This document summarizes the findings of a study analyzing variability in preoperative knee MRI diagnoses across multiple institutions. The study reviewed 203 knee MRI scans and their corresponding arthroscopy results. It found significant differences between imaging centers in detecting medial meniscal tears and ACL tears. Common pitfalls included misdiagnosing normal anatomical variants as pathology, overlooking injuries like menisco-capsular junction tears, and technical issues like magic angle artifacts. The study emphasizes the importance of radiologists understanding normal anatomy, potential errors, and consulting orthopedic surgeons to optimize knee MRI accuracy.
A pithy but thorough discussion on ultrasound elastography. An understanding of basic physics, principles and techniques and most importantly its use in clinical settings.
Presentation in the class Superficial Structures on the Neonate Spine, comparing ultrasound visualization with both MRI and X-ray imaging of this structure.
Ultrasound elastography is a relatively advanced technique used to know the stiffness of the tissue. It is a non-invasive technique. Broadly classified into Quasistatic and Dynamic elastography.
Ultrasound Elastography is a new imaging technique that allows a noninvasive estimation and imaging of tissue elasticity distribution within biological tissues using conventional, Real Time Ultrasound equipment with modified software. It can be viewed as an electronic palpation of tissues. Introduced by Ophir et al in 1991, it subsequently evolved into a Real Time Imaging tool.
Quantitative analysis of patellar tendon size and structure in asymptomatic ...Medical_Lab
Risultati dello studio ecografico in relazione all'analisi quantitativa della dimensione e della struttura del tendine rotuleo in un giocatore professionista asintomatico.
Presentations from Professor Adnan Saithna at the North West Upper Limb Group Meeting January 2018, focusing on current concepts in the diagnosis and management of long head of biceps tendon pathology, with an emphasis on the young, active patient with anterior shoulder pain
A pithy but thorough discussion on ultrasound elastography. An understanding of basic physics, principles and techniques and most importantly its use in clinical settings.
Presentation in the class Superficial Structures on the Neonate Spine, comparing ultrasound visualization with both MRI and X-ray imaging of this structure.
Ultrasound elastography is a relatively advanced technique used to know the stiffness of the tissue. It is a non-invasive technique. Broadly classified into Quasistatic and Dynamic elastography.
Ultrasound Elastography is a new imaging technique that allows a noninvasive estimation and imaging of tissue elasticity distribution within biological tissues using conventional, Real Time Ultrasound equipment with modified software. It can be viewed as an electronic palpation of tissues. Introduced by Ophir et al in 1991, it subsequently evolved into a Real Time Imaging tool.
Quantitative analysis of patellar tendon size and structure in asymptomatic ...Medical_Lab
Risultati dello studio ecografico in relazione all'analisi quantitativa della dimensione e della struttura del tendine rotuleo in un giocatore professionista asintomatico.
Presentations from Professor Adnan Saithna at the North West Upper Limb Group Meeting January 2018, focusing on current concepts in the diagnosis and management of long head of biceps tendon pathology, with an emphasis on the young, active patient with anterior shoulder pain
Suture anchor Bone Response Validation StudyLennard Funk
Suture anchors are routinely used for shoulder labral reconstruction procedures. There is paucity of literature on how the response of bone to suture anchor should be measured following labral reconstruction. A new system, based on the use of magnetic resonance (MR) imaging, has been developed by Professor Bhatti and his trainee which grades bone signal changes around suture anchors using a five-point scale. This system, however, has not yet been tested on a clinical dataset. We tested the reliability of the grading system in an independent dataset.
This validation study demonstrates that the grading system is feasible and has generally moderate reliability. And, although results could be improved if a training document is added at the beginning of the study, this grading system should undergo further validation testing for use in clinical trials.
Predictors of Patients’ Functional Outcome after Motor Nerve Transfers in Man...Professor M. A. Imam
To maximize outcome in nerve transfers:
1- The recipient nerve reinnervated close to the target muscle.
2- Direct repair without intervening grafts.
3- Similarly behaving neuromuscular units (agonistic donors and recipients)
Presentation at the Atlas medical centre in Moscow about modern radiology, expert-as-a-service, big data analysis for quality and safety improvement, perspectives on machine learning and artificial intelligence
Доклад о проблемах маммографии, флюорографии и УЗД в скрининге. Аргументы за маммографию, рентгенографию и НДКТ, против УЗД в скрининге и массового применения флюорографии.
The shared radiology workflow consists of physician’s referral, study approval, scheduling, patient arrival, imaging, reporting, validating, and results distribution. The performance of this process can be measured on different levels: resources utilization, current operations, and outcomes.
