F Candela

Role of high-resolution ultrasonography without and with real-time spatial compound imaging in evaluating the injured posterior cruciate ligament: preliminary study

PurposeThis study sought to compare high-resolution ultrasonography (HRUS) without and with compound imaging in evaluating the injured posterior cruciate ligament (PCL).Materials and methodsThirteen patients with a magnetic resonance imaging (MRI) diagnosis of PCL lesions (ten acute and three chronic) and 20 healthy controls underwent conventional and compound HRUS performed by the same radiologist who was blinded to the subjects’ case-control status. The PCL was scanned in a longitudinal direction in all cases. HRUS images were assessed for PCL thickness by two other radiologists blinded to the number and type of PCL injury. PCLs were classified as normal or injured, and the latter as having acute or chronic injuries. Intermethod reproducibility of measuring PCL thickness was assessed on conventional and compound HRUS images.ResultsComplete agreement in classifying normal or injured PCL and acute or chronic PCL injuries was achieved. PCL thickness in volunteers was 4.5±0.7 mm on conventional images and 4.6±0.7 mm on compound images. On conventional and compound HRUS images, the thickness of acutely injured PCL was 9.1±1.5 mm and 9.2±1.7 mm, respectively, and that of chronically injured PCL was 7±0.9 mm and 7±0.8 mm. Intermethod reproducibility of PCL thickness measurements on conventional vs. compound HRUS images was 98.6%.ConclusionsHRUS is a reliable technique for studying the PCL and detecting PCL injuries.AbstractObiettivoConfrontare l’ecografia ad alta risoluzione (HRUS) senza e con il compound nello studio del legamento crociato posteriore (LCP) con lesioni traumatiche.Materiali e metodiTredici pazienti con diagnosi RM di lesione del LCP, 10 acuta e 3 cronica, sono stati sottoposti ad HRUS convenzionale e compound eseguita in cieco dallo stesso radiologo. Il gruppo controllo HRUS era composto da 20 volontari sani e sono state eseguite scansioni HRUS longitudinali del LCP. In consenso ed in cieco altri due radiologi hanno misurato nelle immagini HRUS lo spessore degli LCP, quindi i casi sono stati classificati in normali/patologici e questi ultimi in acuti/cronici. È stata valutata la riproducibilità intermetodo nella misurazione dello spessore degli LCP nelle immagini convenzionali versus compound.RisultatiNella classificazione del LCP normale/patologico e con lesione acuta/cronica abbiamo evidenziato la completa concordanza HRUS/RM e HRUS convenzionale/compound. Nelle immagini HRUS convenzionali e compound lo spessore del LCP era rispettivamente nel normale 4,5±0,7 mm e 4,6±0,7 mm, nelle lesioni acute 9,1±1,5 mm e 9,2±1,7 mm e nelle croniche 7±0,9 mm e 7±0,8 mm. La riproducibilità intermetodo nella misurazione dello spessore del LCP nelle immagini convenzionali versus compound era del 98,6%.ConclusioniL’HRUS consente lo studio del LCP con riconoscimento incidentale delle alterazioni traumatiche.

Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers

PurposeThis study assessed the usefulness of upright weight-bearing examination of the ankle/hind foot performed with a dedicated magnetic resonance (MR) imaging scanner in the evaluation of the plantar fascia in healthy volunteers and in patients with clinical evidence of plantar fasciitis.Materials and methodsBetween January and March 2009, 20 patients with clinical evidence of plantar fasciitis (group A) and a similar number of healthy volunteers (group B) underwent MR imaging of the ankle/hind foot in the upright weight-bearing and conventional supine position. A 0.25-Tesla MR scanner (G-Scan, Esaote SpA, Genoa, Italy) was used with a dedicated receiving coil for the ankle/hind foot. Three radiologists, blinded to patients’ history and clinical findings, assessed in consensus morphological and dimensional changes and signal intensity alterations on images acquired in both positions, in different sequences and in different planes.ResultsIn group A, MR imaging confirmed the diagnosis in 15/20 cases; in 4/15 cases, a partial tear of the plantar fascia was identified in the upright weight-bearing position alone. In the remaining 5/20 cases in group A and in all cases in group B, the plantar fascia showed no abnormal signal intensity. Because of the increased stretching of the plantar fascia, in all cases in group A and B, thickness in the proximal third was significantly reduced (p<0.0001) under upright weight-bearing compared with the supine position.ConclusionsImaging the ankle/hind foot in the upright weight-bearing position with a dedicated MR scanner and a dedicated coil might enable the identification of partial tears of the plantar fascia, which could be overlooked in the supine position.RiassuntoObiettivoScopo del nostro lavoro è stato dimostrare l’utilità dell’esame sotto carico del retropiede/caviglia eseguito con apparecchiatura di risonanza magnetica (RM) dedicata finalizzato alla valutazione della fascia plantare in volontari sani ed in pazienti con evidenza clinica di fascite plantare.Materiali e metodiNel periodo compreso tra gennaio e marzo 2009, 20 pazienti con diagnosi clinica di fascite plantare (gruppo A) ed altrettanti volontari sani (gruppo B), sono stati sottoposti ad esame RM del retropiede/caviglia sia in ortostatismo che in clinostatismo. Per le indagini è stata utilizzata una apparecchiatura RM dedicata da 0,25 Tesla (G-Scan, Esaote SpA, Genova, Italia) con bobina di ricezione dedicata per retropiede/caviglia. Tre radiologi in consenso e in cieco sull’anamnesi e l’obiettività clinica dei soggetti hanno valutato le alterazioni morfo-dimensionali e dell’intensità di segnale nelle immagini acquisite nelle due posizioni, nelle diverse sequenze e nei differenti piani di scansione.RisultatiNel gruppo A, la RM ha confermato la diagnosi in 15/20 casi; in 4/15 casi è stata evidenziata una rottura parziale della fascia plantare visualizzata solo nella posizione ortostatica. Nei restanti 5/20 casi del gruppo A ed in quelli del gruppo B la fascia plantare non presentava alterazioni dell’intensità di segnale. A causa della maggiore tensione della fascia plantare in tutti i casi, gruppo A e B, lo spessore del tratto peri-inserzionale sotto carico si riduceva significativamente (p<0,0001) rispetto al clinostatismo.ConclusioniL’imaging del retropiede/caviglia nella posizione ortostatica con RM dedicata e bobina dedicata potrebbe consentire di dimostrare le rotture parziali della fascia plantare che possono rimanere misconosciute in clinostatismo.

