ABSTRACT
Elbow pain in overhead sport athletes is not uncommon. Repetitive throwing can lead to chronic overuse and/or acute injury to tendons, ligaments, bones, or nerves about the elbow. A thorough history and physical examination of the thrower's elbow frequently establishes the diagnosis for pain. Imaging can provide additional information when the clinical picture is unclear or further information is necessary for risk stratification and treatment planning. This article focuses on current imaging concepts and image-guided treatments for injuries commonly affecting the adult throwing athlete's elbow.
Subject(s)
Arthralgia/diagnostic imaging , Arthralgia/etiology , Athletic Injuries/diagnostic imaging , Athletic Injuries/therapy , Elbow Injuries , Elbow Joint/diagnostic imaging , Analgesics/administration & dosage , Arthralgia/prevention & control , Arthrography/methods , Athletic Injuries/complications , Collateral Ligament, Ulnar/diagnostic imaging , Collateral Ligament, Ulnar/injuries , Evidence-Based Medicine , Fractures, Bone/diagnostic imaging , Fractures, Bone/therapy , Humans , Magnetic Resonance Imaging/methods , Plastic Surgery Procedures/methods , Surgery, Computer-Assisted/methods , Treatment Outcome , Ulnar Collateral Ligament Reconstruction , Ultrasonography/methodsABSTRACT
OBJECTIVE: The purpose of this study was to determine whether the use of radial reformatted images could improve the diagnostic performance of a 3D fast spin-echo (FSE) sequence for detecting surgically confirmed cartilage lesions within the knee joint. MATERIALS AND METHODS: An MRI examination consisting of five 2D FSE sequences and a sagittal 3D FSE sequence was performed at 3 T on the knee joint of 150 patients who underwent subsequent knee arthroscopy, which included grading of the articular cartilage. Conventional axial, sagittal, and coronal reformatted images and radial reformatted images were created from the 3D FSE source data. Two musculoskeletal radiologists independently used the 2D FSE sequences, the 3D FSE sequence with conventional reformatted images only, and the 3D FSE sequence with both radial and conventional reformatted images at three separate sessions to grade each articular surface of the knee joint. McNemar tests were used to compare diagnostic performance for detecting cartilage lesions using arthroscopy as the reference standard. RESULTS: The 3D FSE sequence with radial and conventional reformatted images had higher sensitivity (p < 0.001) and similar specificity (p = 0.73) to the 2D FSE sequences for detecting cartilage lesions and higher sensitivity (p < 0.001) and specificity (p = 0.002) than the 3D FSE sequence with conventional reformatted images for detecting cartilage lesions. The 3D FSE sequence with conventional reformatted images had similar sensitivity (p = 0.93) and lower specificity (p = 0.005) than did the 2D FSE sequences for detecting cartilage lesions. CONCLUSION: A 3D FSE sequence had improved diagnostic performance compared with 2D FSE sequences for detecting cartilage lesions within the knee joint but only when using both radial and conventional reformatted images for cartilage evaluation.
Subject(s)
Cartilage, Articular/pathology , Image Interpretation, Computer-Assisted , Magnetic Resonance Imaging/methods , Osteoarthritis, Knee/diagnosis , Adolescent , Adult , Aged , Arthroscopy , Female , Humans , Male , Middle Aged , Osteoarthritis, Knee/pathology , Osteoarthritis, Knee/surgery , Retrospective Studies , Sensitivity and SpecificityABSTRACT
This article reviews the normal labral variants of the shoulder and describes imaging features, including secondary signs, to help discriminate tears from normal variants. The labral variants can be divided into two main groups. One group is composed of nonstandard appearances in the labral shape, signal intensity, or the site of affixation to the glenoid rim. The other group consists of classic labral variants, where the labrum is partially or completely unattached to the subjacent bone, or a segment of the labrum is absent.
Subject(s)
Arthrography/methods , Joint Diseases/diagnosis , Magnetic Resonance Imaging/methods , Shoulder Injuries , Shoulder Joint/anatomy & histology , Humans , Shoulder Joint/pathologyABSTRACT
BACKGROUND: Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized. OBJECTIVE: To describe our institution's development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis. MATERIALS AND METHODS: A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17 years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results. RESULTS: Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1-99.9%), specificity 97.0% (CI: 93.2-99.0%), positive predictive value 88.9% (CI: 76.0-96.3%), and negative predictive value 99.4% (CI: 96.6-99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/- 52.5 min, median 65 min; first-to-last sequence time stamp mean 14.2 +/- 8.8 min, median 12 min; last sequence to report mean 57.4 +/- 35.2 min, median 46 min. Mean age was 11.2 +/- 3.6 years old. Girls represented 57% of patients. CONCLUSION: MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation.
