Papers by Marcelo Bordalo
American Journal of Roentgenology
Clinics, 2012
OBJECTIVE: To compare the existence of radiographic abnormalities in two groups of patients, thos... more OBJECTIVE: To compare the existence of radiographic abnormalities in two groups of patients, those with and without hip pain. METHODS: A total 222 patients were evaluated between March 2007 and April 2009; 122 complained of groin pain, and 100 had no symptoms. The individuals in both groups underwent radiographic examinations of the hip using the following views: anteroposterior, Lequesne false profile, Dunn, Dunn 45˚, and Ducroquet. RESULTS: A total of 1110 radiographs were evaluated. Female patients were prevalent in both groups (52% symptomatic, 58% asymptomatic). There were statistically significant differences between the groups in age (p,0.0001), weight (p = 0.002) and BMI (p = 0.006). The positive findings in the group with groin pain consisted of the presence of a bump on the femoral head in the anteroposterior view (p,0.0001) or in the Dunn 45˚view (p = 0.008). The difference in the a angle in the anteroposterior, Dunn, Dunn 45˚, and Ducroquet views for all of the cases studied was p,0.0001. The joint space measurement differed significantly between groups in the Lequesne view (p = 0.007). The Lequesne anteversion angle (r) and the femoral offset measurement also differed significantly (p = 0.005 and p = 0.0001, respectively). CONCLUSIONS: We conclude that the best views for diagnosing a femoroacetabular impingement are the anteroposterior pelvic orthostatic, the Dunn 45˚, and the Ducroquet views. The following findings correlated with hip pain: a decrease in the femoral offset, an increase in the a angle, an increase in the Lequesne r angle, a decrease in the CE angle of Wiberg, a thinner articular space and the presence of a bump on the femoral head-neck transition.
Magnetic Resonance Imaging Clinics of North America, 2004
Purpose The main aim of this study was to correlate measurements
of the width and retraction of i... more Purpose The main aim of this study was to correlate measurements
of the width and retraction of isolated full-thickness
supraspinatus tendon tears determined by magnetic resonance
imaging (MRI) with measurements recorded by arthroscopy
using a continuous millimetre scale.
Methods A total of 53 individuals with isolated supraspinatus
tears and retraction < 30 mm underwent arthroscopy at our
centre. Tear width and retraction measured by arthroscopy
(reference standard) and MRI (index test) on a continuous
millimetre scale were compared. All measurements were performed
by a single radiologist blinded to intra-operative findings
and one surgeon who had previous access toMRI results.
Results The average tear retraction was 12.60±4.89 mm by
arthroscopy and 16.81±6.29 mm by MRI. Those measures
exhibited moderate correlation (r=0.643, p<0.001) and an
average difference of 4.21mm( p<0.001).Average tearwidth
was 12.87±4.15mmby arthroscopy and 14.19±5.20 byMRI.
Those measures exhibited moderate correlation (r=0.526,
p<0.001) and an average difference of 1.32 mm, which was
not statistically significant ( p=0.109).
Conclusion Measures of retraction and width obtained by
MRI and arthroscopy exhibited moderate correlation in
small- or medium-sized supraspinatus tears.
Objective: To assess the importance of using conventional
magnetic resonance imaging and T2 mappi... more Objective: To assess the importance of using conventional
magnetic resonance imaging and T2 mapping to determine
the pre-slip stage of the contralateral epiphysis in patients
with a clinical and radiographic diagnosis of unilateral
proximal femoral epiphysiolysis who were initially treated
with in-situ fixation. Methods: This prospective clinical
study on 11 patients with unilateral epiphysiolysis
was conducted between February 2009 and August 2010, using magnetic resonance imaging on the contralateral
hip. Results: We observed abnormalities in the proximal
femoral capital physis of the contralateral unaffected hip,
with edema under the growth plate in 27% of the patients
assessed. Conclusion: Magnetic resonance imaging is an
early and sensitive method for detecting the pre-slip stage
of the proximal femoral epiphysis.
OBJECTIVE: To compare the existence of radiographic abnormalities in two groups of patients, thos... more OBJECTIVE: To compare the existence of radiographic abnormalities in two groups of patients, those with and
without hip pain.
METHODS: A total 222 patients were evaluated between March 2007 and April 2009; 122 complained of groin pain,
and 100 had no symptoms. The individuals in both groups underwent radiographic examinations of the hip using
the following views: anteroposterior, Lequesne false profile, Dunn, Dunn 45°, and Ducroquet.
RESULTS: A total of 1110 radiographs were evaluated. Female patients were prevalent in both groups (52%
symptomatic, 58% asymptomatic). There were statistically significant differences between the groups in age
(p,0.0001), weight (p = 0.002) and BMI (p = 0.006). The positive findings in the group with groin pain consisted of
the presence of a bump on the femoral head in the anteroposterior view (p,0.0001) or in the Dunn 45° view
(p = 0.008). The difference in the a angle in the anteroposterior, Dunn, Dunn 45°, and Ducroquet views for all of the
cases studied was p,0.0001. The joint space measurement differed significantly between groups in the Lequesne
view (p = 0.007). The Lequesne anteversion angle (r) and the femoral offset measurement also differed significantly
(p = 0.005 and p = 0.0001, respectively).
