Sonographic examination of the buttock

The buttock is a common site of pathology and ultrasound and is often the first-line imaging modality to examine soft tissue lesions of the buttock region. This review describes the ultrasound technique used, the relevant ultrasound anatomy, and the sonographic appearances of common and uncommon pathological conditions found in the buttock region.

Prevalence and risk factors of lumbar spondylolisthesis in elderly Chinese men and women

OBJECTIVE

A screening survey for osteoporotic fractures in men and women in Hong Kong represents the first large-scale prospective population-based study on bone health in elderly (≥65 years) Chinese men and women. This study aims to identify the prevalence and potential risk factors of lumbar spondylolisthesis in these subjects.

METHODS

The lateral lumbar radiographs of 1,994 male and 1,996 female patients were analysed using the Meyerding classification.

RESULTS

Amongst the men, 380 (19.1%) had at least one spondylolisthesis and 43 (11.3%) had slips at two or more levels; 283 had anterolisthesis, 85 had retrolisthesis, whereas 12 subjects had both anterolisthesis and retrolisthesis. Amongst the women, 499 (25.0%) had at least one spondylolisthesis and 69 (13.8%) had slips at two or more levels; 459 had anterolisthesis, 34 had retrolisthesis, whereas 6 subjects had both anterolisthesis and retrolisthesis. Advanced age, short height, higher body mass index (BMI), higher bone mineral density (BMD) and degenerative arthritis are associated with spondylolisthesis. Lower Physical Activity Scale for the Elderly (PASE) score was associated with spondylolisthesis in men; higher body weight, angina and lower grip strength were associated with spondylolisthesis in women.

CONCLUSION

The male/female ratio of lumbar spondylolisthesis prevalence was 1:1.3 in elderly Chinese. Men are more likely to have retrolisthesis.

KEY POINTS

• The prevalence of spondylolisthesis is 19.1% in elderly Chinese men. • The prevalence of spondylolisthesis is 25.0% in elderly Chinese women. • Men are more likely to have retrolisthesis. • Anterolisthesis is most commonly seen at the L4/L5 level. • Retrolisthesis is most commonly seen at the L3/L4 level.

Relationship between marrow perfusion and bone mineral density: a pharmacokinetic study of DCE-MRI

A reduced bone perfusion has been found for osteoporotic subjects in previous studies. However, the physiological changes underlying the varied perfusion function is not well known yet. Tofts model is one of the most frequently used pharmacokinetic models in analyzing perfusion process. This study modified the Tofts model by replacing the arterial input function (AIF) by a new algorithm. The modified model was then employed to analyze vertebral bone marrow perfusion in subjects with different bone mineral density (BMD). Eighty-two male subjects were involved in this study and classified into three groups (normal, osteopenia, and osteoporosis) according to T-score. BMD was measured by dual-energy X-ray absorptiometry (DXA). The quantitative parameters derived from the pharmacokinetic model, K(trans) (extravasation transfer efficiency for blood perfusion) and v(e) (extravascular extracellular space for blood perfusion), showed a significant reduction in subjects with lower BMD, respectively. The results suggested that with the bone mineral content lost, the vascular wall properties as well as the bone marrow content may also vary. The resultant perfusion change may also influence the bone nutrition supply in reverse.

SLE disease per se contributes to deterioration in bone mineral density, microstructure and bone strength

OBJECTIVE

The objective of this report is to assess the effect of systemic lupus erythematosus (SLE) disease itself on deterioration of bone mineral density (BMD), microstructure and bone strength.

METHOD

Thirty age-matched SLE patients on long-term glucocorticoids (GC) (SLE/GC), 30 SLE patients without GC (SLE/non-GC) and 60 healthy controls were examined. Areal BMD (aBMD) was measured by dual-energy X-ray absorptiometry. Bone geometry, volumetric BMD (vBMD), and architectural parameters at the nondominant distal radius were assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT). Bone strength was estimated by HR-pQCT-based micro-finite element analysis.

RESULTS

Adjusted for menopausal status and adjusted calcium level, when compared with controls, SLE/non-GC patients had significantly lower aBMD at femoral neck and total hip, and diminished radial total vBMD, cortical area, vBMD and thickness, respectively, by 8.3%, 8%, 2.7% and 9.2%, as well as significant compromised bone strength (stiffness, failure load and apparent modulus) by 8.3%, 9.1% and 9.5%, respectively. Similar alterations were also found in SLE/GC patients when compared to controls. In the premenopausal subgroup analysis, when compared with controls, total hip aBMD and radial cortical area were significantly lower in SLE/non-GC patients, and cortical area and thickness were significantly deficit in SLE/GC patients. However, no significant difference in any bone variables was present between SLE/GC and SLE/non-GC patients in the entire cohort or in the premenopausal subgroup.

CONCLUSION

SLE disease per se contributes to the deterioration in bone density, cortical microstructure and bone strength. This might help to explain the considerably higher fracture risk seen in SLE patients.

Is dynamic contrast-enhanced MRI useful for assessing proximal fragment vascularity in scaphoid fracture delayed and non-union?

OBJECTIVE

To assess dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) as a measure of vascularity in scaphoid delayed-union or non-union.

MATERIALS AND METHODS

Thirty-five patients (34 male, one female; mean age, 27.4 ± 9.4 years; range, 16-51 years) with scaphoid delayed-union and non-union who underwent DCE MRI of the scaphoid between September 2002 and October 2012 were retrospectively reviewed. Proximal fragment vascularity was classified as good, fair, or poor on unenhanced MRI, contrast-enhanced MRI, and DCE MRI. For DCE MRI, enhancement slope, Eslope comparison of proximal and distal fragments was used to classify the proximal fragment as good, fair, or poor vascularity. Proximal fragment vascularity was similarly graded at surgery in all patients. Paired t test and McNemar test were used for data comparison. Kappa value was used to assess level of agreement between MRI findings and surgical findings.

RESULTS

Twenty-five (71 %) of 35 patients had good vascularity, four (11 %) had fair vascularity, and six (17 %) had poor vascularity of the proximal scaphoid fragment at surgery. DCE MRI parameters had the highest correlation with surgical findings (kappa = 0.57). Proximal scaphoid fragments with surgical poor vascularity had a significantly lower Emax and Eslope than those with good vascularity (p = 0.0043 and 0.027). The sensitivity, specificity, positive and negative predictive value and accuracy of DCE MRI in predicting impaired vascularity was 67, 86, 67, 86, and 80 %, respectively, which was better than that seen with unenhanced and post-contrast MRI. Flattened time intensity curves in both proximal and distal fragments were a feature of protracted non-union with a mean time interval of 101.6 ± 95.5 months between injury and MRI.

