Biomedical subjects

M J Breitenseher

Publications and source records attributed to M J Breitenseher.

29 records · Page 2Linked to original sources

PubMed1997

[Determination of cartilage thickness in the ankle joint. an MRT (1.5)-anatomical comparative study].

PURPOSE: The aim of this study was to evaluate the accuracy of MRI in the measurement of cartilage thickness of the ankle joint in comparison to pathologic and histologic specimens. PATIENTS AND METHODS: The ankle joints of four fresh cadaver feet were imaged on a 1.5T MR-unit in the coronal plane. Standard T1-weighted spin echo (SE) and a T1-weighted 3D-GE (FLASH-3D) sequence with fat saturation were applied. Following MR imaging, the talus was explanted and cut parallel to the MR images for macroscopic evaluation and histologic specimens were prepared. MRI measurements of the cartilage thickness of the talus were carried out in two ways: without and with consideration of a transition zone of intermediate signal intensity between hyperintense cartilage and hypointense cortical bone. The data were compared with the anatomic specimens as the gold standard expressing the difference as a percentage value. On histologic specimens thickness of deep calcified cartilage layer was measured. RESULTS: Measurements without the transition zone showed a mean underestimation of talus cartilage thickness of 46.8% (41.3-52.1) for T1-SE and 47.5% (43.1-52.1) for fat saturated FLASH-3D images. Considering the transition zone the mean values were 25.0% (23.1-26.2) and 14.1% (6.7-21.5). The histologic specimens showed a three-fold increase of thickness of deep calcified cartilage layer. CONCLUSIONS: Measurements of the cartilage layer of the ankle joint on MR images are only accurate if the transition zone (calcified cartilage layer) is considered and the optimal pulse sequence (FLASH-3D-fat-sat) is applied.

Aged↗

PubMed1997

MR imaging of meniscal subluxation in the knee.

PURPOSE: The aim of this study was to establish diagnostic criteria for meniscal subluxation, and to determine whether there was any connection between meniscal subluxation and other common meniscal and knee-joint abnormalities. MATERIAL AND METHODS: The normal position of the meniscal body was assessed in 10 asymptomatic volunteers. MR signs of meniscal subluxation were evaluated retrospectively in 60 symptomatic patients with pain in the knee, impaired mobility, and/or joint swelling who had no clear diagnosis after the evaluation of case history, clinical examination, and radiography. The criterion for subluxation of the meniscus was defined as a distance of > or = 3 mm between the peripheral border of the meniscus and the edge of the tibial plateau. RESULTS: In the volunteers, the mean distance from the medial meniscus to the edge of the tibial plateau was 0.07 mm, and that from the lateral meniscus was 0 mm. In 55 symptomatic patients without meniscal subluxation, the mean distance from the meniscus to the edge of the tibial plateau was 0.27 mm. Five patients (8%) had evidence of meniscal subluxation, 4 in the medial meniscus and one in the lateral meniscus. The most commonly associated knee abnormality was joint effusion in 5 knees and osteoarthritis in 2 knees. CONCLUSION: Meniscal subluxation was not a rare finding with MR imaging in patients with painful knees. Meniscal subluxation was associated with other knee abnormalities such as joint effusion or osteoarthritis.

Adolescent↗

PubMed1997

Radiographically occult scaphoid fractures: value of MR imaging in detection.

PURPOSE: To evaluate the diagnostic value of magnetic resonance (MR) imaging in patients with clinical suspicion of scaphoid fractures and normal initial plain radiographs. MATERIALS AND METHODS: MR imaging was performed within 7 days after trauma in 42 patients with clinical suspicion of scaphoid fractures and normal plain radiographs. T1-weighted spin-echo, T2*-weighted gradient-echo, and short inversion time inversion-recovery (STIR) sequences were performed. MR images were evaluated independently by two radiologists. Six-week follow-up radiographs were used as a standard to diagnose fractures. RESULTS: MR imaging depicted occult fractures of the scaphoid bone in 14 patients (33%), the capitate bone in four (10%), the trapezium in one (2%), and the distal radius in two (5%). All wrist fractures were detected with a combination of STIR and T1-weighted spin-echo sequences. The sensitivity and specificity for detection of radiographically occult fractures of the wrist were 100% each for the first and 95% and 100%, respectively, for the second radiologist with an almost perfect interobserver agreement (K = 0.953). CONCLUSION: MR imaging has a high sensitivity for detection of fractures of the scaphoid bone and wrist not evident on plain radiographs and may enable early diagnosis and treatment.

Adolescent↗

PubMed1997

Diagnosis of lateral ankle ligament injuries. Comparison between talar tilt, MRI and operative findings in 112 athletes.

