OBJECTIVE:To observe the necessity and usefulness of follow-up Magnetic Resonance Imaging (MRI) and Computed Tomography Imaging (CTI) after RFA of osteoid osteoma.STUDY DESIGN:A descriptive study.PLACE AND DURATION OF STUDY:Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey, between May 2015 and January 2020.METHODOLOGY:Patients, who underwent CT-guided RFA for osteoid osteoma treatment, were followed-up both clinically and radiologically. MRI was recommended between the third and sixth months and CTI at 12th month or later for follow-up. All the pre and post-treatment radiological images were evaluated retrospectively. Radiological recovery was noted in three categories as complete/almost-complete, partial, and minimal-no recovery according to the healing of pre-treatment radiological findings.RESULTS:One-hundred and thirty-one patients with at least one follow-up CT or MRI were included. All had technically and clinically successful RFA treatments. Of 131 patients, 64.1% had CTI and 82.4% had MRI follow-up. In follow-up images, complete/almost-complete-recovery was observed in 70.2%, partial recovery in 26.7%, and minimal recovery in 3.1% of the cases. Re-ablation therapies were applied in 2 cases in this study due to pain recurrence after three months of successful treatments.CONCLUSION:Radiological follow-up is beneficial for the evaluation of outcome after RFA of osteoid-osteoma. At least one follow-up MRI may be helpful for the assessment of healing or recurrence. Follow-up CTI may not be needed unless planning a re-ablation.KEY WORDS:Osteoma osteoid, Radiofrequency ablation, Tomography, Magnetic resonance imaging.

BACKGROUND: The objective of the study is to compare the clinical results of the single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) repairing techniques using magnetic resonance imaging (MRI). METHODS: Thirty-eight patients were randomized by block randomization into two different groups of ACL reconstruction: DB (n=19) and SB techniques (n=19). MRI evaluation and clinical examination with modified Cincinnati Knee Rating Score and Lysholm knee scores were performed pre-operatively and at the end of a follow-up period of 36 months. RESULTS: No significant differences were found in the ACL angle, posterior cruciate ligament angle, and tibial translation between the DB and the SB groups. Regarding the clinical scores, there were no significant differences between the techniques. As for the correlation of radiologic results with clinical scores in the SB group, there was a strong and significant correlation between the post-operative ACL angle values and the Lysholm clinical score (r=-0.66; p=0.002). CONCLUSION: The post-operative ACL angle can predict the degree of clinical recovery in patients undergoing SB ACL reconstruction.

Background Iliotibial band friction syndrome (ITBFS) is an overuse injury of the lateral aspect of the knee. This syndrome classically affects the active young population. Purpose To determine the diameter of the ITB using magnetic resonance imaging (MRI) in patients clinically diagnosed with ITBFS, compare the results with asymptomatic patients, and assess the inter-observer agreement between a senior and a junior radiologist with different levels of experience in musculoskeletal imaging. Material and Methods From April 2014 to October 2019, 78 knee MRI scans of 78 patients were included in the study group who were referred from the orthopedic clinic with a clinical diagnosis of ITBFS. In the control group, there were 114 knee MRI scans of 114 patients who had knee MRI for various reasons and had no radiological abnormality on the performed knee MRI. The ITB diameters, cut-off values, and interclass correlation coefficient (ICC) were calculated. Results Mean thickness of the ITB was higher in the study group compared to the control group in measurements done by both the senior and junior radiologists and this was statistically significant ( P < 0.001). Cut-off values of the diameters of the ITB were calculated as 2.385 for the senior radiologist and 2.420 for the junior radiologist. ICC of 0.80 was determined, which showed excellent agreement among interpreters. Conclusion ITB thickness in the study group was significantly higher than in the control group. There was also excellent agreement among the two observers. Measurement of ITB thickness on axial plane knee MRI is one of the reliable criteria for ITBFS.

