A radiological classification system for talocalcaneal coalition based on a multi-planar imaging study using CT and MRI.

OBJECTIVE: To develop a radiological classification system for talocalcaneal coalition suitable for adults. METHODS AND MATERIALS: A retrospective review was performed on patients diagnosed with talocalcaneal coalition from July 2001 to November 2011. Based on the cartilaginous or bony nature, facet joint orientation and bony structure morphology, we classified talocalcaneal coalitions into four types: I (linear with or without posterior hooking), II (talar overgrowth), III (calcaneal overgrowth) and IV (complete osseous). RESULTS: Seventy feet (59 patients) with talocalcaneal coalition were evaluated by CT (61/70 feet) using multi-planar reformation and/or magnetic resonance imaging (43/70 feet). Type I, II, III and IV coalitions were detected in 45 (64 %), 10 (14 %), 13 (19 %), and 2 feet (3 %), respectively. Fracture fragments were observed in 16 feet (seven Type I and nine Type III coalitions) with hooked or overgrown calcanei and in one foot in the talus (Type I). Eleven patients had bilateral talocalcaneal coalitions; ten patients had coalitions of the same type and one had both Type I and Type III coalitions. Among 48 patients with unilateral involvement, the left and right feet were affected in 26 and 22 patients, respectively. CONCLUSIONS: A classification system for talocalcaneal coalition based on multi-planar imaging studies was developed. KEY POINTS: • A classification system for talocalcaneal coalition based on multi-planar imaging was developed. • The relative frequencies of different talocalcaneal coalition types were determined. • Fracture fragments were easily distinguished and frequently originated from the calcaneus. • Fracture fragments were mostly associated with Type I (linear) with posterior hooking and Type III (calcaneal overgrowth).

Comparison of arthroscopic and magnetic resonance imaging findings in osteochondral lesions of the talus.

BACKGROUND: Magnetic resonance imaging (MRI) is widely used for diagnosing osteochondral lesions in the talus. The purpose of this study was to directly compare the MRI with the arthroscopic findings. MATERIALS AND METHODS: MR images of 42 ankles were retrospectively reviewed during a period of 67 months. The osteochondral lesions were evaluated by both MRI (0, normal; 1, subchondral trabecular compression and marrow edema; 2A, subchondral cyst; 2B incomplete separation fragment; 3, unattached, nondisplaced fragment with synovial fluid surrounding it; 4, displaced fragment) and arthroscopy (A, smooth and intact, but soft and ballottable cartilage; B, rough surfaces; C, fibrillations or fissures; D, flap present or bone exposed; E, loose, undisplaced fragment; F, displaced fragment). Arthroscopic grade A was considered to be equivalent to MR grade 1, B and C to MR grade 2A, D to 2B, E to 3, and F to 4. RESULTS: Of the 44 lesions in 42 ankles, 29 lesions marked the same grade on both MRI and arthroscopy (65.9%). Nine lesions were upgraded on arthroscopy (20.5%), and six were downgraded (13.6%). MR grade 3 lesions showed the best correlation (83.3%) and MR grade 1 and 2B lesions showed the worst (50.0 and 55.6 %). Arthroscopic grade A and F showed good correlation (80 and 100%). Grade C and E showed poor (25.0%) and intermediate correlation (66.7%), respectively. CONCLUSION: The MRI grading of osteochondral lesions in the talus was useful and showed a fairly good correlation with arthroscopic classification.

The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images.

PURPOSE: The purpose of this study was to evaluate the accuracy of the characteristic magnetic resonance imaging (MRI) findings of medial meniscal root tear in the coronal, sagittal and axial planes. METHODS: Thirty arthroscopically diagnosed patients who had undergone preoperative knee MRI were included in this study. They were compared to 30 age-matched patients with medial meniscus tears without root tears. The findings used for imaging analysis were as follows: the radial tear on the meniscal root of the medial meniscus in the axial plane, the presence of the truncation sign in the coronal plane and the ghost meniscus sign in the sagittal plane. Meniscal extrusion in the coronal plane was also evaluated. All the MRI findings of both groups were statistically analyzed. RESULTS: All the findings were more frequently found in the root tear group than those in the control group (P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value of finding a radial tear in the axial plane were 93.3, 100, 100 and 93.8%, respectively. In the coronal plane, rates for the presence of the truncation sign were 90, 100, 100 and 90.9%, respectively. In the sagittal plane, rates for the presence of the ghost meniscus sign were 96.7, 96.7, 96.7 and 96.7%, respectively. The rates for the meniscus extrusion in the coronal plane were 63.3, 90, 86.4 and 71.1%, respectively. CONCLUSIONS: The findings of medial meniscal root tear were characteristic as compared with the control group. Radial tear in the axial plane also showed similar diagnostic accuracy as that seen in the other planes. The characteristic findings provide high diagnostic accuracy, and axial plane is helpful to detect medial meniscal root tear. LEVEL OF EVIDENCE: Diagnostic study, Level III.

