Infrapatellar plica injury

This article, published sometime back in the AJR describes the MRI appearances of infrapatellar plica injury. I came across this article while reading another recent publication on the quadriceps fat pad and anterior knee pain.

Though there is controversy regarding the significance of plicae (and the authors mention this as well), they have reported five knees in four patients who had documented infrapatellar plica injury with abnormal MRI appearances. The abnormalities parallel those seen in "Hoffitis" and the authors speculate that the mechanism of injury and presentation may be similar as well.

We came across a case recently that suggested infrapatellar plica injury. The image shows a partially curvlinear thick band with increased signal and stranding of Hoffa's fat pad.

For a review of the anatomy and pathology of knee plicae, this article is excellent.

MRI of gallstones

This article published in the June issue of AJR is extremely interesting.

We are all used to seeing gallstones as signal void areas on MRCPs and T2W images. Since we have started using VIBE imaging, we have on many occassions identified gallstones as hyperintense structures on this sequence.

This article has actually analyzed gallstones studied using single-shot T2W sequences and the GE equivalent of a T1W VIBE sequence and the authors have shown that pigment stones are almost always hyperintense on this sequence, whereas cholesterol stones are isointense.

It would be worthwhile adding this sequence to a routine MRCP protocol and to use the information obtained to report the gallstone composition as well.

CMR in apical hypertrophic cardiomyopathy

Moon et al from the Royal Brompton have finally published their study on apical hypertrophic cardiomyopathy (apical HCM).

Basically in those patients who have abnormal inverted T waves, apical HCM is one of the diagnostic possiblities. Traditionally, echo has been used to make this diagnosis. However echo has problems looking at the apex of the heart and CMR does much better in this situation.

This is one more indication where CMR can be a gold standard, i.e. in patients with abnormal ECG suggesting apical HCM with a normal echo.


Incidentally, if you log in from India, the full-text of this article is free.