A rare case of Enchondromatosis of the knees and hands with involvement of Hoffa's fat pad and peri-articular soft-tissues

We report a case of a 56-year old man with chronic pain in both knees for several years. This patient had already undergone surgery on his left knee in 2002 after an x-ray showed multiple lytic and well margined lesions in the distal femur and proximal tibia with ground-glass matrix, involving Hoffa's fat pad and the patellar ligament. Histology was consistent with an enchondroma. The most recent MRI examination showed enchondromatosis involving both knees with bilateral extension into Hoffa's fat pad and the patellar ligament. Subsequently, we performed an additional radiographic examination of the hands and feet, as well as an MRI of both hands to identify other possible enchondromas in the most common sites for this disease. Enchondromatosis with soft tissue involvement is extremely rare, and involvement of Hoffa's fat pad has not been reported in the scientific literature. The clinical presentation of this case and the general aspects of Enchondromatosis are discussed

Evaluation of lumbar pain with weight-bearing MRI: Preliminary experience.

PURPOSE/INTRODUCTION: To assess the usefulness of weight-bearing examination of the lumbar spine performed with a dedicated MRI scanner in the evaluation of patients with clinical evidence of lumbar pain. MATERIALS AND METHODS: Between August 2008 and July 2009, 40 patients with clinical evidence of lumbar pain (group A) and a similar number of healthy volunteers (group B) were submitted to MRI examination of lumbar spine. Spin echo T1w and fast spin echo T2w images were acquired with a 0.25 Tesla scanner (G-Scan, Esaote Spa, Genoa, Italy) in both weight-bearing position and conventional supine position. A dedicated receiving coil for the lumbar spine was used. Three radiologists, blinded on history and clinical examination of subjects, assessed, in consensus, variations of lumbar lordosis angle and presence of pathology on images acquired in both positions, in different sequences and in different planes. RESULTS: In group A, conventional supine MRI was positive for pathology in 30/40 cases while weight-bearing MRI was positive in 39/40 cases. In all cases of group B, no signs of pathology was found in both positions. Weight-bearing MRI showed modifications of lumbar lordosis angle in all cases of both groups in respect to conventional supine MRI. DISCUSSION/CONCLUSION: Imaging the lumbar spine in weight-bearing position with a dedicated MRI scanner and a dedicated coil could allow identification of pathology which could be overlooked if imaging patients only in the supine position

MR imaging of entrapment neuropathies of the shoulder

LEARNING OBJECTIVES: To describe the MRI features of most common entrapment neuropathies of the shoulder: - Parsonage-Turner syndrome - quadrilateral space syndrome (axillary neuropathy) - suprascapular nerve syndrome BACKGROUND: Entrapment neuropathies are characterized by alteration of nerve function secondary to compression by mechanical or dynamic forces. The compression may be acute, chronic or intermittent. Not infrequently compressive neuropathies are related to space-occupying lesions such as tumors, cysts, inflammatory processes, or post-traumatic conditions. IMAGING FINDINGS: The MR imaging appearance of Parsonage-Turner syndrome is quite characteristic, with marked edema in the affected muscles of the shoulder, most commonly those innervated by the suprascapular nerve, although deltoid muscle can also be compromised. MR imaging of quadrilateral space syndrome may reveal fatty atrophy or edema isolated to the teres minor muscle. MR imaging of suprascapular nerve syndrome is established when edema or fatty changes of supraspinatus and/or infraspinatus muscle is present along with a cyst or ganglion in the spinoglenoid or suprascapular notch. CONCLUSION: MRI is a powerful diagnostic imaging tool in the diagnosis of entrapment neuropathies of the shoulder and underlying causes, thus excluding other possible causes of shoulder pain. Moreover, MRI may recognize active changes of denervation in muscle from chronic denervation muscle changes or “fatty atrophy” in isolation, and therefore it may change treatment and management

Presacral Myelolipoma

Many reports have described adrenal myelolipomas but there have been only a few reports of extra-adrenal myelolipomas. We describe a 74-year-old woman who came to our observa- tion for MRI of the lumbar spine for typical lumbar back pain. In addition to signs of mild scoliosis and spondylo disc arthrosis, MR imaging revealed a presacral mass showing a heterogeneously high signal in all pulse sequences and almost completely suppressed on inversion recovery sequences for fat tissue. CT imaging confirmed the fatty nature of the lesion and no signs of bone involvement. These findings were most consistent with a diagnosis of a rare presacral myelolipoma as confirmed at histopathologic analysis. This work reports a case of one of the rarest presacral masses, empha- sizing the role of imaging in the differential diagnosis of other presacral masses

Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers.

