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Belair JA, Jung J, Desai V, Morrison WB, DeLuca PF, Zoga AC. Bone bruise vs. non-displaced fracture on MRI: a novel grading system for predicting return-to-play. Skeletal Radiol 2024; 53:947-955. [PMID: 37993556 DOI: 10.1007/s00256-023-04504-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/18/2023] [Accepted: 10/28/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To devise an MRI grading scheme for osseous contusion patterns in elite hockey players for predicting return-to-play (RTP). METHODS A retrospective review was performed to identify traumatic lower extremity osseous injuries in professional hockey players. A total of 28 injuries (17 players) were identified over a 10-year period. All had MRIs acquired at ≥ 1.5 T within a mean interval of 2 days from initial injury. MRIs were retrospectively reviewed by 3 musculoskeletal radiologists for osseous contusion pattern, classified as grade 1 (mild), 2 (moderate), or 3 (severe). Grade 3 contusions were further subdivided by the presence or absence of fracture, defined as discrete cortical disruption on MRI or follow-up CT. RTP was calculated from date of injury to next game played based on game log data. Statistical analysis was performed using ANOVA and post hoc unpaired t test. RESULTS Mean RTP for grade 1, 2, and 3 injuries was 2.8, 4.5, and 20.3 days, respectively. Grade 3 injuries without and with cortical fractures had mean RTP of 18.3 and 21.4 days, respectively. ANOVA analysis between groups achieved statistical significance (p < 0.001). Post hoc t test demonstrated statistically significant differences between grade 3 and grades 1 (p < 0.001) and 2 (p < 0.001) injuries. There was no statistical difference in RTP between grade 3 subgroups without and with fracture (p = 0.327). CONCLUSION We propose a novel MRI grading system for assessing severity of osseous contusions and predicting RTP. Clinically, there was no statistically significant difference in RTP between severe osseous contusions and nondisplaced fractures in elite hockey players.
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Affiliation(s)
- Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA.
| | - Jin Jung
- Larchmont Medical Imaging, Mt Laurel Township, NJ, USA
| | - Vishal Desai
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | - William B Morrison
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | | | - Adam C Zoga
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
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Belair JA, Zoga AC. Bone Bruise versus Fracture on MRI and the Relevance to Return to Play. Semin Musculoskelet Radiol 2024; 28:139-145. [PMID: 38484766 DOI: 10.1055/s-0043-1778023] [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: 03/19/2024]
Abstract
We review the spectrum of acute osseous injuries in athletes, ranging from osseous contusion (bone bruise) injuries to nondisplaced cortical fractures. The basic biomechanical concepts, underlying histopathologic changes, and characteristic magnetic resonance imaging (MRI) features of acute osseous injuries are presented. Bone bruise injuries of varying severity are highlighted to showcase the breadth of imaging findings on MRI and methods for characterizing such lesions. We emphasize the importance of accurately assessing patterns of injury on MRI to communicate more effectively with team medical staff and recognize the implications on return to play. This article offers the foundational tools for approaching bone bruise injuries in elite athletes to add value to the diagnosis and treatment of this unique patient population.
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Affiliation(s)
- Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam C Zoga
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
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The association of bone bruising and grade of MCL injury in patients sustaining isolated MCL injuries. Skeletal Radiol 2022; 51:1073-1080. [PMID: 34628510 DOI: 10.1007/s00256-021-03932-3] [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: 07/20/2021] [Revised: 09/15/2021] [Accepted: 10/03/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the incidence of bone bruising with isolated medial collateral ligament injury and to assess whether the presence of bone bruising is related to the injury grade. MATERIALS AND METHODS Patients who sustained an acute isolated medial collateral ligament injury demonstrated on knee MRI between 2016 and 2020 were included in this study. Patient's characteristics and injury classification (clinical and radiological) were reviewed from clinical notes and imaging. The patients were divided into two groups, based on the presence of bone bruising. Fisher's exact test was used for dichotomous variables and odds ratios were computed in areas of clinical significance. RESULTS Sixty patients with a median age of 37.6 ± 13.8 were included. Twenty-eight (46.7%) had bone bruising demonstrated on MRI scan. The bone bruising group were 7 times (95% CI [1.4;36.5]) more likely to have a complete disruption of the superficial medial collateral ligament and MRI grade III injury. Injury to the deep medial collateral ligament was more often observed in this group (p < 0.05). The most common location of bone bruising was the lateral femoral condyle (57.1%, 16/28) and/or the medial femoral condyle (57.1%, 16/28). CONCLUSIONS The incidence of bone bruising with isolated medial collateral ligament injury is significant and is more common with radiologically higher grade injuries. There was no statistically significant difference between the anatomical location of bone bruise and the grade of MCL injury. Bone bruising patterns can help determine the mechanism of injury, with a valgus impact or avulsion type injury most commonly seen.
