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Daffinà J, Monti R, Arrigoni F, Bruno F, Palumbo P, Splendiani A, Di Cesare E, Masciocchi C, Barile A. MR Imaging of the Lower Limb: Pitfalls, Tricks, and Tips. Radiol Clin North Am 2023; 61:375-380. [PMID: 36739151 DOI: 10.1016/j.rcl.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of this article is to discuss most common diagnostic pitfalls of the lower limb with specific attention to the knee, ankle, and foot joints. The knowledge of normal anatomic variants, correlation with age, symptoms, and medical history together with these potential MR imaging pitfalls is fundamental for an accurate interpretation of the imaging findings of the lower limb.
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Affiliation(s)
- Julia Daffinà
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Riccardo Monti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Federico Bruno
- San Salvatore Hospital, Via Lorenzo Natali 1, L'Aquila 67100, Italy.
| | | | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Blythe CS, Reynolds MS, Gregory LS. Quantifying the ossification and fusion of the calcaneal apophysis using computed tomography. J Anat 2022; 241:484-499. [PMID: 35468228 PMCID: PMC9296023 DOI: 10.1111/joa.13677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/04/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022] Open
Abstract
Knowledge of the anatomical development of the calcaneal apophysis is essential in clinical assessment and management of both paediatric and sub‐adult patients presenting with heel pain. Despite this, the current understanding of calcaneal apophyseal development is constrained by the limitations of the imaging modalities used to examine the apophysis, with no current literature reporting the development of the medial and lateral processes. This study aimed to overcome these limitations by investigating the ossification and fusion of the calcaneal apophysis using three‐dimensional computed tomography analysis, and statistically predicting the apophyseal developmental stage in contemporary Australian children. The development and fusion status of the apophysis was scored using a novel 11‐stage scoring system on 568 multi‐slice computed tomography scans (295 females; 274 males) and 266 lateral radiographic scans (119 females; 147 males) from the Queensland Children's Hospital. Multinomial logistic regression along with classification tables and predictive probabilities were then utilised to assess developmental stage likelihood from known age and sex. The apophysis commenced ossification at a mean age of 5.2 years for females and 7.2 years for males, and then elongated to form the apophyseal cap around 10 years for females and 12.4 years for males. Fusion of the apophysis commenced at a mean age of 11.18 years for females and 13.3 years for males, with the earliest age of complete fusion observed at 10 years for females and 14 years for males. The results demonstrate significant sexual dimorphism in ossification and fusion with females developing and fusing significantly earlier. Furthermore, the use of computed tomography in this study allowed for the first time evaluation of the ossification and fusion of the medial and lateral processes of the calcaneus. The medial process formed at a mean age of 9.5 years for females and 10.9 years for males while the lateral process formed at around 9.8 years for females and 11.7 years for males. The medial process demonstrated slower rates of fusion compared to the lateral process. The present study provides Queensland specific standards for assessing the calcaneal apophyseal developmental stage as well as novel predictive regression models for apophyseal stage estimation using known age and sex to aid in the diagnosis of heel pain conditions such as apophysitis or screen for developmental delays in children and subadults.
