MR cartilage imaging in assessment of the regenerative power of autologous peripheral blood stem cell injection in knee osteoarthritis

Background

Osteoarthritis (OA) describes an age-related, heterogeneous group of disorders characterized pathologically by focal areas of loss of articular cartilage in synovial joints, associated with varying degrees of osteophyte formation, subchondral bone change, and synovitis. Currently, cartilage repair remains a major challenge for physicians, being avascular with limited regenerative capacity. Stem cell therapy opened new horizons for hyaline cartilage repair. Peripheral blood stem cells (PBSC) due to their multi-lineage potential, immunosuppressive activities, and limited immunogenicity, were tried as an intra articular injection.

Aim of study

To find out the regenerative effect of repeated intra articular injections of autologous PBSC in knee joints of OA patients using MR cartilage imaging.

Methods

10 patients (3 males and 7 females) diagnosed with bilateral knee joints OA were included in this study, they underwent history taking, clinical examination and MR cartilage imaging using the semi-quantitative whole joint assessment score of knee for OA (MOAKS). Three intra articular injections of 8 ml of autologous PBSC in each knee were administered. Clinical and MRI assessments were repeated after 1 year.

Results

A significant reduction was seen in all parameters post injection. MR images analysis showed increased cartilage thickness in 65 knee joint compartments out of 160 affected compartments.

Conclusion

Limited good level of evidence showed that repeated intra-articular injections of autologous PBSC resulted in an improvement of the quality of articular cartilage repair and physical function as observed by MRI and clinical assessment.     

Digital radiographic measurement of normal knee joint space in adults at Kano,Nigeria

Objective

The measurement of knee joint space width (JSW), between the distal femur and the proximal tibia is an indirect way of measuring the tibio-femoral cartilage thickness, which is considered a valuable parameter, in assessing knee cartilage disease. This study is aimed at establishing normal references of JSW for use in diagnosis and follow up of knee cartilage diseases.

Methods

This prospective study was conducted on 30° fixed-flexion erect knee computed radiographs of 160 adults. The JSW of both medial and lateral compartments of each knee was measured using in-built electronic calipers.

Results

The mean right medial and lateral JSW measured 4.74 mm ± 0.75 and 5.63 mm ± 0.86, respectively. The mean left medial and lateral JSW measured 4.74 mm ± 0.76 and 5.66 mm ± 0.87. No statistically significant difference was found between right and left knee JSW compartments.

Discussions

The radiographic reference values of the knee JSW were obtained, showing no significant gender variation in knee JSW. However, there is a decrease in JSW with increasing age.     

Loading of the knee during 3.0T MRI is associated with significantly increased medial meniscus extrusion in mild and moderate osteoarthritis

Purpose

Standard knee MRI is performed under unloading (ULC) conditions and not much is known about changes of the meniscus, ligaments or cartilage under loading conditions (LC). The aim is to study the influence of loading of different knee structures at 3 Tesla (T) in subjects with osteoarthritis (OA) and normal controls.

Materials and methods

30 subjects, 10 healthy and 20 with radiographic evidence of OA (10 mild and 10 moderate) underwent 3 T MRI under ULC and LC at 50% body weight. All images were analyzed by two musculoskeletal radiologists identifying and grading cartilage, meniscal, ligamentous abnormalities. The changes between ULC and LC were assessed. For meniscus, cartilage and ligaments the changes of lesions, signal and shape were evaluated. In addition, for the meniscus changes in extrusion were examined. A multivariate regression model was used for correlations to correct the data for the impact of age, gender, BMI. A paired T-Test was performed to calculate the differences in meniscus extrusion.

Results

Subjects with degenerative knee abnormalities demonstrated significantly increased meniscus extrusion under LC when compared to normal subjects (p = 0.0008–0.0027). Subjects with knee abnormalities and higher KL scores showed significantly more changes in lesion, signal and shape of the meniscus (80% (16/20) vs. 20% (2/10); p = 0.0025), ligaments and cartilage during LC.

