1
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Bisciotti GN, Di Pietto F, Rusconi G, Bisciotti A, Auci A, Zappia M, Romano S. The Role of MRI in Groin Pain Syndrome in Athletes. Diagnostics (Basel) 2024; 14:814. [PMID: 38667460 PMCID: PMC11049591 DOI: 10.3390/diagnostics14080814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Groin pain syndrome (GPS) is one of the most frequent injuries in competitive sports. Stresses generated in the lower limbs by quick turns and accelerations, such as in soccer, basketball or hockey, can produce localized regions of increased forces, resulting in anatomical lesions. The differential diagnoses are numerous and comprise articular, extra-articular, muscular, tendinous and visceral clinical conditions and a correct diagnosis is crucial if treatment is to be efficient. MRI is the gold standard of diagnostic techniques, especially when an alternative pathology needs to be excluded and/or other imaging techniques such as ultrasound or radiography do not lead to a diagnosis. This paper, based on the current literature, gives a comprehensive review of the anatomy of the pubic region and of the typical MRI findings in those affected by GPS. Many clinical conditions causing GPS can be investigated by MRI within appropriate protocols. However, MRI shows limits in reliability in the investigation of inguinal and femoral hernias and therefore is not the imaging technique of choice for studying these clinical conditions.
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Affiliation(s)
| | - Francesco Di Pietto
- Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, 81030 Castel Volturno, Italy
| | - Giovanni Rusconi
- Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, 81030 Castel Volturno, Italy
| | | | - Alessio Auci
- Dipartimento delle Diagnostiche, Azienda USL Toscana Nord Ovest, 56121 Massa, Italy;
| | - Marcello Zappia
- Department of Medicine and Health Science V. Tiberio, Università degli Studi del Molise, 86100 Campobasso, Italy;
| | - Stefania Romano
- Department of Radiology, S. Maria delle Grazie Hospital, 80078 Pozzuoli, Italy;
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2
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Malhotra G, Hansford BG, Felcher C, Wuerfel KA, Yablon CM. Fluoroscopic-guided procedures of the lower extremity. Skeletal Radiol 2023; 52:855-874. [PMID: 35930079 PMCID: PMC9362560 DOI: 10.1007/s00256-022-04139-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
This article reviews the literature and the authors' experiences regarding the performance of lower extremity fluoroscopically guided procedures from the hip to the toes. An overview of injections and aspirations, their indications, risks, and complications are provided, focusing on anesthetics, corticosteroids, and contrast agents. A variety of approaches to each joint and the associated pearls and pitfalls of each approach will be discussed.
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Affiliation(s)
- Gunjan Malhotra
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Barry G. Hansford
- grid.5288.70000 0000 9758 5690Department of Radiology, Oregon Health & Science University, 3181 SW Jackson Park Rd., Portland, OR 97239 USA
| | - Cindy Felcher
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Kristie A. Wuerfel
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Corrie M. Yablon
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
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3
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Chuang CA, Sheu H, Yang CP, Tang HC, Wu CT, Fu CJ, Chan YS. Combined 3-Dimensional CT and Multidirectional CT Arthrography for Femoroacetabular Impingement and Hip Lesions: A Cross-sectional Study Comparing Imaging and Hip Arthroscopic Surgery Findings. Orthop J Sports Med 2023; 11:23259671221143459. [PMID: 36644778 PMCID: PMC9834784 DOI: 10.1177/23259671221143459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 01/11/2023] Open
Abstract
Background There is limited research investigating the diagnostic strength of 3-dimensional computed tomography (3D-CT) and multidirectional CT arthrography (CTA) for femoroacetabular impingement (FAI) and related hip lesions. Purpose To evaluate the diagnostic strength of combined 3D-CT and CTA in patients with FAI and related hip lesions by comparing it with hip arthroscopic surgery findings. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods This study included patients who were suspected of having FAI and related hip lesions and who underwent a combination of 3D-CT and CTA and subsequent hip arthroscopic surgery between December 2013 and December 2017. The CT and intraoperative arthroscopic findings were recorded and compared. The sensitivity, specificity, and accuracy of 3D-CT for FAI and those of CTA for related hip lesions were calculated. Results A total of 114 patients with 114 hips were included in our study. There were 101 patients with positive findings and 13 patients with negative findings for FAI (including cam, pincer, and combined morphology) according to 3D-CT. The sensitivity, specificity, and accuracy of 3D-CT for FAI were 91.58%, 57.14%, and 89.47%, respectively. The sensitivity, specificity, and accuracy of CTA for labral tears were 94.64%, 100.00%, and 94.73%, respectively. For acetabular cartilage defects, the sensitivity, specificity, and accuracy of CTA were 60.71%, 91.37%, and 76.31%, respectively. For femoral cartilage defects, the sensitivity, specificity, and accuracy of CTA were 82.22%, 76.81%, and 78.94%, respectively. Conclusion The study results indicated that 3D-CT was able to provide excellent accuracy for FAI compared with hip arthroscopic surgery findings. In addition, multidirectional CTA demonstrated promising diagnostic strength for hip lesions such as labral tears and chondral defects.
