Purpose In this prospective, double-center cohort study, we aim to assess how the anterior cruciate ligament (ACL) signal intensity on magnetic resonance imaging (MRI) potentially varies between a group of patients with anatomic ACL reconstruction using autogenous hamstring grafts 6 months postoperatively and a healthy ACL control group, and how MRI-based graft signal intensity is related to knee laxity. Methods Sixty-two consecutive patients who underwent ACL reconstruction using quadrupled hamstring tendon autograft were prospectively invited to participate in this study, and they were evaluated with MRI after 6 months of follow-up. 50 patients with an MRI of their healthy ACL (Clinica Luganese, Lugano, Switzerland) and 12 patients of their contralateral healthy knee (Department of Orthopaedic and Trauma Surgery, Medical University of Vienna, Austria) served as the control group. To evaluate graft maturity, the signal-to-noise quotient (SNQ) was measured in three regions of interest (ROIs) of the proximal, mid-substance and distal ACL graft and the healthy ACL. KT-1000 findings were obtained 6 months postoperatively in the ACL reconstruction group. Statistical analysis was independently performed to outline the differences in the two groups regarding ACL intensity and the correlation between SNQ and KT-1000 values. Results There was a significant difference in the mean SNQ between the reconstructed ACL grafts and the healthy ACLs in the proximal and mid-substance regions (p = 0.001 and p = 0.004). The distal region of the reconstructed ACL showed a mean SNQ similar to the native ACL (n.s). Patients with a KT-1000 between 0 and 1 mm showed a mean SNQ of 0.1; however, a poor correlation was found between the mean SNQ and KT-1000 findings, probably due to the small sample size of patients with higher laxity. Conclusion After 6 months of follow-up, hamstring tendon autografts for anatomic ACL reconstruction do not show equal MRI signal intensity compared to a healthy ACL and should therefore be considered immature or at least not completely healed even if clinical laxity measurement provides good results. However, in the case of a competitive athlete, who is clinically stable and wants to return to sports at 6 months, performing an MRI to confirm the stage of graft healing might be an option. Level of evidence Prospective, comparative study II.
Focal lesions arising in patients with HCV-related chronic liver disease can be other than hepatocellular carcinoma, and ultrasound-guided fine-needle biopsy plays an important role in their diagnosis. The prevalence of non-Hodgkin's lymphoma in this selected population was 0.31%. The fact that all five lymphoma patients had cirrhosis related to hepatitis C strengthens the hypothesis of an etiological correlation between the latter infection and B-cell lymphoproliferative disorders.
The chance of success with repeat biopsy of hepatocellular carcinoma is limited and may depend to some extent on the characteristics of the lesions (i.e., areas of necrosis in large nodules, well-differentiated cellular populations in small ones).
Objective: Evaluate incidence, etiology, and sonographic features of Baker's cyst in children. Materials and methods: We examined 16 pediatric patients, with the clinical diagnosis of Baker's cyst. The possibility to confirm or to exclude the presence of the lesion, assess the structure, presence of bilateralism and joint effusion were considered. Three subjects had known juvenile arthritis, 2 hemophilia, 11 a popliteal swelling in the absence of concomitant diseases. Results: In all patients it was possible to confirm (11) or to exclude (5) the presence of Baker's cyst. The idiopathic forms (6) exhibited anechoic structure; in patients with arthritis (3) there was hypertrophic synovium; in hemophilic patients at the presentation (2) anechoic structure with layering (serum and red blood cells); in chronic hemophilia synovial hypertrophy was seen. Joint effusion was constantly present in children with hemophilia and arthritis and in 1 case of idiopathic cyst. Conclusion: Baker's cysts in children are rare. Ultrasound is able to confirm or to exclude the presence of the lesion and it is able to evaluate characteristics, bilateralism and association with joint effusion.Sommario Obiettivi: Scopo del lavoro è valutare incidenza, eziologia e caratteristiche ecografiche delle cisti di Baker nei bambini. Materiali e metodi: Sono stati esaminati 16 pazienti di età pediatrica, con diagnosi clinica di cisti di Baker. È stata valutata la possibilità di confermare o di escludere la presenza di tale formazione, di documentarne la struttura, la presenza di bilateralità e di versamento articolare. Tra i pazienti esaminati 3 soggetti presentavano artrite reumatoide giovanile, 2 erano affetti da emofilia, 11 si presentavano con una tumefazione nel cavo popliteo, in assenza di patologie concomitanti. Risultati: In tutti i giovani pazienti è stato possibile confermare (11) o escludere (5) la presenza di cisti di Baker. Le forme idiopatiche (6) presentavano struttura oncogena, nei pazienti con artrite (3) mostravano ipertrofia della sinovia, in quelli emofilici (2), in fase iniziale, si osservava struttura anecogena con stratificazione (siero e globuli rossi), nelle forme croniche era presente ipertrofia sinoviale. Nei bambini con emofilia, artrite e in 1 caso di cisti idiopatica era presente versamento articolare. Conclusioni: Le cisti di Baker nei bambini sono rare. L'ecografia permette di confermare o di escludere la presenza di tali formazioni e di valutarne le caratteristiche, la bilateralità e la concomitante presenza di versamento articolare. ª
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