PURPOSE Traumatic fat and fluid effusion in a tendon sheath, known as lipohaematoma, in the wrist... more PURPOSE Traumatic fat and fluid effusion in a tendon sheath, known as lipohaematoma, in the wrist is rarely reported even in the literature. The aim of this study is to correlate the presence of lipohaematoma and fluid effusion in cases of wrist trauma with the pattern, location and severity of distal radio fracture. The frequency of these findings in patients with traumatic radio fracture was also estimated. METHOD AND MATERIALS From January to December 2012, 211 CT (137/64%) and MRI (74/36%) exams of patients were reviewed for the presence of distal radio fractures. Each wrist tendon was analyzed individually, looking for fat or/and fluid effusion. Others evaluated findings were the location, pattern and severity of distal radio fracture, such as involvement of Lister tubercle, involvement of wrist dorsal cortical, intra-articular communication, deviated bone fragments and presence of lipohemartrosis. RESULTS 62/211 (29.3%) retrospectively reviewed cases had distal radio fracture....
Category: Ankle; Sports; Trauma Introduction/Purpose: Although there are several imaging options ... more Category: Ankle; Sports; Trauma Introduction/Purpose: Although there are several imaging options for diagnosing the syndesmotic injury, a fundamental question that guides treatment remains unanswered. Syndesmotic instability is still challenging to diagnose correctly, and syndesmotic disruption and true syndesmotic instability should be differentiated. Currently, imaging tests quickly diagnose severe syndesmotic instability but have difficulty in diagnosing mild and moderate cases. Recently, weight-bearing CT (WB-CT) has emerged as a new modality for the examination of syndesmosis; however, studies have shown that WB-CT is not superior to conventional computed tomography (CT), and axial loading has no benefit for the diagnosis of instability. This study aims to investigate which index test between a CT in a neutral position (CTNP) and a new CT test with stress maneuvers (CTSM) can more accurately diagnose syndesmotic instability. Methods: This diagnostic accuracy-test study consecut...
The purpose of this review is to describe the anatomy and lesions affecting the peripheral portio... more The purpose of this review is to describe the anatomy and lesions affecting the peripheral portion of posterior horn of medial menisci (ramp lesions), along with illustrations and MRI cases. We will correlate imaging features with arthroscopic classification of ramp lesions. Also, postoperative and chronic changes related to meniscocapsular tears will be presented, as well as biomechanical consequences and treatment approach.
Snapping scapula syndrome manifests as an audible or palpable crackling during the sliding moveme... more Snapping scapula syndrome manifests as an audible or palpable crackling during the sliding movements of the scapula over the rib cage, often perceived during physical or professional activities. It can be caused by morphological alteration of the scapula and rib cage, by an imbalance in periscapular musculature forces (dyskinesia), or by neoplasia (bone tumors or soft tissue tumors). In this pictorial essay, we review the main causes of snapping scapula syndrome, exemplified by a collection of didactic cases.
The term avascular necrosis describes any one of a number of bone diseases that have a common mec... more The term avascular necrosis describes any one of a number of bone diseases that have a common mechanism: the death of bone components due to lack of blood supply. Avascular necrosis can occur in diverse parts of the skeleton, each location-specific form not only receiving a distinct designation but also presenting unique epidemiologic characteristics. However, the imaging findings are similar in all of the forms, which pass through well-described radiological phases, regardless of the site of involvement. Because avascular necrosis can cause considerable morbidity if not properly detected and managed, the radiologist plays a fundamental role. The present study provides a brief review of the main radiological aspects of the various forms of avascular necrosis, illustrated on the basis of a collection of cases from our institution.
