Biphasic bioresorbable scaffold (TruFit®) in knee osteochondral defects: 3-T MRI evaluation of osteointegration in patients with a 5-year minimum follow-up.

PURPOSE: The aim of this study is to follow morphological imaging characteristics and osteointegration of TruFit® bone graft substitute (BGS) plugs in cases of chondral and osteochondral defects of the articular surface of the knee joint, using high-quality cartilage-sensitive 3-T magnetic resonance imaging (MRI), linked to clinical outcomes. METHODS: The MRI was used to assess osteointegration and biological evolution of the TruFit® BGS plugs in cases with minimum 5-year follow-up: The TruFit® plug was used in 46 patients for a total of 47 cases with mean age of 57.89 (range 32-80). In this study, we reviewed only the cases with minimum follow-up of 5 years: 5 patients with mean age 64.4 years (minimum 38, maximum 80). The mean follow-up was 71 months (range 63-77). Patients were evaluated clinically, with Lysholm Knee Scoring Scale and MOCART Scale. RESULTS: 3-T MRI, which is preferable to 1.5 T for the better signal-to-noise ratio, contrast and the ability to acquire morphological images at higher spatial resolution, shows a satisfactory integration of bone scaffolds in studied cases for more than 5 years and a satisfactory restoration of the articular cartilage, with the exception of a case of which we still have to consider the factors age, type of lesion and the relationship between the plugs implanted. CONCLUSION: Clinical and radiological results significantly improve in a longer follow-up time.

Ultrasonographic evaluation of liver volume and the metabolic syndrome in obese women.

Non-alcoholic fatty liver disease is a common finding in obese subjects, and increasing evidence has been provided suggesting that it represents the hepatic component of the metabolic syndrome. The aim of this study was to evaluate whether the extent of liver enlargement is related to the severity of the metabolic syndrome in obese women. The relationship between ultrasound- measured hepatic left lobe volume (HLLV) and various features of the metabolic syndrome was evaluated in 85 obese women. The mean+/-SD value of HLLV in obese women was 431+/-214 ml (range 46-1019 ml) while it was 187+/-31 ml (range 143-258 ml) in lean subjects. In a multiple logistic regression analysis, ultrasound-measured intra-abdominal fat was the only anthropometric measure independently associated with HLLV. A strong positive association was found between HLLV and serum liver enzymes, triglycerides, glucose, insulin, uric acid, C reactive protein, systolic and diastolic blood pressure, while a negative correlation was observed between HLLV and HDL cholesterol. The values of HLLV corresponding to the cut-off values of various risk factors for the diagnosis of the metabolic syndrome were calculated, yielding a mean value of 465 ml. In conclusion, ultrasound measurement of HLLV represents a simple, reliable and low-cost tool for the evaluation of liver involvement in the metabolic syndrome. The strong association between liver enlargement and various cardiovascular risk factors associated with insulin resistance supports the role of liver steatosis as an important link among the many facets of the metabolic syndrome in human obesity.

Magnetic resonance of the temporomandibular joint: experience at an Italian university center.

AIM: The aim of this investigation was to suggest criteria in order to evaluate magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ). Such criteria have been discussed on the basis of our experience at the Section of Prosthetic Dentistry, Department of Neurosciences, University of Pisa. METHODS: The study sample was constituted by 135 patients. All subjects underwent bilateral MRI of the TMJs to evaluate disc structure and position, bony structure abnormalities, joint effusion localization and entity. RESULTS: MRI allowed depiction of the articular disc in 98.9% of the TMJs, showing a normal disc structure in 91.1% of the cases and abnormal in 7.7%. The disc-condyle relationship was normal in 46.6% TMJs, while a disc displacement with reduction was revealed in 35.5% cases, a disc displacement without reduction in 16.7% and a posterior disc displacement in 1.5% joints. In the coronal images, the disc was positioned lateral to the condyle in 8.9% of the TMJs and medial in 6.7%. Osseous abnormalities have been found in 177 joints (65.5%), with cases of bony flattening (condyle and/or tuberculum), erosions, subchondral cysts, osteophytosis and sclerosis. T2 sequences showed effusion in 26.7% of the TMJs. CONCLUSIONS: These findings suggest that standardized methodology application and well-defined criteria can facilitate MR imaging observations and interpretation as well as the diagnosis of intra-articular pathologies.

