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Objective: Using magnetic resonance imaging (MRI) to evaluate the characteristics of pathological changes of fibro-cartilage of the knee in patients with Baker cyst, to assess the compliance of degrees of damage stages of osteoarthritis on a scale of Kellgren–Lawrence (K–L), and compare the results with the data of other researchers., Material and Methods: This study included patients (38–82 years) with a cyst Baker accidentally detected during ultrasound veins of the lower extremities. The subjects underwent a single knee MRI. MRI was made in three dimensions using 3D gradient-echo protocol. Independent radiologist evaluated the presence and severity of chondral defect osteophytosis, damage to the menisci and ligaments, intraosseous edema and subchondral cysts. The osteoarthritis stage of the knee were identified by X-ray performed in a standing position in the standard two projections, with K–L scale., Results: In this study, the results of a survey of 20 people, whose average age was 57.2 years. According to the radiological scale of K–L two patients were assigned to the stage 0 degree, 5 people to stage 1, 2, 4 each, and 3 – to stage 3. Synovitis of various severity was detected in 85% of the studies. Nineteen visualized the patellar cartilage damage, the condyles of the femur and tibia are most commonly affects the joint area. Among the most commonly injured ligament anterior cruciate ligament was determined – 9 (45%) patients in the same amount of detected intramedullary edema condyles femur and tibia. Eighteen subjects had at least one anomaly meniscus detectable by MRI, while in 11 (55%) persons were deviations, at least two or more regions of the knee examined., Conclusions: Our results suggest that not all visualized on MRI degenerative damage to intra fibro-cartilaginous tissue correlate positively with the stages of osteoarthritis of the knee, identified by standard radiographs and may not significantly affect the onset and progression of synovial cyst of the popliteal region.

Objective: Assess the diagnostic accuracy of 3-T indirect magnetic resonance arthrography (iMRA) for hip cartilage and labral pathology detection using arthroscopy as the reference standard and compare it to the published performance of direct magnetic resonance arthrography (dMRA)., Materials and Methods: Between 2009 and 2011, 290 patients suspected of having femoroacetabular impingement underwent iMRA. Our study group consisted of 41 of these patients (17 males, mean age 35 years; 24 females, mean age 33 years) who did not have a prior history of hip surgery and who subsequently underwent arthroscopy. Two experienced musculoskeletal radiologists separately evaluated the randomized and anonymized studies for the presence and quadrant location of labral and cartilage pathology. These recorded data were compared to arthroscopic reports., Results: Forty-one patients had labral pathology, 34 patients had acetabular and 5 patients had femoral cartilage pathology at arthroscopy. Sensitivity, specificity, accuracy, negative- and positive-predictive values for labral lesion detection were respectively 98, 99, 99, 99 and 98 %; for acetabular cartilage lesion detection they were 69, 98, 89, 87 and 95 %; for femoral cartilage lesion detection they were 69, 95, 93 and 39 %. Sensitivities of iMRA by quadrant (anteroinferior, anterosuperior, posteroinferior, posterosuperior) for the labrum were 100.0, 95.0, NA and 85.7 %, for acetabular cartilage were NA, 58.8, NA and 39.5 % and for femoral cartilage were 50.0, 33.3, 75.0 and 75.0 %). NA indicates results not available because of the absence of findings in those quadrants. Specificities of iMRA by quadrant (anteroinferior, anterosuperior, posteroinferior, posterosuperior) for the labrum (95.0, 100.0, 95.1, 67.5 %), acetabular (100.0, 85.7, 92.6, 79.5 %) and femoral cartilage (100.0, 94.7, 96.2, 85.9 %)., Conclusion: iMRA at 3 T is accurate in detecting labral pathology suggesting that it is a viable alternative to dMRA.