CONCLUSIONS

DCE MRI has a higher diagnostic accuracy than either non-enhanced MRI or contrast enhanced MRI for assessing proximal fragment vascularity in scaphoid delayed-union and non-union. For proper interpretation of contrast-enhanced studies in scaphoid vascularity, one needs to incorporate the time frame between injury and MRI.

Alterations of bone geometry, density, microarchitecture, and biomechanical properties in systemic lupus erythematosus on long-term glucocorticoid: a case-control study using HR-pQCT

Compared to controls, HR-pQCT at distal radius of SLE patients on chronic glucocorticoid (SLE/GC) revealed reduced bone area, vBMD, deteriorated microarchitecture, and unevenly distributed stresses limited to cortical bone. Despite similar trabecular quality, whole bone strength decreased in patients. These alterations may partly explain high fracture rates in SLE/GC.

INTRODUCTION

To assess bone geometric, densitometric, microarchitectural, and biomechanical properties in patients with systemic lupus erythematosus (SLE) on long-term glucocorticoid (GC) (SLE/GC) as compared with healthy controls.

METHODS

A total of 180 female SLE patients and 180 healthy controls were in this cross-sectional study to assess areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry. High-resolution peripheral quantitative computed tomography (HR-pQCT) and microfinite element analysis (μFEA) was performed at distal radius.

RESULTS

In addition to significantly lower aBMD at femoral neck, total hip and lumbar spine, cortical area, average volumetric BMD (vBMD) and cortical vBMD also significantly reduced by 5.3, 5.7, to 1.9 % in SLE patients, respectively. Deteriorations of cortical microarchitecture were pronounced in patients, with 6.3 % reduction in cortical thickness and 13.6 % higher in cortical porosity. Local stresses were more unevenly distributed through cortical bone in patients. SLE/GC patients had decreased whole bone stiffness, estimated failure load, and apparent modulus. Parameters related to trabecular bone density and microarchitecture were comparable between patients and controls.

CONCLUSION

In SLE/GC patients, despite a reduction in bone area, vBMD and deteriorated microarchitecture and unevenly distributed stresses limited to the cortical compartment, whole bone strength decreased. HR-pQCT and μFEA were promising in elucidating the potential underlying pathophysiology of bone loss and propensity to fracture in SLE/GC and provide us additional information about alterations of bone quality which might better predict fracture risk beyond aBMD in SLE/GC.

Prevalence and sex difference of lumbar disc space narrowing in elderly chinese men and women: osteoporotic fractures in men (Hong Kong) and osteoporotic fractures in women (Hong Kong) studies

OBJECTIVE

Osteoporotic Fractures in Men (Hong Kong) and Osteoporotic Fractures in Women (Hong Kong) represent the first large-scale prospective population-based studies on bone health in elderly (age≥65 years) Chinese men (n=2,000) and women (n=2,000). We undertook the current study to investigate the prevalence of lumbar disc space narrowing in these subjects, and to identify the potential relationship between disc space narrowing and sex, bone mineral density (BMD), and other demographic and clinical data.

METHODS

On lumbar lateral radiographs, L1/L2-L4/L5 disc space was classified into 4 categories: 0=normal; 1=mild narrowing; 2=moderate narrowing; 3=severe narrowing. We compared demographic and clinical data between subjects with and those without total disc space narrowing scores≥3.

RESULTS

Disc space narrowing was more common in elderly women than in elderly men. The mean±SD disc space narrowing score for the 4 discs was 2.71±2.21 for men and 3.08±2.50 for women (P<0.0001). For the 3 age groups of 65-69 years, 70-79 years, and ≥80 years, the average disc space narrowing score increased with increasing age in both men and women, and to a greater degree in women than in men. The average disc space narrowing score differences between women and men were 0.12, 0.40, and 0.90, respectively, in the 3 age groups. For both men and women, a disc space narrowing score≥3 was associated with older age, higher spine and hip BMD, low back pain, and restricted leg mobility.

CONCLUSION

The prevalence and severity of disc space narrowing are higher in elderly women than in elderly men. With increasing age, disc space narrowing progresses at a greater rate in women than in men. A disc space narrowing score≥3 is associated with higher spine and hip BMD.

Structure and strength of the distal radius in female patients with rheumatoid arthritis: a case-control study

The purpose of this work was to investigate the volumetric bone mineral density (vBMD), bone microstructure, and mechanical indices of the distal radius in female patients with rheumatoid arthritis (RA). We report a cross-sectional study of 66 middle-aged female RA patients and 66 age-matched healthy females. Areal BMD (aBMD) of the hip, lumbar spine, and distal radius was measured by dual-energy X-ray absorptiometry (DXA). High-resolution peripheral quantitative computed tomography (HR-pQCT) was performed at the distal radius, yielding vBMD, bone microstructure, and mechanical indices. Cortical and trabecular vBMD were 3.5% and 10.7% lower, respectively, in RA patients than controls, despite comparable aBMD. Trabecular microstructural indices were -5.7% to -23.1% inferior, respectively, in RA patients compared to controls, with significant differences in trabecular bone volume fraction, separation, inhomogeneity, and structural model index. Cortical porosity volume and percentage were 128% and 93% higher, respectively, in RA patients, with stress being distributed more unevenly. Fourteen RA patients had exaggerated periosteal bone apposition primarily affecting the ulnovolar aspect of the distal radius. These particular patients were more likely to have chronic and severe disease and coexisting wrist deformity. The majority of the differences in density and microstructure between RA patients and controls did not depend on menstrual status. Recent exposure to glucocorticoids did not significantly affect bone density and microstructure. HR-pQCT provides new insight into inflammation-associated bone fragility in RA. It detects differences in vBMD, bone microstructure, and mechanical indices that are not captured by DXA. At the distal radius, deterioration in density and microstructure in RA patients involved both cortical and trabecular compartments. Excessive bone resorption appears to affect cortical more than trabecular bone at distal radius, particularly manifested as increased cortical porosity. Ulnovolar periosteal apposition of the distal radius is a feature of chronic, severe RA with wrist deformity.

