Topographic analysis of the inferior parietal lobule in high-resolution 3D MR imaging

BACKGROUND AND PURPOSE

Recent functional MR imaging studies have revealed that the inferior parietal lobule (IPL) supports numerous functions; however, the precise organization of the IPL remains unclear. It has been previously reported that the individual components of the IPL show variable morphologic features; thus, any investigations of IPL function must take into account the variable topography of the IPL. However, it is difficult to understand the topography of the IPL only in transaxial and/or sagittal MR images. We generated volume rendering (VR) images of the brain from high-resolution 3D MR imaging data and analyzed the topography of the IPL.

MATERIALS AND METHODS

Forty healthy volunteers were examined with 1.5T MR imaging, and VR images were generated. Sulcal continuity, sulcal connections, and the gyral pattern of the IPL were investigated.

RESULTS

The main sulci and gyri were able to be identified excellently on VR images of all volunteers. One long, continuous postcentral sulcus (postCS) was seen in 47.5% and 40% in the right and left hemisphere, respectively. The frequency with which the postCS connected with the anterior end of the IPS was 72.5% and 75% in the right and left, respectively. The gyral pattern of the IPL showed variable morphology.

CONCLUSIONS

VR images can depict the sulcal continuity and connections of the IPL accurately. VR imaging is a very useful noninvasive technique to observe the topography of the IPL and should contribute to the investigation of functional localization.

Phase transformation of a new generation yttria-stabilized zirconia femoral head after total hip arthroplasty

We examined a new-generation yttria-stabilized zirconia head manufactured by NGK 1 year after total hip arthroplasty. Monoclinic content of the retrieved head was twice that of the unused head at the pole and equator. A fourfold increase in monoclinic content was observed at 5 mm below the equator. Transformation from the tetragonal phase to the monoclinic phase occurred in the new generation zirconia with alumina doping within a relatively short period in vivo.

Ultrastructure of placental hyperplasia in mice: comparison of placental phenotypes with three different etiologies

Hyperplastic placentas have been reported in several experimental mouse models, including animals produced by somatic cell nuclear transfer, by inter(sub)species hybridization, and by somatic cytoplasm introduction to oocytes followed by intracytoplasmic sperm injection. Of great interest are the gross and histological features common to these placental phenotypes--despite their quite different etiologies--such as the enlargement of the spongiotrophoblast layers. To find morphological clues to the pathways leading to these similar placental phenotypes, we analyzed the ultrastructure of the three different types of hyperplastic placenta. Most cells affected were of trophoblast origin and their subcellular ultrastructural lesions were common to the three groups, e.g., a heavy accumulation of cytoplasmic vacuoles in the trophoblastic cells composing the labyrinthine wall and an increased volume of spongiotrophoblastic cells with extraordinarily dilatated rough endoplasmic reticulum. Although the numbers of trophoblastic glycogen cells were greatly increased, they maintained their normal ultrastructural morphology, including a heavy glycogen deposition throughout the cytoplasm. The fetal endothelium and small vessels were nearly intact. Our ultrastructural study suggests that these three types of placental hyperplasias, with different etiologies, may have common pathological pathways, which probably exclusively affect the development of certain cell types of the trophoblastic lineage during mouse placentation.

Hip motion analysis using multi phase (virtual and physical) simulation of the patient-specific hip joint dynamics

In total hip arthroplasty (THA), the patient-specific bone geometry or the characteristics of the skeletal movement should be considered during treatment in order to prevent complications. In this paper, we propose a novel approach for the analysis of joints which combines the patient-specific virtual and physical simulation. The patient-specific anatomical structure and hip motion was obtained from CT and optical motion capture. The virtual simulation was conducted by integrating these data using virtual reality technique. The physical simulation was achieved by using plaster models of the patient's pelvis and femur and robotic manipulator. The plaster models were driven by two robotic manipulators to reproduce the hip motion. The accuracy of the robot movement was 0.245 mm over the working area according to the validation by an optical tracking system. By combining this system with linear actuators that reproduce the muscle functions, patient-specific muscle function can be simulated, thereby helping clinicians to diagnose and make a treatment plan.

