VoE 19 - Musculoskeletal
The thoracic spine of patients with diffuse idiopathic skeletal hyperostosis: reduced disc height and other degenerative intervertebral disc changes
Aims and objectives: Contrary to the commonly used classification for diffuse idiopathic skeletal hyperostosis (DISH) by Resnick, degenerative intervertebral disease (DID) were previously described in DISH. We aimed to assess for the presence and prevalence of such changes on CT examinations of the thoracic spine of sub[...]
Methods and materials: Intervertebral space (D1-L1) on chest CT examinations of DISH subjects were retrospectively evaluated for the presence of DID. Parameters evaluated included disc space height (D7-D11), disc protrusion, subchondral cysts/sclerosis, Schmorl nodes, vacuum phenomenon, and degenerative changes in the po[...]
Results: A total of 158 subjects (DISH/Control 1/Control 2: 54/54/50, M/F: 106/52, average age: 70.6 years) were evaluated. Average osteophyte score was significantly higher in DISH compared to controls (DISH/Control 1/Control 2: 5.22/1.72/2.68/, p<0.001). Average intervertebral disc height was significan[...]
Conclusion: In conclusion, we have shown that intervertebral disc height is reduced in DISH subjects, costochondral degenerative changes are more prevalent and except for vacuum phenomenon, other intervertebral degenerative changes are as common in DISH as in control subjects. These findings serve to reiterate [...]
References: References: 1. Mader R, Sarzi-Puttini P, Atzeni F, et al. Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis. Rheumatology. 2009;48(12):1478-81. 2. Resnick D, Niwayama G. Radiographic and p[...]
Learning objectives: To describe the normal post-operative imaging appearance of anterior cruciate ligament (ACL) reconstruction on magnetic resonance imaging (MRI). To review the causes and imaging appearances of the various complications of ACL reconstruction.
Background: The ACL is the most commonly injured and reconstructed ligament in the knee. MRI is the gold standard for imaging ACL reconstruction. Indications for post-operative ACL imaging include persistent instability, postoperative stiffness, postoperative re-injury, and evaluation prior to graft revision. G[...]
Findings and procedure details: The anterior cruciate ligament is an important stabilizer of the knee joint and is crucial in preventing anterior translation of the tibia in relation to the femur. Rupture of the ACL is among the most commonly seen sports injuries, with about 250,000 new ruptures a year estimated in the United Stat[...]
Conclusion: Given the increasing number of patients who undergo ACL reconstruction, familiarity with the normal post-operative imaging appearance and the imaging appearance of complications of graft reconstruction is critical in guiding treatment management.
Personal information: Elizabeth S. Levin, MD. Radiology resident, University of California, Los Angeles, USA Benjamin D. Levine, MD. Associate Clinical Professor of Radiology, Director, Musculoskeletal Interventions. Department of Radiological Sciences, University of California, Los Angeles, USA Benjamin Plotkin[...]
References: 1. Paterno MV, Rauh MJ, Schmitt LC, et al. Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin J Sport Med 2012;22(2):116–21. 2. Naraghi A, White LM. MR imaging of cruciate ligaments. Magn Reson Imaging Clin [...]
Height of lumbar disc and vertebral body: what is the relation with body mass index, subcutaneous fat thickness, body weight, length and age?
Aims and objectives: The aim of this study was to determine the correlation between anthropometric (age, body mass index, body weight and length) and morphometric parameters (lumbar disc height, vertebral body height and subcutaneous fat thickness) on MRI of the lumbar spine (Fig. 1). To our knowledge, no study has ever[...]
Methods and materials: A retrospective study was performed in 50 patients, aged 19 to 72 years old (mean: 46,3 y; median 45,5 y), who underwent an MRI of the lumbar spine. Body weight and length were measured in all subjects. MRI was performed on two 1,5 T MR units with a specific lumbar spine protocol. For this study onl[...]
Results: I. Disc height (Table 1) Disc height was positively correlated with: + Body length: at all levels + Body weight: at all levels Disc height was negatively correlated with: - Age: at levels L3-L4 and L4-L5 II. Vertebral body height (Table 2) Vertebral body height was posit[...]
Conclusion: 1. Disc height was positively correlated with body length and weight at all levels. It’s logical that when someone is larger, vertebral body height and disc height will also be higher, since body length and weight are constitutional determinants of the human body. The positive correlation of weight [...]
Personal information: Nicolas M. Salamon Department of Radiology, Ghent University Hospital, Ghent University, Belgium E-mail: firstname.lastname@example.org Charlotte Van Langenhove, MD Department of Radiology, Ghent University Hospital, Ghent University, Belgium E-mail: email@example.com Koenraad[...]
