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To assess the accuracy of routine knee MRI in detecting acute popliteal artery and/or common peroneal nerve (CPN) dysfunction following multiligamentous knee injury (MLKI), with correlation of MRI findings to clinical outcome. Routine MRI knee examinations in 115 MLKI patients (54/115 with acute neurovascular injury, 61/115 without neurovascular injury) were retrospectively reviewed. Cases were classified by injury mechanism and ligamentous injuries sustained. MRI examinations were reviewed by two readers for vascular (arterial flow void, arterial calibre, intimal flap, perivascular hematoma) and CPN (intraneural T2-hyperintensity, calibre, discontinuity, perineural hematoma) injuries. Accuracy of routine knee MRI in the diagnosis of acute neurovascular injury and correlation of MRI findings to clinical outcome were evaluated. Patients included 86/115 males, mean age 33 years. The accuracy of MRI in diagnosis of acute CPN injury was 80.6%, 83.6% (readers 1 and 2): sensitivity (78%, 79.7%), specificity (80%, 86.7%), PPV (78%, 82.5%), and NPV (82.7%, 84.4%). Increased intraneural T2 signal showed a significant correlation to acute CPN dysfunction (p

To review the clinical and imaging findings of patients with remote history of intramuscular (IM) in vitro fertilization (IVF) gluteal injections, presenting with signs and symptoms of a possible gluteal soft tissue sarcoma. Retrospective review of consecutive patients with a history of prior IVF therapy referred for MRI evaluation of a gluteal soft tissue mass was performed. Six patients were reviewed, with 5 patients meeting study inclusion criteria. Imaging exams (ultrasound n = 3, MRI n = 5) were assessed for lesion location, morphology, and intrinsic imaging characteristics. One case proceeded to percutaneous biopsy with histopathologic correlation. Average patient age was 43 years (range 38–50). Mean time interval between IVF IM injections and MRI was 5.7 years (range 2.2–13 years). Clinical findings included palpable gluteal mass (5/5) and local pain (4/5). Ultrasound showed heterogeneous subcutaneous lesions with varying complex cystic/solid internal echogenicity. On MRI, each case illustrated an irregularly marginated lesion, mean maximal dimension 3.5 cm (range 1.5–5.9 cm), within the deep gluteal subcutaneous fat composed of solitary (1/5) or multifocal (4/5) lobules demonstrating internal areas of high T1 and homogeneous low T2 fat suppressed signal with surrounding peripheral reticular high T2 signal. Correlative histological assessment showed central areas with features of fat necrosis and a peripheral inflammatory rim. In the setting of prior IVF therapy, imaging features of an irregularly marginated, deep subcutaneous gluteal lesion with inflammatory soft tissue changes surrounding solitary or multifocal areas of loculated fat signal may be seen as an inflammatory response to previous inadvertent subcutaneous injection(s).

To highlight the spectrum of pathology and patterns of gluteus minimus tendon tearing observed on MR imaging of the hip. Retrospective review of consecutive hip MRI exams with findings of gluteus minimus tendon (GMin) pathology. A total of 194 exams in 178 patients (148 female, mean age 61) were reviewed. MRI exams are assessed for GMin: tendinopathy, partial, or complete tendon tears. GMin muscular fatty atrophy, enthesopathic cortical irregularities of the greater trochanter (GT), and peri-trochanteric edema or bursal fluid collections were assessed in all cases. In all cases of complete GMin tendon tearing, position and relationship of GMin tendon were assessed relative to its normal insertion site and adjacent soft tissues. Clinical indications for MR imaging included hip pain (n = 151), and weakness or altered gait (n = 13). Insertional GMin tendinopathy was seen in 72, partial tearing in 81, and complete tendon tearing in 40 cases. Complete tendon tearing without proximal retraction was observed in 38/40 cases with soft tissue continuity visualized between distal tendon fibers and the proximal vastus lateralis muscle. Peri-trochanteric bursal fluid (n = 61), osseous irregularities of the GT (n = 118), and fatty atrophy GMin (n = 102) were statistically associated with partial or complete GMin tendon tearing (p

