Biomedical subjects

J Hodler

Publications and source records attributed to J Hodler.

At least 73 records · Page 4Linked to original sources

PubMed1998

[Imaging methods].

A number of abnormalities of the shoulder joint can cause pain or dysfunction. Imaging of this complex joint is demanding. Standard radiographs are considered to represent the basis of all imaging. For more detailed diagnoses, especially concerning soft tissue, more advanced imaging methods are required. Standard arthrography (without combination with either CT or MRI) is rarely indicated anymore. Bone scintigraphy is another imaging method with limited use in shoulder joint abnormalities (neoplasm, infection, occult fracture). Sonography is useful in abnormalities of the rotator cuff and the biceps tendon. This method is commonly employed for screening. CT is useful in the demonstration of complex fractures. CT arthrography is indicated in instability of the glenohumeral joint and is competing with MR arthrography. MRI and MR arthrography are the imaging method of choice for many indications, mainly due to their free choice of imaging planes and excellent contrast resolution. These methods provide the most detailed diagnosis mainly with regard to abnormalities of the rotator cuff (partial versus intact or full-thickness tears) and the biceps tendon and are useful in the assessment of instability.

Diagnosis, Differential↗

PubMed1997

[Magnetic resonance tomography in osteoid osteoma: more confusion than benefit?].

The purpose of this evaluation was the description of potentially misleading MR appearances of osteoid osteoma. The MR images of 10 patients with osteoid osteoma were retrospectively evaluated and compared to radiographic, intraoperative and histologic findings. 4 of the 10 abnormalities were located in the proximal femur, two in the lumbar spine, and one each in the tibial plateau, in the cervical spine, in the sacrum and in the first metacarpal. 8 of the 9 nidi visible on standard radiographs and/or CT scans were demonstrated on MR images. Edema was visible within the bone marrow in 3, within soft tissue in 2 and in both locations in 4 MR examinations. The soft tissue abnormalities were circumscribed in 3 patients and could be misdiagnosed as soft tissue tumors or an abscess in these patients. One of 5 osteoid osteomas located in the proximity of a joint mimicked septic arthritis. The MR appearance of osteoid osteoma may be misleading. However, false diagnoses usually can be avoided with a careful search of a nidus. MR imaging in osteoid osteoma is important for differential diagnosis.

Adolescent↗

PubMed1997

Magnetic resonance imaging of injuries to the ankle joint: can it predict clinical outcome?

OBJECTIVE: To predict clinical outcome after ankle sprains on the basis of magnetic resonance (MR) findings. DESIGN AND PATIENTS: Twenty-nine consecutive patients (mean age 32.9 years, range 13-60 years) were examined clinically and with MR imaging both after trauma and following standardized conservative therapy. Various MR abnormalities were related to a clinical outcome score. RESULTS: There was a tendency for a better clinical outcome in partial, rather than complete, tears of the anterior talofibular ligament and when there was no fluid within the peroneal tendon sheath at the initial MR examination (P = 0.092 for either abnormality). A number of other MR features did not significantly influence clinical outcome, including the presence of a calcaneofibular ligament lesion and a bone bruise of the talar dome. CONCLUSION: Clinical outcome after ankle sprain cannot consistently be predicted by MR imaging, although MR imaging may be more accurate when the anterior talofibular ligament is only partially torn and there are no signs of injury to the peroneal tendon sheath.

Adolescent↗

PubMed1997

Hemophilic pseudotumor: spectrum of MR findings.

OBJECTIVE: To determine the MR imaging appearance of hemophilic pseudotumor (HP) and its clinical implications. DESIGN AND PATIENTS: Five hemophilic patients (aged 35-77 years) with 12 HPs in various anatomic locations were included in this study. The MR images were retrospectively evaluated for the appearance of the lesions and accompanying abnormalities, as well as their clinical implications. RESULTS AND CONCLUSION: MR images of all five patients (12 lesions) showed well-defined masses containing blood clots in various stages of organization surrounded by a fibrous capsule in subcutaneous fat or in intramuscular, interfascial, subperiosteal, and intraosseous locations. Intramuscular HP frequently had mural nodules. This is an almost unique appearance that is somewhat unexpected. MR imaging allowed determination of number, size, and extent of the lesions, evidence of neurovascular involvement, and accompanying musculoskeletal alterations. It is concluded that MR imaging not only is a sensitive and accurate method for detecting and diagnosing HP and providing useful information for therapeutic decision making, but can also be used to assess results of treatment by allowing evaluation of the evolution of blood products, the size of lesions in regions difficult to access by physical examination, and recurrent bleeding within a chronic lesion.