Accelerated T1rho relaxation quantification in intervertebral disc using limited spin-lock times

OBJECTIVE

T1rho relaxation measurement has the potential to identify early biochemical changes in the intervertebral disc. Traditionally, multiple spin-lock times (SLT), often ~5 SLTs, are used to ensure the accuracy and robustness of T1rho mapping. It will be advantageous to use fewer SLT points if comparable accuracy of T1rho mapping can be achieved. In this study, the feasibility of using 3 SLT points to measure intervertebral disc T1rho relaxation time is explored.

MATERIALS AND METHODS

The lumbar spine of 12 subjects (age range: 30-75 years, disc =60) were studied on 3-T MRI. For T1rho measurement, a rotary echo spin-lock pulse was implemented in a 3D balanced fast field echo (b-FFE) sequence. Spin-lock frequency was set as 500 Hz and the SLTs of 1, 10, 20, 40, and 60 ms were acquired. T1rho maps were generated by fitting each pixel's intensity as a function of SLT using a non-negative least-square fitting algorithm. Images were analysed in the mid-sagittal section. T1rho maps were re-constructed using all 5 SLT points of 1, 10, 20, 40, and 60 ms, and three SLT points of 1, 20, and 60 ms respectively. ROIs included nucleus pulposus (NP), anterior annulus fibrosus (AF) and posterior annulus fibrosus. Values of anterior AF and posterior AF were averaged as the value for AF. Agreement of T1rho measurements using different SLT points was assessed using intra-class correlation coefficient (ICC) on absolute agreement as well as Bland and Altman plot.

RESULTS

There was no significant difference for T1rho values by 5-SLT measurement and 3-SLT measurement in both NP (P=0.63) and AF (P=0.31). The ICC for 5-SLT T1rho measurement vs. 3-SLT T1rho measurement was 0.991 and 0.981 respectively for NP and AF T1rho time. The Bland and Altman plots for the comparison showed a mean difference of 3.14 and 1.83 for NP and AF respectively. Polling the T1rho values for NP and AF in 60 discs together, the ICC for 5-SLT T1rho measurement vs. 3-SLT T1rho measurement was 0.993, and the Bland and Altman analysis showed a mean difference of 2.56.

CONCLUSIONS

This study suggests that adopting 3 SLTs of 1, 20, and 60 ms can be an acceptable alternative for the disc T1rho measurement.

Prevalence and risk factors of radiographic vertebral fractures in elderly Chinese men and women: results of Mr. OS (Hong Kong) and Ms. OS (Hong Kong) studies

This study investigated the prevalence of radiographic vertebral fractures using Genant's semiquantitative (SQ) scoring system in elderly Chinese men (n = 2,000; mean age, 72.4 years) and women (n = 2,000; mean age, 72.6 years). Vertebral deformities had similar prevalence in elderly men (14.9 %) and women (16.5 %). Majority of the deformities in men were mild (9.9 %, grade = 1). The prevalence of vertebral fractures (grade ≥ 2) was 5.0 % among men and 12.1 % among women.

INTRODUCTION

Vertebral fracture is a serious consequence of osteoporosis and is often under-diagnosed. Researches on different ethnicities and territories to estimate the prevalence of vertebral fractures and to identify the risk factors are necessary.

METHODS

Mr. OS (Hong Kong) and Ms. OS (Hong Kong) represent the first large-scale cohort studies ever conducted on bone health in elderly Chinese men (n = 2,000) and women (n = 2,000). The current study investigated the prevalence of radiographic vertebral fractures in these subjects using Genant's SQ scoring system and identified risk factors for vertebral fractures.

RESULTS

The radiographs of all men (mean age, 72.4 years) and women (mean age, 72.6 years) were obtained. Six hundred twenty-seven subjects (15.7 %) had at least one vertebral deformity (SQ grade ≥ 1), including 297 men (14.9 %) and 330 women (16.5 %, p = 0.151). Three hundred forty-two participants (8.6 %) were defined as having at least one vertebra fracture (SQ grade ≥ 2), consisted of 100 men (5.0 %) and 242 women (12.1 %, p < 0.001). Older age, lower bone mineral density, lower physical activity, lower grip strength, fracture history, and low back pain were significantly associated with higher vertebral fracture rate for both men and women.

CONCLUSION

Vertebral deformity had similar prevalence in older men and women, while vertebral fracture was more common in women. Majority of deformities in men was mild. The vertebral deformity prevalence of women from this study is similar to previous reports of other East Asian women and Latin American women.

Phalangeal microgeodic disease: report of two cases and review of imaging

Phalangeal microgeodic disease is a rare disease that is frequently (though not invariably) related to cold exposure. In most cases, the clinical and radiographic findings of phalangeal microgeodic disease are sufficient to reach the diagnosis. The magnetic resonance imaging (MRI) findings of phalangeal microgeodic disease have been described in four cases in the English literature with two additional cases presented here. MRI allows a greater appreciation of affected bone areas and adds specificity to radiography with regard to diagnosis. In this sense, MRI is a helpful investigation in those cases of phalangeal microgeodic disease when doubt still exists following clinical and radiographic assessment.

MRI diagnosis of ACL bundle tears: value of oblique axial imaging

OBJECTIVE

To investigate the diagnostic accuracy of oblique axial intermediate weighting MR imaging in detecting partial thickness anterior cruciate ligament (ACL) bundle tears.

MATERIALS AND METHODS

The study protocol was approved by the institutional ethics committee. Sixty-one subjects (43 male, 18 female; mean age 27.4 years; range 9 to 57 years) with clinically suspected ACL tear or meniscal tear between September 2009 and January 2011 were studied with MRI and arthroscopy. Detection of partial tear for the ACL as a whole and for each ACL bundle by protocol A (standard orthogonal sequences) and protocol B (standard orthogonal sequences plus oblique axial intermediate weighted imaging) was compared in a blinded fashion. Performance characteristics for protocol A and protocol B were compared using sensitivity, specificity, accuracy and ROC curves. A two-tailed p value of <0.05 indicated statistical significance.

RESULTS

Fifteen (24.6%) normal, 15 (24.6%) partial and 31 complete tears were diagnosed by arthroscopy. Sensitivity, specificity and accuracy of protocol A for the diagnosis of partial tear of the ACL was 33%, 87% and 74%, while for protocol B the values were 87%, 87% and 87% respectively. The area under the curve (AUC) for the diagnosis of partial ACL tear and individual bundle tear was higher for protocol B, although this difference did not reach statistical significance (p > 0.05).

