Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 115
Filtrar
Más filtros

Banco de datos
País/Región como asunto
Tipo del documento
Intervalo de año de publicación
1.
Semin Musculoskelet Radiol ; 28(2): 139-145, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38484766

RESUMEN

We review the spectrum of acute osseous injuries in athletes, ranging from osseous contusion (bone bruise) injuries to nondisplaced cortical fractures. The basic biomechanical concepts, underlying histopathologic changes, and characteristic magnetic resonance imaging (MRI) features of acute osseous injuries are presented. Bone bruise injuries of varying severity are highlighted to showcase the breadth of imaging findings on MRI and methods for characterizing such lesions. We emphasize the importance of accurately assessing patterns of injury on MRI to communicate more effectively with team medical staff and recognize the implications on return to play. This article offers the foundational tools for approaching bone bruise injuries in elite athletes to add value to the diagnosis and treatment of this unique patient population.


Asunto(s)
Enfermedades Óseas , Contusiones , Fracturas Óseas , Traumatismos de la Rodilla , Humanos , Volver al Deporte , Fracturas Óseas/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Contusiones/diagnóstico por imagen , Contusiones/epidemiología
2.
Semin Musculoskelet Radiol ; 28(4): 396-407, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39074723

RESUMEN

The pediatric elbow is a complex joint that undergoes rapid growth and development. The normal anatomy of the elbow varies depending on the age of the patient, which can be challenging for imaging interpretation. This article reviews developmental variants and common pathologies of the pediatric elbow, with a focus on their radiologic features. Normal anatomy and development of the pediatric elbow are discussed, including the six ossification centers and elbow alignment. Congenital anomalies such as longitudinal deficiencies of the upper extremity are reviewed. Some common injuries that affect the elbow, such as supracondylar fracture, lateral condyle fracture, medial epicondyle avulsion, and radial head dislocation are also described.


Asunto(s)
Lesiones de Codo , Articulación del Codo , Humanos , Niño , Articulación del Codo/diagnóstico por imagen , Artropatías/diagnóstico por imagen , Preescolar , Diagnóstico por Imagen/métodos , Lactante
3.
Semin Musculoskelet Radiol ; 28(2): 180-192, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38484770

RESUMEN

Increase in youth sports participation, longer duration of play, and earlier starting points have increased the prevalence of acute and repetitive overuse musculoskeletal injuries. This rise in injury rates has led to increased efforts to better understand the susceptible sites of injury that are unique to the growing immature skeleton. Upper extremity injuries are currently the best studied, particularly those that occur among pediatric baseball players and gymnasts. The weak link in skeletally immature athletes is the growth plate complex that includes those injuries located at the epiphyseal and apophyseal primary physes and the peripherally located secondary physes. This article reviews the anatomy and function of these growth plate complexes, followed by a discussion of the pathophysiologic mechanisms, spectrum of imaging findings, and existing evidence-based guidelines for injury prevention and return to play.


Asunto(s)
Traumatismos en Atletas , Béisbol , Humanos , Adolescente , Niño , Traumatismos en Atletas/diagnóstico por imagen , Volver al Deporte , Extremidad Superior/diagnóstico por imagen , Extremidad Superior/lesiones , Atletas , Radiólogos , Béisbol/lesiones
4.
Pediatr Radiol ; 54(1): 105-116, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-38015294

