Biomedical subjects

A Barile

Publications and source records attributed to A Barile.

At least 19 recordsLinked to original sources

PubMed2006

The ischiatic region: normal and MRI anatomy.

AIM: The aim of this study was to describe the anatomy correlated to the normal magnetic resonance imaging (MRI) images of the proximal thigh region and the ischial tuberosity. METHODS: MRI coronal and axial sequences were obtained from 20 asymptomatic volunteers (10 male and 10 female) aged 20 to 38 years (mean age: 28 years), and then they were compared with 2 anatomical dissections and 7 cryosections of 6 cadaver thighs. RESULTS: The anatomical specimens were directly correlated with MRI scans. From the comparison it could be seen how the axial MRI sequences well outlined the sciatic nerve, usually observed oval in shape with moderate signal intensity, and thus easily detectable from other surrounding organs. Other structures were also identified by axial images: the ischial tuberosity, the proximal origin of the hamstring muscles arising from the ischium and the related bursae, the gluteus maximus and its bursa, the quadratus femoris and its inconstant bursa, a triangular adipose body and vessels. Coronal scans also showed well the hamstring muscles, both in length and thickness. CONCLUSIONS: Both MRI images and cadaver dissections showed the ischial tuberosity as an interesting intersection area that could be delimited as follows: on the dorsal border the gluteus maximus and its bursa, on the dorso-medial side the hamstring muscle origin, and on the antero-lateral side the quadratus femoris muscle with its inconstant bursa and the ischial tuberosity. These anatomical and MRI descriptions are very useful to give a contribution to the right explanation of sciatic symptoms caused by those sports specifically overloading the hamstring muscles. Frequently, in fact, in these athletes a sciatic syndrome arise drawing the physician's attention to the lumbosacral joint or to the sciatic nerve course near the piriformis muscle. Another very important site where the sciatic symptoms can rise, indeed, could also be found in the hamstring muscle region, where the nerve run under the gluteus maximus beside the ischiatic bone. Athletes who manifest notorious muscle overload in this anatomical region usually show sciatic pain symptoms that are not to be related with pathologies of the lumbosacral junction nor to relationships of the sciatic nerve with the piriformis muscle but rather to relationships that this nerve acquires with either gluteal muscles as well as with muscles of the underneath ischiatic region.

Adult↗

PubMed2002

Soft tissue liposarcoma: histological subtypes, MRI and CT findings.

PURPOSE: Liposarcoma is the second most common malignancy of soft tissues. The commonly accepted classification of liposarcoma includes five basic histological categories: well-differentiated, myxoid, round cell, dedifferentiated and pleomorphic liposarcoma. The clinical behaviour of liposarcoma closely reflects its histological appearance, so that to identify the histological subtypes is very important for both prognosis and therapy. The aim of this study was to ascertain whether the histological features of liposarcoma subtypes can be correlated with MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) findings by retrospectively evaluating nineteen cases of histologically-proved liposarcoma. MATERIALS AND METHODS: The MRI examinations performed over the past eight years on nineteen patients affected by liposarcoma were retrospectively reviewed. All patients underwent ultrasound and MRI examination; T2 and T1-weighted sequences were available in all cases and fat-saturated sequences in 4 cases; all patients were administered paramagnetic contrast material. CT scans were obtained in twelve patients. All patients had a biopsy, surgical resection and histology. RESULTS: The study group had 7 well-differentiated, 8 myxoid, 3 pleomorphic and 1 round cell liposarcoma. Well-differentiated liposarcomas had largely lipomatous appearance on both CT and MRI, typically with septa and areas showing high signal intensity on T2w MR images and low signal intensity on T1w images, and slightly hypodense compared to the muscle in CT, representing the sarcomatous areas. Myxoid liposarcomas were mildly heterogeneous with typical high signal intensity on T2w images and isointense to the muscle in T1w images, with lacy or linear septa of fatty tissue in six cases. The pleomorphic and round-cell subtypes demonstrated marked heterogeneity on MR images, with areas of necrosis and heterogeneous contrast enhancement, indistinguishable from other high-grade sarcomas. DISCUSSION AND CONCLUSIONS: Well-differentiated liposarcoma may be distinguished from other types of liposarcoma by its largely lipomatous appearance. Myxoid liposarcoma may be distinguished on the basis of its homogeneous or mildly heterogeneous structure due to the large amounts of the extracellular myxoid material that give it its typical MR appearance. Both well-differentiated and myxoid liposarcomas, the most common types accounting for about 50% of all liposarcomas, have a more favourable clinical behaviour than the other histological types. Differentiation of these from the other histological types of liposarcoma therefore has a high significance for prognosis and therapeutical approach. On the basis of our experience and of the literature, we believe that diagnostic imaging and in particular the MR examination may lead to a correct diagnosis.

