Ligaments of the os trigonum: an anatomical study

Abstract Purpose The aim of the study was to examine the ligaments of the os trigonum. Methods The ankle joint magnetic resonance imaging (MRI) of 104 patients with the os trigonum (experimental group) and 104 patients without the os trigonum (control group) were re-reviewed. The connections of the os trigonum and posterior talofibular ligament (PTFL), the fibulotalocalcaneal ligament (FTCL), the paratenon of the Achilles tendon, the posterior talocalcaneal ligament (PTCL), the osteofibrous tunnel of the flexor hallucis longus (OF-FHL) and the flexor retinaculum (FR) were studied. Results The os trigonum is connected to structures. The posterior part of the PTFL inserted on the os trigonum in 85.6% of patients, whereas in all patients in the control group, the posterior part of the PTFL inserted on the posterior talar process (p < 0.05). The connection of the PTCL was seen in 94.2% of patients in the experimental group, while it was seen in 90.4% of patients in the control group (p > 0.05). The connection to the FTCL in the experimental group was 89.4%, while in the control group, it was 91.3% (p > 0.05). The communication with the paratenon was seen more often in the control group compared to that in the experimental group (31.7% vs. 63.8%, p < 0.001). The FTCL was prolonged medially into the FR in 85.6% of patients in the experimental group and in 87.5% of patients in the control group (p > 0.05). The flexor hallucis longus (FHL) run at the level of articulation between the os trigonum 63.5% and the posterior process of the talus 25% and less often on the os trigonum 11.5%. Conclusion The os trigonum is connected with all posterior ankle structures and more connections than previously reported.

Download Full-text

Efficacy evaluation and mechanism study of electroacupuncture intervention in acute phase of IFP: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05632-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yinan Qin ◽

Lihong Yang ◽

Man Zhang ◽

Yang Bai ◽

Zexin Li ◽

...

Keyword(s):

Facial Nerve ◽

Acute Phase ◽

Oral Prednisone ◽

Recovery Phase ◽

Control Group ◽

Resonance Imaging ◽

Randomized Controlled ◽

Magnetic Resonance Imaging Mri ◽

Receive Treatment ◽

Experimental Group

Abstract Background Previous studies had already reported the efficacy of electroacupuncture treatment for idiopathic facial nerve palsy (IFP) in a recovery phase; however, the initial use of electroacupuncture in the acute phase remains controversial. Hence, in the present study, we will add electroacupuncture intervention based on oral prednisone tablets in the acute phase of IFP and compare the clinical effects with simple oral prednisone tablets. Besides, the prognosis and safety will be evaluated. The present study aims to evaluate the clinical efficacy, prognosis, and safety of electroacupuncture combined with oral prednisone tablets in the acute phase of IFP, using surface electromyography (sEMG) to objectively observe the recovery of facial expression muscle function. In addition, the morphological changes of the facial nerve were observed dynamically by magnetic resonance imaging (MRI) in the acute phase to reveal the effect mechanism of this therapy. Methods Randomized controlled trials will be conducted in the first teaching hospital of Tianjin University of Traditional Chinese Medicine in China from September 2020 to April 2021. The treatment will be carried out in two phases, including the acute phase and the recovery phase. Eighty IFP patients will be recruited and randomized into two groups with a 1:1 ratio. Subjects in the acute phases of the control group will be given oral prednisone tablets, based on the control group, and subjects of the experimental group will be given electroacupuncture therapy simultaneously in the acute phase. Both groups will be stopped taking prednisone tablets and turn to electroacupuncture therapy in a recovery phase. Patients in the experimental group will receive treatment at least 6 times in the acute phase and both groups will receive treatment 9 times in the recovery phase, and there will be a follow-up period of 15 days after the treatment. The primary outcome is supposed to be related to the changes observed in the Sunnybrook (Toronto) Facial Grading System (SFGS) on the baseline and day 30 after the onset. Secondary outcome measures will include House-Brackmann Facial Nerve Grading System (H-B), measurement of Numerical Rating Scale (NRS), Facial Disability Index scale (FDI, including physical function subscore, FDIP, and social functioning and well-being subscore, FDIS), surface electromyogram (sEMG), and magnetic resonance imaging (MRI). Adverse events will be recorded for safety assessment. Discussion The results of this trial will allow the present study to compare the difference in efficacy and prognosis between the strategy of combined electroacupuncture in the acute phase and only oral prednisone tablets. The findings from this trial will be published in peer-reviewed journals. Trial registration CHICTR ChiCTR2000038472. Registered on 23 September 2020

