Reporting rotator cuff tears on magnetic resonance arthrography using the Snyder's arthroscopic classification

AIM: To determine diagnostic performance of magnetic resonance arthrography (MRA) in evaluating rotator cuff tears (RCTs) using Snyder's classification for reporting. METHODS: One hundred and twenty-six patients (64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists (14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial- and full-thickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics. RESULTS: On arthroscopy, 71/126 patients (56%) had a full-thickness RCT. The remaining 55/126 patients (44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed full-thickness RCTs, 66 (93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent (k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases (92%); in the remaining 5/66 cases (8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total (k = 1.000). CONCLUSION: MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA

Adult Dual-Energy X-ray Absorptiometry in Clinical Practice : How I Report it

Several imaging methods for the diagnosis and management of osteoporosis exist. Dual-energy X-ray absorptiometry (DXA) is the most widely available and commonly used for measuring bone mineral density (BMD). Central DXA has several advantages: It has very good reproducibility, administers a negligible radiation dose to the patient, and BMD values obtained by DXA relate to fracture risk. Nevertheless, DXA has some technical limitations that should be recognized by those physicians who interpret and report this examination. We provide recommendations for optimal DXA scan reporting in adults, including indications, skeletal sites to be measured, serial BMD measurements, and fracture risk assessment. In conclusion, DXA is the standard of reference in evaluating BMD and is effective in following up patients over time. Adequate reporting and analysis of previous DXA examinations is crucial to manage patients correctly

MR imaging of the knee in patients with medial unicompartmental arthroplasty : comparison among sequences at 1.5 T

Purpose: This study was done to test a series of magnetic resonance (MR) imaging sequences of the knee after medial unicompartmental arthroplasty. Materials and methods: Four patients who had undergone Oxford III medial unicompartmental arthroplasty underwent 1.5-T MR imaging of the operated knee using coronal sequences: T1-weighted spin-echo (SE), T1-weighted turbo SE (TSE), proton-density (PD)- and T2-weighted TSE, T1-weighted gradient echo (GE), short-tau inversion recovery (STIR), multi echo data image combination (MEDIC), T2*-weighted GE, volumetric interpolated breath-hold examination (VIBE), and dual-echo steady state (DESS). For each sequence, we evaluated the visibility of the anatomical structures of the central pivot, lateral compartment, and anterior compartment using a semiquantitative score (0=total masking; 1=insufficient visibility; 2=sufficient visibility; 3=optimal visibility). The sum of the scores given to each sequence was divided by the maximal sum, obtaining a percentage visibility index. Friedman and sign tests were used for statistical analysis. Results: MR examination time was 30-32 min. No patients reported pain, heat or other local discomfort. The visibility index ranged between 83% and 89% for the first four sequences without significant differences among them, 58% for STIR and 11%-36% for the last five sequences. Significant differences were found between each of the four first sequences and the remaining sequences (p<0.004) and between STIR and the last five sequences (p<0.008). Conclusions: MR imaging of the knee after medial unicompartmental arthroplasty was not associated with adverse events. An imaging protocol including SE, TSE and STIR sequences could be used to study the knee with unicompartmental arthroplasty

Magnetic resonance imaging of painful total hip replacement: detection and characterisation of periprosthetic fluid collection and interobserver reproducibility

The purpose of our study was to demonstrate the diagnostic value of magnetic resonance imaging (MRI) when measuring and characterising periprosthetic fluid collections in patients with painful hip prosthesis and to provide an estimation of interobserver reproducibility

Rotator cuff calcific tendinitis: does warm saline solution improve the short-term outcome of double-needle US-guided treatment?

Purpose: To determine whether saline temperature influences procedure performance and outcome in patients undergoing ultrasonography (US)-guided lavage for the treatment of rotator cuff calcific tendinitis (RCCT). Materials and Methods: This study was approved by the institutional review board, and informed consent was obtained from all patients. From December 2009 to May 2011, 462 patients (191 men and 271 women; mean age, 39.7 years) with painful RCCT diagnosed at US were prospectively enrolled and randomized into two groups. Operators subjectively classified calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous treatment of RCCT (local anesthesia, double-needle lavage, intrabursal steroid injection) was performed with warm saline (42\ub0C, 107\ub0F) in 229 patients and with room-temperature saline in 233. Operators and patients were not blinded to saline temperature. The ease of calcium dissolution was subjectively scored (easy = 1, intermediate = 2, difficult = 3). Procedure duration was recorded. Patient discomfort was assessed by using a visual analog scale (VAS). The occurrence of postprocedure bursitis was recorded. Statistical analyses were performed with Mann-Whitney U, \u3c7 2, and analysis of variance tests. Results: Procedure duration was significantly shorter (P < .001) in patients treated with warm saline (mean, 576 seconds \ub1 121) than in those treated with room-temperature saline (mean, 777 seconds \ub1 151). Calcium dissolution was significantly easier in patients treated with warm saline (median score, 1) than in those treated with room-temperature saline (median score, 2). Subgroup analysis according to calcification appearance at US showed a significant difference between groups for both soft ( P = .003) and hard ( P <.001) calcifications. No overall significant differences were found for VAS score (warm saline group: baseline = 8.9 \ub1 0.6, 1 month = 4.7 \ub1 0.6, 2 months = 4.0 \ub1 0.7, 3 months = 3.4 \ub1 0.4, 1 year = 3.0 \ub1 0.7; room-temperature saline group: baseline = 9.2 \ub1 0.4, 1 month = 4.5 \ub1 0.7, 2 months = 4.1 \ub1 0.9, 3 months = 3.1 \ub1 0.7, 1 year = 3.2 \ub1 0.8; P =.491). Postprocedural bursitis was observed in eight patients in the warm saline group and 20 in the room-temperature saline group ( P < .022). Conclusion: In the treatment of RCCT, warm saline appears to reduce procedure duration and improve calcification dissolution while reducing the frequency of postprocedural bursitis

