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1.
Eur Radiol ; 33(10): 7330-7337, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37209124

RESUMEN

OBJECTIVES: To determine whether high-resolution ultrasound (US) can identify the course and relations of the medial calcaneal nerve (MCN). METHODS: This investigation was initially undertaken in eight cadaveric specimens and followed by a high-resolution US study in 20 healthy adult volunteers (40 nerves) by two musculoskeletal radiologists in consensus. The location and course of the MCN as well as its relationship to adjacent anatomical structures were evaluated. RESULTS: The MCN was consistently identified by US along its entire course. The mean cross-sectional area of the nerve was 1 mm2 (range 0.5-2). The level at which the MCN branched from the tibial nerve was variable, located a mean of 7 mm (range - 7-60) proximal to the tip of the medial malleolus. At the level of the medial retromalleolar fossa, the MCN was located inside the proximal tarsal tunnel a mean of 8 mm (range 0-16) posterior to the medial malleolus. More distally, the nerve was depicted in the subcutaneous tissue at the surface of the abductor hallucis fascia with a mean direct distance to the fascia of 1.5 mm (range 0.4-2.8). CONCLUSIONS: High-resolution US can identify the MCN at the level of the medial retromalleolar fossa, as well as more distally in the subcutaneous tissue at the surface of the abductor hallucis fascia. In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of nerve compression or neuroma, and perform selective US-guided treatments. CLINICAL RELEVANCE STATEMENT: In the setting of heel pain, sonography is an attractive tool for diagnosing compression neuropathy or neuroma of the medial calcaneal nerve, and enables the radiologist to perform selective image-guided treatments such as diagnostic blocks and injections. KEY POINTS: • The MCN is a small cutaneous nerve which rises from the tibial nerve in the medial retromalleolar fossa to the medial side of the heel. • The MCN can be depicted by high-resolution ultrasound along its entire course. • In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of neuroma or nerve entrapment, and perform selective ultrasound-guided treatments such as steroid injection or tarsal tunnel release.


Asunto(s)
Síndromes de Compresión Nerviosa , Neuroma , Adulto , Humanos , Cadáver , Pie , Nervio Tibial/diagnóstico por imagen , Dolor
2.
Skeletal Radiol ; 52(1): 119-127, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35780259

RESUMEN

Pseudomyogenic hemangioendothelioma (PMH) is a rare vascular tumor that occurs in young mostly male patients. Seventy percent of PMH cases are multifocal and 25% involve bones. PMH is an indolent tumor with mild local aggressiveness and an unclear pathology. Only two cases of spontaneous regressive bone PMH have been reported. Here, we report the case of a 17-year-old boy with a multifocal bone PMH diagnosed from a chronic pain in his left knee. The PMH affected the right scapula, both humeri, the right olecranon, the second metacarpal bone, the second and fourth right ribs, the thoracic and lumbar spine, the pelvic ring, the left and right femoral neck, and the left patella. Every lesion presented with a lobulated, lytic pattern, sometimes with a peripheral sclerotic rim. MRI showed a tissue lesion with a low intensity on T1-weighted sequences and high intensity on T2-weighted sequences. Enhancement of T1 gadolinium fat-saturated sequences was bright. After discussion, a national specialized board decided to actively monitor the patient and start general chemotherapy in the case of progression. The disease was stable at 3 and 6 months and showed signs of regression at 1 year, which was further confirmed at 2 years. CT scan and MRI highlighted a progressive filling of the tumor with cancellous bone and a regression of the tissue contingent. This case report highlights to a new therapeutic approach for indolent PMH that does not prevent further treatment in the case of progression.


Asunto(s)
Hemangioendotelioma , Hemangioma , Neoplasias Vasculares , Humanos , Masculino , Adolescente , Femenino , Hemangioendotelioma/diagnóstico por imagen , Hemangioendotelioma/patología , Rótula/patología , Imagen por Resonancia Magnética
3.
Eur Radiol ; 32(1): 582-592, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34255158