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Osseous Pathology on Wrist Magnetic Resonance Imaging. Top Magn Reson Imaging 2021; 29:245-261. [PMID: 33021576 DOI: 10.1097/rmr.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Advanced imaging of the osseous structures of the wrist by magnetic resonance imaging (MRI) yields powerful information regarding marrow composition and overall bone structure. Various forms of pathology, both benign and malignant, have unique marrow signal abnormalities that can be easily detected by MRI given its high sensitivity to radiographically occult processes. In particular, osseous pathology can be seen in the setting of traumatic, degenerative, congenital, infectious, and neoplastic conditions. The acuity or chronicity of these conditions can often be determined by imaging to aid in appropriate therapy. A thorough understanding of the breadth of pathology and corresponding MRI appearances can allow the interpreting radiologist to formulate a concise and accurate assessment of an examination.
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Oetelaar G, Heng HG, Lim CK, Cox A, Weng HY. Differentiation of Antemortem and Postmortem Appendicular Fractures Using Magnetic Resonance Imaging Signal Intensity Changes in Bone and Soft Tissues. J Forensic Sci 2020; 65:1524-1529. [PMID: 32525570 DOI: 10.1111/1556-4029.14475] [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: 04/20/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Abstract
Intraosseous T1-weighted (T1W) and short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) signal intensity changes-so-called bone marrow edema-may be able to differentiate antemortem and postmortem fractures in human forensic imaging. The primary objective of this study was to investigate this hypothesis using an animal model. Three juvenile Landrace pigs were anesthetized and underwent MRI of both tibiae and both radii using a 1.5 T magnet. T1W, T2-weighted (T2W), STIR, and T2* sequences were included. Antemortem fractures were induced in both tibiae and postmortem fractures in both radii, and MRI was repeated. Two board-certified radiologists blinded to fracture group jointly evaluated the images for intraosseous and soft tissue signal intensity changes. Sensitivity (Se) and specificity (Sp) in identifying antemortem fractures were calculated based on intraosseous, soft tissue, and combined intraosseous and soft tissue signal intensity changes. Intraosseous and soft tissue signal intensity changes, when present, were hyperintense in all sequences. Intraosseous hyperintensity in T1W and T2W sequences yielded Sp of 100% for antemortem fractures. Regardless of sequence, soft tissue hyperintensity was comparatively more sensitive than intraosseous hyperintensity. Sensitivity for each sequence could be maximized by assessment of soft tissue and intraosseous hyperintense signals together; for the T1W sequence, such assessment optimized diagnostic utility yielding a Se of 100% and Sp of 83%. In summary, MRI-particularly the T1W sequence-can differentiate antemortem and postmortem fractures and may be a useful adjunct to the forensic analyses of fractures.
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Affiliation(s)
- Garrett Oetelaar
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Chee Kin Lim
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Hsin-Yi Weng
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
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Shi H, Ding L, Jiang Y, Zhang H, Ren S, Hu X, Liu Z, Huang H, Ao Y. Bone Bruise Distribution Patterns After Acute Anterior Cruciate Ligament Ruptures: Implications for the Injury Mechanism. Orthop J Sports Med 2020; 8:2325967120911162. [PMID: 32313810 PMCID: PMC7160777 DOI: 10.1177/2325967120911162] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Bone bruises observed on magnetic resonance imaging (MRI) after an anterior cruciate ligament (ACL) injury could provide significant information about ACL injury mechanisms. Purpose/Hypothesis The purpose of this study was to investigate common bone bruise patterns after an ACL injury. It was hypothesized that the most common bone bruise distribution pattern would be only the lateral side of both the femur and tibia. Study Design Cross-sectional study; Level of evidence, 3. Methods Knee MRI scans of patients who underwent acute ACL reconstruction from August 2016 to August 2018 at our institution were selected. Imaging sequences in the sagittal and coronal planes were used for determining the bone bruise location in the lateral-medial and anterior-posterior directions, respectively. The presence, location, and intensity of bone bruises within specific compartments of the tibia and femur were documented. The relative bone bruise patterns of the tibia and femur were classified and analyzed. Results A total of 207 patients (165 men, 42 women) met the inclusion criteria from a total of 4209 ACL reconstruction cases. The most common relative bone bruise pattern was located on only the lateral side of both the femur and the tibia (44.4%), followed by the lateral and medial sides of both the femur and tibia (29.0%). For the pattern found on the lateral and medial sides of both the femur and tibia, the bone bruises on only the lateral side of both the tibia and femur were more severe (P < .001 and P < .001, respectively) and more anterior (P < .001 and P < .001, respectively) than those on only the medial side. Conclusion The most common relative bone bruise pattern observed was on only the lateral side of both the tibia and femur. Bone bruises on the lateral side were more severe than those on the medial side in patients with bone bruises on the lateral and medial sides of both the femur and tibia. Anterior translation of the tibia relative to the femur occurred during an ACL injury based on the location of bone bruises in the anterior-posterior direction.