Less is better? Intraindividual and interindividual comparison between 0.075mmol/kg of gadobenate dimeglumine and 0.1mmol/kg of gadoterate meglumine for cranial MRI

Purpose To retrospectively compare a reduced dose (RD) (0.075 mmol/kg) of gadobenate dimeglumine (RD-gadobenate) with standard single dose (SSD) (0.1 mmol/kg) of gadoterate meglumine (SSD-gadoterate) for cranial MRI. Materials and methods Thirty-one patients (12 males; aged 52 \ub1 16 years) underwent cranial MRI with SSD-gadoterate and repeated the examination with RD-gadobenate after a median interval of 10 months. Signal-to-noise ratio (SNR) was obtained on contrast-enhanced images for enhancing lesions (n = 10) as well as for right and left transverse venous sinuses, internal carotid arteries, and parotid glands. Moreover, a consecutive series of 100 cranial MRI with SSD-gadoterate (49 males; aged 51 \ub1 19 years) was compared with a consecutive series of 100 cranial MRI with RD-gadobenate (45 males; aged 54 \ub1 18 years). Two blinded neuroradiologists (R1, R2) judged contrast enhancement as sufficient, good, or optimal. Wilcoxon, Mann-Whitney, \u3c72, and Cohen \u3ba statistics were used. Results At intraindividual analysis, median SNR ranged 57-88 for SSD-gadoterate and 79-99 for RD-gadobenate, the latter being systematically higher, the difference being significant for both transverse venous sinuses (p 64 0.011), not significant for both internal carotid arteries and both parotid glands, and enhancing lesions (p 0.101). The two series of interindividual analysis were not significantly different for gender/age (p > 0.415). Contrast enhancement was optimal in 59% (R1) and 76% (R2) of patients using RD-gadobenate, in 39% (R1) and 49% (R2) of patients using SSD-gadoterate (p 64 0.016), with substantial reproducibility (\u3ba 65 0.606). Conclusion Both analyses showed an equal or better contrast enhancement when using RD-gadobenate compared to SSD-gadoterate for routine cranial MRI. The high relaxivity of gadobenate allowed for a 25% dose reduction

A new diagnostic score to detect osteoporosis in patients undergoing lumbar spine MRI

Objectives: Signal intensity of lumbar-spine at magnetic resonance imaging (MRI) correlates to bone mineral density (BMD). Our aim was to define a quantitative MRI-based score to detect osteoporosis on lumbar-spine MRI. Methods: After Ethics Committee approval, we selected female patients who underwent both lumbar-spine MRI and dual-energy X-ray absorptiometry (DXA) and a reference group of 131 healthy females (20\u201329 years) who underwent lumbar-spine MRI. We measured the intra-vertebral signal-to-noise ratio in L1-L4. We introduced an MRI-based score (M-score), on the model of T-score. M-score diagnostic performance in diagnosing osteoporosis was estimated against DXA using receiver operator characteristic (ROC) analysis. Results: We included 226 patients (median age 65 years), 70 (31 %) being osteoporotic at DXA. MRI signal-to-noise ratio correlated to BMD (r = 120.677, P < 0.001). M-score negatively correlated to T-score (r = 120.682, P < 0.001). Setting a 90 %-specificity, an M-score threshold of 5.5 was found, distinguishing osteoporosis from non-osteoporosis (sensitivity 54 %; ROC AUC 0.844). Thirty-one (14 %) patients had a fragility fracture, with osteoporosis detected in 15 (48 %) according to M-score and eight (26 %) according to T-score (P = 0.016). Conclusions: M-score obtained on lumbar spine MRI is a quantitative method correlating with osteoporosis. Its diagnostic value remains to be demonstrated on a large prospective cohort of patients. Key Points: \u2022 M-score is a quantitative score potentially screening osteoporosis on lumbar-spine MRI;\u2022 This method showed good intra- and inter-reader reproducibility;\u2022 M-score may be used for identifying patients who should undergo DXA