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1.
Eur Radiol ; 32(1): 582-592, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34255158

RESUMO

OBJECTIVES: A recent treatment algorithm suggests that proximal anterior cruciate ligament (ACL) tears with good-to-excellent tissue quality are amenable to primary repair. Our primary objective was to assess the ability of MRI to determine the exact tear location and tissue quality, using arthroscopy as a reference standard. METHODS: In an initial sample of 71 patients with prior ACL surgery (repair or reconstruction), the diagnostic accuracy of MRI was assessed using arthroscopy as a reference standard. Each native ACL tear was graded according to Sherman's arthroscopic classifications during the surgical procedure. MRI scans were retrospectively reviewed for grading, blinded to arthroscopic findings and in consensus by two musculoskeletal radiologists. Tear location and tissue quality were graded using the MRI Sherman tear location (MSTL), MRI Sherman tissue quality (MSTQ) and simplified MRI Sherman tissue quality (S-MSTQ) classifications. Intra- and inter-observer agreement was assessed on a second sample of 77 patients. MRI classification accuracy was compared by McNemar's tests. Intra- and inter-observer agreement was assessed using Cohen's kappa coefficient. RESULTS: Regarding tear location, diagnostic accuracy was 70% (50/71) based on the MSTL classification. Diagnostic accuracy for tissue quality was 52% (15/29) based on the MSTQ classification and 90% (26/29) for the S-MSTQ classification (p = 0.003). Inter-observer agreement was good for MSTL (κ = 0.78) and moderate-to-good for the MSTQ and S-MSTQ classifications (κ = 0.44 and 0.63 respectively). CONCLUSIONS: MRI seems to be accurate in assessing tear location and tissue quality and may help clinicians to predict the reparability of ACL tears. KEY POINTS: • MRI seems to be accurate in assessing tear location and tissue quality and may help clinicians to predict the reparability of ACL tears. • High intra-observer agreement was demonstrated when grading the tear location into one of five types. • The diagnostic accuracy of the simplified MRI tissue quality classification, involving deletion of the ligament stump signal criterion, was better than that observed with the MRI Sherman tissue quality classification, but was moderate to good in terms of inter- and intra-observer agreement.


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Humanos , Imageamento por Ressonância Magnética , Estudos Retrospectivos
2.
Skeletal Radiol ; 47(8): 1051-1068, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29549379

RESUMO

Lesion to subcutaneous nerves is a well-known risk of orthopedic surgery and a significant cause of postoperative pain and dissatisfaction in patients. High-resolution ultrasound can be used to visualize the vast majority of small subcutaneous nerves of the upper and lower limbs. Ultrasound detects nerve abnormalities such as focal hypoechoic thickening, stump neuroma, and scar encasement, and provides information not only about the peripheral nerve itself but also about its relationship to adjacent anatomical structures. The purpose of this review is to provide an overview of the anatomy of the main subcutaneous nerves damaged during orthopedic surgery, recall at-risk procedures, and offer useful anatomic landmarks to help the sonographer identify and follow the nerves when an iatrogenic lesion is suspected.


Assuntos
Neuroma/diagnóstico por imagem , Procedimentos Ortopédicos/efeitos adversos , Traumatismos dos Nervos Periféricos/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Pele/inervação , Ultrassonografia , Braço/diagnóstico por imagem , Braço/inervação , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/inervação , Neuroma/etiologia , Traumatismos dos Nervos Periféricos/etiologia , Complicações Pós-Operatórias/etiologia
3.
Joint Bone Spine ; 84(1): 87-90, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27369646

RESUMO

Osteopathia striata with cranial sclerosis is a rare X-linked disorder. It is often lethal in male patients, and is considered X-linked dominant since affected females exhibit clinical signs, although milder than males. We describe here an adult male patient, with clinical and radiological signs similar to those described in female patients. Diagnosis was confirmed by the identification of an AMER1 mutation. The presence of long bones striation and the clinical phenotype of the patient also led to the diagnosis of non-mosaic Klinefelter syndrome, probably explaining the non-lethal and even rather minor phenotype compared to the rare affected males already described.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Síndrome de Klinefelter/diagnóstico por imagem , Síndrome de Klinefelter/genética , Osteosclerose/diagnóstico por imagem , Osteosclerose/genética , Proteínas Supressoras de Tumor/genética , Adulto , Predisposição Genética para Doença , Humanos , Síndrome de Klinefelter/fisiopatologia , Masculino , Mutação , Osteosclerose/fisiopatologia , Linhagem , Radiografia/métodos , Doenças Raras , Medição de Risco
5.
J Neurosurg ; 121(1): 63-6, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24527815

RESUMO

The authors report a very rare presentation of traumatic carotid-cavernous fistula (CCF) with extensive edema of the basal ganglia and brainstem because of an anatomical variation of the basal vein of Rosenthal (BVR). A 45-year-old woman was admitted to the authors' institution for left hemiparesis, dysarthria, and a comatose state caused by right orbital trauma from a thin metal rod. Brain MRI showed a right CCF and vasogenic edema of the right side of the brainstem, right temporal lobe, and basal ganglia. Digital subtraction angiography confirmed a high-flow direct CCF and revealed a hypoplastic second segment of the BVR responsible for the hypertension in inferior striate veins and venous congestion. Endovascular treatment was performed on an emergency basis. One month after treatment, the patient's symptoms and MRI signal abnormalities almost totally disappeared. Basal ganglia and brainstem venous congestion may occur in traumatic CCF in cases of a hypoplastic or agenetic second segment of the BVR and may provoke emergency treatment.


Assuntos
Doenças dos Gânglios da Base/etiologia , Edema Encefálico/etiologia , Fístula Carótido-Cavernosa/complicações , Angiografia Digital , Doenças dos Gânglios da Base/cirurgia , Edema Encefálico/cirurgia , Fístula Carótido-Cavernosa/cirurgia , Embolização Terapêutica , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Resultado do Tratamento
6.
J Neuroradiol ; 41(1): 45-51, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23764260

RESUMO

BACKGROUND AND PURPOSE: This study compared three different combinations of DWI parameters: three and six diffusion imaging directions (3dir and 6dir, respectively) using b=1000 or 2000 s/mm(2) (b1000 or b2000, respectively) to improve detection of recent ischemic lesions at 3 Tesla (3 T). MATERIALS AND METHODS: A total of 47 consecutive patients underwent three DWI scans: 3dir b1000; 6dir b1000; and 6dir b2000. Qualitative visual analysis was performed by three readers based on evaluation of the number of lesions, presence of artifacts and diagnostic confidence. Interobserver agreement, sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: Forty-five lesions were detected by 3dir b1000, 52 by 6dir b1000 and 56 by 6dir b2000 in 30 patients. The additional lesions identified by 6dir b2000 were either small or located in the posterior fossa. Sensitivity with 6dir b2000 was significantly higher than with 3dir b1000 (98.1% vs 77.4%; P<0.05). CONCLUSION: At 3 T, 6dir b2000 DWI detected more acute ischemic lesions than 3dir b1000, particularly small lesions and those located in the brain stem.


Assuntos
Isquemia Encefálica/patologia , Encéfalo/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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