Focal bone lesions are not uncommon findings in the daily practice of radiology. Therefore, it is... more Focal bone lesions are not uncommon findings in the daily practice of radiology. Therefore, it is essential to differentiate between lesions with aggressive, malignant potential that require action and those that have no clinical significance, many of which are variants or benign lesions, sometimes self-limited and related to reactive processes. In some cases, a diagnostic error can have catastrophic results. For example, a biopsy performed in a patient with myositis ossificans can lead to an incorrect diagnosis of sarcomatous lesions and consequently to mutilating surgical procedures. The present study reviews the main radiological aspects of the lesions that are most commonly seen in daily practice and have the potential to be confused with aggressive, malignant bone processes. We also illustrate these entities by presenting cases seen at our institution.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2018
To determine if posterior cruciate ligament (PCL) and intercondylar notch (IN) morphometries and ... more To determine if posterior cruciate ligament (PCL) and intercondylar notch (IN) morphometries and volumetrics act as risk factors for anterior cruciate ligament (ACL) tears. A prospective case-controlled magnetic resonance imaging (MRI) study was conducted with subjects presenting noncontact knee injuries. Exclusion criteria were previous surgery, PCL tear, osteoarthritis, tumors, or infectious and inflammatory conditions. All participants underwent a flexed-knee 3-dimensional (3D) magnetic resonance imaging (MRI) to uniformly straighten PCL. MR images were independently reviewed by 2 radiologists and assessed for 2D and 3D measurements (bicondylar width; IN angle, depth, width, and cross-sectional area; PCL width, thickness, and cross-sectional area; and IN and PCL volumes). Clinical profiles were tabulated and subjects were divided into cases (ACL tear) and controls (without ACL tear). The study was composed of 50 cases versus 52 controls (N = 102), with a mean age of 36.8 years. T...
Magnetic resonance neurography is a high-resolution imaging technique that allows evaluating diff... more Magnetic resonance neurography is a high-resolution imaging technique that allows evaluating different neurological pathologies in correlation to clinical and the electrophysiological data. The aim of this article is to present a review on the anatomy of the lumbosacral plexus nerves, along with imaging protocols, interpretation pitfalls, and most common pathologies that should be recognized by the radiologist: traumatic, iatrogenic, entrapment, tumoral, infectious, and inflammatory conditions. An extensive series of clinical and imaging cases is presented to illustrate key-points throughout the article.
Low back pain and vertebral endplate abnormalities are common conditions within the population. S... more Low back pain and vertebral endplate abnormalities are common conditions within the population. Subclinical infection caused by indolent pathogens can potentially lead to these findings, with differentiation between them notably challenging from a clinical perspective. Progressive infection of the intervertebral disc has been extensively associated with increasing low back pain, with Propionibacterium acnes specifically implicated with in relation to sciatica. The main purpose of this study is to identify if the presence of an infective pathogen within the intervertebral disc is primary or is a result of intraoperative contamination, and whether this correlates to low back pain. An open prospective cohort study will be performed. Subjects included within the study will be between the ages of 18 and 65 years and have a diagnosis of lumbar disc herniation requiring open decompression surgery. Excised herniated disc fragments, muscle and ligamentum flavum samples will be collected duri...
ABSTRACT PURPOSE To evaluate the association between Osgood-Schlatter disease and patella alta us... more ABSTRACT PURPOSE To evaluate the association between Osgood-Schlatter disease and patella alta using MRI. METHOD AND MATERIALS A retrospective case-control study included patients evaluated by MRI of the knee performed in the period from January 2009 to December 2011 at our hospital. We included 103 patients with late sequel of Osgood-Schlatter disease (94 males and 9 females, average 37 years-old) and 393 controls without Osgood-Schlatter disease (326 males, and 67 females, average 41 years-old). Patients with Osgood-Schlatter disease in acute phase, patients younger than 15 years, prior surgery, fracture and bone deformities of the knee, and quadriceps and patellar tendon injuries were excluded. Patellar height was calculated using Insall-Salvati index technique and reference indexes on MRI were based in Shabshin et al published study. All case and control exams were independently evaluated by two radiologists. The used statistical methodologies were scatter and Bland Altman plots, intraclass correlation and kappa coefficients, and Fisher's exact tests. RESULTS In the comparison between cases and controls, there was association with statistical significance between Osgood-Schlatter disease and patella alta (p<0.001). There was also a high intraclass correlation coefficient (0.785, 95% CI 0.593-0.872). CONCLUSION As demonstrated in the study, there was a statistical significant association between Osgood-Schlatter disease and patella alta and a good interobserver concordance. This fact highlights the importance of the evaluation for patellar height by Insall-Salvati index technique on MRI of the knees in patients with sequelae of Osgood-Schlatter. CLINICAL RELEVANCE/APPLICATION In patients with Osgood-Schlatter disease, radiologists must be aware to the presence of patella alta, which can be important to the therapeutic decision and detection of associated lesions.