CONCLUSIONS: We conclude that the best views for diagnosing a femoroacetabular impingement are the
anteroposterior pelvic orthostatic, the Dunn 45°, and the Ducroquet views. The following findings correlated with
hip pain: a decrease in the femoral offset, an increase in the a angle, an increase in the Lequesne r angle, a decrease in
the CE angle of Wiberg, a thinner articular space and the presence of a bump on the femoral head-neck transition.
Objective: the anatomical study of the
cervical vertebrae in our population,
measuring the dimens... more Objective: the anatomical study of the
cervical vertebrae in our population,
measuring the dimensions of the
thickness, length and lamina angle
have as intention to bring trustworther
parameters to improve and guide the
cervical procedure with intralaminar
screws in C2 fixation. Methods: ninety
six computerized tomographies had
been studied, evaluating sex, age,
and measurements of the dimension
e angle of the C2 vertebrae lamina,
in the point of lesser thickness of the
lamina in the sequenced tomographic
axial cut. Statistical analysis was
performed using Student “t” tests.
Recent advances in medicine conjecture that certain body fat may have mechanical function in addi... more Recent advances in medicine conjecture that certain body fat may have mechanical function in addition to its
classical role of energy storage. In particular we aim to analyze if the intra-articular fat pad of Hoffa is merely
a space holder or if it changes shape to provide cushioning for the knee bones. Towards this goal, 3D CT
images of real knees, as well as a skeletal knee model with fat simulating Hoffa’s pad, were acquired in both
extension and flexion. Image segmentation was performed to automatically extract the real and simulated fat
regions from the extension and flexion images. Utilizing the segmentation results as binary masks, we performed
automatic multi-resolution image registration of the fat pad between flexed and extended knee positions. The
resulting displacement fields from flexion-extension registration are examined and used to calculate local fat
volume changes thus providing insight into shape changes that may have a mechanical component.
PURPOSE: To retrospectively evaluate the accuracy of various magnetic resonance
(MR) imaging find... more PURPOSE: To retrospectively evaluate the accuracy of various magnetic resonance
(MR) imaging findings in the diagnosis of reactive carpal synovitis.
MATERIALS AND METHODS: Institutional review board approval was obtained,
and the need for informed consent was waived. This study was compliant with the
Health Insurance Portability and Accountability Act. Thirty-five consecutive patients
(19 male and 16 female patients; age range, 13–57 years) who underwent arthroscopy
and MR imaging within 4 weeks of surgery were evaluated by two reviewers
for the following potential findings of synovitis: (a) distention of the pisotriquetral
recess by fluid, (b) distention of the radial and/or prestyloid recess, (c) synovial
enhancement (in patients who received contrast material), (d) amount of dorsal
capsule distention, and (e) the location of bone marrow edema, if any. The 2 and
paired t tests were used to assess these findings in patients with and patients without
arthroscopically proved synovitis. The sensitivity, specificity, positive and negative
predictive values, and accuracy of these findings in the detection of synovitis were
calculated.
RESULTS: Fluid in the pisotriquetral recess was seen in nine of the 14 patients with
synovitis and five of the 21 patients without synovitis (P .018). Distention of the
radial and/or prestyloid recess was observed in six of the 14 patients with synovitis
and two of the 21 patients without synovitis (P .027). Among the 24 patients who
received contrast material, synovial enhancement was seen in seven of eight patients
with synovitis and three of 16 patients without synovitis (P .002). The dorsal
capsule measured 1–7 mm (mean, 3.07 mm) in the 14 patients with synovitis and
2–7 mm (mean, 3.76 mm) in the 21 patients without synovitis (P .193). Although
bone marrow edema was seen globally in similar frequencies (nine of 14 patients
with synovitis, nine of 21 patients without synovitis), pisotriquetral bone marrow
edema was seen only in patients with synovitis (two of nine patients).
CONCLUSION: Fluid in the pisotriquetral recess, enhancing synovium, and, less
commonly, pisotriquetral bone marrow edema are MR imaging findings that may
help in the diagnosis of reactive carpal synovitis.
Purpose. With anomalous insertion of the pectoralis minor muscle, its distal fibers pass over the... more Purpose. With anomalous insertion of the pectoralis minor muscle, its distal fibers pass over the coracoid process instead
of inserting on it, following sometimes a trajectory very similar to that of the coracohumeral ligament. The aim of this prospective
study was to evaluate the frequency of detection of this anomalous insertion by ultrasonography.
Materials and Methods. Ultrasound demonstrated the abnormal insertion of the pectoralis minor muscle by directly visualizing
its fibers slipping over the coracoid process during external and internal rotation of the humerus. Three hundred and
three individuals underwent ultrasound of the shoulders (64,7% female, mean age of 45 years), for a total of six hundred
and six shoulders; 30% (183/606) were symptomatic.
Results. An abnormal insertion was demonstrated in 9,57% of the examined shoulders (58/606), with a statistically significant
predominance on the left side (12,2%) compared to the right side (6,9%), and of women (12,2%) compared to men
(4,7%).
Conclusion. Ultrasound demonstrated an abnormal insertion of the pectoralis minor muscle in 9,57% of 606 examined
shoulders. There was a female and left side predominance and no significant correlation with symptoms.
OBJECTIVE. Chondromalacia is a commonly encountered abnormality at arthroscopy
and may be respons... more OBJECTIVE. Chondromalacia is a commonly encountered abnormality at arthroscopy
and may be responsible for significant clinical symptoms and disability. In the wrist, the most
common location for chondromalacia is the lunate bone. Consequently, we sought to study the
accuracy of clinical MRI in the assessment of lunate articular cartilage.
