Validity of gradient-echo three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage: A histologically controlled study

Objective

To validate gradient-echo three-dimensional (3D) delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) by means of histological analyses in the assessment of hip joint cartilage.

Materials and methods

Twenty-one femoral head specimens collected from 21 patients (7 males, 14 females, mean age: 60.9 ± 9.6 years; range: 37.6–77.3 years), who underwent total hip replacement for symptomatic hip joint osteoarthritis, underwent MRI and histological assessment. A region of 2 cm² at the weight-bearing area was marked with four pins to enable multi-planar MRI reformatting to be matched with histological sections. MRI was performed at 3 T with a 3D double-echo steady-state (DESS) sequence for morphological cartilage assessment and 3D Volumetric Interpolated Breathhold Examination (VIBE) for T1_Gd mapping. Histological sections were evaluated according to the Mankin score system. Total Mankin score, grade of toluidine staining (sensitive for glycosaminoglycan content) and a modified Mankin score classification system with four sub-groups of cartilage damage were correlated with MRI data.

Results

Spearman's rho correlation analyses revealed a statistically significant correlation between T1_Gd mapping and histological analyses in all categories including total Mankin score (r = −0.658, p-value ≤ 0.001), toluidine staining (r = −0.802, p-value < 0.001) and modified Mankin score (r = −0.716, p-value < 0.001). The correlation between morphological MRI and histological cartilage assessment was statistically significant but inferior to the biochemical cartilage MRI (r-values ranging from −0.411 to 0.525, p-values < 0.001).

Conclusions

Gradient-echo dGEMRIC is reliable while offering the unique features of high image resolution and 3D biochemically sensitive MRI for the assessment of early cartilage degeneration.     

US-guided interventional joint procedures in patients with rheumatic diseases—When and how we do it?

Objective

To describe the main indications and the technical steps to perform ultrasound guided procedures in patients with rheumatic diseases. To access procedures accuracy, safety and effectiveness.

Materials and methods

27 patients with pain related to articular complications of rheumatic diseases and according to previous radiographic or US exam were submitted to several US-guided procedures. 42% of patients (n = 11) had rheumatoid arthritis, 11% (n = 3) spondyloarthropathies, 18% (n = 5) psoriatic arthritis, 15% (n = 4) undifferentiated arthritis, 3% (n = 1) Sjögren syndrome and 11% (n = 3) had gout.Described procedures are synovial biopsies, intra-articular injections of corticosteroids, radiation synovectomy and synovial cysts drainage procedures. When a therapeutical procedure was made, patients were evaluated by 2 rheumatologists.Corticosteroids used were Prednisolone and Triamcinolone. Yttrium-90 was used for synovectomy.

Results

In all cases success was achieved with correct needle placement inside the joint. After injection/aspiration symptoms successfully solved with all patients improving their health status. No complications were recorded during follow-up period.

Conclusions

US-guidance is very reliable to afford a safety procedure always checking the injection, biopsy or aspiration. Guided-biopsy has high success rates obtaining several samples. Thus is also possible to use more powerful/long acting therapeutic drugs aggressive to extra-articular structures avoiding complications.     

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.     

The utility of multi-detector computed tomography in the diagnosis of malignant pleural effusion in the patients with ovarian cancer

Purpose

The purpose of this study was to retrospectively assess possible clinical predictors of malignant pleural effusion in patients with ovarian cancer.

Materials and methods

This review was performed on 38 ovarian cancer patients that showed pleural effusion in a CT scan and who underwent thoracocentesis before treatment. CT scans were obtained using a 4-channel multi-detector CT scanner. Fisher's exact test was used to determine the probability of malignant pleural effusion as a function of; amount of ascites, lymph node enlargement, amount of pleural effusion, pleural nodules, and pleural thickening.

Results

Sixteen (42.1%) of the 38 patients had malignant pleural effusion and malignant pleural effusion amounts were greater than those with nonmalignant effusion.Pleural nodules were more frequently found in the malignant pleural effusion group (eight [50%] patients) than in the nonmalignant group (zero [0%] patient) (p < 0.001). Supradiaphragmatic lymph node enlargement (with short axis diameter 1 cm or more) was more frequent in malignant group (12 [75%] patients) than in the nonmalignant group (two [9.1%] patients) (p < 0.001).

Conclusion

The probability of malignant pleural effusion in patients with ovarian cancer was found to be correlated with the amount of pleural effusion, the presence of pleural nodules, and supradiaphragmatic lymph node enlargement.     