Adult↗

PubMed2001

[Staging and re-staging of soft tissue sarcoma using MRI. Usefulness of contrast media].

PURPOSE: This study aims to evaluate the usefulness of paramagnetic contrast medium (Gadolinium) in the staging and re-staging of soft tissue tumors using Magnetic Resonance Imaging (MRI). MATERIAL AND METHODS: Sixty patients affected by soft tissue sarcoma of different histotype were retrospectively evaluated. Age ranged from 23 to 78 years. Data were obtained from the musculoskeletal tumor database of our Department of Radiology and cases from the last 7 years (1993-1999) entered this study. All the patients were submitted to ultrasound (US) and to routine and enhanced MR examinations (SE T1-weighted and Fast-SE T1 and T2-weighted before and after fat saturation pulse; GE T2-weighted sequences). At least two different scan planes were obtained depending on the major axis of the lesion. Once imaging information had been obtained all the patients underwent surgery and histology. After surgery, the mean follow-up period was 18 months. Paramagnetic contrast medium (0,2mmol/Kg) was administered in all the MR follow-up examinations. RESULTS: Lesions included adipose histology in 15 cases; muscular histology in 12 cases; fibro-hystiocitic histology in 20 cases; synovial histology in 8 cases; mixed histology in 5 cases. Excluding lesions with mainly adipose content showing obvious high signal intensity on T1-weighted sequences, the other lesions rarely presented MR features specific to histological category also after contrast medium administration. In all the cases MRI allowed an accurate definition of the lesion boundaries to exclude or demonstrate neighbor region invasion. In 11 cases, MRI was able to demonstrate the presence of a recurrent tumor. In 2 out of 11 cases, recurrences were detected out only after intravenous administration of Gadolinium, plain MRI having failed to recognize them. DISCUSSION AND CONCLUSIONS: Despite the absence of specific MRI signs of the different soft tissue tumor histotypes also after Gadolinium administration, MRI remains the best imaging technique to establish the exact morphology of the lesions and to establish the invasion of the neighbor regions by the tumors. The presence of regional spreading of the tumor has to be considered a sign of malignancy. During the follow-up, the use of Gadolinium allows the MR examinations to reach high sensitivity levels and makes it also possible to recognize local recurrences of a very small size. Considering our experience we recommend, whenever a follow-up of resected soft tissue tumors is requested, to perform MRI examination before and after intravenous Gadolinium administration.

Adult↗

PubMed2000

Prevalence of genotypic and phenotypic resistance to anti-retroviral drugs in a cohort of therapy-naïve HIV-1 infected US military personnel.

OBJECTIVE: While transmission of drug-resistant HIV-1 has been reported, estimates of prevalence of resistance in drug-naïve populations are incomplete. We investigated the prevalence of genotypic mutations and phenotypic antiretroviral resistance in a cohort of HIV-1 infected U.S. military personnel prior to the institution of antiretroviral therapy. DESIGN: Cross-sectional cohort study. METHODS: Plasma was obtained from 114 recently HIV-1 infected subjects enrolled in an epidemiological study. Genotypic resistance was determined by consensus sequencing of a PCR product from the HIV-1 pol gene. Sequences were interpreted by a phenotypic-genotypic correlative database. Resistance phenotypes were determined by a recombinant virus cell culture assay. RESULTS: Genotypic mutations and phenotypic resistance were found at a higher than expected frequency. Resistance to non-nucleoside reverse transcriptase inhibitors was most common, with a prevalence of 15% of 95 subjects by genotype and 26% of 91 subjects by phenotype. Genotypic and phenotypic resistance respectively were found in 4% and 8% of subjects for nucleoside reverse transcriptase inhibitors and in 10% and 1% for protease inhibitors. One subject harbored virus with resistance to all three drug classes. CONCLUSIONS: A substantial frequency of resistance to antiretroviral drugs was identified in a therapy-naïve U.S. cohort. In most cases, the genotypic and phenotypic assays yielded similar results, although the genotypic assay could detect some protease inhibitor resistance-associated mutations in the absence of phenotypic resistance. These data suggest the need for optimization of treatment guidelines based on current estimates of the prevalence of drug resistance in HIV-1 seroconverters.

