Diagnostic and Prognostic Implications of Spine Magnetic Resonance Imaging at Diagnosis in Patients with Multiple Myeloma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study is to determine the diagnostic and prognostic role of baseline spinal magnetic resonance imaging (MRI) in patients with multiple myeloma. MATERIALS AND METHODS: We enrolled patients newly diagnosed with multiple myeloma from 2004-2011 at a single center. Abnormal MRI findings that were not detected in radiographs have been analyzed and categorized as malignant compression fractures or extramedullary plasmacytoma. The bone marrow (BM) infiltration patterns on MRI have been classified into five categories. RESULTS: A total of 113 patients with a median age of 65 years (range, 40 to 89 years) were enrolled in the study. Malignant compression fractures not detected in the bone survey were found in 26 patients (23.0%), including three patients (2.6%) with no related symptoms or signs. Extramedullary plasmacytoma was detected in 22 patients (19.5%), including 15 (13.3%) with epidural extension of the tumor. Of these 22 patients, 11 (50.0%) had no relevant symptoms or signs. The presence of malignant compression fractures did not influence overall survival; whereas non-epidural extramedullary plasmacytoma was associated with poor overall survival in the multivariate analysis (hazard ratio, 3.205; 95% confidence interval [CI], 1.430 to 9.845; p=0.042). During the follow-up for a median of 21 months (range, 1 to 91 months), overall survival with the mixed BM infiltrative pattern (median, 24.0 months; 95% CI, 22.9 to 25.1 months) was shorter than those with other patterns (median 56 months; 95% CI, 48.9 to 63.1 months; p=0.030). CONCLUSION: These results indicate that spine MRI at the time of diagnosis is useful for detecting skeletal lesions and predicting the prognosis in patients with multiple myeloma.

Traumatic Dissection of Subcutaneous Fatty Tissue: Ultrasonographic Findings and Treatment

PURPOSE: To evaluate the imaging findings of a traumatic dissection of subcutaneous fatty tissue and the treatment. MATERIALS AND METHODS: Fifteen lesions from 13 patients treated by sonography were investigated in our study. The lesions were treated by aspiration only, aspiration followed by steroid injection, and by surgical procedure. Based on the treatment, five factors such as location, size and extent of the lesions, nature of the contents, and treatment effectiveness were assessed. RESULTS: A total of 6 lesions in the thigh, 4 in the leg, 3 in the knee, and 1 each in proximal forearm and flank. All lesions were found in subcutaneous fatty tissue with an average size of 8.9 cm. The nature of the contents was serous (n = 2), hemorrhaging (n = 9), and an abscess (n = 1). Without treatment, three lesions disappeared. Five of the 7 lesions vanished after being treated by aspiration. Only one out of three lesions disappeared when they were treated by steroid injection after aspiration. The three hemorrhaging lesions disappeared after operation, but one serous lesion remained. CONCLUSION: Dissection of subcutaneous fatty tissue represents a cystic mass with serous fluid or hemorrhage. The effectiveness of lesion treatment may relate to the location, size, and content of the lesion.

Serial MR Imaging of Intramuscular Hematoma: Experimental Study in a Rat Model with the Pathologic Correlation

OBJECTIVE: We wanted to demonstrate the temporal changes of the magnetic resonance imaging (MRI) findings in experimentally-induced intramuscular hematomas in rats and to correlate these data with the concurrent pathologic observations. MATERIALS AND METHODS: Intramuscular hematoma was induced in 30 rats. The MR images were obtained at 1, 4, 7 and 10 days and at 2, 3, 4, 6 and 8 weeks after muscle injury. The characteristic serial MRI findings were evaluated and the relative signal intensities were calculated. Pathologic specimens were obtained at each time point. RESULTS: On the T1-weighted imaging (T1WI), the intramuscular hematomas exhibited isointensity compared to that of muscle or the development of a high signal intensity (SI) rim on day one after injury. The high SI persisted until eight weeks after injury. On the T2-weighted imaging (T2WI), the hematomas showed high SI or centrally low SI on day one after injury, and mainly high SI after four days. A dark signal rim was apparent after seven days, which was indicative of hemosiderin on the pathology. The gradient echo (GRE) imaging yielded dark signal intensities at all stages. CONCLUSION: Unlike brain hematomas, experimentally-induced intramuscular hematomas show increased SI on both the T1WI and T2WI from the acute stage onward, and this is pathologically correlated with a rich blood supply and rapid healing response to injury in the muscle. On the T2WI and GRE imaging, high SI with a peripheral dark signal rim is apparent from seven days to the chronic stage.