Conclusion

The study demonstrates that axial loading has an effect on articular cartilage, ligament, and meniscus morphology, which is more significant in subjects with degenerative disease and may serve as an additional diagnostic tool for disease diagnosis and assessing progression in subjects with knee OA.     

Conservative treatment of spontaneous osteonecrosis of the knee in the early stage: Pulsed electromagnetic fields therapy

Background

Hypothesis: pulsed electromagnetic fields treatment might improve symptoms in the early stage of spontaneous osteonecrosis of the knee.

Methods

Twenty-eight patients (19M/9F, age 49.8 ± 16.4 years) suffering from symptomatic (pain) Koshino stage I spontaneous osteonecrosis of the knee, confirmed by magnetic resonance imaging (MRI) were treated with local pulsed electromagnetic fields therapy (6 h daily for 90 days). Clinical evaluation: baseline, 6- and 24-month follow-up by VAS for pain, knee society score (KSS), Tegner and EQ-5D scales. MRI evaluation: baseline and 6-month follow-up, measuring bone marrow lesion's areas and grading these lesions by WORMS score. Failures: patients undergoing knee arthroplasty.

Results

Pain significantly reduced at 6 months (from 73.2 ± 20.7 to 29.6 ± 21.3, p < 0.0001), which remained almost unchanged at final follow-up (27.0 ± 25.1). KSS significantly increased in first 6 months (from 34.0 ± 13.3 to 76.1 ± 15.9, p < 0.0001) and was slightly reduced at final follow-up (72.5 ± 13.5, p = 0.0044). Tegner median level increased from baseline to 6-month follow-up (1(1–1) and 3(3–4), respectively, p < 0.0001) and remained stable. EQ-5D improved significantly throughout the 24 months (0.32 ± 0.33, baseline; 0.74 ± 0.23, 6-month follow-up (p < 0.0001); 0.86 ± 0.15, 24-month follow-up (p = 0.0071)). MRI evaluation: significant reduction of total WORMS mean score (p < 0.0001) and mean femoral bone marrow lesion's area (p < 0.05). This area reduction was present in 85% and was correlated to WORMS grading both for femur, tibia and total joint (p < 0.05). Four failures (14.3%) at 24-month follow-up.

Conclusions

Pulsed electromagnetic fields stimulation significantly reduced knee pain and necrosis area in Koshino stage I spontaneous osteonecrosis of the knee already in the first 6 months, preserving 86% of knees from prosthetic surgery at 24-month follow-up. No correlation was found between MRI and clinical scores.

Level of evidence

Level IV; case series.     

Changes in knee cartilage T2 values over 24 months in subjects with and without risk factors for knee osteoarthritis and their association with focal knee lesions at baseline: data from the osteoarthritis initiative

Purpose:

To examine the changes in knee cartilage T2 values over 24 months in subjects with and without risk factors for knee osteoarthritis (OA) and their association with focal knee lesions at baseline.

Materials and Methods:

Forty‐one subjects without and 101 subjects with OA risk factors (such as history of knee injury or surgery) were selected from the Osteoarthritis Initiative database (age: 45–55 years, no radiographic OA in the right knee). Baseline magnetic resonance imaging (MRI) of the right knee were assessed for prevalence and grade of focal knee lesions. Right knee cartilage T2 measurements were performed in five compartments (patella, medial/lateral femur/tibia) at baseline and at 24‐month follow‐up.

Results:

Compared to subjects without OA risk factors, those with OA risk factors showed no significant differences in baseline prevalence and grade of focal knee lesions (P > .05), but had significantly higher T2 values in the medial femur compartment at both timepoints (P < 0.05). T2 values averaged over all five compartments increased significantly over 24 months in both groups, but differences in T2 increase between the groups were not significant. Subjects with cartilage lesions showed significantly higher T2 values compared to subjects without cartilage lesions at both timepoints, but no accelerated T2 increase over 24 months (P > 0.05).

