Biomedical subjects

Marco Zanetti

Publications and source records attributed to Marco Zanetti.

52 records · Page 3Linked to original sources

PubMed2003

MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation.

A system for grading lumbar nerve root compromise (no compromise, contact of disk material with nerve root, deviation of nerve root, and compression of nerve root) was tested in the interpretation of routine magnetic resonance images of 500 lumbar nerve roots in 250 symptomatic patients. Intra- and interobserver reliability was assessed for three independent observers. In the 94 nerve roots evaluated at surgery, surgical grading was correlated with image-based grading. kappa statistics indicated substantial agreement between different readings by the same observer and between different observers (for intraobserver agreement, kappa = 0.72-0.77; for interobserver agreement, kappa = 0.62-0.67). Correlation of image-based grading with surgical grading was high (r = 0.86). The image-based grading system enabled reliable evaluation and reporting of nerve root compromise.

Adult↗

PubMed2003

Suspected rotator cuff lesions: tissue harmonic imaging versus conventional US of the shoulder.

PURPOSE: To compare tissue harmonic imaging (THI) of the shoulder with conventional ultrasonography (US) in patients suspected of having rotator cuff lesions. MATERIALS AND METHODS: THI and conventional US images were obtained in 50 patients suspected of having rotator cuff lesions. Images were graded for visibility of acromioclavicular (AC) joint surfaces and rotator cuff tendon contours and substances: Grade 1 meant poor; grade 2, moderate; and grade 3, good visibility. Accuracy, sensitivity, and specificity of the diagnosis of AC joint osteoarthritis and accuracy of the diagnosis and rates of underestimation and overestimation of the extent of rotator cuff tears were evaluated. Visibility grade differences were evaluated with the Wilcoxon signed rank test. The McNemar test was used to assess differences in diagnoses. Magnetic resonance (MR) arthrography was the reference standard. RESULTS: Mean visibility grades for readers 1 and 2, respectively, were as follows: for AC joint bone surfaces, 2.1 and 2.0 with THI and 1.7 (P =.010) and 1.7 (P =.16) with conventional US; for AC joint capsule surfaces, 2.2 and 1.9 with THI and 1.8 (P =.005) and 1.8 (P =.34) with US; for supraspinatus tendon contour, 2.6 and 2.2 with THI and 2.1 (P =.001) and 1.9 (P =.055) with US; for supraspinatus tendon substance, 2.2 and 1.9 with THI and 2.0 (P =.036) and 1.7 (P =.070) with US; for subscapularis tendon contour, 2.4 and 2.1 with THI and 2.2 (P =.07) and 2.0 (P =.25) with US; and for subscapularis tendon substance, 1.8 and 1.7 with THI and 2.0 (P =.86) and 1.7 (P =.91) with US. Diagnostic accuracies for the supraspinatus tendon for readers 1 and 2, respectively, were 84% and 74% with THI and 86% and 70% with US (P >.99 for both readers). Corresponding values for the subscapularis tendon were 78% and 72% with THI and 64% (P =.27) and 52% (P =.006) with US. CONCLUSION: Joint and tendon surface visibility improves with THI, as compared with the visibility achieved with conventional US. THI is superior to conventional US for diagnosis of subscapularis tendon abnormalities.

Adult↗

PubMed2003

CT arthrography of the glenohumeral joint: CT fluoroscopy versus conventional CT and fluoroscopy--comparison of image-guidance techniques.