Proximal femoral bone mineral density after resurfacing total hip arthroplasty and after standard stem-type cementless total hip arthroplasty, both having similar neck preservation and the same articulation type

To examine whether the Freeman cementless total hip arthroplasty (THA), with femoral neck preservation and a large metal head, can prevent stress shielding in a manner similar to resurfacing THA, we compared femoral bone mineral density (BMD) change in 10 resurfacing THA patients (group A) and 16 cementless THA patients (group B). Six and twelve months postoperatively, the mean BMD ratio in zone 1 was significantly higher in group A (97% +/- 10%, 95% +/- 11%) than in group B (79% +/- 15%, 77% +/- 20%); at 12 months, the mean BMD ratio in zone 7 was significantly higher in group A (104% +/- 15%) than in group B (84% +/- 21%). The cementless THA might not be a substitute for the resurfacing THA with respect to prevention of proximal femoral bone loss at the femoral neck, although it may prevent some major complications after resurfacing THA such as neck fracture and avascular necrosis of the femoral head.

Open-configuration MRI study of femoro-acetabular impingement

Femoro-acetabular impingement has been proposed as a causative factor of primary hip osteoarthritis. However, primary osteoarthritis of the hip is infrequent in Japan and other Asian countries, even though the hips of Asians frequently sustain impingement, since the Asian lifestyle commonly requires a larger range of hip motion than the Western lifestyle. Therefore, using open-configuration MRI, we investigated whether impingement actually occurs during some traditional Japanese hip positions. The hips of 5 healthy Japanese females were examined in 5 sitting postures: 1) sitting straight; 2) bowing while sitting straight; 3) sitting cross-legged; 4) W-sitting; and 5) squatting. The impingement point was detected by multiple plane reconstructed (MPR) views along with the acetabular rim depicted circumferentially. Impingement was considered to have occurred when, on MRI, the anterior femoral head-neck junction approached the acetabular rim and the femoral head was seen to float from the bottom of the acetabulum with the acetabular rim acting as a fulcrum. Impingement was observed in all volunteers in the W-sitting position, and in 2 of 5 volunteers during squatting. These findings show that impingement occurs frequently during daily Japanese activities. Thus, depending on race, femoro-acetabular impingement might not always cause primary osteoarthritis of the hip. (c) 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:1582-1588, 2007.

Anatomic hip range of motion after implantation during total hip arthroplasty as measured by a navigation system

Simulation of prosthetic impingement is important for preventing complications after total hip arthroplasty (THA). Although the anatomical hip range of motion (ROM) in patients after THA is an essential parameter for these simulations, previous simulation studies substituted various clinical hip ROMs for the anatomical hip ROM. Using a navigation system, anatomical hip ROM was accurately assessed after implantation during primary THA in 30 patients. We found that the hip could be passively moved to 113 degrees of flexion, 34 degrees of extension, 46 degrees of abduction, 75 degrees of internal rotation, and 36 degrees of external rotation. Almost all reference hip ROMs used in previous simulations were smaller than these values. Therefore, wider hip ROM values should be used as parameters for such simulations.

Colorectal resection by a minilaparotomy approach vs. conventional operation for colon cancer. Results of a prospective randomized trial

BACKGROUND/AIMS

The aim of this study was to evaluate the outcome of patients undergoing colorectal resection for colon cancer using a minilaparotomy approach or conventional surgical procedure.

METHODOLOGY

In a prospective randomized trial, twenty consecutive patients undergoing colon resection by minilaparotomy and 26 patients undergoing conventional open colorectal resection were evaluated. Immunologic, metabolic and hemodynamic studies were performed in all patients. Cell surface markers were used to characterize Th1/2 balance, using flow cytometry. Indirect calorimetry to measure energy expenditure, and pulse dye densitometry for a hemodynamic study were performed in patients until 14 POD.

