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Magnetic resonance imaging of the painful shoulder: A comparison with the surgical findings in 30 consecutive cases (in Italian)
OCTI)BER-DECEMBER
1996
ABSTRACTS
the sutured tendon and not the reinforcement flap, which further confirms the exclusively mechanical, and not biological, function of the latter. Authors’
Summary
MRI OF THE ACHILLES TENDON: CORRELATION WITH THE MICRO-ANATOMIC AND HISTOLOGIC FEATURES (In French) Mantel D, Flaure B, Bastian D, et al. (Unite d’imagerie de l’appareil locomoteur, Institut Calot, F-62608 Berck-sur-mer Cedex, France). J Radio1 1996;77:261-265. Magnetic resonance imaging (MRI) was performed in 20 ankles of volunteers, seven men and 13 women of ages ranging from 17 fo 68 years and without history of previous pathological processes or pain in the ankle. Tl- and TZweighted transverse scans were obtained at 0.2T. The microanatomy and histology of the tendon were studied in two Achilles tendons fixed in formalin obtained from the cadaver of a woman aged 73 years. MRI of these tendons showed a homogeneous signal of intermediary intensity. The tendons were then dissected and eight slices were obtained along the transversal plane. The thickness of the first slice was 4 mm and of the others 8 mm. The normal anatomy of the tendon has been reported already in the literature and is classically described as a long homogeneous band with signals of low intensity. The analysis of the data obtained by MRI and by the microanatomic and histologic observations showed that the detection of punctiform intratendineal high signals, identified in particular in the anterior portion of the tendon, corresponded to normal anatomic and microanatomic structures and should not be considered to represent anomalous intratendineal signals. Antonio
F. Govoni,
MD
LOW-DOSE SPIRAL COMPUTED TOMOGRAPHY (In German) Diederichs CG, Bruhn H, Funke M, Grabbe E (Radiologie III, Universitgt Ulm, Robert-Koch-Str. 8, D-89070, Germany). Fortschr Rijntgenstr 1996;164:183-188. The authors evaluated dose in high-resolution
the clinical use of a reduced spiral-computed tomography
289
(HR-SCT) in combination with a multiplanar volume reconstruction technique (MPVR) to decrease image noise. The facial bones, skull, and extremities of 33 patients with different pathological processes were examined with spiral-CT using a slice thickness of 1 mm (pitch 1.7-2.0), a tube amperage of 40 mA, and tube voltages of 80 or 120 kV. Additionally, 2D, 3D, and MPVR image reconstructions were performed. MPVR takes advantage of displaying planar volumes of variable thickness. The results showed that the increased image noise was negligible if high-contrast structures like bones were examined. However, very small bony structures like the stapes of the middle ear were not seen. Soft tissues could also be imaged by using the MPVR technique. This technique did reduce image noise while at the same time partial volume averaging was increased. The skin entrance dose per investigation did not exceed 3 mGy, which is based on 12 dose measurements in two patients. The authors conclude that it is feasible to perform HR-SCT with secondary reconstructions of facial bones, skull, and extremities using reduced skin entrance doses by lo- to 2O-fold to below 3 mGy. With the exception of imaging very small structures, sufficient image quality can be accomplished in routine examinations without relevant diagnostic compromise. Authors’
Summary
MAGNETIC RESONANCE IMAGING OF THE PAINFUL SHOULDER: A COMPARISON WITH THE SURGICAL FINDINGS IN 30 CONSECUTIVE CASES (In Italian) Della Sala SW, Bianchini G (U.O. di Radiologia, Sezione TAC-RM, Ospedale Santa Chiara, Largo Medaglie d’Oro, I-38100 Trento TN, Italy). Radio1 Met1 1996;91:348-355. In the period January 1993 to December 1994, 80 patients, 23 men and seven women with painful shoulder syndrome, were examined by magnetic resonance imaging (MRI). and of these, 30 were then operated. The images obtained were evaluated by a team of radiologists and orthopedic surgeons, and a common terminology was adopted: normal cuff; tendinosis; increased focal signal, noled in particular at the level of the middle-distal third of the supraspinatus tendon; tears, total or partial. MRI showed complete tear of the rotator cuff in 16 patients, a partial tear in 4, a subacromial impingement in 8, and one case each of
