Association Between Measures of Vertebral Endplate Morphology and Lumbar Intervertebral Disc Degeneration.

PURPOSE: The aim of this study was to evaluate the association between vertebral endplate morphology and the degree of lumbar intervertebral disc degeneration via magnetic resonance imaging (MRI). METHODS: In total, 150 patients who met the inclusion criteria and were 20-60 years of age were retrospectively evaluated. Patients were evaluated for the presence of intervertebral disc degeneration or herniation, and the degree of degeneration was assessed at all lumbar levels. Vertebral endplate morphology was evaluated based on the endplate sagittal diameter, endplate sagittal concave angle (ECA), and endplate sagittal concave depth (ECD) on sagittal MRI. The association between intervertebral disc degeneration or herniation and endplate morphological measurements was analysed. RESULTS: In MRI, superior endplates (ie, inferior endplates of the superior vertebra) were concave and inferior endplates (ie, superior endplates of the inferior vertebra) were flat at all disc levels. A decrease in ECD and an increase in ECA were detected at all lumbar levels as disc degeneration increased (P < .05). At the L4-L5 and L5-S1 levels, a decrease in ECD and an increase in ECA were detected in the group with herniated lumbar discs (P < .05). There was no association between lumbar disc degeneration or herniation and endplate sagittal diameter at lumbar intervertebral levels (P > .05). At all levels, ECD of women was significantly lesser than that of men and ECA of women was significantly greater than that of men (P < .05). CONCLUSIONS: There is an association between vertebral endplate morphology and lumbar intervertebral disc degeneration. Vertebral endplates at the degenerated disc level become flat; the severity of this flattening is correlated with the degree of disc degeneration.

The effect of rotational deformity on patellofemoral parameters following the treatment of femoral shaft fracture.

OBJECTIVE: The purpose of this study was to investigate the effect of rotational deformities on patellofemoral alignment using the dynamic magnetic resonance imaging method on patients whose femur fractures were treated with intramedullary locking nails. METHODS: The dynamic patellofemoral magnetic resonance imaging results of 33 patients (5 females and 28 males) were reviewed. The mean age of the patients was 36.3 (range 19-61) years. The mean follow-up was 30.2 months (range 24-38). All the patients were given Kujala patellofemoral clinical evaluation scores at the latest follow-up. Those with less than 10° of rotational deformity in either direction were classified as Group A, those with more than a 10° of internal rotation deformity as Group B and more than a 10° of external rotation deformity as Group C. The three groups were then compared regarding to clinical scores. Patellofemoral parameters of operated and contralateral side were also compared in each group. RESULTS: There were 14 (42.4 %) patients in Group A, 12 (36.4 %) patients in Group B and 7 (21.2 %) patients in Group C. The mean patella score in Group C (74 ± 7.02) was significantly lower when compared with Group B (87.6 ± 9.9) and group A (90.6 ± 6.1) (p < 0.05). In Group C patients, medial patellar tilt was detected when compared with the intact side. There were no significant changes in patellofemoral position in either Group A or Group B. CONCLUSION: The results of this study revealed that more than 10° of external rotation deformity could cause a detoriation in the patellofemoral scores. Anatomic reduction of the fracture site should be performed as soon as possible and external rotational deformities should especially be avoided in order to prevent patellofemoral malalignment.

Spinal inflammation by magnetic resonance imaging in patients with ankylosing spondylitis: association with disease activity and outcome parameters.

Magnetic resonance imaging (MRI) has major contribution in early diagnosis of ankylosing spondylitis (AS). As it is difficult to determine disease activity owing to the lack of close relation between laboratory tests, clinical findings and imaging, MRI has been used as an objective outcome measure. The aim of this study is to investigate the relation between spinal MRI findings with disease activity and other outcome measures. Fifty patients fulfilling modified New York criteria for AS were enrolled to the study. All the patients were evaluated with Bath AS Disease Activity Index (BASDAI), AS Disease Activity Score (ASDAS), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), Bath AS Radiology Index (BASRI) and As Quality of Life. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured as laboratory parameters, and ASspiMR scores were determined by spinal MRI. The median total ASspiMR-a score was 5.2. Spinal inflammation was evaluated in spinal segments, and thoracic segments had the highest mean ASspiMR-a level (3.1 ± 5.94). Cervical and lumbar ASspiMR were correlated with only BASRI, and total ASspiMR score was correlated with BASRI, BASMI and CRP. Thoracic ASspiMR score was correlated with patient's and doctor's global assessments, BASFI, BASMI, BASRI, ASDAS A, ASDAS B, ASDAS C, ASDAS D, ESR and CRP (P < 0.05). According to our results, the thoracic spine was the most related region with disease activity parameters and clinical outcome measures, so we suggest thoracic spine MRI evaluation in order to determine the disease activity.