RESULTS

The lengths of laparotomy incisions were 7.5+/-1.5 cm and 20.5+/-2.5 cm in the minilaparotomy and conventional group, respectively. Mean operative time, morbidity and postoperative hospital stay of the two groups was not significantly different. However, mean operative blood loss, days to p.o. liquids and walking, and amount of analgesic usage were significantly less in the minilaparotomy group. The postoperative ratio of Th1/2 in CD4+T cells was decreased in both groups, but no significant difference was seen between the groups. Significant increase of resting energy expenditure and cardiac index was seen until day 3 in the conventional group, whereas those values increased until day 1 in the minilaparotomy group.

CONCLUSIONS

Compared with conventional colorectal resection for colon cancer, colorectal resection by minilaparotomy results in a more rapid return of bowel function, less pain and host response. However, the alternations of the host response for surgical stress between the two groups are similar in the early postoperative stage (days 1-2).

Mid-term results of cementless total hip replacement using a ceramic-on-ceramic bearing with and without computer navigation

We have developed a CT-based navigation system using infrared light-emitting diode markers and an optical camera. We used this system to perform cementless total hip replacement using a ceramic-on-ceramic bearing couple in 53 patients (60 hips) between 1998 and 2001. We reviewed 52 patients (59 hips) at a mean of six years (5 to 8) postoperatively. The mid-term results of total hip replacement using navigation were compared with those of 91 patients (111 hips) who underwent this procedure using the same implants, during the same period, without navigation. There were no significant differences in age, gender, diagnosis, height, weight, body mass index, or pre-operative clinical score between the two groups. The operation time was significantly longer where navigation was used, but there was no significant difference in blood loss or navigation-related complications. With navigation, the acetabular components were placed within the safe zone defined by Lewinnek, while without, 31 of the 111 components were placed outside this zone. There was no significant difference in the Merle d'Aubigne and Postel hip score at the final follow-up. However, hips treated without navigation had a higher rate of dislocation. Revision was performed in two cases undertaken without navigation, one for aseptic acetabular loosening and one for fracture of a ceramic liner, both of which showed evidence of neck impingement on the liner. A further five cases undertaken without navigation showed erosion of the posterior aspect of the neck of the femoral component on the lateral radiographs. These seven impingement-related mechanical problems correlated with malorientation of the acetabular component. There were no such mechanical problems in the navigated group. We conclude that CT-based navigation increased the precision of orientation of the acetabular component and control of limb length in total hip replacement, without navigation-related complications. It also reduced the rate of dislocation and mechanical problems related to impingement.

Therapeutic effects of Saireito (TJ-114), a traditional Japanese herbal medicine, on postoperative edema and inflammation after total hip arthroplasty

Saireito (TJ-114) is a traditional Japanese herbal medicine that has been used for treating edema and inflammation in diseases such as nephritic disease. This study investigates the effect of TJ-114 on postoperative edema and inflammation after total hip arthroplasty (THA). Patients who underwent cementless THA were randomly divided into two groups: Group A consisted of 8 hips of 8 patients who were treated with TJ-114 at a dose of 9 g/day 2 days before surgery and for 2 weeks after surgery; Group B consisted of 9 hips of 9 patients who did not take TJ-114. Although no significant difference was observed between the two groups for lower extremity edema, it was found that swelling of the proximal leg in Group A was less than that in Group B. Furthermore, 3 weeks after surgery, every measuring point in the lower extremity showed that TJ-114 tended to decrease postoperative swelling compared to measurements of swelling of patients who did not take TJ-114. Serum C-reactive protein (CRP) levels of 6 out of 8 patients in Group A decreased and became negative 2 weeks after surgery; however, there were no patients in Group B whose CRP levels became negative after 2 weeks. In conclusion, TJ-114 is safe and useful for the prevention and early recovery of postoperative leg edema after THA with an association of rapid CRP reduction.