The Stieda process (SP) and os trigonum (OT) are primary risk factors for posterior ankle impingement syndrome. The aim of this study was to elucidate the prevalence of the elongated lateral tubercle of the posterior talar process (SP) and OT in Turkish subjects using lateral ankle radiographs. In this study, 1088 ankle radiographs in the lateral view were evaluated retrospectively using a picture archiving and communication system at two large medical centers. Subjects with a history of mild-to-moderate trauma were selected from the emergency departments of both hospitals from January to June 2019. Data on the presence of SP and OT, the side of the foot that was evaluated, sex, and age were recorded. The prevalence of SP and OT was 16.7 % and 9.3 %, respectively, in the Turkish population. The prevalence of SP was significantly higher in men (20.3 %) than in women (12.7 %) (p = 0.001). The prevalence of OT was also significantly higher in men (13.7 %) than in women (4.3 %) (p = 0.000). The SP and OT were found in 17 % and 9.9 % of the right feet, respectively, and 16.4 % and 8.6 % of the left feet, respectively, with no statistical difference. Approximately one-fourth of the Turkish population had SP or OT, which made them susceptible to posterior ankle impingement syndrome. The prevalence of SP was higher than that of OT, and both were more common in men than in women.

To evaluate whether patients with anterior cruciate ligament (ACL) graft tear who do not undergo revision reconstruction surgery are more likely to exhibit osteoarthritic features than patients with intact ACL graft using MRI. We retrospectively evaluated our hospital medical archive for identifying all consecutive patients with ACL graft failure who underwent MRI between January 2015 and January 2019. An equal number of patients with intact ACL graft was selected for the control group. An observer with 6 years of musculoskeletal radiology experience evaluated the baseline and last available follow-up MRIs of the patients for bone marrow lesions (BMLs), cartilage defects, osteophytes, anterior tibial translation, and effusion-synovitis. A total of 130 patients, 118 males (90.8%), and 12 females (9.2%), with the mean age of 29.22 ± 9.3 years, were enrolled in the study. Of 130 patients, 65 had a deficient ACL graft, and 65 had an intact ACL graft. The time from the index injury to the last follow-up MRI was 45 months (IQR, 19) for the study cohort. On the follow-up MRIs, patients with ACL graft deficiency showed more prominent degenerative features compared with the patients with intact ACL graft characterized as follows: higher grades of medial meniscal tears (P = 0.06); higher grades of BMLs in the anteromedial (P = 0.014) and posteromedial (P = 0.006) femur, higher grades of cartilage defects in the medial patella (p = 0.0P); higher grades of osteophytes in the anteromedial (P = 0.018) and central medial femur (p = 0.048), central medial tibia (P = 0.048), and medial patella (P = 0.07); and more frequent anterior tibial translation (P = 0.022). Patients with ACL graft deficiency present with more prominent degenerative features, particularly on the medial side, suggestive of osteoarthritis compared with patients with intact ACL grafts in the medium-term follow-up.

Osteoid osteoma with multiple nidi is a rare condition. The aim of this report is to share a case of an osteoid osteoma with two separate nidi, which underwent radio-frequency ablation (RFA) treatment under CT-guidance for each of the nidi in the same session. A 15-year girl with osteoid osteoma in left tibia was referred to our clinic for percutaneous RFA. She had pain that worsened at nights. The patient was diagnosed as osteoidosteoma, according to radiologic findings and the clinical symptoms. After CT-guided percutaneous RFA of each nidi in the same procedure, pain was relieved in 24 hours. Each of the RFA-treatments was successful in pain control without any complications and no recurrence occurred during eight months of follow-up period. To our knowledge, this case is one of the very few cases with double nidi, which was treated with RFA in one session. RFA is safe in treatment of osteoid osteomas; even two close and separate nidi can safely be treated in the same session. Key Words: Osteoid osteoma, Nidi, Treatment, Radiofrequency ablation.