Download Full-text

Analysis of Combined Treatment of Embolic Stroke in Rat with r-tPA and a GPIIb/IIIa Inhibitor

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/sj.jcbfm.9600010 ◽

2005 ◽

Vol 25 (1) ◽

pp. 87-97 ◽

Cited By ~ 23

Author(s):

Guangliang Ding ◽

Quan Jiang ◽

Li Zhang ◽

Zheng Gang Zhang ◽

Lian Li ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Thrombolytic Therapy ◽

Combination Treatment ◽

Infarct Volume ◽

Embolic Stroke ◽

Control Group ◽

Resonance Imaging ◽

Cerebral Microvessels ◽

Magnetic Resonance Imaging Mri

Suppression of platelet activation improves the efficacy of thrombolytic therapy for stroke. Thus, combination treatment with recombinant tissue plasminogen activator (r-tPA) and 7E3 F(ab′)2, a GPIIb/IIIa inhibitor that binds the platelet to fibrin, may improve the efficacy of thrombolytic therapy in embolic stroke. Magnetic resonance imaging (MRI) was used to monitor treatment response in rats subjected to embolic middle cerebral artery (MCA) occlusion (MCAo). Animals were randomized into treated ( n = 12) and control ( n = 10) groups and received intravenous combination therapy or saline, respectively, 4 hours after MCAo. Magnetic resonance imaging (MRI) measurements performed 1 hour after MCAo showed no difference between groups. However, an increased incidence (50%) of MCA recanalization was found in the treated group at 24 hours compared with 20% in the control group. The area of low cerebral blood flow at 24 and 48 hours was significantly smaller in the combination treatment group, and the lesion size, as indicated from the T2 and T1 maps, differed significantly between groups. Fluorescence microscopy measurements of cerebral microvessels perfused with fluorescein isothiocyanate-dextran and measurements of infarct volume revealed that the combination treatment significantly increased microvascular patency and reduced infarct volume, respectively, compared with the control rats. The efficacy of combination treatment 4 hours after ischemia is reflected by MRI indices of tissue perfusion, MCA recanalization, and reduction of lesion volume. The treatment also reduced secondary microvascular perfusion deficits.

Download Full-text

SÍNDROME DEL ESPACIO CUADRILÁTERO: ¿INFRECUENTE O INSOSPECHADO? Quadrilateral space syndrome: infrequent or unsuspected?

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v8.n2.14372 ◽

2016 ◽

Vol 8 (2) ◽

pp. 87-92

Author(s):

Lucas M. Gutierrez ◽

Matias Cullari ◽

Maximiliano Ranaletta ◽

Ignacio Tanoira ◽

César Gomez ◽

...

Keyword(s):

