The results of magnetic resonance imaging (MRI) were compared with those of arthroscopy in a prospective series of 244 patients. A dedicated system for MRI of limbs and peripheral joints--the 0.2-T Artoscan (Esaote, Italy)--was used for imaging knee joint lesions. T1-weighted spin-echo sagittal images, T2-weighted gradient-echo coronal images, and axial views for lesions of the femoropatellar joint were acquired. Paraxial sagittal and oblique coronal views were obtained for imaging of the cruciate ligaments. This protocol allowed excellent visualization of the cruciate ligaments and medial and lateral meniscus in almost all patients. Compared with arthroscopy performed within 48 h after imaging, the sensitivity, specificity, and accuracy were respectively 93%, 97%, and 95% for tears of the medial meniscus; 82%, 96%, and 93% for tears of the lateral meniscus; 100%, 100%, and 100% for tears of the posterior cruciate ligament; 98%, 98%, and 97% for tears of the anterior cruciate ligament; and 72%, 100%, and 92% for full-thickness articular cartilage lesions. The examination can be performed within 30-45 min at lower cost than diagnostic arthroscopy. MRI with a 0.2-T magnet is a safe and valuable adjunct to the clinical examination of the knee and an aid to efficient preoperative planning.
Sclerotherapy is a safe and effective alternative treatment of idiopathic varicocele. It can be performed on an outpatient basis. Success depends on the anatomic variant.
In the age of health care cost containment new imaging technology has to meet diagnostic requirements as well as economic limitations. In the MR sector new dedicated systems promise reliable diagnostic information at considerably lower costs than whole-body imagers. Within the past 18 months we have examined 2200 patients with acute and chronic lesions of peripheral joints (knee, ankle, foot, elbow, wrist, hand) in a 0.2T dedicated MR system (ARTOSCAN, Esaote Biomedica, Genoa, Italy). We report our experience with this system focusing on its special features, cost-effectiveness and on diagnostic accuracy of low-field MR studies of the knee in correlation with arthroscopy and in comparison with high-field whole-body imagers.
During a period of four years, 386 patients with left sided varicoceles were treated by sclerotherapy of the left internal spermatic vein. This was successful in 93.8%. The most common complication was perforation of the vein in 6.2%. Technical success and complications depended on anatomical variations. Of particular significance was Bähren type IVb (competent main vein, incompetent collaterals) which occurred in 18.9%. This accounted for 66.5% of all perforations and 54.2% of unsuccessful interventions. The recurrence rate was 3.8%.
The results of magnetic resonance imaging (MRI) were compared with those of arthroscopy in a prospective series of 276 patients. A "dedicated system" for MRI of limbs and peripheral joints--the 0,2 Tesla ARTOSCAN (ESAOTE, Italy)--was used for imaging knee joint lesions. T1-weighted spin echo sagittal images, T2-weighted gradient-echo coronal images, and axial views for lesions of bone and the femoropatellar joint were acquired. If necessary paraxial sagittal and oblique coronal views were obtained for imaging of the cruciate ligaments. This protocol allowed excellent visualization of the cruciate ligaments, medial and lateral meniscus in almost all patients. Compared with arthroscopy performed within 48 hours after imaging, the sensitivity, specificity, and accuracy were respectively, 91, 92 and 91 per cent for tears of the medial meniscus; 80, 96, and 92 per cent for tears of the posterior meniscus; 100, 100, and 100 per cent for tears of the posterior cruciate ligament; 93, 98, and 99 per cent for tears of the anterior cruciate ligament; and 73, 100, and 92 per cent for full-thickness articular cartilage lesions. The examination can be performed within 30 to 45 minutes at a cost that is lower than that of diagnostic arthroscopy. ARTOSCAN imaging is a safe and valuable adjunct to the clinical examination of the knee and an aid to efficient preoperative planning.
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