Epiphyseal bone-marrow abnormalities and restitution in legg-calvé-perthes disease

1997 ◽  
Vol 38 (5) ◽  
pp. 855-862 ◽  
Author(s):  
P. Hochbergs ◽  
G. Eckervall ◽  
H. Wingstrand ◽  
N. Egund ◽  
K. Jonsson
Keyword(s):  
Bone Marrow ◽  
Mr Imaging ◽  
Perthes Disease ◽  
Mr Images ◽  
Group I ◽  
Radiological Classification ◽  
Signal Changes ◽  
Over Time ◽  
Epiphyseal Bone

Purpose: By means of MR imaging, to determine signal abnormalities in the femoral epiphysis; to determine their location, extent and restitution over time; and to correlate these findings to the Catterall radiological classification. Material and Methods: A total of 247 MR images in 86 patients (101 hips) with Legg-CalvC-Perthes disease were examined. The MR images were taken in the coronal plane, and the images through the center of the femoral head were used for this study. Results: T1-weighted images proved as good as T2-weighted images for the MR evaluation of the extent of the necrosis. In almost every case, the central-cranial part of the epiphysis showed a low initial signal. In Catterall group I, the medial part was never involved. In Catterall III and IV, almost the entire epiphysis showed signal changes. In the period 3–6 years after diagnosis, we still found signal changes in the epiphysis in some hips but there was no correlation with the Catterall classification. After 6 years, the epiphysis showed normal signal intensity in MR imaging. In T1-weighted images, Gd-enhancement occurred in the peripheral regions in the early stages of the disease. The central part of the epiphysis became more enhanced over time and peaked in the period 1–3 years after diagnosis. Conclusion: MR is a valuable modality for monitoring changes in the femoral epiphysis. We propose a new classification of the extent and pattern of epiphyseal bone-marrow abnormalities based on the 4 zones most commonly observed in MR imaging.

Synovitis in legg-calvé-perthes disease

1998 ◽  
Vol 39 (5) ◽  
pp. 532-537 ◽  
Author(s):  
P. Hochbergs ◽  
G. Eckerwall ◽  
N. Egund ◽  
K. Jonsson ◽  
H. Wingstrand
Keyword(s):  
Clinical Outcome ◽  
Mr Imaging ◽  
Hip Joint ◽  
Group Iv ◽  
Perthes Disease ◽  
Mr Images ◽  
Poor Clinical Outcome ◽  
Lateral Pillar ◽  
Group I ◽  
Signal Changes

Purpose: to evaluate, by means of MR imaging, the degree and persistence of synovitis in the hip joint in Legg-Calvé-Perthes disease and to correlate the degree of synovitis with the degree of epiphyseal necrosis Material and Methods: A total of 170 MR images in 72 patients (84 hips) were examined. the T2-weighted MR images were taken in the coronal plane in order to evaluate the degree of synovitis in the hip joint Results: MR revealed synovitis in all cases in the early phase of the disease. in Catterall group II, synovitis was discreet to moderate for up to 6 months after diagnosis. Hips with more severe necrosis, Catterall groups III and IV, had moderate or intense degrees of synovitis. There was a correlation between the degree of synovitis and the lateral pillar classification according to HERRING et al. Also, there was a good correlation between the extent of signal changes in the epiphysis on MR imaging and the degree of synovitis. There was no difference when signal changes were evaluated on T1- or T2-weighted images. Signs of synovitis could be seen for up to 30 months after diagnosis in Catterall group I hips, and in Catterall groups II and III for up to 36 months, and in 2 cases even longer. Some Catterall group IV hips had discreet or mild synovitis for 60 months or more, after diagnosis Conclusion: the degree of synovitis on MR imaging correlates to the extent of epiphyseal necrosis seen on radiographs or MR imaging as well as to the lateral pillar classification, i.e. to a poor clinical outcome. in Catterall group IV hips, synovitis can even persist for up to 60 months after diagnosis

Resection of insular gliomas: the importance of lenticulostriate artery position

2008 ◽  
Vol 109 (5) ◽  
pp. 825-834 ◽  
Author(s):  
Yaron A. Moshel ◽  
Joshua D.S. Marcus ◽  
Erik C. Parker ◽  
Patrick J. Kelly
Keyword(s):  
Mr Imaging ◽  
Surgical Techniques ◽  
Brain Parenchyma ◽  
Growth Patterns ◽  
Normal Brain ◽  
Imaging Features ◽  
Mr Images ◽  
Presenting Symptoms ◽  
Group I ◽  
Neurological Morbidity