Adult↗

PubMed1997

Dynamic MR imaging of carpal tunnel syndrome.

OBJECTIVE: To evaluate the diagnostic value of the MR imaging syndrome before and after performance of provocative exercises in patients with dynamic carpal tunnel syndrome. DESIGN: Fat-suppressed proton-density and T2-weighted spin-echo images of the wrist were obtained prior to and after provocative, standardized exercises. Images were interpreted in masked fashion with regard to six MR criteria of carpal tunnel syndrome: (a) bowing of the transverse ligament, (b) and (c) deformation of the median nerve at the pisiform and hamate levels respectively, (d) signal abnormality of the median nerve, (e) presence of fluid in the wrist joints and/or carpal tunnel, and (f) presence of synovial swelling. PATIENTS: Twenty-one wrists in 20 patients with subjective complaints of carpal tunnel syndrome and equivocal or negative clinical findings and negative electrodiagnostic examinations were included (age range 21-61 years, mean 37 years, 2 men and 18 women). The diagnosis of dynamic carpal tunnel syndrome was made and confirmed by surgery in 18 of the 21 symptomatic wrists. The control group consisted of 15 asymptomatic wrists in volunteers (age range 22-60 years, mean 35 years, 8 men and 7 women). RESULTS AND CONCLUSIONS: Sensitivities and specificities of the six MR criteria were 90.5-100%, and 6.7-86.7%, respectively, both before and after exercise. Likelihood ratios proved statistically significant differences between the symptomatic and asymptomatic wrists (P < 0.0001-0.0002) for the prevalence of all MR criteria with the exception of fluid within the carpal joints and/or carpal tunnel. Changes of the MR appearance after exercise had a low sensitivity (4.8-71.4%) but high specificity (86.7-100%) for dynamic carpal tunnel syndrome. In conclusion, MR imaging contributes to the diagnosis of carpal tunnel syndrome when clinical signs are confusing and electrodiagnostic studies are negative. Dynamic examinations improve specificity of MR imaging for such diagnosis.

Adult↗

PubMed1997

Rapid prototyping (stereolithography) in the management of intra-articular calcaneal fractures.

The purpose of this study was to evaluate and compare the diagnostic performance of stereolithography vs workstation-based three-dimensional (3D) reformations in intra-articular calcaneal fractures. A total of 30 intra-articular calcaneal fractures were examined using standard radiographs, coronal CT scans, and 2D and 3D reformations. The CT data were transferred to an outside institution, and stereolithograms were produced from photopolymer resin employing a laser beam system. 3D reformations and stereolithograms were analyzed in a blinded fashion by two staff radiologists. Receiver-operating-characteristic (ROC) curves were obtained for six clinically significant fracture components. Standard radiographs, coronal CT scans, and 2D reformations served as the standard of reference. The area under the ROC curves for 3D reformations and stereolithograms were 1.0 and 0.98 for abnormal tuber angles, 0.91 and 0.91 for anterior and middle talo-calcaneal joint involvement, 0. 90 and 0.95 for involvement of the posterior talo-calcaneal joint, 0. 65 and 0.78 for the presence of a lateral bulge, 0.80 and 0.81 for the involvement of the calcaneocuboidal joint, and 0.62 and 0.67 for the presence of a "tongue-type" fracture. No statistically significant difference was demonstrated for the two methods (Wilcoxon signed-rank test, p = 0.138). Based on our results stereolithograms did not prove to be statistically superior to workstation-based 3D reformations. Stereolithograms may still be useful for teaching purposes and for surgical planning at a thinking-efficacy level.

Adult↗

PubMed1997

Contrast media in MR arthrography of the glenohumeral joint: intra-articular gadopentetate vs saline: preliminary results.

