Seminars in Musculoskeletal Radiology, May 25, 2023
Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases aff... more Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach.
Resumen Presentamos 5 pacientes diagnosticados y tratados de meningocele intrasacro oculto. Anali... more Resumen Presentamos 5 pacientes diagnosticados y tratados de meningocele intrasacro oculto. Analizamos las diferentes teorias patogenicas, el cuadro clinico y el papel que desempenan los diferentes estudios neurorradiologicos, destacando el de la resonancia magnetica en el diagnostico y correcta evaluacion preoperatoria de esta lesion. Igualmente se exponen los hallazgos quirurgicos, la tecnica empleada y los hallazgos anatomopatologicos de la pared del quiste.
La osteonecrosis de los huesos del tobillo y pie es un problema clínico relativamente infrecuente... more La osteonecrosis de los huesos del tobillo y pie es un problema clínico relativamente infrecuente. Los factores predisponentes son múltiples, incluyendo traumatismo, esteroides, hemoglobinopatías, alcoholismo, pancreatitis, lupus eritematoso sistémico... El diagnóstico precoz de la osteonecrosis permite una adecuada planificación del tratamiento y mejorar el pronóstico. Dado que los hallazgos clínicos son frecuentemente inespecíficos, los métodos de imagen son especialmente importantes en el diagnóstico. Revisamos el papel de los diferentes métodos de imagen en el diagnóstico de la osteonecrosis, con especial énfasis en la utilidad de la resonancia magnética. PALABRAS CLAVE Pie. Tobillo. Osteonecrosis.
The elbow is a complex joint whose stability is imparted by osseous and soft-tissue constraints. ... more The elbow is a complex joint whose stability is imparted by osseous and soft-tissue constraints. Anatomical and biomechanical knowledge of the supporting structures that provide stability to the medial and lateral elbow is essential to correctly interpret the pathological findings. Conventional MRI and MR arthrography are the imaging modalities of choice in the evaluation of elbow ligament injuries. Elbow instability can be classified according to timing (acute, chronic, or recurrent), the direction of displacement, the degree of displacement, and the articulations involved. This article reviews the MR imaging protocols recommended for each diagnosis and the normal anatomy and biomechanical aspects of the medial and lateral collateral ligament complex. We also present multiple cases of typical and atypical patterns of injury.
Seminars in Musculoskeletal Radiology, Jun 1, 2019
Over the last 2 decades, the definition of pathomechanical concepts that link osseous deformities... more Over the last 2 decades, the definition of pathomechanical concepts that link osseous deformities to chondrolabral damage and expose young and active patients to the risk of early osteoarthritis has led to a tremendous increase in the number of joint-preserving surgeries performed. The rise in arthroscopic procedures has led to an increasing demand for comprehensive preoperative magnetic resonance imaging (MRI) assessment of the hip joint. This includes conventional MRI for the assessment of extra-articular and periarticular pathologies such as greater trochanteric pain, deep gluteal pain syndrome, and sports injuries. Magnetic resonance arthrography with or without traction is reserved for the accurate evaluation of deformities associated with impingement and hip instability and for detecting the resulting intra-articular lesions. This article summarizes the current standard imaging techniques that the radiologist should know. It also explores the potential of computer-assisted analysis of three-dimensional MRI for virtual impingement simulation and volumetric analysis of cartilage composition and geometry.
Femoroacetabular impingement, both cam and pincer types, is a recently appreciated cause of hip p... more Femoroacetabular impingement, both cam and pincer types, is a recently appreciated cause of hip pain, acetabular cartilage and labral damage, and hip degenerative change. Abnormalities in the morphology of the acetabulum or the proximal femur may be the primary predisposing factor. This article reviews the imaging findings and treatment strategies of cam- and pincer-type femoroacetabular impingement.
junction tear of the anterior bundle of the supraspinatus muscle-a rare pattern of injury involvi... more junction tear of the anterior bundle of the supraspinatus muscle-a rare pattern of injury involving rotator cuff muscles.
