PubMed Health⌕ Search

Biomedical subjects

Juerg Hodler

Publications and source records attributed to Juerg Hodler.

At least 37 records · Page 2Linked to original sources
PubMed2006

Diagnostic performance of MR arthrography after rotator cuff repair.

OBJECTIVE: The objective of this study was to investigate the diagnostic performance of MR arthrography after rotator cuff repair. MATERIALS AND METHODS: MR arthrographic examinations of the shoulder performed after rotator cuff repair and before revision surgery were retrospectively analyzed in 48 patients (31 males, 17 females; mean age, 50.3 years; age range, 17-69 years). Full-thickness and partial-thickness defects of the supraspinatus, infraspinatus, and subscapularis tendons were diagnosed independently by two radiologists. Revision surgery served as the standard of reference. RESULTS: Observer 1 correctly recognized five of eight intact supraspinatus tendons, 10 of 19 partial-thickness defects, and 19 of 21 full-thickness defects. For observer 2, the numbers were three of eight, eight of 19, and 18 of 21. The corresponding numbers for the infraspinatus tendon for observer 1 were 28 of 31, 0 of three, and 14 of 14 tendons. For observer 2, they were 28 of 31, two of three, and 11 of 14. For the subscapularis tendon, observer 1 made the correct diagnosis in 18 of 31, five of six, and nine of 11 tendons. The results for observer 2 were 26 of 31, one of six, and 10 of 11 tendons. Interobserver agreement (weighted kappa) was 0.47 for the supraspinatus, 0.64 for the infraspinatus, and 0.20 for the subscapularis tendons, respectively. CONCLUSION: Postoperative full-thickness defects of the rotator cuff are reliably diagnosed with MR arthrography. The diagnostic performance for partial-thickness defects is only moderate.

Adolescent↗
PubMed2006

MRI of meniscal lesions: soft-copy (PACS) and hard-copy evaluation versus reviewer experience.

OBJECTIVE: The purpose of our study was to compare diagnostic performance, reviewer confidence, and time requirements in the MRI diagnosis of meniscal tears for three types of reviewers and two types of image documentations (PACS vs hard copies). MATERIALS AND METHODS: An experienced musculoskeletal radiologist (reviewer 1), a fellow in musculoskeletal radiology (reviewer 2), and a junior staff member in orthopedic surgery (reviewer 3) evaluated MR images displayed on PACS monitors and hard copies independently and in a blinded fashion with regard to the presence or absence of meniscal tears. Seventy-one patients (mean age, 45.4 years; range, 16-80 years) were consecutively included if they had undergone both MRI of the knee and arthroscopy within 4 months. Arthroscopy was the standard of reference. Evaluation time and the reviewer's confidence in his or her diagnosis (Visual Analogue Scale, possible values of 0-100) were determined. RESULTS: Accuracies, sensitivities, and specificities in diagnosing meniscal tears were 80-87%, 63-85%, and 87-93% for soft copies and 82-85%, 64-76%, and 87-94.0%, respectively, for hard copies. Intrareviewer differences between PACS and hard copies were not significant for any of the three reviewers (McNemar tests). Reviewer 3 was less sensitive but more specific in the diagnosis of meniscal tears than reviewers 1 and 2. This difference was significant for both the PACS and hard copies. The reviewers' confidence in their diagnoses and evaluation times were not significantly different for PACS and hard copies (analysis of variance with Bonferroni post hoc analysis). CONCLUSION: Differences in the diagnostic performance of suspected meniscal tears depend on reviewer experience rather than on the type of documentation.

Adolescent↗
PubMed2006

CT-guided core biopsy of subchondral bone and intervertebral space in suspected spondylodiskitis.

OBJECTIVE: Our objective was to determine the diagnostic performance of CT-guided core biopsy including both intervertebral disks and subchondral bone in suspected spondylodiskitis and compare the results with those for other biopsy techniques. CONCLUSION: CT-guided core biopsy of subchondral bone and intervertebral space compares favorably to previously published studies because histology can provide the diagnosis even when no specific infectious agent is isolated.

Biopsy↗
PubMed2005

Clinical course of knees with asymptomatic meniscal abnormalities: findings at 2-year follow-up after MR imaging-based diagnosis.