Appropriate Position of the Forearm for the Measurement of BMD / 대한골다공증학회지

OBJECTIVES: The aim of this study was to evaluate the appropriate position of the forearm for measuring the BMD (Bone Mineral Density). MATERIAL & METHODS: CT scanning was performed in 21 men to determine the appropriate position for the forearm. Twenty one healthy volunteers who were without any history of operations, anomalies or trauma were enrolled. CT scanning was used to evaluate the cross sectional structures and the rotation angle on the horizontal plane of the distal radius. The rotation angle was measured by the m-view program on the PACS monitor. The DXA was used for measuring 20 dried radii of cadaveric specimens in pronation and supination with 3degrees, 5degrees, 7degrees and 10degrees of rotation respectively, including a neutral position (0degrees) to evaluate the changes of BMD according to the rotation. RESULTS: The mean rotation angle of the distal radius on the CT scan was 7degrees of supination (76%, n=16), 3.3degrees of pronation (15%, n=3), and 0degrees at the neutral position (9%, n=2), respectively. The total average rotation angle in the 21 people was 5.2degrees of supination. In the cadaveric study, the BMD of the distal radius was different according to the rotational angles. The lowest BMD was obtained in 1.4degrees of pronation. CONCLUSION: In the case of the measuring of the BMD in the forearm in a neutral position, the rotational angle of the distal radius is close to supination. Therefore, pronation is needed for the constant measurement of BMD in the forearm. We recommend measuring the lowest BMD of the distal radius at about five degrees of pronation.

Clinical Findings of the CompleteRadial Rupture of the Meniscal Root Ligament of the Medial Meniscus Posterior Horn: Preliminary Report / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical findings of a complete radial rupture of the meniscal root ligament of the medial meniscus posterior horn. MATERIALS AND METHODS: From April, 2004 to December, 2004, nineteen patients (mean age, 56.5 years old) who were diagnosed with a medial root ligament rupture of the medial meniscus posterior horn during an arthroscopic treatment were enrolled in this study. The clinical findings, physical examinations, and the radiological and arthroscopic findings were analyzed retrospectively. RESULTS: Thirteen out of the nineteen cases had tenderness of the knee without specific trauma. The preoperative physical examination revealed posteromedial joint line tenderness in fifteen cases. A medial joint line protrusion with direct tenderness was observed in six cases (31.5%) and a positive McMurray test was observed in seventeen cases (89.5%). MRI was carried out in sixteen patients. All sixteen patients were diagnosed with a rupture of the meniscal root ligament using the author's diagnostic MRI criteria. CONCLUSION: Non-traumatic pain and posteromedial joint line tenderness in patients in their sixth decade are indications of a rupture of the meniscal root ligament of the medial meniscus posterior horn. Confirmation using MRI and arthroscopy is important for making a diagnosis.

An Arteriovenous Malformation in the Suprapatellar Fat Pad of the Knee associated with Klippel-Trenaunay-Weber Syndrome: A Case Report

Klippel-Trenaunay-Weber syndrome (KTWS) is a vascular disorder that has significant arteriovenous malformation (AVM). We report a case of an AVM in the suprapatellar fat pad of the knee in a patient with the characteristic manifestations of KTWS, including cutaneous hemangioma, limb hypertrophy, and varicose veins. Magnetic resonance imaging, color Doppler sonography, and subsequent angiography demonstrated an AVM in the supra-patellar fat pad of the right knee causing painful swelling of the knee.