RESUMEN

OBJECTIVES: A recent treatment algorithm suggests that proximal anterior cruciate ligament (ACL) tears with good-to-excellent tissue quality are amenable to primary repair. Our primary objective was to assess the ability of MRI to determine the exact tear location and tissue quality, using arthroscopy as a reference standard. METHODS: In an initial sample of 71 patients with prior ACL surgery (repair or reconstruction), the diagnostic accuracy of MRI was assessed using arthroscopy as a reference standard. Each native ACL tear was graded according to Sherman's arthroscopic classifications during the surgical procedure. MRI scans were retrospectively reviewed for grading, blinded to arthroscopic findings and in consensus by two musculoskeletal radiologists. Tear location and tissue quality were graded using the MRI Sherman tear location (MSTL), MRI Sherman tissue quality (MSTQ) and simplified MRI Sherman tissue quality (S-MSTQ) classifications. Intra- and inter-observer agreement was assessed on a second sample of 77 patients. MRI classification accuracy was compared by McNemar's tests. Intra- and inter-observer agreement was assessed using Cohen's kappa coefficient. RESULTS: Regarding tear location, diagnostic accuracy was 70% (50/71) based on the MSTL classification. Diagnostic accuracy for tissue quality was 52% (15/29) based on the MSTQ classification and 90% (26/29) for the S-MSTQ classification (p = 0.003). Inter-observer agreement was good for MSTL (κ = 0.78) and moderate-to-good for the MSTQ and S-MSTQ classifications (κ = 0.44 and 0.63 respectively). CONCLUSIONS: MRI seems to be accurate in assessing tear location and tissue quality and may help clinicians to predict the reparability of ACL tears. KEY POINTS: • MRI seems to be accurate in assessing tear location and tissue quality and may help clinicians to predict the reparability of ACL tears. • High intra-observer agreement was demonstrated when grading the tear location into one of five types. • The diagnostic accuracy of the simplified MRI tissue quality classification, involving deletion of the ligament stump signal criterion, was better than that observed with the MRI Sherman tissue quality classification, but was moderate to good in terms of inter- and intra-observer agreement.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/diagnóstico por imagen , Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/diagnóstico por imagen , Lesiones del Ligamento Cruzado Anterior/cirugía , Artroscopía , Humanos , Imagen por Resonancia Magnética , Estudios Retrospectivos
4.
Eur Radiol ; 32(12): 8394-8403, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35726103

RESUMEN

OBJECTIVES: To develop a deep-learning algorithm for anterior cruciate ligament (ACL) tear detection and to compare its accuracy using two external datasets. METHODS: A database of 19,765 knee MRI scans (17,738 patients) issued from different manufacturers and magnetic fields was used to build a deep learning-based ACL tear detector. Fifteen percent showed partial or complete ACL rupture. Coronal and sagittal fat-suppressed proton density or T2-weighted sequences were used. A Natural Language Processing algorithm was used to automatically label reports associated with each MRI exam. We compared the accuracy of our model on two publicly available external datasets: MRNet, Bien et al, USA (PLoS Med 15:e1002699, 2018); and KneeMRI, Stajduhar et al, Croatia (Comput Methods Prog Biomed 140:151-164, 2017). Receptor operating characteristics (ROC) curves, area under the curve (AUC), sensitivity, specificity, and accuracy were used to evaluate our model. RESULTS: Our neural networks achieved an AUC value of 0.939 for detection of ACL tears, with a sensitivity of 87% (0.875) and a specificity of 91% (0.908). After retraining our model on Bien dataset and Stajduhar dataset, our algorithm achieved AUC of 0.962 (95% CI 0.930-0.988) and 0.922 (95% CI 0.875, 0.962) respectively. Sensitivity, specificity, and accuracy were respectively 85% (95% CI 75-94%, 0.852), 89% (95% CI 82-97%, 0.894), 0.875 (95% CI 0.817-0.933) for Bien dataset, and 68% (95% CI 54-81%, 0.681), 93% (95% CI 89-97%, 0.934), and 0.870 (95% CI 0.821-0.913) for Stajduhar dataset. CONCLUSION: Our algorithm showed high performance in the detection of ACL tears with AUC on two external datasets, demonstrating its generalizability on different manufacturers and populations. This study shows the performance of an algorithm for detecting anterior cruciate ligament tears with an external validation on populations from countries and continents different from the study population. KEY POINTS: • An algorithm for detecting anterior cruciate ligament ruptures was built from a large dataset of nearly 20,000 MRI with AUC values of 0.939, sensitivity of 87%, and specificity of 91%. • This algorithm was tested on two external populations from different other countries: a dataset from an American population and a dataset from a Croatian population. Performance remains high on these two external validation populations (AUC of 0.962 and 0.922 respectively).