PURPOSE: To compare examination time with radiologist time and to measure radiation dose of computed tomographic (CT) fluoroscopy, conventional CT, and conventional fluoroscopy as guiding modalities for shoulder CT arthrography. MATERIALS AND METHODS: Glenohumeral injection of contrast material for CT arthrography was performed in 64 consecutive patients (mean age, 32 years; age range, 16-74 years) and was guided with CT fluoroscopy (n = 28), conventional CT (n = 14), or conventional fluoroscopy (n = 22). Room times (arthrography, room change, CT, and total examination times) and radiologist times (time the radiologist spent in the fluoroscopy or CT room) were measured. One-way analysis of variance and Bonferroni-Dunn posthoc tests were performed for comparison of mean times. Mean effective radiation dose was calculated for each method with examination data, phantom measurements, and standard software. RESULTS: Mean total examination time was 28.0 minutes for CT fluoroscopy, 28.6 minutes for conventional CT, and 29.4 minutes for conventional fluoroscopy; mean radiologist time was 9.9 minutes, 10.5 minutes, and 9.0 minutes, respectively. These differences were not statistically significant. Mean effective radiation dose was 0.0015 mSv for conventional fluoroscopy (mean, nine sections), 0.22 mSv for CT fluoroscopy (120 kV; 50 mA; mean, 15 sections), and 0.96 mSv for conventional CT (140 kV; 240 mA; mean, six sections). Effective radiation dose can be reduced to 0.18 mSv for conventional CT by changing imaging parameters to 120 kV and 100 mA. Mean effective radiation dose of the diagnostic CT arthrographic examination (140 kV; 240 mA; mean, 25 sections) was 2.4 mSv. CONCLUSION: CT fluoroscopy and conventional CT are valuable alternative modalities for glenohumeral CT arthrography, as examination and radiologist times are not significantly different. CT guidance requires a greater radiation dose than does conventional fluoroscopy, but with adequate parameters CT guidance constitutes approximately 8% of the radiation dose.

Adolescent↗

PubMed2003

Achilles tendons: clinical relevance of neovascularization diagnosed with power Doppler US.

PURPOSE: To evaluate the clinical relevance of neovascularization diagnosed with power Doppler ultrasonography (US) in Achilles tendons in patients with chronic achillodynia. MATERIALS AND METHODS: Forty consecutive patients (mean age, 52 years; age range, 30-72 years) were examined. US was performed bilaterally and repeated after 3 months. Shape and echogenicity were assessed with gray-scale US and vascularization with power Doppler US. All patients were treated conservatively. Clinical assessment was performed after 0, 3, and 6 months by using visual analogue scale (VAS) scores (0, no pain; 100, unbearable pain). The VAS scores were compared with the initial US findings, and analysis of variance was used for repeated measurements. RESULTS: Neovascularization was present in 30 of 55 painful tendons and in one of 25 asymptomatic tendons. The mean VAS scores at 0, 3, and 6 months, respectively, for tendons with neovascularization were 52, 26, and 20; those for tendons without neovascularization were 39, 19, and 18 (P =.15). Forty-eight painful and nine asymptomatic tendons were spindle shaped. The mean VAS scores at 0, 3, and 6 months, respectively, for the spindle-shaped tendons were 48, 25, and 20; those for normally shaped tendons were 33, 10, and 16 (P =.17). Thirty-five painful and four asymptomatic tendons were inhomogeneous. The mean VAS scores at 0, 3, and 6 months, respectively, for symptomatic inhomogeneous tendons were 54, 29, and 25; those for symptomatic homogeneous tendons were 32, 12, and 9 (P <.001). CONCLUSION: Although neovascularization is a specific sign for pain, it does not indicate an unfavorable outcome. Conversely, tendon inhomogeneity seems to be associated with an unfavorable outcome.

Achilles Tendon↗

PubMed2003

Morton neuroma: MR imaging in prone, supine, and upright weight-bearing body positions.