Conclusion:

Cartilage T2 values significantly increased over 24 months in subjects with and without OA risk factors, but neither the presence of OA risk factors nor the presence of cartilage lesions at baseline were associated with these T2 increases. J. Magn. Reson. Imaging 2012;370‐378. © 2011 Wiley Periodicals, Inc.     

Contribution of regional 3D meniscus and cartilage morphometry by MRI to joint space width in fixed flexion knee radiography—A between-knee comparison in subjects with unilateral joint space narrowing

Background

Radiographic joint space width (JSW) is considered the reference standard for demonstrating structural therapeutic benefits in knee osteoarthritis. Our objective was to determine the proportion by which 3D (regional) meniscus and cartilage measures explain between-knee differences of JSW in the fixed flexion radiographs.

Methods

Segmentation of the medial meniscus and tibial and femoral cartilage was performed in double echo steady state (DESS) images. Quantitative measures of meniscus size and position, femorotibial cartilage thickness, and radiographic JSW (minimum, and fixed locations) were compared between both knees of 60 participants of the Osteoarthritis Initiative, with strictly unilateral medial joint space narrowing (JSN). Statistical analyses (between-knee, within-person comparison) were performed using regression analysis.

Results

A strong relationship with side-differences in minimum and a central fixed location JSW was observed for percent tibial plateau coverage by the meniscus (r = .59 and .47; p < .01) and central femoral cartilage thickness (r = .69 and .75; p < .01); other meniscus and cartilage measures displayed lower coefficients. The correlation of central femoral cartilage thickness with JSW (but not that of meniscus measures) was greater (r = .78 and .85; p < .01) when excluding knees with non-optimal alignment between the tibia and X-ray beam.

Conclusion

3D measures of meniscus and cartilage provide significant, independent information in explaining side-differences in radiographic JSW in fixed flexion radiographs. Tibial coverage by the meniscus and central femoral cartilage explained two thirds of the variability in minimum and fixed location JSW. JSW provides a better representation of (central) femorotibial cartilage thickness, when optimal positioning of the fixed flexion radiographs is achieved.     

Can diffusion weighted imaging distinguish between benign and malignant solid or predominantly solid gynecological adnexal masses?

Objective

To determine the benefit of DWI in diagnosis of benign and malignant solid or predominantly solid gynecological adnexal or ovarian masses.

Material and Methods

This study is carried out on 23 patients with histologically proven solid or predominantly solid adnexal or ovarian masses out of which 5 cases (21.8%) have benign and 18 cases (78.2%) have malignant neoplasms. Among these 19 cases (82.6%) have unilateral disease and 4 cases (17.4%) have bilateral disease which was metastatic ovarian carcinoma.

Result

On DWI, high signal intensity is noted in malignant lesion more frequently than in benign lesion. (P < 0.001) in adnexal lesions, while in ovarian lesions (P = 0.001).The differentiation between benign and malignant adnexal lesions revealed no significant difference in the apparent diffusion coefficient (ADC) value (P = 0.22).

Conclusion

DWI is a helpful tool in differentiation between predominantly solid and solid benign and malignant adnexal lesions because there is an increased frequency of higher signal intensity (diffusion restriction) in malignant lesions.     

Asymmetry of the knee extension deficit in standing affects weight-bearing distribution in patients with bilateral end-stage knee osteoarthritis

Purpose

The aim of this study was to evaluate weight-bearing distribution in patients with bilateral end-stage knee osteoarthritis (OA) and to clarify the gait parameters affecting the weight-bearing distribution during both standing and walking using gait analysis.