MATERIALS AND METHODS. MR images of 34 patients who underwent arthroscopy
and had an MRI examination within 1 month of surgery were evaluated by two reviewers for
the presence and location of lunate cartilage defects and subchondral edema.
RESULTS. Lunate cartilage defects were seen on MRI in 10 of the 13 patients with chondromalacia,
but these defects were also incorrectly noted in three of 21 of patients without
chondromalacia. The visible locations for cartilage defects were the ulnar aspect of the proximal
lunate bone (n = 3), radial aspect of the proximal lunate bone (n = 4), ulnar aspect of the
distal lunate bone (n = 2), and radial aspect of the distal lunate bone (n = 1). Subchondral marrow
edema was observed in six of the 10 patients with chondromalacia seen on MRI; in all six
patients, the edema was seen in the same quadrant as the cartilage defect. Marrow edema was
detected in one patient without chondromalacia.
CONCLUSION. We conclude that lunate chondromalacia can be accurately assessed using
routine MRI sequences, although there are occasional false-positive interpretations.
669 e report the case of a patient with bronchioloalveolar carcinoma with focal nodular hyperplas... more 669 e report the case of a patient with bronchioloalveolar carcinoma with focal nodular hyperplasia of the hematopoietic marrow in dorsal vertebral bodies revealed on FDG positron emission tomography (PET) and MR imaging. Differentiation with metastatic disease is discussed.
Objective To describe magnetic resonance imaging (MRI)
features of Kager’s fat pad inflammation i... more Objective To describe magnetic resonance imaging (MRI)
features of Kager’s fat pad inflammation in HIV-positive
patients with lipodystrophy due to protease inhibitor treatment
and posterior ankle pain.
Methods A case-control, cross-sectional study; group 1 included
14 HIV-positive patients using protease inhibitors,
presenting lipodystrophy syndrome and having posterior ankle
pain; group 2 (CGHIV-) included 112 HIV-negative patients
without lipodystrophy syndrome who were being evaluated
for posterior ankle pain; group 3 (CGHIV+1) included
23 HIV-positive patients not using a protease inhibitor, without
lipodystrophy syndrome and with posterior ankle pain;
group 4 (CGHIV+2) comprised 18 HIV-positive patients who
were being treated with a protease inhibitor and had
lipodystrophy syndrome but did not have posterior ankle pain.
Images were evaluated for the presence of edema by two
radiologists who were blinded to clinical features. Fisher’s
exact test was used to evaluate differences among the groups.
Interobserver variation was tested using Cohen’s kappa (κ)
statistic.
Results The presence of edema within Kager’s fat pad was
strongly associated with symptoms in HIV-positive patients
who had lipodystrophy (p≤0.0001). Concordance between
observers was excellent (κ > 0.9).
Conclusion MRI findings of Kager’s fat pad inflammation
related to HIV/AIDS is a source of symptoms in HIV patients
with posterior ankle pain using protease inhibitors and having
lipodystrophy syndrome.
Objective This study evaluated the ability of routine 1.5-T
MRI scans to visualize the anterolate... more Objective This study evaluated the ability of routine 1.5-T
MRI scans to visualize the anterolateral ligament (ALL) and
describe its path and anatomic relations with lateral knee
structures.
Materials and methods Thirty-nine 1.5-T MRI scans of the
knee were evaluated. The scans included an MRI knee protocol
with T1-weighted sequences, T2-weighted sequences with
fat saturation, and proton density (PD)-weighted fast spinecho
sequences. Two radiologists separately reviewed all
MRI scans to evaluate interobserver reliability. The ALL
was divided into three portions for analyses: femoral,
meniscal, and tibial. The path of the ALL was evaluated with
regard to known structural parameters previously studied in
this region.
Results At least a portion of the ALL was visualized in 38
(97.8 %) cases. The meniscal portion was most visualized
(94.8 %), followed by the femoral (89.7 %) and the tibial
(79.4 %) portions. The three portions of the ALL were visualized
in 28 (71.7 %) patients. The ALL was characterized
with greater clarity on the coronal plane and was visualized as
a thin, linear structure. The T1-weighted sequences showed a
statistically inferior ligament visibility frequency.With regard
to the T2 and PD evaluations, although the visualization
frequency in PD was higher for the three portions of the
ligament, only the femoral portion showed significant values.
Conclusion The ALL can be visualized in routine 1.5-TMRI
scans. Although some of the ligament could be depicted in
nearly all of the scans (97.4 %), it could only be observed in its
entirety in about 71.7 % of the tests.
Objective: To determine
the accessibility of the coracohumeral
ligament (CHL) by ultrasound (US)
... more Objective: To determine
the accessibility of the coracohumeral
ligament (CHL) by ultrasound (US)
and to determine CHL thickness in
adhesive capsulitis of the shoulder.
Design and patients: US examinations
were carried out in 498 consecutive
shoulders of 306 individuals
(194 women and 112 men), mean age
47.4 years (range 15–92 years), in
order to identify and measure the
maximum thickness of the CHL. The
patients were divided into three study
groups: asymptomatic shoulders
(n=121), painful shoulders (n=360)
and shoulders with arthrographic evidence
of adhesive capsulitis (n=17).
