26 research outputs found
Extensor carpi ulnaris accessory tendinous slips (ECUATS): MRI features at 3.0T and correlation with tendinosis : 49
Purpose: To assess the visibility and the features of ECUATS on
3.0-T MRI studies, and evaluate their correlation with tendinosis.
Methods and materials: Our retrospective study was approved
by IRB, with waiver of informed consent. Fifty wrist MRI and 48 MR
arthrographies from 98 patients (55 males, 43 females, mean age 42.3
years) performed between January and November 2009 on 3.0-T units
were reviewed. Images (transverse T1, T2, FS Gd T1 and VIBE) were
independently analyzed by two radiologists, and a consensus reached
with a third reader in case of disagreement. The visibility of ECUATS
was assessed on each available transverse sequence. When present,
ECUATS' origins, diameters and insertions were noted. ECU tendinosis
was also evaluated. Inter-rater agreement was assessed using Cohen's
Kappa coefficient.
Results: ECUATS observed prevalence was 23.5% (23/98). ECUATS
were more frequently noted on the VIBE sequence, with a good
inter-rater agreement (Kappa = 0.72). Origins were noted in 95.7% of
cases: 3 were at the level of, and 20 distal to ECU subsheath. Insertions
were seen in 43.5%: 2 were on 5th metacarpal bone, 8 on extensor
apparatus of 5th finger. ECUATS mean shortest and longest diameters
were 0.54 and 0.85 mm respectively. ECU tendinosis was statistically
more frequently noted in patients with ECUATS (p <0.05).
Conclusion: ECUATS are readily visible on 3.0-T MRI studies,
especially on transverse GRE VIBE images. ECU tendinosis is more
frequently noted in patients bearing ECUATS
MDCT imaging of calcinosis in systemic sclerosis.
Calcinosis is a typical feature of systemic sclerosis (SSc) and can be found in many different tissues including the superficial soft tissues, periarticular structures, muscles, and tendons. It can also provoke erosive changes on bones. Investigation is conducted most often with plain radiographs. However, when a more detailed assessment is necessary, multidetector computed tomography (MDCT) is helpful owing to its multiplanar reformat (MPR) ability. The purpose of this review is to provide an overview of the various appearances of calcinosis in SSc patients as visualized at MDCT
Cervical radiculopathy: Efficiency of CT-guided cervical facet joint corticosteroid injection : 47
Purpose: Cervical foraminal injection performed with a direct approach
of the foramen may induce serious neurologic complications. Cervical
facet joint (CFJ) injections are easier to perform and safe, and may
diffuse in the epidural and foraminal spaces. We analyzed the efficiency
and tolerance of CT-guided CFJ slow-acting corticosteroid injection in
patients with radiculopathy related to disc herniation.
Methods and materials: Pilot study included 17 patients presenting
typical cervical radiculopathy related to disc herniation without relief of
pain after medical treatment (one month duration). CFJ puncture was
performed under CT guidance with a lateral approach. CT control of
the CFJ opacification was performed after injections of contrast agent
(1 ml), followed by slow-acting corticosteroid (25 mg). Main criteria for
judgment was pain relief one month later (delta visual analogical scale
VAS for 0 to 100 mm). Diffusion of iodinated contrast agent in the
foramen was assessed by two radiologists in consensus.
Results: Pain relief was significant at one month (delta VAS 22 ± 23
mm, p = 0.001) and 41% (7/17) of patients had pain relief more than
50%. In cases with foraminal diffusion, pain relief more than 50%
occured in 5 patients (50%) and only in 2 patients (29%) in cases
without foraminal diffusion. No complication occurred.
Conclusion: CT-guided CFJ slow-acting corticosteroid injection is safe
and provided good results at one month follow-up. It may be considered
as an interesting percutaneous treatment in patients suffering from
cervical radicular pain related to disc herniation
CT-guided sacroiliac joint injection: Easy or difficult? : 53
Purpose: Fluoroscopy-guided sacroiliac joint (SIJ) injections are
technically difficult to perform because of the complex anatomy with
helicoidal conformation of the joint. Our study describes the procedure
of CT-guided SIJ injection, its feasibility and its rate of success.
Methods and materials: Retrospective study included 46 consecutive
patients. The procedure was performed by 3 MSK radiologists and
consisted in a puncture with a posterior approach in the inferior articular
part of SIJ, then in an injection of iodinated contrast agent (1ml) with CT
control of SIJ space opacification and finally in an injection of slowacting
corticosteroid. The SIJ approach was noticed as correct if there
was an inferior articular puncture and if the needle was in the articular
space, and as impossible if there was ankylosis or osteophytosis. The
study was divided in two successive periods: period 1 (4 first months)
and period 2 (12 last months).
