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Biomedical subjects

V P Chandnani

Publications and source records attributed to V P Chandnani.

At least 19 recordsLinked to original sources
PubMed1998

MR arthrography of the ankle.

Injuries to the lateral ankle ligaments are extremely common. Many patients with acute injuries to the lateral ligament complex develop chronic ankle instability that requires surgical intervention. MR arthrography of the ankle plays a valuable role in identifying those patients who are most at risk for the development of chronic instability. MR arthrography of the ankle also aids in preoperative planning and in differentiating among other entities that can present as ankle instability.

Ankle Injuries↗
PubMed1998

Magnetic resonance imaging arthrography of the ankle.

Magnetic resonance imaging (MRI) arthrography of the ankle is a useful diagnostic modality in the detection and staging of lateral ankle ligament tears, particularly in patients who fail to respond to conservative management. MRI arthrography also may be helpful in determining the extent of ligamentous injury in professional athletes, for whom immediate surgical repair may be the initial treatment. Preoperative planning is optimized with MRI arthrography. Frequently, alternative diagnoses may be made for conditions that can simulate lateral ligamentous injury, thus obviating the need for diagnostic arthroscopy.

Ankle Injuries↗
PubMed1997

Incidence and methods of diagnosis of musculoskeletal injuries incurred in Operations Desert Shield and Desert Storm.

RATIONALE AND OBJECTIVES: The authors studied the incidence and distribution of orthopedic injuries sustained in Operation Desert Shield and Desert Storm by evaluating whether existing diagnostic imaging modalities were sufficient to diagnose the types of musculoskeletal injuries incurred. The authors also sought to determine if a dedicated extremity MR scanner would provide monetary benefits and enhance military readiness. METHODS: The authors retrospectively reviewed data on all musculoskeletal injuries incurred in Desert Shield/Desert Storm to determine the total number of injuries, proportion of orthopedic injuries, number of soft-tissue orthopedic injuries, and the country where the diagnosis was established. The authors also determined the number of patients, duration, and economic impact of the evacuation process. RESULTS: There were 1011 fractures and 1177 soft-tissue injuries; 408 soft-tissue injuries were diagnosed in the Persian Gulf countries, and 769 diagnosed in the United States and Germany. The average time to evacuate these 769 patients was 21 days with an estimated replacement cost of $836,885. CONCLUSIONS: Musculoskeletal soft-tissue injuries comprised 34% of the overall injuries in the Persian Gulf War, and twice as many patients required evacuation for diagnosis as were diagnosed locally using existing imaging modalities. A dedicated extremity magnetic resonance scanner in the battlefield would obviate many evacuations and hence be of both monetary and military readiness benefit.

Fractures, Bone↗
PubMed1996

Ribbing disease (multiple diaphyseal sclerosis): imaging and differential diagnosis.

OBJECTIVE: This study describes the clinical presentation and the course of Ribbing disease in six patients and illustrates imaging features on plain radiography, conventional and computed tomography, and 99mTc-methylene diphosphonate bone scans. MATERIALS AND METHODS: Between 1982 and 1990, six female patients presented with painful bony lesions that were believed to be Ribbing disease. Ten bones were affected: both tibiae in three patients, a unilateral tibia in one, both femora in one, and a unilateral femur in one. Plain radiographs and either conventional or computed tomography were available for all patients and 99mTc-methylene diphosphonate bone scans, for five patients. All patients underwent open biopsy and/or surgical decompression. RESULTS: The diagnosis was reached in all patients through a combination of clinical findings (lack of systemic signs of infection or laboratory values suggesting metabolic bone disease), imaging, histologic evaluation, and specimen cultures. Radiographs and tomographic studies showed benign-appearing endosteal and periosteal cortical thickening. Intense uptake of radionuclide tracer was confined to the shaft of all involved bones. All pathologic specimens revealed nonspecific changes that included a slow increase in the mass of cortical and endosteal bone. These specimens also assisted in excluding neoplastic or infectious causes for the new bone formation. CONCLUSION: Ribbing disease is a rare disorder that, on imaging studies, may simulate stress fracture, chronic infection, bone-forming neoplasia, or a systemic metabolic or endocrine disorder. Clinical and imaging features may suggest the correct diagnosis.

