Biomedical subjects
Publications and source records attributed to Ustün Aydingöz.
A suprapatellar plica is a persistent remnant of the embryologic synovial membrane between the suprapatellar pouch and the knee joint. Pathologic synovial plica is not a common entity, however, when present, it can mimic a variety of clinical situations. We describe here a case of pathologic suprapatellar plica that has a check-valve mechanism, which results in a clinical presentation as knee joint swelling.
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We report a case of childhood lipoma arborescens of both knee joints who had been erroneously diagnosed to have initially acute rheumatic fever and subsequently oligoarticular juvenile rheumatoid arthritis. She had taken anti-inflammatory medication for 8 years without remission of the effusion. Magnetic resonance imaging (MRI) and synovectomy revealed the diagnosis of lipoma arborescens. Lipoma arborescens should be kept in mind in the differential diagnosis of refractory chronic joint effusion and synovial hypertrophy in the childhood period, and MRI yields the correct diagnosis in this setting.
The objective is to evaluate the prevalence and morphology of recesses along the posterior margin of the infrapatellar fat pad on routine MR imaging of the knee. MR images of 213 knees in 204 consecutive individuals were evaluated with regard to the prevalence and morphology of recesses (a "suprahoffatic" recess close to the inferior border of the patella and the previously described "infrahoffatic" recess anterior to the inferior portion of the infrapatellar plica). The recesses were analyzed with regard to synovial effusion and the condition of the anterior cruciate ligament (ACL). Anatomic dissection was made in 29 knees in 16 cadavers to verify the presence of the suprahoffatic recess. The infrahoffatic recess was present in 45% of the knees and mostly linear in shape (44%). The suprahoffatic recess was detected in 71% of the knees (45% in cadavers). Very weak to moderate positive correlation was found between the synovial effusion or the condition of the ACL and the presence and dimensions of the recesses. An awareness of the recesses in the infrapatellar fat pad is important in order to distinguish between pathology and anatomic variants on routine MR imaging of the knee.
Magnetic resonance (MR) imaging is capable of detecting a wide spectrum of diseases involving clivus bone marrow. To evaluate any pathology in this region, the normal MR signal intensity patterns according to age should be known. Assessment of clivus bone marrow is usually and more efficiently made visually (qualitatively) on routine MR imaging. To compare the qualitative and quantitative analyses of age-related changes in clivus bone marrow on MR imaging, midsagittal T1-weighted MR images of the clivus bone marrow were prospectively evaluated in 201 subjects. MR signal intensity patterns of clivus bone marrow were qualitatively graded from I to III according to the proportions of low and high signal intensity areas within the clivus (Grade I: predominantly hypointense, Grade III: predominantly hyperintense). Signal intensity measurements were also made from the clivus, pons, and the cerebrospinal fluid within the fourth ventricle. Grade I pattern was observed in 92% of the subjects in the first decade, whereas Grade III pattern was not seen in this decade; Grade I pattern was absent in all but one of the subjects over the age of 50. Mean values of clivus/pons and clivus/CSF signal intensity measurements gradually increased with age in both males and females. Comparison of these ratios in each gender showed statistically significant higher values for males (P < 0.05). Comparison of the qualitative and quantitative results showed that calculated mean values of intensity ratios for each grade were different from each other; however, there was an overlap of the ranges of signal intensity ratios for Grades II and III. Visual evaluation of the clivus bone marrow MR signal is validated with the quantitative assessment results. Statistically significant higher intensity ratios in males may reflect a difference between gender in the bone mineral content under the influence of sex hormones.
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PURPOSE: The goal of this study was to evaluate arthroscopic partial resection of discoid lateral meniscus tears with an emphasis on radiographic evidence of degenerative changes after this procedure. TYPE OF STUDY: Retrospective clinical study. METHODS: Of 41 patients with an arthroscopic diagnosis of discoid meniscus over an 8-year period, 34 symptomatic lateral discoid meniscus tears in 33 patients were analyzed at an average follow-up of 5.6 years. The average age at operation was 19.8 years and most patients had vague and intermittent symptoms that caused delay in clinical diagnosis. RESULTS: Eight patients were lost to follow-up and were excluded from the study. Magnetic resonance imaging, performed in 12 cases, and arthroscopy in all of these patients provided the precise diagnosis. All of the knees with symptomatic torn discoid menisci underwent arthroscopic partial meniscectomy. Only 1 Watanabe Wrisberg ligament type of discoid meniscus with posterior instability was totally meniscected. Based on Ikeuchi's grading, 39% of the knees had an excellent result, 46% had a good result, and 15% had a fair result; none of the results was poor. CONCLUSIONS: At an average 5-year follow-up, partial meniscectomy in patients with a Watanabe complete or incomplete discoid meniscus showed 85% good or excellent clinical results. However, a significant percentage of patients show femoral condyle flattening on radiography.
Although radiology utilizes highly sophisticated equipment, its basic tool remains radiology reports. Of the many problems related to the use of radiology language in Turkish, several are more prominent. Among these more prominent problems are the selective use of non-Turkish words in the presence of their Turkish counterparts, mistakes in the use of non-Turkish words, and improper use of the Turkish grammar and linguistics. The content and visual design of radiology reports in Turkey also need considerable improvement. In this article, problems in these areas are outlined and some advices regarding solutions are made.
