Serum uric acid and knee osteoarthritis in community residents without gout: a longitudinal study.

OBJECTIVES: Emerging evidence suggests a potential link between OA and gout; however, the association between serum uric acid (UA) itself and knee OA remains uncertain due to a lack of longitudinal studies. Here, we investigated the association between serum UA and knee OA according to cartilage status in elderly community residents without gout. METHODS: In this longitudinal study, participants without a history of gout were recruited from among the Korean cohort of the Hallym Aging Study (n = 296 for radiography study and n = 223 for MRI study). Weight-bearing knee radiographs and 1.5-T MRI scans, along with blood collection for analysis of serum UA, were performed at baseline and after 3 years. The severity and structural progression of knee OA were evaluated using the Kellgren-Lawrence grading system and the Whole-Organ MRI Score (WORMS) cartilage scoring method. Multivariable logistic regression analysis was conducted using generalized estimating equation (GEE) models. RESULTS: Serum UA levels were not associated with radiographic progression after adjusting for age, sex and BMI. There was no significant association between serum UA and tibiofemoral cartilage loss on MRI. However, baseline serum UA levels were negatively associated with patellofemoral cartilage loss over 3 years (adjusted odd ratio 0.70 per 1 mg/dl increase, 95% CI: 0.49, 0.98). CONCLUSION: In this population-based cohort, serum UA was not a risk factor for knee OA progression. Further large-scale longitudinal studies in other populations are needed to validate the effects of UA on cartilage damage.

MRI assessment of bone marrow oedema in the sacroiliac joints of patients with spondyloarthritis: is the SPAIR T2w technique comparable to STIR?

OBJECTIVE: To compare short tau inversion-recovery (STIR) with another fat saturation method in the assessment of sacroiliac joint inflammation. METHODS: This prospective cross-sectional study comprised 76 spondyloarthritis (SpA) patients who underwent magnetic resonance imaging of the sacroiliac joints in a 1.5-T scanner, using STIR, spectral attenuated inversion recovery (SPAIR) T2w and spectral presaturation with inversion recovery (SPIR) T1w post-contrast sequences. Two independent readers (R1 and R2) assessed the images using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. We assessed agreement of the SPARCC scores for SPAIR T2w and STIR with that for T1 SPIR post-contrast (reference standard) using the St. Laurent coefficient. We evaluated each sequence using the concordance correlation coefficient (CCC). RESULTS: We observed a strong agreement between STIR and SPAIR T2w sequences. Lin's CCC was 0.94 for R1 and 0.84 for R2 for STIR and 0.94 for R1 and 0.84 for R2 for SPAIR. The interobserver evaluation revealed a good CCC of 0.79 for SPAIR and 0.78 for STIR. CONCLUSION: STIR technique and SPAIR T2w sequence showed high agreement in the evaluation of sacroiliac joint subchondral bone marrow oedema in patients with SpA. SPAIR T2w may be an alternative to the STIR sequence for this purpose. KEY POINTS: • There are no studies evaluating which fat saturation technique should be used. • SPAIR T2w may be an alternative to STIR for sacroiliac joint evaluation. • The study will lead to changes in guidelines for spondyloarthritis.

Metabolic obesity and the risk of knee osteoarthritis progression in elderly community residents: A 3-year longitudinal cohort study.

OBJECTIVE: Metabolic syndrome is a major health problem worldwide associated with obesity, thus drawing attention to its relation to osteoarthritis (OA). However, it is still uncertain whether metabolic syndrome or body fat distribution is associated with knee OA. The aim of this longitudinal study was to elucidate the association between metabolic obesity and adverse structural changes of knee OA assessed by magnetic resonance imaging (MRI). METHODS: Participants were recruited from the Hallym Aging Study cohort in Korea. Knee MRI scans, along with dual-energy X-ray absorptiometry, were assessed in 226 participants at baseline and after 3 years. The structural progression in the tibiofemoral joint was evaluated using the semi-quantitative Whole-Organ MRI Score (WORMS) for cartilage morphology and bone marrow lesions (BML). Logistic regression with generalized estimating equation was performed for associations of metabolic risk factors with worsening of WORMS scores at the subregional level. RESULTS: In the medial compartment, fat mass in women was associated with cartilage loss, but the statistical significance disappeared after adjusting for body mass index. Metabolic syndrome and each of its components were not associated with cartilage loss or increase of BML. On the other hand, the interaction effects of metabolic syndrome on the association between obesity and knee OA progression were not significant. CONCLUSION: In this cohort, metabolic effects of obesity on knee cartilage damage and BML were not demonstrated. Further large-scale studies are required to prove the causal relationship between metabolic obesity and knee OA.