Objective: To 1) test the feasibility of delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC) at 3 T in the temporomandibular joint (TMJ) and 2) to determine the optimal delay for measurements of the TMJ disc after i.v. contrast agent (CA) administration., Design: MRI of the right and left TMJ of six asymptomatic volunteers was performed at 3 T using a dedicated coil. 2D inversion recovery (2D-IR) sequences were performed at 4 time points covering 120 minutes and 3D gradient-echo (3D GRE) dual flip-angle sequences were performed at 14 time points covering 130 minutes after the administration of 0.2 mmol/kg of Gd-diethylenetriamine pentaacetic acid ion (Gd-DTPA)(2-), i.e., 0.4 mL of Magnevist™ per kg body weight. Pair-wise tests were used to assess differences between pre-and post-contrast T1 values., Results: 2D-IR sequences showed a statistically significant drop (p<0.001) in T1 values after i.v. CA administration. The T1 drop of 50% was reached 60 minutes after bolus injection in the TMJ disc. The 3D GRE dual flip-angle sequences confirmed these results and show plateau of T1 after 60 minutes., Conclusions: T1(Gd) maps calculated from dGEMRIC data allow in vivo assessment of the fibrocartilage disc of the TMJ. The recommended measurement time for dGEMRIC in the TMJ after i.v. CA administration is from 60 to 120 minutes., (Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Anterior (3 o'clock) acetabular labral tears (AALTs) have been reported to be associated with iliopsoas impingement (IPI). However, no study has examined the association between anatomical bony variables of the hip joint and AALTs. The purpose of this study was to evaluate the association between AALTs, femoroacetabular impingement (FAI) and other bony variables of the hip., Material and Methods: Seventy-six out of 274 hip MRI records met the inclusion criteria. Two independent blinded investigators evaluated the location of acetabular labral tears (ALTs), edema at the musculotendinous junction of the iliopsoas insertion, femoral neck anteversion angle, femoral neck shaft angle, acetabular anteversion angle, alpha angle, lateral central edge angle (LCEA), acetabular index, and acetabular depth. Comparison analyses between groups were performed., Results: Twenty-two patients had no ALTs (controls), 19 patients had AALTs, and 35 patients had ALTs not isolated at the 3 o'clock position (25 with cam-bony deformities [FAI-cam] and 10 with pincer-bony deformities [FAI-pincer]). The alpha angle mean was significantly higher (p < 0.001) in the FAI-cam group (62.7º, 95 % confidence interval [CI]: 56.2-69.2º) compared with the AALTs group (46.9º, 95 % CI: 40.1-53.7º). The LCEA mean was significantly higher (p < 0.001) in FAI-pincer group (41.9º, 95 % CI: 39.3º-44.5º) compared to AALTs group (29.4º, 95 % CI: 24.2º-34.6º). There was no statistically significant difference in any of the bony variables between the controls and the AALTs group., Conclusion: Our study demonstrated that AALTs are pathologically distinct and not associated with FAI or other bony abnormalities. This supports the previous studies, which proposed that AALTs are associated with IPI.

Purpose: Indirect magnetic resonance arthrography (I-MRA) confers significant logistical advantages over direct MRA and does not require articular injection. In this study, we determined the diagnostic performance of I-MRA in relation to conventional MRI and arthroscopy or surgery in detecting tears of the glenoid labrum, including Bankart lesions and superior labral antero-posterior (SLAP) tears in a standard clinical setting., Patients and Methods: Ninety-one symptomatic patients underwent conventional MRI and I-MRA of the affected shoulder, followed by either arthroscopy or open surgery. The scans were interpreted independently by two experienced radiology consultants with a special interest in musculoskeletal radiology. Using the surgical findings as the standard of reference, sensitivity, specificity, and diagnostic accuracy of conventional non-contrast MRI and I-MRA in the detection of labral tears were calculated., Results: The sensitivity of I-MRA was 95 and 97 %, respectively, for two radiologists as opposed to 79 and 83 % for conventional MRI. For both radiologists, the specificity of I-MRA, as well as MRI, was 91 % for detection of labral tears of all types. Accuracy of diagnosis was 93 and 95 %, respectively, for two radiologists with indirect MRA, compared to 84 and 86 % with non-contrast MRI., Conclusions: This retrospective study shows that I-MRA is a highly accurate and sensitive method for the detection of labral tears. The data obtained supports the use of I-MRA as standard practice in patients with shoulder instability due to suspected labral pathology where further investigative imaging is indicated.