Object The object of this study was to identify characteristic preoperative angiographic and MR imaging features of safely resectable insular gliomas and describe the surgical techniques and postoperative clinical outcomes. Methods Thirty-eight patients with insular gliomas underwent transsylvian resection between 1995 and 2007. Patient demographics, presenting symptoms, pathological findings, and neurological outcomes were retrospectively reviewed. Preoperative MR imaging–defined tumor volumes were superimposed onto the preoperative stereotactic cerebral angiograms to determine whether the insular tumor was confined lateral to (Group I) or extended medially around (Group II) the lenticulostriate arteries (LSAs). Results Twenty-five patients (66%) had tumors situated lateral to the LSAs and 13 (34%) had tumors encasing the LSAs. Insular gliomas situated lateral to the LSAs led to significant medial displacement of these vessels (161 ± 39%). In 20 (80%) of these 25 cases the boundaries between tumor and brain parenchyma were well demarcated on preoperative T2-weighted MR images. In contrast, there was less displacement of the LSAs (130 ± 14%) in patients with insular gliomas extending around the LSAs on angiography. In 11 (85%) of these 13 cases, the tumor boundaries were diffuse on T2-weighted MR images. Postoperative hemiparesis or worsening of a preexisting hemiparesis, secondary to LSA compromise, occurred in 5 patients, all of whom had tumor volumes that extended medial to the LSAs. Gross-total or near-total resection was achieved more frequently in cases in which the insular glioma remained lateral to the LSAs (84 vs 54%). Conclusions Insular gliomas with an MR imaging–defined tumor volume located lateral to the LSAs on stereotactic angiography displace the LSAs medially by expanding the insula, have well-demarcated tumor boundaries on MR images, and can be completely resected with minimal neurological morbidity. In contrast, insular tumors that appear to surround the LSAs do not displace these vessels medially, are poorly demarcated from normal brain parenchyma on MR images, and are associated with higher rates of neurological morbidity if aggressive resection is pursued. Preoperative identification of these anatomical growth patterns can be of value in planning resection.

Prognostic relevance of the postoperative evolution of intramedullary spinal cord changes in signal intensity on magnetic resonance imaging after anterior decompression for cervical spondylotic myelopathy

2007 ◽  
Vol 7 (6) ◽  
pp. 615-622 ◽  
Author(s):  
Luciano Mastronardi ◽  
Ahmed Elsawaf ◽  
Raffaelino Roperto ◽  
Alessandro Bozzao ◽  
Manuela Caroli ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Signal Intensity ◽  
Cervical Spondylotic Myelopathy ◽  
Mr Images ◽  
Intramedullary Spinal Cord ◽  
Signal Changes ◽  
T1 And T2 ◽  
T2 Weighted Images

Object Areas of intramedullary signal intensity changes (hypointensity on T1-weighted magnetic resonance [MR] images and hyperintensity on T2-weighted MR images) in patients with cervical spondylotic myelopathy (CSM) have been described by several investigators. The role of postoperative evolution of these alterations is still not well known. Methods A total of 47 patients underwent MR imaging before and at the end of the surgical procedure (intraoperative MR imaging [iMRI]) for cervical spine decompression and fusion using an anterior approach. Imaging was performed with a 1.5-tesla scanner integrated with the operative room (BrainSuite). Patients were followed clinically and evaluated using the Japanese Orthopaedic Association (JOA) and Nurick scales and also underwent MR imaging 3 and 6 months after surgery. Results Preoperative MR imaging showed an alteration (from the normal) of the intramedullary signal in 37 (78.7%) of 47 cases. In 23 cases, signal changes were altered on both T1- and T2-weighted images, and in 14 cases only on T2-weighted images. In 12 (52.2%) of the 23 cases, regression of hyperintensity on T2-weighted imaging was observed postoperatively. In 4 (17.4%) of these 23 cases, regression of hyperintensity was observed during the iMRI at the end of surgery. Residual compression on postoperative iMRI was not detected in any patients. A nonsignificant correlation was observed between postoperative expansion of the transverse diameter of the spinal cord at the level of maximal compression and the postoperative JOA score and Nurick grade. A statistically significant correlation was observed between the surgical result and the length of a patient's clinical history. A significant correlation was also observed according to the preoperative presence of intramedullary signal alteration. The best results were found in patients without spinal cord changes of signal, acceptable results were observed in the presence of changes on T2-weighted imaging only, and the worst results were observed in patients with spinal cord signal changes on both T1- and T2-weighted imaging. Finally, a statistically significant correlation was observed between patients with postoperative spinal cord signal change regression and better outcomes. Conclusions Intramedullary spinal cord changes in signal intensity in patients with CSM can be reversible (hyperintensity on T2-weighted imaging) or nonreversible (hypointensity on T1-weighted imaging). The regression of areas of hyperintensity on T2-weighted imaging is associated with a better prognosis, whereas the T1-weighted hypointensity is an expression of irreversible damage and, therefore, the worst prognosis. The preliminary experience with this patient series appears to exclude a relationship between the time of signal intensity recovery and outcome of CSM.