A comparison of microwave ablation and bipolar radiofrequency ablation both with an internally cooled probe: Results in ex vivo and in vivo porcine livers

Purpose

The purpose of this study was to compare the effectiveness of microwave (MW) ablation and radiofrequency (RF) ablation using a single internally cooled probe in a hepatic porcine model.

Materials and methods

In the ex vivo experiment, MW ablations (n = 40) were performed with a 2450 MHz and 915 MHz needle antenna, respectively at 60 W, 70 W power settings. Bipolar RF ablations (n = 20) were performed with a 3-cm (T30) and 4-cm (T40) active tip needle electrodes, respectively at a rated power 30 W and 40 W according to automatically systematic power setting. In the in vivo experiment, the 2450 MHz and 915 MHz MW ablation both at 60 W and T30 bipolar RF ablation at 30 W were performed (n = 30). All of the application time were 10 min. Long-axis diameter (Dl), short-axis diameter (Ds), ratio of Ds/Dl, the temperature data 5 mm from the needle and the time of temperature 5 mm from the needle rising to 54 °C were measured.

Results

Both in ex vivo and in vivo models, Ds and Dl of 915 MHz MW ablations were significantly larger than all the RF ablations (P < 0.05); the Ds for all the 2450 MHz MW ablations were significantly larger than that of T30 RF ablations (P < 0.05). 2450 MHz MW and T30 RF ablation tended to produce more elliptical-shaped ablation zone. Tissue temperatures 5 mm from the needle were considerably higher with MW ablation, meanwhile MW ablation achieved significantly faster rate of temperature rising to 54 °C than RF ablation. For in vivo study after 10 min of ablation, the Ds and Dl of 2450 MHz MW, 915 MHz MW and Bipolar RF were 2.35 ± 0.75, 2.95 ± 0.32, 1.61 ± 0.33 and 3.86 ± 0.81, 5.79 ± 1.03, 3.21 ± 0.51, respectively. Highest tissue temperatures 5 mm from the needle were 80.07 ± 12.82 °C, 89.07 ± 3.52 °C and 65.56 ± 15.31 °C and the time of temperature rising to 54 °C were respectively 37.50 ± 7.62 s, 24.50 ± 4.09 s and 57.29 ± 23.24 s for three applicators.

Conclusion

MW ablation may have higher potential for complete destruction of liver tumors than RF ablation.     

MRI findings in 6 cases of children by inadvertent ingestion of diphenoxylate-atropine

Purpose

Compound diphenoxylate (diphenoxylate-atropine) poisoning can cause toxic encephalopathy in children, and magnetic resonance imaging (MRI) of the brain in this condition has not been reported. This study is to analyze brain MRI findings and to investigate the relations between MRI features and possible pathophysiological changes in children.

Methods

Six children accidentally swallowed compound diphenoxylate, 4 males, 2 females, aged 20-46 months, average 33 months. Quantity of ingested diphenoxylate-atropine was from 6 to 30 tablets, each tablet contains diphenoxylate 2.5 mg and atropine 0.025 mg. These patients were referred to our hospital within 24 h after diphenoxylate-atropine ingestion, and underwent brain MRI scan within 24-72 h after emergency treatment. The characteristics of conventional MRI were analyzed.

Results

These pediatric patients had various symptoms of opioid intoxication and atropine toxicity. Brain MRI showed abnormal low signal intensity on T1-weighted images (T1WI) and abnormal high signal intensity on T2-weighted images (T2WI) and fluid-attenuated inversion recovery (FLAIR) imaging in bilateral in all cases; abnormal high signal intensity on T1WI, T2WI and FLAIR in 4 cases. Encephalomalacia was observed in 3 cases during follow-up.

Conclusion

In the early stage of compound diphenoxylate poisoning in children, multiple extensive edema-necrosis and hemorrhagic-necrosis focus were observed in basic nucleus, pallium and cerebellum, these resulted in the corresponding brain dysfunction with encephalomalacia. MRI scan in the early stage in this condition may provide evidences of brain impairment, and is beneficial for the early diagnosis, treatment and prognosis assessment.     

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.     

Three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage at 3T: A prospective controlled study

Purpose

To assess acetabular and femoral hip joint cartilage with three-dimensional (3D) delayed gadolinium-enhanced magnetic resonance imaging (dGEMRIC) in patients with degeneration of hip joint cartilage and asymptomatic controls with morphologically normal appearing cartilage.

