Novel Semiquantitative Bone Marrow Oedema Score and Fracture Score for the Magnetic Resonance Imaging Assessment of the Active Charcot Foot in Diabetes

There are no accepted methods to grade bone marrow oedema (BMO) and fracture on magnetic resonance imaging (MRI) scans in Charcot osteoarthropathy. The aim was to devise semiquantitative BMO and fracture scores on foot and ankle MRI scans in diabetic patients with active osteoarthropathy and to assess the agreement in using these scores. Three radiologists assessed 45 scans (Siemens Avanto 1.5T, dedicated foot and ankle coil) and scored independently twenty-two bones (proximal phalanges, medial and lateral sesamoids, metatarsals, tarsals, distal tibial plafond, and medial and lateral malleoli) for BMO (0—no oedema, 1—oedema < 50% of bone volume, and 2—oedema > 50% of bone volume) and fracture (0—no fracture, 1—fracture, and 2—collapse/fragmentation). Interobserver agreement and intraobserver agreement were measured using multilevel modelling and intraclass correlation (ICC). The interobserver agreement for the total BMO and fracture scores was very good (ICC = 0.83, 95% confidence intervals (CI) 0.76, 0.91) and good (ICC = 0.62; 95% CI 0.48, 0.76), respectively. The intraobserver agreement for the total BMO and fracture scores was good (ICC = 0.78, 95% CI 0.6, 0.95) and fair to moderate (ICC = 0.44; 95% CI 0.14, 0.74), respectively. The proposed BMO and fracture scores are reliable and can be used to grade the extent of bone damage in the active Charcot foot.

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Relationship Between the Size of Bone Marrow Edema of the Talus and Ankle Pain

Journal of the American Podiatric Medical Association ◽

10.7547/1010430 ◽

2011 ◽

Vol 101 (5) ◽

pp. 430-436 ◽

Cited By ~ 6

Author(s):

Murat Tonbul ◽

Aliye Yildirim Guzelant ◽

Aysun Gonen ◽

Emre Baca ◽

Mehmet U. Ozbaydar

Keyword(s):

Magnetic Resonance Imaging ◽

Bone Marrow ◽

Magnetic Resonance ◽

Bone Marrow Edema ◽

Rating Scale ◽

Foot And Ankle ◽

Resonance Imaging ◽

Mri Scans ◽

American Orthopaedic ◽

Marrow Edema

Background: We sought to determine the changes in the size of the edema observed on MRI scans and its relation to the patient’s pain during activity and pain during rest in bone marrow edema. Methods: A total of 26 patients were followed up at 3-month intervals for a period of 1 year. During the follow-ups, magnetic resonance imaging scans of the patients’ ankles were obtained; the scores obtained on the American Orthopaedic Foot and Ankle Society functional rating scale and visual analog scale were determined. The changes in these parameters and the correlation between them were examined. Results: The size of the edema as observed on magnetic resonance imaging scans decreased, and the pain during activity and rest decreased. Although there is a correlation between the decrease in the edema size observed on magnetic resonance imaging scans and decrease in the pain during activity, there is no correlation between the decrease in the edema size observed on magnetic resonance imaging scans and the decrease in pain during rest. Conclusions: Patients can be informed more precisely, that the pain during rest and activity may not decrease after the third and sixth month, respectively. Magnetic resonance imaging may not alter after the ninth month, so it may not be necessary to be performed again. (J Am Podiatr Med Assoc 101(5): 430–436, 2011)

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Interobserver Agreement in Diagnosing Early-Stage Kienböck Disease on Radiographs and Magnetic Resonance Imaging

Hand ◽

10.1177/1558944716677538 ◽

2016 ◽

Vol 12 (6) ◽

pp. 573-578 ◽

Cited By ~ 3

Author(s):

