Post-operative lumbar spine: comparative study of TSE T2 and turbo-FLAIR sequences vs contrast-enhanced SE T1.

AIM: To compare turbo T2 weighted spin echo (TSE T2) and turbo-FLAIR (fluid attenuated inversion recovery) vs gadolinium enhanced T1 weighted spin echo (SE T1) sequence in the differential diagnosis between disc herniation and post-surgical fibrosis. MATERIALS AND METHODS: Sixty-four patients who underwent surgical treatment for lumbar disc herniation with persistent or recurrent post-surgical symptoms were studied with a 0.5 Tesla MR system. The sequences used were TSE T2, turbo-FLAIR and T1 SE with and without intravenous gadolinium DTPA. The enhanced T1 SE sequence was considered the gold standard. Sensitivity and specificity were calculated. RESULTS: The sensitivity was 100% for both TSE T2 and turbo-FLAIR sequences. The specificity was 94% for TSE T2 and 92% for turbo-FLAIR. Negative predictive value was 100% for both sequences and positive predictive value 84% and 80% for TSE T2 and turbo-FLAIR, respectively. CONCLUSION: Although both sequences show high sensitivity, TSE-T2 presents greater specificity than turbo-FLAIR as compared to enhanced T1 SE. TSE T2 also offers the advantage of myelographic effect. We consider that the use of rapid sequences may avoid the need for intravenous contrast medium in most cases, reserving gadolinium DTPA only to those where all the criteria for hernia or fibrosis are not fulfilled.

Lateral stabilizing structures of the knee: functional anatomy and injuries assessed with MR imaging.

The lateral aspect of the knee is stabilized by a complex arrangement of ligaments, tendons, and muscles. These structures can be demonstrated with routine spin-echo magnetic resonance (MR) imaging sequences performed in the sagittal, coronal, and axial planes. Anterolateral stabilization is provided by the capsule and iliotibial tract. Posterolateral stabilization is provided by the arcuate ligament complex, which comprises the lateral collateral ligament; biceps femoris tendon; popliteus muscle and tendon; popliteal meniscal and popliteal fibular ligaments; oblique popliteal, arcuate, and fabellofibular ligaments; and lateral gastrocnemius muscle. Injuries to lateral knee structures are less common than injuries to medial knee structures but may be more disabling. Most lateral compartment injuries are associated with damage to the cruciate ligaments and medial knee structures. Moreover, such injuries are frequently overlooked at clinical examination. Structures of the anterolateral quadrant are the most frequently injured; posterolateral instability is considerably less common. Practically all tears of the lateral collateral ligament are associated with damage to posterolateral knee structures. Most injuries of the popliteus muscle and tendon are associated with damage to other knee structures. MR imaging can demonstrate these injuries. Familiarity with the musculotendinous anatomy of the knee will facilitate accurate diagnosis with MR imaging.

Pancreatic hydatid disease.

Pancreatic location of hydatid disease is exceptional. We report our findings in a 10-year-old asymptomatic patient who was admitted because of epigastric trauma. Radiological findings were considered secondary to trauma and therefore undervalued.