OBJECTIVE:The purpose of this study was to evaluate an association between fall-related intertrochanteric or femoral neck fractures and gluteus medius and minimus atrophy, furthermore, to find a correlation of whether any difference between femoral neck or intertrochanteric fracture and degree of muscle atrophy MATERIALS AND METHODS: A retrospective review of 230 patients with intertrochanteric or femoral neck fracture, aged > 65 years, and 60 age- matched controls was performed. We assessed gluteus medius and minimus atrophy and calculated the cross-sectional area (CSA) and ratio of lean muscle to adipose infiltration (M/A ratio) for each muscle.RESULTS:The atrophy scores for the g.medius and g.minimus muscles on the fractured side were significantly higher than scores on the healthy side and scores in the control group. The atrophy scores for the g.medius on the healthy side were not significantly different from scores in the control group. The atrophy scores for g.medius were significantly different between the fractured side and the healthy side for all ages, the atrophy scores for g.minimus was significantly different in the patients aged over 75. There was no significant difference in the following parameters between the fractured side and healthy side of the patients aged 65 - 75 years; the atrophy score, CSA and M/A ratio. The patients have a lower CSA and M/A ratio on the fractured side than on the healthy side and lower CSA and M/A ratio than in the control group. However, there were no significant differences in the M/A ratio between the healthy side and the control group. CSA was not significantly different between the fractured side and healthy side in the male patients and in the patients with lower BMI (<30). There was no significant difference in the atrophy scores between subjects with intertrochanteric versus femoral neck fractures, the CSAs of the g.medius and g.minimus were significantly different between the intertrochanteric fracture and femoral neck fracture groups.CONCLUSIONS:The fractured sides showed greater g.medius and g.minimus muscle atrophy, which may be a predictor of fall-related hip fractures in the elderly. Gluteal muscle volume may be associated with proximal femur fracture subtype.

Developmental dysplasia of the hip (DDH) is still one of the biggest orthopedic problems in the world. Global poverty and refugee crises have led to it becoming a greater issue even in developed nations. Early diagnosis and effective treatment of DDH are required to prevent the possibility of arthrosis, limb shortening, pelvic asymmetry, and vertebral scoliosis. In late cases, surgery is the only choice for correction. Direct radiography has been used for many years and continues to have an important role, though ultrasonography is the primary source for early postnatal screening. Although magnetic resonance imaging (MRI) has become an important modality to provide sectional imaging in many cases, in late-period dysplasia, computed tomography (CT) and three-dimensional (3D) CT are preferred because it can more effectively demonstrate the cortical bony structures. The aim of this review was to demonstrate the effectiveness of 3D CT and multiplanar reconstruction based on previous studies.

Objectives: The aim of the study was to evaluate magnetic resonance imaging (MRI) findings of iliotibial band friction syndrome (ITBFS) and its association with patellar height and facet shape variations. Patients and Methods: Forty-one knees of 32 patients (14 female, 18 male) referred from the orthopedic surgery outpatient clinics with the MRI diagnosis of ITBFS composed the study group. Thirty two knees of 29 patients (13 female, 16 male) with MRI records without any radiologic findings of knee pathology were chosen as the control group. All of the patients were evaluated by MRI, including the assessments of patellar length ratios according to Insall-Salvati method and patellar facet variations according to Wiberg’s classification. Results: According to Wiberg’s classification, nine knees (21.9%) had type I, 20 (48.8%) had type II, and 12 (29.3%) had type III shape of patella in the study group. Wiberg type I and type III patella ratio in the IBFS group was higher than the control group (P < 0.001, and P = 0.003, respectively). Wiberg type II patella ratio in the IBFS group was lower than the control group (P = 0.006). Ten knees (24.3%) had patella alta and the remaining 31 had patella norma (75.7%) in the study group. The frequency of patella alta was significantly higher in the study group in comparison with the controls (P = 0.002). Conclusion: ITBFS can easily be diagnosed by MRI and it is more likely associated with patella alta and type I and III patella according to Wiberg’s classification.

Objective: Today, magnetic resonance imaging (MRI) procedures used to detect and measure articular hyaline cartilaginous defects are being increasingly investigated. In this study, we evaluated the sensitivity and diagnostic efficiency of MRI in the detection of particularly advanced cartilage pathologies compared to the arthroscopic results. Methods: In this study, we enrolled 16 male (% 38.1) 26 female (% 61.9) patients who applied to Sisli Hamidiye Etfal Education and Research Hospital with complaints of throbbing knee pain after long walks and uneasiness during climbing stairs and whose arthroscopies were already scheduled. Forty-two knee joints were evaluated using routine fat-saturated T2-weighted fast spin echo (FSE), sagittal T1, sagittal fat-suppressed proton density (PD) FSE, and coronal short inversion time inversion recovery (STIR) sequences. The MRI results were retrospectively analyzed and compared with the arthroscopic outcomes. Results: The comparison of advanced cartilage lesions at the specified six regions of the knee joint detected using sagittal fat saturated T2-and axial T2-weighted sequences with arthoscopic results revealed that 199 out of 252 regions results showed concordance. At a total number of 38 regions, MRI results failed to detect cartilage lesions, and at 15 regions, the MRI evaluated pathologic results, while arthroscopy revealed normal results. The success of MRI in grading cartilage defects and its concordance with arthroscopy were higher at the medial condyl of the femur and patellar facets. Conclusion: Although MRI is the leading imaging modality due to its high sensitivity and diagnostic efficiency, particularly in detecting advanced cartilage pathologies, the magnetic power of the device and the sequences used are important to obtain optimal images. Although the success rates of different sequences in different planes in detecting and grading chondropathy vary in studies, MRI reaches high accuracies in detecting and grading advanced cartilage lesions with the use of appropriate sequences.

