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Objectives: To present the process of creating an imaging-guided injections outcomes database and to reflect on how this database has affected the scientific activities of the radiology department. Materials and methods: The literature was searched to identify studies on the effectiveness of musculoskeletal therapeutic injections, areas where research is lacking, and relevant outcome measures. Validated outcome measures were chosen and tested in a pilot study. Data collection time points of 1day, 1week and 1month post-injection were determined and the post-pilot study postal questionnaires were created. The data collection process began and has been ongoing for over 4years. Critical reflection on the process and outcomes from the database occurred. Results: The 9 steps to creating this outcomes database are presented. The numerical rating scale for pain (NRS) and the Patient's Global Impression of Change (PGIC) were identified as the most valid, reliable, and time-effective outcome measures. At most, 50% of patients return their postal questionnaire. The database has facilitated the publication of numerous research projects. Conclusions: Setting up an outcomes database is straightforward and productive. The NRS and PGIC were considered the most useful outcome measures. This database facilitated critical reflection on current practice and provides the foundation for several research studies.

To determine the exact origin of hip pain can be challenging. Symptoms apparently originating from the hip may arise from the pelvis, the sacroiliac joint, the lumbar spine, periarticular structures such as muscles and bursae, or from unexpected sites such as the abdominal wall, the genitourinary tract, or the retroperitoneal space. This article reviews the differential diagnosis of hip pain arising from the hip and surrounding structures and the role of different imaging methods with emphasis on magnetic resonance imaging where most recent advances have occurred.

European Spine Journal, 16 (6), ISSN:0940-6719, ISSN:1432-0932, ISSN:001991155

This article discusses potential technical problems of MR arthrography. It starts with contraindications, followed by problems relating to injection technique, contrast material and MR imaging technique. For some of the aspects discussed, there is only little published evidence. Therefore, the article is based on the personal experience of the author and on local standards of procedures. Such standards, as well as medico-legal considerations, may vary from country to country. Contraindications for MR arthrography include pre-existing infection, reflex sympathetic dystrophy and possibly bleeding disorders, avascular necrosis and known allergy to contrast media. Errors in injection technique may lead to extra-articular collection of contrast agent or to contrast agent leaking from the joint space, which may cause diagnostic difficulties. Incorrect concentrations of contrast material influence image quality and may also lead to non-diagnostic examinations. Errors relating to MR imaging include delays between injection and imaging and inadequate choice of sequences. Potential solutions to the various possible errors are presented.

The influence of foot positioning on prevalence of the magic angle effect (MAE) in ankle tendons was investigated. In 30 asymptomatic volunteers and five cadaveric feet, MR imaging of the ankle was performed in the supine (neutral position of the foot) and prone (plantar-flexed foot) position. MAE was considered if increased T1-weighted signal at a certain site was seen in one position only. Histological correlation was obtained at 25 sites of the cadaveric posterior tibialis tendons (PTT). MAE occurred in 6/30 vs 1/30 (supine vs prone) anterior tibialis tendons (ATT), 30/30 vs 0/30 extensor hallucis longus and 27/30 vs 0/30 extensor digitorum longus tendons, 29/30 vs 0/30 PTTs, 30/30 vs 0/30 flexor digitorum and flexor hallucis longus tendons, 30/30 vs 1/30 peroneus brevis and 23/30 vs 1/30 peroneus longus tendons. At 12/25 cadaveric PTT sites where MAE was exclusively responsible for the increased signal, histology revealed normal tissue (11/12) or minimal degeneration (1/12). In conclusion, the supine body position with neutral position of the foot, a high prevalence (77–100%) of MAE in ankle tendons except for the ATT (20%) is seen. MAE is almost absent in the prone body position with plantar flexion of the foot.