Evaluation of the anterolateral ligament of the knee by magnetic resonance imaging in patients with chronic anterior cruciate ligament rupture.

OBJECTIVE: The purpose of this study was to evaluate the visibility of the anterolateral ligament (ALL) by magnetic resonance imaging (MRI) in patients with chronic anterior cruciate ligament (ACL) rupture. MATERIALS AND METHODS: This retrospective case - control study compared 1.5 - T MRI scans for 50 patients with a chronic ACL rupture with those of a control group of 50 patients with an intact ACL. The ALL was evaluated in three portions: femoral, meniscal, and tibial. The status of each portion was classified as visualized or non-visualized. Two radiologists separately reviewed all the MRI scans to evaluate interobserver reliability. RESULTS: At least one portion of the ALL was visualized in 100% of the control group and 72% of the chronic ACL rupture group. All three portions of the ALL were identified in 72% of the control group but only 10% of the chronic ACL rupture group. In both groups, the most commonly visualized portion was the meniscal portion and the least visualized was the tibial portion. In 18% of the chronic ACL rupture group, no portion of the ALL was visualized. CONCLUSIONS: The visibility of the ALL of the knee was significantly lower in patients with a chronic ACL rupture than in those with an intact one.

Association between trochlear morphology and chondromalacia patella: an MRI study.

This study aimed to compare trochlear morphology seen in magnetic resonance imaging between patients with chondromalacia patella and age-matched control patients without cartilage lesion. Trochlear morphology was evaluated using the lateral trochlear inclination, medial trochlear inclination, sulcus angle and trochlear angle on the axial magnetic resonance images. Consequently, an association between abnormal trochlear morphology and chondromalacia patella was identified in women. In particular, women with flattened lateral trochlea are at an increased risk of patellar cartilage structural damage.

Are metric parameters sufficient alone in evaluation of the patellar instability? New angular measuring parameters.

PURPOSES: When the evaluation of patellar instability is examined from the aspect of the conical-cylindrical anatomy of the tibia, metric measurement parameters such as the tuberositas tibia (TT)-trochlear groove (TG) and patellar tendon (PT) insertion-trochlear groove (TG) distances are not sufficient. We asked whether defined angular parameters reveal the rotational movement of the tuberositas tibia on the tibia shaft, additional to the metric parameters and there is a correlation between the metric and angular parameters. METHODS: 19 patients with patellar instability and 22 patients without patellar instability were evaluated. For all patients, two angle and three length parameters were evaluated on the slices taken. Evaluations were made of the TT-TG, the midpoint of the PT insertion-TG distances, the anatomic midpoint of the dome of the TT-TG, the TG-PT angle, and the TG-dome angle (DA). The Pearson correlation test was used for the statistical analysis of correlations between groups. RESULTS: A statistically significant increase was determined in the patellar instability group in the TG-DA and TG-PT angle values compared to the group without patellar instability ( p < 0.05). In both groups, a positive and strong correlation was determined between the TT-TG and the TG-PT and dome of the TT-TG distances, but no statistically significant correlation was determined between the tuberositas TT-TG and TG-PT angle and TG-DA. CONCLUSION: Metric parameters may not be sufficient alone in the evaluation of patellar instability. Metric parameters should be supported by additional angular parameters which reveal the rotational movement of the TT on the tibia shaft.

Diffusion-Weighted Mri of Postmenopausal Women with Vaginal Bleeding and Endometrial Thickening: Differentiation of Benign and Malignant Lesions.