Resection of the Proximal Tendinous Portion in Avulsion of the Semimembranosus Tendon from the Ischial Tuberosity in an Adult: A Case Report / 대한정형외과학회잡지

Hamstrings are composed of the semimembranosus and semitendinosus and biceps femoris muscles and act as extensors of the thigh and flexors of the leg. Avulsion of the hamstring from the ischial tuberosity has a high rate of incidence among adolescents and young adults, and most often results from exercises that require sudden acceleration and deceleration, such as running, soccer, hurdling and basketball. This injury, caused by forcible flexion of the hip with the knee extended, is commonly called "hurdlers' injury". There have been several reports describing treatment of hamstring proximal tendon avulsion injury by open reduction and internal fixation. We describe a case of semimembranosus tendon avulsion from the ischial tuberosity in the adult that was satisfactorily treated by resection of the proximal portion of the tendon.

Radiologic and Clinical Findings of Anterior Femoroacetabular Impingement in Early Osteoarthritis of the Hip / 대한정형외과학회잡지

PURPOSE: A patient diagnosed with early osteoarthritis due to hip pain who went through arthroscopic treatment were studied in the radiologic aspect and clinical aspect of anterior femoroacetabular impingement (FAI). MATERIALS AND METHODS: The subjects were 43 early osteoarthritis patients from May 1995 to May 2003 who underwent arthroscopic treatment and were able to be followed for at least 1 year. These patients were divided into two groups, the first group with patients who had no osteoarthritis on simple radiograph but with degenerative changes of the labrum and cartilage on MR arthorgram and arthroscopy, and the second group with osteoarthirtic findings on simple radiograph. Both groups were checked to see if they showed signs of anterior FAI at the acetabulum and proximal femur on radiograph and MR arthrogram. Improvement after surgery was evaluated using the JOA (Japanese Orthopaedic Association) pain score. RESULTS: About FAI, 6 patients (29%) out of 21 in group 1 showed radiologic evidence of FAI, while 12 of out 22 (56%) had it in group 2, with a total of 18 patients (42%). The pain score of pre/post operation were improved in group 1 which showed evidence of FAI and while the score of group 2 were improved from 0.83 to 1.83 and 0.92 to 1.67 in group 2. And the pain score of the group 1 which showed no evidence of FAI were improved from 0.73 to 2.60 and the score of group 2 were improved from 0.60 to 2.10. As a result, there was small improvement in pain scores of patient group with FAI. CONCLUSION: Among the patients who were diagnosed with early primary osteoarthritis of th hip, we could find anterior femoroacetabular impingement in the radiogram in some cases and the patients with FAI have low pain relief. Therefore we can expect more improved clinical result with inspection of the anterior FAI.

Arthroscopic Treatment of the Lipoma Arborescens in All Compartments of the Knee: A Case Report / 대한정형외과학회잡지

Lipoma arborescens is a villous proliferation of fatty tissue in the synovial membrane, and known causes are trauma, meniscal injury, inflammation, infection, degenerative change, tumor, and so forth. The reported cases are extremely rare. We report a case of lipoma arborescens developed in all compartments of the knee joint, and treated well with arthroscopic surgery.

MR Findings of Acute Rhabdomyolysis: Case Report

Rhabdomyolysis is an acute disorder resulting from skeletal muscle injury in which intracellular contents are released into extracellular space and plasma. The condition may result from drug or alcohol overdose, infection, crush injuries, collagen disease, or intensive exercise. We report two cases of acute rhabdomyolysis resulting from CO poisoning and alcohol overdose, and discuss the MRI and ultrasonographic findings.

