1
|
Tucker BM, Hsu FC, Register TC, Xu J, Smith SC, Murea M, Bowden DW, Freedman BI, Lenchik L. Psoas and Paraspinous Muscle Measurements on Computed Tomography Predict Mortality in European Americans with Type 2 Diabetes Mellitus. J Frailty Aging 2019; 8:72-78. [PMID: 30997919 DOI: 10.14283/jfa.2019.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Appendicular skeletal muscle mass index and muscle attenuation (density) are negatively associated with mortality in European-derived populations. OBJECTIVES The present analyses assessed association between axial skeletal muscle density and muscle index with mortality in European Americans with type 2 diabetes mellitus (T2D). DESIGN Single-center observational study. SETTING Diabetes Heart Study. PARTICIPANTS 839 European Americans with T2D. METHODS Computed tomography-measured psoas and paraspinous muscle mass index (cross sectional area/height2) and radiographic density (Hounsfield Units) were assessed in all participants. A Cox proportional hazards model was computed. The fully-adjusted model included covariates age, sex, body mass index, smoking, alcohol use, diabetes duration, insulin use, hormone replacement therapy (women), prevalent cardiovascular disease (CVD), hypertension, and coronary artery calcified atherosclerotic plaque mass score. Deaths were recorded in the National Death Index data through December 31, 2015. RESULTS Participants included 428 women and 411 men with median (25th, 75th quartile) age 62.8 (56.1, 69.1) years and diabetes duration 8.0 (5.0, 14.0) years. After 11.9 (9.4, 13.3) years of follow-up, 314 (37.4%) of participants were deceased. In the fully-adjusted model, psoas muscle density (hazard ratio [HR] 0.81, p<0.001), psoas muscle index (HR 0.82, p=0.008), and paraspinous muscle density (HR 0.85, p=0.003) were inversely associated with mortality. Paraspinous muscle index was not significantly associated with mortality (HR 0.90, p=0.08). Results did not differ significantly between men and women. CONCLUSIONS In addition to established risk factors for mortality and CVD, higher psoas muscle index, psoas muscle density, and paraspinous muscle density were significantly associated with lower all-cause mortality in European Americans with T2D.
Collapse
Affiliation(s)
- B M Tucker
- Barry I. Freedman, MD, Internal Medicine - Nephrology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1053, Phone: 336-716-6461, Fax: 336-716-4318,
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Lenchik L, Register TC, Russell GB, Xu J, Smith SC, Bowden DW, Divers J, Freedman BI. Volumetric bone mineral density of the spine predicts mortality in African-American men with type 2 diabetes. Osteoporos Int 2018; 29:2049-2057. [PMID: 29855664 PMCID: PMC6103915 DOI: 10.1007/s00198-018-4578-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/15/2018] [Indexed: 12/21/2022]
Abstract
UNLABELLED The study showed that in African-American men with type 2 diabetes mellitus (T2D), vertebral volumetric bone mineral density (vBMD) predicts all-cause mortality, independent of other risk factors for death. INTRODUCTION Compared to European Americans, African Americans have lower rates of osteoporosis and higher rates of T2D. The relationships between BMD and fractures with mortality are unknown in this population. The aim of this study was to determine relationships between vertebral fractures and vertebral vBMD and mortality in African Americans with T2D. METHODS Associations between vertebral fractures and vBMD with all-cause mortality were examined in 675 participants with T2D (391 women and 284 men) in the African American-Diabetes Heart Study (AA-DHS). Lumbar and thoracic vBMD were measured using quantitative computed tomography (QCT). Vertebral fractures were assessed on sagittal CT images. Associations of vertebral fractures and vBMD with all-cause mortality were determined in sex-stratified analyses and in the full sample. Covariates in a minimally adjusted model included age, sex, BMI, smoking, and alcohol use; the full model was adjusted for those variables plus cardiovascular disease, hypertension, coronary artery calcified plaque, hormone replacement therapy (women), African ancestry proportion, and eGFR. RESULTS After mean 7.6 ± 1.8-year follow-up, 59 (15.1%) of women and 58 (20.4%) of men died. In men, vBMD was inversely associated with mortality in the fully adjusted model: lumbar hazard ratio (HR) per standard deviation (SD) = 0.70 (95% CI 0.52-0.95, p = 0.02) and thoracic HR per SD = 0.71 (95% CI 0.54-0.92, p = 0.01). Only trends toward association between vBMD and mortality were observed in the combined sample of men and women, as significant associations were absent in women. Vertebral fractures were not associated with mortality in either sex. CONCLUSIONS Lower vBMD was associated with increased all-cause mortality in African-American men with T2D, independent of other risk factors for mortality including subclinical atherosclerosis.
Collapse
Affiliation(s)
- L Lenchik
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1053, USA.
| | - T C Register
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - G B Russell
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J Xu
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - S C Smith
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - D W Bowden
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J Divers
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - B I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
3
|
Liu CK, Leng X, Hsu FC, Kritchevsky SB, Ding J, Earnest CP, Ferrucci L, Goodpaster BH, Guralnik JM, Lenchik L, Pahor M, Fielding RA. The impact of sarcopenia on a physical activity intervention: the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P). J Nutr Health Aging 2014; 18:59-64. [PMID: 24402391 PMCID: PMC4111145 DOI: 10.1007/s12603-013-0369-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine if sarcopenia modulates the response to a physical activity intervention in functionally limited older adults. DESIGN Secondary analysis of a randomized controlled trial. SETTING Three academic centers. PARTICIPANTS Elders aged 70 to 89 years at risk for mobility disability who underwent dual-energy x-ray absorptiometry (DXA) for body composition at enrollment and follow-up at twelve months (N = 177). INTERVENTION Subjects participated in a physical activity program (PA) featuring aerobic, strength, balance, and flexibility training, or a successful aging (SA) educational program about healthy aging. MEASUREMENTS Sarcopenia as determined by measuring appendicular lean mass and adjusting for height and total body fat mass (residuals method), Short Physical Performance Battery score (SPPB), and gait speed determined on 400 meter course. RESULTS At twelve months, sarcopenic and non-sarcopenic subjects in PA tended to have higher mean SPPB scores (8.7±0.5 and 8.7±0.2 points) compared to sarcopenic and non-sarcopenic subjects in SA (8.3±0.5 and 8.4±0.2 points, p = 0.24 and 0.10), although the differences were not statistically significant. At twelve months, faster mean gait speeds were observed in PA: 0.93±0.4 and 0.95±0.03 meters/second in sarcopenic and non-sarcopenic PA subjects, and 0.89±0.4 and 0.91±0.03 meters/second in sarcopenic and non-sarcopenic SA subjects (p = 0.98 and 0.26), although not statistically significant. There was no difference between the sarcopenic and non-sarcopenic groups in intervention adherence or number of adverse events. CONCLUSION These data suggest that older adults with sarcopenia, who represent a vulnerable segment of the elder population, are capable of improvements in physical performance after a physical activity intervention.