OBJECTIVES: : To show the feasibility of flat-panel computed tomography (FPCT) arthrography and quantitatively and qualitatively compare different FPCT protocols with standard multidetector computed tomography (MDCT). MATERIALS AND METHODS: : First, a phantom simulating joint space with increasing iodine concentrations was scanned using a standard MDCT and 3 different FPCT protocols. Quantitative analyses were performed by measuring CT numbers of iodine dilutions, radiation dose, and image noise as well as signal-to-noise ratio and contrast-to-noise ratio. Second, FPCT arthrographies of 4 animal joint specimens were performed and analyzed qualitatively by 2 independent readers who evaluated image artifacts, image noise, overall image quality and anatomic depiction of bone, cartilage, and soft tissue. Kappa values were calculated for inter-reader agreement. Pearson's correlation coefficient (r) and Wilcoxon signed-ranks test with Bonferroni corrections for multiple comparisons were used to compare MDCT and FPCT. RESULTS: : In phantoms, all CT scans showed a linear correlation between increasing iodine concentrations and mean HU values of contrast media and radiation dose, respectively (r = 0.98-0.99, P < 0.01). Dose-length product remained constant for MDCT scans. Signal-to-noise ratio for phantom water linearly decreased in all FPCT scans with increasing iodine concentrations. Contrast-to-noise ratio curves showed reduced slope at iodine concentrations higher than 75 mg/mL. FPCT arthrography after intra-articular administration of 5 to 6 mL of a 25% dilution of iopromide (Ultravist 300 mg/mL, Bayer HealthCare, Berlin, Germany) was successfully performed in all 4 animal joint specimens. Kappa values for inter-reader agreement of qualitative image analyses were 0.62 to 0.91. Image and depiction quality of 20-s FPCT scans were similar or superior compared with standard MDCT (P < 0.005). CONCLUSION: : FPCT arthrography is feasible and may allow similar image quality compared with standard MDCT arthrography.

Objective: To describe a posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint and to report patient outcomes 1month post-injection. Materials and methods: Twenty-three consecutive adult patients who underwent fluoroscopy-guided injection into the posterior subtalar joint using a direct posterolateral approach and who returned an outcomes-based postal questionnaire after receiving this injection were included. Numerical pain rating scale (NRS) data were collected prior to injection. NRS and Patient's Global Impression of Change (PGIC) scales were completed 1day, 1week, and 1month after injection. The proportion of patients who improved was calculated for each time period. Baseline NRS data were compared to each time point using the Wilcoxon test to assess differences. Spearman's correlation coefficient was used to compare the 20min NRS score with all follow-up NRS scores. All available images were reviewed for the presence of subtalar osteoarthritis (OA). Patient charts were reviewed to identify characteristics of patients referred for subtalar injections. Risk ratios were calculated comparing presence of OA or other abnormalities with improvement. Results: A posterolateral approach for fluoroscopy-guided injections into the subtalar joint is described. There was a significant reduction in the mean NRS score at all time periods compared to baseline (p ≤ 0.004). One-third of patients (7/21) reported clinically relevant improvement at 1month. Conclusions: Fluoroscopy-guided puncture of the posterior subtalar joint using a posterolateral approach is possible. Clinically significant improvement is reported in 33% of patients after 1month

This editorial and the “Perspective” on scientific journals and impact factors by W. Hendee, Bernstein, and Levine are the outcome of the Annual Editors’ Forum, which was hosted by the Imaging Institute of the Cleveland Clinic on August 20, 2011. In attendance at the forum were editors from Europe, Canada, and the United States representing 13 scientific journals concerned with medical imaging. One of the items on the agenda was the influence of the Impact Factor (IF) on the make-up of the journal. In our view, as lucidly outlined by Hendee et al., the IF has been brandished out of proportion as a signal of a journal’s worthiness. The IF is a metric that measures the citations of a journal’s articles over a 2-year period. The ranking of a journal is based on the 2-year IF. One of us (J.H.) gave a presentation on the influence of the IF on European radiology departments. Based on responses to a questionnaire survey, Hodler reported that promotions committees placed more emphasis on work published in journals with higher IFs and that a rise in a journal’s IF could influence the probability that a work would be submitted to Skeletal Radiology. To evaluate this position, we would like to share with you some metrics as they pertain to Skeletal Radiology with regard to citations, impact factor rank, and time. Based upon the 2-year IF, Skeletal Radiology is ranked 70 of 111 imaging journals. However, it ranks 38th based on the number of citations and 10th based on the cited half-life of articles, which is 8.8 years. These facts require interpretation. In a fast moving scientific field, it is probable that citations within 2 years capture the importance of an article. However, in our field, because of the relative rarity of the conditions, knowledge grows by the gradual accretion of information over a much longer time. In recognition of this, the journal has had a dedicated case report section since its inception. Case reports can be a sacrificial lamb on the altar of the IF because by their nature, they represent rarities, unlikely to be cited promptly after publication. It is often assumed that the higher the IF, the better the science. This is certainly an oversimplification. In their “Perspective” article, Hendee et al. have shown how the IF can be manipulated. To this we would add that the number of citations is merely an indicator of the degree to which a topic is “au courant”, not the accuracy or value of a paper. Completely false papers may receive a large number of citations as others debunk them. Scientific validity is a test of time and not a 2-year citation count. For these reasons and because of the narrowness of what it measures, we believe that the IF is of limited value for a journal such as Skeletal Radiology. The quality of a publication can not be evaluated based upon the IF of the journal in which it is published. M. Sundaram (*) The Cleveland Clinic Foundation, Cleveland, OH, USA e-mail: sundarm@ccf.org