PURPOSE: To prospectively evaluate the clinical course of asymptomatic meniscal lesions diagnosed by using magnetic resonance (MR) imaging. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. The clinical courses of meniscal lesions in 84 asymptomatic knees (in 48 men and 36 women; mean age, 43.6 years; age range, 18-73 years) were assessed. Thirty-one asymptomatic meniscal lesions were depicted among the 84 knees at MR imaging. The follow-up period was at least 2 years (mean, 29.8 months; range, 24-36 months). Knee pain, stiffness, and function during daily and sports activities were assessed by using a visual analogue scale (VAS), on which a score of 0 indicated no pain or complaints and a score of 100 indicated maximal pain and/or complaints. The chi2 test was used for statistical analysis. RESULTS: At follow-up, 12 (39%) of the 31 patients with and 10 (19%) of the 53 patients without meniscal lesions reported having knee pain (P = .046). Nine (29%) patients with and five (9%) patients without meniscal lesions reported having knee stiffness (P = .02). Ten (32%) patients with and five (9%) patients without meniscal lesions reported having impaired function during daily activities (P = .008). Thirteen (42%) patients with and 15 (28%) patients without meniscal lesions reported having impaired function during sports activities (P = .20). Mean VAS scores ranged from 22 to 30; mean VAS scores for pain, stiffness, impaired daily function, and impaired sports function were 26, 22, 27, and 30, respectively. None of the initially asymptomatic knees was treated with surgery during the follow-up period. CONCLUSION: The clinical course of knees with initially asymptomatic meniscal lesions, compared with the clinical course of knees without meniscal lesions, is characterized by an increased frequency of complaints. However, severities of pain and knee function impairment remain low.

Activities of Daily Living↗
PubMed2005

Fatty atrophy of supraspinatus and infraspinatus muscles: accuracy of US.

PURPOSE: To prospectively evaluate the accuracy of ultrasonography (US) in depicting fatty atrophy of the supraspinatus (SSP) and infraspinatus (ISP) muscles, with magnetic resonance (MR) imaging as the reference standard. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. SSP and ISP muscles of 65 consecutive patients (27 women, 38 men; mean age, 53.1 years; range, 28-83 years) with possible rotator cuff tears were evaluated with US in two planes. Visibility of muscle contour, pennate pattern, the central tendon, and muscle echogenicity was assessed by two radiologists. On the basis of these findings, diagnosis of substantial fatty atrophy was made at US. Accuracy, sensitivity, specificity, proportion of over- and underestimations, and interobserver agreement in diagnosis of substantial (grade 2 or greater) muscle atrophy were determined. Fatty atrophy was graded at MR imaging as follows: score of 0 = no intramuscular fat, score of 1 = some fatty streaks, score of 2 = fat evident but less extensive than muscle, score of 3 = fat equal to muscle, and score of 4 = fat more extensive than muscle. RESULTS: For readers 1 and 2, the accuracy of US in depicting fatty atrophy of SSP muscle was 75% (49 of 65) and 72% (47 of 65), sensitivity was 89% (eight of nine) and 100% (nine of nine), and specificity was 73% (41 of 56) and 68% (38 of 56), respectively. For readers 1 and 2, the accuracy of US in depicting fatty atrophy of ISP muscle was 85% (55 of 65) and 80% (52 of 65), sensitivity was 58% (11 of 19) and 63% (12 of 19), and specificity was 96% (44 of 46) and 87% (40 of 46), respectively. Overestimation of SSP muscle atrophy was more common (23% [15 of 65] for reader 1 and 28% [18 of 65] for reader 2) than underestimation (2% [one of 65] for reader 1 and 0% [0 of 65] for reader 2). For readers 1 and 2, overestimation of ISP muscle atrophy was 3% (two of 65) and 9% (six of 65) and underestimation was 12% (eight of 65) and 9% (seven of 65), respectively. Interobserver agreement was moderate for SSP (kappa = 0.55) and substantial for ISP (kappa = 0.71) muscles. CONCLUSION: US is moderately accurate in the diagnosis of substantial fatty atrophy of the SSP or ISP muscle.

Adipose Tissue↗
PubMed2005

Spring ligament complex: MR imaging-anatomic correlation and findings in asymptomatic subjects.