RESUMEN

BACKGROUND: Elbow pain is common among youth baseball players and elbow MRI is increasingly utilized to complement the clinical assessment. OBJECTIVE: To characterize, according to skeletal maturity, findings on elbow MRI from symptomatic youth baseball players. MATERIALS AND METHODS: This IRB-approved, HIPAA-compliant retrospective study included pediatric (<18 years of age) baseball players with elbow pain who underwent MRI examinations between 2010 and 2021. Two radiologists, blinded to the outcome, independently reviewed examinations to categorize skeletal maturity and to identify osseous and soft tissue findings with consensus used to resolve discrepancies. Findings were compared between skeletally immature and mature patients and logistic regression models identified predictors of surgery. RESULTS: This study included 130 children (115 boys, 15 girls): 85 skeletally immature and 45 mature (12.8±2.3 and 16.2±1.0 years, respectively, p<0.01). Kappa coefficient for interobserver agreement on MRI findings ranged from 0.64 to 0.96. Skeletally immature children, when compared to mature children, were more likely to have elbow effusion (27%, 23/85 vs 9%, 4/45; p=0.03), medial epicondyle marrow edema (53%, 45/85 vs 16%, 7/45; p<0.01), avulsion fracture (19%, 16/85 vs 2%, 1/45; p=0.02), and juvenile osteochondritis dissecans (OCD, 22%, 19/85 vs 7%, 3/45; p=0.04), whereas skeletally mature children were more likely to have sublime tubercle marrow edema (49%, 22/45 vs 11%, 9/85; p<0.01) and triceps tendinosis (40%, 18/45 vs 20%, 17/85; p=0.03). Intra-articular body (OR=4.2, 95% CI 1.5-47.8, p=0.02) and osteochondritis dissecans (OR=3.7, 95% CI 1.1-11.9, p=0.03) were independent predictors for surgery. CONCLUSION: Differential patterns of elbow MRI findings were observed among symptomatic pediatric baseball players based on regional skeletal maturity. Intra-articular body and osteochondritis dissecans were independent predictors of surgery.


Asunto(s)
Béisbol , Articulación del Codo , Osteocondritis Disecante , Masculino , Adolescente , Femenino , Humanos , Niño , Codo/diagnóstico por imagen , Estudios Retrospectivos , Articulación del Codo/diagnóstico por imagen , Imagen por Resonancia Magnética , Dolor , Edema
5.
Skeletal Radiol ; 53(5): 947-955, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-37993556

RESUMEN

OBJECTIVE: To devise an MRI grading scheme for osseous contusion patterns in elite hockey players for predicting return-to-play (RTP). METHODS: A retrospective review was performed to identify traumatic lower extremity osseous injuries in professional hockey players. A total of 28 injuries (17 players) were identified over a 10-year period. All had MRIs acquired at ≥ 1.5 T within a mean interval of 2 days from initial injury. MRIs were retrospectively reviewed by 3 musculoskeletal radiologists for osseous contusion pattern, classified as grade 1 (mild), 2 (moderate), or 3 (severe). Grade 3 contusions were further subdivided by the presence or absence of fracture, defined as discrete cortical disruption on MRI or follow-up CT. RTP was calculated from date of injury to next game played based on game log data. Statistical analysis was performed using ANOVA and post hoc unpaired t test. RESULTS: Mean RTP for grade 1, 2, and 3 injuries was 2.8, 4.5, and 20.3 days, respectively. Grade 3 injuries without and with cortical fractures had mean RTP of 18.3 and 21.4 days, respectively. ANOVA analysis between groups achieved statistical significance (p < 0.001). Post hoc t test demonstrated statistically significant differences between grade 3 and grades 1 (p < 0.001) and 2 (p < 0.001) injuries. There was no statistical difference in RTP between grade 3 subgroups without and with fracture (p = 0.327). CONCLUSION: We propose a novel MRI grading system for assessing severity of osseous contusions and predicting RTP. Clinically, there was no statistically significant difference in RTP between severe osseous contusions and nondisplaced fractures in elite hockey players.


Asunto(s)
Contusiones , Fracturas Óseas , Humanos , Estudios Retrospectivos , Volver al Deporte , Imagen por Resonancia Magnética
6.
Eur Radiol ; 33(5): 3172-3177, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-36809434

