Long-term monitoring of children with Pseudo Tumor Cerebri Syndrome by transbulbar sonography

Determination of optic nerve sheath diameter (ONSD) with transbulbar sonography has become an easily accessible and time-effective tool in the assessment of increased intracranial pressure. The aim of our study was to evaluate the usefulness of transbulbar sonography in the initial diagnosis and in follow-up examinations of children and adolescents with the diagnosis of pseudotumor cerebri syndrome (PTCS). We retrospectively reviewed imaging results of 24 patients aged 0.75-17 years with PTCS. Serial transbulbar sonography examinations were performed between 2011 and 2021. Sonographic evaluation included the ONSD, papilledema and subarachnoid space. 240 sonographic measurements taken at 108 time points in 17 patients met the inclusion criteria. All patients underwent serial lumbar punctures and routine fundoscopy in close relation to transbulbar sonography. We found that ONSD values remained high in all patients. The longest follow-up period was dated 2498 days (6.84 years) after initial diagnosis. Papilledema resolved in close correlation to fundoscopy normalization. In 16/17 patients the subarachnoid space remained cystic in appearance. These findings were independent of clinical symptoms and lumbar puncture opening pressure. We conclude that transbulbar sonography is a useful diagnostic tool in the initial diagnostic workup of children with PTCS. On follow-up however ONSD values and the cystic transformation of the subarachnoid space remained pathologic in the majority of cases while papilledema resolved parallel to fundoscopy findings. Serial measurements of ONSD are therefore of limited value in the follow-up of patients with PTCS and cannot be considered a reliable tool in subsequent therapeutic decisions.

Normal values for transbulbar sonography and magnetic resonance imaging of the optic nerve sheath diameter (ONSD) in children and adolescents

PURPOSE

To establish normal values of the optic nerve sheath diameter (ONSD) in children and adolescents for transbulbar sonography and magnetic resonance imaging.

MATERIALS AND METHODS

In 99 children and adolescents (age: 5.6 - 18.6 years, mean: 12 years) without neurologic or ophthalmologic disease, measurements of the ONSD with transbulbar sonography were performed. For comparison 59 children and adolescents (age: 5.1 - 17.4 years, mean 12.3 years) with a normal MR examination of the brain had measurements of the ONSD on a T2-weighted thin section sequence of the orbit. Besides establishing modality-related normal values, age dependency, accuracy and reproducibility of measurements were assessed.

RESULTS

Overall the mean ONSD was 5.75 ± 0.52 mm for transbulbar sonography and 5.69 ± 0.31 mm for MRI. There was no statistical significance between the 95 % percentiles and age for both transbulbar sonography (p = 0.332) and MRI (p = 0.336). As a parameter for the reproducibility of measurements, the repeatability coefficient (RC) was between 0.34 mm and 0.46 mm. The concordance correlation coefficient (CCC) values revealed a high agreement between readers both for transbulbar sonography (0.868) and MRI (0.796).

CONCLUSION

Normal values for ONSD in children and adolescents found in this study are significantly higher than assumed. The values found for transbulbar sonography are confirmed by comparable results for MR measurements. A precise sonographic measurement technique and the consideration of normal values found hereby are essential for correct interpretation of ONSD measurements in children and adolescents.

Measurement of the Optic Nerve Sheath Diameter in Children: Comparison Between Transbulbar Sonography and Magnetic Resonance Imaging

PURPOSE

 To evaluate the accuracy of measurements of the optic nerve sheath diameter (ONSD) in children by comparing transbulbar sonography with magnetic resonance imaging (MRI).

MATERIALS AND METHODS

 65 children (age: 3 mo- 17y; mean age: 11.3y) underwent MR imaging of the brain including a heavily T 2-w sequence of the orbit and transbulbar sonography using a 17 MHz linear array transducer. Measurements of the ONSD were performed retrospectively by two experienced readers and all images were evaluated regarding the image quality. Bland-Altman Plots were produced to assess the accuracy of measurements. The correlation between readers and between MR imaging and transbulbar sonography was calculated by the concordance correlation coefficient (CCC).