Collapse
Affiliation(s)
- C K Liu
- Christine Liu, M.D., M.S. Jean Mayer-USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111-1524, Phone: (617) 556-3377 Fax: (617) 556-3040, E-mail: . Alternate Corresponding Author: E-mail:
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Monabang CZ, De Maeseneer M, Shahabpour M, Lenchik L, Pouliart N. MR imaging findings in patients with a surgically significant mediopatellar plica. JBR-BTR 2007; 90:384-387. [PMID: 18085193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE To identify MR imaging findings seen in patients with an arthroscopically confirmed significant plica. MATERIALS AND METHODS MR and arthroscopy reports of 450 patients were reviewed. Nine patients were identified with an arthroscopically significant plica that was resected. Nine patients from these 450 were randomly chosen as a control group. Different criteria were evaluated on the MR images of all patients including: interposition of plica, number of slices with interposition, presence of fluid (focal or generalized), and thickening of the plica. RESULTS Interposition was found on 3 to 10 transverse imaging slices in the study group (mean, 5.9), and 1 to 4 imaging slices in the control group (mean, 3). Thickening was present in 4/9 patients of the study group and 2/9 patients in the control group. Focal fluid, out of proportion to fluid in the remainder of the joint was found in all patients of the study group and in none of the control group. CONCLUSION Interposition of the plica on more than 5 transverse slices, and focal fluid adjacent to the plica may suggest the presence of a plica that will be considered significant at arthroscopy.
Collapse
Affiliation(s)
- C Z Monabang
- Dpt of Radiology, Vrije Universiteit Brussel, Jette, Belgium
| | | | | | | | | |
Collapse
|
5
|
De Maeseneer M, Buls N, Cleeren N, Lenchik L, De Mey J. An ancient Roman bowl embedded in a soil sample: surface shaded three dimensional display using data from a multi-detector CT. JBR-BTR 2006; 89:264-5. [PMID: 17147016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We present an unusual application of multidetector CT and shaded surface rendering in the investigation of a soil sample, containing an ancient Roman bronze bowl. The CT findings were of fundamental importance in helping the archaeologists study the bronze bowl from the soil sample.
Collapse
Affiliation(s)
- M De Maeseneer
- Department of Radiology, Wake Forest University, Winston Salem, NC 27157, USA,
| | | | | | | | | |
Collapse
|
6
|
Register TC, Lenchik L, Hsu FC, Lohman KK, Freedman BI, Bowden DW, Carr JJ. Type 2 diabetes is not independently associated with spinal trabecular volumetric bone mineral density measured by QCT in the Diabetes Heart Study. Bone 2006; 39:628-33. [PMID: 16690365 DOI: 10.1016/j.bone.2006.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 02/17/2006] [Accepted: 03/14/2006] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate the association between type 2 diabetes mellitus (DM2) and trabecular volumetric bone mineral density (vBMD) of the thoracic and lumbar spine measured by quantitative computed tomography (QCT) in 483 female (410 with DM2) and 398 male (365 with DM2) adults (age 36-86 years, BMI 16-58, 88% with DM2) in the Diabetes Heart Study. After accounting for familial correlation using generalized estimating equations (GEE), lumbar spine vBMD was positively associated with BMI (r = 0.24, P < 0.0001) and inversely associated with age (r = -0.51, P < 0.0001). In women, age-adjusted thoracic spinal vBMD (mg/ml, mean +/- SE) was higher in diabetics (147.6 +/- 2.3) compared to unaffected individuals (138.6 +/- 3.4) (P = 0.02), with age-adjusted lumbar spinal vBMD showing a similar but non-significant trend (132.9 +/- 2.1 in diabetics vs. 127.2 +/- 3.6 in unaffected individuals, P = 0.15). In contrast, in men, age-adjusted lumbar and thoracic vBMD were not different between diabetics and unaffected controls (lumbar vBMD = 125.0 +/- 1.8 in diabetics and 125.8 +/- 5.6 in unaffected individuals, P = 0.89; thoracic vBMD = 137.4 +/- 2.1 in diabetics vs. 134.2 +/- 5.5 in controls, P = 0.56). After multivariate analysis adjusting for age, sex, race, BMI, physical activity, dietary intake, smoking, and alcohol use, interaction between diabetes status and trabecular vBMD of the spine was no longer observed. In women only, age-adjusted areal BMD (determined by dual X-ray absorptiometry (DXA)) of the spine and hip were significantly higher in diabetics than non-diabetic (all P < 0.05), although the differences disappeared after additional adjustment for BMI. These data suggest that areal BMD measured by DXA and trabecular volumetric BMD measured by QCT are not associated with type 2 diabetes independently from BMI.