PURPOSE: To use magnetic resonance (MR) imaging to assess the anatomy of the spring ligament complex (SLC) in cadaveric feet and to prospectively evaluate the MR imaging depiction of this complex in asymptomatic subjects. MATERIALS AND METHODS: Cadaveric feet were obtained and used according to institutional guidelines and with institutional approval and consent from the donors (before death) or the appropriate family members. Healthy volunteers were examined, with institutional review board approval and informed consent from each volunteer. MR imaging findings of the SLC in five cadaveric feet were analyzed and correlated with the findings in dissected foot specimens. Then, the MR imaging findings in the feet of 78 asymptomatic subjects were analyzed. For all three parts of the SLC, visibility, optimal imaging plane, and signal intensity characteristics were analyzed. The thicknesses of all SLC parts were measured. The measurements obtained in men and women were compared by using the Mann-Whitney U test, and Pearson correlation coefficients for associations between ligament thickness and subject age and sex were calculated. RESULTS: In the cadaveric feet, MR imaging enabled differentiation of all three parts of the SLC. The superomedial calcaneonavicular ligament (CNL) was visible in all; the medioplantar oblique CNL, in 60; and the inferoplantar longitudinal CNL, in 71 volunteers. The superomedial CNL had a mean thickness of 3.2 mm, was best seen on transverse oblique or coronal MR images, and had mainly intermediate signal intensity on T1-weighted images and low signal intensity on T2-weighted images. The medioplantar oblique CNL had a mean thickness of 2.8 mm, was best seen on transverse oblique MR images, and had mainly a typical striated appearance on T1- and T2-weighted images. The inferoplantar longitudinal CNL was the thickest (mean thickness, 4.0 mm), was best seen on coronal MR images, and had mainly intermediate signal intensity on T1-weighted images and variable signal intensity on T2-weighted images. Women had significantly thinner superomedial (mean thickness, 3.3 vs 3.5 mm; P = .015, Mann-Whitney U test) and inferoplantar longitudinal (mean thickness, 3.8 vs 4.2 mm; P = .02) CNLs than men. There was no significant correlation between ligament thickness and subject age. CONCLUSION: The superomedial and inferoplantar longitudinal CNLs are consistently visible portions of the SLC. The medioplantar oblique ligament is thinner, is seen less consistently, and has mainly a characteristic striated MR imaging appearance.

Adult↗
PubMed2005

Prospective evaluation of two different injection techniques for MR arthrography of the hip.

The aim of the study was to evaluate prospectively the technical feasibility and discomfort of two different injection techniques for MR arthrography of the hip. Sixty-one consecutive patients undergoing MR arthrography of the hip (68 hips) were randomly injected either at the femoral head (36 hips) or the femoral neck (32 hips). The patients rated discomfort during and 0-72 h after arthrography using a visual analogue scale (VAS, 0="did not feel anything", 100="unbearable"). The volume injected, the distance between the needle tract and the neurovascular bundle, the duration of the procedure and the extra-articular contrast leakage were measured. No significant differences were found for the volume injected, the distance between the needle tract and the neurovascular bundle, or the procedure duration. Volume of extra-articular contrast leakage was statistically significantly different (head 1+/-2 cm(3), neck 3+/-5 cm(3), P=0.024). The VAS score for needle advancement was significantly different (head 25+/-20, neck 19+/-23, P=0.031). No significant differences were found for the VAS score regarding delayed discomfort. Before the examination the arthrography-related discomfort was overestimated by 74% (50/68), correctly anticipated by 22% (15/68) and underestimated by 4% (3/68) of the patients. MR-related discomfort was overestimated by 32% (22/68), correctly anticipated by 57% (39/68) and underestimated by 10% (7/68) of the patients. Both hip puncture techniques were well tolerated. The neck injection technique produced less discomfort and was associated with greater extra-articular contrast leakage.

Adolescent↗
PubMed2005

Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients.