RESULTS

 Overall the mean values of the ONSD for MRI (5.86 ± 0.66 mm) and transbulbar sonography (5.86 ± 0.71 mm) were identical. There was a high correlation between readers for measurements of the ONSD both for transbulbar sonography (CCC = 0.93) as well as for MRI (CCC = 0.9). Comparing the measurement values between transbulbar sonography and MRI, the correlation of ONSD values was good to moderate with a high dependency on image quality (CCC [0.31, 0.68]).

CONCLUSION

 We were able to demonstrate that the ONSD values of transbulbar sonography in children correlate well with MRI if the relevant anatomic structures are depicted and the measuring points are set correctly. Based on the findings of our study, it seems necessary to define normal and cut-off values for the ONSD in children again to finally assess the clinical relevance of the ONSD as a noninvasive parameter for the evaluation of intracranial pressure.

High resolution ultrasound and magnetic resonance imaging of the optic nerve and the optic nerve sheath: anatomic correlation and clinical importance

PURPOSE

We performed a cadaver study to evaluate the accuracy of measurements of the optic nerve and the optic nerve sheath for high resolution US (HRUS) and magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Five Thiel-fixated cadaver specimens of the optic nerve were examined with HRUS and MRI. Measurements of the optic nerve and the ONSD were performed before and after the filling of the optic nerve sheath with saline solution. Statistical analysis included the calculation of the agreement of measurements and the evaluation of the intraobserver and interobserver variation.

RESULTS

Overall a good correlation of measurement values between HRUS and MRI can be found (mean difference: 0.02-0.97 mm). The repeatability coefficient (RC) and concordance correlation coefficient (CCC) values were good to excellent for most acquisitions (RC 0.2-1.11 mm; CCC 0.684-0.949). The highest variation of measurement values was found for transbulbar sonography (RC 0.58-1.83 mm; CCC 0.615/0.608).

CONCLUSION

If decisive anatomic structures are clearly depicted and the measuring points are set correctly, there is a good correlation between HRUS and MRI measurements of the optic nerve and the ONSD even on transbulbar sonography. As most of the standard and cut-off values that have been published for ultrasound are significantly lower than the results obtained with MRI, a reevaluation of sonographic ONSD measurement with correlation to MRI is necessary.

Total body MRI-governed involved compartment irradiation combined with high-dose chemotherapy and stem cell rescue improves long-term survival in Ewing tumor patients with multiple primary bone metastases

We examined the role of total body magnetic resonance imaging (TB-MRI)-governed involved compartment irradiation (ICI) and high-dose chemotherapy (HDC), followed by stem cell rescue (SCR) in patients with high-risk Ewing tumors (ETs) with multiple primary bone metastases (high-risk ET-MBM). Eleven patients with high-risk ET-MBM receiving initial assessment of involved bones by TB-MRI were registered from 1995 to 2000 (group A). In all, 6 patients out of 11 had additional lung disease at initial diagnosis; all had multifocal bone disease with more than three bones involved. After systemic induction with etoposide, vincristine, adriamycin (doxorubicin), ifosfamide, and actinomycin D (EVAIA) or VAIA chemotherapy, ICI of all sites positive by TB-MRI was administered, followed by HDC and SCR. A second group matched for observation period and consisting of 26 patients with more than three involved bones at diagnosis was treated with the European Intergroup Cooperative Ewing Sarcoma Study-92 (EICESS-92) protocol (group B). These patients did not receive TB-MRI and consequently did not receive TB-MRI-governed ICI, or HDC and SCR. Survival in group A vs group B was 45 vs 8% at 5 years and 27 vs 8% at 10 years after diagnosis (log rank and Breslow: P<0.005). We conclude that TB-MRI-governed ICI followed by HDC and SCR in ET-MBM is feasible and warrants further evaluation in prospective studies.

