Fat-saturated Magnetic Resonance Imaging Research Articles

Increased Postoperative Deltoid Signal seen after Suprapectoral Biceps Tenodesis: Potential Risk to the Anterior Branch of the Axillary Nerve

BackgroundArthroscopic suprapectoral biceps tenodesis is a common procedure for lesions of the long head of the biceps in the setting of anterior shoulder pain. However, the distal portal poses a theoretical risk to the terminal branches of the axillary nerve as the nerve travels from posterior to anterior to innervate the anterior deltoid. The purpose of this retrospective cohort study was to assess for axillary nerve branch injury, identified by deltoid signal change in postoperative magnetic resonance imaging (MRI) in patients who underwent an arthroscopic suprapectoral biceps tenodesis. MethodsPatients who underwent rotator cuff repair with a concomitant arthroscopic suprapectoral biceps tenodesis, had a postoperative MRI, and at least 1 year of follow-up were included. The incidence of increased deltoid signal consistent with injury to an anterior branch of the axillary nerve on proton density fat saturated sequences was collected. Age, sex, body mass index (BMI), and patient reported outcome measures (PROMs) including the American Shoulder and Elbow Surgeons Shoulder Score (ASES) score, Patient-Reported Outcomes Measurement Information System (PROMIS) pain, physical function (PF), and upper extremity (UE) scores, and Single Assessment Numeric Evaluation (SANE) score were compared in patients with and without increased deltoid signal on postoperative MRI. P<0.05 was used for significance. ResultsTwenty-four patients were eligible for inclusion (9 female, average age 59.0±10.1, BMI 27.6±6.7). Edema-like signal within the anterior deltoid musculature was observed in 9 patients on postoperative MRI. Two patients had a second follow-up MRI performed which demonstrated resolution of signal, and one patient required a second surgery for release of adhesions. Patients with increased deltoid signal had higher BMI (p=0.03). There was no difference in any other demographic or postoperative PROM between patients with increased signal and those without at any follow-up time point. No patient demonstrated persistent weakness or numbness in the axillary nerve distribution at final follow-up. DiscussionOver one third of patients in our cohort had MRI evidence of axillary nerve branch injury as seen on proton density fat saturated MRI sequences postoperatively. The distal arthroscopic portal for a suprapectoral biceps tenodesis may place anterior terminal branches of the axillary nerve at risk for injury. Additional investigation and strategies for avoidance of nerve injury in this area should be pursued.

Synovial hemangioma presenting with chronic painful infrapatellar mass: a case report

BackgroundSynovial hemangiomas are rare benign vascular anomalies surrounded by a synovial lining and were first described by Bouchut in 1856. These neoplasms can develop in the intra-articular region, resulting in effusions and knee pain. However, their cause remains unknown. Prompt diagnosis and intervention are critical to prevent chondral damage. Histopathological examination is used to achieve the diagnosis, which is often delayed because of a lack of specific clinical signs. This report describes a unique case in which a painful infrapatellar mass was diagnosed as a synovial hemangioma. The absence of typical magnetic resonance imaging (MRI) findings highlights the importance of arthroscopic excision for diagnosis and symptom relief.Case presentationA 20-year-old woman presented with persistent anterior left knee pain that became exacerbated when she climbed stairs. Despite previous pain management and physical therapy, she developed a painful lump beneath her patella that worsened over time. She had also undergone arthrocentesis, but this did not relieve her pain. Physical examination revealed a palpable, immobile 5-cm mass along the patellar tendon with limited knee flexion and extension and normal ligament stability. T1-weighted fat-saturated MRI of the left knee with gadolinium-based contrast revealed a lobulated intra-articular mass in Hoffa’s fat pad that resembled a soft tissue chondroma. A biopsy of the mass was performed to provide histopathological evidence, confirming the benign nature of the mass. The subsequent excisional arthroscopy, combined with incision enlargement for mass removal, confirmed the histopathologic diagnosis of synovial hemangioma based on the presence of numerous dilated blood vessels and venous proliferation within sections of the synovium. Recovery was complete, and no residual tumor was detected on follow-up MRI after 1 year.ConclusionThis case study emphasizes the importance of arthroscopic excision over open surgery for patients with synovial hemangioma. The minimally invasive nature of arthroscopy combined with the well-encapsulated nature and location of the mass facilitates complete resection.

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.