To develop a list of radiologic criteria for describing lumbar spinal stenosis, to learn from experts which parameters they consider to be most important, and to assess the strength of agreement among experts on the most relevant criteria.An expert panel of 41 radiologists (musculoskeletal experts and neuroradiologists from Europe and the United States) was formed. A three-round Delphi survey was conducted. Twenty-seven of the 41 nominated experts agreed to participate; 21 completed all three rounds. In the first round, experts were asked to complete a list of suggested parameters and cutoff values to describe lumbar spinal stenosis. In the second round, panelists rated the diagnostic relevance of each parameter (visual analog scale, 0-10). In the third round, panelists were provided with the group results (median and range) and their own answers and had the opportunity to adapt their judgments from round 2. To assess the degree of consensus among experts, the Cronbach α was calculated.The qualitative criteria disk protrusion and perineural intraforaminal fat were rated as the most important diagnostic indicators, with median scores of 9 (range, 2-10). The highest rated quantitative criterion was the anteroposterior diameter of the osseous canal, with a median score of 8; however, there was a wide range of scores (range, 0-10). The median Cronbach α of all panelists within the group was 0.81 after the third round.Results of the survey suggest that there are no broadly accepted quantitative criteria and only partially accepted qualitative criteria for the diagnosis of lumbar spinal stenosis. The latter include disk protrusion, lack of perineural intraforaminal fat, hypertrophic facet joint degeneration, absent fluid around the cauda equine, and hypertrophy of the ligamentum flavum.

Purpose To evaluate in vivo MR imaging of the wrist at 3.0 Tesla (T) and 7.0T quantitatively and qualitatively. Materials and Methods To enable unbiased signal-to-noise ratio (SNR) comparisons, geometrically identical eight-channel receiver arrays were used at both field strengths. First, in vitro images of a phantom bottle were acquired at 3.0T and 7.0T to obtain an estimate of the maximum SNR gain that can be expected. MR images of the dominant wrist of 10 healthy volunteers were acquired at both field strengths. All measurements were done using the same sequence parameters. Quantitative SNR maps were calculated on a pixel-by-pixel basis and analyzed in several regions-of-interest. Furthermore, the images were qualitatively evaluated by two independent radiologists. Results The quantitative analysis showed SNR increases of up to 100% at 7.0T compared with 3.0T, with considerable variation between different anatomical structures. The qualitative analysis revealed no significant difference in the visualization of anatomical structures comparing 3.0T and 7.0T MR images (P>0.05). Conclusion The presented results establish the SNR benefits of the transition from 3.0T to 7.0T for wrist imaging without bias by different array designs and based on exact, algebraic SNR quantification. The observed SNR increase nearly reaches expected values but varies greatly between different tissues. It does not necessarily improve the visibility of anatomic structures but adds valuable latitude for sequence optimization. J. Magn. Reson. Imaging 2011;33:661–667. © 2011 Wiley-Liss, Inc.

