Amilcare Gentili

Magnetic resonance imaging of the hip

Standard magnetic resonance imaging (MRI) as well as MR arthrography (MRA) have been important diagnostic tools to assess for a spectrum of clinical presentations related to the hip. MRA has allowed the radiologist to closely examine intracapsular structures such as the acetabular labrum. In this article, we provide a general review of soft tissue and osseous anatomy of hips, especially focusing on the MR appearances of the acetabular labrum and the osseous morphology of the greater trochanter and ischial tuberosity with their muscle and tendon attachments. In addition, current topics in recent literature will be discussed such as femoroacetabular impingement (FAI) and rotator cuff tears of the hip. J. Magn. Reson. Imaging 2008.

Degenerative changes in the ligamentum teres of the hip: cadaveric study with magnetic resonance arthrography, anatomical inspection, and histologic examination.

Objective: Review and classify the pathologic abnormalities of the ligamentum teres in degenerative hip joints. Material and Methods: Eleven cadaveric hip joints were examined with magnetic resonance arthrography and were then sectioned. The appearance of the ligamentum teres and its attachment seen by inspection of the anatomical sections was correlated with findings seen at magnetic resonance imaging. Histologic evaluation was done. Results: Magnetic resonance arthrographic and histologic findings showed a spectrum of ligamentum teres degeneration. The thickest ligamentum teres revealed mucoid and fibromatous degeneration with microscopic tear. Ligamentum teres with intermediate thickness revealed fatty replacement with and without fibromatous degeneration, fibromatous degeneration with and without mucoid degeneration, and eosinophilic change. The thinnest ligamentum teres was near-complete disruption of the ligament. Conclusions: The ligamentum teres revealed degenerative changes that were similar histologically to degenerative changes in tendons. Magnetic resonance arthrography provided a sensitive technique for demonstration of the ligamentum teres and various patterns of degeneration.

Calcific tendinosis and periarthritis: classic magnetic resonance imaging appearance and associated findings.

Calcification within tendon and periarticular soft tissues with or without a history of pain is commonly encountered in the interpretation of musculoskeletal MR imaging (MRI) studies. This article presents a pictorial illustration of both the classic and atypical MR imaging (MRI) features of soft tissue calcifications in the musculoskeletal system. Familiarity with this topic can help to avoid pitfalls in imaging diagnosis.

Cost accounting for the radiologist.

OBJECTIVE Cost accounting is the branch of managerial accounting that deals with the analysis of the costs of a product or service. This article reviews methods of classifying and allocating costs and relationships among costs, volume, and revenues. CONCLUSION Radiology practices need to know the cost of a procedure or service to determine the selling price of a product, bid on contracts, analyze profitability, and facilitate cost control and cost reduction.

Patterns of cartilage degeneration in knees with medial tibiofemoral offset

ObjectiveTo determine if radiographic medial tibiofemoral offset (MTFO) is associated with: (1) magnetic resonance imaging (MRI) pathology of cartilage, meniscus, and ligament; and (2) a distinct pattern of lateral cartilage degeneration on MRI.Materials and methodsThree hundred consecutive adult knee MRIs with anteroposterior (AP) radiographs were retrospectively reviewed, and 145 studies were included. MTFO was defined as a medial extension of the medial femoral condyle beyond the articular surface of the medial tibial plateau on weight-bearing AP radiographs. The patients were then divided into the MTFO (n = 61) or no-offset (n = 84) groups. On MRI data obtained on a 1.5-Tesla system, articular cartilage of the femoral condyle and tibial plateau were graded using a modified Outerbridge classification (36 sub-regions similar to whole-organ MRI Score (WORMS) system). In addition, MR pathology of the ACL, MCL, LCL, medial and lateral menisci, were determined.ResultsSignificantly increased (ANOVA p < 0.007) MR grade of the ligaments, menisci, and cartilage in the MTFO group (ranging from 0.3 to 2.5) compared to the control group (0.2 to 1.1). Color maps of the cartilage grades suggested a marked difference in both severity of degeneration and regional variations between the groups. MTFO group exhibited focally increased cartilage grades in the central, non-weight regions of lateral compartment (region p = 0.07 to 0.12, interaction p = 0.05 to 0.1).ConclusionsMTFO is associated with overall degeneration of the knee and features a distinct lateral cartilage degeneration pattern, which may reflect non-physiologic contact of the cartilage between the lateral tibial eminence and lateral central femoral condyle.

Bladder herniation within the inguinal canal simulating Paget's disease.

Inguinal hernias are relatively common in the elderly population, more typically among men. An inguinal hernia may be asymptomatic or may cause considerable problems. Various pelvic contents may hemiate into the inguinal canal, most commonly the bowel. The authors describe the appearance of an unusual inguinal hernia containing bladder with corresponding images from a skeletal scintigram and computed tomographic examination.