The Diabetic Foot: MRI Spectrum of Bilateral Soft Tissue Changes in Correlation with X-Rays

Principal Investigators:  Claude Pierre-Jerome MD, P.D, Valeria Moncayo MD, Michael R. Terk MD
Co- Investigators: Usama Albastaki M.D. (Sahlgrenska University Hospital, Sweden)

Purposes: 1) to assess the soft tissue changes in the diabetic foot in correlation with X-Rays and 2) to present a protocol for the bilateral MR imaging of the diabetic foot.

Materials and Methods: We examined sixteen patients -9 men and 7 women- with clinically confirmed diabetes mellitus. All were Caucasians with an age ranged between 22 and 69 years. The disease duration from the time of the diagnosis and MR examination varied from 1 to 14 years. All have signs radiological signs of neuroarthropathy on X-Rays either unilaterally or bilaterally. Bilateral MRI examination of the feet was performed without and with intravenous contrast. The images were analyzed in search for changes in the muscles from the distal leg to the forefoot bilaterally.

MR Distribution of Soft Tissue Injuries on the Wrist in Patients with Acute Trauma and Negative X-Ray

Principal Investigators: Claude Pierre-Jerome MD, PhD, Valeria Moncayo MD, Michael R. Terk MD
Co-investigator: Ryan Buss, EUSOM M3

Purposes: 1) To assess the prevalence of muscle injuries in traumatic wrists with negative x-rays. 2) To demonstrate the conspicuity of MRI in the detection of soft tissue damage.

Material and methods: Patients with history of trauma, negative x-ray and persistent wrist pain.  The population is divided in two subgroups: a)  patients with high velocity trauma and b) patients with chronic repetitive trauma (low velocity). Evaluation of  MR images  searching for  injury of thenar eminence, hypothenar eminence, lumbricals, interosseous and pronator quadratus muscles. Assessment of the distribution and prevalence of muscle injuries on MR images in 3 planes using images with and without fat saturation.

MR Distribution of Bone Injuries in Patients with High and Low Velocity Trauma of the Wrist

Principal Investigators: Claude Pierre-Jerome MD, PhD, Valeria Moncayo MD, Michael R Terk MD
Co-Investigator: Ryan Buss, EUSOM M3

Purposes: 1) To assess the prevalence of bone injuries in traumatic wrists with negative x-rays. 2) To demonstrate the differences in appearance of bone damage from high velocity versus low velocity trauma using MRI.

Material and methods: Patients with history of trauma, negative x-ray and persistent wrist pain. The population is divided in two subgroups: a)  patients with high velocity trauma and b) patients with chronic repetitive trauma (low velocity). Evaluation of  MR images  searching for  occult lesions (contusions and fractures) in the carpus, base of metacarpals and distal forearm. Correlation of distribution of these lesions and type of trauma.

Variations in Normal Sternoclavicular Joints; A Retrospective Study to Quantify SCJ Asymmetry
 
Principal Investigators: Michael R. Terk, MD, Daymen Tuscano, MD, Sima Banerjee, MD
 
Abstract: A wide degree of normal anatomical variation can occur at the sternoclavicular joint (SCJ). On occasion, this has lead to concern for a pathological process, potentially resulting in a costly work up, unnecessary patient worry and invasive procedures such as biopsy. The purpose of this study is to determine the normal range of anatomical variation at SCJ. 104 consecutive patients with chest CT done at our institution were selected. The Mean age was 59.2 years and there were 55 females and 49 males. We measured the SCJ space, maximum clavicular head diameter within the joint and the distance from manubrium to anterior margin of clavicular head. We subtracted the left side measurements from the corresponding right side measurements to calculate the delta or asymmetry for each case. Both sides of the joints were reviewed for presence of intra-articular gas, calcifications and any gross irregularity. Left and right SCJ space ranged from 0.2 to 1.37 cm. The delta between left SCJ space and right SCJ space ranged from 0(symmetrical) to 0.57cm in the 104 cases. Left and right clavicular head diameter ranged from 1.2 to 3.7 cm and delta from 0 to 1cm. Manubrium to anterior margin of clavicular head ranged from 0.1 to 2.13cm with delta from 0 to 0.8cm. 33 patients had air in joint. 14% had maximal asymmetry in MCA and 11% in clavicular head size. Greater then 10% of patients show substantial asymmetry in sternoclavicular joints, which may be misinterpreted as pathological

Meniscus Tear Detection at 1.5 Tessla Vs 3 Tessla

Principal Investigators: Michael R. Terk, MD, Sima Banerjee, MD

Abstract: Accurate meniscus tear detection on MRI allows for appropriate surgical planning. With 3T we have higher signal to noise ratio and better resolution. The purpose of this study is compare sensitivity and specificity levels for meniscus tear detection at 1.5T and 3T with arthroscopy results as the gold standard. Preliminary data analysis shows higher sensitivity for 1.5T than 3T.

