A delay in establishing the diagnosis of an occult fracture of the hip that remains unrecognised after plain radiography can result in more complex treatment such as an arthroplasty being required. This might be avoided by earlier diagnosis using MRI. The aim of this study was to investigate the best MR imaging sequence for diagnosing such fractures. From a consecutive cohort of 771 patients admitted between 2003 and 2011 with a clinically suspected fracture of the hip, we retrospectively reviewed the MRI scans of the 35 patients who had no evidence of a fracture on their plain radiographs. In eight of these patients MR scanning excluded a fracture but the remaining 27 patients had an abnormal scan: one with a fracture of the pubic ramus, and in the other 26 a T₁-weighted coronal MRI showed a hip fracture with 100% sensitivity. T₂-weighted imaging was undertaken in 25 patients, in whom the diagnosis could not be established with this scanning sequence alone, giving a sensitivity of 84.0% for T₂-weighted imaging.

If there is a clinical suspicion of a hip fracture with normal radiographs, T₁-weighted coronal MRI is the best sequence of images for identifying a fracture.

Acromial morphology has been implicated as a risk factor for unidirectional posterior shoulder instability. Studies utilising plain film radiographic landmarks have identified an increased risk of posterior shoulder dislocation in patients with higher acromion positioning. The aims of this study were to develop a reproducible method of measuring this relationship on cross sectional imaging and to evaluate acromial morphology in patients with and without unidirectional posterior shoulder instability. We analysed 24 patients with unidirectional posterior instability. These were sex and age matched with 61 patients with unidirectional anterior instability, as well as a control group of 76 patients with no instability. Sagittal T1 weighted MRI sequences were used to measure posterior acromial height relative to the scapular body axis (SBA) and long head of triceps insertion axis (LTI). Two observers measured each method for inter-observer reliability, and the intraclass correlation coefficient (ICC) calculated. LTI method showed good inter-observer reliability with an ICC of 0.79. The SBA method was not reproducible due suboptimal MRI sequences. Mean posterior acromial height was significantly greater in the posterior instability group (14.2mm) compared to the anterior instability group (7.7mm, p=0.0002) as well when compared with the control group (7.0mm, p<0.0001). A threshold of 7.5mm demonstrated a significant increase in the incidence of posterior shoulder instability (RR = 9.4). We conclude that increased posterior acromial height is significantly associated with posterior shoulder instability. This suggests that the acromion has a role as an osseous restraint to posterior shoulder instability

Myxofibrosarcoma (MFS) is the second most common subtype of soft tissue sarcoma (STS) and is associated with a high rate of local recurrence after resection. These tumours frequently present with peri-lesional edema, termed “tumour tails” on staging MRI scans [1]. Tumour tails(TT) may contain satellite neoplastic cells or can represent benign reactive edema. There are no clear radiological features to distinguish malignant from reactive peri-lesional edema which limits accurate surgical planning, resulting in either high rates of inadvertently positive resection margins and local recurrences or overly-aggressive resections which negatively impact function and increase morbidity [2]. The objective of this pilot study was to prospectively study a cohort of MFS patients with TTs in an attempt to identify radiological features that predict which type of edema is malignant and requires resection together with the main tumour mass. Patients diagnosed with MFS on biopsy at an orthopaedic oncology referral centre between January 1-December 31 2018 who also had TTs on staging MRI scans were prospectively recruited for the study. Tumours were treated with wide surgical excision, including the TTs, and (neo)adjuvant radiotherapy as per institutional protocol. Staging MRI scans were reviewed in a blinded fashion by two musculoskeletal radiologists to distinguish malignant from reactive TTs. The main tumour mass underwent standard histological evaluation while the regions encompassing the TTs were photographed and sectioned into grids. Each tissue section was examined histologically for the presence of satellite neoplastic cells based on morphological criteria. Radiological and histological findings were compared. Six patients met the inclusion criteria and underwent analysis. All tumours were located in the extremities and were deep to fascia. Mean age at presentation was 67 years (range 51 – 85), with a male:female ratio of 4:2. All patients received radiotherapy (50 Gy), either pre- (n=4) or post-operatively (n=2) based on multidisciplinary tumor board discussion or enrolment in a prospective clinical trial. Radiologically, TTs were labelled as malignant in four patients (66.7%) and as benign TTs in two others. The tails were recognised to be malignant due to the differing signal characteristics to reactive edema on mixed MRI sequences. The radiological evaluation correlated exactly with histological analysis, as satellite neoplastic cells were identified microscopically in the same four cases in which the TTs were designated to be malignant by MRI (specificity&sensitivity=100%). Surgical resection margins were microscopically positive in 50% of cases in the TTs themselves, and 75% of cases in which TTs were designated as malignant on staging MRI. “The malignant nature of peri-lesional edema in MFS, also known as the TT, was accurately predicted in this small pilot study based on specific radiological features which correlated exactly with histologic identification of isolated tumor cells. These findings validate development of a larger prospective study to recruit additional patients with tumor tails beyond just MFS, in order to more robustly study the correlation between the MRI appearance and histological distribution of satellite sarcoma cells in peri-lesional edema in STS. We are already recruiting to this expanded radiological-histological investigation including evaluation of additional novel MRI sequences