Collapse
Affiliation(s)
- T C Register
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | | | | | | | | | | | | |
Collapse
|
7
|
Bowden DW, Lohman K, Hsu FC, Langefeld CD, Carr JJ, Lenchik L, Wagenknecht LE, Freedman BI, Herrington DM. Hormone replacement therapy is associated with increased C-reactive protein in women with Type 2 diabetes in the Diabetes Heart Study. Diabet Med 2006; 23:763-7. [PMID: 16842481 DOI: 10.1111/j.1464-5491.2006.01912.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Increased levels of inflammatory biomarkers, especially C-reactive protein (CRP), are associated with increased risk for cardiovascular disease (CVD) events, such as myocardial infarction, stroke, peripheral vascular disease, and sudden cardiac death. Medical interventions that increase CRP levels, such as hormone replacement therapy (HRT) in post-menopausal women, are under increasing scrutiny. The effect of HRT on CRP levels in women with Type 2 diabetes (T2DM) is not well documented, and conflicting conclusions have been reported. The aim of this study was to determine the influence of HRT on women with diabetes in a large cross-sectional study. METHODS Three hundred and twenty-seven post-menopausal women with T2DM from the Diabetes Heart Study participated. Current use of HRT was determined and serum CRP levels were measured using a high-sensitivity ELISA kit. Generalized estimating equation methods were used to assess the relationship of multiple clinical and lifestyle (e.g. smoking) measures on CRP levels including differences between women taking HRT (HRT+) and not taking HRT (HRT-). RESULTS Overall serum CRP levels were strongly associated with body mass index (P < 0.0001) and age (P < 0.0001). Of the women, 243 were not using HRT and 84 were using HRT. HRT+ and HRT- women did not differ significantly in measures of clinical traits, with the exception of higher mean low-density lipoprotein cholesterol in HRT- women (P = 0.004). In all models tested, HRT+ women had significantly higher circulating CRP levels, with P-values ranging from 0.0045 to 0.010. CONCLUSIONS In this study of serum CRP concentration as a function of HRT in women with Type 2 diabetes, there was consistent evidence for increased circulating CRP levels in women receiving oestrogen-containing HRT. Whether HRT-induced increases in CRP can account for the adverse cardiovascular effects of HRT remains to be established; however, based on these data, there is little reason to believe that diabetic women would be spared from such an effect.
Collapse
Affiliation(s)
- D W Bowden
- Department of Biochemistry, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
You T, Murphy KM, Lyles MF, Demons JL, Lenchik L, Nicklas BJ. Addition of aerobic exercise to dietary weight loss preferentially reduces abdominal adipocyte size. Int J Obes (Lond) 2006; 30:1211-6. [PMID: 16446745 DOI: 10.1038/sj.ijo.0803245] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine if hypocaloric diet, diet plus low-intensity exercise, and diet plus high-intensity exercise differentially influence subcutaneous abdominal and gluteal adipocyte size in obese individuals. DESIGN Longitudinal intervention study of hypocaloric diet, diet plus low-intensity exercise, and diet plus high-intensity exercise (calorie deficit = 2800 kcal/week, 20 weeks). SUBJECTS Forty-five obese, middle-aged women (BMI = 33.0+/-0.6 kg/m2, age = 58+/-1 years). MEASUREMENTS Body composition testing and adipose tissue biopsies were conducted before and after the interventions. Subcutaneous abdominal and gluteal adipocyte size was determined. RESULTS All three interventions reduced body weight, fat mass, percent fat, and waist and hip girths to a similar degree. Diet only did not change subcutaneous abdominal adipocyte size, whereas both diet plus exercise groups significantly reduced abdominal adipocyte size. Changes in abdominal adipocyte size in the diet plus exercise groups were significantly different from that of the diet group. Gluteal adipocyte size decreased similarly in all three groups. CONCLUSION Addition of exercise training to dietary weight loss preferentially reduces subcutaneous abdominal adipocyte size in obese women. This may be of importance for the treatment of health complications associated with subcutaneous abdominal adiposity.
Collapse
Affiliation(s)
- T You
- J Paul Sticht Center on Aging, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Winston-Salem, NC 27157, USA.
| | | | | | | | | | | |
Collapse
|
9
|
Lenchik L, Hsu FC, Register TC, Lohman KK, Freedman BI, Langefeld CD, Bowden DW, Carr JJ. Heritability of spinal trabecular volumetric bone mineral density measured by QCT in the Diabetes Heart Study. Calcif Tissue Int 2004; 75:305-12. [PMID: 15549645 DOI: 10.1007/s00223-004-0249-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Accepted: 03/31/2004] [Indexed: 03/28/2023]
Abstract
The heritability of trabecular volumetric bone mineral density (BMD) determined by quantitative computed tomography (QCT) has not yet been reported. The purpose of this study was to investigate the heritability of BMD as determined by QCT and DXA in 124 women and 120 men (age 39-83 years, BMI 17-75, 84% type 2 diabetics) from 101 families (232 sibling pairs) in the Diabetes Heart Study. Volumetric BMD had a heritability (h2) estimate of 0.73 (SE = 0.15, P < 0.0001) at the lumbar spine and 0.71 (SE = 0.15, P < 0.0001) at the thoracic spine. Areal BMD heritability estimates were 0.56 for PA spine, 0.43 for total hip, 0.43 for femoral neck, 0.45 for distal radius, 0.42 for mid-radius, and 0.52 for whole body (all P < 0.01). After accounting for familial correlation using generalized estimating equations, volumetric BMD was inversely associated with age (r = -0.52, P < 0.0001) and duration of diabetes (r = -0.24, P < 0.01) and positively associated with body weight (r = 0.25, P < 0.01). In multivariate analysis, adjustment for age, sex, and race lowered the h2 estimates for volumetric BMD at the lumbar (h2 = 0.41, P < 0.01) and thoracic (h2 = 0.48, P < 0.001) spine, increased the h2 estimate for areal BMD at the mid radius (h2 = 0.58, P < 0.0001), and had little effect on the h2 estimate for areal BMD at other sites (h2 = 0.41-0.55, all P < 0.01). Additional adjustment for BMI, duration of diabetes, and physical activity had little effect on the h2 estimates for volumetric BMD or areal BMD except at the hip where they were lowered (h2 = 0.31-0.33, all P < 0.05). These data suggest that, like areal BMD, volumetric BMD is highly heritable and may be used in designing linkage studies to locate genes governing bone metabolism.
Collapse
Affiliation(s)
- L Lenchik
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
Growing evidence suggests that positive associations between fat mass (FM) and bone mineral density (BMD) are mediated by not only biomechanical but also biochemical factors. Adiponectin is a novel adipocyte-derived hormone that regulates energy homeostasis and has anti-inflammatory and anti-atherogenic effects. Unlike other adipokines such as leptin, adiponectin levels decrease in obesity and type 2 diabetes. The purpose of our study was to investigate associations of serum adiponectin with BMD (DXA and QCT), FM (DXA and QCT), and serum leptin and soluble leptin receptor levels in 38 women and 42 men (age 39-81, BMI 17-55, 86% with type 2 diabetes). After adjusting for age, gender, race, smoking, and diabetes status, serum adiponectin was inversely associated with areal BMD (r = -0.20 to -0.3, all P < 0.01), volumetric BMD (r = -0.35 to -0.44, all P < 0.01), and visceral fat volume (r = -0.30, P < 0.01). These associations remained significant after adjusting for whole body fat mass. The associations of adiponectin with subcutaneous fat volume, whole body FM, and serum leptin level were not significant (all P > 0.1). These data suggest that adiponectin may play a role in the protective effects of visceral fat on BMD.