The end-result of the process is defined by the goal, which can also vary. The major goals are effectiveness (e.g. high-quality, high-safety, high-volume, high-accessibility services, patients’ and physicians’ satisfaction), efficiency (cost-effectiveness, cost-control, revenue generation), and health improvement (better treatment because of accurate diagnostics, less morbidity and mortality because of early diagnostics).
The problem with the radiology services is that we often incorrectly measure incorrect metrics. Wherever we see systematic measurement of results in health care—no matter what the country—we see those results improve (R.S. Kaplan, M.E. Porter).
Hence, we should move from current radiology operational metrics (report turn-around-time, back-log time, discrepancies, equipment utilization rate, revenue) to clinical operational metrics (diagnosis-related delays of treatment, time to begin treatment) and outcome measurements (patients’ and clinicians’ satisfaction, gross margin of services, involvement in disease-specific clinical teams, better treatment because of accurate diagnostics).
The best method for tackling ‘bottlenecks’ is time-driven activity-based costing (TDABC) through better resource utilization, standardized processes, proper staffing, and logistics optimization.
Building an enabling IT platform is the key for embedding the changes in the system.
Ideal physician measurements are aligned to electronic data collection, attributable to individuals, cascade from organizational goals, supported by evidence and physicians, comparative, and transparent.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. 27.01.16
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Radiology Research and
Practice Center, Moscow
Pitfalls of knee MRI
Sergey Morozov, MD, PhD, MPH
Irina Trofimenko, MD, PhD
Radiology Research and
Practice Center, Moscow
Radiology Research and
Practice Center, Moscow
Agenda
• Knee trauma diagnosis
• Role of MRI
• Multi-center trial of MRI effectiveness
• Major pitfalls of MRI
• Recommendations and regional
solutions
2. 27.01.16
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Radiology Research and
Practice Center, Moscow
3
Clinical symptoms of knee
injury
• Pain, limitation of movement
• Hemarthrosis
• Instability
→ Clinical Dx
Radiology Research and
Practice Center, Moscow
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 20, No 7 (September), 2004: pp 696-700
Trained and experienced traumatologist has
100% accuracy in ACL tear diagnosis
Lachman
test
Med. Men. Lat. Men. ACL
Clin. Dx MRI Clin. Dx MRI Clin. Dx MRI
Accuracy 80 80 92 90 100 98
Sens 87 80 75 85 100 96
Spec 68 79 95 97 100 96
3. 27.01.16
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Radiology Research and
Practice Center, Moscow
5
MRI – preoperative verification of Dx
• MRI as predictor for arthroscopic treatment
– Senc 79%
– Spec 100%
Vincken et al. Radiology 2002; 223:739.
Strategy with MRI Strategy without MRI
Arthroscopy, % 57 92
Treatment costs 1296 961
Sick leaves, % 44 58
Sick days 11,8 15,8
Radiology Research and
Practice Center, Moscow
Knee MRI dilemma
Lateral meniscus tear ACL tear
Sn 69,5 70 (55,2-84,7)
Sp 94,5 94,5
NPV 80,5 59,6
PPV 90,5 96,5
Radiology 2002; 223:739–746
4. 27.01.16
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Radiology Research and
Practice Center, Moscow
Sources of pitfalls
Technical
aspects
Normal
variants
Pathology
Radiology Research and
Practice Center, Moscow
Purpose
• To analyze variability of
preoperative knee MRI by
means of retrospective multi-
institutional study
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Radiology Research and
Practice Center, Moscow
Design of study
A
C
B
D
E
Arthroscopy
(1 surgeon)
MRI centers
Traumatologist
consultation
(3 physicians)
Retrospective analysis
Ortho General
1.5-3.0 T A, E B
0.5-1.0 T C D
Radiology Research and
Practice Center, Moscow
Materials and Methods
% of patients with pathology at each MRI center
A B C D E
Med. Meniscus 58,3 35,7 52,5 52,5 46,9
Lat. Meniscus 18,3 35,7 22,5 27,9 18,8
ACL 88,3 81,0 87,5 86,9 84,4
Cartilage 51,7 85,7 55,0 67,2 62,5
• 203 patients
• 15-74 y.o. (35.0 ± 12.7 years)
• Difference in age among diagnostic
centers - NS
43,30
%
56,70
%
malefemale
p<0.05
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Radiology Research and
Practice Center, Moscow
Materials and Methods: study
flow chart
1. Retrieval of data from MRI and arthroscopy
protocols (203 patients; 35.0 ± 12.7 y.o.)
