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Objective: To assess if posterior oblique ligament and distal semi-membranosus tendon tears are associated with posterior horn medial meniscus tears on MRI. Methods: From January 1, 2018 to December 31, 2019, 56 patients who met the inclusion criteria were enrolled in this study. Of the 56 patients, 43 patients who had a posterior horn of medial meniscus tear were included in the study group. A control group of 13 individuals was formed for comparison. Two radiologists reviewed the MR images and recorded the presence and grades of posterior oblique ligament and distal semi-membranosus tendon tears. We used the independent t-test and one-way ANOVA to compare the tear grades. Interobserver agreement was analyzed using a Cohen’s κ coefficient (κ value) for categorical variables. Results: The mean grades for the posterior oblique ligament and distal semi-membranosus tendon tears were significantly higher in the study group (all, p < 0.001). Interobserver agreement between the two readers was substantial in assessing the grade of posterior oblique ligament tear (κ = 0.653±0.087) and almost perfect in assessing the grade of distal semi-membranosus tendon tear (κ = 0.876±0.060). Conclusion: Posterior oblique ligament and distal semi-membranosus tendon tears are significantly associated with posterior horn of medial meniscus tear and medial meniscus posterior root tears, and the peel-back mechanism could be related to this association. Advances in knowledge: Presenting this paper could adjust radiologist search patterns and potentially help orthopedists with management and pre-surgical planning for the posteromedial corner injury of the knee.

Background Dual-layer spectral detector computed tomography (DLCT) may potentially improve CT arthrography through enhanced image quality and analysis of the chemical composition of tissue. Purpose To evaluate the image quality of monoenergetic reconstructions from DLCT arthrography of the shoulder and assess the additional diagnostic value in differentiating calcium from iodine. Material and Methods Images from consecutive shoulder DLCT arthrography examinations performed between December 2016 and February 2018 were retrospectively reviewed for hyperattenuating lesions within the labrum and tendons. The mean attenuation of the target lesion, noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) of the virtual monoenergetic images obtained at 40–200 keV were compared with conventional 140-kVp images. Two evaluators independently classified each target lesion as contrast media or calcification, without and with DLCT spectral data. Receiver operating curve (ROC) analysis was performed to assess the diagnostic performance of shoulder DLCT arthrography, without and with the aid of spectral data. Results The study included 20 target lesions (18 DLCT arthrography examinations of 17 patients). The SNRs of the monoenergetic images at 40–60 keV were significantly higher than those of conventional images ( P Conclusion DLCT had no additive value in differentiating calcium from iodine in small, hyperattenuating lesions in the labrum and tendons.

Lymphovenous anastomosis (LVA) is primarily used for treating early-stage lymphedema. Here, we aimed to investigate the relationship between lymphatic flow velocity and the efficacy of LVA in breast cancer-related lymphedema patients. To this end, we assessed the transit velocity of lymphatic fluid using indocyanine green (ICG) lymphography and radioisotope lymphoscintigraphy.We retrospectively examined patients diagnosed with breast cancer-related lymphedema who underwent LVA from January to December 2020. Patient data, including demographics, clinical stage, and postoperative surgical outcomes, were collected from electronic medical records. ICG lymphography results and dynamic lymphoscintigrams were analyzed to measure the lymphatic flow velocity and to determine the grade of the limb lymphedemas.Eighty patients (all female, mean age of 53.6 years) were included. The lymphatic flow velocity ranged between 0.58 and 21.5 cm/min (average, 7.61 cm/min); 37 (46.3%), 18 (22.5%), 15 (18.8%), and 10 (12.5%) arm lymphedemas were classified as lymphoscintigraphy grade 0, 1, 2, and 3, respectively. A significant association was observed between lymphatic flow velocity and lymphedema grade determined using lymphoscintigraphy and between the amount of volume reduction after LVA and preoperative lymphatic flow velocity (P 0.05).Our findings suggest that lymphatic flow velocity is positively correlated with surgical outcomes in patients undergoing LVA. Therefore, surgical treatment plans for lymphedema should not be based only on the International Society of Lymphedema stage, because advanced-stage lymphedema patients with high ICG velocities can benefit from LVA alone.

The Association Research Circulation Osseous developed a novel classification for early-stage (precollapse) osteonecrosis of the femoral head (ONFH). We hypothesized that the novel classification is more reliable and valid when compared to previous 3 classifications: Steinberg, modified Kerboul, and Japanese Investigation Committee classifications.In the novel classification, necrotic lesions were classified into 3 types: type 1 is a small lesion, where the lateral necrotic margin is medial to the femoral head apex; type 2 is a medium-sized lesion, with the lateral necrotic margin being between the femoral head apex and the lateral acetabular edge; and type 3 is a large lesion, which extends outside the lateral acetabular edge. In a derivation cohort of 40 early-stage osteonecrotic hips based on computed tomography imaging, reliabilities were evaluated using kappa coefficients, and validities to predict future femoral head collapse by chi-squared tests and receiver operating characteristic curve analyses. The predictability for future collapse was also evaluated in a validation cohort of 104 early-stage ONFH.In the derivation cohort, interobserver reliability (k = 0.545) and intraobserver agreement (63%-100%) of the novel method were higher than the other 3 classifications. The novel classification system was best able to predict future collapse (P.05) and had the best discrimination between non-progressors and progressors in both the derivation cohort (area under the curve = 0.692 [0.522-0.863], P.05) and the validation cohort (area under the curve = 0.742 [0.644-0.841], P = 2.46 × 10This novel classification is a highly reliable and valid method of those examined. Association Research Circulation Osseous recommends using this method as a unified classification for early-stage ONFH.Level III, diagnostic study.