PURPOSE: To assess the effect of prone, supine, and upright weight-bearing body positions on visibility, position, shape, and size of Morton neuroma during magnetic resonance (MR) imaging. MATERIALS AND METHODS: Eighteen patients with 20 Morton neuromas underwent MR imaging of the forefoot in prone (plantar flexion of the foot), supine (dorsiflexion of the foot), and upright weight-bearing positions. Visibility (3 = good, 2 = moderate, 1 = poor), position relative to the metatarsal bone, shape, and transverse diameter of Morton neuroma were assessed on transverse T1-weighted MR images. Associations between different body positions and variables of interest were calculated with Wilcoxon signed rank test, chi2 test, and paired Student t test. RESULTS: In the prone position, visibility of all 20 Morton neuromas was rated with a score of 3; visibility in the supine and weight-bearing positions was inferior (mean score, 2.4). All 20 (100%) Morton neuromas changed their position relative to the metatarsal bone between prone and supine and between prone and weight-bearing positions. When compared with the prone position, there was a difference in the shape of all 20 Morton neuromas in the weight-bearing position (P <.001). Between prone (mean transverse diameter of Morton neuroma, 8 mm) and supine (mean transverse diameter of Morton neuroma, 6 mm) positions, the transverse diameter of Morton neuroma significantly decreased by 2 mm (P =.03); between prone and weight-bearing positions, the decrease of the mean transverse diameter was also significant (difference, 2 mm; P =.03). CONCLUSION: Morton neuroma appears significantly different during MR imaging in prone, supine, or weight-bearing positions. The transverse diameter of Morton neuroma is significantly larger on images obtained in the prone position than it is on images obtained in the supine and upright weight-bearing positions. Visibility of Morton neuroma is best on MR images obtained in the prone position.

Adult↗

PubMed2003

Articular cartilage lesions of the glenohumeral joint: diagnostic effectiveness of MR arthrography and prevalence in patients with subacromial impingement syndrome.

PURPOSE: To determine the prevalence of articular cartilage lesions in patients with subacromial impingement syndrome and to assess the diagnostic effectiveness of magnetic resonance (MR) arthrography in detecting such cartilage abnormalities. MATERIALS AND METHODS: MR arthrographic images obtained in 52 consecutive patients (mean age, 45.8 years; age range, 17-73 years; 26 male and 26 female patients) were retrospectively evaluated for glenohumeral cartilage lesions. Two experienced musculoskeletal radiologists who were blinded to the arthroscopy report independently analyzed the articular cartilage. Humeral and glenoidal cartilage were assessed separately. The lesions were graded as either subtle or marked. Arthroscopic findings were the standard of reference. Sensitivity, specificity, accuracy, and interobserver agreement were calculated. RESULTS: At arthroscopy, humeral cartilage lesions were found in 15 patients (frequency, 29%). Four lesions were subtle, and 11 were marked. Cartilage lesions of the glenoid were less frequent (eight patients; frequency, 15%): Three were subtle, and five were marked. For reader 1 and reader 2, respectively, sensitivity of MR arthrography for humeral cartilage lesions was 53% and 100%, specificity was 87% and 51%, and accuracy was 77% and 65%; sensitivity for glenoidal cartilage lesions was 75% and 75%, specificity was 66% and 63%, and accuracy was 67% and 65%. Interobserver agreement for the grading of cartilage lesions with MR arthrography was fair (humeral lesions, kappa = 0.20; glenoidal lesions, kappa = 0.27). CONCLUSION: Glenohumeral cartilage lesions are found in up to one third of patients referred for MR arthrography for subacromial impingement syndrome. The performance of MR arthrography in the detection of glenohumeral cartilage lesions is moderate.

Adolescent↗

PubMed2003

Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography.

PURPOSE: To evaluate the diagnostic performance of magnetic resonance (MR) arthrography in the detection of articular cartilage lesions in patients suspected of having femoroacetabular impingement and/or labral abnormalities. MATERIALS AND METHODS: Forty-two MR arthrograms obtained in 40 patients with a clinical diagnosis of femoroacetabular impingement and/or labral defect were retrospectively analyzed. Two readers independently interpreted the images for cartilage lesion location, depiction, and characteristics. Within 6 months after MR arthrography, each patient underwent open hip surgery, during which the entire cartilage of the hip joint was inspected. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated. kappa values were calculated to quantify the level of interobserver agreement. RESULTS: At surgery, most (37 [88%] of 42) cartilage defects were identified in the anterosuperior part of the acetabulum. In 23 (55%), 12 (29%), 10 (24%), and 10 (24%) hips, lesions were found in the posterosuperior acetabulum, anteroinferior acetabulum, posteroinferior acetabulum, and femoral head, respectively. The sensitivities and specificities of MR arthrographic detection of cartilage damage in all regions combined were 79% (73 of 92 regions) and 77% (91 of 118 regions), respectively, for reader 1 and 50% (46 of 92 regions) and 84% (99 of 118 regions), respectively, for reader 2. At interobserver comparison, agreement was fair (kappa = 0.31) for detection of cartilage lesions in the femoral head and poor (kappa <or= 0.2) for detection of lesions in all acetabular regions. CONCLUSION: Cartilage lesions are common in young and middle-aged patients with femoroacetabular impingement and/or labral abnormalities and are most frequently found in the anterosuperior part of the acetabulum. 2003