Advances in orthopedic and arthroscopic surgical procedures of the knee such as, knee replacement, ligamentous reconstruction as well as articular cartilage and meniscus repair techniques have resulted in a significant increase in the number of patients undergoing knee arthroscopy or open surgery. As a consequence postoperative MR imaging examinations increase. Comprehensive knowledge of the normal postoperative MR imaging appearances and abnormal findings in the knee associated with failure or complications of common orthopedic and arthroscopic surgical procedures currently undertaken is crucial. This article reviews the various normal and pathological postoperative MR imaging findings following anterior and posterior cruciate ligament, medial collateral ligament and posterolateral corner reconstruction, meniscus and articular cartilage surgery as well as total knee arthroplasty with emphasis on those surgical procedures which general radiologists will likely be faced in their daily clinical routine. J. Magn. Reson. Imaging 2011;. © 2011 Wiley-Liss, Inc.

Objective: To describe an "indirect” cervical nerve root injection technique with a dorsal approach that should carry less inherent risk than the "direct” cervical transforaminal injection approach, and to compare the immediate post-injection results of the two procedures. Materials and methods: The indirect and direct cervical nerve root injection procedures are described in detail. Fifty-three consecutive patients receiving the indirect nerve root injections during 2009-2010 were age- and gender-matched to 53 patients who underwent direct transforaminal nerve root injections performed in 2006. Pain level data were collected immediately before and 20-30min after each procedure. The percentages of pain change in the two groups were compared using the unpaired Student'st test. Results: Fifty-two men (mean age 49) and 54 women (mean age 55) were included. The mean percentage of pain reduction for patients receiving indirect nerve root injections was 38.4% and for those undergoing the direct nerve root injections approach it was 43.2%. This was not significantly different (P = 0.455). No immediate or late adverse effects were reported after either injection procedure. Conclusions: The indirect cervical nerve root injection procedure is a potentially safer alternative to direct cervical transforaminal nerve root injections. The short-term pain reduction is similar using the two injection methods

Despite years of extensive research in lumbar spinal stenosis, many uncertainties remain and might be solved only through collaboration of experts in different specialties.

A few studies have reported on short-term outcomes of patients receiving imaging-guided injections into the foot articulations, but none have compared patient responses depending on the anatomic site injected. This study includes a large sample size facilitating the investigation of postinjection pain reduction overall and by specific articulation.Three hundred forty-eight patients with imaging-guided diagnostic or therapeutic injections into the foot articulations, with complete preinjection and 20- to 30-minute postinjection numeric rating scale pain data were included. The proportions of patients reporting clinically relevant pain reduction (≥ 50%) were calculated overall and for specific subgroups. The risk ratio comparing patients with osteoarthritis to those without osteoarthritis was calculated. Analysis of variance was used to compare outcomes between subgroups of patients based on injection site. The unpaired Student t test was used to compare responses of men versus women, those with and without a diagnosis of osteoarthritis, and more experienced versus less experienced radiologists.Sixty-four percent of patients (224/348) reported clinically relevant pain reduction. The average decrease overall was 56% (SD, 36). Injections into the Lisfranc articulation were significantly more effective (61% pain reduction, p = 0.007) compared with other sites, with 74% of patients obtaining clinically relevant pain relief. Patients with osteoarthritis reported more relief (62%) compared with those without (50%, p = 0.002). No difference in outcomes comparing musculoskeletal radiologists with residents or fellows in training was found.Nearly two thirds of patients receiving imaging-guided injections into the foot articulations reported clinically relevant pain reduction. Lisfranc joint injections and patients with a diagnosis of osteoarthritis responded better.

This review article classifies the various adverse reactions arising from intra-articular injections by severity, diagnostic category, and whether they are due to corticosteroid, local anesthetic or viscosupplementation injections. Life-threatening and serious adverse events from intra-articular injections are rare and range from local complications to systemic afflictions. Measures to reduce the likelihood of an adverse event occurring are outlined and patients with significant features in their clinical histories, predisposing them to adverse events, are highlighted.