290
CLINICALIMAGINGVOL. 20,NO. 4
ABSTRACTS
osteochondritis of the head of the humerus with and without complete tear of the rotator cuff. The surgical findings confirmed the MRI diagnosis in 97% of the cases. MRI showed also other pathological processes not associated with rotator cuff tears: a case of acromioclavicular arthrosis and three cases of hypertrophy of the coracoacromial ligament. The procedure was also of value in the demonstration and evaluation of the process of osteochondritis. Accurate and up-to-date is the review of the literature on the painful shoulder syndrome. Antonio
F. Govoni,
MD
MAGNETIC RESONANCE IMAGING OF PRIMARY BONE TUMORS: REVIEW OF 10 YEARS EXPERIENCE (In Italian) Balzarini L, Sicilia A, Ceglia E, et al. (Radiologia Diagnostica E, Istituto Nazionale per 10 Studio e Cura dei Tumori, Via Venezian 1, I-20133 Milan0 MI, Italy). Radio1 Med 1996;91:344-347. The authors reviewed all the primary bone tumors studied by magnetic resonance imaging (MRI) from 1985 to 1995. Four hundred eighty-four examinations were performed in 220 patients, 133 males and 87 females of ages ranging between 3 and 77 years. Malignant tumors were detected in 160/220 patients. One hundred sixty MRI examinations were performed in tumors in the initial stage, 219/484 during therapy and 105/484 during the follow-up with a minimum of 8 months from the end of the therapy. The most frequent tumors were the osteosarcoma (69 cases, 31.4%), Ewing sarcoma (55, 25%), chondrosarcoma (34,15.4%), osteoclastoma (11, 5%) and aneurysmatic bone cyst (10, 4.5%). MRI showed a 100% enhancement of the tumor after injection of the contrast medium. An infiltration of the adjacent soft tissues was detected in 83.3% of the cases with a highly inhomogeneous signal, usually in the T2 sequences. Fading and irregular contours of the lesion were shown in 54.2%. An involvement of the articulation could be demonstrated in 10.8% and a simple reactive edema of the soft tissues in 3.9%. Comparing MRI with standard radiological procedures an agreement in the diagnosis was observed in 87.6% and reached 90.1% comparing computed tomography with MRI. During the therapeutic treatment MRI satisfactorily showed the favorable reaction by the lesion. In conclusion, MRI obtained a diagnostic ac-
curacy of 88.8% during therapy, 95.2% in the follow-up, a sensibility of 97.7% and of 92.3% respectively, and a specificity of 66.6% and of 96.2%. Antonio
F. Govoni,
MD
THE SNAPPING HIP: CLINICAL AND IMAGING FINDINGS IN TRANSIENT SUBLUXATION OF THE ILIOPSOAS TENDON Janzen DL, Partridge E, Logan M, et al. (Department of Radiology, Vancouver Hospital and Health Science Centre, 855 W 12th Ave., Vancouver BC V5Z lM9, Canada). Can Assoc Radio1 J 1996;47:202-208. The objective of this research was to define the clinical, ultrasonographic (US), and magnetic resonance imaging (MRI) findings in patients with painful snapping of the hip secondary to transient subluxation of the iliopsoas tendon. Seven patients, ranging in age from 17 to 30 years, with a total of eight painful snapping hips were examined with static and dynamic US and MRI during hip motion producing the painful snapping. The duration of symptoms, the level of disability, and the response to therapy were recorded. Static US showed thickening of the iliopsoas tendon (tendinitis) in two cases and a peritendinous fluid collection in two cases. In all cases dynamic US of the iliopsoas tendon during hip motion showed distinct abnormal motion of the tendon corresponding temporally to the painful palpable and audible sensation. MRI demonstrated normal intraarticular structures in all cases, tendinitis in two cases, and iliopsoas bursitis in one case. Clinically, subluxation of the iliopsoas tendon is a chronic (mean duration of symptoms in this series, 23 months) disabling condition that may be relieved by surgical tendon release. The data obtained showed that dynamic US is useful for detecting transient subluxation of the iliopsoas tendon in patients with a painful snapping hip. MRI is useful for excluding intra-articular abnormalities in patients with this condition. Authors’
