Fat-saturated Magnetic Resonance Research Articles

Generation of synthetic PET/MR fusion images from MR images using a combination of generative adversarial networks and conditional denoising diffusion probabilistic models based on simultaneous 18F-FDG PET/MR image data of pyogenic spondylodiscitis

BACKGROUND CONTEXTCross-modality image generation from magnetic resonance (MR) to positron emission tomography (PET) using the generative model can be expected to have complementary effects by addressing the limitations and maximizing the advantages inherent in each modality. PURPOSEThis study aims to generate synthetic PET/MR fusion images from MR images using a combination of generative adversarial networks (GANs) and conditional denoising diffusion probabilistic models (cDDPMs) based on simultaneous 18F-fluorodeoxyglucose (18F-FDG) PET/MR image data. STUDY DESIGNRetrospective study with prospectively collected clinical and radiological data. PATIENT SAMPLEThis study included 94 patients (60 men and 34 women) with thoraco-lumbar pyogenic spondylodiscitis (PSD) from February 2017 to January 2020 in a single tertiary institution. OUTCOME MEASURESQuantitative and qualitative image similarity were analyzed between the real and synthetic PET/ T2-weighted fat saturation MR (T2FS) fusion images on the test data set. METHODSWe used paired spinal sagittal T2FS and PET/T2FS fusion images of simultaneous 18F-FDG PET/MR imaging examination in patients with PSD, which were employed to generate synthetic PET/T2FS fusion images from T2FS images using a combination of Pix2Pix (U-Net generator + Least Squares GANs discriminator) and cDDPMs algorithms. In the analyses of image similarity between the real and synthetic PET/T2FS fusion images, we adopted the values of mean peak signal to noise ratio (PSNR), mean structural similarity measurement (SSIM), mean absolute error (MAE), and mean squared error (MSE) for quantitative analysis, while the discrimination accuracy by three spine surgeons was applied for qualitative analysis. RESULTSTotal of 2,082 pairs of T2FS and PET/T2FS fusion images were obtained from 172 examinations on 94 patients, which were randomly assigned to training, validation, and test data sets in 8:1:1 ratio (1664, 209, and 209 pairs). The quantitative analysis revealed PSNR of 30.634 ± 3.437, SSIM of 0.910 ± 0.067, MAE of 0.017 ± 0.008, and MSE of 0.001 ± 0.001, respectively. The values of PSNR, MAE, and MSE significantly decreased as FDG uptake increased in real PET/T2FS fusion image, with no significant correlation on SSIM. In the qualitative analysis, the overall discrimination accuracy between real and synthetic PET/T2FS fusion images was 47.4%. CONCLUSIONSThe combination of Pix2Pix and cDDPMs demonstrated the potential for cross-modal image generation from MR to PET images, with reliable quantitative and qualitative image similarities.

The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

Background: Research on the cause of lateral patellar dislocation (LPD) has focused on trochlear morphologic parameters, joint alignment, and patellofemoral soft tissue forces. A paucity of information is available regarding how patellar morphologic parameters influence the risk for LPD. Purpose/Hypothesis: The purpose was to assess whether patellar morphology is a risk factor for recurrent LPD. It was hypothesized that (1) patients with recurrent LPD would have decreased patellar width and volume and (2) patellar morphologic parameters would accurately discriminate patients with recurrent LPD from controls. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 21 adults with recurrent LPD (age, 29.7 ± 11.1 years; height, 170.8 ± 9.9 cm; weight, 76.1 ± 17.5 kg; 57% female) were compared with 21 sex- and height-matched controls (age, 27.2 ± 6.7 years; height, 172.0 ± 10.6 cm; weight, 71.1 ± 12.8 kg; 57% female). Three-dimensional axial fat-saturated magnetic resonance imaging scans were used to measure patellar medial, lateral, and total width; patellar volume; patellar medial and lateral facet length; the Wiberg index; and previously validated knee joint alignment and femoral shape measurements (eg, tibial tuberosity to trochlear groove distance, trochlear dysplasia). Results: The LPD group demonstrated reduced medial patellar width (Δ = −3.6 mm; P < .001) and medial facet length (Δ = −3.7 mm; P < .001) but no change in lateral width or facet length. This resulted in decreased total patellar width (Δ = −3.2 mm; P = .009), decreased patellar volume (Δ = −0.3 cm3; P = .025), and an increased Wiberg index (Δ = 0.05; P < .001). No significant differences were found for all other patellar shape measures between cohorts. Medial patellar width was the strongest single discriminator (83.3% accuracy) for recurrent LPD. Combining medial patellar width, patellofemoral tilt, and trochlear groove length increased the discrimination to 92.9%. Conclusion: The medial patellar width was significantly smaller in patients with recurrent LPD and was the single most accurate discriminator for recurrent LPD, even compared with traditional trochlear shape and joint alignment measures (eg, trochlear dysplasia, patella alta). Therefore, medial patellar morphology should be assessed in patients with LPD as a risk factor for recurrence and a potential means to improve treatment.

