Quantitative characterization of metacarpal and radial bone in rheumatoid arthritis using high resolution- peripheral quantitative computed tomography.

AIM: The objectives of this study were: (i) to develop a standardized method of quantifying bone mineral density (BMD) and microarchitecture in the hand and wrist bones of patients with rheumatoid arthritis (RA) using high resolution- peripheral quantitative computed tomography (HR-pQCT); (ii) to compare quantitative bone parameters between RA and post-menopausal osteopenic (PM-OP) subjects; and (iii) to correlate quantitative bone parameters at the distal radius with those at the metacarpal heads in RA subjects. METHODS: HR-pQCT imaging of the dominant hand and wrist was performed in 12 female RA patients. BMD and trabecular parameters for the 2-12% head region of the second and third metacarpals were calculated and compared between RA patients and healthy controls. Bone parameters were also calculated for 110 slices of the distal radius in RA patients and compared to data from controls and PM-OP women from a previous study. RESULTS: Compared to controls, RA patients had significantly decreased BMD, trabecular volume and number, and increased trabecular heterogeneity in the third metacarpal and distal radius. Significantly lower trabecular number and significantly higher ratio of outer annular trabecular BMD to inner trabecular BMD were observed in patients with RA, compared to patients with osteopenia (P < 0.05). Trabecular BMD in the third metacarpal and in the distal radius were significantly correlated (ρ = 0.918, P < 0.0001) in RA patients. CONCLUSION: This study established a standardized method for quantifying bone density and trabecular properties in the hand and wrist bones of RA patients using HR-pQCT. Deterioration of bone structure in RA patients was found comparable to that in osteopenic women, and trabecular bone loss near affected joints was found to be correlated with bone loss away from joints.

Correlation of structural abnormalities of the wrist and metacarpophalangeal joints evaluated by high-resolution peripheral quantitative computed tomography, 3 Tesla magnetic resonance imaging and conventional radiographs in rheumatoid arthritis.

AIM: In rheumatoid arthritis (RA) hands, we applied high-resolution peripheral quantitative computed tomography (HR-pQCT) and 3 Tesla (3 T) magnetic resonance imaging (MRI), which are new methods for erosion detection and bone marrow edema (BME) quantification. We compared the erosion measurements between these techniques with conventional radiographs (CR) in order to examine their significance for evaluating structural abnormalities. METHODS: In 16 RA patients, HR-pQCT of metacarpophalangeal and wrist joints, 3 T MRI of wrist joints, as well as CR in both hands and feet were performed. Ten patients had 1-year follow-up CR. CRs were graded according to the modified Sharp score (MSS). Bone erosions were evaluated in HR-pQCT and MRI. BME pattern was quantified from MRI for volume, signal change and total burden. RESULTS: The erosion detection sensitivity of MRI was 85.7% and CR was 60.9% when HR-pQCT was considered as a reference method. The smallest dimensions of erosion detected by HR-pQCT, MRI and CR were 0.09, 0.14 and 0.66 cm, respectively. Baseline total MSS was correlated with HR-pQCT erosion measures, MRI erosion measures and MRI BME volume (P < 0.05). The mean difference between baseline and 1-year follow-up MSS (delta MSS) was 1.2. A trend was observed toward a correlation between delta MSS and MRI BME volume and burden. CONCLUSION: This study demonstrates that HR-pQCT detects more and smaller bone erosions compared to MRI and CR. In addition, 3 T MRI can provide quantitative measurement of BME. Combination of HR-pQCT and MRI modalities may provide powerful tools to evaluate joint inflammation and bone damage in RA.

MR T(1)ρ quantification of cartilage focal lesions in acutely injured knees: correlation with arthroscopic evaluation.