CONCLUSION

The addition of oblique axial imaging to standard MR imaging improves diagnostic accuracy for detecting partial tears of the ACL as well as individual bundle tears of the ACL.

Glenoid bone loss: assessment with MR imaging

PURPOSE

To investigate the agreement among magnetic resonance (MR) imaging, computed tomography (CT), and arthroscopy in the measurement of glenoid bone loss.

MATERIALS AND METHODS

This study was approved by the institutional ethics committee. One hundred seventy-six patients (158 male and 18 female patients; mean age, 26.8 years ± 12.3) with anterior shoulder dislocation underwent both shoulder MR imaging and CT examination. Anterior straight line length, glenoid width, and best-fit bone loss were measured with MR imaging and CT. Sixty-five patients also underwent arthroscopy, which was used as the standard of reference. Assessment of glenoid bone loss at MR imaging was compared with that at CT and arthroscopy. Inter- and intrareader reproducibility of MR imaging-derived measurements of glenoid bone loss was evaluated.

RESULTS

There was excellent correlation between CT and MR imaging with regard to anterior straight line length (r = 0.97, P < .0001), glenoid width (r = 0.95, P < .0001), and severity of glenoid bone loss-particularly with use of best-fit circle width (r = 0.83, P < .0001) rather than best-fit circle area (r = 0.82, P < .0001). In the assessment of glenoid bone loss, the correlation between CT and arthroscopy (r = 0.91, P < .0001) was marginally better than that between MR imaging and arthroscopy (r = 0.84, P < .0001). The inter- and intrareader correlations of MR imaging-derived measurements of glenoid bone loss were excellent (R = 0.90-0.95).

CONCLUSION

MR imaging assessment of glenoid bone loss, particularly with use of glenoid width, is almost as accurate as CT assessment.

Bone marrow perfusion of proximal femur varied with BMD--a longitudinal study by DCE-MRI

This study investigated bone marrow perfusion at proximal femur varying with bone mineral density (BMD) and aging over 4 years. Dynamic contrast enhanced MRI data was extracted pixel-by-pixel and classified into 3 patterns to indicate the perfusion function. Eighty-seven elderly females were involved. A notable reduced perfusion as a whole was observed in osteoporotic subjects. Moreover, perfusion distribution varies as BMD decreases, especially at the area crossing the femoral neck to the shaft. Consistent for all subjects, the perfusion decreases significantly from the lesser trochanter to the greater trochanter. Further, the subjects with good bone marrow perfusion would keep stable BMD after 4 years, while for those with bad perfusion, their BMD consistently decreased over 4 years. The results indicated that the bone marrow perfusion function interacts with bone modeling and could have a long term effect on BMD. A good perfusion function would help to keep the bone health.

Characteristics of rat lumbar vertebral body bone mineral density and differential segmental responses to sex hormone deficiency: a clinical multidetector computed tomography study

OBJECTIVE

To investigate sex hormone deficiency related osteoporosis and efficacy of different therapies.

METHODS

Orchiectomized and ovariectomized rat models are used to investigate sex hormone deficiency related osteoporosis and efficacy of different therapies. A rat vertebral body can be longitudinally divided into central portion, which contain more trabecular bone, and para-endplate portions which contain more compact bone. In matured male and female Wistar and Sprague-Dawley rat lumbar spines, we investigated baseline bone mineral density (BMD) characteristics and the differential segmental responses in bone loss within the lumbar vertebral body post gonadal surgery with clinical multidetector computed tomography.

RESULTS

Para-endplate sections had a higher BMD than central sections. The cephalad para-endplate sections had a higher BMD than the caudad para-endplate sections. Eight weeks after gonadal removal, there was more bone loss in central sections than para-endplate sections. The relative difference of bone loss between para-endplate and central sections was more apparent in male rats than in female rats. There was more bone loss in caudad sections than cephalad sections; this lead to a further increase of BMD difference between caudad para-endplate sections and cephalad para-endplate sections post gonadal surgery.

CONCLUSION

The approach described in this study provided a consistent way to study BMD change within predominantly compact bone portion and trabecular bone portion of the vertebral body.

Bone density and microarchitecture: relationship between hand, peripheral, and axial skeletal sites assessed by HR-pQCT and DXA in rheumatoid arthritis

We assessed the relationship of bone density and microarchitecture between hand, peripheral, and axial skeletal sites using high-resolution peripheral quantitative computed tomography (HR-pQCT) and dual-energy X-ray absorptiometry (DXA) in patients with rheumatoid arthritis (RA) and which factors influence these parameters. This was a cross-sectional study of 100 female patients (53.4 ± 9.3 years) with RA. HR-pQCT scans at distal radius and the second metacarpal head were performed to assess cortical and trabecular volumetric bone mineral density (vBMD) and microarchitecture. DXA scans at the hip, lumbar spine, and ultradistal radius were performed to assess areal BMD. There was significant correlation in vBMD and microarchitectural parameters between the second metacarpal head and distal radius (r = 0.201-0.628). Areal BMD at the axial skeleton was moderately associated with vBMD at the peripheral sites (r = 0.354-0.558). Factors related to disease severity/chronicity significantly correlated with vBMD and microarchitecture at the distal radius and the second metacarpal head. Factors related to disease activity were more likely to correlate with vBMD and microarchitecture at the second metacarpal head but not those at the distal radius. HR-pQCT is a promising technique that is capable of providing detailed quantitative assessment of disease-associated periarticular bone loss at both cortical and trabecular bone compartments in patients with RA. Future longitudinal studies will be needed to investigate whether assessment by HR-pQCT can be used as a marker of disease activity and a predictor of disease progression in RA.

Computerized quantification of bone tissue and marrow in stained microscopic images

Stained histological images assist physicians to identify different types of tissues or cells and their architectures. They can be applied on the diagnosis of various diseases and the assessment of treatment effects. Osteoporosis is an aging disease that reduces the density of bones and increases the risk of bone fracture. Literatures indicate that osteoporosis is associated with the ratio of trabecular bone tissues and bone marrow cells, and bones in osteoporosis patients consist of a significantly higher marrow fat content. Interactive segmentation of bone tissue and different types of bone marrow cells in high-resolution histological images, however, is a very tedious and labor-intensive process. The aim of this study is to develop an automatic algorithm to quantify the areas of different tissues such as the trabecular bones and yellow and red marrow cells. This image segmentation method consists of a series of mathematical morphological operation steps based on both the color and morphology features of tissues and was implemented in Matlab. The results obtained from the proposed method have been verified by comparing with those obtained interactively from an experienced histotechnician (Pearson correlation coefficient > 0.94, P < 0.001). The result suggests that the proposed algorithm can effectively assist physicians to quantify stained bone histological images.