Methods and materials

A total of 40 symptomatic patients (18 males, 22 females; mean age: 32.8 ± 10.2 years, range: 18–57 years) with different hip joint deformities including femoroacetabular impingement (n = 35), residual hip dysplasia (n = 3) and coxa magna due to Legg–Calve–Perthes disease in childhood (n = 2) underwent high-resolution 3D dGEMRIC for the evaluation of acetabular and femoral hip joint cartilage. Thirty-one asymptomatic healthy volunteers (12 males, 19 females; mean age: 24.5 ± 1.8 years, range: 21–29 years) without underlying hip deformities were included as control. MRI was performed at 3 T using a body matrix phased array coil. Region of interest (ROI) analyses for T1_Gd assessment was performed in seven regions in the hip joint, including anterior to superior and posterior regions.

Results

T1_Gd mapping demonstrated the typical pattern of acetabular cartilage consistent with a higher glycosaminoglycan (GAG) content in the main weight-bearing area. T1_Gd values were significantly higher in the control group than in the patient group whereas significant differences in T1_Gd values corresponding to the amount of cartilage damage were noted both in the patient group and in the control group.

Conclusions

Our study demonstrates the potential of high-resolution 3D dGEMRIC at 3 T for separate acetabular and femoral hip joint cartilage assessment in various forms of hip joint deformities.     

Radiological and clinical outcome after operations in patients with congenital deficiencies of the wrist and hand

Purpose

To evaluate the incidence, therapy results, complications and radiologic workup of operatively treated congenital disorders of the hand and wrist in a large university center during a 10-year period.

Methods

The institutional database was retrospectively analysed for patients with congenital disorders of the hand and wrist treated operatively during a 10-year period (1998-2007). Disorders were classified according to Van Schoonhoven into 11 different entities. For each entity the incidence, the patients’ age at the time of operation, the pre- and postoperative clinical and radiological workup and the frequency of complications and reoperations were evaluated.

Results

A total of 278 patients was treated operatively for congenital disorders of the hand and wrist with syndactyly being present in 112, thumb hypoplasia in 15, polydactyly in 11, radial clubhand in 7, radioulnar synostosis in 6, clinodactyly in 6, thumb duplication in 6, brachydactyly in 4 and macrodactyly in 4 cases. Patients’ age at the time of operation varied substantially between the different entities with a mean age between 0.9 and 6.2 years. There were 9 complications (3%, n = 278) - all of them infections. There were 28 reoperations (10%, n = 278), 13 of them (5%, n = 278) due to reoccurring webs in syndactyly.

Conclusion

Congenital disorders of the hand and wrist include various rare diseases with syndactyly and thumb hypoplasia being the most frequent entities. As a rule, diagnosis is obtained clinically. Radiologic workup typically consists of plain radiography. Complications are rare, whereas reoperations are frequent, mostly due to reoccurring webs in syndactyly.     

MR imaging of the biliary tract with Gd-EOB-DTPA: Effect of liver function on signal intensity

Objective

To quantitatively evaluate the signal intensity of the biliary tract in gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging and to investigate the effect of liver function on the signal intensity of the biliary tract.

Materials and methods

A total of 32 patients with and without chronic liver disease (normal liver group, n = 15; chronic liver disease group, n = 17) were included in this study. All patients were prospectively enrolled for evaluation of known or suspected focal liver lesions. In the chronic liver disease group, the etiologies were chronic hepatitis C virus infection (n = 12) and chronic hepatitis B virus infection (n = 5). The median Child-Pugh score was 5 (range, 5-7). Each patient received the standard dose of Gd-EOB-DTPA (0.025 mmol/kg of body weight). Post-contrast T1-weighted MR images were obtained at 5, 10, 15, 20, 25, and 30 min after administration of Gd-EOB-DTPA. Maximum signal intensities (SIs) of the right and left hepatic ducts, common hepatic duct, and common bile duct were measured. Relative signal intensity was calculated as follows: relative SI = maximum SI_bile duct/mean SI_muscle. Serum albumin level, serum total bilirubin level, prothrombin time, indocyanine green retention rate at 15 min (ICG-R15), and estimated glomerular filtration rate were entered into regression analysis.

