Edema Pattern Research Articles

MRI with state-of-the-art metal artifact reduction after total hip arthroplasty: periprosthetic findings in asymptomatic and symptomatic patients.

To assess the spectrum of periprosthetic MRI findings after primary total hip arthroplasty (THA). This multi-center cohort study analyzed 31 asymptomatic patients (65.7 ± 12.7 years) and 27 symptomatic patients (62.3 ± 11.9 years) between 6 months and 2 years after THA. 1.5-T MRI was performed using Compressed Sensing SEMAC and high-bandwidth sequences. Femoral stem and acetabular cup were assessed for bone marrow edema, osteolysis, and periosteal reaction in Gruen zones and DeLee and Charnley zones. Student t test and Fisher's exact test were performed. The asymptomatic and symptomatic groups showed different patterns of imaging findings. Bone marrow edema was seen in 19/31 (61.3%) asymptomatic and 22/27 (81.5%) symptomatic patients, most commonly in Gruen zones 1, 7, and 8 (p ≥ 0.18). Osteolysis occurred in 14/31 (45.2%) asymptomatic and 14/27 (51.9%) symptomatic patients and was significantly more common in Gruen zone 7 in the symptomatic group (8/27 (29.6%)) compared to the asymptomatic group (2/31 (6.5%)) (p = 0.03). Periosteal reaction was present in 4/31 asymptomatic (12.9%) and 9/27 symptomatic patients (33.3%) and more common in Gruen zones 5 and 6 in the symptomatic group (p = 0.04 and 0.02, respectively). In the acetabulum, bone marrow edema pattern was encountered in 3/27 (11.1%) symptomatic patients but not in asymptomatic patients (p ≥ 0.21). Patient management was altered in 8/27 (29.6%) patients based on MRI findings. Periprosthetic bone marrow edema is common after THA both in asymptomatic and symptomatic patients. Osteolysis and periosteal reaction are more frequent in symptomatic patients. MRI findings led to altered patient management in 29.6% of patients. • Bone marrow edema pattern was frequent in both asymptomatic and symptomatic patients after THA, particularly around the proximal femoral stem in Gruen zones 1, 7, and 8. • Osteolysis was significantly more frequent in symptomatic patients in Gruen zone 7. • Periosteal reaction occurred more frequently in symptomatic patients in Gruen zones 5 and 6.

Imaging features and classification of peritumoral edema in vestibular schwannoma.

Peritumoral edema (PTE) is rarely present in patients with vestibular schwannomas (VS). We studied the correlation between radiological tumor characteristics and the presence of edema, describe its magnetic resonance imaging features and classify the different edema patterns. We analysed 605 consecutive patients treated for VS at our Institute. PTE was found in 30 patients, studied on fluid attenuated inversion recovery sequences and categorised as involving the brachium pontis, cerebellum and/or brainstem. Tumor volume, shape, surface, internal structure and axis of growth were evaluated and compared to a matched series of 30 patients without PTE. In our population of patients, 5% showed PTE. Edema involved the brachium pontis in 22 cases (88%), cerebellum in 15 (60%) and brainstem in 3 (12%). PTE was classified as mild (one region involved), moderate (two regions) and severe (three regions). Edema was present not only perpendicular to the major tumor growth axis but also parallel to it (91%). The difference between the two groups in regards to tumor shape and surface was not significant. We found no correlation between tumor and edema volumes. VS can cause PTE, but its incidence is less frequent than in skull base meningiomas. PTE involves most frequently the brachium pontis, followed by the cerebellum and brainstem. Its occurrence correlates with tumor size but not with other radiological VS features. PTE is not always located perpendicular to the major axis of tumor growth, which indicated that the compressive theory proposed for meningiomas is not plausible explanation for its manifestation.

