Imaging of Osteoarthritis of the Hip.

Hip osteoarthritis (OA) is a disease process that impacts the aging population. OA of the hip is the result of degeneration of the articular cartilage, underlying bone and soft tissue structures. Radiography is the first-line modality for imaging OA. Radiographic assessment includes imaging features of joint space narrowing, sclerosis, osteophytes, and bony deformities. CT can provide detailed evaluation of the hip with multiplanar reformats. MRI can assess bone marrow signal, articular cartilage damage, and labral abnormalities. Other disease process may appear similar or present concurrently with OA, such as osteonecrosis, rapidly progressive arthritis, and inflammatory and infectious arthropathies.

Occult fracture propagation in patients with isolated greater trochanteric fractures: patterns and management.

OBJECTIVE: To demonstrate the degrees of occult intertrochanteric extension on MRI in patients with a greater trochanteric fracture on radiography or computer tomography (CT) and whether these patients undergo conservative or surgical management with hardware. MATERIALS AND METHODS: Retrospective review was performed of 146 patients (104 females, 42 males, ages 33-102) who had follow-up MRI after identification of a greater trochanteric fracture without intertrochanteric extension on radiography or CT. Extent of intertrochanteric extension was recorded. Subsequently, EMR review was performed to see if patients underwent surgery. Specific note was made of hardware type. Analysis was performed to determine if there is a correlation with fracture type and surgical management as well as fracture type and age and gender. RESULTS: Nineteen patients had horizontal greater trochanter fractures without intertrochanteric extension; none underwent surgery. Seventeen patients had a vertical fracture along the lateral femoral cortex; one underwent surgery. Thirty-three patients had a fracture with intertrochanteric extension less than 50% in the mid coronal plane; 21 underwent surgery. Forty patients had intertrochanteric extension greater than 50% in the midcoronal plane not contacting the medial cortex; 28 underwent surgery. Thirty-seven patients had fractures contacting the medial cortex; 28 underwent surgery. There was significant difference with fractures extending 50% or greater of the midline of the intertrochanteric region undergoing surgical management compared with fractures less than 50% (p < 0.0001). CONCLUSION: MRI identifies the presence and extent of occult intertrochanteric fractures in patients with greater trochanteric fractures. Description of intertrochanteric fractures on MRI helps determine the patient's treatment course and influence surgical decisions.

Closed rupture of the flexor tendon pulleys of the thumb.

Closed rupture of the thumb flexor tendon pulleys is rare and, to our knowledge, the MRI findings associated with this injury have not been described in the radiology literature. The injury can result in nonspecific clinical and physical exam findings and advanced imaging may be crucial to diagnosis. A familiarity with the normal anatomy of the flexor mechanism of the thumb and the imaging appearance of pathology is therefore necessary. We report a case of a 31-year-old female nurse with ruptures of several of the thumb flexor pulleys and the corresponding findings on MRI.

Cadaveric Study of the Safety and Device Functionality of Magnetically Controlled Growing Rods After Exposure to Magnetic Resonance Imaging.