Un uomo di 34 anni, bracciante, si presenta con dolore cronico al polso che si e incrementato neg... more Un uomo di 34 anni, bracciante, si presenta con dolore cronico al polso che si e incrementato negli ultimi 6 mesi. Presenta in anamnesi una caduta sulla mano aperta piu di 10 anni fa. Una ri-sonanza magnetica eseguita senza previo studio radiografico ha dimostrato una completa rottura del legamento interosseo scafo-lunato, un’instabilita del polso intercalata semilunare dorsale (DISI), un’estesa erosione condrale radio-scafoidea e un marcato rimodellamento osseo del radio distale. Inoltre, sono stati individuati un osso semilunare di tipo 2 di Viegas (presenza di una faccetta articolare comune tra uncinato e semilunare), con condromalacia avanzata del polo prossimale dell’osso uncinato, e una piccola rottura centrale della fibrocartilagine triangolare (lesione di Palmer 1 A). La resezione dello scafoide carpale e successive artrodesi carpale hanno portato a riduzione completa del dolore e a un buon risultato funzionale.
The ultrasound examination of hamstrings inspires respect due to the connective complexity of the... more The ultrasound examination of hamstrings inspires respect due to the connective complexity of their structures, particularly for sonographers who are not used to this kind of study. Therefore, it is important to know the specific ultrasound reference points that facilitate the location of the hamstring structures, dividing them into four areas of interest: (a) tendinous origin of the hamstring, (b) the proximal half, (c) distal and medial half, and (d) distal and lateral half. The origin of the hamstrings is found at the level of the ischial tuberosity. Here, the connective structures under study are the common tendon and the semimembranosus tendon, together with the muscle fibers more proximal to the semitendinosus, which can also be assessed through ultrasound locating the ischial tuberosity. The proximal half of the thigh consists of a characteristic structure made up by the common tendon, the sciatic nerve and the semimembranosus tendon, enabling to define the biceps femoris and the semitendinosus, respectively. To identify the distal and medial section, the volumetric relationship between the ST and SM muscle masses is used, where it is also possible to identify the three muscles in the knee that make up the pes anserine. To identify the distal and lateral sections, the sciatic nerve pathway is followed until identifying both heads of the biceps femoris. These four areas of interest, with their specific landmarks, show a tuning fork that enables the comprehensive study of hamstrings through ultrasound.
Experience with modern neuroimaging techniques, computed tomography (CT) and magnetic resonance i... more Experience with modern neuroimaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI) scans, in the diagnosis of Tolosa-Hunt syndrome (THS) is reviewed. Conventional CT scan remains normal in about two-thirds of these patients. In the reported 22 patients meeting the IHS criteria for a THS diagnosis on whom an MRI study was performed, MRI revealed a convex enlargement of the symptomatic cavernous sinus by an abnormal tissue isointense with gray matter on short TR/TE images and isohypointense on long TR/TE images. This abnormal tissue markedly increases in signal intensity after contrast injection. MRI seems also to be the ideal technique to follow progressive resolution of the abnormal tissue after steroids. Therefore, normal MRI would probably exclude THS, whereas in the appropriate clinical setting of steroid-responsive painful ophthalmoplegia, MRI showing the cavernous sinus abnormality described here suggests a diagnosis of THS. From these data, we propos...
Journal of neuroradiology. Journal de neuroradiologie, 1994
Malignant melanomas of the choroid are the most frequent symptomatic eye tumours in adults. They ... more Malignant melanomas of the choroid are the most frequent symptomatic eye tumours in adults. They often have a pathognomonic appearance, being collar-button or mushroom shaped due to rupture of Bruch's membrane by the tumoral mass. The ultrasonographic image of collar-button melanoma is well known: the head of the tumour is hyperechogenic and its base hypoechogenic. According to some authors, this is caused by difference in blood supply between the two parts. At MRI strongly pigmented melanomas emit a high-intensity signal on T1-weighted sequences and a low-intensity signal on T2-weighted sequences, but these characteristic features are inconstant. We present a case of collar-button melanoma explored by ultrasonography, colour Doppler Flow Imaging (CDFI) ultrasound and MRI, then enucleated. Flows and signals were different in front of, or behind the rupture of Bruch's membrane: ultrasounds showed a hyperechogenic image at the head and a hypoechogenic image at the base; on T2-...
Shoulder pain accounts for 16% of the musculoskeletal complaints and represents an important caus... more Shoulder pain accounts for 16% of the musculoskeletal complaints and represents an important cause of absenteeism of work. Abnormalities of the rotator cuff, including tears, are frequently seen on imaging studies. Unfortunately, asymptomatic tears are frequent, up to 60% in patients older than 60 years old; therefore clinical correlation is essential.New anatomical concepts and new surgical techniques have evolved within the entire spectrum of lesions. It is essential to be aware of the information that is important for the decision-making as this information should stand out in our reports.In this course we will therefore review the different rotator cuff tears and its differential diagnosis.