Collapse
Affiliation(s)
- L Lenchik
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Lenchik L, Watts NB. Regression to the mean: what does it mean? Using bone density results to monitor treatment of osteoporosis. J Clin Densitom 2001; 4:1-4. [PMID: 11309514 DOI: 10.1385/jcd:4:1:01] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2000] [Revised: 11/27/2000] [Accepted: 12/05/2000] [Indexed: 11/11/2022]
|
12
|
Bui-Mansfield LT, Kline M, Chew FS, Rogers LF, Lenchik L. Osteochondritis dissecans of the tibial plafond: imaging characteristics and a review of the literature. AJR Am J Roentgenol 2000; 175:1305-8. [PMID: 11044029 DOI: 10.2214/ajr.175.5.1751305] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED OBJECTIVE; Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). CONCLUSION Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body.
Collapse
Affiliation(s)
- L T Bui-Mansfield
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088, USA
| | | | | | | | | |
Collapse
|
13
|
De Maeseneer M, Van Roy F, Lenchik L, Barbaix E, De Ridder F, Osteaux M. Three layers of the medial capsular and supporting structures of the knee: MR imaging-anatomic correlation. Radiographics 2000; 20 Spec No:S83-9. [PMID: 11046164 DOI: 10.1148/radiographics.20.suppl_1.g00oc05s83] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The authors used a three-layer approach to correlate the appearance of the capsule and ligaments of the medial side of the knee on magnetic resonance (MR) images with corresponding anatomic slices. MR images of six fresh cadaveric specimens were obtained by using a proton-density-weighted fast spin-echo sequence with a 256 x 512 matrix. Specimens were frozen and sliced with a band saw into 3. 0-mm-thick sections that corresponded to the MR images. Three layers were depicted on both anatomic slices and MR images. Layer 1 consisted of the deep crural fascia; layer 2, the superficial portion of the medial collateral ligament (MCL); and layer 3, the capsule, the deep portion of the MCL, the meniscofemoral and meniscotibial extensions of the deep portion of the MCL, and the patellomeniscal ligament. Along the anterior aspect of the medial side of the knee, layer 1 was fused with layer 2; along the posterior aspect of the knee, layer 2 was fused with layer 3.
Collapse
Affiliation(s)
- M De Maeseneer
- Department of Radiology, Vrije Universiteit Brussel, Laerbeeklaan 101, 1090 Jette, Belgium.
| | | | | | | | | | | |
Collapse
|
14
|
De Maeseneer M, Van Roy F, Lenchik L, Shahabpour M, Jacobson J, Ryu KN, Handelberg F, Osteaux M. CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. Radiographics 2000; 20 Spec No:S67-81. [PMID: 11046163 DOI: 10.1148/radiographics.20.suppl_1.g00oc03s67] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Interpretation of computed tomographic and magnetic resonance arthrograms of the shoulder is complicated by normal variants of the labrum and glenohumeral ligaments. A superior sublabral recess is located at the 12 o'clock position and represents a normal recess between the superior labrum and the cartilage of the glenoid cavity. A sublabral foramen is located at the 2 o'clock position and represents localized detachment of the labrum from the glenoid rim. Buford complex is characterized by absence of the anterosuperior labrum and cordlike thickening of the middle glenohumeral ligament. Imaging features of damage to the anterior labrum include absence or detachment of the labrum and an irregular frayed appearance. Superior labrum anterior-to-posterior (SLAP) lesions are classified as type I (tear confined to the superior labrum), type II (labrum and biceps tendon detached from the superior glenoid), type III (bucket handle tear of the superior labrum), or type IV (bucket handle tear of the superior labrum with lateral extension into the biceps tendon). Increased distance between the labrum and the glenoid, an irregular appearance of the labral margin, or lateral extension of the separation may suggest a SLAP lesion rather than a normal anatomic variant. However, differentiation between normal variants and pathologic conditions and between various types of SLAP lesions remains difficult.
Collapse
MESH Headings
- Adolescent
- Adult
- Arthrography/methods
- Cartilage, Articular/diagnostic imaging
- Cartilage, Articular/injuries
- Cartilage, Articular/pathology
- Diagnosis, Differential
- Female
- Humans
- Joint Diseases/diagnosis
- Joint Diseases/diagnostic imaging
- Ligaments, Articular/diagnostic imaging
- Ligaments, Articular/pathology
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Muscle, Skeletal/diagnostic imaging
- Muscle, Skeletal/injuries
- Muscle, Skeletal/pathology
- Rotator Cuff/diagnostic imaging
- Rotator Cuff/pathology
- Rotator Cuff Injuries
- Rupture
- Rupture, Spontaneous
- Shoulder Injuries
- Shoulder Joint/anatomy & histology
- Shoulder Joint/diagnostic imaging
- Tendon Injuries
- Tendons/diagnostic imaging
- Tendons/pathology
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- M De Maeseneer
- Department of Radiology, Vrije Universiteit Brussel, Laerbeeklaan 101, 1090 Jette, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Bui-Mansfield LT, Lenchik L, Rogers LF, Chew FS, Boles CA, Kline M. Osteochondritis dissecans of the tarsal navicular bone: imaging findings in four patients. J Comput Assist Tomogr 2000; 24:744-7. [PMID: 11045697 DOI: 10.1097/00004728-200009000-00015] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report the imaging characteristics of osteochondritis dissecans of the tarsal navicular bone in four cases and review the current literature. Its radiological findings are similar to osteochondritis dissecans found in other sites: focal lucency that disrupts the sharp cortical line, the presence of sclerosis, and cortical depression.