STUDY DESIGN: Cadaveric study. OBJECTIVE: To establish the safety and efficacy of magnetically controlled growing rods (MCGRs) after magnetic resonance imaging (MRI) exposure. SUMMARY OF BACKGROUND DATA: MCGRs are new and promising devices for the treatment of early-onset scoliosis (EOS). A significant percentage of EOS patients have concurrent spinal abnormalities that need to be monitored with MRI. There are major concerns of the MRI compatibility of MCGRs because of the reliance of the lengthening mechanism on strongly ferromagnetic actuators. METHODS: Six fresh-frozen adult cadaveric torsos were used. After thawing, MRI was performed four times each: baseline, after implantation of T2-T3 thoracic rib hooks and L5-S1 pedicle screws, and twice after MCGR implantation. Dual MCGRs were implanted in varying configurations and connected at each end with cross connectors, creating a closed circuit to maximize MRI-induced heating. Temperature measurements and tissue biopsies were obtained to evaluate thermal injury. MCGRs were tested for changes to structural integrity and functionality. MRI images obtained before and after MCGR implantation were evaluated. RESULTS: Average temperatures increased incrementally by 1.1°C, 1.3°C, and 0.5°C after each subsequent scan, consistent with control site temperature increases of 1.1°C, 0.8°C, and 0.4°C. Greatest cumulative temperature change of +3.6°C was observed adjacent to the right-sided actuator, which is below the 6°C threshold cited in literature for clinically detectable thermal injury. Histologic analysis revealed no signs of heat-induced injury. All MCGR actuators continued to function properly according to the manufacturer's specifications and maintained structural integrity. Significant imaging artifacts were observed, with the greatest amount when dual MCGRs were implanted in standard/offset configuration. CONCLUSIONS: We demonstrate minimal MRI-induced temperature change, no observable thermal tissue injury, preservation of MCGR-lengthening functionality, and no structural damage to MCGRs after multiple MRI scans. Expectedly, the ferromagnetic actuators produced substantial MR imaging artifacts. LEVEL OF EVIDENCE: Level V.

MRI of the Extensor Tendons of the Wrist.

OBJECTIVE: This article reviews the normal anatomy of the extensor tendons of the wrist as well as the clinical presentation and MRI appearances of common tendon abnormalities, such as tears, tenosynovitis, intersection syndromes, and associated or predisposing osseous findings. Treatment options are also discussed. CONCLUSION: We review the anatomy and normal MRI appearance of the clinically important dorsal extensor tendons of the wrist, in addition to the spectrum of abnormalities associated with these tendons.

Human Platelet Vesicles Exhibit Distinct Size and Proteome.

In the past 50 years, isolated blood platelets have had restricted use in wound healing, cancer therapy, and organ and tissue transplant, to name a few. The major obstacle for its unrestricted use has been, among others, the presence of ultrahigh concentrations of growth factors and the presence of both pro-angiogenic and anti-angiogenic proteins. To overcome this problem requires the isolation and separation of the membrane bound secretory vesicles containing the different factors. In the current study, high-resolution imaging of isolated secretory vesicles from human platelets using atomic force microscopy (AFM) and mass spectrometry enabled characterization of the remaining vesicles size and composition following their immunoseparation. The remaining vesicles obtained following osmotic lysis, when subjected to immunoseparation employing antibody to different vesicle-associated membrane proteins (VAMPs), demonstrate for the first time that VAMP-3-, VAMP-7-, and VAMP-8-specific vesicles each possesses distinct size range and composition. These results provide a window into our understanding of the heterogeneous population of vesicles in human platelets and their stability following both physical manipulation using AFM and osmotic lysis of the platelet. This study further provides a platform for isolation and the detailed characterization of platelet granules, with promise for their future use in therapy. Additionally, results from the study demonstrate that secretory vesicles of different size found in cells reflect their unique and specialized composition and function.

Postoperative Imaging of the Knee: Meniscus, Cartilage, and Ligaments.

This article reviews the normal and abnormal postoperative imaging appearance of frequently performed surgical procedures of the meniscus, articular cartilage, and ligaments. Imaging algorithms and protocols are discussed with particular attention to MR imaging techniques. Attention is paid to surgical procedures and the expected postoperative appearance as well to commonly identified recurrent and residual disorders and surgical complications.

Imaging of shoulder instability.

The glenohumeral joint is an inherently unstable articulation and consequently the most frequently subluxed and frankly dislocated joint in the body. Shoulder instability can be uni- or multidirectional related to acute or repetitive stress and is occasionally secondary to congenital or developmental abnormalities such as a lax joint capsule or glenoid dysplasia. The clinical diagnosis of instability can be difficult, and knowledge of the imaging findings of anterior, posterior, multidirectional, and microinstability is essential to guide the correct treatment of these patients. This requires the appropriate use of many different imaging modalities as well as specific positioning and directed protocols. This review article explains the clinical scenarios associated with shoulder instability and how they relate to the choice of imaging techniques. The imaging findings of the most common soft tissue and osseous pathology are reviewed and explained with specific attention to anterior and posterior instability.

