The results of magnetic resonance imaging (MRI) were compared with those of arthroscopy in a prospective series of 276 patients. A "dedicated system" for MRI of limbs and peripheral joints--the 0,2 Tesla ARTOSCAN (ESAOTE, Italy)--was used for imaging knee joint lesions. T1-weighted spin echo sagittal images, T2-weighted gradient-echo coronal images, and axial views for lesions of bone and the femoropatellar joint were acquired. If necessary paraxial sagittal and oblique coronal views were obtained for imaging of the cruciate ligaments. This protocol allowed excellent visualization of the cruciate ligaments, medial and lateral meniscus in almost all patients. Compared with arthroscopy performed within 48 hours after imaging, the sensitivity, specificity, and accuracy were respectively, 91, 92 and 91 per cent for tears of the medial meniscus; 80, 96, and 92 per cent for tears of the posterior meniscus; 100, 100, and 100 per cent for tears of the posterior cruciate ligament; 93, 98, and 99 per cent for tears of the anterior cruciate ligament; and 73, 100, and 92 per cent for full-thickness articular cartilage lesions. The examination can be performed within 30 to 45 minutes at a cost that is lower than that of diagnostic arthroscopy. ARTOSCAN imaging is a safe and valuable adjunct to the clinical examination of the knee and an aid to efficient preoperative planning.

Adolescent↗

PubMedDate not supplied

[Legg-Calve-Perthes disease in the MRI: possibilities and limits].

Magnetic resonance imaging (MRI) was performed on the hips of 32 children with Legg-Calve-Perthes disease. Each patient had between 2 and 6 MR-tomographies in the course of the disease. We found that MR-tomography is superior to plain radiography in the early diagnosis of the avascular femoral necrosis. In addition it is also advantageous because it does not involve the use of ionizing radiation. MR-tomography is more accurate in defining the extent of capital femoral epiphyseal necrosis and metaphyseal involvement and in showing the contours of the femoral head. The characteristics of MR images in the 4 radiographic stages were analysed. For better distinction the radiographic stages I and II could be subdivided into the MR stages Ia and Ib and IIa and IIb. According to our experience it is now possible to replace plain radiographs by MR images.

Cartilage, Articular↗

PubMedDate not supplied

[Changes in blood flow characteristics as a cause of non-traumatic femur head necrosis].

Most authors associate avascular necrosis of the femoral head with ischemia, caused by injuries or diseases of the nutrient vessels or by alteration of the hemorheology. We examined the rheological properties of the blood in 39 patients with nontraumatic avascular necrosis of the femoral head by following tests: viscosimetry, filtrometry and aggregation of red blood cells. Aggregation of red blood cells showed statistically significant pathologic alterations. Our results confirm that irreversible agglutination phenomenons followed by ischemia can be caused by 1. stenosis or obliteration of nutrient vessels 2. rheologic alterations of the blood.

Adult↗

PubMedDate not supplied

[Diagnosis of osteoid osteoma with special reference to angiography, scintigraphy, computerized tomography and magnetic resonance imaging].

Clinical results from 50 patients with an osteoid-osteoma, show that night pain is considered one of the most important symptoms (90%). 88% responded to salicylic acid. The diagnosis can often be made from normal X-rays. Diagnostic problems are especially common in cases of rare, atypical localisations (spine, sacrum, clavicula, talus, calcaneus and the proximal part of the femur). The scintigraphy represents an unspecific but sensitive method of diagnosis in the early stages. The osteoid-osteoma is visible as a "hot spot" or, in the subperiosteal type, as a diffuse accumulation. Angiography is of great importance for preoperative localisation and differential diagnosis. Computer tomography is particularly valuable for localisation in the region of the spine. Magnetic resonance is an excellent method of examination. The three dimensional imaging allows an exact localisation, especially in atypical and difficult localisations. This will be the preferred method of the future, not least because there is no exposure to radiation.

