Cedric Boulet

Assessment of the long head of the biceps tendon of the shoulder with 3T magnetic resonance arthrography and CT arthrography

We studied the assessment of proximal biceps tendon lesions including degeneration, tendon luxation, and partial and complete tendon tears with 3T MR arthrography and CT arthrography. Thirty-six patients who underwent both studies, as well as arthroscopy were included in the study. The images were randomized and blinded and independently reviewed by two musculoskeletal radiologists. The pooled sensitivity for lesion detection for CT arthrography was 31% and the specificity 95%. The pooled sensitivity for MR arthrography was 27% and the specificity 94%. There were no statistically significant differences between CT and MR. The interobserver agreement calculated with the kappa statistic was poor for CT and for MR. Both CT arthrography and MR arthrography perform poorly in the detection of biceps tendon pathology of the shoulder.

Ultrasound of the knee with emphasis on the detailed anatomy of anterior, medial, and lateral structures

ObjectiveTo describe the detailed ultrasound anatomy of the anterior, medial, and lateral aspects of the knee and present the ultrasound examination technique used.Materials and MethodsWe present ultrasound using images of patients, volunteer subjects, and cadaveric specimens. We correlate ultrasound images with images of anatomical sections and dissections.ResultsThe distal quadriceps tendon is made up of different laminas that can be seen with ultrasound. One to five laminas may be observed. The medial retinaculum is made up of three anatomical layers: the fascia, an intermediate layer, and the capsular layer. At the level of the medial patellofemoral ligament (MPFL) one to three layers may be observed with ultrasound. The medial supporting structures are made up of the medial collateral ligament and posterior oblique ligament. At the level of the medial collateral ligament (MCL), the superficial band, as well as the deeper meniscofemoral and meniscotibial bands can be discerned with ultrasound. The posterior part, corresponding to the posterior oblique ligament (POL), also can be visualized. Along the posteromedial aspect of the knee the semimembranosus tendon has several insertions including an anterior arm, direct arm, and oblique popliteal arm. These arms can be differentiated with ultrasound. Along the lateral aspect of the knee the iliotibial band and adjacent joint recesses can be assessed. The fibular collateral ligament is encircled by the anterior arms of the distal biceps tendon. Along the posterolateral corner, the fabellofibular, popliteofibular, and arcuate ligaments can be visualized.ConclusionThe anatomy of the anterior, medial, and lateral supporting structures of the knee is more complex than is usually thought. Ultrasound, with its exquisite resolution, allows an accurate assessment of anatomical detail. Knowledge of detailed anatomy and a systematic technique are prerequisites for a successful ultrasound examination of the knee.

Pathology of Extrinsic Ligaments: A Pictorial Essay

The role of the extrinsic ligaments, together with the intrinsic ligaments, appears to be much more important than previously thought in the setting of carpal stability. The anatomy and pathology of the extrinsic wrist ligaments is complex. Magnetic resonance imaging (MRI) with thin slices is essential for visualization. This article describes the pathological appearance of the extrinsic palmar and dorsal radiocarpal and ulnocarpal ligaments on MRI, correlated with arthroscopy (performed by two skilled hand surgeons), clinical findings, and follow-up. High-resolution MRI, especially using isotropic three-dimensional sequences with orthogonal multiplanar reconstructions on 3T MR systems, allows detailed depiction of many of the extrinsic ligaments affected in carpal injuries. Recognition of ligament abnormalities is improved by intra-articular or intravenous injection of contrast before the examination. Both techniques may help to determine the precise localization, size, and extent of dorsal and palmar radiocarpal and ulnocarpal ligament lesions. Further experience with these techniques is needed to define the place of MRI in the management of traumatic wrist injuries.

Ultrasound follow-up of posttraumatic injuries of the sagittal band of the dorsal hood treated by a conservative approach

Traumatic dislocation of the extensor tendon over the metacarpophalangeal (MCP) joint is a rare problem in patients without rheumatoid disorders. The common extensor tendon is stabilized on the metacarpal head by components of the dorsal hood (DH). A tear in the sagittal bands, allows (sub)luxation of the tendon. To ensure appropriate treatment, the identification of the damaged structures is essential. Ultrasound (US) is a valuable method in the evaluation of DH injuries and in the follow-up for evaluation of healing or lack of healing of the lesions. We report three cases with partial rupture of the sagittal band of the DH: two cases in the index finger and one case in the long finger, which caused pain and swelling and was diagnosed with US. The patients were treated conservatively and the pain resolved after 9 months in case 1, 3 months in case 2 and 6 months in case 3. The follow-up at one year revealed painless full range of motion and no residual subluxation during the dynamic ultrasound.

Indications for body MRI Part I. Upper abdomen and renal imaging.