Collapse
Affiliation(s)
- L T Bui-Mansfield
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Chao D, Espeland MA, Farmer D, Register TC, Lenchik L, Applegate WB, Ettinger WH. Effect of voluntary weight loss on bone mineral density in older overweight women. J Am Geriatr Soc 2000; 48:753-9. [PMID: 10894313 DOI: 10.1111/j.1532-5415.2000.tb04749.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the effect of diet and exercise-induced weight loss on bone mineral density in overweight postmenopausal women DESIGN A 1-year prospective, randomized clinical trial. SETTING Two university medical school research centers. PARTICIPANTS Sixty-seven overweight postmenopausal women, a subset of the women who participated in the Trial of Nonpharmacological Interventions in the Elderly (TONE) to control hypertension. The participants were assigned randomly to one of four groups: usual care, weight loss only, sodium restriction only, or combined weight loss/sodium restriction. INTERVENTION All TONE participants in the treatment groups attended regular dietary intervention sessions to lose weight, reduce sodium intake, or both that they might refrain from using antihypertensive medications for a period of 15 to 36 months (median = 29 months). MEASUREMENTS Bone mineral density (BMD) assessed by dual energy X-ray absorptiometry (DXA), serum and urine markers of bone metabolism, and other demographic and clinical data were collected at baseline, 6 months, and 12 months. RESULTS Women assigned to the weight loss interventions lost 9.2 +/- 1.2 lbs (mean +/- SE) at 6 months and 7.7 +/- 2.0 lbs at 12 months compared with 1.8 +/- 1.0 lbs at 6 months and 1.9 +/- 1.6 lbs at 12 months for those assigned to no weight loss intervention (P < .0001). Weight loss was correlated with a decrease in total body BMD (P = .004) and an increase in osteocalcin (P = .004) after controlling for baseline bone measures, intervention assignment, and other baseline covariates. Regression analyses indicated that total body BMD decreased by 6.25 +/- 2.06 g/cm2 x 10-4 for each pound of weight loss. CONCLUSIONS Voluntary weight loss in overweight postmenopausal women is associated with modest decrease in total body BMD. Clinicians recommending weight loss for older postmenopausal women may need to include recommendations for reducing the risk of bone loss.
Collapse
Affiliation(s)
- D Chao
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
The purpose of this study was to determine if shoulder exercise prior to MR imaging accentuates findings related to rotator cuff tears. In 32 consecutive patients undergoing MR imaging to evaluate the rotator cuff, after routine MR examination, the joint was moved by active or passive exercise (circumduction, including abduction, if possible) in an attempt to redistribute any joint fluid. The exercise was performed according to pain tolerance and for no longer than 4 minutes. The coronal oblique fast spin-echo T2-weighted images of these patients performed before exercise were reviewed by consensus agreement of two musculoskeletal radiologists who were blinded to clinical information. The appearance of the rotator cuff tendons and the distribution of fluid in the glenohumeral joint were determined. The identical postexercise MR images then were placed alongside the corresponding preexercise MR images, and a direct comparison of findings was made with regard to any change in the appearance of the rotator cuff or joint fluid by consensus opinion of the same two radiologists. Five patients (five shoulders) could not perform exercise because of pain. In the remaining 27 patients (27 shoulders), changes in the location of joint fluid were seen when the preexercise and postexercise images were reviewed together, the diagnosis of partial rotator cuff tear (n = 8) was changed to normal in two cases, and the diagnosis of partial tear was made with more confidence in one case. The diagnoses of normal rotator cuff (n = 16) and complete rotator cuff tear (n = 3) were unchanged. Eight patients had arthroscopy; in each of these, the preexercise and postexercise images showed similar results, and proved to be correct surgically (six normal, one partial rotator cuff tear, and one complete rotator cuff tear). Although postexercise MR images show changes in the distribution of joint fluid when compared to preexercise images, the diagnostic benefits of the postexercise images in the analysis of the rotator cuff appear to be limited.
Collapse
Affiliation(s)
- S Jaovisidha
- Department of Radiology, Veteran Affairs Medical Center, University of California-San Diego, USA
| | | | | | | |
Collapse
|
18
|
De Maeseneer M, Lenchik L, Everaert H, Marcelis S, Bossuyt A, Osteaux M, Beeckman P. Evaluation of lower back pain with bone scintigraphy and SPECT. Radiographics 1999; 19:901-12; discussion 912-4. [PMID: 10464798 DOI: 10.1148/radiographics.19.4.g99jl03901] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bone scintigraphy and single photon emission computed tomography (SPECT) may be performed for evaluation of lower back pain, especially when a bone abnormality is suspected. Various patterns of tracer activity based on precise identification of the anatomic location of increased uptake may be observed and used to evaluate bones and joints. Lesions centered about the disk space and vertebral body include spondylodiskitis, metastatic disease, vertebral body fracture, and degenerative disease (disk disease, spondylosis deformans). In diskitis, tracer uptake has a vertical orientation. Metastatic involvement should be suspected in solitary lesions evaluated with SPECT when the area of increased uptake extends from the vertebral body into the pedicle. Fractures are seen on planar and SPECT images as a linear, horizontally oriented area of increased uptake centered in the vertebral body. In degenerative disease, increased uptake is centered about the disk space and may be seen in and project beyond the surface of the vertebral body. Lesions of the posterior arch (comprising the pedicle, lamina, and facet joints) include spondylolysis, pedicle lesions, osteoarthritis of the facet joints, and fracture of the transverse process. Scintigraphy may help differentiate long-standing asymptomatic spondylolysis from ongoing disease. In osteoarthritis of the facet joints, SPECT may be used to select patients to be treated with therapeutic injections. Increased uptake in the transverse process most often indicates a fracture, although tumors may also occur in this location. These findings at planar bone scintigraphy and SPECT allow differentiation of common pathologic conditions and can lead to a specific diagnosis.
Collapse
Affiliation(s)
- M De Maeseneer
- Department of Radiology and Nuclear Medicine, Sint Andriesziekenhuis, Tielt, Belgium
| | | | | | | | | | | | | |
Collapse
|
19
|
Affiliation(s)
- L Lenchik
- Departent of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| |
Collapse
|
20
|
Abstract
PURPOSE To determine the MR imaging findings in patients with complications of Paget disease of bone. MATERIALS AND METHODS Of 45 patients with Paget disease who underwent MR imaging, 33 (26 men, seven women; age range, 64-91 years) with known complications of the disease were examined. Imaging in this subgroup included radiography (n = 26), computed tomography (n = 12), bone scintigraphy (n = 15), and magnetic resonance (MR) imaging (n = 33). Patients were examined specifically for musculoskeletal and neurologic complications of Paget disease, including fracture, basilar impression, spinal stenosis, bone tumor, and osteoarthrosis. RESULTS The 56 complications documented in the 33 patients were fracture (n = 17), neurologic entrapment (n = 19), neoplasm (n = 9), and arthropathy (n = 11). MR imaging was beneficial in the diagnostic evaluation of basilar impression (n = 7), spinal stenosis (n = 12), and the tumor stage (n = 9). It also helped to successfully evaluate pagetic bone narrowing of the coracoacromial arch, which was associated with impingement syndrome and rotator cuff rupture (n = 2). The signal intensities in pagetic bone were most commonly similar to those in fat; this finding had a 100% negative predictive value in excluding neoplasm. CONCLUSION Although Paget disease is diagnosed economically with conventional radiography, MR imaging is well suited for demonstrating the presence and extent of several characteristic disease complications, including basilar impression, spinal stenosis, and secondary neoplasm.