Purpose: To relate histologic changes in rotator cuff tendons to the appearance on T1-weighted as well as fat-suppressed T2-weighted and proton density-weighted magnetic resonance imaging (MRI) sequences. Materials and Methods: T1-weighted, fat-suppressed T2-weighted and fat-suppressed proton density-weighted sequences of 18 cadaveric shoulders were acquired. The supraspinatus, infraspinatus, and subscapularis tendons were evaluated histologically. Twenty-six abnormalities were found in 23 of 37 tendons. In addition, histologically normal tendon parts (n = 32), including three segments with normal histology but abnormal MR signal, considered to represent magic angle effects, were defined. All regions of interest (ROIs) were evaluated by two musculoskeletal radiologists independently and blinded to histology. Results: In the 26 areas with anatomically intact tendons but abnormal histological findings mucoid degeneration (n = 13), chondroid metaplasia (n = 11), fatty infiltration (n = 1), and foreign-body granuloma (n = 1) after tendon suture were found. Compared to normal tendon, mucoid degeneration was hyperintense on T2-weighted fat-suppressed (P = 0.007) and on proton density-weighted fat-suppressed images (P = 0.006). Chondroid metaplasia was hyperintense compared to normal tendon in all sequences (P < 0.05). Mucoid degeneration was hypointense compared to chondroid metaplasia on T2-weighted fat-suppressed images (P = 0.038) and hypointense compared to magic angle artifacts on T1-weighted images (P = 0.046). Conclusion: Chondroid metaplasia of rotator cuff tendons appears to be more common than expected. Both mucoid degeneration and chondroid metaplasia may explain increased tendon signal on MR images of the rotator cuff. J. Magn. Reson. Imaging 2010;32:165–172. © 2010 Wiley-Liss, Inc.

The purpose of this study was to evaluate pain relief 20 to 30 minutes after diagnostic or therapeutic injections into the sternoclavicular joint and to compare patient outcomes based on the CT diagnosis.Informed consent was obtained from each patient. Ethics approval was not required. Fifty patients who had CT-guided injections of corticosteroid and local anesthetic into their sternoclavicular joints were included in the study. Preinjection and 20- to 30-minute postinjection visual analog scale data were recorded and compared with the imaging findings agreed by consensus. Kappa statistics were calculated for the reliability of imaging diagnosis. The percentage of patients improving after joint injection was calculated, and the risk ratio comparing the response of patients with osteoarthritis to those without osteoarthritis was completed. The correlation between the severity of each patient's osteoarthritis and the pain response was calculated using Spearman's correlation coefficient.Sixty-six percent of the patients reported clinically significant pain reduction at between 20 and 30 minutes after injection. The proportion of patients with osteoarthritis who had a clinically significant response was 67% compared with 64% for patients who did not have osteoarthritis. This difference was not statistically or clinically significant. There was no correlation between the severity of osteoarthritis and the amount of pain reduction (r = 0.03). The reliability of imaging diagnosis was substantial.Two thirds of patients having sternoclavicular joint injections of corticosteroids and local anesthetics report clinically significant improvement regardless of the abnormalities detected on their CT images.

To prospectively evaluate pain and other side effects after magnetic resonance (MR) arthrography.Institutional review board approval and patient informed consent were obtained. MR arthrography was performed in 1085 patients. In 1011 patients, 2 mmol/L gadopentetate dimeglumine was injected. In patients whose wrists were examined, 5 mmol/L gadoterate dimeglumine was injected. Pain was measured directly after injection, 4 hours after injection, 1 day [18-30 hours] after injection, and 1 week [6-8 days] after injection and compared with pain at baseline (before contrast material was injected). A visual analogue scale or verbal rating scale (score range, 0-10) was used to measure pain. When increased pain persisted at the end of the observation period, additional assessment was performed to exclude infection. Evaluated factors with a potential effect on pain were time after injection, joint type, contrast agent volume, patient age and sex, and radiologist experience. Repeated measures analysis of variance was used.Mean pain increase was most pronounced 4 hours after injection (P.0001). This increase was most pronounced in the hip, followed by the elbow, knee, wrist, ankle, and shoulder. (Differences between joints were not significant [P = .26].) Pain scores returned to baseline levels 1 week after injection. Patients younger than 30 years had more pronounced pain than did patients in other age groups at all time points (P = .044). Joint type, contrast agent volume (P = .44), patient sex (P = .29), and radiologist experience (P = .10) did not significantly affect pain scores. No patient had infection or any other severe side effect. Besides joint pain, minor side effects included pressure, headache, muscle ache, swollen hand, fatigue, vertigo, increased blood glucose level, and pruritus.MR arthrography temporarily increases joint-related pain. Such pain depends on patient age but not on joint type, contrast material volume, patient sex, or radiologist experience.

