D. Guenoun

The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament

When faced with a clinical suspicion of knee ligament injury, MRI nowadays has a central role in the diagnostic strategy. In particular, it is essential for assessing the cruciate ligaments and any associated meniscal tears. The objective of this review is to present the various direct and indirect MRI signs of tearing of the anterior cruciate ligament (ACL) and then describe the lesions associated with it. The anatomical and clinical aspects are also discussed so that the contribution of MRI to the diagnosis and therapeutic management of an ACL tear can be better understood.

Radiographical texture analysis improves the prediction of vertebral fracture: an ex vivo biomechanical study.

Study Design. Compression biomechanical tests using fresh cadaveric thoracolumbar motion segments. Objective. The purpose of this study was to determine if the combination of bone texture parameters using bone microarchitecture, and bone mineral density (BMD) measurement by dual-energy x-ray absorptiometry provided a better prediction of vertebral fracture than BMD evaluation alone. Summary of Background Data. Bone strength is routinely evaluated using BMD, as measured by dual-energy x-ray absorptiometry. Currently, there is an ongoing debate about the strengths and limitations of bone densitometry in clinical practice. To assess the fracture risk properly, other factors are important to be taken into account such as the macro- and microarchitecture of the bone. Recently, a new high-resolution x-ray device with direct digitization, named bone microarchitecture (BMA, D3A Medical Systems), has been developed to provide a better precision of texture parameters than those previously obtained on digitized films. Methods. Twenty-seven 3-level thoracolumbar motion segments (T11, T12, L1, and L2, L3, L4) of excised spines, obtained at the Anatomy Department of Marseille, were studied using bone microarchitecture to estimate 3 textural parameters: fractal parameter Hmean, co-occurrence matrix, and run-length matrix, dual-energy x-ray absorptiometry to measure BMD, and mechanical compression tests to failure. All specimens were examined by computed tomography before and after compression. The prediction of the vertebral failure load was evaluated using multiple regression analyses. Results. Twenty-seven vertebral fractures were observed with a mean failure load of 2636.3 N (standard deviation, 996 N). Fractal parameter Hmean, co-occurrence matrix, and run-length matrix were each significantly correlated with BMD (P< 0.01) and bone strength (P< 0.01). Combining bone texture parameters and BMD significantly improved the fracture load prediction from adjusted r2 = 0.701 to adjusted r2 = 0.806 (P< 0.01). Conclusion. In these excised vertebrae, the combination of bone texture parameters with BMD demonstrated a better performance in the failure load prediction than that of BMD alone. Level of Evidence: N/A

Splenic sarcoidosis mimicking neoplastic disease

Sarcoidosis is a multisystem granulomatous disease of unknown cause that commonly involves the spleen. Sarcoid can produce either homogeneous splenomegaly or multiple splenic nodules. Although other organ system involvement usually occurs, this is not invariable. Herein, we report on the clinical, histological, and radiological features—including sonography and MRI—of an isolated splenic sarcoidosis that mimicked neoplastic disease in a 37‐year‐old female. Knowledge of this atypical sonographic presentation may prevent unnecessary splenectomy.

Focal myositis: Sonographic findings

may be the effect of modifier genes or may due to environmental factors. Although the contribution of epigenetic factors was not explored in this study, we did investigate the potential role of lifestyle and associated conditions in determining disease manifestations. These data show that age-related penetrance is a characteristic feature of LGMD1F that reduces the predictive value of the genetic test. Because age-related penetrance is a major challenge when attempting to quantify the genetic risk of a patient’s offspring, our results may be useful for genetic counseling, especially in younger patients with the mutation.

Diagnostic Performance of Flat-Panel CT Arthrography for Cartilage Defect Detection in the Ankle Joint: Comparison With MDCT Arthrography With Gross Anatomy as the Reference Standard