Results

The signal intensity of the bile duct reached a peak 30 min after administration of Gd-EOB-DTPA. The mean relative signal intensity of the right and left hepatic ducts at the peak time point was not significantly different between the two groups, while increase in signal intensity was delayed in the chronic liver disease group. The mean relative signal intensity of the common hepatic duct and that of the common bile duct at the peak time point were significantly different between the two groups (Wilcoxon rank-sum test, P = 0.03, respectively). Stepwise regression analysis revealed that ICG-R15 was a significant predictor of the signal intensity of the bile duct (right and left hepatic ducts, P = 0.04; common hepatic duct, P = 0.008; common bile duct, P = 0.003).

Conclusions

The results of our study demonstrate that the presence of chronic liver disease significantly affects the signal intensity of the bile duct in Gd-EOB-DTPA-enhanced MR imaging. ICG-R15 was only a significant predictor of the signal intensity of the bile duct. The signal intensity of the bile duct may reflect underlying liver function.     

Role of the MDCT urography in diagnosis of renovascular diseases

Purpose

The current study aimed to evaluate the efficiency of the MDCT urography in the diagnosis of renovascular diseases.

Material and methods

Ten consecutive patients were recruited from the Urology out patients’ clinics of Assuit University. Their ages ranged from 22 to 60 years. Prior to Multidetector Computed Tomography (MDCT) examination, relevant clinical data and renal function tests were obtained in every patient.

Result

In the current study MDCT easily diagnosed during the arterial phase, six patients with renal aneurysms, two patients with nutcracker syndrome, one patient with arteriovenous malformation (AVM) and one patient of renal artery stenosis.

Conclusion

MDCT plays an important role in the evaluation and management of both primary renovascular disease and the secondary manifestations of each disease. MDCT angiography with multiplanar reconstruction and three-dimensional display is valuable in studying patients with renovascular lesions involving the proximal renal vessels.     

Evaluation of subjective image quality in relation to diagnostic task for cone beam computed tomography with different fields of view

Aims

To evaluate subjective image quality for two diagnostic tasks, periapical diagnosis and implant planning, for cone beam computed tomography (CBCT) using different exposure parameters and fields of view (FOVs).

Materials and methods

Examinations were performed in posterior part of the jaws on a skull phantom with 3D Accuitomo (FOV 3 cm × 4 cm) and 3D Accuitomo FPD (FOVs 4 cm × 4 cm and 6 cm × 6 cm). All combinations of 60, 65, 70, 75, 80 kV and 2, 4, 6, 8, 10 mA with a rotation of 180° and 360° were used. Dose-area product (DAP) value was determined for each combination. The images were presented, displaying the object in axial, cross-sectional and sagittal views, without scanning data in a random order for each FOV and jaw. Seven observers assessed image quality on a six-point rating scale.

Results

Intra-observer agreement was good (κ_w = 0.76) and inter-observer agreement moderate (κ_w = 0.52). Stepwise logistic regression showed kV, mA and diagnostic task to be the most important variables. Periapical diagnosis, regardless jaw, required higher exposure parameters compared to implant planning. Implant planning in the lower jaw required higher exposure parameters compared to upper jaw. Overall ranking of FOVs gave 4 cm × 4 cm, 6 cm × 6 cm followed by 3 cm × 4 cm.

Conclusions

This study has shown that exposure parameters should be adjusted according to diagnostic task. For this particular CBCT brand a rotation of 180° gave good subjective image quality, hence a substantial dose reduction can be achieved without loss of diagnostic information.     

Diffusion weighted imaging and estimation of prognosis using apparent diffusion coefficient measurements in ischemic stroke

Objective

Estimation of the prognosis of infarction by using diffusion weighted imaging (DWI) and quantitative apparent diffusion coefficient (ADC) measurements.

Methods

23 patients having acute stroke symptoms with verified infarction in magnetic resonance imaging (MRI) were included in this study. Their MRI studies were performed between 6 and 12 h after the onset of their symptoms and were repeated on the fifth day. The infarction volumes were calculated by using DWI and the patients were divided into two groups as the ones having an expansion in the infarction area (group 1, n = 16) and the others having no expansion in the infarction area (group 2, n = 7). Quantitative ADC values were estimated. The groups were compared in terms of the ADC values on ADC maps obtained from DWI, performed during the between 6 and 12 h from the onset of the symptoms, referring to the core of the infarction (ADC_IC), ischemic penumbra (ADC_P) and the nonischemic parenchymal tissue (ADC_N). P values < 0.05 were accepted to be statistically significant.