Effect of robotic milling on periprosthetic bone remodeling

The ROBODOC system has provided better fit and fill of the stem and less destruction of the bony architecture than with manual surgery. These benefits might affect femoral periprosthetic bone remodeling. We evaluated the effects of robotic milling in cementless total hip arthroplasty (THA) in a longitudinal 24-month follow-up study using dual energy X-ray absorptiometry (DEXA) and plain radiographs of 29 patients (31 hips) after ROBODOC THA and 24 patients (27 hips) after manual THA with the same stem design. To minimize the influence of other factors on bone remodeling, only female osteoarthritis patients, who had no drugs that might affect bone metabolism were enrolled. Significantly less bone loss occurred at the proximal periprosthetic areas in the ROBODOC group. In zone 1, the decrease was 15.5 versus 29.9% using conventional rasping; in zone 7, the loss was 17.0% with ROBODOC compared to 30.5% with conventional rasping (p < 0.05). On radiographs, endosteal spot welds in the proximal medial portion were more pronounced in the ROBODOC group (48 vs. 11% in the conventional group, p < 0.05). Our results suggest that robotic milling is effective in facilitating proximal load transfer around the femoral component and minimizing bone loss after cementless THA.

Preoperative templating of femoral components on plain X-rays. Rotational evaluation with synthetic X-rays on ORTHODOC

INTRODUCTION

Preoperative femoral templating for total hip arthroplasty (THA) has been performed by antero-posterior radiographs of both hips which should be taken with the femur rotated internally to reduce the effect of femoral anteversion. However, there is no criterion to evaluate the optimal rotated radiograph. Here, we quantitatively investigated 50 femora whether the thickness of the lesser trochanter (TLT) was useful when evaluating the femoral rotation, and assessed the effect of prosthetic templating on the inappropriate rotated radiographs.

MATERIALS AND METHODS

We assessed 50 femora of 46 consecutive osteoarthritic patients using "synthetic X-ray" based on computer tomography (CT) images, which can be displayed as virtual plain radiographs with any magnification and any projected direction such as plain radiographs. We made four femoral radiograph groups of different rotation prepared (neutral, 15 degrees, 30 degrees, and 45 degrees external rotation), and measured the TLT. We also templated femoral stem on the different rotated synthetic X-ray of each patient, and investigated the effect of inappropriate rotated radiograph by the measurement of the position and the size of the stem.

RESULTS

Seventy-four percent of the neutral rotational group had less than 5 mm of the TLT. While 30 degrees and 45 degrees external rotation group had few cases with less than 5 mm of the TLT. Compared to the neutral group, smaller stem size was selected in more than 80% cases of 30 degrees and 45 degrees external rotational group, and the stem position in these two groups was more than 5 mm proximally.

CONCLUSION

We suggest that when templating femoral stem, this criterion "the TLT is less than 5 mm" reduces some risks by inappropriate rotated radiograph.

Proximal bone remodelling differed between two types of titanium long femoral components after cementless revision arthroplasty

In revision surgery with proximal femoral bone loss, progressive bone atrophy due to stress shielding remains a concern. We compared 2-year radiological results between two types of cementless long titanium stems with different configurations and surface coatings. Of 17 hips implanted with a wholly hydroxyapatite-coated stem, 12 (71%) exhibited stress shielding of the second degree or higher according to Engh's criteria, and the mean relative bone mass index decreased from 22.1% pre-operatively to 14.6% at 2 years post-operatively. In 23 hips implanted with a sand-blasted, conically shaped stem, no hip showed stress shielding of the second degree or higher. The mean relative bone mass index increased from 21.6% to 31.4%. These results indicate that the configuration and surface coating of the stem have a significant influence on proximal bone remodelling after revision surgery.