Adult↗

PubMed2000

Musculoskeletal MRI: dedicated systems.

The "dedicated" MRI units have characteristics of high diagnostic accuracy and lower installation and management costs as compared with whole-body systems. The dedicated MRI units are easy to install. The low weight allows their installation also under unfavorable circumstances. In a dedicated system cost-effectiveness and ease of installation must be accompanied by the capability of providing high-quality images. In our experience, the high number of examinations performed, the most part of which provided with the surgical controls, allowed an accurate evaluation of the diagnostic potentialities of the dedicated magnet. We were not able to perform the examinations in only 3 % of cases due to the physical shape of the patient and the clinical condition of the patient which may hinder the correct positioning of the limb. The overlapping of the diagnostic accuracy of the E-scan and Artoscan units in the study of the lower limbs, compared with whole-body units and surgery, prompted us to exploit the potentialities of the E-Scan in the study of the shoulder. We had a good correlation between E-Scan, whole-body units, and surgical findings, which confirmed the high diagnostic accuracy of the dedicated system. In conclusion, in our experience carried out in the musculoskeletal system, the dedicated magnets showed promising results. Their diagnostic reliability and utility was comparable to that obtained from conventional units operating at higher magnetic fields.

Female↗

PubMed2000

[Antero-posterior lesions of the superior glenoid labrum. Magnetic resonance evaluation].

PURPOSE: To assess MR potentials in the evaluation of superior glenoid labrum disease and possible associated conditions of the rotator cuff and of the anterior mechanism of the shoulder. MATERIAL AND METHODS: We retrospectively evaluated 51 patients (age range 18 to 53 years) with a diagnosis of anteroposterior lesion of the superior glenoid labrum. MR examinations were performed with a 0.2 T permanent magnet and a dedicated coil, using T1- and T2-weighted SE sequences on mostly coronal-oblique planes. Slice thickness was 4 mm. In 8 cases, the examination was completed with intra-articular injection of contrast agent. Twenty-eight patients were submitted to surgery (arthrotomy in 7 cases; arthroscopy in 21 cases). RESULTS: We considered only the cases with surgical confirmation and divided them into 2 groups: 15 patients with isolated alteration of the superior glenoid labrum and 13 patients with an anteroposterior lesion of the glenoid labrum associated with disease of the rotator cuff or of the anterior mechanism of the shoulder. MRI demonstrated 5 cases of superior labrum irregularities at the level of its glenoid insertional portion (type I lesion); 6 cases of detachment of the superior portion of the labrum (type II); 9 cases of bucket handle tear of the superior labrum with involvement of the insertional portion of the long head of the biceps tendon (type III); 8 cases of superior labrum tear extending within the long head of the biceps tendon (type IV). In the patients with associated disease MRI demonstrated supraspinatus tendon tear in 5 cases, lesion of the labrum also in its anteroinferior portion in 1 case, Hill-Sachs intraspongious fracture with involvement of the inferior glenohumeral complex in 1 case, and complete tear of the rotator cuff in 7 cases. Subsequent surgery always confirmed the presence of associated lesions, while the superior labrum lesion was not confirmed in 3 patients. In 4 cases, surgical findings provided a different classification of the lesion type than MRI. DISCUSSION: In the presence of a type I anteroposterior lesion of the superior glenoid labrum, coronal MRI can depict the loss of the triangular shape of the labrum. Type II lesions show detachment of the labrum, which appears on the MR images as a high signal intensity band passing through the labrum with caudocranial orientation. A superior glenoid labrum tear with a low signal intensity area within the joint indicates a type III lesion. Complete tear of the superior glenoid labrum with involvement of the long head of the biceps tendon demonstrated on the coronal T1-weighted SE and T2-weighted GE sequences is a sign of a type IV lesion. CONCLUSIONS: MRI can be a valuable diagnostic technique in type III and IV lesions of the superior glenoid labrum. It often provides important information about the possible presence of associated diseases, especially of the rotator cuff, which are helpful for treatment planning.