Background: The objective of this study is to bring attention to the importance of differential diagnosis in adolescent patients with skeletal involvement and hypercalcemia. Case: A 17-year-old male patient with a complaint of severe leg pain was admitted to our hospital. Seven months before he had a fracture of his distal humerus after falling on to his left shoulder and was treated conservatively. Five months previously, he had a rupture of his quadriceps tendon. Magnetic resonance imaging (MRI) was performed for the quadriceps tendon rupture and was evaluated as polyostotic fibrous dysplasia (PFD). Doctors decided to operate for the ruptured tendon but they detected severe hypercalcemia in the pre-operative blood tests and noticed that the main disease was primary hyper-parathyroidisim (PHPT) which was caused by a giant parathyroid adenoma. Conclusions Giant parathyroid adenoma can present in adolescent patients with multiple bone lesions and severe hypercalcemia. PHPT should be considered in the differential diagnosis of pathological bone fractures and benign bone tumors in every age. This may prevent patients from miss or delayed diagnosis of PHPT.

This report presents the case of a 51-year-old woman with intermittent left knee pain, especially during full flexion of the knee, which had been ongoing for 1 year. Magnetic resonance imaging (MRI) showed mild effusion and round mass at the posterior compartment without synovial changes. Computerized tomography (CT) indicated mass had homogeneous low attenuation and density measurement of -99.4±62.3 Hounsfield units (HU), correlated with a lipomatous lesion.

Poster: ESSR 2016 / P-0066 / Magnetic resonance imaging assesment of Lateral Meniscus anterior horn tear with parameniscal cyst in Hoffa ‘s fat Pad;Unusual combination of pathology in young population by: M. Bankaoglu , A. S. Mahmutoglu, U. Erdem, I. Celebi, S. M. Erturk; Istanbul/TR

Fazit Nach der palmaren Plattenosteosynthese einer distalen Radiusfraktur liegt häufig eine Verdickung der Sehne des FPL und eine Verringerung des Abstandes zwischen der Platte und der FPL-Sehne vor. Dies weist auf eine Tenosynovitis hin, die möglicherweise die Gefahr einer späteren Sehnenruptur birgt.

Purpose To evaluate with ultrasound the thickness of the flexor pollicis longus (FPL) tendon and its relationship to the volar locking plate after the fixation of distal radius fractures.Methods We evaluated 27 type C2 and C3 distal radius fractures with ultrasound to evaluate damage to the FPL tendon after volar plate fixation. The thickness of the FPL tendon and its distance to the volar plate in the involved wrists and to the volar rim in the contralateral uninjured wrist were measured on sonograms taken 12 months postoperatively. Measurements of the involved wrists were compared with those of the intact wrists.Results The mean plate-tendon distance in the involved wrist was considerably shorter than the mean volar rim-tendon distance in the intact wrist, and the FPL tendon was considerably thicker in the involved wrist than in the intact wrist.Conclusions In distal radial fractures treated with volar locking plates, increases in the thickness of the FPL tendon and a consequent decrease in the distance between the tendon and the plate can be determined with ultrasonography. This finding is a warning that asymptomatic tenosynovitis may eventually cause tendon ruptures. (Copyright (C) 2016 by the American Society for Surgery of the Hand. All rights reserved.)