RESUMEN

OBJECTIVES: To evaluate extensor carpi ulnaris (ECU) tendon pathology and ulnar styloid process bone marrow edema (BME) as diagnostic MRI markers for peripheral triangular fibrocartilage complex (TFCC) tears. METHODS: One hundred thirty-three patients (age range 21-75, 68 females) with wrist 1.5-T MRI and arthroscopy were included in this retrospective case-control study. The presence of TFCC tears (no tear, central perforation, or peripheral tear), ECU pathology (tenosynovitis, tendinosis, tear or subluxation), and BME at the ulnar styloid process were determined on MRI and correlated with arthroscopy. Cross-tabulation with chi-square tests, binary logistic regression with odds ratios (OR), and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were used to describe diagnostic efficacy. RESULTS: On arthroscopy, 46 cases with no TFCC tear, 34 cases with central perforations, and 53 cases with peripheral TFCC tears were identified. ECU pathology was seen in 19.6% (9/46) of patients with no TFCC tears, in 11.8% (4/34) with central perforations and in 84.9% (45/53) with peripheral TFCC tears (p < 0.001); the respective numbers for BME were 21.7% (10/46), 23.5% (8/34), and 88.7% (47/53) (p < 0.001). Binary regression analysis showed additional value from ECU pathology and BME in predicting peripheral TFCC tears. The combined approach with direct MRI evaluation and both ECU pathology and BME yielded a 100% positive predictive value for peripheral TFCC tear as compared to 89% with direct evaluation alone. CONCLUSIONS: ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to diagnose tears. KEY POINTS: • ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to confirm the presence of TFCC tears. • If there is a peripheral TFCC tear on direct MRI evaluation and in addition both ECU pathology and BME on MRI, the positive predictive value is 100% that there will be a tear on arthroscopy compared to 89% with direct evaluation alone. • If there is no peripheral TFCC tear on direct evaluation and neither ECU pathology nor BME on MRI, the negative predictive value is 98% that there will be no tear on arthroscopy compared to 94% with direct evaluation alone.


Asunto(s)
Biomarcadores , Enfermedades de la Médula Ósea , Edema , Tendones , Traumatismos de la Muñeca , Tendones/diagnóstico por imagen , Tendones/patología , Radio (Anatomía)/diagnóstico por imagen , Radio (Anatomía)/patología , Enfermedades de la Médula Ósea/complicaciones , Enfermedades de la Médula Ósea/diagnóstico por imagen , Enfermedades de la Médula Ósea/patología , Imagen por Resonancia Magnética , Edema/complicaciones , Edema/diagnóstico por imagen , Edema/patología , Fibrocartílago Triangular/diagnóstico por imagen , Fibrocartílago Triangular/lesiones , Estudios de Casos y Controles , Traumatismos de la Muñeca/complicaciones , Traumatismos de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/patología , Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Sensibilidad y Especificidad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Rotura/complicaciones , Rotura/diagnóstico por imagen , Rotura/patología
7.
AJR Am J Roentgenol ; 217(6): 1390-1400, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34161130

RESUMEN

Rotator cuff tears are the most likely source of shoulder pain in adults and may cause protracted disability. Management of rotator cuff tears is associated with considerable costs. Accurate diagnosis can guide surgical planning and help achieve a favorable clinical outcome. Although radiography remains the initial imaging test for shoulder injury, the roles of MRI and ultrasound (US) as first-line imaging after radiography are evolving. This article leverages current literature and the practical experience of subspecialty musculoskeletal radiologists from different institutions in describing a practical approach to imaging rotator cuff pathology. Both MRI and US are accurate for identifying rotator cuff tears, but each has advantages and shortcomings. As both modalities currently represent reasonable first-line approaches, considerable practice variation has evolved. Given the low cost of US, imagers should strive to optimize the quality of shoulder US examinations and to build referrer confidence in this modality. The roles of direct CT and MR arthrography as well as imaging evaluation of the postoperative rotator cuff are also considered. Through careful selection among the available imaging modalities and optimal performance and interpretation of such examinations, radiologists can positively contribute to the diagnosis and treatment of patients with rotator cuff injuries.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Ultrasonografía/métodos , Humanos , Manguito de los Rotadores/diagnóstico por imagen
8.
Skeletal Radiol ; 50(1): 189-199, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32699952