The Diagnostic Usefulness of CT-guided Needle Biopsy or Aspiration in Infectious Spondylitis

PURPOSE: To determine the diagnostic value of CT-guided biopsy or aspiration of the spine and paraspinal soft tissue in infectious spondylitis. MATERIALS AND METHODS: Between January 2000 and June 2002, 58 patients underwent 67 biopsies and/or aspirations under CT guidance to identify the organism causing infectious spondylitis, and were included in this study. Nine underwent rebiopsy. In all patients, MR images were available before biopsy and/or aspiration. In 63 of 67 procedures, the specimens or aspirates obtained were prepared for culture and smear, and for histological examination, four procedures involved aspiration only. In ten patients with suspected tuberculosis, a polymerase chain reaction test was performed. For all procedures, the transpedicular, transcostovertebral or paravertebral route was involved, according to the level and shape of the lesions, and 14-, 16-, or 18-gauge core biopsy needles and/or 20-gauge aspiration needles were employed. Lesions invloved a paravertebral (n=17), psoas (n=8) or epidural (n=1) abscess; an intervertebral disc (n=20); or a vertebral body (n=21). The levels at the mid-thoracic spine were T4-T10 (n=11); at the thoracolumbar junction, T11-L1 (n=14); at the lumbar spine, L1-L4 (n=25); and at the lumbo-sacral junction, L5-S1 (n=17). In nine of 58 patients, rebiopsy was performed. RESULTS: Diagnosis was confirmed in 22 of 58 patients (38%), and was as follows: tuberculous spondylitis (n=17), pyogenic spondylitis (n=4), and fungal spondylitis (n=1). Thirty-six unconfirmed cases were diagnosed as nonspecific inflammation (n=21), fibrosis involving cortical bone (n=1), necrotic material (n=5) and inadequate specimen without evidence of malignancy (n=9). Only one of the nine cases in which biopsy was repeated was confirmed as tuberculous spondylitis. Diagnosis was confirmed in 7 of 17 paravertebral abscesses (41%), 8 of 21 vertebral bodies (38%), 6 of 20 intervertebral discs (30%) and 1 of 8 psoas abscesses (13%). CONCLUSION: In infectious spondylitis, the overall diagnostic yield of CT-guided needle biopsy and/or aspiration is relatively low, but the procedure seems to be effective for excluding malignancy. In identifying the organisms involved in infectious spondylitis, a paravertebral lesion is in a more favoured location than a psoas lesion.

Acute Rhabdomyolysis and Ischemia of the Spinal Cord Following the Heavy Alcohol Ingestion: A case report

Ischemic myelopathy is a rare and uncommon disease than the cerebral ischemia. Ischemia of spinal cord usually occur in the midthoracic regions (T4-T8). The major arteries supplying spinal cord are anterior and posterior spinal arteries. Anterior spinal artery is more responsible for the ischemic change of the spinal cord. We report a 45 years old man with ischemia of the spinal cord and acute renal failure due to rhabdomyolysis following the heavy alcohol ingestion.

Inflammatory Myofibroblastic Tumor of Perineal Soft Tissue: A Case Report

Inflammatory myofibroblastic tumor is a rare benign condition of unknown etiology, and it may simulate malignancy. It is composed of myofibroblast, plasma cells and histiocytes and is found in lung, the liver, orbit, skin, mesentery, retroperitoneum and maxillary sinus. We report a case of inflammatory myofibroblastic tumor of perineal subcutaneous fat in a 35-year-old woman who complained of a palpable mass. Ultrasonography revealed a well-marginated lobulated hypoechoic lesion with peripheral poorly-defined hyperechoic strands in the subcutaneous fat of the right perineum. The lesion demonstrated low signal intensity on T1-weighted images and of heterogenous high signal intensity on T2-weighted images, compared with surrounding muscle. After intravenous injection of gadolinium, it showed clear homogeneous enhancement but poorlydefined adjacent strands. The final histologic diagnosis was inflammatory myofibroblastic tumor.