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Aprendizaje Profundo , Humanos , Ligamento Cruzado Anterior , Lesiones del Ligamento Cruzado Anterior/diagnóstico por imagen , Artroscopía , Imagen por Resonancia Magnética/métodos , Estudios Retrospectivos , Sensibilidad y Especificidad
5.
Rheumatol Int ; 42(3): 431-440, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34636939

RESUMEN

Sacroiliitis and spondyloarthritis (SpA) have been associated to sarcoidosis. Sarcoidosis bone involvement of the sacral or iliac bones has been reported to mimic SpA. We aimed to evaluate the prevalence of structural sacroiliitis and structural changes of the sacroiliac joints (SIJ) in patients with sarcoidosis by abdominal-pelvic computed tomography (AP-CT). In this monocentric retrospective study, three blinded readers evaluated AP-CT that had already been performed on patients with sarcoidosis and classified them as normal, degenerative, or inflammatory. A consensus was reached for the divergent cases. Erosion, ankylosis, and sclerosis, classically associated with sacroiliitis, were noted. SpA was defined according to the ASAS 2009 classification criteria. We identified 217 patients with proven sarcoidosis who underwent AP-CT. Only three patients had sacroiliitis by CT and four had SpA, representing 1.38% and 1.85% of the patients, respectively. Degenerative SIJs represented 28.1% of patients and were significantly associated with age, at least one pregnancy, rural lifestyle, ankylosis, diffuse idiopathic skeletal hyperostosis, sclerosis, and the presence of osteophytes. Four patients had axial bone sarcoidosis. Sacroiliitis, SpA, and degenerative changes of the SIJ have been highlighted by AP-CT in patients with sarcoidosis. Osteoarthritis of the SIJ in sarcoidosis was associated with age, pregnancy, and rural lifestyle. Further studies are needed to assess the link between SpA and sarcoidosis.


Asunto(s)
Articulación Sacroiliaca/patología , Sarcoidosis/patología , Espondiloartritis/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Prevalencia , Estudios Retrospectivos , Articulación Sacroiliaca/diagnóstico por imagen , Sarcoidosis/diagnóstico por imagen , Sarcoidosis/epidemiología , Espondiloartritis/diagnóstico por imagen , Espondiloartritis/epidemiología , Tomografía Computarizada por Rayos X/métodos
6.
J Magn Reson Imaging ; 49(3): 768-776, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30194746

RESUMEN

BACKGROUND: A limited number of studies have used the intravoxel incoherent motion (IVIM) approach on bone marrow. In none of the previous studies were the effects of fat suppression on the IVIM parameters investigated. PURPOSE: To measure the water diffusion coefficient and the perfusion fraction in vertebral bone marrow using IVIM with multishot, readout-segmented (RESOLVE) echo-planar imaging and to assess the effects of different fat suppression techniques on the measurement of the IVIM parameters. STUDY TYPE: Prospective. POPULATION/SUBJECTS: Six healthy volunteers (24.2 ± 4.3 years). FIELD STRENGTH/SEQUENCE: 1.5T, RESOLVE. ASSESSMENT: Four experiments were performed: 1) RESOLVE imaging without fat suppression, 2) with fat saturation (FS), 3) with spectral attenuated inversion recovery (SPAIR), and 4) with short-tau inversion recovery (STIR). The water diffusion coefficient D, pseudo-diffusion coefficient D*, and the perfusion fraction f were assessed in the vertebral bodies of the lumbar vertebrae. STATISTICAL TESTS: One-way repeated-measures analysis of variance (ANOVA) followed by Bonferroni's multiple comparison test. RESULTS: The RESOLVE IVIM protocol allowed for measurement of D, D*, and f in all volunteers. The signal of lipid protons affected the quantification of the IVIM diffusion coefficient: D = 0.24 ± 0.10 (×10-3 mm2 /s), no FS; D = 0.43 ± 0.07 (×10-3 mm2 /s), FS; D = 0.42 ± 0.07 (×10-3 mm2 /s), SPAIR; D = 0.35 ± 0.10 (×10-3 mm2 /s), STIR; and IVIM perfusion fraction f = 7.5 ± 1.9% no FS, f = 14.5 ± 5.4%, FS; f = 12.5 ± 2.6%, SPAIR; f = 18.1 ± 6.1%, STIR. No significant effect (P = 0.36) was found on the quantification of D*. DATA CONCLUSION: An IVIM-MRI protocol using the RESOLVE sequence was implemented for measurements of vertebral bone marrow diffusion and the perfusion. The comparison between the protocols with and without fat suppression indicates that the lipid signal results in an underestimation of both D and f. LEVEL OF EVIDENCE: Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2019;49:768-776.