OBJECTIVE: Quantitative T1ρ MRI has been suggested as a promising tool to detect changes in cartilage composition that are characteristic of cartilage damage and degeneration. The objective of this study was to evaluate the capability of MR T1ρ to detect cartilage lesions as evaluated by arthroscopy in acutely ACL-injured knees and to compare with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) using clinical standard MRI. METHOD: Ten healthy controls (mean age 35) with no ACL injury or history of osteoarthritis (OA) and 10 patients with acute ACL injuries (mean age 39) were scanned at 3 Tesla (3T). ACL patients underwent ACL reconstruction, where focal lesions were graded according to an Outerbridge grading system during arthroscopic evaluation. Normalized MR T1ρ values (T1ρ z-scores normalized to control values in matched regions) in full thickness, and superficial and deep layers of cartilage were compared between defined sub-compartments with and without focal lesions. Intraclass (ICC) correlation and the root mean square coefficient of variation (RMS-CV) were performed to evaluate the inter-observer reproducibility of T1ρ quantification. Sub-compartments of cartilage were also evaluated using WORMS scoring and compared to their Outerbridge score respectively. RESULTS: The inter-observer ICC and the RMS-CV of the sub-compartment T1ρ quantification were 0.961 and 3.9%, respectively. The average T1ρ z-scores were significantly increased in sub-compartments with focal lesions compared to those without focal lesions and to the control cohort (p<0.05). CONCLUSION: Our results indicate that T1ρ provided a better diagnostic capability than clinical standard MRI grading in detecting focal cartilage abnormalities after acute injuries. Quantitative MRI may have great potential in detecting cartilage abnormalities and degeneration non-invasively, which are occult with standard morphological MRI.

Cartilage lesion score: comparison of a quantitative assessment score with established semiquantitative MR scoring systems.

PURPOSE: To describe a scoring system for quantification of cartilage lesions (Cartilage Lesion Score [CaLS]), to determine its reproducibility, to examine the association of CaLS-detected longitudinal change with known risk factors for osteoarthritis (OA) progression by comparing a group of subjects with OA risk factors with a group of subjects without OA risk factors, and to compare the CaLS system with the established semiquantitative Whole-Organ Magnetic Resonance Imaging Score (WORMS) and Boston-Leeds Osteoarthritis Knee Score (BLOKS) systems in terms of detection of cartilage defect progression. MATERIALS AND METHODS: All subjects provided written informed consent, and the local institutional review board approved this HIPAA-compliant study. Fifty-two subjects with and 25 subjects without risk factors for knee OA were randomly selected from the Osteoarthritis Initiative. Inclusion criteria were age of 45-60 years, body mass index of 19-27 kg/m(2), and no knee pain or OA on radiographs at baseline. Baseline and 24-month follow-up right knee 3-T magnetic resonance images were analyzed with WORMS, BLOKS, and CaLS systems. Progression of cartilage lesions with each scoring system was compared by using multilevel mixed-effects linear-regression models. κ values were calculated to determine reliability. RESULTS: Intraclass coefficient values for inter- and intraobserver reliability of the CaLS system were 0.86 and 0.91, respectively. Interobserver κ value range for individual features was 0.81-0.94. The CaLS system enabled significantly higher detection of cartilage lesion progression than did WORMS or BLOKS systems (P < .001); 51.8% (56 of 108), 17.6% (19 of 108), and 13.0% (14 of 108) of the lesions progressed when analyzed with the CaLS, WORMS, and BLOKS systems, respectively. With the CaLS system, subjects with OA risk factors had significantly higher odds of progression than did subjects without risk factors (odds ratio, 2.78; P = .005). CONCLUSION: The CaLS system is a reproducible scoring system for cartilage lesions that yields an improved detection rate for monitoring progression when compared with detection rates of semiquantitative WORMS and BLOKS systems.

Bone marrow changes related to disuse.