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Affiliation(s)
- Connor S Blythe
- Clinical Anatomy and Paediatric Imaging Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mikaela S Reynolds
- Clinical Anatomy and Paediatric Imaging Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Laura S Gregory
- Clinical Anatomy and Paediatric Imaging Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Gall N, Boiocchi S, Bourbos A. Bilateral calcaneal epiphysiolysis in a Dobermann puppy presenting for a unilateral femoral fracture. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nick Gall
- Langford Veterinary Services Langford Bristol UK
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Walter WR, Goldman LH, Rosenberg ZS. Pitfalls in MRI of the Developing Pediatric Ankle. Radiographics 2020; 41:210-223. [PMID: 33216674 DOI: 10.1148/rg.2021200088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Normal skeletal development in the pediatric ankle is dynamic and often produces variable imaging appearances that are subject to misinterpretation. Radiologists must understand the underlying developmental phenomena, such as endochondral and membranous ossification and physeal fusion, and be familiar with their common and uncommon imaging manifestations unique to the pediatric ankle. This is especially true as the use of MRI in the evaluation of musculoskeletal trauma expands among younger populations. The authors focus on MRI evaluation of the skeletally maturing pediatric ankle and present pearls for accurately distinguishing normal findings and imaging pitfalls from true pathologic findings. The normal but often variable imaging findings of preossification, secondary ossification, and multiple ossification centers, as well as the range of bone marrow signal intensities that can be visualized within ossification centers, are described, along with tips to help differentiate these from true pathologic findings such as contusion, fracture, or tumor. The authors also review dynamic periosteal and physeal contributions to bone growth to highlight helpful distinguishing features and avoid misdiagnosis of common subperiosteal and periphyseal abnormalities. For example, the normal trilaminar appearance of the immature cortex and periosteum should not be mistaken for periosteal reaction, traumatic stripping, or subperiosteal hematoma. In addition, the physis can have several confusing but normal appearances, including normal physeal undulations (eg, Kump bump) or focal periphyseal edema, which should not be mistaken for pathologic findings such as physeal fracture, infection, or bar. ©RSNA, 2020.
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Affiliation(s)
- William R Walter
- From the Department of Radiology, NYU Langone Health, 301 E 17th St, 6th Floor, New York, NY 10003
| | - Lauren H Goldman
- From the Department of Radiology, NYU Langone Health, 301 E 17th St, 6th Floor, New York, NY 10003
| | - Zehava S Rosenberg
- From the Department of Radiology, NYU Langone Health, 301 E 17th St, 6th Floor, New York, NY 10003
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Gao Y, Liu J, Li Y, Liu Q, Xu S. Radiographic study of Sever's disease. Exp Ther Med 2020; 20:933-937. [PMID: 32742336 PMCID: PMC7388271 DOI: 10.3892/etm.2020.8796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/13/2019] [Indexed: 11/06/2022] Open
Abstract
X-ray and MRI differences of calcaneal epiphysis between Sever's disease patients and normal children were compared and analyzed to raise awareness of Sever's disease. A total of 98 children with Sever's disease were enrolled in the study, including 72 males and 26 females. Among them, 6 patients underwent MRI. There were 120 patients in the control group, including 73 males and 47 females, aged 8 to 15 years. The calcaneus epiphysis density (compact and cancellous bone type), the difference of the radiolucent line and the signal changes of Sever's disease on MRI of the two groups were observed and analyzed. Among the patients with Sever's disease, the male incidence rate was 79.59%, the female incidence rate was 20.41%, the average age of onset was 11.35, the average age of onset for male was 11.49, and the average age of onset for female was 10.80. There were significant statistical differences between the two groups in terms of epiphysis density (compact and cancellous type) and translucent line (χ2=38.85, 137.51, P<0.05). Six cases of MRI showed partial or complete different degrees of bone marrow, ligament, soft tissue edema, and joint effusion. Sever's disease is mainly characterized by increased density of the calcaneus epiphysis and a radiolucent line of the epiphysis. It manifests as heel edema on MRI image.
