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ABSTRACT: OBJECTIVE. The purpose of this article is to review the clinical and imaging features as well as the potential complications of hip dysplasia in the young adult. Hip dysplasia is an important cause of secondary osteoarthrosis, which accounts for a significant proportion of patients requiring total hip arthroplasty. The radiographic diagnosis of mild hip dysplasia in the young adult may be subtle and is primarily based on the detection of deficient coverage of the femoral head by the acetabulum. CONCLUSION. Cross-sectional imaging, including CT and MRI, afford improved detection and characterization by providing morphologic information about acetabular deficiency. MRI also allows evaluation of potential associated injuries to the articular cartilage, the labrum, and the ligamentum teres. Familiarity with the radiographic and cross-sectional imaging findings of mild hip dysplasia in the young adult may allow a timely diagnosis and implementation of treatment strategies, which may prevent or delay the development of early osteoarthritis.
American Journal of Roentgenology 05/2013; 200(5):1077-88. · 2.78 Impact Factor
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ABSTRACT: Sports ankle injuries are very common worldwide. In the United States, it is estimated that 2 million acute ankle sprains occur each year, averaging to $318 to $914 per sprain. Magnetic resonance imaging is excellent for depicting normal ankle anatomy and can elegantly demonstrate ligamentous injuries of the ankle and associated conditions after ankle sprain. This article encompasses epidemiology, biomechanics, normal anatomy, and pathologic conditions of the ankle and foot ligaments. The specific ligaments discussed include the syndesmotic ligaments, lateral ligament complex of the ankle, deltoid ligament, spring ligament, ligaments of the sinus tarsi, and the Lisfranc ligament.
Radiologic Clinics of North America 05/2013; 51(3):455-78. · 2.59 Impact Factor
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ABSTRACT: Hip pain is a common but potentially vexing clinical problem; symptoms may be protean, referred, and poorly localized. History and physical examination can be unreliable in discriminating between intra-articular and extra-articular origins of pain. MR imaging augments clinical evaluation by providing information about the hip joint as well as the periarticular structures, which can be a source of symptoms. This article presents an anatomy-based review of common and less common tendon pathologies on MR imaging, which are considered in the differential diagnosis of hip pain.
Magnetic resonance imaging clinics of North America 02/2013; 21(1):75-96.
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ABSTRACT: The objective of our study was to investigate the association between high fovea capitis (fovea alta) and hip dysplasia in young adults.
In a retrospective study, blinded observers reviewed 82 pelvic radiographic and hip MRI studies of three groups of patients: those with developmental dysplasia of the hip (DDH) (center-edge angle, ≤ 20°), those with borderline DDH (center-edge angle, 21°-25°), and control patients (center-edge angle, > 25°). The center-edge angle and coxa valga (femoral neck-shaft angle, > 135°) were assessed on pelvic radiographs, and fovea alta was assessed on MR images (delta angle, ≤ 10°). The Mann-Whitney and Fisher exact tests were used to correlate fovea alta with DDH and with coxa valga, respectively. Interobserver agreement for center-edge and delta angles and the diagnostic performance of fovea alta as a marker of DDH were calculated.
Thirty-one patients with DDH, 23 with borderline DDH, and 28 without DDH were included. Excellent interobserver agreement was found for center-edge angle (concordance correlation coefficient, 0.94) and for delta angle (concordance correlation coefficient, 0.91). Fovea alta had a significant association with DDH (p < 0.001) but no association with coxa valga (p > 0.57). A significant difference (p < 0.001) was found between patients with DDH (3.4°) and those without DDH (21.7°) with respect to mean delta angle measurements. Fovea alta had 69.4% sensitivity, 82.1% specificity, 67.2% positive predictive value, 81.0% negative predictive value, and 75.6% overall accuracy as an indicator of DDH.
Fovea alta shows promise as a strong MRI marker of DDH.
American Journal of Roentgenology 10/2012; 199(4):879-83. · 2.78 Impact Factor
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ABSTRACT: Tunnel cyst formation is a rare complication after anterior cruciate ligament reconstruction, usually occurring 1-5 years post-operatively, which may occasionally be symptomatic. There are multiple proposed theories regarding the etiology of tunnel cysts. Theories include necrosis, foreign-body reaction, lack of complete graft osteo-integration, and intravasation of articular fluid. It is important to know if the tunnel cysts are communicating or not communicating with the joint, as surgical management may be different. Imaging characteristics on magnetic resonance images (MRI) include tibial tunnel widening, multilocular or unilocular cyst formation in the graft or tibial tunnel, with possible extension into the pretibial space, intercondylar notch, and/or popliteal fossa. The MR imaging differential diagnosis of tibial tunnel cysts includes infection, foreign-body granuloma, or tibial screw extrusion. Importantly, to the best of our knowledge, graft failure or instability has not been reported in association with tibial tunnel cysts.
Skeletal Radiology 07/2012; 41(11):1375-9. · 1.54 Impact Factor
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ABSTRACT: The rotator cable is an extension of the coracohumeral ligament coursing along the undersurface of the supraspinatus and infraspinatus tendons. The rotator cable is thought to play a role in the biomechanical function of the intact and torn rotator cuff. It can be seen on all the imaging planes used for the conventional magnetic resonance imaging of the shoulder. Clinically, the integrity of the rotator cable can play a role in the treatment selection for patients with a rotator cuff tear.