OBJECTIVES: To evaluate bone marrow changes on knee magnetic resonance imaging (MRI) in patients with 3- to 6-week-long period of unloading. METHODS: MRI knee examinations were performed in 30 patients (14 men, 16 women; aged 20-53 years) at baseline and 5-10 weeks after immobilisation of the ipsilateral lower extremity; subsets of patients were examined at additional time-points. Ten volunteers (4 men, 6 women; aged 20-50 years) were studied as control cohort at two time-points. Bone marrow signal abnormalities were analysed according to: (1) severity, (2) signal alteration relative to hyaline cartilage, (3) morphology, (4) increased vascularity in the knee joint and (5) T1-signal alteration. Spearman's rank correlation test (SRC) and Kendall's tau (KT) were used to compare individual scores. RESULTS: All 30 patients presented abnormal bone marrow findings after unloading, which reached a peak at 10-25 weeks (P <0.001). These findings decreased within 1 year (P < 0.001). High scores of severity were associated with confluent and patchy patterns of bone marrow (SCR = 0.923, P < 0.001 and KT = 0.877, P <0.001). CONCLUSIONS: Signal abnormalities of the bone marrow related to unloading are consistent findings and most prominent 10-25 weeks following immobilisation when both confluent and patchy hyperintense patterns are present.

Association of frequent knee bending activity with focal knee lesions detected with 3T magnetic resonance imaging: data from the osteoarthritis initiative.

OBJECTIVE: To evaluate the association of baseline frequent knee bending activities with the prevalence and progression of cartilage and meniscal abnormalities over 3 years and to assess the effect of frequent knee bending on the different knee compartments with 3T magnetic resonance imaging (MRI). METHODS: We studied 115 subjects without radiographic knee osteoarthritis (OA) but with risk factors for OA from the Osteoarthritis Initiative database. The inclusion criteria at baseline were age 45-55 years, body mass index of 19-27 kg/m(2) , Western Ontario and McMaster Universities Osteoarthritis Index pain score of 0, and Kellgren/Lawrence grade <2. Knee bending activities (kneeling, squatting, stair climbing, and weight lifting) were assessed by questionnaire at the baseline clinic visit. Cartilage and meniscal abnormalities were graded using the Whole-Organ MRI Score. Logistic regression was used to determine the association of frequent knee bending with cartilage and meniscal abnormalities. RESULTS: Frequent knee bending activities were associated with an increased risk of prevalent cartilage lesions (odds ratio [OR] 3.63, 95% confidence interval [95% CI] 1.39-9.52), in particular in the patellofemoral compartment (OR 3.09, 95% CI 1.22-7.79). The increase in risk was higher in subjects involved in ≥2 knee bending activities. At 3-year followup, individuals reporting frequent knee bending were more likely to show progression of cartilage damage (OR 4.12, 95% CI 1.27-13.36) and meniscal abnormalities (OR 4.34, 95% CI 1.16-16.32). CONCLUSION: Frequent knee bending activities were associated with a higher prevalence of knee cartilage lesions (particularly in the patellofemoral compartment) and with an increased risk of progression of cartilage and meniscal lesions in asymptomatic middle-aged subjects.

Quantitative and semiquantitative bone erosion assessment on high-resolution peripheral quantitative computed tomography in rheumatoid arthritis.

OBJECTIVE: To develop novel quantitative and semiquantitative bone erosion measures at metacarpophalangeal (MCP) and wrist joints in patients with rheumatoid arthritis (RA) using high-resolution peripheral quantitative computed tomography (HR-pQCT), and to correlate these measurements with disease duration and bone marrow edema (BME) patterns derived from magnetic resonance imaging (MRI). METHODS: Sixteen patients with RA and 7 healthy subjects underwent hand and wrist HR-pQCT and 3-Tesla MRI. Bone erosions of the MCP2, MCP3, and distal radius were evaluated by measuring maximal erosion dimension on axial slices, which is a simple and fast measurement, and then were graded (grades 0-3) based on the maximal dimension. Correlation coefficients were calculated between (1) sum maximal dimensions, highest grades, and sum grades of bone erosions; (2) erosion measures and the clinical evaluation; (3) erosion measures and BME volume in distal radius. RESULTS: The inter- and intrareader agreements of maximal erosion dimensions were excellent (intraclass correlation coefficients 0.89, 0.99, and root mean square error 9.4%, 4.7%, respectively). Highest grades and sum grades were significantly correlated to sum maximal dimensions of all erosions. Number of erosions, sum maximal erosion dimensions, highest grades, and sum grades correlated significantly with disease duration. Number of erosions, sum maximal dimensions, and erosion grading of the distal radius correlated significantly with BME volume. CONCLUSION: HR-pQCT provides a sensitive method with high reader agreement in assessment of structural bone damage in RA. The good correlation of erosion measures with disease duration as well as BME volume suggests that they could become feasible measures of erosions in RA.