Asunto(s)
Médula Ósea/diagnóstico por imagen , Imagen Eco-Planar , Columna Vertebral/diagnóstico por imagen , Tejido Adiposo/diagnóstico por imagen , Adulto , Algoritmos , Imagen de Difusión por Resonancia Magnética , Femenino , Voluntarios Sanos , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Movimiento (Física) , Perfusión , Estudios Prospectivos , Reproducibilidad de los Resultados , Relación Señal-Ruido , Adulto Joven
7.
Eur Radiol ; 29(1): 40-45, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29922929

RESUMEN

PURPOSE: To determine whether ultrasound allows precise assessment of the course and relations of the medial plantar proper digital nerve (MPPDN). MATERIALS AND METHODS: This work was initially undertaken in six cadaveric specimens and followed by a high-resolution ultrasound study in 17 healthy adult volunteers (34 nerves) by two musculoskeletal radiologists in consensus. Location and course of the MPPDN and its relationship to adjacent anatomical structures were analysed. RESULTS: The MPPDN was consistently identified by ultrasound along its entire course. Mean cross-sectional area of the nerve was 0.8 mm2 (range 0.4-1.4). The MPPDN after it branches from the medial plantar nerve was located a mean of 22 mm (range 19-27) lateral to the medial border of the medial cuneiform. More distally, at the level of the first metatarsophalangeal joint, mean direct distances between the nerve and the first metatarsal head and the medial hallux sesamoid were respectively 3 mm (range 1-8) and 4 mm (range 2-9). CONCLUSION: The MPPDN can be depicted by ultrasonography. Useful bony landmarks for its detection could be defined. Precise mapping of its anatomical course may have important clinical applications. KEY POINTS: • The medial plantar proper digital nerve (MPPDN) rises from the medial plantar nerve to the medial side of the hallux. • Because of its particularly long course and superficial position, the MPPDN may be subject to trauma, resulting in a condition known as Joplin's neuroma. • The MPPDN can be clearly depicted by ultrasound along its entire course. Precise mapping of its anatomical course may have important clinical applications.


Asunto(s)
Hallux/diagnóstico por imagen , Articulación Metatarsofalángica/inervación , Nervio Tibial/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Anciano de 80 o más Años , Cadáver , Femenino , Hallux/inervación , Voluntarios Sanos , Humanos , Masculino , Articulación Metatarsofalángica/diagnóstico por imagen , Adulto Joven
8.
J Ultrasound Med ; 38(9): 2457-2467, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30690764

RESUMEN

OBJECTIVES: Subcutaneous neuromas usually result from trauma and may lead to dissatisfaction in patients with a trigger point, loss of sensitivity in the relevant territory of innervation, and spontaneous neuropathic pain. Confirming clinically suspected cases of neuroma may prove difficult. The objective of this study was to evaluate the visibility and morphologic features of traumatic subcutaneous neuromas of the limbs with ultrasound (US). METHODS: Between January 2012 and August 2016, 38 consecutive patients clinically suspected of having subcutaneous neuromas were investigated with US. The diagnosis was confirmed on the basis of a focal morphologic abnormality of the nerve associated with trigger pain. Each neuroma was classified into 1 of 3 subtypes based on its injury pattern. The subtypes were terminal neuroma, spindle neuroma, and scar encasement, either isolated or associated with these subtypes. RESULTS: Forty-four lesions were found in the 38 patients, including 29 spindle neuromas (65.9%), 14 terminal neuromas (31.8%) and 1 scar encasement with no nerve caliber abnormality (2.3%). Fifteen neuromas (35% of all neuromas) were associated with scar encasement. In 13 cases that required surgery, the diagnosis of neuroma or scar encasement could be surgically proven and confirmed the validity of the US findings. CONCLUSIONS: Ultrasound can be used to show and classify subcutaneous nerves of the upper and lower limbs with high accuracy. The US trigger sign provides an indication of neuroma involvement in pain. This modality can play a substantial role both in the preoperative planning of neuroma surgery and in therapeutic US-guided procedures.