Purpose. This study assessed the usefulness of upright weight-bearing examination of the ankle/hind foot performed with a dedicated magnetic resonance (MR)imaging scanner in the evaluation of the plantar fascia in healthy volunteers and in patients with clinical evidence of plantar fasciitis. Materials and methods. Between January and March 2009, 20 patients with clinical evidence of plantar fasciitis (group A) and a similar number of healthy volunteers (group B) underwent MR imaging of the ankle/hind foot in the upright weight-bearing and conventional supine position. A 0.25-Tesla MR scanner (G-Scan, Esaote SpA, Genoa, Italy) was used with a dedicated receiving coil for the ankle/hind foot. Three radiologists, blinded to patients’ history and clinical findings, assessed in consensus morphological and dimensional changes and signal intensity alterations on images acquired in both positions, in different sequences and in different planes.Results. In group A, MR imaging confirmed the diagnosis in 15/20 cases; in 4/15 cases, a partial tear of the plantar fascia was identified in the upright weight-bearing position alone. In the remaining 5/20 cases in group A and in all cases in group B, the plantar fascia showed no abnormal signal intensity. Because of the increased stretching of the plantar fascia, in all cases in group A and B, thickness in the proximal third was significantly reduced (p<0.0001) under upright weight-bearing compared with the supine position Conclusions. Imaging the ankle/hind foot in the upright weight-bearing position with a dedicated MR scanner and a dedicated coil might enable the identification of partial tears of the plantar fascia, which could be overlooked in the supine position

Hip viscosupplementation under ultra-sound guidance riduces NSAID consumption in symptomatic hip osteoarthritis patients in a long follow-up. Data from Italian registry.

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) consumption is strictly related to a high gastrointestinal and cardiovascular mortality and morbidity rate. Osteoarthritis Research Society International (OARSI) recommendations in patients with symptomatic hip or knee OA stated that NSAIDs should be used at the lowest effective dose but their long-term use should be avoided if possible. OARSI guidelines for the treatment of the hip OA include the use of viscosupplementation, which aims to restore physiological and Theological features of the synovial fluid. Objective: Aim of this multicentric, open and retrospective study is to investigate if NSAID consumption may be reduced by the use of ultrasound-guided intra-articular injection of several hyaluronic acid (HA) products in hip joint administered in patients affected by symptomatic hip OA. Materials and Methods: Patients affected by mono or bilateral symptomatic hip OA according to American Rheumatology Association (ARA) criteria, radiological OA graded II-IV (Kellgren and Lawrence) entered the study and were administered with ultrasound-guided intra-articular injection of hyaluronic acid products. As a primary endpoint, consumption of NSAIDs was evaluated by recording the number of days a month (range 0-30) the patient had used NSAID during the previous month, reported at each visit during the 24 months follow-up period. Secondary endpoints included further analysis for subgroups of patients categorized for Lequesne index score, Kellgren-Lawrence score, pain visual analogue scale (VAS) score, ultrasound pattern, age, hyaluronic acid used. Results: 2343 patients entered the study. Regarding primary endpoint, the consumption of NSAIDs was reduced of 48.2% at the third month when compared with baseline values. This sparing effect increased at 12th and 24th month with a reduction respectively of 50% and 61% in comparison to baseline values. These differences were statistically significant. Conclusions: These data point out that intraarticular hyaluronan preparations provide OA pain relief and reduce NSAIDs consumption in a large cohort of patients for a long period of follow-up. Multiple courses of viscosupplementation (vs) are required to maintain low dose of NSAID consumption over time. NSAIDs consumption is strictly related to an high gastrointestinal and cardiovascular mortality and morbidity rate, instead HA intra-articular treatment is well tolerated and is associated with a low incidence of adverse effects. For these reasons further studies evaluating cost-effectiveness and cost-utility of VS in the management of hip OA are required