Evaluation of the Glenoid Track Tomographic Method in Magnetic Resonance Imaging/Arthro-MRI.

Objective To evaluate and compare the glenoid track method in 3D-reconstructed computed tomography (3D-CT) scans with magnetic resonance imaging (MRI) and/or arthro-MRI. Methods Forty-four shoulders with clinical and radiographic diagnosis of traumatic anterior instability were assessed using 3D-CT, MRI, and/or arthro-MRI scans. Glenoid track (GT), Hill-Sachs interval (HSI), and glenoid bone loss (GBL) were determined by a radiologist using 3D-CT images, and classified as on-track/off-track. Three surgeons, blinded to the radiologist's evaluation, performed the same determinations using MRI/arthro-MRI. Descriptive analysis, variance analysis, results disagreement analysis, and receiver operating characteristic (ROC) curves were performed. Results Results from the 4 examiners were fully consistent in 61.4% of the cases. Magnetic resonance imaging/arthro-MRI diagnosed off-track injuries with 35 to 65% sensitivity and on-track injuries, with 91.67 to 95.83% specificity. Accuracy ranged from 68.1 to 79.5%. The greatest data divergence occurred for off-track injuries diagnosed by MRI/arthro-MRI. The greatest data variability referred to HSI calculation. Higher HSI and GBL values were associated with greater disagreement among examiners. Hill-Sachs interval values were lower at MRI/arthro-MRI when compared to 3D-CT. Agreement between CT and MRI/arthro-MRI for the GT method was only moderate (kappa value, 0.325-0.579). Conclusion Magnetic resonance imaging/arthro-MRI showed low accuracy and moderate agreement for the GT method; as such, it should be used with caution by surgeons.

Evaluation of the Glenoid Track Tomographic Method in Magnetic Resonance Imaging/Arthro-MRI / A avaliação do método tomográfico glenoid track na ressonância magnética/artro RM

Abstract Objective To evaluate and compare the glenoid track method in 3D-reconstructed computed tomography (3D-CT) scans with magnetic resonance imaging (MRI) and/or arthro-MRI. Methods Forty-four shoulders with clinical and radiographic diagnosis of traumatic anterior instability were assessed using 3D-CT, MRI, and/or arthro-MRI scans. Glenoid track (GT), Hill-Sachs interval (HSI), and glenoid bone loss (GBL) were determined by a radiologist using 3D-CT images, and classified as on-track/off-track. Three surgeons, blinded to the radiologist's evaluation, performed the same determinations using MRI/arthro-MRI. Descriptive analysis, variance analysis, results disagreement analysis, and receiver operating characteristic (ROC) curves were performed. Results Results from the 4 examiners were fully consistent in 61.4% of the cases. Magnetic resonance imaging/arthro-MRI diagnosed off-track injuries with 35 to 65% sensitivity and on-track injuries, with 91.67 to 95.83% specificity. Accuracy ranged from 68.1 to 79.5%. The greatest data divergence occurred for off-track injuries diagnosed by MRI/arthro-MRI. The greatest data variability referred to HSI calculation. Higher HSI and GBL values were associated with greater disagreement among examiners. Hill-Sachs interval values were lower at MRI/arthro-MRI when compared to 3D-CT. Agreement between CT and MRI/arthro-MRI for the GT method was only moderate (kappa value, 0.325-0.579). Conclusion Magnetic resonance imaging/arthro-MRI showed low accuracy and moderate agreement for the GT method; as such, it should be used with caution by surgeons.

Resumo Objetivo Comparar a avaliação do método glenoid-track (GT) em exames de tomografia computadorizada com reconstrução 3-D (TC-3D) com a avaliação realizada em exames de ressonância magnética (RM) e/ou artro-ressonância magnética (ARM). Métodos Quarenta e quatro ombros com diagnóstico clínico e radiográfico de instabilidade anterior traumática foram avaliados por meio de exames de TC-3D, RM e/ou ARM. As variáveis GT, intervalo de Hill-Sachs (IHS) e a perda óssea da glenoide (POG) foram realizadas por um médico radiologista, utilizando imagens de TC-3D, e classificadas em on-track/off-track. Três cirurgiões cegos à avaliação do radiologista realizaram o mesmo método utilizando RM/ARM. O estudo realizou análise descritiva, de variância, de associação da discordância de resultados, de concordância e curva característica de operação do receptor. Resultados Os resultados dos 4 examinadores foram totalmente concordantes em 61,4%. A RM/ARM diagnosticou lesões off-track com a sensibilidade variando de 35 a 65%, e lesões on-track com a especificidade variando de 91,67 a 95,83%. A acurácia variou de 68,1 a 79,5%. A maior divergência de dados ocorreu para o diagnóstico por RM/ARM de lesões off-track. A maior variabilidade dos dados ocorreu para o cálculo do IHS. Valores maiores de IHS e de POG foram associados a maior discordância entre os examinadores. A RM/ARM apresentou menor medida de valores de IHS quando comparado com a TC-3D. Ocorreu apenas moderada concordância no método GT entre a TC e a RM/ARM (Kappa 0,325-0,579). Conclusão A RM/ARM apresentou baixa acurácia e moderada concordância para o método GT, devendo ser utilizada com cautela por cirurgiões.