Methods

Twenty-five patients (averaged 71 years) with symptomatic bilateral end-stage medial knee OA participated in this study. They performed relaxed standing, placing one foot on a force plate and thereafter, level walking. First, knee resultant force was calculated on bilateral knees during standing. The knees in each patient were divided into Higher and Lower force side for the definition of dominant side limb. Second, gait parameters in each subject were compared between both sides.

Results

Each patient had large weight-bearing asymmetry, though passive range of motion, subjective pain level, femorotibial angle and radiographic disease severities were not significantly different between both sides. In standing, knees on Higher force side were significantly extended (11.2 ± 6.5°) than on Lower force side (14.4 ± 7.3°, P = 0.0086). Similarly, knees on Higher force side were also significantly extended at heel strike during gait. Besides, peak values of extension moment, knee adduction moment, knee adduction moment impulse and vertical force during gait were significantly greater on Higher force side.

Conclusions

Ability to extend the knee in standing was considered to be an essential factor to decide loading condition. It is clinically important to examine the ability to extend the knee in standing when considering loading asymmetry during gait in patients with bilateral knee OA.

Level of evidence

III.     

The contralateral knee may not be a valid control for biomechanical outcomes after unilateral total knee arthroplasty

BackgroundAlthough unilateral symptoms and unilateral total knee arthroplasty (TKA) are common, many patients have bilateral radiographic osteoarthritis (OA). Because the contralateral (non-operated) limb is often used as a comparison for clinical and biomechanical outcomes, it is important to know if the presence of OA influences movement patterns in either limb.Research questionThe purpose of this study was to compare bilateral sagittal plane biomechanics between subjects with and without contralateral knee OA after unilateral TKA.MethodsFifty-three subjects who underwent unilateral TKA underwent three-dimensional gait analysis 6–24 months after surgery participated in this cross-sectional study. Kellgren-Lawrence (KL) OA severity in the contralateral limb was measured, and subjects were classified into either a non-OA (KL 0 or 1) or OA (KL 2–4) group. Mixed-model ANOVA tests with factors of group and limb were used to compare biomechanical measures. In the presence of a significant interaction effect, post-hoc comparisons were performed.ResultsThe OA group had more knee flexion at initial contact, less knee flexion and extension excursions, and less knee extension in the contralateral limb compared to the non-OA group. The non-OA group had significant differences between limbs, with more knee flexion at initial contact, less knee joint excursion, and less peak knee extension on the operated limb compared to the contralateral limb, whereas there were no limb differences for the OA group. Kinetic variables were not different in the ANOVA models.Significance and interpretationSubjects with contralateral knee OA have more symmetrical gait, although they adopt a more abnormal and stiff-legged gait pattern bilaterally. Researchers and clinicians should consider radiographic disease severity, not just symptoms, in the contralateral limb when identifying appropriate subject samples for unilateral biomechanical studies. Symmetrical movement patterns between limbs after surgery should not be the sole factor upon which movement recovery is based.     

Quadriceps muscle weakness is related to increased risk of radiographic knee OA but not its progression in both women and men: the Matsudai Knee Osteoarthritis Survey

Purpose

The purpose of this study was to investigate the causal relationship between quadriceps muscle strength and radiographic knee osteoarthritis (OA) in a longitudinal study.

Methods

The present study included 976 knees from 488 subjects who participated in both the 5th (2007) and 7th (2013) surveys of the Matsudai Knee Osteoarthritis Survey. Bilateral quadriceps strengths of each subject were measured using the quadriceps training machine (QTM-05F, Alcare Co., Ltd., Tokyo, Japan). Additionally, weight-bearing standing knee radiographs were obtained, and knee OA was graded according to the Kellgren–Lawrence classification system. The relationships between quadriceps strength and the incidence and progression of radiographic knee OA were assessed using multiple logistic regression analysis.