The lack of ionizing radiation use in MRI makes the high spatial resolution technique very appealing. Also, the easy access to multiplanar imaging and the fact that gadolinium-DTPA is well tolerated and not nephrotoxic makes MRI a robust alternative in the healthy as well as the renal compromised patient. Furthermore, MRI adds advanced possibility for tissue characterization and pathology detection and dynamic imaging can be performed. Specific contrast agents specific to the hepatobiliary or the reticuloendothelial system can help with additional information in problem cases. The role of MRI for different organs is discussed and a review of the literature is given. We concluded that MRI is considered a useful and non-invasive diagnostic tool for the detection of hepatic iron concentration, to correct misdiagnosis (pseudolesions) from US and CT in focal steatosis and to help with focal lesion detection and characterization, in the healthy and especially in the cirrhotic liver, where MRI is superior to CT. Moreover, MRCP is excellent for identifying the presence and the level of biliary obstruction in malignant invasion and is considered in the literature as a non-invasive screening tool for common bile duct stones, appropriately selecting candidates for preoperative ERCP and sparing others the need for an endoscopic procedure with its associated complications. MRI is the first choice modality for adrenal evaluation in contemporary medical imaging. It is a useful examination in renal as well as splenic pathology and best assesses loco-regional staging, i.e. arterial involvement in pancreatic cancer.

Advanced imaging of the glenohumeral ligaments.

The glenohumeral ligaments (GHLs) are the most important passive stabilizers of the shoulder joint. Recognition of acute and chronic glenohumeral ligamentous lesions is very important in the preoperative work-up of shoulder instability and trauma. This article describes and depicts the normal anatomy of the GHLs and their appearance during arthroscopy and on MR and computed tomography arthrography (CTA). Pathologic findings of the superior, middle, and inferior GHLs are described and illustrated with MR and CTA and their corresponding intraoperative arthroscopic images. MR arthrography (MRA) is useful for direct visualization of all GHLs including most lesions of their intra-articular portion and associated capsulolabral pathologies. Sprains, midsubstance tears, avulsion, or fibrous infiltration of the GHL can be identified on MRA images using fast spin-echo sequences with and without fat saturation in the three planes. Although CTA is reputed to better depict associated bony and cartilage lesions, CTA allows only indirect evaluation of the GHLs by outlining their contour or showing contrast penetration. Normal variants may create pitfalls that one should be aware of. Signs of GHL pathology on imaging include: discontinuity, nonvisualization, changes in signal intensity (on MRA), contrast extravasation, contour irregularity, thickening, or waviness.

Sclerosing bone dysplasias: genetic, clinical and radiology update of hereditary and non-hereditary disorders

There is a wide variety of hereditary and non-hereditary bone dysplasias, many with unique radiographic findings. Hereditary bony dysplasias include osteopoikilosis, osteopathia striata, osteopetrosis, progressive diaphyseal dysplasia, hereditary multiple diaphyseal sclerosis and pyknodysostosis. Non-hereditary dysplasias include melorheostosis, intramedullary osteosclerosis and overlap syndromes. Although many of these dysplasias are uncommon, radiologists should be familiar with their genetic, clinical and imaging findings to allow for differentiation from acquired causes of bony sclerosis. We present an overview of hereditary and non-hereditary bony dysplasias with focus on the pathogenesis, clinical and radiographic findings of each disorder.

Magnetic Resonance Arthrography of Glenohumeral Lesions: Anatomy and Arthroscopically Confirmed Pathology

Interpretation of magnetic resonance (MR) arthrography images of the glenohumeral ligaments is made difficult by anatomical variations and by the lack of descriptions of signs of pathology of the ligaments. In this review, we describe the normal and pathologic appearance of the glenohumeral ligaments of the shoulder. These ligaments play an important role in stabilization of the shoulder. Both 1.5 and 3 T MR units were used to acquire the MR images. The principal investigator reviewed the imaging reports and arthroscopic reports. All cases were correlated with arthroscopy. Lesions of the superior glenohumeral, middle glenohumeral, and inferior glenohumeral, including humeral avulsion of the glenoid ligament are discussed. Diagnosis of lesions of the glenohumeral ligaments remains a challenge.

Ankle and midfoot ligaments: Ultrasound with anatomical correlation: A review

We present a detailed overview of anatomical and US features of ankle and midfoot ligaments based on our own dissections and cadaver studies as well as US imaging in cadavers and volunteers. The ligament anatomy about the ankle and midfoot is complex. Most ligaments are superficial and hence very well accessible for US. US technique to obtain optimal visualization however is difficult and requires a learning curve. We discuss US technique in detail for each individual ligament. We divided the ligaments in different groups: tibiofibular ligaments, Bassetts ligament, lateral collateral ligament complex (anterior talofibular ligament, calcaneofibular ligament, lateral talocalcaneal ligament, posterior talofibular ligament), medial collateral ligament complex, spring ligament, Chopart joint ligaments (bifurcate ligament, dorsal talonavicular ligament, lateral calcaneocuboid ligament, long and short plantar ligaments), Lisfranc ligaments, sinus tarsi ligaments.

Looking Beyond the Obvious: Subtle Cortical Metastasis Masked by Gonarthrosis

An 82-year-old woman with known breast carcinoma presented with complaints of pain in both knee joints, which had worsened on the right side in recent months. X-rays of both knee joints, including an AP and a lateral view, revealed moderate to severe osteoarthritis, which was initially thought to be the reason for her complaints. However, on closer inspection, a subtle lysis in the medial cortex of the metaphysis of the right femur with discrete subjacent diffuse area of medullary sclerosis was seen (Figure 1). The craniocaudal length of the lesion was 28 mm and the depth of the lesion including the subcortical medullary sclerosis was 14 mm. Neither a periosteal reaction nor an associated soft tissue mass was visible on X-rays. Skeletal scintigraphy confirmed a metabolically active focus in the same location (Figure 2) and revealed multiple other skeletal metastases.