Comparing bone shape models from deep learning processing of magnetic resonance imaging to computed tomography-based models

The purpose of this study was to develop a deep learning approach to automatically segment the scapular bone on magnetic resonance imaging (MRI) images and to compare the accuracy of these three-dimensional (3D) models with that of 3D computed tomography (CT). Fifty-five patients with high-resolution 3D fat-saturated T2 MRI were retrospectively identified. The underlying pathology included rotator cuff tendinopathy and tears, shoulder instability, and impingement. Two experienced musculoskeletal researchers manually segmented the scapular bone. Five cross-validation training and validation splits were generated to independently train two-dimensional (2D) and 3D models using a convolutional neural network approach. Model performance was evaluated using the Dice similarity coefficient (DSC). All models with DSC > 0.70 were ensembled and used for the test set, which consisted of four patients with matching high-resolution MRI and CT scans. Clinically relevant glenoid measurements, including glenoid height, width, and retroversion, were calculated for two of the patients. Paired t-tests and Wilcoxon signed-rank tests were used to compare the DSC of the models. The 2D and 3D models achieved a best DSC of 0.86 and 0.82, respectively, with no significant difference observed. Augmentation of imaging data significantly improved 3D but not 2D model performance. In comparing clinical measurements of 3D MRI and CT, there was a mean difference ranging from 1.29 mm to 3.46 mm and 0.05° to 7.47°. We have presented a fully automatic, deep learning-based strategy for extracting scapular shape from a high-resolution MRI scan. Further developments of this technology have the potential to allow for surgeons to obtain all clinically relevant information from MRI scans and reduce the need for multiple imaging studies for patients with shoulder pathology.

Symptoms: Purple Ear Drum and Hearing Loss

Symptoms: Purple Ear Drum and Hearing Loss

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.

Development of a rat model with lumbar vertebral endplate lesion.

Vertebral endplate lesion (EPL) caused by severe disc degeneration is associated with low back pain. However, there is no suitable animal model to elucidate the pathophysiology of EPL. This study aimed to develop a rat model of EPL and evaluate rat behavior and imaging and histological findings. The L4-5 intervertebral discs of Sprague-Dawley rats were transperitoneally removed, except for the outer annulus fibrosus and cartilage endplate, in the EPL group. The L4-5 discs were not removed and simply exposed in the sham group. Changes around the vertebral endplate on magnetic resonance imaging (MRI) and computed tomography (CT) were evaluated. Additionally, pain-related behavioral and histological assessments were performed. In the EPL group, a low-signal area around the vertebral endplate was observed on T1-weighted and T2-weighted fat-saturated MRI at 8weeks or later after surgery. In the same group, CT showed osteosclerosis around the vertebral endplate at 12weeks after surgery. The sham group did not show abnormal imaging features on the MRI and CT. Behavioral evaluation showed that the EPL group had a significantly longer grooming time than the sham group. Conversely, the 12-week postoperative locomotion time and the 1- and 12-week postoperative standing times were significantly shorter in the EPL group than in the sham group. Histological evaluation showed a high degree of vertebral endplate degeneration and an increased number of osteoclasts and proportion of nerve fibers expressing calcitonin gene-related peptide in the EPL group compared to those in the sham group. Our rat EPL model showed pain-related behavioral patterns and an increased expression of pain-related neuropeptide. This model could contribute to the study of the pathophysiology of EPL and will help in the treatment of low back pain in the future.

Radiomics Analysis of Fat-Saturated T2-Weighted MRI Sequences for the Prediction of Prognosis in Soft Tissue Sarcoma of the Extremities and Trunk Treated With Neoadjuvant Radiotherapy.

PurposeTo create a prognostic prediction radiomics model for soft tissue sarcoma (STS) of the extremities and trunk treated with neoadjuvant radiotherapy.MethodsThis study included 62 patients with STS of the extremities and trunk who underwent magnetic resonance imaging (MRI) before neoadjuvant radiotherapy. After tumour segmentation and preprocessing, 851 radiomics features were extracted. The radiomics score was constructed according to the least absolute shrinkage and selection operator (LASSO) method. Survival analysis (disease-free survival; DFS) was performed using the log-rank test and Cox’s proportional hazards regression model. The nomogram model was established based on the log-rank test and Cox regression model. Harrell’s concordance index (C-index), calibration curve and receiver operating characteristic (ROC) curve analysis were used to evaluate the prognostic factors. The clinical utility of the model was assessed by decision curve analysis (DCA).ResultsThe univariate survival analysis showed that tumour location (p = 0.032), clinical stage (p = 0.022), tumour size (p = 0.005) and the radiomics score were correlated with DFS (p < 0.05). The multivariate analysis showed that tumour location, tumour size, and the radiomics score were independent prognostic factors for DFS (p < 0.05). The combined clinical-radiomics model based on the multivariate analysis showed the best predictive ability for DFS (C-index: 0.781; Area Under Curve: 0.791). DCA revealed that the use of the radiomics score-based nomogram was associated with better benefit gains relative to the prediction of 2-year DFS events than other models in the threshold probability range between 0.12 and 0.38.ConclusionThe radiomics score from pretreatment MRI is an independent prognostic factor for DFS in patients with STS of the extremities and trunk. The radiomics score-based nomogram could improve prognostic stratification ability and thus contribute to individualized therapy for STS patients.