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Affiliation(s)
- Chieh-An Chuang
- Division of Sports Medicine, Department of Orthopaedic Surgery,
Linkou Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital,
Taoyuan.,Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial
Hospital, Taoyuan
| | - Huan Sheu
- Division of Sports Medicine, Department of Orthopaedic Surgery,
Linkou Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital,
Taoyuan.,Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial
Hospital, Taoyuan
| | - Cheng-Pang Yang
- Division of Sports Medicine, Department of Orthopaedic Surgery,
Linkou Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital,
Taoyuan.,Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial
Hospital, Taoyuan
| | - Hao-Che Tang
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial
Hospital, Taoyuan.,Department of Orthopaedic Surgery, Keelung Chang Gung Memorial
Hospital, Keelung
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention, Linkou Chang Gung
Memorial Hospital, Taoyuan
| | - Chen-Ju Fu
- Department of Medical Imaging and Intervention, Linkou Chang Gung
Memorial Hospital, Taoyuan
| | - Yi-Sheng Chan
- Division of Sports Medicine, Department of Orthopaedic Surgery,
Linkou Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital,
Taoyuan.,Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial
Hospital, Taoyuan.,Department of Orthopaedic Surgery, Keelung Chang Gung Memorial
Hospital, Keelung.,Yi-Sheng Chan, MD, Department of Orthopaedic Surgery, Linkou
Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan
City, 333 ()
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4
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Friedman JM, Diaz LE, Roemer FW, Guermazi A. Imaging of common hip pathologies in runners. Jpn J Radiol 2023; 41:488-499. [PMID: 36607548 DOI: 10.1007/s11604-022-01381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023]
Abstract
Running is an increasingly popular sport and form of exercise. Because of the importance of the hip in the biomechanics involved with running, forming the primary connection between the axial and appendicular skeleton of the lower extremities, accurate diagnosis and reporting of hip pathology are vital for appropriate management. This review provides an overview of the most common hip pathologies and injuries encountered in runners. Radiologic studies, primarily conventional radiography and magnetic resonance imaging (MRI) provide useful diagnostic information and should be used in combination with clinical findings to help guide therapeutic management.
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Affiliation(s)
- Jonathan M Friedman
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA.
| | - Luis E Diaz
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA.,Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA
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5
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Walsh PJ, Walz DM. Imaging of Osteoarthritis of the Hip. Radiol Clin North Am 2022; 60:617-628. [DOI: 10.1016/j.rcl.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Bojicic KM, Meyer NB, Yablon CM, Brigido MK, Gaetke-Udager K. Hip Pain: Imaging of Intra-articular and Extra-articular Causes. Clin Sports Med 2021; 40:713-729. [PMID: 34509207 DOI: 10.1016/j.csm.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hip pain is a common and complex clinical entity. The causes of hip injuries in athletes are many and diverse, requiring efficient, accurate diagnosis for proper management. Imaging is an important step in the clinical evaluation of hip pain, and familiarity with multiple imaging modalities as well as characteristic imaging findings is a helpful tool for sports medicine clinicians. This article discusses imaging recommendations and gives imaging examples of common causes of intra-articular and extra-articular hip pain including femoroacetabular impingement, labral tears, cartilage defects, ligamentum teres injuries, snapping hip syndrome, femoral stress injuries, thigh splints, athletic pubalgia, avulsion injuries, and hip dislocation.
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Affiliation(s)
- Katherine M Bojicic
- Diagnostic Radiology Resident, University of Michigan Medical Center, 1500 E Medical Center Drive, B1 D502, Ann Arbor, MI 48103, USA
| | - Nathaniel B Meyer
- University of Michigan Medical Center, 1500 E Medical Center Drive, TC 2910, Ann Arbor, MI 48103, USA
| | - Corrie M Yablon
- University of Michigan Medical Center, 1500 E Medical Center Drive, TC 2910, Ann Arbor, MI 48103, USA
| | - Monica Kalume Brigido
- University of Michigan Medical Center, 1500 E Medical Center Drive, TC 2910, Ann Arbor, MI 48103, USA
| | - Kara Gaetke-Udager
- University of Michigan Medical Center, 1500 E Medical Center Drive, TC 2910, Ann Arbor, MI 48103, USA.