P1528The added value of cardiac magnetic resonance to the diagnosis of patients after aborted sudden cardiac death

Abstract Introduction An estimated 25% of all cardiovascular deaths are due to sudden cardiac death (SCD). The primary cause of SCD is coronary artery disease, however cardiac diseases accounted for SCD differ in young vs. older individuals. In patients with normal coronary angiography (NCA) the differential diagnosis is still challenging, due to the broad spectrum of underlying cardiovascular abnormalities. Cardiac magnetic resonance (CMR) provides accurate tissue specific and functional information of the heart. Purpose We aimed to investigate patients after aborted sudden cardiac death but NCA using cardiac magnetic resonance imaging (CMR). Our goal was to evaluate left and right ventricular parameters, presence of late gadolinium enhancement (LGE) and to assess the diagnostic value of CMR. Methods We enrolled 84 consecutive patients (39±13 y; 51% male) after aborted SCD with NCA and without CMR contraindication. CMR examination including long- and short-axis cine, T2-weighted and LGE images were performed. Left and right ventricular parameters were evaluated. Presence and pattern of the oedema and LGE were also assessed. Results Structural myocardial abnormality was present in 57% of pts: dilated (n=13), arrhythmogenic right ventricular (n=6) and hypertrophic (n=4) cardiomyopathy (CMP), moreover acute (n=2) and chronic (n=3) myocardial infarction, acute (n=2) and chronic (n=2) myocarditis, Tako-Tsubo CMP (n=1), noncompaction CMP (n=1), endomyocardial fibrosis (n=1). In 13 cases aspecific structural alterations were detected with (n=7) and without (n=6) LGE. Only 13% of the patients showed ejection fraction lower than 35% (LVEF=52±9%), 54% showed LV dilation (LVEDVi>100 ml/m2 in males and >90 ml/m2 in females; LVEDVi=104±22 ml/m2). LGE was present in 36%, showing ischemic pattern in five cases and nonischaemic pattern in 25 cases. Eleven patients were elite athletes (28±10y, 91% male, training hours: >10 hours/week). Three of them showed ARVC based on the current Task Force criteria, another three athletes showed aspecific structural alteration with nonischaemic LGE. The CMR examination confirmed the referral diagnosis in 22%, excluded the presence of structural myocardial alteration in 43% and changed the clinical diagnosis in 35% of the patients. Conclusion CMR has an important diagnostic value in patients after reanimation but NCA. More than half of these patients showed structural alteration and CMR provided a diagnosis in 42%. Acknowledgement/Funding Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary

MR variability of collagen meniscal implant remodelling in patients with good clinical outcome.

Collagen meniscal implants (CMI) have variable imaging findings on MRI and it remains ambiguous, if alterations may be present in asymptomatic patients. The aim was, to evaluate MR morphological characteristics and volume of CMI in the early, mid- and long-term follow-up. Fifty-seven patients (mean age, 43.6±11years; 41 male/16 female) with good clinical outcome (subjective visual analogue scale for satisfaction < 2 and a Lysholm-score ≥ 84) after CMI were assessed retrospectively using MRI 1, 2 and 3-8years postoperatively. CMI morphology, signal intensity (SI), homogeneity and size were assessed and a meniscal score was calculated. Chondral defects and bone marrow edema pattern were reported and summarized in a chondral score. Meniscal extrusion and volume were evaluated. Intra- and inter-reader reliabilities were calculated. Spearman and partial correlations were used (p < 0.05). One year postoperatively, the CMI varied in size [10% (4/40) normal, 30% (12/40) small, 60% (24/40) hypertrophic] and was hyperintense and inhomogeneous in all patients. At long-term follow-up, the size of CMI decreased [6% (1/17) resorbed, 18% (3/17) normal, 41% (7/17) small, 35% (6/17) hypertrophic]. The SI of the CMI changed to normal in only 13% (2/16). The majority was still hyperintense [87% (14/16)]. Less meniscal extrusion was present in the follow-up [71% (11/16) versus initially 93% (37/40)]. The meniscal score improved significantly (ρ = 0.28). Over time, full-thickness femoral chondral defects were increasingly present [65% (10/17) versus initially 33% (13/40)] and the chondral score worsened significantly (p = 0.017). Abnormal and inhomogeneous SI and irregular margins of the early postoperative CMI on MRI are findings seen in patients with good clinical results and should not necessarily be overcalled when reporting MRI. These features tend to decrease over time. IV.

Pharmaco-Analytical Study and Phytochemical Profile of Hydroethanolic Extract of Algerian Prickly Pear (Opuntia ficus-indica.L).