Asunto(s)
Neuroma/complicaciones , Neuroma/diagnóstico por imagen , Dolor/etiología , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Grasa Subcutánea/lesiones , Ultrasonografía/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuroma/fisiopatología , Dolor/fisiopatología , Neoplasias de los Tejidos Blandos/fisiopatología , Grasa Subcutánea/diagnóstico por imagen , Grasa Subcutánea/fisiopatología , Adulto Joven
9.
J Ultrasound Med ; 37(6): 1439-1446, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29171058

RESUMEN

OBJECTIVES: To assess visibility of the acetabular cup in total hip replacement and to determine the value of direct and indirect signs of iliopsoas impingement syndrome with ultrasound. METHODS: Ultrasound examinations were performed by a single operator in 17 patients with iliopsoas impingement syndrome and 48 control patients. Cup visibility, contact between the cup and psoas tendon, and the presence of indirect signs of iliopsoas impingement syndrome were investigated in all patients. When the acetabular cup was visible, its size and position in relation to the psoas tendon were recorded. RESULTS: Anterior cup visibility (P = .03), contact with the psoas tendon (P < .001), psoas tendinopathy (P = .02), and iliopsoas bursitis (P < .001) were significantly associated with iliopsoas impingement syndrome, the latter reported with specificity of 100%. In the sagittal plane at the level of the psoas tendon, a maximum sagittal length of greater than 5 mm and a posteroanterior cup shift of 3 mm or greater yielded respective sensitivities of 82% and 59% and specificities of 81% and 100%. CONCLUSIONS: When iliopsoas impingement syndrome is clinically suspected, the presence of iliopsoas bursitis or a posteroanterior cup shift of greater than 3 mm under the psoas tendon serve to confirm the diagnosis. In the absence of these conditions, a therapeutic test may be necessary because of the incomplete, albeit high, specificity of other signs.


Asunto(s)
Acetábulo/diagnóstico por imagen , Artroplastia de Reemplazo de Cadera , Articulación de la Cadera/diagnóstico por imagen , Tendinopatía/diagnóstico por imagen , Tendones/diagnóstico por imagen , Ultrasonografía/métodos , Acetábulo/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Articulación de la Cadera/patología , Humanos , Masculino , Persona de Mediana Edad , Síndrome , Tendinopatía/patología , Tendones/patología
10.
Skeletal Radiol ; 47(8): 1051-1068, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29549379

RESUMEN

Lesion to subcutaneous nerves is a well-known risk of orthopedic surgery and a significant cause of postoperative pain and dissatisfaction in patients. High-resolution ultrasound can be used to visualize the vast majority of small subcutaneous nerves of the upper and lower limbs. Ultrasound detects nerve abnormalities such as focal hypoechoic thickening, stump neuroma, and scar encasement, and provides information not only about the peripheral nerve itself but also about its relationship to adjacent anatomical structures. The purpose of this review is to provide an overview of the anatomy of the main subcutaneous nerves damaged during orthopedic surgery, recall at-risk procedures, and offer useful anatomic landmarks to help the sonographer identify and follow the nerves when an iatrogenic lesion is suspected.


Asunto(s)
Neuroma/diagnóstico por imagen , Procedimientos Ortopédicos/efectos adversos , Traumatismos de los Nervios Periféricos/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Piel/inervación , Ultrasonografía , Brazo/diagnóstico por imagen , Brazo/inervación , Humanos , Pierna/diagnóstico por imagen , Pierna/inervación , Neuroma/etiología , Traumatismos de los Nervios Periféricos/etiología , Complicaciones Posoperatorias/etiología
11.
J Magn Reson Imaging ; 44(3): 549-55, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-26918280

RESUMEN

PURPOSE: To assess the feasibility of measuring the fat fraction, T1 and T2 * relaxation times of water and fat signals in vertebral bone marrow using breath-hold magnetic resonance imaging (MRI) gradient echo images of the spine. MATERIALS AND METHODS: MRI experiments were performed at 1.5T on eight healthy volunteers (35.1 ± 15.7 years, five men and three women) using two sagittal four-echo 3D gradient echo volumetric interpolated breath-hold examination (VIBE Dixon) sequences acquired at two different flip angles (5° and 15°). The water/fat decomposition was performed in the vertebral bodies of L1 to L5 by fitting the signal to a function that depends on the echo time and the flip angle to calculate the fat fraction (FF) and T1 and T2 * relaxation times of water and fat signals. Repeatability was assessed by scanning one volunteer six times. RESULTS: The mean fat fraction over L1 to L5 was 33 ± 8%. The mean T1 and T2 * of water and fat signals were respectively T1w = 701 ± 151 msec, T2 *w = 13.7 ± 2.9 msec, T1f = 334 ± 113 msec, and T2 *f = 11.4 ± 2.7 msec. When considering each vertebra separately, the fat fraction increased from L1 to L5 and the T1w decreased from L1 to L5. The mean coefficients of variation obtained from the repeatability study were 8% (FF), 11% (T1w ), 17% (T1f ), 8% (T2 *w ), and 27% (T2 *f ). CONCLUSION: The method introduced in the current study allows for the measurement of the fat fraction and water and fat relaxation times, with a total acquisition time of less than 40 seconds. J. Magn. Reson. Imaging 2016;44:549-555.