The purpose of this investigation was to compare gadopentetate and saline as contrast media in MR arthrograms of the glenohumeral joint. In 60 consecutive patients MR arthrograms with either gadopentetate (n = 26) or saline (n = 34) were performed. After injection of gadopentate, 3D gradient-echo (GE) images were obtained (TR 32 ms, TE 10 ms, flip angle 40 degrees). With saline, double-echo steady-state images (heavily T2-weighted 3D GE images) were obtained (TR 40 ms, TE 9/45 ms, flip angle 40 degrees). In the last 14 of these patients T2-weighted turbo spin-echo (SE) images were added (TR 2900 ms, TE 96 ms). Contrast-to-noise ratios standardized for imaging times proved to be superior for the gadolinium arthrograms compared with GE and SE saline arthrograms (intra-articular fluid vs subacromial fat: p = 0.0001 and 0.0008; intra-articular fluid vs supraspinatus tendon: p = 0.0001 and 0.046). Using a qualitative scoring system gadolinium arthrograms were superior to saline arthrograms (p < 0.0001 and p < 0.0001). Saline arthrograms in combination with GE and SE sequences are inferior to gadopentetate arthrograms with GE sequences.

Adolescent↗

PubMed1997

Botulinum A toxin as a treatment of detrusor-sphincter dyssynergia in patients with spinal cord injury: MRI controlled transperineal injections.

OBJECTIVES: To correlate clinical and urodynamic findings with MRI in patients with spinal cord injury and detrusor-sphincter dyssynergia who were consecutively treated with transperineal injections of botulinum-A toxin (BTX-A) under EMG control. METHODS: Six patients with spinal cord injury and upper motor neuron bladder dysfunction associated with detrusor-sphincter dyssynergia were prospectively analysed. One hundred international units (IU) BTX-A (Botox in 1 ml normal saline without preservative) diluted 1 to 1 with 1 ml gadopentetate were injected transperineally under EMG control. MRI was started immediately after needle withdrawal. RESULTS: In all six patients gadopentetate was located in the external urethral sphincter on MRI. In no patient did traces of gadopentetate appear in the perineal musculature located in the vicinity of the external urethral sphincter. No patient developed resistance to BTX-A. All patients showed an (ongoing) improvement of their voiding function after BTX-A injections. CONCLUSIONS: Transperineal injections of BTX-A under EMG control are efficient in the release or amelioration of lower urinary tract obstruction due to detrusor sphincter dyssynergia in patients with spinal cord injury. Despite well described methods, EMG of the external urethral sphincter is difficult and it is not possible to definitively exclude false recordings of the surrounding perineal musculature. By the use of MRI it was shown that both the EMG recordings and transperineal injection method are precise.

Botulinum Toxins, Type A↗

PubMed1997

Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers.

PURPOSE: To determine the prevalence and size of presumed Morton neuromas and fluid in the intermetatarsal bursae on magnetic resonance (MR) images. MATERIALS AND METHODS: In 70 asymptomatic subjects, transaxial T1-weighted spin-echo and T2-weighted turbo spin-echo images were obtained of the right forefoot. The prevalence and size of presumed Morton neuromas (diagnosed with MR imaging criteria) were evaluated, and the sizes were compared with those of 16 symptomatic, surgically proved Morton neuromas. The prevalence and diameter of fluid collections in the intermetatarsal bursae were evaluated on the T2-weighted images. RESULTS: Twenty-four Morton neuromas were diagnosed in 21 subjects (prevalence, 30%). The transverse diameter of the neuromas was 3-7 mm (mean, 4.5 mm) versus 4-8 mm (mean, 5.6 mm) in symptomatic subjects; this difference was significant (P = .0075). The prevalence of fluid in the intermetatarsal bursa was 20%, 47%, 49%, and 0% for the first through fourth intermetatarsal spaces. The transverse diameter of the fluid collection was 1-4 mm. CONCLUSION: The diagnosis of Morton neuroma at MR imaging may be relevant only when the transverse diameter is 5 mm or more and can be correlated to clinical findings. Fluid collections in the first three intermetatarsal bursae with a transverse diameter of 3 mm or less can be considered physiologic.

Adult↗

PubMed1997

Efficacy of MR imaging in patients suspected of having Morton's neuroma.

