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Biomedical subjects

D Trudell

Publications and source records attributed to D Trudell.

At least 19 recordsLinked to original sources
PubMed2004

Calcification in calcium pyrophosphate dihydrate (CPPD) crystalline deposits in the knee: anatomic, radiographic, MR imaging, and histologic study in cadavers.

OBJECTIVE: To demonstrate and determine the frequency and location of calcification within cadaveric knees with or without calcification typical of calcium pyrophosphate dihydrate (CPPD), utilizing histologic, radiographic and MR imaging techniques. DESIGN AND PATIENTS: Ten cadaveric knees of elderly individuals that demonstrated no radiographic evidence of prior surgery or trauma were studied with MR imaging and subsequently sectioned in planes corresponding to those obtained with MR imaging. The slices were imaged with high-resolution radiography. Two musculoskeletal radiologists correlated the anatomic, MR and radiographic findings. Three of the knees, which did not demonstrate calcifications, were utilized as controls. Histologic sections were obtained from four knees that contained calcifications and from the three controls, and analyzed with special histologic stains that demonstrate phosphorus and calcium. RESULTS: Radiographic imaging and histologic analysis demonstrated widespread CPPD crystal deposition in four of the 10 knee specimens (40%). MR imaging demonstrated some calcifications only within the articular cartilage of the femoral condyles in three of the four (75%) specimens that had CPPD deposits. In all four specimens radiographs and histologic analysis were more sensitive than MR imaging. Histologic analysis demonstrated no evidence of CPPD crystals in the control specimens. CONCLUSION: MR imaging is insensitive to the presence of CPPD deposits in the knee, even when such deposits are widespread. Our study suggests that the sensitivity of MR imaging was significantly better in detecting CPPD deposits in the hyaline cartilage of the femoral condyles when compared with other internal structures, even when such structures contained a higher amount of calcification.

Aged↗
PubMed2003

Avulsion fractures of the medial and lateral malleoli of the ankle in cadavers: new radiographic projections for improved diagnosis.

The malleolar attachment sites of the tibionavicular (TN), tibiocalcaneal (TC), posterior tibiotalar (PTT), anterior talofibular (ATF), and calcaneofibular (CF) ligaments of 3 cadaveric ankles were dissected. Standard and new radiographic projections of the ankle were obtained with the foot in different positions and various degrees of beam angulation. Simulated avulsion injuries related to these ligaments were created, and the visibility of these structures was assessed. Avulsion injuries of the TN ligament were better assessed in the plantar-flexed radiographs with lateral beam angulation. Standard projections were found to adequately depict avulsion fractures related to the TC and CF ligaments. Radiographs in external ankle rotation were best for evaluating injuries of the PTT ligament. Avulsion injuries related to the ATF ligament were best visualized in the plantar-flexed views with medial beam angulation. Modified radiographic projections of the ankle improve visualization of ligamentous structures of the malleoli and avulsion injuries related to those.

Ankle Injuries↗
PubMed2002

Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis.

OBJECTIVE: To determine the relationship between sites of calcaneal plantar enthesophytes and surrounding fascial and soft tissue structures using routine radiography, MR imaging, and data derived from cadaveric and paleopathologic specimens. DESIGN AND PATIENTS: Two observers analyzed the MR imaging studies of 40 ankles in 38 patients (35 males, 3 females; mean age 48.3 years) with plantar calcaneal enthesophytes that were selected from all the ankle MR examinations performed during the past year. Data derived from these MR examinations were the following: the size of the enthesophyte; its location in relation to the plantar fascia (PF) and flexor muscles; and the thickness and signal of the PF. The corresponding radiographs of the ankles were evaluated at a different time by the same observers for the presence or absence of plantar enthesophytes and, when present, their measurements. A third observer reviewed all the discordant observations of MR imaging and radiographic examinations. Two observers analyzed 22 calcaneal specimens with plantar enthesophytes at an anthropology museum to determine the orientation of each plantar enthesophyte. MR imaging of a cadaveric foot with a plantar enthesophyte with subsequent sagittal sectioning was performed to provide further anatomic understanding. RESULTS: With regard to MR imaging, the mean size of the plantar enthesophytes was 4.41 mm (SD 2.4). Twenty (50%) enthesophytes were located above the PF, 16 (40%) between the fascia and abductor digiti minimi, flexor digitorum brevis and abductor hallucis muscles, and only one (3%) was located within the PF. In three (8%) cases the location was not determined. The size of enthesophytes seen with MR imaging and radiographs was highly correlated (P<0.01). The interobserver agreement for all measurements was good (Pearson >0.8, kappa >0.9). Eleven of the 22 bone specimens had plantar enthesophytes oriented in the direction of the abductor digiti minimi and 11 oriented in the direction of the flexor digitorum brevis and PF. The cadaveric sections revealed different types of enthesophytes. CONCLUSIONS: Plantar calcaneal enthesophytes arise in five different locations: at the insertion sites of abductor digiti minimi and flexor digitorum brevis muscles; between the PF and these muscles; and, less frequently, within the PF and at the insertion site of the short plantar ligament.

