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Oosterbos C, Weerdt OD, Lembrechts M, Radwan A, Brys P, Brusselmans M, Bogaerts K, Peeters R, Van Hoylandt A, Hoornaert S, Lemmens R, Theys T. Diagnostic accuracy of ultrasound and MR imaging in peroneal neuropathy: A prospective, single-center study. Muscle Nerve 2024. [PMID: 38934723 DOI: 10.1002/mus.28187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 05/28/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION/AIMS Magnetic resonance imaging (MRI) findings in peroneal neuropathy are not well documented and the prognostic value of imaging remains uncertain. Upper limits of cross-sectional area (CSA) on ultrasound (US) have been established, but uncertainty regarding generalizability remains. We aimed to describe MRI findings of the peroneal nerve in patients and healthy controls and to compare these results to US findings and clinical characteristics. METHODS We prospectively included patients with foot drop and electrodiagnostically confirmed peroneal neuropathy, and performed clinical follow-up, US and MRI of both peroneal nerves. We compared MRI findings to healthy controls. Two radiologists evaluated MRI features in an exploratory analysis after images were anonymized and randomized. RESULTS Twenty-two patients and 38 healthy controls were included. Whereas significant increased MRI CSA values were documented in patients (mean CSA 20 mm2 vs. 13 mm2 in healthy controls), intra- and interobserver variability was substantial (variability of, respectively, 7 and 9 mm2 around the mean in 95% of repeated measurements). A pathological T2 hyperintense signal of the nerve was found in 52.6% of patients (50% interobserver agreement). Increased CSA measurements (MRI/US), pathological T2 hyperintensity of the nerve and muscle edema were not predictive for recovery. DISCUSSION Imaging is recommended in all patients with peroneal neuropathy to exclude compressive intrinsic and extrinsic masses but we do not advise routine MRI for diagnosis or prediction of outcome in patients with peroneal neuropathy due to high observer variability. Further studies should aim at reducing MRI observer variability potentially by semi-automation.
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Affiliation(s)
- Christophe Oosterbos
- Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Olaf De Weerdt
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Ahmed Radwan
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Brys
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Marius Brusselmans
- Department of Public Health and Primary Care, I-BioStat, Leuven, Belgium
- I-BioStat, UHasselt, Hasselt, Belgium
| | - Kris Bogaerts
- Department of Public Health and Primary Care, I-BioStat, Leuven, Belgium
- I-BioStat, UHasselt, Hasselt, Belgium
| | - Ronald Peeters
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Anaïs Van Hoylandt
- Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Sophie Hoornaert
- Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Theys
- Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Dalili D, Holzwanger DJ, Fleming JW, Igbinoba Z, Dalili DE, Beall DP, Isaac A, Yoon ES. Advanced Interventional Procedures for Knee Osteoarthritis: What Is the Current Evidence? Semin Musculoskelet Radiol 2024; 28:267-281. [PMID: 38768592 DOI: 10.1055/s-0044-1781432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The prevalence of knee osteoarthritis (OA) is the highest among all joints and likely to increase over the coming decades. Advances in the repertoire of diagnostic capabilities of imaging and an expansion in the availability and range of image-guided interventions has led to development of more advanced interventional procedures targeting pain related to OA pain while improving the function of patients presenting with this debilitating condition. We review the spectrum of established advanced interventional procedures for knee OA, describe the techniques used to perform these procedures safely, and discuss the clinical evidence supporting each of them.