Biochemical and ultrasound tests for early diagnosis of active neuro-osteoarthropathy (NOA) of the diabetic foot.

OBJECTIVES: To test the effectiveness of a combined approach to an early diagnosis of neuro-osteoarthropathy (NOA) of the diabetic foot, we studied a group of outpatients with active NOA, presenting for the first time to our Diabetic Foot Clinic in 1998, by means of an integrated approach designed to assess bone turnover. PATIENTS AND METHODS: Fifteen consecutive diabetic patients (five Type 1 and ten Type 2 diabetic individuals, age 61.9+/-12.2 years, diabetes duration 18.7+/-8.9 years, HbA(1c) 8.4+/-1.5%) with active NOA (Group 1) were compared to nine diabetic patients with chronic stable NOA (Group 2), 14 neuropathic diabetic patients without NOA (Group 3), 13 non-neuropathic diabetic patients (Group 4) and 15 healthy controls (Group 5). Determination of serum carboxy-terminal collagen telopeptide (ICTP), bone alkaline phosphatase isoenzyme (B-ALP), osteocalcin (BGP) concentrations, as well as urinary excretion of deoxypyridinoline (DPD) were obtained in all individuals for assessment of bone reabsorption and new bone formation. Moreover in all individuals quantitative ultrasound (QUS) of the calcaneal bone was performed and mass density of lumbar spine and femur bone was determined by dual-energy X-ray absorptiometry (DEXA). RESULTS: QUS was significantly lower in the active NOA patients as compared with other groups (P<0.01), while ICTP was higher in both NOA groups (P<0.01). Urinary DPD was higher in the neuropathic non-NOA group (P<0.01) than the other groups, and osteocalcin was higher in healthy controls compared to diabetic patients without NOA. QUS and ICTP were inversely correlated (r=0.44, P=0.000). QUS in the active NOA group was significantly (P<0.01) lower in the affected compared to the unaffected foot. CONCLUSION: Our results indicate a possible role for an integrated approach to the diagnosis and monitoring of NOA involving the diabetic foot. DPD may identify patients at-risk for NOA, ICTP could be tested as a marker for NOA in asymptomatic cases. Finally, QUS of the calcaneal bone may be useful in discriminating active versus quiescent phases.

Reflex sympathetic dystrophy syndrome with microtrabecular fracture in a patient with osteogenesis imperfecta.

A case of reflex sympathetic dystrophy syndrome (RSDS) in a patient with osteogenesis imperfecta (OI) is reported. We discuss the association of OI, manifested by microfractures of the trabecular bone due to marked bone fragility, and the appearance of RSDS. Magnetic resonance imaging (MRI) was helpful in assessing the presence and extent of the trabecular fractures.

Ultrasonographic vs magnetic resonance imaging findings of temporomandibular joint effusion.