Complications of Acute Cruciate Ligament Reconstructions: MRI Evaluation

Principal Investigators:  Michael R. Terk, MD, Claude Pierre-Jerome MD, PhD, Sima Banerjee, MD

Abstract: Complications of ACL reconstruction include, poor positioning of graft, graft tear, impingement, screw displacement, arthrofibrosis and tunnel enlargement. The purpose of this study is to describe the MR findings associated and distribution of complications by patient age, graft age, history of trauma and level of activity. We looked at 61 patients with pain after graft reconstructions and MRI performed at our institute. We found the commonest complications are graft tear and impingements which are easily detected on MR. We found a higher level of graft tear in grafts less then a year old as compared to older grafts, higher levels of re tear in women and patients less then 35. On MR we saw evidence of all the complications described and cases of symptomatic cysts secondary to failure of bioabsorbable screw absorption.

How Big is Your Navicular? A Study to Correlate Size of Accessory Navicular Bone to Symptoms and Imaging

Principal Investigators: Michael R. Terk, MD, Sima Banerjee, MD

Abstract: Accessory navicular bones are associated with medial foot pain and posterior tibial tendon dysfunction leading to pes planus. The purpose of this study is to correlate the three types of A/N with presence or absence of symptoms and presence of symptoms with MR Findings. We find, contrary to past literature, a high level of symptomatic type I accessories and the classic MR findings associated.

Patella Alta: Lack of Correlation between Patellotrochlear Cartilage Congruence And Commonly Used Patellar Height Ratios

Principal Investigator: Syed A Ali, MD
Co-Investigators: Michael R Terk, MD

Objective: To assess the degree of Patellotrochlear chondral overlap (Patellotrochlear Index) as an indirect measure of contact area correlated to the Insall Salvati Index and the Modified Insall Savati Index.

Materials and Methods:1.5T/3.0T MR Images of 100 consecutive patients with various pathological knee conditions were analyzed. The Insall Salvati Index, Modified Insall Salvati Index and Patellotrochlear Index and Patellar-Physeal Index (new ratio determining the length of the patella lying above the femoral physeal line) were measured on the sagital MR images. The distribution of the patellar height ratios were evaluated and two standard deviations were used to define patella alta and baja. Correlation coefficient curves were plotted and the correlation coefficients were calculated to compare each technique.

Results: The mean Patellotrochlear Index was 0.49 (range 0 to 0.88, SD +/-0.15). Based upon calculation of the two standard deviations, patella alta and baja was determined as less than 0.18 and greater than 0.80 respectively. There was a weak correlation between the measured Patellotrochlear Index and Insall Salvati Index r = -0.224, and Patellotrochlear Index and Modified Insall Salvati Index r = -0.073. A strong correlation was seen between the Patellotrochlear Index and Patellar Physeal Index r = - 0.8123.

Conclusion: Our results indicate that the commonly used Insall Salvati Index and Modified Insall Salvati Index measurements do not correlate to the patellotrochlear articular cartilage congruence and hence fail to accurately assess premorbid anatomy.

Morphological Analysis of the Patellofemoral Region on MRI: Association with Articular Cartilage Defects

Principal Investigator: Syed A. Ali MD
Co-Investigators: Robert Helmer MD, Michael R Terk MD

Purpose: To assess patellofemoral measurements on MR Imaging and to correlate the measurements with different grades of cartilage defect.

Methods and Materials: Axial and sagittal MR images of one hundred subjects with various pathological knee conditions were analyzed. The patients were divided into two age groups: < 40years and > 40years. Patellar measurements of facet asymmetry (PFA), patella to patellar tendon ratio (ISI) and amount of patellotrochlear cartilage overlap (PTI) were measured in each subject. Similarly, trochlear measurements of ventral trochlear prominence (VTP), trochlear depth (TD), facet asymmetry (TFA), sulcus angle (SA) and lateral inclination (LTI) were measured. Axial and sagital MR images were reviewed to grade the severity of focal cartilage defects in the patellofemoral region based on the depth of the lesion. Measurements in knees without chondral defect were compared with knees with mild and severe chondral defects.

Results: There was a statistically significant difference in the trochlear measurements of ventral prominence (p=0.0123), trochlear depth (p=0.0017), sulcus angle (p=0.0030) and lateral inclination (p=0.0065) between knees with normal and severe cartilage defects in patients less than 40 years. No significant difference was seen in patellar measurements between knees with normal and severe cartilage defects.

Conclusion: We established the role of abnormal trochlear morphology as being a risk factor in the etiology of patellofemoral cartilage defects.  Hence in young patients with trochlear dysplasia, we recommend an early assessment of the patellofemoral articular surface cartilage with MRI.

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