[Whole-body MRI in children with langerhans cell histiocytosis for the evaluation of the skeletal system]

PURPOSE

The usefulness of whole-body MRI (WB-MRI) for the detection of skeletal lesions in patients with Langerhans cell histiocytosis should be documented on the basis of case presentations.

MATERIALS AND METHODS

In six patients with histologically proven Langerhans cell histiocytosis, 14 WB-MRI examinations were performed to evaluate the skeletal system within disease staging (6 primary, 8 follow-up examinations). The examinations were performed on a 1.5 Tesla, 32-channel whole-body scanner. The examination protocol consisted of T 1-weighted and STIR sequences in coronal and sagittal orientation. For comparison, radiographs of the initial skeletal lesions and those that were additionally detected on WB-MRI were available.

RESULTS

In 4 patients no additional skeletal lesions were found on WB-MRI besides the initial lesion leading to the diagnosis of unifocal single system disease. In 2 patients WB-MRI was able to identify additional skeletal lesions. In a 5 S year-old boy with the primary lesion located in the cervical spine, a second lesion was detected in the lumbar spine on the initial scan and in the skull and proximal femur during follow-up examination. In a 12 year-old girl with a primary lesion of the thoracic spine, WB-MRI diagnosed additional lesions in the pelvic bone and the tibia. In both patients the diagnosis of multifocal skeletal involvement led to chemotherapy. During follow-up examination, the healing response under therapy could be demonstrated. Comparison with conventional imaging showed that especially lesions located in the spine or the pelvis were not detectable on radiographs even when knowing the MR results.

CONCLUSION

The extent of skeletal involvement in Langerhans cell histiocytosis has crucial impact on therapy and prognosis. Whole-body MRI has been reported to be an established method for the evaluation of disseminated skeletal disease with distinct advantages over conventional radiography and bone scintigraphy. Our results suggest that WB-MRI should also be the imaging modality of choice for the assessment of skeletal involvement in children with Langerhans cell histiocytosis.

[Sonographic detection of normal appendix in children and adolescents]

PURPOSE

The frequency of depiction of the normal appendix by real time B-mode sonography in children was evaluated in a prospective study.

MATERIALS AND METHODS

In 274 consecutive patients, age one to nineteen, without abdominal pain, depiction of the normal appendix was attempted using a 5-12 MHz linear array transducer. The ultrasound examination was performed using the graded compression technique according to the description of Puylaert. Depiction of the normal appendix was graded as a) complete, b) partial and c) unable to be depicted. In addition the position and diameter of the appendix, the examination time and the image quality were documented.

RESULTS

The appendix was depicted completely in 74% of all patients and partially in 10%. In the age group of one to nine years, complete depiction was possible in 86% of the cases. The most common position with 87% was caudal and mediocaudal, 11% of the appendices were located retrocecal and 2% had a cranioventral position. The mean diameter of the appendices was 4.1 mm (range 3-7 mm). The mean examination time to depict the normal appendix completely was 3.7 min compared to 7.6 min in partial or incompletely depicted cases. In most cases in which complete depiction of the appendix was possible, the image quality was excellent.

CONCLUSION

Since the normal appendix in children can be reliably depicted by experienced examiners using high-resolution linear transducers, ultrasound is suitable as a reliable imaging modality for excluding acute appendicitis in children.

[Acute encephalopathy in salmonella infection]

While infections with salmonella typhi may frequently result in encephalopathy, this complication is rare in infections with salmonella enteritidis and has been rarely reported. We report about a 21 months old girl which developed encephalopathy with convulsion, ataxia and cortical blindness following salmonella infection. Moreover, we show a summary of ten previous case reports.

[Estimation of diffuse bone marrow infiltration of the spine in multiple myeloma: correlation of MRT with histological results]

PURPOSE

To determine the detection of diffuse bone marrow infiltration with MRI in comparison with histopathological findings.

MATERIALS AND METHODS

MRI was performed on 45 patients with histologically proven multiple myeloma and on 30 healthy individuals. Three experienced radiologists read separately Tl-weighted SE sequences, STIR sequences and the combination of Tl-weighted SE and STIR sequences of the spine. Additionally, Tl-weighted SE sequences were obtained after gadolinium administration and the percentage increase in signal intensity was calculated. Bone marrow histology was used as gold standard for assessing the grade of infiltration. A dichotomous decision (infiltration yes/no) was made when assessing the MRI examinations.