RESUMEN

OBJECTIVE: To describe imaging characteristics and demographics of lateral femoral condyle insufficiency fractures (LFCIFs) and identify characteristics associated with progression to epiphyseal collapse. MATERIALS AND METHODS: A retrospective review of 105 consecutive patients with LFCIF was performed (mean age 58.1 years) after excluding post-traumatic and pathological fractures. Lesion size and location, presence of bone marrow edema-like signal, soft tissue edema, chondrosis grade, and meniscus pathology were documented. Demographics were recorded from the electronic patient record. Follow-up MRI and/or radiographs were evaluated for healing/stability or progression to epiphyseal collapse. Bone mineral density was assessed from dual-energy x-ray absorptiometry (DEXA) scans and/or radiographs. RESULTS: Fifty-six female and 49 male subjects were included. Female subjects were older at presentation (60.5 versus 56.3 years, p = .02). A total of 61.7% of the subjects with available DEXA and/or radiographs had osteopenia/osteoporosis. The central weight-bearing (61%) and outer condyle (54.3%) were most involved. High-grade chondrosis was present in ≥ 1 compartment in 70.5% including 42% in the lateral compartment. A total of 67.6% had ≥ 1 meniscus tear with similar frequency of medial and lateral tears (47.6% versus 41%). Bone marrow edema-like signal was present in all cases; soft tissue edema was present in 83.8%. Fifty-three subjects had available follow-up MRI (n = 24) and/or radiographs (n = 29). Increased age, fracture dimensions, presence of medial meniscus tears, and high-grade patellofemoral chondrosis were associated with progression (p ≤ .05). CONCLUSION: LFCIFs are associated with meniscus tears, high-grade chondrosis, and osteopenia/osteoporosis with more global knee pathology present when compared with medial femoral condyle insufficiency fracture. Increased age, medial meniscus tears, fracture dimensions, and high-grade patellofemoral chondrosis were associated with progression.


Asunto(s)
Fracturas por Estrés , Traumatismos de la Rodilla , Demografía , Femenino , Fémur/diagnóstico por imagen , Fracturas por Estrés/diagnóstico por imagen , Fracturas por Estrés/epidemiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
9.
Skeletal Radiol ; 50(11): 2205-2212, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33876276

RESUMEN

OBJECTIVE: Patellar maltracking is an important subset of patellofemoral pain syndrome. We hypothesize that maltracking patients have an increased incidence of extensor mechanism dysfunction due to repetitive attempts at stabilization of the patella. Our purpose is to delineate imaging features to identify maltracking patients at risk for extensor mechanism tendinopathy. MATERIALS AND METHODS: Retrospective review of knee MRIs performed for anterior knee pain over a year was conducted to identify 218 studies with imaging findings of maltracking. The cases were evaluated for the presence and degree of patellar and quadriceps tendinopathy, tibial tuberosity-trochlear groove distance (TT-TG) and the distribution and grade of patellofemoral chondrosis. Cases were compared to 100 healthy, age-matched control knee MRIs. RESULTS: The mean age of maltracking patients with either patellar or quadriceps tendinosis was 41.2 years versus 48.2 years in the control population (p = 0.037). The TT-TG was significantly higher in maltracking patients with either patellar or quadriceps tendinosis at 16.49 mm versus 14.99 mm (p = 0.006). Maltrackers with isolated lateral patellofemoral chondrosis had a higher mean TT-TG at 17.4 mm versus 15.4 mm (p = 0.007). Extensor mechanism tendinosis was increased in the maltracking population compared to the controls at 57.8% versus 27.3% (p = 0.004). CONCLUSION: Extensor mechanism tendinosis is more common in the maltracking population and occurs at a younger age. TT-TG distance is significantly increased in patients with extensor mechanism dysfunction and in patients with isolated lateral patellofemoral chondrosis. TT-TG measurement can be used independently to identifying maltrackers who may be at risk for future complications.


Asunto(s)
Inestabilidad de la Articulación , Articulación Patelofemoral , Tendinopatía , Adulto , Humanos , Rótula/diagnóstico por imagen , Estudios Retrospectivos , Tendinopatía/diagnóstico por imagen , Tibia
10.
Skeletal Radiol ; 50(7): 1399-1409, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33404668

