The magnetic resonance imaging of musculoskeletal hemorrhage

Bush, Charles H.

doi:10.1007/s002560050001

Cited by 90 publications

(52 citation statements)

References 24 publications

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“…ing on the time between the incident and the MR scan (i.e., evolution of hematoma), paramagnetic products of hemoglobin (12) could produce further local field degradation and T2 shortening, which would mask the lipids. The image of case 5 ( Fig.…”

Section: Discussionmentioning

confidence: 99%

Vertebrae adjacent to spinal bone lesion are inconsistent reference markers: A magnetic resonance spectroscopic viewpoint

Rumpel

Chan

et al. 2006

Magnetic Resonance Imaging

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Purpose:To ascertain the suitability of vertebrae adjacent to spinal bone lesions as a signal intensity reference on MRI, and compare the MR spectroscopic appearance of vertebral body compression fractures due to malignant tumor infiltration, bone weakening (e.g., osteoporosis), and/or minor trauma. Materials and Methods:Twenty-five patients with spinal compression fractures underwent routine spinal MRI with an additional 1 H MRS study protocol to assess the percent fat fraction of the compressed vertebrae as well as the adjacent bony environment. Peak areas for water and total lipid were calculated from short-TE single-voxel 1 H MR spectra using the LCModel analyzing tool.Results: There were consistent water-only patterns in the fractured vertebra suggesting either near complete marrow replacement by malignant tissue or local edematous fluid/ hemorrhage within the marrow spaces. However, the adjacent vertebrae showed a wide range of patterns from a dominant lipid signal to the inverse of a pronounced water level. These results far exceed the normal variation expected based on age and sex. Conclusion:The results suggest that the adjacent vertebrae may not be an accurate reference, especially in diffusion-weighted imaging (DWI), because of the large difference between the two compartments. Furthermore, in the case of gradient-echo measurements, the in-phase vs. opposed-phase effects are significant. MR IMAGES OF SPINAL VERTEBRAE reflect signals from red marrow and yellow marrow (i.e., water and lipid protons, respectively) (1). Although they are separable in MR spectroscopic techniques, in MRI the two signals become mixed within pixels. Nevertheless, the relative water/lipid composition at a location in an image can be unraveled by the use of a number of contrast-weighted techniques (1). Interpreting MR images involves making decisions as to whether regions of interest (ROIs) are hypo-, iso-, or hyperintense, which requires the use of a reference region in the same image for distinction. One can usually make an unambiguous distinction if the reference is consistent. In the case of vertebral MRI, however, it is difficult to separate lesions based on relative signal intensities (or contrast) because the reference is a priori unknown (i.e., the relative water and lipid content of the "reference" bone marrow (adjacent vertebra) is variable). This is especially true for diffusion-weighted imaging (DWI) because an unknown lipid content will affect the image intensity, which serves as the reference. The discrepancy between DWI (which depends on a reference signal) vs. the apparent diffusion coefficient (ADC) (which focuses on the lesion only) has been highlighted in a few reports (2-4). Zhou et al (2) showed that although DWI alone did not allow discrimination between benign osteoporotic fractures and pathologic malignant vertebral fractures, an ADC analysis of these lesions resulted in an improved distinction between the two pathologies. In response to Ref. 2, Mulkern and Schwartz (5) emphasized the dependency of the A...

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Section: Discussionmentioning

confidence: 99%

Vertebrae adjacent to spinal bone lesion are inconsistent reference markers: A magnetic resonance spectroscopic viewpoint

Rumpel

Chan

et al. 2006

Magnetic Resonance Imaging

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“…The characteristic feathered appearance of a musculotendinous junction strain injury to the biceps (straight arrow) is typical. Note that the gluteus maximus insertion onto the ilio-tibial band (open arrowhead) serves as a guide as to where to expect some reasonable long head of biceps femoris muscle bulk to start appearing dependent [37]. The same area of oedema is demonstrated with ultrasound.…”

Section: Strainmentioning

confidence: 94%

Imaging of hamstring injuries: therapeutic implications

Koulouris

Connell

2006

Eur Radiol

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Though recent research into the diagnosis and management of hamstring disorders has resulted in early and accurate recognition of injury, hamstring strain remains the most common form of muscle injury in the active population. With prompt recognition of hamstring strain, an appropriate rest and rehabilitation routine may be devised by the sports clinician in the hope of avoiding future and possibly more debilitating injury. As such, imaging has played a pivotal role in assisting athletes, both elite and recreational, in returning to activity expeditiously.

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“…4A and 4B). This T1 signal-intensity behavior is probably related to the existence of methemoglobin, characteristic of subacute hematomas [10,11]. Methemoglobin is first observed on the periphery of subacute hematomas and produces a "concentric ring" sign.…”

Section: B a D Cmentioning

confidence: 97%