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Affiliation(s)
- Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, United Kingdom
- Department of Diagnostic and Interventional Radiology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, Epsom, London, United Kingdom
| | - Daniel J Holzwanger
- Division of Vascular and Interventional Radiology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Jacob W Fleming
- Comprehensive Specialty Care, Edmond, Oklahoma City, Oklahoma
| | - Zenas Igbinoba
- Department of Radiology, Hospital for Special Surgery, New York, New York
| | - Daniel E Dalili
- Department of Radiology, Southend University Hospital, Mid and South Essex NHS Trust, United Kingdom
| | - Douglas P Beall
- Comprehensive Specialty Care, Edmond, Oklahoma City, Oklahoma
| | - Amanda Isaac
- School of Biomedical Engineering & Imaging Sciences, Kings College London, London, United Kingdom
| | - Edward S Yoon
- Department of Radiology, Hospital for Special Surgery, New York, New York
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Parkar AP, Adriaensen MEAPM. ESR essentials: MRI of the knee-practice recommendations by ESSR. Eur Radiol 2024:10.1007/s00330-024-10706-7. [PMID: 38536461 DOI: 10.1007/s00330-024-10706-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 05/07/2024]
Abstract
Many studies and systematic reviews have been published about MRI of the knee and its structures, discussing detailed anatomy, imaging findings, and correlations between imaging and clinical findings. This paper includes evidence-based recommendations for a general radiologist regarding choice of imaging sequences and reporting basic MRI examinations of the knee. We recommend using clinicians' terminology when it is applicable to the imaging findings, for example, when reporting meniscal, ligament and tendon, or cartilage pathology. The intent is to standardise reporting language and to make reports less equivocal. The aim of the paper is to improve the usefulness of the MRI report by understanding the strengths and limitations of the MRI exam with regard to clinical correlation. We hope the implementation of these recommendations into radiological practice will increase diagnostic accuracy and consistency by avoiding pitfalls and reducing overcalling of pathology on MRI of the knee. CLINICAL RELEVANCE STATEMENT: The recommendations presented here are meant to aid general radiologists in planning and assessing studies to evaluate acute and chronic knee findings by advocating the use of unequivocal terminology and discussing the strengths and limitations of MRI examination of the knee. KEY POINTS: • On MRI, the knee should be examined and assessed in three orthogonal imaging planes. • The basic general protocol must yield T2-weighted fluid-sensitive and T1-weighted images. • The radiological assessment should include evaluation of ligamentous structures, cartilage, bony structures and bone marrow, soft tissues, bursae, alignment, and incidental findings.
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Affiliation(s)
- Anagha P Parkar
- Radiology Department, Haraldsplass Deaconess Hospital, Postboks 6165 Posterminalen, 5892, Bergen, Norway.
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Postboks 7804, 5021, Bergen, Norway.
| | - Miraude E A P M Adriaensen
- Department of Radiology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
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Abstract
Acute knee injury ranges among the most common joint injuries in professional and recreational athletes. Radiographs can detect joint effusion, fractures, deformities, and malalignment; however, MR imaging is most accurate for radiographically occult fractures, chondral injury, and soft tissue injuries. Using a structured checklist approach for systematic MR imaging evaluation and reporting, this article reviews the MR imaging appearances of the spectrum of traumatic knee injuries, including osteochondral injuries, cruciate ligament tears, meniscus tears and ramp lesions, anterolateral complex and collateral ligament injuries, patellofemoral translation, extensor mechanism tears, and nerve and vascular injuries.