PURPOSE: To investigate the feasibility of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) values in differentiating endometrial cancer from benign endometrial lesions in postmenopausal patients with vaginal bleeding and endometrial thickening and to predict the depth of myometrial invasion in endometrial cancer. MATERIALS AND METHODS: Postmenopausal patients with vaginal bleeding and endometrial thickening were enrolled in this prospective study. T2-weighted, pre- and postcontrast T1-weighted and diffusion-weighted images were obtained. The ADC values of all the patients with endometrial pathologies were recorded. The staging accuracies of DWI and postcontrast T1-weighted images in the assessment of myometrial invasion were evaluated in histopathologically proven endometrial cancer patients. RESULTS: Fifty-two patients (mean age: 57 ± 10, range: 41-79) were enrolled in the study. Thirty-eight of the lesions were benign (27 as hyperplasia and endometritis; 11 as polyps). Fourteen of the 52 endometrial lesions were pathologically proven as cancers and underwent hysterectomy, and all the specimens were reported as endometrioid adenocarcinomas. The mean ADC value (10-3 mm2/second) of cancer (0.88 ± 0.10) was significantly lower than that of benign lesions (1.78 ± 0.27, p = 0,001). There was no significant difference between ADC values of endometrial tissue in patients with FIGO stage 1A (0.87 ± 0.11, n = 9) and FIGO stage 1B (0.91 ± 0.07, n = 5). The staging accuracy was 92.9 per cent (13/14) for DWI and 85.7 per cent (12/14) for postcontrast T1-weighted images. CONCLUSION: ADC values allow benign endometrial lesions to be differentiated from endometrial cancer in postmenopausal patients but do not correlate with the depth of myometrial invasion and histological tumor grading.

Idiopathic granulomatous hypophysitis: a rare cystic lesion of the pituitary.

Idiopathic granulomatous hypophysitis (GH) is a rare inflammatory disease of the pituitary gland. A 48-year-old woman was admitted to the hospital with an irregular menstrual cycle. MRI showed pituitary cystic lesion with sellar enlargement. The patient underwent endoscopic endonasal transsphenoidal surgical excision. A histopathological assessment revealed non-necrotizing granulomatous lesions and a diagnosis of GH was made. The rarity of GH and cystic form of the disease make it difficult to confirm the diagnosis until surgery. We herein report this rare case and provide a discussion of the MRI findings and relevant literature of GH.

Prospective comparative study of the range of movement of temporomandibular joints after mandibular fractures: rigid or non-rigid fixation.

Temporomandibular joints (TMJ) are negatively affected by trauma and disuse. In this prospective study, 103 patients with mandibular fractures were evaluated for the influence of trauma and maxillomandibular fixation on the TMJ. A total of 54 patients were treated by maxillomandibular fixation and 49 by titanium miniplate fixation. Those patients with condylar fractures and multiple mandibular fractures and malocclusion at presentation were not included in the study. The control group consisted of 44 randomly-selected healthy people with no past history of mandibular fracture or symptoms referable to the TMJ. Trauma was a major factor leading to TMJ dysfunction and maxillomandibular fixation increased the incidence and severity of TMJ dysfunction.

Magnetic resonance cisternographic evaluation of glossopharyngeal, vagus, and accessory nerves.

PURPOSE: The individual visualization of the glossopharyngeal, vagus, and accessory nerves has been a troublesome issue. After the recent developments in the microsurgical field, the detailed knowledge of the relationship of these nerves and the tumour has gained importance. The purpose of this study is to compare the visibility of each of these nerves. METHODS: Thirty patients (M/F: 14/16; mean age 52.46 years) with complaints of vertigo, tinnitus, and hearing loss were examined with routine temporal magnetic resonance imaging (MRI) study. The imaging protocol consisted of 3-dimensional fast imaging with steady state acquisition in axial and sagittal oblique planes in addition to routine sequences. These images were transferred to a workstation and reformatted. Visibility of the nerves was evaluated by consensus of 2 radiologists who used an evaluation scale of 2 (excellently visible), 1 (partially visible), to 0 (not visible). RESULTS: In 26 patients, both sides were scanned; in 4 patients, only one side was scanned. A total of 168 nerves were investigated. The rates for visualization for each nerve were as follows: glossopharyngeal nerve, 100% and 100%; vagus nerve, 67.9% and 100%; and accessory nerve, 10.8% and 83.85% on axial and sagittal oblique 3-dimensional fast imaging with steady state acquisition, respectively. CONCLUSIONS: Glossopharyngeal, vagus, and accessory nerve assessment improved when images were obtained in the sagittal oblique plane to the jugular foramen.