Adolescent↗

PubMed2000

[Magnetic resonance angiography with contrast media bolus in the evaluation of aneurysms of the abdominal aorta].

PURPOSE: To investigate the potentials of 3D breath-hold contrast-enhanced Magnetic Resonance Angiography (MRA) in the diagnosis, follow-up and treatment planning of abdominal aortic aneurysms. MATERIAL AND METHODS: Twenty-four patients with infrarenal aortic aneurysm underwent MRA. We used a 1.5 T unit (GE Horizon, Echospeed 8.2), a phased array surface coil and 3D Fast SPGR T1-weighted sequences acquired on the coronal plane during patient breath-hold and after contrast agent i.v. administration. A bolus-test was done before angiography to optimize imaging delay time. After 3D MRA a Fast-SPGR T1-weighted sequence was acquired on the axial plane. The 3D MRA source images were processed with the MIP algorithm. Qualitative and quantitative analyses were carried out. Helical CT was performed in 6 cases and DSA in 7 cases. Surgery was the reference standard in 15 patients. RESULTS: MRA depicted aneurysm thrombosis in 22 cases, carrefour involvement in 18 cases and iliac arteries involvement in 3 cases. Accessory renal arteries were shown in 4 cases; iliac artery stenosis was associated in 5 cases. There was agreement between MR and Helical CT and DSA findings: surgery confirmed MRA results in 15/15 cases. CONCLUSIONS: 3D contrast-enhanced MRA can be considered the method of choice in the follow-up and treatment planning of abdominal aortic aneurysms, because it provides both angiographic and tomographic images: this allows to obtain more information, noninvasively and without the use of ionizing radiations.

Aged↗

PubMed2000

[Groin pain in athletes: role of magnetic resonance].

INTRODUCTION: Aim of our work was to evaluate the diagnostic role and potentials of Magnetic Resonance Imaging (MRI) in the study of groin pain in athletes and in the differential diagnosis among the pathological conditions that cause this syndrome. MATERIAL AND METHODS: MRI examinations were performed with a 1.5 T superconductive magnet, and a 0.2 T permanent magnet. Spin-Echo (SE) T1-w, PD, SE T2-w, Gradient-Echo (GE) T2-w and fat saturation sequences were used, on axial, sagittal and coronal scan planes. We performed MRI on twenty-five athletes (22 men and 3 women; age range 17 to 32 years) with chronic groin pain of questionable origin who had been complaining of it for at least 6 months. In 22 cases, radiographs were available; Computed Tomography (CT) had been performed in 3 cases and Ultrasound (US) in 7 cases. Nine patients were submitted to MRI after the symptoms had disappeared. RESULTS: In all patients, MRI provided an accurate depiction of pubic bone alterations and of adjacent myotendinous structures. In 14 cases, osteitis pubis was diagnosed, which was bilateral in 2 cases only (muscular asymmetry of the rectus abdominis was found in 4 of these patients); 4 patients had myotendinous posttraumatic changes (1 hematoma of the psoas muscle and 3 injuries of the abductor muscles of the thigh); 4 patients presented isolated dysmetria of rectus abdominis muscles, with unilateral involvement of the sacroiliac joint in 1 patient; 3 patients had inguinal hernia, surgically confirmed in all cases. DISCUSSION: Osteitis pubis, intended as reactive intraspongiuos edema of the pubic bones, is the most frequent cause of groin pain in athletes. In the early diagnostic phases, both plain films and CT may be negative or not specific. On the other hand, MRI has always proved to be a valuable diagnostic technique in detecting the osteitic change as an area of low signal intensity on T1-w images and of high and homogeneous signal intensity on T2-w scans without fat suppression. Dysmetria of the straight muscles of the abdomen, which may be associated, is always well depicted by MRI on axial planes. Both posttraumatic and dysmetric changes of the muscular structures adjacent to the pubis are well documented by US and MRI. The latter, however, thanks to its multiplanar capabilities, allows better spatial assessment of the alteration, especially if located at peri-insertional level. Possible associated diseases such as the involvement of the sacroiliac joints are also well shown by MRI. Inguinal hernias are easily demonstrated by MRI, which allows the direct visualization of the hernial sac within the inguinal canal. CONCLUSIONS: In our experience, only MRI can permit an accurate and early diagnosis of the different sport-related pubic conditions. MRI is also a valuable tool in monitoring the alterations with reference to their response to treatment, which may also help bring the athletes back to their activities.

