Computed tomography evaluation of skeletal muscle quality and quantity in people with morbid obesity with and without metabolic abnormality.

We investigated the differences in quantity and quality of skeletal muscle between metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) individuals using abdominal CT. One hundred and seventy-two people with morbid obesity who underwent bariatric surgery and 64 healthy control individuals participated in this retrospective study. We divided the people with morbid obesity into an MHO and MUO group. In addition, nonobese metabolic healthy people were included analysis to provide reference levels. CT evaluation of muscle quantity (at the level of the third lumbar vertebra [L3]) was performed by calculating muscle anatomical cross-sectional area (CSA), which was normalized to patient height to produce skeletal muscle index (SMI). Muscle quality was assessed as skeletal muscle density (SMD), which was calculated from CT muscle attenuation. To characterize intramuscular composition, muscle attenuation was classified into three categories using Hounsfield unit (HU) thresholds: -190 HU to -30 HU for intermuscular adipose tissue (IMAT), -29 to +29 HU for low attenuation muscle (LAM), and +30 to +150 HU for normal attenuation muscle (NAM). People with morbid obesity comprised 24 (14%) MHO individuals and 148 (86%) MUO individuals. The mean age of the participants was 39.7 ± 12.5 years, and 154 (65%) participants were women. MUO individuals had a significantly greater total skeletal muscle CSA than MHO individuals in the model that adjusted for all variables. Total skeletal muscle SMI, SMD, NAM index, LAM index, and IMAT index did not differ between MHO and MUO individuals for all adjusted models. Total skeletal muscle at the L3 level was not different in muscle quantity, quality, or intramuscular composition between the MHO and MUO individuals, based on CT evaluation. MHO individuals who are considered "healthy" should be carefully monitored and can have a similar risk of metabolic complications as MUO individuals, at least based on an assessment of skeletal muscle.

Longitudinal Association between L1 Trabecular Attenuation from Chest Computed Tomography (CT) and Bone Mineral Density from Dualenergy X-ray Absorptiometry (DXA).

BACKGROUND: Many studies have shown that vertebral trabecular attenuation measured on CT scan corresponds well to DXA results for bone mineral density. These studies were based on crosssectional data. Hence, there were limitations in explaining the constantly changing vertebral trabecular attenuation from CT and T-score from DXA over time. OBJECTIVE: This study aimed to determine the longitudinal association between the vertebral trabecular attenuation measured on computed tomography (CT) and the T-score measured by dual-energy X-ray absorptiometry (DXA). METHODS: We performed a database search for 333 patients who underwent surgery for breast cancer, preoperative treatment, and at least one follow-up chest CT and DXA from January, 2013 through May, 2021. One musculoskeletal radiologist measured the mean vertebral trabecular attenuation of lumbar vertebra 1(L1) on axial unenhanced images at the pedicle level by manually placing the region of interest (ROI). DXA of the lumbar spine was performed, and the lowest T-score of the lumbar spine was used for the analysis. We evaluated the association between L1 trabecular attenuation from chest CT and T-score from DXA over time using the generalized estimating equations (GEE) model to analyze longitudinal corrected data. RESULTS: A total of 150 women (mean age, 52.4 ± 11.0 years) were included. There was a statistically significant association between L1 trabecular attenuation from chest CT and T-score from DXA in the unadjusted model (p < 0.001) and adjusted model (p < 0.001). T-score value increased by 0.172 (95% confidence interval (CI): 0.145-0.200, p < 0.001) per 10 unit (HU) of L1 trabecular attenuation at time = 0 in unadjusted model and by 0.173 (95% CI: 0.143-0.203, p < 0.001) in all adjusted model. CONCLUSION: We demonstrated that L1 attenuation from chest CT images was longitudinally associated with T-score from DXA, and the degree of association appeared to be decreased over time in breast cancer patients regardless of their medical condition.

Differentiation between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl's node.

