Faculty Bibliography

Entrapment neuropathies can manifest with confusing clinical features and therefore are often underrecognized and underdiagnosed at clinical examination. Historically, electrophysiologic evaluation has been considered the mainstay of diagnosis. Today, cross-sectional imaging, particularly magnetic resonance (MR) imaging and specifically MR neurography, plays an increasingly important role in the work-up of entrapment neuropathies. MR imaging is a noninvasive operator-independent technique that allows identification of the underlying cause of injury, differentiation between surgically treatable and untreatable causes, and guidance of selective diagnostic anesthetic nerve blocks. Pathologic conditions affecting the lumbosacral plexus and major motor and mixed nerves of the pelvis and hip include neuropathies of the lumbosacral plexus, femoral nerve, lateral femoral cutaneous nerve, obturator nerve, and sciatic nerve; piriformis muscle syndrome; and injury of the gluteal nerves. Diagnosis of entrapment neuropathies of the pelvis and hip with MR imaging requires familiarity with the normal MR imaging anatomy and awareness of the anatomic and pathologic factors that put peripheral nerves at risk for injury

PURPOSE:: To determine the feasibility of performing MRI of the wrist at 7 Tesla (T) with parallel imaging and to evaluate how acceleration factors (AF) affect signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and image quality. MATERIALS AND METHODS:: This study had institutional review board approval. A four-transmit eight-receive channel array coil was constructed in-house. Nine healthy subjects were scanned on a 7T whole-body MR scanner. Coronal and axial images of cartilage and trabecular bone micro-architecture (3D-Fast Low Angle Shot (FLASH) with and without fat suppression, repetition time/echo time = 20 ms/4.5 ms, flip angle = 10 degrees , 0.169-0.195 x 0.169-0.195 mm, 0.5-1 mm slice thickness) were obtained with AF 1, 2, 3, 4. T1-weighted fast spin-echo (FSE), proton density-weighted FSE, and multiple-echo data image combination (MEDIC) sequences were also performed. SNR and CNR were measured. Three musculoskeletal radiologists rated image quality. Linear correlation analysis and paired t-tests were performed. RESULTS:: At higher AF, SNR and CNR decreased linearly for cartilage, muscle, and trabecular bone (r < -0.98). At AF 4, reductions in SNR/CNR were:52%/60% (cartilage), 72%/63% (muscle), 45%/50% (trabecular bone). Radiologists scored images with AF 1 and 2 as near-excellent, AF 3 as good-to-excellent (P = 0.075), and AF 4 as average-to-good (P = 0.11). CONCLUSION:: It is feasible to perform high resolution 7T MRI of the wrist with parallel imaging. SNR and CNR decrease with higher AF, but image quality remains above-average. J. Magn. Reson. Imaging 2010;31:740-746. (c) 2010 Wiley-Liss, Inc

OBJECTIVE: The purpose of this study was to evaluate experience with and determine the efficacy and safety of thermal ablation in the management of spinal osteoid osteomas close to neural elements. MATERIALS AND METHODS: The records of all patients with osteoid osteomas of the spine managed with thermal ablation at two academic centers from 1993 to 2008 were reviewed. RESULTS: Seventeen patients (13 male patients, four female patients; mean age, 25.9 years) had lesions in the lumbar (seven patients), thoracic (six patients), cervical (three patients), and sacral (one patient) regions of the spine. Two lesions were in the vertebral body, one was within the dens, and the others were in the posterior elements. The mean lesion diameter was 8.8 mm, and the mean distance between the lesion and the closest neural element was 4.3 mm. The lesions were managed with laser (13 lesions) or radiofrequency (four lesions) ablation. Special thermal protection techniques involving the epidural injection of gas or cooled fluid were used. Pain levels were assessed immediately before the procedure and on the day after the procedure. Long-term follow-up findings were available for 11 patients. No complications were encountered, and all patients reported relief of pain. The 11 patients who participated in long-term follow-up reported continued relief of pain. CONCLUSION: Percutaneous thermal ablation can be used to manage spinal osteoid osteomas close to the neural elements. Special thermal protection techniques may add a margin of safety

Magnetic resonance imaging (MRI) at 7.0 T has the potential for higher signal-to-noise ratio (SNR), improved spectral resolution, and faster imaging compared with 1.5-T and 3.0-T MR systems. This is especially interesting for challenging imaging regions like the wrist and the hand because of the small size of the visualized anatomical structures; the increase in SNR could then be directly converted into higher spatial resolution of the images. Practically, imaging at 7.0 T poses a variety of technical challenges such as static (B (0)) and radiofrequency (B (1)) homogeneities, shimming, chemical shift artifacts, susceptibility artifacts, alterations in tissue contrast, specific absorption rate limitations, coil construction, and pulse sequence tuning. Despite these limitations, this first experience in anatomical imaging of the wrist and the hand at 7.0 T is very promising. Functional imaging techniques will gain importance at ultra-high-field MRI and need to be assessed in detail in the future