Correlation of magnetic resonance imaging-based knee cartilage T2 measurements and focal knee lesions with body mass index: thirty-six-month followup data from a longitudinal, observational multicenter study.

OBJECTIVE: To compare magnetic resonance imaging (MRI)-based knee cartilage T2 measurements and focal knee lesions and 36-month changes in these parameters among knees of normal controls and knees of normal weight, overweight, and obese subjects with risk factors for knee osteoarthritis (OA). METHODS: A total of 267 subjects ages 45-55 years from the Osteoarthritis Initiative database were analyzed in this study. Two hundred thirty-one subjects had risk factors for knee OA, but no radiographic OA (Kellgren/Lawrence score ≤1) at baseline. Thirty-six subjects were normal controls. Subjects with OA risk factors were stratified in 3 groups: normal weight (n = 78), overweight (n = 84), and obese (n = 69). All subjects underwent 3T MRI of the right knee at baseline and after 36 months. Focal knee lesions were assessed and cartilage T2 measurements (mean T2 and T2 texture analysis) were performed. RESULTS: The baseline prevalence and severity of meniscal and cartilage lesions were highest in obese subjects and lowest in normal controls (P < 0.05). Obese subjects had the highest mean T2 values and the most heterogeneous cartilage (as assessed by T2 texture analysis), while normal controls had the lowest mean T2 values and the most homogeneous cartilage at baseline (P < 0.05). Increased body mass index (BMI) was significantly (P < 0.05) associated with greater progression of cartilage lesions and constantly elevated cartilage T2 entropy over 36 months. CONCLUSION: In preclinical OA, increased BMI is associated with more severe cartilage degeneration as assessed by both morphologic and quantitative MRI measurements.

Lumbosacral transitional vertebrae: association with low back pain.

PURPOSE: To assess the prevalence and degree of lumbosacral transitional vertebrae (LSTV) in the Osteoarthritis Initiative (OAI) cohort, to assess whether LSTV correlates with low back pain (LBP) and buttock pain, and to assess the reproducibility of grading LSTV. MATERIALS & METHODS: Institutional review board approval was obtained, and informed consent documentation was approved for the study protocol. Standard standing pelvic radiographs that included the transverse processes of L5 were graded according to Castellvi classification of LSTV in 4636 participants (1992 men and 2804 women; aged 45-80 years) from the OAI cohort. These data were correlated with prevalence and severity of LBP and buttock pain. RESULTS: Prevalence of LSTV was 18.1% (841 of 4636), with a higher rate in men than in women (28.1% vs 11.1%, respectively; P<.001). Of the 841 individuals with LSTV, 41.72% were type I (dysplastic enlarged transverse process), 41.4% were type II (pseudoarticulation), 11.5% were type III (fusion), and 5.2% were type IV (one transverse process fused and one with pseudoarticulation). Of the participants without LSTV, 53.9% reported LBP, while the prevalence of LBP for types I, II, III, and IV was 46%, 73%, 40%, and 66%, respectively (P<.05, χ2 test). Types II and IV had higher prevalence and severity of LBP and buttock pain (P<.001). CONCLUSION: LSTV types II and IV positively correlate with prevalence and severity of LBP and buttock pain.

Association of magnetic resonance imaging-based knee cartilage T2 measurements and focal knee lesions with knee pain: data from the Osteoarthritis Initiative.