Adult↗
PubMed1995

Tropical pyomyositis.

A 22-year-old male presented with symptoms of diffuse muscle pain and multiple abnormal laboratory findings that were eventually attributed to tropical myositis. Computed tomography scan was more reliable than ultrasound and served as a guide to needle aspiration and pathologic diagnosis.

Adult↗
PubMed1995

Partial thickness supraspinatus tears: diagnosis by magnetic resonance arthrography.

Two patients, with clinical symptoms of advanced impingement syndrome, presented for radiologic evaluation. The magnetic resonance (MR) images of each patient were interpreted as representing a full thickness tear of the supraspinatus tendon. Magnetic resonance arthrography was performed on both patients to further determine the extent of the tear. Using this technique, both patients were diagnosed correctly as having partial thickness tears; one on the articular surface and the other on the bursal surface of the tendon. This information is useful in surgical planning and in patient outcome.

Adult↗
PubMed1995

Glenohumeral ligaments and shoulder capsular mechanism: evaluation with MR arthrography.

PURPOSE: To evaluate the efficacy of magnetic resonance (MR) arthrography in identification of the glenohumeral ligaments (GHLs) and to determine the location of abnormalities of the GHL, joint capsule, and labrum. MATERIALS AND METHODS: MR arthrograms were evaluated retrospectively in 46 patients with a history of shoulder instability, impingement syndrome, or pain of unknown cause. Imaging findings were correlated with surgical observations. RESULTS: The superior, middle, and inferior GHLs were identified on MR arthrograms in 39 (85%), 39 (85%), and 42 (91%) of the 46 patients, respectively. In diagnosis of tears of the superior, middle, and inferior GHLs, MR arthrography had a sensitivity of 100%, 89%, and 88% and a specificity of 94%, 88%, and 100%, respectively. CONCLUSION: Findings at MR arthrography can help accurate identification and demonstration of the integrity of the GHL and labrum and can help in staging of abnormalities. The large number of abnormalities depicted in the middle and inferior GHLs suggests that both might be important in the maintenance of glenohumeral joint congruity.

Adult↗
PubMed1994

Shoulder impingement syndrome: diagnostic accuracy of magnetic resonance imaging and radiographic signs.

Shoulder impingement syndrome is commonly encountered in orthopaedics. In a blinded retrospective study, magnetic resonance imaging and roentgenographic signs in 41 patients with clinical signs of impingement syndrome were compared with 40 control patients. Statistically significant differences between the groups included the absence of subarcromial fat, as well as the presence of a supraspinatus tear, subacromial osteophytes, and a decreased coracohumeral distance. Other signs reported to occur in patients with impingement syndrome did not vary significantly in the population studied.

Adult↗
PubMed1994

Chronic ankle instability: evaluation with MR arthrography, MR imaging, and stress radiography.

PURPOSE: To compare the efficacy of conventional magnetic resonance (MR) imaging, MR arthrography, and stress radiography in the detection of lateral collateral ligament abnormalities in patients with chronic ankle instability. MATERIALS AND METHODS: Seventeen patients with chronic lateral ankle instability underwent stress radiography, MR imaging, and MR arthrography after intraarticular injection of gadopentetate dimeglumine. Imaging findings were correlated with surgical findings. RESULTS: The anterior talofibular (ATF) ligament was torn in 14 patients, and the calcaneofibular (CF) ligament was torn in 10. MR arthrography was more accurate and sensitive in the detection of ATF tears than was MR imaging or stress radiography (P < or = .05). Associated injuries were detected with both MR imaging and MR arthrography. CONCLUSION: MR arthrography is a sensitive technique for detecting and staging tears of the lateral collateral ligaments.

Adult↗
PubMed1994

Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography.

