Biomedical subjects

M Larciprete

Publications and source records attributed to M Larciprete.

6 recordsLinked to original sources

PubMed2000

[Ankle impingement syndrome].

PURPOSE: The ankle impingement syndrome depends on many factors (fiber or bone production changes) manifested with pain and limited range of movement of the tibiotarsal joint. We tried to classify the various causes and sites of impingement syndromes with MRI. MATERIALS AND METHODS: A cohort of 42 selected patients underwent a 2-year orthopedic follow-up. All patients were examined with MRI using both a low field permanent dedicated magnet at 0.2 Tesla (Artoscan, Esaote Biomedica, Genoa, Italy) and a high field General Electric unit at 1.0 T; sequences and views were chosen according to the condition studied. Gd-DTPA was administered in 26/42 patients. All patients underwent arthroscopy. RESULTS: Twenty-one patients had positive symptoms in the anterolateral region of the ankle and 14 of them had lateral changes. In 13 patients we found fibrous tissue (meniscoid lesion) or hypertrophy of the synovial tissue. An intra-articular body was observed in one patient. An osteophyte was found in 5 patients at the level of the anterior margin of the tibia, with the presence of reactive synovial tissue. Three of 18 patients with posterior pain had a traumatic injury of the posterior exterior tubercle of the astragalus, 7 had a fracture of the os trigonum and 2 had small sclerotic foci formations in calceneal site; chondropathy with sclerosis of subchondral bone was diagnosed in 2 patients. Posterior bone impingement was observed in the remaining 4 patients. Two patients had synovial impingement in posterolateral site. A posterior plica synovialis was seen in 1 patient. Fibrotic-scar tissue was observed in one case, in the subtalus region (impingement synovialis subtalaris). The administration of intra-articular Gd-DTPA provided better definition of the fibrous tissue and the intra-articular free bodies. Modest vascular enhancement of the tissues was seen in 9 of 8 patients receiving the contrast agent. In the other two cases, where signal tissue was low, no signal enhancement was observed after the contrast agent administration. DISCUSSION: Based on integrated MR, clinical and arthroscopic findings we classified tibiotarsal joint impingement syndromes into three types, namely: 1) bone impingement; 2) fibrous impingement where both site and grade are considered; 3) impingement synovialis subtalaris. CONCLUSIONS: MRI appears to be a fundamental diagnostic imaging tool in depicting and detailing the various patterns and sites of the impingement syndrome of the tibiotarsal joint thus allowing an objective classification.

Adult↗

PubMed1998

Knee impingement syndromes.

INTRODUCTION: The so-called knee impingement syndromes are very frequently reported in both professional and amateur sportsmen. PURPOSE: The objective of our study was to classify the most frequent knee changes responsible for such syndromes considering both pathology and diagnostic work-up. MATERIAL AND METHODS: Our patients complained of aspecific symptoms related to articular meniscal, ligament or cartilage, conditions. The site of pain was periarticular and there was no apparent sign of acute traumatic events. All individuals, aged 16-55, practised sports at different levels and women were the majority of the sample. The study was carried out from 1995 to 1997 and all the medical records presented in occasion of the sports-medicine check-up were reviewed. RESULTS: The sites of symptom onset were divided into medial, lateral, anterior and posterior. For each of them the most frequent conditions which could be defined as impingement syndromes, were defined paying particular attention to the possible methods of diagnosis useful to classify the disorder. As for anterior syndromes, patellofemoral disorders were the most frequent findings. They were associated with either incorrect torsion movements of the lower limbs or local dysplasia. Alterations in the single skeletal and cartilage structures were reported. Always referring to anterior syndromes, Hoffa's fat pad imflammation and the jumper's knee were a less frequent finding. As for posterior impingement syndromes, the most frequent abnormalities involved the insertional tract of the midcalf muscle associated with bursa reaction and insertional popliteus hypertrophy. As for medial syndromes, the most frequent abnormality involved the parapatellar synovial fold whose symptoms can be often mistaken for a meniscal injury. Less frequent is the involvement of the 'pes anserinus' tendinitis and the insertional enthesopathy of the semimembranosus muscle. As for lateral syndromes, the phlogistic involvement of the distal insertional tract of the broad fascia tensor tendon with bursa reaction is very frequently reported, while the inflammation of the popliteal tendon and of the femoral bicipital tendon is less common. CONCLUSIONS: Although less frequent than meniscal and ligament injuries, impingement syndromes must be taken into due consideration when looking for knee disorders resorting to different diagnosis methods. Diagnostic imaging is very useful in this regard as it allows a proper and correct diagnosis procedure for any single condition.