Results

After adjusting for age and body mass index (BMI), both female and male knees in the lowest quantile of quadriceps strength had higher risk of the incidence of radiographic knee OA compared with the highest quantile of quadriceps strength (women: OR 2.414, 95% CI 1.098–5.311; men: OR 2.774, 95% CI 1.053–7.309). In contrast, after adjusting for age, BMI and femorotibial angle, both female and male knees in the lowest quantile compared with the highest quantile of quadriceps strength did not differ in risk of the progression of radiographic knee OA (women: OR 1.040, 95% CI 0.386–2.802; men: OR 2.814, 95% CI 0.532–14.898).

Conclusion

Quadriceps muscle weakness was related to increased risk of the incidence of radiographic knee OA, but not its progression, in both women and men. Therefore, the clinically important finding of this study is that, in both women and men, maintaining higher quadriceps muscle strength may be one of the most effective prevention methods for incident radiographic knee OA.

Level of evidence

II.

     

Role of three-dimensional multidetector computerized tomography in diagnosis of Eagle’s syndrome

Objective

To confirm the diagnosis of Eagle’s syndrome by three-dimensional MDCT among patients with clinical suspicion of the disease.

Materials and methods

Non-contrast MDCT neck scans of 18 patients of clinical prediagnosis of Eagle’s syndrome and 6 control subjects over 9 months period were reviewed for styloid process lengths and medial angulations using conventional and three-dimensional images.

Results

Our study included 18 patients and 6 controls. The means of styloid process lengths and medial angulations were 2.6° and 69.4°, 2.2 cm and 73° respectively. Statistical significance was found (P < 0.05) between the medial angulations of SP of patients and controls rather than between the lengths. MDCT revealed that 10 out of 18 patients had elongated styloid processes, 6 were bilateral, and 4 were unilateral 3 of them were right sided. Mean length of elongated styloid processes was 4.4 cm (range from 3.3 to 5.4 cm), 4.5 cm in males and 4.2 cm in females. Three out of 18 patients had narrowed bilateral medial styloid process angulation, two of whom were bilateral and one case was unilateral with additional styloid process elongation.

Conclusion

MDCT with three-dimensional reconstructions is valuable in diagnosing Eagle’s syndrome by virtue of determining styloid process length and medial angulation, thus confirming clinical suspicion and aiding proper management.     

Relationship between knee alignment and T1ρ values of articular cartilage and menisci in patients with knee osteoarthritis

Objective

To assess the relationship between knee alignment and subregional T1ρ values of the femorotibial cartilage and menisci in patients with mild (Kellgren–Lawrence grade 1) to moderate (KL3) osteoarthritis (OA) at 3 T.

Materials and methods

26 subjects with a clinical diagnosis of KL1-3 OA were included and subdivided into three subgroups: varus, valgus, and neutral. All subjects were evaluated on a 3 T MR scanner. Mann–Whitney and Wilcoxon signed rank tests were performed to determine any statistically significant differences in subregional T1ρ values of femorotibial cartilage and menisci among the three subgroups of KL1-3 OA patients.

Results

Medial femoral anterior cartilage subregion in varus group had significantly higher (p < 0.05) T1ρ values than all cartilage subregions in valgus group. Medial tibial central cartilage subregion had significantly higher T1ρ values (p < 0.05) than lateral tibial central cartilage subregion in varus group. The posterior horn of the medial meniscus in neutral group had significantly higher T1ρ values (p < 0.0029) than all meniscus subregions in valgus group.

Conclusion

There exists some degree of association between knee alignment and subregional T1ρ values of femorotibial cartilage and menisci in patients with clinical OA     

Multidetector computed tomography arthrography of the knee: diagnostic accuracy and indications

Purpose

To evaluate the diagnostic accuracy and indications of arthrography with multidetector computed tomography (arthro-MDCT) of the knee, in patients with absolute or relative contraindications to MRI and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard.