2. Standardization and systematization of data
3. Database management
4. Data analysis:
– Diagnostic effectiveness of MRI
(relative to arthroscopy)
– ROC
5. MR images revision
Radiology Research and
Practice Center, Moscow
Results: menisci
Medial meniscus
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
1
0 0,2 0,4 0,6 0,8 1
A B C D E
Lateral meniscus
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
1
0 0,2 0,4 0,6 0,8 1
A B C D E
AUC: 0.57-0.87
Significant difference between MRI centers
for medial meniscus
AUC: 0.56-0.80
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Radiology Research and
Practice Center, Moscow
0,87
0,78
0,67
0,87
0,77
0 0,5 1 1,5
Sensitivity
A
B
C
D
E
0,76
0,38
0,79
0,85
0,76
0 0,5 1 1,5
Specificity
Medial meniscus: Significant difference in
specificity of MRI between centers B and D
Results: medial meniscus
A
B
C
D
E
Radiology Research and
Practice Center, Moscow
0,67
0,47
0,33
0,60
0,64
0 0,5 1 1,5
Sensitivity
Lateral meniscus: No significant difference
between MRI centers
Results: lateral meniscus
A
B
C
D
E
1,00
0,89
0,94
0,92
0,89
0 0,5 1 1,5
Specificity
A
B
C
D
E
8. 27.01.16
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Radiology Research and
Practice Center, Moscow
Results: anterior cruciate
ligament
0
0,2
0,4
0,6
0,8
1
0 0,2 0,4 0,6 0,8 1
A B C D E
0,75
0,86
1,00
0,75
1,00
0 0,2 0,4 0,6 0,8 1 1,2
0,47
0,82
0,77
0,49
0,59
0 0,2 0,4 0,6 0,8 1
AUC: 0.67-0.89
Significant difference
between centers A, B, D
Sensitivity
Specificity
A
B
C
D
E
A
B
C
D
E
Radiology Research and
Practice Center, Moscow
Example 1 MRI report: Partial tear of ACL
Arthroscopy: Full-thickness tear of ACL
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Radiology Research and
Practice Center, Moscow
Example 2 MRI report: Tear of posterior horn of MM
Arthroscopy:
no tear of menisci
Radiology Research and
Practice Center, Moscow
Sources of pitfalls
Technical
aspects
Normal
variants
Pathology
10. 27.01.16
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Radiology Research and
Practice Center, Moscow
19
Incomplete MRI protocol
Radiology Research and
Practice Center, Moscow
Flow artifacts
A>>P
• The same shape
as popliteal
vessels
• Strongly
depends on
phase encoding
directionH>>F
11. 27.01.16
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Radiology Research and
Practice Center, Moscow
Flow artifacts
• Solution 1 = change phase-encoding
direction
frequency-encoding
phase-encoding
K-space
K-space
center
• Solution 2 = PROPELLER/
BLADE reconstruction
• K-space center is oversampled →
↑SNR, ↑CNR
•↑ time of reconstruction, ↑SAR
Radiology Research and
Practice Center, Moscow
Magic angle artifact
TE 20 ms
• ↑ SI at 550 relative
B0
• Affects only
structured collagen
fibers (tendons,
cartilage, menisci,
ligaments)
TE 70 ms
B
0
55
0
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Radiology Research and
Practice Center, Moscow
Magic angle artifact
TE 20 ms
• Only exists with
short TE (<
37ms)
TE 70 ms
Radiology Research and
Practice Center, Moscow
Inadequate fat suppression
• Mimics edema
• Off-center or at the
edge of the coil
• Solution = STIR
13. 27.01.16
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Radiology Research and
Practice Center, Moscow
Inadequate fat suppression
• Solution 1 = STIR
- tolerance to B0 and B1 inhomogeneity
- ↓ SNR
• Solution 2 = SPAIR
- combination of CHESS+STIR
- uses adiabatic inverting pulse →
↓sensitivity to B1
- longer time than STIR
• Solution 3 = DIXON
- ↓ insensitive to B0 and B1 inhomogeneity
- increases minimal TR
Radiology Research and
Practice Center, Moscow
Sources of pitfalls
Technical
aspects
Normal
variants
Pathology
14. 27.01.16
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Radiology Research and
Practice Center, Moscow
Fatty synovial folds
• Mimics loose
bodies at fat
sat
• ↑SI at T1-WI
Radiology Research and
Practice Center, Moscow
Lateral tibial plateau cartilage
• Mimics
chondrocalcinosis
True
chondrocalcinosis
15. 27.01.16
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Radiology Research and
Practice Center, Moscow
Meniscal flounce
Mohancumar et al, AJR:
203
• Up to 5% of MM
• Transient physiologic
distortion
• Seen with knee flexed,
disappears with full
extension
Radiology Research and
Practice Center, Moscow
Lateral meniscus anterior
horn
• Striated
appearance =
normal
• Isolated tears
LMAH only 16%
of all LM tears
16. 27.01.16
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Radiology Research and
Practice Center, Moscow
Menisco-femoral ligament
• When MFL hyperplasia mimics PCL tear or bucket-
