Study of Coincidence of Hoffa’s Fat Pad Associated Injuries in Knee Traumas in Magnetic Resonance Imaging

The aim of this study is to investigate the demographic and clinical characteristics of knee and ankle traumas that could not be detected in the first post-traumatic evaluation and diagnosed within 15 days after the follow-up examination and to discuss the results we obtained with current data. Patients admitted to the emergency department trauma department between January 1, 2017, and December 31, 2018, were retrospectively analyzed. Applications due to traffic accidents and all traumas except knee and ankle trauma were excluded from the study. Medical records were used to reveal the demographic characteristics of the cases, clinical findings, mechanisms of injury, additional injuries, and interventions in the emergency room. The mean age of 2,039 patients included in the study due to knee, foot, and ankle trauma was 35.69±12.01, and the median value was 36 (age range 11-71). The patients were divided into 2 groups knee trauma and ankle trauma and statistical evaluations were made. Of the patients evaluated for knee trauma (n=1,157), 463 (40%) were female and 694 (60%) were male. Of the patients evaluated for ankle trauma (n=882), 397 (45%) were female and 485 (55%) were male. It is evident that knee, foot, and ankle traumas after simple falls and sports injuries are frequently encountered by emergency physicians. It is known that post-traumatic ligament injury, bone contusion, intraarticular fluid/hematoma formation, and fractures that cannot be detected by radiographs can be overlooked in emergency departments where patient density is high.

To assess the predictive value of a short magnetic resonance (MR) imaging examination, in addition to or instead of radiography, performed in patients with acute knee trauma to identify those who require additional treatment versus those who do not and can be discharged without further follow-up. The randomized controlled trial and use of collected data for prediction modeling were approved by the institutional review board; informed consent was obtained. Patients with recent knee injury were included in the trial if radiography was ordered. They were randomized into a group undergoing only radiography and a group undergoing radiography plus immediate MR imaging. A 0.2-T dedicated extremity MR imager and four short pulse sequences were used. Univariable and multivariable logistic regression analysis was used to evaluate patient characteristics, trauma mechanism, and findings at radiography and MR imaging for their value in prediction of need for subsequent treatment within the 6-month follow-up. Data in 189 patients (123 male patients, 66 female patients; mean age, 33.4 years), 109 of whom underwent treatment after their initial visit, were analyzed. Age of 30 years or older, indirect trauma mechanism, radiographic results, and MR imaging results were significant predictors of need for treatment in univariable and multivariable analyses (P < .05). In the multivariable analysis, only abnormal MR imaging results were significantly predictive of need for treatment, and only when MR imaging replaced radiography (odds ratio, 2.61; 95% confidence interval: 1.12, 6.06). Implementation of a dedicated extremity MR imaging examination, in addition to or instead of radiography, performed in patients with traumatic knee injury improves prediction of the need for additional treatment but does not significantly aid in identification of patients who can be discharged without further follow-up. Value of a short MR imaging examination in the initial stage after knee trauma is limited.

Background: Magnetic resonance imaging (MRI) is a non-invasive, quick and convenient investigation for evaluation of ligament and meniscal pathologies of the knee joint. Although arthroscopy is an invasive procedure it is considered the gold standard for evaluating injuries to menisci and ligaments and can be used for both diagnostic and therapeutic purpose. The purpose of this study was to evaluate cruciate ligament and meniscal injuries following knee trauma by MRI and correlate the findings with arthroscopy. Materials and methods: This was a prospective study conducted at our institution including 61 patients with clinically suspected ligament and meniscal injury of knee. All the patients initially underwent MRI and subsequent arthroscopy. The location, type and grade of meniscal and ligament tears on MRI were recorded and later correlated with arthroscopic findings. Results: The right knee joint was involved in 65.6 % and the left knee in 34.4 % of cases. The anterior cruciate ligament was the most commonly injured structure. The sensitivity, specificity and accuracy of MRI in detecting anterior cruciate ligament injury were 100%, 71.4% and 96.72 % respectively, posterior cruciate ligament injury (100%, 100% and 100% respectively), medial meniscus injury (100%, 78.8% and 88.5% respectively) and lateral meniscus injury (100%, 90.5% and 93.44% respectively). Conclusion: MRI is highly sensitive and accurate in detection of cruciate ligament and meniscal tears. A good correlation was obtained between MRI and arthroscopic findings in this study. MRI used as a screening tool prior to arthroscopy helps in avoiding negative diagnostic arthroscopy. Keywords: anterior cruciate ligament; posterior cruciate ligament; medial meniscus; lateral meniscus; arthroscopy