Our objective was to review the MR imaging signs of meniscal bucket-handle tears and assess the relevance of these signs to the arthroscopic classification of displaced meniscal tears. Forty-five menisci in 42 patients who had a diagnosis of bucket-handle tear either on MR imaging or on subsequent arthroscopy (in which Dandy's classification of meniscal tears was used) were retrospectively analyzed for MR imaging findings of double posterior cruciate ligament (PCL), fragment within the intercondylar notch, absent bow tie, flipped meniscus, double-anterior horn, and disproportional posterior horn signs. Arthroscopy, which was considered as the gold standard, revealed 41 bucket-handle tears (either diagnosed or not diagnosed by MR imaging) in 38 patients (33 males, 5 females). There was a statistically significant male preponderance for the occurrence of meniscal bucket-handle tears. Overall, sensitivity and positive predictive value of MR imaging for the detection of meniscal bucket-handle tears were calculated as 90%. Common MR imaging signs of meniscal bucket-handle tears in arthroscopically proven cases of such tears were the fragment in the notch and absent bow tie signs (98% frequency for each). Double-PCL, flipped meniscus, double-anterior horn, and disproportional posterior horn signs, however, were less common (32, 29, 29, and 27%, respectively). An arthroscopically proven bucket-handle tear was found in all patients who displayed at least three of the six MR imaging signs of meniscal bucket-handle tears. The presence of three or more MR imaging signs of meniscal bucket-handle tears is highly suggestive of this condition.
A ring-shaped lateral meniscus is a very rare entity within the spectrum of abnormalities of lateral meniscus. We present the second case in the literature of a symptomatic ring-shaped lateral meniscus in combination with a meniscal cyst and in association with an osteochondritis dissecans lesion of the medial femoral condyle. A potential pitfall of magnetic resonance imaging (i.e., displaced meniscal tear) is addressed in the diagnosis of this entity, as well as the role of magnetic resonance imaging in revealing associated abnormalities.
An unusual type of anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion in the superior, instead of the usual inferior, part of the anterior glenoid labrum is presented in a 33-year-old man who sustained a traumatic dislocation of his left shoulder. Magnetic resonance imaging raised the possibility of an ALPSA lesion and later arthroscopy confirmed the diagnosis. Arthroscopic repair of the lesion was performed after the labral avulsion was lateralized.
A patient with dysphagia and a history of breast cancer 11 yr ago was admitted to the hospital. A tumor presumably originating from the esophagus was detected. It could not be surgically removed and biopsy revealed adenocarcinoma. The patient received radiotherapy and chemotherapy consisting of etoposide, adriamycin, and cisplatin. An unexpectedly good response was achieved and the possibility of metastatic breast cancer was reinvestigated. Biopsy specimens showed positive estrogen and progesterone receptor staining. Tamoxifen treatment was started. The patient is well after 5 yr following relapse. Solitary esophageal metastasis of breast cancer is a rare event, especially after a remission period lasting more than a decade. Dysphagia in breast cancer patients should raise the suspicion of metastatic disease as well as esophageal cancer and benign strictures.
Our objective was to study the frequency of anterior intermeniscal ligament on MR imaging and to make a classification according to its insertion sites on MR images. Sagittal T1-weighted and thin-section transverse T2*-weighted MR images of the knee were prospectively evaluated in 229 subjects without significant synovial effusion or total rupture of the anterior cruciate ligament. By using thin-section transverse images, the ligament was classified into three types according to its insertion sites (type A: between anterior horns of medial and lateral menisci; type B: between anterior horn of medial meniscus and anterior margin of lateral meniscus; type C: between anterior margins of medial and lateral menisci). On sagittal images location of the ligament was determined with respect to a line drawn between anterior of the tibial epiphysis and posterior of the intercondylar notch to look for a relation between its type on transverse images and location on sagittal images. Separately, arthroscopy was made in 36 patients to verify the MR assessment of the presence of the ligament. Anterior intermeniscal ligament was found in 53% of the subjects. Type B was the most common group (58%). Magnetic resonance imaging has a sensitivity and a specificity of 67 and 100%, respectively, in the detection of the ligament. Types A and C had a statistically significant location posterior and anterior, respectively, to the master line on sagittal images. In arthroscopy, the ligament was either cord-like (67%) or flat (33%) in appearance. Routine sagittal MR images can help identify anterior intermeniscal ligament.
A very rare case of spontaneous rupture of the tibialis anterior tendon diagnosed by MR imaging is presented. The tendon rupture occurred in a patient with recent onset psoriasis of both shins who used a corticosteroid cream (0.1% of methylprednisolone aceponate) for his skin lesions during the last 3 months before the incident causing tendon rupture. This is the first report of a spontaneous tendon rupture in a patient with psoriasis.
Eleven hips of 10 patients with Legg-Calvé-Perthes disease (LCPD) were examined by arthrography and magnetic resonance (MR) imaging. Arthrogram and MR images were obtained with the hips in neutral position and in 20 degrees flexion-abduction and internal rotation. Modified arthrographic index (AI) was used for the evaluation of sphericity and acetabulum head index (AHI) was used for the assessment of containment. According to AI, there is no significant difference between the arthrograms and coronal MR imaging, but the difference between the coronal and sagittal MR imaging was significant. There was no statistical difference between the arthrograms and MR measurements in terms of AHI. Anterior flattening of the femoral head and the effect of hip flexion in the containment at the sagittal plane could be demonstrated clearly in sagittal MR imaging. Even if there was significant flattening in coronal plane, the sphericity of the head was preserved in the sagittal plane. Bipositional MR imaging is comparable to arthrography for the demonstration of sphericity and containment of the femoral head in both coronal and sagittal planes in LCPD.
The location of conus medullaris according to age and sex was retrospectively evaluated with a 0.5-T magnetic resonance (MR) imaging system. A total of 639 subjects without any conspicuous spinal canal pathology on the lumbar MR imaging examination were selected. The level of conus medullaris was most commonly located at the T(12)-L(1) intervertebral disc level in the whole population. Our results do not correlate with the previous studies. No significant difference in the conus level was found with increasing age.
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