References: Videman T, Levalahti E, Battie MC. The effects of anthropometrics, lifting strength, and physical activities in disc degeneration. Spine (Phila Pa 1976). 2007; 32(13):1406-13. Hangai M, Kaneoka K, Kuno S et al. Factors associated with lumbar intervertebral disc degeneration in the elderly. Spine J 2[...]
Learning objectives: Rationale Fractures of the scaphoid are frequently difficult to see on plain radiographs immediately following injury. However a missed scaphoid fracture can have a significant negative impact on long term hand function and quality of life. Therefore clinicians have previously opted to treat with ca[...]
Background: Audit questions With regard to our current clinical practice and the patient cohort - “adult patients with post-traumatic radial wrist pain and indeterminate initial x-ray findings”: 1. What proportion is diagnosed with a scaphoid fracture relating to this presentation? 2.&n[...]
Findings and procedure details: Data collection: The first 100 consecutive adult patients from 1st January 2015 onwards undergoing scaphoid x-rays at RBCH for a first presentation of post traumatic radial wrist pain were identified using a Soliton search of computer-based radiology records. To achieve this, the search fields were [...]
Conclusion: Results 100 consecutive patients undergoing scaphoid radiographs from 1st January 2015 onwards were identified using Soliton imaging records as described in the methods. The 100 consecutive patients presented in a time period of 52 days. The demographics of the patients identified were as follows: ([...]
References: NICE guideline 38, Fractures (non-complex): assessment and management. Section 1.2.3 Imaging of scaphoid fractures. February 2016. nice.org.uk/guidance/ng38 Draft for Consultation – Fractures (non-complex): assessment and management. Section 7.3. National Clinical Guideline Centre, August 2015. &nb[...]
Learning objectives: To clarify the radiological approach to conditions that show abnormal subcutaneous fat distribution.
Background: Adipose tissue is known to play multiple and complex roles for mechanical cushioning and as a secretory organ that regulates energy balance, homeostasis, appetite, inflammation, insulin sensitivity, and lipid metabolism (1). Radiologists encounter abnormal fat distribution in various congenital or a[...]
Findings and procedure details: (A) Generalized 1) Congenital generalized lipodystrophy (CGL) Congenital (genetic) lipodystrophy has been reported in about 1000 patients with various types related to the pattern of fat loss and genetic molecular defect (2,3). Congenital generalized lipodystrophy is an autosomal recess[...]
Conclusion: Radiologists should understand the typical imaging finding and disease spectrum of abnormal deposition of subcutaneous fat. Although the underlying conditions are diverse, radiological findings can be the key for early assessment suggesting the proper methods for definitive diagnosis.
References: 1. Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev. 2010;11(1):11-8. 2. Garg A. Clinical review#: Lipodystrophies: genetic and acquired body fat disorders. J Clin Endocrinol Metab. 2011;96(11):3313-25. 3. Garg A. Lipodystrophies. Am J Med. 2000;1[...]
Aims and objectives: Foam rolling has been developed to a popular intervention and has been established in training and rehabilitation. Despite the growing application of foam rolling, there is a lack of studies that observed its effects on cellular and physiological level. Thus the aim of the present study was to asses[...]
Methods and materials: In total, 21 healthy participants (age 25 ± ( years, height 177 ± 9 cm, body weight 74 ± 9 kg) were recruited from the medical and sports faculty. Arterial tissue perfusion was determined by terms of spectral Doppler and power Doppler ultrasound, represented as Peak Flow (Vmax), Time Average Velocit[...]
Results: Our results indicate that arterial blood flow of the lateral thigh increases significant following foam rolling exercises in comparison to baseline conditions (p<0.05). We could detect a relative raise for Vmax of 73.6% (2 min) and 52.7 % (30 min) (p<0.001), for TAMx of 53.2% (p<0.001) and [...]
Conclusion: An increase of arterial blood flow suggests a role for the acute phase after foam rolling. Our data may contribute to the understanding of local physiological reactions of selfmyofascial release. The advantages of enhanced blood flow might be important for warmup and recovery and our data support th[...]
References: Bushell JE, Dawson SM, and Webster MM. Clinical Relevance of Foam Rolling on Hip Extension Angle in a Functional Lunge Position. Journal of strength and conditioning research / National Strength & Conditioning Association 29: 2397-2403, 2015. Mohr AR, Long BC, and Goad CL. Effect of foam rolli[...]