Comparison between STIR and T2-weighted SPAIR sequences in the evaluation of inflammatory sacroiliitis: diagnostic performance and signal-to-noise ratio.

OBJECTIVE: To compare two different fat-saturated magnetic resonance imaging (MRI) techniques-STIR and T2 SPAIR-in terms of image quality, as well as in terms of their diagnostic performance in detecting sacroiliac joints (SIJ) active inflammation. MATERIALS AND METHODS: We included 69 consecutive patients with suspected spondyloarthritis undergoing MRI between 2012 and 2014. The signal-to-noise ratio (SNR) was calculated with the method recommended by the American College of Radiology. Two readers evaluated SIJ MRI following ASAS criteria to assess diagnostic performance regarding the detection of active SIJ inflammation. T1 SPIR Gd+ sequence was used as the reference standard. RESULTS: The mean SNR was 72.8 for the T1 SPIR Gd+ sequence, compared with 14.1 and 37.6 for the STIR and T2 SPAIR sequences, respectively. The sensitivity and specificity of STIR and SPAIR T2 sequences did not show any statistically significant differences, for the diagnosis of sacroiliitis with active inflammation. CONCLUSION: Our results corroborate those in the recent literature suggesting that STIR sequences are not superior to T2 SPAIR sequences for SIJ evaluation in patients with suspected spondyloarthritis. On 1.5-T MRI, T2-weighted SPAIR sequences provide better SNRs than do STIR sequences, which reinforces that T2 SPAIR sequences may be an advantageous option for the evaluation of sacroiliitis.

OBJETIVO: O objetivo deste estudo foi comparar a qualidade da imagem das técnicas de saturação de gordura T2 SPAIR e STIR e, adicionalmente, comparar o desempenho diagnóstico das duas sequências para detecção de inflamação ativa nas imagens de ressonância magnética (RM) das sacroilíacas. MATERIAIS E MÉTODOS: Foram incluídos 69 pacientes consecutivos que realizaram RM das articulações sacroilíacas no período de 2012 a 2014. O cálculo da relação sinal/ruído (RSR) foi realizado pelo método do Colégio Americano de Radiologia. O desempenho diagnóstico foi realizado utilizando os resultados da leitura das imagens da sequência T1 SPIR Gd+ como referência. RESULTADOS: A avaliação da RSR mostrou média de 72,8 para a sequência T1 SPIR Gd+. A sensibilidade e a especificidade das sequências STIR e SPAIR 2 para o diagnóstico de sacroiliite com inflamação ativa não apresentaram diferenças estatisticamente significantes. CONCLUSÃO: Nossos resultados reforçam a literatura recente sugerindo que não há superioridade da sequência STIR em relação à sequência SPAIR T2 para a avaliação das sacroilíacas em pacientes com espondiloartrite. A sequência SPAIR T2 apresenta melhor RSR em relação à sequência STIR em imagens de RM de 1,5 T, o que reforça que a sequência SPAIR T2 possa ser utilizada como opção vantajosa na avaliação da sacroiliite inflamatória.

Epidemiology of Judo-Related Injuries in 21 Seasons of Competitions in France: A Prospective Study of Relevant Traumatic Injuries.