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7
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Sandhu R, Aslan M, Obuchowski N, Primak A, Karim W, Subhas N. Dual-energy CT arthrography: a feasibility study. Skeletal Radiol 2021; 50:693-703. [PMID: 32948903 DOI: 10.1007/s00256-020-03603-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the feasibility of producing 2-dimensional (2D) virtual noncontrast images and 3-dimensional (3D) bone models from dual-energy computed tomography (DECT) arthrograms and to determine whether this is best accomplished using 190 keV virtual monoenergetic images (VMI) or virtual unenhanced (VUE) images. MATERIALS AND METHODS VMI and VUE images were retrospectively reconstructed from patients with internal derangement of the shoulder or knee joint who underwent DECT arthrography between September 2017 and August 2019. A region of interest was placed in the area of brightest contrast, and the mean attenuation (in Hounsfield units [HUs]) was recorded. Two blinded musculoskeletal radiologists qualitatively graded the 2D images and 3D models using scores ranging from 0 to 3 (0 considered optimal). RESULTS Twenty-six patients (mean age ± SD, 57.5 ± 16.8 years; 6 women) were included in the study. The contrast attenuation on VUE images (overall mean ± SD, 10.5 ± 16.4 HU; knee, 19.3 ± 10.7 HU; shoulder, 5.0 ± 17.2 HU) was significantly lower (p < 0.001 for all comparisons) than on VMI (overall mean ± SD, 107.7 ± 43.8 HU; knee, 104.6 ± 31.1 HU; shoulder, 109.6 ± 51.0 HU). The proportion of cases with optimal scores (0 or 1) was significantly higher with VUE than with VMI for both 2D and 3D images (p < 0.001). CONCLUSIONS DECT arthrography can be used to produce 2D virtual noncontrast images and to generate 3D bone models. The VUE technique is superior to VMI in producing virtual noncontrast images.
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Affiliation(s)
- Rashpal Sandhu
- Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Mercan Aslan
- Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Andrew Primak
- Siemens Medical Solutions USA, Inc., Malvern, PA, 19355, USA
| | - Wadih Karim
- Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Naveen Subhas
- Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
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8
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Klaan B, Wuennemann F, Kintzelé L, Gersing AS, Weber MA. [MR and CT arthrography in cartilage imaging : Indications and implementation]. Radiologe 2019; 59:710-721. [PMID: 31286150 DOI: 10.1007/s00117-019-0564-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The imaging of chondral pathologies is an essential part in the work-up of acute and chronic joint diseases. Besides conventional MR imaging, CT and MR arthrography are well-established methods in evaluating articular cartilage. The application of these techniques requires knowledge of indications and safe injection procedures by the performing radiologist. PURPOSE Our goal is to describe the techniques of cross-sectional arthrographies of different joints, give an overview of general and joint-specific considerations for practical application as well as provide typical indications for cartilage imaging. MATERIALS AND METHODS A selective PubMed literature search concerning "arthrography", "CT arthrography", "MR arthrography", "arthrography cartilage", "arthrography wrist", "arthrography elbow", "arthrography shoulder", "arthrography hip", "arthrography knee", "arthrography ankle", "arthrography complications", "arthrography imaging guidance" "osteochondral lesion", "cartilage imaging" and "cartilage lesion" was performed. RESULTS AND CONCLUSION CT and MR arthrography are valuable and safe tools in cartilage imaging. They are useful to verify and specify chondral pathologies, usually after conventional MR imaging, and have an important role in evaluating the stability and therefore in therapeutic decision making of osteochondral lesions. CT arthrography is not only a substitute technique in case of MR contraindications, it can be advantageous in small joints (wrist, elbow, ankle) compared to MR arthrography due to its higher image resolution. Fluoroscopic guided joint puncture is still the most commonly used image guidance method, but the role of ultrasound is steadily increasing. Joint traction in MR arthrography is a promising technique to improve cartilage visualization, though it is not yet used in clinical routine imaging.
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Affiliation(s)
- B Klaan
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland.