We evaluated the reliability of the radiographic talar tilt test by MRI examinations in 112 athletes with injuries to the lateral ligaments of the ankle. 25 athletes with a talar tilt > 15 degrees were treated operatively. Intraoperative findings and the talar tilt test were compared with MR imaging results. Our results suggest that MRI is a reliable method for diagnosing injuries of the lateral ankle ligaments. The talar tilt test cannot evaluate the specific pathology of lateral ankle ligaments, but it was reliable in indicating complete double-ligament ruptures (anterior talofibular and calcaneo-fibular ligaments), when talar tilt was 15 degrees or more than on the uninjured side.

Adolescent↗

PubMed1996

[Injuries to the lateral ligaments of the ankle joint: study technic and demonstration by means of MRI].

PURPOSE: To evaluate the visualisation and extent of injury of lateral ankle ligaments using MRI. METHODS: 56 patients with the clinical diagnosis of sprained ankles were investigated. Evaluation of the anterior (AFTL) and posterior fibulotalar ligament (PFTL) was performed with the foot in dorsiflexion (20 degrees) and of the fibulo calcanear ligament (FCL) in plantarflexion (45 degrees). Axial T1w-SE and T2w-TSE images were obtained. Full-length visualisation of ligaments in one slice and the extent of injury were evaluated. 12 ankle injuries were confirmed by operation. RESULTS: With MRI full-length visualisation of lateral ankle ligaments was possible in 86%. A partial/complete rupture of the AFTL was noticed in 33/64% and of the FCI in 29/39%, and of the PFTL in 27/5%. Sensitivity/specificity of MRI when compared to surgery was 100/100% for injuries of the AFTL, 64/100% for the FCL, and 33/78% for the PFTL. CONCLUSION: Full-length visualisation of ligaments, achieved by appropriate combination of foot position and imaging plane is essential for evaluation of injured ankle ligaments on MRI. High assessment for ligamentous injuries on MRI in relation to surgery was found.

Adolescent↗

PubMed1996

[Hallux rigidus operated on by Keller and Brandes method: radiological parameters of success and prognosis].

PURPOSE: The aim of this study was to evaluate the pre- and postoperative radiographic findings of hallux rigidus treated with Keller and Brandes arthroplasty to determine the radiographic outcome and to identify a prognostic marker. METHODS: 83 patients with a total of 121 cases of hallux rigidus operated using Keller and Brandes arthroplasty were followed up (mean 9.7 y). A comparison of the pre- and postoperative radiographs, the clinical and subjective findings was predicated on a five point scale: 1. percentage of proximal phalanx resected ( < 33%, 33-50%, > 50%), 2. joint space, 3. ratio of the length of the first and second metatarsals, 4. first intermetatarsal angle, and 5. hallux valgus angle. RESULTS: In the patient group which had 33-50% of the proximal phalanx excised (n = 67. 55%) the highest patient satisfaction was observed (96%). If resection of the proximal phalanx exceeded 50% (n = 13. 11%), non physiologic dorsiflexion of the toe occurred and patients were dissatisfied (62%). Excision of less than 33% of the hallux (n = 41. 34%) was associated with a recurrent hallux rigidus. No other evaluated radiological parameter proved to be of significance. CONCLUSION: The most important radiological parameter in the evaluation of the outcome of Keller and Brandes arthroplasty as a surgical treatment method for hallux rigidus was the percentage of the proximal phalanx which had ben excised.

Adult↗

PubMed1994

[The traumatized and surgically treated spine. Current diagnostic imaging].

In trauma patients X-ray and CT are the important imaging modalities for detecting instability of the spine and determining the cause of a spinal cord lesion. MRI should be done to demonstrate the spinal cord lesion itself. Operations on spinal injuries are based on X-ray films and CT. Polydirectional tomography is valuable in the assessment of bone healing, determining osteomyelitis with fistulae, pseudarthrosis and imaging of bone graft fusion in the presence of metallic fixation devices. MRI is indicated for diagnosis and ascertaing the prognosis of spinal cord lesions. In the long-term follow-up syrinx, myelomalacia and atrophy can be differentiated. MRI can also be done for osteomyelitis and complications of bone graft fusion.

Diagnostic Imaging↗

PubMedDate not supplied

MRI of unfused lumbar segments after spondylodesis.

PURPOSE: Our goal was to find a causal relation between disk degeneration in nonfused lumbar segments, back pain, and the angle of scoliotic curves 21-30 years after dorsal spondylodesis. METHOD: Thirty-two patients with scoliosis had been treated by dorsal spondylodesis 21-30 years prior to this study (mean 25.2 +/- 2.4 years). With use of MRI, signs of disk degeneration in the nonfused lumbar segments (n = 131, mean 4.1 +/- 1.4) were evaluated. Back pain evaluation was performed using the Oswestry disability score. On plain X-ray films, the angle of scoliotic curves was measured (Cobb technique). Percentage and absolute number of degenerated disks were compared to the fusion level (number of unfused caudal segments), the Oswestry score, and the Cobb angle. RESULTS: Disk degeneration was present in 20 of 32 patients (62.5%) and in 37 of 131 unfused lumbar segments (28.2%). Of eight patients (24.2%), seven had moderate back pain and one severe back pain. The mean lumbar scoliotic curve was 44.4 +/- 24.9 degrees. No statistically significant correlation was found between patients with disk degeneration and fusion level, amount of back pain, or lumbar scoliotic angle (p < 0.05). CONCLUSION: A lack of correlation between disk degeneration in unfused lumbar segments and other parameters like fusion level, back pain, and scoliotic angle can be assessed in the long-term follow-up of multisegment fusion of scoliotic curves.