RESULTS

For the visual detection of diffuse infiltration, the best sensitivity was found with Tl-weighted SE sequences, achieving 71 % on average. The specificity was 89 %. The STIR sequences showed a sensitivity of 61 % and a specificity of 98 %, and the combination of Tl-weighted/STIR-sequences achieved a sensitivity of 65 % and a specificity of 94 %. In comparison with the histological findings, the sensitivity of the Tl-weighted sequences was 35 % for low-grade, 89 % for moderate and 100 % for high-grade infiltration. The application of contrast material with calculation of the percentage signal increase improved the detection by 7 %.

CONCLUSION

The sensitivity of the visual detection of diffuse multiple myeloma with unenhanced MRI is limited for low-grade or moderate infiltration, whereas the sensitivity for high grade infiltration is reliable. The specificity is high and the diagnostic confidence improves after application of contrast material with calculation of the percentage increase in signal intensity.

Resurfacing knee arthroplasty in patients with allergic sensitivity to metals

BACKGROUND

The problem of metal sensitivity (Ni, Cr, and Co) in arthroplasty is still unsolved. To prevent the risk of allergy in cases with proved metal allergy in an epicutaneous test, a Natural Knee total knee arthroplasty, made totally from titanium (Ti-6Al-4V) and polyethylene, can be implanted. The results of this device have to be compared to the results of normal knee arthroplasty designed with a femoral component out of CrCoNi alloy. The mechanical resistance of this alloy is much higher than that of titanium, and therefore it is the standard for the femoral components of most knee-resurfacing devices.

METHODS

Thirty-five patients with a titanium Natural Knee were examined retrospectively after a mean follow-up of 2 years and 5 months (range 6 months to 5 years and 4 months). In comparison, 36 patients with a Genesis-I knee with a CrCoNi alloy femoral component were studied after a mean follow-up of 2 years and 4 months (range 8 months to 6 years and 2 months).

RESULTS

In spite of the lower mechanical resistance of titanium, the Natural Knee showed better results (knee score 84.1 points, function score 77.7 points, HSS score 80.1 points, 82.9% excellent and good results) than the Genesis-I knee (knee score 80.6 points, function score 76.4 points, HSS score 76.4 points, 68.5% excellent and good results), although these differences had no statistical significance.

CONCLUSIONS

The titanium Natural Knee prosthesis has proven to be a reliable knee joint replacement in the medium term.

[The roentgenmorphologic aspects of symptomatic calcifications in patients with calcifying tendinitis of the shoulder: determination of intra- and interobserver variabilities of Gärtner's classification]

AIM OF THE STUDY

The roentgenologic morphology of symptomatic calcified deposits of the rotator cuff can be classified according Gärtner. This classification influences therapeutic procedures and prognosis of clinical outcome in these patients. In the present study intraoberserver-reproducibility and interobserver-reliability of Gärtner's classification were tested.

METHODS

Plane radiographs of 100 patients with calcifications of the supraspinatus tendon were classified according the criteria of Gärtner by 6 independent observers twice within 4 months. Intraoberserver-reproducibility and interobserver-reliability were calculated by means of Cohen's kappa-index.

RESULTS

kappa-values of intraoberserver-reproducibility had a mean of 0.4208 (SD 0.1299), kappa-values of interobserver-reliability were 0.490 for the first and 0.474 for the second classification.

CONCLUSIONS

Determination of intraoberserver-reproducibility gave insufficient to satisfactory results, interobserver-reliability was sufficient. The clinical use of Gärtner's classification to plan therapeutic procedures or to determine clinical prognosis in patients with calcifying tendinitis can be recommended only with limitations.