PURPOSE: To prospectively evaluate magnetic resonance (MR) imaging findings of abductor tendons and muscles in asymptomatic and symptomatic patients after lateral transgluteal total hip arthroplasty (THA). MATERIALS AND METHODS: The institutional review board approved the study, and all patients provided informed consent. Two musculoskeletal radiologists blinded to clinical information analyzed triplanar MR images of the greater trochanter obtained in 25 patients without and 39 patients with trochanteric pain and abductor weakness after THA. Tendon defects, diameter, signal intensity, and ossification; fatty atrophy; and bursal fluid collections were assessed. In 14 symptomatic patients, MR imaging and surgical findings were correlated. Differences in the frequencies of findings between the two groups were tested for significance by using chi2 analysis. RESULTS: Tendon defects were uncommon in asymptomatic patients and significantly more frequent in symptomatic patients: Two asymptomatic versus 22 symptomatic patients had gluteus minimus defects (P < .001); four asymptomatic versus 24 symptomatic patients, lateral gluteus medius defects (P < .001); and no asymptomatic versus seven symptomatic patients, posterior gluteus medius defects (P = .025). In both patient groups, tendon signal intensity changes were frequent, with the exception of those in the posterior gluteus medius tendon, which demonstrated these changes more frequently in symptomatic patients (in 23 vs five asymptomatic patients, P = .002). Tendon diameter changes were frequent in both groups but significantly (P = .001 to P = .009) more frequent in symptomatic patients (all tendon parts). Fatty atrophy was evident in the anterior two-thirds of the gluteus minimus muscle in both groups, without significant differences. In the posterosuperior third of the gluteus minimus muscle, however, differences in fatty atrophy between the two groups were significant (P = .026). Fatty atrophy of the gluteus medius muscle was present in symptomatic patients only, with significant differences among all muscle parts. Bursal fluid collections were more frequent in symptomatic patients (n = 24) than in asymptomatic patients (n = 8, P = .021). The MR imaging-based diagnosis was confirmed in all 14 patients who underwent revision surgery. CONCLUSION: Abductor tendon defects and fatty atrophy of the gluteus medius muscle and the posterior part of the gluteus minimus muscle are uncommon in asymptomatic patients after THA.

Adult↗
PubMed2005

Swiss teleradiology survey: present situation and future trends.

The purpose of this study was to obtain a survey about the present situation including the usage pattern, technical characteristics and the anticipated future of teleradiology in Switzerland. An internet-based questionnaire was made available to all members of the Swiss Society of Radiology. Questions concerning current teleradiology usage, the type of transmitted modalities, the technology employed, security, billing issues and the anticipated future of teleradiology were addressed. One hundred and two (22.67%) of 450 radiologists responded to the survey. Of the total, 41.2% (42) were teleradiology users, 35.3% (36) planned to use teleradiology in the near future and 24.5% (25) did not use or plan to use teleradiology. The mean number of examinations transmitted per month was 198 (range 1-2,000) and the mean distance was 33 km (range 1,250 km). An emergency service was considered the most important purpose (mean score 6.90; minimum 1, maximum 10) for the use of teleradiology, followed by image distribution (mean 6.74) and expert consultation (mean 6.61). The most commonly transmitted modality was computed tomography (mean 8.80), followed by conventional X-rays (8.40) and magnetic resonance imaging (8.32). The most commonly transmitted format was Digital Imaging and Communications in Medicine (DICOM) (66.7%), followed by bitmap/Joint Photographic Experts Group (jpg) (38.1%), using the DICOM send/receive protocol (52.4%), followed by the hypertext transfer protocol (26.2%) and e-mail (21.4%). For security a secure connection (54.8%) followed by encryption (14.3%) and anonymization (9.5%) was used. For the future, image distribution was rated the most important aspect of teleradiology (7.88), followed by emergency (7.22) and expert consultation (6.53). Development of legal regulations is considered most important (8.17), followed by data security guidelines (8.15). Most radiologists believe that insurance companies should pay for the costs of teleradiology (37.3%), followed by the radiologist (33.3%). In conclusion, in Switzerland a wide spectrum of teleradiology applications and technologies is in use. Guidelines and reimbursement issues remain to be solved.

Humans↗
PubMed2005

Lumbar disk herniation: do MR imaging findings predict recurrence after surgical diskectomy?