T1rho and T2 relaxation times for lumbar disc degeneration: an in vivo comparative study at 3.0-Tesla MRI

OBJECTIVE

To determine the relative performance of T1rho and T2 relaxation times in disc degeneration assessment.

METHODS

Lumbar sagittal MRI was performed at 3 T in 52 subjects. With a spin-lock frequency of 500 Hz, T1rho was measured using a rotary echo spin-lock pulse embedded in a three-dimensional (3D) balanced fast field echo sequence. A multi-echo TSE sequence was used for T2 mapping. Regions of interest (ROIs) were drawn over the T1rho and T2 maps, including nucleus pulposus (NP) and annulus fibrosus (AF). Eight- and five-level disc degeneration semi-quantitative grading was performed.

RESULTS

For NP, T1rho and T2 decreased quadratically with disc degeneration grades and had no significant trend difference (P = 0.40). For AF, T1rho decreased linearly as the disc degenerated and had a slope of -3.02 and -4.56 for eight- and five-level gradings respectively; while the slopes for T2 values were -1.43 and -1.84 respectively, being significantly flatter than those of T1rho (P < 0.001). There was no significant difference in T1rho and T2 values for both NP and AF among discs of grade 5/8 to 8/8 degeneration.

CONCLUSION

T1rho is better suited for evaluating AF in degenerated disc than T2. In NP, T1rho and T2 decrease in a similar pattern following disc degeneration.

Comprehensive surface-based morphometry reveals the association of fracture risk and bone geometry

Surface-based morphometry method is advantageous in its objectivity and increased capability in detecting focal morphological changes, but has not been applied in bone-related research. Orthopedics research in human has confirmed the association of the bone geometry in proximal femur and its fracture. In this study, surface-based morphometry is used to test the hypothesis that there is relationship between bone geometry and fracture risk of the proximal sesamoid bone (PSB) in forelimbs of Thoroughbred racehorses. The PSB surfaces were extracted from CT images of nonfractured forelegs (i.e., right foreleg in this study) of 6 racehorses with fractures in the contralateral (i.e., left) foreleg, and the right forelegs of 6 matched controls. Significant differences were detected at the abaxial margin of the medial PSB base which was found to be up to 3.5 mm more prominent in the fracture-group compared to the control-group. This study demonstrated a successful application of computational morphometry in bone. The detected anatomical differences may lead to a larger moment arm generated via the medial branch of the suspensory apparatus, increasing pressure on the sesamoid surface, and thus potentially predisposing to fracture. Findings from this pilot study not only increase the likelihood of accurate PSB fracture risk assessment, but also shed light on investigating the influence of sports and exercise on human athletes.

New advances in imaging osteoporosis and its complications

Tremendous advances have been made over the past several decades in assessing osteoporosis and its complications. High resolution imaging combined with sophisticated computational techniques now provide a detailed analysis of bone structure and a much more accurate prediction of bone strength. These techniques have shown how different mechanisms of age-related bone weakening exist in males and females. Limitations peculiar to these more advanced imaging techniques currently hinder their adoption into mainstream clinical practice. As such, the ultimate quest remains a readily available, safe, high resolution technique capable of fully predicting bone strength, capable of showing how bone strength is faltering and precisely monitoring treatment effect. Whether this technique will be based on acquisition of spine/hip data or data obtained at peripheral sites reflective of changes happening in the spine and hip regions is still not clear. In the meantime, mainstream imaging will continue to improve the detection of osteoporosis related insufficiency fracture in the clinical setting. We, as clinicians, should aim to increase awareness of this fracture type both as a frequent and varied source of pain in patients with osteoporosis and as the ultimate marker of severely impaired bone strength.

Imaging and treatment of scaphoid fractures and their complications

The scaphoid is the most commonly fractured carpal bone, with frequent complications that are predisposed by its anatomical location, anatomical configuration (shape and length), and vascular supply. The most common mechanism of injury is a fall onto an outstretched hand. Imaging plays a significant role in the initial evaluation and treatment of scaphoid fractures and their complications. Radiography should be the first imaging modality in the initial evaluation and follow-up of scaphoid fractures. Computed tomography with its superb spatial resolution enables better visualization and characterization of the fracture line, and the amount of displacement and angulation of the fracture fragments. Using the metal reduction artifact with computed tomography allows good follow-up of scaphoid fractures despite surgical hardware. Magnetic resonance imaging without contrast is the imaging modality of choice for depiction of radiographically occult scaphoid fracture, bone contusion, and associated soft tissue injury; contrast-enhanced imaging aids assessment of scaphoid fracture nonunion, osteonecrosis, fracture healing after bone grafting, and revitalization of the necrotic bone after bone grafting. Proper identification and classification of scaphoid fracture and its complications is necessary for appropriate treatment. This article describes the normal anatomy, mechanism of injury, and classification of stable and unstable fractures, together with the imaging and treatment algorithm of scaphoid fractures and their complications with an emphasis on magnetic resonance imaging.

Vertebral body corner oedema vs gadolinium enhancement as biomarkers of active spinal inflammation in ankylosing spondylitis

OBJECTIVE

To investigate the relative performance of T(2) weighted short tau inversion-recovery (STIR) and fat-suppressed T(1) weighted gadolinium contrast-enhanced sequences in depicting active inflammatory lesions in ankylosing spondylitis (AS).

METHODS

Whole-spine MRI was performed on 32 patients with AS, who participated in a clinical trial of infliximab treatment, by STIR and contrast-enhanced sequences at baseline and after 30 weeks. The AS spine MRI-activity (ASspiMRI-a) scoring method was used. The images from these two imaging techniques were evaluated separately by two independent readers.