The acromiohumeral distance (AHD) measured on conventional, true anteroposterior radiographs taken with the patient standing and the arm held in neutral rotation can predict the presence or absence of a large, chronic rotator cuff tears, and narrowing of the acromiohumeral distance can predict irreparability of rotator cuff tears. The relation between AHD measured on conventional radiographs and the integrity of the rotator cuff tendons is well known. Conversely, the correlation between the AHD on conventional radiographs and that measured on magnetic resonance imaging (MRI) or computed tomography (CT) scans is unknown. It has also not been determined which method correlates better with fatty infiltration of the rotator cuff muscles and might thereby be a better prognostic value for the outcome of rotator cuff repair. Conventional radiographs, plus MRI and or CT studies taken at the same time of patients with rotator cuff tears, shoulder instability, primary glenohumeral osteoarthritis, or idiopathic frozen shoulder, were randomly selected, and the AHD was measured both on conventional radiographs and on MRI or CT. The values were correlated with the stage of fatty degeneration of the rotator cuff muscles in the cases of rotator cuff tears. The AHD on conventional radiographs was larger than on MRI and CT, and correlation of the values measured (conventional radiography vs MRI and CT) could be demonstrated. For rotator cuff diseases, a significant but moderate correlation (r = 0.6; P < .05) between conventional and MRI was identified, and the conventional values were approximately 0.6 mm greater than the corresponding MRI values. It is, therefore, possible to use the AHD read on MRI or CT studies for prognostic reasons, provided the values obtained are converted accordingly and remembering that the correlation of the values is only moderate.

Objective: To evaluate the value of a dedicated interpretation of the CT images in the differential diagnosis of benign vs. malignant primary bone lesions with 18fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT). Materials and methods: In 50 consecutive patients (21 women, 29 men, mean age 36.9, age range 11-72) with suspected primary bone neoplasm conventional radiographs and 18F-FDG-PET/CT were performed. Differentiation of benign and malignant lesions was separately performed on conventional radiographs, PET alone (PET), and PET/CT with specific evaluation of the CT part. Histology served as the standard of reference in 46 cases, clinical, and imaging follow-up in four cases. Results: According to the standard of reference, conventional 17 lesions were benign and 33 malignant. Sensitivity, specificity, and accuracy in assessment of malignancy was 85%, 65% and 78% for conventional radiographs, 85%, 35% and 68% for PET alone and 91%, 77% and 86% for combined PET/CT. Median SUVmax was 3.5 for benign lesions (range 1.6-8.0) and 5.7 (range 0.8-41.7) for malignant lesions. In eight patients with bone lesions with high FDG-uptake (SUVmax ≥ 2.5) dedicated CT interpretation led to the correct diagnosis of a benign lesion (three fibrous dysplasias, two osteomyelitis, one aneurysmatic bone cyst, one fibrous cortical defect, 1 phosphaturic mesenchymal tumor). In four patients with lesions with low FDG-uptake (SUVmax

The objective of our study was to retrospectively evaluate the association between abnormalities of the lesser tuberosity and subscapularis tendon lesions.Cortical irregularities and cysts of the lesser tuberosity were evaluated on radiographs and MR images in 70 patients: 31 with normal subscapularis tendons and 39 with subscapularis tendon tears. These imaging findings were correlated with subscapularis tendon tears diagnosed during arthroscopy and with fatty atrophy of the subscapularis muscle seen on MR images. Correlations between imaging findings, patient age, history of trauma, and the reference standards were assessed using gamma coefficients. Interreader agreement was calculated using kappa values.For the diagnosis of subscapularis tendon tears, the sensitivity of cortical irregularities and cysts on radiographs was 44%/51% (reader 1/reader 2) and 21%/21%, respectively; specificity was 65%/68% and 87%/87%. The sensitivity of cortical irregularities and cysts on MRI was 64%/72% and 36%/39%. Specificity was 48%/45% and 81%/77%. For fatty atrophy of the subscapularis muscle, the sensitivity of cortical irregularities and cysts on radiographs was 67%/73% and 17%/27%, respectively; the specificity was 63%/63% and 83%/85%. Significant (p0.05) positive correlations were found between cortical irregularities and surgical grade of subscapularis tendon tear for reader 2 (radiography, gamma = 0.39; MRI, gamma = 0.45) and between lesser tuberosity abnormalities and patient age (gamma = 0.11 and 0.43) for both readers. Interobserver agreement of imaging findings varied from moderate to substantial (kappa = 0.50-0.76).Abnormalities of the lesser tuberosity are moderately associated with subscapularis tendon tears and patient age. Cysts seen in the lesser tuberosity on shoulder radiographs or MR images are relatively specific for subscapularis tendon tears and muscle atrophy.