Clinical Presentation ◽

Matched Control ◽

External Rotation ◽

Axillary Nerve ◽

Control Group ◽

Vascular Compression ◽

Resonance Imaging ◽

Diagnostic Protocol ◽

Magnetic Resonance Imaging Mri ◽

Teres Minor

Introducción: El síndrome del espacio cuadrilátero (QSS) es un cuadro clínico causado por la compresión nerviosa y/o vascular a nivel del espacio axilar lateral. La prevalencia de este síndrome se desconoce y se cree que es baja, sin embargo, formas de presentación incompleta podrían llevar a que el mismo sea subdiagnosticado. Objetivo: Describir un protocolo diagnóstico utilizado en una serie de casos consecutivos de pacientes con omalgia inespecífica y sospecha de QSS. Materiales y Métodos: De manera prospectiva se evaluaron 10 pacientes con omalgia agravada con la rotación externa forzada, uno de ellos con síntomas bilaterales. Se realizó electromiografía (EMG) de deltoides y redondo menor bilaterales, con estudios de conducción nerviosa. Los valores se compararon con el hombro sano, y con un grupo control. El diagnóstico se confirmó mediante resonancia magnética nuclear (RMN). Resultados: El EMG mostró en todos los casos atrapamiento con compromiso axonal de la rama para el redondo menor, con preservación de la inervación del deltoides. La RMN mostró en los 11 hombros afectados atrofia selectiva del redondo menor. Conclusión: El QSS en sus formas incompletas suele ser subdiagnosticado, siendo necesario mantener un alto índice de sospecha clínica frente a un cuadro de omalgia inespecífica. Palabras Claves: espacio cuadrilátero, omalgia, electromiografía, redondo menor, nervio axilar. Introduction: The quadrilateral space syndrome (QSS) has clinical features caused by a nervous and /or vascular compression at the lateral axillary space. The prevalence of this syndrome is unknown but it is believed to be low. Nevertheless, some cases with an incomplete clinical presentation might be misdiagnosed. Purpose: To describe a diagnostic protocol used in a series of consecutive cases of patients with non-specific omalgia and suspected QSS. Materials and Methods: Ten patients of both genders suffering shoulder pain aggravated by forced external rotation were prospectively evaluated. One of them had bilateral symptoms. Evaluation included clinical examination, electromyography (EMG) and nerve conduction studies of the deltoid and teres minor bilaterally. The results were compared with an age-matched control group. Diagnosis was confirmed by magnetic resonance imaging (MRI). Results: The EMG showed in all the cases a selective entrapment of the branch for the teres minor, with preservation of the innervation of the deltoid. The RMN showed in the 11 affected shoulders selective atrophy of the teres minor. Conclusion: Incomplete presentations of the QSS are usually underdiagnosed, making it necessary to maintain a high index of clinical suspicion in front of any non-specific omalgia case. Key words: quadrilateral space, omalgia, electromyography, teres minor, axillary nerve.

Download Full-text

Optimal Cut-Off Value of the Superior Articular Process Area as a Morphological Parameter to Predict Lumbar Foraminal Stenosis

Pain Research and Management ◽

10.1155/2017/7914836 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Tae-Ha Lim ◽

Soo Il Choi ◽

Hyung Rae Cho ◽

Keum Nae Kang ◽

Chang Joon Rhyu ◽

...

Keyword(s):

Facet Joint ◽

Control Group ◽

Foraminal Stenosis ◽

Morphological Parameter ◽

Resonance Imaging ◽

Cross Sectional ◽

Lumbar Foraminal Stenosis ◽

Articular Process ◽

Magnetic Resonance Imaging Mri ◽

Bone Margin

Background. We devised a new morphological parameter called the superior articular process area (SAPA) to evaluate the connection between lumbar foraminal stenosis (LFS) and the superior articular process. Objective. We hypothesized that the SAPA is an important morphologic parameter in the diagnosis of LFS. Methods. All patients over 60 years of age were included. Data regarding the SAPA were collected from 137 patients with LFS. A total of 167 control subjects underwent lumbar magnetic resonance imaging (MRI) as part of a routine medical examination. We analyzed the cross-sectional area of the bone margin of the superior articular process at the level of L4-L5 facet joint in the axial plane. Results. The average SAPA was 96.3±13.6 mm2 in the control group and 128.1±17.2 mm2 in the LFS group. The LFS group was found to have significantly higher levels of SAPA (p<0.001) in comparison to the control group. In the LFS group, the optimal cut-off value was 112.1 mm2, with 84.4% sensitivity, 83.9% specificity, and AUC of 0.94 (95% CI: 0.91–0.96). Conclusions. Higher SAPA values were associated with a higher possibility of LFS. These results are important in the evaluation of patients with LFS.