Adolescent↗

PubMedDate not supplied

[Value of myelography and computer tomography in problem cases of lumbar intervertebral disk diagnosis].

The accuracy of myelographic and computerized tomographic findings in lumbar layer diagnostic techniques is examined in a total of 133 patients suffering from root compression syndrome. The comparatively high percentage of accurate results 94% (myelogr.) and 90% (ct) in 93 cases where the findings were operatively substantiated,--sinks when the problem cases are considered apart. In 22% of our patients, one method alone was not sufficient for satisfactory preoperative diagnosis. The value of myelography and ct in the diagnosis of problem cases in herniated lumbar disk disease is different. Because of specific advantages (Tab. 1) in the representation of the spinal canal the techniques have their own position. When clinical and computertomographical results are clear and corresponding, myelography-as an invasive diagnostic technique--is unnecessary. In problem cases, however, both methods should be used to complement one another.

Adult↗

PubMedDate not supplied

[Surgical treatment of primary and secondary malignant tumors of the thoracic and lumbar spine].

After considering conservative therapeutic measures, the authors opt for surgical treatment of primary or secondary spinal tumors if neurologic deficits occur or the structural stability of the spine is at risk. The majority of the tumors are located in the ventral section of the spine, i.e., in the vertebral body, and therefore the present authors mainly perform ventral tumor resection and spinal reconstruction (traction implant plus bone cement and ventral traction bracing with the DKS system). In cases with tumor spread over several segments and/or lumbosacral involvement the authors recommend combined ventral and dorsal procedures in order to achieve adequate stability of the vertebral body prosthesis.

Bone Cements↗

PubMedDate not supplied

[Non-radical surgery of malignant pelvic tumors].

Because of an often excessive tumor extension, radical surgical resection of malignant tumors of the pelvis was possible in only half of our patients. Until now we refused to perform hemicorporectomy. In view of a temporary improvement of the quality of life it seems reasonable to perform these radical and palliative operations, even if a high recurrence rate can be anticipated. As for the survivor-rate, no exact conclusions can be drawn from our results. The possibility of a radical resection is largely dependent upon the tumor's localisation (I, III) i.e. most of the periacetabular tumors additionally involve several regions of the pelvis (II + III + I). In the region of the sacrum (IV) a radical resection could not be achieved in our patients. Functionally, type I and III resections show the best results. These days there is a good chance of achieving a satisfying result with endoprosthetic reconstruction of the pelvis following resection of periacetabular tumors--however a high complication rate has to be taken into account.

Adolescent↗

PubMedDate not supplied

[Clinical significance of computerized tomography of the posterior area of the foot].

Computertomographic examinations of the hindfoot in the frontal and horizontal view will show us morphological findings, which we could not see with conventional X-ray-technique. Out of these findings we are able to control our operative reconstruction as well as late changes in bone healing. The horizontal view will show us the osseous structures of the talus and calcaneus as well as of the navicular and cuboid bone, as it is necessary for preoperative evaluation of the hindfoot.

Ankle Joint↗

PubMedDate not supplied

[Imaging of the internal structures of the knee by MR tomography].

With magnetic resonance imaging it is possible to demonstrate the cruciate ligaments of the knee reproducibly without the need for invasive measures. Prerequisites for this are high-resolution coil systems and a stratum thickness of 5 mm or less. Examination of 29 patients and volunteers showed that normal cruciate ligaments can be delineated as homogeneous zones of low signal intensity and high contrast from the surrounding fatty tissue, while in cases of injury to the cruciate ligaments an interruption of the ligament structure, inability to detect them in anatomic position, or an intermediate signal is observed. In 13 cases operated on, with 12 injuries of the cruciate ligaments, the MR findings corresponded to findings at surgery. In 6 patients who had previously had cruciate ligament plasties there correlation with clinical findings was only partial.

Adolescent↗

PubMedDate not supplied

Is the wellness movement dying?

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Health Promotion↗

PubMedDate not supplied

[Roentgen diagnosis in orthopedics].

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Bone Diseases↗