Sternoclavicular joint infection is a rare condition that usuallyoccurs in patients with predispo... more Sternoclavicular joint infection is a rare condition that usuallyoccurs in patients with predisposing factors. There are few casesof spontaneous septic arthritis of the sternoclavicular joint in healthyadults reported in the medical literature. Diagnosis may be difficultsince sternoclavicular pain may be referred to distant sites anddepends on specialized radiological studies. It is presented the caseof a 45-year old, previously healthy male, with sternoclavicular septicarthritis due to Staphylococcus aureus diagnosed by computedtomography of the sternoclavicular joint region and blood cultures.
PURPOSE/AIM Some anatomical studies performed on cadavers have shown the possible variations of t... more PURPOSE/AIM Some anatomical studies performed on cadavers have shown the possible variations of the sciatic nerve and its relationship to the piriformis. Our goal is to review and ilustrate these know variantions using a T2W volumetric sequence of the pelvis in vivo. CONTENT ORGANIZATION 1- The anatomic variations in the proximal course of the sciatic nerve and its relationship to the piriformis muscle. 2- T2W volumetric sequence of the pelvis parameters. 3- Using a T2W volumetric sequence illustrate the described variations in the high division of the sciatic nerve. 4- Correlation with some clinical scenarios, such as non-discogenic sciatica and the piriformis syndrome, and iatrogenic lesions in hip surgery. SUMMARY The frequency of variations in the high division of the sciatic nerve is relatively high and sometimes can be clinically relevant. High resolution sequences are already widely available, and allow the radiologist to accurately define the course of this nerve when prompted.
PURPOSE Traumatic fat and fluid effusion in a tendon sheath, known as lipohaematoma, in the wrist... more PURPOSE Traumatic fat and fluid effusion in a tendon sheath, known as lipohaematoma, in the wrist is rarely reported even in the literature. The aim of this study is to correlate the presence of lipohaematoma and fluid effusion in cases of wrist trauma with the pattern, location and severity of distal radio fracture. The frequency of these findings in patients with traumatic radio fracture was also estimated. METHOD AND MATERIALS From January to December 2012, 211 CT (137/64%) and MRI (74/36%) exams of patients were reviewed for the presence of distal radio fractures. Each wrist tendon was analyzed individually, looking for fat or/and fluid effusion. Others evaluated findings were the location, pattern and severity of distal radio fracture, such as involvement of Lister tubercle, involvement of wrist dorsal cortical, intra-articular communication, deviated bone fragments and presence of lipohemartrosis. RESULTS 62/211 (29.3%) retrospectively reviewed cases had distal radio fracture....
Category: Ankle; Sports; Trauma Introduction/Purpose: Although there are several imaging options ... more Category: Ankle; Sports; Trauma Introduction/Purpose: Although there are several imaging options for diagnosing the syndesmotic injury, a fundamental question that guides treatment remains unanswered. Syndesmotic instability is still challenging to diagnose correctly, and syndesmotic disruption and true syndesmotic instability should be differentiated. Currently, imaging tests quickly diagnose severe syndesmotic instability but have difficulty in diagnosing mild and moderate cases. Recently, weight-bearing CT (WB-CT) has emerged as a new modality for the examination of syndesmosis; however, studies have shown that WB-CT is not superior to conventional computed tomography (CT), and axial loading has no benefit for the diagnosis of instability. This study aims to investigate which index test between a CT in a neutral position (CTNP) and a new CT test with stress maneuvers (CTSM) can more accurately diagnose syndesmotic instability. Methods: This diagnostic accuracy-test study consecut...