Results: SIJ opacification was successful in 57% (26/46). We observed
a learning curve: opacification was succeeded in 66% (23/35) and there
was incorrect approach in 9% (3/35) during period 2 versus respectively
27% (3/11) and 45% (5/11) during period 1. Causes of failure were
incorrect approach in 40% (6/20 too low, 2/20 too high), impossible
approach in 30% (6/20) and unexplained in 30% (6/20). Mean duration
of procedure was about 28 minutes. No complication occurred.
Conclusion: CT guided SIJ injection is safe and successful in 66%
after a training period. The success depends on SIJ correct approach
and also on anatomical lesions
Extensor carpi ulnaris (ECU) subsheath: Normal MRI appearance and findings in athletic injuries : 40
Purpose: First, to report ECU subsheath's normal MRI appearance
and the findings in athletic injuries. Second, to determine the best MRI
sequence for diagnosis.
Methods and materials: Sixteen patients (13 males, 3 females, mean
age 30.3 years) with ECU subsheath's athletic injuries sustained
between January 2003 and June 2009 were retrospectively reviewed.
Wrist MRI studies were performed on 1.5-T units and consisted of at
least transverse T1 and STIR sequences in pronation, and FS Gd T1
in pronation and supination. Two radiologists assessed the following
items, in consensus: injury type (A to C according to Inoue), ECU
tendon stability, and associated lesions (ulnar head oedema, extensor
retinaculum injury, ECU tendinosis and tenosynovitis). Then, each
reader independently rated the sequences' diagnostic value:
0 = questionable, 1 = suggestive, 2 = certain. Follow-up studies were
present in 8 patients. ECU subsheath's normal visibility (medial, central
and lateral parts) was retrospectively evaluated in 30 consecutive
control MRI studies.
Results: FS Gd T1 sequences in supination (1.63) and pronation (1.59)
were the most valuable for diagnosis, compared to STIR (1.22) and T1
(1). The study group included 9 type A, 1 type B and 6 type C injuries.
There were trends towards diminution in pouches' size, signal intensity
and enhancement in follow-up studies, along with tendon stabilization
within the ulnar groove. In control studies, ECU subsheath's visibility in
medial, central and lateral parts were noted in 66.7-80%, 63.3-80%
and 30-50% respectively.
Conclusion: ECU subsheath's athletic injuries are visible on 1.5-T MRI
studies. FS Gd T1 sequences in supination and pronation are the most
valuable
Fractures dorsales du triquetrum : avulsion ou conflit ulno-carpien? Aspects IRM 3T et lésions associées.
Objectifs: Déterminer les caractéristiques en IRM 3T et discuter l'étiologie des fractures dorsales du triquetrum. Evaluer les lésions associées, notamment des ligamentsextrinsèques dorsaux.Matériels et méthodes: Etude rétrospective (septembre 2007 - décembre 2010) incluant 18 patients avec radiographies conventionnelles et IRM du poignet à 3T présentant une fracturedorsale du triquetrum. Protocole IRM comprenant une séquence T1-VIBE coronale haute résolution (0,3mm) isotropique avec suppression de graisse et aprèsinjection intraveineuse de Gadolinium. Lecture consensuelle par 2 radiologues évaluant les caractéristiques suivantes : taille et déplacement du fragment osseux,localisation de l'oedème médullaire, lésion des ligaments extrinsèques dorsaux (radio-triquetral, scapho-triquetral et ulno-triquetral), autres lésions associées.Inclusion d'un groupe contrôle de 20 patients, afin d'évaluer localisation et visibilité des enthèses ligamentaires extrinsèques dorsales .Résultats: Identification de 14 lésions ligamentaires scapho-triquetrales, 12 ulno-triquetrales et 8 radio-triquetrales, corrélées à la localisation de l'oedème osseux. Absenced'oedème de la styloïde ulnaire évocatrice de conflit. Volume moyen des fragments de 210 mm3, avec déplacement le plus fréquemment distal. Dans le groupecontrôle, visibilité des ligaments scapho-triquetral, radio-triquetral et ulno-triquetral dans respectivement 100% (20/20), 90% (18/20) et 70% (14/20) des cas.Conclusion: L'IRM 3T permet d'évaluer précisément les fractures dorsales du triquetrum et leurs lésions associées , y compris la distribution des oedèmes osseux. Cesfractures auraient donc une étiologie mixte