ABSTRACT
Hip pain can have multiple causes, including intra-articular, juxta-articular, and referred pain, mainly from spine or sacroiliac joints. In this review, we discuss the causes of intra-articular hip pain from childhood to adulthood and the role of the appropriate imaging techniques according to clinical suspicion and age of the patient. Stress is put on the findings of radiographs, currently considered the first imaging technique, not only in older people with degenerative disease but also in young people without osteoarthritis. In this case plain radiography allows categorization of the hip as normal or dysplastic or with impingement signs, pincer, cam, or a combination of both.
ABSTRACT
The aim of this review is to compare the effectiveness of percutaneous vertebroplasty and kyphoplasty to treat pain and improve functional outcome from vertebral fractures secondary to osteoporosis and tumor conditions. In 2009, two open randomized controlled trials published in the New England Journal of Medicine questioned the value of vertebroplasty in treating vertebral compression fractures. Nevertheless, the practice of physicians treating these conditions has barely changed. The objective of this review is to try to clarify the most important issues, based on our own experience and the reported evidence about both techniques, and to guide towards the most appropriate choice of treatment of vertebral fractures, although many questions still remain unanswered.
ABSTRACT
OBJECTIVE: To study the correlation between the T2 relaxation times of the patellar cartilage and morphological MRI findings of chondromalacia. METHODS: This prospective study comprises 50 patients, 27 men and 23 women suffering of anterior knee pain (mean age: 29.7, SD 8.3 years; range: 16-45 years). MRI of 97 knees were performed in these patients at 1.5T magnet including sagittal T1, coronal intermediate, axial intermediate fat sat and T2 mapping. Chondromalacia was assessed using a modified version of Noyes classification. The relaxation time, T2, was studied segmenting the full thickness of the patellar cartilage in 12 areas: 4 proximal (external facet-proximal-lateral (EPL), external facet-proximal-central (EPC), internal facet-proximal-central (IPC), internal facet-proximal-medial (IPM), 4 in the middle section (external facet-middle-lateral (EML), external facet-middle-central (EMC), internal facet-middle-central (IMC), internal facet-middle-medial (IMM) and 4 distal (external facet-distal-lateral (EDL), external facet-distal-central (EDC), internal facet-distal-central (IDC), internal facet-distal-medial (IDM). RESULTS: T2 values showed a significant increase in mild chondromalacia regarding normal cartilage in most of the cartilage areas (p<0.05), except in the internal distal facet (IDC and IDM), EPC, EDL, and IMM. Severe chondromalacia was characterized by a fall of T2 relaxation times with loss of statistical significant differences in comparison with normal cartilage, except in EMC and IMC, where similar values as mild chondromalacia were maintained (p<0.05). CONCLUSIONS: Steepest increase in T2 values of patellar cartilage occurs in early stages of patellar cartilage degeneration. Progression of morphologic changes of chondromalacia to more severe degrees is associated to a new drop of T2 relaxation times approaching basal values in most of the areas of the patellar cartilage, except in the central area of the middle section, where T2 values remain increased.
Subject(s)
Algorithms , Arthralgia/diagnosis , Arthralgia/etiology , Chondromalacia Patellae/complications , Chondromalacia Patellae/pathology , Image Enhancement/methods , Image Interpretation, Computer-Assisted/methods , Magnetic Resonance Imaging/methods , Adolescent , Adult , Female , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and Specificity , Young AdultABSTRACT
En este artículo se realiza una revisión general de los diferentes procedimientos intervencionistas percutáneos, guiados mediante técnicas de imagen, y utilizados para el diagnóstico y tratamiento de las diversas causas responsables del dolor de raquis. Estos procedimientos pueden ser meramente diagnósticos, como la discografía y la biopsia, diagnósticos y terapéuticos, como las infiltraciones, o puramente terapéuticos, como la vertebroplastia, las técnicas descompresivas del disco intervertebral o la ablación tumoral. Se revisan las indicaciones, ventajas y complicaciones de las diferentes técnicas (AU)
The aim of this article is to perform a general review of the different radiological percutaneous procedures used to diagnose and treat the many causes of back pain. These procedures can be merely diagnostic, such as discography and biopsy, diagnostic and therapeutic, such as epidural and facets injections, or only therapeutic, such as vertebroplasty, decompressive techniques of the intervertebral disk and tumour ablation. We review the indications, advantages and complications of these techniques (AU)
Subject(s)
Humans , Radiography, Interventional/methods , Low Back Pain , Spinal Diseases , Spine/physiopathology , Vertebroplasty , Kyphoplasty , BiopsyABSTRACT
The aim of this article is to perform a general review of the different radiological percutaneous procedures used to diagnose and treat the many causes of back pain. These procedures can be merely diagnostic, such as discography and biopsy, diagnostic and therapeutic, such as epidural and facets injections, or only therapeutic, such as vertebroplasty, decompressive techniques of the intervertebral disk and tumour ablation. We review the indications, advantages and complications of these techniques.
Subject(s)
Back Pain/diagnostic imaging , Radiography, Interventional , Radiology, Interventional/trends , Back Pain/etiology , Back Pain/pathology , Back Pain/surgery , Biopsy/methods , Decompression, Surgical/methods , Diskectomy/methods , Double-Blind Method , Evidence-Based Medicine , Humans , Injections , Intervertebral Disc Displacement/diagnostic imaging , Intervertebral Disc Displacement/surgery , Kyphoplasty/methods , Nerve Block/methods , Preoperative Care , Radiography, Interventional/adverse effects , Radiography, Interventional/methods , Radiology, Interventional/methods , Randomized Controlled Trials as Topic , Rhizotomy/methods , Spinal Diseases/diagnostic imaging , Spinal Diseases/surgery , Spinal Neoplasms/diagnostic imaging , Spinal Neoplasms/surgery , Vertebroplasty/methodsABSTRACT
We present our experience of the treatment of bone tumors with radiofrequency thermal ablation (RFTA). Over the past 4 years, we have treated 26 cases (22 benign and 4 malignant) using CT-guided RFTA. RFTA was the sole treatment in 19 cases and was combined with percutaneous cementation during the same session in the remaining seven cases. Our approach to the tumors was simplified, using a single point of entrance for both RFTA and percutaneous osteoplasty. In the benign cases, clinical success was defined as resolution of pain within 1 month of the procedure and no recurrence during the follow-up period. It was achieved in 19 out of the 21 patients in which curative treatment was attempted. The two non-resolved cases were a patient with osteoid osteoma who developed a symptomatic bone infarct after a symptom-free period of 2 months and another with femoral diaphysis osteoblastoma who suffered a pathological fracture after 8 months without symptoms. The procedure was considered clinically successful in the five cases (4 malign and 1 benign) in which palliative treatment was attempted, because there was a mean (±SD) reduction in visual analogue scale (VAS) pain score from 9.0±0.4 before the procedure to <4 during the follow-up period.
Subject(s)
Bone Neoplasms/diagnostic imaging , Bone Neoplasms/surgery , Catheter Ablation/methods , Surgery, Computer-Assisted/methods , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
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