Eoin C. Kavanagh

Athletic pubalgia and the "sports hernia": MR imaging findings

PURPOSE To retrospectively determine the sensitivity and specificity of magnetic resonance (MR) imaging findings in patients with clinical athletic pubalgia, with either surgical or physical examination findings as the reference standard. MATERIALS AND METHODS Institutional review board approval was granted for this HIPAA-compliant study, and informed consent was waived. MR imaging studies in 141 patients (134 male patients, seven female patients; mean age, 30.1 years; range, 17-71 years) who had been referred to a subspecialist because of groin pain were reviewed for findings including hernia, pubic bone marrow edema, secondary cleft sign, and rectus abdominis and adductor tendon injury. MR imaging findings were compared with surgical findings for 102 patients, physical examination findings for all 141 patients, and MR imaging findings in an asymptomatic control group of 25 men (mean age, 29.8 years; range, 18-39 years). Sensitivity and specificity of MR imaging for rectus abdominis and adductor tendon injury were determined by using a chi(2) analysis, and significance of the findings was analyzed with an unpaired Student t test. Disease patterns seen at MR imaging were compared with those reported in the surgical and sports medicine literature. RESULTS One hundred thirty-eight (98%) of 141 patients had findings at MR imaging that could cause groin pain. Compared with surgery, MR imaging had a sensitivity and specificity, respectively, of 68% and 100% for rectus abdominis tendon injury and 86% and 89% for adductor tendon injury. Injury in each of these structures was significantly more common in the patient group than in the control group (P < .001). Only two patients had hernias at surgery. At MR imaging, injury or disease could be fit into distinct groups, including osteitis pubis, adductor compartment injury, rectus abdominis tendon injury, and injury or disease remote from the pubic symphysis. Patients with injury involving the rectus abdominis insertion were most likely to go on to surgical pelvic floor repair. CONCLUSION MR imaging depicts patterns of findings in patients with athletic pubalgia, including rectus abdominis insertional injury, thigh adductor injury, and articular diseases at the pubic symphysis (osteitis pubis).

Carotid plaque inflammation on 18F-fluorodeoxyglucose positron emission tomography predicts early stroke recurrence.

Symptomatic carotid stenosis is associated with a 3‐fold risk of early stroke recurrence compared to other stroke subtypes. Current carotid imaging techniques rely on estimating plaque‐related lumen narrowing but do not evaluate intraplaque inflammation, a key mediator of plaque rupture and thromboembolism. Using combined 18F‐fluorodeoxyglucose positron‐emission tomography (FDG‐PET)/computed tomography, we investigated the relation between inflammation‐related FDG uptake and stroke recurrence.

Injectable Corticosteroid and Local Anesthetic Preparations: A Review for Radiologists

Corticosteroids and local anesthetics are some of the most commonly administered medications in radiology departments. These medications have marked variability in their formulations, which may increase their adverse event profile for specific procedures. In particular, certain corticosteroid preparations are associated with adverse central nervous system (CNS) sequelae. This is most likely due to distal embolization by particulate formulations. Nonparticulate steroid formulations are not associated with such events. Local anesthetics have severe CNS and cardiac adverse effects if injected intravascularly and have recently been associated with intraarticular chondrolysis if used in large doses. This review discusses these medications with particular emphasis on their established and postulated adverse effects. The administering radiologist should be aware of these potential effects and how best to reduce their occurrence.

Normal Appearance and Complications of Double-Bundle and Selective-Bundle Anterior Cruciate Ligament Reconstructions Using Optimal MRI Techniques

OBJECTIVE Double-bundle and selective-bundle anterior cruciate ligament (ACL) reconstructions are increasingly performed to better reproduce the double-bundle anatomy of the native ACL and to improve knee stability and surgical outcomes. This article illustrates how to optimize visualization of the ACL bundle anatomy and the appearances of graft components and postoperative complications. CONCLUSION It is important for the radiologist to be familiar with the appearance of double-bundle and selective-bundle ACL reconstructions and associated complications.

MRI findings in bipartite patella

PurposeBipartite patella is a known cause of anterior knee pain. Our purpose was to detail the magnetic resonance imaging (MRI) features of bipartite patella in a retrospective cohort of patients imaged at our institution.Materials and methodsMRI exams from 53 patients with findings of bipartite patella were evaluated to assess for the presence of bone marrow edema within the bipartite fragment and for the presence of abnormal signal across the synchondrosis or pseudarthrosis. Any other significant knee pathology seen at MRI was also recorded. We also reviewed 400 consecutive knee MRI studies to determine the MRI prevalence of bipartite patella.ResultsOf the 53 patients with bipartite patella 40 (75%) were male; 35 (66%) had edema within the bipartite fragment. Of the 18 with no edema an alternative explanation for knee pain was found in 13 (72%). Edema within the bipartite fragment was the sole finding in 26 of 53 (49%) patients. Bipartite patella was seen in 3 (0.7%) of 400 patients.ConclusionIn patients with bipartite patella at knee MRI, bone marrow edema within the bipartite fragment was the sole finding on knee MRI in almost half of the patients in our series.