INTRODUCTION: We aimed to identify imaging-based findings that can differentiate between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl's nodes that have been histopathologically confirmed. METHODS: Between March 2010 and April 2016, 11 patients who had undergone spinal magnetic resonance (MR) imaging or computed tomography (CT) with final radiologic reports that included 'subchondral bone metastasis with focal pathologic endplate fracture' or 'edematous Schmorl's node' and had also undergone percutaneous imaging-guided spinal biopsies were included. Two radiologists retrospectively evaluated the following imaging features in consensus: size, location, presence of sclerotic margin, presence of intralesional or perilesional enhancement and opposite endplate enhancement of the involved disc, presence of disc height loss and presence of metabolic uptake at a corresponding lesion on nuclear medicine imaging. RESULTS: A total of 11 patients, including six patients with spinal subchondral bone metastasis with focal pathologic endplate fracture and five patients with oedematous Schmorl's nodes, were included in this study (median age, 58 years; range, 50-63 years; six men). Sclerotic margin (P = 0.002) and enhancement on the opposite endplate of the involved disc (P = 0.047) were significantly different between oedematous Schmorl's node and subchondral bone metastasis with focal pathologic endplate fracture. CONCLUSION: Sclerotic margin and enhancement on the opposite endplate of the involved disc suggest oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture. Decreased disc height is likely to be an oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture.

Reproducibility and diagnostic performance of the vascular index of superb microvascular imaging in real-time breast ultrasonography for evaluating breast masses.

PURPOSE: This study aimed to evaluate the reproducibility and diagnostic performance of a quantitative parameter of superb microvascular imaging (SMI) in real-time breast ultrasonography (US) for differentiating benign from malignant breast masses. METHODS: Eighty-seven breast masses in 75 patients who underwent both B-mode US and SMI before US-guided core needle biopsy were included in this study. Two radiologists performed B-mode US and measured the vascular index (VI) of SMI respectively for each lesion in real time. Intraobserver and interobserver agreements were analyzed for the VI of SMI. The diagnostic performance of B-mode US using the Breast Imaging Reporting and Database System lexicon and combined use with the VI of SMI was evaluated compared to pathology. RESULTS: The median VI of malignant masses (n=32) was significantly higher than that of benign masses (n=55) (7.6% and 2.6%, respectively; P<0.001). The intraobserver agreement for VI was excellent regardless of the pathology, size, or depth of the lesion. The interobserver agreement for VI was excellent regardless of the presence of a measurement interval. The interobserver agreement for the final diagnostic decision was improved by combining B-mode US and VI (κ=0.883) in comparison with B-mode US only (κ=0.617). Adding VI led to significant improvements in the specificity (87.2% vs. 52.7%, 83.6% vs. 49.0%), accuracy (89.7% vs. 69.3%, 84.0% vs. 65.9%) and positive predictive value (81.5% vs. 55.1%, 75.6% vs. 52.6%) of B-mode US for both observers compared with B-mode US alone (all, P=0.001). CONCLUSION: The VI of SMI for real-time breast US is highly reproducible and leads to improved diagnostic performance for differentiating between benign and malignant breast lesions in combination with B-mode US.

Electronic Cigarette or Vaping Product Use-Associated Lung Injury: A Case Report.

Electronic cigarette (e-cigarette) or vaping product use-associated lung injury (EVALI) has emerged as a social issue as e-cigarette use is rapidly increasing worldwide and is related to many deaths in the United States. To our knowledge, this is the first case report of EVALI in South Korea of a 24-year-old man with acute respiratory symptoms and a history of e-cigarette use. Chest CT revealed diffuse bilateral ground-glass opacities with subpleural sparing, airspace consolidation, and centrilobular micronodules as typical patterns of EVALI with organizing pneumonia and diffuse alveolar damage. Infection was excluded with meticulous laboratory examinations, and the patients' illnesses were not attributed to other causes. EVALI was diagnosed by meeting the diagnostic criteria with consistent clinico-radiologic findings through a multidisciplinary approach. Radiologists should have good knowledge of EVALI radiologic findings and play a cardinal role in the proper diagnosis and management of EVALI.