BACKGROUND: Judo is a full-contact fighting sport that may lead to severe injuries. There are limited data available on the incidence of judo-related injuries. The French Judo Federation has established a surveillance system to document the frequency and type of injuries during judo competitions. PURPOSE: To describe the incidence rates and types of judo-related traumatic injuries during 21 seasons of competitions in France with respect to athlete (judoka) age, sex, and level of performance. STUDY DESIGN: Descriptive epidemiology study. METHODS: Between 1993 and 2014, each physician in charge of each judo competition filled out a form in which he/she documented the number of competing judokas, the number of fights, the number of medical interventions, the specific type of traumatic injuries for each intervention, the number of fight interruptions, and the number of athletes removed from the competition venue because of an injury. The age, sex, and level of performance of each judoka were also documented. Variance analysis was applied to assess whether differences in incidence rates of injuries between groups were significant (Student t test and chi-square test). RESULTS: Surveillance of 421,670 fights demonstrated 3511 injuries in 316,203 judokas (incidence proportion, 1.1%). Among the injuries recorded, the most common were sprains (54.3%), fractures (15.6%), and dislocations (12.5%). Female athletes exhibited significantly higher incidence rates for knee sprains and elbow dislocations, whereas male athletes exhibited a higher incidence rate for shoulder dislocations (P < .001 for all). Regarding age, higher incidence rates were observed in young adults (aged 18-20 years) for acromioclavicular sprains and in children (aged 10-14 years) for clavicle fractures compared with adults (aged 21-35 years) (P < .001 for both). Both young adult and adult athletes had a higher incidence rate of shoulder dislocations (P < .001). Regarding the level of performance, athletes competing at higher levels had a higher incidence rate of sprains to the knee (P < .001). CONCLUSION: During 21 years of surveillance of injuries in judo competitions in France, the incidence proportion of injuries was 1.1%. Significant differences in incidence rates demonstrated when considering age, sex, and level of performance may help in developing strategies to prevent traumatic injuries in the future.

Diagnostic performance of magnetic resonance imaging in the assessment of periosteal reactions in bone sarcomas using conventional radiography as the reference.

OBJECTIVE: To evaluate the performance of magnetic resonance imaging (MRI) in detecting periosteal reactions and to compare MRI and conventional radiography (CR) in terms of the classification of periosteal reactions. MATERIALS AND METHODS: Retrospective study of 42 consecutive patients (mean age, 22 years; 20 men) with a confirmed diagnosis of osteosarcoma or Ewing's sarcoma, MRI and CR images having been acquired pretreatment. Three blinded radiologists detected periosteal reactions and evaluated each periosteal reaction subtype in CR and MRI images: Codman's triangle; laminated; and spiculated. The CR was used as a benchmark to calculate the diagnostic performance. We used the kappa coefficient to assess interobserver reproducibility. A two-tailed Fisher's exact test was used in order to assess contingency between CR and MRI classifications. RESULTS: In the detection of periosteal reactions, MRI showed high specificity, a high negative predictive value, and low-to-moderate sensitivity. For CR and for MRI, the interobserver agreement for periosteal reaction was almost perfect, whereas, for the classification of different subtypes of periosteal reaction, it was higher for the Codman's triangle subtype and lower for the spiculated subtype. There was no significant difference between MRI and CR in terms of the classifications (p < 0.05). CONCLUSION: We found no difference between MRI and CR in terms of their ability to classify periosteal reactions. MRI showed high specificity and almost perfect interobserver agreement for the detection of periosteal reactions. The interobserver agreement was variable for the different subtypes of periosteal reaction.

OBJETIVO: Avaliar o desempenho da ressonância magnética (RM) na detecção de reação periosteal e comparar a classificação de presença ou ausência de reações periosteais entre a RM e a radiografia convencional (RC). MATERIAIS E MÉTODOS: Estudo retrospectivo incluindo 42 pacientes consecutivos (idade média, 22 anos; 20 homens) com diagnóstico confirmado de osteossarcoma ou sarcoma de Ewing, tendo exames de RM e RC adquiridos pré-tratamento. Três radiologistas avaliaram às cegas a presença ou ausência de reação periosteal e de cada subtipo de reação periosteal nas imagens de RC e RM: triângulo de Codman, multilamelada e espiculada. A RC foi usada como padrão de referência para cálculo do desempenho diagnóstico. Foi utilizado o coeficiente kappa para reprodutibilidade interobservador. Adicionalmente, foi realizado teste exato de Fisher bicaudal para avaliar se houve diferença significativa entre as leituras da RC e RM. RESULTADOS: A RM mostrou alta especificidade, alto valor preditivo negativo e baixa sensibilidade na detecção de reação periosteal. A concordância interobservador para a reação periosteal foi quase perfeita para a RC e RM. A concordância interobservador para a classificação dos diferentes subtipos de reação periosteal foi maior para o subtipo triângulo de Codman e menor para o subtipo espiculada. Não houve diferença na detecção por RM e RC (p < 0,05). CONCLUSÃO: Não houve diferença significativa entre as classificações da presença ou ausência de reações periosteais entre os métodos RC e RM. A RM apresentou alta especificidade e concordância interobservador quase perfeita para a detecção de reação periosteal. A concordância interobservador para os diferentes subtipos de reação periosteal foi variável.

Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy.

OBJECTIVE: To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders. MATERIALS AND METHODS: We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. RESULTS: The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6º, versus +1.6º for the normal, contralateral limbs. CONCLUSION: The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head.

OBJETIVO: Avaliar os parâmetros de imagem relacionados com a morfologia da articulação glenoumeral em crianças com paralisia obstétrica do plexo braquial (POPB) unilateral, comparando-os com os observados em ombros saudáveis. MATERIAIS E MÉTODOS: Foi realizada uma busca retrospectiva de casos de POPB unilateral diagnosticados em nossa instituição. Somente foram incluídos os pacientes com diagnóstico clínico de POPB unilateral, e a amostra final do estudo consistiu em 10 pacientes consecutivos avaliados por meio de imagens transversais. Foram avaliados a retroversão da cavidade glenoide, a translação da cabeça do úmero e o grau de displasia glenoumeral. RESULTADOS: A média do diâmetro da cabeça do úmero foi 1,93 cm nos membros afetados e 2,33 cm nos membros normais. Em dois casos, não houve deslocamento posterior significativo da cabeça do úmero, cinco casos apresentaram subluxação posterior da cabeça do úmero, e os três casos restantes apresentaram luxação total da cabeça do úmero. A média do ângulo de retroversão glenoide dos membros afetados (90-α) foi -9,6º, ao passo que a dos membros contralaterais normais foi +1,6º. CONCLUSÃO: As principais deformidades encontradas neste estudo foram retroversão da cavidade glenoide relacionada com POPB, atraso no desenvolvimento da cabeça do úmero e translação posterior da cabeça do úmero.

Diagnostic performance of 3D TSE MRI versus 2D TSE MRI of the knee at 1.5 T, with prompt arthroscopic correlation, in the detection of meniscal and cruciate ligament tears.

OBJECTIVE: To compare the diagnostic performance of the three-dimensional turbo spin-echo (3D TSE) magnetic resonance imaging (MRI) technique with the performance of the standard two-dimensional turbo spin-echo (2D TSE) protocol at 1.5 T, in the detection of meniscal and ligament tears. MATERIALS AND METHODS: Thirty-eight patients were imaged twice, first with a standard multiplanar 2D TSE MR technique, and then with a 3D TSE technique, both in the same 1.5 T MRI scanner. The patients underwent knee arthroscopy within the first three days after the MRI. Using arthroscopy as the reference standard, we determined the diagnostic performance and agreement. RESULTS: For detecting anterior cruciate ligament tears, the 3D TSE and routine 2D TSE techniques showed similar values for sensitivity (93% and 93%, respectively) and specificity (80% and 85%, respectively). For detecting medial meniscal tears, the two techniques also had similar sensitivity (85% and 83%, respectively) and specificity (68% and 71%, respectively). In addition, for detecting lateral meniscal tears, the two techniques had similar sensitivity (58% and 54%, respectively) and specificity (82% and 92%, respectively). There was a substantial to almost perfect intraobserver and interobserver agreement when comparing the readings for both techniques. CONCLUSION: The 3D TSE technique has a diagnostic performance similar to that of the routine 2D TSE protocol for detecting meniscal and anterior cruciate ligament tears at 1.5 T, with the advantage of faster acquisition.

OBJETIVO: Comparar o desempenho diagnóstico da técnica tridimensional turbo spin-eco (3D TSE) de ressonância magnética (RM) do joelho na detecção de rupturas meniscais e ligamentares em comparação com o protocolo bidimensional turbo spin-eco (2D TSE). MATERIAIS E MÉTODOS: A sequência 3D TSE foi adicionada ao protocolo de rotina 2D TSE em 38 pacientes que foram submetidos a cirurgia artroscópica do joelho em até três dias após a realização da RM. Usando os achados artroscópicos como referência padrão ouro, foram calculados o desempenho diagnóstico e a concordância entre os protocolos. RESULTADOS: A técnica 3D TSE e o protocolo 2D TSE apresentaram, respectivamente, sensibilidade (93%/93%) e especificidade (80%/ 85%) semelhantes na detecção de rupturas do ligamento cruzado anterior, sensibilidade (85%/83%) e especificidade (68%/71%) semelhantes na detecção de rupturas do menisco medial, assim como sensibilidade (58%/54%) e especificidade (82%/92%) semelhantes na detecção de rupturas do menisco lateral. A concordância intraobservador entre os dois métodos foi de substancial a quase perfeita em todos os parâmetros avaliados para ambos os leitores. CONCLUSÃO: A técnica 3D- SE apresentou desempenho diagnóstico semelhante ao protocolo de rotina 2D TSE na detecção de rupturas meniscais e ligamentares em magneto de 1,5 T, com a vantagem de possibilitar uma redução significativa no tempo de aquisição.