Wouter F. van Leeuwen ◽

Stein J. Janssen ◽

Thierry G. Guitton ◽

Neal Chen ◽

David Ring

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Interobserver Agreement ◽

Early Stage ◽

Imaging Modality ◽

Ulnar Variance ◽

Categorical Variables ◽

Resonance Imaging ◽

Mri Scans ◽

Kienböck Disease

Background: The appearance of early Kienböck disease on radiographs and magnetic resonance imaging (MRI) may be difficult to distinguish from other conditions that affect the lunate. We aimed to assess the interobserver agreement in the diagnosis of early Kienböck disease when evaluated on different imaging modalities. Methods: Forty-three hand surgeon members of the Science of Variation Group were randomized to evaluate radiographs and 35 hand surgeons to evaluate radiographs and MRI scans of 26 patients for the presence of Kienböck disease, the lunate type, and the ulnar variance. We used Fleiss’ kappa analysis to assess the interobserver agreement for categorical variables and compared the κ values between the 2 groups. Results: We found that agreement on the diagnosis of early Kienböck disease was fair (κ, 0.36) among observers who evaluated radiographs alone and moderate (κ, 0.58) among observers who evaluated MRI scans in addition to radiographs, and that the difference in κ values was not statistically significant ( P = .057). Agreement did not differ between observers based on imaging modality with regard to the assessment of the lunate type ( P = .75) and ulnar variance ( P = .15). Conclusions: We found, with the numbers evaluated, a notable but nonsignificant difference in agreement in favor of observers who evaluated MRI scans in addition to radiographs compared with radiographs alone. Surgeons should be aware that the diagnosis of Kienböck disease in the precollapse stages is not well defined, as evidenced by the substantial interobserver variability.

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Magnetic resonance imaging scans are not a reliable tool for predicting symptomatic acromioclavicular arthritis

Shoulder & Elbow ◽

10.1177/1758573217724080 ◽

2017 ◽

Vol 10 (4) ◽

pp. 250-254 ◽

Cited By ~ 5

Author(s):

Bijayendra Singh ◽

Abhinav Gulihar ◽

Praveen Bilagi ◽

Arpit Goyal ◽

Pallavi Goyal ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Bone Marrow ◽

Magnetic Resonance ◽

Clinical Symptoms ◽

Bone Marrow Oedema ◽

Control Group ◽

Resonance Imaging ◽

Level Of Evidence ◽

Asymptomatic Group ◽

Mri Scans

Background We investigated whether magnetic resonance imaging (MRI) scans can accurately diagnose arthritis of the acromioclavicular joint (ACJ) because it has recently been suggested that bone marrow oedema on MRI scans is a predictive sign of symptomatic ACJ arthritis. Methods The MRI scans of 43 patients (50 shoulders) who underwent ACJ excision for clinically symptomatic ACJ arthritis were compared to a control group of 43 age- and sex-matched patients (48 shoulders) who underwent an MRI scan for investigation of shoulder pain but did not have clinical symptoms or signs of ACJ arthritis. The scans were evaluated by an experienced musculoskeletal radiologist, who was blinded to the examination findings. Results Bone marrow oedema was present in only 15 (30%) shoulders in the ACJ excision group, although this was higher than the six shoulders in the asymptomatic group ( p = 0.03). Forty-one (82%) shoulders in the symptomatic group had grade III/IV ACJ arthritis compared to 31 (65%) in the asymptomatic group ( p = 0.05). However, 44 out of 48 (92%) shoulders in the asymptomatic group had signs of osteoarthritis on MRI scans. Conclusions In contrast to recent reports, the present study shows that MRI is not helpful in making the diagnosis of ACJ arthritis. A focused history and clinical examination should remain the mainstay for surgical decision making. Level of evidence Level 3

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Timing of magnetic resonance imaging affects the accuracy and interobserver agreement of anterolateral ligament tears detection in anterior cruciate ligament deficient knees

Knee Surgery and Related Research ◽

10.1186/s43019-020-00082-z ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Audrey Xinyun Han ◽

Tien Jin Tan ◽

Tiep Nguyen ◽

Dave Yee Han Lee

Keyword(s):

