Acetabular labrum: MRI in asymptomatic volunteers.

PURPOSE: The purpose of this study was to describe the MR appearance of the acetabular labrum in asymptomatic hips on high resolution MRI. METHOD: Fifty-two hips in 46 asymptomatic volunteers with an age range of 15-85 years were evaluated with coronal and axial T1-weighted and T2-weighted sequences. The shape, margin, size, and signal intensity of the acetabular labrum were analyzed. RESULTS: The labrum was absent in its anterosuperior aspect in five hips (10%). Intralabral regions of intermediate of high signal intensity were detected in 30 hips (58%) imaged with T1-weighted and proton density-weighted sequences. Intralabral linear hyperintense foci reaching the articular surface and consistent with a labral tear were detected in four labra on T2-weighted images. Intralabral microcysts were seen in three labra. CONCLUSION: The MR appearance of the hip labrum is varied in asymptomatic volunteers. Intralabral increased signal intensity and absent anterosuperior labra are especially frequent and may represent asymptomatic lesions or normal variations.

Percutaneous vertebroplasty in patients with osteolytic metastases or multiple myeloma.

UNLABELLED: Osteolytic metastases and spinal myeloma lesions are difficult to treat because they denote disseminated malignant disease. The pain-relieving and other effects of radiation therapy are delayed. We evaluated short- and medium-term outcomes of vertebroplasty in this indication, in patients with severe or excruciatingly severe pain (McGill-Melsack score 4 or 5) unresponsive to narcotics. PATIENTS AND METHODS: forty vertebras were treated in 37 patients including 29 with bone metastases and eight with multiple myeloma. Mean age was 58 years (range 36-83). The spinal segment involved was the cervical spine in five cases, the thoracic spine in 12 and the lumbar spine in 23. Vertebroplasty was done under fluoroscopy guidance after premedication and local anesthesia. RESULTS: thirty-six patients (97.3%) reported a decrease in their pain 48 hours after the procedure; five of these patients (13.5%) were completely free of pain, 20 (55%) were significantly improved and 11 (30%) were moderately improved. One patient failed to respond. The clinical results were not correlated to the extent of vertebral body filling. Beneficial effects were increased or unchanged in 100% of cases after one month, 88.9% after three months and 75% after six months. Leakage of the cement outside the vertebral body occurred in 29 cases (72.5%), usually into the paraspinal soft tissues (n = 21,52.5%). Leakage was usually clinically silent and only two patients developed severe nerve root pain due to leakage into a neural foramen, with in both instances a favorable outcome after surgery. CONCLUSION: Vertebro- plasty is simple and effective for the treatment of osteolytic metastases and multiple myeloma lesions, but should be performed only in centers with neurosurgical and/or orthopedic surgery units because of the possibility of severe complications.

Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up.

PURPOSE: To determine whether the percentage of vertebral lesion filling and the leakage of methyl methacrylate have any clinical significance at follow-up. MATERIALS AND METHODS: Forty percutaneous vertebroplasties were performed for metastases (30 cases) and myeloma (10 cases) in 37 patients. A computed tomographic scan was obtained 1-8 hours after methyl methacrylate injection and was used to assess the percentage of lesion filling by methyl methacrylate and the leakage of methyl methacrylate into the epidural tissues, neural foramina, intervertebral disks, venous plexus, and paravertebral tissue. The results were correlated with those obtained at clinical follow-up. RESULTS: Partial or complete pain relief was sustained in 36 of 37 patients. Pain relief was not proportional to the percentage of lesion filling. Clinical improvement was maintained in most patients. The 15 epidural leaks, eight intradiskal leaks, and two venous leaks of methyl methacrylate had no clinical importance. Two of eight foraminal leaks produced nerve root compression that required decompressive surgery. One of 21 paravertebral leaks produced transitory femoral neuropathy. CONCLUSION: Pain relief can occur despite insufficient lesion filling. In most patients, intradiskal and paravertebral leaks of cement had no clinical importance.

[Normal and pathological aspects of the glenoid labrum in opaque arthro-scanner]. / Aspects normaux et pathologiques du bourrelet glénoïdien en arthroscanner opaque.

The morphology of the glenoid labrum was studied by CT arthrography in 88 patients. These were divided in 2 groups. In the first group, the patients underwent CT arthrography for a clinical instability of the shoulder. The second group was the reference group to study the morphology of the glenoid labrum, it included patients with rotator cuff tears or other pathology of the shoulder, without clinical instability. We described the normal labrum which presents important morphologic variations. Its study may be difficult because of the proximity of capsular structures of the shoulder, mainly the gleno-humeral ligaments. The normal variants and the pathologic aspects of the labrum were studied: the clefts, tears and degenerative phenomenous. The cleft aspect was studied comparatively in the instable population and in the reference population.