Objective: Key markers of injury processes in acute knee trauma are bone bruises, which are detected by magnetic resonance imaging (MRI) as increased signal intensity on T2-weighted images and signal loss on T1-weighted imaging. However, due to its restricted availability and lengthy acquisition times, particularly in emergency situations, MRI is not often employed in knee trauma cases. A viable substitute is dual-energy computed tomography (DECT) with virtual non-calcium (VNCa) techniques, which improves bone marrow edema (BME) visibility and allows for greater material distinction. This study uses MRI as the reference standard to assess the diagnostic performance of third-generation DECT and VNCa methods for detecting BME in acute knee injuries. Methods: This prospective observational study involved 40 patients with acute knee trauma who had both MRI and DECT between July 2019 and July 2021 at Kovai Medical Center and Hospital in Coimbatore. Individuals who were pregnant had a history of knee injuries or were above the age of 18 were eliminated, as were those who had an MRI or CT contraindication. Siemens Healthcare’s Somatom Force, a third-generation 192-slice dual-source CT scanner, was used for DECT imaging, while Philips Ingenia 1.5T was used for MRI. Image analysis used SPSS version 27.0 for statistical analysis to determine whether BME was present in MRI and DECT images. Results: The study participants had a mean age of 47±16 years, predominantly male (72.5%). DECT demonstrated a sensitivity of 81.15% and a specificity of 96.70% for detecting BME compared to MRI. The diagnostic accuracy was notably high in the lateral femoral condyle (sensitivity and specificity of 93.33%) and the lateral tibial condyle (sensitivity and specificity of 86.36%). Overall, DECT identified 59 out of 69 MRI-positive regions, reflecting its robustness in detecting true positives and true negatives in acute trauma settings. Conclusion: Third-generation DECT with VNCa techniques is a highly effective imaging modality for detecting edema of the bone marrow in acute knee trauma, offering high diagnostic accuracy comparable to MRI. It is ability to provide clear visual differentiation and rapid acquisition makes it a valuable alternative, particularly in emergency settings where MRI is unavailable or contraindicated. DECT’s shorter reconstruction time and high reliability can optimize workflow and improve patient outcomes, underscoring its potential role in early diagnosis and management of knee trauma.

MR Imaging of the Thorax

Background No previous research has investigated the diagnostic validity of magnetic resonance imaging for acute versus chronic meniscal tears using comparable materials and methods. Hypothesis There is no difference in the diagnostic validity of magnetic resonance imaging for acute versus chronic meniscal tears in young adults. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods A total of 628 young adult military personnel underwent magnetic resonance imaging and arthroscopy of the knee over a 6-year period. Inclusion criteria were met by 82 patients with acute knee trauma (magnetic resonance imaging within 30 days from trauma) and 40 patients with chronic knee symptoms (symptoms lasting over 6 months before magnetic resonance imaging). The original magnetic resonance imaging and arthroscopy records were reviewed twice by a musculoskeletally trained radiologist, blinded to previous magnetic resonance imaging and arthroscopy findings. Interobserver correlations and intraobserver reliability were calculated and reported. Arthroscopy served as the gold standard when calculating the diagnostic values of magnetic resonance imaging for acute and chronic meniscal tears. Results The median age of the patients was 20 years (range, 18-25). Magnetic resonance imaging detected acute meniscal tears with sensitivity of 67%, specificity of 93%, and diagnostic accuracy of 88% and chronic meniscal tears with 64%, 91%, and 86%, respectively. There was no statistically significant difference in magnetic resonance imaging results between the 2 groups. Conclusion The diagnostic validity of magnetic resonance imaging is similar for meniscal tears in acute knee trauma and in knee symptoms lasting over 6 months in young adults. The results also suggest that effusion or hemarthrosis do not weaken the diagnostic validity of magnetic resonance imaging. The magnetic resonance imaging sensitivity achieved in the present study was relatively poor, but the specificity was good for both acute and chronic meniscal tears. Despite negative magnetic resonance imaging findings at the acute stage of knee trauma, patient monitoring and readiness for arthroscopy should be considered if justified by the patient's symptoms.