Adult↗

PubMed2003

Prevalence and size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections in asymptomatic knees on MR imaging.

OBJECTIVE: The purposes of this study were to evaluate the prevalence and determine the size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections on MR images of asymptomatic knees. MATERIALS AND METHODS: MR images of 102 asymptomatic knees were evaluated with regard to the prevalence of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections. The MR examinations were performed in patients (mean age, 42.8 years; age range, 18-73 years) with clinically suspected meniscal lesions in the contralateral knee. The craniocaudal, anteroposterior, and mediolateral diameters of detectable abnormal fluid collections were measured. RESULTS: Medial meniscal cysts (mean size [craniocaudal x anteroposterior x mediolateral], 9 x 6 x 13 mm) were found in four asymptomatic knees. Neither lateral meniscal cysts nor ganglionic cysts of the cruciate ligaments were identified. Twenty-six synovial cysts of the popliteal space (Baker's cyst)-consisting of 11 gastrocnemius portions (mean size, 19 x 8 x 10 mm) and 15 semimembranosus portions (mean size, 20 x 7 x 9 mm)-were found in 19 knees. Twenty-four (92%) of these cysts had a maximal diameter of 30 mm or less. Fluid-filled bursae were found in 49 knees. The deep infrapatellar bursa was most commonly involved (42 knees; mean size, 6 x 3 x 5 mm). Fluid-filled anserine bursae (mean size, 27 x 12 x 10 mm) were detected in five knees. CONCLUSION: Meniscal cysts may be present in asymptomatic knees, at least on the medial side. Synovial cysts of the popliteal space can be found in approximately one fifth of asymptomatic knees. Their maximal diameter is usually smaller than 30 mm.

Adult↗

PubMed2003

Patients with suspected meniscal tears: prevalence of abnormalities seen on MRI of 100 symptomatic and 100 contralateral asymptomatic knees.

OBJECTIVE: The purpose of this study was to evaluate the prevalence of MR abnormalities of the knee on the symptomatic and contralateral asymptomatic sides in patients with suspected meniscal tears. SUBJECTS AND METHODS. One hundred patients (mean age, 42.7 years; range, 18-73 years) referred for suspected meniscal tears were prospectively examined with MRI of both knees when the contralateral knee was asymptomatic. The prevalence of various types of meniscal tears and other MR abnormalities was determined. RESULTS: Meniscal tears were found in 57 symptomatic knees and in 36 contralateral asymptomatic knees. In those 57 patients with a meniscal tear on the symptomatic side, the prevalence of asymptomatic tears in the contralateral side was 63% (36/57). Horizontal or oblique meniscal tears were found medially in 32 and laterally in 11 symptomatic knees, and medially in 29 and laterally in eight asymptomatic knees. Radial, vertical, complex, or displaced tears were found medially in 18 and laterally in five symptomatic knees, and medially in five and laterally in none of the asymptomatic knees. Collateral ligament abnormalities were found in 53 symptomatic knees and in six asymptomatic knees. Pericapsular soft-tissue abnormalities were found in 64 symptomatic and in 12 asymptomatic knees. Edema-like bone marrow abnormalities were found in 36 symptomatic and in three asymptomatic knees. CONCLUSION: Horizontal or oblique meniscal tears are frequently encountered in both asymptomatic and symptomatic knees and may not always be related to symptoms. However, radial, vertical, complex, or displaced meniscal tears and abnormalities of the collateral ligaments, pericapsular soft tissues, and bone marrow are found almost exclusively on the symptomatic side and appear to be clinically more meaningful.