Collapse
Affiliation(s)
- R D Boutin
- Department of Radiology, University of California, San Diego School of Medicine, USA
| | | | | | | | | |
Collapse
|
21
|
Affiliation(s)
- L Lenchik
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1088, USA
| | | | | |
Collapse
|
22
|
De Maeseneer M, Lenchik L, Starok M, Pedowitz R, Trudell D, Resnick D. Normal and abnormal medial meniscocapsular structures: MR imaging and sonography in cadavers. AJR Am J Roentgenol 1998; 171:969-76. [PMID: 9762977 DOI: 10.2214/ajr.171.4.9762977] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to develop imaging criteria for the diagnosis of meniscocapsular separation by correlating findings on MR imaging, MR arthrography, and sonography of normal and abnormal medial meniscocapsular structures with corresponding anatomic sections in cadavers. MATERIALS AND METHODS Eight cadaveric knee specimens were examined with MR imaging, MR arthrography, and sonography before arthroscopy. In six specimens the following lesions were arthroscopically created: meniscocapsular separation (n = 3), medial collateral ligament (MCL) tear (n = 3), tear of the meniscofemoral extension of the deep MCL (n = 2), and coronary ligament tear (n = 2). After arthroscopy, all imaging studies were repeated. The specimens were sectioned for correlation with imaging studies. RESULTS MR findings that correlated with meniscocapsular separation were interposition of fluid between the meniscus and the MCL, irregular meniscal outline, and increased distance between the meniscus and the MCL. On MR arthrography meniscocapsular separation correlated with interposition of contrast medium between the meniscus and the MCL. Tears of the meniscofemoral extension of the deep MCL were best shown on MR arthrography. Sonography showed deep and superficial MCL lesions but did not show meniscocapsular separations. CONCLUSION In arthroscopically created meniscocapsular separation, the lesion is suggested on MR images when fluid is interposed between the meniscus and the MCL, when the meniscal outline is irregular, or when the distance between the meniscus and the MCL is increased. On MR arthrograms, a meniscocapsular separation is suggested when contrast medium is interposed between the meniscus and the MCL. Sonography does not allow accurate diagnosis of meniscocapsular separation.
Collapse
Affiliation(s)
- M De Maeseneer
- Department of Radiology, Veterans Administration Medical Center, San Diego, CA 92161, USA
| | | | | | | | | | | |
Collapse
|
23
|
Abstract
Although meniscal cysts are common, erosions of bone caused by these cysts are quite rare. We report MR imaging findings of two cases in which lateral meniscal cysts resulted in erosion of the lateral tibial plateau.
Collapse
Affiliation(s)
- S K Juhng
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1088, USA
| | | | | |
Collapse
|
24
|
Abstract
We present a case of subcutaneous granuloma annulare evaluated with MR imaging. The mass was poorly defined and showed thickened interconnecting strands with low signal intensity on T1- and T2-weighted MR images. When a poorly defined subcutaneous mass with low signal intensity on both T1- and T2-weighted MR images is observed in an otherwise healthy child, subcutaneous granuloma annulare should receive serious consideration. Subcutaneous granuloma annulare should be added to the list of tumors with short T2.
Collapse
Affiliation(s)
- M De Maeseneer
- Department of Radiology, Vrije Universiteit Brussel, Jette, Belgium
| | | | | | | | | |
Collapse
|
25
|
De Maeseneer M, Jacobson JA, Jaovisidha S, Lenchik L, Ryu KN, Trudell DR, Resnick D. Elbow effusions: distribution of joint fluid with flexion and extension and imaging implications. Invest Radiol 1998; 33:117-25. [PMID: 9493728 DOI: 10.1097/00004424-199802000-00010] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES The authors study the distribution of elbow joint fluid with flexion and extension of the joint and evaluate the imaging implications of such distribution. METHODS Three cadaveric elbows were studied with radiography, ultrasonography, and magnetic resonance imaging after the incremental injections of 1 to 15 mL of saline solution into the elbow joint. Imaging was obtained with full flexion and extension of the joint. Anatomic sections were obtained for correlation. RESULTS In flexion fluid initially collected posteriorly and, with larger quantities, anteriorly. In extension the anterior fat pad was pressed into its fossa and the posterior fat pad was displaced superiorly by the olecranon process. On lateral radiographs in elbow flexion a positive fat pad sign was seen with 5 to 10 mL of fluid in the joint. Sonography allowed identification of 1 to 3 mL of fluid posteriorly with the elbow flexed. Magnetic resonance imaging allowed identification of 1 mL of fluid, regardless of joint position and location. CONCLUSIONS The distribution of joint fluid in the elbow is influenced by flexion and extension of the joint. Radiography is best performed in flexion. Sonography is more sensitive than radiography in diagnosing effusions, but should be performed along the olecranon fossa with the elbow flexed. Magnetic resonance imaging is most sensitive in identifying effusions, regardless of joint position or location.
Collapse
Affiliation(s)
- M De Maeseneer
- Department of Radiology, Veterans Administration Medical Center, San Diego, California 92161, USA
| | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Although metabolic bone disorders are common, they may be difficult to distinguish on the basis of clinical and radiologic findings. Understanding their diverse manifestations on imaging studies may allow early diagnosis. This article discusses osteoporosis, osteomalacia, rickets, hyperparathyroidism, hypothyroidism, hyperthyroidism, renal osteodystrophy, and Paget disease, with emphasis on radiologic differential diagnosis.