Study Design: A retrospective, consecutive case series., Objective: To analyze the relationship between retro-odontoid soft-tissue thickness and patients' age, sex, and degenerative changes of cervical spine and to investigate the effect these factors have on retro-odontoid soft-tissue thickness., Summary of Background Data: Thickening of the soft tissue posterior to the odontoid process can form a retro-odontoid pseudotumor causing symptoms of spinal cord compression. Rheumatoid arthritis and long-term dialysis have been reported as possible causes for this. However, there have been reports of retro-odontoid pseudotumors without coexisting diseases., Methods: Findings from a total of 503 cases of cervical spine magnetic resonance images were reviewed, and retro-odontoid soft-tissue thickness was measured. The values were matched for age, sex, presence of degenerative changes, rheumatoid arthritis, and dialysis and were analyzed for significance., Results: Retro-odontoid soft tissue thickened with age, and this was also seen in male patients and patients with degenerative changes. Significant increase in thickness was also observed in patients undergoing dialysis and further increased with prolonged dialysis. There was no significant association with presence of rheumatoid arthritis., Conclusion: There is association between age, sex, degenerative cervical spine changes, and dialysis with retro-odontoid soft-tissue thickness. With dialysis, retro-odontoid soft-tissue thickness increases with increasing duration. Thus, reviewing magnetic resonance image from daily practice indicates that cervical spine degeneration is associated with the development of retro-odontoid pseudotumors.

Background: Derangements of the plantar plate and joint capsule are an underrecognized cause of lesser metatarsalgia. Fluoroscopic arthrography and magnetic resonance (MR) arthrography are both used for diagnosis. Currently there are no studies comparing the effectiveness of these two modalities., Methods: Patients suspected of having plantar plate or capsular tears underwent both fluoroscopic arthrography and MR arthrography; the imaging findings were then compared and correlated with intraoperative findings, when available, to evaluate the effectiveness of the different imaging modalities. Forty consecutive patients underwent both fluoroscopic and MR arthrography., Results: Thirty-two of 40 patients (80%) were found to have tears of the plantar plate, joint capsule, or both. MR arthrography identified all 32 tears. Four cases in the first 29 patients, 13.8%, demonstrated discrepancy where a tear was identified only on the MR arthrogram. A midpoint review of the data was performed. Of the 4 missed tears they were all noted to be plantar lateral in location. Four other patients in this group had plantar lateral tears that were not missed. These patients had an additional steep lateral oblique image on fluoroscopic arthrography, which showed the plantar lateral tear. Therefore an additional steep lateral oblique image was performed routinely capturing these small tears in the last 11 patients., Conclusion: MR arthrography was more accurate in identifying tears of the plantar plate and capsule than fluoroscopic arthrography. Fluoroscopic arthrography with additional views, like a steep lateral oblique view, was found to be as reliable, and more cost-effective, than MR arthrography., Level of Evidence: Level II, prospective comparative study.

MRI plays a critical role in all orthopaedic practices. A basic working knowledge of the most commonly used pulse sequences in musculoskeletal imaging and the appearance of normal tissues on those sequences is critical to confident MRI interpretation. The orthopaedic surgeon should be familiar with appropriate use of intravenous and intra-articular contrast and its limitations. Concepts key to MRI interpretation include image contrast and resolution, signal, noise, and pulse sequence. Recent advances in anatomic and functional imaging highlight the robust potential of MRI for musculoskeletal evaluation. As MRI technology evolves, the orthopaedic surgeon must stay current on these technologic advances to use this tool to its fullest potential.

Objective: The purpose of this study was to identify the presence of a fibrocartilaginous node within the distal peroneus longus tendon (PLT) just proximal to the cubital tunnel and correlate this with MRI signal characteristics of the distal PLT, which could result in a pseudotear appearance on MRI. We correlated imaging characteristics with pathologic specimens., Materials and Methods: Institutional review board approval was obtained. Retrospectively, 91 ankle MRIs utilizing a standard ankle protocol were reviewed by two musculoskeletal radiologists. Four cadaver ankles were imaged using a standard ankle MRI protocol and reviewed by the same radiologists. All the MRIs were examined for signal changes in the PLT. The cadaver ankles then underwent PLT dissection by an orthopaedic surgeon, and a pathologic review was undertaken by a pathologist with orthopaedic specialization, who looked for an os peroneum or proposed fibrocartilaginous node relating to the signal change found on the MRIs., Results: In the 91 ankle MRI studies, the PLT demonstrated normal low and increased signals. On the fat-saturated T2-weighted sequence, 76 (83.5%) ankles demonstrated low signal and 15 (16.5%) demonstrated increased signal. Of the cadaver ankle MRIs, all four demonstrated increased signal within the PLT; three contained a fibrocartilaginous node and one contained an os peroneum in that same region., Conclusions: The MRI signal of the PLT can change with the presence of a fibrocartilaginous node, which may be due to the molecular and chemical content of the fibrocartilage. This node increases the MRI signal in the distal PLT and gives the appearance of a pseudotear.