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Affiliation(s)
- Huijuan Shi
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Li Ding
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yanfang Jiang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Haocheng Zhang
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shuang Ren
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Xiaoqing Hu
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Zhenlong Liu
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Hongshi Huang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
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Abstract
OBJECTIVE. The purpose of this article is to summarize the nomenclature of nonneoplastic conditions affecting subchondral bone through a review of the medical literature and expert opinion of the Society of Skeletal Radiology Subchondral Bone Nomenclature Committee. CONCLUSION. This consensus statement summarizes current understanding of the pathophysiologic characteristics and imaging findings of subchondral nonneoplastic bone lesions and proposes nomenclature to improve effective communication across clinical specialties and help avoid diagnostic errors that could affect patient care.
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Klengel A, Stumpp P, Klengel S, Böttger I, Rönisch N, Kahn T. Detection of Traumatic Bone Marrow Lesions after Knee Trauma: Comparison of ADC Maps Derived from Diffusion-weighted Imaging with Standard Fat-saturated Proton Density–weighted Turbo Spin-Echo Sequences. Radiology 2017; 283:469-477. [DOI: 10.1148/radiol.2016160306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexis Klengel
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Patrick Stumpp
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Steffen Klengel
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Ina Böttger
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Nadja Rönisch
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Thomas Kahn
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
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Mutlu S, Mutlu H, Kömür B, Guler O, Yucel B, Parmaksızoğlu A. Magnetic resonance imaging-based diagnosis of occult osseous injuries in traumatic knees. Open Orthop J 2015; 9:84-8. [PMID: 25861410 PMCID: PMC4384224 DOI: 10.2174/1874325001509010084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/13/2015] [Accepted: 02/28/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Occult osseous knee injuries, such as bone bruises, can produce persistent pain and functional loss. Although bone bruises cannot be identified through direct examination or traditional radiographs, magnetic resonance imaging (MRI) has emerged as an effective diagnostic method. Nevertheless, the natural history of these injuries remains to be fully defined. Therefore, we used MRI to detect and follow bone bruise injuries secondary to knee trauma. METHODS We retrospectively reviewed knee MRIs from patients with bone bruising caused by trauma. Occult injuries were initially identified by MRI and subsequently rescanned for follow-up at 3 and 9 months. All patients underwent physical examinations, direct radiological imaging, and MRI. RESULTS Although direct radiographs showed no abnormalities, we used MRI to identify a total of 22 patients (age range: 19-42 years; mean: 28 years) with bone bruising. After 3 months, injuries remained detectable in 68.2% of the subjects, whereas 18.2% displayed bone bruising after 9 months. The majority of Type I lesions resolved spontaneously, whereas 80% of Type II injuries remained following 3 months, and 30% persisted at 9 months. Ligament and meniscal lesions were observed in 63.6% of patients with bone bruising and appeared to hinder recovery. CONCLUSION Bone bruises generally resolved within 3 to 9 months in subjects with no soft tissue lesions and minor trauma. However, ligament and meniscal lesions were observed in the majority of patients, and these individuals required longer treatment and recuperation. Overall, these findings can contribute to improving the management of occult osseous knee injuries.