Das akute CRPS I (Morbus Sudeck) nach distaler Radiusfraktur - Methoden der Frühdiagnostik

INTRODUCTION

CRPS I represents a frequent complication following distal radial fractures. Early diagnosis may prevent chronification of the disease. However posttraumatic pain, swelling and motor disturbances render the differentiation from normal fracture patients more difficult. The incidence of CRPS I in patients at risk and the diagnostic value of clinical evaluation, radiography and thermography in the early posttraumatic phase are analysed.

METHODS

158 consecutive patients with distal radial fractures were followed-up for 16 weeks after trauma. Apart from a detailed clinical examination 8 and 16 weeks after trauma, thermography and bilateral radiographs of both hands were performed.

RESULTS

At the end of the observation period 18 patients (11%) were clinically identified as CRPS I. The severity of the preceding trauma and the chosen therapy did not influence the process of the disease. 16 weeks after trauma easy differentiation between normal fracture patients and CRPS I patients was possible. 8 weeks after distal radial fracture clinical evaluation showed a sensitivity of 78% and a specificity of 94%. Thermography (58%) however and bilateral radiography (33%) revealed a poor sensitivity, respectively. The specificity was high for radiography (91%) and again poor for thermography (66%), respectively.

CONCLUSION

The results of the study support the importance of clinical evaluation in the early diagnosis of CRPS I. Plain radiographs facilitate the diagnosis as soon as bony changes develop.

Extracorporeal shock-wave therapy for chronic lateral tennis elbow--prediction of outcome by imaging

Today the clinical use of extracorporeal shockwave application (ESWA) for the treatment of lateral tennis elbow is hampered by the lack of results from randomized controlled trials and of predictive parameters of clinical outcome. The present prospective study aimed to provide the latter by means of magnetic resonance imaging (MRI). Twenty-three female and 19 male patients with unilateral chronic tennis elbow of the dominant site were clinically examined before and after repetitive low-energy ESWA. MRI was performed before ESWA to evaluate signal intensity changes or contrast enhancement of the common extensor tendon and the lateral epicondyle. After ESWA (mean follow-up period 18.6 months for all patients), clinical evaluation showed a significantly better mean clinical performance after ESWA than before treatment. Interestingly, male patients showed a significantly better mean clinical performance after ESWA than female patients, and male and female patients differed significantly in the signal intensity of the common extension tendon cross-section and tendon thickening on MRI. For female patients, MRI scans could be applied for predicting a positive clinical outcome of ESWA. This study reports the first indication of predictability of positive clinical outcome of the treatment of chronic lateral tennis elbow by ESWA using imaging prior to treatment. This may serve as an important step towards overcoming the therapeutic nihilism with respect to the non-operative management of this condition recently in the literature.

[Benign bone-forming tumors]

Benign bone-forming tumors include osteomas, enostomas, osteoid osteomas, and osteoblastomas. These lesions are often characterized by typical imaging findings on radiographs, CT and MR imaging studies. Radiologic findings and additional clinical information allow for a specific diagnosis in most cases. This review article emphasizes the radiological patterns of benign bone-forming tumors as well as their epidemiological, clinical, and pathological characteristics. In addition, minimally invasive interventional procedures for the therapy of osteoid osteoma are reviewed.

Extracorporeal shock wave application for chronic plantar fasciitis associated with heel spurs: prediction of outcome by magnetic resonance imaging

OBJECTIVE

To clarify morphologic features associated with the clinical outcome of extracorporeal shock wave application (ESWA) in chronic plantar fasciitis.

METHODS

In this prospective study 43 patients (48 heels) with chronic courses of plantar fasciitis were clinically examined before and after repetitive low energy ESWA. Standard radiographs of the affected heels were obtained before ESWA to document the existence of a calcaneal heel spur. Magnetic resonance imaging (MRI) was performed before ESWA to evaluate abnormalities of the plantar fascia, the surrounding soft tissue structures, and bone marrow edema of the calcaneus.