Results

During the between 6 and 12 h mean infarction volume calculated by DWI was 23.3 cm³ for group 1 patients (ranging from 1.1 to 68.6) and this was found to be 40.3 cm³ (ranging from 1.8 to 91.5) on the fifth day. For the group 2 patients these values were found to be 42.1 cm³ (ranging from 1 to 94.7) and 41.9 (ranging from 1 to 94.7) for the same intervals respectively. A significant statistical result was failed to be demonstrated between the mean ADC_IC and ADC_N values (p = 0.350 and p = 0.229 respectively). However the comparison of the ADC_P values between the groups was found to be highly significant (p < 0.001). When the differences between the ADC_P and ADC_IC and ADC_N and ADC_P were compared the results proved to be statistically significant (p = 0.038 and p < 0.001 respectively).

Conclusions

We believe that ADC results that would be obtained from the core and the penumbra of the infarction area will be beneficial in the estimation of the infarction prognosis and in the planning of a treatment protocol.     

New proposal for the staging of nonalcoholic steatohepatitis: Evaluation of liver fibrosis on Gd-EOB-DTPA-enhanced MRI

Purpose

We investigated whether the gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI was useful for nonalcoholic steatohepatitis (NASH) staging based on the severity of liver fibrosis.

Materials and methods

Twenty-one male Sprague-Dawley rats aged 7 weeks, weighing about 150 g in NASH group were fed a choline-deficient diet for 4, 7 or 10 weeks, and seven rats in the control group were fed a standard diet (n = 7). After the feeding period, the rats were subjected to contrast-enhanced MRI (2D-FLASH; TR/TE = 101/2.9 ms, flip angle 90°). Gd-DTPA (0.1 mmol Gd/kg) and Gd-EOB-DTPA (0.025 mmol Gd/kg) were injected at 24-h intervals, and the speed of contrast injection was 1 mL/s. Signal intensities of the liver were measured and the relative enhancement (RE), the time of maximum RE (T_max) and elimination half-life of RE (T_1/2) in the liver were compared. The fibrosis rate (%) was calculated with the following formula: fibrosis/whole area × 100.

Results

The fibrosis rates of each group were as follows: 0.52, 0.79, 2.84, and 0.50% (4, 7, 10 weeks and control groups). The fibrosis rate of the 10 weeks group was significantly higher than the control and 4 or 7 weeks groups. Although there was no difference between the T_max and T_1/2 of each group after Gd-DTPA injection, the T_max and T_1/2 of the 10 weeks group were significantly prolonged in comparison with the control and 4 or 7 weeks groups after Gd-EOB-DTPA injection (p < 0.01). There was a significant correlation between the fibrosis rate and T_max or T_1/2 after Gd-EOB-DTPA injection (r = 0.90 or 0.97).

Conclusion

It was possible to assess the progress of liver fibrosis in NASH by evaluating the signal intensity-time course on Gd-EOB-DTPA-enhanced MRI.     

A qualitative approach to combined magnetic resonance imaging and spectroscopy in the diagnosis of prostate cancer

Purpose

To investigate the feasibility and diagnostic value of a whole prostate qualitative approach to combined magnetic resonance imaging and spectroscopy (MRI + MRS) in the detection of prostate cancer in patients with elevated PSA.

Materials and methods

Three hundred and fifty six subjects (mean serum PSA 11.47 ng/ml, range 0.40-133 ng/ml) were examined with fast-T2-weighted images (MRI) and 3D-magnetic resonance spectroscopy (MRS). Both modalities were qualitatively analyzed on a whole prostate basis by a single radiologist using a 4-point diagnostic scale. Prostate cancer was histopathologically proven in 220 patients and non-evidence of cancer was determined after at least 12 months clinical follow-up in 136 subjects.

Results

Receiver operating curve analysis revealed a significantly better diagnostic performance of MRI + MRS (A_z = 0.857) than MRI alone (A_z = 0.801) and MRS alone (A_z = 0.810). The sensitivity, specificity and accuracy of MRI + MRS for detection of prostate cancer were 72.3%, 92.6%, and 80.1%, respectively.

Conclusions

Spectral evaluation with a whole prostate qualitative approach is feasible in routine clinical practice. The combination of MRI and MRS yields superior diagnostic results than either modality alone.     

