Magnetic resonance arthrography accuracy in the detection of labral tears in young patients with chronic unstable shoulder: correlation with arthroscopy.

The aim of this study is to determine the diagnostic performance of Magnetic Resonance Arthrography (MRA) in evaluating lesions of the glenoid labrum, in young active patients with chronic unstable shoulder, compared to shoulder arthroscopy. We retrospectively considered 65 MRA examinations, performed between December 2011 and January 2018. Among them, thirty-five patients (31 men, 4 women; mean age, 27.3 years; range, 16-53 years; 4 patients with a previous arthroscopy of the same shoulder) underwent shoulder arthroscopy after MRA. Arthroscopic reports were collected and analyzed for the correlation with MRA results.

Risk of fracture prevention in spina bifida patients: correlation between bone mineral density, vitamin D, and electrolyte values.

PURPOSE: The aim of our study was to investigate the relationship between bone mineral density (BMD), vitamin D, and electrolyte blood values in patients with spina bifida, to find a possible therapeutic regimen and an intervention to reduce the risk of fractures in this population. METHODS: BMD values were measured in 49 patients (32 females, 17 males; aged 14.1 ± 3.86 years; range 5-20 years) using dual-energy X-ray absorptiometry (DEXA) and were analyzed based on sex, the level of spinal involvement, vitamin D, and electrolyte values, physical activity, body mass index (BMI), and ambulatory status [patients were divided into three subgroups: full-time wheelchair (FTWC), limited ambulator (LA), and full-time ambulator (FTA)]. These data were analyzed considering sex-, age-, and BMD-matched values and compared with those of normal population. RESULTS: BMD was significantly lower in these patients compared with that in the general healthy population (Z-score: -1.2 ± 1.8); in particular, females had Z-score values significantly lower that of the males (Z-score: -2.43 ± 2.02; P < 0.0004). In FTWC subgroup, Z-score was lower than that of the other two subgroups (P < 0.009). Vitamin D values were significantly lower compared with those in the general healthy population (vitamin D spina bifida group: 14.6 ± 8.7 mg/dL; normal subjects: 35 ± 9.8 mg/dL; P < 0.001). Subjects with spina bifida showed hypophosphatemia (<3 mg/dL) because of the lower levels of vitamin D (3.1 ± 0.9 mg/dL; P < 0.001). CONCLUSIONS: Spina bifida patients showed lower BMD, vitamin D, and electrolyte values than the healthy population; hence, they have an increase risk of developing pathological fractures. Vitamin D supplementation for a longer time period could reduce this risk.

Imaging of spondylodiscitis.

BACKGROUND: Spinal infections (pyogenic or non-pyogenic) are increasing in incidence and are a common cause of morbidity in high-risk patients (elderly, immunocompromised patients, diabetic patients, drug addicts, and patients with sickle-cell disease). AIM: To provide an overview of the radiological features of spinal infections, focusing on magnetic resonance (MR) imaging, and to illustrate the differential diagnosis. MATERIALS AND METHODS: We reviewed the spine imaging of 118 patients with spinal infections from our files. All patients underwent radiography and MR imaging examinations. computed tomography (CT) was performed in 96 patients. RESULTS: MR imaging has greatly contributed to prompt diagnosis, thus allowing implementation of timely appropriate treatment. CONCLUSIONS: Prompt diagnosis and treatment are essential to prevent serious bone and joint destruction, and severe neurologic sequelae.

Clinical features, imaging findings, treatment aspects of elastofibroma dorsi and long-term outcomes after surgical resection.

OBJECTIVE: We aim to present clinical features, imaging findings, treatment aspects of the elastofibroma dorsi (ED), which is a benign tumor arising from connective tissue at the scapular region, and long-term outcomes after surgical resection. PATIENTS AND METHODS: We evaluated retrospectively 82 patients (55 females, 27 males; mean age, 60 years; age range, 23-78 years) with ED who underwent surgery between January 1994 and May 2014; subsequently all patients were invited for follow-up, which consisted of physical and US examinations. RESULTS: Subscapular location was almost constant (79/82 patients). Right, left and bilateral location was noted in 39, 28 and 15 cases, respectively. 52/82 patients were symptomatic. The diagnosis was made on physical examination and imaging studies: 49 ultrasound, 43 computed tomography and 54 magnetic resonance examinations were performed overall. Surgical treatment consisted in marginal excision; in all cases diagnosis was confirmed by histological examination. The mean hospitalization was 3 days, with minor complications. Out of the 82 patients, only 25 gave their consent to follow-up; mean time passed after surgery was 64.7 months; 1 case of local recurrence was suspected by ultrasound and, then, confirmed by magnetic resonance imaging. CONCLUSIONS: In our series, clinical features and imaging findings of ED are consistent with current evidence; however, results of our follow-up group marks a difference from the literature, according to which there is no evidence of local recurrence after complete resection. Diagnosis of ED is based on clinical and imaging features; treatment is surgical, especially in symptomatic cases. Prolonging the clinical and US follow-up period may be useful in identifying local recurrence.

The spine in Paget's disease.

Paget's disease (PD) is a chronic metabolically active bone disease, characterized by a disturbance in bone modelling and remodelling due to an increase in osteoblastic and osteoclastic activity. The vertebra is the second most commonly affected site. This article reviews the various spinal pathomechanisms and osseous dynamics involved in producing the varied imaging appearances and their clinical relevance. Advanced imaging of osseous, articular and bone marrow manifestations of PD in all the vertebral components are presented. Pagetic changes often result in clinical symptoms including back pain, spinal stenosis and neural dysfunction. Various pathological complications due to PD involvement result in these clinical symptoms. Recognition of the imaging manifestations of spinal PD and the potential complications that cause the clinical symptoms enables accurate assessment of patients prior to appropriate management.