OBJECTIVE: The purpose of our study was to evaluate the role of MR imaging in patients with suspected Morton's neuroma and to assess the value of various MR sequences in this diagnosis. MATERIALS AND METHODS: Thirty-two consecutive patients with suspected Morton's neuroma were studied using a 1.0-T MR scanner. Axial T1- and T2-weighted spin-echo, short inversion time inversion recovery, and enhanced T1-weighted fat-suppressed spin-echo images were obtained on each patient. Eighteen intermetatarsal spaces in 16 of the 32 patients were evaluated surgically. Contrast-to-noise ratios for Morton's neuroma versus surrounding fat were calculated and standardized for imaging times. RESULTS: In 15 of 18 intermetatarsal spaces, a Morton's neuroma was surgically proven. Thirteen true-positive, two false-negative, three true-negative, and no false-positive MR diagnoses were given. In six of 15 proven neuromas, the clinical examiner was not able to identify the correct intermetatarsal space. The MR diagnoses in the 16 remaining patients who did not undergo surgery were Morton's neuroma (n = 8), stress fracture (n = 1), foreign body reaction (n = 1), tendon sheath ganglion (n = 1), postoperative changes (n = 2), and no abnormality (n = 3). Standardized contrast-to-noise ratios (+/- SD) were 2.42 +/- 0.72 for T1-weighted images; 1.43 +/- 1.13 for T2-weighted images; 1.26 +/- 1.47 for short inversion time inversion recovery images; and 0.83 +/- 0.59 gadolinium-enhanced fat-suppressed images. The differences were statistically significant for the T1-weighted spin-echo images versus the three other sequences (p = .001-.018), but not among the other sequences (p = .209-.710). CONCLUSION: MR imaging is accurate in diagnosing Morton's neuroma and may be important for correct localization. A limited examination employing axial T1-weighted spin-echo images is adequate; additional sequences should be employed only for differential diagnosis.

Female↗

PubMed1997

Real-time monitoring of laser diskectomies with a superconducting, open-configuration MR system.

OBJECTIVE: The objective of our study was to assess the ability of a 0.5-T superconducting, open-configuration MR system to guide laser diskectomies. The study was performed ex vivo on six human cadavers as well as in vivo on three patients. CONCLUSION: The macroscopic size of necrosis correlated well with the monitored temperature spread (r2 = .76-.85). After MR-guided introduction of the laser fiber into the targeted disk space, temperature spread was visualized in all subjects.

Adolescent↗

PubMed1997

[Sonography of the musculoskeletal system].

Beside standard radiographs, bone scintigraphy and MR imaging, ultrasonography plays an important role in assessing abnormalities of the musculoskeletal system. Ultrasonography is widely available, inexpensive and provides high-contrast resolution; however, interobserver variability is a major problem. Ultrasonography should only be employed by experienced examiners and for proven indications in order to prevent inadequate results. Most peer-reviewed publications have evaluated the role of ultrasonography for abnormalities of the rotator cuff and the achilles tendon. Ultrasonography also commonly provides useful information in hip, knee, foot, and wrist abnormalities as well as in the initial work-up in suspected infection or neoplasm; moreover, the role of ultrasonography in some less accepted indications is discussed, such as in meniscal and cruciate ligament injuries as well as in Morton's neuroma.

Achilles Tendon↗

PubMed1997

[Comparison between magnetic resonance imaging and arthroscopy for the diagnosis of knee meniscal lesions].

PURPOSE OF STUDY: The authors evaluated the use of MR-imaging of the menisci compared to arthroscopy considered as the gold standard by which all noninvasive imaging procedures of the knee have to be measured. MATERIAL AND METHODS: In a prospective study, we evaluated the use of MRI in 50 patients with clinically suspected disorders of the meniscus, followed by an arthroscopic examination by an experienced arthroscopist. MRI studies were performed after clinical evaluation and were interpreted by an experienced radiologist, who had no knowledge of the clinical findings. RESULTS: The accuracy of the diagnosis from MRI was 78 per cent for the medial meniscus (sensitivity 79 per cent and specificity 78 per cent) and 94 per cent for the lateral meniscus (sensitivity 50 per cent and specificity 98 per cent). The average age of the patients was 34 years, with a range from 3 to 73 years. The imaging studies revealed 9 false positive test and suggested that the meniscus was either degenerated or form in the horizontal plane. In all 9 menisci the abnormal MR imaging signal was limited to the posterior horns. The positive predictive value was 59 per cent and the negative predictive value was 94 per cent representing a moderate level of diagnostic certainty, both in patients who had a positive result and in those who had a negative result. High predictive negative value of MRI indicates that a negative MRI is quite reliable for meniscal lesions. DISCUSSION: Problems of MR-imaging are the popliteus tendon sheath and the transverse ligament. This ligament is seen in association with a large branch of the lateral inferior geniculate artery, and may be mistaken for a grade 3 signal intensity in the anterior horn of the lateral meniscus. CONCLUSION: A normal MRI allows to eliminate a meniscal lesion and so there is no need for a diagnostic arthroscopy. But with a pathologic MRI there is a risk to establish too often the diagnostic of a meniscal lesion rather then to identify structural modifications as a degeneration.