OBJECTIVE: To evaluate the association of magnetic resonance imaging (MRI)-based knee cartilage T2 measurements and focal knee lesions with knee pain in knees without radiographic osteoarthritis (OA) among subjects with OA risk factors. METHODS: We studied the right knees of 126 subjects from the Osteoarthritis Initiative database. We randomly selected 42 subjects ages 45-55 years with OA risk factors, right knee pain (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] pain score ≥5), no left knee pain (WOMAC pain score 0), and no radiographic OA (Kellgren/Lawrence [K/L] score ≤1) in the right knee. We also selected 2 comparison groups: 42 subjects without knee pain in either knee and 42 with bilateral knee pain. Both groups were frequency matched to subjects with right knee pain only by sex, age, body mass index, and K/L score. All of the subjects underwent 3T MRI of the right knee. Focal knee lesions were assessed and cartilage T2 measurements were performed. RESULTS: Prevalences of meniscal, bone marrow, and ligamentous lesions and joint effusion were not significantly different between the groups (P > 0.05), while cartilage lesions were more frequent in subjects with right knee pain only compared to subjects without knee pain (P < 0.05). T2 values averaged over all of the compartments were similar in subjects with right knee pain only (mean ± SD 34.4 ± 1.8 msec) and in subjects with bilateral knee pain (mean ± SD 34.7 ± 4.7 msec), but were significantly higher compared to subjects without knee pain (mean ± SD 32.4 ± 1.8 msec; P < 0.05). CONCLUSION: These results suggest that elevated cartilage T2 values are associated with findings of pain in the early phase of OA, whereas among morphologic knee abnormalities only knee cartilage lesions are significantly associated with knee pain status.

Quantitative characterization of bone marrow edema pattern in rheumatoid arthritis using 3 Tesla MRI.

PURPOSE: To develop imaging techniques that provide quantitative characterization of bone marrow edema pattern (BME) in wrist joints of patients with rheumatoid arthritis (RA), including volume, signal intensity changes, and perfusion properties. MATERIALS AND METHODS: Fourteen RA patients and three controls were scanned using 3 Tesla MR. BME was semi-automatically segmented in water images obtained from iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) sequences. BME perfusion parameters (enhancement and slope) were evaluated using three-dimensional (3D) dynamic enhanced MRI (DCE-MRI). Experimental reproducibility, inter- and intra-observer reproducibility of BME quantification were evaluated using root mean square coefficients of variation (RMS-CV) and intraclass correlation (ICC). RESULTS: The RMS-CV for BME volume quantification with repeated scans were 6.9%. The inter-observer ICC was 0.993 and RMS CV was 5.2%. The intra-observer ICC was 0.998 and RMS CV was 2.3%. Both maximum enhancement and slope during DCE-MRI were significantly higher in BME than in normal bone marrow (P < 0.001). No significant correlation was found between BME quantification and clinical evaluations. CONCLUSION: A highly reproducible semi-automatic method for quantifying BME lesion burden in RA was developed, which may enhance our capability of predicting disease progression and monitoring treatment response.

Obesity increases the prevalence and severity of focal knee abnormalities diagnosed using 3T MRI in middle-aged subjects--data from the Osteoarthritis Initiative.

OBJECTIVE: To study the effect of BMI on the prevalence, severity, and 36-month progression of early degenerative changes in the knee by using 3T MRI in middle-aged subjects without radiographic osteoarthritis (OA). MATERIALS AND METHODS: We examined baseline and 36-month follow-up MR studies from 137 middle-aged individuals (45-55 years old) with risk factors for knee OA but no radiographic OA from the Osteoarthritis Initiative. Subjects were grouped into three categories: normal BMI (BMI < 25 kg/m(2), n = 38), overweight (BMI 25-29.9 kg/m(2), n = 37), and obese (BMI ≥ 30 kg/m(2), n = 62). Using 3T MRI, cartilage, meniscus, and bone marrow abnormalities were graded using the OA Whole-organ MR Imaging Score (WORMS). The statistical analysis was corrected as necessary for differences in age, sex, and OA risk factors other than BMI. RESULTS: The overall prevalence of lesions was 64% for meniscus and 79% for cartilage (including low grade lesions). At baseline, the prevalence and severity of knee lesions was positively associated with BMI, with a nearly fourfold increase in meniscal tears and more than twofold increase in high-grade cartilage defects in obese individuals relative to normal-weight subjects. Over the 36-month follow-up period, the number of new or worsening cartilage lesions of any grade was significantly higher in obese subjects (p = 0.039), while there was no significant difference in meniscal lesion progression. CONCLUSION: Obesity was associated with both higher prevalence and severity of early degenerative changes in the knee in middle-aged individuals without radiographic OA and with significantly increased cartilage lesion progression (of any grade) over 36 months.