Materials and methods

After intra-articular injection of iodixanol and volumetric acquisition, 68 knees in patients of both sexes (30 females, 38 males, age range 32–60 years) were examined with a 16-detector-row CT scanner. The patients had arthralgia but no radiologically detected fractures. They could not be studied by MRI either because of absolute contraindications (subcutaneous electronic implants), surgical metal implants or claustrophobia. In 37 of 68 patients who had had previous knee surgery, the arthro-CT examination was preceded by an MRI on the same day.All examinations were interpreted by two experienced musculoskeletal radiologists.The findings were compared with arthroscopic findings carried out within 28 days of the CT study.

Results

In non-operated patients the comparison between arthro-MDCT and arthroscopy showed sensitivity and specificity ranging between 86% and 100%. In the 37 operated knees, arthro-MDCT had an accuracy of 95% compared with 53% of the MRI.Inter-observer agreement was almost perfect (K = 0.97) in the evaluation of all types lesions, both on MDCT and MRI.When arthro-MDCT was compared with MRI in post-operative patients by a McNemar test, a significant difference (p < 0.05) was found between these two techniques.

Conclusions

Arthro-MDCT of the knee is a safe technique that provides accurate diagnosis in identifying chondral, fibrocartilaginous and intra-articular ligamentous lesions, in patients that cannot be evaluated by MRI, and in patients after surgical.     

Ultrasound guided percutaneous treatment and follow-up of Baker's cyst in knee osteoarthritis

Objective

Purpose of this study is to assess sonographic changes and clinical response in different subgroups of Baker's cyst patients with knee osteoarthritis after a single session of ultrasound-guided percutaneous aspiration and corticosteroid injection.

Materials and methods

Thirty-two knee osteoarthritis patients (46–85 years, mean 58.97 ± 9.88) with symptomatic Baker's cyst diagnosed at ultrasonography were included in the study. To determine the grade of the symptoms, Visual Analogue Scale was applied. The patients were grouped in two, as simple (n = 24) and complex (n = 8) Baker's cyst. Thirty-two ultrasound-guided cyst aspirations concomitant 1 ml betamethasone injection (24 simple, 8 complex subgroups) were performed. Patients were followed clinically as well as via ultrasonography for 6 months after procedures.

Results

A significant decrease in volume of the Baker's cysts after percutaneous treatment was accompanied by a significant clinical improvement. Moreover, the volume reduction of Baker's cyst after the treatment was significantly correlated with the clinical improvement (Pearson correlation coefficient = 0.542, p = 0.001). All 6 Baker's cysts relapsed at ultrasonography were complex type. Furthermore, a comparison of patients with simple Baker's cysts and those with complex Baker's cysts demonstrated no significant change in Visual Analogue Scale scores between two groups (p = 0.061, Mann–Whitney U). No complications (minor or major) occurred secondary to percutaneous treatment.

Conclusion

Baker's cysts can be grouped as simple and complex groups via ultrasonography prior to the treatment. Cyst aspiration with ultrasound-guided corticosteroid injection yields clinical improvement and cyst volume reduction in all subgroups of patients with Baker's cyst secondary to knee osteoarthritis.     

Malignant focal brain lesions. Value of MRS tumour biomarkers in preoperative prediction of grades of malignancy

Purpose

Our aim is to describe the spectrum of proton-MR spectroscopy in malignant focal brain lesions and to detect grade of malignancy using MRS tumor biomarkers.

Materials and methods

87 patients (63 males and 24 females) with focal brain lesion(s) are included in this study. All had a brain tumor recently diagnosed by MRI and had received no previous treatment. They were referred to MRS examination before surgical biopsy and/or resection or radiotherapy.

Results

In malignant brain tumors, average Cho/NAA ratio was 3.3 ± 0.22, Cho/Cr ratio was 2.95 ± 0.21, MI/NAA ratio was 1.5 ± 0.12, MI/Cr was 0.53 ± 0.11 with lower MI levels and higher choline levels in more malignant tumours, lipid/lactate peak was detected in brain metastasis and high grade malignant brain tumors.