RESULTS

After ESWA (mean followup 19.3 mo), clinical evaluation of all 48 heels revealed a statistically significant decrease in the mean visual analog scale score from 74.5 to 25.4. Using the Roles and Maudsley score (RM), an established scoring system for categorizing results of treatment following ESWA for patients with plantar fasciitis, patients could be divided into 2 groups, i.e., satisfactory clinical outcome of ESWA (grades 1 and 2 by RM scale; n = 36 heels) and unsatisfactory outcome (grades 3 and 4 by RM scale; n = 12 heels). While thickness of plantar aponeurosis, soft tissue signal intensity changes, and soft tissue contrast medium uptake did not correlate with clinical outcome, the presence of a calcaneal bone marrow edema was highly predictive for satisfactory clinical outcome (positive predictive value 0.94, sensitivity 0.89, specificity 0.8).

CONCLUSION

This study indicates that in patients with chronic plantar fasciitis, the presence of calcaneal bone marrow edema on pretherapeutic MRI is a good predictive variable for a satisfactory clinical outcome of ESWA.

[The diagnosis of metastases in the bone marrow by MRT]

MRI plays an important role in the diagnostic workup of skeletal metastases. In principle two different applications of MRI can be distinguished: apart from the well known indications of clarifying uncertain lesions seen with other imaging modalities or demonstrating known osseous lesions with high resolution imaging for therapeutic planing, MRI can also be used as a primary screening modality for skeletal metastases. Besides the higher lesion detection rate the major advantage of MRI compared to bone scintigraphy lies in the demonstration of morphology which on the one hand exactly shows the extension of tumorous lesions and on the other hand clearly distinguishes between malign and benign processes. As unclear findings on bone scintigraphy often require additional imaging studies, especially in patients with clinical findings or lab results suggestive for metastatic disease, we think that whole-body-skeletal-MRI is not only an accurate but also a cost effective diagnostic modality in the detection and screening for skeletal metastases, if the indication for the examination is closely related to clinical findings and the therapeutic relevance of the imaging results.

[Spondylolysis in the developmental stage: diagnostic contribution of MRI]

PURPOSE

To assess the value of MR imaging in demonstrating ongoing spondylolysis in adolescents.

METHODS

MRI was performed in 9 juvenile patients (3 female, 6 male aged 8-16 years; mean 12.5 y) with pain during hyperextension. In 6 patients a CT scan and in 5 a plain film was available.

RESULTS

In all patients bone marrow edema was found in the pars interarticularis and the pedicle, which was bilateral in 4 patients. In 7/9 cases the L5 vertebra was affected, in 2/9 cases spondylolysis was found in L4. In 3 cases the edema reached the middle third of the vertebral body and a tumor was suspected. In all CT scans a bilateral incomplete or complete cleft in the pars inter-articularis was found. In 4/6 CT-scans a sclerosis was seen in the area of the bone marrow edema. Only in 1/5 plain films was there a suspicion for a spondylolysis, four examinations were completely normal.

CONCLUSIONS

To eliminate underlying causal conditions of spondylolysis and to install specific therapy, early diagnosis is mandatory. MR imaging should be the first and only imaging modality in young patients with low back pain during and after exercise and pain with hyperextension. Bone scans and CT scans should be avoided due to irradiation, plain films usually do not reveal pathological findings in developing sponylolysis.

MR findings in a patient with Kernicterus

We report on a 2.5-year-old boy with severe mental retardation, choreoathetosis, dystonia, muscle rigidity, opisthotonus and severe hearing impairment. He had history of severe hyperbilirubinaemia immediately after birth presumably due to ABO incompatibility. The history and the clinical picture suggested the diagnosis of Kernicterus. The MR imaging examination upon admission revealed bilateral signal intensity increase in the globus pallidum on T2-weighted sequences. Additionally, our patient showed signal intensity changes within the subthalamic nuclei, which is known to be another characteristic area of bilirubin deposition in Kernicterus.

[Contrast enhanced MR angiography in the preoperative evaluation of living kidney donors]

PURPOSE

To compare Gadolinium-enhanced MR angiography with conventional DSA in the preoperative evaluation of living kidney donors.