Texture analysis of cartilage T2 maps: individuals with risk factors for OA have higher and more heterogeneous knee cartilage MR T2 compared to normal controls--data from the osteoarthritis initiative.

INTRODUCTION: The goals of this study were (i) to compare the prevalence of focal knee abnormalities, the mean cartilage T2 relaxation time, and the spatial distribution of cartilage magnetic resonance (MR) T2 relaxation times between subjects with and without risk factors for Osteoarthritis (OA), (ii) to determine the relationship between MR cartilage T2 parameters, age and cartilage morphology as determined with whole-organ magnetic resonance imaging scores (WORMS) and (iii) to assess the reproducibility of WORMS scoring and T2 relaxation time measurements including the mean and grey level co-occurrence matrix (GLCM) texture parameters. METHODS: Subjects with risk factors for OA (n = 92) and healthy controls (n = 53) were randomly selected from the Osteoarthritis Initiative (OAI) incidence and control cohorts, respectively. The specific inclusion criteria for this study were (1) age range 45-55 years, (2) body mass index (BMI) of 19-27 kg/m2, (3) Western Ontario and McMaster University (WOMAC) pain score of zero and (4) Kellgren Lawrence (KL) score of zero at baseline. 3.0 Tesla MR images of the right knee were analyzed using morphological gradings of cartilage, bone marrow and menisci (WORMS) as well as compartment specific cartilage T2 mean and heterogeneity. Regression models adjusted for age, gender, and BMI were used to determine the difference in cartilage parameters between groups. RESULTS: While there was no significant difference in the prevalence of knee abnormalities (cartilage lesions, bone marrow lesions, meniscus lesions) between controls and subjects at risk for OA, T2 parameters (mean T2, GLCM contrast, and GLCM variance) were significantly elevated in those at risk for OA. Additionally, a positive significant association between cartilage WORMS score and cartilage T2 parameters was evident. CONCLUSIONS: Overall, this study demonstrated that subjects at risk for OA have both higher and more heterogeneous cartilage T2 values than controls, and that T2 parameters are associated with morphologic degeneration.

CT-guided biopsy of bone and soft-tissue lesions: role of on-site immediate cytologic evaluation.

PURPOSE: To assess the impact of on-site immediate cytologic assessment (ICA) on the diagnostic success rate of computed tomography (CT)-guided percutaneous needle biopsy (PNB) of musculoskeletal lesions and the long-term outcome in inconclusive PNB findings. MATERIALS AND METHODS: A total of 299 CT-guided PNBs of musculoskeletal lesions performed between January 1997 and December 2009 were retrospectively reviewed. The lesions were categorized by their morphology, location, and size, and by biopsy type. The diagnostic success rates, impact of ICA, and outcome in inconclusive PNBs were studied, with final histopathologic findings and/or clinical follow-up as a reference. RESULTS: The overall diagnostic success rate of PNBs was 72.9% (218 of 299). The success rate increased with larger lesions (> 2 cm to 4 cm; P = .009). Biopsies performed with ICA had a higher success rate (77.0% vs 63.3%; P = .015). PNBs had inconclusive results in 109 of 299 cases (36.5%). In 66 of these, repeat open biopsy or clinical follow-up demonstrated 19 malignant/aggressive lesions (28.8%) and 47 benign/nonaggressive lesions (71.2%). CONCLUSIONS: CT-guided PNB had a satisfactory success rate, which significantly increased when performed with ICA. Inconclusive results in PNB were most frequently associated with benign findings during further workup.

Osteoid osteoma of the femur in a 7-month-old infant treated with radiofrequency ablation.