Comparison between STIR and T2-weighted SPAIR sequences in the evaluation of inflammatory sacroiliitis: diagnostic performance and signal-to-noise ratio / Comparação do desempenho diagnóstico e da relação sinal-ruído das sequências SPAIR T2 e STIR na avaliação de sacroiliite inflamatória

Abstract Objective: To compare two different fat-saturated magnetic resonance imaging (MRI) techniques-STIR and T2 SPAIR-in terms of image quality, as well as in terms of their diagnostic performance in detecting sacroiliac joints (SIJ) active inflammation. Materials and Methods: We included 69 consecutive patients with suspected spondyloarthritis undergoing MRI between 2012 and 2014. The signal-to-noise ratio (SNR) was calculated with the method recommended by the American College of Radiology. Two readers evaluated SIJ MRI following ASAS criteria to assess diagnostic performance regarding the detection of active SIJ inflammation. T1 SPIR Gd+ sequence was used as the reference standard. Results: The mean SNR was 72.8 for the T1 SPIR Gd+ sequence, compared with 14.1 and 37.6 for the STIR and T2 SPAIR sequences, respectively. The sensitivity and specificity of STIR and SPAIR T2 sequences did not show any statistically significant differences, for the diagnosis of sacroiliitis with active inflammation. Conclusion: Our results corroborate those in the recent literature suggesting that STIR sequences are not superior to T2 SPAIR sequences for SIJ evaluation in patients with suspected spondyloarthritis. On 1.5-T MRI, T2-weighted SPAIR sequences provide better SNRs than do STIR sequences, which reinforces that T2 SPAIR sequences may be an advantageous option for the evaluation of sacroiliitis.

Resumo Objetivo: O objetivo deste estudo foi comparar a qualidade da imagem das técnicas de saturação de gordura T2 SPAIR e STIR e, adicionalmente, comparar o desempenho diagnóstico das duas sequências para detecção de inflamação ativa nas imagens de ressonância magnética (RM) das sacroilíacas. Materiais e Métodos: Foram incluídos 69 pacientes consecutivos que realizaram RM das articulações sacroilíacas no período de 2012 a 2014. O cálculo da relação sinal/ruído (RSR) foi realizado pelo método do Colégio Americano de Radiologia. O desempenho diagnóstico foi realizado utilizando os resultados da leitura das imagens da sequência T1 SPIR Gd+ como referência. Resultados: A avaliação da RSR mostrou média de 72,8 para a sequência T1 SPIR Gd+. A sensibilidade e a especificidade das sequências STIR e SPAIR 2 para o diagnóstico de sacroiliite com inflamação ativa não apresentaram diferenças estatisticamente significantes. Conclusão: Nossos resultados reforçam a literatura recente sugerindo que não há superioridade da sequência STIR em relação à sequência SPAIR T2 para a avaliação das sacroilíacas em pacientes com espondiloartrite. A sequência SPAIR T2 apresenta melhor RSR em relação à sequência STIR em imagens de RM de 1,5 T, o que reforça que a sequência SPAIR T2 possa ser utilizada como opção vantajosa na avaliação da sacroiliite inflamatória.

Diagnostic performance of magnetic resonance imaging in the assessment of periosteal reactions in bone sarcomas using conventional radiography as the reference / Desempenho diagnóstico da ressonância magnética na avaliação de reações periosteais em sarcomas ósseos utilizando a radiografia convencional como padrão de referência

