to be read by radiological trainees who are starting out with reporting musculoskeletal imaging studies. Based on the author's experience of over 25 years, it provides tips on how to report musculoskeletal imaging succinctly and effectively using a prose style report.


Assuntos
Anormalidades Musculoesqueléticas , Radiologia , Humanos , Anormalidades Musculoesqueléticas/diagnóstico por imagem
4.
Semin Musculoskelet Radiol ; 25(5): 652-660, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34861710

RESUMO

Magnetic resonance imaging of the shoulder is a commonly performed investigation. This article discusses the common shoulder pathologies encountered, emphasizes the key features to report, and provides examples of terminology used to describe these pathologies.


Assuntos
Articulação do Ombro , Ombro , Humanos , Imageamento por Ressonância Magnética , Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Extremidade Superior
5.
Semin Musculoskelet Radiol ; 25(5): 661-669, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34861711

RESUMO

The elbow is the least common of the main joints examined with magnetic resonance imaging (MRI), thus radiologists may be less familiar with writing these reports. This article addresses the main pathologies encountered in and around the elbow, emphasizing the specific features that need reporting and providing examples of terminology to use when describing these abnormalities.


Assuntos
Articulação do Cotovelo , Cotovelo , Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Radiologistas
6.
Semin Musculoskelet Radiol ; 25(5): 690-699, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34861714

RESUMO

The knee is the most commonly examined joint with magnetic resonance imaging (MRI) and, as such, it is the joint that most trainee radiologists start reporting. This article addresses the main pathologies encountered on MRI examination of the knee, outlining the key features to note and report, as well as providing examples of terminology used to describe these findings.


Assuntos
Traumatismos do Joelho , Articulação do Joelho , Humanos , Joelho/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética
7.
Semin Musculoskelet Radiol ; 25(5): 681-689, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34861713

RESUMO

Writing a good magnetic resonance imaging (MRI) hip report requires a sound understanding of hip anatomy, imaging, and related pathologies. The structures of the hip most prone to pathology are the articular surfaces, labrum, subchondral bone, and gluteal tendons. Particular attention should be paid to abnormal hip morphology that is relatively common and can manifest as internal or external hip derangement. It is essential to appreciate and report the specific features of each pathology that carry clinical significance to aid patient management. This article is aimed at trainee radiologists and those less experienced with reporting hip MRI, focusing on the essential features to comment on and providing examples of terminology to use and MR images to illustrate these features.


Assuntos
Articulação do Quadril , Imageamento por Ressonância Magnética , Articulação do Quadril/diagnóstico por imagem , Humanos , Radiologistas , Tendões
8.
Semin Musculoskelet Radiol ; 25(5): 700-708, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34861715

RESUMO

Reporting ankle magnetic resonance imaging involves the assessment of multiple joints, tendons, and ligaments in several planes and numerous sequences. This article describes an approach using four anatomical categories (subcutaneous fat, bones and joints, tendons, and ligaments) to simplify and improve reporting efficiency. The main pathologies are covered, emphasizing the specific features to comment on, as well as suggesting terminology and phrases to use when reporting.


Assuntos
Tornozelo , Tendões , Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Humanos , Ligamentos , Imageamento por Ressonância Magnética
9.
Semin Musculoskelet Radiol ; 25(5): 670-680, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34861712

RESUMO

Knowledge of the imaging anatomy of the wrist is essential for reporting magnetic resonance imaging (MRI). This familiarity should include the carpal bones, tendons (extensor and flexor compartments), triangular fibrocartilage complex (TFCC), intrinsic and extrinsic ligaments, and nerves, especially the median and ulnar nerves. Limitations of MRI in visualizing these structures, particularly the intrinsic ligaments and the TFCC, need to be considered. This article outlines the main features to comment on when reporting common conditions of the wrist on MRI, with some examples of terminology that can be used to describe these abnormalities.


Assuntos
Fibrocartilagem Triangular , Traumatismos do Punho , Humanos , Imageamento por Ressonância Magnética , Tendões , Punho/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem
10.
Skeletal Radiol ; 48(1): 5-10, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29797016

RESUMO

Although bicipitoradial bursitis is not commonly seen, when it does occur, it can frequently lead to diagnostic difficulty, mimicking either a soft-tissue tumor or infection. Lack of awareness of this uncommon entity can lead to unnecessary anxiety or tissue biopsy. This pictorial essay discusses the normal anatomy of the bicipitoradial bursa and the spectrum of imaging findings of bicipital bursitis.


