Condromalácia patelar: análise de quatro testes clínicos / Chondromalacia patella: analysis of four clinical tests

Introdução: Condromalácia patelar (CP) é a perda da cartilagem de uma ou mais porções da patela, agravada por atividades que aumentam a compressão entre a patela e o fêmur. Objetivo: Analisar quatro testes clínicos para CP em indivíduos com e sem CP. Método: Foram avaliados 52 indivíduos: 28 com condromalácia e 24 sem. O diagnóstico foi determinado por raio-x (22), ressonância magnética (9) e ultrassom (4). Foi feita anamnese e exame físico, onde aplicaram-se os testes de Waldron (TW), apreensão patelar (AP), Sinal de Frund (SF) e Sinal de Clarke (SC). Resultados: SF e SC identificaram o maior número de sujeitos (12) com CP, seguido do TW (10) e o AP (7). Entretanto, os testes também evidenciaram resultados falso-positivos (SC ? 12; SF ? 4; TW ? 2 e AP -1) Conclusão: Os testes clínicos utilizados nesse estudo foram inconsistentes, evidenciando resultados falso-positivos, sugerindo cautela na sua utilização como indicadores da CP.

Introduction: chondromalacia patella (CP) is the loss of cartilage of one or more portions of the patella, aggravated by activities that increase the compression between the patella and femur. Objective: To assess four clinical trials for lung cancer for individuals with and without CP. Methods: We studied 52 subjects: 28 with and 24 without chondromalacia. The diagnosis was determined by X-ray (22), MRI (9) and ultrasound (4). Was made medical history and physical examination, where we applied tests Waldron (TW), patellar apprehension (AP) Signal Fründe (SF) and Signal Clarke (SC). Results: SF and SC identified the largest number of subjects (12) with CP, followed by TW (10) and AP (7). However, tests also showed false-positive results (SC - 12, SF - 4, TW - 2, AP -1) Conclusion: The clinical tests used in this study were inconsistent, showing false positive results, suggesting caution in its use as Indicators of CP.

Evaluation of the Chondromalacia Patella Using a Microscopy Coil: Comparison of the Two-Dimensional Fast Spin Echo Techniques and the Three-Dimensional Fast Field Echo Techniques

OBJECTIVE: We wanted to compare the two-dimensional (2D) fast spin echo (FSE) techniques and the three-dimensional (3D) fast field echo techniques for the evaluation of the chondromalacia patella using a microscopy coil. MATERIALS AND METHODS: Twenty five patients who underwent total knee arthroplasty were included in this study. Preoperative MRI evaluation of the patella was performed using a microscopy coil (47 mm). The proton density-weighted fast spin echo images (PD), the fat-suppressed PD images (FS-PD), the intermediate weighted-fat suppressed fast spin echo images (iw-FS-FSE), the 3D balanced-fast field echo images (B-FFE), the 3D water selective cartilage scan (WATS-c) and the 3D water selective fluid scan (WATS-f) were obtained on a 1.5T MRI scanner. The patellar cartilage was evaluated in nine areas: the superior, middle and the inferior portions that were subdivided into the medial, central and lateral facets in a total of 215 areas. Employing the Noyes grading system, the MRI grade 0-I, II and III lesions were compared using the gross and microscopic findings. The sensitivity, specificity and accuracy were evaluated for each sequence. The significance of the differences for the individual sequences was calculated using the McNemar test. RESULTS: The gross and microscopic findings demonstrated 167 grade 0-I lesions, 40 grade II lesions and eight grade III lesions. Iw-FS-FSE had the highest accuracy (sensitivity/specificity/accuracy = 88%/98%/96%), followed by FS-PD (78%/98%/93%, respectively), PD (76%/98%/93%, respectively), B-FFE (71%/100%/93%, respectively), WATS-c (67%/100%/92%, respectively) and WATS-f (58%/99%/89%, respectively). There were statistically significant differences for the iw-FS-FSE and WATS-f and for the PD-FS and WATS-f (p < 0.01). CONCLUSION: The iw-FS-FSE images obtained with a microscopy coil show best diagnostic performance among the 2D and 3D GRE images for evaluating the chondromalacia patella.

Condromalácia de patela: comparação entre os achados em aparelhos de RM de alto e baixo campo magnético / Chondromalacia patellae: comparison of high-field strength versus low-field strength magnetic resonance imaging findings

OBJETIVO: Comparar os aparelhos de ressonância magnética de baixo campo e de alto campo para estudo da cartilagem articular da patela. MATERIAIS E MÉTODOS: Foi realizado estudo usando as seqüências GRE 2D, GRE 3D, FSE T2 e STIR (baixo campo) e TSE T2 SPIR. Cada seqüência foi analisada separadamente para o estudo da cartilagem, sem o conhecimento dos dados do paciente e do resultado das outras seqüências, sendo atribuído grau de lesão de 0 a 3 e descrita a sua localização. Os resultados de concordância e discordância foram analisados pelos testes de Kappa e McNemar. RESULTADOS: Na faceta medial houve baixas concordâncias e as discordâncias mostraram significativa superestimação. Na faceta lateral houve boas concordâncias e as discordâncias não foram significativas. No ápice houve boas concordâncias e as discordâncias mostraram significativa subestimação. CONCLUSÃO: A seqüência STIR teve a melhor concordância com a seqüência TSE T2 SPIR. Lesões de alto grau são mais bem caracterizadas pelas seqüências do aparelho de baixo campo. Areas de aumento de sinal dificultam o estudo da cartilagem da faceta medial da patela no aparelho de baixo campo.

OBJECTIVE: To compare the performance of low-field-strength and high-field-strength magnetic resonance imaging equipments for evaluation of the patella articular cartilage. MATERIALS AND METHODS: The study was developed using GRE 2D, GRE 3D, FSE T2, STIR sequences (low-field) and TSE T2 SPIR sequence. Each sequence has been separately analyzed for evaluation of the cartilage without knowledge of other sequences results or any patients data; the lesion was assigned a grade from 0 to 3 and had its location defined. Agreement and disagreement results were analyzed by Kappa and McNemar tests. RESULTS: Medial facet has presented low agreement index and disagreements showed to be significantly overestimated. Lateral facet has presented a reasonable agreement index and disagreement index was not significant. Medial ridge has presented a reasonable agreement index and disagreement index has showed to be underestimated. CONCLUSION: The STIR sequence versus TSE T2 SPIR sequence has presented the higher agreement index. High grade lesions are better characterized by low-field-strength magnetic resonance imaging equipment sequences. Areas of increased signal intensity make difficult the study of the patella medial facet cartilage in low-field-strength equipment.

Ressonância magnética no diagnóstico da condromalácia de patela: [revisão] / Use of magnetic resonance imaging in the diagnosis of chondromalacia patella: [revision]

As lesões da cartilagem articular da patela são bastante comuns, e em virtude da dissociação entre os sintomas e sinais e o estágio das lesões condrais o exame de escolha inicial é a ressonância magnética, sendo importante para o radiologista estar habituado às alterações condrais nesta doença para o correto diagnóstico.

Patellar articular cartilage lesions are very common and due to the dissociation between signs and symptoms and the stage of the chondral lesions the diagnostic method of choice is magnetic resonance imaging. Therefore, radiologists shold be familiar with chondral abnormalities in order to correctly diagnose this condition.