Quantifying Bone Marrow Edema Adjacent to the Lumbar Vertebral Endplate on Magnetic Resonance Imaging: A Cross-Sectional Study of Patients with Degenerative Lumbar Disease.

Study DesignCross-sectional study.PurposeWe aimed to quantitatively assess bone marrow edema (BME) on magnetic resonance imaging (MRI) for patients with degenerative lumbar diseases.Overview of LiteratureBME adjacent to a sclerotic endplate of the lumbar spine, detected using T2-weighted fat-saturated MRI, is closely associated with low back pain in patients with degenerative lumbar diseases. However, currently, there no quantitative evaluation methods for BME adjacent to the vertebral endplate.MethodsPatients with degenerative lumbar diseases, whose MRIs detected BME, were enrolled. On a T2-weighted fat-saturated MRI, BME appeared as a high-intensity region adjacent to the vertebral endplate. We calculated the contrast ratios (CRs) of BME and normal bone marrow using the signal intensities of BME, normal bone marrow, and the spinal cord. On computed tomography, we calculated Hounsfield unit (HU) values in the same area as BME, the sclerotic endplate, and normal bone marrow to assess bone density.ResultsThere were 16 men and 14 women, with an average age of 73.5 years. The mean CRs of BME and normal bone marrow were −0.015±0.056 and −0.407±0.023, respectively. BME’s CR was significantly higher than that of normal bone marrow (p<0.01). The HU values in the same area as BME, the sclerotic endplate, and normal bone marrow were 251.9±24.6, 828.3±35.6, and 98.1±9.3, respectively; these values were significantly different from each other (p<0.01).ConclusionsThe CR on MRI is a useful quantitative assessment tool for BME in patients with degenerative lumbar diseases.

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.

Quantitative Assessment of Bone Marrow Edema in Adolescent Athletes with Lumbar Spondylolysis Using Contrast Ratio on Magnetic Resonance Imaging.

Study DesignProspective cohort study.PurposeTo quantitatively evaluate bone marrow edema (BME) in the pedicle on magnetic resonance imaging (MRI) for adolescent athlete patients with spondylolysis.Overview of LiteratureSpondylolysis, a stress fracture of the pars interarticularis, is a common occurrence in adolescent athletes with low back pain. T2-weighed fat-saturated MRI is reportedly useful for the detection of BME in the pedicle in the early stage of spondylolysis; however, to our knowledge, the quantitative assessment of BME in spondylolysis has not been reported.MethodsAdolescent athletes with spondylolysis, including those with symptoms of low back pain, were enrolled. The sporting activity of the patients was restricted, and a hard brace was attached to the spine. The BME range of interest was taken on T2-weighed fat-saturated MRI, and the signal intensity (SI) of the BME (SIedema) was measured. The contrast ratio (CR) between the SI of the BME and SI of the spinal cord (SIcord) was calculated per the following formulae: CRedema=(SIedema−SIcord)/(SIedema+SIcord). The CR of the normal pedicle was measured as a control per the following formulae: CRcontrol=(SIcontrol−SIcord)/(SIcontrol+SIcord).ResultsThe study enrolled 32 men and one woman; the mean patient age was 15.2 years (range, 12–18 years). The average CR of the edema and normal pedicle at the first visit was 0.506 (range, 0.097–0.804) and 0.137 (range, −0.741 to 0.572), respectively. The CR of the edema was significantly higher as compared to that of the normal pedicle (p<0.01). MRI that was performed 1 month after the first visit showed that the CR of the edema had decreased to 0.204 (range, −0.152 to 0.517). The CR of the edema 1 month thereafter was significantly lower than that at the first visit (p<0.01).ConclusionsQuantitative assessment of BME using CR on MRI is useful in the evaluation of the healing process of spondylolysis.