Patients with late-stage Kellgren-Lawrence knee osteoarthritis received a single intra-articular injection of 1, 10, or 50 million bone marrow mesenchymal stromal cells (BM-MSCs) in a phase I/IIa trial to assess safety and efficacy using a broad toolset of analytical methods. Besides safety, outcomes included patient-reported outcome measures (PROMs): Knee Injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); contrast-enhanced magnetic resonance imaging (MRI) for cartilage morphology (Whole Organ MRI Scores [WORMS]), collagen content (T2 scores), and synovitis; and inflammation and cartilage turnover biomarkers, all over 12 months. BM-MSCs were characterized by a panel of anti-inflammatory markers to predict clinical efficacy. There were no serious adverse events, although four patients had minor, transient adverse events. There were significant overall improvements in KOOS pain, symptoms, quality of life, and WOMAC stiffness relative to baseline; the 50 million dose achieved clinically relevant improvements across most PROMs. WORMS and T2 scores did not change relative to baseline. However, cartilage catabolic biomarkers and MRI synovitis were significantly lower at higher doses. Pro-inflammatory monocytes/macrophages and interleukin 12 levels decreased in the synovial fluid after MSC injection. The panel of BM-MSC anti-inflammatory markers was strongly predictive of PROMs over 12 months. Autologous BM-MSCs are safe and result in significant improvements in PROMs at 12 months. Our analytical tools provide important insights into BM-MSC dosing and BM-MSC reduction of synovial inflammation and cartilage degradation and provide a highly predictive donor selection criterion that will be critical in translating MSC therapy for osteoarthritis. Stem Cells Translational Medicine 2019;8:746–757

To assess the accuracy of routine knee MRI in detecting acute popliteal artery and/or common peroneal nerve (CPN) dysfunction following multiligamentous knee injury (MLKI), with correlation of MRI findings to clinical outcome.Routine MRI knee examinations in 115 MLKI patients (54/115 with acute neurovascular injury, 61/115 without neurovascular injury) were retrospectively reviewed. Cases were classified by injury mechanism and ligamentous injuries sustained. MRI examinations were reviewed by two readers for vascular (arterial flow void, arterial calibre, intimal flap, perivascular hematoma) and CPN (intraneural T2-hyperintensity, calibre, discontinuity, perineural hematoma) injuries. Accuracy of routine knee MRI in the diagnosis of acute neurovascular injury and correlation of MRI findings to clinical outcome were evaluated.Patients included 86/115 males, mean age 33 years. The accuracy of MRI in diagnosis of acute CPN injury was 80.6%, 83.6% (readers 1 and 2): sensitivity (78%, 79.7%), specificity (80%, 86.7%), PPV (78%, 82.5%), and NPV (82.7%, 84.4%). Increased intraneural T2 signal showed a significant correlation to acute CPN dysfunction (p 0.05). MRI was 75%, 69.8% (readers 1 and 2) accurate in detecting acute vascular injury: sensitivity (73.3%, 86.7%), specificity (75.2%, 67.3%), PPV (30.5%, 36.1%), and NPV (95%, 97.1%). No MRI features of vascular injury showed a statistical correlation with clinical outcome. Neurovascular complications were more common in ultra-low-energy injuries and KD-V3L pattern of ligament disruption.Routine MRI is of limited accuracy in assessing vascular complication, but higher accuracy in assessing CPN injury following MLKI. Increased intraneural T2 signal on conventional knee MR imaging shows statistically significant association with clinically documented acute CPN dysfunction following MLKI.

Solitary fibrous tumors (SFTs) uncommonly occur in the musculoskeletal system, with limited available data on their MRI appearance. This study was performed to assess the MRI features of SFTs in the musculoskeletal system (MSK-SFTs).Pre-treatment MRI in 39 patients with pathologically proven SFTs in the trunk or extremities was evaluated. Patient demographics, clinical management and follow-up, and lesion histology were reviewed. MRI features including lesion location, size, morphology, signal characteristics, vascularity, and relationship to major neurovascular structures were assessed.MSK-SFTs most frequently occurred in the lower extremity (23/39 cases, 59%), deep to fascia (29/39, 74%), and intermuscular (22/29, 76%) in location. The majority of deep lesions were located along a major neurovascular bundle (20/29, 69%). Lesions had well-defined margins (39/39, 100%), multilobulated contours (27/39, 69%), and measured mean 6.9 ± 2.8 cm. The majority of lesions had slightly hyperintense T1 signal (34/39, 87%) and heterogenous intermediate-to-high T2/STIR signal (28/38, 74%). A "pseudo-cerebriform" internal architectural pattern on fluid-sensitive sequences, with internal lobulations and low signal bands/septations, was observed in 63% (24/38) of lesions. Lesions commonly demonstrated prominent intra-lesional (30/39, 75%) and peripheral juxta-lesional flow voids. Local invasion of surrounding structures was uncommon (3/39, 8%). Mitotically active lesions (p = 0.02) and lesions with tumor necrosis (p 0.01) were larger in size. Tumor necrosis was associated with T1 heterogeneity (p = 0.04). Distant metastasis occurred in 10% (4/39) of patients, all in mitotically active lesions pre-operatively considered at least at intermediate risk of metastasis.MSK-SFTs commonly present as well-defined, hypervascular masses deep to fascia along major neurovascular bundles, with heterogeneous slightly hyperintense T1 signal, intermediate-to-high T2/STIR signal, and prominent macroscopic flow voids.