Download Full-text

Support Vector Machine-Based Backprojection Algorithm for Detection of Gastric Cancer Lesions with Abdominal Endoscope Using Magnetic Resonance Imaging Images

Scientific Programming ◽

10.1155/2021/9964203 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Huajia Dai ◽

Yuhao Bian ◽

Libin Wang ◽

Junfeng Yang

Keyword(s):

Magnetic Resonance Imaging ◽

Gastric Cancer ◽

Support Vector Machine ◽

Magnetic Resonance ◽

Hospital Stay ◽

Radical Resection ◽

Support Vector ◽

Control Group ◽

Resonance Imaging ◽

Experimental Group

This study was to analyze the diagnostic value of magnetic resonance imaging (MRI) for gastric cancer (GC) lesions and the treatment effect of complete laparoscopic radical resection (CLSRR). A malignant tumor recognition algorithm was constructed in this study based on the backprojection (BP) and support vector machine (SVM), which was named BPS. 78 GC patients were divided into an experimental group (received CLSRR) and a control group (received assisted laparoscopic radical resection (ALSRR)), with 39 cases in each group. It was found that the BPS algorithm showed lower relative mean square error (MSE) in axle x (OMSE, x) and axle y (OMSE, x), but the classification accuracy (CA) was the opposite ( P < 0.05 ). The postoperative hospital stay, analgesia duration, first exhaust time (FET), and first off-bed activity time (FOBA) for patients in the experimental group were less ( P < 0.05 ). The operation time of the experimental group (270.56 ± 90.55 min) was significantly longer than that of the control group (228.07 ± 75.26 min) ( P < 0.05 ). There were 3 cases of anastomotic fistula, 1 case of acute peritonitis, and 2 cases of lung infections in the experimental group, which were greatly less than those in the control group (7 cases, 4 cases, and 3 cases) ( P < 0.05 ). In short, the BPS algorithm was superior in processing MRI images and could improve the diagnostic effect of MRI images. The CLSRR could reduce the length of hospital stay and the probability of complications in GC patients, so it could be used as a surgical plan for the clinical treatment of advanced GC.

Download Full-text

A Study of Epileptic Psychosis Using Magnetic Resonance Imaging

The British Journal of Psychiatry ◽

10.1192/bjp.156.2.231 ◽

1990 ◽

Vol 156 (2) ◽

pp. 231-235 ◽

Cited By ~ 25

Author(s):

P. Conlon ◽

M. R. Trimble ◽

D. Rogers

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Temporal Lobe ◽

Relaxation Times ◽

Control Group ◽

Resonance Imaging ◽

Left Temporal Lobe ◽

Magnetic Resonance Imaging Mri ◽

Patients With Epilepsy ◽

State Examination

Magnetic resonance imaging (MRI) was used in patients with epilepsy and psychosis. From 50 patients with epilepsy, a subgroup of 12 patients were categorised by the Present State Examination (PSE) as having nuclear schizophrenia (NS) and then compared with an epileptic control group with no psychiatric history. Further, patients with hallucinations were compared with patients without hallucinations. No differences in T1 relaxation times in any regions of interest were noted in the NS group compared with the other group. However, patients with hallucinations had a significantly higher T1 value in the left temporal lobe. These findings support the concept that specific abnormalities in limbic system structures relate to the phenomenology of the psychoses of epilepsy, especially left temporal lobe epilepsy.

Download Full-text

Posterior Ankle and Hind Foot Arthroscopy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00206 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0020

Author(s):

Kemal Gökkuş ◽

Ahmet Turan Aydın

Keyword(s):