Seminars in Musculoskeletal Radiology, May 25, 2023
Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases aff... more Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach.
Resumen Presentamos 5 pacientes diagnosticados y tratados de meningocele intrasacro oculto. Anali... more Resumen Presentamos 5 pacientes diagnosticados y tratados de meningocele intrasacro oculto. Analizamos las diferentes teorias patogenicas, el cuadro clinico y el papel que desempenan los diferentes estudios neurorradiologicos, destacando el de la resonancia magnetica en el diagnostico y correcta evaluacion preoperatoria de esta lesion. Igualmente se exponen los hallazgos quirurgicos, la tecnica empleada y los hallazgos anatomopatologicos de la pared del quiste.
La osteonecrosis de los huesos del tobillo y pie es un problema clínico relativamente infrecuente... more La osteonecrosis de los huesos del tobillo y pie es un problema clínico relativamente infrecuente. Los factores predisponentes son múltiples, incluyendo traumatismo, esteroides, hemoglobinopatías, alcoholismo, pancreatitis, lupus eritematoso sistémico... El diagnóstico precoz de la osteonecrosis permite una adecuada planificación del tratamiento y mejorar el pronóstico. Dado que los hallazgos clínicos son frecuentemente inespecíficos, los métodos de imagen son especialmente importantes en el diagnóstico. Revisamos el papel de los diferentes métodos de imagen en el diagnóstico de la osteonecrosis, con especial énfasis en la utilidad de la resonancia magnética. PALABRAS CLAVE Pie. Tobillo. Osteonecrosis.
The elbow is a complex joint whose stability is imparted by osseous and soft-tissue constraints. ... more The elbow is a complex joint whose stability is imparted by osseous and soft-tissue constraints. Anatomical and biomechanical knowledge of the supporting structures that provide stability to the medial and lateral elbow is essential to correctly interpret the pathological findings. Conventional MRI and MR arthrography are the imaging modalities of choice in the evaluation of elbow ligament injuries. Elbow instability can be classified according to timing (acute, chronic, or recurrent), the direction of displacement, the degree of displacement, and the articulations involved. This article reviews the MR imaging protocols recommended for each diagnosis and the normal anatomy and biomechanical aspects of the medial and lateral collateral ligament complex. We also present multiple cases of typical and atypical patterns of injury.
Seminars in Musculoskeletal Radiology, Jun 1, 2019
Over the last 2 decades, the definition of pathomechanical concepts that link osseous deformities... more Over the last 2 decades, the definition of pathomechanical concepts that link osseous deformities to chondrolabral damage and expose young and active patients to the risk of early osteoarthritis has led to a tremendous increase in the number of joint-preserving surgeries performed. The rise in arthroscopic procedures has led to an increasing demand for comprehensive preoperative magnetic resonance imaging (MRI) assessment of the hip joint. This includes conventional MRI for the assessment of extra-articular and periarticular pathologies such as greater trochanteric pain, deep gluteal pain syndrome, and sports injuries. Magnetic resonance arthrography with or without traction is reserved for the accurate evaluation of deformities associated with impingement and hip instability and for detecting the resulting intra-articular lesions. This article summarizes the current standard imaging techniques that the radiologist should know. It also explores the potential of computer-assisted analysis of three-dimensional MRI for virtual impingement simulation and volumetric analysis of cartilage composition and geometry.
Femoroacetabular impingement, both cam and pincer types, is a recently appreciated cause of hip p... more Femoroacetabular impingement, both cam and pincer types, is a recently appreciated cause of hip pain, acetabular cartilage and labral damage, and hip degenerative change. Abnormalities in the morphology of the acetabulum or the proximal femur may be the primary predisposing factor. This article reviews the imaging findings and treatment strategies of cam- and pincer-type femoroacetabular impingement.
junction tear of the anterior bundle of the supraspinatus muscle-a rare pattern of injury involvi... more junction tear of the anterior bundle of the supraspinatus muscle-a rare pattern of injury involving rotator cuff muscles.