Asunto(s)
Tejido Adiposo/diagnóstico por imagen , Agua Corporal/diagnóstico por imagen , Médula Ósea/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador/métodos , Vértebras Lumbares/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Tejido Adiposo/fisiología , Adiposidad/fisiología , Adulto , Agua Corporal/fisiología , Médula Ósea/fisiología , Estudios de Factibilidad , Femenino , Humanos , Aumento de la Imagen/métodos , Vértebras Lumbares/fisiología , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Mecánica Respiratoria , Sensibilidad y Especificidad , Adulto Joven
12.
Skeletal Radiol ; 44(2): 223-31, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25179795

RESUMEN

OBJECTIVE: To describe the aponeurotic expansion of the supraspinatus tendon with anatomic correlations and determine its prevalence in a series of patients imaged with MRI. MATERIALS AND METHODS: In the first part of this HIPAA-compliant and IRB-approved study, we retrospectively reviewed 150 consecutive MRI studies of the shoulder obtained on a 1.5-T system. The aponeurotic expansion at the level of the bicipital groove was classified as: not visualized (type 0), flat-shaped (type 1), oval-shaped and less than 50% the size of the adjacent long head of the biceps section (type 2A), or oval-shaped and more than 50% the size of the adjacent long head of the biceps section (type 2B). In the second part of this study, we examined both shoulders of 25 cadavers with ultrasound. When aponeurotic expansion was seen at US, a dissection was performed to characterize its origin and termination. RESULTS: An aponeurotic expansion of the supraspinatus located anterior and lateral to the long head of the biceps in its groove was clearly demonstrated in 49% of the shoulders with MRI. According to our classification, its shape was type 1 in 35%, type 2A in 10 % and type 2B in 4%. This structure was also identified in 28 of 50 cadaveric shoulders with ultrasound and confirmed at dissection in 10 cadavers (20 shoulders). This structure originated from the most anterior and superficial aspect of the supraspinatus tendon and inserted distally on the pectoralis major tendon. CONCLUSION: The aponeurotic expansion of the supraspinatus tendon can be identified with MRI or ultrasound in about half of the shoulders. It courses anteriorly and laterally to the long head of the biceps tendon, outside its synovial sheath.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Articulación del Hombro/anomalías , Articulación del Hombro/patología , Tendones/anomalías , Tendones/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Anatómicos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto Joven
13.
AJR Am J Roentgenol ; 203(6): 1280-5, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25415706

RESUMEN

OBJECTIVE: In some cases, sciatica-like symptoms radiating through the buttock, anterior thigh, or leg result from spinal root compression in an extraspinal location or from injury to the pelvic girdle. It has been suggested that adding a coronal STIR sequence dedicated to the lumbosacral plexus and pelvis to the routine MRI protocol can provide a good depiction of disorders of this type. MATERIALS AND METHODS: Two hundred nine patients with sciatica-like symptoms of suspected lumbar origin were included in the study. Disorders responsible for symptoms involving extraspinal compression of the lumbosacral plexus or pelvic girdle were retrospectively noted and correlated with age, sex, location of pain, referring physician, presence of discoradicular impingement liable to explain symptoms, and history of neoplasia. RESULTS: An extraspinal cause of symptoms was depicted in 12 cases (5.7%), including three cases of extraspinal compression and nine differential diagnoses in the pelvic region. Prevalence of an extraspinal cause of pain was significantly correlated with the absence of discoradicular impingement in the spine (p=0.046). A higher prevalence of extraspinal compression of the lumbosacral plexus (p=0.029) was seen in patients 60 years old or older, whereas no other feature was statistically associated with an extraspinal cause of pain. CONCLUSION: Because of its short acquisition time and subsequent low cost, the additional coronal STIR sequence should be performed in the routine MRI investigation of sciatica-like symptoms when no discoradicular impingement is seen in the spine to depict an extraspinal cause of symptoms.


Asunto(s)
Interpretación de Imagen Asistida por Computador/métodos , Pierna/patología , Plexo Lumbosacro/patología , Imagen por Resonancia Magnética/métodos , Dolor/patología , Huesos Pélvicos/patología , Ciática/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Aumento de la Imagen/métodos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto Joven
14.
AJR Am J Roentgenol ; 202(4): 828-38, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24660713

RESUMEN

OBJECTIVE: This article provides an overview of the typical appearance of biomechanical and physiologic changes in pregnancy and an update on related pathophysiology. Conditions occurring during the childbearing, delivery and postpartum periods will be reported separately. CONCLUSION: Pregnancy causes biomechanical and physiologic changes that may be responsible for a wide spectrum of musculoskeletal disorders in the mother.