Flexor Hallucis Longus ◽

Fat Pad ◽

Aofas Score ◽

Os Trigonum ◽

Haglund’S Deformity ◽

Hind Foot ◽

The Mean ◽

Neurovascular Structures ◽

Posterior Talofibular Ligament

Objectives: While anterior ankle arthroscopy is a widely accepted technique, posterior ankle/hind foot arthroscopy is still a relatively new procedure. The arthroscopic visualisation was often initially limited and vulnerabilty of the posteromedial neurovascular structures to injury scared orthopaedic surgeons. The goal of this review is to highlight the indications, and to present the long term follow up results of posterior ankle/hind foot arthroscopy. Methods: The study included 21 ankles in 21 patients (12 male and 9 female ).The mean age was 37.7 , the mean duration of preoperative symptoms 12.8 months . Arthroscopy performed with the patient prone , under general and spinal anesthesia with tourniquet hemostasis . Preoperative intravenous antibiotic prophylaxis is performed (cefazolin 1g) , sand bag placed under ipsilateral anteresuperior iliac spine to correct natural external rotated posture of the ankle and ankle is left hanging of the table so that it can moved freely during surgery. We applied noninvasive distraction method with simple rope which tied and knotted waist of the surgeon . The posterolateral and posteromedial portals which described by Van Dijk was utilized . The arthroscopic visualisation was often initially limited and careful debritement of some adipose tissue of the kager fat pad (Kager's fat pad, also known as the pre-Achilles fat pad) was necessary to create more space to aid visualization .The most valuable point to stay clear from trouble is to understand , know and aware where the flexor hallucis longus tendon exist .So neurovascular structures located beyond this tendon. Principally the process must advance into lateral to medial manner. The mean follow up period was 55 months. The most common preoperative diagnoses were osteochondral lesions of talus (ten ),painful os trigonum syndrome with (five )or without (three) FHL tenosynovitis (total eight ), posterior talofibular ligament thickenning (two ), Haglund’s deformity (one ) Results: The mean pre operative AOFAS score was 50.75, the mean post operative AOFAS score was 93.75. Complications were noted. Complex regional pain syndrome (CRPS) and oedema was diagnosed during early post operative period in one patient (%4.7), resolved with physical therapy. Conclusion: The most common procedures were osteochondral lesion debritement and curettage with multidrilling /microfracture (10), isolated os trigonum excision (2), tenolysis of the flexor hallucis longus tendon with os trigonum excision (6 ), debritment of the thickened posterior talofibular ligament (2), endoscopic partial calcanectomy for Haglund’s deformity (1) . Our experience demostrated that posterior ankle and hind foot arthroscopy can be performed with low rate of major postoperative complication.

Download Full-text

Magnetic Resonance Imaging Features under Deep Learning Algorithms in Evaluated Cerebral Protection of Craniotomy Evacuation of Hematoma under Propofol Anesthesia

Contrast Media & Molecular Imaging ◽

10.1155/2021/2209527 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Deqian Xin ◽

Zhongzhe An ◽

Juan Ding ◽

Zhi Li ◽

Leyan Qiao

Keyword(s):

Magnetic Resonance Imaging ◽

Deep Learning ◽

Magnetic Resonance ◽

Diffusion Tensor ◽

Super Resolution ◽

Control Group ◽

Imaging Features ◽

Resonance Imaging ◽

Resolution Algorithm ◽

Experimental Group

This study aimed to explore the value of magnetic resonance imaging (MRI) features based on deep learning super-resolution algorithms in evaluating the value of propofol anesthesia for brain protection of patients undergoing craniotomy evacuation of the hematoma. An optimized super-resolution algorithm was obtained through the multiscale network reconstruction model based on the traditional algorithm. A total of 100 patients undergoing craniotomy evacuation of hematoma were recruited and rolled into sevoflurane control group and propofol experimental group. Both were evaluated using diffusion tensor imaging (DTI) images based on deep learning super-resolution algorithms. The results showed that the fractional anisotropic image (FA) value of the hind limb corticospinal tract of the affected side of the internal capsule of the experimental group after the operation was 0.67 ± 0.28. The National Institute of Health Stroke Scale (NIHSS) score was 6.14 ± 3.29. The oxygen saturation in jugular venous (SjvO2) at T4 and T5 was 61.93 ± 6.58% and 59.38 ± 6.2%, respectively, and cerebral oxygen uptake rate (CO2ER) was 31.12 ± 6.07% and 35.83 ± 7.91%, respectively. The difference in jugular venous oxygen (Da-jvO2) at T3, T4, and T5 was 63.28 ± 10.15 mL/dL, 64.89 ± 13.11 mL/dL, and 66.03 ± 11.78 mL/dL, respectively. The neuron-specific enolase (NSE) and central-nerve-specific protein (S100β) levels at T5 were 53.85 ± 12.31 ng/mL and 7.49 ± 3.16 ng/mL, respectively. In terms of the number of postoperative complications, the patients in the experimental group were better than the control group under sevoflurane anesthesia, and the differences were substantial ( P < 0.05). In conclusion, MRI images based on deep learning super-resolution algorithm have great clinical value in evaluating the degree of brain injury in patients anesthetized with propofol and the protective effect of propofol on brain nerves.