"Opuntia ficus-indica" (prickly pear) is the cactus member of the Cactaceae family as an important nutrient and food source. The purpose of this study was to characterize the phytochemical composition of hydroalcoholic extract of prickly pear seeds that cause therapeutic effects. Phytochemical screening based on simple tests and determination of secondary metabolites were performed by High-Performance Liquid with Diode-Array Detection (HPLC-DAD) analysis. For the pharmacological studies, the anti-inflammatory activity in rats was evaluated by carrageenaninduced inflammation, the description of the sedative activity was carried to the following behavioural tests, and the analgesic effect of the extract was assessed by the resistance induced by acetic acid, and the tail immersion test in mice. The test drug at 500 mg/kg dose showed a significant increase in mean latency in the TAIL FLICK test, and a decrease in the average number of twisting movements in the KOSTER test, thus, a significant anti-inflammatory activity in the pattern of paw edema induced by carrageenan, and an important sedative effect on the central nervous system. These data suggest that the seeds of the cactus "Opuntia ficus-indica" could be a potential source of natural compound and reveal that the hydroethanolic extract of this species is a promising source, as well as a therapeutic agent for the research of new natural active ingredients.

Relationship between Type of White Matter Tract Affection and Pathological Grade of Pediatric Brain Tumour Assessed by MR Diffusion Tensor Imaging and Fiber Tractography

AbstractBackground: Incorporation of WM fibers within a tumor mass, seen especially in low-grade tumors, and destruction of WM fibers by high-grade tumors can be depicted by MR diffusion tensor imaging and fiber tractography. These features have profound implications for the extent of resection amenable for the individual tumor.Aim of Study: The purpose of this study is to evaluate the role of MR diffusion tensor imaging and fiber tractography in accurately depicting the relation between the grade and aggressivity of the paediatric brain tumour and the pattern of affection of white matter tracts in their direct vicinity. These information help the neurosurgeons to take a decision about the extent of excision and safety margin around the tumour.Material and Methods: A total of fifty patients with brain tumors were included in this study using pre-operative contrast-enhanced magnetic resonance imaging and DTI fiber tractog-raphy for preoperative depiction of the relation between white matter tract affection and aggressivity of the tumour.Diffusion tensor imaging, by improving the recognition and characterization of white matter tracts, offers a glimpse into the brain microstructure at a scale that is not easily accessible with other modalities.Result: The extent of white matter pathway involvement was clearly identified in all patients by using color-coded DT imaging maps and MR Tractography and was correlated with the pathological grade of the tumour.Pattern I (not affected) is a rare pattern exclusively found in benign acting tumours. It was seen within 4 cases (17.4%) of the benign acting group only.Pattern II (displacement) is the most common pattern being detected in 19 cases (82.6%) of the benign acting group and in 15 cases (68.2%) of the malignant acting group.Pattern III (oedematous) is the second most common type of tract involvement seen within 2 cases (8.7%) of the benign acting group and within 9 cases (40.9%) of the malignant acting group.Pattern IV (infiltrated and partially disrupted) was seen within 2 cases (8.7%) of the benign acting group and within 7 cases (31.2%) of the malignant acting group.Pattern V (destroyed) was detected in 3 cases (13.6%) of the malignant group and no cases in the benign acting group.Conclusion: Diffusion-tensor imaging allowed for the detailed visualization of WM tract affection by the tumour. The most common pattern of affection detected in our study is the displacement pattern with prevalence in the benign acting group of tumours. Destruction pattern was totally confined to the malignant acting lesions. Edema pattern and partial disruption pattern are more prevalent in the malignant acting lesions. Despite some limitations and pitfalls, DTI is currently the only clinically feasible method of demonstrating the white matter tracts in vivo.

Pattern of Cystoid Macular Edema in Erbil

Cystoid Macular Edema (CME) in its various forms can be considered one of the leading causes of central vision loss in the developed world. It is not a disease itself, It represents a common pathologic sequel of the retina and occurs in a variety of pathological conditions such as, diabetic retinopathy, central or branch retinal vein occlusion, intraocular inflammation and following cataract extraction. This study was done to investigate the pattern of CME in patient attending Erbil Teaching Hospitals. This is a hospital base prospective study that included 61 patients (75 eyes) conducted at Erbil Teaching Hospital and Rigor Teaching Hospital for six months. All patients underwent a comprehensive assessment including medical and ophthalmic history and detailed ophthalmic examination including slit lamp examination, intraocular pressure measurement (IOP), Best corrected visual acuity (BCVA), dilated fundus examination and Optical Coherence Tomography (OCT) examination. It was found that of the 61 patients 32 (52.5%) were females and 29 (47.5%) were males. The mean age (56.4±10.8) years. Out of the 75 eyes included in the study, 41 eyes (54.66%) had diabetic retinopathy, 10 (13.34%) eyes had CME following cataract operation (Irvine-Gass syndrome), 8 eyes (10.67%) had BRVO, 6 eyes (8%) were had CRVO, 5 eyes (6.66%) had Age related Macular Degeneration, 3 eyes (4%) with uveitis, and 2 (2.67%) had Retinitis Pigmentosa. The average macular thickness was (415.6± 107). It was concluded that diabetic retinopathy is the most common predictive factor of CME, followed by cataract surgery. CME is more severe in diabetic retinopathy, CRVO and after cataract surgery.