Asunto(s)
Diagnóstico por Imagen , Enfermedades Musculoesqueléticas/diagnóstico , Complicaciones del Embarazo/diagnóstico , Adulto , Fenómenos Biomecánicos , Parto Obstétrico , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Musculoesqueléticas/fisiopatología , Periodo Posparto/fisiología , Embarazo , Complicaciones del Embarazo/fisiopatología
15.
Eur Spine J ; 23(5): 1150-5, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24363041

RESUMEN

PURPOSE: Anterior iliac crest bone is a widely used donor site for bone harvesting. It provides an autologous bone graft consisting of cancellous bone that can be packed or cortical bone with greater structural support. Uses include spinal fusion and fracture non-union surgery. Although its use is common, dedicated anatomical and radiological studies analysing graft dimensions and optimal harvesting site in relation to local anatomical landmarks [anterior superior iliac spine (ASIS), anterior iliac tubercle (AIT) and lateral femoral cutaneous nerve (LFCN)] have not been described. METHODS: Twenty-eight female hemipelvises were dissected for this study. The LFCN, ASIS and AIT were identified. Calliper measurements and CT scan analysis were undertaken to determine the optimum positions in obtaining a 5-mm-thickness tricortical graft whilst remaining safe for the LFCN. RESULTS: According to our measurements, the optimal location for harvesting a 5-mm-thick tricortical graft with 35-mm height and 47-mm width is situated anterior to a line passing at the level of the thickest point of the AIT. This thickest point was situated at a mean 67 mm from the centre of the EIAS in our study. CONCLUSION: This anatomical and radiographic study determined the anatomical iliac crest landmarks to avoid neurological injury when taking an optimal 5-mm-width tricortical bone graft.


Asunto(s)
Trasplante Óseo/métodos , Ilion/anatomía & histología , Anciano , Cadáver , Femenino , Humanos , Ilion/diagnóstico por imagen , Ilion/trasplante , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
16.
Eur Spine J ; 23(7): 1515-22, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24781380

RESUMEN

PURPOSE: Non-traumatic cervical chronic joint instability in young adults is a rare and underexplored entity. We assessed the diagnostic relevance of dynamic MRI, and the clinical and radiological outcome after anterior cervical interbody fusion (ACIF) in these cases. METHODS: Six young patients (mean age 34 years) with cervical myelopathy without compression on static imaging had a dynamic MRI. Joint instability was defined by a reduction of the canal diameter on dynamic sequences. Clinical and radiological outcomes were assessed after surgery by examination, cervical X-rays, static and dynamic MRI. RESULTS: All the patients had joint instability. Four patients underwent surgery. Clinical status improved 1 year after surgery. All patients had a satisfactory fusion at 6-month follow-up and no residual compression at 1 year. CONCLUSION: Dynamic MRI can help detect a joint instability in young patients with cervical myelopathy without compression. ACIF seems to be efficient in these cases.


Asunto(s)
Vértebras Cervicales/cirugía , Inestabilidad de la Articulación/diagnóstico , Imagen por Resonancia Magnética , Compresión de la Médula Espinal/diagnóstico , Fusión Vertebral , Adulto , Femenino , Humanos , Inestabilidad de la Articulación/cirugía , Imagen por Resonancia Magnética/métodos , Masculino , Compresión de la Médula Espinal/cirugía , Estenosis Espinal/clasificación , Estenosis Espinal/diagnóstico , Estenosis Espinal/cirugía
17.
Skeletal Radiol ; 42(10): 1361-75, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23784480

RESUMEN

The deltoid is a fascinating muscle with a significant role in shoulder function. It is comprised of three distinct portions (anterior or clavicular, middle or acromial, and posterior or spinal) and acts mainly as an abductor of the shoulder and stabilizer of the humeral head. Deltoid tears are not infrequently associated with large or massive rotator cuff tears and may further jeopardize shoulder function. A variety of other pathologies may affect the deltoid muscle including enthesitis, calcific tendinitis, myositis, infection, tumors, and chronic avulsion injury. Contracture of the deltoid following repeated intramuscular injections could present with progressive abduction deformity and winging of the scapula. The deltoid muscle and its innervating axillary nerve may be injured during shoulder surgery, which may have disastrous functional consequences. Axillary neuropathies leading to deltoid muscle dysfunction include traumatic injuries, quadrilateral space and Parsonage-Turner syndromes, and cause denervation of the deltoid muscle. Finally, abnormalities of the deltoid may originate from nearby pathologies of subdeltoid bursa, acromion, and distal clavicle.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Músculo Esquelético , Enfermedades Musculares/diagnóstico , Articulación del Hombro , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/lesiones , Músculo Esquelético/patología , Lesiones del Hombro , Articulación del Hombro/patología , Articulación del Hombro/efectos de la radiación
18.
Eur J Surg Oncol ; 49(10): 107012, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37572589