Download Full-text

Evaluating the Endometrial Hyperechoic Zone in Early Postpartum Women May Be Deceptive When Utilizing Transcutaneous Sonography

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479318769029 ◽

2018 ◽

Vol 34 (3) ◽

pp. 182-188

Author(s):

Size Wu ◽

Xian Liang ◽

Xiaojing Cui ◽

Dongsheng Zuo ◽

Lian Hong ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Endometrial Thickness ◽

Uterine Cavity ◽

Control Group ◽

Postpartum Women ◽

Resonance Imaging ◽

Early Postpartum ◽

Significant Difference ◽

Normal Menstrual Cycle ◽

Magnetic Resonance Imaging Mri

The objective of this study was to investigate the concordance of measurements for early postpartum endometrial thickness between magnetic resonance imaging (MRI) and transcutaneous diagnostic medical sonography (DMS) as well as its implications. The measurements of early postpartum endometrial thickness were reviewed across 51 postpartum women who underwent MRI and transcutaneous DMS. Additionally, 30 women with a normal menstrual cycle formed a control group, and their data were compared. The results indicated that the endometrial thickness at early postpartum was 4.63 ± 0.62 mm on MRI and 8.18 ± 4.70 mm on DMS, with a comparative significant difference ( P < .001). The endometrial thickness of the control group was 10.02 ± 1.71 mm on MRI and 10.17 ± 1.81 mm on DMS with no comparative significant difference ( P = .124). This cohort study questions whether the hyperechoic zone in the early postpartum uterine cavity represents the actual endometrial thickness. Care should be taken by sonographers in labeling the hyperechoic zone in the early postpartum stage as endometrium.

Download Full-text

Association between Brachycephaly, Chiari Malformation, and Basilar Invagination

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1739503 ◽

2021 ◽

Author(s):

Ricardo Vieira Botelho ◽

Pedro Bittencourt Botelho ◽

Bruna Hernandez ◽

Mauricio Bezerra Sales ◽

José Marcus Rotta

Keyword(s):

Posterior Fossa ◽

Chiari Malformation ◽

Normal Subjects ◽

Craniovertebral Junction ◽

Basilar Invagination ◽

Control Group ◽

Cephalic Index ◽

Resonance Imaging ◽

Coronal Synostosis ◽

Magnetic Resonance Imaging Mri

Abstract Background There is evidence that Chiari malformation (CM) and basilar invagination (BI) are largely due to disproportion between the content and volume of the posterior fossa. A recent study identified an increased association between brachycephaly and BI. In several types of craniosynostosis, the posterior fossa volume is smaller than normal, and this is more pronounced in coronal synostosis. The aim of this study is to evaluate the association between CM and BI. Methods The cephalic index (CI) measured on magnetic resonance imaging (MRI) from a sample of patients with craniocervical malformation was compared with that of normal subjects. Results The average CI in the craniovertebral junction malformation (CVJM) group was significantly higher in BI patients than in normal subjects. The BI patients also had the highest CI among the whole sample of patients (p = 0.009). Conclusions In this study, BI patients had the highest CI among patients with CVJM and a significantly higher CI than those in the control group. Our data confirm the association between BI and brachycephaly.

Download Full-text