Adhesive Capsulitis of the Shoulder: MR Arthrography

PURPOSE: Adhesive capsulitis is a clinical syndrome involving pain and decreased joint motion caused by thickening and contraction of the joint capsule. The purpose of this study is to describe the MR arthrographic findings of this syndrome. MATERIALS AND METHODS: Twenty-nine sets of MR arthrographic images were included in the study. Fourteen patients had adhesive capsulitis diagnosed by physical examination and arthrography, and their MR arthrographic findings were compared with those of 15 subjects in the control group. The images were retrospectively reviewed with specific attention to the thickness of the joint capsule, volume of the axillary pouch (length, width, height(depth)), thickness of the coracohumeral ligament, presence of extra-articular contrast extravasation, and contrast filling of the subcoracoid bursa. RESULTS: Mean capsular thickness measured at the inferior portion of the axillary pouch was 4.1 mm in patients with adhesive capsulitis and 1.5 mm in the control group. The mean width of the axillary pouch was 2.5 mm in patients and 9.5 mm in controls. In patients, the capsule was significantly thicker and the axillary pouch significantly narrower than in controls (p<0.05). Capsule thickness greater than 2.5 mm at the inferior portion of the axillary pouch (sensitivity 93%, specificity 80%) and a pouch narrower than 3.5 mm (sensitivity 93%, specificity 100%) were useful criteria for the diagnosis of adhesive capsulitis. In patients with this condition, extra-articular contrast extravasation was noted in six patients (43%) and contrast filling of the subcoracoid bursa in three (21%). CONCLUSION: The MR arthrographic findings of adhesive capsulitis are capsular thickening, a low-volume axillary pouch, extra-articular contrast extravasation, and contrast filling of the subcoracoid bursa. Capsule thickness greater than 2.5 mm at the inferior portion of the axillary pouch and a pouch width of less than 3.5 mm are useful diagnostic imaging characteristics.

Acetabular labral tear: Diagnosis and Treatment / 대한정형외과학회잡지

PURPOSE: To determine the significance of Magnetic Resornance Arthrography (MRA) and arthroscopy for diagnosis and treatment of acetabular labral tears as a cause of chronic hip pain. MATERIALS & METHODS: Thirty-seven hips with clinical suspicion of labral lesions were examined with MRA between Mar. 1995 and Mar. 1998. Among them, twenty-two patients underwent the diagnostic and operative arthroscopy. Another fifteen patients were observed closely without management. RESULTS: The mean age was 43 years (18-68 years) and male was twenty-five (68%) . Most common causes was degenerative (10 cases, 27%) and idiopathic (10 cases, 27%) . In MRA, stage IIA (partial tear by Czerny classification) were most common findings (twenty-one portion, 47%) . Including double tears in several patients, most common labral tear was located in the anterosuperior portion ( twenty-three cases, 51%) . Comparing arthroscopic finding, the accuracy of MRA for diagnosis of labral tear was 86.4%. Arthroscopically, we modified the morphological classification of labral tear to radial fibrillated (10 portions) , radial fibrillated + peripheral longitudinal (3) , peripheral longitudinal (4) , complete detachment (5) . All patients except three (86.4%) were improved by the arthroscopic partial labrectomy. In conservative patients, only three (20%) were spontaneously improved. CONCLUSION: MRA, and subsequent arthroscopic management appears to be a promising modality for detection and treatment of labral tear in patients with chronic hip pain.

Unilateral and Bilateral Lumbosacral Transitional Vertebrae: Comparison of the Incidence of Combined Diseases