| | - F Wuennemann
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - L Kintzelé
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A S Gersing
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - M-A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland
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9
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Nelson BB, Kawcak CE, Barrett MF, McIlwraith CW, Grinstaff MW, Goodrich LR. Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging. Equine Vet J 2018; 50:564-579. [DOI: 10.1111/evj.12808] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Affiliation(s)
- B. B. Nelson
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - C. E. Kawcak
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. F. Barrett
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
- Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins Colorado USA
| | - C. W. McIlwraith
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering, Chemistry and Medicine Boston University Boston Massachusetts USA
| | - L. R. Goodrich
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
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11
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Chopra A, Grainger AJ, Dube B, Evans R, Hodgson R, Conroy J, Macdonald D, Robinson P. Comparative reliability and diagnostic performance of conventional 3T magnetic resonance imaging and 1.5T magnetic resonance arthrography for the evaluation of internal derangement of the hip. Eur Radiol 2017; 28:963-971. [PMID: 28986631 PMCID: PMC5811590 DOI: 10.1007/s00330-017-5069-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/09/2017] [Accepted: 09/11/2017] [Indexed: 11/06/2022]
Abstract
Objective To compare the diagnostic accuracy of conventional 3T MRI against 1.5T MR arthrography (MRA) in patients with clinical femoroacetabular impingement (FAI). Methods Sixty-eight consecutive patients with clinical FAI underwent both 1.5T MRA and 3T MRI. Imaging was prospectively analysed by two musculoskeletal radiologists, blinded to patient outcomes and scored for internal derangement including labral and cartilage abnormality. Interobserver variation was assessed by kappa analysis. Thirty-nine patients subsequently underwent hip arthroscopy and surgical results and radiology findings were analysed. Results Both readers had higher sensitivities for detecting labral tears with 3T MRI compared to 1.5T MRA (not statistically significant p=0.07). For acetabular cartilage defect both readers had higher statistically significant sensitivities using 3T MRI compared to 1.5T MRA (p=0.02). Both readers had a slightly higher sensitivity for detecting delamination with 1.5T MRA compared to 3T MRI, but these differences were not statistically significant (p=0.66). Interobserver agreement was substantial to perfect agreement for all parameters except the identification of delamination (3T MRI showed moderate agreement and 1.5T MRA substantial agreement). Conclusion Conventional 3T MRI may be at least equivalent to 1.5T MRA in detecting acetabular labrum and possibly superior to 1.5T MRA in detecting cartilage defects in patients with suspected FAI. Key Points • Conventional 3T MRI is equivalent to 1.5T MRA for diagnosing labral tears. • Conventional 3T MRI is superior to 1.5T MRA for diagnosing acetabular cartilage defect. • Conventional 3T MRI is equivalent to 1.5T MRA for diagnosing cartilage delamination. • Symptom severity score was significantly higher (p<0.05) in group proceeding to surgery.
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Affiliation(s)
- A Chopra
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, LS7 4SA, UK
| | - A J Grainger
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, LS7 4SA, UK.,University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - B Dube
- University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - R Evans
- University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - R Hodgson
- University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - J Conroy
- Trauma and Orthopaedics Department, Harrogate and District NHS Trust, Harrogate, UK
| | - D Macdonald
- Trauma and Orthopaedics Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK
| | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, LS7 4SA, UK. .,University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK.
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12
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MR Arthrography versus conventional MRI in evaluation of labral and chondral lesions in different types of femoroacetabular impingement. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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13
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Diagnostic Value of CT Arthrography for Evaluation of Osteochondral Lesions at the Ankle. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3594253. [PMID: 27891511 PMCID: PMC5116491 DOI: 10.1155/2016/3594253] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/18/2016] [Indexed: 11/18/2022]
Abstract
Background. To retrospectively determine the diagnostic value of computed tomography arthrography (CTA) of the ankle in the evaluation of (osteo)chondral lesions in comparison to conventional magnetic resonance imaging (MRI) and intraoperative findings. Methods. A total of N = 79 patients had CTAs and MRI of the ankle; in 17/79 cases surgical reports with statements on cartilage integrity were available. Cartilage lesions and bony defects at talus and tibia were scored according to defect depth and size by two radiologists. Statistical analysis included sensitivity analyses and Cohen's kappa calculations. Results. On CTA, 41/79 and 31/79 patients had full thickness cartilage defects at the talus and at the tibia, respectively. MRI was able to detect 54% of these defects. For the detection of full thickness cartilage lesions, interobserver agreement was substantial (0.72 ± 0.05) for CTA and moderate (0.55 ± 0.07) for MRI. In surgical reports, 88–92% and 46–62% of full thickness defects detected by CTA and MRI were described. CTA findings changed the further clinical management in 15.4% of cases. Conclusions. As compared to conventional MRI, CTA improves detection and visualization of cartilage defects at the ankle and is a relevant tool for treatment decisions in unclear cases.
