The interpubic cavity: A scoping review.

The interpubic cavity (cleft) is a narrow, slit-like, oval-shaped cavity which has frequently been described within the fibrocartilaginous interpubic disc. The aim of this article is to thoroughly analyze what is known about the interpubic cavity. The following three scientific databases (PubMed, Web of Science and Google Scholar) were systematically searched. Combinations of the search terms "interpubic cleft", "interpubic cavity", "symphysis pubis cleft", "symphysis pubis cavity" and "symphysis cleft sign" were used. All databases were searched from inception until August of 2022. Searching of the three databases resulted in 711 hits, of which 280 remained after checking for duplicates. In the first step, 152 studies were excluded due to irrelevant content. Thus, 128 proceeded to the second step, of which 23 were finally selected for meeting the objectives of this review. Until now the reason for the cavity forming remains unclear. The interpubic cavity is present in the anterior portion of the interpubic disc, within 2 mm from its anterior margin. There is no predilection in the craniocaudal dimension. The secondary cavity is usually called a "cleft sign". The results of our scoping review summarize information about the interpubic cavity. Its composition and morphology are still not well understood.

Increased cleft width during knee flexion is useful for the diagnosis of medial meniscus posterior root tears.

PURPOSE: This study aimed to evaluate changes in the cleft width, defined as the distance between the lateral edge of the medial tibial plateau and that of the medial meniscus (MM) posterior root, using open magnetic resonance imaging (MRI) in patients with MM posterior root tear (MMPRT). METHODS: This study included 25 patients (20 women and 5 men; mean age: 65.2 years) who were diagnosed with MMPRT and underwent pullout repair. Upon coronal imaging, the cleft width was evaluated at the 10° and 90° flexed knee positions. The difference in the cleft width (defined as the cleft width at 90° minus the cleft width at 10°) was also calculated. Upon sagittal imaging, the MM posterior extrusion (MMPE) at 90° was also evaluated. Separate univariate linear regression models were used to determine the association between the time from injury to MRI and radiographic measurements. RESULTS: The mean cleft width at 10° and 90° was 4.9 ± 2.6 mm and 7.4 ± 3.7 mm, respectively; the mean difference in cleft width was 2.5 ± 1.5 mm, and the mean MMPE at 90° was 3.7 ± 1.3 mm. There was a significant difference in cleft width at 10° and 90° (p < 0.001). The time from injury to MRI was significantly associated with the cleft width at 10° (R = 0.42; p = 0.023), cleft width at 90° (R = 0.59; p = 0.002), the difference in the cleft width (R = 0.62; p = 0.008), and MMPE at 90° (R = 0.53; p = 0.008). CONCLUSION: This study demonstrates that the cleft width is significantly larger during knee flexion than during knee extension. Increased cleft width during knee flexion ("graben" sign) may help diagnose MMPRT, especially in cases where the cleft sign is unclear during knee extension. LEVEL OF EVIDENCE: III.

The cleft sign may be an independent factor of magnetic resonance imaging findings associated with a delayed return-to-play time in athletes with groin pain.

PURPOSE: To investigate the prevalence of magnetic resonance imaging (MRI) findings and define prognostic factors of the return-to-play time in young athletes with groin pain. METHODS: A total of 1091 consecutive athletes were retrospectively screened; 651 athletes, aged 16-40 years, with pain in the groin regions were assessed using MRI. Of these athletes, 356 were included for analysing the time to return-to-play. Univariate and multiple linear regression analyses were used to determine the associations between the time to return-to-play (primary outcome variable) and the following variables: age, sex, body mass index, type of sports, Hip Sports Activity Scale, clear trauma history, and 12 MRI findings. RESULTS: Four MRI findings, including cleft sign, pubic bone marrow oedema of both the superior and inferior ramus, and central disc protrusion of the pubic symphysis, appeared together in more than 44% of the cases. The median time to return-to-play was 24.7 weeks for athletes with a cleft sign on MRI, which was significantly longer than the 11.9 weeks for athletes without the sign. The median time to return-to-play was 20.8 weeks for athletes with BMI > 24, which was significantly longer than the 13.6 weeks for athletes with BMI â‰¦ 24. In multiple linear regression analysis of 356 athletes, in whom hip-related groin pain was excluded, and who were followed-up until the return-to-play, the body mass index and cleft sign were the independent factors associated with a delayed return-to-play. In contrast, iliopsoas muscle strain and other muscle injuries were associated with a shorter return-to-play. CONCLUSIONS: Multiple MRI findings were present in almost half of all cases. Body mass index and the cleft sign were independently associated with a delayed return-to-play time in young athletes suffering from groin pain. LEVEL OF EVIDENCE: III.