Abstract. Objectives. Spinal disorders such as back pain incur a substantial societal and economic burden. Unfortunately, there is lack of understanding and treatment of these disorders are further impeded by the inability to assess spinal forces in vivo. The aim of this project is to address this challenge by developing and testing a novel image-driven approach that will assess the forces in an individual's spine in vivo by incorporating information acquired from multimodal imaging (magnetic resonance imaging (MRI) and biplane X-rays) in a subject-specific model. Methods. Magnetic resonance and biplane X-ray imaging are used to capture information about the anatomy, tissues, and motion of an individual's spine as they perform a range of everyday activities. This information is then utilised in a subject-specific computational model based on the finite element method to predict the forces in their spine. The project is also utilising novel machine learning algorithms and in vitro, six-axis mechanical testing on human, porcine and bovine samples to develop and test the modelling methods rigorously. Results & Discussion. MRI sequences have been identified that provide high-quality image data and information on different tissue types which will be used to predict subject-specific disc properties. In-vivo protocols to capture motion analysis, EMG muscle activity, and video X-rays of the spine have been designed with planned data collection of 15 healthy volunteers. Preliminary modelling work has evaluated potential machine learning approaches and quantified the sensitivity of the models developed to material properties. Conclusion. The development and testing of these image-driven subject-specific spine models will provide a new tool for determining forces in the spine. It will also provide new tools for measuring and modelling spine movement and quantifying the properties of the spinal tissues. Acknowledgments. Funding from the EPSRC: EP/V036602/1 (Meakin, Holsgrove & Javadi) and EP/V032275/1 (Holt & Williams). Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Aims. To explore the clinical relevance of joint space width (JSW) narrowing on standardized-flexion (SF) radiographs in the assessment of cartilage degeneration in specific subregions seen on MRI sequences in knee osteoarthritis (OA) with neutral, valgus, and varus alignments, and potential planning of partial knee arthroplasty. Methods. We retrospectively reviewed 639 subjects, aged 45 to 79 years, in the Osteoarthritis Initiative (OAI) study, who had symptomatic knees with Kellgren and Lawrence grade 2 to 4. Knees were categorized as neutral, valgus, and varus knees by measuring hip-knee-angles on hip-knee-ankle radiographs. Femorotibial JSW was measured on posteroanterior SF radiographs using a special software. The femorotibial compartment was divided into 16 subregions, and MR-tomographic measurements of cartilage volume, thickness, and subchondral bone area were documented. Linear regression with adjustment for age, sex, body mass index, and Kellgren and Lawrence grade was used. Results. We studied 345 neutral, 87 valgus, and 207 varus knees. Radiological JSW narrowing was significantly (p < 0.01) associated with cartilage volume and thickness in medial femorotibial compartment in neutral (r = 0.78, odds ratio (OR) 2.33) and varus knees (r = 0.86, OR 1.92), and in lateral tibial subregions in valgus knees (r = 0.87, OR 3.71). A significant negative correlation was found between JSW narrowing and area of subchondral bone in external lateral tibial subregion in valgus knees (r = −0.65, p < 0.01) and in external medial tibial subregion in varus knees (r = −0.77, p < 0.01). No statistically significant correlation was found in anterior and posterior subregions. Conclusion. SF radiographs can be potentially used for initial detection of cartilage degeneration as assessed by MRI in medial and lateral but not in anterior or posterior subregions. Cite this article: Bone Joint Res 2021;10(3):173–187