Adolescent↗

PubMed2003

MRI features of the acromioclavicular joint that predict pain relief from intraarticular injection.

OBJECTIVE: Our objective was to evaluate the predictive value of various MRI findings in the acromioclavicular joint for pain relief after intraarticular injection. MATERIALS AND METHODS: The acromioclavicular joint of 50 patients (20 women, 30 men; mean age, 51 years; range, 25-75 years) was evaluated on MRIs of the shoulder. Osteophytes, subchondral cysts and irregularities, bone marrow edema, joint effusion, and joint capsule hypertrophy were assessed by two musculoskeletal radiologists in consensus. Local anesthetics were injected into the acromioclavicular joint with fluoroscopic guidance. Patients graded pain relief on a visual analogue scale (0-100%) after 15 min. The relationship between pain relief and MRI findings was assessed with the Mann-Whitney U test. Pain relief equal to or greater than 70% was rated as a positive response to the injection. This cutoff value was used to calculate sensitivity, specificity, accuracy, and predictive values of the various MRI findings in determining which acromioclavicular joints were responsive to joint injections. RESULTS: Mean pain relief after injection was 38%. Pain relief was significantly related to capsular hypertrophy (p = 0.007) and was equal to or greater than 70% in 11 patients. The sensitivity in diagnosing a successful injection (range, 9-82%) was highest for caudal osteophytes (82%) and capsular hypertrophy (73%). The specificity (range, 51-97%) was highest for subchondral cysts (97%), subchondral bone marrow edema (95%), and joint effusion (92%). CONCLUSION: Pain relief after intraarticular injection is significantly related to capsular hypertrophy diagnosed on MRI. MRI findings have a reasonable sensitivity and a high specificity in predicting relevant short-term pain relief after intraarticular injection.

Acromioclavicular Joint↗

PubMed2002

Risk factors for lumbar disc degeneration: a 5-year prospective MRI study in asymptomatic individuals.

STUDY DESIGN: A longitudinal magnetic resonance imaging investigation of lumbar disc degeneration in asymptomatic individuals was conducted. OBJECTIVE: To investigate risk factors for the development or deterioration of lumbar disc degeneration. SUMMARY OF BACKGROUND DATA: Numerous studies have explored the significance of certain risk factors for the development or progression of disc degeneration, but no comprehensive longitudinal magnetic resonance imaging-based study has been reported that simultaneously considers clinical, morphologic, physical, psychosocial, and occupational risk factors. METHODS: In the 5-year follow-up evaluation of 41 asymptomatic individuals, the risk factors for the development of lumbar disc degeneration and its progression were investigated. All 41 individuals had a magnetic resonance imaging scan at baseline and at the minimum 5-year follow-up assessment using the same scanner and protocol. The magnetic resonance images were analyzed independently by two radiologists with regard to disc degeneration. Various predictor variables were assessed both at baseline and follow-up, with special emphasis on physical job characteristics, sports activities, and magnetic resonance image-based morphologic findings. RESULTS: Of the 41 individuals, 17 (41%) exhibited a deterioration of the disc status. In 10 individuals, the progression of disc degeneration was one grade or more. Only a weak correlation existed between progressive disc degeneration and low back pain development during a 5-year follow-up period. Multiple logistic regression analysis demonstrated that the extent of disc herniation (odds ratio [OR], 12.63; confidence interval [CI], 1.24-128.49), the lack of sports activities (OR, 2.71; CI, 1.04-7.07), and night shift work (OR, 23.01; CI, 1.26-421.31) were significant predictors for disc degeneration during follow-up evaluation when control was used for the number of degenerated discs at baseline, gender, age, and body mass index. CONCLUSIONS: The results indicate that the extent of disc herniation, the lack of sports activities, and night shift work are significant risk factors for the development of lumbar disc degeneration and its progression.