Relative contribution of HIV infection, demographics and body mass index to bone mineral density.

Introduction:Low bone mineral density (BMD) is common in HIV-positive patients, although the role played by HIV infection versus sociodemographic and metabolic factors remains unclear. Methods:Understanding the Pathology of Bone Disease in HIV-infected individuals (HIV UPBEAT) is a prospective cohort study, enrolled HIV-positive and HIV-negative participants from similar demographic backgrounds. Dual X-ray absorptiometry at femoral neck, total hip and lumbar spine and blood tests were performed. Associations between BMD and factors of interest were assessed using multivariable linear regression. Results:A total of 474 participants were recruited. Two hundred and ten were HIV-positive, of whom, 59% were male, 40% African and median (interquartile range) age was 39 (33, 46) years. HIV acquisition risks were heterosexual sex (46.9%), homosexual sex (25.4%) and intravenous drug use (18.7%). Of the HIV-negative participants, 44% were male, 25% were African and median (interquartile range) age was 42 (34–49) years. HIV infection was independently associated with a 0.062 (P < 0.0001), 0.078 (P < 0.0001) and 0.060 g/cm2 (P = 0.0002) lower BMD at femoral neck, total hip and lumbar spine, respectively, after adjustment for demographic/ lifestyle factors and BMI. After further adjustment for bone biomarkers, HIV remained independently associated with reduced BMD at each site, although effect sizes were reduced. The HIV-positive group had significantly higher bone turnover (all between-group P < 0.0001). Treatment variables and cumulative exposure to antiretroviral therapy were not associated with lower BMD at femoral neck or total hip, but acquisition of HIV infection via intravenous drug use and longer time since HIV diagnosis were independently associated with lower lumbar spine BMD. Discussion:HIV is independently associated with lower BMD, and its effect is likely mediated, in part, by alterations in bone metabolism.

MRI findings of prepatellar Morel-Lavallée effusions.

ObjectiveTo describe MR imaging characteristics and treatment options for prepatellar closed degloving injuries or Morel-Lavallée effusions. Imaging features are discussed that may aid in the distinguishing of this entity from “housemaids knee” or prepatellar bursitis.Materials and methodsMR images of four young wrestlers were reviewed by two attending radiologists and one fellow, and correlative clinical data were collected using the electronic medical database.ResultsMR images in all cases showed a unilocular, T2 hyperintense prepatellar collection extending beyond the normal boundaries of the prepatellar bursa. No necrotic fat or blood products were identified in the collections. Surgical pathology proving the absence of synovial tissue was available for one case, and differentiation of the collection from the adjacent bursa was confirmed visually by the surgeon in a second case.ConclusionAlthough prepatellar hemorrhagic bursitis and Morel-Lavallée effusions share many imaging features, making a specific diagnosis in most cases is not necessary, as treatment is often similar for both entities.

Whole-body turbo STIR MR imaging: controversies and avenues for development

Abstract.The idea of a non-ionizing high-resolution technique to screen the entire body for occult disease is immensely appealing. This article outlines an evolving technique, controversies and clinical application of whole-body scanning using MRI with turbo short tau inversion recovery tissue excitation.

Overuse Injuries of the Knee

Overuse injuries are a common cause of morbidity in athletes. They occur after repetitive microtrauma, abnormal joint alignment, and poor training technique without appropriate time to heal. Overuse injuries are frequent in the knee joint because of the numerous attachment sites for lower limb musculature and tendons surrounding the joint. MR imaging is regarded as the noninvasive technique of choice for detection of internal derangements of the knee. This article describes the characteristic findings on MR of the common overuse injuries in the knee, including patellar tendinopathy, iliotibial band syndrome, cartilage disorders, medial plica syndrome, and bursitis.

MR Imaging of Muscle Injury

Although most muscle injuries in the athlete are diagnosed clinically, MR imaging is an excellent noninvasive diagnostic adjunct to clinical examination, which allows the site and severity of muscle injury to be assessed accurately, influencing therapy and overall outcome. There has been a rapid expansion in the clinical use of MR imaging during the past decade. MR imaging conveys unparalleled anatomic resolution and high sensitivity in the detection of acute and chronic muscle abnormalities. This article discusses the spectrum of muscle injuries, emphasizing the important role of MR imaging in their diagnosis and management.