MATERIAL AND METHODS

27 potential living kidney donors were examined with contrast-enhanced MR angiography after conventional angiography. The MR angiograms were evaluated for the number of renal arteries, the presence of early arterial branching and vascular pathologies by two independent readers. The results were compared with those of selective conventional angiography and intraoperative findings.

RESULTS

Conventional angiography detected 14 accessory renal arteries. Reader A detected 13 of 14 accessory arteries with no false positive result (sensitivity 93%, specificity 100%). Reader B detected 11 of 14 accessory vessels with one false positive finding (sensitivity 79%, specificity 98%). Early arterial branching was detected by both readers in 9 of 12 vessels with no false positive result (sensitivity 75%, specificity 100%). None of the patients had additional vascular pathology.

DISCUSSION

Gadolinium-enhanced MR angiography is a non-invasive alternative to conventional angiography in the preoperative evaluation of living kidney donors. In order to achieve high accuracy in detecting accessory renal arteries and early arterial branching extensive experience with the method and the specific preoperative needs is required. Selective conventional angiography is still superior in detecting very small accessory vessels and early arterial branching.

Magnetic resonance imaging of lateral epicondylitis of the elbow with a 0.2-T dedicated system

The purpose of this study was to evaluate MR imaging findings of the common extensor tendon in patients with lateral epicondylitis and asymptomatic volunteers studied on a 0.2-T dedicated system. In 23 patients (age range 29-58 years, mean age 47 years) with clinical symptoms of lateral epicondylitis MR imaging was performed using T1-, T2- and contrast-enhanced T1-weighted spin-echo sequences. In addition, the elbows of seven healthy volunteers (age range 22-29 years, mean age 25 years) and the symptom-free contralateral elbow of 11 of the 23 patients (age range 29-58 years, mean age 47 years) were studied as controls. Five patients were surgically treated after the MR examination and the results of histopathology were correlated with MR findings. Of the patients, 95.6 % showed intratendinous signal intensity changes on T1-weighted images on the symptomatic side. In 69.6 % signal alterations were observed on T2-weighted sequences and in 56.5 % an intratendinous contrast enhancement was present. Histopathology showed fibrovascular proliferation and fatty degeneration in patients with distinct signal intensity changes and contrast enhancement. Patients with only minor signal intensity changes on T1- and T2-weighted sequences and no contrast enhancement demonstrated fibrosclerotic degeneration and intratendinous cartilage formation in histopathology. The contralateral elbow showed signal intensity changes in 6 of 11 (54.5 %) cases on T1-weighted images and in 3 of 11 (27.3 %) on T2-weighted images. In the group of healthy volunteers minor signal intensity changes of the common extensor tendon could be seen in only 1 case. In patients with lateral epicondylitis of the elbow the type and extent of pathologic changes within the common extensor tendon can be evaluated using a dedicated low-field MR system. On the basis of MR imaging findings a more specified therapy planning among the variety of treatment modalities can be achieved.

Magnetic resonance imaging in lateral epicondylitis of the elbow

The purpose of the study was to determine the changes that might be detected using magnetic resonance imaging (MRI) on patients with chronic lateral epicondylitis of the elbow and to judge its value concerning the clinical treatment. Thirty-four patients with chronic lateral epicondylitis were included in a prospective study. All individuals underwent MRI of the elbow on a 0.2-T dedicated system. The MRI findings were interpreted by an independent radiologist without knowledge of the clinical findings. In 6 surgical cases an additional histological study was done. The biopsy of the extensor tendon was performed for correlation with the MRI. In 21 of 34 symptomatic patients, increased signal changes in T1- and T2-weighted images were seen. In a further 11 cases, the morphology and signal intensity were normal. The histopathological analysis of 6 surgical cases confirmed the preoperative MRI findings by showing either focal fibrous degenerative tendon tissue or microruptures of collagenous fibres. MRI in patients with chronic lateral epicondylitis can help to differentiate the disease and may be of use in clinical management, preoperative planning, and in the evaluation of the degree of degeneration at the common extensor tendon insertion.