PURPOSE: The purpose of this study was to evaluate the radiologic findings of lumbosacral transitional verte-brae (LSTV), as seen on plain radiographs and MRI, and to compare the incidence of combined diseases be-tween unilateral and bilateral groups. MATERIALS AND METHODS:We retrospectively evaluated the plain radiographs and MR images of 63 patients with LSTV, classifying its type according to Castellvi 's criteria, and evaluated disc herniations, facet joint os-teoarthritic change, scoliosis, and spondylolisthesis. We then compared the incidence of each combined diseases between unilateral and bilateral groups, and as a control group, 63 patients without LSTV were also eval-uated. RESULTS: Forty of 63 cases of LSTV (63.5%) were bilateral, and 23 (36.5%) unilateral. According to Castellvi 's criteria, the incidence of type I was 41.3% (unilateral 7 cases, bilateral 19), type III30.2% (unilateral 8 cases, bilateral 11), type II23.8% (unilateral 8 cases, bilateral 7), and type IV 4.8% (unilateral 0 cases, bilateral 3).With combined diseases, the incidence of disc herniation was 66.7% (unilateral 15 cases, bilateral 27), moderate to severe facet joint osteoarthritic change 28.6% (unilateral 11 cases, bilateral 7), scoliosis 27.0% (unilateral 9 cases, bilateral 8), and spondylolisthesis 9.5% (unilateral 2 cases, bilateral 4). The incidence of facet joint os-teoarthritic change was significantly higher in the unilateral group (47.8%) than in the bilateral group (17.5%) (p=0.02), and scoliosis occurred at a higher rate in the unilateral group (39.1%) than in the bilateral group (20.0%) (p=0.18). There was, however, no significant difference in the incidence of disc herniation and spondylolisthesis between the two groups (unilateral group: 65.2% and 8.7%; bilateral group: 67.5% and 10.0%, respectively). CONCLUSION: With LSTV, the incidence of facet joint osteoarthritic change was significantly higher in the unilat-eral group than in the bilateral group, and scoliosis also showed a higher rate of occurrence in the unilateral group.

Magnetic Resonance Imaging on Postoperative Pain Syndrome / 대한정형외과학회잡지

PURPOSE: To determine the accuracy of MRI on postoperative pain syndrome (POPS), including early complications such as hematoma or infection. MATERIALS AND METHODS: Of the 54 patients with the POPS, we analyzed pre-operative MRI findings compared with operative findings on 39 patients, excluding nonunion, instability, metal failure and pseudarthrosis, who underwent an operation for POPS from December 1994 to June 1997. There were 25 men (64.1%) and 14 women (35.9%), aged from 16 to 68 years (average 44.5 years). They were divided into 5 subgroups and calculated for sensitivity, specificity and positive predictability. RESULTS: MRI accuracy in recurred disc was 84%, scar adhesion, recurred or developed stenosis, infection and hematoma was 100% for each overall accuracy of MRI was 93%. Average interval of reoperation in POPS was 3.2 years. In 21 cases (53.8%), symptoms persisted without pain-free interval after first operation. CONCLUSIONS: Early complications, including hematoma and infection, are easily detected with MRI. Especially if patient complains of severe leg pain or neurologic deficit, MRI is a good diagnostic tool. MRI is a useful method for evaluation of most cases of POPS, but it is limited in evaluating recurred disc or scar adhesion only in T1, T2 weighted image. Therefore, Gd-DTPA enhancement is necessary for an accurate diagnosis.

Prophylaxis of Postoperative Deep Vein Thrombosis and Thromboembolism with Low Molecular Weight Heparin ( Nadroparin Calcium ) after Hip Arthroplasty: Comparison with Warfarin and Low Molecular Weight Dextran / 대한정형외과학회잡지

PURPOSE: To evaluate the preventive effect of deep vein thrombosis (DVT) by low molecular weight heparin (LMWH) after hip arthroplasty. MATERIALS AND METHODS: We analyzed 98 consecutive patients (107 cases) who were older than forty years of age and were scheduled to have elective primary or revision hip arthroplasty from August 1996 to March 1998. All of them received prophylactic LMWH, Nadroparin calcium (Fraxi-parine, Sanofi France). The effectiveness and safety of LMWH were evaluated in a prospective randomized trial. LMWH was injected subcutaneously once daily, from twelve hours before the operation to the tenth postoperative day with fixed dosage according to patient s body weight. For the detection of DVT after hip arthroplasty, patients were evaluated with color doppler image (CDI) preoperatively, postoperatively 7-10 days and six weeks consecutively. RESULTS: DVT was detected in six patients (5.61%) and no symptomatic pulmonary embolism occurred. Asymptomatic isolated calf vein thrombosis was identified in four patients, they had no therapeutic treatment for the thrombosis but the thrombi were resolved spontaneously without any proximal propagation. Proximal vein DVT was identified in two patients and the thrombi were resolved within 6 weeks with additional treatment using Nadroparin calciurn administration. In three cases, late developing thrombi was detected at follow-up CDI carried out at the sixth postoperative week. There were three cases of bleeding complications. CONCLUSIONS: Compared to our previous report of the incidence of DVT using low molecular weight dextran (12.2%) and warfarin (16.6%) with the incidence of DVT using low molecular weight heparin (5.61%), we considered that prophylaxis with LMWH is more effective in preventing DVT after hip arthroplasty. We also found that asymptomatic isolated calf vein thrombosis is resolved spontaneously. For the detection of late developing thrombosis, we recommend consecutive follow-up CDI.