Introduction: Menisci are clinically significant due to their role in load distribution, shock absorption, and joint stability. Additionally, in patients with anterior cruciate ligament (ACL) injuries, knee joint laxity can lead to progressive meniscal tears. Treatment of meniscal tears requires accurate identification of the location and type of tear. Therefore, precise determination of the meniscal tear is crucial for subsequent management. This study aims to describe the imaging characteristics and the value of meniscal tears and associated injuries on magnetic resonance imaging (MRI). Methods: A cross-sectional descriptive study was conducted on all patients with knee trauma who underwent MRI prior to surgery and were indicated for knee surgery at Can Tho University of Medicine and Pharmacy Hospital and Can Tho Central General Hospital from 2023 to 2025. Results: MRI plays a significant role in identifying the type, location, and pattern of meniscal tears. The sensitivity of MRI in diagnosing lateral meniscal injuries was 91.2%, while the specificity was 80.4%. For medial meniscal injuries, the sensitivity was 93.9% and the specificity was 75.0%. The positive predictive value and negative predictive value of MRI for lateral meniscal injuries were 75.6% and 87.5%, respectively, while for medial meniscal injuries, they were 70.5% and 95.1%. Classification of meniscal injuries according to the AJR and ISAKOS systems demonstrated high accuracy for various tear types, such as vertical/ longitudinal (sensitivity 82.8%, specificity 91.1%), horizontal (sensitivity 76.2%, specificity 90.9%), and complex (sensitivity 84.2%, specificity 96.4%). Notably, when combined with ACL tears, the sensitivity and specificity of MRI for meniscal tear types were as follows: Vertical/ longitudinal 76.9%, 85.9%; horizontal 100.0%, 86.8%; radial 55.6%, 96.0%; bucket handle (horizontal flap) 100.0%, 97.1%; vertical flap 50.0%, 96.2%; complex 77.8%, 94.9%. Conclusion: MRI plays a crucial role in evaluating meniscal injuries in patients with knee trauma.

Neuropsychiatric Significance of Subcortical Hyperintensity

Background Magnetic resonance imaging (MRI) is often indicated in the diagnosis of pediatric knee trauma, but using traditional MRIs in children can be time-consuming, require anaesthesia, and sometimes cause discomfort. Recently, 3D turbo spin echo (TSE) MRIs with isotropic datasets have been found to reduce acquisition times substantially, but they have been little-studied in pediatric patients. The purpose of our study was to determine the arthroscopy-based diagnostic performance of 10-minute isotropic 3D TSE MRI for the detection of internal derangement in children with acute knee trauma. Methods Institutional review board approval was obtained for prospective data collection, and informed consent and assent were obtained from all parents and children, respectively. The final study group consisted of 60 children (38 boys, 22 girls; 11 (2-16) years-of-age) with acute knee trauma who underwent 10-minute isotropic 3D prototype CAIPIRINHA SPACE MRI at 3 T and subsequent arthroscopic knee surgery. Two fellowship-trained musculoskeletal radiologists retrospectively evaluated the MRI studies independently and resolved discrepancies through consensus. Outcome variables included image quality, motion artifacts, meniscal abnormalities, cruciate ligament tears, and cartilage lesions. Statistical analysis included the diagnostic performance of MRI with arthroscopy as the reference standard and inter-reader agreements using kappa statistics. Results All studies were suitable for diagnostic interpretation with good-to-very-good image quality and little-to-no motion degradation in the majority of cases. The sensitivities/specificities/accuracies of MRI were 0.93/0.93/0.93 for 15/60 (25%) medial meniscal tears, 0.95/0.90/0.92 for 21/60 (35%) lateral meniscal tears, 0.83/1.0/0.92 for 10/60 (17%) discoid menisci, 1.0/0.95/0.98 for 16/60 (27%) anterior cruciate ligament tears, 1.0/0.95/0.98 for 2/60 (3%) posterior cruciate ligament tears, 1.0/1.0/1.0 for 5/60 (8%) osteochondritis dissecans lesions, and 0.71/0.97/0.84 for 48 (13%) defects in 360 cartilage segments. The inter-reader agreements were overall good-to-very-good (kappa, 0.730 -1.00). Conclusion 10-minute isotropic 3D TSE MRI of the knee is feasible in children with acute knee trauma and yields high diagnostic accuracies for the diagnosis of internal knee derangement. Accuracies for the detection of meniscal tears, discoid menisci, anterior and posterior cruciate ligament tears, osteochondritis dissecans lesions, and cartilage defects ranged from 84-100%. Using previously published protocols for pediatric 2D MRI knee exams with total acquisition times of 25 minutes as a benchmark for traditional MRI, a 10-minute protocol could increase the efficiency by a factor of two or more, and thus substantially improve the availability of MRI and timely care for children with acute knee trauma. [Table: see text]