Symptomatic torn discoid lateral meniscus in adults.

The purposes of this study were to report degenerative changes that coexist with a symptomatic torn discoid lateral meniscus in adults and to analyze the factors associated with the accompanied degenerative changes. From 1997 to 2008, 329 knees in the 305 patients were included. Associations between the status of the meniscus and the coexisting degenerative changes on the images and the arthroscopic findings were statistically analyzed. Marginal osteophyte was seen on conventional radiography in 118 patients (36%). Ninety patients (27%) had arthroscopically confirmed chondral lesion. Age, duration of symptoms, the type of meniscus, the type of tear and the magnetic resonance image classification were associated with the formation of the marginal osteophyte and chondral lesion on univariate analysis (P < 0.05). After conducting multivariate analysis, the type of tear and magnetic resonance image classification had a statistically significant association with the severity of marginal osteophyte and chondral lesion (P < 0.05).

Comparison of indirect isotropic MR arthrography and conventional MR arthrography of labral lesions and rotator cuff tears: a prospective study.

OBJECTIVE: The purpose of our study was to prospectively compare the diagnostic accuracy of 3D isotropic indirect MR arthrography with conventional sequences of indirect MR arthrography for the diagnosis of labral and rotator cuff lesions on a 3-T MR unit. SUBJECTS AND METHODS: Thirty-six consecutive patients who were scheduled for shoulder arthroscopic surgery at our institution underwent indirect MR arthrography. Both conventional sequences and an additional 3D isotropic sequence were obtained 1 day before arthroscopic surgery. Two musculoskeletal radiologists prospectively evaluated the images in consensus for the presence of superior and anterior labral lesions and subscapularis and supraspinatus-infraspinatus tendon tears using the conventional sequences and the 3D isotropic sequence. We analyzed the statistical difference between the sensitivities and specificities of both methods using arthroscopic findings as the reference standard. RESULTS: Surgical findings confirmed the presence of 23 superior labral lesions, eight anterior labral lesions, 21 subscapularis tears, and 24 supraspinatus-infraspinatus tears. The sensitivity and specificity of the conventional sequences were 74% and 54% for superior labral lesions, 88% and 96% for anterior labral lesions, 67% and 85% for subscapularis tendon tears, and 96% and 75% for supraspinatus-infraspinatus tendon tears. The sensitivity and specificity of the 3D isotropic sequence were 70% and 85% for superior labral lesions, 100% and 100% for anterior labral lesions, 67% and 85% for subscapularis tendon tears, and 96% and 67% for supraspinatus-infraspinatus tendon tears. No statistically significant difference was seen in sensitivities and specificities for both methods. CONCLUSION: Three-dimensional isotropic MR arthrography sequences with multiplanar reconstruction can provide a similar capability for the diagnosis of labral and rotator cuff lesions as conventional MR arthrography sequences but in a shorter imaging time.

Ethanol embolotherapy of pelvic arteriovenous malformations: an initial experience.

OBJECTIVE: We retrospectively assessed the results of performing ethanol embolization for pelvis arteriovenous malformations (AVMs). MATERIALS AND METHODS: During the past 10 years, eight patients (8 females, age range: 27-52 years) with AVMs in the pelvic wall (n = 3) and uterus (n = 5) underwent staged ethanol embolizations (range: 1-5, mean: 2.5) under general anesthesia. Ethanol embolization was performed by the use of the transcatheter and/or direct puncture techniques. Clinical follow-up was performed for all of the patients, and imaging follow-up was available for seven patients. The therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms, as well as the degree of devascularization observed on post-procedural angiography. RESULTS: During the 20 sessions of ethanol embolization, the solitary transarterial approach was used 14 times, the transvenous approach was used three times and direct puncture was used once. For two patients, the transarterial and transvenous or direct puncture approaches were used together in one session. For four patients, ethanol and coils were used as embolic agents, and n-butyl cyanoacrylate (NBCA) and ethanol were used in one patient. Seven (88%) of eight patients were cured of their AVMs and one patient (12%) displayed improvement. Major complications were seen in two patients (25%). CONCLUSION: Ethanol embolization is effective for the treatment of pelvic arteriovenous malformations, though there is a chance of a major complication.