PURPOSE: To retrospectively evaluate if the degree of disk degeneration and disk herniation volume at magnetic resonance (MR) imaging are risk factors for recurrent disk herniation. MATERIALS AND METHODS: The institutional review board permits such retrospective studies, and individual informed consent was not required. MR imaging findings obtained before initial diskectomy in 30 patients (mean age, 42.8 years; 10 women, 20 men) with recurrent disk herniation (study group) and 30 patients (mean age, 42.2 years; nine women, 21 men) without recurrence for at least 2 years after surgery (control group) were compared. Disk degeneration was assessed on T2-weighted sagittal MR images with a five-point grading system (grade I indicated no degeneration; grade II, horizontal hypointense bands within disk; grade III, inhomogeneous disk with intermediate signal intensity; grade IV, no distinction between inner and outer parts of disk; and grade V, collapsed hypointense disk). Disk herniation was classified as representing protrusion, extrusion, or sequestration. The volume of both the affected intervertebral disk and the herniated disk material was measured. Qualitative and quantitative analyses were performed by two readers. The chi(2) test was used for comparison of categorical variables. For comparison of disk degeneration and volumes between patients with and those without recurrence, a paired two-tailed t test was used. Odds ratios based on the extent of disk degeneration were calculated for the entire sample. RESULTS: Advanced disk degeneration (grades IV and V) was significantly less frequent in the study group than in the control group (P < .006). The risk of recurrent disk herniation decreased by a factor of 3.4 for each increase in grade of disk degeneration (odds ratio: 3.58; 95% confidence interval: 1.3, 9.6; P = .011). Mean disk herniation volume as a percentage of intervertebral disk volume was 10.59% +/- 3.41 in the study group and 11.56% +/- 3.84 in the control group. This difference was not significant (P = .31). CONCLUSION: Minor disk degeneration but not herniation volume represents a risk factor for the recurrence of disk herniation after diskectomy.

Adult↗
PubMed2005

Primary lymphoma of bone: MRI and CT characteristics during and after successful treatment.

OBJECTIVE: Our aim was to describe MRI and CT characteristics of primary lymphoma of bone during and after successful treatment. CONCLUSION: MRI showed a rapid decrease of tumor volume with complete disappearance of the soft-tissue component. Minor signal abnormalities of bone marrow without clinical relevance persisted for up to 2 years. CT showed bone remodeling within months with a persistent architecture similar to that of Paget's disease of the bone.

Adolescent↗
PubMed2005

Imaging of patellar cartilage with a 2D multiple-echo data image combination sequence.

OBJECTIVE: We sought to evaluate the diagnostic value of a 2D multiple-echo data image combination (MEDIC) MRI sequence in the detection of patellar cartilage defects. MATERIALS AND METHODS: Our study included 52 consecutive patients who had knee surgery within 4 months of undergoing an MRI examination including an axial 2D MEDIC (TR/TE, 884/26; flip angle, 30 degrees ) sequence. Cartilage was surgically graded on a 5-point scale: 0, normal; 1, softening or swelling; 2, partial thickness defect; 3, fissuring to the level of the subchondral bone; or 4, exposed subchondral bone. Cartilage was graded on MRI according to a scale that was almost identical to the surgical scale except that grade 1 lesions were defined as signal alteration or swelling of cartilage. Two blinded reviewers independently analyzed patellar cartilage. Sensitivity, specificity, accuracy, and weighted kappa values for interobserver variability were calculated. RESULTS: Low-grade cartilage lesions predominated in our study group. When grade 2 or higher was considered the threshold for relevance, the sensitivity, specificity, and accuracy for the MEDIC sequence was as high as 79%, 82%, and 81%, respectively. Increasing the threshold of relevance to grade 3 increased the sensitivity, specificity, and accuracy to as high as 83%, 91%, and 90%, respectively. Interobserver agreement for the MEDIC sequence was good (weighted kappa = 0.68). CONCLUSION: The 2D MEDIC sequence performs comparably to previously described sequences optimized for cartilage imaging such as the 3D double-echo steady-state or 3D spoiled gradient-recalled sequences with good interobserver agreement, high sensitivity, and excellent specificity for revealing low- to intermediate-degree cartilage defects.

Adult↗
PubMed2004

Cervical nerve root blocks: indications and role of MR imaging.

PURPOSE: To examine whether magnetic resonance (MR) imaging findings of the cervical spine can predict pain relief after selective computed tomography (CT)-guided nerve root block and thus assist in the appropriate selection of patients who are suitable for this procedure. MATERIALS AND METHODS: Sixty consecutive patients with cervical radicular pain were examined with MR imaging and then treated with CT-guided cervical nerve root blocks (CNRBs). Various MR imaging findings were assessed and compared in terms of associated pain relief after CNRB. Pain relief was graded (0%-100%) by using a visual analogue scale (VAS). The relationship between MR imaging findings and level of pain relief was tested by using Mann-Whitney U and Kruskal-Wallis tests. RESULTS: The mean percentage of pain reduction at VAS grading was 46%. There was a significant relationship between pain relief level and both location of disk herniation (mean pain reductions of 41% at median or mediolateral locations and 64% at foraminal locations, P =.034) and location of nerve root compromise (mean pain reductions of 19% at intraspinal, 45% at foraminal entrance, and 58% at foraminal locations; P =.019). There was an inverse relationship between pain relief level and absence or presence of spinal canal stenosis (mean pain reductions of 29% when stenosis present and 53% when stenosis absent, P =.013). Other parameters were not significantly related to pain relief. CONCLUSION: MR imaging of the cervical spine assists in the appropriate selection of patients suitable for CNRB. Patients with foraminal disk herniation, foraminal nerve root compromise, and no spinal canal stenosis appear to have the greatest pain relief after this procedure.