The purpose of this study was to evaluate the prevalence, pattern and size of bone marrow changes on short-tau inversion recovery (STIR) magnetic resonance (MR) images of asymptomatic feet and ankles. In 78 asymptomatic volunteers (41 women, 37 men; median age 47 years; range 23–83 years) sagittal STIR MR images of hindfoot and midfoot were reviewed for various patterns of high signal changes in bone marrow. The size of these bone marrow changes was measured, and signal intensity was rated semi-quantitatively using a scale from 0 (=normal) to 10 (=fluid-like). Fifty percent (39/78) of all volunteers had at least one bone marrow change. Thirty-six percent (28/78) of all volunteers had edema-like changes, 26% (20/78) had necrosis-like changes, and 5% (4/78) had cyst-like changes. The long diameters of all changes varied between 4 mm and 16 mm (median 7.5 mm). The median signal intensity for all changes was 5.0 (range 1–10). Bone marrow changes on STIR MR images are commonly detected in asymptomatic feet and ankles. However, such changes tend to be small (

European Spine Journal, 16 (11), ISSN:0940-6719, ISSN:1432-0932, ISSN:001991155

To prospectively evaluate the clinical course of asymptomatic meniscal lesions diagnosed by using magnetic resonance (MR) imaging.Institutional review board approval and informed consent were obtained. The clinical courses of meniscal lesions in 84 asymptomatic knees (in 48 men and 36 women; mean age, 43.6 years; age range, 18-73 years) were assessed. Thirty-one asymptomatic meniscal lesions were depicted among the 84 knees at MR imaging. The follow-up period was at least 2 years (mean, 29.8 months; range, 24-36 months). Knee pain, stiffness, and function during daily and sports activities were assessed by using a visual analogue scale (VAS), on which a score of 0 indicated no pain or complaints and a score of 100 indicated maximal pain and/or complaints. The chi2 test was used for statistical analysis.At follow-up, 12 (39%) of the 31 patients with and 10 (19%) of the 53 patients without meniscal lesions reported having knee pain (P = .046). Nine (29%) patients with and five (9%) patients without meniscal lesions reported having knee stiffness (P = .02). Ten (32%) patients with and five (9%) patients without meniscal lesions reported having impaired function during daily activities (P = .008). Thirteen (42%) patients with and 15 (28%) patients without meniscal lesions reported having impaired function during sports activities (P = .20). Mean VAS scores ranged from 22 to 30; mean VAS scores for pain, stiffness, impaired daily function, and impaired sports function were 26, 22, 27, and 30, respectively. None of the initially asymptomatic knees was treated with surgery during the follow-up period.The clinical course of knees with initially asymptomatic meniscal lesions, compared with the clinical course of knees without meniscal lesions, is characterized by an increased frequency of complaints. However, severities of pain and knee function impairment remain low.

The purpose of this study was to evaluate and compare the diagnostic performance of stereolithography vs workstation-based three-dimensional (3D) reformations in intra-articular calcaneal fractures. A total of 30 intra-articular calcaneal fractures were examined using standard radiographs, coronal CT scans, and 2D and 3D reformations. The CT data were transferred to an outside institution, and stereolithograms were produced from photopolymer resin employing a laser beam system. 3D reformations and stereolithograms were analyzed in a blinded fashion by two staff radiologists. Receiver-operating-characteristic (ROC) curves were obtained for six clinically significant fracture components. Standard radiographs, coronal CT scans, and 2D reformations served as the standard of reference. The area under the ROC curves for 3D reformations and stereolithograms were 1.0 and 0.98 for abnormal tuber angles, 0.91 and 0.91 for anterior and middle talo-calcaneal joint involvement, 0. 90 and 0.95 for involvement of the posterior talo-calcaneal joint, 0. 65 and 0.78 for the presence of a lateral bulge, 0.80 and 0.81 for the involvement of the calcaneocuboidal joint, and 0.62 and 0.67 for the presence of a "tongue-type" fracture. No statistically significant difference was demonstrated for the two methods (Wilcoxon signed-rank test, p = 0.138). Based on our results stereolithograms did not prove to be statistically superior to workstation-based 3D reformations. Stereolithograms may still be useful for teaching purposes and for surgical planning at a thinking-efficacy level.