Cadaver↗
PubMed2001

Assessment of the position of the distal portion of the ulna in lateral projection radiographs of the wrist: analysis of the influence of pronation-supination and flexion-extension on the pisoscaphoid and the ulnotriquetral distances: a cadaver study.

RATIONALE AND OBJECTIVES: Accurate assessment of the distal radioulnar joint is of paramount importance for the detection of possible dislocation or subluxation. Using a cadaveric model, the authors attempted to establish a quantitative method that would allow identification of normal and abnormal distal radioulnar joint anatomy on well-positioned and rotated conventional radiographs. METHODS: Four cadaveric wrists, in which subsequent sectioning confirmed the absence of disease, and one cadaveric wrist with a circumscribed lesion of the triangular fibrocartilaginous complex were studied. Defined movements in flexion and extension (+/- 10 degrees, 20 degrees, 30 degrees ) and in pronation and supination (+/- 10 degrees, 20 degrees, 30 degrees ) as well as combined flexion/extension and pronation/supination were performed. The ulnotriquetral and the pisoscaphoid distances were assessed in each position. Correlation with cryosections was achieved. RESULTS: A strong linear correlation between the degree of pronation or supination and the pisoscaphoid and ulnotriquetral distances was noted. Flexion and extension produced no significant effect on the pisoscaphoid distance, but a defined shift of the ulnotriquetral distance occurred with increasing flexion and extension. CONCLUSIONS: If all parameters are taken into account, this correlation aids in estimating the degree of possible malpositioning of the wrist during radiography and the degree of subluxation of the distal radioulnar joint. Tabular data with parameters to correct for instances of malrotated images and to estimate the extent of dislocation or malrotation of the distal radioulnar joint are provided.

Cadaver↗
PubMed2001

Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion.

PURPOSE: To demonstrate the normal anatomy of the stabilizing structures of the lateral aspect of the knee and to investigate pathogenesis of the Segond fracture, with emphasis on the iliotibial tract (ITT) and anterior oblique band (AOB) of the fibular collateral ligament. MATERIALS AND METHODS: Dissection of the region of the AOB, ITT, and lateral capsular ligament was performed in three cadaveric knees, with placement of gadopentetate dimeglumine-filled tubes along their course and tibial insertions. These knees, in addition to three nondissected knees, were studied with magnetic resonance (MR) imaging by using standard and specialized oblique planes. Specimen sectioning provided anatomic correlation. Retrospective review of radiographs and MR images in 17 patients with acute Segond fractures was performed, and the relationship between the fragment and the demonstrated lateral supporting structures of the knee was noted. RESULTS: Anatomic dissection and MR imaging of the cadaveric knees demonstrated a broad tibial insertion of the ITT, with fibers extending posterior to the Gerdy tubercle. A firm band of tissue, the AOB, extended from the fibular collateral ligament to the midportion of the lateral tibia, the typical site of a Segond fracture. The lateral capsular ligament proved to be a mere thickening of the capsule, inserting at the lateral tibia. Clinical analysis of acute Segond fractures confirmed the frequent attachment of the ITT and AOB to the avulsed fragment. CONCLUSION: Anatomic and clinical findings suggest that fibers of the ITT and AOB are important factors in the pathogenesis of the Segond fracture.

Adolescent↗
PubMed2001

Tarsal sinus: arthrographic, MR imaging, MR arthrographic, and pathologic findings in cadavers and retrospective study data in patients with sinus tarsi syndrome.

PURPOSE: To evaluate the tarsal sinus by using different imaging techniques and specialized planes. MATERIALS AND METHODS: Magnetic resonance (MR) imaging of the tarsal sinus was performed in 10 cadavers. Conventional arthrography of the anterior and posterior subtalar joints was then performed. Tarsal sinus ligaments were evaluated further on initial and reconstructed MR arthrograms along and perpendicular to their axes. Pathologic correlation was performed in five specimens suspected of having tarsal sinus lesions on the basis of initial imaging findings. In 37 patients with a clinical diagnosis of sinus tarsi syndrome, MR images of the ankle were obtained before and after intravenous gadolinium-based contrast material administration and were reviewed to verify the integrity of the tarsal sinus ligaments. RESULTS: Two complete and three partial cervical ligament (CL) tears and one complete interosseous talocalcaneal ligament (ITCL) tear were diagnosed with MR imaging. Only one complete and one partial CL tear were seen after evaluation of both initial and reconstructed MR arthrograms and confirmed with pathologic correlation. In 18 patients, the diagnosis was confirmed at MR imaging, which depicted ITCL and CL tears in 11 patients, isolated CL tears in three patients, ganglia in three patients, and pigmented villonodular synovitis in one patient. CONCLUSION: Cadaveric study results indicate that initial and reconstructed MR arthrograms along and perpendicular to the ligament axes are potentially useful for further evaluation of individual tarsal sinus structures.