Adolescent↗

PubMed1998

[New prospects in the assessment of the knee extensor complex with dynamic magnetic resonance].

INTRODUCTION: Altered patellofemoral biomechanics may result in pain, instability and early involutive processes. Magnetic Resonance Imaging (MRI), with its panoramic capabilities, has proved to be an effective technique in the study of knee extensor complex changes. The diagnostic advantages of dynamic studies of patellofemoral kinetics are reported in the recent scientific literature. We investigated the diagnostic potentials of passive studies of the knee extensor complex with sagittal and axial cine MRI. Then, we developed and optimized an innovative study method overcoming the limitations of the other dynamic techniques for the correct assessment of patellofemoral biomechanics. MATERIAL AND METHODS: We studied the knee with a .2 T permanent magnet dedicated to the limbs and acquired the images in different positions of flexion-extension with T1-weighted SE and T2-weighted GE sequences. We examined 21 healthy volunteers and 37 of 38 patients with anterior knee joint pain of suspected patellofemoral origin. All the images needed for dynamic studies were acquired in about 20 minutes. For the scan planes not to be affected by patellar motion in the different degrees of knee extension, it is necessary to acquire single axial images to be edited in cine motion afterwards. Each acquisition is aligned along sagittal reference planes depiciting always the same patellar aspect. RESULTS: Significant correlations were found between clinical and cine MR findings in 25 patients. In particular we depicted some extensor complex impingement conditions missed at conventional MRI, which clarified the role played by patellar dysplastic changes in cartilage microtraumas. Our technique was accurate, quite easy to perform and repeatable. We performed cost-effective dynamic studies which were useful in the evaluation of patients with anterior knee pain in whom conventional MRI had failed to provide enough information. CONCLUSIONS: Our technique differs from other passive or active dynamic studies reported on in the literature because the patellar volume does not change during acquisitions. This permits to decrease morphological changes and to simplify, on cine MR reconstructions, the specific analysis of patellofemoral dynamics during flexion-extension. Fewer morphological changes also mean a more accurate analysis showing the role of patellar dysplasia in cartilage microtraumas. Our dynamic MR protocol is accurate, easy to perform and to repeat; it allows dynamic studies in the patients with poor static MR findings.

Humans↗

PubMed1997

[Role of magnetic resonance in the evaluation of the normal and osteochondrosis hip in early and late childhood].