Magnetic resonance arthrography (MRA) is a useful pre-operative investigation for patients with clinical signs and symptoms of femoroacetabular impingement. Our aim was to assess the diagnostic accuracy of MRA in detecting labral tears and chondral wear in this context. Sixty nine hips were included in the study after exclusions. All patients underwent pre-operative MRA and then subsequent hip arthroscopy. The findings at MRA were compared to those found intraoperatively. For labral tears, sensitivity, specificity and accuracy were 81%, 51% and 58% respectively. For chondral wear these figures were 17%, 100%, and 55% respectively. In our institution, MRA was therefore not as accurate as previously published work suggests.

Objective: To investigate the utility of ultrasound cross-sectional area (CSA) measurements for diagnosing acetabular labral (AL) tears., Methods: The study included qualitative/quantitative ultrasound examinations of 55 hips in 52 patients with a presumed diagnosis of AL tear and 56 hips in 28 healthy volunteers. MR arthrography examinations were available only for the patients and were reviewed for the presence of AL thickening and tear., Results: The CSA of the anterior labrum was significantly larger in patients with an AL tear on MR arthrography than those in healthy volunteers (P < 0.01). The CSA cut-off value in determining labral thickening that maximises accuracy was 34.7 mm(2), and sensitivity, specificity and accuracy were 86.7%, 74.1% and 77.5%. Direct signs of AL tear on ultrasound had sensitivity, specificity and accuracy of 34.9%, 91.7% and 47.3%. The CSA cut-off value that maximises the accuracy of the AL tear was 40.6 mm(2), and sensitivity, specificity and accuracy were 58.1%, 91.2% and 78.4%., Conclusions: Ultrasound detects the thickened labrum frequently observed in MR arthrography studies, especially in patients with dysplastic hips. Although specificity of the method of detecting AL tears is high, sensitivity is low, with an overlap between subjects with AL tear and controls., Key Points: • Labral degeneration is frequent in dysplastic hips • Thickened labra are frequently observed on MR arthrograms • Labral thickening can be depicted by quantitative ultrasound measurements • The sensitivity is low with overlap between subjects with AL tear and controls.

With increasing youth participation in organized sports, more injuries in this age group are being treated by primary care and sports medicine physicians. Overuse injuries are much more common now than in past decades, with Little League shoulder, Little League elbow, and gymnast wrist being particular concerns. Rotator cuff tears and glenoid labral injuries, once thought to be rare in this age group, are also more common now. Osteochondritis dissecans of the elbow is relatively common and typically fares poorly without surgery. Wrist abnormalities that occur nowadays include triangular fibrocartilage tears. Tendonitis, which is now observed frequently in clinical practice in this age group, rarely requires imaging., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Fibrocartilaginous embolism (FCE), a disorder of rapid onset featured by nonprogressive paralysis and paresis of four legs, shows clinical symptoms very similar to those of other disorders, e.g., disk herniation. We examined 10 animals diagnosed with FCE based on clinical symptoms and magnetic resonance imaging (MRI) findings in a retrospective study to examine the relationship between onset-to-diagnosis/treatment initiation time and prognosis of FCE. Statistical procedures, including Fisher's exact probability test, were conducted. All animals in a group, in which the diagnosis was made and treatment was initiated after an elapse of <15 days after onset, showed improved symptoms; the group showed a positive correlation (r = 0.76) between "onset-to-symptom improvement time" and "onset-to-diagnosis/treatment initiation time". Furthermore, the mean onset-to-diagnosis/ treatment initiation times were 2.67 days and 10.25 days in groups without and with sequelae, respectively; the time was significantly (P < 0.02) shorter in the group without sequelae. A significant difference was found between the groups in early diagnosis and treatment initiation. Our study indicates that the early precise diagnosis for acutely developed paralysis and paresis of four legs through testings including MRI, as well as the early onset of their treatment are important to obtain a favorable prognosis.