The widespread use of MRI has revolutionised the diagnostic process for spinal disorders. A typical protocol for spinal MRI includes T1 and T2 weighted sequences in both axial and sagittal planes. While such an imaging protocol is appropriate to detect pathological processes in the vast majority of patients, a number of additional sequences and advanced techniques are emerging. The purpose of the article is to discuss both established techniques that are gaining popularity in the field of spinal imaging and to introduce some of the more novel ‘advanced’ MRI sequences with examples to highlight their potential uses. Cite this article: Bone Joint J 2015;97-B:1683–92

Spinal lipomatosis is seldom reported in spinal literature and although the condition occurs commonly, we seldom recognise it in reviewing spinal MRI scans. We aim to highlight the condition and show MRI signs to allow easier recognition. We also introduce a new method of evaluation of the severity of the condition using T1 MRI axial views to evaluate the area of the spinal canal involved in the pathological process. We have evaluated 30 patients with a diagnosis of spinal lipomatosis made on sagittal MRI scanning of the spine. The T1 and T2 axial images have been evaluated using standard digital software which allows calculation of the surface area occupied by fat and allows representation of this as a ratio to total canal diameter. This has then been correlated to the traditional method of classifying lipomatosis on sagittal MRI sequences. We have found this method useful and believe it provides a more accurate representation of how fat in the canal may produce symptoms of nerve compression. This shows that the condition behaves more like our traditional understanding of spinal stenosis with symptoms more likely when the relationship of fat to canal reaches greater than 50%. This approach to spinal lipomatosis has not been described before but we feel produces a better understanding of the condition than we have had before by using a classification based on purely on sagittal MRI sequences. Ethics approval: None Audit. Interest Statement: No conflict of interest

Patellar tendinosis (PT) is common and can result in prolonged disability, especially in jumping athletes. Recently developed ultra-short-echo (UTE) MRI sequences allow for quantitative evaluation of tendon biostructure with T2* relaxometry. This study evaluated the relationships between changes over time (COT) in quantitative T2*-metrics, qualitative PT grades, and patient reported symptoms within 10 male basketball players from a single collegiate basketball team. All subjects completed weekly VISA-P symptomology questionnaires over the basketball season. Bilateral 3-Tesla MRIs (GE Healthcare) were obtained at pre- and post-season study visits. High-resolution, PD-weighted, FSE sequences were used to qualitatively grade PT. Quantitative T2*-metrics were evaluated using high-resolution, 3D, multi-echo, UTE-MRI sequences. Bilinear exponential fits of SI to corresponding echo time were used to calculate T2*-metrics. All qualitative and quantitative evaluations were region specific (proximal, middle, distal). Linear mixed effects models assessed associations of side and region with T2*-metrics. Spearman correlations evaluated relationships between outcome measures. Within and between study visits, significant side-to-side differences in T2*-metrics were found and were significantly impacted by leg dominance (p<0.05). Pre-season T2*-metrics correlated with COT in T2*-metrics, COT in T2*-metrics correlated with COT in qualitative PT grades, and post-season T2*-metrics correlated with max changes in VISA-P scores (ρ≥0.64). Quantitative T2*-metrics can detect PT and may be capable of predicting the onset of pathology. T2*-metrics could benefit the clinical management of PT: it is sensitive to changes in pathologic severity over time, and therefore can serve as a quantitative metric to guide treatment and evaluate intervention efficacy

The identification of the extent of neural damage in patients with acute or chronic spinal cord injury is imperative for the accurate prediction of neurological recovery. The changes in signal intensity shown on routine MRI sequences are of limited value for predicting functional outcome. Diffusion tensor imaging (DTI) is a novel radiological imaging technique which has the potential to identify intact nerve fibre tracts, and has been used to image the brain for a variety of conditions. DTI imaging of the spinal cord is currently only a research tool, but preliminary studies have shown that it holds considerable promise in predicting the severity of spinal cord injury. . This paper briefly reviews our current knowledge of this technique