Cleft Sign and Bone Marrow Edema of the Pubic Symphysis Are Associated With Sports and Bony Morphology in Patients With Femoroacetabular Impingement and Labral Tears.

BACKGROUND: The cleft sign (CS) and bone marrow edema (BME) are considered magnetic resonance imaging (MRI) findings signifying a pubic pathology, which is associated with groin pain; however, their relationship with bony morphology related to femoroacetabular impingement (FAI) has not been established. PURPOSE: To investigate the prevalence of CS and BME in symptomatic patients with acetabular labral tears and assess their possible association with bone morphology and sport-specific activities. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: This study enrolled 418 patients (469 hips) undergoing hip arthroscopic surgery for labral tears. Also included were patients with labral tears in the setting of either hip dysplasia or borderline hip dysplasia who were undergoing endoscopic shelf acetabuloplasty combined with hip arthroscopic labral repair, cam osteoplasty, and capsular plication. All patients were screened for superior CS (SCS), inferior CS (ICS), and BME of the ipsilateral side of the pubis using 3-T MRI. We measured the following angles: lateral center edge (LCE), Sharp, Tönnis, vertical-central-anterior, and alpha. Then, we evaluated the relationship between patient characteristics and abnormal findings on MRI scans (preoperatively vs 1 year postoperatively). RESULTS: An overall 397 hips were included: 200 in men and 197 in women (mean ± SD age, 35.3 ± 16.0 years). There were hips in 214 athletes (53.9%) and hips in 183 nonathletes (46.1%). MRI findings revealed SCS, ICS, and BME in 18 (4.5%), 13 (3.3%), and 34 hips (8.6%), respectively. Abnormal MRI findings at the pubis were seen more often in athletes than nonathletes (23.8% vs 3.3%), and contact sports athletes had the most frequent abnormalities. There was no SCS in patients with an LCE angle <22°. SCS was more frequently seen in those who had an alpha angle ≥71°. More than 60% of abnormal findings at the pubis diminished after arthroscopic surgery that included FAI correction and labral repair. CONCLUSION: In patients with labral tears, CS and BME were seen more frequently in athletes versus nonathletes, especially contact athletes with FAI-related bony abnormalities. More than 60% of abnormal MRI pubis findings resolved after arthroscopic treatment of FAI.

Glioblastoma Mimicking Meningioma: Report of 2 Cases.

BACKGROUND: Glioblastoma can mimic various pathologies, including arteriovenous malformation, hemorrhage from ischemic stroke, cerebral contusion, metastatic disease, lymphoma, and infection. The literature is limited regarding diagnostic confusion with meningioma. Herein, we present 2 patients that exhibited imaging, including cerebral angiography during preoperative embolization, which was consistent with meningioma, but where final surgical diagnosis revealed glioblastoma. CASE DESCRIPTION: Case 1 was a 57-year-old woman presenting with headache, ataxia, and memory lapses for the past month. Brain magnetic resonance imaging (MRI) demonstrated a heterogeneous-enhancing right temporoparietal mass with broad contact along the right tentorium, cerebrospinal fluid (CSF) cleft sign, and dural tail sign-consistent with meningioma. Patient underwent angiography with successful polyvinyl alcohol foam (PVA) particle embolization of the petrosquamosal branch of the right middle meningeal artery (MMA) and meningeal branch of the right occipital artery, resulting in significant devascularization of the tumor blush. Subsequently, the patient underwent tumor resection, where pathology revealed glioblastoma. Case 2 was a 60-year-old man presenting with right hemiparesis. Brain MRI demonstrated a left parasagittal, heterogeneous-enhancing mass abutting the falx with a dural tail sign-consistent with meningioma. Patient underwent angiography with successful PVA particle embolization of the left MMA, resulting in significant devascularization of the tumor blush. Patient underwent a tumor resection where pathology revealed glioblastoma. CONCLUSIONS: Glioblastoma can mimic meningioma on MRI with dural tail sign, CSF cleft sign, and broad dural contact. Moreover, cerebral angiography can reveal tumor feeders commonly associated with meningioma. These features can contribute to diagnostic confusion. Based on these 2 cases, preoperative embolization of tumor feeders is possible with glioblastoma.

