OBJECTIVE: To compare the accuracy of diagnosing aqueductal patency and image quality between high spatial resolution three-dimensional (3D) high-sampling-efficiency technique (sampling perfection with application optimized contrast using different flip angle evolutions [SPACE]) and T2-weighted (T2W) two-dimensional (2D) turbo spin echo (TSE) at 3-T in patients with hydrocephalus. MATERIALS AND METHODS: This retrospective study included 99 patients diagnosed with hydrocephalus. T2W 3D-SPACE was added to the routine sequences which consisted of T2W 2D-TSE, 3D-constructive interference steady state (CISS), and cine phase-contrast MRI (PC-MRI). Two radiologists evaluated independently the patency of cerebral aqueduct and image quality on the T2W 2D-TSE and T2W 3D-SPACE. PC-MRI and 3D-CISS were used as the reference for aqueductal patency and image quality, respectively. Inter-observer agreement was calculated using kappa statistics. RESULTS: The evaluation of the aqueductal patency by T2W 3D-SPACE and T2W 2D-TSE were in agreement with PC-MRI in 100% (99/99; sensitivity, 100% [83/83]; specificity, 100% [16/16]) and 83.8% (83/99; sensitivity, 100% [67/83]; specificity, 100% [16/16]), respectively (p < 0.001). No significant difference in image quality between T2W 2D-TSE and T2W 3D-SPACE (p = 0.056) occurred. The kappa values for inter-observer agreement were 0.714 for T2W 2D-TSE and 0.899 for T2W 3D-SPACE. CONCLUSION: Three-dimensional-SPACE is superior to 2D-TSE for the evaluation of aqueductal patency in hydrocephalus. T2W 3D-SPACE may hold promise as a highly accurate alternative treatment to PC-MRI for the physiological and morphological evaluation of aqueductal patency.
Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Hydrocephalus/*radiography ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Young Adult

OBJECTIVE: To evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI. MATERIALS AND METHODS: Lumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described. RESULTS: The diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization. CONCLUSION: The spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anatomic Landmarks/*anatomy & histology ; Aorta, Abdominal/anatomy & histology ; Diagnostic Errors ; Female ; Humans ; Intervertebral Disc/anatomy & histology ; Lumbar Vertebrae/*anatomy & histology ; Lumbosacral Region ; Magnetic Resonance Imaging ; Male ; Mesenteric Artery, Superior/anatomy & histology ; Middle Aged ; Renal Artery/anatomy & histology ; Reproducibility of Results ; Sacrum/*anatomy & histology ; Spinal Cord/anatomy & histology ; Spine ; Young Adult

Background: This retrospective study aimed to analyze avulsion and osteochondral fractures associated with patellar dislocation using 3-dimensional (3D) computed tomography (CT). Methods: A retrospective analysis was conducted on patients admitted between 2015 and 2023 with acute or recurrent patellar dislocations. A musculoskeletal radiologist and 2 orthopedic surgeons evaluated CT scans of 148 patients (160 knees) to identify and categorize all avulsion and osteochondral fractures. The included fracture patterns were as follows: pattern I: medial patellofemoral ligament (MPFL) avulsion from the upper two-thirds of the patella, pattern II: medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML) avulsion from the lower one-third, pattern III: inferomedial patellar facet osteochondral fracture, pattern IV: lateral femoral condyle osteochondral fracture, and pattern V: MPFL avulsion from the femoral footprint. The dimensions of patellar articular surface osteochondral fractures were measured, and patient age, sex, and side were recorded. Descriptive statistics and chi-squared tests were performed. Results: A total of 148 patients (93 female and 55 male patients) with a mean age of 18.7 ± 6.8 years were included. Of these, 116 patients (72.5%) had 1 or more fractures, with 71 (44.4%) having isolated lesions and 45 (28.1%) having combined lesions.Pattern II was the most prevalent, observed in 66 knees (41.2%), followed by pattern I in 52 knees (32.5%), and pattern III in 45 knees (28.1%). Patterns IV and V were seen in 4 (2.5%) and 1 (0.6%) knee, respectively. The mean articular fragment size in pattern III was 128.4 ± 95.6 mm 2 (range, 12–412.5 mm 2 ), all involving the inferomedial facet of the patella. Osteochondral fragments were found in the lateral gutter (35.5%), anterior joint space (51.1%), posterior joint space (8.9%), and suprapatellar space (4.5%). No significant sex differences were observed in isolated versus combined lesions (p = 0.542) or fracture patterns (p = 0.274). Conclusions This study, the first to evaluate fractures after patellar dislocation using 3D CT, identified 5 distinct fracture patterns. The results show that MPTL/MPML injuries are more common than previously thought, challenging traditional views on patellar dislocation injuries and emphasizing the need for a comprehensive diagnostic approach.

