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J Hodler

Publications and source records attributed to J Hodler.

At least 109 records · Page 6Linked to original sources
PubMed1994

[Relevance of proton spin tomographic meniscus diagnosis in correlation with arthroscopy].

Arthroscopy of the menisci is considered the gold standard by which all noninvasive imaging procedures of the knee are measured. In a prospective study we evaluated the use of MRI in 50 patients in whom a disorder of the meniscus was suspected clinically; this was followed by an arthroscopic examination by an experienced arthroscopist. The MR studies were performed after clinical evaluation and were interpreted by an experienced radiologist, who had no knowledge of the clinical findings. The accuracy of the diagnosis from MRI was 78% for the medial meniscus (sensitivity 79% and specificity 78%) and 94% for the lateral meniscus (sensitivity 50% and specificity 98%). The average age of the patients was 34 years, with a range of 3-73 years. The imaging studies revealed 9 false-positive tests and suggested that the meniscus was either degenerated or torn 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% and the negative predictive value was 94%, representing a moderate level of diagnostic certainty both in patients who had a positive result and in those who had a negative result. The high predictive negative value of MRI indicates that a negative MRI is quite reliable for meniscal lesions. The problem areas in MR imaging are the popliteal 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.

Adolescent↗
PubMed1993

Patterns of central acetabular osteophytosis in osteoarthritis of the hip.

RATIONALE AND OBJECTIVES: The frequency and morphology of central acetabular osteophyte formation were evaluated in patients with osteoarthritis. METHODS: One hundred preserved acetabular specimens were evaluated for the occurrence of central osteophytes (excrescences present in the articulation of the hip joint), their relationship to marginal and femoral osteophytes of the hip, and their radiographic appearance. RESULTS: In both specimen and patient analysis, the authors found that central excrescences occur commonly and appear to be related temporally to osteophytes of the femur and the margin of the acetabulum. CONCLUSIONS: The authors demonstrated a close relationship between the degree of marginal and femoral osteophytes with those found centrally, indicating a temporal relationship. The new radiographic signs discussed are: 1) a fine linear density associated with early osteoarthritis; 2) larger, more irregular densities associated with a more advanced stage of osteoarthritis; and 3) obliteration of the acetabular fossa by excrescences as found in severe osteoarthritis.

Acetabulum↗
PubMed1993

Gamekeeper thumb: differentiation of nondisplaced and displaced tears of the ulnar collateral ligament with MR imaging. Work in progress.

Ulnar collateral ligament (UCL) injury of the first metacarpophalangeal joint (gamekeeper thumb) is common. If the UCL becomes displaced superficially to the adductor pollicis aponeurosis, surgical treatment has been advocated. Radiography cannot help differentiate between displaced and nondisplaced tears. The authors investigated the use of magnetic resonance (MR) imaging in the evaluation of UCL injury. Ten displaced and six nondisplaced UCL tears were surgically created in 16 nonembalmed cadaveric specimens. Twelve unaltered specimens served as controls. Coronal MR images were obtained and interpreted by two observers. The MR images were compared with corresponding anatomic slices. MR imaging depicted UCL displacement in all 10 specimens with displaced tears. A displaced tear was interpreted in one control specimen. Non-displaced tears were diagnosed in four control specimens. Although MR imaging was only 67% specific for all tears, it was 100% sensitive and 94% specific for depicting UCL displacement and, therefore, may be useful for evaluating gamekeeper thumb.

Adult↗
PubMed1993

MR imaging of the knee: can changes in the intracapsular fat pads be used as a sign of synovial proliferation in the presence of an effusion?

OBJECTIVE: Synovial proliferation is difficult to detect on MR images when joint effusions are present. The objective of this study was to assess the efficacy of MR changes in intracapsular fat pads (prefemoral, quadriceps, Hoffa's) as a sign of synovial proliferation in patients with knee effusions. MATERIALS AND METHODS: MR images were obtained in 70 patients with knee effusions. An effusion was considered present if the suprapatellar bursa was distended 1 cm in anterior to posterior diameter on T2-weighted sagittal images. The experimental group consisted of 32 patients with proliferative effusions (effusions associated with synovial proliferation) diagnosed on the basis of histologic or microbiologic data or strict rheumatologic criteria. This group comprised 11 patients with pigmented villonodular synovitis, six with rheumatoid arthritis, one with psoriatic arthritis, three with hemosideric arthritis, and 11 with septic arthritis. The control group comprised 38 subjects with knee effusions who had no arthroscopic evidence of synovial proliferation. After determining the MR criteria of proliferative effusion, two observers who had no knowledge of these cases evaluated abnormalities of the intracapsular fat pads seen on sagittal intermediate-weighted midline MR images. RESULTS: Characteristic changes in the fat pads were noted on MR images in patients with proliferative synovial effusions. Scalloping or truncation of the prefemoral fat pad was 77% sensitive and 95% specific as a predictor of proliferative effusion. Defects and displacement of Hoffa's fat pad had a sensitivity of 57% and a specificity of 99%, and nonvisualization or irregular margins of the quadriceps fat pad had a sensitivity of 61% and a specificity of 100%. CONCLUSION: Characteristic changes in intracapsular fat pads seen on MR images of patients with proliferative effusions can help distinguish these patients from those with effusions without synovial proliferation.