RESULTS

For the pre-treatment lesion status, the intraclass correlation coefficients comparing STIR readings and contrast-enhanced readings were 0.69±0.23 for Reader 1 and 0.65±0.21 for Reader 2. At baseline, the mean ASspiMRI-a score was 15.4% and 17.7% higher for contrast-enhanced images than for STIR images for Reader 1 and Reader 2, respectively. After infliximab treatment, Reader 1 rated an ASspiMRI-a score reduction of 50.8±33.6% and 25.3±35.3% for STIR images and contrast-enhanced images, respectively, whereas Reader 2 rated an ASspiMRI-a score reduction of 42.4±50.4% and 32.9±35.6% for STIR images and contrast-enhanced images, respectively.

CONCLUSION

While both contrast-enhanced and STIR sequences showed sensitivity to change over a short period of time after infliximab treatment, these two sequences may reflect different disease mechanisms.

Effectiveness of qPCR permutations, internal controls and dilution as means for minimizing the impact of inhibition while measuring Enterococcus in environmental waters

AIMS

  Draft criteria for the optional use of qPCR for recreational water quality monitoring have been published in the United States. One concern is that inhibition of the qPCR assay can lead to false-negative results and potentially inadequate public health protection. We evaluate the effectiveness of strategies for minimizing the impact of inhibition.

METHODS AND RESULTS

  Five qPCR method permutations for measuring Enterococcus were challenged with 133 potentially inhibitory fresh and marine water samples. Serial dilutions were conducted to assess Enterococcus target assay inhibition, to which inhibition identified using four internal controls (IC) was compared. The frequency and magnitude of inhibition varied considerably among qPCR methods, with the permutation using an environmental master mix performing substantially better. Fivefold dilution was also effective at reducing inhibition in most samples (>78%). ICs were variable and somewhat ineffective, with 54-85% agreement between ICs and serial dilution.

CONCLUSIONS

  The current IC methods appear to not accurately predict Enterococcus inhibition and should be used with caution; fivefold dilution and the use of reagents designed for environmental sample analysis (i.e. more robust qPCR chemistry) may be preferable.

SIGNIFICANCE AND IMPACT OF THE STUDY

  Suitable approaches for defining, detecting and reducing inhibition will improve implementation of qPCR for water monitoring.

Perfusion and bone mineral density as function of vertebral level at lumbar spine

The objective of this study is to characterize perfusion and bone mineral density (BMD) in the lumbar spine as a function of level and anatomic location. Fourteen male subjects with healthy vertebral endplates were selected to avoid gender and endplate disease influence. The bone perfusion and BMD of different vertebral level (L1-L4) were measured by the dynamic contrast enhancement MRI (DCE MRI) and the dual-energy X-ray absorptiometry (DXA) respectively. Perfusion parameters showed a significant negative correlation with upper to lower vertebral levels while inverse observation was found for BMD. The results indicated that the perfusion and BMD are as function of vertebral level and anatomic location at lumbar spine. The BMD varying with vertebral level may be determined by the biomechanical usage at the lumbar spine, where the lower levels sustain more mechanical forces. Perfusion changes along the lumbar spine level suggested that the bone marrow component could be different when BMD varies, which needs further histological verification.

Compromised perfusion in femoral head in normal rats: distinctive perfusion MRI evidence of contrast washout delay

OBJECTIVES

The femoral head is prone to osteonecrosis. This study investigated dynamic contrast-enhanced (DCE) MRI contrast washout features of the femoral head and compared the data with data from other bony compartments in normal rats.

METHODS

7-month-old Wistar rats were used. DCE MRI of the right hip (n=18), right knee (n=12) and lumbar spine (n=10) was performed after an intravenous bolus injection of Gd-DOTA (0.3 mmol kg(-1)). Temporal resolution was 0.6 s for hip and spine, and 0.3 s for knee. The total scan duration was 8 min for hip and spine, and 4.5 min for knee. The regions of interest for enhancement measurement included femoral head, proximal femoral diaphysis, distal femoral diaphysis and epiphysis, proximal tibial epiphysis and diaphysis, and lumbar vertebrae L1-5.

RESULTS

Femoral head showed no enhancement signal decay during the DCE MRI period, while all other bony compartments showed a contrast washin phase followed by a contrast washout phase. In the knee joint, the contrast washout of the proximal tibia diaphysis was slower that of other bony compartments of the knee.

CONCLUSION

Based on the evidence of delayed contrast washout, this study showed that blood perfusion in the femoral head could be compromised in normal rats.

TENOSYNOVIAL OSTEOCHONDROMATOSIS OF BOTH FLEXOR AND EXTENSOR TENDONS

An unusual case of a 52-year-old woman with tenosynovial osteochondromatosis involving both of the wrist flexor and extensor tendons is reported.

ULTRASOUND FOR THE DETECTION OF VEGETATIVE FOREIGN BODY IN HAND — A CASE REPORT

Foreign bodies in soft tissues are commonly encountered in daily orthopaedic practice. While most of the metals and glass foreign bodies can be detected by plain radiograph, organic substances such as wood and vegetative materials are radiolucent. Unfortunately, these radiolucent foreign bodies are usually more prone to cause an inflammatory reaction and infection. The detection can be even more difficult in cases of multiple foreign bodies and in penetrating injuries with small innocuous skin wounds. Ultrasonography is a sensitive and reliable investigation for detection of foreign bodies in soft tissue. We present a case of penetration injury to thumb with residual radiolucent foreign bodies and demonstrate the proper role of ultrasonography in the management of foreign bodies in soft tissues.

Relationship between hip bone mineral density and lumbar disc degeneration: a study in elderly subjects using an eight-level MRI-based disc degeneration grading system

PURPOSE

To study the relationship between hip bone mineral density (BMD), lumbar disc degeneration, and lumbar disc space narrowing in elderly subjects.

MATERIALS AND METHODS

The study cohort comprised 196 females and 163 males (age range, 67-89 years) with no age difference between the two groups. Anteroposterior total hip areal BMD was measured with DXA and lumbar spine MRI was acquired using a 1.5 Tesla scanner. Lumbar disc degeneration was assessed using an eight-level grading system wherein each grade represents a stepwise progression from normal disc to severe disc degeneration and disc space narrowing.

RESULTS

After controlling for the age effect, no significant relationship was observed between total hip T-score status and severity of disc degeneration. There was no significant difference in total hip BMD in the subjects with or without the disc space narrowing (P < 0.05). Female subjects are more likely to have a narrowed disc space than males at all levels, and being statistically significant at L3/4 and L4/5 levels, and with an overall significance of P = 0.007.