Collapse
Affiliation(s)
- L Lenchik
- Department of Radiology, The Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1088, USA
| | | |
Collapse
|
27
|
Abstract
A 37-year-old woman with myositis ossificans of the left foot is reported. A faint density was seen on foot radiographs, whereas computed tomography images showed a rim of mineralization inferior to the second and third metatarsal bones. On short tau inversion recovery-weighted magnetic resonance images, a hyperintense lesion was demonstrated with hyperintensity extending to the surrounding soft tissues. The rim of ossification appeared hypointense. Other non-neoplastic soft tissue processes with bone formation such as pseudomalignant osseous tumor of soft tissues, florid reactive periostitis, and bizarre parosteal osteochondromatous proliferation occur more commonly in the foot than myositis ossificans. A differential diagnosis of these lesions including periosteal and parosteal osteosarcoma, periosteal chondroma, and osteomyelitis is discussed.
Collapse
Affiliation(s)
- M De Maeseneer
- Department of Osteoradiology, Veterans Administration Medical Center, San Diego, California 92161, USA
| | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE The purpose of our study was to define retinacular anatomy with MR imaging and sonography. MATERIALS AND METHODS Five cadaveric knee specimens underwent sonography and MR imaging using the following sequences: T1-weighted axial, sagittal, coronal, and five oblique planes and axial three-dimensional gradient-echo imaging. Three knees were injected with gelatin gadolinium solution before imaging. All five specimens were sectioned. Correlation was made between findings derived from MR imaging, sonography, and cadaveric sections. RESULTS T1-weighted axial images without intraarticular gadolinium were most useful for revealing the superficial layer and deep ligaments of the retinacula; however, the oblique sagittal and oblique coronal planes showed the deep ligaments more clearly in their craniocaudal dimensions. Sonography revealed the retinacula as bilaminar structures with discrete superficial and deep layers but failed to distinguish the deep ligaments from one another. CONCLUSION Conventional T1-weighted axial MR images showed the various components of the retinacula including the medial patellofemoral ligament, which is an important stabilizing structure. Oblique imaging planes may be a helpful adjunct to axial imaging planes. Sonography can consistently identify the retinacula and may be useful in their assessment.
Collapse
Affiliation(s)
- M Starok
- Department of Medical Imaging, Sunnybrook Health Science Center, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
29
|
Abstract
The infrapatellar fat pad of Hoffa is an intracapsular structure that is routinely visualized on magnetic resonance images of the knee. Because disease in this region is not uncommon, it is important to be familiar with the various pathologic entities that may occur here. Abnormalities that are intrinsic to this fat pad include Hoffa disease, intracapsular chondroma, localized nodular synovitis, postarthroscopy and postsurgery fibrosis, and shear injury. In addition, the infrapatellar fat pad may be involved secondarily from extrinsic processes, including articular disorders (eg, joint effusion, intraarticular bodies, meniscal cyst, ganglion cyst, cyclops lesion), synovial abnormalities (eg, pigmented villonodular synovitis; hemophilia; synovial hemangioma; primary synovial chondromatosis; chondrosarcoma; lipoma arborescens; rheumatoid, seronegative, and septic arthritis; arthritis associated with inflammatory intestinal disorders; synovitis associated with primary osteoarthritis), and anterior extracapsular abnormalities. The approach to pathologic processes involving the infrapatellar fat pad of Hoffa is simplified when one is familiar with regional anatomy and possible differential diagnostic considerations.
Collapse
Affiliation(s)
- J A Jacobson
- Department of Radiology, University of California, San Diego, USA
| | | | | | | | | |
Collapse
|
30
|
Affiliation(s)
- L Lenchik
- Department of Radiology, Bowman Gray School of Medicine, Winston-Salem, NC 27157, USA
| | | |
Collapse
|
31
|
Abstract
OBJECTIVE To analyze the MR imaging features of fibrolipomatous hamartoma (FLH) of nerves. DESIGN AND PATIENTS MR imaging studies from six patients (three men and three women) were retrospectively reviewed by three musculoskeletal radiologists. In four patients, a biopsy of the nerve lesion was performed. In two patients, biopsy data were unavailable and the diagnosis was based on the clinical history combined with the MR imaging findings. RESULTS AND CONCLUSION MR imaging demonstrated fusiform nerve enlargement that was caused by fatty proliferation and thickening of nerve bundles. Nerve bundles appeared as serpentine tubular structures, hypointense on both T1- and T2-weighted images. The degree of fatty proliferation varied among patients. In addition, significant variation in the distribution of fat along the course of the nerves was noted. In three patients, FLH followed the branching pattern of the nerves, a characteristic pathologic finding. In two patients, intramuscular fat deposition (biceps and tibialis posterior muscles) was present. MR imaging findings of FLH are typical, allowing a confident diagnosis. The variation of fatty proliferation among patients and involved nerves as well as the tendency of the abnormalities to follow the branching pattern of the nerves is well demonstrated with MR imaging. FLH may present as an isolated nerve lesion, may be associated with intramuscular fat deposition, or may occur as a feature of macrodystrophia lipomatosa (MDL).
Collapse
Affiliation(s)
- M De Maeseneer
- Department of Radiology, Veterans Affairs Medical Center and University of California, San Diego 92161, USA
| | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
OBJECTIVE Chondrocalcinosis of the knee is a common radiological finding in the elderly. However, visualization of chondrocalcinosis may be difficult in patients with advanced cartilage loss. The purpose of this study was to determine sensitivity, specificity, and accuracy of gastrocnemius tendon calcification that might serve as a radiographic marker of chondrocalcinosis in patients with painful knees. DESIGN AND PATIENTS We prospectively evaluated 37 knee radiographs in 30 consecutive patients (29 men, 8 women; mean age 67 years, age range 37-90 years) with painful knees who had radiographic evidence of chondrocalcinosis. The frequency of fibrocartilage, hyaline cartilage, and gastrocnemius tendon calcification was determined. For a control group, we evaluated knee radiographs in 65 consecutive patients with knee pain (54 men, 11 women; mean age 59 years, age range 40-93 years) who had no radiological signs of chondrocalcinosis. The frequency of gastrocnemius tendon calcification in the control group was determined. RESULTS Gastrocnemius tendon calcification was 41% sensitive, 100% specific, and 78% accurate in predicting chondrocalcinosis. The gastrocnemius tendon was calcified on 15 of 37 (41%) radiographs in the experimental group and on 0 of 67 radiographs in the control group. In the chondrocalcinosis group, 23 (62%) had posterior hyaline cartilage calcification, 14 (38%) had anterior hyaline cartilage calcification, 31 (84%) had medial meniscus calcification, and 36 (97%) had lateral meniscus calcification. CONCLUSIONS Our results show that gastrocnemius tendon calcification is an accurate radiographic marker of chondrocalcinosis in patients with knee pain.