RESUMEN

OBJECTIVE: To evaluate adults with history of Osgood Schlatter disease (OSD) for imaging features of lateral patellofemoral maltracking. METHODS: In a span of four years, 10,181 unique non-contrast knee MRIs were performed on patients aged 20-50. Patients with acute trauma, prior surgery, and synovial pathologies were excluded. 171 exams had imaging findings of OSD, and an age-matched control group of 342 patients without OSD was randomly selected. Two radiologists retrospectively reviewed MRIs for features of lateral patellofemoral maltracking. Maltracking was defined as edema in superolateral Hoffa's fat or a tibial tuberosity-trochlear groove (TT-TG) distance ≥20 mm with either patellar tilt/translation. Binomial logistic regression identified predictors of maltracking in OSD. Optimal TT-TG distance to indicate maltracking was determined by receiver operating characteristic curve. RESULTS: 59% (101/171) of the knees with OSD showed findings of maltracking, with patella alta, trochlear dysplasia, and quadriceps tendinosis as significant predictors of maltracking (p < 0.001). Patellofemoral chondrosis was present in 63% (107/171), with maltracking contributing to higher grade chondrosis more so than increasing age (OR 8.4 versus 1.07). 13 mm was the optimal cut-off TT-TG distance to indicate maltracking (sensitivity 83%, specificity 80%). The prevalence of maltracking in the control group was 15% (p < 0.001 compared with the OSD group). CONCLUSION: Adults with sequelae of OSD are at high risk of maltracking and are likely to develop patellofemoral chondrosis. A lower threshold for identifying maltracking patients, including a lower cut-off TT-TG distance can help identify those at risk. Radiologists should maintain a high index of suspicion for maltracking in adults with OSD to guide clinical intervention.


Asunto(s)
Inestabilidad de la Articulación , Osteocondrosis , Articulación Patelofemoral , Adulto , Humanos , Imagen por Resonancia Magnética , Rótula , Articulación Patelofemoral/diagnóstico por imagen , Prevalencia , Estudios Retrospectivos , Tibia
11.
Skeletal Radiol ; 50(12): 2319-2347, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34145466

RESUMEN

The Society of Skeletal Radiology (SSR) Practice Guidelines and Technical Standards Committee identified musculoskeletal infection as a White Paper topic, and selected a Committee, tasked with developing a consensus on nomenclature for MRI of musculoskeletal infection outside the spine. The objective of the White Paper was to critically assess the literature and propose standardized terminology for imaging findings of infection on MRI, in order to improve both communication with clinical colleagues and patient care.A definition was proposed for each term; debate followed, and the committee reached consensus. Potential controversies were raised, with formulated recommendations. The committee arrived at consensus definitions for cellulitis, soft tissue abscess, and necrotizing infection, while discouraging the nonspecific term phlegmon. For bone infection, the term osteitis is not useful; the panel recommends using terms that describe the likelihood of osteomyelitis in cases where definitive signal changes are lacking. The work was presented virtually to SSR members, who had the opportunity for review and modification prior to submission for publication.


Asunto(s)
Imagen por Resonancia Magnética , Osteomielitis , Absceso , Consenso , Humanos , Osteomielitis/diagnóstico por imagen
12.
Skeletal Radiol ; 49(3): 491-501, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31707422

RESUMEN

Talus partitus is a rare skeletal developmental abnormality characterized by a split of the posterior talar bone in the coronal plane. Patients with talus partitus typically present with posterior ankle pain and instability, often displaying varying degrees of chondrosis and secondary degenerative change on imaging. To date, only few case reports describing the imaging appearance of talus partitus have been published. The majority of these publications are limited to radiographic and computed tomography (CT) imaging findings, despite the ubiquity of magnetic resonance imaging (MRI). To the authors' knowledge, there is little description of typical MRI findings of the symptomatic talus partitus in the radiologic literature. We present a series of five cases of talus partitus identified on MRI and examine pitfalls in diagnosis, differential considerations, pathophysiology, and treatment options.


Asunto(s)
Artralgia/diagnóstico por imagen , Inestabilidad de la Articulación/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Astrágalo/diagnóstico por imagen , Astrágalo/inmunología , Adolescente , Adulto , Humanos , Masculino , Persona de Mediana Edad
13.
Skeletal Radiol ; 49(12): 1977-1985, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32556471