The mean maximal thickness of CHL
was compared among the 3 study
groups (non-parametric test of
Kruskal–Wallis, p<0.05). Results:
The CHL was visualized in 92 out of
121 shoulders in the asymptomatic
group (76.0%), in 227 out of 360
shoulders in the painful shoulder
group (63.0%), and in 15 out of 17
shoulders in the adhesive capsulitis
group (88.2%). The average thickness
of the CHL was significantly greater
in adhesive capsulitis (3 mm) than in
the asymptomatic (1.34 mm) and
painful (1.39 mm) shoulders. No
significant difference was found
between asymptomatic and painful
shoulders. Conclusion: CHL depiction
can be achieved in a reasonable
proportion of shoulders. A thickened
CHL is suggestive of adhesive
capsulitis. More studies are needed
for clinical validation of these data.
Arquivos de Neuro-Psiquiatria, 2012
Uploads
Papers by Marcelo Bordalo
of the width and retraction of isolated full-thickness
supraspinatus tendon tears determined by magnetic resonance
imaging (MRI) with measurements recorded by arthroscopy
using a continuous millimetre scale.
Methods A total of 53 individuals with isolated supraspinatus
tears and retraction < 30 mm underwent arthroscopy at our
centre. Tear width and retraction measured by arthroscopy
(reference standard) and MRI (index test) on a continuous
millimetre scale were compared. All measurements were performed
by a single radiologist blinded to intra-operative findings
and one surgeon who had previous access toMRI results.
Results The average tear retraction was 12.60±4.89 mm by
arthroscopy and 16.81±6.29 mm by MRI. Those measures
exhibited moderate correlation (r=0.643, p<0.001) and an
average difference of 4.21mm( p<0.001).Average tearwidth
was 12.87±4.15mmby arthroscopy and 14.19±5.20 byMRI.
Those measures exhibited moderate correlation (r=0.526,
p<0.001) and an average difference of 1.32 mm, which was
not statistically significant ( p=0.109).
Conclusion Measures of retraction and width obtained by
MRI and arthroscopy exhibited moderate correlation in
small- or medium-sized supraspinatus tears.
magnetic resonance imaging and T2 mapping to determine
the pre-slip stage of the contralateral epiphysis in patients
with a clinical and radiographic diagnosis of unilateral
proximal femoral epiphysiolysis who were initially treated
with in-situ fixation. Methods: This prospective clinical
study on 11 patients with unilateral epiphysiolysis
was conducted between February 2009 and August 2010, using magnetic resonance imaging on the contralateral
hip. Results: We observed abnormalities in the proximal
femoral capital physis of the contralateral unaffected hip,
with edema under the growth plate in 27% of the patients
assessed. Conclusion: Magnetic resonance imaging is an
early and sensitive method for detecting the pre-slip stage
of the proximal femoral epiphysis.
without hip pain.
METHODS: A total 222 patients were evaluated between March 2007 and April 2009; 122 complained of groin pain,
and 100 had no symptoms. The individuals in both groups underwent radiographic examinations of the hip using
the following views: anteroposterior, Lequesne false profile, Dunn, Dunn 45°, and Ducroquet.
RESULTS: A total of 1110 radiographs were evaluated. Female patients were prevalent in both groups (52%
symptomatic, 58% asymptomatic). There were statistically significant differences between the groups in age
(p,0.0001), weight (p = 0.002) and BMI (p = 0.006). The positive findings in the group with groin pain consisted of
the presence of a bump on the femoral head in the anteroposterior view (p,0.0001) or in the Dunn 45° view
(p = 0.008). The difference in the a angle in the anteroposterior, Dunn, Dunn 45°, and Ducroquet views for all of the
cases studied was p,0.0001. The joint space measurement differed significantly between groups in the Lequesne
view (p = 0.007). The Lequesne anteversion angle (r) and the femoral offset measurement also differed significantly
(p = 0.005 and p = 0.0001, respectively).
CONCLUSIONS: We conclude that the best views for diagnosing a femoroacetabular impingement are the
anteroposterior pelvic orthostatic, the Dunn 45°, and the Ducroquet views. The following findings correlated with
hip pain: a decrease in the femoral offset, an increase in the a angle, an increase in the Lequesne r angle, a decrease in
the CE angle of Wiberg, a thinner articular space and the presence of a bump on the femoral head-neck transition.
cervical vertebrae in our population,
measuring the dimensions of the
thickness, length and lamina angle
have as intention to bring trustworther
parameters to improve and guide the
cervical procedure with intralaminar
screws in C2 fixation. Methods: ninety
six computerized tomographies had
been studied, evaluating sex, age,
and measurements of the dimension
e angle of the C2 vertebrae lamina,
in the point of lesser thickness of the
lamina in the sequenced tomographic
axial cut. Statistical analysis was
performed using Student “t” tests.
classical role of energy storage. In particular we aim to analyze if the intra-articular fat pad of Hoffa is merely
a space holder or if it changes shape to provide cushioning for the knee bones. Towards this goal, 3D CT
images of real knees, as well as a skeletal knee model with fat simulating Hoffa’s pad, were acquired in both
extension and flexion. Image segmentation was performed to automatically extract the real and simulated fat
regions from the extension and flexion images. Utilizing the segmentation results as binary masks, we performed
automatic multi-resolution image registration of the fat pad between flexed and extended knee positions. The
resulting displacement fields from flexion-extension registration are examined and used to calculate local fat
volume changes thus providing insight into shape changes that may have a mechanical component.