handle meniscal tear
Radiology Research and
Practice Center, Moscow
Menisco-femoral ligament / LM
junction
• Mimics radial
vertical
tears
• Attention:
Wrisberg rip
(ACL tear)
Pseudo-tear True-tear
17. 27.01.16
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Radiology Research and
Practice Center, Moscow
Medial meniscus: menisco-
capsular injury
Menisco-capsular
injury
Menisco-capsular
recess
• Fluid SI between
PHMM and
capsule
• Recessus: fluid SI
doesn’t reach both
meniscal surfaces
Radiology Research and
Practice Center, Moscow
Anterior transverse ligament
• Mimics LM
anterior horn
tear
18. 27.01.16
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Radiology Research and
Practice Center, Moscow
Popliteus tendon
• PT / LM
posterior horn
interface mimic
LM tear
Radiology Research and
Practice Center, Moscow
Patella bi/tripartite
• Typical location SL
pole
• 2% of population
• D e g e n e r a t i v e
remodelling
19. 27.01.16
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Radiology Research and
Practice Center, Moscow
Patella dorsal defect
Patella dorsal defect Chondromalacia 4
grade
• Subchondral
bone
irregularity
with intact
overlying
cartilage
Courtesy of Dr. D. Zimmermann Stefani
(Radiopaedia.org )
Radiology Research and
Practice Center, Moscow
Haematopoetic bone marrow
• Red bone marrow
mimics edema or
infarction
• ↑ SI than muscle
on T1-WI
• Signal drop at
opposed phase
images
20. 27.01.16
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Radiology Research and
Practice Center, Moscow
Sources of pitfalls
Technica
l aspects
Normal
variants
Pathology
Radiology Research and
Practice Center, Moscow
Flap meniscal tear
normalpericapsular flap
tear
Dandy DJ. The arthroscopic anatomy of symptomatic meniscal lesions. J Bone Joint
Surg Br 1990; 72-B:628-633
• ~ 6% of
meniscal
tears
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Radiology Research and
Practice Center, Moscow
Root meniscal tear
• Often
associated
with meniscal
extrusion
• 28% of MM
tears
Bin SI et al Radial tears of the posterior horn of the medial
meniscus. Arthroscopy. 2004 Apr. 20(4):373-8.
Radiology Research and
Practice Center, Moscow
Chronic ACL tear
• Fibrotic tissue
mimics ↓ SI of
normal ligament
• Normal ACL =
layered
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Radiology Research and
Practice Center, Moscow
Partial ACL tear
Radiology Research and
Practice Center, Moscow
Postoperative ACL
• Graft made from
harmstring
tendon normally
shows layered
structure
• Mimics
longitudinal tear
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Radiology Research and
Practice Center, Moscow
Iliotibial tract syndrom
• Frequently
overestimated
Radiology Research and
Practice Center, Moscow
Posterolateral corner injuries
• Frequently
overlooked with
ACL tears
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Radiology Research and
Practice Center, Moscow
Fat pad impingement
• Underestimated
reason of
anterior knee
pain
Radiology Research and
Practice Center, Moscow
Take home points
• Remember what is frequently missed:
• Menisco-capsular junction injuries
• ACL tears (multiplanar evaluation!)
• Posterolateral corner injuries
• Anterior fat pads impingement
+ Over-diagnosis of medial meniscus tears
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Radiology Research and
Practice Center, Moscow
Take home points
• Technical issues:
• Check phase encoding direction
• Choose appropriate fat suppression
technique
• Remember the magic angle
• Anatomical issues:
• carefully assess menisco-capsular junction
Radiology Research and
Practice Center, Moscow
Major cause of
MRI mistakes –
lack of
cooperation with
orthopedic
surgeons
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Radiology Research and
Practice Center, Moscow
Radiology Research and
Practice Center, Moscow
Moscow RIS
RIS installed in February 2015
• 63 out-patient departments
• CT 61
• MRI 40
• > 85000 studies
Second opinion
• 100 consultations per week
• 400 audits per week
• 3320 errors
Teaching
• 124 radiologists
• 97 technicians
www.rpcmr.org.ru
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Radiology Research and
Practice Center, Moscow
Conclusions
– Standard imaging protocol
– Correct interpretation (templates,
terminology, classifications)
– Second opinion (PACS, RIS)
– Cooperation with clinicians (MDT)
– Teaching by radiologists and
traumatologists (focus: radiologists
and technicians)
Radiology Research and
Practice Center, Moscow
THANK YOU FOR
YOUR KIND ATTENTION!
morozov@rpcmr.org.ru
www.rpcmr.org.ru
itrofimenko@emcmos.ru
www.emc-school.ru