Anastasia Fotiadou

Sport injuries in the paediatric and adolescent patient: a growing problem

With an increasing number of paediatric and adolescent athletes presenting with injuries due to overuse, a greater demand is put on clinicians and radiologists to assess the specific type of injury. Repetitive forces applied to the immature skeleton cause a different type of injury than those seen in adults due to the differences in vulnerability of the musculoskeletal system, especially at the site of the growth cartilage. Intrinsic and extrinsic risk factors all play a role in the development of overuse injuries. MRI plays a key role in imaging overuse injuries due to its high potential for depicting cartilaginous and soft-tissue structures. Sport-specific biomechanics are described, since this knowledge is essential for adequate MRI assessment. An overview of several sport-related injuries is presented, based on anatomical location.

Wrist injuries in young adults: the diagnostic impact of CT and MRI.

PURPOSEnTo evaluate the diagnostic impact of MRI or/and multidetector CT in young patients with wrist injury and inconclusive or negative clinical examination and X-rays and to analyze variations in imaging strategies between a district general hospital (GH) and a university hospital (UH).nnnMATERIALS AND METHODSnA retrospective analysis of 34 young patients (mean age 23 years) with wrist trauma who underwent CT or/and MRI was performed. The injury was acute in 24, and chronic in 10 patients. Twenty-two patients were from a GH and 12 from a UH. Two experienced musculoskeletal radiologists blindly reviewed the imaging studies. The effect of cross-sectional imaging on patient care and treatment plan was evaluated.nnnRESULTSnIn 9 of 34 patients one or more fractures were diagnosed on cross-sectional imaging. The scaphoid was fractured in four patients, the lunate and/or the trapezium in three patients, the scaphoid together with the lunate in one patient, and finally the distal radius in one patient. Ligamentous trauma was identified solely on MRI in 11 patients (involving the TFCC in eight cases). In four patients with both imaging methods, CT revealed one fracture of the trapezium not seen on MRI, and one scapholunate fracture with MRI findings of distal radial fracture only. In two patients with normal CT, MRI revealed bone marrow oedema of the scaphoid in one and of the distal radius, lunate and triquetrum in the other.nnnCONCLUSIONnBoth CT and MRI might be considered in patients with acute or chronic wrist injury, clinical dilemma and normal initial radiographs, depending on the availability and the individual institution policies.

Diagnostic performance of magnetic resonance arthrography of the shoulder in the evaluation of anteroinferior labrum abnormalities: a prospective study

ObjectiveTo evaluate the diagnostic performance of magnetic resonance (MR) arthrography of the shoulder in the diagnosis of anteroinferior labrum lesions, using arthroscopy as the reference standard and to classify these lesions.MethodsInstitutional review board approval was obtained. The study population included 59 consecutive patients with history and clinical diagnosis of acute or chronic anterior shoulder instability. A total of 62xa0MR arthrograms were performed, since three patients had undergone a bilateral procedure. Arthroscopy, which was performed within a mean of 3xa0months (range 2–5xa0months) after MR arthrography, was used as the reference standard. Sensitivity, specificity, accuracy, positive and negative predictive values were then calculated.ResultsMR arthrography showed a sensitivity of 96xa0% and a specificity of 80xa0% for the overall detection of anteroinferior labrum abnormalities. The diagnostic accuracy was 95xa0% and the positive and negative predictive values were 98xa0% and 66xa0% respectively. Ten lesions were non-classifiable on surgery, of which eight were non classifiable on MR arthrography also.ConclusionsMR arthrography is highly accurate for the detection and classification of shoulder anteroinferior labrum lesions. Shoulder surgeons can confidently rely on this method to determine which patients will benefit from arthroscopy.Main Messages• MR arthrography is accurate for the detection and classification of shoulder labrum lesions.• MR arthrography is a valuable tool for the preoperative planning in acute or chronic instability.• Shoulder surgeons can rely on this method to determine which patients will benefit from arthroscopy.

Type II autosomal dominant osteopetrosis: radiological features in two families containing five members with asymptomatic and uncomplicated disease.