Magnetic resonance imaging clinics of North America 05/2012; 20(2):173-85, ix.
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ABSTRACT: A 29-year-old female presented with pain and a palpable mass in the left wrist. Imaging demonstrated a multiloculated cystic mass adjacent to the radial aspect of the scaphoid, which was intimately associated with and appeared to arise from the wall of the radial artery and its dorsal branch. The mass was surgically resected. The histological analysis confirmed the presence of adventitial cystic disease (ACD) of the radial artery. In addition, within a year time span, a second 34-year-old male patient presented with a palpable mass in the right hand. Imaging demonstrated a cystic mass encasing the dorsal carpal branch of the radial artery and its terminal vessels to the thumb and index finger. The diagnosis of ACD was raised based on MR imaging. Histological analysis confirmed the presence of an adventitial cyst. ACD of the arteries is a rare disorder of unknown etiology, which usually involves the popliteal artery. Less common sites of involvement include the external iliac, common femoral, radial, and ulnar arteries. To our knowledge, there have only been six previous case reports of adventitial cystic disease involving the radial artery. The imaging features, histology, differential diagnosis, pathogenesis, and treatment are discussed.
Bulletin of the NYU hospital for joint diseases 01/2012; 70(4):262-7.
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Skeletal Radiology 12/2011; 41(3):339, 361-2. · 1.54 Impact Factor
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Skeletal Radiology 11/2011; · 1.54 Impact Factor
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Zehava Sadka Rosenberg,
Renata La Rocca Vieira,
Sarah S Chan,
James Babb,
Yakup Akyol,
Leon D Rybak,
Sandra Moore, Jenny T Bencardino,
Valerie Peck,
Nirmal C Tejwani,
Kenneth A Egol
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ABSTRACT: The objective of our study was to evaluate the diagnostic utility of conventional radiography for diagnosing bisphosphonate-related atypical subtrochanteric femoral fractures.
Retrospective interpretation of 38 radiographs of complete subtrochanteric and diaphyseal femoral fractures in two patient groups-one group being treated with bisphosphonates (19 fractures in 17 patients) and a second group not being treated with bisphosphonates (19 fractures in 19 patients)-was performed by three radiologists. The readers assessed four imaging criteria: focal lateral cortical thickening, transverse fracture, medial femoral spike, and fracture comminution. The odds ratios and the sensitivity, specificity, and accuracy of each imaging criterion as a predictor of bisphosphonate-related fractures were calculated. Similarly, the interobserver agreement and the sensitivity, specificity, and accuracy of diagnosing bisphosphonate-related fractures (i.e., atypical femoral fractures) were determined for the three readers.
Among the candidate predictors of bisphosphonate-related fractures, focal lateral cortical thickening and transverse fracture had the highest odds ratios (76.4 and 10.1, respectively). Medial spike and comminution had odd ratios of 3.8 and 0.63, respectively. Focal lateral cortical thickening and transverse fracture were also the most accurate factors for detecting bisphosphonate-related fractures for all readers. The sensitivity, specificity, and overall accuracy for diagnosing bisphosphonate-related fractures were 94.7%, 100%, and 97.4% for reader 1; 94.7%, 68.4%, and 81.6% for reader 2; and 89.5%, 89.5%, and 89.5% for reader 3, respectively. The interobserver agreement was substantial (κ > 0.61).
Radiographs are reliable for distinguishing between complete femoral fractures related to bisphosphonate use and those not related to bisphosphonate use. Focal lateral cortical thickening and transverse fracture are the most dependable signs, showing high odds ratios and the highest accuracy for diagnosing these fractures.
American Journal of Roentgenology 10/2011; 197(4):954-60. · 2.78 Impact Factor
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Jenny T Bencardino
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ABSTRACT: A tailored review of peer-reviewed abstracts presented at the 2010 Radiological Society of North America (RSNA) Annual Meeting was performed following oral presentation. This review will highlight 15 formal and informal scientific paper presentations focusing on three main topics: (1) 3D isotropic MR imaging of joints, (2) diffusion tensor imaging of peripheral nerves, and (3) dual-energy CT in the diagnosis of Gout.
Skeletal Radiology 06/2011; 40(8):1109-12. · 1.54 Impact Factor
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ABSTRACT: The objective of this study was to describe the anatomy and MR appearance of the spring ligament recess of the talocalcaneonavicular joint.
Forty-nine MR examinations of the ankle with a spring ligament recess were prospectively collected. The size of the recess was measured. The presence of the following variables was recorded: talocalcaneonavicular joint effusion, ankle joint effusion, talar head impaction, acute lateral ankle sprain, chronic lateral ankle sprain, spring ligament tear, sinus tarsi ligament tear, talar dome osteochondral injury, and talonavicular osteoarthrosis. The Fisher exact test was performed to quantify the association of the talocalcaneonavicular effusion with the other variables. MR arthrography and dissection with histologic analysis were performed in two cadaveric ankles.