RESUMEN

OBJECTIVE: To provide a novel MRI classification system for the symptomatic type II os naviculare by creating a standardized grading of associated bone marrow edema (BME) and correlating with patient symptoms. METHODS: BME was classified on an ordinal scale: grade 1, faint signal immediately adjacent to the synchondrosis; grade 2, intermediate signal within the os and navicular tuberosity without extending to the navicular body; grade 3, intense signal extending to the navicular body. BME on 59 MRIs was independently graded by three radiologists. Inter- and intra-observer agreement was analyzed using intraclass correlation coefficient. Univariate and multivariate analyses assessed for patient and imaging characteristics predictive of subjective pain score. A cohort of 82 patients without BME represented a control group. RESULTS: Inter-observer agreement of BME grade was 0.95 (CI 0.93-0.97) and intra-observer was 0.92 (CI 0.87-0.96), indicating excellent agreement. In patients with BME, predictors of more severe pain were longer duration of pain (p = 0.02) and presence of soft tissue edema overlying the os naviculare (p < 0.001). One hundred percent of subjects with BME localized their pain to the medial midfoot (59/59) versus 25.6% (21/82) of controls (p < 0.001). CONCLUSIONS: This novel grading system provides reliable quantification of BME associated with os naviculare, which is a specific cause of medial foot/ankle pain. Early diagnosis is important as pain severity worsens with longer duration of symptoms. Pain severity is correlated with soft tissue edema overlying the os, which may be secondary to extrinsic compression, reactive to biomechanical stress, or reflect direct trauma.


Asunto(s)
Enfermedades de la Médula Ósea , Huesos Tarsianos , Enfermedades de la Médula Ósea/diagnóstico por imagen , Edema/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Dolor
14.
Skeletal Radiol ; 49(4): 555-561, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31642975

RESUMEN

PURPOSE: To determine the value of anesthetic injection during hip MR arthrography (anesthetic MRA) to differentiate between intra- and extra-articular pathology in patients with hip pain. MATERIALS AND METHODS: This retrospective study was IRB-approved and HIPAA-compliant. We included 75 consecutive adult patients (46 women, mean age 38 ± 13 years) who were referred for MRA. All patients underwent a focused hip examination including active flexion, passive flexion, and passive flexion with internal and external rotation, immediately prior to injection. Anesthetic MRA was performed following fluoroscopically guided intra-articular injection of contrast mixed with anesthetic. Following the injection, the hip examination was repeated, and the pain response was recorded. Clinical records, including response to corticosteroid injections, physical therapy notes, and operative reports were reviewed for verification of intra- and extra-articular pathology as the source of hip pain (gold standard). The positive (PPV) and negative predictive values (NPP) of anesthetic MRA to differentiate between intra- and extra-articular pathology were calculated. RESULTS: On MRI, 41 patients had only intra-articular and 5 patients only extra-articular pathology, while 29 patients had both, intra- and extra-articular pathology. Forty-three patients had pain relief and 32 patients had no pain relief after anesthetic injection. PPV of anesthetic MRA to detect intra-articular pathology was 91% and NPV was 67%. CONCLUSION: Anesthetic MRA can be used as an adjunct to define the origin of hip pain. A positive response suggests intra-articular pathology which can be helpful to localize the source of pain in equivocal cases where both intra- and extra-articular pathology are evident on MRI.


Asunto(s)
Anestésicos Locales/uso terapéutico , Articulación de la Cadera/diagnóstico por imagen , Artropatías/diagnóstico por imagen , Artropatías/patología , Imagen por Resonancia Magnética/métodos , Dolor/tratamiento farmacológico , Examen Físico/métodos , Adulto , Anestésicos Locales/administración & dosificación , Artrografía/métodos , Enfermedades de los Cartílagos/diagnóstico por imagen , Enfermedades de los Cartílagos/patología , Diagnóstico Diferencial , Femenino , Fluoroscopía , Articulación de la Cadera/patología , Humanos , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Radiografía Intervencional , Rango del Movimiento Articular , Estudios Retrospectivos , Traumatismos de los Tendones/diagnóstico por imagen , Traumatismos de los Tendones/patología
15.
Skeletal Radiol ; 49(8): 1239-1247, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32130445