Cutaneous Melanoma with Metastasis to the Lateral Rectus Muscle

A 47-year-old White man with metastatic cutaneous melanoma developed limited abduction in the right eye. An axial T2 fat-saturated magnetic resonance imaging (Fig A) revealed a heterogeneous right lateral rectus mass with mass effect on the optic nerve. There were no radiographic signs of globe tenting or exophthalmos. A skin biopsy from the patient’s back (Fig B) revealed large mononuclear cells with high nuclear-to-cytoplasm ratios, abundant mitotic figures, and that were positive for SOX-10. One week after Nivolumab, the patient developed compressive optic neuropathy.

Visualization of meniscus with 3D axial reconstructions

PurposeTo visualize the meniscus of the knee joint in the axial plane and identify injuries that cannot be visualized using conventional sequences. MethodsTwo hundred and two subjects underwent an improvised 3-Dimensional Proton Density Fat Saturation (3D-PD FS) Magnetic Resonance (MR) sequence on their meniscus. The transverse images were reconstructed and examined. Fifty-three of the subjects had a healthy meniscus and their images were used as part of a qualitative evaluation to verify that all parts of the meniscus were properly visualized. The evaluation was based on a four-level scale indicating the visualization of meniscal parts. The same evaluation was also performed on the 149 subjects with meniscal pathologies. Another qualitative evaluation was performed on all subjects concerning five image characteristics based on a five-level scale. Finally, images from 20 patients with meniscal pathologies were compared with arthroscopic images visualizing meniscal tears. ResultsIn all subjects, all parts of the meniscus were clearly visualized. The axial reformats provided ideal imaging of the meniscus, yielding high total image quality, satisfactory smoothing and sharpening, fewer artifacts, and successful fat saturation. The findings of the MR images from the 20 subjects with meniscal pathologies, concerning the topography of meniscal tears coincided at 100% with their arthroscopic findings. ConclusionThe use of the improvised 3D-PD FS sequence provides the possibility of axial reconstruction with a better depiction of the meniscus. These images can accurately illustrate the range of the meniscus and any meniscal tears along with their exact location with high image quality.

Acute-Phase Intraoperative Findings of Traumatic Spinal Cerebrospinal Fluid Leakage

The acute-stage intraoperative findings of the spinal dural laceration in patients with traumatic cerebrospinal fluid (CSF) leakage have not been clearly revealed so far. Herein, we report an interesting case of traumatic CSF leakage in a patient who underwent acute-stage direct closure for a dural laceration similar to a stab at the C1/2 level. Because a 41-year-old man strongly twisted his neck, he had a typical orthostatic headache. Whole-spine T2 fat-saturated magnetic resonance imaging and computed tomographic myelography were examined, and fluid collection between the intrathecal site and epidural dorsal space, including soft tissue, was confirmed as a direct CSF leakage at the C1/2 level. Direct surgical closure was performed 13 days after the onset of symptoms, and dural laceration with sharp edges was detected on the right side at the C1/2 level. The laceration was sutured and coated with dural sealant. Finally, the patient's orthostatic headache was relieved completely after the operation.

Bone Marrow Reconversion With Reambulation: A Prospective Clinical Trial.