Background: This retrospective study aimed to analyze avulsion and osteochondral fractures associated with patellar dislocation using 3-dimensional (3D) computed tomography (CT). Methods: A retrospective analysis was conducted on patients admitted between 2015 and 2023 with acute or recurrent patellar dislocations. A musculoskeletal radiologist and 2 orthopedic surgeons evaluated CT scans of 148 patients (160 knees) to identify and categorize all avulsion and osteochondral fractures. The included fracture patterns were as follows: pattern I: medial patellofemoral ligament (MPFL) avulsion from the upper two-thirds of the patella, pattern II: medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML) avulsion from the lower one-third, pattern III: inferomedial patellar facet osteochondral fracture, pattern IV: lateral femoral condyle osteochondral fracture, and pattern V: MPFL avulsion from the femoral footprint. The dimensions of patellar articular surface osteochondral fractures were measured, and patient age, sex, and side were recorded. Descriptive statistics and chi-squared tests were performed. Results: A total of 148 patients (93 female and 55 male patients) with a mean age of 18.7 ± 6.8 years were included. Of these, 116 patients (72.5%) had 1 or more fractures, with 71 (44.4%) having isolated lesions and 45 (28.1%) having combined lesions.Pattern II was the most prevalent, observed in 66 knees (41.2%), followed by pattern I in 52 knees (32.5%), and pattern III in 45 knees (28.1%). Patterns IV and V were seen in 4 (2.5%) and 1 (0.6%) knee, respectively. The mean articular fragment size in pattern III was 128.4 ± 95.6 mm 2 (range, 12–412.5 mm 2 ), all involving the inferomedial facet of the patella. Osteochondral fragments were found in the lateral gutter (35.5%), anterior joint space (51.1%), posterior joint space (8.9%), and suprapatellar space (4.5%). No significant sex differences were observed in isolated versus combined lesions (p = 0.542) or fracture patterns (p = 0.274). Conclusions This study, the first to evaluate fractures after patellar dislocation using 3D CT, identified 5 distinct fracture patterns. The results show that MPTL/MPML injuries are more common than previously thought, challenging traditional views on patellar dislocation injuries and emphasizing the need for a comprehensive diagnostic approach.

Background: This retrospective study aimed to analyze avulsion and osteochondral fractures associated with patellar dislocation using 3-dimensional (3D) computed tomography (CT). Methods: A retrospective analysis was conducted on patients admitted between 2015 and 2023 with acute or recurrent patellar dislocations. A musculoskeletal radiologist and 2 orthopedic surgeons evaluated CT scans of 148 patients (160 knees) to identify and categorize all avulsion and osteochondral fractures. The included fracture patterns were as follows: pattern I: medial patellofemoral ligament (MPFL) avulsion from the upper two-thirds of the patella, pattern II: medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML) avulsion from the lower one-third, pattern III: inferomedial patellar facet osteochondral fracture, pattern IV: lateral femoral condyle osteochondral fracture, and pattern V: MPFL avulsion from the femoral footprint. The dimensions of patellar articular surface osteochondral fractures were measured, and patient age, sex, and side were recorded. Descriptive statistics and chi-squared tests were performed. Results: A total of 148 patients (93 female and 55 male patients) with a mean age of 18.7 ± 6.8 years were included. Of these, 116 patients (72.5%) had 1 or more fractures, with 71 (44.4%) having isolated lesions and 45 (28.1%) having combined lesions.Pattern II was the most prevalent, observed in 66 knees (41.2%), followed by pattern I in 52 knees (32.5%), and pattern III in 45 knees (28.1%). Patterns IV and V were seen in 4 (2.5%) and 1 (0.6%) knee, respectively. The mean articular fragment size in pattern III was 128.4 ± 95.6 mm 2 (range, 12–412.5 mm 2 ), all involving the inferomedial facet of the patella. Osteochondral fragments were found in the lateral gutter (35.5%), anterior joint space (51.1%), posterior joint space (8.9%), and suprapatellar space (4.5%). No significant sex differences were observed in isolated versus combined lesions (p = 0.542) or fracture patterns (p = 0.274). Conclusions This study, the first to evaluate fractures after patellar dislocation using 3D CT, identified 5 distinct fracture patterns. The results show that MPTL/MPML injuries are more common than previously thought, challenging traditional views on patellar dislocation injuries and emphasizing the need for a comprehensive diagnostic approach.

Background: This retrospective study aimed to analyze avulsion and osteochondral fractures associated with patellar dislocation using 3-dimensional (3D) computed tomography (CT). Methods: A retrospective analysis was conducted on patients admitted between 2015 and 2023 with acute or recurrent patellar dislocations. A musculoskeletal radiologist and 2 orthopedic surgeons evaluated CT scans of 148 patients (160 knees) to identify and categorize all avulsion and osteochondral fractures. The included fracture patterns were as follows: pattern I: medial patellofemoral ligament (MPFL) avulsion from the upper two-thirds of the patella, pattern II: medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML) avulsion from the lower one-third, pattern III: inferomedial patellar facet osteochondral fracture, pattern IV: lateral femoral condyle osteochondral fracture, and pattern V: MPFL avulsion from the femoral footprint. The dimensions of patellar articular surface osteochondral fractures were measured, and patient age, sex, and side were recorded. Descriptive statistics and chi-squared tests were performed. Results: A total of 148 patients (93 female and 55 male patients) with a mean age of 18.7 ± 6.8 years were included. Of these, 116 patients (72.5%) had 1 or more fractures, with 71 (44.4%) having isolated lesions and 45 (28.1%) having combined lesions.Pattern II was the most prevalent, observed in 66 knees (41.2%), followed by pattern I in 52 knees (32.5%), and pattern III in 45 knees (28.1%). Patterns IV and V were seen in 4 (2.5%) and 1 (0.6%) knee, respectively. The mean articular fragment size in pattern III was 128.4 ± 95.6 mm 2 (range, 12–412.5 mm 2 ), all involving the inferomedial facet of the patella. Osteochondral fragments were found in the lateral gutter (35.5%), anterior joint space (51.1%), posterior joint space (8.9%), and suprapatellar space (4.5%). No significant sex differences were observed in isolated versus combined lesions (p = 0.542) or fracture patterns (p = 0.274). Conclusions This study, the first to evaluate fractures after patellar dislocation using 3D CT, identified 5 distinct fracture patterns. The results show that MPTL/MPML injuries are more common than previously thought, challenging traditional views on patellar dislocation injuries and emphasizing the need for a comprehensive diagnostic approach.