OBJECTIVE The purpose of this study is to compare the diagnostic performance and radiation exposure of flat-panel CT arthrography for cartilage defect detection in the ankle joint to standard MDCT arthrography, using gross anatomy and thermoluminescent dosimetry as reference standards. MATERIALS AND METHODS Ten cadaveric ankle specimens were obtained from individuals who had willed their bodies to science. Five milliliters of a mixture of diluted ioxaglate and saline were injected. Specimens were examined consecutively with the use of flat-panel CT and MDCT. Radiation doses of flat-panel CT and MDCT were recorded using thermoluminescent dosimeters. Flat-panel CT and MDCT arthrography examinations were blinded and randomly evaluated by two musculoskeletal radiologists in consensus. In each ankle specimen, eight cartilage areas were assessed separately: medial talar surface, medial talar trochlea, lateral talar trochlea, lateral talar surface, tibial malleolus, medial tibial pla-fond, lateral tibial plafond, and fibular malleolus. Findings at flat-panel CT and MDCT arthrography were compared with macroscopic assessments in 80 cartilage areas. RESULTS For the detection of cartilage lesions, flat-panel CT showed a sensitivity of 80%, specificity of 98%, and accuracy of 94%, and MDCT arthrography showed a sensitivity of 55%, specificity of 98%, and accuracy of 88%. Flat-panel CT and MDCT arthrography showed almost perfect (κ = 0.83) and substantial (κ = 0.65) agreement, respectively, with anatomic examination. Radiation dose was significantly lower for flat-panel CT (mean, 2.1 mGy; range, 1.1-3.0 mGy) than for MDCT (mean, 47.2 mGy; range, 39.3-53.8 mGy) (p < 0.01). CONCLUSION Flat-panel CT arthrography is accurate for detecting cartilage defects in the ankle joint and is an alternative to MDCT arthrography that may have better diagnostic performance and may permit the use of a lower radiation dose.

Design and properties of a novel radiopaque injectable apatitic calcium phosphate cement, suitable for image-guided implantation: DESIGN AND PROPERTIES OF A NOVEL RADIOPAQUE INJECTABLE APATITIC CPC

An injectable purely apatitic calcium phosphate cement (CPC) was successfully combined to a water-soluble radiopaque agent (i.e., Xenetix® ), to result in an optimized composition that was found to be as satisfactory as poly(methyl methacrylate) (PMMA) formulations used for vertebroplasty, in terms of radiopacity, texture and injectability. For that purpose, the Xenetix dosage in the cement paste was optimized by injection of the radiopaque CPC in human cadaveric vertebrae under classical PMMA vertebroplasty conditions, performed by interventional radiologists familiar with this surgical procedure. When present in the cement paste up to 70 mg I mL-1 , Xenetix did not influence the injectability, cohesion, and setting time of the resulting composite. After hardening of the material, the same observation was made regarding the microstructure, mechanical strength and alpha-tricalcium phosphate to calcium deficient apatite transformation rate. Upon implantation in bone in a small animal model (rat), the biocompatibility of the Xenetix-containing CPC was evidenced. Moreover, an almost quantitative release of the contrast agent was found to occur rapidly, on the basis of in vitro static and dynamic quantitative studies simulating in vivo implantation.

Percutaneous cryoablation for the treatment of osteoid osteoma in the adult population

PurposeTo evaluate the technical feasibility and efficacy of percutaneous cryoablation for the treatment of osteoid osteoma (OO) in adults.Methods and materials21 patients (12 male and nine female; mean age, 29.9 years) who underwent CT-guided percutaneous cryoablation for the treatment of OO were retrospectively evaluated. Procedures were carried out under local anaesthesia and conscious sedation in 13 patients, and under general anaesthesia in eight patients. Then, the ablation zone was evaluated with post-procedure magnetic resonance imaging at 6 weeks. Clinical outcome was assessed using a visual analogue scale (VAS) to evaluate severity of pain before procedure, as well as at primary (6 weeks) and secondary follow-up (6-40 months).ResultsAll procedures were technically successful. Median VAS scores were: 8 (range, 5-10) before procedure and after procedure, respectively, 0 (range, 0-2; p < .0001) and 0 (range, 0-7; p < .0001) at primary and secondary follow-up. There were three minor complications (14.3%) and no major complication. A single patient reported symptom recurrence (4.8%) at secondary follow-up and successfully underwent a second cryoablation procedure.ConclusionCT-guided percutaneous cryoablation is safe and effective in the treatment of OO in adults, and can be accomplished without general anaesthesia in selected cases.Key Points• CT-guided percutaneous cryoablation of osteoid osteoma is safe and effective• Cryoablation allows precise visual control of the aggregated iceball during procedure• Percutaneous cryoablation can be accomplished without general anaesthesia in selected cases• Another advantage of cryoablation is reduction of immediate postprocedural pain• Post-procedure MRI is helpful in the evaluation of technical success

A symptomatic anomalous biceps femoris tendon insertion

The biceps femoris is the most lateral component of the so-called hamstring muscles. Classically, this muscle has a distal insertion onto the fibular head, proximal tibia and the crural fascia. We report a case of lateral knee pain related to an anomalous biceps femoris tendon insertion.