Shall We Bury the Sword? Imaging of Hepatic Fibrosis

Purpose To compare the diagnostic accuracy of dynamic contrast-enhanced magnetic resonance (MR) imaging (DCE) to multiparametric (MP) MR imaging with two [DCE, diffusion weighted imaging (DWI) or three dimensional proton MR spectroscopy (3D1H-MRSI)] or three MR imaging parameters (DCE, DWI,3D 1H-MRSI) in breast cancer diagnosis. Materials and Methods This prospective HIPAA-compliant study was approved by the Institutional review board. Written informed consent was obtained in all patients. One hundred thirteen patients with an imaging abnormality (BIRADS 0, 4-5) were included in this study. MP MR imaging of the breast at 3Tesla with DCE, DWI and 3D-1H-MRSI was performed. The likelihood of malignancy was assessed for DCE and MP MR imaging with two and three parameters separately. Histopathology was used as the standard of reference. Appropriate statistical tests were used to assess sensitivity, specificity and diagnostic accuracy for each assessment combination. Results There were 74 malignant and 39 benign breast lesions. Sensitivities, specificities, PPV, NPV, diagnostic accuracies and the AUCs for dynamic contrast-enhanced MR imaging of the breast and MP MR imaging with two or three MR imaging parameters are summarized in Table 1. Sensitivities, specificities, PPV, NPV, diagnostic accuracy, AUC and 95% CIs for DCE and MP MR imaging SensitivitySpecificityPPVNPVDiagnostic AccuracyAUCDynamic contrast enhanced MR imaging (one parameter)98.6% (92.7%-99.8%)64.1% (48.4%-77.3%)83.9% (74.8%-90.2%)96.2% (81.1%-99.3%)86.7% (79.2%-91.8%)0.814 (0.72-0.91)MP MR imaging with dynamic contrast-enhanced MR imaging and DWI (two parameters)100% (93.6%-100%)61.5% (44.7%-76.2%)83.1% (74%-89.5%)100% (86.2%-100%)86.7% (79.2%-91.8%)0.808 (0.71-0.91)MP MR imaging with dynamic contrast-enhanced MR imaging and 3D 1H-MRSI (two parameters)100% (93.6%-100%)61.5% (45.9%-75.1%)83.1% (74%-89.5%)100% (86.2%-100%)86.7% (79.2%-91.8%)0.808 (0.71-0.91)MP MR imaging with dynamic contrast-enhanced MR imaging, DWI and 3D 1H-MRSI (three parameters)100% (95.1%-100%)87.2% (73.3%-94.4%)†*93.7% (86.0%-97.3%)†*100% (89.8%-100%)95.6% (90.1%-98.1%)†*0.936 (0.87-0.99)†*†* significantly different from DCE and MP MRI with 2 parameters (p&amp;lt;0.001) MP MR with three MR imaging parameters yielded significantly higher AUCs (0.936) than dynamic contrast-enhanced MR imaging alone (0.814) (p&amp;lt;0.001). MP MR with just two MR imaging parameters at 3T did not yield higher AUCs (0.808) than dynamic contrast-enhanced MR imaging alone (0.814). MP MR imaging with three MR imaging parameters allowed an elimination of all false-negative findings and a significant reduction of false-positives (p = 0.002). Conclusion MP MR imaging with three MR imaging parameters has greater diagnostic accuracy in breast cancer diagnosis than DCE alone or MP MR imaging with two MR imaging parameters. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-02-03.