In a prospective clinical trial, 20 healthy men participated in a 60-day, 6-degree head-down tilt bed rest study. Serial 3-T magnetic resonance (MR) imaging measures of the lumbar spine were performed at baseline, after 57 days of bed rest, and at 30, 360, and 720 days of reambulation (100 MR imaging scans). Proton density with and without fat saturation, 2-point Dixon, and single-voxel MR spectroscopy techniques were used to assess bone marrow composition (300 measures). Erythropoiesis was measured using hematocrit, reticulocyte, and ferritin. Also, participants randomly received either a nutritional intervention composed of polyphenols, omega-3, vitamin E, and selenium or a normal diet. Thirty days of reambulation after 60 days of bed rest caused a marked decrease of the mean lumbar vertebral fat fraction (VFF) (-9.2 ± 1.6 percentage points, -8.0 ± 1.3 percentage points, and -12.7 ± 1.2 percentage points compared with baseline using proton density, Dixon, MR spectroscopy, respectively; all 3, P < 0.05). Reambulation also decreased the fat saturation index (-5.3 ± 1.1 percentage points compared with baseline; P < 0.05). These coincided with lower hematocrit and ferritin and with increased reticulocytes at reambulation day 13 compared with baseline (all 3, P < 0.05). After 57 days of bed rest, the VFF was unchanged from baseline (all 3 MR techniques, P > 0.05); reambulation for 2 years returned the lumbar VFF to baseline values. This longitudinal trial established that 30 days of reambulation after 60 days of bed rest constituted a powerful stimulus for bone marrow reconversion. In this model, the enhanced erythropoiesis coupled with preferential consumption of fatty acids from regulated marrow adipose tissue to supply energy for erythropoiesis and bone anabolism may explain the lumbar vertebrae reconversion. These results will help interpreting bone marrow signal in ambulatory patients after long periods of bed rest.

Comparison between STIR and T2-weighted SPAIR sequences in the evaluation of inflammatory sacroiliitis: diagnostic performance and signal-to-noise ratio.

ObjectiveTo compare two different fat-saturated magnetic resonance imaging (MRI) techniques-STIR and T2 SPAIR-in terms of image quality, as well as in terms of their diagnostic performance in detecting sacroiliac joints (SIJ) active inflammation.Materials and MethodsWe included 69 consecutive patients with suspected spondyloarthritis undergoing MRI between 2012 and 2014. The signal-to-noise ratio (SNR) was calculated with the method recommended by the American College of Radiology. Two readers evaluated SIJ MRI following ASAS criteria to assess diagnostic performance regarding the detection of active SIJ inflammation. T1 SPIR Gd+ sequence was used as the reference standard.ResultsThe mean SNR was 72.8 for the T1 SPIR Gd+ sequence, compared with 14.1 and 37.6 for the STIR and T2 SPAIR sequences, respectively. The sensitivity and specificity of STIR and SPAIR T2 sequences did not show any statistically significant differences, for the diagnosis of sacroiliitis with active inflammation.ConclusionOur results corroborate those in the recent literature suggesting that STIR sequences are not superior to T2 SPAIR sequences for SIJ evaluation in patients with suspected spondyloarthritis. On 1.5-T MRI, T2-weighted SPAIR sequences provide better SNRs than do STIR sequences, which reinforces that T2 SPAIR sequences may be an advantageous option for the evaluation of sacroiliitis.

Association Between Quantitatively Measured Infrapatellar Fat Pad High Signal-Intensity Alteration and Magnetic Resonance Imaging-Assessed Progression of Knee Osteoarthritis.

To describe the cross-sectional and longitudinal associations between quantitative measures of infrapatellar fat pad (IPFP) signal-intensity alteration and knee structural abnormalities in patients with symptomatic knee osteoarthritis (OA). A total of 261 patients (mean ± SD age 63.0 ± 7.2 years) with symptomatic knee OA were selected from a randomized controlled trial with a follow-up of 2 years. IPFP signal-intensity alterations at baseline were quantitatively measured on T2-weighted fat-saturated magnetic resonance imaging using MATLAB. These quantitative measures included the SD of whole IPFP signal intensity measurement, the upper quartile value of high signal intensity (UQH ), the ratio of volume of high signal-intensity alteration to volume of whole IPFP (percentageH ), and the clustering effect of high signal intensity (clustering-factorH ). Cartilage volume and defects and bone marrow lesions (BMLs) were assessed using validated measures. Higher baseline SD of the IPFP, UQH , and clustering-factorH were associated with greater loss of tibial cartilage volume and larger increases in tibiofemoral cartilage defects over 2 years. Patients with high and medium tertiles of clustering-factorH had greater loss of cartilage volume per annum compared with those with a low tertile (for high 4.9%, for medium 4.6%, and for low 3.3% annually). Baseline percentageH and clustering-factorH were positively and significantly associated with increases in tibiofemoral BMLs over 2 years. Cross-sectional associations between IPFP measures and knee structures were similar but more consistent. Quantitative measures of increased signal intensity in the IPFP were associated with knee structural abnormalities in the tibiofemoral compartment, suggesting that these measurements could be used as an additional entry criterion to enrich studies for faster progressors of knee OA.