Assuntos
Bursite/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Bolsa Sinovial/patologia , Diagnóstico Diferencial , Articulação do Cotovelo/patologia , Humanos , Imageamento por Ressonância Magnética , Ultrassonografia
11.
Eur Spine J ; 26(10): 2666-2675, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28702785

RESUMO

PURPOSE: Weight bearing does alter the dimension of lumbar spinal canal, but no study has analyzed its clinical correlation. This study aims to evaluate whether the changes in dural sac cross-sectional area (DSCA) and sagittal anteroposterior (AP) diameter on standing magnetic resonance imaging (MRI) correlate better with clinical symptoms of lumbar spinal stenosis. METHODS: Seventy consecutive patients with neurogenic claudication were prospectively recruited to undergo a 0.25-T MRI examination performed in supine and standing positions. Clinical symptoms including the walking distance, Visual Analogue Score of leg pain, Chinese Oswestry Disability Index, and short form-12 were assessed. DSCA and sagittal AP diameter at the most constricted spinal level on supine and standing positions were measured and correlated with each clinical symptom by Pearson correlation coefficients (r). RESULTS: DSCA and AP diameter on standing MRI and their % changes from supine to standing showed significant (r = 0.55, 0.53, -0.44, -0.43; p < 0.001) and better correlations than those on supine MRI (r = 0.39, 0.42; p < 0.001) with walking distance. Significant correlations were also found between dural sac calibers on standing MRI and leg pain scores (r = -0.20, r = -0.25; p < 0.05). Patients walking ≤500 m had a significantly smaller DSCA, narrower AP diameter and greater % change in dural sac calibers (p < 0.01) than those walking >500 m. A >30% reduction of DSCA and AP diameter was observed in patients with worse claudication distance (p < 0.05). CONCLUSION: DSCA and sagittal AP diameter on standing MRI correlate significantly and better than findings on supine MRI with claudication symptoms. Standing MRI demonstrates dynamic changes of dural sac and provides an additional value to supine MRI in correlating clinical symptoms of lumbar spinal stenosis.


Assuntos
Dura-Máter/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Postura , Estenose Espinal/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Claudicação Intermitente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escala Visual Analógica , Adulto Jovem
12.
Semin Musculoskelet Radiol ; 25(5): 639-640, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34861707
13.
J Clin Ultrasound ; 43(9): 525-37, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26265305

RESUMO

Ultrasound (US) is increasingly being used as the first-line imaging modality for investigating the chest wall for soft tissue and bony lesions. This article describes the technique used for the US examination, the relevant chest-wall anatomy, and the appearances on US scanning of pathologic entities either unique to or common in the region of the chest wall.


Assuntos
Parede Torácica/diagnóstico por imagem , Humanos , Ultrassonografia Doppler
14.
AJR Am J Roentgenol ; 202(6): W532-40, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24848846

RESUMO

OBJECTIVE: The objective of our study was to evaluate the diagnostic accuracy of ultrasound in assessing musculoskeletal soft-tissue tumors superficial to the investing fascia. MATERIALS AND METHODS: Seven hundred fourteen superficial soft-tissue tumors evaluated with ultrasound by two musculoskeletal radiologists were retrospectively reviewed. In all ultrasound reports, the reporting radiologists provided one, two, or three diagnoses depending on their perceived level of diagnostic certainty. Two hundred forty-seven tumors had subsequent histologic correlation, thus allowing the accuracy of the ultrasound diagnosis to be determined. Images of the lesions with a discordant ultrasound diagnosis and histologic diagnosis were reviewed, and the ultrasound features were further classified as concordant with the known histologic diagnosis, concordant with the known histologic diagnosis with atypical features present, or discordant with the known histologic diagnosis. Four hundred sixty-seven tumors without pathologic confirmation were followed up clinically. RESULTS: Overall the accuracy of ultrasound examination for assessing superficial soft-tissue masses was 79.0% when all differential diagnoses were considered and 77.0% when only the first differential diagnosis was considered. The sensitivity and specificity of the first ultrasound diagnosis were 95.2% and 94.3%, respectively, for lipoma; 73.0% and 97.7% for vascular malformation; 80.0% and 95.4% for epidermoid cyst; and 68.8% and 95.2% for nerve sheath tumor. Reduced observer awareness of specific tumor entities tended to contribute to underdiagnosis more than poor specificity of ultrasound findings. Most tumors (236/247, 96%) were benign. The sensitivity and specificity of ultrasound for identifying malignant superficial soft-tissue tumors was 94.1% and 99.7%, respectively. CONCLUSION: The diagnostic accuracy of ultrasound in the assessment of superficial musculoskeletal soft-tissue tumors is high and can be improved through increased radiologist awareness of less frequently encountered tumors. Ultrasound is accurate for differentiating benign from malignant superficial soft-tissue tumors.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Fáscia/diagnóstico por imagem , Neoplasias Musculares/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
15.
Perioper Med (Lond) ; 13(1): 45, 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38783315