RESUMEN

INTRODUCTION: The distinction between lipoma and well-differentiated liposarcoma (WDLPS), or "atypical lipomatous tumor" (ALT), is crucial as it impacts patient management. A group of European experts led by Benjamin Moulin recently issued a consensus report to define the role of radiology in managing these lesions. It describes an algorithm defining the criteria prompting a diagnostic biopsy of deep lipomatous tumors of the limbs and chest wall. The primary aim of this study was to evaluate the algorithm's diagnostic performance. MATERIALS AND METHODS: Between 2012 and 2019, all biopsies of deep fatty tumors of the limbs or chest wall with a pre-biopsy MRI assessment were recorded at our institution. The MRI scans were reviewed by two radiologists. Each lesion was classified according to biopsy status by applying the algorithm of the European panel. The algorithm's diagnostic performance was assessed by calculating the sensitivity, specificity, positive predictive value and negative predictive value. Inter-rater agreement was also assessed. RESULTS: Of the 156 tumors in our study, 148 (94.9%) required a biopsy, and the algorithm's sensitivity for detecting ALT/WDLPS was 100% with specificity of 6.3% and a PPV of 20.3%. Inter-rater agreement was almost perfect with a kappa value of 0.882. CONCLUSION: The European algorithm demonstrates perfect sensitivity, an important criterion for a screening examination such as MRI in this setting. The algorithm's low specificity, however, emphasizes the need for further studies to redefine the optimum size cut-off value, especially for lesions without atypical criteria or an anatomical location at risk of post-surgical recurrence.


Asunto(s)
Lipoma , Liposarcoma , Neoplasias de los Tejidos Blandos , Adulto , Humanos , Estudios Retrospectivos , Liposarcoma/diagnóstico por imagen , Liposarcoma/patología , Lipoma/diagnóstico por imagen , Lipoma/patología , Biopsia , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/patología , Diagnóstico Diferencial
19.
AJR Am J Roentgenol ; 199(1): 142-50, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22733905

RESUMEN

OBJECTIVE: The purpose of this article is to illustrate the causes of snapping knee. The value of imaging techniques is discussed with an emphasis on dynamic sonography in light of the available surgical and radiologic literature. CONCLUSION: Because of its dynamic capabilities, dynamic sonography provides real-time visualization of snapping knee syndrome and may be used as a first-line modality.


Asunto(s)
Artropatías/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Prótesis de la Rodilla , Meniscos Tibiales/diagnóstico por imagen , Neoplasias Óseas/diagnóstico por imagen , Diagnóstico Diferencial , Análisis de Falla de Equipo , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Cuerpos Libres Articulares/diagnóstico por imagen , Rodilla/diagnóstico por imagen , Síndrome , Sinovitis/diagnóstico por imagen , Atrapamiento del Tendón/diagnóstico por imagen , Ultrasonografía
20.
J Ultrasound Med ; 31(9): 1457-63, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22922627

RESUMEN

The purpose of this pictorial essay is to describe the sonographic appearance of orthopedic hardware impingement of the extremities. Sonography is not limited by metallic artifacts, can show the orthopedic hardware, and can be used to assess damage of adjacent soft tissues, including tendons, synovial bursas, muscles, nerves, and vessels. Its dynamic capabilities permit assessment of orthopedic hardware impingement present only in certain joint positions, during muscle contractions, and during tendon movements. Local pain elicited with application of pressure from the transducer confirms the diagnosis. Sonographically guided injections of steroid-anesthetic mixtures have both diagnostic and therapeutic effects.


Asunto(s)
Extremidades/diagnóstico por imagen , Extremidades/cirugía , Enfermedades Musculoesqueléticas/diagnóstico por imagen , Dispositivos de Fijación Ortopédica/efectos adversos , Lesiones del Sistema Vascular/diagnóstico por imagen , Artefactos , Medios de Contraste , Humanos , Traumatismos de los Tendones/diagnóstico por imagen , Ultrasonografía
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