Remnant-Tensioning Single-Bundle Anterior Cruciate Ligament Reconstruction Provides Comparable Stability to and Better Graft Vascularity Than Double-Bundle Anterior Cruciate Ligament Reconstruction in Acute or Subacute Injury: A Prospective Randomized Controlled Study Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging.

PURPOSE: To compare the clinical, second-look arthroscopic, magnetic resonance imaging (MRI), and dynamic-contrast-enhanced MRI (DCE-MRI) findings between remnant-tensioning single-bundle (RT-SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR). METHODS: Sixty-seven patients with acute or subacute anterior cruciate ligament (ACL) injury were randomized to undergo RT-SB or DB ACLR. Twenty-six patients in the RT-SB group and 28 in the DB group were evaluated using stability tests (Lachman test, pivot-shift test, and KT-2000 arthrometer) and multiple clinical scores. One year postoperatively, all 54 patients underwent MRI for evaluation of graft continuity and graft signal/noise quotient and DCE-MRI for the calculation of normalized area under the curve (nAUC) as a marker of graft vascularity. Among them, 41 patients underwent second-look arthroscopy for the evaluation of graft continuity, graft tension, and synovialization. The results were compared between the 2 groups. RESULTS: At the minimum 2-year follow-up (28.7 ± 6.4 months), the stability tests, clinical scores, second-look arthroscopic findings, and MRI findings were not significantly different between the groups. However, the mean nAUC values on DCE-MRI for the ACL graft were significantly higher in the RT-SB group than those in the DB group in all 3 zones (nAUCproximal, P = .005; nAUCmiddle, P = .021; nAUCdistal, P = .027; and nAUCaverage, P = .008). CONCLUSION: For acute or subacute ACL injury, the RT-SB ACLR showed an outcome comparable to that of DB ACLR in terms of knee stability, clinical scores, MRI findings, and second-look arthroscopic findings. Moreover, RT-SB ACLR showed better graft vascularity 1 year postoperatively than DB ACLR using DCE-MRI. LEVEL OF EVIDENCE: II, prospective randomized controlled trial.

The relationship between graft synovialization and graft revascularization after ACL reconstruction: Assessment using dynamic contrast enhanced-MRI and second-look arthroscopy.

PURPOSE: To assess graft vascularity via dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) at 1-year and 2-year postoperatively and to evaluate the relationship between the vascularity using DCE-MRI and the synovialization using second-look arthroscopy. MATERIALS AND METHODS: Fifty-four patients from prospective data included who underwent anterior cruciate ligament reconstruction (ACLR) and DCE-MRI. The graft was divided into proximal, middle, and distal zones; average of three zones was calculated. Signal/noise quotient (SNQ) was measured on proton-density image and normalized area under the curve (nAUC) was calculated from DCE-MRI. The results at 1-year (SNQ-1 and nAUC-1) and 2-year (SNQ-2 and nAUC-2) postoperatively were compared between two time points. Forty-one patients underwent second-look arthroscopy were classified into three groups according to the synovialization: Excellent (n = 17), Fair (n = 16), and Poor (n = 8). The SNQs and nAUCs were compared between three groups. RESULTS: Fifty-four and 23 patients underwent DCE-MRI at 1-year and 2-year, respectively. A significant decrease was observed from nAUCaverage-1 to nAUCaverage-2 (95 % confidential interval, 0.4-2.3; P = .007). Both SNQaverage-1 and SNQaverage-2 were significantly lower in the excellent than in the poor (SNQaverage-1, P < .001; SNQaverage-2, P = .003). Both SNQaverage-1 and SNQaverage-2 were significantly lower in the fair than in the poor (SNQaverage-1, P=.032; SNQaverage-2, P = .012). Both nAUCaverage-1 and nAUCaverage-2 were significantly higher in the excellent than in the poor (nAUCaverage-1, P < .001; nAUCaverage-2, P = .010). The nAUCaverage-1 was significantly higher in the excellent than the fair (nAUCaverage-1, P < .001). CONCLUSION: Well-synovialized grafts showed significantly lower SNQs and significantly higher nAUCs than did poor-synovialized grafts based on the second-look arthroscopic findings. We can indirectly infer from this result that well-synovialized grafts may have better biomechanical properties.