Septic arthritis of the cervical facets: Unusual cause of neck pain.

Sagittal T2-weighted fat saturation magnetic resonance imaging reveals erosion and a high-intensity area around the C3-C4 facet joint.

Evaluation of lymphedema in upper extremities by MR lymphangiography: Comparison with lymphoscintigraphy

PurposeTo validate usefulness of magnetic resonance (MR) lymphangiography for evaluation of peripheral lymphedema in upper extremities by comparison with lymphoscintigraphy. Materials and methodsThis prospective study had institutional review board approval and written informed consent was obtained from all patients. Initially, protocol of MR lymphangiography for upper extremity was established in seven healthy volunteers with 3.0T fat-saturated three-dimensional gradient-echo MR after gadobutrol injection. Then six patients with unilateral lymphedema of the upper extremities were examined with MR lymphangiography and lymphoscintigraphy, and the results were correlated with each other. Four categories were defined to scale the quality of drainage. Results of both techniques were separately evaluated by two radiologists and a nuclear physician. We evaluated sensitivity, specificity and correlation of both techniques. ResultsMR lymphangiography showed sensitivities of 100% for all four categories, while lymphoscintigraphy yielded a sensitivity of 83.3% for delineation of lymph vessels and 100% for the other three categories. Specificity of MR lymphangiography was 85.7% for delay of drainage and 100% for other three categories, while lymphoscintigraphy showed specificity of 66.7% for pattern of lymphatic drainage and 100% for other three categories. Delay and pattern of drainage was same in 83.3% and non-visualization of axillary LNs was indistinguishably noted in all patients on both techniques. Anatomic level of enhanced lymph vessel was identical in 66.7% of the patients. ConclusionMR lymphangiography showed better performance for depiction of lymph vessels. MR lymphangiography and lymphoscintigraphy yielded same results in all or most patients for evaluation of axillary lymph nodes enhancement and lymphatic drainage in upper extremity.

Association Between Pain at Sites Outside the Knee and Knee Cartilage Volume Loss in Elderly People Without Knee Osteoarthritis: A Prospective Study.

Pain is common in the elderly. Knee pain may predict knee cartilage loss, but whether generalized pain is associated with knee cartilage loss is unclear. This study, therefore, aimed to determine whether pain at multiple sites predicts knee cartilage volume loss among community-dwelling older adults, and, if so, to explore potential mechanisms. Data from the prospective Tasmanian Older Adult Cohort study was utilized (n = 394, mean age 63 years, range 52-79 years). Experience of pain at multiple sites was assessed using a questionnaire at baseline. T1-weighted fat-saturated magnetic resonance imaging of the right knee was performed to assess the cartilage volume at baseline and after 2.6 years. Linear regression modeling was used with adjustment for potential confounders. The median number of painful sites was 3 (range 0-7). There was a dose-response relationship between the number of painful sites and knee cartilage volume loss in the lateral and total tibiofemoral compartments (lateral β = -0.28% per annum; total β = -0.25% per annum, both P for trend < 0.05), but not in the medial compartment. These associations were stronger in participants without radiographic knee osteoarthritis (OA) (P < 0.05) and independent of age, sex, body mass index, physical activity, pain medication, and knee structural abnormalities. The number of painful sites independently predicts knee cartilage volume loss, especially in people without knee OA, suggesting that widespread pain may be an early marker of more rapid knee cartilage loss in those without radiographic knee OA. The underlying mechanism is unclear, but it is independent of anthropometrics, physical activity, and knee structural abnormalities.