Posterolateral corner (PLC) injuries of the knee are often sustained in combination with anterior or posterior cruciate ligament injuries. A variety of surgical techniques including acute repair, nonanatomical reconstructions, and anatomical reconstructions have been used to treat grade III PLC injuries. Scant literature is available on postoperative imaging of the PLC. This article reviews the more commonly used surgical techniques and the postoperative imaging assessment of the PLC of the knee.

Acute knee injuries are a common source of morbidity in athletes and if overlooked may result in chronic functional impairment. Magnetic resonance (MR) imaging of the knee has become the most commonly performed musculoskeletal MR examination and is an indispensable tool in the appropriate management of the injured athlete. Meniscal and ligamentous tearing are the most frequent indications for surgical intervention in sports injuries and an understanding of the anatomy, biomechanics, mechanisms of injury, and patterns of injury are all critical to accurate diagnosis and appropriate management. These will be discussed in reference to meniscal tears and injuries of the cruciate ligaments as well as injuries of the posterolateral and posteromedial corners of the knee. (©) RSNA, 2016.

Magnetic CoFe2O4 and silver nanoparticles were synthesized via simple chemical reactions using precipitation method at temperature of 60 °C. The all obtained materials are in the range of nano-scale magnetic particles. The effect of different surfactants (anionic, cationic and neutral) on the morphology of the products was investigated. zeolite Y–Ag–CoFe2O4 nanocomposites were also prepared by so called “ship in bottle” procedure. Scanning electron microscopy, X-ray diffraction pattern, Fourier transform infra-red were used to study the structural and physical properties of CoFe2O4 nanoparticles. The magnetic properties of the product were also investigated using a vibrating sample magnetometer. The cobalt ferrite nanoparticles exhibit various ferromagnetic behaviours by changing in surfactants at room temperature. The photocatalytic behaviour of zeolite Y–Ag–CoFe2O4 nanocomposite was evaluated using the degradation of four various azo dyes aqueous solution under UV light irradiation. The results confirm that zeolite Y–Ag–CoFe2O4 nanocomposites are suitable materials with suitable performance in photo-catalytic applications.

The high sensitivity and specificity of magnetic resonance imaging in diagnosis of anterior cruciate ligament (ACL) tears makes it the “gold standard” imaging modality in the diagnosis of ACL injuries. In this chapter, we discuss the imaging appearances of an intact ACL, as well as the primary and secondary imaging signs of an ACL tear. We also discuss the imaging appearances of partial ACL injuries and associated injuries identified with ACL tears.

Objective.To describe the dorsal 4-finger technique (DFFT) in examining metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA) and compare it to the traditional 2-finger technique (TFT) using ultrasound (US) as a gold standard.Methods.Four rheumatologists evaluated 180 MCP joints of 18 patients with RA. All patients underwent US for greyscale (GSUS) and power Doppler US (PDUS). Agreements between rheumatologists, the 2 techniques, and US were evaluated using Cohen κ and the first-order agreement coefficient (AC1) κ methods.Results.The population comprised 17 females (94.4%) with a mean (SD) age and disease duration of 56.8 (14.4) and 21.8 (12.9) years, respectively. Eight patients (44.4%) were taking methotrexate monotherapy, while 10 patients (55.6%) were receiving biologics. US evaluation revealed 69 (38.3%) and 30 (16.7%) joints exhibited synovitis grade 2–3 by GSUS and PDUS, respectively. Effusion was documented in 30 joints (16.7%). The mean intraobserver agreement using the DFFT and TFT were 80.5% and 86%, respectively. The mean interobserver agreements using the DFFT and TFT were 84% and 74%, respectively. κ agreement with US findings was similar for both techniques in tender joints but was higher for the DFFT in nontender joints (0.33 vs 0.07, p = 0.015 for GSUS) and (0.48 vs 0.11, p = 0.002 for PDUS). The DFFT had a higher sensitivity in detecting ballottement by GSUS (0.47 vs 0.2, p < 0.001) and PDUS (0.60 vs 0.27, p < 0.001).Conclusion.The DFFT is a novel, reproducible, and reliable method to examine MCP joints, and it has a better correlation with US than the traditional TFT.