OBJECTIVE: Chondromalacia patellae is a condition characterized by softening, fraying, and ulceration of patellar articular cartilage. We compare the sensitivity, specificity, and accuracy of conventional MR imaging, MR arthrography, and CT arthrography in detecting and staging this abnormality. SUBJECTS AND METHODS: Twenty-seven patients with pain in the anterior part of the knee were prospectively examined with MR imaging, including T1-weighted (650/16), proton density-weighted (2000/20), T2-weighted (2000/80), and spoiled two-dimensional gradient-recalled acquisition in the steady state (SPGR/)/35 degrees (51/10) with fat saturation pulse sequences. All were also examined with T1-weighted MR imaging after intraarticular injection of dilute gadopentetate dimeglumine and with double-contrast CT arthrography. Each imaging technique was evaluated independently by two observers, who reached a consensus interpretation. The signal characteristics of cartilage on MR images and contour abnormalities noted with all imaging techniques were evaluated and graded according to a modification of the classification of Shahriaree. Twenty-six of the 54 facets examined had chondromalacia shown by arthroscopy, which was used as the standard of reference. The sensitivity, specificity, and accuracy of each imaging technique in the diagnosis of each stage of chondromalacia patellae were determined and compared by using the McNemar two-tailed analysis. RESULTS: Arthroscopy showed that 28 facets were normal. Grade 1 chondromalacia patellae was diagnosed only with MR and CT arthrography in two (29%) of seven facets. Intermediate (grade 2 or 3) chondromalacia patellae was detected in two (13%) of 15 facets with T1-weighted and SPGR MR imaging, in three (20%) of 15 facets with proton density-weighted MR imaging, in seven (47%) of 15 facets with T2-weighted MR imaging, in 11 (73%) of 15 facets with CT arthrography, and in 12 (80%) of 15 facets with MR arthrography. Grade 4 was detected in three (75%) of four facets with T1-, proton density-, and T2-weighted MR imaging, two (50%) of four facets with SPGR MR imaging, and four (100%) of four facets with MR and CT arthrography. Thus, all imaging techniques were insensitive to grade 1 lesions and highly sensitive to grade 4 lesions, so that no significant difference among the techniques could be shown. CONCLUSION: All imaging techniques studied had high specificity and accuracy in the detection and grading of chondromalacia patella; however, both MR arthrography and CT arthrography were more sensitive than T1-weighted, proton density-weighted, and SPGR with fat saturation MR imaging for showing intermediate grades of chondromalacia patellae. Although the arthrographic techniques were not significantly better than T2-weighted imaging, the number of false-positive diagnoses was greatest with T2-weighted MR imaging.

Adult↗
PubMed1994

Achilles tendon and miscellaneous tendon lesions.

Abnormalities of the tendons of the foot and ankle are quite common and their number seems to be increasing. Commonly involved tendons include the Achilles and peroneal tendons; the tibialis anterior and flexor hallucis longus tendons are involved less commonly. Magnetic resonance imaging is well suited to imaging these abnormalities. It is a noninvasive modality that uses no ionizing radiation. It has the capability of imaging in any plane, which is well suited to imaging the tendons of the ankle because their course is not in standard orthogonal planes. MR imaging provides excellent soft tissue contrast and is well able to differentiate the tendons from surrounding fat as well as to detect the presence of hemorrhage and edema. Abnormalities of these tendons include complete and partial tears as well as tendinitis and tenosynovitis. These abnormalities are usually secondary to trauma or to mechanical irritation or synovial inflammation. They can be diagnosed routinely and confidently by MR imaging. Complete tears may be seen as a discontinuity within the substance of a tendon with interposed edema or hemorrhage. Partial tears may be seen as increased signal within a tendon that extends to a surface. Tendinitis is manifested by thickening of the tendon with intratendinous signal that does not extend to its surface.

Ankle Injuries↗
PubMed1993

Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography.

