Introduction To determine the inter-observer reliability of ultrasound measurements and grading of rotator cuff and shoulder joint disease in patients with inflammatory arthritis. Methods Both shoulders of 50 patients (56 ± 18 years, 39F:11M) with inflammatory arthritis, being treated with biologics, were scanned by two experienced radiologists. Rotator cuff and articular surface features in the shoulder joint were measured and graded using previously published ultrasound scoring methods. The inter-observer agreements for rotator cuff tendon, glenohumeral joint (GHJ) and subacromial subdeltoid bursal (SSB) measurements were obtained with intraclass correlation coefficients (ICC) for continuous data. Those for the grade of rotator cuff tendon tear, humeral head (HH) and acromio-clavicular joint (ACJ) appearances were analysed with kappa ( K) statistics for categorical data. Results Moderate inter-observer agreement (ICC = 0.58, P ≤ 0.01) was shown for the supraspinatus tendon thickness. Poor agreement (ICC < 0.49) was found for the thickness of the subscapularis ( P ≤ 0.01), infraspinatus ( P ≤ 0.05) and biceps tendons. There was excellent agreement for the SSB thickness (ICC = 0.88, P ≤ 0.01) and poor agreement for GHJ distance. Moderate agreement ( K = 0.57, P ≤ 0.01) for grading of a supraspinatus tendon tear was found while excellent agreement for the subscapularis ( K = 0.81, P ≤ 0.01), infraspinatus and biceps (both K = 1, P ≤ 0.01) tendons was noted. The most common agreement occurred for no tear or a complete tear. Poor agreement ( K < 0.49) was demonstrated for grading of HH erosions and ACJ appearances. Conclusion Ultrasound measurement of the subacromial subdeltoid bursa was reliable between observers, as was detection of the presence or absence of a complete rotator cuff tendon tear. Reliability was limited for measurements of rotator cuff tendon thickness, grading partial tendon tears or identification of subtle shoulder joint pathology.
Fluid in the subcutaneous fat is a common finding anterior to the knee on MRI. This may be caused by chronic low-grade shearing injuries in patients who are overweight. The purpose of this study was to determine if there is a difference in the amount of subcutaneous fat around the knee between patients with these appearances and controls.This was a retrospective case-control study. Following a sample size calculation on pilot data, eighteen sequential patients demonstrating hyper-intense subcutaneous signal changes around the knee on fat-saturated T2-weighted MRI were identified from PACS (18 females, mean age 45, range 31-62). Age and gender-matched patients without abnormal T2 MR signal changes were selected. Two observers independently drew regions of interest representing cross-sectional areas of bone and fat. The location of T2 signal hyper-intense lesions was characterized by consensus.Inter and intra-rater intraclass reproducibility was "excellent" (ICC > 0.8). The mean cross-sectional area of bone for patients with T2 hyper-intense lesions was 31.79cm2 (SD 2.57) and for controls 30.11cm2 (SD 3.20) which was not significantly different (p = 0.09). The median cross-sectional area of fat for the study group was 62.29cm2 (IQR 57.1-66.5) and for controls was 32.77cm2 (IQR 24.8-32.3) which was significantly different (p < 0.0001). Consensus agreement demonstrated all T2 hyper-intense lesions were anterior to the knee extensor mechanism.Subcutaneous fluid around the knee is associated with an increased amount of subcutaneous fat, anterior to the knee extensor mechanism. This may be caused by shearing injuries in fat with reduced elasticity associated with metabolic syndrome.
The aim of this review is to describe the clinical, histopathologic, and MRI features of aseptic lymphocytic vasculitis-associated lesions in total hip replacements.The introduction of modern metal-on-metal hip arthroplasty has been accompanied by a newly described disease, aseptic lymphocytic vasculitis-associated lesions, which is characterized histologically by bland necrosis and dense perivascular lymphocytic infiltrates. Conventional radiographic findings are often normal, but the typical MRI findings include periprosthetic fluid collections, soft-tissue masses, gluteal tendon avulsion, bone loss, periosteal stripping, neurovascular involvement, and periprosthetic fractures. The severity of the histologic and MRI appearances can be graded according to defined published criteria.
Metal-on-metal (MoM) total hip arthroplasties (THAs) have been linked with increased incidence of pseudotumours and revision rate. magnetic resonance imaging (MRI) is useful in diagnosing adverse reaction to metal debris (ARMD) disease but it is not known if MRI findings correlate with cup position.From a cohort of 79 MoM THA, 34 MRI studies were available. MRI was classified according to Anderson classification. Mean follow-up was 7.1 years. Evaluation included cup position including margin of safety, measurement of metal ion levels and evaluation of function.44% of patients had definite ARMD. We did not find any correlation between MRI stage and Co, Cr, margin of safety (MOS) or functional scores. However, patients with a margin of safety angle < 21° had more severe findings in MRI.Patients with MoM THA experience high degree of ARMD. In our study, the disease did not correlate with metal ion levels but correlated with cup position, evaluated with the MOS angle.
Major advances have been made in CT technology since its introduction 30 years ago. Examination time has been markedly reduced and it is possible to cover considerably larger scan ranges. Multidetector technology now allows near isotopic imaging with the ability to perform high quality multiplanar reconstructions. It is also now possible to image in well defined vascular phases. In this article we share our experience in the use of multislice CT and detail protocols used in imaging of the abdomen.
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