Classification and distribution of fracture areas in fresh osteoporotic vertebral compression fractures based on CT multi-planar reconstruction and MRI / 中国组织工程研究

BACKGROUND; Some scholars have classified osteoporotic vertebral compression fractures based on X-ray and MRI findings. However, little is reported on the morphological types and distribution rules of fracture areas in osteoporotic vertebral compression fractures. OBJECTIVE; To investigate and summarize the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures based on CT multi-planar reconstruction and MRI. METHODS; Clinical data from 352 patients with osteoporotic vertebral compression fractures, 73.07 years of age, including 69 males and 283 females admitted at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2011 to June 2017 were retrospectively reviewed. After admission, CT multi-planar reconstruction, MRI and bone mineral density measurements were conducted in each patient. Fresh osteoporotic vertebral compression fractures were confirmed in 477 vertebrae according to clinical manifestations and imaging findings. Fracture areas were defined as shade compact or bright line based on CT multi-planar reconstruction or bone marrow edema on the MRI. Morphological type and distribution of fracture areas were recorded by two experienced spinal surgeons and one senior radiologist independently. The study protocol was approved by the Ethic Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine in China with an approval No. ZYYECKYJ[2017]057. RESULTS AND CONCLUSION: Fracture areas of 472 vertebrae were indicated distinctly on the MRI, whereas the fracture areas of 5 vertebrae were unclear. Meanwhile, fracture areas of 469 vertebrae were shown clearly on the CT multi-planar reconstruction, but the areas of 8 vertebrae were obscure on the CT. Fracture areas of 5 vertebrae were unclear in both CT and MRI. There was no significant difference between CT and MRI in the observation of fracture areas (P=0.402). Finally, fracture areas of 8 vertebrae could not be described accurately on CT, MRI or both. In the sagittal plane of CT and MRI, morphological types of fracture areas of 469 vertebrae were divided into impacted fracture area (n=311, 66.31%) and cleft fracture area (n=158, 33.69%). Of the 158 cleft fracture areas, 26 vertebrae contained gas, 28 vertebrae contained liquid, and 7 vertebrae included both gas and liquid. Of the 469 vertebrae, the location of fracture areas was divided into 5 types: Superior (n=238, 50.75%), inferior (n=80,17.06%), anterior (n=21, 4.48%), central (n=110, 23.45%) and mixed (n=20, 4.26%). These findings indicate that the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures can be effectively distinguished by CT multi-planar reconstruction and MRI, which is important for early diagnosis and further treatment of fresh osteoporotic vertebral compression fractures.

Infectious Spondylitis Mimicking Osteoporotic Vertebral Compression Fractures: Report of Two Cases

STUDY DESIGN: Case study of two cases. OBJECTIVES: The aim of our study is to describe the rare MR imaging patterns of infectious spondylitis. SUMMARY OF LITERATURE REVIEW: It is generally accepted that the intravertebral cleft sign is not shown in cases of infection or malignancy, and thus, its recognition can obviate unnecessary imaging or biopsy because of its benign significance. MATERIALS AND METHODS: Two patients are presented who developed worsening back pain after a minor trauma. Preoperative MR images of these patients showed intravertebral fluid and benign vertebral compression fractures. Anterior decompression and fusion were done and the bacteria isolated from the intraoperative cultures were Listeria monocytogenes and Mycobacterium tuberculosis, respectively. RESULTS: After 2 years of follow-up, the patients were free of pain, without signs of infection, and showed correct fusion. CONCLUSIONS: MR findings in infectious spondylitis may simulate the patterns of osteoporotic VCFs.

Definition, Diagnosis, Pathophysiology and Treatment of Kummell's Disease / 대한골다공증학회지

Over 100 years ago, Hermann Kummell described a clinical condition in which patients sustained a trivial trauma, had essentially asymptomatic period lasting weeks to months, then developed a painful, progressive angular kyphosis. Since then, many post-traumatic delayed kyphosis have been reported as a Kummell's disease. As a radiologic finding of intravertebral cleft sign was related to this delayed collapse, this abnormal gas or fluid signal in the involved vertebral body was considered as a pathognomic sign. However, recent evidences indicate this delayed progressive collapse and kyphosis of the spine is related to osteoporotic spine fracture in many reports. At this point, by defining and reviewing the definition and etiology of Kummell's disease, we have to look into whether Kummell's disease is a distinct or rare pathophysiologic entity or a complicated clinical result of osteoporotic spine fracture. In this review, author tried to clearly define the definition and diagnosis criteria to diagnose Kummell's disease as a complicated osteoporotic spine fracture and review treatment modalities for this complicated clinical condition.