The purpose of this review is to describe the anatomy and lesions affecting the peripheral portio... more The purpose of this review is to describe the anatomy and lesions affecting the peripheral portion of posterior horn of medial menisci (ramp lesions), along with illustrations and MRI cases. We will correlate imaging features with arthroscopic classification of ramp lesions. Also, postoperative and chronic changes related to meniscocapsular tears will be presented, as well as biomechanical consequences and treatment approach.
Snapping scapula syndrome manifests as an audible or palpable crackling during the sliding moveme... more Snapping scapula syndrome manifests as an audible or palpable crackling during the sliding movements of the scapula over the rib cage, often perceived during physical or professional activities. It can be caused by morphological alteration of the scapula and rib cage, by an imbalance in periscapular musculature forces (dyskinesia), or by neoplasia (bone tumors or soft tissue tumors). In this pictorial essay, we review the main causes of snapping scapula syndrome, exemplified by a collection of didactic cases.
The term avascular necrosis describes any one of a number of bone diseases that have a common mec... more The term avascular necrosis describes any one of a number of bone diseases that have a common mechanism: the death of bone components due to lack of blood supply. Avascular necrosis can occur in diverse parts of the skeleton, each location-specific form not only receiving a distinct designation but also presenting unique epidemiologic characteristics. However, the imaging findings are similar in all of the forms, which pass through well-described radiological phases, regardless of the site of involvement. Because avascular necrosis can cause considerable morbidity if not properly detected and managed, the radiologist plays a fundamental role. The present study provides a brief review of the main radiological aspects of the various forms of avascular necrosis, illustrated on the basis of a collection of cases from our institution.
Focal bone lesions are not uncommon findings in the daily practice of radiology. Therefore, it is... more Focal bone lesions are not uncommon findings in the daily practice of radiology. Therefore, it is essential to differentiate between lesions with aggressive, malignant potential that require action and those that have no clinical significance, many of which are variants or benign lesions, sometimes self-limited and related to reactive processes. In some cases, a diagnostic error can have catastrophic results. For example, a biopsy performed in a patient with myositis ossificans can lead to an incorrect diagnosis of sarcomatous lesions and consequently to mutilating surgical procedures. The present study reviews the main radiological aspects of the lesions that are most commonly seen in daily practice and have the potential to be confused with aggressive, malignant bone processes. We also illustrate these entities by presenting cases seen at our institution.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2018
To determine if posterior cruciate ligament (PCL) and intercondylar notch (IN) morphometries and ... more To determine if posterior cruciate ligament (PCL) and intercondylar notch (IN) morphometries and volumetrics act as risk factors for anterior cruciate ligament (ACL) tears. A prospective case-controlled magnetic resonance imaging (MRI) study was conducted with subjects presenting noncontact knee injuries. Exclusion criteria were previous surgery, PCL tear, osteoarthritis, tumors, or infectious and inflammatory conditions. All participants underwent a flexed-knee 3-dimensional (3D) magnetic resonance imaging (MRI) to uniformly straighten PCL. MR images were independently reviewed by 2 radiologists and assessed for 2D and 3D measurements (bicondylar width; IN angle, depth, width, and cross-sectional area; PCL width, thickness, and cross-sectional area; and IN and PCL volumes). Clinical profiles were tabulated and subjects were divided into cases (ACL tear) and controls (without ACL tear). The study was composed of 50 cases versus 52 controls (N = 102), with a mean age of 36.8 years. T...
Magnetic resonance neurography is a high-resolution imaging technique that allows evaluating diff... more Magnetic resonance neurography is a high-resolution imaging technique that allows evaluating different neurological pathologies in correlation to clinical and the electrophysiological data. The aim of this article is to present a review on the anatomy of the lumbosacral plexus nerves, along with imaging protocols, interpretation pitfalls, and most common pathologies that should be recognized by the radiologist: traumatic, iatrogenic, entrapment, tumoral, infectious, and inflammatory conditions. An extensive series of clinical and imaging cases is presented to illustrate key-points throughout the article.