Quantitative stiffness of the median nerve, flexor tendons, and flexor retinaculum in the carpal tunnel measured with acoustic radiation force impulse elastography in various wrist and finger positions.

Despite the high prevalence and clinical importance of soft-tissue disorders, objective methods for evaluation of the biomechanical properties of soft tissues are lacking. This study aimed to quantitatively evaluate stiffness, an important biomechanical characteristic of soft tissue, using acoustic radiation force impulse (ARFI) elastography. The shear wave velocity (SWV, m/s) values of soft tissue structures within the carpal tunnel (CT) were measured in various combinations of wrist and finger positions.Twenty-six healthy adults were enrolled in this study. We measured the cross-sectional area of the median nerve (MN) and the SWV values of several structures within the CT at the CT inlet level. Measurement of SWV of the MN, flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), and transverse carpal ligament (TCL) were conducted in six wrist/finger motion combinations.When the wrist and fingers were in neutral positions (position A), the mean SWV was lowest for the MN (mean ±â€Šstandard deviation, 2.3 ±â€Š0.5 m/s), followed by the FDS (2.9 ±â€Š0.2), FDP (3.2 ±â€Š0.3), and TCL (3.3 ±â€Š0.4). The SWV was significantly different among the six different wrist/finger positions for all structures (P < .001). However, the MN cross-sectional area was not significantly different (P = .527). The SWV values for the MN, FDS, and FDP increased significantly as the wrist/finger positions the stress on the tendons increased (from position B to F) compared with a neutral position, while the SWV of the TCL was significantly higher for in all positions compared with neutral, except for wrist neutral, finger extension. The SWV values for the MN, FDS, and TCL gradually increased as stress increased.The intra-CT structures are under increased stress during wrist and finger motions than when the hand is in a neutral position. We have used ARFI elastography to gain insight into the pathophysiology of CTS.

What is the reason of the high fibular head in the Discoid Lateral Meniscus?

The purpose of this study was to assess the factors associated with high fibular head in symptomatic discoid lateral meniscus (DLM). Eighty-seven patients with complete DLM (discoid group) and 80 normal subjects (control group) were included prospectively. Plain X-rays and MRI were analyzed for level and angle of the fibular head and thickness and type of Wrisberg ligament. Multivariate regression analysis was performed to find the factors associated with levels of the fibular head and DLM. The angle of the fibular head was the only factor associated with level of the fibula in the discoid group (odds ratio : 3.0, p=0.007). The 13.6mm cut off value for fibular level had 70.5% sensitivity and 77.0% specificity for diagnosis of DLM. A high fibular head was associated with larger angle and type of fibular head. Level of evidence : Level II.

Tuberculous peritonitis following intestinal perforation in malignancy.

Tuberculous peritonitis is one of the most common causes of exudative ascites, especially in the young, and is an important cause of extra-pulmonary disease. However, tuberculous peritonitis is challenging to diagnose because there are no pathognomonic clinical features or imaging findings. Therefore, it is commonly misdiagnosed as another type of peritoneal disease, especially so in elderly patients with malignant disease. In this report, we described two cases of tuberculous peritonitis that were observed after intestinal perforation in elderly patients with malignancies. These diagnoses were established by laparoscopic peritoneal biopsy or AFB cultures of the ascitic fluid. Both patients were treated with anti-TB medications.

Percutaneous Image-Guided Spinal Lesion Biopsies: Factors Affecting Higher Diagnostic Yield.