Quantitative Assessment of Knee Effusion‐Synovitis in Older Adults: Association With Knee Structural Abnormalities

ObjectiveTo describe the natural history of quantitatively measured knee effusion‐synovitis and the longitudinal associations between effusion‐synovitis and knee structural factors, including cartilage defects, cartilage volume, subchondral bone marrow lesions, and meniscal pathology, in older adults.Methods A total of 406 subjects (with a mean age of 63 years, 50% women) were randomly selected at baseline and followed up 2.7 years later. T2‐ or T1‐weighted fat saturation magnetic resonance imaging was used to assess knee effusion‐synovitis maximal area, cartilage defects, cartilage volume, bone marrow lesions, and meniscal pathology at baseline and follow‐up. Multivariable generalized linear regression was performed to analyze the associations between the maximal area of effusion‐synovitis and other joint structural factors after adjustment for age, sex, body mass index, tibial bone area, and/or radiographic osteoarthritis (OA).ResultsOver 2.7 years of follow‐up, the size of effusion‐synovitis increased in 29%, remained stable in 50%, and decreased in 22% of the participants. Baseline effusion‐synovitis maximal area was significantly associated with changes in knee cartilage defects (β = 0.18 [95% confidence interval (95% CI)] 0.07, 0.29), bone marrow lesions (β = 0.17 [95% CI 0.05, 0.30]), and cartilage volume (β = −0.40 [95% CI −0.71, −0.09]) but not with change in meniscal pathology. In contrast, baseline structural measures were not associated with change or increase in effusion‐synovitis maximal area.ConclusionOur findings indicate that knee effusion‐synovitis is not static in older adults. It is predictive of, but not predicted by, other structural abnormalities, suggesting a potential role in early knee OA changes.

Association between circulating adipokines, radiographic changes, and knee cartilage volume in patients with knee osteoarthritis

Objectives: To explore the associations between serum adipokine levels, radiographic osteoarthritis (ROA) severity, and articular cartilage volume in patients with knee OA.Method: A cross-sectional sample of 205 patients (aged 45–74 years) with knee OA were consecutively recruited to the Anhui Osteoarthritis (AHOA) study. ROA was assessed using the Kellgren–Lawrence (KL) grading system (grades 0–4). Knee cartilage volume was determined using fat-saturated T1-weighted magnetic resonance imaging (MRI). Serum levels of the adipokines leptin, adiponectin, and resistin were measured by using an enzyme-linked immunosorbent assay (ELISA).Results: Serum adiponectin, but not serum leptin or resitin, was significantly associated with reduced ROA severity in univariable analyses and this association remained significant after adjustment for age, sex, body masss index (BMI), and disease duration [β = −0.012, 95% confidence interval (CI) −0.021 to −0.002]. In ROA patients, leptin was significantly and positively associated with knee cartilage volume at patellar and medial tibial sites in both unadjusted and adjusted analyses (β = 0.006, 95% CI 0.02–0.010 for medial tibia and β = 0.009, 95% CI 0.001–0.018 for patella sites) but adiponectin and resistin had no significant associations with cartilage volume. In non-ROA patients, leptin, adiponectin, and resistin were not significantly associated with cartilage volume at any site.Conclusions: Serum levels of leptin are independently associated with increased knee cartilage volume. In addition, serum adiponectin is significantly and negatively associated with ROA severity, suggesting a potentially protective effect.

Changes in patellofemoral bone marrow lesions and knee pain: Natural history and the associations with structure