Purpose: The decision of whether or not an injury to the sub-axial cervical spine needs operative management often hinges on the stability of the spine. The posterior Ligamentous Complex (PLC) is one of the primary soft tissue stabilizers of the cervical spine. Fat-saturated T2-wieghted MRI sequences are able to demonstrate soft tissue injury to the cervical spine. No studies to date have assessed the ability of MRI to accurately and reliably demonstrate PLC disruption in the sub-axial cervical spine. Method: Forty-nine consecutive patients aged 14–85 years presenting to the two participating institutions with injury between C3 and T1 who required posterior surgery as part of their management were prospectively enrolled in the study. All patients had radiographs, CT, and MRI scans preoperatively, which were reviewed by a Neuroradiologist, and the treating surgeon separately. Their posterior intraoperative findings were then recorded by the treating surgeon and his assistant. Statistical analysis included Spearman’s rank order correlation, and Cohen’s kappa score. Results: There was a moderate level of agreement between the radiologist’s interpretation of the preopera-tive MRI and the surgeon’s intraoperative findings for the supraspinous and intraspinous ligaments, (kappa.49 & .48 respectively). A fair level of agreement was found for the ligamentum flavum, left and right facet capsules, and the cervical fascia (kappa scores.31,.30,.30,.39 respectively). Conclusion: MRI has a high sensitivity (78.6% to 100%) for detecting cervical PLC injury but a low specificity (53.6% to 75%). On its own MRI is not a useful tool for diagnosing cervical spine PLC injury. The clinician should be aware of the relatively high rate of false positive PLC injury diagnosis with MRI

Purpose of the study: Four elements differentiate myotendinous tears of the infraspinatus from other rotator cuff tears: the tendon insertion on the trochiter and the joint capsule are spared; the onset in characterized by intense muscle oedema followed at 6 to 12 months by severe and definitive fatty degeneration. Material and method: Fifty-nine myotendinous tears of the infraspinatus were collected prospectively from 1993 to 2007. Female gender predominated (58%); trauma was noted at onset in 22% of the shoulders and the mean age of discovery was 48.9 years. Twenty-nine shoulders were seen at the acute phase with significant muscle oedema recognized on the MRI T2 Fat Sat sequence. A second group of 30 patients had grade 4 fatty infiltration of the infraspinatus without full thickness cuff tears. The EMG was available for 23 shoulders and was normal in all, ruling out a neurological cause. Associated lesions of the supraspinatus and infraspinatus tendons were: tendon calcification (61%) and partial tears at the acute phase (21%) and chronic phase (70%) suggesting a degenerative cause. Results: Twenty-four patients underwent surgery and 35 had a medical treatment. At mean 46 months follow-up (range 12–125) the Constant score improved from 51.7 to 69.4 points (p< 0.0001). There was no different statistically between the operated and non-operated patients (p=0.325). All patients seen at the acute phase of the oedema progressed to complete grade 4 fatty degeneration of the muscle, irrespective of the treatment delivered. Discussion: Early diagnosis of this lesion can be achieved with T2 Fat Sat MRI sequences. Arthroscopic repair to tighten the infraspinatus muscle could avoid the irremediable degeneration with total loss of muscle function

Purpose of the study: Kinetic studies of total knee arthroplasty (TKA) in vivo have provided divergent data but have agreed on one point: knee kinetics is abnormal after TKA. Restitution of a normal kinetics is thus the goal to reach to improve functional outcome after TKA. The Journey. ®. TKA is specifically designed to induce automatic medial rotation of the tibia during flexion. This would align the extensor system during flexion and would reduce mediolateral shear forces applied to the patellofemoral joint. Fluoroscopic dynamic studies have been conducted in vivo to confirm the reality of the femorotibal kinematics but to date there has been no study of the patellofemoral kinematics. Magnetic resonance imaging (MRI) is the gold standard for exploring the knee. The important artefacts caused by metal implants made of chromium-cobalt alloys make it difficult or impossible to interpret the images in patients with TKA. Oxinium. ®. implants are weakly ferromagnetic, allowing the development of a specific MRI sequence which can be used to explore a TKA. Material and methods: We used this technique in vivo for a 3D exploration of the patellofemoral kinematics of six Jouney. ®. TKA in comparison with five Genesis II. ®. TKA with preservation of the posterior cruciate ligament and with 13 normal knees. We analysed: patellofemoral surface area of contact, patellar translation and shift during weight-bearing flexion. Results: The results showed that the patellofemoral kinematics of the Journey. ®. TKA are close to that observed in normal knees and that the patellofemoral pressures of the posterior cruciate ligament TKA are significantly higher than with the Journey. ®. TKA. Discussion: These findings confirm our initial hypothesis and allow hop for better functional outcome and reduced wear of the patellar implant with the Journey. ®. TKA

