Emily N. Vinson

Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction

Bone tunnel widening poses a problem for graft fixation during revision anterior cruciate ligament (ACL) reconstruction. Large variability exists in the utilization of imaging modalities for evaluating bone tunnels in pre-operative planning for revision ACL reconstruction. The purpose of this study was to identify the most reliable imaging modality for identifying bone tunnels and assessing tunnel widening, and specifically, to validate the reliability of radiographs, MRI, and CT using intra- and inter-observer testing. Data was retrospectively collected from twelve patients presenting for revision ACL surgery. Five observers twice measured femoral and tibial tunnels at their widest point using digital calipers in coronal and sagittal planes. Measurements were corrected for magnification. Tunnel identification, diameter measurements, and cross-sectional area (CSA) calculations were recorded. A categorical classification of tunnel measurements was created to apply clinical significance to the measurements. Using kappa statistics, intra- and inter-observer reliability testing was performed. CT demonstrated excellent intra- and inter-observer reliability for tunnel identification. Intra- and inter-observer reliability was significantly less for MRI and radiographs. CT revealed superior reliability versus either radiographs or MRI for CSA analysis. Intra-observer kappa scores for tibial CSA using CT, radiographs, and MRI were 0.66, 0.5, and 0.37, respectively. Inter-observer kappa scores for tibial CSA using CT, radiographs, and MRI were 0.65, 0.39, and 0.32, respectively. Our results demonstrate CT is the most reliable imaging modality for evaluation of ACL bone tunnels as proven by superior intra- and inter-observer testing results when compared to MRI and radiographs. Radiographs and MRI were not reliable, even for simply identifying the presence of a bone tunnel.

Promotion of the development of enteric neurons and glia by neuropoietic cytokines: Interactions with neurotrophin-3

Neurotrophin-3 (NT-3) is known to promote enteric neuronal and glial development. Ciliary neurotrophic factor (CNTF) and leukemia inhibitory factor (LIF) were investigated to test the hypothesis that the development of subsets of enteric neurons and/or glia is also affected by a neuropoietic cytokine, by itself, or together with NT-3. Crest-derived cells, immunoselected from the fetal rat gut (E14) with antibodies to p75NTR, were found by RT-PCR and immunocytochemistry (after culture) to express both alpha (CNTER alpha) and beta components (gp130 and LIFR beta) of the tripartite CNTF receptor. In situ, myenteric ganglia below the esophagus were CNTFR alpha-immunoreactive by E16-E18. In vitro, CNTF and LIF induced in crest-derived cells nuclear translocation of STAT3 (signal transducer and activator of transcription 3), a concentration-dependent increase in expression of neuronal or glial markers, and a decrease in expression of the precursor marker, nestin. LIFR beta was expressed by more cells than CNTFR alpha; therefore, although the factors were equipotent, the maximal effect of LIF > CNTF. The cytokines and NT-3 were additive in promoting neuronal but not glial development. Specifically, the development of neurons expressing NADPH-diaphorase activity (an early marker found in inhibitory motor neurons) was promoted by CNTF and NT-3. These observations support the idea that a ligand for the tripartite CNTF receptor complex plays a role in ENS development.

Contamination of Catheter-Drawn Blood Cultures

ABSTRACT To assess the risk of contamination, we reviewed retrospectively 1,408 matched pairs of simultaneous catheter-drawn and venipuncture blood cultures. Catheter-drawn cultures were equally likely to be truly positive (14.4 versus 13.7%) but more likely to be contaminated (3.8 versus 1.8% [P = 0.001]). Direct venipuncture cultures are preferred.

The Posterolateral Corner of the Knee

OBJECTIVE The purpose of this article is to review the clinical importance and MRI appearances of injuries to the posterolateral corner of the knee. CONCLUSION Injuries to the posterolateral corner structures of the knee can cause significant disability due to instability, cartilage degeneration, and cruciate graft failure. Becoming familiar with the anatomy of this region can improve ones ability to detect subtle abnormalities and can perhaps lead to improvements in diagnosing and understanding injuries to this area.

MRI Appearance of Posterior Cruciate Ligament Tears

OBJECTIVE There is little in the radiology literature regarding the MRI appearance of a torn posterior cruciate ligament (PCL). The purpose of this study was to describe the MRI appearance of surgically proven PCL tears and to emphasize previously unreported signs. CONCLUSION The PCL is usually injured as the result of stretching deformation; on MRI, the ligament maintains continuity as a single structure with apparent thickening. On sagittal T2-weighted images, an anteroposterior diameter of 7 mm or more is highly suggestive of a torn PCL. Increased intrasubstance signal intensity in the PCL on proton-density images with lower signal intensity on T2-weighted images is another common feature.

Rim-rent tear of the rotator cuff : A common and easily overlooked partial tear

OBJECTIVE The purpose of this study was to determine the incidence of rim-rent rotator cuff tears in a population of patients referred for shoulder MRI and to determine the sensitivity of MRI for the detection of these tears. CONCLUSION Rim-rent tears are a common type of partial-thickness rotator cuff tear, much more commonly present than has been previously reported. In particular, infraspinatus rim-rent tears are more common than previously believed. Rim-rent tears of the infraspinatus tendon and those involving the anterior-most fibers of the supraspinatus tendon are commonly overlooked on MRI, possibly because of failure to appreciate the high incidence of these types of tears and failure to inspect the anterior-most fibers of the rotator cuff.