(MR) imaging findings in the diagnosis of reactive carpal synovitis.
MATERIALS AND METHODS: Institutional review board approval was obtained,
and the need for informed consent was waived. This study was compliant with the
Health Insurance Portability and Accountability Act. Thirty-five consecutive patients
(19 male and 16 female patients; age range, 13–57 years) who underwent arthroscopy
and MR imaging within 4 weeks of surgery were evaluated by two reviewers
for the following potential findings of synovitis: (a) distention of the pisotriquetral
recess by fluid, (b) distention of the radial and/or prestyloid recess, (c) synovial
enhancement (in patients who received contrast material), (d) amount of dorsal
capsule distention, and (e) the location of bone marrow edema, if any. The 2 and
paired t tests were used to assess these findings in patients with and patients without
arthroscopically proved synovitis. The sensitivity, specificity, positive and negative
predictive values, and accuracy of these findings in the detection of synovitis were
calculated.
RESULTS: Fluid in the pisotriquetral recess was seen in nine of the 14 patients with
synovitis and five of the 21 patients without synovitis (P .018). Distention of the
radial and/or prestyloid recess was observed in six of the 14 patients with synovitis
and two of the 21 patients without synovitis (P .027). Among the 24 patients who
received contrast material, synovial enhancement was seen in seven of eight patients
with synovitis and three of 16 patients without synovitis (P .002). The dorsal
capsule measured 1–7 mm (mean, 3.07 mm) in the 14 patients with synovitis and
2–7 mm (mean, 3.76 mm) in the 21 patients without synovitis (P .193). Although
bone marrow edema was seen globally in similar frequencies (nine of 14 patients
with synovitis, nine of 21 patients without synovitis), pisotriquetral bone marrow
edema was seen only in patients with synovitis (two of nine patients).
CONCLUSION: Fluid in the pisotriquetral recess, enhancing synovium, and, less
commonly, pisotriquetral bone marrow edema are MR imaging findings that may
help in the diagnosis of reactive carpal synovitis.
of inserting on it, following sometimes a trajectory very similar to that of the coracohumeral ligament. The aim of this prospective
study was to evaluate the frequency of detection of this anomalous insertion by ultrasonography.
Materials and Methods. Ultrasound demonstrated the abnormal insertion of the pectoralis minor muscle by directly visualizing
its fibers slipping over the coracoid process during external and internal rotation of the humerus. Three hundred and
three individuals underwent ultrasound of the shoulders (64,7% female, mean age of 45 years), for a total of six hundred
and six shoulders; 30% (183/606) were symptomatic.
Results. An abnormal insertion was demonstrated in 9,57% of the examined shoulders (58/606), with a statistically significant
predominance on the left side (12,2%) compared to the right side (6,9%), and of women (12,2%) compared to men
(4,7%).
Conclusion. Ultrasound demonstrated an abnormal insertion of the pectoralis minor muscle in 9,57% of 606 examined
shoulders. There was a female and left side predominance and no significant correlation with symptoms.
and may be responsible for significant clinical symptoms and disability. In the wrist, the most
common location for chondromalacia is the lunate bone. Consequently, we sought to study the
accuracy of clinical MRI in the assessment of lunate articular cartilage.
MATERIALS AND METHODS. MR images of 34 patients who underwent arthroscopy
and had an MRI examination within 1 month of surgery were evaluated by two reviewers for
the presence and location of lunate cartilage defects and subchondral edema.
RESULTS. Lunate cartilage defects were seen on MRI in 10 of the 13 patients with chondromalacia,
but these defects were also incorrectly noted in three of 21 of patients without
chondromalacia. The visible locations for cartilage defects were the ulnar aspect of the proximal
lunate bone (n = 3), radial aspect of the proximal lunate bone (n = 4), ulnar aspect of the
distal lunate bone (n = 2), and radial aspect of the distal lunate bone (n = 1). Subchondral marrow
edema was observed in six of the 10 patients with chondromalacia seen on MRI; in all six
patients, the edema was seen in the same quadrant as the cartilage defect. Marrow edema was
detected in one patient without chondromalacia.
CONCLUSION. We conclude that lunate chondromalacia can be accurately assessed using
routine MRI sequences, although there are occasional false-positive interpretations.
features of Kager’s fat pad inflammation in HIV-positive
patients with lipodystrophy due to protease inhibitor treatment
and posterior ankle pain.
Methods A case-control, cross-sectional study; group 1 included
14 HIV-positive patients using protease inhibitors,
presenting lipodystrophy syndrome and having posterior ankle
pain; group 2 (CGHIV-) included 112 HIV-negative patients
without lipodystrophy syndrome who were being evaluated
for posterior ankle pain; group 3 (CGHIV+1) included
23 HIV-positive patients not using a protease inhibitor, without
lipodystrophy syndrome and with posterior ankle pain;
group 4 (CGHIV+2) comprised 18 HIV-positive patients who
were being treated with a protease inhibitor and had
lipodystrophy syndrome but did not have posterior ankle pain.
Images were evaluated for the presence of edema by two
radiologists who were blinded to clinical features. Fisher’s
exact test was used to evaluate differences among the groups.
Interobserver variation was tested using Cohen’s kappa (κ)
statistic.