Abdominal Muscles↗

PubMed2000

[Magnetic resonance imaging of hepatic focal lesions: dynamic contrastographic evaluation with gadolinium versus reticulo-endothelial hepato-specific contrast media].

PURPOSE: To compare the potentials of AMI-25 (Endoren) to those of Gadolinium with the dynamic contrast-enhanced technique in the differential diagnosis of focal liver lesions. MATERIAL AND METHODS: Forty patients with at least one focal liver lesion diagnosed at US underwent MRI. We used a 1.5 T unit and employed single-shot half-Fourier T2-weighted FSE and spoiled gradient-echo T1-weighted sequences before and after Gadolinium injection. Multiple acquisitions were obtained during the arterial, portal and delayed phases. Twenty-four to 48 hours later T2*-weighted GRE and SPGR/90 degrees sequences were obtained after AMI-25 administration. In the characterization of solid lesions the gold standard was biopsy performed with a shearing needle; for the diagnosis of angiomas and of 11 metastatic lesions we considered follow-up and clinical data as important diagnostic elements. RESULTS: We found 12 hepatocarcinomas, 14 metastases, 4 cases of focal nodular hyperplasia (FNH), 4 adenomas and 6 angiomas. The diagnosis was correct and confirmed by the conventional examination in all cases but 2 adenomatous lesions and 2 angiomas. Precontrast studies showed slight hyperintensity in 2 of 4 cases of FNH, while the other 2 lesions appeared isointense and were therefore detected only on postcontrast images, where there was contrast agent uptake during the arterial phase and rapid washout. We found only one central scar hyperintense on T2- and hypointense on T1-weighted images. After AMI-25 administration all lesions appeared isointense to surrounding parenchyma on T2* GRE sequences. Adenomas were isointense in the precontrast phase and postcontrast 3 of them showed strong Gadolinium uptake and rapid washout. After AMI-25 two of the 4 lesions were hyperintense while the other two were isointense to the parenchyma. Four of 6 angiomas exhibited a typical pattern characterized by signal hyperintensity on T2-weighted sequences and on AMI-25-enhanced T1- and T2-weighted sequences. Two angiomas were supposed to be of malignant nature but histology showed the presence of a strong fibrotic component. Hepatocarcinomas could be detected on precontrast images. After Gadolinium administration 10 lesions appeared hyperintense in the arterial phase and 2 were hypointense. After AMI-25 all lesions exhibited homogeneous signal hyperintensity and appeared slightly bigger than on Gadolinium-enhanced images. The metastases were only partly demonstrated by MRI. Postgadolinium studies showed 13 lesions with hyperintense signal in the portal phase. AMI-25 administration detected 14 lesions that appeared slightly bigger than on Gadolinium-enhanced images. CONCLUSIONS: AMI-25 can help also in characterizing primary lesions with an atypical signal pattern after contrast agent administration thanks to its intrinsic capability of accumulating in benign lesions. However it remains difficult to characterize well differentiated hepatocarcinomas and adenomas. Finally, AMI-25 improves MR capabilities in detecting secondary lesions and possible satellite nodules.

Adenoma↗

PubMed1999

Drug resistance patterns, genetic subtypes, clinical features, and risk factors in military personnel with HIV-1 seroconversion.

BACKGROUND: Regular testing of military personnel identifies early HIV infection; this identification provides a sentinel cohort in which to describe the evolving molecular epidemiology of HIV-1 transmission. OBJECTIVE: To describe the prevalence and epidemiologic correlates associated with the acquisition of non-subtype B and drug-resistant HIV infections. DESIGN: Cross-sectional study. SETTING: Military referral hospital. PATIENTS: 95 military personnel with HIV-1 seroconversion. MEASUREMENTS: Self-reported questionnaire, CD4 cell counts, plasma HIV-1 RNA levels, and nucleic acid sequence analysis for drug-resistant mutations and HIV-1 genetic subtype. RESULTS: 95 patients were enrolled between February 1997 and February 1998. The likely geographic location of HIV-1 acquisition was overseas in 8% of patients, the United States in 68%, and either overseas or the United States in 24%. Seven patients (7.4%) had subtype E infection; the remainder had subtype B infection. Eight of 31 (26%) treatment-naive patients had mutations in the reverse transcriptase or protease gene associated with drug resistance. CONCLUSIONS: The percentage of HIV-1 non-subtype B infection and antiretroviral drug-resistant mutations was relatively high in U.S. military personnel with recently acquired HIV-1 infection.