Influence of the glenoid track and glenoid bone loss on the apprehension test for shoulder instability.

BACKGROUND: The investigation of Hill-Sachs and bony Bankart lesions continues to evolve. Patients with large bone lesions can present with a positive apprehension test even at ranges below 45° of abduction and external rotation of the shoulder. Modern concepts, such as glenoid track and quantification of glenoid bone loss, have been increasingly applied to shoulder instability. The objective of this study was to assess the correlation of the glenoid track and glenoid bone loss on the apprehension test conducted at 0°, 45°, and 90° of shoulder abduction. METHODS: Ninety-four shoulders of 90 patients with anterior glenohumeral instability were retrospectively assessed. The apprehension test was performed at 0°, 45°, and 90° of shoulder abduction. Computed tomography, magnetic resonance imaging, or magnetic resonance arthrogram scans were performed to calculate the glenoid track and glenoid bone loss. A descriptive analysis, an association analysis, and a logistic regression analysis were used in this study. Logistic regression analysis was used to assess the influence of glenoid track and glenoid bone loss when the apprehension test was positive in lower degrees of abduction. RESULTS: A positive apprehension test at 0°, 45°, and 90° of abduction revealed significant association with off-track lesions, glenoid bone losses greater than 13.5%, and bipolar bone lesions. Shoulders classified as off-track were 36.4 times more likely to test positive at 0°, 45°, and 90° than on-track shoulders. The logistic regression analysis revealed that the positive apprehension test at 0°, 45°, and 90° of abduction seems to be more influenced by off-track lesions than by glenoid bone loss greater than the 13.5% threshold. CONCLUSION: Shoulders with a positive apprehension test at 0°, 45°, and 90° are significantly associated with off-track lesions, bipolar bone lesions, and glenoid bone losses greater than 13.5%.

Evaluation of the acromiohumeral distance by means of magnetic resonance imaging umerus.

OBJECTIVE: To demonstrate the relationship between the size, degree of retraction and topography of rotator cuff injuries and the degree of rise of the humeral head, and to evaluate the influence of gravity, using magnetic resonance imaging (MRI). METHODS: We evaluated 181 shoulder MRIs from 160 patients aged over 45 years, between November 2013 and July 2014. The patients were divided into two groups: one control (no lesion or partial damage to the rotator cuff); and the other with complete tears of the rotator cuff. We measured the acromiohumeral distance in the sagittal plane, and established the shortest distance between the apex of the head and the acromion. RESULTS: In this study, 96 examinations on female patients (53.04%) and 58 on male patients (46.96%) were evaluated. The mean age was 63.27 years: in the control group, 61.46; and in the group with injuries, 65.19. From analysis on the measurements of the subacromial space, we observed significantly higher values in the control group (7.71 mm) than in the group with injuries (6.99). In comparing the control group with some specific subgroup, i.e. posterosuperior (6.77), anteroposterior-superior (4.16) and retraction Patte III (5.01), we confirmed the importance of topography and degree of retraction in relation to the rise of the humeral head. CONCLUSION: The rise of the humeral head was directly related to the size, degree of retraction and topography of the rotator cuff injuries, with greater degrees of rise in cases of superior and posterior lesions and anteroposterior-superior (massive) lesions. The assessment using MRI was not influenced by the force of gravity.

OBJETIVO: Demonstrar a relação entre o tamanho, grau de retração e topografia das lesões do manguito rotador com o grau de ascensão da cabeça umeral e avaliar a influência da força da gravidade na ressonância magnética. MÉTODOS: Avaliamos 181 ressonâncias magnéticas de ombro de 160 pacientes com mais de 45 anos, entre novembro de 2013 e julho de 2014. Os pacientes eram divididos em dois grupos, um de controle (sem lesão ou com lesão parcial do MR) e outro com lesão completa do MR. Fizemos a mensuração da distância acrômio-umeral nos cortes sagitais e foi estabelecida a menor distância entre o ápice da cabeça e o acrômio. RESULTADOS: Foram avaliados neste estudo 96 (53,04%) exames de pacientes do sexo feminino e 58 de pacientes do sexo masculino (46,96%). A idade média foi 63,27 anos, a do grupo controle 61,46 e a do grupo com lesão 65,19. Ao analisar as medidas do espaço subacromial, observamos valores significativamente maiores no grupo controle (7,71 mm) do que no grupo com lesão (6,99). Quando comparamos o grupo controle com alguns subgrupos específicos, posterossuperior (6,77), anteroposterossuperior (4,16) e retração Patte III (5,01), confirmamos a importância da topografia e grau de retração para ascensão da cabeça umeral. CONCLUSÃO: A ascensão da cabeça umeral tem relação direta com o tamanho, grau de retração e a topografia das lesões do manguito rotador, com graus maiores de ascensão nas lesões posterossuperiores e anteroposterossuperiores (extensas). A avaliação feita pela ressonância magnética não sofre influência da força da gravidade.