AIM: The aim of this study was to assess the accuracy of ultrasonography (US) in the evaluation of temporomandibular joint (TMJ) effusion compared with magnetic resonance imaging (MRI) findings, assumed as the gold standard. METHODS: The study group consisted of 44 patients with signs and symptoms of temporomandibular disorders (TMD). Each joint (N=88) was evaluated using US and magnetic resonance (MR) to detect the presence of effusion. The 2 examinations were carried out by 2 blinded operators within no more than 2 weeks from each other. During that period the patients did not receive any kind of treatment. Sensitivity, specificity, positive predictive values (PPV) and negative predective values (NPV) of US were calculated. The agreement between the 2 diagnostic techniques was then evaluated by Cohen's K test. RESULTS: MRI depicted intra-articular effusion in 41 of the 88 TMJs (46.5%) while no effusion was detected in the remaining 47 joints (53.5%). Ultrasonographic imaging revealed effusion in 42/88 joints (47.8%), while the remaining 46 joints (52.2%) showed no effusion. US showed a sensitivity of 75.6% and a specificity of 76.5%. The PPV and NPV were 73.8% and 78.2% respectively. US vs MRI agreement for the diagnosis of TMJ effusion was fairly good (pct. agreement 76.1%; K=0.521). CONCLUSION: US is a low-cost, easy-performing, non-invasive, rapidly-executing imaging technique whose possible employ in the study of the TMJ is very promising.

[Problems and errors of magnetic resonance in the diagnosis of renal masses]. / Problemi ed errori della Risonanza Magnetica nella diagnostica delle masse renali.

Since the impact of MRI on the diagnostic evaluation of renal masses is affected by the intrinsic complexity of the modality, the problems related to the specific knowledge, on the part of the radiologist, of the examination itself to make a correct diagnosis are carefully analyzed. The problems related to the technical features of the equipment are presented as well, with a special emphasis on the still inadequate spatial resolution of MRI, and on its long acquisition time and unfavorable signal-to-noise ratio. On the other hand, its good contrast resolution is mentioned, which will be further improved by the new gradient-echo sequence (GRE) and by the use of paramagnetic contrast media. As for diagnostic problems, the results are analyzed of a series of 62 patients showing US "solid" renal mass. MRI allowed lesion detection in 59/62 cases, with 95.1% sensitivity. False negatives were due solely to the poor image quality determined by motion artifacts. MRI did not provide significant information in the structural evaluation of the lesions when tissue characterization was concerned, but was helpful in the correct assessment of necrotic foci (thus allowing the calculation of viable neoplastic mass) and in the detection of collateral vessels. Finally, the spatial relationships of the mass could be easily assessed by MRI, thanks to both its multiplanarity and to its good capabilities in the visualization of vascular involvement.

MRI of cerebellar white matter damage due to carbon monoxide poisoning: case report.

Extensive bilateral cerebellar white matter signal change, with sparing of the overlying cortex, consistent with demyelination was seen in a 12-year-old boy who had suffered carbon monoxide poisoning 6 years previously. His youth at the time of exposure and the long delay between exposure and examination might account for this unusual finding.

Breath-hold spin-echo MR imaging for evaluation of dynamic enhancement of native and treated hepatocellular carcinoma after intravenous Gd-DTPA administration.

Using a simple modification of a standard spin-echo sequence which enable acquisition of three breath-hold images in 15 s, dynamic enhancement of 30 histologically proven hepatocellular carcinomas (17 native tumors, 6 completely necrotic tumors after nonsurgical treatments, and 7 tumors with viable and necrotic portions) after intravenous injection of gadolinium-DTPA was evaluated. Native hepatocellular carcinomas and viable portions in treated nodules showed elective enhancement in images obtained 40 s after contrast injection. Contrast between these lesions and the normal liver decreased thereafter. No contrast uptake was seen in entirely necrotic nodules and necrotic portions of treated nodules. Because of the capability to demonstrate the elective arterial blood supply typical of hepatocellular carcinoma, breath-hold T1-weighted spin-echo sequence should replace conventional T1-weighted images for the evaluation of intravenously administered gadolinium-DTPA enhancement of this tumor before and after nonsurgical treatments.

Ultrasound assessment of increased capsular width as a predictor of temporomandibular joint effusion.