Fat Saturated Magnetic Resonance Imaging (Fs-MRI) in the Evaluation of Lumbar Facet Arthrosis in Adult Patients with Low Back Pain in a Teaching Hospital of Eastern Nepal

Introduction: Facet joint arthropathy is one of the myriad of abnormalities for low back pain and since conventional Magnetic resonance Imaging detects the facet joint pathologies poorly when compared to fat suppressed MRI sequences, fat suppressed MRI promises to be contributory to proper diagnosis and management.&#x0D; Objective: The objective of this study was to find the prevalence of lumbar facet joint arthrosis among patients with low back pain and comparing conventional versus fat saturated sequence in detecting the MRI findings of facet joint arthrosis.&#x0D; Methodology: A cross sectional study was conducted at the Department of Radiodiagnosis and Department of Orthopedics at Birat Medical College Teaching Hospital from February 15, 2020 to May 15, 2020. Ethical clearance was taken and 100 participants having low back pain were enrolled for Magnetic Resonance imaging after informed consent. Data were&#x0D; Results: 57% study participants were found to have facet joint arthrosis (FJA) in their lumbar spine and on comparing the detection rate of the grades of arthrosis between the conventional and FS MRI, the difference in diagnosis of grade 2 and grade 3 changes of FJA were 87.9% and 42.9% respectively whereas no difference was found in diagnosing grade 4 changes in both the sequences. Data was entered in MS excel and analysed by SPSS.&#x0D; Conclusion: This study showed that facet joint arthrosis is frequently seen in the patients presenting with low back pain and these changes are better diagnosed by fat saturated MRI sequence as compared to conventional sequence.

Serum Biomarkers for Connective Tissue and Basement Membrane Remodeling are Associated with Vertebral Endplate Bone Marrow Lesions as Seen on MRI (Modic Changes).

Vertebral endplate bone marrow lesions, visualized on magnetic resonance imaging (MRI) as Modic changes (MC), are associated with chronic low back pain (cLBP). Since guidelines recommend against routine spinal MRI for cLBP in primary care, MC may be underdiagnosed. Serum biomarkers for MC would allow early diagnosis, inform clinical care decisions, and supplement treatment monitoring. We aimed to discover biomarkers in the blood serum that correlate with MC pathophysiological processes. For this single-site cross-sectional study, we recruited 54 subjects with 38 cLBP patients and 16 volunteers without a history of LBP. All subjects completed an Oswestry Disability Index (ODI) questionnaire and 10-cm Visual Analog Score (VAS) for LBP (VASback) and leg pain. Lumbar T1-weighted and fat-saturated T2-weighted MRI were acquired at 3T and used for MC classification in each endplate. Blood serum was collected on the day of MRI. Biomarkers related to disc resorption and bone marrow fibrosis were analyzed with enzyme-linked immune-absorbent assays. The concentration of biomarkers between no MC and any type of MC (AnyMC), MC1, and MC2 were compared. The Area Under the Curve (AUC) of the Receiver Operating Characteristics were calculated for each biomarker and for bivariable biomarker models. We found that biomarkers related to type III and type IV collagen degradation and formation tended to correlate with the presence of MC (p = 0.060–0.088). The bivariable model with the highest AUC was PRO-C3 + C4M and had a moderate diagnostic value for AnyMC in cLBP patients (AUC = 0.73, specificity = 78.9%, sensitivity = 73.7%). In conclusion, serum biomarkers related to the formation and degradation of type III and type IV collagen, which are key molecules in bone marrow fibrosis, correlated with MC presence. Bone marrow fibrosis may be an important pathophysiological process in MC that should be targeted in larger biomarker and treatment studies.

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.

Three-dimensional fat-saturated T1-weighted Cartesian volumetric interpolated breath-hold examination (VIBE) for the diagnosis of aortitis in patients with suspected large vessel vasculitis: a comparative study with 18F-FDG PET applying fully integrated PET/MRI

To evaluate the feasibility of T1-weighted (T1W) three-dimensional (3D) fat saturated Cartesian volumetric interpolated breath-hold examination (VIBE) magnetic resonance imaging (MRI) sequence for the diagnosis of aortitis in patients with suspected large vessel vasculitis (LVV) applying fully integrated 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography (PET)/MRI. Fourteen patients with aortitis and 14 patients with a negative study for aortitis using 18F-FDG PET as the standard of reference for the evaluation of inflammatory aortic involvement were included retrospectively. All patients were imaged at 3 T using T1W VIBE pre- and post-contrast. Four aortic segments were evaluated for image quality (IQ), diagnostic confidence (DC), and the degree of inflammatory activity (IA) using a Likert scale. Binomial and generalised estimating equation model tests were used to assess the diagnostic performance of T1W VIBE. Cohen's k was applied to test for interobserver reproducibility with respect to IA. Spearman's rank correlation coefficient was calculated to examine correlations between IQ, DC, IA, and PET results. On a patient- and segment-based analysis, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 85.7% and 59.8%, 100% and 100%, 100% and 100%, 87.5% and 68%, and 92.9% and 82.1%, respectively. IQ and DC were acceptable to good in all examinations and substantial interobserver agreement was observed for IA (Cohen's k = 0.69). IQ and DC as well as IA and 18F-FDG vessel wall uptake were significantly correlated (r=0.763 and 0.679, respectively; p<0.0001). T1W 3D fat saturated VIBE MRI allows diagnosis of aortitis and may aid in the management of patients with suspected LVV.