Magnetic resonance imaging features of osteochondral lesions of the talus.

Background: Osteochondral lesions of the talus (OLT) traditionally have been thought to occur anterolaterally or posteromedially. Recent studies utilizing magnetic resonance imaging (MRI) have questioned this teaching. The purpose of this study was to use MRI to describe the location, frequency, and morphology of OLT and determine if any correlations exist between lesion location and other data points. Methods: The location, frequency, and size of OLT based on a nine-zone grid were recorded on 77 MRI examinations. Lateral ligaments were inspected for evidence of injury. Stability of the lesions was assessed based on four MRI criteria: presence or absence of cartilage defects, edema-like signal abnormality, T2 bright rim, and/or subchondral cysts. Demographic data including patient age, injury mechanism, and chronicity were recorded. An ANOVA model was used to determine if statistical differences existed between lesion size and location. Pearson correlation coefficients were used to examine any association between lesion location and demographic data. Results: Most of the lesions were located medially and centrally on the talar dome (54.5%), with the second highest frequency found laterally and centrally (31.2%). With the numbers available there was no statistical difference between the size of the lesions based on location. No strong correlations were found between lesion location and demographic data. Conclusion: This study refutes traditional teachings regarding the location of OLT and supports recent studies showing that most lesions are located medially and centrally on the talar dome. Level of Evidence: IV, Retrospective Case Series

Magnetic resonance imaging findings associated with surgically proven rotator interval lesions.

ObjectiveTo identify shoulder magnetic resonance imaging (MRI) findings associated with surgically proven rotator interval abnormalities.Materials and methodsThe preoperative MRI examinations of five patients with surgically proven rotator interval (RI) lesions requiring closure were retrospectively evaluated by three musculoskeletal-trained radiologists in consensus. We assessed the structures in the RI, including the coracohumeral ligament, superior glenohumeral ligament, fat tissue, biceps tendon, and capsule for variations in size and signal alteration. In addition, we noted associated findings of rotator cuff and labral pathology.ResultsThree of three of the MR arthrogram studies demonstrated extension of gadolinium to the cortex of the undersurface of the coracoid process compared with the control images, seen best on the sagittal oblique images. Four of five of the studies demonstrated subjective thickening of the coracohumeral ligament, and three of five of the studies demonstrated subjective thickening of the superior glenohumeral ligament. Five of five of the studies demonstrated a labral tear.ConclusionsThe MRI arthrogram finding of gadolinium extending to the cortex of the undersurface of the coracoid process was noted on the studies of those patients with rotator interval lesions at surgery in this series. Noting this finding—especially in the presence of a labral tear and/or thickening of the coracohumeral ligament or superior glenohumeral ligament—may be helpful in the preoperative diagnosis of rotator interval lesions.

Bone Marrow Biopsy: RNA Isolation with Expression Profiling in Men with Metastatic Castration-resistant Prostate Cancer—Factors Affecting Diagnostic Success

PURPOSE To determine the rate at which computed tomographically guided pelvic percutaneous bone biopsy in men with metastatic castration-resistant prostate cancer (mCRPC) yields adequate tissue for genomic profiling and to identify issues likely to affect diagnostic yields. MATERIALS AND METHODS This study was institutional review board approved, and written informed consent was obtained. In a phase II trial assessing response to everolimus, 31 men with mCRPC underwent 54 biopsy procedures (eight men before and 23 men both before and during treatment). Variables assessed were lesion location (iliac wing adjacent to sacroiliac joint, iliac wing anterior and/or superior to sacroiliac joint, sacrum, and remainder of pelvis), mean lesion attenuation, subjective lesion attenuation (purely sclerotic vs mixed), central versus peripheral lesion sampling, lesion size, core number, and use of zoledronic acid for more than 1 year. RESULTS Of 54 biopsy procedures, 21 (39%) yielded adequate tissue for RNA isolation and genomic profiling. Three of four sacral biopsies were adequate. Biopsies of the ilium adjacent to the sacroiliac joints were more likely adequate than those from elsewhere in the ilium (48% vs 28%, respectively). All five biopsies performed in other pelvic locations yielded inadequate tissue for RNA isolation. Mean attenuation of lesions with inadequate tissue was 172 HU greater than those with adequate tissue (621.1 HU ± 166 vs 449 HU ± 221, respectively; P = .002). Use of zoledronic acid, peripheral sampling, core number, and lesion size affected yields, but the differences were not statistically significant. Histologic examination with hematoxylin-eosin staining showed that results of 36 (67%) biopsies were positive for cancer; only mean attenuation differences were significant (707 HU ± 144 vs 473 HU ± 191, negative vs positive, respectively; P < .001). CONCLUSION In men with mCRPC, percutaneous sampling of osseous metastases for genomic profiling is possible, but use of zoledronic acid for more than 1 year may reduce the yield of adequate tissue for RNA isolation. Sampling large low-attenuating lesions at their periphery maximizes yield.

Synovial lipomatosis arborescens of the peroneal tendon sheath

The term “lipoma arborescens” has been used to describe the diffuse infiltration of fat within hypertrophic synovial villi, a condition which has been most frequently described in the knee. We advocate the term “synovial lipomatosis arborescens” for this process and present what is, to our knowledge, the first reported case of this disorder isolated to the peroneal tendon sheath, with imaging, intraoperative, and histological correlation.