Degenerative disc disease has been implicated as a major component of spine pathology. The current major clinical procedures for treating disc degeneration have been disappointing, because of altered spinal mechanics leading to subsequent degeneration at adjacent disc levels. Disc pathology treatment is shifting toward prevention and treatment of underlying etiologic processes at the level of the disc matrix composition and integrity and the biomechanics of the disc. The ability to perform such treatment relies on one's ability to accurately and objectively assess the state of the matrix and the effectiveness of treatment by a non-invasive technique. In this review, we will summarize our advances in efforts to develop an objective, accurate, non-invasive diagnostic tool (quantitative MRI) in the detection and quantification of matrix composition and integrity and of biomechanical changes in early intervertebral disc degeneration.

Entheses are the sites of attachment of a tendon, ligament, or joint capsule to bone. In a previous article new options for visualizing entheses and related structures, including ultrashort echo time (UTE) pulse sequences, and magic angle imaging were described. In this article an approach to image interpretation is described together with normal examples using UTE and other pulse sequences with and without magic angle imaging. Examples of images seen in disease are included. The new options for imaging entheses may provide useful options for biomechanical study and recognition of involvement in disease.

Objective: The purpose of this study was to evaluate cartilage defect at medial femoral condyle on MRI in early osteoarthritis and to compare with early osteoarthritis with meniscal tear without clear cartilage defect., Materials and Methods: Twelve patients with medial pain of the knee and cartilage defect without meniscal tear by MRI were studied for cartilage defect. There were two males and 10 females with cartilage defect, and they were between 42 and 61 years of age (average, 51.6). Fifteen patients with medial pain of the knee and meniscal tear and without clear cartilage defect had been studied as meniscal tear cases. There were five males and 10 females with meniscal tear, and they were between 45 and 61 years of age (average 54.5). In both groups, knee injuries by trauma and Kellgren radiographic grade III and IV osteoarthritis were excluded. We compared cartilage defect cases and meniscal tear cases by gender, age, medial meniscus displacement ratio from the edge of the tibial medial joint surface, femorotibial angle (FTA) and Mikulicz line. We measured medial meniscus displacement ratio by the proportion of medial meniscus lesion protruding from the edge of tibial medial joint surface to all the medial meniscus width on MRI. For the evaluation of Mikulicz line, we measured the score by the length from tibial medial joint surface to Mikulicz line to tibial plateau width. chi(2) Test was used for gender, and Mann-Whitney U test was used for age, medial meniscus displacement ratio, FTA and Mikulicz line., Results: Statistically significant difference was not observed between cartilage defect cases and meniscal tear cases for age and gender. Medial meniscus displacement ratio was 13+/-12.3% in cartilage defect cases and 50.4+/-20.1% in meniscal tear cases. Medial meniscus displacement ratio in cartilage defect cases was significantly smaller than in meniscal tear cases (P=.0001). FTA was 174.9+/-2.2 degrees in cartilage defect cases and 178.3+/-4.8 degrees in meniscal tear cases. FTA in cartilage defect cases was significantly smaller than in meniscal tear cases (P=.00390). The score by the length from tibial medial joint surface to Mikulicz line to tibial plateau width was 35.8+/-11.8% in cartilage defect cases and 21.7+/-15.8% in meniscal tear cases. Mikulicz line in cartilage defect cases passes more laterally than in meniscal tear cases significantly (P=.0264)., Conclusion: In this study, we reported cartilage defect cases at medial femoral condyle in the early osteoarthritis of the knee. We think that these cases were different from early osteoarthritis with meniscal tear in alignment of lower limb and onset mechanism. It is necessary to evaluate meniscus and cartilage in MRI when we diagnose middle-aged patients with medial pain of the knee and without remarkable changes of X-ray.