RESUMEN

PURPOSE: We endeavored to determine which characteristics of diabetic ulcers portend the strongest risk for osteomyelitis in patients whose initial T1-weighted imaging was normal. By determining which features have a greater risk for osteomyelitis, clinicians can treat patients more aggressively to reduce the sequela of inadequately treated osteomyelitis. MATERIALS AND METHODS: We performed a retrospective analysis of MR imaging from 60 pedal ulcers with suspected osteomyelitis. Ulcer dimensions and depth were measured. Ratios of marrow ROI/joint fluid ROI on T2/STIR sequences were obtained. Progression to osteomyelitis on subsequent MRI was characterized by loss of normal marrow signal on T1-weighted images. Statistical analysis was performed with a two-sample t test and Cox proportional hazard model. A p value < 0.05 was used as the threshold for statistical significance. RESULTS: Sixty MR exams were identified. Thirty-four progressed to osteomyelitis. Marrow ROI/joint fluid ratios averaged 65% in the osteomyelitis group, and 45% in the non-osteomyelitis group, p < 0.001. ROI ratios > 53% had a 6.5-fold increased risk of osteomyelitis, p < 0.001. Proximity to bone averaged 6 mm in the osteomyelitis group and 9 mm in the non-osteomyelitis group, p = 0.02. Ulcer size averaged 4 cm2 in the osteomyelitis group versus 2.4 cm2 in the non-osteomyelitis group, p = 0.07. Ulcers greater than 3 cm2 has a 2-fold increase in the risk of osteomyelitis, p = 0.04. CONCLUSION: Increasing bone marrow ROI signal/joint fluid ratios on T2/STIR images were the strongest risk factors for developing osteomyelitis, while ulcer size and depth are weaker predictors.


Asunto(s)
Enfermedades de la Médula Ósea/diagnóstico por imagen , Pie Diabético/diagnóstico por imagen , Edema/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Osteomielitis/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Pie Diabético/complicaciones , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/etiología , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo
17.
Skeletal Radiol ; 48(12): 1961-1974, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31250037

RESUMEN

OBJECTIVE: To propose an magnetic resonance imaging (MRI) grading system for subchondral insufficiency fracture of the knee (SIFK) to predict outcome and assess risk factors. MATERIALS AND METHODS: A total of 50 SIFK patients were retrospectively reviewed utilizing two MRI examinations approximately a year apart and compared them with 51 control subjects. A grading system was introduced that classifies lesions as low- vs high-grade. Lesion location 3D dimensions, extent of bone marrow edema (BME), location of meniscal tears and associated extrusion, degree of chondrosis and among other parameters were stratified according to lesion grade and compared with follow-up examinations. Statistical analyses were performed (Pearson's correlation, binary logistic regression, and Chi-squared analysis). RESULTS: The majority of SIFK lesions were low-grade (LG; 78%) and most of them (70%) were observed in the medial femoral condyle. Predictor variables comparing low-grade and high-grade SIFK lesions included meniscal tear (p = 0.01), degree of extrusion (p < 0.003), chondrosis (p = 0.01), medial chondrosis grade (p = 0.001), medial femoral condyle (p = 0.01), surface collapse (p < 0.0001), marrow edema improvement (p < 0.0001), first MRI anteroposterior dimension (p = 0.001), transverse dimension (p < 0.001), and ellipsoid volume (p = 0.02). Predictor variables found to be significantly different between controls and patients were meniscal tear (p = 0.024), location of the medial meniscal tear (p < 0.0001), degree of extrusion (p < 0.0001), chondrosis (p < 0.0001), joint effusion (p < 0.0001), Baker's cyst (p < 0.0001), knee lock (p = 0.03) and buckle (p = 0.01), and history of trauma (p = 0.01). CONCLUSION: A SIFK grading system for MRI is introduced. Surrogate markers of high-grade lesions include medial meniscus posterior root tears with associated moderate to severe extrusion, high-grade chondrosis, larger lesion sizes (anteroposterior/transverse), and articular surface collapse. Improvement of BME on follow-up was highly predictive of low-grade disease.