CD4 Lymphocyte Count↗

PubMed1999

Age as a risk factor in cervicofacial reconstruction.

The Authors report their experience from January 1980 to January 1998 with 392 reconstructive flaps for the oncological reconstruction of the cervicofacial district. One hundred and forty-two were conventional flaps, 187 were myocutaneous or pedicled muscular ones and 63 were microvascular. Ninety percent of the patients had Stage IV disease, 80% were tumors involving the oral cavity structures, 40% of the patients had received preoperative radiotherapy; 35% of the cases were recurrences. The complications related to the surgery were evaluated for each type of flap, comparing them to the same flaps employed in patients > 70. Complications were divided into major and minor that were observed at an overall rate of 22%. With the use of conventional flaps, there was an 11.3% rate of minor complications and a 5.6% rate of major ones. Examining the 187 myocutaneous or pedicled muscular flaps, 21% of the overall 27% were minor and 6% were major complications. Of the remaining 63 free flaps, minor complications were observed in 4.7% and major complications in 14.2% of cases. Thirty-four of the 392 flaps, 24 of which were myocutaneous or pedicled muscular and 10 free flaps, were utilized in elderly patients and compared with the 216 of the same type, in patients < 70. A comparative analysis shows that there was a major complication rate of 11.7% in the flaps employed on the elderly patients as opposed to 7.9% for those employed in the younger patients. In terms of minor complications, a 20.5% complication rate was observed for those > 70 as opposed to 16.7% for patients < 70. A more detailed analysis of these data, enabled to postulate that the smaller group of flaps used in elderly patients is statistically influenced by the "dilution" of the complication rate in favour of the larger group of younger patients. Furthermore, by appropriately correcting the risk factors due to concomitant diseases that were not related to surgery in the older patients, a realignment of the results may be seen. Therefore, a careful preoperative study must be carried out in the elderly patients with cervicofacial tumors who are eligible for surgery to establish and possibly treat the concomitant disease responsible for the increased peri- and postoperative morbidity. In conclusion, complications in elderly patients are correlated to the state of co-morbidity and neither to age nor to the duration of the operation. Responsiveness may therefore be obtained also in elderly patients employing sophisticated techniques such as microvascular flaps.

Aged↗

PubMed1998

Incidence of postoperative infection or positive culture after facial laser resurfacing: a pilot study, a case report, and a proposal for a rational approach to antibiotic prophylaxis.

BACKGROUND: Laser skin resurfacing (LSR) has emerged as a popular procedure for facial rejuvenation; however, there are no clear guidelines regarding systemic antibiotic prophylaxis. OBJECTIVE: We attempt to provide practical guidelines for antibiotic prophylaxis in LSR based on our experiences, pharmacology, and a review of the literature. METHODS: In a pilot study, four consecutive full-face LSR patients were treated without oral or topical antibiotics. The next four patients received oral prophylaxis with a narrow spectrum antibiotic. We also report the case of a severe gram-negative infection after LSR. RESULTS: For full-face LSR, 2 of 4 consecutive patients without antibiotic prophylaxis experienced focal Staphylococcus aureus infection. The next 4 consecutive patients, who had received gram-positive oral prophylaxis, were all culture negative after 2 days. All test sites (5 of 5) were culture negative despite the absence of systemic or topical antibiotics. One patient not in the pilot study receiving gram-positive antibiotic prophylaxis experienced a gram-negative infection. CONCLUSION: We recommend narrow-spectrum gram-positive oral antibiotic coverage for full-face and regional LSR.

Aged↗

PubMed1998

Joint impingement syndrome: clinical features.

