Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy? A prospective study.

The role of magnetic resonance tomography (MRI) for the diagnosis of chondral lesions of the knee joint is still unclear. The sensitivity of the method ranges from 15% to 96%. The scope of our daily experiences showed that there were considerable deviations between the tomographical and arthroscopical results, which vary from the results of experimental studies. Therefore we have conducted a prospective study to investigate the question of how MRI can replace arthroscopy (ASC) in the diagnosis of cartilage damages in the scope of daily routine. All 195 patients included in this study received a magnetic resonance tomography followed by an arthroscopy. A clear diagnosis of supposition had to be determined before the magnetic resonance tomography. The patients were divided into 3 Groups. Group A (n=86) received a standard Military Hospital Ulm (MH) MRI--sagittal STIR TSE and PD TSE, coronal and transversal T2 FFE (TR=660 ms, TE=18 ms, FA=30 degrees, 512 matrix). In addition, one sub-Group, AK (n=21) was examined with a special cartilage sequence of the cartilage fs T1 W FFE. Neither patients in Group AK nor in Group A as a whole received any contrast medium. Group B (n=88) was examined with an alternate MRI protocol (Radiological Joint Practice, Neu-Ulm--sagittal T1 SE, T2 SE and T2 FLASH (TR=608 ms, TE=18 ms, FA=20 degrees, 256 matrix), coronal PD fs), employing gadolinium as a contrast medium. 156 cartilage lesions were found arthroscopically. In Group A the sensitivity was 33%, the specificity 99%, and the positive and negative prediction values 75% and 98% respectively. Group B reached a sensitivity of 53% and a specificity of 98%. The positive prediction value was 48% and the negative was 98%. Group AK showed a sensitivity of 38% and specificity of 98%; the positive and negative prediction values came to 50% and 97% respectively. In conclusion, our results indicate that the MRI examination techniques recommended in the literature at present are not able to replace the ASC for the diagnosis of cartilage damages of the knee joint. In view of the high specificity (97%-99%) and the high negative prediction value (97%-98%), MRI is suitable for the exclusion of cartilage lesions. For a negative MRI associated with a cartilage injury, a cautious attitude towards an operative cartilage treatment is therefore justified. Because the MRI can not replace the ASC for diagnostic of cartilage damage, the ASC still has to be seen as the method of choice for the evaluation of cartilage damage.

[MRI vs. arthroscopy in the diagnosis of cartilage lesions in the knee. Can MRI take place of arthroscopy?]. / MRT versus Arthroskopie bei der Diagnostik von chondralen Läsionen des Kniegelenkes. Kann die MRT die Arthroskopie ersetzen? Eine prospektive Studie.

INTRODUCTION: The accuracy of magnet resonance imaging in diagnosing cartilage lesions is discussed controversially. The sensitivity of this examination ranges from 15 % to 96 %. Clinical evidence demonstrates that cartilage lesions, diagnosed by MRI, were not confirmed in arthroscopy. The purpose of this prospective study was to analyse the practicability of replacing arthroscopy by MRI in diagnosis of cartilage lesions. PATIENTS AND METHODS: 195 patients with acute or chronic knee pain were examined by reason of a pathological clinic result by MRI preoperatively. In group A (n = 86), a standard program was performed in the radiological department of German Army Hospital (sagittal STIR TSE und PD TSE, coronary und transversal T2 FFE [TR = 660 ms, TE = 18 ms, FA = 30 degrees, 512er-Matrix]), in 21 patients (subgroup AK) a cartilage specific sequence (fs T1 W FFE) without gadolinium was added. Patients in group B (n = 88) were examined in a private outpatient clinic (sagittal T1 SE, T2 SE and T2 FLASH [TR = 608 ms, TE = 18 ms, FA = 20 degrees, 256er-Matrix]) with the use of gadolinium. A clear clinical diagnosis had to be performed before MRI examination. RESULTS: 156 lesions of the cartilage were detected arthroscopically. The sensitivity of the examination was in group A 33 %; group B 53 %; group AK 38 %, specificity in group A 99 %; group B 98 % and group AK 98 %. The positive and negative predictive values were in group A 75 %/98 %; group B 48 %/98 % and in group AK 50 %/97 %. CONCLUSION: MRI was not able to detect reliable cartilage lesions. Until now, arthroscopy is the golden standard to detect cartilage lesions.

Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging.