Evaluation of the acromiohumeral distance by means of magnetic resonance imaging umerus / Avaliação da distância úmero-acromial por meio da ressonância magnética

OBJECTIVE: To demonstrate the relationship between the size, degree of retraction and topography of rotator cuff injuries and the degree of rise of the humeral head, and to evaluate the influence of gravity, using magnetic resonance imaging (MRI). METHODS: We evaluated 181 shoulder MRIs from 160 patients aged over 45 years, between November 2013 and July 2014. The patients were divided into two groups: one control (no lesion or partial damage to the rotator cuff); and the other with complete tears of the rotator cuff. We measured the acromiohumeral distance in the sagittal plane, and established the shortest distance between the apex of the head and the acromion. RESULTS: In this study, 96 examinations on female patients (53.04%) and 58 on male patients (46.96%) were evaluated. The mean age was 63.27 years: in the control group, 61.46; and in the group with injuries, 65.19. From analysis on the measurements of the subacromial space, we observed significantly higher values in the control group (7.71 mm) than in the group with injuries (6.99). In comparing the control group with some specific subgroup, i.e. posterosuperior (6.77), anteroposterior-superior (4.16) and retraction Patte III (5.01), we confirmed the importance of topography and degree of retraction in relation to the rise of the humeral head. CONCLUSION: The rise of the humeral head was directly related to the size, degree of retraction and topography of the rotator cuff injuries, with greater degrees of rise in cases of superior and posterior lesions and anteroposterior-superior (massive) lesions. The assessment using MRI was not influenced by the force of gravity.

OBJETIVO: Demonstrar a relação entre o tamanho, grau de retração e topografia das lesões do manguito rotador com o grau de ascensão da cabeça umeral e avaliar a influência da força da gravidade na ressonância magnética. MÉTODOS: Avaliamos 181 ressonâncias magnéticas de ombro de 160 pacientes com mais de 45 anos, entre novembro de 2013 e julho de 2014. Os pacientes eram divididos em dois grupos, um de controle (sem lesão ou com lesão parcial do MR) e outro com lesão completa do MR. Fizemos a mensuração da distância acrômio-umeral nos cortes sagitais e foi estabelecida a menor distância entre o ápice da cabeça e o acrômio. RESULTADOS: Foram avaliados neste estudo 96 (53,04%) exames de pacientes do sexo feminino e 58 de pacientes do sexo masculino (46,96%). A idade média foi 63,27 anos, a do grupo controle 61,46 e a do grupo com lesão 65,19. Ao analisar as medidas do espaço subacromial, observamos valores significativamente maiores no grupo controle (7,71 mm) do que no grupo com lesão (6,99). Quando comparamos o grupo controle com alguns subgrupos específicos, posterossuperior (6,77), anteroposterossuperior (4,16) e retração Patte III (5,01), confirmamos a importância da topografia e grau de retração para ascensão da cabeça umeral. CONCLUSÃO: A ascensão da cabeça umeral tem relação direta com o tamanho, grau de retração e a topografia das lesões do manguito rotador, com graus maiores de ascensão nas lesões posterossuperiores e anteroposterossuperiores (extensas). A avaliação feita pela ressonância magnética não sofre influência da força da gravidade.

Ressonância magnética da osteonecrose do joelho: estudo de 19 casos / Magnetic resonance imaging of knee osteonecrosis: a study of 19 cases

OBJETIVO: Descrever os achados epidemiológicos, clínicos e de ressonância magnética da osteonecrose das porções distal do fêmur e proximal da tíbia. MATERIAIS E MÉTODOS: Avaliação de 19 pacientes (12 mulheres e 7 homens), sem história prévia de fatores causais, com achados à ressonância magnética sugestivos de osteonecrose do platô tibial ou côndilo femoral. RESULTADOS: Verificou-se a presença de anormalidades osteocondrais em 63,1 por cento dos casos e em 73,6 por cento destes houve associação com lesão meniscal ipsilateral. Houve também importante associação com edema na medular óssea em correspondência (grau III em 16 casos). CONCLUSÃO: A ressonância magnética demonstrou ser um método não invasivo com boa sensibilidade no diagnóstico da osteonecrose do joelho, bem como das lesões associadas, sendo mais frequente nas mulheres (63 por cento dos casos).