A reliability study of the Kraus grading system for ankle osteoarthritis and comparison with a modified Kellgren-Lawrence score
Aims and objectives: Radiographic atlases have been developed to be used as a standardised guide in the evaluation of individual features of OA. They have both clinical and research value, particularly in the confirmation and grading of OA in patients. The first pictorial atlas to grade ankle osteoarthritis from ankle r[...]
Methods and materials: Ankle radiographs with 2 orthogonal views were obtained from attendances in various clinical settings (outpatient, inpatient, emergency). Images were selected and given a score from the modified Kellgren-Lawrence grading after consensus assessment of the tibiotalar joint by 2 radiology residents ([...]
Results: Objective 1: For the 16-point Kraus score, the inter-rater reliability values calculated using the weighted kappa were higher when compared to the data published by Kraus et al (Tables 3 and 4). There was “substantial” agreement (kw0.63– 0.9) in 15 of 16 Kraus grading categories. Of these, the con[...]
Conclusion: The Kraus atlas is straightforward and reliable despite minimal radiology experience. The 1-point modified Kellgren-Lawrence score alone is sufficient to estimate the severity of ankle osteoarthritis.
References: Kraus VB, Kilfoil TM, Hash II TW, McDaniel G, Renner JB, Carrino JA, Adams S (2015). Atlas of radiographic features of osteoarthritis of the ankle and hindfood. Osteoarthritis and Cartilage. 23, 2059-85. Altman RD, Gold GE. (2007). Atlas of individual radiographic features in osteoarthritis, revised[...]
A systematic diagnostic imaging-based approach for the work-up of a suspected soft-tissue mass around the knee.
Learning objectives: Introduce the etiologic spectrum of soft-tissue masses about the knee with emphasis on the most common entities. Discuss the role of Conventional Radiography (CR), Ultrasonography (US), Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Positron Emission Tomography – CT (PET-CT) in the d[...]
Background: Soft-tissue tumors and tumorlike lesions are encountered often in daily radiologic practice. Byfar, the majority of these lesions are cystic and benign. There is a broad differential for soft-tissue lesions about the knee. The list includes tumorlike lesions as synovial cyst (Baker cyst, meniscal cy[...]
Findings and procedure details: Evaluation of a patient who presents with a soft tissue mass about the knee often includes radiography, ultrasonography (US), and magnetic resonance (MR) imaging. Initial assessment of a suspected musculoskeletal soft-tissue mass should start with radiographic evaluation, a fundamental concept that [...]
Conclusion: By systematically using clinical history, lesion location, mineralization on radiographs, appearance on US and signal intensity characteristics on MR images, one can (a) determine the diagnosis for the subset of determinate lesions that have characteristic clinical and imaging features and (b) narro[...]
Personal information: Ana Mª Crespo Rodríguez, MD, PhD Radiology Hospital Clínico San Carlos, Madrid, SPAIN Formerly Hospital Universitario Puerta de Hierro firstname.lastname@example.org @AnaCrespo_RX
References: 1. Zoga AC, Weissman BN, Kransdorf MJ, et al. Soft tissue masses. https://acsearch.acr.org/docs/69435/Narrative/. Published 2012. Accessed February 7, 2016. 2. Kransdorf MJ, Murphey MD. Radiologic evaluation of soft-tissue masses: a current perspective. AJR Am J Roentgenol 2000;175(3):575–587. 3. G[...]
Learning objectives: To know the indications and contraindications of ACL reconstruction To evaluate the different types of grafts and to differentiate between the advantages and disadvantages of both synthetic and biological grafts To gain knowledge of how to assess the proper positions and signal intensities of the gr[...]
Background: Background: The demand for ACL reconstruction (ACLR) surgeries has been increasing over the past years, and the scenario of postoperative complaint is commonly encountered. Since we believe in the quote “the eye sees what the brain knows” every radiologist should grasp the basic concepts of how to e[...]
Findings and procedure details: ACL Reconstruction Complications Include but not limited to: Graft tear/disruption Patient complains of knee laxity and giving away after re-trauma to the knee during the first post-operative year which is the remodelling phase. It can either be partial or complete. Primary signs of [...]
Conclusion: Conclusion: Given the fact that MR evaluation after ACLR procedures is commonly encountered, knowledge of the different ACLR procedures, normal postoperative appearances and possible complications using MRI is mandatory for proper diagnosis and therefore proper management.
References: References: Recht MP, Kramer J. MR imaging of the postoperative knee: A pictorial essay. Radiographics 2002; 22:765-774. Bencardino JT, Beltran J, Feldman MI, Rose DJ. MR imaging of complications of anterior cruciate ligament graft recostruction. Radiographics 2009; 29:2115-2126. Saupe N, White L[...]