Joint impingement is a painful syndrome caused by the friction of joint tissues, which is both the cause and the effect of altered joint biomechanics. From the anatomical and clinical viewpoints, these syndromes are classified as bone impingement, soft tissue impingement and entrapment neuropathy, depending on what joint portion impinges on the others. We considered the most important impingement syndromes of the upper and the lower limbs from the clinical viewpoint. As for the upper limb, supraspinatus impingement is a frequent cause of shoulder pain in both athletes and the normal population; the painful subacromial arch is a typical sign of the rotator cuff impingement syndrome and of outlet and non-outlet impingement as well. As for the elbow, we considered both medial and lateral impingement. The carpal tunnel syndrome is the most common peripheral entrapment neuropathy of the upper limb; it is caused by compression of the median nerve at the wrist. We considered the main causes of carpal tunnel narrowing and the relative clinical findings. As for the lower limb, we considered the iliotibial band friction syndrome, which is the most common overuse syndrome of the knee and the ankle impingement syndrome. The latter includes anterolateral impingement (with chronic anterolateral and lateral pain and ankle instability), sinus tarsi impingement, anterior impingement (with pain during foot dorsiflection and posterior impingement. The tarsal tunnel syndrome is the most important ankle entrapment neuropathy causing burn pain and paresthesias in the toes and sole of the foot.

Cumulative Trauma Disorders↗

PubMed1998

Ankle impingement syndromes.

The ankle impingement syndrome is a frequent condition in both athletes and the normal population. We investigated this painful syndrome from both a clinical and a diagnostic viewpoint. Depending on what ankle tissue impinges on the other, it is possible to distinguish bone impingement, soft tissue impingement and peripheral nerve entrapment. For each of these pathologic conditions we investigated the diagnostic role of conventional radiography, Computed Tomography and Magnetic Resonance Imaging. The evidence of osteophytes, exostosis and presence of the os trigonum on plain films make clinical diagnosis easy in both anterior and posterior bone impingement. CT can provide useful information about the component of the posterior ankle. MRI always adds important information about chondral or subchondral bone injuries, synovial reaction and adjacent soft tissue involvement. The anterolateral impingement syndrome is caused by repeated injuries in plantar flexion and ankle intrarotation. MRI well detects the meniscoid injury thanks to high contrast sequences; it can also distinguish this syndrome from painful chondral and/or bony lesions at this level. MRI is also the method of choice to study sinus tarsi impingement, especially thanks to fat suppression sequences which increase MR diagnostic capabilities in this important anatomic area. Deep peroneal nerve entrapment, the medial plantar nerve entrapment syndrome and the tarsal tunnel syndrome are the most important entrapment neuropathies of the ankle. US and MRI are very useful to study the tendon and soft tissue abnormalities causing the anterior tarsal tunnel syndrome. CT and particularly MRI can easily detect many pathologic conditions causing the medial plantar nerve entrapment and the tarsal tunnel syndromes.

Ankle Injuries↗

PubMed1998

Diagnostic imaging of malignant cartilage tumors.

We compared the diagnostic capabilities of CT and MRI in the study of malignant cartilage tumors. Information about the characterization and the intra-/extraosseous spread of these lesions is of primary importance in the preoperative planning. Besides peripheral chondrosarcomas, arising from an osteochondroma and central chondrosarcomas, which are the most common malignant cartilaginous tumors, we also considered secondary, periosteal, dedifferentiated, clear cells and mesenchymal chondrosarcomas. Our study was performed using a standard MRI and CT protocol; in some cases, the examination was completed by the intravenous administration of a contrast agent. High contrast T2-weighted GE images can perfectly depict and differentiate the cartilage cap of an osteochondroma from the adjacent soft tissues. Evaluation of the growth of exostosis and of the thickness of its cap is essential in the assessement of malignant transformation. Both CT and MRI provide important information about peculiar aspects of the cartilaginous matrix such as the shape of calcifications-ossifications and lobulated growth, septa, septal enchancement and necrotic intratumoral areas, furthermore, CT perfectly shows the patterns of bone destruction. MRI should be considered as the most reliable imaging technique for the locoregional staging of malignant bone tumors thanks to its spatial and contrast resolution. CT plays a major role in the characterization of most bone tumors, especially those with a cartilaginous matrix.