Osteoid osteoma occurs most commonly in children, adolescents, and young adults between the ages of 5 and 30 years. In the preschool age group, it is quite uncommon, accounting for only 3-8% of all osteoid osteoma cases. We report a case of osteoid osteoma in a 7-month-old infant, who presented with decreased use of the right lower extremity due to pain. Magnetic resonance imaging (MRI) showed an atypical appearance. A biopsy of the lesion, with histopathological examination, confirmed the diagnosis of osteoid osteoma. Radiofrequency ablation (RFA) of the nidus under computed tomography (CT) guidance was performed. The patient developed a recurrence after 3 months, which was treated with a second RFA. On subsequent follow-up, the infant did not show signs of pain after 1 month. In summary, this case report shows that osteoid osteoma can present in early infancy and can be successfully treated with RFA at this age, however, recurrence after the procedure can occur and close follow-up is recommended.

Presacral fibrosarcoma in childhood: a case report.

Presacral fibrosarcoma is a rare malignant tumor in childhood. Because of its rarity in the presacral region, it is often missed from the differential diagnosis of presacral mass in childhood. The authors present a case of large presacral fibrosarcoma involving spinal canal, with an initial presentation of back pain and abnormal gaiting.

The prevalence of carotid artery calcifications detected on panoramic radiographs in patients with metabolic syndrome.

OBJECTIVES: The purpose of this study was to determine the prevalence of carotid artery calcifications (CAC) detected on panoramic radiographs in patients with metabolic syndrome (MetS). STUDY DESIGN: Eighty-five Thai subjects (29 men, 56 women) who had MetS according to the International Diabetes Federation definition were evaluated for CAC detected on panoramic radiographs. The confirmation of findings was done by ultrasonography. RESULTS: Carotid artery calcifications were detected in 19 subjects (22.4%) with a mean age of 64 years, range 48-74 years. These subjects included 12 men and 7 women. The CAC were significantly more common in men than in women (P = .002). There were 8 subjects (9.4%) with bilateral calcifications and 11 subjects (12.9%) with unilateral calcification. No significant difference between the right and left sides was found (P = .44). CONCLUSION: Thai people with MetS have high prevalence of radiographically detectable carotid artery calcifications.

Three-Tesla MRI diagnosis of meniscal tears of the knee.

OBJECTIVE: To study and diagnose meniscal tear of the knee using 3-Tesla (3-T) magnetic resonance imaging (MRI) compared with arthroscopy. MATERIAL AND METHOD: One hundred twenty eight consecutive patients who underwent MRI of the knee using a 3-T magnet between April 2007 and Nov 2008 were included in this study. The inclusion criteria were the patients who had (i) subsequent knee arthroscopy, (ii) available medical records, and (iii) no history of meniscal surgery. Their MR images were retrospectively reviewed by two radiologists with consensus agreement. The diagnostic values for diagnosing meniscal tears were evaluated and compared to the arthroscopic results. RESULTS: Thirty-two patients (64 menisci) were included; 26 males and 6 females, mean age was 36.4 years (range 19-62). The mean interval between MRI and arthroscopy was 93 days. To diagnose tear of medial, lateral, and both menisci; the sensitivity was 100%, 90%, 100%; the specificity was 77%, 73%, 50%; the accuracy was 91%, 78%, 84%; the positive predictive value (PPV) was 86%, 60%, 81%; and the negative predictive value (NPV) was 100%, 94%, 100%, respectively. False positive MR findings were found predominantly at the posterior horn and at the peripheral third of the menisci. By dividing the patients into 2 groups according to the mean MRI-arthroscopy interval (< 93 and > 93 days): increased sensitivity and NPV of detecting lateral meniscal tear; increased specificity, accuracy, and PPV of both meniscal tear was observed in the longer duration group, but there was no statistical significance in the present study. CONCLUSION: The present results with 3-T MRI revealed high sensitivity and NP V comparable to the literature, thus supporting previous studies that if a meniscal tear is not seen on 3-T MRI, it is highly unlikely to be present. False positive MR findings found predominantly at the posterior horn and at the peripheral third of the menisci. The longer the MRI-arthroscopy interval yielded increased diagnosing values of meniscal tear but there is no statistical significance in the present study