Adult↗
PubMed2000

Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath.

PURPOSE: To describe the normal anatomy of the finger flexor tendon pulley system, with anatomic correlation, and to define criteria to diagnose pulley abnormalities with different imaging modalities. MATERIALS AND METHODS: Three groups of cadaveric fingers underwent computed tomography (CT), magnetic resonance (MR) imaging, and ultrasonography (US). The normal anatomy of the pulley system was studied at extension and flexion without and with MR tenography. Pulley lengths were measured, and anatomic correlation was performed. Pulley lesions were created and studied at flexion, extension, and forced flexion. Two radiologists reviewed the studies in blinded fashion. RESULTS: MR imaging demonstrated A2 (proximal phalanx) and A4 (middle phalanx) pulleys in 12 (100%) of 12 cases, without and with tenography. MR tenography showed the A3 (proximal interphalangeal) and A5 (distal interphalangeal) pulleys in 10 (83%) and nine (75%) cases, respectively. US showed the A2 pulley in all cases and the A4 pulley in eight (67%). CT did not allow direct pulley visualization. No significant differences in pulley lengths were measured at MR, US, or pathologic examination (P: =.512). Direct lesion diagnosis was possible with MR imaging and US in 79%-100% of cases, depending on lesion type. Indirect diagnosis was successful with all methods with forced flexion. CONCLUSION: MR imaging and US provide means of direct finger pulley system evaluation.

Aged↗
PubMed1999

Intracapsular origin of the long head of the biceps tendon.

A developmental anomaly of the long head of the biceps tendon was found in a cadaveric shoulder. Findings on arthroscopy, routine MR imaging, and MR arthrography were compared and correlated with results of anatomic dissection. MR arthrography appears to be a very good diagnostic imaging method for depicting this anomaly prior to arthroscopy.

Aged↗
PubMed1999

Peripheral focal low signal intensity areas in the degenerated annulus fibrosus on T2-weighted fast spin echo MR images: correlation with macroscopic and microscopic findings in elderly cadavers.

OBJECTIVE: To correlate the peripheral focal low signal intensity areas in the degenerated annulus fibrosus on T2-weighted fast spin echo MR images with the macroscopic and microscopic findings in cadavers derived from elderly subjects. DESIGN: Twenty-eight intervertebral disks (16 lumbar and 12 cervical) derived from four nonembalmed cadavers were examined with T1-weighted spin echo and proton density-weighted and T2-weighted fast spin echo MR imaging. The signal intensities of the annulus fibrosus were evaluated on sagittal MR images and correlated with the findings on corresponding sagittal anatomic sections. The MR imaging-histologic correlation was then studied. RESULTS: Peripheral focal low signal intensity areas and adjacent regions of high signal intensity were found in five lumbar intervertebral disks. Peripheral focal low signal intensity regions consisted of disorganized compact annular fibers, tiny fissures, and dense fibrosis. The high signal intensity regions, adjacent to the areas of low signal intensity, consisted of mucoid degeneration, tiny fissures, and chondroid metaplasia. CONCLUSIONS: Awareness of the histologic findings in regions that reveal peripheral focal low signal intensity with adjacent regions of high signal intensity in the degenerated annulus fibrosus on T2-weighted images may facilitate effective interpretation of clinical MR images of the spine.

Aged↗
PubMed1999

Posteromedial corner of the knee: MR imaging with gross anatomic correlation.

OBJECTIVE: The objective of this study was to illustrate the magnetic resonance (MR) image appearance of the structures of the posteromedial "corner" of the knee with particular emphasis on the anatomy and differentiation between the medial collateral ligament and the posterior oblique ligament. DESIGN: Six cadaveric knee specimens underwent MR imaging, before and following instillation of intra-articular contrast material. The knees were sectioned in the axial, coronal, and coronal oblique planes and the gross morphology of the posteromedial corner and surrounding structures was studied and correlated with the MR images. PATIENTS: The human cadaveric specimens were from two female and four male patients (age at death, 72-86 years; average, 78 years). RESULTS AND CONCLUSIONS: The contrast-enhanced sequences and the coronal oblique images allowed for improved visualization of the structures.