OBJECTIVES: This was a pilot study which aimed to assess the feasibility of 3D-spin-lock (3D-T(1rho)) MRI of the shoulder joint and to establish baseline values of healthy humeral and glenoid cartilages in vivo. MATERIAL AND METHODS: Four asymptomatic volunteers [mean age 31 years (range 29-36 years)] were recruited. A 3.0 T scanner, employing a four-channel, phased-array, shoulder, radio-frequency (RF) coil was used. Three-dimensional T(1rho)-weighted images were acquired with a 3D gradient-echo (GRE) sequence with T(1rho) magnetization preparation. In order to a construct T(1rho) map, we acquired four 3D-T(1rho)-weighted images with spin-locking length (TSL) values of 2 ms, 10 ms, 20 ms, and 30 ms. The glenoid and humeral cartilage were segmented manually at each slice of the 3D images. We performed additional regional analysis by dividing the cartilage into anterior/posterior and superior/inferior regions. RESULTS: The global average T(1rho) value of the shoulder cartilages varied from 37.9 ms to 48.5 ms and from 32.4 ms to 36.9 ms for humeral and glenoid cartilages, respectively. In the humeral cartilage, the average regional T(1rho) values varied from 35.9 ms to 52.2 ms; 54.4 ms to 69.0 ms; 39.1 ms to 49.3 ms and 34.6 ms to 57.2 ms for the anterior-superior, anterior-inferior , posterior-superior and posterior-inferior regions, respectively. In the glenoid cartilage, the values varied from 31.3 ms to 40.8 ms; 34.1 ms to 35.3 ms; 26.7 ms to 37.2 ms and 32.8 ms to 35.7 ms for the same regions, respectively. CONCLUSION: We demonstrated that 3D-T(1rho) MRI of the shoulder can be performed on a 3 T clinical scanner within specific absorption rate (SAR) limits, and we present baseline values for healthy patients which may be useful for quantitative comparison with diseased shoulders

OBJECTIVE: The objectives of our study were to describe the previously unreported normal MR anatomy of the distal biceps femoris muscle and its relationship with the common peroneal nerve and to present a case in which previously unreported MR evidence of an anatomic variation in the distal biceps femoris muscle was associated with common peroneal entrapment neuropathy. MATERIALS AND METHODS: One hundred consecutive 1.5-T knee MR studies of 97 asymptomatic patients were retrospectively reviewed by two observers in consensus for, first, normal anatomy of the distal biceps femoris muscle; second, anatomic variations of the muscle; and, third, the relationship of the muscle to the common peroneal nerve. Measurements of the distal and posterior extents of the short and long heads of the biceps femoris were performed. An MR study of a symptomatic patient with clinical evidence of common peroneal neuropathy associated with a surgically proven anatomic variation of the distal biceps femoris was reviewed. RESULTS: Two MR anatomic patterns were seen in the asymptomatic patient group: First, in 77 knees (77%), the common peroneal nerve was located within abundant fat posterolateral to the biceps femoris; and, second, in 23 cases (23%), the common peroneal nerve traversed within a narrow fatty tunnel between the biceps femoris and lateral head of the gastrocnemius muscles. There was a positive correlation between the distal and posterior extents of the short head of the biceps femoris muscle and the presence of the tunnel. CONCLUSION: Variations in the posterior and distal extents of the biceps femoris muscle can produce a tunnel in which the common peroneal nerve travels. We also described a case of common peroneal neuropathy secondary to tunnel formation

The description of the complex molecular network responsible for cell behavior requires new tools to integrate large quantities of experimental data in the design of biological information systems. These tools could be used in the characterization of these networks and in the formulation of relevant biological hypotheses. The building of an ontology is a crucial step because it integrates in a coherent framework the concepts necessary to accomplish such a task. We present MONET (molecular network), an extensible ontology and an architecture designed to facilitate the integration of data originating from different public databases in a single- and well-documented relational database, that is compatible with MONET formal definition. We also present an example of an application that can easily be implemented using these tools

We report a case of hyperplastic callus formation that occurred in both femurs in a patient with type V osteogenesis imperfecta (OI), with 4-year follow-up and resolution. The clinical, histological and imaging aspects of this condition are discussed. Recognition of the hyperplastic callus formation in this particular type of OI is important in order to avoid misdiagnosis

RATIONALE AND OBJECTIVES: To measure signal-to-noise ratio (SNR), contrast, and relaxation times (T1 and T2) in human knee joint at 7.0T whole-body scanner. MATERIALS AND METHODS: MRI experiments were performed on a 7.0T Siemens whole-body scanner using an 18-cm diameter transmit/receive knee coil. Normalized SNR and relaxation times (T1 and T2) were computed on all volunteers (healthy, n=5) for femoral, tibial, and patellar cartilage. RESULTS: Average T1 values of femoral, tibial, and patellar cartilages were found as 1.55, 1.76, and 1.62 seconds, respectively. Average T2 values of femoral, tibial, and patellar cartilages were found as 51.3, 43.9, and 39.7 milliseconds, respectively. No statistically significant differences were observed between T1 and T2 values of different cartilage tissues (P>.08 for all comparisons). Compared with previously reported relaxation times of cartilage tissue at 3.0T, an approximately 35% increase was observed in T1 values, whereas no significant change was observed in T2. Regional analysis was also performed to investigate the change in relaxation parameters for weight-bearing vs. non-weight-bearing areas. A statistically significant difference was observed in T2 of tibial cartilage (P=.009). The rest of the comparisons yielded insignificant differences (P>.32). CONCLUSION: Our preliminary results demonstrate the feasibility of acquiring high resolution three-dimensional images of knee joint (with and without fat suppression) at 7.0T whole-body scanner