To investigate the accuracy of non-arthrographic 3-T MRI compared to hip arthroscopy in the assessment of labral and cartilaginous pathology in patients with suspected FAI. Following IRB approval and waived consent, 42 consecutive cases of suspected FAI with non-arthrographic 3-T MRI and arthroscopy of the hip were reviewed. High-resolution TSE MR imaging was evaluated in consensus by two musculoskeletal radiologists, blinded to arthroscopic findings, for the presence of labral tears and articular cartilage lesions. Acetabular cartilage was categorized as normal, degeneration/fissuring, delamination, or denudation. MRI findings were compared to arthroscopy. Sensitivity, specificity, accuracy, and predictive values for MRI were calculated using arthroscopy as the standard of reference. Forty-two hips in 38 patients with a mean age of 29 (range 13–45 years) were assessed. Mean interval between MRI and arthroscopy was 154 days (range 27–472 days). MRI depicted 41 cases with labral tears (sensitivity 100%, specificity 50%, accuracy 98%, PPV 98%, NPV 100%), 11 cases with femoral cartilage abnormalities (sensitivity 85%, specificity 100%, accuracy 95%, PPV 100%, NPV 94%), and 36 cases with acetabular cartilage lesions (sensitivity 94% specificity 67%, accuracy 90%, PPV 94%, NPV 67%). Of the 36 cases with acetabular cartilage lesions on MRI, 7 were characterized as degeneration/fissuring, 26 as delamination, and 3 as denudation, with discordant results between MRI and arthroscopy for grading of articular cartilage in ten cases. Non-arthrographic 3-T MR imaging is a highly accurate technique for evaluation of the labrum and cartilage in patients with clinically suspected FAI.

To determine the association between traumatic bone marrow abnormalities, the knee injury mechanism, and associated soft tissue injuries in a larger cohort than those in the published literature. Retrospective study including 220 patients with traumatic knee injuries. Knee MRIs were evaluated for trauma mechanism, soft tissue injury, and the location of bone marrow abnormalities. The locations of the abnormalities were correlated with trauma mechanisms and soft tissue injuries using the chi-square test with Bonferroni correction. One hundred and forty-four valgus injuries, 39 pivot shift injuries, 25 lateral patellar dislocations, 8 hyperextensions, and 4 dashboard injuries were included. Valgus and pivot shift injuries showed traumatic bone marrow abnormalities in the posterolateral regions of the tibia. Abnormalities after patellar dislocation were found in the anterolateral and centrolateral femur and patella. Hyperextension injuries were associated with abnormalities in almost all regions, and dashboard injuries were associated with changes in the anterior regions of the tibia and femur. Our study provides evidence of associations between traumatic bone marrow abnormality patterns and different trauma mechanisms in acute knee injury, and reveals some overlap, especially of the two most common trauma mechanisms (valgus and pivot shift), in a large patient cohort. • Specific bone marrow oedema patterns after knee trauma were confirmed. • New associations between bone marrow oedema patterns and knee trauma were shown. • Bone marrow oedema patterns help in identifying associated soft tissue injuries.

Diffusion tensor imaging (DTI) is a powerful MR imaging technique that can be used to probe the microstructural environment of highly anisotropic tissues such as peripheral nerves. DTI has been used predominantly in the central nervous system, and its application in the peripheral nervous system does pose some challenges related to imaging artifacts, the small caliber of peripheral nerves, and low water proton density. However advances in MRI hardware and software have made it possible to use the technique in the peripheral nervous system and to obtain functional data relating to the effect of pathologic processes on peripheral nerves. This article reviews the imaging principles behind DTI and examines the literature regarding its application in assessing peripheral nerves.

Cruciate ligament injuries, and in particular injuries of the anterior cruciate ligament (ACL), are the most commonly reconstructed ligamentous injuries of the knee. As such, accurate preoperative diagnosis is essential in optimal management of patients with cruciate ligament injuries. This article reviews the anatomy and biomechanics of the ACL and posterior cruciate ligament (PCL) and describes the magnetic resonance (MR) imaging appearances of complete and partial tears. Normal postoperative appearances of ACL and PCL reconstructions as well as MR imaging features of postoperative complications will also be reviewed.

