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Abstract Alveolar echinococcosis (AE) of human being caused by Echinococcus multilocularis is a rare but important zoonosis especially in tempered zones of middle Europe and Northern America with endemic character in many countries. Due to the long incubation period, various clinical manifestations, critical prognosis, and outcome AE presents a serious and severe disease. The primary focus of infection is usually the liver. Although secondary affection of visceral organs is possible extrahepatic AE is highly uncommon. Moreover, the involvement of bone and muscle presents with an even lower incidence. In the literature numerous cases on hepatic AE have been reported. However, extrahepatic AE involving bones and/or muscles was described very rarely. We report a case of an 80-year-old man with primary extrahepatic alveolar Echinococcosis of the lumbar spine and the psoas muscle. The etiology, diagnosis, differential diagnoses, treatment options and outcome of this rare disease are discussed in context with the current literature.

Purpose: To determine the impact of axial traction during high resolution 3.0T MR imaging of the ankle on morphological assessment of articular cartilage and quantitative cartilage imaging parameters.Materials and Methods: MR images of n=25 asymptomatic ankles were acquired with and without axial traction (6kg). Coronal and sagittal T1-weighted (w) turbo spin echo (TSE) sequences with a driven equilibrium pulse and sagittal fat-saturated intermediate-w (IMfs) TSE sequences were acquired for morphological evaluation on a four-point scale (1=best, 4=worst). For quantitative assessment of cartilage degradation segmentation was performed on 2D multislice-multiecho (MSME) SE T2, steady-state free-precession (SSFP; n=8) T2 and SSFP diffusion-weighted imaging (DWI; n=8) images. Wilcoxon-tests and paired t-tests were used for statistical analysis.Results: With axial traction, joint space width increased significantly and delineation of cartilage surfaces was rated superior (P<0.05). Cartilage surfaces were best visualized on coronal T1-w images (P<0.05). Differences for cartilage matrix evaluation were smaller. Subchondral bone evaluation, motion artifacts and image quality were not significantly different between the acquisition methods (P>0.05). T2 values were lower at the tibia than at the talus (P<0.001). Reproducibility was better for images with axial traction.Conclusion: Axial traction increased the joint space width, allowed for better visualization of cartilage surfaces and improved compartment discrimination and reproducibility of quantitative cartilage parameters. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate magnetic resonance (MR) perfusion and diffusion imaging characteristics in patients with transient bone marrow edema (TBME), avascular necrosis (AVN), or subchondral insufficiency fractures (SIF) of the proximal femur., Materials and Methods: 29 patients with painful hip and bone marrow edema pattern of the proximal femur on non-contrast MR imaging were examined using diffusion-weighted and dynamic gadolinium-enhanced sequences. Apparent diffusion coefficients (ADCs) and perfusion parameters were calculated for different regions of the proximal femur. Regional distribution and differences in ADC values and perfusion parameters were evaluated., Results: Seven patients presented with TBME, 15 with AVN and seven with SIF of the proximal femur. Perfusion imaging showed significant differences for maximum enhancement values (Emax), slope (Eslope) and time to peak (TTP) between the three patient groups (p<0.05). In contrast, no significant differences for ADC values were calculated when comparing TBME, AVN, and SIF patients., Conclusion: Diffusion weighted imaging of bone marrow of the proximal femur did not show significant differences between patients with TBME, AVN or SIF. In contrast, MR perfusion imaging demonstrated significant differences for the different patient groups and may as a complementary imaging technique add information to the understanding of the pathophysiology of diseases associated with bone marrow edema., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: The purpose of the study was to evaluate whether patients with clinically suspected femoroacetabular impingement (FAI) show higher epiphyseal torsion angle values on MR arthrography than healthy volunteers. Another objective was to estimate whether patients with increased epiphyseal torsion angles show a higher incidence of hip abnormalities or a higher incidence of increased alpha angles on MR arthrography than patients with an epiphyseal torsion angle considered normal., Materials and Methods: Sixty-eight consecutive patients with clinically suspected FAI, no history of hip surgery, and MR arthrography of the hip performed at our institution were included in the study group. The control group included 50 standard MR examinations of the hip of 25 healthy volunteers with negative findings on a clinical impingement test. Epiphyseal torsion angles and alpha angles were measured independently by three radiologists. Furthermore, MR arthrograms were retrospectively evaluated by two radiologists in consensus for hip abnormalities associated with FAI., Results: The epiphyseal torsion angles were significantly higher in the study group than the control group for all three readers (reader 1, p = 0.001; reader 2, p = 0.003; reader 3, p = 0.045). There was no statistical correlation between increased epiphyseal torsion angles and pathologic alpha angles (readers 1-3: p = 0.199, p = 0.343, p = 0.058, respectively). Patients with increased epiphyseal torsion angles did not show a higher incidence of labral abnormalities than patients with epiphyseal torsion angles considered normal (readers 1-3: p = 0.335, p = 0.383, p = 0.676)., Conclusion: Patients with clinically suspected FAI show increased epiphyseal torsion angles compared with healthy volunteers. Values greater than 20° should be considered pathologic. A pathologic retrotorsion of the femoral epiphysis may play a role in developing hip pain related to FAI and premature osteoarthritis.