Is treated HIV infection associated with knee cartilage degeneration and structural changes? A longitudinal study using data from the osteoarthritis initiative

BackgroundMetabolic disorders presenting in HIV-infected patients on antiretroviral therapy (ART) may increase the risk of osteoarthritis. However, structural changes of the knee in HIV infected subjects are understudied. The aim of this study is to investigate knee cartilage degeneration and knee structural changes over 8 years in subjects with and without HIV infection determined based on the use of ART.MethodsWe studied 10 participants from the Osteoarthritis Initiative who received ART at baseline and 20 controls without ART, frequency matched for age, sex, race, baseline body mass index (BMI) and Kellgren & Lawrence grade. Knee abnormalities were assessed using the whole-organ magnetic resonance imaging score (WORMS) and cartilage T2 including laminar and texture analyses were analyzed using a multislice-multiecho spin-echo sequence. Signal abnormalities of the infrapatellar fat pad (IPFP) and suprapatellar fat pad (SPFP) were assessed separately using a semi-quantitative scoring system. Linear regression models were used in the cross-sectional analysis to compare the differences between ART/HIV subjects and controls in T2 (regular and laminar T2 values, texture parameters) and morphologic parameters (subscores of WORMS, scores for signal alterations of IPFP and SPFP). Mixed effects models were used in the longitudinal analysis to compare the rate of change in T2 and morphological parameters between groups over 8 years.ResultsAt baseline, individuals on ART had significantly greater size of IPFP signal abnormalities (P = 0.008), higher signal intensities of SPFP (P = 0.015), higher effusion scores (P = 0.009), and lower subchondral cysts sum scores (P = 0.003) compared to the controls. No significant differences were found between the groups in T2-based cartilage parameters and WORMS scores for cartilage, meniscus, bone marrow edema patterns and ligaments (P > 0.05). Longitudinally, the HIV cohort had significantly higher global knee T2 entropy values (P = 0.047), more severe effusion (P = 0.001) but less severe subchondral cysts (P = 0.002) on average over 8 years.ConclusionsKnees of individuals with HIV on ART had a more heterogeneous cartilage matrix, more severe synovitis and abnormalities of the IPFP and SPFP, which may increase the risk of incident knee osteoarthritis.

Characterization of intramuscular calf vein thrombosis on routine knee MRI.

Literature regarding intramuscular calf vein thrombosis (IMCVT) or infrapopliteal deep vein thrombosis (DVT) evaluation by magnetic resonance imaging (MRI) is limited, particularly with regard to routine unenhanced knee examinations. We attempt to correlate routine unenhanced MRI findings with ultrasound evaluations of the lower extremity deep venous system. The radiology information system was searched, yielding a total of 67 patients who had undergone both routine knee MRI and duplex ultrasound examinations within 14days. The MRI examination findings recorded were the presence and pattern of edema, segmental vein dilation, intraluminal signal on fluid-sensitive sequences, and abnormal hyperintense signal on axial T1-weighted sequences. The presence and extent of thrombus more centrally (i.e., intramuscular calf vein thrombosis with or without extension into the popliteal vein) was reassessed on ultrasound. When comparing patients with positive (n = 13) and negative (n = 54) ultrasound, there were significant differences in each of these parameters: perivascular edema, intramuscular edema, focal vein dilation, and abnormal fluid-sensitive signal. In the subset of patients with popliteal extension of the intramuscular calf vein thrombosis compared with those without any deep vein thrombosis, there was a statistically significant increase in peripopliteal edema, abnormal fluid-sensitive signal, and abnormal hyperintense T1 signal. Imaging findings on routine unenhanced MRI have a high rate of concordance with duplex ultrasound performed through the calf in the detection of intramuscular calf vein thrombosis.