Adipose Tissue↗
PubMed1993

Degenerative changes of the menisci of the knee. Value of different MR pulse sequences.

Increased meniscal MR signal attributable to meniscal degeneration is a common finding. The role of different MR sequences in the analysis of the extent and distribution of meniscal degeneration in middle-aged and elderly patients has not been thoroughly evaluated. We retrospectively studied the role of different MR sequences in 175 anatomic meniscal sections originating from 20 freshly frozen knees from 10 cadavers using MR-anatomic correlation. T1-weighted and proton-density spin-echo images as well as postprocessed meniscal windows based on T1-weighted spin-echo images proved to be the most reliable in this diagnosis (53.7%, 54.9%, and 53.1% correctly diagnosed meniscal sections, respectively). T2-weighted spin-echo images and gradient-echo images proved to be less reliable (37.1% and 40.0% correctly diagnosed meniscal sections). While the T2-weighted spin-echo images commonly underestimated the extent of meniscal degeneration, gradient-echo images commonly overestimated the extent of such changes. These last two types of sequences should not be used alone in the description of meniscal degeneration.

Aged↗
PubMed1993

[Magnetic resonance tomography (MRT) of the knee joint: meniscus, cruciate ligaments and hyaline cartilage].

The use of MRT for diagnosing injury to the meniscus, the cruciate ligaments and hyaline cartilage was evaluated retrospectively in 82 knee joints without any knowledge of operative findings. In 49 cases the results were verified by arthroscopy and in 33 cases by arthrotomy. Sensitivity, specificity and diagnostic accuracy of MRT for meniscus lesions was 73.9%, 96.9%, and 94.6%. Corresponding values for lesions of the anterior cruciate ligament were 88.9%, 96.6%, and 94.7%, and for lesions of the hyaline cartilage 62.6%, 96.1%, and 87.9%, respectively. In addition to its high specificity, MRT proved accurate in excluding lesions of the meniscus (97.1%) of the anterior cruciate ligament (96.6%) and of hyaline cartilage (88.8%). A negative finding on MRT therefore makes the presence of a lesion of the meniscus, cruciate ligaments of cartilage unlikely. In such cases one is justified in delaying the use of arthroscopy or arthrotomy.

Adolescent↗
PubMed1993

[Possibilities of shoulder arthroscopy in comparison with magnetic resonance tomography and arthro-computerized tomography].

In the last 15 years the methods of examination of the shoulder have intensively expounded. According to a well documented retrospective study we describe the value of the shoulder arthroscopy and its correlation to MRI and arthro-CT findings. MRI represents nowadays the best way of exploring rotator cuff lesions and of investigating an impingement syndrome. Associated with a contrast medium its ability to clear up an anterior or posterior shoulder instability is now superior to the arthro-CT's. The arthroscopy allows the dynamic exploration of the joint and can be used not only as a diagnostic but also as a therapeutic procedure.

Adolescent↗
PubMed1992

Bone excrescence at the medial base of the distal phalanx of the first toe: normal variant, reactive change, or neoplasia?

In a review of 157 anteroposterior (AP) foot radiographs in 117 adult and pediatric patients, we observed a medial excrescence on the plantar aspect of the terminal phalanx of the hallux in 88.5% of the feet. Histologic analysis documented the presence of reactive bone. The bony outgrowth appears after closure of the adjacent physeal plate and is rarely symptomatic. Its high prevalence indirectly implies that it is not specific to any particular type of foot. Although certain types of foot may contribute to its development, we believe that repetitive forces occurring during ambulation induce this reactive bone formation.

Adipose Tissue↗
PubMed1992

Chronic wrist pain: spin-echo and short tau inversion recovery MR imaging and conventional and MR arthrography.