OBJECTIVE: To evaluate computed tomography (CT) guided corticosteroid injections of inflamed sacroiliac (SI) joints in patients with spondyloarthropathies (SpA), and to evaluate dynamic magnetic resonance imaging (DMRI) of the SI joints in serial examinations of these patients, who had different degrees of inflammatory back pain. METHODS: We examined and treated 30 patients with ankylosing spondylitis (n = 9) or undifferentiated SpA (n = 11) (14 women and 16 men, mean age 36.5 +/- 13.4 years, mean disease duration 5.4 +/- 4.0 years) who had severe inflammatory back pain for more than 3 months. All patients had DMRI of the SI joints before and 4-6 months after a CT guided injection of 40 mg triamcinolone acetonide into SI joints (n = 54; 24 patients received injections in both joints). Enhancement of the contrast agent gadolinium-DTPA was quantified by calculating the enhancement of the contrast agent gadolinium-DTPA was quantified by calculating the enhancement gradient Fenh. A subjective index with a visual analog scale (0 = no pain, 10 = very severe pain) was used for assessment of back pain. Followup visits were done every 3 months for a maximum of 18 months. RESULTS: There was significant improvement of inflammatory back pain and sacroiliitis at 5.2 +/- 1.3 months after therapy in 25/30 patients (83.3%). The differences between the Fenh values before (98.2 +/ 56.1) and after (44.3 +/- 31.2) therapy and of the subjective pain index (8.5 +/- 1.5 and 3.0 +/- 2.3, respectively) were statistically significant. Subjective improvement lasted a mean of 8.9 +/- 5.3 months. CONCLUSION: CT guided corticosteroid injection of inflamed SI joints is a useful option in therapy for sacroiliitis in patients with SpA. Different degrees of inflammation in the SI joints can be quantitatively assessed by DMRI.

[The measurement of the femoral torsion angle in children by NMR tomography compared to CT and ultrasound]. / Messung des femoralen Torsionswinkels von Kindern durch Magnetresonanztomographie im Vergleich mit CT und Ultraschall.

PURPOSE: Anteversion of the femoral neck was measured by MRI in 19 children (37 hips) preoperatively before femoral rotation osteotomies. MATERIAL AND METHODS: The results of this new technique were compared with values for anteversion obtained by CT and ultrasound. The measurements were performed independently by two observers to determine the correlation between the three different methods and to assess their reliability. RESULTS: It was possible to show a high correlation coefficient (Pearson) between MRI and CT (r = 0.77) as well as MRI and sonography (r = 0.81). The mean angles obtained by CT (34 degrees, range +5 to +82 degrees) and ultrasound (25.6 degrees, range +10 to +40 degrees) appeared larger than the MRI values (mean angle 23.2 degrees, range 0 to +65 degrees), which can be explained by the different measurement techniques. Mean inter- and intra-variability was low for MRI (r = 0.97 and r = 0.97) and CT (r = 0.99 and r = 0.96) but slightly higher for sonography (r = 0.88 and r = 0.88). MRI is a new reliable and precise method to evaluate femoral anteversion that does not require ionising radiation. CONCLUSION: MRI is recommended for preoperative planning of paediatric femoral rotation osteotomy patients.

[The value of various ultrasound criteria in objective assessment of acute reactive cholecystitis. A prospective follow-up study of ventilated intensive care patients]. / Stellenwert verschiedener Ultraschallkriterien zur Objektivierung einer reaktiven akuten Cholezystitis. Eine prospektive Verlaufsstudie bei intensivtherapiepflichtigen Beatmungspatienten.

Ultrasound of the abdomen was performed in 30 artificially respirated patients under intensive care conditions for 7 days per patient over a time period of 6 months to elucidate the therapeutic value of different ultrasonographic findings with respect to the diagnosis "reactive acute cholecystitis". Our results show, that neither the detection of concrements or sludge within the gallbladder, nor the transient dilatation of the bile duct, nor a transient wall-thickening or the occurrence of a three-layered wall of the gallbladder can be interpreted as reliable sonographic criteria for the occurrence of an acute reactive cholecystitis. From this we conclude, that reactive acute cholecystitis leading to the indication for cholecystectomy can only be diagnosed from the combination of clinical and sonographic findings. However, reactive acute cholecystitis can almost certainly be excluded, even in obscure upper abdominal symptoms, when the sonogram of the gallbladder is normal.

[Dynamic arthro-CT in the diagnosis of recurrent shoulder dislocations]. / Dynamisches Arthro-CT in der Diagnostik rezidivierender Schulterluxationen.

"Dynamic" double contrast arthro-CT in internal and external rotation was performed on 42 patients with recurrent subluxation of the shoulder. The differential distribution of contrast and air caused by the rotation resulted in optimal demonstration of the capsulo-labrale components responsible for joint stability. In 22 patients there appeared to be an indication for arthroscopy; this confirmed the previous findings. In all cases the anterior part of the capsule and the middle and lower labrum were seen best during internal rotation. In this way all the 15 anterior capsule lesions could be seen, as well as 16 out of 17 Bankart lesions; it also showed one lesion of the middle labrum which had been masked by a haemarthrosis during external rotation. The study also defined lesions of the upper labrum caused by a different pathological mechanism which was present in 7 patients (6 Andrews and 1 S.L.A.P. lesion). These and 2 posterior labrum tears could be diagnosed during external rotation. Sensitivity for lesions of the anterior labrum was 95%.