Optical coherence tomography patterns of diabetic macular edema in a Saudi population.

Purpose: The study aims to describe the patterns of diabetic macular edema (DME) and their association with visual acuity using optical coherence tomography (OCT).Patients and methods: This is a retrospective observational study with chart review of patients with DME including both type 1 and 2 diabetics seen between January 2015 and January 2016.Main Outcome Measures: Type of diabetes, diabetes duration, best-corrected visual acuity, DME pattern, central macular thickness (CMT), and stage of diabetic retinopathy. DME was classified based on OCT scans into: sponge-like diffuse retinal thickness (SLDRT), cystoids macular edema (CME), and sub-retinal fluid (SRF).Results: 227 eyes (144 patients) were included. The SLDRT represented 67.84%, CME 19.82%, and presence of SRF 2.20%. OCT scan from 21 patients (22 eyes) displayed more than a single pattern. The CMT and visual acuities varied depending on the DME morphologic patterns. SLDRT was associated with the least affected mean visual acuity of 0.2±0.21. SRF signified the worst mean visual acuities. Increase in CMT significantly correlated with reduced visual acuity (P=0.005). A statistically significant positive correlations between diabetic stage—high risk proliferative diabetic retinopathy (PDR) and severe non-proliferative diabetic retinopathy (NPDR)—with the CMT (P=0.050) and (P=0.021) respectively, were observed. A significant positive correlation between the duration of diabetes, age and type 1 diabetes with visual acuity in LogMAR (P=0.003), (P=0.03), and (P=0.0005) respectively.Conclusions: SLDRT was the most common morphological subtype of DME patterns and increasing retinal thickness impaired the visual acuity. Older ages, longer diabetic duration and type 1 diabetes are considered significant risk factors for visual acuity impairment. The study also suggests that there is a significant correlation between the DME patterns and visual acuity.

Analysis of anatomical biomarkers in subtypes of diabetic macular edema refractory to anti-vascular endothelial growth factor treated with dexamethasone implant.

To analyze functional and anatomical outcomes in subtypes of diabetic macular edema treated with a single dexamethasone implant and to assess the usefulness of a pro-re-nata treatment among subtypes. Retrospective study in morphologic patterns of diabetic macular edema (diffuse retinal thickening n = 15; cystoid macular edema n = 38, and serous retinal detachment n = 17) recalcitrant to anti-vascular endothelial growth factor, treated with dexamethasone implant. Examinations included timing to recidive of diabetic macular edema, best-corrected visual acuity, and central subfield macular thickness at 2, 4, and 6 months. In previously treated patients with a mean of 6.64 ± 3.69 anti-vascular endothelial growth factor injections, the best-corrected visual acuity improved from 61.64 ± 13.71 to 65.71 ± 14.65 as per the Early Treatment Diabetic Retinopathy Study protocol (p = 0.009) and central subfield macular thickness change from 447.46 ± 110.82 to 354.39 ± 80.46 µm (p < 0.005). The best-corrected visual acuity improvement was better in the diffuse retinal thickening group (68.67 ± 13.81 vs 65.26 ± 14.04 in cystoid macular edema and vs 64.12 ± 17.06 in serous retinal detachment), whereas higher central subfield macular thickness thinning was observed in serous retinal detachment group (368.47 ± 29.96 to 310.27 ± 67.47 in diffuse retinal thickening, vs 445.92 ± 105.06 to 364.39 ± 80.28 and 520.59 ± 122.96 to 370.94 ± 81.73 in cystoid macular edema and serous retinal detachment, respectively). Cystoid macular edema group was the group with more recurrences after 6 months (86.8% vs 66.7% in diffuse retinal thickening and 70.6% in serous retinal detachment). Dexamethasone implant is effective for all persistent diabetic macular edema subtypes with sustained functional and morphologic gains in the first 6 months.

Ultrasound patterns of pulmonary edema

Since its first description in 1967 (1), acute respiratory distress syndrome (ARDS) represents a well known major clinical problem in intensive care units (ICUs), carrying a high morbidity and mortality. Differentiating between hydrostatic or cardiogenic pulmonary edema (CPE) and ARDS is challenging, especially in the early stages of illness (2). This diagnostic task becomes more difficult in older patients, where a higher number of morbidities often coexists. Moreover, in septic patients with ARDS, the myocardium is dysfunctional due to systemic inflammatory activation and mitochondrial impairment, and sepsis related cardiomyopathy (3) is a recognized cause of left ventricular failure and of an increase in hydrostatic extravascular lung water and CPE.

