Jeremiah C. Healy

Magnetic resonance imaging of the pelvic floor in patients with obstructed defaecation

Background Evacuation proctography and measurements of anorectal physiology are frequently used to clarify the pathophysiology of obstructed defaecation. In some patients these tests are normal, despite convincing clinical evidence of defaecatory difficulty. The aim of this study was to determine whether magnetic resonance imaging (MRI) could reveal pelvic floor abnormality in patients with obstructed defaecation.

Imaging of muscle injury in the elite athlete

Injuries to muscle in the elite athlete are common and may be responsible for prolonged periods of loss of competitive activity. The implications for the athlete and his/her coach and team may be catastrophic if the injury occurs at a critical time in the athletes diary. Imaging now plays a crucial role in diagnosis, prognostication and management of athletes with muscle injuries. This article discusses the methods available to clinicians and radiologists that are used to assess skeletal muscle injury. The spectrum of muscle injuries sustained in the elite athlete population is both discussed and illustrated.

Posterior impingement syndromes of the ankle.

Acute, or repetitive, compression of the posterior structures of the ankle may lead to posterior ankle impingement (PAI) syndrome, posteromedial ankle impingement (PoMI) syndrome, or Haglunds syndrome. The etiology of each of these conditions is quite different. Variations in posterior ankle osseous and soft tissue anatomy contribute to the etiology of PAI and Haglunds syndromes. The presence of an os trigonum or Stieda process is classically associated with PAI syndrome, whereas a prominent posterosuperior tubercle of the os calcis or Haglunds deformity is the osseous predisposing factor in Haglunds syndrome. PoMI has no defined predisposing anatomical variants but typically follows an inversion-supination injury of the ankle joint. This article discusses the biomechanics, clinical features, imaging, and management of each of these conditions. Magnetic resonance imaging (MRI) provides the optimal tool in posterior ankle assessment, and this review focuses on the MRI findings of each of the conditions just listed.

MRI of the popliteofibular ligament: isotropic 3D WE-DESS versus coronal oblique fat-suppressed T2W MRI

ObjectiveThe objective was to compare isotropic 3D water excitation double-echo steady state (WE-DESS) MRI with coronal oblique fat-suppressed T2-weighted (FS T2W) images in the identification of the popliteofibular ligament (PFL).Materials and methodsA prospective analysis of 122 consecutive knee MRIs was performed in patients referred for knee pain from the orthopaedic clinic. In addition to the standard knee sequences, isotropic WE-DESS volume acquisition through the whole knee and coronal oblique FS T2W fast spin echo sequences through the posterolateral corner were obtained. The presence of the popliteus and biceps femoris tendons, lateral collateral and PFL was documented. Anterior cruciate ligament injury was present in 33 cases and these were excluded from the study because of the risk of associated PFL injury, leaving a total of 89 cases. Of the 42 patients in whom arthroscopic evaluation was subsequently obtained, none were found to have an injury to the PFL.ResultsThe lateral collateral ligament, biceps femoris and popliteus tendon were identified in all cases on all sequences. The PFL was seen in 81 (91.0%; 95% CI 85.1–97.0%) patients using the WE-DESS sequence and 63 (70.8%; 95% CI 61.3–80.2%) patients using the coronal oblique FS T2W sequence, a statistically significant difference (p < 0.00005).ConclusionIsotropic 3D WE-DESS MRI significantly enhances our ability to identify the popliteofibular ligament compared with coronal oblique fat-suppressed T2-weighted images.

Normal Sonographic Anatomy of the Posterolateral Corner of the Knee

OBJECTIVE The posterolateral corner of the knee comprises a group of structures that are important to knee stability. MRI is currently the standard imaging technique, but visualization of individual structures is often incomplete. Sonography allows rapid real-time assessment of these superficial structures, but knowledge of the anatomy is essential to allow accurate examination. CONCLUSION We present an illustrated review of the sonographic anatomy of the posterolateral corner of the knee with MRI correlation.

Ultrasound-guided treatments for chronic Achilles tendinopathy: an update and current status

Minimally-invasive treatments for chronic Achilles tendinopathy may prevent the need for surgery when conservative methods have failed. Whilst injections have traditionally been used to manage symptoms, recently described therapies may also have disease-modifying potential. Ultrasound provides the ability to guide therapeutic interventions, ensuring that treatment is delivered to the exact site of pathology. Treatments can be broadly categorised according to their intended therapeutic targets, although some may act through several possible mechanisms. In this article, we review the ultrasound-guided techniques currently used to treat chronic Achilles tendinopathy, with reference to the available literature. There is strong pilot-level evidence supporting the use of many of these techniques, although large definitive trials are lacking. An approach towards the management of chronic Achilles tendinopathy is suggested.

Musculoskeletal sonography of the normal foot

Traumatic, degenerative and rheumatological injuries of the foot are common and can be managed by an ever increasing number of treatments and surgical interventions. High-frequency sonography is inexpensive, portable and is unique in allowing true dynamic assessment of the ligamentous, muscular and tendinous structures. The ultrasound technique demonstrates a steep learning curve and requires detailed knowledge of the foot anatomy. Ultrasound assessment plays an important role in the diagnosis and management of injuries of these structures by guiding rehabilitation and surgical intervention without delay. However, intimate knowledge of the ultrasound appearances of the foot anatomy and normal variants is paramount to correctly identify pathological conditions. We describe the normal sonographic appearances of the foot musculoskeletal structures with MR correlation including joints and their ligaments, dorsal and plantar surfaces of the foot, and the arches of the foot and their supporting structures.

CT of microcystic (serous) pancreatic adenoma.

Although microcystic adenoma of the pancreas is well recognised as a benign tumour, it is often treated surgically. We present serial CT over 9 years of a patient with this tumour that demonstrated a substantial rate of growth and the development of pathognomonic features.

Groin Pain: Clinical Assessment and the Role of MR Imaging

Groin pain is a common problem in the elite athlete and may lead to prolonged inactivity if inadequately treated. Groin pain, arising from injuries to the hip and pelvis, accounts for 5 to 6% of athletic injuries in adults and 10 to 24% of these injuries in children. Lower limb-dominated athletic activities such as football, rugby, ice hockey, running, and ballet are particularly at risk. Comprehensive evaluation of all the anatomical locations prone to injury including the hip joint, sacrum, ilium and proximal femora, pelvic tendon attachments, and pelvic musculature is required. Magnetic resonance (MR) imaging provides superb soft tissue contrast resolution, multiplanar capabilities, and a wide field of view to evaluate many potential causes of groin pain. Careful clinical examination allows the optimal use of MR imaging and MR arthrography to evaluate the articular, osseous, tendinous, and muscular structures, which may be the source of groin pain. Accurate diagnosis is essential for appropriate management and rehabilitation plans. This article reviews the role of clinical assessment in guiding diagnostic imaging and also describes the relevant MR imaging findings in athletes presenting with groin pain.

Ankle and Foot Injuries

Injuries to the foot and ankle are common in elite athletes and may be responsible for prolonged periods of absence from competitive activity. The osseous, articular, ligamentous and tendinous structures of the foot and ankle may be injured in isolation or, more commonly, in combination. Various impingement syndromes of the ankle are described, many of which have characteristic features on imaging. Radiology now plays a crucial role in management of these injuries, not only in diagnosis but increasingly in guiding percutaneous therapies. The plain radiograph still plays a crucial role in diagnosis but is now supplemented with advanced imaging techniques such as ultrasound, computed tomography and magnetic resonance imaging. We present a comprehensive review of the anatomy, biomechanics, imaging and surgical management of foot and ankle injuries and impingement syndromes encountered in the sporting population.