Adolescent↗

PubMedDate not supplied

MRI of the sinus tarsi in acute ankle sprain injuries.

PURPOSE: Our goal was to evaluate the visibility and incidence of traumatic abnormalities of the sinus tarsi in patients with acute ankle sprain injuries and compare these findings with the extent of lateral ankle ligament injuries on MRI. METHOD: Sixty athletically active patients (aged 18-45 years) with recent inversion trauma (< or = 7 days) underwent MRI. Replacement of fat tissue in the sinus tarsi was recorded. Inter/intraobserver agreement was calculated (kappa-statistics). Injuries of the three lateral ligaments, evaluated by MRI, were graded according to partial (1 point) or complete (2 points) tears for each of three lateral ligaments (together 0-6 points) and were compared with sinus tarsi abnormalities. RESULTS: In 26 patients (43%), replacement of sinus tarsi fat tissue was depicted by MRI. Inter/intraobserver agreement for MR changes of the sinus tarsi was good to moderate (kappa = 0.675/0.584). Grade of lateral ankle ligament injury showed a statistically significant difference (p = 0.033) between the two sinus tarsi groups (normal/abnormal). CONCLUSION: Acute ankle sprain injuries, evaluated by MRI, are associated with acute abnormalities of the sinus tarsi in 43% of patients and correlate with the extent of lateral ankle ligament tears.

Acute Disease↗

PubMedDate not supplied

MRI versus lateral stress radiography in acute lateral ankle ligament injuries.

PURPOSE: Our goal was to compare the abilities of MRI and stress radiography to detect the extent of recent lateral ankle ligament inversion injuries. METHOD: In this prospective study, 60 athletically active patients (aged 18-45 years) with recent inversion trauma (< or = 7 days) underwent stress radiography and MRI. In 15 patients, the MR findings were reviewed at surgery. Patients were divided into three groups according to severity of ligament injury on MRI (no, one, or two to three ligament tears). Based on bilateral stress radiography, patients were classified into three groups according to the differential degree of talar tilt (< or = 5, 6-14, or > or = 15 degrees) and compared with patients from the MR groups. RESULTS: Surgery showed MRI to have 74% sensitivity and 100% specificity in the evaluation of complete lateral ankle ligament tears. Agreement between MR and stress radiography groups for the severity of recent lateral ankle ligament tears was poor (kappa = 0.030). CONCLUSION: MRI should be performed in young, athletically active patients if surgical intervention is contemplated, especially at 6-14 degrees talar tilt on stress radiography, since stress radiography tends to over- and underestimate the severity of lateral ligament trauma.

Acute Disease↗

PubMedDate not supplied

Imaging articular cartilage defects with 3D fat-suppressed echo planar imaging: comparison with conventional 3D fat-suppressed gradient echo sequence and correlation with histology.

PURPOSE: Our goal was to shorten examination time in articular cartilage imaging by use of a recently developed 3D multishot echo planar imaging (EPI) sequence with fat suppression (FS). We performed comparisons with 3D FS GE sequence using histology as the standard of reference. METHOD: Twenty patients with severe gonarthrosis who were scheduled for total knee replacement underwent MRI prior to surgery. Hyaline cartilage was imaged with a 3D FS EPI and a 3D FS GE sequence. Signal intensities of articular structures were measured, and contrast-to-noise (C/N) ratios were calculated. Each knee was subdivided into 10 cartilage surfaces. From a total of 188 (3D EPI sequence) and 198 (3D GE sequence) cartilage surfaces, 73 and 79 histologic specimens could be obtained and analyzed. MR grading of cartilage lesions on both sequences was based on a five grade classification scheme and compared with histologic grading. RESULTS: The 3D FS EPI sequence provided a high C/N ratio between cartilage and subchondral bone similar to that of the 3D FS GE sequence. The C/N ratio between cartilage and effusion was significantly lower on the 3D EPI sequence due to higher signal intensity of fluid. MR grading of cartilage abnormalities using 3D FS EPI and 3D GE sequence correlated well with histologic grading. 3D FS EPI sequence agreed within one grade in 69 of 73 (94.5%) histologically proven cartilage lesions and 3D FS GE sequence agreed within one grade in 76 of 79 (96.2%) lesions. The gradings were identical in 38 of 73 (52.1%) and in 46 of 79 (58.3%) cases, respectively. The difference between the sensitivities was statistically not significant. CONCLUSION: The 3D FS EPI sequence is comparable with the 3D FS GE sequence in the noninvasive evaluation of advanced cartilage abnormalities but reduces scan time by a factor of 4.

Aged↗