INTRODUCTION: Despite MR potentials, few studies investigate the features of normal hips and of hip osteochondrosis in early and late childhood. We report our personal experience with MRI of hip osteochondrosis in pediatric patients. MATERIAL AND METHODS: MR images were obtained with total body MR equipment at medium and high fields. The normal hips were studied in children aged 34 months to 6 years with abdominal-urinary tract disorders and in 9 patients of the same age with unilateral Perthes disease. Hip osteochondrosis was studied in 6 children with Catteral's type III and IV and in 3 with type I and II disease. General anesthesia was never necessary to perform MRI. RESULTS: MRI exactly defined the cephalic anatomic profiles of normal hips which are not depicted with conventional radiography before the femoral head cartilage ossifies completely. MR contrast resolution was very high in depicting the maturation of the epiphyseal nucleus and its exact site in the cartilagineous epiphyseal hemisphere proximal to the femur. The analysis of MR morphological and structural changes permitted to correlate MR findings with the histopathologic features described in the literature. In addition, MRI of childhood hip osteochondrosis showed maked structural changes of the epiphyseal nucleus which are usually missed with conventional radiography. MRI permits early location of the abnormal area and the recognition of growing disk abnormalities; it also shows the whole cephalic cartilage and the changes of the epiphyseal nucleus evolution, which permits to differentiate osteochondrosis evolution from recessive patterns. Finally, MRI clearly showed the increased equatorial diameters of the involved femoral heads and the associated decrease in polar diameters, which is essential to study the biomechanics of hip osteochondrosis and therefore to plan treatment. CONCLUSIONS: MRI, even with coronal sequences and T1-weighting only, permits: 1) to image normal hips and hip osteochondrosis, especially in early and late childhood; 2) to clearly define cephalocotyloid relationships; 3) to depict the actual anatomic margins of the head and its structure; 4) to investigate the head cartilage extent and to locate the ossification nucleus. These morphologic and structural data are very useful to diagnose and manage hip osteochondrosis in the evolutive age. MRI shows abnormal changes in anatomic structures which are not seen with conventional radiography and demonstrates the evolution of the osteochondrosis process over time. In children over six, at the end of the ossification process of the head cartilage, conventional radiography alone is often sufficient to depict cephalocotyloid relationships and the MR diagnostic criteria of bone-cephalic diseases are similar to those used in adult hip studies.

Adult↗

PubMed1996

Sonographic findings in haemodialysis-related chronic arthropathy.

In 33 subjects receiving long-term haemodialysis sonographic examination of shoulders, hips and knees was performed. Changes of both joints and periarticular soft tissues were found in 60 shoulders, 16 hips and 42 knees. In the shoulder besides the presence of tenosynovitis and bursitis, even significant thickening of rotator cuff and increased distance between capsule and bone in transascellar scan were found. Also, in the hip the distance between capsule and bone was significantly increased. In the knee effusion was present in 14 cases and synovial hypertrophy in 20. Articular femoral cartilage was significantly thinned. Results obtained suggest the hypothesis of the presence of an important inflammatory component in the pathogenesis of arthropathy related to haemodialytic treatment. The production of cytokines by mononuclear cells stimulated by beta-2 microglobulin may cause the inflammatory response. Sonographic findings of alterations in 42 symptomless joints show the importance of this diagnostic method to begin an early therapy.

Adult↗

PubMedDate not supplied

Fibro-cartilaginous lesions of the glenoid labrum in shoulder instability: a proposed classification using sagittal-oblique arthro-MRI.

PURPOSE: To propose a graded classification of lesions of the fibrocartilaginous glenoid labrum in traumatic dislocations of the shoulder, based on arthro-MRI in sagittal-oblique views. MATERIALS AND METHODS: Seventy-one patients with histories of chronic post-traumatic shoulder instability were studied from May 2000 to May 2001. MR images were obtained using superconducting magnets operating at 1 and 1.5 Tesla, with a dedicated shoulder coil. The study was carried out in combination with arthrography, with axial sections oriented perpendicularly to the longitudinal axis of the glena, oblique coronal sections parallel to the course of the supraspinous muscle tendon and oblique sagittal sections with axis parallel to the longitudinal axis of the glena. RESULTS: In one case an anatomical variant was found (Buford complex). In 18 patients a simple fissuration of the fibrocartilaginous glenoid labrum was found, whereas 28 patients displayed more extensive lesions affecting the middle-inferior portions of the labrum. In 15 patients the lesion extended to the middle-superior third of the glena, involving the middle glenohumeral ligament. In 9 cases, in addition to a complete lesion of the labrum, with typical "bucket-handle" appearance, a lesion of the superior and middle glenohumeral ligaments was also observed. DISCUSSION AND CONCLUSIONS: In traumatic shoulder dislocations it is essential to provide the surgeon with precise information regarding the location, extension and degree of damage to the capsule, ligaments and especially the labrum of the glenohumeral joint. On the basis of the results obtained in the sagittal-oblique sections we propose an MR-arthrography classification dividing lesions of the fibrocartilaginous labrum into 4 grades.

Adolescent↗