[Percutaneous aspiration thromboembolectomy in the treatment of acute occlusion of the lower leg arteries]. / Perkutane Aspirationsthromboembolektomie in der Behandlung akuter Verschlüsse der Unterschenkelarterien.

Percutaneous aspiration thrombembolectomy (PAT) is a very suitable method for the recanalization of the popliteal and lower limb arteries after embolic occlusion. In thrombotic occlusion in patients with arteriosclerotic disease, PAT can easily be combined with other interventional procedures, yielding good results. With the use of PAT the dose of regionally effective fibrinolytic drugs, which may be additionally administered, can be significantly reduced.

[Sonographic aspects of clinically suspected acute appendicitis]. / Sonographische Aspekte bei klinischem Verdacht auf akute Appendizitis.

Revealing a sensitivity of 97.5% and a specificity of 95.12% this study emphasizes the excellent diagnostic value of sonography in the elucidation of patients with clinical signs of "acute appendicitis". Evaluation of morphology on the one hand and maximal diameter of the organ and the organ wall on the other, in conjunction with the clinical presentation, allows a restrictive management of the surgical treatment and thus decreases the rate of negative laparotomy.

[The CT classification of intra-articular calcaneus fractures]. / CT-Klassifikation intraartikulärer Kalkaneusfrakturen.

93 patients with 102 intraarticular calcaneus fractures (ICF) were examined by CT from 1986 to 1992. The images were evaluated with the use of a modified classification based on the number of fractured heel bone facets (2 facets in 4.8%, 3 facets in 53.9%, 4 facets in 32.3%, comminution in 8.8% of the fractures), the involvement of the calcaneus-cuboid joint (60.8%) and the fracture mechanism (tongue-type in 28.4%, joint depression in 62.7%) with the weight-bearing calcaneal compartments taken into special consideration. In that way, each intraarticular calcaneus fracture could be scored, enabling a fast diagnosis comprising factors relevant for the therapy and prognosis.

[The place of portangiography in the follow-up control of locoregional chemotherapy]. / Stellenwert der Portangiographie bei der Verlaufskontrolle der lokoregionären Chemotherapie.

101 portangiographies in patients with liver metastases from colorectal primaries who underwent hepatic intraarterial or intraperitoneal chemotherapy were performed and studied between January 1991 and February 1992. 81% of the examinations did not involve complications. In 19% of the angiographies abnormalities of the arterial perfusion of the liver, like occlusion, dissection or narrowing of hepatic arteries, were found. We conclude that portangiography is a very important investigation before regional chemotherapy.

[Computed tomographic aspects of intestinal intussusception]. / Computertomographische Aspekte intestinaler Intussuszeption.

This article describes typical CT findings of intestinal intussusception of different genesis and localisation. It is shown that a characteristic image resembling a target is obtained both in case of an invaginated Meckel's diverticulum, an idiopathic ileocolic intussusception in an infant, and in colorectal invagination in condition after resection of a polyp of the sigmoid. Compared with the conventional imaging methods such as sonography, colon contrast enema or contrast imaging of the small intestine, CT enables not only unequivocal diagnosis of intestinal invagination but frequently also the identification or exclusion of underlying causes that trigger the phenomenon.

[The diagnosis of spinal trauma: the indication for CT and myelo-CT on the day of the injury]. / Diagnostik des Wirbelsäulentraumas: Indikation zur CT und Myelo-CT am Unfalltag.

During a period of 24 months, 211 patients were investigated in our radiological clinic by emergency CT of the spine on the day of the injury. In 128 (61%) a traumatic lesion could be demonstrated. Most frequently involved were the transitional zones of the spine (occipito-atlanto-axial segment, cervico-thoracic and thoracolumbar segments). In 68% of these patients, conventional radiographs of the spine of these critical zones proved to be inadequate. 20% of the lesions demonstrated by CT could not be seen on conventional radiographs and 41% were shown incompletely. In 61% of cases CT provided additional information when compared with conventional radiography.

[Congenital and acquired anomalies of the inferior vena cava. Differential diagnosis using digital subtraction angiography and computed tomography]. / Kongenitale und erworbene Anomalien der Vena cava inferior. Differentialdiagnose durch digitale Subtraktionsangiographie (DSA) und Computertomographie (CT).

Segmental aplasias of the inferior vena cava, thrombosis of the vena cava, tumour infiltration (e.g. renal neoplasms via the renal vein) and external compression (e.g. large hepatic metastases) may produce similar radiomorphologic changes in chest x-ray DSA and CT. These radiomorphological changes are described by case reports. DSA clearly demonstrates the course of the vessels and the collaterals involved. CT may elucidate the paracaval vascular changes. It is only a synopsis of cavography (DSA) and CT with reference to embryogenesis that will lead to a reliable diagnosis and enable a definite decision on therapy and prognosis.