Conclusion

Higher Cho/NAA, Cho/Cr and MI/NAA ratios with lower MI/Cr, and high lipid/lactate peak, were most likely to be in high grade malignant brain tumors.     

90°-Flip-angle three-dimensional double-echo steady-state (3D-DESS) magnetic resonance imaging of the knee: Isovoxel cartilage imaging at 3 T

Purpose

The purpose of this study was to investigate whether 3D-double echo steady state (3D-DESS) with improved contrast by setting the FA (Flip angle) at 90° is useful in 3D isotropic cartilage imaging of the knee at 3 T.

Materials and methods

Imaging was performed in 10 healthy volunteers using 3 methods: with 3D-DESS using FA of 25° and 90°, and with true fast imaging with steady-state precession (True-FISP). The signal-to-noise ratio (SNR) of the synovial fluid and cartilage, and contrast-to-noise ratio (CNR) were measured, and mean values were compared. Visual assessment of artifacts was performed with the cartilage divided into 6 regions.

Results

There were no significant differences in synovial fluid SNR in the comparison between FA-90° 3D-DESS and True-FISP (P = 0.364). A significantly higher cartilage SNR was observed with FA-90° 3D-DESS than with True-FISP (P = 0.031). There were no significant differences in synovial fluid-cartilage CNR between FA-90° 3D-DESS and True-FISP (P = 0.892). In the evaluation of artifacts, FA-90° 3D-DESS imaging showed a significantly higher score than True-FISP imaging in the patella and trochlea cartilage (P < 0.001, P < 0.002).

Conclusions

FA-90° 3D-DESS is useful in 3D isotropic cartilage imaging of the knee at 3 T.     

T2-weighted MR imaging of the liver: Qualitative and quantitative comparison of SPACE MR imaging with turbo spin-echo MR imaging

Objective

To qualitatively and quantitatively compare T2-weighted MR imaging of the liver using volumetric spin-echo with sampling perfection with application-optimized contrast using different flip angle evolutions (SPACE) with conventional turbo spin-echo (TSE) sequence for fat-suppressed T2-weighted MR imaging of the liver.

Materials and methods

Thirty-three patients with suspected focal liver lesions had SPACE MR imaging and conventional fat-suppressed TSE MR imaging. Images were analyzed quantitatively by measuring the lesion-to-liver contrast-to-noise ratio (CNR), and the signal-to-noise ratio (SNR) of main focal hepatic lesions, hepatic and splenic parenchyma and qualitatively by evaluating the presence of vascular, respiratory motion and cardiac artifacts. Wilcoxon signed rank test was used to search for differences between the two sequences.

Results

SPACE MR imaging showed significantly greater CNR for focal liver lesions (median = 22.82) than TSE MR imaging (median = 14.15) (P < .001). No differences were found for SNR of hepatic parenchyma (P = .097), main focal hepatic lesions (P = .35), and splenic parenchyma (P = .25). SPACE sequence showed less artifacts than TSE sequence (vascular, P < .001; respiratory motion, P < .001; cardiac, P < .001) but needed a longer acquisition time (228.4 vs. 162.1 s; P < .001).

Conclusion

SPACE MR imaging provides a significantly increased CNR for focal liver lesions and less artifacts by comparison with the conventional TSE sequence. These results should stimulate further clinical studies with a surgical standard of reference to compare the two techniques in terms of sensitivity for malignant lesions.     

Embolization for control of refractory posterior epistaxis

Objectives

Many methods are included in the treatment of intractable epistaxis including selective embolization. We report our experience with 10 patients treated with this technique.

Patients and methods

Ten patients with posterior idiopathic epistaxis were selected in this study. They were managed by double-balloon device followed by embolization.