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Relationship Between Peroneal Nerve and Anterior Cruciate Ligament Involvement in Multiligamentous Knee Injury: A Multicenter Study. J Am Acad Orthop Surg 2022; 30:e1461-e1466. [PMID: 36326829 DOI: 10.5435/jaaos-d-21-01252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/15/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Peroneal nerve injuries are rare injuries and usually associated with multiligamentous knee injuries (MLKIs) involving one or both cruciate ligaments. The purpose of our study was to perform a multicenter retrospective cohort analysis to examine the rates of peroneal nerve injuries and to see whether a peroneal nerve injury was suggestive of a particular injury pattern. METHODS A retrospective chart review was conducted in patients who were diagnosed with MLKI at two level I trauma centers from January 2001 to March 2021. MLKIs were defined as complete injuries to two or more knee ligaments that required surgical reconstruction or repair. Peroneal nerve injury was clinically diagnosed in these patients by the attending orthopaedic surgeon. Radiographs, advanced imaging, and surgical characteristics were obtained through a chart review. RESULTS Overall, 221 patients were included in this study. The mean age was 35.9 years, and 72.9% of the population was male. Overall, the incidence of clinical peroneal nerve injury was 19.5% (43 patients). One hundred percent of the patients with peroneal nerve injury had a posterolateral corner injury. Among patients with peroneal nerve injury, 95.3% had a complete anterior cruciate ligament (ACL) rupture as compared with 4.7% of the patients who presented with an intact ACL. There was 4.4 times of greater relative risk of peroneal nerve injury in the MLKI with ACL tear group compared with the MLKI without an ACL tear group. No statistical difference was observed in age, sex, or body mass index between patients experiencing peroneal nerve injuries and those who did not. CONCLUSION The rate of ACL involvement in patients presenting with a traumatic peroneal nerve palsy is exceptionally high, whereas the chance of having a spared ACL is exceptionally low. More than 90% of the patients presenting with a nerve palsy will have sustained, at the least, an ACL and posterolateral corner injury. LEVEL OF EVIDENCE IV, Case Series.
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Dalili D, Ahlawat S, Isaac A, Rashidi A, Fritz J. Selective MR neurography-guided anterior femoral cutaneous nerve blocks for diagnosing anterior thigh neuralgia: anatomy, technique, diagnostic performance, and patient-reported experiences. Skeletal Radiol 2022; 51:1649-1658. [PMID: 35150298 DOI: 10.1007/s00256-022-04014-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the clinical utility of selective magnetic resonance neurography-(MRN)-guided anterior femoral cutaneous nerve (AFCN) blocks for diagnosing anterior thigh neuralgia. MATERIALS AND METHODS Following institutional review board approval and informed consent, participants with intractable anterior thigh pain and clinically suspected AFCN neuralgia were included. AFCN blocks were performed under MRN guidance using an anterior groin approach along the medial sartorius muscle margin. Outcome variables included AFCN identification on MRN, technical success of perineural drug delivery, rate of AFCN anesthesia, complications, total procedure time, patient-reported procedural experiences, rate of positive diagnostic AFCN blocks, and positive subsequent treatment rate. RESULTS Eighteen MRN-guided AFCN blocks (six unilateral and six bilateral blocks) were performed in 12 participants (6 women; age, 49 (30-65) years). Successful MRN identified the AFCN, successful perineural drug delivery, and AFCN anesthesia was achieved in all thighs. No complications occurred. The total procedure time was 19 (10-28) min. Patient satisfaction and experience were high without adverse MRI effects. AFCN blocks identified the AFCN as the symptom generator in 16/18 (89%) cases, followed by 14/16 (88%) successful treatments. CONCLUSION Our results suggest that selective MR neurography-guided AFCN blocks effectively diagnose anterior femoral cutaneous neuralgia and are well-tolerated.
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Affiliation(s)
- Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, London, Epsom, KT18 7EG, UK.,Department of Diagnostic and Interventional Radiology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, London, Epsom, KT18 7EG, UK.,The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Amanda Isaac
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ali Rashidi
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, USA.