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14
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Magnetic resonance arthrography and the prevalence of acetabular labral tears in patients 50 years of age and older. Skeletal Radiol 2016; 45:1061-7. [PMID: 27098353 DOI: 10.1007/s00256-016-2392-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/22/2016] [Accepted: 04/11/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Arthroscopy for acetabular labral tears has minimal impact on pain and function in older patients, especially in the setting of concomitant osteoarthritis. Still, many physicians seek this diagnosis with MR arthrography. Our purpose is to assess the frequency of acetabular labral tears in older patients with hip pain and correlate likelihood of labral pathology with severity of osteoarthritis as visualized on conventional radiograph. MATERIALS AND METHODS From 2004 to 2013, 208 hip MRI arthrograms and corresponding radiographs on patients aged 50 years and older were identified. Age, gender, grade and location of labral tear, alpha angle, Tönnis grade, and joint space width were documented. Labral tears and alpha angle were identified and measured on MR arthrogram. Tönnis grade and joint space width were measured on radiographs. RESULTS AND CONCLUSIONS On MR arthrography, true labral tearing was identified in 73 % of patients. There was some degree of labral pathology in 93.3 % of patients, and this increased to 100 % in patients with moderate to severe osteoarthritis, as defined by Tönnis grade 2-3 or joint space width ≤ 2 mm. There were no statistically significant correlations between labral tear grade and Tönnis grade or joint space width. Given the high frequency of labral pathology and the questionable efficacy of arthroscopic surgical intervention in older patients, MR arthrography should be primarily for those with minimal arthritis on radiograph and potential to benefit from surgery. If further imaging beyond radiographs is necessary in these patients, standard MRI may be a more appropriate imaging tool.
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15
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Abstract
Hip pain is common in all age groups, and osteoarthritis of this joint is an increasingly recognized problem particularly in aging populations. One of the primary goals in the diagnostic evaluation in patients with hip pain is to identify and correct pathologies that could progress to osteoarthritis. Magnetic resonance imaging (MRI) has become an important noninvasive method for characterizing hip anatomy and pathology in these patients. Improvements in MRI hardware and techniques have allowed high spatial and contrast resolution imaging to detect subtle abnormalities, such as acetabular labral and articular cartilage injuries, which often contribute to patient symptoms. Newer MRI techniques, such as delayed gadolinium-enhanced MRI of cartilage and T2 mapping, can give insight into the biochemical structure of tissues such as the articular cartilage. In turn, these can allow quantitative assessment and enable imagers to more directly compare the findings of patients at earlier stages of disease. It is important to understand the fundamental principles of various MRI techniques and their limitations to know when these techniques can best be applied. In addition, understanding of normal hip anatomy and common anatomic variants is useful for being able to accurately detect and localize areas of pathology and to prevent misinterpreting normal structures as diseased. The aims of this work were to briefly review normal hip anatomy and common anatomic variants seen on routine MRI examination, to discuss principles often used in high-resolution hip MRI and newer techniques for biochemical evaluation, and to examine several intra-articular pathologic conditions of the hip joint that are of current clinical interest.
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Affiliation(s)
- Imran M Omar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
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16
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MDCT arthrography of the hip: value of the adaptive statistical iterative reconstruction technique and potential for radiation dose reduction. AJR Am J Roentgenol 2015; 203:W665-73. [PMID: 25415733 DOI: 10.2214/ajr.14.12821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this article is to assess the effect of the adaptive statistical iterative reconstruction (ASIR) technique on image quality in hip MDCT arthrography and to evaluate its potential for reducing radiation dose. SUBJECTS AND METHODS Thirty-seven patients examined with hip MDCT arthrography were prospectively randomized into three different protocols: one with a regular dose (volume CT dose index [CTDIvol], 38.4 mGy) and two with a reduced dose (CTDIvol, 24.6 or 15.4 mGy). Images were reconstructed using filtered back projection (FBP) and four increasing percentages of ASIR (30%, 50%, 70%, and 90%). Image noise and contrast-to-noise ratio (CNR) were measured. Two musculoskeletal radiologists independently evaluated several anatomic structures and image quality parameters using a 4-point scale. They also jointly assessed acetabular labrum tears and articular cartilage lesions. RESULTS With decreasing radiation dose level, image noise statistically significantly increased (p=0.0009) and CNR statistically significantly decreased (p=0.001). We also found a statistically significant reduction in noise (p=0.0001) and increase in CNR (p≤0.003) with increasing percentage of ASIR; in addition, we noted statistically significant increases in image quality scores for the labrum and cartilage, subchondral bone, overall diagnostic quality (up to 50% ASIR), and subjective noise (p≤0.04), and statistically significant reductions for the trabecular bone and muscles (p≤0.03). Regardless of the radiation dose level, there were no statistically significant differences in the detection and characterization of labral tears (n=24; p=1) and cartilage lesions (n=40; p≥0.89) depending on the ASIR percentage. CONCLUSION The use of up to 50% ASIR in hip MDCT arthrography helps to reduce radiation dose by approximately 35-60%, while maintaining diagnostic image quality comparable to that of a regular-dose protocol using FBP.
