Hicham Moukaddam

MRI characteristics and classification of peripheral vascular malformations and tumors

Vascular malformations and tumors comprise a broad spectrum of lesions that can cause significant morbidity and even mortality in children and adults. Classification of vascular malformations into high flow and low flow has significant impact on management since the main treatment of the former is transarterial embolization and the later percutaneous sclerotherapy. Magnetic resonance imaging (MRI) is a noninvasive effective tool for imaging and classification of vascular malformations based on the presence of lobulated masses, signal voids, and hemodynamic flow characteristics. MRI also provides details about anatomic extent of the lesion, proximity to vital structures, and involvement of multiple tissue planes. The prototype of vascular tumors is infantile hemangioma with its typical involution after a proliferative phase during infancy. Hemangioma appears as a distinct intensely enhancing soft tissue mass with enlarged feeding arteries and draining veins. Less common vascular tumors include congenital hemangioma, kaposiform hemangioendothilioma, angiolipoma, angiosarcoma, and hemangiopericytoma.

Complications of Adjustable Gastric Banding, a Radiological Pictorial Review

OBJECTIVE The purpose of this article is to review the radiologic appearance of complications of the adjustable gastric band. CONCLUSION Continuous progress in surgical technique of adjustable gastric banding and the increasing experience of surgeons have decreased the rate of complications. However, because different complications may have the same clinical presentation but require different treatment, to give a definitive diagnosis, the radiologist must be aware of the surgical procedures and possible sequelae.

Imaging of anterior cruciate ligament repair and its complications.

OBJECTIVE This article provides a review of anterior cruciate ligament (ACL) reconstruction procedures and their normal postoperative appearance. Then, we review commonly encountered complications: those associated with decreased range of motion (impingement, arthrofibrosis, intraarticular bodies, ganglion cysts) and those associated with laxity (graft tearing, graft stretching). Finally, we review some miscellaneous complications. CONCLUSION Given the number of patients undergoing ACL reconstruction, it is important for radiologists to be familiar with the different reconstruction surgeries and their common complications.

MRI of Heel Pain

OBJECTIVE The purpose of this article is to review the normal anatomy of the posterior ankle and hindfoot and review the causes of heel pain, with attention to the clinical, radio-graphic, and MRI findings. CONCLUSION Heel pain is a common problem that may be due to a variety of soft-tissue and osseous abnormalities. Knowledge of the anatomy of the posterior ankle and hind-foot offers a useful way in approaching heel pain. Some of the more common causes include Achilles tendinosis, Haglund phenomenon, and plantar fasciitis. MRI offers superior soft-tissue contrast resolution and can be helpful in diagnosis as well as in presurgical planning.

Lipoma arborescens of the peroneal tendon sheath

Lipoma arborescens or synovial lipomatosis is a rare disorder characterized by mature fat infiltration of hypertrophic synovial villi, most frequently affecting the suprapatellar pouch of the knee. Involvement of the synovial tendon sheath is extremely rare with only a few reported cases in the literature. We present a case of lipoma arborescens involving the peroneal and flexor tendons sheaths of the ankle, review the few reported cases to date, and discuss MR imaging features of this rare entity. J. Magn. Reson. Imaging 2011;33:221–224.

MRI of anterior knee pain

Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa’s disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.

Comparison of 3D vs. 2D fast spin echo imaging for evaluation of articular cartilage in the knee on a 3 T system scientific research

PURPOSE We sought to retrospectively compare the accuracy of a three-dimensional fat-suppressed, fast spin-echo sequences acquired in the sagittal plane, with multiplanar reconstructions to that of two-dimensional fat-suppressed, fast spin echo sequences acquired in three planes on a 3T MR system for the evaluation of articular cartilage in the knee. MATERIALS AND METHODS Our study group consisted of all patients (N=34) that underwent 3T MR imaging of the knee at our institution with subsequent arthroscopy over an 18-month period. There were 21 males and 13 females with an average age of 36 years. MR images were reviewed by 3 musculoskeletal radiologists, blinded to operative results. 3D and 2D sequences were reviewed at different sittings separated by 4 weeks to prevent bias. Six cartilage surfaces were evaluated both with MR imaging and arthroscopically with a modified Noyes scoring system and arthroscopic results were used as the gold standard. Sensitivity, specificity, and accuracy were calculated for each reader along with Fleiss Kappa assessment agreement between the readers. Accuracies for each articular surface were compared using a difference in proportions test with a 95% confidence interval and statistical significance was calculated using a Fishers Exact Test. RESULTS Two hundred and four articular surfaces were evaluated and 49 articular cartilage lesions were present at arthroscopy. For the patellofemoral surfaces, the sensitivity, specificity, and accuracy were 76.5%, 83%, and 78.2% for the 3D sequences and were 82.3%, 76%, and 82% respectively for the 2D sequences. For the medial compartment surfaces, the sensitivity, specificity, and accuracy were 81.1%, 65.1%, and 78.5% for the 3D sequences and were 82.5%, 48%, and 76.7% respectively for the 2D sequences. For the lateral compartment surfaces, the sensitivity, specificity, and accuracy were 89.3%, 39%, and 79.5% for the 3D sequences and were 94.7%, 18.8%, and 79.5% respectively for the 2D sequences. The accuracies were not significantly different between 3D and 2D sequences. Fleiss Kappa agreement values for the assessment of inter-observer agreement ranged from substantial for the patella and medial femur to moderate for the trochlea and fair for the medial tibia and lateral compartment. CONCLUSION There was no significant difference in accuracy for the evaluation of articular cartilage of a single three-dimensional, fast spin echo sequence with multi-planar reformatted images vs. two-dimensional, fast spin echo sequences acquired in all three imaging planes in the knee.

Semimembranosus muscle herniation: a rare case with emphasis on muscle biomechanics

Muscle herniations are rare and most reported cases involve muscles of the lower leg. We use a case of muscle herniation involving the semimembranosus muscle, presenting as a painful mass in an adolescent male after an unspecified American football injury, to highlight a simple concept of muscle biomechanics as it pertains to muscle hernia(s): decreased traction upon muscle fibers can increase conspicuity of muscle herniation(s)—this allows a better understanding of the apt provocative maneuvers to employ, during dynamic ultrasound or magnetic resonance imaging, in order to maximize diagnostic yield and, thereby, limit patient morbidity related to any muscle herniation. Our patient subsequently underwent successful decompressive fasciotomy and has since returned to his normal daily activities.

Imaging of Mueller-Weiss Syndrome: A Review of Clinical Presentations and Imaging Spectrum

OBJECTIVE Mueller-Weiss syndrome is a complex condition of the adult tarsal navicular characterized by progressive fragmentation leading to mid- and hindfoot pain and deformity. Since its first descriptions in the early 20th century, controversy has persisted regarding its pathogenesis. CONCLUSION This article reviews the literature and discusses the anatomy, epidemiology, causes, clinical and radiologic findings, and treatment of Mueller-Weiss syndrome, and thus permits a better understanding of this disease and its management.

Middle subtalar osseous coalition with associated fusion of the sinus tarsi: a previously undescribed type of tarsal coalition

Tarsal coalitions affect up to 13% of the population and may cause chronic ankle and hindfoot pain. Coalitions can be subdivided as osseous, cartilaginous, or fibrous types. The most common type of tarsal coalition involvesthe talocalcaneal joint, where it usually affects the middle subtalar joint. In this article, we describe a previously unpublished form of talocalcaneal coalition with osseous coalition at the level of the middle subtalar joint with associated fusion of the sinus tarsi.