Results The presence of edema within Kager’s fat pad was
strongly associated with symptoms in HIV-positive patients
who had lipodystrophy (p≤0.0001). Concordance between
observers was excellent (κ > 0.9).
Conclusion MRI findings of Kager’s fat pad inflammation
related to HIV/AIDS is a source of symptoms in HIV patients
with posterior ankle pain using protease inhibitors and having
lipodystrophy syndrome.
MRI scans to visualize the anterolateral ligament (ALL) and
describe its path and anatomic relations with lateral knee
structures.
Materials and methods Thirty-nine 1.5-T MRI scans of the
knee were evaluated. The scans included an MRI knee protocol
with T1-weighted sequences, T2-weighted sequences with
fat saturation, and proton density (PD)-weighted fast spinecho
sequences. Two radiologists separately reviewed all
MRI scans to evaluate interobserver reliability. The ALL
was divided into three portions for analyses: femoral,
meniscal, and tibial. The path of the ALL was evaluated with
regard to known structural parameters previously studied in
this region.
Results At least a portion of the ALL was visualized in 38
(97.8 %) cases. The meniscal portion was most visualized
(94.8 %), followed by the femoral (89.7 %) and the tibial
(79.4 %) portions. The three portions of the ALL were visualized
in 28 (71.7 %) patients. The ALL was characterized
with greater clarity on the coronal plane and was visualized as
a thin, linear structure. The T1-weighted sequences showed a
statistically inferior ligament visibility frequency.With regard
to the T2 and PD evaluations, although the visualization
frequency in PD was higher for the three portions of the
ligament, only the femoral portion showed significant values.
Conclusion The ALL can be visualized in routine 1.5-TMRI
scans. Although some of the ligament could be depicted in
nearly all of the scans (97.4 %), it could only be observed in its
entirety in about 71.7 % of the tests.
the accessibility of the coracohumeral
ligament (CHL) by ultrasound (US)
and to determine CHL thickness in
adhesive capsulitis of the shoulder.
Design and patients: US examinations
were carried out in 498 consecutive
shoulders of 306 individuals
(194 women and 112 men), mean age
47.4 years (range 15–92 years), in
order to identify and measure the
maximum thickness of the CHL. The
patients were divided into three study
groups: asymptomatic shoulders
(n=121), painful shoulders (n=360)
and shoulders with arthrographic evidence
of adhesive capsulitis (n=17).
The mean maximal thickness of CHL
was compared among the 3 study
groups (non-parametric test of
Kruskal–Wallis, p<0.05). Results:
The CHL was visualized in 92 out of
121 shoulders in the asymptomatic
group (76.0%), in 227 out of 360
shoulders in the painful shoulder
group (63.0%), and in 15 out of 17
shoulders in the adhesive capsulitis
group (88.2%). The average thickness
of the CHL was significantly greater
in adhesive capsulitis (3 mm) than in
the asymptomatic (1.34 mm) and
painful (1.39 mm) shoulders. No
significant difference was found
between asymptomatic and painful
shoulders. Conclusion: CHL depiction
can be achieved in a reasonable
proportion of shoulders. A thickened
CHL is suggestive of adhesive
capsulitis. More studies are needed
for clinical validation of these data.
of the width and retraction of isolated full-thickness
supraspinatus tendon tears determined by magnetic resonance
imaging (MRI) with measurements recorded by arthroscopy
using a continuous millimetre scale.
Methods A total of 53 individuals with isolated supraspinatus
tears and retraction < 30 mm underwent arthroscopy at our
centre. Tear width and retraction measured by arthroscopy
(reference standard) and MRI (index test) on a continuous
millimetre scale were compared. All measurements were performed
by a single radiologist blinded to intra-operative findings
and one surgeon who had previous access toMRI results.
Results The average tear retraction was 12.60±4.89 mm by
arthroscopy and 16.81±6.29 mm by MRI. Those measures
exhibited moderate correlation (r=0.643, p<0.001) and an
average difference of 4.21mm( p<0.001).Average tearwidth
was 12.87±4.15mmby arthroscopy and 14.19±5.20 byMRI.
Those measures exhibited moderate correlation (r=0.526,
p<0.001) and an average difference of 1.32 mm, which was
not statistically significant ( p=0.109).
Conclusion Measures of retraction and width obtained by
MRI and arthroscopy exhibited moderate correlation in
small- or medium-sized supraspinatus tears.
magnetic resonance imaging and T2 mapping to determine
the pre-slip stage of the contralateral epiphysis in patients
with a clinical and radiographic diagnosis of unilateral
proximal femoral epiphysiolysis who were initially treated
with in-situ fixation. Methods: This prospective clinical
study on 11 patients with unilateral epiphysiolysis
was conducted between February 2009 and August 2010, using magnetic resonance imaging on the contralateral
hip. Results: We observed abnormalities in the proximal
femoral capital physis of the contralateral unaffected hip,
with edema under the growth plate in 27% of the patients
assessed. Conclusion: Magnetic resonance imaging is an
early and sensitive method for detecting the pre-slip stage
of the proximal femoral epiphysis.
without hip pain.
METHODS: A total 222 patients were evaluated between March 2007 and April 2009; 122 complained of groin pain,
and 100 had no symptoms. The individuals in both groups underwent radiographic examinations of the hip using
the following views: anteroposterior, Lequesne false profile, Dunn, Dunn 45°, and Ducroquet.