Adult↗
PubMed2004

FDG PET for differentiation of infection and aseptic loosening in total hip replacements: comparison with conventional radiography and three-phase bone scintigraphy.

PURPOSE: To compare the diagnostic efficacy of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) with that of conventional radiography and three-phase bone scintigraphy in patients suspected of having infection in their total hip replacements. MATERIALS AND METHODS: Thirty-five patients with painful total hip replacements and possible septic prosthetic loosening were examined with FDG PET, conventional radiography, and three-phase bone scintigraphy. PET, radiographic, and scintigraphic images were each evaluated by two independent observers in a blinded fashion. For 32 of 35 patients, serial conventional radiographs were available. Results of microbiologic examinations of surgical specimens represented the standard of reference in 26 patients, and results of joint aspiration plus clinical follow-up of at least 6 months represented the standard of reference in the remaining nine patients. Sensitivity, specificity, accuracy, and interobserver variability (kappa) values were calculated. The imaging modalities were compared in terms of diagnostic confidence by using the sign test. RESULTS: Nine patients had septic and 21 patients had aseptic loosening. In five patients, neither loosening nor infection was confirmed. For diagnosing infection with FDG PET, conventional radiography, and bone scintigraphy, respectively, sensitivity values for reader 1 and reader 2 were 33% and 22%, 89% and 78%, and 56% and 44%, while specificity values were 81% and 85%, 50% and 65%, and 88% and 92% and accuracy values were 69% for both readers, 60% and 69%, and 80% for both readers. PET was significantly more specific (P =.035) but less sensitive (P =.016) than conventional radiography for the diagnosis of infection. CONCLUSION: In a study population of patients suspected of having infected total hip replacements, FDG PET performed similarly to three-phase bone scintigraphy. FDG PET was more specific but less sensitive than conventional radiography for the diagnosis of infection.

Aged↗
PubMed2004

Assessment of fat content in supraspinatus muscle with proton MR spectroscopy in asymptomatic volunteers and patients with supraspinatus tendon lesions.

PURPOSE: To evaluate proton magnetic resonance (MR) spectroscopy in the assessment of lipid content of the supraspinatus muscle in asymptomatic volunteers and patients with supraspinatus tendon lesions. MATERIALS AND METHODS: Single-voxel proton MR spectroscopy was used to assess lipid content of the supraspinatus muscle in asymptomatic volunteers (n = 30) and patients with partial-thickness supraspinatus tendon tears (n = 30), newly diagnosed full-thickness supraspinatus tendon tears (n = 30), and chronic full-thickness supraspinatus tendon tears (n = 30). The apparent lipid content of the supraspinatus muscle measured with proton MR spectroscopy was related to its appearance on sagittal-oblique T1-weighted spin-echo MR images (grades 0-4). One-way analysis of variance was performed to test for significant differences, and the Tukey honestly significant difference procedure was performed for post hoc comparisons. RESULTS: Mean apparent lipid content was 13.7% (95% confidence interval [CI]: 11.5%, 15.8%) for asymptomatic volunteers, 29.5% (95% CI: 25.1%, 34.0%) for patients with partial-thickness tears, 48.6% (95% CI: 41.3%, 55.9%) for patients with full-thickness tears, and 66.1% (95% CI: 57.7%, 74.5%) for patients with chronic tears. Values were significantly different (analysis of variance, P <.001; P <.001-.002 for all post hoc pairwise comparisons). Mean apparent lipid content for the supraspinatus muscle was as follows: grade 0, 19.6% (95% CI: 16.7%, 22.6%); grade 1, 36.8% (95% CI: 33.2%, 40.4%); grade 2, 53.6% (95% CI: 43.1%, 64.2%); grade 3, 67.5% (95% CI: 52.6%, 82.3%); and grade 4, 79.2% (95% CI: 73.2%, 85.3%). With analysis of variance (P <.001), all post hoc pairwise comparisons were significant (P </=.001) except between grades 2 and 3 (P =.112) and between grades 3 and 4 (P =.261). In 14 (25%) subjects who had grade 0 appearance on T1-weighted images, lipid content values were greater than the upper range of values in the volunteers. CONCLUSION: Proton MR spectroscopy is suitable in the assessment of apparent lipid content of rotator cuff muscles.