Summary
A COMPUTER-ASSISTED METHOD FOR 3D SUBTRACTION ANGIOGRAPHY BASED ON SPIRAL CT (In German)
1996
ABSTRACTS
the sutured tendon and not the reinforcement flap, which further confirms the exclusively mechanical, and not biological, function of the latter. Authors’
Summary
MRI OF THE ACHILLES TENDON: CORRELATION WITH THE MICRO-ANATOMIC AND HISTOLOGIC FEATURES (In French) Mantel D, Flaure B, Bastian D, et al. (Unite d’imagerie de l’appareil locomoteur, Institut Calot, F-62608 Berck-sur-mer Cedex, France). J Radio1 1996;77:261-265. Magnetic resonance imaging (MRI) was performed in 20 ankles of volunteers, seven men and 13 women of ages ranging from 17 fo 68 years and without history of previous pathological processes or pain in the ankle. Tl- and TZweighted transverse scans were obtained at 0.2T. The microanatomy and histology of the tendon were studied in two Achilles tendons fixed in formalin obtained from the cadaver of a woman aged 73 years. MRI of these tendons showed a homogeneous signal of intermediary intensity. The tendons were then dissected and eight slices were obtained along the transversal plane. The thickness of the first slice was 4 mm and of the others 8 mm. The normal anatomy of the tendon has been reported already in the literature and is classically described as a long homogeneous band with signals of low intensity. The analysis of the data obtained by MRI and by the microanatomic and histologic observations showed that the detection of punctiform intratendineal high signals, identified in particular in the anterior portion of the tendon, corresponded to normal anatomic and microanatomic structures and should not be considered to represent anomalous intratendineal signals. Antonio
F. Govoni,
MD
LOW-DOSE SPIRAL COMPUTED TOMOGRAPHY (In German) Diederichs CG, Bruhn H, Funke M, Grabbe E (Radiologie III, Universitgt Ulm, Robert-Koch-Str. 8, D-89070, Germany). Fortschr Rijntgenstr 1996;164:183-188. The authors evaluated dose in high-resolution
the clinical use of a reduced spiral-computed tomography
289
(HR-SCT) in combination with a multiplanar volume reconstruction technique (MPVR) to decrease image noise. The facial bones, skull, and extremities of 33 patients with different pathological processes were examined with spiral-CT using a slice thickness of 1 mm (pitch 1.7-2.0), a tube amperage of 40 mA, and tube voltages of 80 or 120 kV. Additionally, 2D, 3D, and MPVR image reconstructions were performed. MPVR takes advantage of displaying planar volumes of variable thickness. The results showed that the increased image noise was negligible if high-contrast structures like bones were examined. However, very small bony structures like the stapes of the middle ear were not seen. Soft tissues could also be imaged by using the MPVR technique. This technique did reduce image noise while at the same time partial volume averaging was increased. The skin entrance dose per investigation did not exceed 3 mGy, which is based on 12 dose measurements in two patients. The authors conclude that it is feasible to perform HR-SCT with secondary reconstructions of facial bones, skull, and extremities using reduced skin entrance doses by lo- to 2O-fold to below 3 mGy. With the exception of imaging very small structures, sufficient image quality can be accomplished in routine examinations without relevant diagnostic compromise. Authors’
Summary
MAGNETIC RESONANCE IMAGING OF THE PAINFUL SHOULDER: A COMPARISON WITH THE SURGICAL FINDINGS IN 30 CONSECUTIVE CASES (In Italian) Della Sala SW, Bianchini G (U.O. di Radiologia, Sezione TAC-RM, Ospedale Santa Chiara, Largo Medaglie d’Oro, I-38100 Trento TN, Italy). Radio1 Met1 1996;91:348-355. In the period January 1993 to December 1994, 80 patients, 23 men and seven women with painful shoulder syndrome, were examined by magnetic resonance imaging (MRI). and of these, 30 were then operated. The images obtained were evaluated by a team of radiologists and orthopedic surgeons, and a common terminology was adopted: normal cuff; tendinosis; increased focal signal, noled in particular at the level of the middle-distal third of the supraspinatus tendon; tears, total or partial. MRI showed complete tear of the rotator cuff in 16 patients, a partial tear in 4, a subacromial impingement in 8, and one case each of