Collapse
Affiliation(s)
- K Foldes
- Department of Radiology, Veterans Administration Medical Center (VAMC), San Diego, CA 92161, USA
| | | | | | | | | | | |
Collapse
|
33
|
Lenchik L, Kier R. Popliteal cysts on MR imaging: value as an ancillary sign of meniscal tears. AJR Am J Roentgenol 1996; 166:1232. [PMID: 8615285 DOI: 10.2214/ajr.166.5.8615285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
34
|
Silverman CS, Lenchik L, Shimkin PM, Lipow KL. The value of MR in differentiating subligamentous from supraligamentous lumbar disk herniations. AJNR Am J Neuroradiol 1995; 16:571-9. [PMID: 7793383 PMCID: PMC8337650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine the value of MR criteria in differentiating subligamentous from supraligamentous lumbar disk herniations. METHODS A retrospective review of surgical reports and MR images of 50 patients undergoing first-time lumbar surgery was performed. Three MR imaging criteria were assessed: the presence and integrity of a low-signal-intensity line posterior to the disk herniation, the size of the disk herniation in comparison with the size of the spinal canal, and the presence of disk fragments. Correlation was made with surgical findings to determine the value of these MR criteria in differentiating subligamentous from supraligamentous disk herniations. RESULTS For determining subligamentous disk herniations: the presence of a continuous low-signal-intensity line posterior to the disk herniation was 29% sensitive, 65% specific, and 42% accurate; disk herniation size less than 50% of the size of the spinal canal was 64% sensitive, 47% specific, and 58% accurate; and the absence of disk fragments was 88% sensitive, 12% specific, and 62% accurate. Combinations of individual MR criteria did not improve diagnostic accuracy. CONCLUSIONS For differentiating subligamentous from supraligamentous lumbar disk herniations, none of the MR imaging criteria assessed was reliable.
Collapse
Affiliation(s)
- C S Silverman
- Department of Radiology, Bridgeport Conn. Hospital 06610, USA
| | | | | | | |
Collapse
|
35
|
Abstract
OBJECTIVE We report imaging features of two cases of subependymoma, a relatively rare benign intraventricular neoplasm. MATERIALS AND METHODS The first case was a lateral ventricular tumor, which grew to a large size before becoming symptomatic. The second case was a fourth ventricular subependymoma with extensive cisternal spread. RESULTS In Case 1, absence of postcontrast enhancement suggested the correct diagnosis. However, in Case 2 heterogeneous enhancement made the diagnosis uncertain. In both cases, pre- and postoperative MRI was superior to other modalities in defining tumor extent and delineating the surrounding anatomy. CONCLUSIONS Magnetic resonance imaging is the modality of choice for studying subependymomas. The diagnosis should be placed among differential considerations for intraventricular tumors.
Collapse
|
36
|
Dovgan DJ, Lenchik L, Kaye AD. Computed tomographic evaluation of maximal diaphragmatic crural thickness. Conn Med 1994; 58:203-6. [PMID: 8045119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of this study is to determine the range of maximal diaphragmatic crural thickness during different phases of respiration and to correlate crural thickness with age and gender. Prospective evaluation of computed tomographic (CT) scans of 200 patients without juxtacrural abnormalities was performed. Maximal short-axis crural thickness measurements were determined in all patients. Measurements were obtained at full inspiration during chest CT (n = 60), full expiration during abdominal CT (n = 89), and unknown phase of respiration during dynamic CT scans (n = 51). Maximal crural thickness measurements were analyzed by side, age, and gender. The right crus was thicker than the left crus in 91% of patients. The range of maximal crural thickness remained fairly constant from the second to the eighth decades of life. The range of maximal crural thickness was 1.8-18.8 mm in men and 1.8-21.1 mm in women. Maximal crural thickness does not significantly vary with age and gender for specific phase of respiration.
Collapse
Affiliation(s)
- D J Dovgan
- Department of Diagnostic Radiology, Bridgeport Hospital, CT 06610
| | | | | |
Collapse
|
37
|
Abstract
OBJECTIVE The iliopsoas compartment is an extraperitoneal space defined by the iliopsoas fascia; its major components include the iliacus, psoas major, and psoas minor muscles. Distinction of neoplastic, inflammatory, and hemorrhagic conditions of the iliopsoas compartment is often difficult, whether based on clinical evaluation or CT findings. The purpose of this study was to determine specific CT features that might help differentiate these three abnormalities. MATERIALS AND METHODS We retrospectively reviewed CT scans of 44 patients who had abnormalities of the iliopsoas compartment (15 neoplasms, 21 abscesses, and eight hematomas). Final diagnoses were established by surgical biopsy (n = 14), percutaneous biopsy (n = 18), or clinical evidence (n = 12). Diagnoses were correlated with 11 CT features to determine findings that could be used to differentiate the three abnormalities. These included enlargement of the iliopsoas muscles; extent, margination, and attenuation of the lesion; presence of gas, calcification, bone destruction, fat infiltration, and fascial disruption; and associated fluid or adenopathy. The radiologist who interpreted the scans had no knowledge of the clinical findings. RESULTS The most reliable CT features for each condition were as follows: irregular margins, 67% sensitive, 52% specific, and 57% accurate for neoplasms; low attenuation, 100% sensitive, 43% specific, and 70% accurate for abscesses; and diffuse involvement of the entire muscle, 88% sensitive, 78% specific, and 80% accurate for hematomas. Combinations of individual CT features did not improve the ability to differentiate the three conditions. CONCLUSION Our results show that the efficacy of CT, when scans are interpreted without knowledge of the clinical history, is poor for differentiating iliopsoas neoplasms, abscesses, and hematomas.
Collapse
Affiliation(s)
- L Lenchik
- Department of Radiology, Bridgeport Hospital, CT 06610
| | | | | |
Collapse
|
38
|
Affiliation(s)
- L Lenchik
- Northwestern University Medical School, Chicago, Illinois
| | | | | | | |
Collapse
|