The accuracy of T1-, proton-density-, and T2-weighted magnetic resonance (MR) imaging sequences and gadolinium-enhanced MR arthrography in evaluation of the triangular fibro-cartilage complex (TFCC) and the scapholunate (SL) and lunotriquetral (LT) ligaments was studied in 15 patients with chronic wrist pain. Arthrography and arthroscopy were used as standards of reference. Twelve patients also underwent imaging with short tau inversion recovery (STIR) sequences. MR imaging was more reliable in evaluation of the morphology of the TFCC and SL ligament than in that of the LT ligament. With arthrography as the standard, sensitivity was 0.721, specificity was 0.947, and accuracy was 0.887 for the TFCC; these values were 0.500, 0.864, and 0.765 for the SL ligament and 0.519, 0.455, and 0.490 for the LT ligament. No visualization of the SL ligament indicated a tear, but this sign was not helpful in evaluation of the LT ligament. Fluid in the distal radioulnar joint had a high association with TFCC tears. Accuracy with MR arthrography was higher than with the other sequences. STIR images were effective in evaluation of the TFCC. The combination of proton-density-and T2-weighted images appears to be useful because morphologic characteristics and the presence of fluid can be evaluated.

Arthrography↗
PubMed1992

Rotator cuff disease: assessment with MR arthrography versus standard MR imaging in 36 patients with arthroscopic confirmation.

Standard proton-density- and T2-weighted magnetic resonance (MR) imaging and MR arthrography were used to depict rotator cuff disease in 36 shoulders in 36 patients; the findings were compared with arthroscopic findings in every patient. In 19 rotator cuffs normal at arthroscopy, MR arthrography revealed no tear in 16 patients, a partial tear in one patient, and a full-thickness tear in two patients. Standard proton-density- and T2-weighted images were normal in 15 of these patients and revealed a partial tear in two patients and a full-thickness tear in two patients. In 13 partial tears found at arthroscopy, MR arthrography showed a partial tear in six patients, no tear in five patients, and a full-thickness tear in two patients; standard MR imaging revealed a partial tear in one patient, no tear in 10 patients, and a full-thickness tear in two patients. All four full-thickness tears proved with arthroscopy were correctly diagnosed with both MR imaging methods. The main advantage of MR arthrography was better depiction of partial tears in the articular surface.

Adolescent↗
PubMed1992

Meniscal changes in the elderly: correlation of MR imaging and histologic findings.

In elderly patients, degenerative changes of the meniscus are common and may mimic a tear. The magnetic resonance (MR) image findings of 179 meniscal sections in 20 cadaver knees were correlated with the histologic and gross pathologic findings. The sensitivity of standard T1-weighted spin-echo images and their corresponding meniscal windows in depicting meniscal tears was 80.6%, specificity was 72.4%, and accuracy was 76.7%. These results are not as good as results reported previously. A major difficulty is the occurrence of grade 3 meniscal signal intensity and diffuse intrameniscal signal intensity in torn and intact menisci. MR imaging in elderly patients, however, is still useful in the diagnosis of meniscal abnormalities. Normal low signal intensity depicted within a meniscus at MR imaging and changes in grades 1 and 2 intrameniscal signal intensity are reliable signs of an intact meniscal surface. Grade 3 and diffuse meniscal signal intensities do not allow a specific diagnosis; menisci with these characteristics should be described as degenerated with a high probability of a tear.

Age Factors↗
PubMed1992

Craniovertebral junction: normal anatomy with MR correlation.

The anatomy of the craniovertebral junction, although complex, may be well visualized by routine MR imaging. This essay discusses the anatomy of the complex articulations of the craniovertebral junction. Representative MR images and gross anatomic photographs are presented to illustrate the intricate ligamentous and articular anatomy. Knowledge of the normal anatomy of the occipitoatlantoaxial region is necessary in order to understand the common disorders that affect this area. The most common disorders are trauma and arthropathies, but also include congenital abnormalities and neoplasm. The resultant abnormal mechanics may lead to neurologic sequelae or pain.

Atlanto-Axial Joint↗
PubMed1992

Width of the articular cartilage of the hip: quantification by using fat-suppression spin-echo MR imaging in cadavers.