Abstract Objective: To evaluate the performance of magnetic resonance imaging (MRI) in detecting periosteal reactions and to compare MRI and conventional radiography (CR) in terms of the classification of periosteal reactions. Materials and Methods: Retrospective study of 42 consecutive patients (mean age, 22 years; 20 men) with a confirmed diagnosis of osteosarcoma or Ewing's sarcoma, MRI and CR images having been acquired pretreatment. Three blinded radiologists detected periosteal reactions and evaluated each periosteal reaction subtype in CR and MRI images: Codman's triangle; laminated; and spiculated. The CR was used as a benchmark to calculate the diagnostic performance. We used the kappa coefficient to assess interobserver reproducibility. A two-tailed Fisher's exact test was used in order to assess contingency between CR and MRI classifications. Results: In the detection of periosteal reactions, MRI showed high specificity, a high negative predictive value, and low-to-moderate sensitivity. For CR and for MRI, the interobserver agreement for periosteal reaction was almost perfect, whereas, for the classification of different subtypes of periosteal reaction, it was higher for the Codman's triangle subtype and lower for the spiculated subtype. There was no significant difference between MRI and CR in terms of the classifications (p < 0.05). Conclusion: We found no difference between MRI and CR in terms of their ability to classify periosteal reactions. MRI showed high specificity and almost perfect interobserver agreement for the detection of periosteal reactions. The interobserver agreement was variable for the different subtypes of periosteal reaction.

Resumo Objetivo: Avaliar o desempenho da ressonância magnética (RM) na detecção de reação periosteal e comparar a classificação de presença ou ausência de reações periosteais entre a RM e a radiografia convencional (RC). Materiais e Métodos: Estudo retrospectivo incluindo 42 pacientes consecutivos (idade média, 22 anos; 20 homens) com diagnóstico confirmado de osteossarcoma ou sarcoma de Ewing, tendo exames de RM e RC adquiridos pré-tratamento. Três radiologistas avaliaram às cegas a presença ou ausência de reação periosteal e de cada subtipo de reação periosteal nas imagens de RC e RM: triângulo de Codman, multilamelada e espiculada. A RC foi usada como padrão de referência para cálculo do desempenho diagnóstico. Foi utilizado o coeficiente kappa para reprodutibilidade interobservador. Adicionalmente, foi realizado teste exato de Fisher bicaudal para avaliar se houve diferença significativa entre as leituras da RC e RM. Resultados: A RM mostrou alta especificidade, alto valor preditivo negativo e baixa sensibilidade na detecção de reação periosteal. A concordância interobservador para a reação periosteal foi quase perfeita para a RC e RM. A concordância interobservador para a classificação dos diferentes subtipos de reação periosteal foi maior para o subtipo triângulo de Codman e menor para o subtipo espiculada. Não houve diferença na detecção por RM e RC (p < 0,05). Conclusão: Não houve diferença significativa entre as classificações da presença ou ausência de reações periosteais entre os métodos RC e RM. A RM apresentou alta especificidade e concordância interobservador quase perfeita para a detecção de reação periosteal. A concordância interobservador para os diferentes subtipos de reação periosteal foi variável.

Fracture of the fabella: a rare injury in knee trauma.

We present a case of a 21-year-old woman sustaining a traumatic [fabellar] fracture following a motor vehicle accident. The fabellar fracture was confirmed on plain films, which prompted further evaluation of the knee with ultrasound and magnetic resonance imaging to evaluate other possible associated injuries. Fracture of the fabella is a rare condition. Clinically, patients present with posterolateral knee pain, edema, and limited knee extension. Occasionally these symptoms may be very subtle, delaying the correct diagnosis and patient management.

Diagnostic performance of 3D TSE MRI versus 2D TSE MRI of the knee at 1.5 T, with prompt arthroscopic correlation, in the detection of meniscal and cruciate ligament tears / Desempenho diagnóstico da técnica 3D-TSE de RM do joelho comparada com a técnica 2D-TSE em 1,5 T na detecção de rupturas meniscais e ligamentares com correlação artroscópica imediata