CONCLUSION

There was no association observed between hip BMD and lumbar disc degeneration. Elderly females were more likely to have a narrowed lumbar disc space than elderly males.

Statistical analysis of bone mineral density using voxel-based morphometry-an application on proximal sesamoid bones in racehorses

Voxel-based morphometry (VBM) is a computational technique that has been used to analyze statistical differences between groups of MR brain images. This study outlines a new VBM pipeline, designed for determining statistical variation in bone mineral density (BMD). CT images of proximal sesamoid bone (PSB) specimens from the right forelimb of six racehorses that had suffered PSB fractures were compared with six age-matched control specimens. Following segmentation, masked gray-scale images were co-aligned to a statistical template generated with all 12 CT datasets iteratively. Student t-tests were performed voxel-by-voxel on spatially aligned 3D images to reveal significant differences in the spatial variation of bone density between the fracture and control groups. Overall density and densities from the axial and abaxial areas of PSBs were compared between groups. The BMD in abaxial regions of the medial and lateral PSBs of the fracture group were 12.7% (p = 0.044) and 13.5% (p = 0.047) higher, respectively, than controls. The overall mean density of paired PSB and the medial and lateral PSBs separately were higher in the fracture group. The VBM pipeline facilitates detailed comparison of density variation between bone groups at the voxel level.

Intravascular papillary endothelial hyperplasia: report of two cases

Intravascular papillary endothelial hyperplasia is a rare benign vascular proliferative process as a result of papillary proliferation of the endothelial cells within the vascular lumen. We report two cases of intravascular papillary endothelial hyperplasia affecting the extremities. The characteristic sonological and MR imaging features are discussed, with updated review of literature. Imaging features are helpful in achieving a definitive diagnosis of the intravascular papillary endothelial hyperplasia.

New imaging modalities in bone

The digital era has witnessed an exponential growth in bone imaging as new modalities and analytic techniques improve the potential for noninvasive study of bone anatomy, physiology, and pathophysiology. Bone imaging very much lends itself to input across medical and engineering disciplines. It is in part a reflection of this multidisciplinary input that developments in the field of bone imaging over the past 30 years have in some respects outshone those in many other fields of medicine. These developments have resulted in much deeper knowledge of bone macrostructure and microstructure in osteoporosis and a much better understanding of the subtle changes that occur with age, concurrent disease, and treatment. This new knowledge is already being translated into improved day-to day clinical care with better recognition, treatment, and monitoring of the osteoporotic process. As "the more you know, the more you know you don't know" certainly holds true with osteoporosis and bone disease, there is little doubt that further advances in bone imaging and analytical techniques will continue to hold center stage in osteoporosis and related research.

A real-time qPCR assay for the detection of the nifH gene of Methanobrevibacter smithii, a potential indicator of sewage pollution

AIMS

To develop a quantitative, real-time PCR assay to detect the nifH gene of Methanobrevibacter smithii. Methanobrevibacter smithii is a methanogenic archaea found in the intestinal tract of humans that may be a useful indicator of sewage pollution in water.

METHODS AND RESULTS

Quantification standards were prepared from Meth. smithii genomic DNA dilutions, and a standard curve was used to quantify the target gene and calculate estimated genome equivalency units. A competitive internal positive control was designed and incorporated into the assay to assess inhibition in environmental extracts. Testing the assay against a panel of 23 closely related methanogen species demonstrated specificity of the assay for Meth. smithii. A set of 36 blind water samples was then used as a field test of the assay. The internal control identified varying levels of inhibition in 29 of 36 (81%) samples, and the Meth. smithii target was detected in all water samples with known sewage input.

CONCLUSIONS

The quantitative PCR assay developed in this study is a sensitive and rapid method for the detection of the Meth. smithii nifH gene that includes an internal control to assess inhibition. Further research is required both to better evaluate host specificity of this assay and the correlation with human health risks.

SIGNIFICANCE AND IMPACT OF THE STUDY

This research is the first description of the development of a rapid and sensitive quantitative assay for a methanogenic archaeal indicator of sewage pollution.

Color quantification for evaluation of stained tissues

The objective evaluation of the color and shade in stained images remains unsolved and is frequently and extensively encountered in biomedical studies. Most of the evaluations on the color and shade in the stained images are currently performed by subjective grading, which is prone to be affected by inter-reader variation. This paper introduces a novel approach to automatically quantify the color and shade in the stained histological image based on its similarity map in the CIELAB color space with respect to a user specified reference color. The proposed algorithm was applied on three datasets, i.e., a phantom image, the Prussian blue staining of human osteosarcoma cell culture, and histological sections of the Prussian blue stained rat kidney, liver and spleen. The result shows that our method is able to represent the color and shade as a numerical value that correlated well with human perception.

Prediction of bone loss in elderly female subjects by MR perfusion imaging and spectroscopy

OBJECTIVE

To determine whether MR perfusion indices or marrow fat content at baseline can predict areal bone mineral density (BMDa) loss.

METHODS

Repeat dual x-ray absorptiometry (DXA) of the hip was performed in female subjects at 2 years (n = 52) and 4 years (n = 45) following baseline MR perfusion imaging and spectroscopy of the hip.

RESULTS

Percentage reduction in femoral neck BMDa at 4 years post-baseline was greater in subjects with below median acetabulum enhancement slope (E(slope)) (-5.6 ± 1.2 Vs -1.1 ± 1.2 (mean ± standard error) p = 0.014) or muscle maximum enhancement (E(max)) (-5.7 ± 1.2 Vs -0.23 ± 1.2, p = 0.009) after adjusting for baseline co-variables. Baseline MR parameters correlated with reduction in BMDa at 4 years (acetabulum E(slope) r = 0.517, p = 0.0003; muscle E(max) r = 0.306, p = 0.043) as well as traditionally applied clinical risk factors. Acetabulum E(slope), femoral neck E(max) and marrow fat content at baseline had sensitivities of 89%, 81% and 72% respectively at distinguishing between fast (>1%/annum) (n = 18) and slow (<1%/annum) (n = 27) BMD losers.

CONCLUSION

Elderly female subjects with reduced perfusion indices at baseline had increased femoral neck bone loss at 4 years. Selected perfusion indices and marrow fat content have a moderate to high sensitivity in discriminating between fast and slow bone losers.