RESUMO

BACKGROUND: Frailty is common in patients undergoing cardiac surgery and is associated with poorer postoperative outcomes. Ultrasound examination of skeletal muscle morphology may serve as an objective assessment tool as lean muscle mass reduction is a key feature of frailty. METHODS: This study investigated the association of ultrasound-derived muscle thickness, cross-sectional area, and echogenicity of the rectus femoris muscle (RFM) with preoperative frailty and predicted subsequent poor recovery after surgery. Eighty-five patients received preoperative RFM ultrasound examination and frailty-related assessments: Clinical Frailty Scale (CFS) and 5-m gait speed test (GST5m). Association of each ultrasound measurement with frailty assessments was examined. Area under receiver-operating characteristic curve (AUROC) was used to assess the discriminative ability of each ultrasound measurement to predict days at home within 30 days of surgery (DAH30). RESULTS: By CFS and GST5m criteria, 13% and 34% respectively of participants were frail. RFM cross-sectional area alone demonstrated moderate predictive association for frailty by CFS criterion (AUROC: 0.76, 95% CI: 0.66-0.85). Specificity improved to 98.7% (95% CI: 93.6%-100.0%) by utilising RFM cross-sectional area as an 'add-on' test to a positive gait speed test, and thus a combined muscle size and function test demonstrated higher predictive performance (positive likelihood ratio: 40.4, 95% CI: 5.3-304.3) for frailty by CFS criterion than either test alone (p < 0.001). The combined 'add-on' test predictive performance for DAH30 (AUROC: 0.90, 95% CI: 0.81-0.95) may also be superior to either CFS or gait speed test alone. CONCLUSIONS: Preoperative RFM ultrasound examination, especially when integrated with the gait speed test, may be useful to identify patients at high risk of frailty and those with poor outcomes after cardiac surgery. TRIAL REGISTRATION: The study was registered on the Chinese Clinical Trials Registry (ChiCTR2000031098) on 22 March 2020.

16.
Rheumatol Adv Pract ; 8(3): rkae073, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38915843

RESUMO

Objective: Bone inflammation (osteitis) in early RA (ERA) manifests as bone marrow oedema (BME) and precedes the development of bone erosion. In this prospective, single-centre study, we developed an automated post-processing pipeline for quantifying the severity of wrist BME on T2-weighted fat-suppressed MRI. Methods: A total of 80 ERA patients [mean age 54 years (s.d. 12), 62 females] were enrolled at baseline and 49 (40 females) after 1 year of treatment. For automated bone segmentation, a framework based on a convolutional neural network (nnU-Net) was trained and validated (5-fold cross-validation) for 15 wrist bone areas at baseline in 60 ERA patients. For BME quantification, BME was identified by Gaussian mixture model clustering and thresholding. BME proportion (%) and relative BME intensity within each bone area were compared with visual semi-quantitative assessment of the RA MRI score (RAMRIS). Results: For automated wrist bone area segmentation, overall bone Sørensen-Dice similarity coefficient was 0.91 (s.d. 0.02) compared with ground truth manual segmentation. High correlation (Pearson correlation coefficient r = 0.928, P < 0.001) between visual RAMRIS BME and automated BME proportion assessment was found. The automated BME proportion decreased after treatment, correlating highly (r = 0.852, P < 0.001) with reduction in the RAMRIS BME score. Conclusion: The automated model developed had an excellent segmentation performance and reliable quantification of both the proportion and relative intensity of wrist BME in ERA patients, providing a more objective and efficient alternative to RAMRIS BME scoring.

