Meniscal flounce on MR: correlation with arthroscopic or surgical findings

The purpose of this study was to investigate the frequency of the meniscal flounce on MR imaging in patients who underwent arthroscopy or open surgery due to symptoms related to internal derangement of the knee, and to investigate associated findings in patients with meniscal flounce by comparing and analyzing the findings from MR imaging and surgery. MR images obtained from 116 knees before surgery were reviewed retrospectively. Seven medial menisci showed buckled, wavy flounce on sagittal MR images. None of the lateral menisci showed flounce. We reviewed the surgical records of all seven patients and the videotapes of six of the patients undergoing arthroscopy or open surgery. The frequency of flounce on sagittal MR images was 6.0% in the medial meniscus and was completely absent in the lateral meniscus. On coronal MR images, the truncated appearance of the affected meniscus was demonstrated in five patients, and a valgus deformity was seen in three patients. Five patients showed a moderate to large amount of joint effusion. On MR imaging and in surgery, ligament injuries were found in six patients (six medial collateral ligament injuries, five anterior cruciate ligament injuries, and two posterior cruciate ligament injuries). Non-specific synovitis was found in the one remaining patient. In the surgery of all seven patients, no tears were found at the meniscus itself showing flounce. In conclusion, the meniscal flounce seen on sagittal MR imaging can be a rare appearance of a transient distortion of a normal meniscus due to a valgus deformity caused by a MCL tear and/or due to an external rotation induced by cruciate ligament injury or positioning of knee joint within the magnet. The meniscal flounce should be interpreted carefully because it frequently appears truncated on the coronal scan and can simulate a meniscal tear.

Bone Signal Abnormality, as seen on Knee Joint MRI: Relationship between Its Location and Associated Injury

PURPOSE: The purpose of the study was to evaluate the relationship between the location of bone signalabnormality and associated injury, as seen on MR, in patients with acute knee joint injury. MATERIALS AND METHODS: Thirty-six patients with acute knee injury and bone signal abnormalities on MR were included in this study. Thefemur and tibia were each divided into six compartments, namely the anteromedial, medial, posteromedial,anterolateral, lateral, and posterolateral ; these were obtained in each knee joint. We evaluated the location ofbone signal abnormality and the corresponding arthroscopic or operative findings of injury to ligaments andmenisci. Cases with signal abnormalities involving more than three compartments were excluded. RESULT: Bonesignal abnormalities were demonstrated in 51 compartments. Most(84%, 43/51) were noted in the lateral half of theknee joint, the most common location being the tibio- posterolateral compartment(13/51). The femoro-lateral(11/51) and tibio- anterolateral compartment(8/51) were the next most common locations. All cases(13/13)with bone signal abnormality in the tibio- posterolateral compartment had tears at the anterior cruciate ligament,while 9 of 11 cases(81%) with abnormality in the femoro- lateral compartment had tears at the anterior cruciateligament. Six of eight cases(75%) with signal abnormality in the tibio- anterolateral compartment had tears at theposterior cruciate ligament ; 31 of 43 cases (72%) with abnormality in the lateral half of the knee joint hadtears at the medial collateral ligament. Six of eight cases(75%) with signal abnormality in the medial half of theknee joint had tears at the medial meniscus, but no lateral meniscal tear was found. Among patients with signalabnormality in the lateral half of the knee joint, the tear was lateral meniscal in nine of 43 cases(21%) andmedial meniscal in six of 43(14%). CONCLUSION: The location of bone signal abnormality, as seen on knee MR, inpatients with acute knee joint injury could be an important finding suggesting associated injury.

Two Days' Repeated Sclerotherapy for Renal Cyst through the Percutaneous Catheter Insertion

PURPOSE: To evaluate the usefullness of repeated alcohol sclerotherapy for two days through the percutaneous catheter in the treatment of renal cyst. MATERIALS AND METHODS: Repeated sclerotherapies using absolute ethanol(99.9%) were parformed on 20 renal cysts in 18 patients through the indwelling catheter. The cyst volume ranged from 50 ml to 1000ml(mean, 300ml). Under the ultrasound- or CT-guidance, 6F catheter was inserted into the cyst percutaneously. After aspirating the fluid in the cyst, absolute ethanol was injected. While maintaining the catheter for 16-20 hours, at least 3 times of sclerotherapies performed with total procedure time of 30-60 minutes. Follow-up sonography was performed to evaluate the recurrence or collapse of the cysts at 1 and 3 months after the procedure. RESULTS: Among 20 renal cysts, 2 cases were recurred on 1 month follow-up sonography(10%). However, the volumes of recurred cysts were decreased to 40% and 10%, respectively. There was no immediate or delayed complication after sclerotherapy. DISCUSSION: Repeated sclerotherapy for 2 days using absolute ethanol through the percutaneous catheter insertion is a useful method of treatment for renal cyst.

Combined Treatment with Metallic Stent Placement and Radiotherapy in Malignant Biliary Obstruction

PURPOSE: To evaluate the efficacy of combined treatment of metallic biliary stent placement and radiotherapy in malignant biliary obstruction. MATERIALS AND METHODS: Between January 1992 and February 1994, 22 patients with malignant biliary obstruction were treated with metallic biliary stent placement and radiotherapy. The causes of the obstruction included cholangiocarcinoma(n=14), gallbladder carcinoma(n=4), colon cancer(n=2), pancreatic head cancer (n=1), and stomach cancer(n=1). According to the sites of obstruction level, patient were divided into 2 groups; hilar obstruction(n=18) and common bile duct obstruction(n=4). The patients received dose of 45 Gray/18 fraction by external radiotherapy and 20Gy/8f by high dose rate brachytherapy with iridium--192 source through percutaneous transhepatic biliary drainage(PTBD) catheter. The duration of stent patency after placement, survival period and survival rate by Kaplan Meier method were calculated in dead and alive patients, respectively. RESULTS: In all 22 patients, the duration of stent patency was 5.5(1.3--18.5)months. Survival periods after stent placement and PTBD were 5.3(2.0--8.5 )months and 7.9(4.0--14.7)months respectively in 9 dead patients and 7.7(1.3--21.0)months and 9.5(2.3--23.0)months in 13 alive patients. In all 22 patients, the survival rates in 6, 12 and 18 months were 78.9%, 47.5 % and 35.6 %, respectively. CONCLUSIONS: The results with combined metallic biliary stent placement and radiotherapy for the palliative treatment of malignant biliary obstruction in this study was more favorable, as compared with those of the other authors with only metallic biliary stent placement.