Aged↗
PubMed1998

MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm.

Magnetic resonance (MR) imaging provides useful information in the evaluation of peripheral nerves. Recent advances in MR imaging allow for detailed depiction of the soft tissue structures of the elbow joint. Three major nerves are present about the elbow. Six cadaveric elbows were imaged to depict the normal anatomy of these nerves and to determine the best plane and position of the elbow for optimal visualization of each nerve. Axial images of the elbow in full extension with the forearm in supination allow identification of all major nerves. Axial images with the elbow in full flexion allow accurate assessment of the cubital tunnel and the ulnar nerve. Axial images of the elbow in full extension with the forearm in pronation are helpful for assessment of the median and radial nerves in the forearm.

Aged↗
PubMed1998

Evaluation of articular cartilage thickness of the humeral head and the glenoid fossa by MR arthrography: anatomic correlation in cadavers.

OBJECTIVE: To evaluate the accuracy of MR arthrography in determining the thickness of articular cartilage of the humeral head and glenoid fossa. DESIGN AND PATIENTS: MR arthrography of the glenohumeral joint was performed in 17 cadaveric shoulders. Articular cartilage thickness was measured on the MR arthrographic images and corresponding anatomic sections. RESULTS: The correlation coefficients for MR arthrographic measurement versus anatomic measurement of the cartilage thickness were 0.7324 and 0.8757 for humeral head and glenoid fossa, respectively. With regard to the humeral head, there was a tendency to overestimate regions of thin cartilage and underestimate regions of thick cartilage. This tendency was not found in the assessment of glenoid cartilage. The mean of the absolute value of MR-anatomic differences was similar on the glenoid side (0.27 mm) and the humeral side (0.29 mm). The accuracy of measurement was significantly better on the glenoid side (Fisher's r-to-Z transformation: Z=5.21, P=0.000001). CONCLUSION: MR arthrography causes a moderate degree of error in the naked-eye measurement of the cartilage of the glenohumeral joint. The accuracy is higher on the glenoid side than on the humeral side.

Aged↗
PubMed1998

Magnetic resonance imaging of the forearm: cross-sectional anatomy in a cadaveric model.

RATIONALE AND OBJECTIVES: Compartmental anatomy of the forearm is complex and controversial. The purpose of this investigation was to demonstrate via magnetic resonance the anatomy of forearm compartments and their preferential ways of communication in a human cadaveric model. METHODS: Twelve forearm spaces (11 muscles and one intermuscular) were injected with a solution containing gadopentetate dimeglumine. The extent and distribution of leakage were evaluated on axial fat-suppressed T1-weighted spin-echo images. The findings were related to known descriptions of compartmental anatomy of the forearm. RESULTS: Contrast leakage occurred mostly into the intermuscular space and into the muscles adjacent to the injected muscle. A frank communication within the classically described three forearm compartments (volar, radial, and dorsal) was not present. The interosseous membrane was not an absolute barrier between flexor and extensor compartments. CONCLUSION: The classic description of three forearm compartments may not be sufficient to explain distribution of soft tissue abnormalities.

Aged↗
PubMed1998

Evaluation of the triangular fibrocartilage and the scapholunate and lunotriquetral ligaments in cadavers with low-field-strength extremity-only magnet. Comparison of available imaging sequences and macroscopic findings.

RATIONALE AND OBJECTIVES: The authors assessed the ability of a low-field-strength extremity-only magnet to provide visualization of the triangular fibrocartilage and the scapholunate and lunotriquetral ligaments. METHODS: Twelve human wrists were examined with a 0.2 T extremity-only magnet. T1-weighted spin echo, proton density-weighted, and T2-weighted turbo spin echo, short-tau inversion recovery, and three-dimensional gradient recalled echo images were acquired, and sections of the specimens were then made that corresponded to the magnetic resonance images. Masked imaging analyses were correlated with macroscopic and limited histopathologic findings. RESULTS: Low-field-strength extremity-only magnet allowed consistent visualization of the triangular fibrocartilage and accurate assessment of a small number of complete tears of the triangular fibrocartilage. The scapholunate ligaments in all cases were identified using a combination of imaging sequences. Consistent visualization of the lunotriquetral ligament with a low-field-strength extremity magnet was difficult. CONCLUSIONS: Magnetic resonance imaging with a low-field-strength extremity-only magnet can be used to visualize the triangular fibrocartilage and the scapholunate ligament, but not the lunotriquetral ligament.