OBJECTIVE: We prospectively compared MR imaging, MR arthrography, and CT arthrography to determine the sensitivity of each technique in detecting glenoid labral tears and in determining whether the labrum is detached or degenerated. SUBJECTS AND METHODS: Thirty patients 19-39 years old (mean, 27 years old) who had either signs and symptoms of shoulder instability or shoulder pain of unexplained origin were referred for diagnostic imaging. Each patient underwent MR imaging, followed by MR arthrography after intraarticular injection of 25 ml of a dilute solution of gadopentetate dimeglumine. Twenty-eight of thirty patients underwent CT arthrography after intraarticular injection of air and radiographic contrast material. Each patient also underwent arthroscopy or open surgery. RESULTS: At surgery, labral tears were found in 28 patients; a detached fragment was found in 26 patients. The labrum was found to be degenerated in 18. A labral tear was detected on MR images in 26 (93%) of 28, on MR arthrograms in 27 (96%) of 28, and on CT arthrograms in 19 (73%) of 26. A detached labral fragment was detected on MR images in 12 (46%) of 26, on MR arthrograms in 25 (96%) of 26, and on CT arthrograms in 13 (52%) of 25. Labral degeneration was detected on MR images in two (11%) of 18, on MR arthrograms in 10 (56%) of 18, and on CT arthrograms in four (24%) of 17. MR arthrography was the best of the three imaging techniques for showing the inferior part of the glenoid labrum and inferior glenohumeral ligament. CONCLUSION: MR arthrography and MR imaging both showed labral tears with greater sensitivity than CT arthrography did. MR arthrography was the most sensitive of the three techniques for detecting a detached labral fragment and labral degeneration. Furthermore, MR arthrography afforded the best visualization of the inferior part of the labrum and the inferior glenohumeral ligament. MR imaging and MR arthrography also enabled direct visualization of rotator cuff disease and other unsuspected associated abnormalities.

Adult↗
PubMed1991

Magnetic resonance imaging detection of early experimental periostitis. Comparison of magnetic resonance imaging, computed tomography, and plain radiography with histopathologic correlation.

This study characterizes the appearance of periosteal reaction by magnetic resonance imaging (MRI), and evaluates the efficacy of MRI versus computed tomography (CT), and plain film radiography (PF) in detecting early, experimentally induced periostitis. Acute Staphylococcus aureus osteomyelitis was induced in 30 legs of 20 New Zealand white rabbits. The rabbits were then imaged with MR, contrast-unenhanced CT, and PF 4 days after infection. Histologically, periosteal elevation was present in 27 cases. Periosteal ossification was seen in 23 cases, and cellular reaction without ossification in 4 cases. Periosteal reaction was demonstrated by PF in 21 (78%) and by CT in 20 (74%) cases. Evidence of periostitis was seen by MR in all 27% (100%) cases. MR resulted in two false-positive diagnoses. Multiple concentric, alternating high and low signal arcs demonstrated by MR in 19 (70%) cases represented periosteal ossification surrounded by fibrous or granulation tissue. These findings demonstrate the ability of MR to detect periostitis despite the absence of periosteal ossification. MR was more sensitive than CT (P less than .05) or PF (P less than .05) in the detection of experimentally induced periostitis.

Acute Disease↗
PubMed1991

Knee hyaline cartilage evaluated with MR imaging: a cadaveric study involving multiple imaging sequences and intraarticular injection of gadolinium and saline solution.

Magnetic resonance (MR) imaging of cadaveric knees was performed to determine optimal sequences for visualization of hyaline cartilage. Six fresh-frozen cadaveric knees were imaged with a 1.5-T imager by means of standard and hybrid fat suppression (HFS) spin-echo techniques, with and without intraarticular injection of saline solution and gadopentetate dimeglumine. The knees then were sectioned at 4-mm intervals. Both the real and the imaged cartilage thicknesses were measured. Areas of cartilage thinning and focal defects seen in the cadaveric sections were most accurately matched, in both the presence and the absence of intraarticular saline solution simulating joint fluid, by images obtained with the T1-weighted HFS sequences. Accurate imaging of hyaline cartilage thickness with differentiation of cartilage from fluid was possible routinely. Standard and HFS spin-echo images obtained after intraarticular injection of gadopentetate dimeglumine depicted cartilage less accurately than HFS sequences either with or without saline injection. MR imaging with T1-weighted HFS sequences provided superior visualization of cartilage, enabling accurate measurements of cartilage thickness and differentiation of cartilage from saline solution simulating joint fluid.

Cartilage, Articular↗
PubMed1991

Diagnostic imaging of osteosarcoma.

The diagnosis, treatment planning, and follow-up evaluation of osteosarcoma rely heavily on a variety of imaging techniques. Plain roentgenography, radionuclide bone scanning, computed tomography, and magnetic resonance imaging play important roles in defining local tumor extent, detecting metastatic disease, and monitoring for recurrent tumor. Invasive studies such as angiography are now rarely necessary. In the future, newer imaging modalities, including positron emission tomography, can be expected to become important tools for evaluation of these tumors.

Angiography↗