Computer-assisted spherical osteotomy with a curved-bladed Tuke Saw

Techniques for spherical osteotomy, such as rotational acetabular osteotomy, can help orthopaedic surgeons correct bony deformities and remove spherical acetabular components. Curved chisels are used during a spherical osteotomy, but they require skill and have a potential risk of damaging blood vessels or nerves. In order to perform a precise, quick and safe spherical osteotomy, we have developed a novel computer-assisted surgical tool using a vibrating bone saw, the Tuke Saw, with a curved blade that operates under the guidance of an optical navigation system. In this study, the accuracy and ease of use of this curved-bladed Tuke Saw in spherical osteotomy were examined in comparison with the conventional curved chisel. Using these surgical tools, hemispherical osteotomies were performed on rectangular parallelepiped Sawbones blocks and rotational acetabular osteotomies were performed on cadaveric pelves. The distance error with the curved-bladed Tuke Saw was significantly smaller than that with the curved chisel, and the procedure time with the Tuke Saw was approximately half that with the chisel. It can thus be concluded that the curved-bladed Tuke Saw is more accurate and easier to use than the conventional curved chisel.

Disorders of acetabular labrum and articular cartilage in hip dysplasia: evaluation using isotropic high-resolutional CT arthrography with sequential radial reformation

OBJECTIVE

Acetabular labral tear may predispose to adjacent articular cartilage disorder and hip osteoarthritis in patients with hip dysplasia. We evaluated the diagnostic ability of isotropic computed tomography (CT) arthrography with radial reformation technique for detection of acetabular labral and articular cartilage disorders, and evaluate those interactions in hip dysplasia.

METHODS

Forty-one hips in 29 patients with hip dysplasia received CT arthrography with isotropic spatial resolution of 0.5mm. After processing of multiplanar radial reformation over the whole acetabular circumference, frequencies of labral tear and acetabular cartilage disorder were evaluated at six divided zones of the weight-bearing areas. Of the 41 hips, 20 hips underwent arthroscopic examinations, and sensitivity, specificity and accuracy for detecting labral tear and acetabular cartilage disorder by CT arthrography were calculated using the arthroscopic findings as the standard of reference.

RESULTS

The sensitivity, specificity and accuracy of CT arthrography were 97%/87%/92% for labral tear and 88%/82%/85% for acetabular cartilage disorder, respectively, using arthroscopic findings as the reference. The CT arthrography showed significantly higher frequency of labral and acetabular cartilage disorders at the anterior zones. Those zones with labral tear had significantly higher frequency of adjacent cartilage disorder than zones without labral tear.

CONCLUSIONS

Isotropic CT arthrography with radial reformation technique allowed simultaneous, accurate assessment of labral and cartilage disorders in the whole acetabular circumference. Our findings indicated that labral tear is closely associated with adjacent cartilage disorder in hip dysplasia.

Five-year results of metal-on-metal resurfacing arthroplasty in Asian patients

Clinical results of 50 metal-on-metal resurfacing arthroplasties in 45 Japanese patients were evaluated to a minimum follow-up of 5 years. The predominant diagnosis was developmental dysplasia or dislocation of the hip (70%). One patient died of an unrelated cause and another was lost to follow-up. Two hips received revision surgery, including 1 femoral neck fracture and 1 septic loosening. In the remaining 46 hips, 1 hip showed femoral component loosening. Clinical scores of the 46 hips were satisfactory at the final follow-up. The survival rate at 5 years was 96% when failure was attributed to revision for any reason. Metal-on-metal resurfacing arthroplasty in Japanese patients, who have a different distribution of hip diseases from European and American patients, showed similarly promising early clinical results.