Objective: To evaluate in patients with knee osteoarthritis (OA) the size changes in bone oedema and cysts over 24 months, and to contrast these changes with cartilage volume loss using quantitative magnetic resonance imaging., Methods: 107 patients with knee OA, selected from a large trial evaluating the effect of a bisphosphonate, were analysed by magnetic resonance imaging at baseline and 24 months. Assessments of subchondral bone oedema and cysts, and cartilage volume were done., Results: At baseline, 86 patients showed the presence of at least one type of bone lesion: 71 oedema, 61 cysts and 51 both. At 24 months, although not statistically significant, the oedema total size change increased by 2.09 (SD 15.03) mm, and the cyst by 1.09 (8.13) mm; mean size change for the oedema was +0.38 (2.18) mm and -0.10 (4.36) mm for the cyst. When analysed according to subregions, an increase was found for the cyst size in the trochlea (+0.67 (2.74) mm, p = 0.02) and in the lateral tibial plateau (+0.15 (0.83) mm, p = 0.09), and for the oedema size in the medial tibial plateau (+1.73 (8.11) mm, p = 0.05). At 24 months, significant correlations were seen between the loss of cartilage volume and oedema size change in the medial condyle (-0.40, p = 0.0001) and the medial tibial plateau (-0.23, p = 0.03), and the changes in cyst size in the medial condyle (-0.29, p = 0.01). A multivariate analysis showed that the oedema size change was strongly and independently associated with medial cartilage volume loss (-0.31, p = 0.0004)., Conclusion: These data demonstrate that bone lesions are prevalent in knee OA. The correlation of the oedema and cyst size increase in the medial compartment over time with a greater loss of cartilage volume in this area underlines the importance of subchondral bone lesions in OA pathophysiology.

Snapping of the elbow joint can cause pain. We report a case of painful snapping elbow produced by an interposed meniscus in the radiohumeral joint in a 20-year-old man. The MR arthrogram demonstrated a meniscus-like tissue interposed between the radial head and humeral capitellum. The MR-arthrographic findings were well correlated with surgical findings. The location and appearance of the meniscus-like tissue was similar to that of meniscus in the knee joint. Histologic findings of the excised meniscus-like tissue showed a typical presentation of fibrocartilage. A meniscus may exist in the elbow joint and can be a rare cause of painful snapping elbow. MR arthrography is helpful for identifying the snapping tissue in the elbow joint.

Purpose: To evaluate the sensitivity and accuracy of magnetic resonance arthrography (MRA) with true sagittal scout image mapped radial reformation in localizing hip labral tears., Type of Study: Case series., Methods: Thirty patients were examined with hip MRA because of suspected labral tears. Every patient underwent normal hip arthrography and MR examinations using a 1.5-T scanner with a 3D-FLASH pulse sequence. Multiplanar reformation using double oblique technique produced radial reformatted rotation images with 10 degrees increment on the acetabular rim. Labral tears were annotated as anterior-superior (AS), anterior-inferior (AI), posterior-superior (PS), and posterior-inferior (PI) quadrant based on the cranial-caudal axis in true sagittal reformatted scout localizing image. Patients with positive MRA findings were counseled to have the arthroscopic hip procedure., Results: Five patients showed no MRA indication of labral tear. Of 25 patients who had MRA evidence of labral tear, 17 underwent arthroscopic hip surgery. One patient had only synovial process in the hip joint near the suspected MRA area. The remaining 16 operated patients had labral tears with a total of 21 quadrant lesions on arthroscopy (distributed as AS, 14; AI, 3; PS, 2; and PI, 2). Radial reformatted images revealed accurate mapping with arthroscopic findings in 21 of the 22 quadrant lesions. The sensitivity and accuracy of MRA for the diagnosis of hip labral tear were 100% and 94%, respectively, and the sensitivity and accuracy of radial reformatted MRA for mapping the tear location were 100% and 96%, respectively., Conclusions: MRA using radial reformatted images with a true sagittal localizer may achieve superior success rates in diagnosing hip labral lesions and in guiding the arthroscopist in portal selection, thus rendering location of hip labral tears simpler in surgery. It supplied detailed preoperative information to the surgeon, avoiding unnecessary surgery for patients if the diagnosis was unconfirmed., Level of Evidence: Level III.