Royal Liverpool University Hospital, Liverpool, UK. To retrospectively review outcomes in patients who underwent vertebroplasty in Liverpool in response to recent level 1 publications claiming vertebroplasty to be no better than sham procedure assessed using 2 criteria. We reviewed cases between 2006 and 2009 looking at 5 criteria for procedure. Visual Analogue Score (VAS). Oswestry disability index scores (ODI). 96 patients identified. 10 patients excluded (inadequate data recorded) (n=86). Operated levels n=134 (thoracic n=61, lumbar n=71, sacral n=2). Presenting symptoms included back pain (86/86) and point tenderness was present in 90% (77/86). Average length of symptoms was 11.50 months with 28% reporting greater than 12 months. 72% recalled definite onset of symptoms with 90% being associated with a low velocity injury. Radiological findings showed an average of 54% height collapse and 91% showing high signal on STIR MRI sequences. Number of levels operated – 3 or more (n=9 VAS 5.3 ODI 10.6); 1 to 2 levels (n= 77 VAS 3.7 ODI 13.9). Average improvement in VAS score was 3.8.and ODI 13.6. 47% (40/86) of patients met all 5 current criteria recommended for operation (VAS 3.7, ODI 14). 53% (46/86) of patients met 2-5 criteria (VAS 3.8, ODI 13.4). There was improvement in pain scores in 91% of patients with an average pre-op VAS 7.8 and post-op VAS 4.0. There was no significant difference in patients meeting all 5 criteria compared to those meeting 2-5 criteria

Introduction: The anterior and anterolateral approach to the hip traditionally are well described exposures in primary hip arthroplasty with fewer dislocations than the posterior approach. A very debilitating complication associated with the anterolateral approach however is the persistent limp and positive Trendelenburg sign. We discuss our results with respect to abductor function and morphological integrity seen on MRI when using an approach in which we preserve the majority of gluteus medius. Methods: We carried out a prospective study of thirty-nine consecutive total hip replacements performed through a gluteus medius sparing anterolateral approach. The same hip surgeon performed all these between April and October 2004. Gait analysis and Trendelenburg tests were evaluated during clinical follow-up at six weeks and three months. Coronal STIR and T1 weighted MRI sequences of the abductors were performed between four and six weeks and the findings were agreed by the consensus of two radiologists. Results: At three-month follow-up all thirty-nine patients tested Trendelenburg negative. Post-operative radiographs showed satisfactory femoral and acetabular component position. MRI findings showed the gluteus medius tendon to be intact with no shortening on T1. Artefacts were found to be less marked in the higher field strength magnet but more apparent in the STIR weighted sequences. Discussion: We have tried to incorporate the advantages of reduced dislocation rate of the anterolateral approach, whilst avoiding violation of the abductors. The clinical result and radiographic findings we have presented suggest that the described exposure is an effective and safe method of approaching the hip, with minimal disruption of the abductor mechanism. In addition to maintaining the reduced dislocation rate associated with the standard anterolateral approach. Intact abductor function allows for rapid rehabilitation

Purpose: Calcified thoracic discal herniation is an uncommon entity. The purpose of this study was to analyse the population concerned to search for radiological signs of sequellar Scheuermann disease and the characteristic features of hernias in this context and to compare computed tomography (CT) and magnetic resonance imaging (MRI) findings with intraoperative and histological findings. Material and methods: A retrospective series of 13 patients with symptomatic calcified thoracic discal herniation (CTDH) who underwent surgery from 1996 to 2001 was analysed. Mean age was 50.7 years. The population included ten men and three women. CT was performed in all cases, with myelography in two. MRI was performed in eleven cases with DTPA-gadolinium injection in six. Two neuroradiologists blinded to intraoperative findings reviewed the images independently to search for radiological signs predictive of dural adherence and/or penetration and the presence of Scheuermann squellae. Pathology data were available for five patients. Results: All herniations occurred in the mid to lower thoracic level in patients in their fourth or fifth decade. The disk was calcified at the zone of herniation in all cases. The hernia occupied more than half of the spinal canal in 70% of patients. The nature of the lesion was analysed on axial CT and T1/T2 weighted MRI sequences with fat suppression. Images confirmed the pathological findings: the majority of the calcified herniations were composed of mature haversian bone. In ten of the eleven cases, the radiological interpretation of the hernia/dural interface was found to correspond to the intraoperative observation. Discussion: The sensitivity and specificity of T2 weighted MRI with gadolinium injection of the hernia/dural interface is superior, enabling prediction of dural penetration. Sequellae of Scheuermann disease found in five patients confirmed a probably non-fortuitous association. Conclusion: The natural history of CTDH starts with discal calcification in a degenerative spine during posterior migration, followed by bone metaplasia which can involve neighbouring structures such as the longitudinal ligament and lead to penetration of the dura by the mature ossified lesion