High-resolution ultrasonography (HRUS) of the meniscal cyst of the knee: Our experience

PurposeThis study was undertaken to assess the diagnostic accuracy of high-resolution ultrasonography (HRUS) in the detection of meniscal cysts.Materials and methodsOver a 2-year period, 1,857 patients underwent magnetic resonance imaging (MRI) of the knee for traumatic or degenerative disorders. All patients with MRI evidence of a meniscal cyst were studied by HRUS. HRUS was also performed on an equal number of patients without MRI evidence of meniscal cyst who were used as a control group. All HRUS examinations were conducted by a radiologist blinded to the MRI findings. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HRUS were assessed with reference to MRI. All patients underwent surgery, and the resected masses were studied by histological examination.ResultsMRI allowed identification of a meniscal cyst in 52 patients. HRUS enabled correct detection of the meniscal cyst in 49/52 cases. In the control group, HRUS excluded the presence of meniscal cysts in all cases. HRUS had a sensitivity, specificity, PPV and NPV of 94.23%, 100%, 100% and 94.54%, respectively, for the detection of meniscal cysts.ConclusionsHRUS is a fairly reliable technique in the detection, characterisation and differentiation of the different forms of meniscal cyst.RiassuntoObiettivoVerificare l’accuratezza diagnostica dell’ecografia ad elevata risoluzione (HRUS) nella detezione delle cisti parameniscali.Materiali e metodiIn un periodo di 2 anni, sono stati sottoposti ad RM del ginocchio per patologia traumatica o degenerativa 1857 pazienti. Tutti i pazienti in cui è stata identificata una cisti parameniscale sono stati sottoposti ad HRUS. Come gruppo controllo sono stati reclutati altrettanti pazienti, esenti da cisti parameniscali. Tutte le indagini HRUS sono state eseguite in cieco da un’altro radiologo. Sono state valutate la sensibilità la specificità, il valore predittivo positivo (VPP) e negativo (VPN) dell’HRUS in comparazione con la RM. Tutti i pazienti sono stati sottoposti ad intervento chirurgico e le formazioni resecate ad esame istologico.RisultatiIn 52 pazienti l’indagine RM ha consentito l’identificazione di una cisti parameniscale. L’HRUS ne ha consentito la detezione in 49/52 casi. Nel gruppo controllo l’HRUS ne ha escluso la presenza in tutti i casi. L’HRUS ha manifestato nella detezione delle cisti parameniscali sensibilità, specificità, VPP e VPN del 94,23%, 100%, 100% e 94,54%, rispettivamente. L’intervento chirurgico e l’istologia hanno confermato la diagnosi RM.ConclusioniL’HRUS è una metodica abbastanza affidabile nell’identificazione, nella valutazione delle caratteristiche semeiologiche e nella distinzione delle differenti forme delle cisti meniscali.

Femoro-acetabular impingement. Classification, diagnosis and treatment.

The success of a total hip arthoplasty is linked to a long survival, and this one is obtained reducing the surfaces wearing. Polyethylene material was introduced by Sir John Charnley in the 60’s and has been until now the cartilage most similar material regarding the Young modulus, despite metal and ceramic ones. It has been also characterized by a good wear, especially nowadays the highly cross-linked polyethylene technology has been developed. In the last years, research has been oriented to already used materials improvement such as metals and metal alloys (steel, titanium, CrCo, tantalum), to study and product dense and bioactive ceramics (alumina), to study and product polymeric and composite materials. The physical properties of some polymers have shown to be very similar to those of the normal cartilage. Considering that the most relevant impairment in an arthritic hip regard the articular cartilage, it’s easy to figure out the importance of regaining the cartilage function in anatomical THA surgery. Years of study and laboratory tests have led to the production of a new acetabulum module made of PCU (polycarbonate urethane), which would play a buffer/plug role, as the normal cartilage of a healthy hip does. The emerging buffer characteristics consist of the mentioned optimum modulus of elasticity which results moreover as a shock absorber, and the optimum microelastodynamic lubrication which reduce the friction coefficient. The buffer is presented as an acetabular cup to be inserted in a metal back (titanium coated CrCoMo) press-fit implanted. It can also be implanted directly in contact with the acetabular bone, previous the thin residual cartilage layer removal, allowing a more anatomical surgery and a bone stock sparing. PCU buffer is intended to be a new way of thinking total hip arthroplasty, nevertheless the acquired experience is actually confined among few Centers and further laboratory tests are going to be concluded. The path has drawn, it has just to be covered!