In this study we analysed the imaging patterns in two families containing five members with asymptomatic and uncomplicated autosomal dominant osteopetrosis (ADO II), and we report new and uncommon radiological manifestations. These findings might be useful in the context of reducing the incidence of fractures and other orthopaedic complications. Diffuse pelvic sclerosis on radiographs was observed incidentally in two patients. Both cases were asymptomatic, and the patients had never suffered a fracture. The suggestion of ADO II was raised. A detailed medical history, an imaging survey, and a haematological study were obtained so that other rare causes of osteosclerosis could be ruled out. No genetic study was conducted. All their first-degree relatives were also examined. Bony sclerosis was observed in five patients, and the radiological findings were analysed. A not previously reported thickening of the skull base without cranial nerve palsy or optic nerve atrophy was revealed in all patients. Scoliosis was present in three of them. This has been reported previously only once in ADO II. No lower limb deformity was detected. This study provided information on the pattern of radiological features in familial asymptomatic ADO II. These data on new and rare imaging findings will increase the diagnostic awareness of physicians and will guide a thorough investigation of the entire family. This might result in a consequent decrease in the incidence of fractures and other orthopaedic complications.

Subchondral impaction fractures of the non-weight-bearing portion of the lateral femoral condyle

ObjectiveTo document the first report of intra-articular, non-weight-bearing, impaction fractures of the lateral femoral condyle.Materials & methodsInstitutional Review Board and Regional Ethics Committee approval for this study was obtained and patient informed consent deemed unnecessary. We prospectively documented all potential cases of non-weight-bearing posterior subchondral impaction fractures of the femoral condyles diagnosed on magnetic resonance imaging (MRI) of the knee performed at our institution between January 2006 and December 2011. The cases were reviewed and discussed by three experienced musculoskeletal radiologists and only cases satisfying pre-defined MRI criteria were included.ResultsSixteen cases of intra-articular impaction fractures in a posterior, non-weight-bearing area of the lateral femoral condyle were diagnosed in patients with a mean age of 40. Eight were associated with recreational sports activities and 4 with repeated kneeling. There were no fractures documented in the non-weight-bearing aspect of the medial femoral condyles. Proposed underlying mechanisms for development of this type of fracture are presented.ConclusionAwareness, along with a high level of suspicion, that non-specific knee pain, especially in patients involved in athletic activities, could be due to intra-articular impaction fractures of the non-weight-bearing posterior aspect of the lateral femoral condyle is essential and MRI is the mainstay of diagnosis.

Management of low back pain with facet joint injections and nerve root blocks under computed tomography guidance. A prospective study

ObjectivesThe aim of this work was to assess the performance of facet joint and nerve root infiltrations under computed tomography guidance for the management of low back pain and to investigate the complications and patient tolerance.Materials and methodsThe study was board-certified and informed consent was obtained from all patients. In 1xa0year, 86 consecutive patients (47 male, 39 female, age range 47–87xa0years, mean age 63) with low back pain for more than 2xa0years were included. All patients were clinically examined and had cross-sectional imaging performed before the procedure. Fifty-five facet joint infiltrations and 31 nerve blocks were performed under computed tomography guidance. All patients completed two valid pain questionnaires before and 3xa0months after the procedures. At the same time, they were clinically examined by the referring Orthopaedic Surgeon. The pain response was assessed by comparing the scores of the questionnaires. The improvement in clinical examination findings was assessed as well.ResultsIn patients who underwent facet joint infiltrations, long-term pain improvement was achieved in 79% and in those with nerve blocks in 85%. Immediate pain relief was demonstrated in 83% of patients with nerve infiltrations. No complications were observed. All procedures were very well tolerated by patients.ConclusionsFacet joint and nerve infiltrations under computed tomography guidance constitute an accurate and safe method that could be used to relieve low back pain and minimize the risk of disability.

Benign and Malignant Vertebral Fractures

Vertebral compression fractures are a common clinical problem, particularly in elderly patients. Osteoporosis is the most common cause in this age group. However, malignancy can also be a cause of vertebral collapse in the same age group. The diagnostic challenge is even greater when vertebral fractures are detected in patients with a history of cancer. In all these patients, determining the cause of vertebral collapse is crucial for the management, treatment planning and prognosis. The purpose of this chapter is to analyze the imaging features used to differentiate malignant from benign causes.

Osteonecrosis and Bone Infarction

Bone ischemia is a relatively common condition, which may be idiopathic or secondary to a variety of clinical situations. Medullary infarction refers to dia-metaphyseal location whereas osteonecrosis to the epiphyseal and sub-articular involvement. In both situations, the lesions may be radiographically occult. Magnetic resonance imaging (MRI) is very sensitive in identifying and characterizing bone ischemia. Newer treatments on femoral head osteonecrosis require early diagnosis, accurate staging, and estimation of prognosis and assessment of treatment. This chapter reviews the current and evolving knowledge on the various faces of bone ischemia with emphasis on the role of MRI on the clinically most important forms of the disease.