Summary. A novel bipolar cooled radiofrequency ablation probe, optimised for bone metastases applications, is shown in two preclinical models to offer a safe and minimally invasive treatment option that can ablate large tissue volumes and preserve the regenerative ability of bone. Introduction. Use of radiofrequency ablation (RFA) in treating of skeletal metastases has been rising, yet its impact on bone tissue is poorly understood. 2–11 RF treatment induces frictional heating and effectively necrotises tissue in a local and minimally invasive manner.1 Bipolar cooled RF (BCRF) is a significant improvement to conventional RF whereby larger regions can be safely treated, protecting sensitive neighbouring tissues from thermal effects. This study aimed to evaluate the safety and feasibility of a novel bipolar RFA probe to create large contained lesions within healthy pig vertebrae and its determine its effects on bone and tumour cells in a rabbit long bone tumour model. Methods. Following a pre-treatment MRI, a BCRF probe was placed transpedicularly into targeted lumbar vertebrae of six Yorkshire pigs. Energy was delivered for 15min at a set temperature of 65°C (n=2 per animal) with a sham control performed at a non-contiguous level (n=1 per animal). Post-treatment neurologic evaluation, MRI and histology were used to characterise the region of effect. Twelve New Zealand White Rabbits received a 200 µl injection of VX2 tumour cells into one femur. On day 14, half of the tumour-bearing and contralateral healthy femora were RF-treated (n=6 per group). RF-treated femora were compared to tumour-bearing and healthy sham groups (n=6 per group) through pre (day 14) and post treatment (day 28) MRI and histology (H&E (for general evaluation), AE1/AE3 (for VX2 tumour cell evaluation), TRAP (for osteoclast evaluation) and TUNEL (for osteocyte evaluation)). Results. In treated porcine spines there were no neurological complications. MR imaging confirmed a 2cm oval shaped ablative zone. External thermocouple measurements indicated output values in the physiological temperature range suggesting treatment was safely confined within targeted vertebrae. Histological results correlated well with the ablation regions determined using MRI sequences in both models. In rabbit femora, large zones of RF ablation (average volume 12.9±5.5 cm3) extended beyond the femur cortex (corresponding to the probe design for human use) into the surrounding soft tissue. The RFA-treated tumour-involved specimens demonstrated a significant reduction in tumour volume compared to sham femora, however a small number of viable tumour cells remained within the ablation volume. Newly formed trabecular structures were also seen in all treated femora. TRAP staining demonstrated a significant reduction in osteoclast number post-RFA in both the tumour-involved and healthy groups. TUNEL staining revealed areas of patchy cortical osteocyte necrosis within the ablation zone. Discussion/Conclusions. The large histologic region of effect created by RFA was consistent with MRI findings in both models. Treatment was contained in the porcine vertebrae without collateral damage to neighbouring sensitive structures. In the femora, while osteoclasts were found to be very susceptible to RFA, a small number of tumour cells and osteocytes in the treated regions remained viable. As the treatment zone did not encompass the full extent of the intramedullary lesions, it is possible that the sporadic VX2 cell viability may be explained by local tumour cell migration. Limited destruction of healthy osteocytes by RFA may be desirable in restoring bone health

Aim Post-traumatic osteoarthritis and osteochondral injuries can cause significant pain and morbidity. Appropriate MRI sequences combined with image analysis techniques can be used to reproducibly measure quantitative cartilage parameters, hence offering a tool for monitoring and detecting degenerative change earlier than previously possible. We demonstrate the performance of a directional gradient vector flow (dGVF) snake segmentation algorithm on an isotropic MR sequence, which allows segmentation of the full articular surfaces (including malleoli) of the ankle. Method Eight ankles were imaged using a 1.5T MRI scanner with an isotropic 3D T1 weighted FLASH sequence with water excitation, resolution 0.3 x 0.3 x 0.3 mm. A subset of five ankles were imaged four times with repositioning and re-shimming of the magnet between acquisitions. Images were interpolated to 0.15 mm3 and segmented using a dGVF snake. Following 3D reconstruction of the cartilage layers normal thickness from cartilage to bone was measured at each voxel on the cartilage surface. Results The mean cartilage thickness (±S.D) was 1.80 mm (±0.05 mm); 1.83 mm (±0.07 mm) and 1.81 mm (±0.07 mm) for the talus, tibia and cumulative ankle cartilage respectively. To measure the technical precision of the segmentation method we determined the coefficient of variation of the four repeated measurements in five ankles. The mean coefficients of variation (min-max) from the repeated measurements were 1.74% (0.69%–3.57%); 1.20% (0.26%–3.06%) and 1.52% (0.26%–3.57%) for the talus, tibia and cumulative ankle cartilage respectively. Conclusion We believe that the reported isotropic image sequence and segmentation algorithm is a valid tool for quantitative assessment of the entire ankle joint. A possible application is the early detection of cartilage injury and degenerative change due to injury or illness