OBJECTIVE: The objectives of this study were to determine the diagnostic yield of percutaneous biopsy of osseous spinal lesions under CT and fluoroscopy guidance and to analyze lesion-related and technical factors affecting higher diagnostic yield. MATERIALS AND METHODS: We retrospectively reviewed 247 consecutive percutaneous spinal biopsies and recorded the following information: size, anatomic location, and bone matrix of lesions; guiding modality; years of attending physicians' experience; number of approaches; pathologic result of initial biopsy; and final diagnosis. The pathologic results of the initial biopsies were classified as diagnostic or nondiagnostic. All variables were compared using Pearson chi-square test or Fisher exact test. Multivariate logistic regression was also conducted. RESULTS: Of the initial 247 biopsies, 197 (80%) biopsies were diagnostic. On multivariate analysis, size, bone matrix, and final diagnosis of lesion were significant factors affecting biopsy yield. Biopsies of large lesions (≥ 20 mm) showed higher diagnostic yield than biopsies of small lesions (p = 0.006). Biopsies of lytic lesions had the highest diagnostic yield (88%), followed by biopsies of mixed (84%), sclerotic (67%), and isodense lesions (61%). Differences were significant for diagnostic yields of biopsies of lytic versus sclerotic lesions (p = 0.004) and lytic versus isodense lesions (p = 0.031). Biopsies of metastases had significantly highest diagnostic yield (97%), followed by biopsies of primary malignancies (84%) and benign lesions (39%) (p < 0.05). CONCLUSION: For percutaneous image-guided biopsies of spinal tumorous lesions, diagnostic yield was 80%. Size, bone matrix, and final diagnosis of lesions affected diagnostic yield of percutaneous image-guided biopsies.

A Longitudinal Study of Functional Outcomes in Patients with Limb Salvage Surgery for Soft Tissue Sarcoma.

BACKGROUND: Many studies have reported on the surgical outcomes of soft tissue sarcoma. However, there was no longitudinal cohort study. Because time is the most valuable factor for functional recovery, adjusting time value was the key for finding the causal relationship between other risk factors and postoperative function. Therefore, existing cross-sectional studies can neither fully explain the causal relationship between the risk factors and the functional score nor predict functional recovery. The aim of this study was to determine important predictive factors that affect postoperative functional outcomes and longitudinal changes in functional outcomes in patients who had undergone limb-sparing surgery (LSS) for soft tissue sarcoma (STS). METHODS: Between January 2008 and December 2014, we retrospectively enrolled 150 patients who had undergone LSS for STS and had been assessed for postoperative functional outcomes with questionnaires. To evaluate functional outcomes, we used the Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS). Multivariate generalized estimating equation (GEE) analysis was used to identify the predictive factors, including size, stage, and anatomic location of tumor, bone resection, flap reconstruction, age, and time after surgery. Each continuous variable such as age and time after surgery was explored for statistically significant cutoff points using the Wilcoxon rank sum test. RESULTS: Functional scores significantly improved until the second year after surgery and plateaued for the rest of the 5-year period. Age (p < 0.0001), bone resection (p=0.0004), and time after surgery (p < 0.0001) were identified as significant predictive factors. The functional score was significantly higher in patients younger than 47 years old. CONCLUSIONS: Functional outcomes can improve until the second year after surgery. Patients who were older than 47 and underwent bone resection may have poor final functional outcomes.

Visibility of bony structures around hip prostheses in dual-energy CT: With or without metal artefact reduction software.

INTRODUCTION: The development of dual-energy CT and metal artefact reduction software provides a further chance of reducing metal-related artefacts. However, there have been only a few studies regarding whether MARs practically affect visibility of structures around a metallic hip prosthesis on post-operative CT evaluation. METHODS: Twenty-seven patients with 42 metallic hip prostheses underwent DECT. The datasets were reconstructed with 70, 90 and 110 keV with and without MARs. The areas were classified into 10 zones according to the reference zone. All the images were reviewed in terms of the severity of the beam-hardening artefacts, differentiation of the bony cortex and trabeculae and visualization of trabecular patterns with a three-point scale. The metallic screw diameter was measured in the acetabulum with 110 keV images. RESULTS: The scores were the worst on 70 keV images without MARs [mean scores:1.84-4.22 (p < 0.001-1.000)]. The structures in zone II were best visualized on 110 keV (p < 0.001-0.011, mean scores: 2.86-5.22). In other zones, there is general similarity in mean scores whether applying MARs or not (p < 0.001-0.920). The mean diameter of the screw was 5.85 mm without MARs and 3.44 mm with MARs (mean reference diameter: 6.48 mm). CONCLUSION: The 110 keV images without MARs are best for evaluating acetabular zone II. The visibility of the bony structures around the hip prosthesis is similar in the other zones with or without MARs regardless of keV. MARS may not be needed for the evaluation of the metallic hip prosthesis itself at sufficient high-energy levels; however, MARS still has a role in the evaluation of other soft tissues around the prosthesis.