Muscle weakness is a prevalent complication in chronic obstructive pulmonary disease (COPD). Atrophy does not fully explain muscle weakness in this population. The recent focus on fat infiltration and its clinical implications in age and diseased muscles are important because it may further explain the extent of declining muscle strength and mobility seen in COPD.The objectives of this study are to quantify fat infiltration (muscle quality) of lower-limb muscles in people with COPD and healthy older adults using magnetic resonance imaging and proton magnetic resonance spectroscopy, and to explore its relationship with muscle strength and walking capacity in COPD.T1-weighted magnetic resonance imaging and proton magnetic resonance spectroscopy were performed in people with COPD (n = 10) and control subjects (n = 10) matched for age, gender, and body mass index. Maximal cross-sectional area (muscle size), isokinetic and isometric muscle peak torques, and 6-min walk distance were also assessed.In addition to muscle atrophy (mean between-group differences of 20% to 25%, P0.05), COPD group presented with fatty infiltration in thigh and calf muscles that were significantly greater than what was observed in their healthy counterparts (mean between-group differences of 74% to 89%, P = 0.001). There was a strong inverse correlation between intramuscular fat infiltration, muscle peak torque, and walking distance (r = -0.6 to -0.8, P0.001) in this group as opposed to fair-to-moderate correlations between muscle size and the same outcomes (r = 0.4-0.6, P0.01).Poor muscle quality accompanies atrophy in people with COPD. Intramuscular fat infiltration not only appears to have a strong correlation with impaired function but also is more profound than muscle atrophy in this group. Monitoring both muscle size and quality may enable a more comprehensive assessment of exercise programs in COPD.

OBJECTIVE. The purpose of this article is to review the common pitfalls in MRI of the knee and pearls on how to avoid them. CONCLUSION. MRI of the knee is highly accurate in evaluation of internal derangements of the knee. However, a variety of potential pitfalls in interpretation of abnormalities related to the knee have been identified, particularly in evaluation of the menisci, ligaments, and articular cartilage.

Surgical treatment of sports injuries has become increasingly common. Patients who remain symptomatic or develop new symptoms following surgery may be referred for further imaging. In the postoperative setting, the radiologist needs to be able to distinguish between normal postsurgical change and pathology. This requires familiarity with the common surgical techniques, their potential complications and the normal postoperative morphological changes. Diagnostic imaging criteria normally used in the preoperative patient may need to be modified as it may be of limited utility following surgery. Imaging protocols may also need to be tailored to reduce hardware related artefacts. Postoperative appearances of the common surgical procedures are reviewed with an emphasis on the knee and the shoulder.

Anabolic-androgenic steroids are used at high doses by athletes for improving athletic ability, physical appearance and muscle mass. Unfortunately, the abuse of these agents has significantly increased. It has been established that exercise and high doses of anabolic-androgenic steroids may influence the hypothalamic-pituitary-gonadal axis, which can in turn affect testicular apoptosis. However, the effect of the combination of exercise and high dose of anabolic-androgenic steroids on testicular apoptosis is not known. We investigated the combined effects of exercise and high doses of nandrolone decanoate on apoptosis in the spermatogenic cell lineage. Five groups of male Wistar strain albino rats were treated as follows for 8 weeks: solvent of nandrolone decanoate (peanut oil) as a vehicle (Sham); nandrolone decanoate (10 mg/kg/weekly) (nandrolone decanoate); exercise (1 hr/day, 5 days a week) (exercise); nandrolone decanoate (10 mg/kg/weekly) and exercise (1 hr/day, 5 days a week) (nandrolone decanoate exercise); and sedentary control without any injection or exercise (Control). Apoptosis in the male germ line was characterized by TUNEL, caspase-3 assay and transmission electron microscopy. The weights of the testis and accessory sex organs, as well as sperm parameters significantly decreased in the experimental groups relative to the sham and control groups (por = 0.05). Germ cell apoptosis and a significant decrease in the number of germ cell layers in nandrolone decanoate exercise-treated testes were observed (por = 0.05). Exercise training seems to increase the extent of apoptotic changes caused by supraphysiological dose of nandrolone decanoate in rats, which in turn affects fertility.

Surgical repair and reconstructive techniques of the knee following injury have become increasingly common with an associated rise in demand for imaging of patients with postoperative symptoms. MRI is an invaluable tool in the noninvasive assessment of such cases but provides a challenge because of the diversity of the operative techniques encountered and the normal variability of postsurgical appearances. The normal postoperative appearances and the complications delineated by MRI in relation to meniscal surgery, ligamentous reconstruction, and cartilage repair procedures are reviewed.