Magnetic Resonance Imaging ◽

Anterior Cruciate Ligament ◽

Magnetic Resonance ◽

Predictive Value ◽

Interobserver Agreement ◽

Cruciate Ligament ◽

Anterolateral Ligament ◽

Resonance Imaging ◽

Mri Scans ◽

Anterior Cruciate

Abstract Purpose We aimed to identify the anterolateral ligament (ALL) tears in anterior cruciate ligament (ACL)-deficient knees using standard 1.5-Tesla magnetic resonance imaging (MRI). Methods We included all patients who underwent primary ACL reconstruction at our center between 2012 and 2015. Exclusion criteria included patients with multiple ligament injuries, lateral collateral ligament, posterolateral corner, and infections, and patients who underwent MRI more than 2 months after their injury. All patients (n = 148) had ACL tears that were subsequently arthroscopically reconstructed. The magnetic resonance (MR) images of the injured knees performed within 2 months of injury were reviewed by a musculoskeletal radiologist and an orthopedic surgeon. The patients were divided into two groups. The first group of patients had MRI performed within 1 month of injury. The second group of patients had MRI performed 1–2 months after the index injury. Both assessors were blinded and the MR mages were read separately to assess the presence of ALL, presence of a tear and the location of the tear. Based on their readings, interobserver agreement (kappa statistic (K)), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were compared. Results The ALL was identified in 100% of the patients. However, there was a discrepancy of up to 15% in the identification of tear of the ALL. In the first group in which MRI scans were performed within 1 month of injury, the ALL tear was identified by the radiologist in 92% of patients and by the surgeon in 90% of patients (Κ = 0.86). In the second group in which MRI scans were performed within 1–2 months of the injury, the ALL tear was identified by the radiologist in 78% of patients and by the surgeon in 93% of patients (K = 0.62). Conclusion The ALL can be accurately identified on MRI, but the presence and location of ALL tear and its location cannot be reliably identified on MRI. The accuracy in identification and characterization of a tear was affected by the interval between the time of injury and the time when the MRI was performed. Level of evidence Diagnostic, level IIIb, retrospective.

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Flexor Hallucis Longus Hypertrophy Secondary to Achilles Tendon Tendinopathy: An MRI-based Case-Control Study

10.21203/rs.3.rs-51795/v1 ◽

2020 ◽

Author(s):

Stephan Wirth ◽

Octavian Andronic ◽

Fabian Aregger ◽

Anna Jungwirth-Weinberger ◽

Thorsten Jentzsch ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Achilles Tendon ◽

Interobserver Agreement ◽

Achilles Tendinopathy ◽

Triceps Surae ◽

Flexor Hallucis Longus ◽

Resonance Imaging ◽

Mri Scans ◽

Magnetic Resonance Imaging Mri

Abstract Background: The purpose of this study was to outline indirect signs of advanced Achilles tendinopathy on magnetic resonance imaging (MRI) and develop a potential tool that could aid in surgical decision-making.Methods: Magnetic resonance imaging (MRI) scans of Achilles tendon were analyzed retrospectively in two consecutive cohorts. Control group consisted of patients that had an MRI due to other reasons and no signs of tendinopathy. Two parameters from two muscle bellies were measured and compared on axial MRI scans 4 to 5 cm above the ankle joint line at the level of greatest thickness: area and diameter of the triceps surae (TS) and of the flexor hallucis longus (FHL). Interobserver agreement was analyzed. A receiver operating characteristic (ROC) curve was created for both quotients to assess potential cut-off points.Results: A total of 60 patients for each study group were included. The ratios for area and for diameter showed significant higher values for FHL in the tendinopathy group (p<0.001). There was strong to very strong interobserver agreement (rho=0.744). A diameter ratio FHL/TS of 2.0 or higher had a sensitivity of 49% and specificity of 90% for concomitant Achilles tendinopathy.Conclusion: In our patient cohort, flexor hallucis longus hypertrophy was observed even before a tendon transfer was employed as a possible compensatory mechanism for Achilles tendon tendinopathy. Using the tool described in this study, measuring a value of 2.0 or higher on an axial MRI, may be indicative as an indirect sign of functional deterioration of the Achilles tendon.

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Magnetic Resonance Imaging of the Hindfoot

Foot & Ankle ◽

10.1177/107110078901000101 ◽

1989 ◽

Vol 10 (1) ◽

pp. 1-7 ◽

Cited By ~ 26

Author(s):

Julia R. Crim ◽

Andrea Cracchiolo ◽

Lawrence W. Bassett ◽

Leanne L. Seeger ◽

Charles A. Soma ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Bone Marrow ◽

Magnetic Resonance ◽

Soft Tissue ◽

Soft Tissue Injuries ◽

Foot And Ankle ◽

Normal Anatomy ◽

Resonance Imaging ◽

Ct Evaluation ◽

Magnetic Resonance Imaging Mri

This article demonstrates normal anatomy of the foot and ankle as visualized with magnetic resonance imaging (MRI) in the sagittal, axial, and coronal planes. Additionally, selected cases chosen from our experience with more than 100 clinical scans are shown to highlight the primary areas in which we have found MRI to be clinically useful: bone marrow abnormalities, especially osteomyelitis and osteonecrosis, soft tissue injuries and masses, and cases in which metallic fixators make CT evaluation problematic.