290
CLINICALIMAGINGVOL. 20,NO. 4
ABSTRACTS
osteochondritis of the head of the humerus with and without complete tear of the rotator cuff. The surgical findings confirmed the MRI diagnosis in 97% of the cases. MRI showed also other pathological processes not associated with rotator cuff tears: a case of acromioclavicular arthrosis and three cases of hypertrophy of the coracoacromial ligament. The procedure was also of value in the demonstration and evaluation of the process of osteochondritis. Accurate and up-to-date is the review of the literature on the painful shoulder syndrome. Antonio
F. Govoni,
MD
MAGNETIC RESONANCE IMAGING OF PRIMARY BONE TUMORS: REVIEW OF 10 YEARS EXPERIENCE (In Italian) Balzarini L, Sicilia A, Ceglia E, et al. (Radiologia Diagnostica E, Istituto Nazionale per 10 Studio e Cura dei Tumori, Via Venezian 1, I-20133 Milan0 MI, Italy). Radio1 Med 1996;91:344-347. The authors reviewed all the primary bone tumors studied by magnetic resonance imaging (MRI) from 1985 to 1995. Four hundred eighty-four examinations were performed in 220 patients, 133 males and 87 females of ages ranging between 3 and 77 years. Malignant tumors were detected in 160/220 patients. One hundred sixty MRI examinations were performed in tumors in the initial stage, 219/484 during therapy and 105/484 during the follow-up with a minimum of 8 months from the end of the therapy. The most frequent tumors were the osteosarcoma (69 cases, 31.4%), Ewing sarcoma (55, 25%), chondrosarcoma (34,15.4%), osteoclastoma (11, 5%) and aneurysmatic bone cyst (10, 4.5%). MRI showed a 100% enhancement of the tumor after injection of the contrast medium. An infiltration of the adjacent soft tissues was detected in 83.3% of the cases with a highly inhomogeneous signal, usually in the T2 sequences. Fading and irregular contours of the lesion were shown in 54.2%. An involvement of the articulation could be demonstrated in 10.8% and a simple reactive edema of the soft tissues in 3.9%. Comparing MRI with standard radiological procedures an agreement in the diagnosis was observed in 87.6% and reached 90.1% comparing computed tomography with MRI. During the therapeutic treatment MRI satisfactorily showed the favorable reaction by the lesion. In conclusion, MRI obtained a diagnostic ac-
curacy of 88.8% during therapy, 95.2% in the follow-up, a sensibility of 97.7% and of 92.3% respectively, and a specificity of 66.6% and of 96.2%. Antonio
F. Govoni,
MD
THE SNAPPING HIP: CLINICAL AND IMAGING FINDINGS IN TRANSIENT SUBLUXATION OF THE ILIOPSOAS TENDON Janzen DL, Partridge E, Logan M, et al. (Department of Radiology, Vancouver Hospital and Health Science Centre, 855 W 12th Ave., Vancouver BC V5Z lM9, Canada). Can Assoc Radio1 J 1996;47:202-208. The objective of this research was to define the clinical, ultrasonographic (US), and magnetic resonance imaging (MRI) findings in patients with painful snapping of the hip secondary to transient subluxation of the iliopsoas tendon. Seven patients, ranging in age from 17 to 30 years, with a total of eight painful snapping hips were examined with static and dynamic US and MRI during hip motion producing the painful snapping. The duration of symptoms, the level of disability, and the response to therapy were recorded. Static US showed thickening of the iliopsoas tendon (tendinitis) in two cases and a peritendinous fluid collection in two cases. In all cases dynamic US of the iliopsoas tendon during hip motion showed distinct abnormal motion of the tendon corresponding temporally to the painful palpable and audible sensation. MRI demonstrated normal intraarticular structures in all cases, tendinitis in two cases, and iliopsoas bursitis in one case. Clinically, subluxation of the iliopsoas tendon is a chronic (mean duration of symptoms in this series, 23 months) disabling condition that may be relieved by surgical tendon release. The data obtained showed that dynamic US is useful for detecting transient subluxation of the iliopsoas tendon in patients with a painful snapping hip. MRI is useful for excluding intra-articular abnormalities in patients with this condition. Authors’
Summary
A COMPUTER-ASSISTED METHOD FOR 3D SUBTRACTION ANGIOGRAPHY BASED ON SPIRAL CT (In German)