MRI of sports injuries of the ankle.
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Achilles Tendon↗
Biomedical subjects
Scot E Campbell
Publications and source records attributed to Scot E Campbell.
Postoperative imaging of the hip.
The number and type of operative procedures involving the hip continue to increase, placing a greater emphasis on characterizing patient postoperative condition accurately. Optimal postoperative imaging evaluation may involve multiple modalities, including conventional radiography, radionuclide scintigraphy, and cross-sectional imaging. Many of the surgical procedures involve the placement of metallic joint replacements or fixation that can make the imaging evaluation of the postoperative anatomy challenging. Clinical examination of patients combined with the type of procedure performed direct the appropriate imaging evaluation; adequate clinical knowledge of these procedures and how to optimally image them provide an opportunity to attain the most accurate evaluation possible.
Arthrography↗
Magnetic resonance imaging appearance of the flexor carpi radialis tendon after harvest in ligamentous reconstruction tendon interposition arthroplasty.
OBJECTIVE: To determine whether the post-harvest magnetic resonance (MR) imaging appearance of flexor carpi radialis (FCR) tendons, harvested during ligamentous reconstruction tendon interposition (LRTI) of the thumb carpometacarpal (CMC) joint arthroplasty, is consistent with tendon regeneration. DESIGN: Operative reports and patient medical records for all patients undergoing LRTI arthroplasty between 1995 and 2003 at our institution were reviewed. MR images of the patients' forearms and wrists were obtained and interpreted by two musculoskeletal radiologists. Using the flexor carpi ulnaris (FCU) tendon as an internal standard, the extent of FCR tendon regeneration was expressed as a percentage by dividing the volume of regenerated FCR tendon by the volume of the FCU tendon. PATIENTS: Fourteen patients who had the full thickness of the FCR tendon harvested and who were available for MR imaging were identified and included in the study. RESULTS AND CONCLUSIONS: At least partial regeneration of the FCR tendon occurred in 11 of the 14 patients (79%). Of these, 2 patients (14%), demonstrated complete, or nearly complete regeneration. Partial regeneration of the FCR tendon was seen in 9 of the 14 patients (64%). In 3 patients (21%), there was no appreciable regeneration of the FCR tendon. Among patients who underwent full-thickness harvest of the FCR tendon for LRTI arthroplasty of the first CMC joint, the follow-up MR imaging appearance of the flexor carpi radialis tendon was consistent with tendon regeneration in 79% of those examined.
Aged↗
Atlanto-occipital dislocation with traumatic pseudomeningocele formation and post-traumatic syringomyelia.
STUDY DESIGN: A case report of traumatic atlanto-occipital dislocation complicated by the development of anterior and posterolateral pseudomeningoceles and the late development of syringohydromyelia is presented. OBJECTIVE: To describe a unique post-traumatic and postsurgical course following atlanto-occipital dislocation. SUMMARY OF BACKGROUND DATA: Syringomyelia is a significant potential long-term complication in patients recovering from traumatic atlanto-occipital dislocation. Cord enlargement and increased T2 signal can be a marker of abnormal cerebrospinal fluid flow dynamics. This "presyrinx state" can be seen before clinical evidence of neurologic compromise. Pseudomeningocele formation after atlanto-occipital dislocation is rare, with only 3 reported cases. To our knowledge, all reported cases describe retropharyngeal pseudomeningoceles, and posterolateral pseudomeningocele as seen in this case has not previously been described. METHODS: A single case is reported with an emphasis on the imaging findings related to the patient's subsequent neurologic deterioration. RESULTS: Following a pedestrian-motor vehicle collision, the patient received initial evaluation and treatment at a local foreign medical facility, where his cervical spine was cleared. Several days following stabilizing treatment and surgery, the patient was transferred to a foreign-based United States military medical facility and ultimately to our institution, where magnetic resonance imaging demonstrated occipitocervical dissociation. The patient was taken to the operating room for surgical stabilization. Four months after his index operation, the patient underwent halo removal. Follow-up magnetic resonance imaging revealed thickening of the cervical spinal cord in conjunction with diffuse high cord T2 signal and a small low cervical segment of syringomyelia. The patient was observed with follow-up magnetic resonance imaging obtained after 1 month. At this time, the low cervical syrinx had enlarged slightly, a small thoracic syrinx was observed, and cine imaging of cerebrospinal fluid flow demonstrated obstruction at the level of the foramen magnum. The patient was taken to the operating room fordecompression of the foramen magnum and posterior fossa and duraplasty. One month later, the patient's clinical condition began to deteriorate, and repeat imaging showed continued enlargement of the patient's syrinx and hydrocephalus. He was admitted for an urgent shunt procedure but unfortunately sustained cardiorespiratory arrest while on the ward awaiting surgery. CONCLUSIONS: Atlanto-occipital dislocation is rarely survivable, and delayed diagnosis can negatively affect long-term clinical outcome. This case illustrates how, despite early signs of improvement, post-traumatic syringomyelia may occur months or even years after spinal trauma and should always be considered in patients who experience late neurologic deterioration after atlanto-occipital dislocation.