Adult↗

PubMed2002

MR imaging of the forefoot under weight-bearing conditions: position-related changes of the neurovascular bundles and the metatarsal heads in asymptomatic volunteers.

PURPOSE: To assess practicability of weight-bearing magnetic resonance (MR) imaging of the forefoot, and to demonstrate position-related changes of the neurovascular bundles and the metatarsal heads in asymptomatic volunteers. MATERIALS AND METHODS: With an open-configuration MR system, 32 feet of 32 asymptomatic individuals aged 20-60 years were studied in supine and weight-bearing body positions. Transverse T1-weighted spin-echo MR images were performed. MR images were evaluated qualitatively with regard to image quality, visibility, and position-dependent changes of the neurovascular bundle. In addition, the position of the metatarsal heads was analyzed quantitatively. RESULTS: Weight-bearing MR imaging was feasible in all 32 feet. Quality of MR images obtained in the weight-bearing position was superior to that obtained in the supine position (P < 0.05). A change in the position of the neurovascular bundle from below a virtual line paralleling the plantar cortical line to above this line was present in 50 of 61 instances (82%) between the supine and the weight-bearing positions. When changing from the supine to the weight-bearing position, there was a significant decrease in the distance between the plantar skin and the metatarsal heads for the second (mean 4.5 mm), third (mean 4.4 mm), and fourth metatarsal heads (mean 3.7 mm) (P < 0.0001). However, the difference for the first (mean 0.5 mm) and fifth (mean 0.9 mm) metatarsal heads was not significant. CONCLUSION: Weight-bearing MR imaging of the forefoot is feasible using an open-configuration MR system and demonstrates position-related changes of the neurovascular bundles relative to the metatarsal heads, as well as position-related changes of the metatarsal heads themselves.

Adult↗

PubMed2002

Joint magnetic resonance imaging: normal variants and pitfalls related to sports injury.

MR imaging abnormalities, such as increased signal within normally hypointense structures, form and attachment abnormalities, fluid collections in joints, tendon sheaths and bursa, or even tumors, such as Morton's neuromas, are common in asymptomatic volunteers. They may be explained by normal physiology, anatomic variability, MR imaging artifacts, or true abnormalities without clinical importance. Although it is not always possible to differentiate such variants or artifacts from clinically relevant findings, it is important to know their potential cause and clinical importance and not to over-report them as abnormality requiring additional imaging or treatment. Thorough knowledge of normal anatomy is crucial in this situation.

Ankle Joint↗

PubMed2002

Clinical outcome of edema-like bone marrow abnormalities of the foot.

PURPOSE: To evaluate the clinical outcome of edema-like bone marrow abnormalities seen on magnetic resonance (MR) images of the foot when their cause is unknown. MATERIALS AND METHODS: The clinical outcome of 31 patients (15 female patients, 16 male patients; mean age, 51; range, 10-79 years) with edema-like bone marrow abnormalities on MR images of the foot was determined. The relevance of three different edema patterns was compared: (a) exclusively ill-defined edema-like zones, (b) edema-like zones plus well-defined necrosis-like zones, and (c) edema-like zones plus linear structures indicating possible fractures. The different edema patterns were compared with persistence of pain. RESULTS: Fifty-four percent of all patients had pain persisting after 1 year, as calculated with the Kaplan-Meier method. The duration of pain in the various subgroups varied significantly (P =.049, log-rank test). The subgroup of patients with a well-defined necrosis-like zone had substantially longer-lasting pain than those with edema-like abnormalities only (n = 16) (P =.065). Only one of seven patients with a well-defined necrosis-like zone (n = 7) was pain free after 1 year. Conversely, patients with possible stress fracture (n = 8) had shorter pain compared with those with edema-like abnormalities only (P =.036); six of eight patients were pain free after 1 year. CONCLUSION: Edema-like bone marrow abnormalities of the foot predict long-lasting pain. Analysis of the image patterns of such abnormalities allows prediction of the clinical outcome to a certain degree.