[Life-threatening bleeding in obsessive-compulsive disorder]. / Lebensbedrohliche Blutung infolge Zwangsstörung.

We report on a case of life-threatening hemorrhoidal bleeding due to obsessive-compulsive disorder. The patient had irrational fears and felt compelled to defecate at least 3 times a day. This required massive abdominal pressing and caused inguinal hernias and prolapsed hemorrhoids. Severe obsessive-compulsive rituals may often result in physical complications. Conversely, obsessive-compulsive disorder should be considered when patients present with uncommon physical complaints, particularly skin symptoms or abnormalities in the context of micturition and defecation.

US of the elbow: indications, technique, normal anatomy, and pathologic conditions.

The elbow, a synovial hinge joint, is a common site of disease. Ultrasonography (US) has become an important imaging modality for evaluating pathologic conditions of the elbow. This powerful imaging tool has the advantages of outstanding spatial resolution, clinical correlation with direct patient interaction, dynamic assessment of disease, and the ability to guide interventions. Unlike most other imaging modalities, US allows the contralateral elbow to be imaged simultaneously, providing an internal control and comparison with normal anatomy. A useful approach to US evaluation of the elbow is to divide it into four compartments: anterior, lateral, medial, and posterior. US of the elbow has varied clinical applications, including evaluation and treatment of lateral and medial epicondylitis, imaging of biceps and triceps musculotendinous injuries, evaluation of ulnar collateral ligament laxity, diagnosis of joint effusions and intraarticular bodies, and evaluation of peripheral nerves for neuropathy and subluxation. US can also be used to evaluate soft-tissue masses about the elbow. Knowledge of the normal US anatomy of the elbow, familiarity with the technique of elbow US, and awareness of the US appearances of common pathologic conditions of the elbow along with their potential treatment options will optimize radiologists' diagnostic assessment and improve patient care. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.334125059/-/DC1.

Water channels in platelet volume regulation.

The regulation of platelet volume significantly affects its function. Because water is the major molecule in cells and its active transport via water channels called aquaporins (AQPs) have been implicated in cellular and organelle volume regulation, the presence of water channels in platelets and their potential role in platelet volume regulation was investigated. G-protein-mediated AQP regulation in secretory vesicle swelling has previously been reported in neurons and in pancreatic acinar cells. Mercuric chloride has been demonstrated to inhibit most AQPs except AQP6, which is stimulated by the compound. Exposure of platelets to HgCl(2)-induced swelling in a dose-dependent manner, suggesting the presence of AQP6 in platelets. Immunoblot analysis of platelet protein confirmed the presence of AQP6, and also of G(αo), G(αi-1) and G(αi-3) proteins. Results from this study demonstrate for the first time that in platelets AQP6 is involved in cell volume regulation via a G-protein-mediated pathway.

Shoulder MR imaging normal variants and imaging artifacts.

The appearance of osseous, labral, hyaline cartilage, ligament, muscle, and tendon variants and pitfalls are discussed with attention to the keys to distinguishing each of the findings from pathologic lesions of the shoulder.

Epicondylitis: pathogenesis, imaging, and treatment.