Mr Evaluation of Mediopatellar Plica

1996 ◽  
Vol 37 (3P2) ◽  
pp. 567-571 ◽  
Author(s):  
K. Nakanishi ◽  
M. Inoue ◽  
T. Ishida ◽  
T. Murakami ◽  
K. Tsuda ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Pulse Sequences ◽  
Screening Method ◽  
Flip Angle ◽  
Knee Joints ◽  
Mr Images ◽  
Medial Condyle ◽  
Low Intensity ◽  
Arthroscopic Findings

Purpose: Evaluation of the usefulness of MR imaging for diagnosing mediopatellar plica (MP) of the knee joint. Material and Methods: We prospectively examined MR images of 40 knee joints in 30 patients with symptoms. The pulse sequences were SE T1-weighted images (600/26 ms), T2-weighted images (1800/70), and FLASH images (320/15/flip angle 90°). When a low-intensity band was found above the medial condyle of the femur on T1-weighted and T2-weighted MR images, we defined it as MP. We compared these MR findings with arthroscopic findings, including the Sakakibara classification of MP. Results: In 29 of the 40 knee joints in which MP was arthroscopically found, 27 were correctly diagnosed as having MP on MR. In the remaining 11 without MP, 9 were correctly diagnosed by MR. Conclusion: MR images are useful not only for detecting MP but also for evaluating its extension. Our results suggest that MR imaging is useful as a screening method for detecting MP before arthroscopy.

Discovertebral Junction of the Spine — A Cadaveric Study by Spin-Echo MR Imaging

1995 ◽  
Vol 36 (1) ◽  
pp. 1-8
Author(s):  
Y. Kakitsubata ◽  
K. Nabeshima ◽  
S. Kakitsubata ◽  
M. Koono ◽  
K. Watanabe
Keyword(s):  
Bone Marrow ◽  
Mr Imaging ◽  
Signal Intensity ◽  
Spin Echo ◽  
Surface Coil ◽  
Proton Density ◽  
Mr Images ◽  
Small Surface ◽  
Intermediate Signal Intensity ◽  
Head Coil

To evaluate the MR appearance of the discovertebral junction (DVJ) of the spine, we examined 161 DVJs in 27 cadaveric spines using superconductive MR imaging. T1-, proton density-, and T2-weighted spin-echo imaging were used. With a small surface coil, higher resolution and more sharply defined contours of the DVJ were obtained than when using a head coil. Cortical bone had very low signal intensity in all sequences. Cartilaginous end-plate (CP) was of low to intermediate signal intensity on T1-weighted images, and of low signal intensity on proton density- and T2-weighted images. MR images were able to reveal the gross CP appearances, Schmorl's nodules, and adjacent bone marrow pathology. We conclude that MR imaging is valuable for assessing abnormalities of the DVJ.