Tuberculous peritonitis following intestinal perforation in malignancy

SUMMARY Tuberculous peritonitis is one of the most common causes of exudative ascites, especially in the young, and is an important cause of extra-pulmonary disease. However, tuberculous peritonitis is challenging to diagnose because there are no pathognomonic clinical features or imaging findings. Therefore, it is commonly misdiagnosed as another type of peritoneal disease, especially so in elderly patients with malignant disease. In this report, we described two cases of tuberculous peritonitis that were observed after intestinal perforation in elderly patients with malignancies. These diagnoses were established by laparoscopic peritoneal biopsy or AFB cultures of the ascitic fluid. Both patients were treated with anti-TB medications.

Reduced field-of-view diffusion-weighted MRI in patients with cervical cancer.

OBJECTIVE: Diffusion-weighted imaging (DWI) with reduced field-of-view (FOV) has been shown to provide high spatial resolution with reduced distorsion in the spinal cord, breast, pancreas, and prostate gland. Therefore, we performed this study to evaluate the qualitative image quality and quantitative ADC value of reduced FOV DWI in patients with cervical cancer in comparison with conventional DWI. METHODS: This study retrospectively included 22 patients (mean age, 53.9 years) with biopsy-proven cervical cancer who underwent pelvic MR imaging including conventional DWI and reduced FOV DWI before therapy. Two observers independently rated image quality for reduced FOV DWI and conventional DWI regarding anatomic detail, lesion conspicuity, presence of artifacts, and overall image quality using the following 4-point scale. Quantitative analysis was performed by measuring the ADC value of the tumor. The Wilcoxon signed-rank test was used to compare qualitative scores and mean ADC value between two DWI sequences. RESULTS: Reduced FOV DWI achieved significantly better anatomic detail, lesion conspicuity, presence of artifacts, and overall image quality compared to conventional DWI (p < 0.05). There was no significant difference in mean tumor ADC value between the two DWI sequences (0.990 × 10-3 mm2 s-1 ± 0.364 at reduced FOV DWI vs 1.253 × 10-3 mm2 s-1 ± 0.387 at conventional DWI) (p = 0.067). CONCLUSION: Reduced FOV DWI shows better image quality in terms of anatomic detail and lesion conspicuity with fewer artifacts compared to conventional DWI. Advance in knowledge: Reduced FOV DWI may enhance diagnostic performance for evaluation of cervical cancer.

Prediction of pathologic femoral fractures in patients with lung cancer using machine learning algorithms: Comparison of computed tomography-based radiological features with clinical features versus without clinical features.

PURPOSE: The purpose of this article is to compare the predictive power of two models trained with computed tomography (CT)-based radiological features and both CT-based radiological and clinical features for pathologic femoral fractures in patients with lung cancer using machine learning algorithms. METHODS: Between January 2010 and December 2014, 315 lung cancer patients with metastasis to the femur were included. Among them, 84 patients who underwent CT scan and were followed up for more than 3 months were enrolled. We examined clinical and radiological risk factors affecting pathologic fracture through logistic regression. Predictive analysis was performed using five different supervised learning algorithms. The power of predictive model trained with CT-based radiological features was compared to those trained with both CT-based radiological and clinical features. RESULTS: In multivariate logistic regression, female sex (odds ratio = 0.25, p = 0.0126), osteolysis (odds ratio = 7.62, p = 0.0239), and absence of radiation therapy (odds ratio = 10.25, p = 0.0258) significantly increased the risk of pathologic fracture in proximal femur. The predictive model trained with both CT-based radiological and clinical features showed the highest area under the receiver operating characteristic curve (0.80 ± 0.14, p < 0.0001) through gradient boosting algorithm. CONCLUSION: We believe that machine learning algorithms may be useful in the prediction of pathologic femoral fracture, which are multifactorial problem.