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Moran J, Schneble CA, Katz LD, Fosam A, Wang A, Li DT, Kahan JB, McLaughlin WM, Jokl P, Hewett TE, LaPrade RF, Medvecky MJ. Examining the Bone Bruise Patterns in Multiligament Knee Injuries With Peroneal Nerve Injury. Am J Sports Med 2022; 50:1618-1626. [PMID: 35384729 DOI: 10.1177/03635465221087406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibiofemoral bone bruise patterns seen on magnetic resonance imaging (MRI) are associated with ligamentous injuries in the acutely injured knee. Bone bruise patterns in multiligament knee injuries (MLKIs) and particularly their association with common peroneal nerve (CPN) injuries are not well described. PURPOSE To analyze the tibiofemoral bone bruise patterns in MLKIs with and without peroneal nerve injury. STUDY DESIGN Case series; Level of evidence, 4. METHODS We retrospectively identified 123 patients treated for an acute MLKI at a level 1 trauma center between January 2001 and March 2021. Patients were grouped into injury subtypes using the Schenck classification. Within this cohort, patients with clinically documented complete (motor and sensory loss) and/or partial CPN palsies on physical examination were identified. Imaging criteria required an MRI scan on a 1.5 or 3 Tesla scanner within 30 days of the initial MLKI. Images were retrospectively interpreted for bone bruising patterns by 2 board-certified musculoskeletal radiologists. The location of the bone bruises was mapped on fat-suppressed T2-weighted coronal and sagittal images. Bruise patterns were compared among patients with and without CPN injury. RESULTS Of the 108 patients with a MLKI who met the a priori inclusion criteria, 26 (24.1%) were found to have a CPN injury (N = 20 complete; N = 6 partial) on physical examination. For CPN-injured patients, the most common mechanism of injury was high-energy trauma (N = 19 [73%]). The presence of a grade 3 posterolateral corner (PLC) injury (N = 25; odds ratio [OR], 23.81 [95% CI, 3.08-184.1]; P = .0024), anteromedial femoral condyle bone bruising (N = 24; OR, 21.9 [95% CI, 3.40-202.9]; P < .001), or a documented knee dislocation (N = 16; OR, 3.45 [95% CI, 1.38-8.62]; P = .007) was significantly associated with the presence of a CPN injury. Of the 26 patients with CPN injury, 24 (92.3%) had at least 1 anteromedial femoral condyle bone bruise. All 20 (100%) patients with complete CPN injury also had at least 1 anteromedial femoral condyle bone bruise on MRI. In our MLKI cohort, the presence of anteromedial femoral condyle bone bruising had a sensitivity of 92.3% and a specificity of 64.6% for the presence of CPN injury on physical examination. CONCLUSION In our MLKI cohort, the presence of a grade 3 PLC injury had the greatest association with CPN injury. Additionally, anteromedial femoral condyle bone bruising on MRI was a highly sensitive finding that was significantly correlated with CPN injury on physical examination. The high prevalence of grade 3 PLC injuries and anteromedial tibiofemoral bone bruising suggests that these MLKIs with CPN injuries most commonly occurred from a hyperextension-varus mechanism caused by a high-energy blow to the anteromedial knee.
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Affiliation(s)
- Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher A Schneble
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lee D Katz
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andin Fosam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Annie Wang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Don T Li
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph B Kahan
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - William M McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Peter Jokl
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | - Michael J Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
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Dalili D, Fritz J, Isaac A. 3D MRI of the Hand and Wrist: Technical Considerations and Clinical Applications. Semin Musculoskelet Radiol 2021; 25:501-513. [PMID: 34547815 DOI: 10.1055/s-0041-1731652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the last few years, major developments have been observed in the field of magnetic resonance imaging (MRI). Advances in both scanner hardware and software technologies have witnessed great leaps, enhancing the diagnostic quality and, therefore, the value of MRI. In musculoskeletal radiology, three-dimensional (3D) MRI has become an integral component of the diagnostic pathway at our institutions. This technique is particularly relevant in patients with hand and wrist symptoms, due to the intricate nature of the anatomical structures and the wide range of differential diagnoses for most presentations. We review the benefits of 3D MRI of the hand and wrist, commonly used pulse sequences, clinical applications, limitations, and future directions. We offer guidance for enhancing the image quality and tips for image interpretation of 3D MRI of the hand and wrist.
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Affiliation(s)
- Danoob Dalili
- Epsom and St Helier University Hospitals, London, United Kingdom
| | - Jan Fritz
- NYU Grossman School of Medicine, New York University, New York, New York
| | - Amanda Isaac
- Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London (KCL), London, United Kingdom
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