Adult↗
PubMed2004

Arthrofibrosis associated with total knee arthroplasty: gray-scale and power Doppler sonographic findings.

OBJECTIVE: The objective of this study was to determine gray-scale and power Doppler sonographic findings in patients with arthrofibrosis associated with total knee arthroplasty. SUBJECTS AND METHODS. From a consecutive cohort of more than 3000 mobilebearing total knee arthroplasties, 44 cases (1.5%) with arthrofibrosis were identified, of which 38 were recruited for a clinical and sonographic investigation. A control group of 38 patients with a well-functioning total knee arthroplasty was matched. Synovial hypertrophy, presence of neovascularity, patellar tendon thickness, and extent of effusion were assessed. RESULTS: Synovial membrane thickness was significantly (p < 0.001) increased in the arthrofibrosis group (medial, 3.4 mm; lateral, 3.0 mm; suprapatellar, 3.1 mm) when compared with the control group (medial, 2.0 mm; lateral, 2.0 mm; suprapatellar, 1.9 mm). When a cutoff of 3.0 mm was used, sonography had a sensitivity of 84% and a specificity of 82% for detecting arthrofibrosis. Neovascularity (rated as grades 0-3) of the synovial membrane and Hoffa's fat pad was significantly (p <or= 0.003) more pronounced in the arthrofibrosis group (medial, 1.1; lateral, 1.2; suprapatellar, 1.0; Hoffa's fat pad, 1.1) than in the control group (medial, 0.1; lateral, 0.3; suprapatellar, 0.2; Hoffa's fat pad, 0.1). No significant difference was seen between study groups with regard to the amount of joint effusion at three locations and with regard to patellar tendon thickness. CONCLUSION: Synovial membrane thickening and neovascularity are characteristic sonographic findings for the diagnosis of arthrofibrosis associated with total knee arthroplasty.

Aged↗
PubMed2004

MR arthrography of the hip: diagnostic performance of a dedicated water-excitation 3D double-echo steady-state sequence to detect cartilage lesions.

OBJECTIVE: The objective of our study was to compare the diagnostic performance of a dedicated cartilage MR sequence (water-excitation 3D double-echo steady-state) with a standard MR sequence (T1-weighted spin-echo) in detecting articular cartilage lesions of the hip after intraarticular injection of gadopentetate dimeglumine. MATERIALS AND METHODS: In 50 MR arthrograms of the hip joint obtained in 47 consecutive patients, a sagittal 3D double-echo steady-state sequence (TR/TE, 24/6.5; flip angle, 25 degrees ) was compared with a sagittal T1-weighted spin-echo sequence (350/14). Two musculoskeletal radiologists independently evaluated articular cartilage. Sensitivity and specificity for detecting cartilage defects were calculated for those hips that underwent open surgery (n = 21). Lesion conspicuity was retrospectively reviewed and graded between 1 (not visible) and 5 (well defined). RESULTS: At surgery, a total of 26 lesions of the acetabular (n = 20) and femoral (n = 6) cartilage were found. For the 3D double-echo steady-state and T1-weighted spin-echo sequences, sensitivities and specificities for cartilage lesion detection were 58% and 88% and 81% and 81% for reviewer 1 and 62% and 94% and 62% and 100% for reviewer 2, respectively. Lesion conspicuity was significantly superior (p = 0.036) for the 3D double-echo steady-state sequence (mean grade, 3.4) compared with the T1-weighted spin-echo sequence (mean grade, 3.0). The kappa value was fair for the 3D double-echo steady-state sequence (kappa = 0.40) and moderate for the T1-weighted spin-echo sequence (kappa = 0.55). CONCLUSION: The 3D double-echo steady-state sequence optimized for cartilage imaging improves lesion conspicuity but does not improve diagnostic performance.

Adult↗