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A298 2. IGF-II is capable of promoting cartilage matrix maintenance in injuryinduced OA in mice and in human OA cartilage ex vivo cultures. 469 CHANGES IN PATELLOFEMORAL BONE MARROW LESIONS AND KNEE PAIN: NATURAL HISTORY AND THE ASSOCIATIONS WITH STRUCTURE Z. Zhu y, C. Ding y, X. Jin y, B. Antony y, W. Han y, L. Laslett y, F. Cicuttini z, G. Jones y. yMenzies Inst. for Med. Res., Hobart, Australia; zDept. of Epidemiology and Preventive Med., Monash Univ., Melbourne, Melbourne, Australia Purpose: Bone marrow lesions (BMls) are recognized as an important subchondral feature in knee OA and play a vital role in the diease progression. The patellofemoral joint (PFJ) is a common site of pain and contributes to functional limitations among OA patients. However, there are very few clinical or epidemiological studies that reveal the association between PFJ BMLs and clinical symptoms as well as cartilage structural morphologies. Meanwhile, the natural history of PFJ BMLs has not yet been described. The aims of this study were, therefore, to describe the natural history of MRI-detected BMLs in PFJ over 2.6 years and evaluate the association between increases in PFJ BMLs, knee pain and knee cartilage morphology in older adults. Methods: 406 males and females were randomly selected from local community (mean age 63 years, range 51 to 79) and followed up for 2.6 years. PFJ BMLs were determined on T2-weighted fat saturated magnetic resonance imaging (MRI) using Whole-Organ MRI Score system (WORMS). Knee cartilage volume and cartilage defects scores (0-4) were determined on T1-weighted fat suppression MRI using WORMS. Knee pain was accessed byWestern Ontario and McMaster Universities Osteoarthritis (WOMAC) scores. Student's t-tests and Pearson's c2 tests were used to compare the differences between subjects with and without an increase in PFJ BMLs. Crude and adjusted linear regression was used to determine whether PFJ BML changes over 2.5 years were associated with changes in knee pain in the different sub-scales over 5 years, before and after adjustment for potential confounders. Binary logistic regression was used to examine the associations between increases in PFJ BMLs as an outcome, and baseline cartilage volumes as well as baseline cartilage defect scores as predictors, both before and after adjustment for potential confounders. Results: At baseline, 27% (n1⁄4109) had PFJ BMLs, 24% of these showed progression (change in score of 1) at follow-up, 44% persisted and 21% completely resolved. Of those 73% (n1⁄4297) who did not have PFJ BMLs at baseline, 19.7% of them developed new PFJ BMLs over 2.6 years. In multivariable analysis, change in PFJ BMLs was positively associated with increases in total knee pain (b: 0.81, 95% CI: 0.15, 1.48) and knee pain when going up/down stairs (b: 0.29, 95% CI: 0.08, 0.50) over 5 years. While baseline patellar cartilage volume predicted a decrease in PFJ BMLs (OR: 0.62, 95% CI: 0.43, 0.90), baseline patellar cartilage defects were associated with an increase in PFJ BMLs (OR: 1.75, 95% CI: 1.28, 2.40) over 2.6 years. Tibiofemoral cartilage volume and defects were not associated with changes in PFJ BMLs. Conclusions: PFJ BMLs are not static and change is clinically relevant. An increase in PFJ BMLs can be predicted by reduced patellar cartilage volume and increased patellar cartilage defects site-specifically.

IGF-II inhibits promotes cartilage integrity in experimental osteoarthritis and IL-1β-induced catabolic activity in chondrocytes

IGF-II inhibits promotes cartilage integrity in experimental osteoarthritis and IL-1β-induced catabolic activity in chondrocytes

Familial effects on structural changes relevant to knee osteoarthritis: a prospective cohort study

Genetic factors play an important role in the pathogenesis of knee osteoarthritis (OA), but which knee structural changes mediate this is unclear. This study aimed to describe the differences in knee structural changes over 8-10 years between offspring having at least one parent with total knee replacement (TKR) for severe primary knee OA and controls with no family history of knee OA. 115 offspring (mean age 45 years) with a family history of TKR for severe knee OA were compared with 104 (mean age 46 years) controls. T1 or T2-weighted fat saturated magnetic resonance imaging (MRI) was performed respectively to evaluate knee cartilage defects, bone marrow lesions (BMLs), meniscal extrusion and tears at baseline and 10 years. Multivariate logistic regression model was used to adjust for potential confounders. Offspring had a greater increase in cartilage defect score (1.03 vs 0.52, P = 0.007) and meniscal extrusion score (0.28 vs 0.10, P = 0.027) over 10 years, and a greater increase in meniscal tear score (0.40 vs 0.10, P = 0.012) over 8 years in the medial but not the lateral tibiofemoral compartment. Changes in BMLs over 8-years were not different between the two groups. These associations were independent of potential confounders, and strengthened after further adjustment for each other. With the exception of BMLs, offspring with a family history of knee OA have a greater risk of increases in multiple knee structural abnormalities in the medial tibiofemoral compartment suggesting pleiotropic familial effects.