Abstract Objective: To compare the diagnostic performance of the three-dimensional turbo spin-echo (3D TSE) magnetic resonance imaging (MRI) technique with the performance of the standard two-dimensional turbo spin-echo (2D TSE) protocol at 1.5 T, in the detection of meniscal and ligament tears. Materials and Methods: Thirty-eight patients were imaged twice, first with a standard multiplanar 2D TSE MR technique, and then with a 3D TSE technique, both in the same 1.5 T MRI scanner. The patients underwent knee arthroscopy within the first three days after the MRI. Using arthroscopy as the reference standard, we determined the diagnostic performance and agreement. Results: For detecting anterior cruciate ligament tears, the 3D TSE and routine 2D TSE techniques showed similar values for sensitivity (93% and 93%, respectively) and specificity (80% and 85%, respectively). For detecting medial meniscal tears, the two techniques also had similar sensitivity (85% and 83%, respectively) and specificity (68% and 71%, respectively). In addition, for detecting lateral meniscal tears, the two techniques had similar sensitivity (58% and 54%, respectively) and specificity (82% and 92%, respectively). There was a substantial to almost perfect intraobserver and interobserver agreement when comparing the readings for both techniques. Conclusion: The 3D TSE technique has a diagnostic performance similar to that of the routine 2D TSE protocol for detecting meniscal and anterior cruciate ligament tears at 1.5 T, with the advantage of faster acquisition.

Resumo Objetivo: Comparar o desempenho diagnóstico da técnica tridimensional turbo spin-eco (3D TSE) de ressonância magnética (RM) do joelho na detecção de rupturas meniscais e ligamentares em comparação com o protocolo bidimensional turbo spin-eco (2D TSE). Materiais e Métodos: A sequência 3D TSE foi adicionada ao protocolo de rotina 2D TSE em 38 pacientes que foram submetidos a cirurgia artroscópica do joelho em até três dias após a realização da RM. Usando os achados artroscópicos como referência padrão ouro, foram calculados o desempenho diagnóstico e a concordância entre os protocolos. Resultados: A técnica 3D TSE e o protocolo 2D TSE apresentaram, respectivamente, sensibilidade (93%/93%) e especificidade (80%/ 85%) semelhantes na detecção de rupturas do ligamento cruzado anterior, sensibilidade (85%/83%) e especificidade (68%/71%) semelhantes na detecção de rupturas do menisco medial, assim como sensibilidade (58%/54%) e especificidade (82%/92%) semelhantes na detecção de rupturas do menisco lateral. A concordância intraobservador entre os dois métodos foi de substancial a quase perfeita em todos os parâmetros avaliados para ambos os leitores. Conclusão: A técnica 3D- SE apresentou desempenho diagnóstico semelhante ao protocolo de rotina 2D TSE na detecção de rupturas meniscais e ligamentares em magneto de 1,5 T, com a vantagem de possibilitar uma redução significativa no tempo de aquisição.

Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy / Avaliação de imagens de displasia glenoumeral secundária a paralisia obstétrica do plexo braquial

Abstract Objective: To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders. Materials and Methods: We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. Results: The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6º, versus +1.6º for the normal, contralateral limbs. Conclusion: The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head.

Resumo Objetivo: Avaliar os parâmetros de imagem relacionados com a morfologia da articulação glenoumeral em crianças com paralisia obstétrica do plexo braquial (POPB) unilateral, comparando-os com os observados em ombros saudáveis. Materiais e Métodos: Foi realizada uma busca retrospectiva de casos de POPB unilateral diagnosticados em nossa instituição. Somente foram incluídos os pacientes com diagnóstico clínico de POPB unilateral, e a amostra final do estudo consistiu em 10 pacientes consecutivos avaliados por meio de imagens transversais. Foram avaliados a retroversão da cavidade glenoide, a translação da cabeça do úmero e o grau de displasia glenoumeral. Resultados: A média do diâmetro da cabeça do úmero foi 1,93 cm nos membros afetados e 2,33 cm nos membros normais. Em dois casos, não houve deslocamento posterior significativo da cabeça do úmero, cinco casos apresentaram subluxação posterior da cabeça do úmero, e os três casos restantes apresentaram luxação total da cabeça do úmero. A média do ângulo de retroversão glenoide dos membros afetados (90-α) foi -9,6º, ao passo que a dos membros contralaterais normais foi +1,6º. Conclusão: As principais deformidades encontradas neste estudo foram retroversão da cavidade glenoide relacionada com POPB, atraso no desenvolvimento da cabeça do úmero e translação posterior da cabeça do úmero.