OBJECTIVES: The aim of this study was to evaluate whether an increased capsular width evidenced by ultrasound (US) could be an indirect marker of temporomandibular joint (TMJ) effusion. METHODS: 138 TMJs were evaluated by US and magnetic resonance imaging (MRI) by two blinded calibrated investigators. US measures of capsular width (in mm) and MRI diagnosis of TMJ effusion (presence/absence) were used to perform a receiver operating characteristic (ROC) curve analysis in order to assess the most accurate cut-off value of capsular width that was able to discriminate between joints with and without MRI effusion. RESULTS: Diagnostic accuracy of US to detect MRI-depicted TMJ effusion was good (area under the ROC curve=0.817). US sensitivity was high for values below the cut-off value of 1.950 mm (true positive rate (TPR)=83.9%; false positive rate (FPR)=26.3%), while specificity was high for values above the cut-off value of 2.150 mm (TPR=71.0%; FPR=11.8%). CONCLUSIONS: Analysis of ROC curve appears to reveal that the critical area is around the 2 mm value for TMJ capsular width. These findings need to be refined by further studies assessing the smallest detectable difference in capsular width, with attention to reliability of interobserver observations.

[Osteochondral lesions of the humeral head: the usefulness of echographic study]. / Lesioni osteocondrali della testa omerale: utilità dello studio ecografico.

PURPOSE: In the cranial humeral end, osteochondral injuries localize in a circular crown including part of the humeral head and part of the major and minor tuberosities. Since this region is easy to depict with US, we investigated the potentials of this technique in detecting osteochondral injuries. MATERIALS AND METHODS: Seventy-five osteochondral injuries found at 492 US examinations performed in 12 months with a 7.5 MHz linear probe were retrospectively reviewed. Clinical history taking was focused on the following: a) previous trauma or b) luxation-instability and c) if the patient was a sportsman devoted to activities requiring forced abduction-external rotation or adduction-internal rotation. Since the site of the head's humeral injury is an important clue for diagnosis, we subdivided the humeral circle into four ideal quadrants by two perpendicular lines with the main line passing through the bicipital groove. Then, each injury was ascribed to a quadrant. All patients were also submitted to radiography (at least two films) and to MRI; CT was performed in 12 patients. Ten patients underwent surgery. RESULTS: We found 34 Hill-Sachs lesions, 15 traumas, 9 arthrotic lesions, 7 cases of anterointernal and 4 of posterosuperior impingement, 4 cases of infraspinatus enthesopathy and 2 erosions due to perihumeral calcifications. In our experience, US was an accurate tool in the identification of humeral head conditions, which were confirmed at CT and/or MRI in all patients (no false positives). As for the injury nature, US diagnosis was confirmed in all Hill-Sachs lesions (34/34 cases), traumas (15/15 cases) and 50% of the cases of posterosuperior impingement (2/4 cases). These conditions made up about 2/3 of the whole cases (51/75 cases). US failed to establish the injury nature in the 9 arthrotic lesions, 7 cases of anterointernal impingement, 4 cases of infraspinatus enthesopathy and 2 erosions due to perihumeral calcifications. CONCLUSIONS: US can be suggested as the method of choice in the study of the osteochondral lining of the humeral head.

Rhabdomyosarcoma of the petrous ridge. CT and MR imaging in an atypical case with multiple cranial nerve palsy.

The CT and MR findings are reported in a case of biopsy proven rhabdomyosarcoma of the skull base. The tumor presumably originated in a pneumatized petrous ridge and had an atypical presentation of multiple cranial nerve palsy. The lesion exhibited a soft tissue density and a nonexpansile bone destruction on unenhanced CT. On MR imaging the lesion showed homogeneous intermediate signal intensity on T1 weighted images and a high signal intensity on proton density and T2 weighted images. The scanty literature on CT and MR features of rhabdomyosarcoma of the head and neck is reviewed.

[Comparison of computerized tomography and magnetic resonance in the assessment of benign and malignant pleural diseases]. / Confronto fra Tomografia Computerizzata e Risonanza Magnetica nella valutazione delle malattie pleuriche benigne e maligne.