OP0064 Cross Sectional and Longitudinal Associations between Knee Joint Effusion and Osteoarthritic Structural Changes in Older Adults

BackgroundMultiple joint pathological changes such as synovial effusion, cartilage and subchondral bone lesions are involved in osteoarthritis (OA). The causal relationship between joint effusion and other knee structural changes was...

Dissection of internal carotid and vertebral arteries: clinical presentation, diagnosis, and treatment

The paper gives the data available in the literature and the author’s results of an examination of almost 140 patients with dissection of the internal carotid and vertebral arteries (ICA and VA). Dissection is blood penetration through an intimal tear from the lumen of an artery into its wall to develop intramural hematoma (IMH). The cause of dissection is the weakness of the arterial wall presumably due to mitochondrial cytopathy. IMH narrows/occludes the arterial lumen or is a source of arterioarterial embolism, which in turn leads to ischemic stroke. Stroke as a result of dissection generally develops in young patients, who are not prone to traditional vascular risk factors, frequently after the influence of provocative factors (mild head/neck injury, head jerks, physical strain, contraceptives, etc.). The characteristics of stroke are head/neck pain on the side of dissection that appears a few days prior to stroke or simultaneously with the latter; quite often a good recovery of impaired functions; and low recurrence rates. Another major manifestation, isolated cervicocephalic pain, is encountered in PA dissection more frequently (in almost a third of cases) and in ICA dissection less frequently (about 5%). Magnetic resonance (MR) angiography and fat-saturated T1-weighted MR imaging play a leading role in the verification of dissection. Dissection should be treated with anticoagulants/antiaggregants in its acute phase, as well as with trophic drugs, primarily actovegin, in both acute and chronic phases.

Propranolol as a First‐line Treatment for Diffuse Infantile Hepatic Hemangioendothelioma

Propranolol as a First‐line Treatment for Diffuse Infantile Hepatic Hemangioendothelioma

MR Lymphangiography at 3.0 T: Correlation with Lymphoscintigraphy

To prospectively compare findings of magnetic resonance (MR) lymphangiography with those of lymphoscintigraphy, evaluate the pattern and delay of lymphatic drainage, compare typical findings, and investigate discrepancies between the techniques. This prospective study was performed according to the Declaration of Helsinki and was approved by the local ethics committee. Thirty consecutive patients with uni- or bilateral lymphedema and lymph vessel transplants of the lower extremities were examined with 3.0-T fat-saturated three-dimensional gradient-echo MR after gadopentetate dimeglumine injection. Results of all examinations were correlated with corresponding results of lymphoscintigraphy examinations. Results of both techniques were separately reviewed in consensus by a radiologist and a nuclear physician, who rated delay and pattern of drainage, number of enhancing levels, and quality of conspicuity of the depiction of lymph nodes and lymph vessels. Sensitivity and specificity were calculated by using combined results of both techniques and clinical presentation findings as reference standard. Correlation was calculated with weighted k coefficients. Weak lymphatic drainage at lymphoscintigraphy correlated with lymphangiectasia at MR lymphangiography (13 of 33 affected extremities). Lymph vessels were clearly visualized with MR lymphangiography (five of 24 affected extremities), while they were not detectable with lymphoscintigraphy. Depiction of inguinal lymph nodes was clearer with lymphoscintigraphy (five of 60 extremities). Correlation of both techniques was excellent for delay (κ=0.93) and pattern (κ=0.84) of drainage, good for depiction of lymph nodes (κ=0.67) and number of enhancing levels (κ=0.77), and moderate for depiction of lymph vessels (κ=0.50). Sensitivity and specificity for delay and pattern of drainage were concordant, whereas MR lymphangiography showed a higher sensitivity for lymph vessel abnormalities (100% vs 79%) and lower specificity for lymph node abnormalities (78% vs 100%). Imaging findings of MR lymphangiography and lymphoscintigraphy show a clear concordance. With lymphoscintigraphy, better visualization of inguinal lymph nodes was achieved, whereas with MR lymphangiography, better depiction of lymph vessels and morphologic features of lymph vessel abnormalities were achieved.