Injury to the triangular fibrocartilage complex (TFCC) may result in ulnar wrist pain with or without instability. One component of the TFCC, the radioulnar ligaments, serve as the primary soft-tissue stabilizer of the distal radioulnar joint (DRUJ). Tears or avulsions of its proximal, foveal attachment are thought to be associated with instability of the DRUJ, most noticed during loaded pronosupination. In the absence of detectable instability, injury of the foveal insertion of the radioulnar ligaments may be overlooked. While advanced imaging techniques such as MRI and radiocarpal arthroscopy are well-suited for diagnosing central and distal TFCC tears, partial and complete foveal tears without instability may be missed without a high degree of suspicion. While technically challenging, DRUJ arthroscopy provides the most accurate method of detecting foveal abnormalities. In this annotation the spectrum of foveal injuries is discussed and a modified classification scheme is proposed.

Cite this article: Bone Joint J 2023;105-B(1):5–10.

Aims

Intra-articular (IA) tumours around the knee are treated with extra-articular (EA) resection, which is associated with poor functional outcomes. We aim to evaluate the accuracy of MRI in predicting IA involvement around the knee.

Background: Conventional magnetic resonance pulse sequence echo times (TEs) produces no signal of cortical bone. In this pilot study we wished to explore the value of a novel pulse sequence with an ultrashort echo time (UTE), which is able to detect signal from cortical bone and periosteum (Ref.). The signal obtained using an UTE sequence from cortical bone reflects the soft tissue component of cortical bone including its vasculature. We hypothesized that conditions, which alter the soft tissue component and vascularity of bone, show a change in signal. We have examined the lower limb in patients and volunteers of different age and at different time points following fracture of the tibia. Subjects and Methods: Seven volunteers (aged 29 – 85 years) and eight patients with acute fractures of the tibia (aged 18 – 56 years) were examined at different time points (2 days – 16 weeks) following fracture, in three of the patients serial scans were obtained. Three patients were examined years following bone injury: one patient with a hypertrophic mal-union at 5 years, one patient with polio 14 years following a tibial osteotomy and one patient 28 years following a tibial fracture. Ultra-short echo time pulse sequences (TE = 0.07 or 0.08 ms) were used with and without preceding fat suppression and / or long T2 component suppression pulses. Intravenous gadolinium (0.3 mmol/kg) was administered to one volunteer and three of the patients. Mean signal intensity (AU) was plotted against time following contrast enhancement. T1 and T2* values for cortical bone were determined and T1 was plotted against age. Results A signal was obtained of cortical bone, periosteum and callus in all subjects. The injection of contrast enhanced the signal in all of these tissues. Distribution curves of gadolinium in cortical bone showed enhanced signal intensity following fracture. The signal was dependent on the type and severity of fracture and the time following fracture. There was a marked increase in signal in a hypertrophic mal-union 5 years following fracture and a moderate increase in signal was still detectable 28 years following fracture. Osteoporosis associated with polio reduced volume and signal of bone. T1 echo times ranged from 140 – 260 ms and increased significantly with age (P < 0.01). T2* ranged from 0.42 – 0.50 ms. Fat suppression and long T2 suppression increased the conspicuity of the periosteum. Conclusion: Magnetic resonance imaging using UTE sequences is able to detect a signal from cortical bone for the first time. Cortical bone, callus and adult periosteum show a distinct signal following fracture with a characteristic time course. Measurements reflect the organic matrix rather than the inorganic crystals of bone. The T1 of cortical bone is very short and changes with age. The distribution curve of gadolinium can be established in cortical bone and is understood to reflect changes in blood flow. We present a pilot study to introduce a new MRI sequence, which at present a research tool, has potential for selected clinical application