Efficacy of MR Arthrography in the Diagnosis of the Acetabular Labral Tear

PURPOSE: To determine the accuracy of magnetic resonance (MR) arthrography in the detection and staging of lesions of the acetabular labrum. MATERIALS AND METHODS: Fifteen hips of 14 patients with chronic hip pain and clinical suspicion of labral lesions were examined with direct or indirect MR arthrography and underwent subsequent arthroscopic evaluation. The study population consisted of six women and eight men aged between 40 and 59 years. Nine arthrograms were obtained intra-articular administration of gadolinium solution, and six involved articular motion exercise after intravenous administration of gadolinium solution. In 14 cases a phased-array pelvic coil was used, and a shoulder coil in one. Fat-suppressed T1-weighted images were obtained in the coronal, oblique coronal and oblique axial planes, and T1-and T2-weighted images were obtained in the axial plane. Labral lesions were graded according to the Czerny classification and evaluated on the basis of presence or absence of a tear and location (anteroinferior, anterosuperior, superior, posterosuperior, posteroinferior). The findings were then correlated with the arthroscopic findings. RESULTS: After direct and indirect MR arthography, the findings-based on the Czerny classification -were as follows : stage IA:3; IB:1; IIA:8; IIB:1; IIIA:4; IIIB:0. MR arthrography also showed that seven cases were located in the anterosuperior portion of the labrum, seven in the superior portion, and three in the posteroinferior portion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR arthrography for diagnosis of the labral tear was 92%, 75%, 92%, 75 %, and 88 %, respectively. CONCLUSION: In this preliminary study, MR arthrography appears to be a promising imaging modality for accurate diagnosis and useful for screening patients with chronic hip pain.

Lumbar Disc Herniation at High Levels: MRI and Clinical Findings

PURPOSE: To assess the frequency, location, associated MR findings, and clinical symptoms of the high levellumbar disc herniation(HLDH). MATERIALS AND METHODS: A total of 1076 patients with lumbar disc herniation wereretrospectively reviewed. MR images of 41 of these with HLDH(T12-L1, L1-2, L2-3) were analysed in terms offrequency, location, and associated MR findings, and correlated with clinical symptoms of HLDH. RESULTS: Theprevalence of HLDH was 3.8%(41/1076). HLDH was located at T12-L1 level in four patients(10%), at L1-2 level in14(34%), at L2-3 level in 21(51%), and at both L1-2 and L2-3 levels in two. The age of patients ranged from 20 to72 years (mean, 44), and there were 26 men and 16 women. In 11(27%), whose mean age was 32 years, isolated discherniation was limited to these high lumbar segments. The remaining 30 patients had HLDH associated with variableinvolvement of the lower lumbar segments. Associated lesions were as follow : lower level disc herniation(14patients, 34%); apophyseal ring fracture(8 patients, 19%); Schmorl's node and spondylolisthesis (each 6patients, each 14%); spondylolysis(3 patients, 7%); and retrolisthesis(2 patients, 5%). In 20 patients(49%) withHLDH(n=41), there was a previous history. CONCLUSION: Patients with HLDH showed a relatively high incidence ofassociated coexisting abnormalities such as lower lumbar disc herniation, apophyseal ring fracture, Schmorl'snode, spondylolysis, and retrolisthesis. In about half of all patients with HLDH there was a previous history oftrauma. The mean age of patients with isolated HLDH was lower; clinical symptoms of the condition were relativelynonspecific and their incidence was low.