RESULTS: A total of 1110 radiographs were evaluated. Female patients were prevalent in both groups (52%
symptomatic, 58% asymptomatic). There were statistically significant differences between the groups in age
(p,0.0001), weight (p = 0.002) and BMI (p = 0.006). The positive findings in the group with groin pain consisted of
the presence of a bump on the femoral head in the anteroposterior view (p,0.0001) or in the Dunn 45° view
(p = 0.008). The difference in the a angle in the anteroposterior, Dunn, Dunn 45°, and Ducroquet views for all of the
cases studied was p,0.0001. The joint space measurement differed significantly between groups in the Lequesne
view (p = 0.007). The Lequesne anteversion angle (r) and the femoral offset measurement also differed significantly
(p = 0.005 and p = 0.0001, respectively).
CONCLUSIONS: We conclude that the best views for diagnosing a femoroacetabular impingement are the
anteroposterior pelvic orthostatic, the Dunn 45°, and the Ducroquet views. The following findings correlated with
hip pain: a decrease in the femoral offset, an increase in the a angle, an increase in the Lequesne r angle, a decrease in
the CE angle of Wiberg, a thinner articular space and the presence of a bump on the femoral head-neck transition.
cervical vertebrae in our population,
measuring the dimensions of the
thickness, length and lamina angle
have as intention to bring trustworther
parameters to improve and guide the
cervical procedure with intralaminar
screws in C2 fixation. Methods: ninety
six computerized tomographies had
been studied, evaluating sex, age,
and measurements of the dimension
e angle of the C2 vertebrae lamina,
in the point of lesser thickness of the
lamina in the sequenced tomographic
axial cut. Statistical analysis was
performed using Student “t” tests.
classical role of energy storage. In particular we aim to analyze if the intra-articular fat pad of Hoffa is merely
a space holder or if it changes shape to provide cushioning for the knee bones. Towards this goal, 3D CT
images of real knees, as well as a skeletal knee model with fat simulating Hoffa’s pad, were acquired in both
extension and flexion. Image segmentation was performed to automatically extract the real and simulated fat
regions from the extension and flexion images. Utilizing the segmentation results as binary masks, we performed
automatic multi-resolution image registration of the fat pad between flexed and extended knee positions. The
resulting displacement fields from flexion-extension registration are examined and used to calculate local fat
volume changes thus providing insight into shape changes that may have a mechanical component.
(MR) imaging findings in the diagnosis of reactive carpal synovitis.
MATERIALS AND METHODS: Institutional review board approval was obtained,
and the need for informed consent was waived. This study was compliant with the
Health Insurance Portability and Accountability Act. Thirty-five consecutive patients
(19 male and 16 female patients; age range, 13–57 years) who underwent arthroscopy
and MR imaging within 4 weeks of surgery were evaluated by two reviewers
for the following potential findings of synovitis: (a) distention of the pisotriquetral
recess by fluid, (b) distention of the radial and/or prestyloid recess, (c) synovial
enhancement (in patients who received contrast material), (d) amount of dorsal
capsule distention, and (e) the location of bone marrow edema, if any. The 2 and
paired t tests were used to assess these findings in patients with and patients without
arthroscopically proved synovitis. The sensitivity, specificity, positive and negative
predictive values, and accuracy of these findings in the detection of synovitis were
calculated.
RESULTS: Fluid in the pisotriquetral recess was seen in nine of the 14 patients with
synovitis and five of the 21 patients without synovitis (P .018). Distention of the
radial and/or prestyloid recess was observed in six of the 14 patients with synovitis
and two of the 21 patients without synovitis (P .027). Among the 24 patients who
received contrast material, synovial enhancement was seen in seven of eight patients
with synovitis and three of 16 patients without synovitis (P .002). The dorsal
capsule measured 1–7 mm (mean, 3.07 mm) in the 14 patients with synovitis and
2–7 mm (mean, 3.76 mm) in the 21 patients without synovitis (P .193). Although
bone marrow edema was seen globally in similar frequencies (nine of 14 patients
with synovitis, nine of 21 patients without synovitis), pisotriquetral bone marrow
edema was seen only in patients with synovitis (two of nine patients).
CONCLUSION: Fluid in the pisotriquetral recess, enhancing synovium, and, less
commonly, pisotriquetral bone marrow edema are MR imaging findings that may
help in the diagnosis of reactive carpal synovitis.
of inserting on it, following sometimes a trajectory very similar to that of the coracohumeral ligament. The aim of this prospective
study was to evaluate the frequency of detection of this anomalous insertion by ultrasonography.
Materials and Methods. Ultrasound demonstrated the abnormal insertion of the pectoralis minor muscle by directly visualizing
its fibers slipping over the coracoid process during external and internal rotation of the humerus. Three hundred and
three individuals underwent ultrasound of the shoulders (64,7% female, mean age of 45 years), for a total of six hundred
and six shoulders; 30% (183/606) were symptomatic.
Results. An abnormal insertion was demonstrated in 9,57% of the examined shoulders (58/606), with a statistically significant
predominance on the left side (12,2%) compared to the right side (6,9%), and of women (12,2%) compared to men
(4,7%).
Conclusion. Ultrasound demonstrated an abnormal insertion of the pectoralis minor muscle in 9,57% of 606 examined
shoulders. There was a female and left side predominance and no significant correlation with symptoms.
and may be responsible for significant clinical symptoms and disability. In the wrist, the most
common location for chondromalacia is the lunate bone. Consequently, we sought to study the
accuracy of clinical MRI in the assessment of lunate articular cartilage.