Sagittal parameters of the spine are closely related to the evaluation and treatment of spine disease. However, there has been little research on variations in preoperative sagittal spinal alignment. This study was conducted to assess the variation in sagittal spinal alignment on serial antero-posterior and latero-lateral projections (EOS imaging) in adult patients before spine surgery. The sagittal parameters of 66 patients were collected from two serial images. Comparison between the first and second sagittal parameters was evaluated using the Wilcoxon signed-rank test. Subgroup analysis was performed based on the time interval between radiographs, patient’s age, and type of surgery. The sagittal vertical axis (SVA) exhibited statistically significant changes (p = 0.023), with the mean SVA increasing statistically (61.7 mm vs. 73.6 mm) and standard deviation increasing (51.5 mm vs. 61.6 mm) in the second image. Subgroup analysis showed significant differences in SVA (p = 0.034) in patients with an interval of &gt, 3 months, statistical differences in borderline levels in the SVA (p = 0.049) were observed in patients aged &gt, 65 years. Other parameters did not show statistically significant differences, except for SVA. Furthermore, SVA differences were statistically significant with increases in the EOS interval (&gt, 3 months) and patient age (&gt, 65 years).

Background Despite transforaminal epidural steroid injection (ESI) being the first choice in patient with recurrent herniated intervertebral disc (HIVD), efficacy of ESI in those patients are not well established. Herein, we evaluate the effectiveness and outcome predictors of fluoroscopic transforaminal ESI for recurrent HIVD. Methods Seventy-seven patients (48 male; mean age, 51.3 years) with recurrent lumbar HIVD were included and divided into three groups according to initial treatment: conservative treatment, transforaminal ESI, and immediate surgery. ESI effectiveness was evaluated by operation rates, injection numbers in 6 months, and pain reduction (visual analog scale (VAS) scores). Clinical and MRI variables were analyzed as possible outcome predictors. Each subject in the transforaminal ESI group was individually matched to two patients with initial HIVD (control group). Results In the transforaminal ESI group (n = 37), 20 patients (54.1%) did not undergo reoperation. The initial and follow-up VAS scores were significantly higher in the reoperation group (p = 0.014, p = 0.019, respectively). Patients with either paresthesia or motor weakness (12/19, 63.2%) had a significantly higher reoperation rate than patients with only pain (5/18, 27.8%; p = 0.031). Extruded disc ratios ≥2.0 were significantly higher in the reoperation group (10/17, 58.8%; p = 0.048). The reoperation rate in the transforaminal ESI group (17/37, 45.9%) was higher than the operation rate in the control group (6/73, 8.2%; p.001). Conclusion Transforaminal ESI was effective in reducing radicular pain in patients with recurrent HIVD. Approximately 54% of patients did not undergo reoperation. An extruded disc ratio ≥2.0 and paresthesia or motor weakness were poor outcome predictors.

To assess the association between morphological changes in the superficial medial collateral ligament and meniscal extrusion with medial meniscus posterior root tear.From January 1, 2018, to December 31, 2019, 124 patients who underwent knee MRI within 90 days prior to knee surgery and whose medial meniscus surgically proved intact, with posterior root tear or posterior horn tear, were enrolled. Two radiologists who were blinded to the surgical results assessed the morphological changes in the superficial medial collateral ligament, including thickness, bowing angle, and presence of signal intensity alteration, and medial meniscus extrusion, according to the presence of tears in the posterior root of the medial meniscus or posterior horn of the medial meniscus using the chi-square test, one-way ANOVA, and Cohen's kappa test.Thirty-six posterior root tears, 31 posterior horn tears, and 57 intact medial menisci were observed surgically. The mean values of thickness showed no significant differences among the three groups. The bowing angle was significantly higher in the posterior root tear than in the posterior horn tear (reader 1 = 0.001, reader 2 = 0.002) and normal meniscus groups (readers 1 and 2 0.001). The percentage of superficial medial collateral ligament signal intensity alteration and meniscal extrusion was highest in the group with posterior root of the medial meniscus tear (80.6% and 94.4%, respectively) and lowest in the group with normal medial meniscus (17.5% and 10.5%, respectively).Morphological changes in the superficial medial collateral ligament and meniscal extrusion were associated with medial meniscus posterior root tears.

To evaluate the usefulness of whole-tumor ADC histogram analysis based on entire tumor volume in determining the histologic grade of STS (soft tissue sarcoma)s.From January 2015 to December 2020, 53 patients with STS who underwent preoperative magnetic resonance imaging, including diffusion weighted imaging and ADC maps (b = 0 and 1400 s/mmEight patients with low-grade STS (15.1%) and 45 with high-grade STS (26.4% [14/53] for grade II; 58.5% [31/53] for grade III) were included. High-grade STS showed positive skewness and low-grade STS showed negative skewness (0.503 vs -0.726, p=.001). High-grade STS showed lower mean ADC (p =.03) and 5th to 50th percentile values (p ≤. 03) than those of low-grade STS. Positive skewness was an independent predictor of high-grade STS (odds ratio: 6.704, p=.002) with 84.4% sensitivity and 87.5% specificity (cut-off values -0.1757, AUC = 0.842).Skewness is the most promising histogram parameter for discriminating high-grade from low-grade STS. The mean ADC values and lower half of percentile values are helpful for differentiating high from low-grade STSs.