ABSTRACT BACKGROUND: The accuracy of magnetic resonance imaging (MRI) for making the diagnosis of subscapularis tears presents wide variation in the literature and there are few prospective studies. OBJECTIVE: To compare the findings from MRI and arthroscopy for diagnosing subscapularis tears. DESIGN AND SETTING: Diagnostic test study performed in a tertiary care hospital. METHODS: We included patients who underwent arthroscopic rotator cuff repair and who had firstly undergone high magnetic field MRI without contrast. The images were independently evaluated by a shoulder surgeon and two musculoskeletal radiologists. Sensitivity, specificity, positive and negative predictive values, accuracy and inter and intra-observer agreement were calculated. RESULTS: MRIs on 200 shoulders were evaluated. The incidence of subscapularis tears was 69.5% (41.5% partial and 28.0% full-thickness). The inter and intra-observer agreement was moderate for detection of subscapularis tears. The shoulder surgeon presented sensitivity of 51.1% to 59.0% and specificity of 91.7% to 94.4%. The radiologists showed sensitivity of 83.5% to 87.1% and specificity of 41% to 45.9%. Accuracy ranged from 60.5% to 73.0%. CONCLUSION: The 1.5-T MRIs without contrast showed mean sensitivity of 70.2% and mean specificity of 61.9% for detection of subscapularis tears. Sensitivity was higher for the musculoskeletal radiologists, while specificity was higher for the shoulder surgeon. The mean accuracy was 67.6%, i.e. lower than that of rotator cuff tears overall.

RESUMO OBJETIVO: Avaliar o efeito da completa ausência de contração muscular na cartilagem humana normal na presença de movimento articular. MÉTODOS: Pacientes com lesão completa da medula espinal foram incluídos. Todos os pacientes foram submetidos à ressonância magnética (RM) em ambos os joelhos assim que as condições clínicas foram estabilizadas e depois de seis meses da lesão inicial. Todos os pacientes receberam tratamento de reabilitação que incluía movimentos passivos para exercitar os membros inferiores duas vezes por dia. RMs foram analisadas por dois radiologistas com experiência em doenças musculoesqueléticas. As regiões de interesse consideradas foram as facetas da patela e a tróclea e os tempos de relaxamento T2 foram calculados. A área da cartilagem abaixo dos valores de relaxamento em T2 foi calculada e padronizada. RESULTADOS: Foram incluídos 14 pacientes com lesão medular completa, porém apenas oito concordaram em participar do estudo e assinaram o termo de consentimento informado. Dois pacientes não puderam fazer RM dos joelhos devido às condições clínicas. RM inicial foi feita em seis pacientes. Após seis meses, apenas dois pacientes fizeram a segunda RM de ambos os joelhos. Ambos estavam em condição neurológica classificada como Frankel A. Um aumento dos valores em T2 no sexto mês foi observado em ambos os joelhos, especialmente na articulação patelofemoral. CONCLUSÃO: A ausência de contração muscular parece ser deletéria à cartilagem do joelho humano normal, mesmo na presença de movimentos articulares normais. Mais estudos com um número maior de pacientes devem ser feitos para confirmar essa hipótese.

ABSTRACT OBJECTIVE: To evaluate the effect of complete absence of muscle contractions on normal human cartilage in the presence of joint motion. METHODS: Patients with complete acute spinal cord injuries were enrolled. All patients underwent magnetic resonance imaging (MRI) on both knees as soon as their medical condition was stable and at six months after the primary lesion. All patients received rehabilitation treatment that included lower-limb passive motion exercises twice a day. The MRIs were analyzed by two radiologists with expertise in musculoskeletal disorders. A region of interest was established at the patellar facets and trochlea, and T2 relaxation times were calculated. The area under the cartilage T2 relaxation time curve was calculated and standardized. RESULTS: Fourteen patients with complete spinal cord injuries were enrolled, but only eight patients agreed to participate in the study and signed the informed consent statement. Two patients could not undergo knee MRI due to their clinical conditions. Initial knee MRIs were performed on six patients. After six months, only two patients underwent the second bilateral knee MRI. Both patients were neurologically classified as Frankel A. An increase in T2 values on the six-month MRI was observed for both knees, especially in the patellofemoral joint. CONCLUSION: The absence of muscle contractions seems to be deleterious to normal human knee cartilage even in the presence of a normal range of motion. Further studies with a larger number of patients, despite their high logistical complexity, must be performed to confirm this hypothesis.

Melanoma maligno é uma doença comum e agressiva que frequentemente causa metástase para o intestino delgado. Este estudo ilustra um caso de intussuscepção do intestino delgado causada por uma lesão metastática de melanoma visualizada à 18F-FDG PET/TC em uma paciente de 48 anos idade que realizou exame de reestadiamento.

Malignant melanoma is a common and aggressive disease that frequently causes metastases to the small bowel. This study illustrates a case of small bowel intussusception secondary to metastatic melanoma visualized at 18F-FDG PET/CT in a 48-year-old woman who had this examination for restaging purposes.