Biomedical subjects
J Bräm
Publications and source records attributed to J Bräm.
MR abnormalities of the intervertebral disks and adjacent bone marrow as predictors of segmental instability of the lumbar spine.
PURPOSE: To assess whether MR abnormalities of the intervertebral disks and adjacent bone marrow can predict segmental instability of the lumbar spine as diagnosed on functional radiographs. MATERIAL AND METHODS: A consecutive review was made of 60 patients examined with MR imaging and with lateral flexion and extension views of the lumbar spine. Sagittal T1- and T2-weighted images were evaluated blindly with regard to abnormalities of the intervertebral disk and the adjacent bone marrow. Segmental instability was diagnosed when a.p. translation of 3 mm or more was present on the functional radiographs. Moreover, the presence of osteophytes was evaluated on lateral standard radiographs. RESULTS: Of a total of 300 segments, 32 (10.7%) were unstable. Anular tears were the most relevant MR finding. Their sensitivity, specificity, and positive and negative predictive values for segmental instability were 18.8%, 97.0%, 42.9% and 90.9%. The corresponding values for traction osteophytes were 12.5%, 98.1%, 44.4% and 90.4%. Abnormalities of bone marrow were not significantly related to segmental instability (p=0.35). CONCLUSION: Functional radiographs should be considered in patients with anular tears or traction osteophytes. No correlation was found between segmental instability and abnormalities of bone marrow adjacent to the endplates.
[The primary cruciate ligament suture--is the method outdated? Results in follow-up of 58 patients].
In the present study 58 out of 105 patients, who had been operated on for anterior cruciate ligament rupture from 1980-1992 by the same experienced surgeon, were followed up clinically and by X-ray examination. Most of them were sports accidents, above all skiing and soccer. In 11 patients an isolated rupture of the anterior cruciate ligament was found, the remaining 47 had sustained additional injuries (mainly the medial collateral ligament and the medial meniscus). In 52 cases the operation was performed with primary repair of the anterior cruciate ligament. For chronic instability 4 patients (7%) had to be treated with secondary anterior cruciate ligament reconstruction. In the follow-up study 60% of all patients achieved a Lysholm-score of 95-100 points, 19% of 84-94 points. The remaining 21% achieved less than 84 points. In the side to side comparison the Lachman Test was equal or showed a slightly diminished stability of the operated knee in 91% of 54 patients without secondary reconstruction. The anterior stability with 90 degrees flexed knee in neutral position was within a similar scope, the anterior medial stability was a little worse. In 48% of all patients we found radiological signs of osteoarthritis (stage II and III according to the classification of Jäger and Wirth).
Triangular fibrocartilage and intercarpal ligaments of the wrist: does MR arthrography improve standard MRI?
The objective of this study was to assess the value of adding MR arthrography to standard MRI for patients with chronic wrist disorders. Thirty consecutive patients (age range, 19-73 years; mean, 36.2 years) were included in the investigation. The images were evaluated blindly and separately by two radiologists with regard to lesions of the scapholunate (SL) and lunotriquetral (LT) ligaments and the triangular fibrocartilage (TFC). Conventional two- or three-compartment arthrography was used as the standard of reference. For TFC lesions, standard MR images had a sensitivity of 92.3% (reader 1) and 84.6% (reader 2) and a specificity of 41.2% (reader 1) and 52.9% (reader 2). For MR arthrography, sensitivity was 84.6% (reader 1) and 84.6% (reader 2) and specificity was 88.2% (reader 1) and 100% (reader 2). For SL ligament tears, standard MRI had a sensitivity of 33.3% (reader 1) and 11.1% (reader 2) and a specificity of 47.6% (reader 1) and 57.1% (reader 2). For MR arthrography, sensitivity was 66.7% (reader 1) and 55.6% (reader 2) and specificity was 52.4% (reader 1) and 81.0% (reader 2). For LT ligament tears, standard MRI had a sensitivity of 28.6% (reader 1) and 35.7% (reader 2) and a specificity of 93.8% (reader 1) and 81.3% (reader 2). For MR arthrography, sensitivity was 35.7% (reader 1) and 23.1% (reader 2) and specificity was 93.8% (reader 1) and 94.1% (reader 2). In conclusion, the diagnostic performance of MRI in suspected lesions of the TFC and the SL and LT ligaments is improved by adding MR arthrography to the standard examination.