Diagnostic performance of wrist magnetic resonance (MR) arthrography: comparison of three-dimensional isotropic T1 weighted fast spin-echo MR arthrography and two-dimensional MR arthrography.

OBJECTIVE: To compare the diagnostic performance of direct wrist MR arthrography (D-MRA) with two-dimensional (2D) T1 weighted fast spin-echo (FSE) and three-dimensional (3D) isotropic T1 weighted FSE sequences for detecting triangular fibrocartilage (TFC) central perforations and scapholunate ligament (SLL) and lunotriquetral ligament (LTL) tears. METHODS: 26 patients who had undergone pre-operative wrist D-MRA with 2D and 3D isotropic T1 weighted FSE sequences and subsequent arthroscopic surgeries were included. Each MRI sequence was independently evaluated and scored by two readers retrospectively for the presence of TFC central perforations and SLL and LTL tears. Arthroscopic findings were used as the reference standard. Diagnostic performance was evaluated by using the area under the receiver operating characteristic curve. The sensitivity, specificity and accuracy of both sequences for diagnosing the injuries were calculated. RESULTS: Arthroscopic surgery revealed 21 TFC central perforations, 7 SLL tears and 3 LTL tears. The area under the receiver operating characteristic curve value of 2D and 3D for central perforations in TFC and tears in SLL and LTL was identical or similar (0.667-0.947). The sensitivity, specificity and accuracy of both sequences for diagnosing the injury of each structure were not significantly different (TFC, 90.5/80/88.5% for both readers/sequences; SLL, 100/89.5/92.3% for both readers' 2D and Reader A's 3D, and 85.7/89.5/88.5% for Reader B's 3D; LTL, 66.7/100/96.2% for both readers' 2D and 33.3/100/92.3% for both readers' 3D). Interobserver agreements were substantial to excellent. CONCLUSION: In wrist D-MRA, the diagnostic performances of 3D isotropic and 2D T1 weighted FSE sequences are comparable for TFC central perforations and SLL and LTL tears. Advances in knowledge: The diagnostic performance of 3D isotropic T1 weighted FSE D-MRA and that of 2D T1 weighted FSE D-MRA were not significantly different in the diagnosis of central perforations in the TFC and tears in the SLL and LTL. 3D isotropic T1 weighted FSE D-MRA has potential for substituting 2D imaging.

Evaluation for fracture patterns around the wrist on three-dimensional extremity computed tomography, especially focused on the triquetrum.

INTRODUCTION: To describe fracture patterns of triquetrum and analyse them according to fracture classifications, anatomy of intrinsic carpal ligaments and comparison with other wrist fractures. METHODS: We retrospectively reviewed 297 three-dimensional extremity computed tomographies (CTs) on wrist fractures from October 2007 to January 2012. We initially classified the fractures according to the involved bones and analyzed them according to the patterns of triquetrum fractures, associated carpal bone fractures and presence of combined distal radius fractures. We also correlated the fracture patterns with the patient's injury patterns. RESULTS: A total of 297 CTs and 291 patients were included (162 males and 129 females; mean age, 47.8 years). There were a total of 131 carpal bone fractures in 102 patients of 102 CTs. Triquetrum fractures were the most commonly observed cases (36 cases/27.5%). For the triquetrum fractures, the following types were observed: 26 dorsal, five volar, two comminuted fractures are observed in triquetrum. Three other triquetrum fractures show combined forms of other carpal bone fractures. For the combined distal radius fractures, 10 dorsal and two volar fractures were shown. Out of 187 distal radius fractures, 20 showed carpal bone fractures (10.7%). There were no differences in injury patterns according to the fracture patterns. The most common pattern of injury was falling on the outstretched hand, followed by fall from height. CONCLUSION: The dorsum of triquetrum is more frequently fractured than the volar aspect. The number of carpal bone fractures among the patients who have distal radius fractures is higher than usual expectation.