To evaluate the diagnostic accuracy of magnetic resonance imaging of the knee in identifying traumatic intraarticular knee lesions. 300 patients with a clinical diagnosis of traumatic intraarticular knee lesions underwent prearthoscopic magnetic resonance imaging. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for a positive test, likelihood ratio for a negative test, and accuracy of magnetic resonance imaging were calculated relative to the findings during arthroscopy in the studied structures of the knee (medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, and articular cartilage). Magnetic resonance imaging produced the following results regarding detection of lesions: medial meniscus: sensitivity 97.5%, specificity 92.9%, positive predictive value 93.9%, positive negative value 97%, likelihood positive ratio 13.7, likelihood negative ratio 0.02, and accuracy 95.3%; lateral meniscus: sensitivity 91.9%, specificity 93.6%, positive predictive value 92.7%, positive negative value 92.9%, likelihood positive ratio 14.3, likelihood negative ratio 0.08, and accuracy 93.6%; anterior cruciate ligament: sensitivity 99.0%, specificity 95.9%, positive predictive value 91.9%, positive negative value 99.5%, likelihood positive ratio 21.5, likelihood negative ratio 0.01, and accuracy 96.6%; posterior cruciate ligament: sensitivity 100%, specificity 99%, positive predictive value 80.0%, positive negative value 100%, likelihood positive ratio 100, likelihood negative ratio 0.01, and accuracy 99.6%; articular cartilage: sensitivity 76.1%, specificity 94.9%, positive predictive value 94.7%, positive negative value 76.9%, likelihood positive ratio 14.9, likelihood negative ratio 0.25, and accuracy 84.6%. Magnetic resonance imaging is a satisfactory diagnostic tool for evaluating meniscal and ligamentous lesions of the knee, but it is unable to clearly identify articular cartilage lesions.

Diagnostic Value of History Taking and Physical Examination to Assess Effusion of the Knee in Traumatic Knee Patients in General Practice

Epidemiology of intra- and peri-articular structural injuries in traumatic knee joint hemarthrosis – data from 1145 consecutive knees with subacute MRI

Imaging technology has progressed dramatically in the last 30 years. Flat panel high-resolution imaging, ultra-thin computed tomography (CT) sections with twoand threedimensional reformatting, and high-contrast and -resolution magnetic resonance imaging (MRI) with dedicated coils have changed our confidence in the exploration of bone trauma. CT and MRI have definitively increased our diagnostic abilities, particularly in children following polytrauma. However, polytrauma only accounts for a minority of trauma cases admitted to an emergency department. This presentation will instead focus on the daily reality. In a previous study performed over a 24-week period, we performed radiography in 3,128 anatomical locations in children admitted following trauma. Only 22% of the radiographic examinations were considered abnormal. In descending order, the hand and fingers, ankle, wrist, knee, elbow, foot and toes, and forearm were the most frequently examined locations. The rate of abnormal findings was 25.7% for the hand and fingers, 9.0% for the ankle, 42.5% for the wrist, 9.5% for the knee, 33.3% for the elbow, 18.3% for the foot and 43.2% for the forearm. When only the direct observation of a fracture was taken into account, these rates decreased for the ankle and knee to 2.6% and 1.9%, respectively. Over the past ten years, these two joints in particular have been the focus of our attention. Despite convincing data on the validity of the Ottawa Ankle Rules, referrals for ankle radiographs remain numerous. Our main explanation for this is the rotation in the emergency department of trainee doctors with various professional experiences and the fear of medicolegal proceedings. We have tried unsuccessfully in several projects to curtail these referrals. We have also investigated the underlying abnormality in swollen ankles when there was suspicion of sprain. Interestingly, in a series of 102 post-trauma MRI scans of ankles without radiographic fractures, we found only two ruptures of the lateral ligament in children with an open physis. Even more interesting, none of these had a classical Salter-Harris type I fracture of the distal fibula, which we believe is overdiagnosed. Two osteochondral avulsion fractures of the distal fibula, and microfractures of the foot were missed on radiographs. MRI has also been reported to be of high interest to modify the Salter-Harris classification of ankle fractures diagnosed on radiographs. However, our experience does not suggest this. In a series of 29 fractures, one patient was misclassified as Salter-Harris type III. MRI modified this classification to a Salter-Harris type III/Ogden type VI, but none of our patients had their therapeutic management changed following MRI. The point is that MRI of the ankle may show numerous abnormalities that are without clinical relevance. A delayed clinical examination, after three to four days’ immobilisation, may also obviate numerous unnecessary imaging procedures. Ultrasounds may have a place in imaging after this period of short immobilization to detect the rare case of rupture of the talofibular and calcaneofibular ligaments. However, expectancy is not suggested in knee trauma, where radiographs underestimate the severity of injury. CT or, even better, MRI must be performed as soon as a SalterHarris fracture is seen radiographically, or when there is Disclaimer Dr. Philippe Petit has no financial interests, investigational or off-label uses to disclose.