MATERIALS AND METHODS. MR images of 34 patients who underwent arthroscopy
and had an MRI examination within 1 month of surgery were evaluated by two reviewers for
the presence and location of lunate cartilage defects and subchondral edema.
RESULTS. Lunate cartilage defects were seen on MRI in 10 of the 13 patients with chondromalacia,
but these defects were also incorrectly noted in three of 21 of patients without
chondromalacia. The visible locations for cartilage defects were the ulnar aspect of the proximal
lunate bone (n = 3), radial aspect of the proximal lunate bone (n = 4), ulnar aspect of the
distal lunate bone (n = 2), and radial aspect of the distal lunate bone (n = 1). Subchondral marrow
edema was observed in six of the 10 patients with chondromalacia seen on MRI; in all six
patients, the edema was seen in the same quadrant as the cartilage defect. Marrow edema was
detected in one patient without chondromalacia.
CONCLUSION. We conclude that lunate chondromalacia can be accurately assessed using
routine MRI sequences, although there are occasional false-positive interpretations.
features of Kager’s fat pad inflammation in HIV-positive
patients with lipodystrophy due to protease inhibitor treatment
and posterior ankle pain.
Methods A case-control, cross-sectional study; group 1 included
14 HIV-positive patients using protease inhibitors,
presenting lipodystrophy syndrome and having posterior ankle
pain; group 2 (CGHIV-) included 112 HIV-negative patients
without lipodystrophy syndrome who were being evaluated
for posterior ankle pain; group 3 (CGHIV+1) included
23 HIV-positive patients not using a protease inhibitor, without
lipodystrophy syndrome and with posterior ankle pain;
group 4 (CGHIV+2) comprised 18 HIV-positive patients who
were being treated with a protease inhibitor and had
lipodystrophy syndrome but did not have posterior ankle pain.
Images were evaluated for the presence of edema by two
radiologists who were blinded to clinical features. Fisher’s
exact test was used to evaluate differences among the groups.
Interobserver variation was tested using Cohen’s kappa (κ)
statistic.
Results The presence of edema within Kager’s fat pad was
strongly associated with symptoms in HIV-positive patients
who had lipodystrophy (p≤0.0001). Concordance between
observers was excellent (κ > 0.9).
Conclusion MRI findings of Kager’s fat pad inflammation
related to HIV/AIDS is a source of symptoms in HIV patients
with posterior ankle pain using protease inhibitors and having
lipodystrophy syndrome.
MRI scans to visualize the anterolateral ligament (ALL) and
describe its path and anatomic relations with lateral knee
structures.
Materials and methods Thirty-nine 1.5-T MRI scans of the
knee were evaluated. The scans included an MRI knee protocol
with T1-weighted sequences, T2-weighted sequences with
fat saturation, and proton density (PD)-weighted fast spinecho
sequences. Two radiologists separately reviewed all
MRI scans to evaluate interobserver reliability. The ALL
was divided into three portions for analyses: femoral,
meniscal, and tibial. The path of the ALL was evaluated with
regard to known structural parameters previously studied in
this region.
Results At least a portion of the ALL was visualized in 38
(97.8 %) cases. The meniscal portion was most visualized
(94.8 %), followed by the femoral (89.7 %) and the tibial
(79.4 %) portions. The three portions of the ALL were visualized
in 28 (71.7 %) patients. The ALL was characterized
with greater clarity on the coronal plane and was visualized as
a thin, linear structure. The T1-weighted sequences showed a
statistically inferior ligament visibility frequency.With regard
to the T2 and PD evaluations, although the visualization
frequency in PD was higher for the three portions of the
ligament, only the femoral portion showed significant values.
Conclusion The ALL can be visualized in routine 1.5-TMRI
scans. Although some of the ligament could be depicted in
nearly all of the scans (97.4 %), it could only be observed in its
entirety in about 71.7 % of the tests.
the accessibility of the coracohumeral
ligament (CHL) by ultrasound (US)
and to determine CHL thickness in
adhesive capsulitis of the shoulder.
Design and patients: US examinations
were carried out in 498 consecutive
shoulders of 306 individuals
(194 women and 112 men), mean age
47.4 years (range 15–92 years), in
order to identify and measure the
maximum thickness of the CHL. The
patients were divided into three study
groups: asymptomatic shoulders
(n=121), painful shoulders (n=360)
and shoulders with arthrographic evidence
of adhesive capsulitis (n=17).
The mean maximal thickness of CHL
was compared among the 3 study
groups (non-parametric test of
Kruskal–Wallis, p<0.05). Results:
The CHL was visualized in 92 out of
121 shoulders in the asymptomatic
group (76.0%), in 227 out of 360
shoulders in the painful shoulder
group (63.0%), and in 15 out of 17
shoulders in the adhesive capsulitis
group (88.2%). The average thickness
of the CHL was significantly greater
in adhesive capsulitis (3 mm) than in
the asymptomatic (1.34 mm) and
painful (1.39 mm) shoulders. No
significant difference was found
between asymptomatic and painful
shoulders. Conclusion: CHL depiction
can be achieved in a reasonable
proportion of shoulders. A thickened
CHL is suggestive of adhesive
capsulitis. More studies are needed
for clinical validation of these data.