Bone Neoplasms↗

PubMed1998

[Anterior cruciate ligament tears in athletes: assessment and clinico-diagnostic control with a dedicated system].

INTRODUCTION: We investigated the MR signs of anterior cruciate ligament (ACL) tears and tried to assess the patterns of both the acute and the chronic phases since more MR examinations are currently performed of the knee joint in the hyper and acute post-traumatic stage. MATERIAL AND METHODS: December, 1994, through September, 1997, a hundred and 89 sportsmen with a history of hyper and acute knee trauma were submitted to MRI: one hundred and four of them were followed-up for 3-6 months. The MR examinations were performed with a dedicated unit (Artoscan, Esaote Biomedica, Genoa) using T1-weighted SE, T2-weighted GE and Turbo ME sequences on the sagittal, coronal and axial planes, respectively (3-5 mm slice thickness). RESULTS: Of 189 patients examined in the hyper and acute post-traumatic stage, 101 had a complete ACL tear, 23 had a partial tear and 65 had an enlarged and inhomogeneous ACL: Eighty-five patients underwent surgery, while the other 104 had 3-6 months' follow-up MRI. Twenty-four of the latter had a complete ACL tear, 20 had a partial tear and 60 had no MR finding of ACL interruption, with a more or less inhomogeneous ligament. DISCUSSION: ACL tears are difficult to demonstrate in the acute phase because of perilesional swelling, synovitis and hemorrhage; high-contrast sequences on the axial plane are therefore required. In the chronic stage, an uninterrupted ACL does not necessarily imply that function is preserved, as well as the MR finding of a deflected ligament does not necessarily imply altered biomechanics. CONCLUSIONS: MRI of the knee joint is increasingly used to study hyper and acute ACL tears thanks to the availability of dedicated units. The MR study of ACL tears is not meant to refer the patients to surgery, which pertains to the physical examination, but it allows to assess lesion severity and to show associated injuries in other knee structures.

Acute Disease↗

PubMed1995

[Technologic advances in magnetic resonance imaging: permanent low-field magnets dedicated to the study of the joints. Clinical results].

Magnetic Resonance Imaging (MRI) has had a significant impact on the diagnosis of musculoskeletal conditions. Technologic advances in the last years allowed the development of cost-effective, compact and easy-to-install MR systems. After an early phase to optimize the units, a 14-month multicentric study was performed to define the possible clinical applications of the system. The obtained data are reported by the authors in the present study to assess the diagnostic accuracy of the new MR system for the study of the limbs. The system consists of an 0.2 T permanent unit, weighting 800 Kg, with a built-in radiofrequency shield and 10 mT/m gradients. October, 1992, to February, 1994, 2437 limbs examinations were carried out in patients whose age ranged 5 to 83 years. In 93% of cases, the exam was performed to study one joint, mostly the knee. MR diagnosis was verified in 311 patients, who were subsequently submitted to surgery. Quite satisfying overall results were obtained, particularly in case of knee traumas, comparable to those provided by units with more potentials. The particular structure of the magnet allowed the comfortable management of the pediatric, aged and acute patients. Nevertheless, in 3% of the investigated knee or elbow conditions, the examinations could not be performed due to technical limitations related to magnet size. In addition, the authors believe that a limited field of view (11-16 cm) does not allow accurate staging of the malignant lesions involving soft tissue and bone, which require a wider locoregional staging.

Adolescent↗

PubMed1995

[Magnetic resonance arthrography. Preliminary experience in study technic and main diagnostic applications].

In the study of osteoarticular conditions, MRI makes a definite diagnostic improvement, even though some problems are still to be solved. Thus, on the basis of their arthrographic experience, the authors experimentally applied this technique to MRI, to assess the actual feasibility of MR arthrography. Forty-three patients were selected to undergo MR examinations after the intraarticular injection of 15-20 ml paramagnetic contrast agent (Gd-DTPA), with 0.25% saline solution. Before MR arthrography every patient underwent a baseline MR arthrography exam. Normal anatomy was better depicted with MR arthrography. In all cases, even small lesions and other structural changes missed at baseline MRI were demonstrated. Therefore, in agreement with previous arthrographic and CT arthrographic reports, we believe MR arthrography to be a simple technique improving MR diagnostic capabilities in selected cases.

Ankle Joint↗