Adult↗

PubMed1996

[Vertebral pain in advanced age: radiological diagnosis].

Vertebral pain is common in elderly patients. This article reviews indications and results of imaging in these patients. The differential diagnosis of degenerative disease and the mass important emergency situations are discussed. Standard radiographs are crucial for adequate diagnosis due to high spatial resolution and the excellent overview they provide. Computed tomography is useful in bone abnormalities and is an important diagnostic tool in this population. Magnetic resonance imaging is preferable in abnormalities of the cervical spine and in suspected spondylodiscitis. Myelography, CT myelography and discography are rarely indicated, but may be ordered for operative planning. Bone scintigraphy is useful in detection of multilocular lesions and can be used for assessing the activity of pathologic processes.

Aged↗

PubMed1996

Metaphyseal peg in geroderma osteodysplasticum: a new genetic bone marker and a specific finding?

We describe two sibs with geroderma osteodysplasticum (GO) who, in addition to the known clinical and radiologic manifestations of the disorder, presented a metaphyseal peg indenting the epiphysis of the long bones, particularly at the knees. The peg was visible only at the age of 4 to 5 years but was invisible in infancy and following physeal closure. This may explain why this anomaly was not described in previous reports of 23 patients in 11 families with GO. The metaphyseal peg is an abnormality of bone development so far unknown to us. We speculate that it represents a primary, agedependent alteration of bone shape and hence a new genetic bone marker apparently specific to GO.

Abnormalities, Multiple↗

PubMed1996

Knee evaluation in two systems and magnetic resonance imaging after operative treatment of posterior cruciate ligament injuries.

We reviewed 30 patients operated on because of acute (n = 14) or chronic (n = 16) rupture of the posterior cruciate ligament (PCL) with an average follow-up time of 6.9 years. The clinical outcome was expressed using the OAK and the International Knee Documentation Committee (IKDC) evaluation forms. All patients had undergone posterior stress X-radiography, 14 patients had additionally undergone magnetic resonance imaging (MRI). OAK score showed good or excellent results in 93% of the acute and 38% of the chronic cases. The IKDC form, however, revealed nearly normal results in only 29% of the acute and 6% of the chronic cases. The length and thickness of the operated PCL on MRI correlated with the clinical result.

Adolescent↗

PubMed1996

[Diagnosis of shoulder impingement syndrome].

This article reviews the pathogenesis and clinical and imaging findings in shoulder impingement syndrome. Shoulder impingement is caused by compression of the supraspinatus tendon underneath the coracoacromial arch, mainly in forward flexion of the arm. Different stages of impingement syndrome are described. Stage I relates to edema and hemorrhage of the supraspinatus tendon. Stage II is characterized by bursal inflammation and fibrosis, as well as tendinopathy. In stage III there is a tear of the rotator cuff. Clinical signs may overlap. Moreover, calcifying tendinitis, fractures and pain originating from the cervical spine may mimic shoulder impingement syndrome. Imaging is important for the exact diagnosis. Standard radiographs are the basis of imaging in shoulder impingement syndrome. They may demonstrate subchondral sclerosis of the major tuberosity, subacromial spurs, and form anomalies of the acromion. They are also important in the differential diagnosis of shoulder impingement syndrome and demonstrate calcifying tendinitis, fractures and neoplasm. Ultrasonography has found acceptance as a screening tool and even as a final diagnostic method by many authors. However, there is a high interobserver variability in the demonstration of rotator cuff tears. Its usefulness has therefore been questioned. MR imaging is probably the method of choice in the evaluation of the rotator cuff and surrounding structures. Several investigations have demonstrated that differentiation of early findings, such as tendinopathy versus partial tears, may be difficult with MR imaging. However, reproducibility for fullthickness tears appears to be higher than for sonography. Moreover, specificity appears to be superior to sonography. MR arthrography is not universally accepted. However, it allows for more exact differentiation of discrete findings and may be indicated in preoperative planning. Standard arthrography and CT have a limited role in the current assessment of the rotator cuff.

Diagnosis, Differential↗

PubMed1996

Hereditary sensory and autonomic neuropathy type I (Thévenard's disease).

Radiographic and MR findings of two cases of hereditary sensory and autonomic neuropathy type I are reported. This rare disease has a non-specific radiographic and MR appearance. Differential diagnosis includes other types of hereditary and acquired sensory neuropathies affecting small myelinated and unmyelinated nerve fibers, as well as vascular abnormalities and lesions of the spinal cord.

Adult↗