Introduction Inflammatory involvement of the anterior chest wall (ACW) affects the quality of life of patients with spondyloarthritis (SpA), although involvement of the ACW is often neglected on clinical and imaging evaluation. Whole-body (WB) MRI is an imaging method used to assess the ACW in addition to the sacroiliac joints and spine without inconvenience for patients. Our goals in this study were to describe the distribution of ACW inflammation by WB MRI in both early and established SpA and associations between clinical and imaging findings indicative of inflammation. Methods The ACWs of 122 consecutive SpA patients (95 with ankylosing spondylitis (AS) and 27 with nonradiographic SpA (nrSpA)) and 75 healthy controls were scanned by sagittal and coronal WB MRI. The MRI scans were scored independently in random order by seven readers blinded to patient identifiers. Active and structural inflammatory lesions of the ACW were recorded on a web-based data entry form. ACW pain by patient self-report, ACW tenderness on physical examination according to the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and lesions detected by MRI were analyzed descriptively. κ statistics served to assess the agreement between clinical and imaging findings. Results ACW pain or tenderness was present in 26% of patients, with little difference between AS and nrSpA patients. Bone marrow edema (BME), erosion and fat infiltration were recorded in 44.3%, 34.4% and 27.0% of SpA patients and in 9.3%, 12.0% and 5.3% of controls, respectively. Lesions found by MRI occurred more frequently in AS patients (BME, erosion and fat infiltration in 49.5%, 36.8% and 33.7%, respectively) than in nrSpA patients (25.9%, 25.9% and 3.7%, respectively). The joint most frequently affected by lesions found on MRI scans was the manubriosternal joint. The κ values between clinical assessments and MRI inflammation ranged from -0.10 to only 0.33 for both AS and nrSpA patients. Conclusions Among SpA patients, 26% had clinical involvement of the ACW. WB MRI signs of ACW inflammation were found in a substantial proportion of patients with AS (49.5%) and nrSpA (25.9%). There was no association between clinical assessments of ACW, including the MASES, and MRI features.

Background Modic changes (MC) have been linked with low back pain (LBP) and worse outcomes from some treatments. No studies have investigated the impact that MCs may have on patient outcomes from lumbar facet injections. Therefore, the purpose of this study is to investigate whether the presence of Modic changes is related to ‘improvement’ in patients undergoing imaging-guided lumbar facet injection therapy. Methods Outcomes from 226 patients with MRI scans within 3 months of their imaging-guided lumbar facet injections were investigated to determine whether MCs are related to ‘improvement’ post injection. At 1 day, 1 week and 1 month post injection the Patients Global Impression of Change scale answers were collected by postal questionnaire. This was the primary outcome measure. The numerical rating scale for pain data was collected prior to treatment and at the same post injection time points. The MRI scans were independently evaluated by two examiners for the presence/absence of Modic changes and the type of Modic change if present. Kappa statistics were used for reliability of diagnosis analysis. Chi-squared test and logistic regression analysis tested MCs with ‘improvement’. Results Intra- and inter-examiner reliability for the diagnosis of MCs was Kappa = 0.77 and 0.74. Intra- and inter-examiner reliability for categorizing MCs was K = 0.77 and K = 0.78. At 1 month post injection 45.2 % of patients without MCs reported clinically relevant ‘improvement’ compared to 34.2 % of patients with MC I and 32.1 % of patients with MC II. However, this did not reach statistical significance. Logistic regression found that Modic changes were not predictive of ‘improvement’. Conclusions There was a tendency for patients without MCs to have better outcomes but this did not reach statistical significance. The reliability of diagnosing MCs was substantial.