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Blum A, Raymond A, Teixeira P. Strategy and optimization of diagnostic imaging in painful hip in adults. Orthop Traumatol Surg Res 2015; 101:S85-99. [PMID: 25599865 DOI: 10.1016/j.otsr.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/28/2014] [Accepted: 11/27/2014] [Indexed: 02/02/2023]
Abstract
Diagnostic imaging strategy in painful hip depends on many factors, but in all cases, plain X-ray is the first investigation. It may be sufficient to reach diagnosis and determine treatment options. More effective but more expensive exploration is indicated in two circumstances: when plain X-ray is non-contributive, and when diagnosis has been established but more accurate imaging assessment is needed to guide treatment. Following radiography, the choice of imaging techniques depends not only on the suspected pathology but also on the availability of equipment and its performance. MRI is probably the technique that provides the most comprehensive results; recent improved accessibility has significantly simplified the diagnostic algorithm. CT remains invaluable, and current techniques have reduced patient irradiation to a level similar to that of standard X-ray. Finally, cost is an important consideration in choosing the means of exploration, but the overall financial impact of the various strategies for diagnosis of painful hip is not well established. This article aims to provide a simple and effective diagnostic strategy for the assessment of painful hip, taking account of the clinical situation, and to detail the most typical semiologic patterns of each disease affecting this joint.
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Affiliation(s)
- A Blum
- Service d'imagerie Guilloz, CHU de Nancy, 54000 Nancy, France.
| | - A Raymond
- Service d'imagerie Guilloz, CHU de Nancy, 54000 Nancy, France
| | - P Teixeira
- Service d'imagerie Guilloz, CHU de Nancy, 54000 Nancy, France
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Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med 2014; 49:811. [PMID: 25515771 DOI: 10.1136/bjsports-2014-094302] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Surgery for hip femoroacetabular impingement/acetabular labral tear (FAI/ALT) is exponentially increasing despite lacking investigation of the accuracy of various diagnostic measures. Useful clinical utility of these measures is necessary to support diagnostic imaging and subsequent surgical decision-making. OBJECTIVE Summarise/evaluate the current diagnostic accuracy of various clinical tests germane to hip FAI/ALT pathology. METHODS A computer-assisted literature search of MEDLINE, CINAHL and EMBASE databases using keywords related to diagnostic accuracy of the hip joint, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 (QUADAS-2). Random effects models were used to summarise sensitivities (SN), specificities (SP), diagnostic odds ratio (DOR) and respective confidence intervals (CI). RESULTS The employed search strategy revealed 21 potential articles, with one demonstrating high quality. Nine articles qualified for meta-analysis. The meta-analysis demonstrated that flexion-adduction-internal rotation (pooled SN ranging from 0.94 (95% CI 0.90 to 0.97) to 0.99 (95% CI 0.98 to 1.00); DOR 5.71 (95% CI 0.84 to 38.86) to 7.82 (95% CI 1.06 to 57.84)) and flexion-internal rotation (pooled SN 0.96 (95% CI 0.81 to 0.99); DOR 8.36 (95% CI 0.41 to 171.3) tests possess only screening accuracy. CONCLUSIONS Few hip physical examination tests for diagnosing FAI/ALT have been investigated in enough studies of substantial quality to direct clinical decision-making. Further high-quality studies across a wider spectrum of hip pathology patients are recommended to discern the confirmed clinical utility of these tests. TRIALS REGISTRATION NUMBER PROSPERO Registration # CRD42014010144.
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Affiliation(s)
- M P Reiman
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA Duke University Medical Center, Durham, North Carolina, USA
| | - A P Goode
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - C E Cook
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - P Hölmich
- Sports Orthopedic Research Centre-Copenhagen (SORC-C), Arthroscopic Center Amager, Copenhagen University Hospital, Copenhagen, Denmark. Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - K Thorborg
- Sports Orthopedic Research Centre-Copenhagen (SORC-C), Arthroscopic Center Amager, Copenhagen University Hospital, Copenhagen, Denmark. Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), and Departments of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Copenhagen, Denmark
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Henak CR, Abraham CL, Peters CL, Sanders RK, Weiss JA, Anderson AE. Computed tomography arthrography with traction in the human hip for three-dimensional reconstruction of cartilage and the acetabular labrum. Clin Radiol 2014; 69:e381-91. [PMID: 25070373 DOI: 10.1016/j.crad.2014.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/20/2014] [Accepted: 06/03/2014] [Indexed: 11/16/2022]
Abstract
AIM To develop and demonstrate the efficacy of a computed tomography arthrography (CTA) protocol for the hip that enables accurate three-dimensional reconstructions of cartilage and excellent visualization of the acetabular labrum. MATERIALS AND METHODS Ninety-three subjects were imaged (104 scans); 68 subjects with abnormal anatomy, 11 patients after periacetabular osteotomy surgery, and 25 subjects with normal anatomy. Fifteen to 25 ml of contrast agent diluted with lidocaine was injected using a lateral oblique approach. A Hare traction splint applied traction during CT. The association between traction force and intra-articular joint space was assessed qualitatively under fluoroscopy. Cartilage geometry was reconstructed from the CTA images for 30 subjects; the maximum joint space under traction was measured. RESULTS Using the Hare traction splint, the intra-articular space and boundaries of cartilage could be clearly delineated throughout the joint; the acetabular labrum was also visible. Dysplastic hips required less traction (∼5 kg) than normal and retroverted hips required (>10 kg) to separate the cartilage. An increase in traction force produced a corresponding widening of the intra-articular joint space. Under traction, the maximum width of the intra-articular joint space during CT ranged from 0.98-6.7 mm (2.46 ± 1.16 mm). CONCLUSIONS When applied to subjects with normal and abnormal hip anatomy, the CTA protocol presented yields clear delineation of the cartilage and the acetabular labrum. Use of a Hare traction splint provides a simple, cost-effective method to widen the intra-articular joint space during CT, and provides flexibility to vary the traction as required.