Epiphyseal bone-marrow abnormalities and restitution in legg-calve-perthes disease

1997 ◽  
Vol 38 (5) ◽  
pp. 855-862 ◽  
Author(s):  
Peter Hochbergs ◽  
G. Eckervall ◽  
H. Wingstrand ◽  
N. Egund ◽  
K. Jonsson
Keyword(s):  
Bone Marrow ◽  
Perthes Disease ◽  
Epiphyseal Bone

The Negative Impact of Biological Variation in the Effect and Clearance of Warfarin on Methods for Prediction of Dose Requirements

1986 ◽  
Vol 56 (03) ◽  
pp. 371-375 ◽  
Author(s):  
Peretz Weiss ◽  
Hillel Halkin ◽  
Shlomo Almog
Keyword(s):  
Individual Variation ◽  
Negative Impact ◽  
Warfarin Dose ◽  
Empirical Therapy ◽  
Maintenance Phase ◽  
Individual Variability ◽  
Dose Prediction ◽  
Group I ◽  
Over Time ◽  
Variance Explained

SummaryWithin-individual variation over time in the clearance (Cl) and effect (PT%) of warfarin, was measured in 25 inpatients (group I) studied after standard single or individualized split loading doses and 1-3 times (n = 16) 8-16 weeks later during maintenance. Mean Cl (2.5 α 0.9 ml/min) was similar in both phases but significant changes occurred in 6/16 patients, exceeding those expected from within-individual variation alone (defined by its 95% tolerance limits -24% to +62%). Initial PT% (21 α 5) was unaffected by dosing schedule, total or free plasma warfarin, varying between patients by only 18-24%. Mean initial and maintenance dose-PT% ratios (8.2 mg/d: 21% and 4.1 mg/d: 40%) were similar but significant changes in sensitivity to warfarin occurred in 4/16 patients. In group I and 64 other outpatients on maintenance therapy, between-individual variability was 36-52% for Cl and 49-56% for effect. PT% correlated best (r = 0.56) with free and total plasma warfarin but poorly with dose (r = 0.29), with only 30% of PT% variance explained at best, due to high between patient variability.Warfarin dose prediction whether based on extrapolation from initial effects to the maintenance phase, or on iterative methods not allowing for between- or within-patient variation in warfarin clearance or effect which may occur independently over time, have not improved on empirical therapy. This, due to the elements of biological variability as well as the intricacy of the warfarin - prothrombin complex interaction not captured by any kinetic-dynamic model used for prediction to date.

scholarly journals Vertebral Bone Marrow and Endplate Assessment on MR Imaging for the Differentiation of Modic Type 1 Endplate Changes and Infectious Spondylodiscitis

2020 ◽  
Vol 9 (3) ◽  
pp. 826 ◽  
Author(s):  
Ursula Schwarz-Nemec ◽  
Klaus M. Friedrich ◽  
Christoph Stihsen ◽  
Felix K. Schwarz ◽  
Siegfried Trattnig ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Mr Imaging ◽  
Diagnostic Accuracy ◽  
Characteristic Analysis ◽  
Vertebral Bone ◽  
Endplate Changes ◽  
Modic Type ◽  
Infectious Spondylodiscitis ◽  
Vertebral Bone Marrow

On magnetic resonance (MR) imaging, Modic type 1 (MT1) endplate changes and infectious spondylodiscitis share similar findings. Therefore, this study investigated vertebral bone marrow and endplate changes to enable their differentiation. The lumbar spine MR examinations of 91 adult patients were retrospectively included: 39 with MT1; 19 with early spondylodiscitis without abscess; and 33 with advanced spondylodiscitis with abscess. The assessment included percentage of bone marrow edema on sagittal short tau inversion recovery images, and the signal ratio of edema to unaffected bone and endplate contour (normal; irregular, yet intact; blurred; destructive) on sagittal unenhanced T1-weighted images. Differences were tested for statistical significance by Chi-square test and mixed model analysis of variance. The MR diagnostic accuracy in differentiating MT1 and spondylodiscitis was assessed by cross-tabulation and receiver-operating characteristic analysis. The endplate contours, edema extents, and T1-signal ratios of MT1 (extent, 31.96%; ratio, 0.83) were significantly different (p < 0.001) from early spondylodiscitis (56.42%; 0.60), and advanced spondylodiscitis (91.84%; 0.61). The highest diagnostic accuracy (sensitivity, 94.87%; specificity, 94.23%; accuracy, 94.51%) in identifying MT1 was provided by an irregular, yet intact endplate contour. This may be a useful MR feature for the differentiation between MT1 and spondylodiscitis, particularly in its early stage.

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