Adolescent↗

PubMed2002

Bone marrow abnormalities of foot and ankle: STIR versus T1-weighted contrast-enhanced fat-suppressed spin-echo MR imaging.

PURPOSE: To compare short inversion time inversion-recovery (STIR) and T1-weighted contrast material-enhanced fat-suppressed spin-echo magnetic resonance (MR) sequences for depiction of bone marrow abnormalities of the foot and ankle. MATERIALS AND METHODS: Fifty-one consecutive patients with bone marrow abnormalities depicted on turbo STIR images were examined with additional T1-weighted contrast-enhanced (0.1 mmol/kg gadopentetate dimeglumine) MR imaging with fat suppression. Volume and signal difference-to-noise ratio (SDNR) were measured. An additional qualitative analysis was performed by two experienced musculoskeletal radiologists to correlate the presence or absence of ill-defined edema-like zones, well-defined zones, and cystlike zones. Diagnoses determined with MR findings with each sequence were compared with the results of a review panel. Correlation coefficients (r(2)) and paired t tests were calculated for all measurements. Agreement percentages and kappa values were calculated for inter- and intraobserver reproducibility. RESULTS: Regarding volume of bone marrow abnormalities, a high correlation (r(2) = 0.98) of both sequences was found. SDNR was substantially higher on T1-weighted contrast-enhanced images than on STIR images (mean, 125.9 vs 95.4; P <.001). The qualitative analysis demonstrated identical imaging patterns with both sequences in 96% (79 of 82, kappa = 0.38) of ill-defined zones, in 88% (72 of 82, kappa = 0.76) of well-defined zones, and in 98% (80 of 82, kappa = 0.84) of cystlike zones. Interobserver reproducibility of the three imaging patterns was similar for both sequences. The kappa values for these three zones with STIR sequence were 0.55, 0.68, and 0.69, and those for the T1-weighted contrast-enhanced MR sequence were 0.49, 0.73, and 0.58, respectively. Diagnoses determined with MR findings were equal with both sequences in 94% (80 of 85) of involved bones. CONCLUSION: STIR images and T1-weighted contrast-enhanced fat-suppressed MR images demonstrate almost identical imaging patterns, and diagnoses determined with these findings show little difference.

Adult↗

PubMed2002

FDG positron emission tomography for differentiation of degenerative and infectious endplate abnormalities in the lumbar spine detected on MR imaging.

OBJECTIVE: The objective of our study was to evaluate the usefulness of FDG positron emission tomography (PET) for the differentiation of degenerative and infectious endplate abnormalities in the lumbar spine that were detected on MR imaging. SUBJECTS AND METHODS: FDG PET was performed prospectively in 30 consecutive patients with substantial endplate abnormalities (craniocaudal diameter of bone marrow abnormalities, > or = 25% of vertebral height) found during MR imaging of the lumbar spine. Both the MR and PET images were evaluated by two experienced musculoskeletal radiologists and two experienced nuclear physicians. The diagnosis of either degeneration with different types of endplate abnormalities or disk-space infection was determined. Clinical follow-up and, in selected cases, bone biopsies with cultures were used as the standard of reference. RESULTS: On the MR images, 25 of the 38 degenerated levels were classified as Modic type I, 13 levels as type II, and none as type III. Five disk-space infections were diagnosed in four patients. MR imaging findings were false-positive at one disk level with type I abnormalities and false-negative at two levels with infection. PET did not show FDG uptake in the intervertebral spaces of any patient with degenerative disease. FDG PET findings were true-positive in all five levels with disk-space infection. The sensitivity and specificity for MR imaging in detecting disk-space infection were 50% and 96%, and were 100% and 100% for FDG PET, respectively (not significant, McNemar test, p = 0.5). CONCLUSION: Our findings suggest that FDG PET may prove useful for differentiation of degenerative and infectious endplate abnormalities detected on MR imaging. Even in active (Modic type I) degenerative endplate abnormalities in our series, PET did not show increased FDG uptake.

Adult↗