Ultrasonographic evaluation of degenerative changes in the distal radioulnar joint: correlation of findings with gross anatomy and MR arthrography in cadavers

Objective

To determine the accuracy of ultrasonography (US) in the evaluation of degenerative changes in the distal radioulnar joint (DRUJ).

Methods and materials

Ten cadaveric specimens were obtained. US evaluation of cartilage degeneration and thickness was performed by two independent and blinded readers (R1 and R2). Gross anatomy and MR arthrography evaluated by two readers in consensus served as the reference standard. The joint surface not accessible to US was measured.

Results

US interreader agreement was non-existent for cartilage thickness measurements and moderate for cartilage degeneration grading (weighted kappa = 0.41).Comparing US and MR imaging evaluation, there was no correlation between US R1 and MR imaging (Pearson correlation coefficient [PCC] = 0.352) and a moderate correlation between US R2 and MR imaging (PCC = 0.570) concerning cartilage thickness measurements. Concerning cartilage degeneration grading, there was a moderate to strong (R1 Spearman correlation coefficient [SCC] = 0.729)/R2 SCC = 0.767) correlation concerning cartilage degeneration grading.Comparing US and gross anatomic evaluation, there was no correlation for US R1 (PCC = 0.220) and a strong correlation for US R2 (PCC = 0.922) concerning cartilage thickness measurements, and a strong to moderate correlation (R1 SCC = 0.808/R2 SCC = 0.597) concerning cartilage degeneration grading.The mean sector of the articular surface of the ulna head not accessible to US was 13°.

Conclusion

In conclusion the DRUJ is accessible to US except in the central 13° sector of the joint surface. US was approved to be sufficient in demonstrating advanced stages of cartilage degeneration. Thus, US of the DRUJ is recommended in patients suffering from ulnar-sided wrist pain.     

7 Tesla quantitative hip MRI: T1, T2 and T2* mapping of hip cartilage in healthy volunteers

Objectives

To evaluate the technical feasibility and applicability of quantitative MR techniques (delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T2 mapping, T2* mapping) at 7 T MRI for assessing hip cartilage.

Methods

Hips of 11 healthy volunteers were examined at 7 T MRI with an 8-channel radiofrequency transmit/receive body coil using multi-echo sequences for T2 and T2* mapping and a dual flip angle gradient-echo sequence before (T1₀) and after intravenous contrast agent administration (T1_Gd; 0.2 mmol/kg Gd-DTPA^2? followed by 0.5 h of walking and 0.5 h of rest) for dGEMRIC. Relaxation times of cartilage were measured manually in 10 regions of interest. Pearson’s correlations between R1_delta?=?1/T1_Gd???1/T1₀ and T1_Gd and between T2 and T2* were calculated. Image quality and the delineation of acetabular and femoral cartilage in the relaxation time maps were evaluated using discrete rating scales.

Results

High correlations were found between R1_delta and T1_Gd and between T2 and T2* relaxation times (all p?<?0.01). All techniques delivered diagnostic image quality, with best delineation of femoral and acetabular cartilage in the T2* maps (mean 3.2 out of a maximum of 4 points).

Conclusions

T1, T2 and T2* mapping of hip cartilage with diagnostic image quality is feasible at 7 T. To perform dGEMRIC at 7 T, pre-contrast T1 mapping can be omitted.

Key Points

? dGEMRIC of hip cartilage with diagnostic image quality is feasible at 7 T. ? To perform dGEMRIC at 7 T, pre-contrast T1 mapping can be omitted. ? T2(*) mapping of hip cartilage with diagnostic image quality is feasible at 7 T. ? T2 and T2* relaxation times of cartilage were highly correlated at 7 T. ? Best delineation of femoral and acetabular cartilage was found in T2* maps.

     

Capillary telangiectasias of the pons. Does diffusion-weighted MR increase diagnostic accuracy?

Background and Purpose

Capillary telangiectasias are benign lesions of the brainstem which are sometimes difficult to distinguish from other lesions in standard MRI. The purpose of this study was to evaluate if diffusion-weighted imaging (DWI) could help to improve diagnostic accuracy.

Methods

148 MR examinations of patients with pontine lesions were evaluated retrospectively and revealed capillary telangiectasia (n = 18), presumed microvascular disease (n = 20), encephalitis disseminata (n = 21), pontine myelinolysis (n = 16), tumor (n = 20), acute infarction (n = 20), subacute infarction (n = 13) and chronic infarction (n = 20).All patients were examined using identical measurement parameters for DWI, Fluid attenuated inversion recovery, T2-weighted turbo spin-echo, and T1-weighted spin-echo before and after application of contrast agent in transverse orientation.