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Affiliation(s)
- Serhat Mutlu
- Department of Orthopaedics, Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303 Küçükçekmece/Istanbul, Turkey
| | - Harun Mutlu
- Department of Orthopaedics, Taksim Training and Research Hospital, Karayollari Mahallesi, Osmanbey Caddesi, No:120, 34255 Gaziosmanpasa/Istanbul, Turkey
| | - Baran Kömür
- Department of Orthopaedics, Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303 Küçükçekmece/Istanbul, Turkey
| | - Olcay Guler
- Department of Orthopaedics, Medipol University Medical School, Atatürk Bulvarı No:27 Unkapanı 34083 Fatih/Istanbul, Turkey
| | - Bulent Yucel
- Department of Orthopaedics, Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh., 1. Cd, 34303 Küçükçekmece/Istanbul, Turkey
| | - Atilla Parmaksızoğlu
- Department of Orthopaedics, Taksim Training and Research Hospital, Karayollari Mahallesi, Osmanbey Caddesi, No:120, 34255 Gaziosmanpasa/Istanbul, Turkey
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Sheehan SE, Khurana B, Gaviola G, Davis KW. A biomechanical approach to interpreting magnetic resonance imaging of knee injuries. Magn Reson Imaging Clin N Am 2014; 22:621-48. [PMID: 25442026 DOI: 10.1016/j.mric.2014.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This article discusses common injury mechanisms and the subsequent constellation of magnetic resonance (MR) imaging findings in the knee following trauma in the context of instability, as distinguished by the degree of knee flexion and tibial rotation at the time of initial injury, in addition to the direction and magnitude of the responsible force vectors. Using 3-dimensional imaging, common injury mechanisms are illustrated and correlated with MR imaging findings of the resulting osteochondral, ligamentous, meniscal, and musculotendinous lesions. The most common classification and grading systems for these individual lesions and their subsequent treatment implications are discussed.
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Affiliation(s)
- Scott E Sheehan
- Department of Musculoskeletal Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Bharti Khurana
- Department of Emergency Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Glenn Gaviola
- Department of Musculoskeletal Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Kirkland W Davis
- Department of Musculoskeletal Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
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11
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MRI of the Hip: Important Injuries of the Adult Athlete. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Total knee arthroplasty MRI featuring slice-encoding for metal artifact correction: reduction of artifacts for STIR and proton density-weighted sequences. AJR Am J Roentgenol 2014; 201:1315-24. [PMID: 24261373 DOI: 10.2214/ajr.13.10531] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to compare slice-encoding for metal artifact correction (SEMAC) sequences versus optimized standard MRI sequences in patients with total knee arthroplasty (TKA). SUBJECTS AND METHODS Forty-two patients with TKA underwent 1.5-T MRI. Sequences optimized for metal implant imaging (SEMAC) were compared with standard sequences optimized with high bandwidth for STIR and proton density (PD)-weighted images. In 29 patients, CT was available as reference standard. Signal void and insufficient fat saturation were quantified. Qualitative criteria (anatomy, distortion, blurring, and noise) were assessed on a 5-point scale (1, no artifacts; 5, severe artifacts) by two readers. Abnormal imaging findings were noted. A Student t test and a Wilcoxon signed rank test was used for statistics. RESULTS Signal void areas and insufficient fat saturation were smaller for the SEMAC sequences than for the optimized standard sequences (p ≤ 0.005 for all comparisons). Depiction of anatomic structures was better on STIR with SEMAC versus standard sequences optimized with high bandwidth (score range, 2.9-3.7 vs 4.2-4.9) and on PD-weighted imaging with SEMAC versus standard sequences optimized with high bandwidth (score range, 2.5-3.5 vs 3.1-3.8), which was statistically significant (p < 0.001 to p = 0.007 for different structures). Distortion and noise were lower for SEMAC than for the standard sequences (p ≤ 0.001), whereas no technique had a clear advantage for blurring. Detection of abnormal imaging findings was markedly increased for the SEMAC technique (p < 0.001) and was most pronounced for STIR images (98 and 74 findings for STIR with SEMAC for readers 1 and 2, respectively, vs 37 and 37 findings for readers 1 and 2, respectively, for STIR with standard sequences optimized with high bandwidth). Sensitivity for detection of periprosthetic osteolysis was improved for STIR with SEMAC (100% and 86% for readers 1 and 2, respectively) compared with STIR with standard sequences optimized with high bandwidth (14% and 29% for readers 1 and 2, respectively). CONCLUSION SEMAC sequences showed a statistically significant artifact reduction. The detection of clinically relevant findings such as periprosthetic osteolysis was markedly improved.