The several faces of Schmorl's node: pictorial essay / As diversas faces do nódulo de Schmorl: ensaio pictórico / Las diversas caras del nódulo de Schmorl: ensayo pictórico

The aim of this review is to present the imaging features of Schmorl's node (SN) occurring in conjunction with several etiologies. The SN is a relatively common finding in diagnostic spinal imaging. This condition is usually asymptomatic and its etiology is not always clear. Any disorder that weakens the subchondral bone of the vertebral body may lead to endplate disruption and consequent intravertebral disc herniation. SN is a common finding among asymptomatic patients, but may possibly be accompanied by symptoms in cases of trauma, hemispherical spondylosclerosis, calcific discitis with intravertebral migration, inflammatory diseases and neoplasms. Even though SN is generally associated with benign diseases, its presence does not exclude the possibility of concomitant malignancy in the vertebral body. Radiologists and spine surgeons must be aware of uncommon conditions that might be associated with SNs, as well as related radiological findings, in order to avoid misdiagnosis.

O objetivo desta revisão é apresentar as características de imagem do nódulo de Schmorl (NS) em conjunto com diversas etiologias. O NS é um achado relativamente comum nas imagens diagnósticas da coluna. Essa afecção geralmente é assintomática e sua etiologia nem sempre é clara. Qualquer doença que enfraqueça o osso subcondral do corpo vertebral pode levar à ruptura da placa terminal e, consequentemente, à hérnia intrassomática do disco intervertebral. O NS é comum em pacientes assintomáticos, mas pode eventualmente ser acompanhado de sintomas em casos de trauma, espondiloesclerose hemisférica, discite calcificada com migração intravertebral, doenças inflamatórias e neoplasias. Embora o NS seja, em geral, associado a doenças benignas, sua presença não exclui a possibilidade de doença maligna concomitante no corpo vertebral. Radiologistas e cirurgiões de coluna devem estar cientes das apresentações menos comuns do NS e dos achados radiológicos relacionados, a fim de evitar erros de diagnóstico.

El objetivo de esta revisión es presentar las características de imagen del nódulo de Schmorl (NS) que ocurren en conjunto con varias etiologías. El NS es un hallazgo relativamente común en imágenes diagnósticas de la columna vertebral. Esta condición suele ser asintomática y su etiología no siempre es clara. Cualquier enfermedad que debilita el hueso subcondral del cuerpo vertebral puede conducir a la ruptura de la placa terminal y la consiguiente hernia de disco intervertebral . El NS es un hallazgo frecuente en pacientes asintomáticos, pero, posiblemente, puede estar acompañada de síntomas en casos de trauma, espondiloesclerosis hemisférica, discitis calcificada con migración intravertebral, enfermedades inflamatorias y neoplasias. A pesar de que el NS se asocia generalmente con enfermedades benignas, su presencia no excluye la posibilidad de malignidad concomitante en el cuerpo vertebral. Los radiólogos y cirujanos de columna deben ser conscientes de las presentaciones menos comunes del NS, así como los hallazgos radiológicos relacionados, a fin de evitar un diagnóstico equivocado.

Magnetic resonance imaging of the ischiorectal fossa: spectrum of disease.

OBJECTIVE: Pelvic magnetic resonance imaging (MRI) studies are widely used to assess the rectum, anal canal, and their environment. The purpose of this article is to review the current role of MRI in the evaluation of diseases involving the ischiorectal fossa and their imaging features. CONCLUSIONS: The radiologist plays an essential role in the evaluation of some conditions typically located in this space and of other conditions that occasionally involve this area or invade the ischioanal space. The accurate assessment of these diseases that MRI provides further cements its role as the primary technique for the evaluation of pelvic pathology.

Computed tomography features of acute thrombosis of central veins with perivenous inflammatory changes.

OBJECTIVE: Our purpose was to examine the computed tomographic findings in 13 patients with acute deep venous thrombosis (DVT) of central veins of the neck, chest, and abdomen in whom major perivenous inflammatory changes were noted. METHODS: During a 10-year period, 13 patients with acute DVT of 21 central veins and marked perivenous inflammatory changes on computed tomography were identified. Computed tomography images were assessed for location of DVT and pattern of perivenous changes. RESULTS: The perivenous changes took the form of a rounded or lobulated perivenous bulky mass (massive pattern or tumorlike) in 5 patients and of infiltrative changes in the other 8 patients. Direct visualization of the thrombotic vein was possible in 8 patients. Follow-up examinations (range, 6-36 months; mean, 15 months) demonstrated resolution of perivenous inflammatory changes with anticoagulation therapy in all cases. CONCLUSION: Perivenous inflammatory changes around the thrombotic vein presented as a rounded or lobulated perivenous bulky mass that may mimic a tumor or as infiltrative perivenous changes.