377 SPERMATOZOA RETRIEVED FROM MALE MICE FROZEN FOR 15 YEARS CAN PRODUCE NORMAL OFFSPRING

Cryopreservation of male germ cells is a strategy to conserve animal species and strains of animals valuable to biomedical research. However, to minimize damage that may occur during freezing and thawing, complex cryopreservation protocols that have been optimized for the stage and species of male germ cells are usually employed. Recently, we have found that mouse male germ cells can be cryopreserved at -80�C by freezing the whole epididymides and testes without cryoprotectant for at least one year (Ogonuki et al. 2006 Reprod. Fertil. Dev. 18, 286 abst). This study was undertaken to determine whether mouse male germ cells retrieved from the bodies of mice frozen at -20�C for 15 years could produce normal offspring by microinsemination. Mature males of BALB/c-nude and C3H/He (8 weeks of age) were euthanized by overdose of pentobarbital on February 20 and March 8, 1991, respectively, and kept in a -20�C freezer. The frozen body was thawed about 15 years after freezing (February 2006) by putting it in a water bath until the outer surface of the body was softened. The body was then removed from the water, and the testes were isolated through an abdominal incision. Testicular spermatozoa were collected from the testes and microinseminated into B6D2F1 oocytes. Within 24 h after sperm injection, over 80% of oocytes developed into 2-cell embryos. Apparently normal pups were born after embryo transfer in both strains of mice at rates of 21% (17/81) and 12% (12/97) per transfer, respectively. Two pups from the BALB/c-nude group died shortly after Caesarian section due to respiratory failure, but others grew normally and were proven to be fertile when they matured (at least 19 mice out of 20 mice tested). We further mated these F1 offspring and confirmed that the nude gene was safely propagated. The present study demonstrates that spermatozoa can retain their fertilizing ability in frozen whole bodies for longer than we anticipated. If spermatozoa of extinct mammalian species (e.g. woolly mammoth) can be retrieved from animal bodies that were kept frozen in permanent frost, live animals might be restored by injecting them into oocytes from females of closely related species.

47 DIFFERENTIAL DEVELOPMENTAL ABILITY OF EMBRYOS CLONED FROM TISSUE-SPECIFIC STEM CELLS

Although cloning animals by somatic cell nuclear transfer is generally an inefficient process, use of appropriate donor cell types may improve the cloning outcome significantly. Among the donor cells tested so far, mouse embryonic stem cells have given the best efficiency in terms of the development of reconstructed embryos into offspring. In this study, we examined whether 2 in vitro-produced pluripotent stem cells—neural stem cells (NSCs) and mesenchymal stem cells (MSCs)—could be better nuclear donors than other differentiated cells. Embryos were reconstructed by transfer of nuclei from NSCs or MSCs with full potential for differentiation in vitro. Most (76%) of the 2-cell NCS embryos developed to the 4-cell stage; 43% implanted and 1.6% developed to term after transfer to pseudopregnant recipients. These rates were very similar to those of embryos cloned from fibroblast cell nuclei. Interestingly, in the patterns of zygotic gene expression, NSC embryos were more similar to in vitro-fertilized embryos than fibroblast cloned embryos. By contrast, embryos reconstructed using MSC nuclei showed lower developmental ability and no implantation was obtained after embryo transfer. Chromosomal analysis of the donor MSCs revealed very high frequencies of monosomy and trisomy, which might have caused the very poor post-implantation development of embryos following nuclear transfer. Thus, in vitro-produced pluripotent cells can serve as donors of nuclei for cloning mice, but may be prone to chromosomal aberrations leading to a high rate of cloned embryo death.