OBJECTIVE: Use of MR imaging to measure the width of the articular cartilage has not been thoroughly investigated. The value of a selective fat-suppression spin-echo sequence in the quantitative assessment of articular cartilage of the hip was studied in cadavers. MATERIALS AND METHODS: Sagittal and coronal images were acquired in 10 cadaveric hips (age range at time of death, 62-81 years). On the coronal and sagittal MR images that were closest to the center of the femoral head, marks were placed every 30 degrees, with the midpoint of the femoral head used as a reference. Cartilage thickness was measured in 123 resulting locations. Sixty-three positions included both femoral and acetabular cartilages, and 60 positions included femoral cartilage without an acetabular counterpart. The findings were compared with corresponding anatomic sections. RESULTS: For the 60 locations containing only femoral cartilage, significant correlation between MR and anatomic sections was found (Pearson correlation coefficient = .34, p = .0089). Of the 63 locations containing both femoral and acetabular cartilages, the two cartilage layers could be differentiated on the MR images in 50 locations. In these 50, the MR and anatomic measurements of the femoral cartilage correlated significant (r = .58, p less than or equal to .0001). Measurements of the acetabular cartilage in these 50 locations yielded no significant correlation (r = .25, p = .08). When the entire cartilage (femoral plus acetabular) was measured in all 63 locations, the correlation between MR and anatomic measurements was .29 (p = .02). The correlation coefficients obtained in this investigation indicate considerable scattering of the data. CONCLUSION: Our results show that measurements of articular cartilage thickness of the hip on fat-suppression spin-echo MR images are not sufficiently accurate to be of clinical value.

Aged↗
PubMed1992

The cruciate ligaments of the knee: correlation between MR appearance and gross and histologic findings in cadaveric specimens.

OBJECTIVE: Using anatomic and histologic correlation, we investigated the reasons for differences in the MR signal intensity between the normal anterior and posterior cruciate ligaments and for the focally increased signal intensity within these ligaments occasionally found in elderly patients. MATERIALS AND METHODS: The MR images of 18 anterior and 20 posterior cruciate ligaments obtained from cadavers (age at death, 56-88 years old; mean, 74 years) were evaluated blindly. Their overall signal intensity and focal regions of increased signal were noted. The findings then were correlated with corresponding anatomic and histologic sections. RESULTS: The anterior cruciate ligament had greater signal intensity than did the posterior cruciate ligament in 15 of 18 knees and had comparable signal intensity in three knees. No histologic basis to explain the different MR appearances of the anterior and posterior cruciate ligaments was found. Rather, differences in macroscopic anatomy appeared to be the best explanation. In the posterior cruciate ligament, the fibers were parallel, whereas they were diverging and twisted in the anterior cruciate ligament, causing volume-averaging artifacts. A focal area of signal increase was found in 29 of the 38 ligaments. In 17 of these 29 ligaments, mucoid and/or eosinophilic degeneration was found that appeared to have caused the focal MR signal change. In nine ligaments without focally increased signal on the MR images, only one had histologic evidence of degeneration. The predictive value of an abnormal finding on MR was 59%, and the predictive value of a normal finding on MR was 89%. The relationship between increased signal on MR and histologic degeneration was statistically significant (chi 2 test, p = .0126). CONCLUSION: The differences in the MR appearances of the anterior and posterior cruciate ligaments probably are due to differences in gross architecture. Increased MR signal within the cruciate ligaments occurring in elderly patients often can be attributed to degenerative changes.

Aged↗
PubMed1992

Injuries of the superior portion of the glenoid labrum involving the insertion of the biceps tendon: MR imaging findings in nine cases.

The goal of this investigation was to describe the MR appearance of traumatic fraying or detachment of the superior portion of the glenoid labrum including the insertion of the tendon of the long head of the biceps. This condition is caused either by an acute injury or by repeated overhead motion during participation in sports. In nine patients with such a lesion, the arthroscopic report and MR images were available for review. These patients were 22-64 years old (mean, 38). In four patients only fraying was noted during arthroscopy, in four patients the superior part of the labrum was detached together with the insertion of the biceps tendon, and in one case there was a bucket-handle tear of the superior portion of the labrum. The MR images were retrospectively evaluated by three osteoradiologists in conference. Signal changes within the labrum and detachment of the labrum were noted, and the findings were compared with the results of arthroscopy. MR imaging did not allow recognition of simple fraying. In two of the five cases with arthroscopic findings of detachment of the superior labrum from the glenoid rim, differentiation between complete and partial labral detachments was not possible even with MR arthrography. However, in these cases the patient's age and history led to the correct diagnosis. We conclude that early traumatic abnormalities of the superior portion of the labrum cannot be detected with MR imaging. Complete detachment, however, can be demonstrated if the patient's age and history are taken into consideration.

Adult↗