Twenty-four men and 25 women (average age, 39 years; range, 21-77 years) were included in the study. The average size of the fluid collection was 0.4 × 0.8 cm (range, 0.2-0.9 × 0.4-1.5 cm). The prevalence of the measured variables was talocalcaneonavicular joint effusion, 67.3%; ankle joint effusion, 61.2%; talar head impaction, 32.7%; acute lateral ankle sprain, 28.6%; chronic lateral ankle sprain, 59.2%; spring ligament tear, 14.3%; sinus tarsi ligament tear, 12.2%; talar dome osteochondral lesion, 20.4%; and talonavicular osteoarthrosis, 18.4%. There was a higher prevalence of talar head impaction among individuals with talocalcaneonavicular joint effusion (p = 0.0522). Cadaveric study revealed communication between the talocalcaneonavicular joint and the spring ligament recess.
The spring ligament recess is a synovium-lined, fluid-filled space that communicates with the talocalcaneonavicular joint. The recess should be distinguished from a tear of the plantar components of the spring ligament.
American Journal of Roentgenology 05/2011; 196(5):1145-50. · 2.78 Impact Factor
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ABSTRACT: The appearance and distribution of the intra-articular plicae of the hip have been addressed in few reports in the anatomic and radiological literature. This study aims to determine the prevalence of visible synovial hip plicae using MR arthrography and to measure the association of visible synovial hip plicae with MR arthrographic diagnosis of labral tears, femoroacetabular impingement, and osteoarthritis.
Following institutional review board approval, 63 direct MR arthrographic examinations of the hip in 61 patients with a clinical history of hip pain were retrospectively reviewed by two experienced musculoskeletal radiologists in consensus. The following variables were measured using a binary system (0 = absent; 1 = present): labral plica, neck plica, ligamental plica, labral tear, femoroacetabular impingement, and osteoarthritis. The surgical reports and arthroscopic images of 10 patients were reviewed. Statistical analysis was performed using the Fisher's exact test.
In all 63 cases at least one plica was visualized on MR-arthrographic images. Labral, neck, and ligamental plicae were found with a prevalence of 76, 97, and 78%, respectively. There was no statistically significant association between the presence of labral tears, femoroacetabular impingement, and osteoarthritis among patients with visible labral, neck, and ligamental plicae. The prevalence of labral tears, femoroacetabular impingement, and osteoarthritis in our patient population was 79, 28, and 28%, respectively. The presence of intra-articular plicae was the only MR-arthrographic finding in 5 of our 63 symptomatic cases.
Visible labral, neck, and/or ligamental plicae are highly prevalent on MR-arthrographic images of the hip performed in the setting of hip pain. There was no statistically significant association between the presence of labral tears, femoroacetabular impingement, and osteoarthritis and visible labral, neck, and ligamental plicae.
Skeletal Radiology 04/2011; 40(4):415-21. · 1.54 Impact Factor
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Skeletal Radiology 03/2011; 40(10):1245-7. · 1.54 Impact Factor
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ABSTRACT: OBJECTIVE: The purpose of this study was to describe the MRI features of cortical desmoids associated with acute trauma. CONCLUSION: Marrow edema, periostitis, and adjacent soft-tissue edema can be seen in cases of cortical desmoid associated with acute trauma.
American Journal of Roentgenology 02/2011; 196(2):424-8. · 2.78 Impact Factor
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Skeletal Radiology 11/2010; 40(4):461-2, 481-2. · 1.54 Impact Factor
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Magnetic resonance imaging clinics of North America 11/2010; 18(4):691-705.
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Skeletal Radiology 11/2010; · 1.54 Impact Factor
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ABSTRACT: MRI has become an important diagnostic tool in the evaluation of rotator cuff pathology and the technology continues to evolve. Direct MR arthrography, diagnosis-specific sequencing such as fat suppression, special positioning such as abducted externally rotated (ABER) views and ultra high field magnets allow for an unprecedented level of detail in imaging. In this article, we review MRI findings in patients with rotator cuff abnormalities that are anatomic variants or incidental findings. Although MRI findings may be diagnostic in some cases, we find that clinical correlation with history and physical examination is critical to differentiate between anatomic variants, incidental findings, and true pathology. We conclude that good communication between the orthopedic surgeon and the radiologist is necessary to optimize diagnostic yield.
Journal of Magnetic Resonance Imaging 06/2010; 31(6):1286-99. · 2.70 Impact Factor
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ABSTRACT: Sports-related injuries to the wrist range from minor sprains to severe soft tissue disruption that can pose a risk to the normal function of the upper extremity. It is important to identify the specific nature of such injuries so as to establish an accurate diagnosis and deliver appropriate treatment. MRI of the wrist has greatly benefited from the use of dedicated surface coils, which allow fine depiction of soft tissue and cartilaginous structures. A review of the normal anatomy, MR interpretation pitfalls, and most common abnormalities of the tendons, ligaments, triangular fibrocartilage complex, and nerves of the wrist are presented.
Clinics in sports medicine 08/2006; 25(3):409-32, vi. · 1.33 Impact Factor