Aged↗
PubMed1998

Gamekeeper thumb: comparison of MR arthrography with conventional arthrography and MR imaging in cadavers.

PURPOSE: To compare magnetic resonance (MR) arthrography with conventional arthrography and standard MR imaging in the evaluation of gamekeeper thumb. MATERIALS AND METHODS: Eighteen cadaveric thumbs with (n = 12) or without (n = 6) experimental abduction stress were examined with conventional arthrography, standard MR imaging, and MR arthrography. Standard MR imaging and MR arthrography were performed with 0.2-T (low-field-strength) extremity-only and 1.5-T (high-field-strength) magnets. Results of blinded imaging analyses were correlated with pathologic findings. Paired MR images and MR arthrograms were rated with a three-point scale. RESULTS: Fourteen ulnar collateral ligaments were torn, including eight nondisplaced (57%) and six displaced (43%) tears. For the presence of tear, diagnostic accuracy of conventional arthrography, low-field-strength MR imaging, high-field-strength MR imaging, low-field-strength MR arthrography, and high-field-strength MR arthrography was 83%, 89%, 90%, 94%, and 100%, respectively. With regard to displacement of the torn ligament, diagnostic accuracy was 61%, 89%, 90%, 94%, and 100%, respectively. MR arthrograms were rated superior to standard MR images in 72% and 90% of specimens with low-field-strength and high-field-strength magnets, respectively. CONCLUSION: Of the tested methods, MR arthrography proved to be the most sensitive to the diagnosis of a torn ulnar collateral ligament of the first metacarpophalangeal joint and of displacement of the torn ligament.

Aged↗
PubMed1998

Evaluation of patellar cartilage in cadavers with a low-field-strength extremity-only magnet: comparison of MR imaging sequences, with macroscopic findings as the standard.

PURPOSE: To assess a low-field-strength extremity-only magnet in the evaluation of patellar cartilage abnormalities. MATERIALS AND METHODS: Four regions in each of 10 patellae from cadavers were examined in the transaxial plane with a 0.2-T extremity-only magnet and the following sequences: T1-weighted spin echo, proton density- and T2-weighted turbo spin echo, short inversion time inversion recovery, and two- and three-dimensional gradient echo with and without magnetization transfer contrast subtraction. Lesions depicted with MR imaging and seen in anatomic sections of the patellae were classified according to a modified standardized arthroscopic grading system. MR imaging and pathologic correlation was then analyzed. RESULTS: On the basis of macroscopic findings, 14 of 40 cartilage regions were found to be intact, grade 2A lesions were present in eight regions, grade 2B lesions in eight, and grade 3 lesions in 10. For the various MR imaging techniques, sensitivity was 25%-62% for grade 2A lesions, 50%-75% for grade 2B lesions, and 60%-90% for grade 3 lesions. Specificity was 81%-97% for grades 2A and 2B lesions, and 80%-97% for grade 3 lesions. Accuracy was 75%-82% for grade 2A lesions, 75%-92% for grade 2B lesions, and 80%-92% for grade 3 lesions. CONCLUSION: High-grade cartilaginous lesions can be evaluated reliably with low-field-strength MR imaging by using a combination of imaging sequences.

Aged↗
PubMed1998

Glenohumeral joint: comparison of shoulder positions at MR arthrography.

PURPOSE: To compare neutral, external rotation, and abduction external rotation positions of the glenohumeral joint during magnetic resonance (MR) arthrography in the assessment of the joint capsule, biceps-labral complex, and glenohumeral ligaments. MATERIALS AND METHODS: MR imaging with intraarticular administration of gadopentetate dimeglumine was performed in 10 adult cadaveric glenohumeral joints. Fat-suppressed oblique coronal, oblique sagittal, and axial. T1-weighted spin-echo imaging and axial three-dimensional spoiled gradient-recalled imaging were performed with each shoulder in the neutral, external rotation, and abduction external rotation positions. Shoulders were sectioned in the planes that yielded optimal MR images. Anatomic and MR imaging findings were correlated. RESULTS: The biceps-labral complex was best visualized on oblique coronal and axial images obtained in external rotation. Oblique axial abduction external rotation imaging best delineated the inferior glenohumeral ligament but did not improve assessment of the superior and middle glenohumeral ligaments in comparison with findings in neutral and external rotation. CONCLUSION: Although MR arthrography of the glenohumeral joint clearly delineates the biceps-labral complex and glenohumeral ligaments, external rotation of the shoulder optimizes visualization of the former structures. Abduction external rotation is the best position for evaluation of the inferior glenohumeral ligament and anterior capsular attachment.

Adult↗