17.
Adv Orthop ; 2024: 5598107, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38328468

RESUMO

Background: Glenoid bone loss is a risk factor leading to the failure of arthroscopic Bankart repair. While 20-25% glenoid bone loss has long been considered the level to necessitate bony augmentation, recent studies indicate that 13.5% has a "subcritical" glenoid bone loss level, which is associated with decreased short- and medium-term functional scores. Few researchers worked on the long-term effect of "subcritical" or even less severe degrees of glenoid bone loss on redislocation rates and functional outcomes after arthroscopic Bankart repair. This study aimed to evaluate the effect of subcritical or less severe glenoid bone loss on redislocation rates and function after arthroscopic Bankart repair. Methods: A patient cohort who had undergone computed tomography (CT) of glenoid bone loss and arthroscopic Bankart repair over 15 years ago was reviewed. Western Ontario Shoulder Instability (WOSI) score, Single Assessment Numeric Evaluation (SANE) score, redislocation after operation, mechanism of recurrence, and revision details were reviewed. Results: Seventy-five patients were reassessed 17.6 ± 1.9 years following initial surgery. The age at enrolment was 26.8 ± 8.3 years. Twenty-two (29%) patients of the 75 patients had a redislocation on long-term follow-up, though this was not related to glenoid bone loss severity. The impaired functional score was found in patients with initial glenoid bone loss of 7% or more on long-term follow-up: WOSI (physical symptoms): 0.98 ± 2.00 vs 2.25 ± 4.01, p=0.04 and WOSI (total): 0.79 ± 1.43 vs 1.88 ± 3.56, p=0.04. Conclusions: At a mean of 17.5 years following arthroscopic Bankart repair, redislocation occurs in over a quarter of 75 patients, and they are not related to initial glenoid bone loss severity. Impaired functional outcome is apparent in patients with initial glenoid bone loss of >7%, though this impairment does not seem sufficiently severe to warrant an alternative treatment approach.

18.
J Ultrason ; 23(95): e299-e312, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38020510

RESUMO

This review outlines a practical approach to the everyday assessment of both non-neoplastic and neoplastic soft tissue tumors, focusing on ultrasound examination, though emphasizing the added benefit of magnetic resonance imaging in certain instances. Ultrasound approach and assessment, practical scenarios, reporting, biopsy, and follow-up are covered, as well as the criteria used to distinguish benign from malignant tumors. The potential benefits and current limitations of elastography and contrast-enhanced ultrasound in assessment are also addressed. Examples of commonly encountered soft tissue tumors are shown. Ultrasound can characterize most soft tissue masses based on their ultrasound appearance alone. Following ultrasound examination, three potential scenarios usually exist in clinical practice: (a) confident regarding diagnosis, (b) indeterminate mass with no evidence of malignancy, and (c) indeterminate mass with possibility of malignancy. A diagnostic pathway for each of these scenarios is provided. Magnetic resonance imaging is generally not helpful in further characterizing masses which are indeterminate on ultrasound assessment, though it is helpful in addressing other issues such as exact tumor location and neurovascular bundle involvement that may not be fully resolved on ultrasound examination. In these situations, magnetic resonance imaging examination can be tailored to address those specific questions that have not been adequately addressed on ultrasound examination. In this sense, both examinations are highly complementary. Tips for undertaking magnetic resonance imaging examinations are provided.

20.
Skeletal Radiol ; 41(4): 387-99, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21826613

RESUMO

PURPOSE: Retrospective review of high-resolution MR imaging features of talar dome osteochondral lesions and development of new classification system based on these features. MATERIAL AND METHODS: Over the past 7 years, 70 osteochondral lesions of the talar dome from 70 patients (49 males, 21 females, mean age 42 years, range 15-62 years) underwent high-resolution MR imaging with a microscopy coil at 1.5 T. Sixty-one (87%) of 70 lesions were located on the medial central aspect and ten (13%) lesions were located on the lateral central aspect of the talar dome. Features evaluated included cartilage fracture, osteochondral junction separation, subchondral bone collapse, bone:bone separation, and marrow change. Based on these findings, a new five-part grading system was developed. Signal-to-noise characteristics of microscopy coil imaging at 1.5 T were compared to dedicated ankle coil imaging at 3 T. RESULTS: Microscopy coil imaging at 1.5 T yielded 20% better signal-to-noise characteristics than ankle coil imaging at 3 T. High-resolution MR revealed that osteochondral junction separation, due to focal collapse of the subchondral bone, was a common feature, being present in 28 (45%) of 61 medial central osteochondral lesions. Reparative cartilage hypertrophy and bone:bone separation in the absence of cartilage fracture were also common findings. Complete osteochondral separation was uncommon. A new five-part grading system incorporating features revealed by high-resolution MR imaging was developed. CONCLUSIONS: High-resolution MRI reveals clinically pertinent features of talar osteochondral lesions, which should help comprehension of symptomatology and enhance clinical decision-making. These features were incorporated in a new MR-based grading system. Whenever possible, symptomatic talar osteochondral lesions should be assessed by high-resolution MR imaging.


Assuntos
Doenças Ósseas/diagnóstico , Fraturas de Cartilagem/diagnóstico , Imageamento por Ressonância Magnética , Tálus , Adolescente , Adulto , Doenças Ósseas/classificação , Feminino , Fraturas de Cartilagem/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
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