Low back pain and vertebral endplate abnormalities are common conditions within the population. S... more Low back pain and vertebral endplate abnormalities are common conditions within the population. Subclinical infection caused by indolent pathogens can potentially lead to these findings, with differentiation between them notably challenging from a clinical perspective. Progressive infection of the intervertebral disc has been extensively associated with increasing low back pain, with Propionibacterium acnes specifically implicated with in relation to sciatica. The main purpose of this study is to identify if the presence of an infective pathogen within the intervertebral disc is primary or is a result of intraoperative contamination, and whether this correlates to low back pain. An open prospective cohort study will be performed. Subjects included within the study will be between the ages of 18 and 65 years and have a diagnosis of lumbar disc herniation requiring open decompression surgery. Excised herniated disc fragments, muscle and ligamentum flavum samples will be collected duri...
ABSTRACT PURPOSE To evaluate the association between Osgood-Schlatter disease and patella alta us... more ABSTRACT PURPOSE To evaluate the association between Osgood-Schlatter disease and patella alta using MRI. METHOD AND MATERIALS A retrospective case-control study included patients evaluated by MRI of the knee performed in the period from January 2009 to December 2011 at our hospital. We included 103 patients with late sequel of Osgood-Schlatter disease (94 males and 9 females, average 37 years-old) and 393 controls without Osgood-Schlatter disease (326 males, and 67 females, average 41 years-old). Patients with Osgood-Schlatter disease in acute phase, patients younger than 15 years, prior surgery, fracture and bone deformities of the knee, and quadriceps and patellar tendon injuries were excluded. Patellar height was calculated using Insall-Salvati index technique and reference indexes on MRI were based in Shabshin et al published study. All case and control exams were independently evaluated by two radiologists. The used statistical methodologies were scatter and Bland Altman plots, intraclass correlation and kappa coefficients, and Fisher's exact tests. RESULTS In the comparison between cases and controls, there was association with statistical significance between Osgood-Schlatter disease and patella alta (p<0.001). There was also a high intraclass correlation coefficient (0.785, 95% CI 0.593-0.872). CONCLUSION As demonstrated in the study, there was a statistical significant association between Osgood-Schlatter disease and patella alta and a good interobserver concordance. This fact highlights the importance of the evaluation for patellar height by Insall-Salvati index technique on MRI of the knees in patients with sequelae of Osgood-Schlatter. CLINICAL RELEVANCE/APPLICATION In patients with Osgood-Schlatter disease, radiologists must be aware to the presence of patella alta, which can be important to the therapeutic decision and detection of associated lesions.
Sternoclavicular joint infection is a rare condition that usuallyoccurs in patients with predispo... more Sternoclavicular joint infection is a rare condition that usuallyoccurs in patients with predisposing factors. There are few casesof spontaneous septic arthritis of the sternoclavicular joint in healthyadults reported in the medical literature. Diagnosis may be difficultsince sternoclavicular pain may be referred to distant sites anddepends on specialized radiological studies. It is presented the caseof a 45-year old, previously healthy male, with sternoclavicular septicarthritis due to Staphylococcus aureus diagnosed by computedtomography of the sternoclavicular joint region and blood cultures.
PURPOSE/AIM Some anatomical studies performed on cadavers have shown the possible variations of t... more PURPOSE/AIM Some anatomical studies performed on cadavers have shown the possible variations of the sciatic nerve and its relationship to the piriformis. Our goal is to review and ilustrate these know variantions using a T2W volumetric sequence of the pelvis in vivo. CONTENT ORGANIZATION 1- The anatomic variations in the proximal course of the sciatic nerve and its relationship to the piriformis muscle. 2- T2W volumetric sequence of the pelvis parameters. 3- Using a T2W volumetric sequence illustrate the described variations in the high division of the sciatic nerve. 4- Correlation with some clinical scenarios, such as non-discogenic sciatica and the piriformis syndrome, and iatrogenic lesions in hip surgery. SUMMARY The frequency of variations in the high division of the sciatic nerve is relatively high and sometimes can be clinically relevant. High resolution sequences are already widely available, and allow the radiologist to accurately define the course of this nerve when prompted.
Uploads
Papers by Durval Santos