Results

All capillary telangiectasias showed low signal intensity in DWI and significant contrast enhancement after application of gadolinium. Hypointense signal on DWI was very rare for the remaining lesions: only 1 pontine myelinolysis, 1 tumor, 4 subacute infarctions, and 19 chronic infarctions also revealed low signal intensity on DWI. The combination of high signal intensity on T1-weighted post-contrast images and low signal intensity on DWI was found for all capillary telangiectasias, but only for 1/20 tumor and for 4/13 subacute infarctions. These lesions could be differentiated by their clinical course and/or MRI follow-up examinations.The results of the visual assessment were confirmed by quantitative evaluation.

Conclusion

DWI seems to be a useful adjunct for the diagnosis of capillary telangiectasias which will facilitate the differential diagnosis concerning tumorous, inflammatory and ischemic lesions.     

Arterial bending angle and wall morphology correlate with slow coronary flow: Determination with multidetector CT coronary angiography

Background and purpose

The purpose of this study was to assess angulations and vessel wall morphology that could lead to bending head loss in the RCA and LMCA arteries of patients with slow coronary flow (SCF) evaluated by MDCT coronary angiography.

Methods

The study involved 51 patients (45 males, mean age: 59.6 years) who were diagnosed with SCF by coronary angiography. Diagnosis of SCF was based on thrombolysis in myocardial infarction (TIMI) frame count. Fifty-one patients with absence of slow flow were selected as the control group. The angulations of the main coronary arteries with the aorta were measured from the axial images obtained through MDCT coronary angiography, and the findings were recorded. In addition, the coronary artery walls of these patients were evaluated. For statistical analysis, SPSS for Windows 10.0 (SPSS Inc., Chicago, IL) was used. For comparisons of the angles, either independent samples t test or the Mann-Whitney U test was used where appropriate.

Results

The results of the study indicated that 38 patients had SCF in the LAD. Comparisons of patients with SCF with the controls revealed that in the patients with SCF, the mean angle of the LMCA with the aorta (40.9 ± 20.5°) was statistically significantly smaller than the mean angle of the LMCA with the aorta in the control cases (71.8 ± 11°). In 12 patients, slow flow was detected in the RCA. Those with slow flow in the RCA had significantly smaller angles (mean: 33.2 ± 20.4°) than the other cases (mean: 78.9 ± 10.7°).

Conclusion

A small angle of origin of the main coronary arteries from the aorta, measured on MDCT examinations is correlated with slow blood flow in those vessels, as calculated by the TIMI frame count in catheter coronary angiography.     

The effect of first ballet classes in the community on various postural parameters in young girls

Objective

To examine the effect of first season ballet classes in the community on the thoracic kyphosis (TK), lumbar lordosis (LL), hip external rotation (ER) and joint flexibility in young girls.

Design

Longitudinal single blinded cohort control study.

Setting

Institutional.

Participants

30 girls aged 6-9, recruited from the same primary school were divided equally into 2 groups: a group bi-weekly community ballet class and a sedentary control group.

Intervention

All girls were assessed prior to ballet classes (t₀), at the conclusion (t₁) (6 months), and approximately one year later (t_fu).

Main outcome measures

Beighton score for joint hyper-flexibility, peak of TK and LL, range of hip ER, ratio TK/LL, and individual’s height, weight and BMI.

Results

LL at t1 became greater in the ballet girls’ group (23.7°± 6) as opposed to the controls (19.5°±3.9) due to a decrease in LL in the controls from t0 to t1 (mean difference = −16.5°) (cut-off score = 3.45°) (p < 0.05). TK decreased from t0 to t1 in the ballet girls’ group (mean difference = −26.1°) and controls (mean difference = −31.3°) (cut-off score = 4.85°) (p < 0.05). Left hip ER decreased only in the controls from t0 to t1 (mean difference = −13.8°) (cut-off score = 5.43°) (p < 0.05). Beighton score at tfu was greater in the ballet girls’ group (6.1 ± 2.3) as opposed to the controls (4.4 ± 1.5) (p < 0.05).

Conclusions

First season ballet classes for young girls in the community can be associated with relatively greater LL, and left hip ER and joint hyper-flexibility.