OBJECTIVE: To describe epidemiological, clinical and magnetic resonance imaging findings of osteonecrosis in the distal femur and proximal tibia. MATERIALS AND METHODS: Evaluation of 19 patients (12 women and 7 men), with no previous history of causative factors, with magnetic resonance imaging findings suggestive of osteonecrosis in the tibial plateau or femoral condyle. RESULTS: Osteochondral abnormalities were observed in 63.1 percent of the cases; in 73.6 percent of them, such abnormality was associated with ipsilateral meniscal lesion. Also, a significant association with bone marrow edema (grade III in 16 cases) was observed. CONCLUSION: Magnetic resonance imaging has demonstrated to be a noninvasive method with good sensitivity in the diagnosis of knee osteonecrosis as well as of associated lesions which are most frequently found in women (63 percent of cases).

Avaliação ultra-sonográfica da articulação do ombro em nadadores de nível competitivo / Sonographic evaluation of the shoulder joint in competitive swimmers

OBJETIVO: Avaliar o ombro de nadadores em nível competitivo, sintomáticos ou não, e quantificar a incidência de lesões do manguito rotador nesses atletas. MATERIAIS E MÉTODOS: Foram estudados, por meio de exame ultra-sonográfico, ambos os ombros de 11 nadadores de nível competitivo (categoria master), sendo oito homens e três mulheres, com idade variando de 28 a 52 anos, tanto sintomáticos quanto assintomáticos, para determinação de alterações e correlação com quadro clínico. Os exames foram realizados avaliando-se os tendões que compõem o manguito rotador em pelo menos dois planos ortogonais distintos, assim como as estruturas não-tendíneas que fazem parte da articulação do ombro. As alterações tendíneas foram classificadas como tendinose, prováveis roturas intra-substanciais e roturas parciais. As lesões não-tendíneas foram classificadas como presentes ou ausentes. Além do exame, foram consideradas, na análise dos resultados, a presença ou ausência de sintomas e a idade dos pacientes. RESULTADOS: A prevalência geral de indivíduos sintomáticos foi de 63,6 por cento (sete atletas). Neste grupo encontravam-se 75 por cento das bursites e 100 por cento das roturas tendíneas parciais. Entre as alterações tendíneas isoladas, o tendão mais freqüentemente acometido foi o supra-espinal, tendo alteração de seu padrão ecográfico em 36,36 por cento. A tendinose foi o achado mais prevalente, estando presente em pelo menos um dos tendões em 50 por cento dos ombros estudados. A incidência de roturas parciais foi semelhante à observada na população geral, sendo de 13 por cento, estando estas, sempre que presentes, na faixa etária acima de 40 anos. CONCLUSÃO: Nadadores não parecem ter maior incidência de roturas ou degenerações tendíneas quando comparados com indivíduos da população geral. A idade dos indivíduos, sendo estes praticantes ou não de atividades que exijam sobrecarga desta articulação, é o fator com maior determinância em relação às lesões...

OBJECTIVE: To evaluate the shoulders of symptomatic or asymptomatic competitive swimmers, quantifying the incidence of rotator cuff lesions in these athletes MATERIALS AND METHODS: Eleven (eight male and three female) symptomatic and asymptomatic, competitive swimmers (master category) in the age range between 28 and 52 years, had both shoulders prospectively evaluated by ultrasonography for determining the prevalence of injuries in correlation with clinical findings. The studies included at least two orthogonal planes of rotator cuff tendons, as well as non-tendinous components of the shoulder joint. Tendinous findings were classified into tendinosis, probable full-thickness tears and partial-thickness tears. Non-tendinous findings were classified into present or absent. Additionally to the sonographic studies results, the analysis has taken the presence or absence of symptoms and the patients' age into consideration. RESULTS: Overall, the prevalence of symptomatic patients was higher (63.6 percent; seven athletes), with 75 percent of patients with bursitis, and 100 percent of those with partial-thickness tendon tears. Among isolated tendinous findings, the supraspinatus tendon was the most frequently involved, showing echographic pattern alteration in 36.36 percent of cases. Tendinosis was the most prevalent finding, present in at least one tendon in 50 percent of the studied shoulders. The incidence of partial-thickness tendon tears was similar to the incidence reported for non-athlete individuals (13 percent), always present in individuals above 40 years of age. CONCLUSION: Swimmers do not seem to present a higher incidence of tendon tears or degeneration when compared with the general population. Individuals' age is the most relevant determining factor, as far as rotator cuff lesions are concerned, no matter these individuals practice or not activities involving an overload of the shoulder joint.