To compare the diagnostic capabilities of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in differentiating benign from malignant pleural disease, we examined with MRI at 0.5 T forty-five patients with pleural lesions identified on CT scans. For 34 patients, a final diagnosis of malignant (n = 18) or benign (n = 16) disease was made. T1, proton density/T2 and enhanced T1-weighted spin-echo images were acquired. CT and MR images were independently studied by two observers, who were unaware of the final diagnosis. Various morphological features suggesting benign or malignant pleural disease were evaluated. On the basis of the morphological CT features, a final diagnosis of benignity of malignancy was expressed in terms of two different levels of confidence-probable or definitive. The MR signal intensity of pleural lesions was compared with that of intercostal muscles (isohypointense or hyperintense). No significant differences were observed between CT and MR morphological findings. High signal intensity on proton density/T2-weighted images was observed in all malignant lesions and in 2 benign lesions (100% sensitivity, 87% specificity). In the absence of this sign (i.e., isointense or hypointense signal), the lesions were always benign (100% negative predictive value). All the definitive CT diagnoses were correct, while 6 of 17 probable CT diagnoses were incorrect. In the subgroup of lesions misinterpreted with CT, MR signal intensity on long-TR images always allowed the correct differentiation of benign from malignant conditions. To conclude, MR signal intensity is a valuable additional feature to differentiate benign from malignant pleural disease. We suggest the use of MRI in the pleural lesions where the level of confidence of CT diagnosis is low.

[Anterolateral fibrous impingement of the ankle. Report of 14 cases]. / Conflitto fibroso antero-laterale della caviglia. Descrizione di 14 casi.

PURPOSE: Anterolateral fibrous impingement of the ankle is one of the causes of post-traumatic pain in the foot. We investigated the comparative accuracy of US and MRI in this condition. MATERIAL AND METHODS: Fourteen patients were submitted to arthroscopy, plain radiography, US and MRI of the foot. The patients, all sportsmen, had a clinical history of sprains; the major symptoms were pain, swelling and clicking on foot dorsiflexion. RESULTS: US showed anterior talofibular ligament changes in all patients and mid-low-echogenicity synovial tissue filling the lateral malleolar gutter. MRI demonstrated a small mass of synovial tissue in the gutter in 8 patients, with mid-low signal intensity before Gd-DTPA and mid-low contrast enhancement after contrast administration and no abnormal findings in 6 patients. Arthroscopy showed a small firm mass of proliferative synovium in the lateral malleolar gutter in all patients. CONCLUSIONS: Fibrous impingement must be suspected in the sportsmen presenting typical symptoms after ankle trauma. US is poorly accurate in diagnosing this condition. MRI shows a small synovial mass in the lateral malleolar gutter in more than half the patients, but aspecific MR findings do not rule impingement our MR images must be acquired along the proper planes and with Gd-DTPA administration.

[Dixon's technic for fat suppression. Its potential applications in combination with gadolinium-DTPA]. / Tecnica di Dixon per la soppressione del grasso. Possibilità applicative della sua associazione con il gadolinio-DTPA.

Modification of the Dixon technique enables the reconstruction of water and fat images operating at midfield strength. The technique was combined with intravenous administration of gadolinium-DTPA in five patients with lumbosacral spine conditions, four patients with soft tissue neoplasms and three with skeletal neoplasms; all patients were examined at 0.5 T. Mean attenuation of fat signal in T1-weighted images was 85% and implied a redistribution of the gray-scale dynamic range. This allowed easier appreciation of normal and abnormal enhancement in both areas containing fat tissue and areas without it. This was useful in the evaluation of fresh scars in two patients recently submitted to lamino-discectomy and of the prevertebral extension of the inflammatory process in one patient with spondylodiscitis. In the patients with soft tissue neoplasms the combination of fat suppression and Gadolinium was helpful to assess lesion size. Finally, in the patients with skeletal neoplasms fat-suppressed images obviated for the lesion disappearance observed on conventional T1-weighted SE images after contrast administration. The combination of intravenous administration of gadolinium-DPTA with Dixon's fat-suppression technique is a new promising capability of midfield MRI.