Results

Study included six males and four females, their age ranged from 49 to 66 years (mean 56 years). Four patients were hypertensive, two were smokers. Epistaxis was unilateral in six patients and bilateral in four. Six internal maxillary and eight sphenopalatine arteries were embolized with polyvinyl alcohol 150–250 μm. Bleeding stopped in all patients after procedure. One patient had recurrent attack 2 months later for whom re-embolization successfully stopped bleeding. No major complications encountered but minor complications occurred in two patients (one severe headache and one transient left temporofacial pain).

Conclusion

Selective embolization is a clinically effective treatment for severe refractory posterior epistaxis. By this method we can avoid the complications of repeated packs and surgery especially in elderly patients.     

Osteoarthritis of the knee: comparison of MR imaging findings with radiographic severity measurements and pain in middle-aged women

PURPOSE: To prospectively compare magnetic resonance (MR) imaging-defined abnormalities of osteoarthritis (OA) of the knee with radiographic severity measurements of OA of the knee and self-reported pain. MATERIALS AND METHODS: This study was approved by the institutional review board of University of Michigan. Informed consent was obtained for this HIPAA-compliant study. Knee MR imaging was performed in 117 women (mean age, 46 years; range, 32-56 years) from a community-based arthritis study (n = 1053) with 30 women in each of four categories: (a) no pain and no OA of the knee, (b) no pain and OA of the knee, (c) pain and no OA of the knee, and (d) pain and OA of the knee. OA of the knee was defined from radiographs. Two hundred thirty-two eligible knees had Kellgren-Lawrence scores for OA of the knee as follows: grade 0, 115 (49.6%); grade 1, 33 (14.2%); grade 2, 66 (28.4%); grade 3, 17 (7.3%); and grade 4, one (0.4%). MR images were assessed for location and severity of defects of cartilage, bone marrow edema (BME), osteophytes, subchondral cysts, sclerosis, meniscal and/or ligamentous tears, joint effusion, synovial cysts, and synovitis. MR imaging findings were compared with radiographic severity of OA of the knee (Kellgren-Lawrence scale) and self-reported pain with analysis of variance, t tests, and contingency table analyses. RESULTS: Defects of cartilage (higher than grade IIA) were found in 75% of knees; BME was found in 57% of knees (<1 cm, 41%; >1 cm, 16%). Large BME lesions were common in the pain and OA of the knee group (P = .001); this group was significantly more likely to have defects of cartilage (P = .001); meniscal tears (P = .001); and osteophytes, subchondral cysts, sclerosis, joint effusion, and synovitis (P < .001). Defects of cartilage, osteophytes, sclerosis, meniscal or ligamentous tears, joint effusion, and synovitis were strongly related to increasing Kellgren-Lawrence grade (P < .001). CONCLUSION: In middle-aged women, there were significant associations between pain, radiographic severity of OA of the knee, and seven MR imaging-identified parameters.     

Reproductibilité test–retest des mesures stabilométriques après reconstruction du ligament croisé antérieur du genou chez le sujet sportif

Objective

To define the 3 day interval test-retest reproducibility of stabilometric measurements in two- and one legged stance in sport subjects recently operated from a knee anterior cruciate ligament reconstruction.

Méthode

Ten subjects aged between 16 to 33 years (23 year ± 5); carried out at 15 days after the knee surgery two sessions to measure steadiness in two legged stance with opened and closed eyes; in one legged stance with opened eyes, in healthy and operated leg, with full knee extension and with 20 degrees knee flexion. The reproducibility was determined using the intraclass correlation coefficient and the standard error of measurement was calculated.

Results

In two legged stance and in one legged stance, knee in 20 degrees flexion, the 95% sway area and the average antero-posterior excursion of the centre of pressure are reproducible (ICC > 0,75).The stabilometric parameters are not reproducible in one legged stance, knee in extension.

Conclusion

The reproducibility of stabilometric parameters is good, in two and in one legged stance knee flexed at 20 degrees, to evaluate the postural progress after anterior cruciate ligament reconstruction.