Dynamic Magnetic Resonance Imaging (MRI) in Inguinal-Related Chronic Groin Pain (CGP): Comparison With Systematic Surgical Assessment.

Objective This study aimed to assess the performance of dynamic MRI in Chronic Groin Pain (CGP) related to the inguinal region, comparing it with surgery as the gold standard. Materials and methods A cohort of 25 consecutive patients exhibiting persistent clinical inguinal-related CGP underwent a pre-surgical pelvis MRI. Imaging encompassed strictly axial Fast Spin Echo (FSE) T1 sequences, both without (static sequence) and with Valsalva Maneuver (VM, dynamic sequence), alongside axial-oblique Proton Density weighted with Fat Saturation (PDFS). Evaluation of these sequences focused on identifying Abdominal Wall (AW) injuries. A consistent surgical approach was employed by the same surgeon across all patients (34 AW injuries in 25 patients). Specificity (Sp), Sensitivity (Se), Negative Predictive Value (NPV), Positive Predictive Value (PPV), and overall accuracy of MRI sequences and their combinations for detecting AW injuries were computed by comparing them to surgical findings. Results Ninety sequences were obtained, revealing that the axial PDFS oblique sequence emerged as the most singularly reliable (Accuracy: 58.82%). The optimal sequence combination was found to be axial T1 combined with axial T1 VM, exhibiting an accuracy of 75.00% (Se: 85.71%, Sp: 70.59%, PPV: 54.55%, NPV: 92.31%, with an average duration of 4 minutes and 31 seconds). Conclusion Based on our findings, we advocate for the adoption of the axial FSE T1 combined with Valsalva Maneuver as a dependable protocol for inguinal-related CGP, characterized by a highly reasonable examination duration.

Transforaminal versus interlaminar CT-guided lumbar epidural steroid injections: prospective study of 237 patients with unilateral radicular pain and up to 5 years of follow-up.

OBJECTIVE: To compare the efficacy of the transforaminal approach (TFA) versus the interlaminar approach (ILA) for CT-guided epidural steroid injection (CTESI) in the treatment of persistent lumbosacral radicular pain (LRP > 6 weeks) with long-term follow-up. METHODS: Patients were prospectively assessed for pain by visual analogue scale (VAS) and functional disability (Oswestry Disability Index, (ODI)) before treatment, then 6 weeks (6W), 6 months (6 M), and 5 years (5Y) after CTESI. RESULTS: Overall, n = 237 patients (TFA, n = 71 and ILA, n = 166) were included, and 96 patients had 5 years of follow-up. Both groups showed a statistically significant improvement in VAS and ODI values at 6W (TFA, n = 60 and ILA, n = 146, P < 0.001 for both), at 6 M (TFA, n = 34 and ILA, n = 96, P < 0.001 for both), and at 5Y (TFA, n = 32 and ILA, n = 64, P < 0.001 for both). No significant differences were observed between the two approaches in VAS or ODI decreases at 6W (P = 0.38 and P = 0.33 respectively), 6 M (P = 0.13 and P = 0.51 respectively), or 5Y (P = 0.15 and P = 0.57 respectively). No major complications were noted. CONCLUSION: Outcomes after CTESI by ILA approaches are similar to those by TFA for the treatment of persistent LRP.

Intra-articular Injection of Bone Marrow Concentrate for Treatment of Patellofemoral Osteoarthritis: Preliminary Results Utilizing an Ultrasound-Guided Marrow Harvesting Technique.

OBJECTIVE: To assess the effectiveness of intra-articular injection of bone marrow concentrate (BMC) under ultrasound (US) guidance in the treatment of patellofemoral osteoarthritis (OA), with clinical and volumetric magnetic resonance (MR) imaging follow-up. METHODS: This retrospective study included 96 consecutive patients referred for US-guided intra-articular injection of BMC for symptomatic patellofemoral OA for which conservative treatment had failed. A control group of 21 patients with symptomatic patellofemoral OA was included for comparison. Data on International Knee Documentation Committee (IKDC), Visual Analog Scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores as well as volumetric MR imaging (using T2 mapping sequence) were collected before and 12 months after injection, and the results were compared. RESULTS: No technical adverse events were noted during bone marrow aspiration, BMC preparation, or intra-articular injection of BMC. No clinical adverse events were reported during long-term follow-up. All mean scores improved between baseline and 12 months after intra-articular injection of BMC (VAS 5.5 to 3.6, P < .0001; WOMAC 36.8 to 22.2, P < .0001; and IKDC 41.8 to 58.2, P < .0001). MR imaging at 1 year of follow-up after BMC treatment showed no statistically significant difference in hyaline cartilage volume compared with that at the baseline (P = .690), suggesting stabilization of the cartilage degradation process. In contrast, the group of untreated patients showed a significant decrease in the cartilage volume (P = .001), corresponding to a cartilage loss of 6.9%. CONCLUSIONS: The results suggest that intra-articular injection of BMC under US guidance could be a promising option for the treatment of symptomatic patellofemoral OA and could promote the preservation of healthy residual cartilage volume.

Comparison of interlaminar CT-guided epidural platelet-rich plasma versus steroid injection in patients with lumbar radicular pain.