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Incidental enchondromas at knee magnetic resonance imaging: intraobserver and interobserver agreement and prevalence of imaging findings

Radiologia Brasileira ◽

10.1590/s0100-39842013000300004 ◽

2013 ◽

Vol 46 (3) ◽

pp. 129-133 ◽

Cited By ~ 8

Author(s):

Sandra Akemi Nakamura ◽

Mário Müller Lorenzato ◽

Edgard Eduard Engel ◽

Maurício Eiji de Almeida Santos Yamashita ◽

Marcello Henrique Nogueira-Barbosa

Keyword(s):

Magnetic Resonance Imaging ◽

Bone Marrow ◽

Magnetic Resonance ◽

Interobserver Agreement ◽

Magnetic Resonance Images ◽

Imaging Findings ◽

Resonance Imaging ◽

Bone Marrow Signal ◽

Marrow Signal ◽

Knee Magnetic Resonance Imaging

Objective To evaluate intra- and interobserver agreement in the identification of incidental enchondromas at knee magnetic resonance imaging, and to assess the prevalence of imaging findings. Materials and Methods Retrospective study reviewing 326 knee magnetic resonance images acquired in the period between November 2009 and September 2010. The images were independently and blindly analyzed by two specialists in musculoskeletal radiology, with the objective of identifying incidental enchondromas, presence of foci with signal similar to bone marrow and foci of signal absence suggestive of calcifications within the enchondromas. Inter- and intraobserver agreements were analyzed. Results Eleven lesions compatible with enchondromas (3.3%) were identified. The interobserver agreement for the presence of enchondroma was high. Prevalence of foci of bone marrow signal inside the enchondromas was of 54.55%, and foci suggestive of calcification corresponded to 36.36%. The intraobserver agreement for foci of bone marrow signal in enchondromas was perfect, and interobserver agreement was high. Conclusion The prevalence of incidental enchondromas in the current study was compatible with data in the literature. Excellent agreement was observed in the identification of enchondromas and in the assessment of imaging findings. A higher prevalence of fat signal foci was observed as compared with signal absence suggestive of calcifications.

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Metal artefacts severely hamper magnetic resonance imaging of the rotator cuff tendons after rotator cuff repair with titanium suture anchors

Shoulder & Elbow ◽

10.1177/1758573217710833 ◽

2017 ◽

Vol 10 (2) ◽

pp. 107-113 ◽

Cited By ~ 1

Author(s):

Femke F. Schröder ◽

Rianne Huis in’t Veld ◽

Lydia A. den Otter ◽

Sjoerd M. van Raak ◽

Bennie ten Haken ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Interobserver Agreement ◽

Diagnostic Value ◽

Suture Anchors ◽

Resonance Imaging ◽

Metal Artefacts ◽

Mri Scans ◽

Operative Findings

Background The rate of retear after rotator cuff surgery is 17%. Magnetic resonance imaging (MRI) scans are used for confirmative diagnosis of retear. However, because of the presence of titanium suture anchors, metal artefacts on the MRI are common. The present study evaluated the diagnostic value of MRI after rotator cuff tendon surgery with respect to assessing the integrity as well as the degeneration and atrophy of the rotator cuff tendons when titanium anchors are in place. Methods Twenty patients who underwent revision surgery of the rotator cuff as a result of a clinically suspected retear between 2013 and 2015 were included. The MRI scans of these patients were retrospectively analyzed by four specialized shoulder surgeons and compared with intra-operative findings (gold standard). Sensitivity and interobserver agreement among the surgeons in assessing retears as well as the Goutallier and Warner classification were examined. Results In 36% (range 15% to 50%) of the pre-operative MRI scans, the observers could not review the rotator cuff tendons. When the rotator cuff tendons were assessable, a diagnostic accuracy with a mean sensitivity of 0.84 (0.70 to 1.0) across the surgeons was found, with poor interobserver agreement (kappa = 0.12). Conclusions Metal artefacts prevented accurate diagnosis from MRI scans of rotator cuff retear in 36% of the patients studied.

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