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.

Can We Accurately Predict the Quadruple Hamstring Graft Diameter From Preoperative Magnetic Resonance Imaging?

Background:Anterior cruciate ligament (ACL) reconstruction with a quadruple hamstring (QH) autograft is a widely utilized procedure with good outcomes. A graft diameter less than 8 mm, however, has been associated with higher revision rates. Accurately determining the diameter of the hamstring tendon preoperatively can help surgeons plan accordingly.Purpose/Hypothesis:The purpose of our study was to determine whether QH graft size can be reliably predicted from preoperative magnetic resonance imaging (MRI) measurements. We hypothesized that we can achieve a high predicted QH graft size correlation with regard to preoperative and intraoperative measurements.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:We evaluated patients undergoing ACL reconstruction using QH autografts. At the time of surgery, the semitendinosus tendon (ST) and gracilis tendon (GT) were harvested and sized and then sized as a QH graft. Preoperative individual ST and GT sizes were determined from T2-weighted fat-saturated MRI at 3 cm above the joint line using correlating axial and coronal images. We then used a predictive chart to predict what the size of the QH graft would be and compared this with the actual measurements. Pearson correlation coefficients between predicted and actual graft sizes were calculated.Results:The predicted GT graft size was within 0.5 mm of the actual size in 45 of 60 (75%) patients and within 1 mm of the actual graft size in 59 of 60 (98%) patients. The predicted GT graft size from MRI measurements correlated with the actual GT graft size (r = 0.62, P < .00001). The predicted ST graft size was within 0.5 mm of the actual size in 45 of 60 (75%) patients and within 1 mm of the actual graft size in 56 of 60 (93%) patients. The predicted ST graft size from MRI measurements correlated with the actual ST graft size (r = 0.71, P < .00001). The predicted QH graft size was within 0.5 mm of the actual size in 52 of 60 (87%) patients and within 1 mm of the actual graft size in 60 of 60 (100%) patients. The predicted QH graft size from MRI measurements correlated with the actual QH graft size (r = 0.81, P < .00001).Conclusion:The current technique can reliably predict the size of a QH graft within 1 mm of the final graft size.

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.

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.

Validation of a Knowledge Transfer Tool for the Knee Inflammation MRI Scoring System for Bone Marrow Lesions According to the OMERACT Filter: Data from the Osteoarthritis Initiative.

To assess feasibility and reliability of scoring bone marrow lesions (BML) on knee magnetic resonance imaging (MRI) in osteoarthritis using the Outcome Measures in Rheumatology Knee Inflammation MRI Scoring System (KIMRISS), with a Web-based interface and online training with real-time iterative calibration. Six readers new to the KIMRISS (3 radiologists, 3 rheumatologists) scored sagittal T2-weighted fat-saturated MRI in 20 subjects randomly selected from the Osteoarthritis Initiative data, at baseline and 1-year followup. In the KIMRISS, the reader moves a transparent overlay grid within a Web-based interface to fit bones, then clicks or touches each region containing BML per slice, to score 1 if BML is present. Regional and total scores are automatically calculated. Outcomes include the interreader intraclass correlation coefficients (ICC) and the smallest detectable change (SDC). Scoring took 3-12 min per scan and all readers rated the process as moderately to very user friendly. Despite a low BML burden (average score 2.8% of maximum possible) and small changes, interobserver reliability was moderate to high for BML status and change in the femur and tibia (ICC 0.78-0.88). Four readers also scored the patella reliably, whereas 2 readers were outliers, likely because of image artifacts. SDC of 1.5-5.6 represented 0.7% of the maximum possible score. We confirmed feasibility of knee BML scoring by new readers using interactive training and a Web-based touch-sensitive overlay system, finding high reliability and sensitivity to change. Further work will include adjustments to training materials regarding patellar scoring, and study in therapeutic trial datasets with higher burden of BML and larger changes.