Un uomo di 34 anni, bracciante, si presenta con dolore cronico al polso che si e incrementato neg... more Un uomo di 34 anni, bracciante, si presenta con dolore cronico al polso che si e incrementato negli ultimi 6 mesi. Presenta in anamnesi una caduta sulla mano aperta piu di 10 anni fa. Una ri-sonanza magnetica eseguita senza previo studio radiografico ha dimostrato una completa rottura del legamento interosseo scafo-lunato, un’instabilita del polso intercalata semilunare dorsale (DISI), un’estesa erosione condrale radio-scafoidea e un marcato rimodellamento osseo del radio distale. Inoltre, sono stati individuati un osso semilunare di tipo 2 di Viegas (presenza di una faccetta articolare comune tra uncinato e semilunare), con condromalacia avanzata del polo prossimale dell’osso uncinato, e una piccola rottura centrale della fibrocartilagine triangolare (lesione di Palmer 1 A). La resezione dello scafoide carpale e successive artrodesi carpale hanno portato a riduzione completa del dolore e a un buon risultato funzionale.
The ultrasound examination of hamstrings inspires respect due to the connective complexity of the... more The ultrasound examination of hamstrings inspires respect due to the connective complexity of their structures, particularly for sonographers who are not used to this kind of study. Therefore, it is important to know the specific ultrasound reference points that facilitate the location of the hamstring structures, dividing them into four areas of interest: (a) tendinous origin of the hamstring, (b) the proximal half, (c) distal and medial half, and (d) distal and lateral half. The origin of the hamstrings is found at the level of the ischial tuberosity. Here, the connective structures under study are the common tendon and the semimembranosus tendon, together with the muscle fibers more proximal to the semitendinosus, which can also be assessed through ultrasound locating the ischial tuberosity. The proximal half of the thigh consists of a characteristic structure made up by the common tendon, the sciatic nerve and the semimembranosus tendon, enabling to define the biceps femoris and the semitendinosus, respectively. To identify the distal and medial section, the volumetric relationship between the ST and SM muscle masses is used, where it is also possible to identify the three muscles in the knee that make up the pes anserine. To identify the distal and lateral sections, the sciatic nerve pathway is followed until identifying both heads of the biceps femoris. These four areas of interest, with their specific landmarks, show a tuning fork that enables the comprehensive study of hamstrings through ultrasound.
Experience with modern neuroimaging techniques, computed tomography (CT) and magnetic resonance i... more Experience with modern neuroimaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI) scans, in the diagnosis of Tolosa-Hunt syndrome (THS) is reviewed. Conventional CT scan remains normal in about two-thirds of these patients. In the reported 22 patients meeting the IHS criteria for a THS diagnosis on whom an MRI study was performed, MRI revealed a convex enlargement of the symptomatic cavernous sinus by an abnormal tissue isointense with gray matter on short TR/TE images and isohypointense on long TR/TE images. This abnormal tissue markedly increases in signal intensity after contrast injection. MRI seems also to be the ideal technique to follow progressive resolution of the abnormal tissue after steroids. Therefore, normal MRI would probably exclude THS, whereas in the appropriate clinical setting of steroid-responsive painful ophthalmoplegia, MRI showing the cavernous sinus abnormality described here suggests a diagnosis of THS. From these data, we propos...
Journal of neuroradiology. Journal de neuroradiologie, 1994
Malignant melanomas of the choroid are the most frequent symptomatic eye tumours in adults. They ... more Malignant melanomas of the choroid are the most frequent symptomatic eye tumours in adults. They often have a pathognomonic appearance, being collar-button or mushroom shaped due to rupture of Bruch's membrane by the tumoral mass. The ultrasonographic image of collar-button melanoma is well known: the head of the tumour is hyperechogenic and its base hypoechogenic. According to some authors, this is caused by difference in blood supply between the two parts. At MRI strongly pigmented melanomas emit a high-intensity signal on T1-weighted sequences and a low-intensity signal on T2-weighted sequences, but these characteristic features are inconstant. We present a case of collar-button melanoma explored by ultrasonography, colour Doppler Flow Imaging (CDFI) ultrasound and MRI, then enucleated. Flows and signals were different in front of, or behind the rupture of Bruch's membrane: ultrasounds showed a hyperechogenic image at the head and a hypoechogenic image at the base; on T2-...
Shoulder pain accounts for 16% of the musculoskeletal complaints and represents an important caus... more Shoulder pain accounts for 16% of the musculoskeletal complaints and represents an important cause of absenteeism of work. Abnormalities of the rotator cuff, including tears, are frequently seen on imaging studies. Unfortunately, asymptomatic tears are frequent, up to 60% in patients older than 60 years old; therefore clinical correlation is essential.New anatomical concepts and new surgical techniques have evolved within the entire spectrum of lesions. It is essential to be aware of the information that is important for the decision-making as this information should stand out in our reports.In this course we will therefore review the different rotator cuff tears and its differential diagnosis.
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