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Berger N, Paula P, Gascho D, Flach PM, Thali MJ, Ross SG, Ampanozi G. Bone marrow edema induced by a bullet after a self-inflicted accidental firing. Leg Med (Tokyo) 2013; 15:329-31. [DOI: 10.1016/j.legalmed.2013.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 09/09/2013] [Accepted: 09/10/2013] [Indexed: 11/26/2022]
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14
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Schaeffeler C, Waldt S, Woertler K. Traumatic instability of the elbow - anatomy, pathomechanisms and presentation on imaging. Eur Radiol 2013; 23:2582-93. [DOI: 10.1007/s00330-013-2855-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 02/27/2013] [Accepted: 03/10/2013] [Indexed: 11/28/2022]
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Sutter R, Ulbrich EJ, Jellus V, Nittka M, Pfirrmann CWA. Reduction of metal artifacts in patients with total hip arthroplasty with slice-encoding metal artifact correction and view-angle tilting MR imaging. Radiology 2012; 265:204-14. [PMID: 22923720 DOI: 10.1148/radiol.12112408] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the new "warp" sequence (slice-encoding metal artifact correction [SEMAC], view-angle tilting [VAT], and increased bandwidth) for the reduction of both through-plane and in-plane magnetic resonance (MR) artifacts with current optimized MR sequences in patients with total hip arthroplasty (THA). MATERIALS AND METHODS The institutional review board issued a waiver for this study. Forty patients with THA were prospectively included. SEMAC, VAT, and increased bandwidth were applied by using the warp turbo-spin-echo sequence at 1.5 T. Coronal short tau inversion-recovery (STIR)-warp and transverse T1-weighted warp (hereafter, T1-warp) images, as well as standard coronal STIR and transverse T1-weighted sequence images optimized with high bandwidth (STIR-hiBW and T1-hiBW), were acquired. Fifteen additional patients were examined to compare the T1-warp and T1-hiBW sequence with an identical matrix size. Signal void was quantified. Qualitative criteria (distinction of anatomic structures, blurring, and noise) were assessed on a five-point scale (1, no artifacts; 5, not visible due to severe artifacts) by two readers. Abnormal imaging findings were recorded. Quantitative data were analyzed with a t test and qualitative data with a Wilcoxon signed rank test. RESULTS Signal void around the acetabular component was smaller for STIR-warp than STIR-hiBW images (21.6 cm2 vs 42.4 cm2; P=.0001), and for T1-warp than T1-hiBW images (17.6 cm2 vs 20.2 cm2; P=.0001). Anatomic distinction was better on STIR-warp compared with STIR-hiBW images (1.9-2.8 vs 3.6-4.6; P=.0001), and on T1-warp compared with T1-hiBW images (1.3-2.8 vs 1.8-3.2; P<.002). Distortion, blurring, and noise were lower with warp sequences than with the standard sequences (P=.0001). Almost half of the abnormal imaging findings were missed on STIR-hiBW compared with STIR-warp images (55 vs 105 findings; P=.0001), while T1-hiBW was similar to T1-warp imaging (50 vs 55 findings; P=.06). CONCLUSION STIR-warp and T1-warp sequences were significantly better according to quantitative and qualitative image criteria, but a clinically relevant artifact reduction was only present for STIR images.
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Affiliation(s)
- Reto Sutter
- Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland.
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Guggenberger R, Gnannt R, Hodler J, Krauss B, Wanner GA, Csuka E, Payne B, Frauenfelder T, Andreisek G, Alkadhi H. Diagnostic Performance of Dual-Energy CT for the Detection of Traumatic Bone Marrow Lesions in the Ankle: Comparison with MR Imaging. Radiology 2012; 264:164-73. [DOI: 10.1148/radiol.12112217] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Athletic traumatic hip subluxations are rare. Classic radiographic features have been well described. This case highlights the potential pitfalls of immediate magnetic resonance imaging. Femoral head contusions and acetabular rim fractures are common associated findings usually apparent with magnetic resonance imaging (MRI). However, in this case an MRI done 3 hours post injury failed to show any edema in either location, making the appearance of these findings on subsequent MRIs difficult to interpret. An acute MRI more than 48 hours post injury may have been more helpful.
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Affiliation(s)
- David C Flanigan
- Department of Orthopedics, The Ohio State University, Columbus, Ohio, USA,Address for correspondence: Dr. David C. Flanigan, Department of Orthopaedics, The Ohio State University, 2050 Kenny Road, Columbus, OH 43221, USA. E-mail:
| | - Arthur A De Smet
- Department of Orthopedic Surgery and Rehabilitation, Division of Sports Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Ben Graf
- Department of Orthopedic Surgery and Rehabilitation, Division of Sports Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
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Kwee TC, Takahara T, Niwa T. Diffusion-weighted whole-body imaging with background body signal suppression facilitates detection and evaluation of an anterior rib contusion. Clin Imaging 2010; 34:298-301. [PMID: 20630343 DOI: 10.1016/j.clinimag.2009.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Accepted: 07/20/2009] [Indexed: 10/19/2022]
Abstract
We report the magnetic resonance imaging (MRI) findings in a 29-year-old woman with anterior chest wall pain following blunt trauma, with special emphasis on the value of diffusion-weighted whole-body imaging with background body signal suppression (DWIBS). Although a rib contusion could be depicted at (fat-suppressed) T2-weighted MRI, anatomical localization and assessment of lesion extent were superior and more straightforward at DWIBS. Thus, this report shows the utility of adding DWIBS to an MRI protocol for anterior chest wall evaluation.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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