ObjectiveThe objective of this study was to radiologically determine frontal sinus drainage pathway variations with respect to superior attachment of uncinate process (SAUP) and their effect on prevalence of frontal rhinosinusitis. DesignThis was a retrospective cohort study. MethodsComputed tomography scans of the 919 frontal sinus sides of 460 patients (252 female, 208 male; mean age, 35.1 ± 10.5 years) who were candidates for endoscopic sinus surgery were evaluated retrospectively between August 2012 and January 2013 by 3 radiologists to determine the SAUP types and the presence of frontal rhinosinusitis. ResultsThe frontal sinus outflow tract was localized medial to the SAUP in 651 frontal sinus sides and lateral to the SAUP in 268 sides. We determined 3 types (types 7, 8, and 9) of SAUP in addition to 6 types defined in literature. The most common type of SAUP was type 3 (n = 332, 36.1%) followed by type 2 (n = 256, 27.8%) and type 7 (n = 160, 17.4%). Of the evaluated sides, 316 (34.3%) had frontal rhinosinusitis. Frontal rhinosinusitis was more common in the sides where the frontal sinus outflow tract was localized medial to the SAUP than those localized lateral (37.2% vs 27.6%, P = 0.006). ConclusionsEndoscopic approach to frontal recess usually requires uncinectomy, and it is necessary to know SAUP to prevent postoperative retained superior portion of the uncinate process. The location of frontal sinus outflow tract on the SAUP affects the prevalence of frontal rhinosinusitis as well. Frontal rhinosinusitis is significantly more common when the frontal sinus outflow tract was localized medial rather than lateral to the SAUP.Level of evidence: 2b.

Bu makalenin amacı torasik acillerin geniş spektrumunu ortaya koymak, düz akciğer radyogramı ve bilgisayarlı tomografi gibi değişik modalitelerde izlenebilecek anahtar bulguları göstermek ve ayırıcı tanıyı tartışmaktır.Acil servislerde travmatik ve nontravmatik toraks acilleri ile karşılaşılabilir ve tansiyon pnömotoraks, aort diseksiyonu ve pulmoner emboli gibi bazıları yüksek mortalite oranına sahiptir

OBJECTIVE:The aim of this study was to compare the accuracy of blind vs. ultrasonography-guided corticosteroid injections in subacromial impingement syndrome and determine the correlation between accuracy of the injection location and clinical outcome.DESIGN:Forty-six patients with subacromial impingement syndrome were randomized for ultrasonography-guided (group 1, n = 23) and blind corticosteroid injections (group 2, n = 23). Magnetic resonance imaging analysis was performed immediately after the injection. Changes in shoulder range of motion, pain, and shoulder function were recorded. All patients were assessed before the injection and 6 wks after the injection.RESULTS:Accurate injections were performed in 15 (65%) group 1 patients and in 16 (70%) group 2 patients. There was no statistically significant difference in the injection location accuracy between the two groups (P > 0.05). At the end of the sixth week, regardless of whether the injected mixture was found in the subacromial region or not, all of the patients showed improvements in all of the parameters evaluated (P < 0.05).CONCLUSIONS:Blind injections performed in the subacromial region by experienced individuals were reliably accurate and could therefore be given in daily routines. Corticosteroid injections in the subacromial region were very effective in improving the pain and functional status of patients with subacromial impingement syndrome during the short-term follow-up.

Objective To evaluate the accuracy of dynamic laryngeal computed tomography (DLCT) for the detection of vocal cord mobility in larynx cancer. Methods Vocal cord mobility of 44 patients (36 men; age range, 49–81 years) with larynx cancer was examined; 13 patients were excluded (owing to poor image quality or bilateral vocal cord involvement), and vocal cord mobility was evaluated for the remaining 31 patients qualitatively and quantitatively with dynamic laryngeal computed tomography during phonation, inspiration, and Valsalva maneuver phase. Results The mobile cords were laterally positioned in a straight configuration on inspiration phase. Phonation phase images revealed medial displacement with protrusion of the cords (shoulder sign) and ventricular niche (31 patients/42 cords). Fixed cords (13 patients/13 cords) conserved their configuration and location during all phases. The distances of the vocal cords to the midline were measured based on the images obtained during inspiration and Valsalva maneuvers. The mean ± SD difference between the movement distances of cords measured during each phase was as follows: 6.16 ± 1.64 mm for the mobile cord (n = 42) and 3.17 ± 0.78 mm for the impaired cord (n = 7) on the midcoronal plane (P = 0.0001). A comparison between the mean distance values of the mobile, impaired and fixed cords groups revealed significant distance. Conclusions Dynamic laryngeal computed tomography of the larynx of patients with laryngeal cancer can be used as a supplemental tool to examine cord mobilization for accurate T-staging (particularly for patient laryngoscopy, which is difficult to perform), and can provide additional information to physicians.