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Affiliation(s)
- C R Henak
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - C L Abraham
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - C L Peters
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - R K Sanders
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - J A Weiss
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - A E Anderson
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA.
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Chai JW, Choi JA, Choi JY, Kim S, Hong SH, Kang HS. Visualization of joint and bone using dual-energy CT arthrography with contrast subtraction: in vitro feasibility study using porcine joints. Skeletal Radiol 2014; 43:673-8. [PMID: 24463780 DOI: 10.1007/s00256-014-1817-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 10/31/2013] [Accepted: 01/01/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the feasibility of subtracting various concentrations of iodinated contrast material on dual-energy computed tomographic (DECT) arthrography to provide both CT arthrography and virtual unenhanced CT (VUCT) in a single CT acquisition. MATERIALS AND METHODS This was an in vitro study for which institutional review board approval was not required. CT arthrographies of 12 joints of pig cadavers were obtained using dual-energy CT. Various concentrations of iodinated contrast material, 25% (75 mg/ml), 50% (150 mg/ml), 75% (225 mg/ml), and 100% (300 mg/ml) were used for the DECT arthrography. The paired regions of interest (ROI) were drawn over the same location on two paired CT scans at different tube voltages (80 kVp and 140 kVp). The average Hounsfield units (HU) ratio of the contrast media(HU on CT at 80 kVp/HU on CT at 140 kVp) was calculated for each joint. Subtraction of contrast material was carried out using VUCT application RESULTS The 25% iodinated contrast mixture was successfully subtracted from DECT arthrography of four joints, in which the average HU ratio ranged from 1.95 to 2.0. The subtraction of the 50%,75%, and 100% iodine contrast mixtures was not successful, because of the upper demonstrable HU limit in dual-energy CT. CONCLUSIONS DECT arthrography with 25% iodinated contrast medium injection can provide both CT arthrography and virtual unenhanced images in a single CT acquisition.
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Affiliation(s)
- Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, 425 Shindaebang-dong, Dongjak-gu, Seoul, 156-707, Republic of Korea
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Halonen KS, Mononen ME, Jurvelin JS, Töyräs J, Salo J, Korhonen RK. Deformation of articular cartilage during static loading of a knee joint--experimental and finite element analysis. J Biomech 2014; 47:2467-74. [PMID: 24813824 DOI: 10.1016/j.jbiomech.2014.04.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
Novel conical beam CT-scanners offer high resolution imaging of knee structures with i.a. contrast media, even under weight bearing. With this new technology, we aimed to determine cartilage strains and meniscal movement in a human knee at 0, 1, 5, and 30 min of standing and compare them to the subject-specific 3D finite element (FE) model. The FE model of the volunteer׳s knee, based on the geometry obtained from magnetic resonance images, was created to simulate the creep. The effects of collagen fibril network stiffness, nonfibrillar matrix modulus, permeability and fluid flow boundary conditions on the creep response in cartilage were investigated. In the experiment, 80% of the maximum strain in cartilage developed immediately, after which the cartilage continued to deform slowly until the 30 min time point. Cartilage strains and meniscus movement obtained from the FE model matched adequately with the experimentally measured values. Reducing the fibril network stiffness increased the mean strains substantially, while the creep rate was primarily influenced by an increase in the nonfibrillar matrix modulus. Changing the initial permeability and preventing fluid flow through noncontacting surfaces had a negligible effect on cartilage strains. The present results improve understanding of the mechanisms controlling articular cartilage strains and meniscal movements in a knee joint under physiological static loading. Ultimately a validated model could be used as a noninvasive diagnostic tool to locate cartilage areas at risk for degeneration.