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Affiliation(s)
- Yan Gao
- Department of Radiology, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Jia Liu
- MRI Room, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Yifang Li
- MRI Room, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Qing Liu
- MRI Room, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Shuhua Xu
- Department of Radiology, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
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Lallemand S, Laredo J. Heel Pain in a Young Patient—Calcaneal Involvement in Juvenile Spondyloarthritis. Arthritis Rheumatol 2019; 71:831. [DOI: 10.1002/art.40839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pombo B, Ferreira AC, Costa L. Bohler Angle and the Crucial Angle of Gissane in Paediatric Population. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2019; 12:1179544119835227. [PMID: 30890861 PMCID: PMC6416676 DOI: 10.1177/1179544119835227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/28/2019] [Indexed: 11/24/2022]
Abstract
Bohler angle and the crucial angle of Gissane are used on the evaluation of
calcaneus fractures. However, few authors have described the variation of the
angles when the calcaneus is growing. In this study, Bohler angle and the
crucial angle of Gissane in paediatric population were measured using lateral
foot radiographs of 429 patients, from 0 to 16 years of age. The control group
was composed of 70 adult patients. The sample had a mean Bohler angle of
35.4° ± 5.9° and a mean crucial angle of Gissane of 110.5° ± 7.4°. The greater
mean difference was identified for Bohler angle (8°) in the age group of 5 to
8 years (39.6° ± 5.7°) and for the crucial angle of Gissane (5°-6°) in the age
group of 0 to 4 years (115.8° ± 7.3) (P < .05). The
influence of the ossification centres on the geometry of the calcaneus across
age groups makes Bohler angle and the crucial angle of Gissane higher in young
children. The increase in Bohler angle points out the relative development of
the posterior facet in young children and the importance of the reconstruction
of the posterior facet height in the intra-articular calcaneus fractures. Level of Evidence: Diagnostic study; Level III.
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Affiliation(s)
- Bruno Pombo
- Department of Orthopaedics, Centro Hospitalar do Porto, Porto, Portugal
| | | | - Luís Costa
- Foot and Ankle Unit, Department of Orthopaedics, Centro Hospitalar do Porto, Porto, Portugal
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The Calcaneal Crescent in Patients With and Without Plantar Fasciitis: An Ankle MRI Study. AJR Am J Roentgenol 2018; 211:1075-1082. [PMID: 30160979 DOI: 10.2214/ajr.17.19399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The bundled, crescent-shaped trabeculae within the calcaneal tuberosity-which we term and refer to here as the "calcaneal crescent"-may represent a structural adaption to the prevailing forces. Given Wolff law, we hypothesized that the calcaneal crescent would be more robust in patients with plantar fasciitis, a syndrome in part characterized by overload of the Achilles tendon-calcaneal crescent-plantar fascia system, than in patients without plantar fasciitis. MATERIALS AND METHODS MR images of 37 patients (27 women and 10 men; mean age ± SD, 51 ± 13 years; mean body mass index [BMI, weight in kilograms divided by the square of height in meters], 26.8 ± 6.3) referred for workup of foot or ankle pain were retrospectively evaluated by two blinded readers in this study. Patients were assigned to two groups: group A, which was composed of 15 subjects without clinical signs or MRI findings of Achilles tendon-calcaneal crescent-plantar fascia system abnormalities, or group B, which was composed of 22 patients with findings of plantar fasciitis. The thickness and cross-sectional area (CSA) of the Achilles tendon, calcaneal crescent, and plantar fascia were measured on proton density (PD)-weighted MR images. The entire crescent volume was manually measured using OsiriX software on consecutive sagittal PD-weighted images. Additionally, contrast-to-noise ratio (CNR) as a surrogate marker for trabecular density and the mean thickness of the calcaneal crescent were determined on PD-weighted MR images. The groupwise difference in the morphologic measurements were evaluated using ANOVA with BMI as a covariate. Partial correlation was used to assess the relationships of measurements for the group with plantar fasciitis (group B). Intraclass correlation coefficient (ICC) statistics were performed. RESULTS Patients with plantar fasciitis had a greater CSA and volume of the calcaneal crescent and had lower CNR (i.e., denser trabeculae) than those without Achilles tendon-calcaneal crescent-plantar fascia system abnormalities (CSA, 100.2 vs 73.7 mm2, p = 0.019; volume, 3.06 vs 1.99 cm3, p = 0.006; CNR, -28.40 vs -38.10, p = 0.009). Interreader agreement was excellent (ICC = 0.85-0.99). CONCLUSION In patients with plantar fasciitis, the calcaneal crescent is enlarged compared with those without abnormalities of the Achilles tendon-calcaneal crescent-plantar fascia system. An enlarged and trabeculae-rich calcaneal crescent may potentially indicate that abnormally increased forces are being exerted onto the Achilles tendon-calcaneal crescent-plantar fascia system.
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