Accidents, Traffic↗
Relation between narrowed coracohumeral distance and subscapularis tears.
PURPOSE: To determine whether coracohumeral distance was significantly narrowed in the presence of a torn subscapularis. TYPE OF STUDY: Retrospective cohort study. METHODS: The coracohumeral distance of a consecutive series of patients (n = 35, 36 shoulders) requiring an arthroscopic repair of the subscapularis was compared with a control group (n = 35). The control group consisted of patients who underwent shoulder arthroscopy but who did not have any rotator cuff, subscapularis, or subcoracoid pathology. The coracohumeral distance was measured from the tip of the coracoid to the cortex of the proximal humerus on an axial cut of preoperative magnetic resonance imaging. A Student t test was used to determine the statistical differences between the 2 groups. RESULTS: The average coracohumeral distance in the subscapularis group was 5.0 +/- 1.7 mm and the average coracohumeral distance in the control group was 10.0 +/- 1.3 mm. Statistical analysis, using the Student t test, showed that the coracohumeral distance was significantly narrowed in the group of patients with a torn subscapularis. CONCLUSIONS: These results show a significant relationship between a narrowed coracohumeral distance and subscapularis pathology. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
Aged↗
Use of preoperative magnetic resonance imaging to predict rotator cuff tear pattern and method of repair.
PURPOSE: To determine the magnetic resonance imaging (MRI) criteria for predicting rotator cuff tear pattern and method of repair. TYPE OF STUDY: Retrospective MRI/arthroscopy correlation. METHODS: Sixty-six preoperative MRI scans were evaluated. The maximum medial to lateral length (L) of the tear was measured on T2-weighted coronal cuts. The maximum anterior to posterior width (W) was measured on T2-weighted sagittal cuts. The cases were divided into 3 groups: group 1, short-wide tears, L < or = W, L < 2 cm; group 2, long-narrow tears, L > W, W < 2 cm; and group 3, long-wide tears, L > or = 2 cm, W > or = 2 cm. RESULTS: Of the 66 MRI scans, 55 were adequate for standardized measurement. Group 1, 16 cases: 15 were found at arthroscopy to be crescent-shaped tears repaired end-to-bone; 1 was repaired with interval slides. Group 2, 22 cases: all 22 were repaired side-to-side/margin convergence. Group 3, 17 cases: 12 required interval slides, 1 partial repair was performed, and 4 were repaired side-to-side/margin convergence. CONCLUSIONS: Tear pattern and method of repair can be predicted on high-quality MRI scan. Group 1, L < or = W and L < 2 cm, predicts a crescent-shaped tear and end-to-bone repair (positive predictive value, 93.8%). Group 2, L > W and W < 2 cm, predicts a longitudinal tear and side-to-side/margin convergence repair (positive predictive value 100%). Group 3, L > or = 2 cm and W > or = 2 cm, predicts a massive contracted tear and that primary end-to-bone or side-to-side repairs are usually not possible and that interval slides or partial repair may be necessary (positive predictive value, 76.5%). The overall diagnostic model based on usable MRI scans significantly predicted arthroscopic findings (P < .001 for chi-square test). LEVEL OF EVIDENCE: Level III, development of diagnostic criteria with universally applied reference (nonconsecutive patients).
Adult↗
Radiography of the hip: lines, signs, and patterns of disease.
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Diagnosis, Differential↗
Vertebral and spinal cord sarcoidosis.
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Biopsy↗
Ultrasound of muscle abnormalities.
Ultrasound is well suited to evaluate a wide variety of abnormalities involving skeletal muscle, including traumatic injuries, inflammatory or infectious myositis, atrophy, and tumors. Ultrasound can accurately localize and characterize a lesion, or grade the severity of injury. The unique ability of ultrasound to assess the dynamic function of muscles on the real-time or perform Doppler evaluation of vascularity provides insights that are not readily obtained with other imaging modalities. With ultrasound, image-guided biopsy can be performed in conjunction with a diagnostic evaluation. This article presents a pictorial review of lesions and abnormalities involving skeletal muscles, and discusses characteristic findings, classifications, and imaging methods.
Diagnosis, Differential↗
Primary periosteal lymphoma: an unusual presentation of non-Hodgkin's lymphoma with radiographic, MR imaging, and pathologic correlation.
This report describes a primary periosteal location of non-Hodgkin's lymphoma, without nodal disease, and without adjacent intramedullary disease at presentation. The clinical and imaging appearance of periosteal lymphoma simulates other neoplastic osseous surface tumors more than that of lymphoma in other locations. Consideration of this rare presentation of non-Hodgkin's lymphoma in the differential diagnosis of periosteal bone lesions can be helpful to ensure proper diagnosis and treatment.
Adult↗