Epicondylitis commonly affects the elbow medially or laterally, typically in the 4th or 5th decade of life and without predilection with regard to sex. Epicondylitis is an inflammatory process that may be more accurately described as tendinosis. In the lateral epicondylar region, this process affects the common extensor tendon; in the medial epicondylar region, the common flexor tendon is affected. The condition is widely believed to originate from repetitive overuse with resultant microtearing and progressive degeneration due to an immature reparative response. Advances in understanding of the anatomy and pathophysiology of epicondylitis have shaped current treatment practices. Conservative measures are undertaken initially, because symptoms in most patients improve with time and rest. Those who fail to respond to conservative therapy are considered for surgical treatment. When surgery is contemplated, magnetic resonance imaging or ultrasonography is useful for evaluating the extent of disease, detecting associated pathologic processes, excluding other primary sources of elbow pain, and planning the surgical approach. Familiarity with the normal anatomy, the pathophysiology of epicondylitis and its mimics, and diagnostic imaging techniques and findings allows more accurate diagnosis and helps establish an appropriate treatment plan.

MR imaging of delamination tears of the rotator cuff tendons.

OBJECTIVE: The objective was to describe the imaging appearances and location of delamination tears of the rotator cuff tendons on non-contrast conventional MR imaging. SUBJECTS AND METHODS: This study was reviewed and approved by our Institutional Review Board. The reports of 548 consecutive MR examinations of the shoulder were reviewed, looking for mention or description of delamination tears of the rotator cuff. The images of the identified cases were then reviewed by two radiologists to confirm the findings. Correlation with surgical and arthroscopic information was then performed. Delamination tears were defined as horizontal retraction of either the bursal or articular surface of the tendon, manifest as thickening of the torn retracted edge, and/or interstitial splitting of the tendon, manifest as fluid-like high signal intensity on fat-suppressed T2-weighted oblique coronal images. RESULTS: Fourteen cases of delamination tears were identified in 13 patients. Ten of the cases involved the supraspinatus tendon, all with articular surface involvement. Nine of these supraspinatus cases were isolated tears and one occurred as part of a full thickness tear. All 10 of these supraspinatus cases showed medial retraction of the articular surface of the tendon, with thickening of the retracted edge, and 5 of the 10 had a demonstrable horizontal cleft in the interstitium. Four cases involved the subscapularis tendon, with articular surface disruption in three and pure interstitial delamination in one. Medial subluxation of the tendon of the long head of the biceps was present in all four cases. No delamination tears occurred on the bursal surface. Only three of the 14 shoulders underwent surgical repair with one confirmation of supraspinatus delamination, one confirmation of a subscapularis tear that had become a full thickness tear 10 months after initial imaging and another interstitial subscapularis delamination that was not identified arthroscopically. CONCLUSION: Delamination tears occur most often in the supraspinatus tendon, and in our series always involved the articular surface of the tendon. Only half of these tears have a visible cleavage plane in the interstitium, but this cleavage plane is not necessary for diagnosis if the torn edge is retracted.

PAK4 and alphaPIX determine podosome size and number in macrophages through localized actin regulation.

Podosomes are actin-rich adhesion structures typical for monocytic cells and are implicated in migration and invasion. Major modes of podosome regulation include RhoGTPase signaling and actin regulatory pathways. However, it is not clearly understood how these signals induce highly localized changes in podosome formation and dynamics. Here, we show that the RhoGTPase effector PAK4, a member of the p21 associated kinase family, and its regulator alphaPIX (PAK-interacting exchange factor), are central to podosome formation in primary human macrophages. Immunofluorescence, biochemical and microarray data indicate that PAK4 acts as physiological regulator of podosomes in this system. Accordingly, transfection of a specific shRNA, as well as expression of PAK4 truncation mutants, resulted in reduced numbers of podosomes per cell. Moreover, expression of kinase active or inactive PAK4 mutants enhanced or reduced the size of individual podosomes, respectively, indicating a modulatory influence of PAK4 kinase activity on podosome size. Similar to the results gained with PAK4, cellular/overexpressed PIX was shown to be closely associated with podosomes. Moreover, both overexpression of alphaPIX wt and a mutant lacking the SH3 domain led to coalescence of podosomes. In sum, we propose that PAK4 and alphaPIX can induce highly localized changes in actin dynamics and thereby regulate size and number of podosomes in primary human macrophages.