[The incidence of disk changes in volleyball players. The magnetic resonance findings]. / Incidenza delle alterazioni discali nei giocatori di pallavolo. Rilievi con risonanza magnetica.

In order to evaluate the to potential hazards related to athletic functional overload on the intervertebral disk we studied with MRI the incidence of intervertebral disk abnormalities in a group of 45 volunteers who had been playing professional volleyball for 3-7 years. As a control group we examined with MRI 30 professional swimmers as well. Among the volley-ball players the incidence of intervertebral disk alterations was 44.4%; they were represented by 8 cases of disk degeneration, 11 cases of bulging and 9 disk herniations (in 8 patients the simultaneous presence of more than one lesion was observed). In the control group the incidence of such lesions was 20%. The obtained results were correlated with the clinical findings and the age of the athletes. Among the 26 athletes with back pain only 13 had positive findings at MRI, while among the 19 asymptomatic athletes 7 showed lesions detectable with MRI. As for age, we observed that the younger athletes (17-19 years) had positive MRI findings in 38.5% of cases, while the players in the age group ranging from 23 to 26 years, had positive MRI findings in 56.2% of cases. The analysis of the different types of training of the volley-ball players and the control group, showed that 19 volley-ball players who followed appropriate training procedures had positive MRI findings in 21.1% of cases (in the control group the percentage was 20%). Among the 26 athletes who were trained with exercises that caused significant functional overload, 16 had intervertebral disk lesions at MRI (61.5%). Moreover, our data showed that the correlation of the incidence of disk lesions with the type of training (and relative varying degree of overload) is definitely more important than the one existing with the age of volley-ball players and the overall period of their athletic activity. MRI proved to be a useful technique for the early assessment of the intervertebral disk damage caused by an incorrect training in young athletes, even when asymptomatic.

[Magnetic resonance imaging of aortic and mitral valve insufficiency. Comparison with Doppler echocardiography and angiocardiography]. / Studio con risonanza magnetica dell'insufficienza valvolare aortica e mitralica. Confronto con ecocardiografia Doppler ed angiocardiografia.

Fourty-five subjects--10 normal volunteers and 35 patients with valvular insufficiency were examined with MRI and [20 of them with mitral (MI) and 15 with aortic (AI) insufficiency] were evaluated with MR imaging and with Doppler echocardiography (echo-Doppler); 22 of these patients were also studied with angiocardiography. The extent of regurgitation jet was classified as follows: minimal (1+), mild (2+), moderate (3+), and severe (4+), according to the max distance of regurgitant jet signal from valvular leaflets. In our series, MR imaging with FFE sequences always showed the regurgitant jet. High agreement was found between MR and echo-Doppler results (80% for MI, and 86% for AI). In 22 patients who underwent angiocardiography, we observed 73% agreement. Cine-MR imaging proved to be an accurate and sensitive technique to recognize and to evaluate severity of regurgitant valvular flow in patients with AI and MI. This technique may be useful in those patients in whom Doppler echocardiography is inadequate or impossible to perform.

[Magnetic resonance-diskography correlation for the therapeutic approach of lumbar herniated disk]. / Correlazione RM-discografia nell'approccio terapeutico all'ernia discale lombare.

In order to evaluate MR reliability in the therapeutic approach to lumbar disk herniation, 51 patients were examined. MR images revealed disk herniation with integrity of posterior longitudinal ligament in 25 subjects. These patients were then examined with diskography, that confirmed MR diagnosis in 23/25 cases. Percutaneous diskectomy according to Onik was successfully performed in 23/25 patients. MR imaging appears as a non-invasive method which allows exhaustive analysis of all components of lumbar spine, yielding reliable information for choosing the appropriate treatment.