Petrous apex cephalocele and empty sella/arachnoid cyst coexistence: a clue for cerebrospinal fluid pressure imbalance?

PURPOSE: To reveal the magnetic resonance imaging (MRI) properties of incidental petrous apex cephalocele (PAC) and coexisting empty sella-arachnoid cyst. MATERIALS AND METHODS: We reviewed our archive from June 2005 to July 2008. Four patients were diagnosed with PAC (four females; age range, 41-60 years; mean, 48.5). All patients underwent MRI examination of the cranium. We evaluated the lesions for extension into the neighboring structures, content, signal intensity, enhancement, and relation to Meckel's cave, petrous apex and for the presence of empty sella. RESULTS: The presenting symptoms included headache for three patients and diplopia for one patient. All patients had bilateral PAC, more prominent on one side. All lesions were centered posterolateral to the Meckel's cave. They were isointense to cerebrospinal fluid signal intensity and continuous with Meckel's cave on T1W, T2W and FLAIR sequences. In two patients, there was no diffusion restriction on diffusion-weighted MR images and the ADC map. Three patients had empty sella. One patient had arachnoid cyst. CONCLUSION: Coexistence with empty sella-arachnoid cyst raises the possibility of cerebrospinal fluid inbalance in the etiology.

Magnetic resonance and diffusion-weighted imaging findings of herpes simplex encephalitis.

Herpes simplex encephalitis (HSE) is a rare, life-threatening disease. This paper draws attention to the role of imaging in early HSE diagnosis. Five consecutive patients diagnosed with HSE (type 1) between June 2005 and June 2006 (three males, two females, mean age 44 [range 16-68] years) were included in this retrospective study. Computed tomography, conventional magnetic resonance imaging (MRI) sequences and diffusion-weighted imaging (DWI) were obtained for each patient. Apparent diffusion coefficient values were calculated in diseased and normal tissue. Therefore, we propose that MRI scan with DWI should be performed when HSE is suspected, although in disease follow-up DWI is not superior to conventional sequences. There is no need for contrast media to be administered at any disease stage. Fluid-attenuated inversion recovery is superior to T2 sequencing in showing cortical lesions at all disease stages.

Evaluation of postoperative menisci with MR arthrography and routine conventional MRI.

OBJECTIVE: The diagnosis of a recurrent tear can be more difficult in the postoperative meniscus. The purpose of our study was to determine the accuracy of conventional magnetic resonance imaging (MRI) and MRI with intraarticular contrast material [magnetic resonance (MR) arthrography] for detecting recurrent meniscal tears after surgery. MATERIALS AND METHODS: Seventy-two patients who had arthroscopic surgery for meniscal tear and still got complaints were selected prospectively for MR arthrography and conventional MRI. Routine knee protocols with appropriate surface coil were used on 0.5 T MRI system. A 1:100 gadolinium-saline solution 30-40 ml was injected intraarticulary for MR arthrography. Of 72 patients, 45 had repeated arthroscopy for comparison of the results. The morphology of the meniscus as seen on MR images was characterized according to meniscal repair an the degree of meniscal resection into three groups. (1) less than 25% of the meniscal resection, (2) more than 25% meniscal resection, (3) meniscal repair. With routine conventional MR images, we grouped patients according to the signal intensity of menisci as Grade 1, Grade 2, Grade 3, and tear. RESULTS: The prevalence of recurrent meniscal tears in our study group was [68% (37/72 tears)]. In the diagnosis of recurrent meniscal tear, conventional MRI and MR arthrography had sensitivities of 54.0% and 94.5%, respectively; specificities of 75.0% and 87.5%, respectively; and accuracy of 57.7% and 93.4%, respectively. The accuracy of the conventional MRI studies was significantly less than that of the MR arthrography group (P<.05). CONCLUSION: Our study results indicate high overall accuracy for MR arthrography in the diagnosis of recurrent or residual meniscal tears. When meniscal resection is minimal, the right diagnosis could be obtained with conventional MRI. MR arthrography is necessary for patients with meniscal resection of more than 25% and who do not have sufficient joint effusion.