Angioneurotic edema. Classification, diagnosis, prophylaxis, treatment tactics

The article highlights the current understanding of the etiology and various mechanisms of development, patterns of angioneurotic edema. Detailed clinical and laboratory picture of allergic and non-allergic forms of angioedema are presented.

Magnetic resonance imaging of the quadriceps fat pad oedema pattern in relation to patellofemoral joint pathologies.

PurposeQuadriceps fat pad is located posterior to the quadriceps tendon. Increased signal intensity of this fat pad is seen on routine knee magnetic resonance imaging (MRI) examinations, but the exact mechanism and related pathologies are not clear. In this study we aimed to evaluate the relationship between MRI signal intensity and morphological features of quadriceps fat pad, as well as various pathologies of the patellofemoral joint.Material and methodsSixty-one knees with quadriceps fat pad oedema out of 457 knee MRI examinations were included. Quadriceps fat pad signal intensity, dimensions, posterior indentation, and various parameters related to patellofemoral joint such as trochlear facet asymmetry, trochlear depth and sulcus angle, and the Insall-Salvati ratio were evaluated.ResultsThere was no statistically significant correlation between quadriceps fat pad oedema intensity and its dimensions, but it was significant when compared to posterior indentation. There was no correlation between fat pad oedema and each of the pathologies. However, there was a significant correlation between the presence of fat pad oedema and the presence of at least one of the pathologies related to patellofemoral joint.ConclusionsQuadriceps fat pad oedema detected in MRI examinations should warn the radiologist against the presence of various pathologies related to the patellofemoral joint.

Spectral domain optical coherence tomography (SD OCT) pattern of macular edema and visual acuity in recent-onset branch retinal vein occlusion (BRVO) in a tertiary hospital

Background: Macular edema is the common sight-threatening condition following branch retinal vein occlusion.&#x0D; Objective: To find spectral domain optical coherence tomography characteristics of macular involvement and visual acuity in the patients with branch retinal vein occlusion&#x0D; Methodology: This is a cross-sectional study; consecutive new cases of branch retinal vein occlusion diagnosed at the ophthalmology department of Kathmandu Medical College, Kathmandu were carried out from November 2016 to October 2017. All subjects were divided three groups with normotensive/controlled hypertension, stage 1 hypertension (systolic pressure &gt;140 mm Hg or diastolic pressure &gt;90mm Hg) and Stage 2 hypertension (systolic pressure &gt;160 mm Hg or diastolic pressure &gt;100 mm Hg).The macular edema was evaluated by taking best corrected visual acuity and spectral domain optical coherence tomography for measurement of central foveal thickness.&#x0D; Results: Forty patients with forty eyes were enrolled. Mean age was 58.5 years SD ± 9.98 years. Stage 1 and stage 2 hypertensive groups had significantly worse best corrected visual acuity and more thickness of central foveal thickness than normotensive/controlled group (p&lt;0.001). The best corrected visual acuity and central foveal thickness were successively worse among normotensive group, stage 1 hypertensive group and stage 2 hypertensive group (between normotensive/controlled group and stage 1 hypertensive group, p = 0.032 and 0.002 respectively and between stage I hypertensive group and stage 2 hypertensive group, p= 0.013 and 0.09 respectively).&#x0D; Conclusion: Control of hypertension could be a main contributing measure to lower incidence of branch retinal vein occlusion and the severity of macular edema.

Magnetic resonance imaging appearances of the capsulo-osseous layer of the iliotibial band and femoral attachments of the iliotibial band in the normal and pivot-shift ACL injured knee