Asunto(s)
Fracturas Intraarticulares/diagnóstico por imagen , Traumatismos de la Rodilla/diagnóstico por imagen , Lesiones de Menisco Tibial/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Fracturas Intraarticulares/clasificación , Traumatismos de la Rodilla/clasificación , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Lesiones de Menisco Tibial/clasificación
18.
Skeletal Radiol ; 48(7): 1079-1085, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30637474

RESUMEN

OBJECTIVE: To report patterns of MRI findings involving carpal boss and extensor carpi radialis brevis (ECRB) tendon insertion in individuals with overuse-related or post-traumatic wrist pain. MATERIALS AND METHODS: Eighty-four MRI cases with carpal bossing between December 2006 and June 2015 were analyzed by two fellowship-trained musculoskeletal radiologists. The following MRI findings were reviewed: type of carpal bossing (bony prominence, partial coalition, os styloideum), insertion of ECRB tendon (to the 3rd metacarpal, to carpal boss or to both), bone marrow edema (BME), insertion site, and tenosynovitis/tendinosis of ECRB tendon. Clinical information on wrist pain was available on 68 patients. RESULTS: Fused carpal bossing was detected in 21%, partial coalition in 35%, and os styloideum in 44% of the cases. Regional BME was observed in 64% of the cases. When BME specifically at the carpal boss was assessed, 78% of stable and 50% of unstable bosses showed BME (p = 0.035). ECRB tendon inserted on a carpal boss in 20%, on the 3rd metacarpal bone in 35%, and on both sites in 45% of the cases. As BME at the carpal boss was assessed, BME was detected at the respective insertion sites in 71%, 35%, and 66% of the cases (p = 0.015). Dorsal wrist pain was associated with BME as 75% of the patients had regional BME in the vicinity of the carpal boss (p = 0.006). CONCLUSION: A spectrum ranging from complete fusion of a boss to an entirely unfused os styloideum exists with a variable ECRB insertional anatomy. BME at the carpal boss is a consistent MRI finding.


Asunto(s)
Huesos del Carpo/diagnóstico por imagen , Huesos del Carpo/lesiones , Trastornos de Traumas Acumulados/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Traumatismos de los Tendones/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagen , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y Cuestionarios , Tomografía Computarizada por Rayos X
19.
Skeletal Radiol ; 48(1): 143-147, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30003278

RESUMEN

OBJECTIVE: To determine factors that lead to significant discrepancies in second-opinion consultation of orthopedic oncology patients, and particularly if musculoskeletal fellowship training can decrease clinically significant discrepancies. METHODS: A PACS database was queried for secondary reads on outside cross-sectional imaging studies, as requested by orthopedic oncology from 2014 to 2017. Comparison of original and secondary reports was performed using a published seven-point scale that defines clinically significant discrepancies. An online search was performed for each original radiologist to record if a fellowship in musculoskeletal imaging was completed. Additionally, years of post-residency experience, number of Medicare part B patients billed per year (marker of practice volume), and average hierarchical condition category for each radiologist (marker of practice complexity) was recorded. RESULTS: A total of 571 patients met the inclusion criteria, with 184 cases initially interpreted by an outside fellowship trained musculoskeletal (MSK) radiologist and 387 cases initially interpreted by a non-MSK trained radiologist. The rate of clinically significant discrepancy was 9.2% when initially interpreted by MSK radiologists compared with 27.9% when initially performed by non-MSK radiologists (p < 0.05). After adjustment by both patient characteristics and radiologist characteristics, the likelihood of clinically significant discrepancies was greater for initial interpretations by non-MSK radiologists compared with MSK radiologists (OR = 1.36; 95% CI = 1.23-2.49). CONCLUSION: In orthopedic oncology patients, the rate of clinically significant discrepancies was significantly higher when initially interpreted by non-MSK radiologists compared with MSK radiologists. The lower rate of clinically significant discrepancies demonstrates that subspecialty training may direct more appropriate diagnosis and treatment.


Asunto(s)
Competencia Clínica , Becas , Oncología Médica/educación , Ortopedia/educación , Radiología/educación , Derivación y Consulta , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
20.
Semin Musculoskelet Radiol ; 22(5): 528-539, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30399617

RESUMEN

Although advancements in the last decade have automated much of the radiology workflow, there are several areas in the complex imaging process where standardization and innovation can be implemented. We discuss multiple tools and integrations that can help improve operational efficiency, quality, and safety.


Asunto(s)
Mejoramiento de la Calidad , Servicio de Radiología en Hospital/organización & administración , Flujo de Trabajo , Inteligencia Artificial , Investigación Biomédica/organización & administración , Seguridad Computacional , Sistemas de Apoyo a Decisiones Clínicas/organización & administración , Humanos , Sistemas de Información Radiológica/organización & administración
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA