Ozgur Tosun

Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability

ObjectiveThe aim of this study was to describe the magnetic resonance imaging (MRI) findings in patients with ischiofemoral impingement (IFI) and to evaluate the reliability of these MRI findings.Materials and methodsSeventy hips of 50 patients with hip pain and quadratus femoris muscle (QFM) edema and 38 hips of 30 control cases were included in the study. The QFM edema and fatty replacement were assessed visually. Ischiofemoral space (IFS), quadratus femoris space (QFS), inclination angle (IA), hamstring tendon area (HTA), and total quadratus femoris muscle volume (TQFMV) measurements were performed independently by two musculoskeletal radiologists. The intra- and interobserver reliabilities were obtained for quantitative variables.ResultsIFS, QFS, and TQFMV values of the patient group were significantly lower than those of controls (P < 0.001). HTA and IA measurements of the patient group were also significantly higher than in controls (P < 0.05). The QFM fatty replacement grades were significantly higher in the patient group than in the control group (P < 0.001). Inter- and intra-observer reliabilities were strong for all continuous variables.ConclusionClinicians and radiologists should be aware of IFI in patients with hip or groin pain, and MRI should be obtained for the presence of the QFM edema/fatty replacement, narrowing of the IFS-QFS, and other features that may help in the clinical diagnosis of IFI for the proper diagnosis and treatment of the disease.

Ischiofemoral impingement in an 11-year-old girl.

Ischiofemoral impingement (IFI) is the entrapment of the quadratus femoris muscle (QFM) between the trochanter minor of the femur and the ischium-hamstring tendon. Patients with IFI generally present with hip pain, which may radiate toward the knee. Although there is no specific diagnostic clinical test for this disorder, the presence of QFM edema/fatty replacement and narrowing of the ischiofemoral space and the quadratus femoris space on magnetic resonance imaging (MRI) are suggestive of IFI. The optimal treatment strategy of this syndrome remains obscure. Patients may benefit from a conservative treatment regimen that includes rest, activity restriction, nonsteroidal anti-inflammatory drugs, and rehabilitation procedures, just as with other impingement syndromes. Herein we report an 11-year-old girl with IFI who was successfully treated conservatively. To our knowledge, our case is the youngest patient reported in the English literature. MRI remains an important tool in the diagnosis of IFI, and radiologists should be aware of the specific features of this entity.

Brucellar spondylodiscitis: a case report.

Brucellosis is a common zoonosis which still remains as a major health problem in certain parts of the world. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylodiscitis is often difficult since the clinical presentation may be obscured by many other conditions.

Glenoid axis is not related with rotator cuff tears—a magnetic resonance imaging comparative study

PurposeThe relationship between glenoid version angle and rotator cuff pathology has been described. However, the effect of glenoid version angle on rotator cuff pathology is still unknown. The aim of this study was to investigate whether there is an impact of glenoid version angle on rotator cuff pathology.MethodsAll shoulder MRI examinations performed in the study centres between August 2008 and August 2009 were evaluated retrospectively. Shoulder MRI examinations having rotator cuff pathology such as trauma, degeneration, and acromion type 2-3-4 reported in previous studies were excluded from the study. Sixty-two shoulder MRIs with rotator cuff pathology having type 1 acromion morphology and 60 shoulder exams without rotator cuff pathology were included in the study. Glenoid version angle was calculated in axial images. Rotator cuff was evaluated in fat-suppressed T2-weighted and proton density-weighted images.ResultThe mean values for glenoid version angle were 2.41° and 0.61° in the control and the study groups, respectively. No statistically significant difference was found between the two groups (p > 0.05). In addition, 26.6% and 33.8% of the glenoids were retroverted and 73.4% and 66.2% were anteverted in the control and the study groups, respectively (all p > 0.05).ConclusionThis study demonstrated no significant relationship between glenoid version angle and rotator cuff pathology. Therefore, the pathologies that can be related to the cuff itself should be investigated if the pathology cannot be explained by an extrinsic cause in subjects with rotator cuff pathology.

The effect of morphometric relationship between the glenoid fossa and the humeral head on rotator cuff pathology

OBJECTIVE The aim of this study was to investigate the impact of the morphometric association between the glenoid fossa and the humeral head on rotator cuff pathology. METHODS Shoulder MRI examinations performed for any cause in study centers between August 2008 and August 2009 were retrospectively evaluated. Shoulder MRI exams having rotator cuff pathology, such as trauma, degeneration, and acromion Type 2, 3 and 4 were excluded. The study included 62 shoulder exams with rotator cuff pathology having Type 1 acromion morphology and 60 shoulder exams without rotator cuff pathology (control group). Glenoid anteroposterior distance and the humeral head diameter in axial images, humeral head diameter and glenoid articular surface diameter in coronal images and their ratios were measured in both groups. Subacromial distance was measured using sagittal images. The rotator cuff was evaluated in fat-suppressed T2-weighted and proton density-weighted images. RESULTS The difference between subacromial distances in the rotator cuff pathology group (8.94 ± 1.43 mm) and control group (10.96 ± 1.62 mm) was statistically significant (p<0.001). There was no statistical significance between the two groups in humeral head diameter, glenoid articular surface diameter, glenoid anteroposterior distance and their ratios (p>0.05). CONCLUSION There is no association between the humeral head and the glenoid articular surface which can result in rotator cuff pathology. The glenohumeral joint was determined as a compatible joint morphometrically. Therefore, if they cannot be explained by an extrinsic cause, pathologies related to the rotator cuff itself should be investigated in subjects with rotator cuff pathology.

Is SYNTAX Score Predictive of Atrial Fibrillation After On-Pump Coronary Artery Bypass Graft Surgery?

Background and Objectives The relationship of synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score and development of atrial fibrillation (AF) after coronary artery bypass surgery (CABG) has not been studied. Therefore, we assessed the relationship between the SYNTAX score and development of AF after CABG (POAF). Subjects and Methods The medical records of consecutive patients, who underwent CABG surgery from January 2013 to September 2015, were retrospectively reviewed for the development of AF in the postoperative period. SYNTAX score, clinical and echocardiographic parameters were evaluated. The independent variables for the development of POAF were defined and their predictive values were measured. Results The study group consisted of 106 patients, of which 36 (34%) developed POAF. Age, hypertension, stroke, chronic obstructive pulmonary disease (COPD), heart failure (HF), diabetes mellitus (DM), left atrial diameter, neutrophil/lymphocyte ratio, platelet large cell ratio, creatinine, blood urea nitrogen and SYNTAX score were identified as important variables for the development of POAF. However, in logistic regression analysis COPD (OR=19.313, 95% CI=2.416-154.407, p=0.005), HF (OR=28.362, 95% CI=2.034-395.515, p=0.013), SYNTAX score (OR=0.863, 95% CI=0.757-0.983, p=0.026), and DM (OR=20.770, 95% CI=3.791-113.799, p<0.001) appeared as independent variables predicting the development of POAF. In receiver operation characteristic analysis, SYNTAX score (≥22.25) (AUC=0.777, 95% CI=0.676-0.877, p<0.001) was one of the strongest predictors for the development of POAF. Conclusion The SYNTAX score level was independently associated with the development of AF after CABG.

Penetrating Stab Injury of Spine; Diagnostic Value of Thin-SectionMultislice Computed Tomography

Penetrating stab injuries of the spinal cord (PSISC) are extremely rare and typically associated with immediate neurological damages. However, some patients may represent with atypical and indistinct symptoms. Herein we report a case of atypical presentation of spinal canal penetration which was not detected in thorax computerized tomography (CT) scans performed in emergency room, but subsequently was revealed in thoracal CT and magnetic resonance imaging (MRI) scans. Initial neurological examination was normal except for the hypoesthesia in the right lower extremity. Surgical treatment was not performed since any foreign body or effusion consistent with hematoma and/or dural leak, or extrinsic cord compression was present. After administering a prophylactic tetanus shot and initiating a broad-spectrum antibiotic prophylaxis, patient was discharged with recommendations. On follow-up, he described that hypoesthesia was decreased, but still present at end of the first month of injury. To conclude, it is very important to scan the affected region with thin slice thickness-multislice CT or with MRI for proper diagnosis in patients with stab wounds presented with neurological symptoms.

Utility of semiquantitative parameters to differentiate benign and malignant focal hepatic lesions.

OBJECTIVE Any distinction and the usefulness of semiquantitative parameters derived from dynamic-contrast-enhanced (DCE) MRI obtained with extracellular gadolinium contrast agent in hemangiomas, hepatocellular carcinomas (HCC) and metastases of the liver was studied prospectively. METHODS Seventy-four focal liver lesions (consisted of 34 hemangiomas, 23 HCC, and 17 metastases) of the 37 patients underwent DCE-MRI (six phases). Functional coloured maps and subsequently semiquantitative parameters were obtained using the FuncTool. Maximum and average (avg) values of mean time to enhancement (MTE), positive enhancement integral (PEI), time to peak (TP), maximum slope of increase (MSI), maximum slope of decrease (MSD) values were measured by placing the region of interest. The diagnosis of HCC and metastases were proven histopathologically and/or clinically. RESULTS The mean values of the paremeters were: In hemangiomas, avgMTE: 271.2 ± 4.7; avgPEI: 840.3 ± 77.3; avgTP: 146.6 ± 13.1; avgMSI: 999.1 ± 108.4; avgMSD: 254.1 ± 30.4. In HCC, avgMTE: 246 ± 3.6; avgPEI: 424.9 ± 31.6; avgTP: 132.8 ± 9.5; avgMSI: 484.1 ± 36.5; avgMSD: 109.1 ± 13.3. In metastases, avgMTE: 248.1 ± 8.2, avgPEI: 453.9 ± 39.6; avgTP: 142.8 ± 13.9; avgMSI: 472.6 ± 50.4 and avg MSD: 200.1 ± 38.2. Both maximum and avg values of MTE, PEI, MSI, and MSD were significantly higher in hemangiomas (P<.05). The most significant difference was found in avgPEI with 82.1% sensitivity and 67.6% specificity when 570 cutoff value was considered. The values however were not significantly different among HCC and metastases (P>.05). CONCLUSIONS Semiquantitative DCE-MRI parameters provide useful, complementary, and quantitative information. This technique increases diagnostic value of extracellular gadolinium contrast agent to characterize focal liver lesions and may be useful for follow-up after local-regional therapies.

Is coracoacromial arch angle a predisposing factor for rotator cuff tears

PURPOSE The aim of the present study was to investigate whether coracoacromial arch angle is a predisposing factor for rotator cuff tears. METHODS Shoulder magnetic resonance imaging (MRI) examinations of 40 patients having shoulder arthroscopy due to rotator cuff tears and 28 patients with normal MRI findings were evaluated retrospectively. Acromio-humeral distance, coraco-humeral distance, the angle between the longitudinal axis of the coracoacromial ligament and longitudinal axis of the acromion (coracoacromial arch angle), and thickness of the coracoacromial ligament were measured. RESULTS In patients with rotator cuff pathology the mean coraco-humeral distance was 7.88±2.37 mm, the mean acromio-humeral distance was 7.89±2.09 mm, and the mean coracoacromial arch angle was 132.38°±6.52° compared to 11.67±1.86 mm, 11.15±1.84 mm, and 116.95°±7.66° in the control group, respectively (P < 0.001, for all). In regression analysis, all three parameters were found to be significant predictors of rotator cuff tears. The mean thickness of the coracoacromial ligament was not significantly different between the patient and control groups (0.95±0.30 mm vs. 1.00±0.33 mm, P > 0.05). CONCLUSION Acromio-humeral and coraco-humeral distances are narrower than normal limits in patients with rotator cuff tears. In addition, coracoacromial arch angle may be a predisposing factor for rotator cuff tears.

Avulsion Fracture and Myositis Ossificans in a Professional Teenage Dancer: A Case Report.

Fractures of the transverse processes in the lumbar vertebrae occur as the result of major forces such as direct blunt trauma, violent lateral flexion-extension forces, avulsion of the psoas muscle, or Malgaigne fractures of the pelvis. Dancers make repeated and forceful hyperextension and flexions of the spine, which may cause fractures of the transverse processes of the lumbar vertebrae. Repeated trauma of muscles in dancers may cause avulsion fractures and myositis ossificans. Herein, we report MRI and CT findings of an avulsion from the right transverse process of the L2 and L3 vertebrae in a 16-year-old professional teenage dancer, who responded to conservative treatment.