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Affiliation(s)
- K S Halonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland.
| | - M E Mononen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland; Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - J S Jurvelin
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland
| | - J Töyräs
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland; Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - J Salo
- Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland
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Optimization of computed tomography (CT) arthrography of hip for the visualization of cartilage: an in vitro study. Skeletal Radiol 2014; 43:169-78. [PMID: 24281772 DOI: 10.1007/s00256-013-1759-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 10/11/2013] [Accepted: 10/13/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We sought to optimize the kilovoltage, tube current, and the radiation dose of computed tomographic arthrography of the hip joint using in vitro methods. MATERIALS AND METHODS A phantom was prepared using a left femoral head harvested from a patient undergoing total hip arthroplasty and packed in a condom filled with iodinated contrast. The right hip joint of a cadaver was also injected with iodinated contrast. The phantom and the cadaver were scanned using different values of peak kilovoltage (kVp) and tube current (milliamp seconds, mAs). Three different regions of interest (ROI) were drawn in the cartilage, subchondral bone plate, and intraarticular contrast. The attenuation values, contrast/noise ratio (CNR), and effective dose were calculated. Two independent observers classified the quality of the contrast-cartilage interface and the cartilage-subchondral bone plate interface as (1) diagnostic quality or (2) nondiagnostic quality. RESULTS Contrast, cartilage, and subchondral bone plate attenuation values decreased at higher kVp. CNR increased with both kVp and mAs. The qualitative analysis showed that in both phantom and cadaver, at 120 kVp and 50 mAs, the contrast-cartilage and cartilage-subchondral bone plate interfaces were of diagnostic quality, with an effective dose decreased to 0.5 MSv. CONCLUSIONS The absolute effective dose is not directly related to the quality of images but to the specific combination of kVp and mAs used for image acquisition. The combination of 120 kVp and 50 mAs can be suggested to decrease the dose without adversely affect the visibility of cartilage and subchondral bone plate.
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Abstract
With advances in imaging technology, there has been a significant increase in the number and range of interventional musculoskeletal image-guided procedures. One of the most commonly performed image-guided musculoskeletal interventions is the diagnostic and therapeutic percutaneous aspiration and drainage of multiple types of intra-articular, juxta-articular, and intramuscular pathologic fluid collections. These procedures may be performed under fluoroscopic, ultrasound, computed tomography, or even magnetic resonance guidance depending on the location to be accessed, type of pathology, patient characteristics, and operator preference. Musculoskeletal image-guided aspiration and drainage procedures are minimally invasive and generally very safe while offering valuable diagnostic information as well as therapeutic benefit. This article focuses on the appropriate indications, contraindications, and general technique for accessing the major joints via imaging guidance. For each joint, we discuss pertinent anatomy, appropriate imaging modalities, and preferred approaches to gaining intra-articular access. Additionally, the article discusses some of the more frequently encountered juxta-articular and intramuscular fluid collections that can be accessed and aspirated via percutaneous intervention, with mention of the importance of recognizing extremity sarcomas that can mimic these benign collections.
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Affiliation(s)
- Barry Glenn Hansford
- Department of Radiology, University of Chicago Medical Center, Chicago, Illinois
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A comparison of 3-T magnetic resonance imaging and computed tomography arthrography to identify structural cartilage defects of the fetlock joint in the horse. Vet J 2013; 199:115-22. [PMID: 24321368 DOI: 10.1016/j.tvjl.2013.10.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 10/14/2013] [Accepted: 10/18/2013] [Indexed: 11/23/2022]
Abstract
Articular cartilage defects are prevalent in metacarpo/metatarsophalangeal (MCP/MTP) joints of horses. The aim of this study was to determine and compare the sensitivity and specificity of 3-Tesla magnetic resonance imaging (3-T MRI) and computed tomography arthrography (CTA) to identify structural cartilage defects in the equine MCP/MTP joint. Forty distal cadaver limbs were imaged by CTA (after injection of contrast medium) and by 3-T MRI using specific sequences, namely, dual-echo in the steady-state (DESS), and sampling perfection with application-optimised contrast using different flip-angle evolutions (SPACE). Gross anatomy was used as the gold standard to evaluate sensitivity and specificity of both imaging techniques. CTA sensitivity and specificity were 0.82 and 0.96, respectively, and were significantly higher than those of MRI (0.41 and 0.93, respectively) in detecting overall cartilage defects (no defect vs. defect). The intra and inter-rater agreements were 0.96 and 0.92, respectively, and 0.82 and 0.88, respectively, for CT and MRI. The positive predictive value for MRI was low (0.57). CTA was considered a valuable tool for assessing cartilage defects in the MCP/MTP joint due to its short acquisition time, its specificity and sensitivity, and it was also more accurate than MRI. However, MRI permits assessment of soft tissues and subchondral bone and is a useful technique for joint evaluation, although clinicians should be aware of the limitations of this diagnostic technique, including reduced accuracy.
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Sara Muñoz C. Procedimientos intervencionales musculoesqueléticos. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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