BackgroundBiomechanical evidence suggests that the anterolateral structures of the knee may be important restraints against anterolateral rotatory instability (ALRI) in the setting of anterior cruciate ligament (ACL) injury.ObjectiveTo describe the anatomy and presence of injury of the capsule-osseous layer of the iliotibial band (CITB), the iliotibial band, and its deep distal femoral attachments in patients with a ‘normal’ knee (no pivot-shift bone marrow edema (BME) pattern) and patients with a pivot-shift BME pattern indicative of a pivot-shift injury associated with ACL tears.MethodsGroup 1: 20 consecutive patients with no MRI evidence of pivot-shift injury and group 2: 20 consecutive patients with a pivot-shift BME pattern on MRI were identified. Retrospective consensus analysis of the anatomy and appearances of the CITB and the ‘proximal’ and ‘epicondylar’ distal femoral attachments of the ITB was performed for each MRI by two experienced musculoskeletal radiologists.ResultsThe positive predictive value (PPV) of CITB injury for pivot-shift ACL injury was 74%, negative predicted Value (NPV) was 80%. The PPV for injury of the ‘proximal’ ITB femoral attachment with pivot-shift ACL injury was 93%, NPV was 84%. The PPV for ‘epicondylar’ iliotibial femoral attachment injury was 62%, NPV was 45%.ConclusionsInjury of the CITB and ‘proximal’ deep femoral attachments of the ITB are good markers for ACL injury even in the absence of a Segond fracture and should be evaluated on all MRIs as they may prove important in the further management of ALRI.

Quadratus femoris muscle: spectrum of MR imaging findings in 51 patients presenting with painful hip

Purpose: To provide an overview of magnetic resonance (MR) imaging findings related to quadratus femoris muscle (QFm) pathologies in symptomatic patients. Material and Methods: MR imaging studies from 51 patients, who were retrospectively recruited within a 2-year period, in 5 health care centers were reviewed. Inclusion criteria included: (i) hip pain; (ii) QFm abnormal signal; (iii) identification of other pathology in the QFm anatomical area. Exclusion criteria included: (i) other symptomatic hip/pelvic pathology; (ii) incomplete MR examination. The presence/location of QFm oedema and configuration of QFm fibers were evaluated and classified. Hamstring tendons were assessed for tendinosis/tear. Ischiofemoral impingement syndrome (IFIs) was indicated by QFm oedema and restriction of ischiofemoral space (IFS)/quadratus femoris space (QFS). QFm tears were categorised as complete/partial/chronic. Fisher’s exact test was used for statistical analysis. Results: IFIs diagnosis, related to various aetiologies, was suggested in 39 patients. The absence of severe QFm oedema and crowded configuration of QFm fibers correlated with IFIs diagnosis (p<0.05). In 18/39 (46.2%) of patients, restriction of the IFS/QFS was due to an underlying pathology. QFm tears were diagnosed in 5 patients. QFm oedema, usually mild, located at the myotendinous junction, was revealed in 4/5 patients. In 7 patients various pathologies related to the QFm were disclosed, which broadly included neoplastic disorders, myositis and bursitis. Conclusions: MR imaging can depict and characterise various QFm pathologies including IFIs, traumatic lesions, myositis and neoplastic disorders. Detailed analysis of the oedema pattern and the configuration of muscular fibers matched with clinical findings can lead to precise diagnosis.

Patterns of Macular Edema in Uveitis as Diagnosed by Optical Coherence Tomography in Tertiary Eye Center.

The aim of the study is to classify the patterns of uveitic macular edema using Optical Coherence Tomography as a diagnostic tool. It is the Descriptive, cross-sectional study. All patients fulfilling the diagnostic criteria with Optical coherence tomography diagnosed macular edema were enrolled from 1 January 2012 to 30 June 2013. Patterns of uveitic macular edema were classified. A total of 65 eyes of 47 patients were included. Twenty eight (59.57%) were male. The male to female ratio was 1.5:1. The mean age was 38 years (SD 14.68). Twenty nine patients (61.71%) had unilateral involvement and 18 (38.29%) had bilateral involvement. Forty five eyes of 33 cases (69.23%, 70.21%) had intermediate uveitis, followed by 10 eyes of 7 cases (15.38, 14.9%) of posterior uveitis, 6 eyes of 5 cases (9.23%, 10.63 %) of anterior uveitis and 4 eyes of 2 cases (6.16%,4.2%) of pan-uveitis. Patterns of macular edema were classified: diff use macular edema (DME), cystoid macular edema (CME) and serous retinal detachment (SRD) of which 35 (53.84%) eyes had CME. The etiological diagnosis was found in 7(14.90 %) out of 47 patients. A significant percentage of cases were idiopathic. Macular edema may go unnoticed unless OCT is performed. Macular detachment is an important feature of macular edema that affects visual acuity and is not readily detected by Fundus Fluorescein Angiography (FFA). Optical coherence tomography (OCT) is safe and non-invasive technique and has the potential for measuring changes in retinal thickness and axial extent of edema.