Relationship between gender, bone mineral density, and disc degeneration in the lumbar spine: a study in elderly subjects using an eight-level MRI-based disc degeneration grading system

The study cohort comprised 196 females and 163 males. Lumbar spine bone mineral density (BMD) and magnetic resonance imaging (MRI) were acquired. Females had more severe disc degeneration than males. Lumbar spine lower BMD was associated with less severe disc degeneration. Lumbar disc spaces were more likely to be narrower when vertebral BMD was higher.

INTRODUCTION

The purpose of this paper is to study the relationship between gender, BMD, and disc degeneration in the lumbar spine.

METHODS

The study cohort comprised 196 females and 163 males (age range 67-89 years) with no age difference between the two groups. Lumbar spine BMD was measured with dual X-ray densitometry, and MRI was acquired at 1.5 T. A subgroup of 48 males had additional lumbar vertebral quantitative computerized tomography densitometry. Lumbar disc degeneration was assessed using a MRI-based eight-level grading system.

RESULTS

Female subjects had more severe disc degeneration than male subjects. After removing age effect, a positive trend was observed between T-score and severity of lumbar disc degeneration. This was significant in female subjects while not significant in male subjects. Lumbar disc spaces were more likely to be narrowed when vertebral BMD was higher. These observations were more significant in the midlumbar region (L3/4 and L4/5) and less so at the thoracolumbar junction.

CONCLUSION

Female subjects tended to have slightly more severe lumbar disc degeneration than male subjects. Lower lumbar spine BMD was associated with less severe disc degeneration.

Ibandronate increases cortical bone density in patients with systemic lupus erythematosus on long-term glucocorticoid

INTRODUCTION

The purpose of this research is to assess the effects of oral ibandronate on bone microarchitecture by using high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with systemic lupus erythematosus (SLE) taking a long-term glucocorticoid.

METHODS

In this double-blind placebo-controlled study, 40 Chinese female SLE patients taking prednisolone were randomly assigned to receive either monthly oral ibandronate (150 mg) or placebo with daily 1-hydroxycholecalciferol (Alfacalcidol; 1 μg) and calcium supplement for 12 months. Assessments of bone microarchitecture by using HR-pQCT and area bone mineral density (aBMD) of the lumbar spine and hip with dual-energy x-ray absorptiometry (DXA) were performed at baseline and 12 months.

RESULTS

No differences in baseline characteristics were found between the two groups. After 12 months, no statistical differences were noted in any of the bone densities, microarchitectural parameters, or percentage changes of these parameters, as measured with HR-pQCT or DXA between the two groups. However, within the active group, the percentage improvement was significant in cortical bone density (P = 0.023) which was absent in the placebo group. Improvement was also seen in the aBMD of both the lumbar spine (P < 0.0001) and the hip (P < 0.005). In the placebo group, the percentage increase in trabecular separation was significant (P = 0.04), and the percentage improvement in aBMD in the spine also was significant (P = 0.049).

CONCLUSIONS

Oral ibandronate treatment improves microarchitecture in SLE patients taking long-term glucocorticoid assessed with HR-pQCT, and this new technology may have a role in assessing bony changes in future longitudinal studies in SLE patients.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00668330.

Fast and accurate 3-D registration of HR-pQCT images

High-resolution peripheral quantitative computed tomography (HR-pQCT) is a new noninvasive bone imaging technology that generates high-resolution 3-D images for quantitatively analysis of the bone microarchitecture in human. To enable quantitative evaluation of bone changes, either bone gain or loss, accurate alignment between the baseline and follow-up scans of the same individual is necessary. The major difficulties in achieving efficient and automatic registration of the HR-pQCT data are the large data size, deformations in the nonskeletal structures, and the complexity of the trabecular bone geometry. In this paper, we propose an automatic surface-based approach for fast and accurate registration of the HR-pQCT data, where the rigid registration is applied on the surfaces of the bony structures extracted from the grayscale HR-pQCT. The bony structure segmentation is performed via an automatic method that can adaptively determine the thresholds for separating the bony structure from the background and nonskeletal tissues. Experimental results performed on ten pairs of baseline and follow-up wrist scans of five adolescents and five elderly patients with osteoporosis showed the advantage of the proposed method in the high degree of automation, while the resultant parameters describing bone mineral density and trabecular architecture after registration were comparable with the outputs of the scanner's software. This automatic and accurate matching procedure may contribute to the clinical application and research of HR-pQCT.

Vertebral fracture

Vertebral fractures are usually the first to occur in osteoporosis, provide indisputable evidence of reduced bone strength, and are frequently a harbinger of further vertebral and nonvertebral fracture. Radiologists are best placed to draw attention to the presence of vertebral fractures, most of which are clinically silent. Magnetic resonance imaging supplemented if necessary by computed tomography is usually sufficient to enable distinction between osteoporotic and non-osteoporotic vertebral fracture, without a need for percutaneous biopsy.

Small field-of-view surface coil mr imaging of talar osteochondral lesions

BACKGROUND

Osteochondral lesion (OCL) treatment is based on patient symptoms, lesion size, and lesion stability. MRI of talar OCL identifies the presence and the characteristics of the lesion and attempts to establish lesion stability. We report our experience that the depiction of OCL can be improved by using a small field-of-view (FOV) surface coil.

MATERIALS AND METHODS

We studied 24 patients (25 lesions) with OCLs of the talar dome. Standard FOV MRI followed by small FOV MRI of the ankle was performed at 1.5-T. Standard FOV MRI was taken using a quadrature knee coil or a 21 cm x 53 cm circularly flexible coil. A 4-cm circular polarized receiver surface coil was used for small FOV imaging. Twelve aspects characteristics of OCLs were assessed, including lesion matrix, margin characteristics, lesion cortical surface, cartilage surface, cartilage depth, cartilage signal, cartilage integrity, and osteochondral gap.

RESULTS

Small FOV MRI provided more detailed morphological information of talar OCL. The following differences were noted. Small FOV coil imaging reclassified cortical surface from flush to depressed in seven cases and from unclear in two cases to flush in one case and proud in the other. Small FOV coil imaging reclassified cartilage integrity from unclear to intact in 16 cases and from unclear to fracture in three cases. For assessment of osteochondral gap, small FOV coil MR imaging reclassified from absent to present in two cases and from unclear to absent in one case. For osteochondral fragment, small FOV coil MR imaging reclassified assessment from absent to present in three cases and from unclear to absent in three cases.

CONCLUSION

Small FOV coil improved visualization of the talar OCL.