System for intraoperative evaluation of soft-tissue-generated forces during total hip arthroplasty by measurement of the pressure distribution in artificial joints

A system for evaluating the soft-tissue-generated forces at the hip joint was developed. The system enabled measurement of contact pressure distribution at hip joint surfaces, as well as evaluation of the artificial hip joint condition during total hip arthroplasty (THA). First, a pressure sensor module that forms part of the artificial joint was constructed. Eight small pressure sensors were installed in the spherical head component of the ball-and-socket joint. Next, software for recording and visualizing the detected pressures at 1-millisecond intervals was developed. The pressure distribution was displayed in real time via 3D computer graphics on a monitor. The system enabled intuitive recognition of the direction of soft-tissue-generated forces and pressure distribution in three dimensions. Accuracy tests were conducted using a high-accuracy 6-degree-of-freedom positioning device and digital force gauge. The error between the applied loads and measured forces was 3.42 +/- 3.26 N (mean +/- standard deviation) for each coordinate in 10 trials involving load application from 10 different directions. Next, a clinical evaluation was conducted during THA. The relative positions of the cup and stem component were measured using a surgical navigation system simultaneously with the pressure measurement. The system allowed real-time acquisition of information regarding the artificial hip joint, as well as comparison of the differences in the hip condition when several types of neck were used. Further improvements to the calibration method should enable more accurate measurements. We believe this system will be a useful tool for selecting an appropriate implant that fits a patient's hip joint or for estimating the risk of complications following surgery.

Methylmethacrylate casting model of temporal bone: a simple technique for skull base research and education

Methylmethacrylate casting model of the temporal bone simulating the translabyrinthine approach from the bone surface down to the internal auditory canal was developed in order to help to understand the complex anatomy that is often encountered during skull base surgery. Using a cadaver temporal bone and applying dental impression technique, fine structures, such as semicircular canals and facial nerve, were precisely reproduced in a life-size resin casting model. This simple cost-effective modeling method would facilitate both anatomical research and medical education by improving our understanding of the complex anatomy of the temporal bone.

Application of three-dimensional magnetic resonance image registration for monitoring hip joint diseases

The purpose of this study was to estimate the accuracy of a method in which three-dimensional (3D) magnetic resonance (MR) volume registration is used for monitoring hip joint disease. Data were analyzed using a normalized cross-correlation (NCC) algorithm involving a user-selected 3D box including the proximal femur. Most of the femoral head was not included in the 3D box because it can become deformed during the course of disease. The accuracy of registration around the femoral head was evaluated using five phantoms and clinical MR data of 17 patients with hip joint disease. In the phantom experiment, registration accuracy was evaluated using four fiducial markers attached to the femoral head. In the experiment using clinical data, registration accuracy was evaluated using a landmark in the femoral head. The registration accuracy in the phantom and clinical experiment was 0.43+/-0.18 mm (S.D.) and 1.12+/-0.46 mm (S.D.), respectively. The former is a value less than half the minimum dimension of a voxel (1.25 x 1.25 x 1.0 mm). Although the latter is slightly larger than the minimum dimension of a voxel, actual errors would be smaller because of the uncertainty in landmark localization. In conclusion, the present method based on an NCC algorithm can be used to accurately register serial MR images of the femoral heads with an error on the order of a voxel. We believe that this method is sufficiently accurate for monitoring hip joint diseases.

Spontaneous regression of steroid-related osteonecrosis of the knee

It is unknown whether lesions of steroid-related osteonecrosis of the knee increase or decrease in size during the course of the disease after diagnosis. We sought to determine whether steroid-related osteonecrosis of the knee would have spontaneous changes in size, and if so, the factors affecting the change. We performed baseline and followup (minimum of 1 year) magnetic resonance imaging scans on 30 knees of 17 patients. We then used image registration techniques to match two sets of images. Lesion size change was evaluated on all contiguous pairs of matched magnetic resonance images. Fourteen Stage 1 (preradiographic stage) knees in seven patients showed spontaneous incomplete regression without subsequent collapse. These patients had early steroid-related lesions detected within 3 years after starting steroid treatment and all showed bilateral and multifocal involvement; lesion regression occurred regardless of location. The initial size and location of the lesions and discontinuing steroid administration did not seem to affect regression. Regression can occur in some patients with early steroid-related osteonecrosis of the knee, and the time between initiation of steroid treatment and its diagnosis might be the most significant predictive factor.