INTRODUCTION: The treatment of persistent lumbar radicular pain (LRP) by CT-guided epidural steroid injection (ESI) is extensively used and associated with rare but serious complications. Platelet-rich plasma (PRP), which has recently been shown to favor healing and the anti-inflammatory process by delivering growth factors and cytokines, might be an alternative and potentially safer option. We compared the efficacy of interlaminar CT-guided epidural PRP injections (EPRPI) and ESI in the treatment of persistent LRP (> 6 weeks). METHODS: In this non-randomized comparative study, patients were prospectively assessed for pain using the numerical rating scale (NRS) and for function with the Oswestry Disability Index (ODI) before and 6 weeks after treatment. Related paired and independent t tests were used for intra- and inter-group comparisons. RESULTS: A total of 60 patients were included in 2 groups (n = 30 EPRPI, n = 30 ESI). A statistically significant improvement was found in both groups at 6 weeks (mean NRS values 5.7 (± 2.36) at D0 and 3.7 (± 2.3) at 6 weeks (p < 0.01); mean ODI values 30 (± 11) at D0 and 21 (± 13) at 6 weeks (p < 0.01)). No significant difference was observed in the decrease in NRS and ODI scores between the 2 groups at 6 weeks (p = 0.848 and p = 0.314 for the NRS and ODI, respectively). No major complications were noted. CONCLUSION: The results of CT-guided interlaminar EPRPI are similar to ESI for the treatment of persistent LRP and could be a safer option. KEY POINTS: • Treatment of persistent lumbar radicular pain by CT-guided epidural steroid injections is associated with rare but serious complications. • By promoting an anti-inflammatory process, epidural platelet-rich plasma injections might be an alternative treatment of persistent radicular pain. • Platelet-rich plasma CT-guided epidural injections are similar to steroid for the treatment of lumbar radicular pain at 6 weeks post-procedure and could be a safer option.

Critical shoulder angle: what do radiologists need to know?

The critical shoulder angle (CSA) constitutes a straightforward and highly reproducible tool. Degenerative rotator cuff tears (RCT) are associated with a significantly larger CSA. In this review, the most relevant features of the CSA are summarized: (1) the relationship between the CSA and RCT pathophysiology, (2) accurate measurement of the CSA according to various imaging modalities, (3) the contribution of the CSA in predicting the occurrence of RCT, and (4) RCT recurrence after surgical repair.

New MRI features improve subtype classification of hepatocellular adenoma.

OBJECTIVE: MRI is crucial for the classification of hepatocellular adenomas (HCA) into subtypes. Our objective was to review and increase MRI criteria for subtype classification and define the limits. METHODS: Pathological and radiological data of 116 HCAs were retrospectively analyzed to investigate MRI features of HCA pathological subtypes. Risk for complication was also evaluated with regard to subtype and tumor size. RESULTS: 38/43 (88%) HNF1α-mutated HCAs (H-HCAs) were discriminated by (i) fatty component (homogeneous or heterogeneous) and (ii) hypovascular pattern, with a sensitivity of 88% and a specificity of 97%. 51/58 (88%) inflammatory HCAs (IHCAs) displayed features of sinusoidal dilatation (SD) including three different patterns (global SD, atoll sign, and a new "crescent sign" corresponding to a partial peripheral rim, hyperintense on T2W and/or arterial phase with persistent delayed enhancement). Sensitivity was 88% and specificity 100%. However, some HCA remained unclassifiable by MRI: HCA remodeled by necrotic/hemorrhagic changes covering > 50% of the lesion, H-HCAs without steatosis, IHCAs without SD, ß-catenin-mutated and unclassified HCAs. Regarding malignant transformation (5/116) and bleeding (24/116), none was observed when the HCA diameter was smaller than 5.2 cm and 4.2 cm, respectively. CONCLUSION: Based on the largest series evaluated until now, we identified several non-described MRI features and propose new highly sensitive and specific MRI criteria. With the addition of these new features, 88% of the two main HCA subtypes could be identified. KEY POINTS: • HNF1α-mutated hepatocellular adenomas (H-HCA) are characterized by the presence of fat and hypovascular pattern in MRI. • Inflammatory hepatocellular adenomas (I-HCA) are characterized by different patterns translating sinusoidal dilatation including the newly described crescent sign. • No MRI specific pattern was identified for ß-catenin-mutated HCA (b-HCA).

Comparison of three CT-guided epidural steroid injection approaches in 104 patients with cervical radicular pain: transforaminal anterolateral, posterolateral, and transfacet indirect.

INTRODUCTION: The treatment of persistent cervical radicular pain (CRP) by CT-guided epidural steroid injections (CTESI) by a transforaminal anterolateral (TFA) approach is associated with rare but serious complications. Two recently described transforaminal posterolateral (TFP) and transfacet indirect (TFT) approaches may be safer options, but have not been extensively evaluated. We compared the efficacy of three CTESI approaches (TFA, TFP, and TFT) in the treatment of persistent CRP (>6 weeks). METHODS: Patients were prospectively assessed for pain using the visual analog scale (VAS) and for functional disability by the Neck Disability Index (NDI) before treatment, then 6 weeks and 6 months after CTESI. RESULTS: A total of 104 patients were included (n = 30 TFA, n = 36 TFP, and n = 38 TFT approaches). Each group was found to have a statistically significant improvement at 6 weeks (median VAS values: 7 (2-9) at D0 and 2 (3-6) at 6 weeks p < 0.01; median NDI values: 38 (24-50) at D0 and 29 (18-42) at 6 weeks (p < 0.01)), and at 6 months (median VAS values: 7 (2-9) at D0 and 4 (2-6) at 6 months (p < 0.01); median NDI values: 38 (24-50) at D0 and 28 (13-40) at 6 months (p < 0.01)). No significant difference was observed in the decrease in VAS and NDI scores among the three approaches at 6 weeks (p = 0.635 and p = 0.54 for VAS and NDI respectively) or 6 months (p = 0.704 and p = 0.315 for VAS and NDI respectively). No major complications were noted. CONCLUSION: The results of CTESI using the TFP or TFT approach are similar to those for TFA in the treatment of persistent CRP and could be a safer option.