A Case of Pyoderma Gangrenosum as Skin Manifestation of SAPHO Syndrome in an IBD Patient

A 39 year old Caucasian male with a history of rectosigmoid ulcerative colitis (UC) was transferred to our hospital with joint pain, skin lesions, and fevers. He was initially diagnosed with UC in 2015 after experiencing hematochezia, abdominal pain and weight loss. He was started on budesonide and oral mesalamines. Given his refractory symptoms, he was started on adalimumab. However he developed rapid formation of high antibody levels, so he was transitioned to vedolizumab and azathioprine a year later. Until the time of presentation, he reported good control of his symptoms. He presented to the outside hospital in June 2018 with chest and back pain. In addition, he reported painful skin “pimples” throughout his chest, back and axilla which began to express pus. I&D's were performed of multiple lesions with purulent drainage; however they increased in size after incision. MRI showed findings concerning for osteomyelitis involving T4-6 and L2 vertebral bodies. He was placed on broad spectrum antibiotics, and his azathioprine was held. Despite antibiotic therapy, he developed fevers and was transferred to our hospital. Upon arrival, physical examination revealed multiple crusted, erythematous 1 cm pustules on his sternum (Fig. 1) and back. There was also a 6x3 cm ulcerated plaque on his left buttock with fibrinous necrotic material surrounded by an indurated rim of gray tissue (Fig. 2). In addition, there was a large ulcerated wound with necrotic center with surrounding violaceous erythema in his right axilla. A shave biopsy of his left buttock revealed a dense neutrophilic infiltrate throughout the dermis. Upon further review of imaging, osteomyelitis was ruled out but there was concern for osteitis (Fig. 3). Based on the clinical and histopathological findings, the diagnosis of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome was made in addition to pyoderma gangrenosum (PG). Antibiotics were discontinued, and he was started on IV steroids with resolution of his fever and improvement in his skin lesions.2055_A Figure 1. Subcutaneous 1 cm pustule with surrounding inflammation and central incision from prior I&D2055_B Figure 2. 6x3 cm ulcerated plaque on his left buttock with fibrinous necrotic material surrounded by an indurated rim of gray tissue with erythema2055_C Figure 3. Pattern of marrow edema and enhancement in T4-T6 and L2, without disc or epidural enhancement, consistent with osteitis.SAPHO syndrome is a rare disease, with an estimated prevalence of 1:10,000 in the Caucasian population. There are only a few cases of PG presenting as a skin manifestation of SAPHO syndrome. This is a rare case highlighting the association between SAPHO syndrome and PG in a patient with well-controlled IBD. Further investigation is warranted regarding the overlap of these conditions and its correlation with IBD.

Impaired cerebral compensatory reserve is associated with admission imaging characteristics of diffuse insult in traumatic brain injury

BackgroundContinuous assessment of cerebral compensatory reserve is possible using the moving correlation between pulse amplitude of intra-cranial pressure (AMP) and intra-cranial pressure (ICP), called RAP. Little is known about the behavior and associations of this index in adult traumatic brain injury (TBI). The goal of this study is to evaluate the association between admission cerebral imaging findings and RAP over the course of the acute intensive care unit stay.MethodsWe retrospectively reviewed 358 adult TBI patients admitted to the Addenbrooke’s Hospital, University of Cambridge, from March 2005 to December 2016. Only non-craniectomy patients were studied. Using archived high frequency physiologic signals, RAP was derived and analyzed over the first 48 h and first 10 days of recording in each patient, using grand mean, percentage of time above various thresholds, and integrated area under the curve (AUC) of RAP over time. Associations between these values and admission computed tomography (CT) injury characteristics were evaluated.ResultsThe integrated AUC, based on various thresholds of RAP, was statistically associated with admission CT markers of diffuse TBI and cerebral edema. Admission CT findings of cortical gyral effacement, lateral ventricle compression, diffuse cortical subarachnoid hemorrhage (SAH), thickness of cortical SAH, presence of bilateral contusions, and subcortical diffuse axonal injury (DAI) were all associated with AUC of RAP over time. Joncheere-Terpstra testing indicated a statistically significant increase in mean RAP AUC across ordinal categories of the abovementioned associated CT findings.ConclusionsRAP is associated with cerebral CT injury patterns of diffuse injury and edema, providing some confirmation of its potential measurement of cerebral compensatory reserve in TBI.