With arthroplasty being increasingly used to relieve joint pain, imaging of patients with metal implants can represent a significant part of the clinical work load in the radiologist's daily ...practice. Computed tomography (CT) plays an important role in the postoperative evaluation of patients who are suspected of having metal prosthesis-related problems such as aseptic loosening, bone resorption or osteolysis, infection, dislocation, metal hardware failure, or periprosthetic bone fracture. Despite advances in detector technology and computer software, artifacts from metal implants can seriously degrade the quality of CT images, sometimes to the point of making them diagnostically unusable. Several factors may help reduce the number and severity of artifacts at multidetector CT, including decreasing the detector collimation and pitch, increasing the kilovolt peak and tube charge, and using appropriate reconstruction algorithms and section thickness. More recently, dual-energy CT has been proposed as a means of reducing beam-hardening artifacts. The use of dual-energy CT scanners allows the synthesis of virtual monochromatic spectral (VMS) images. Monochromatic images depict how the imaged object would look if the x-ray source produced x-ray photons at only a single energy level. For this reason, VMS imaging is expected to provide improved image quality by reducing beam-hardening artifacts.
In numerous countries, large population testing is impossible due to the limited availability of RT-PCR kits and CT-scans. This study aimed to determine a pre-test probability score for SARS-CoV-2 ...infection.
This multicenter retrospective study (4 University Hospitals) included patients with clinical suspicion of SARS-CoV-2 infection. Demographic characteristics, clinical symptoms, and results of blood tests (complete white blood cell count, serum electrolytes and CRP) were collected. A pre-test probability score was derived from univariate analyses of clinical and biological variables between patients and controls, followed by multivariate binary logistic analysis to determine the independent variables associated with SARS-CoV-2 infection.
605 patients were included between March 10th and April 30th, 2020 (200 patients for the training cohort, 405 consecutive patients for the validation cohort). In the multivariate analysis, lymphocyte (<1.3 G/L), eosinophil (<0.06 G/L), basophil (<0.04 G/L) and neutrophil counts (<5 G/L) were associated with high probability of SARS-CoV-2 infection but no clinical variable was statistically significant. The score had a good performance in the validation cohort (AUC = 0.918 (CI: 0.891-0.946; STD = 0.014) with a Positive Predictive Value of high-probability score of 93% (95%CI: 0.89-0.96). Furthermore, a low-probability score excluded SARS-CoV-2 infection with a Negative Predictive Value of 98% (95%CI: 0.93-0.99). The performance of the score was stable even during the last period of the study (15-30th April) with more controls than infected patients.
The PARIS score has a good performance to categorize the pre-test probability of SARS-CoV-2 infection based on complete white blood cell count. It could help clinicians adapt testing and for rapid triage of patients before test results.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives
Synovial sarcomas (SS) of the extremities are rare soft tissue sarcomas that are more common in young adults. We deciphered the imaging phenotype of SS with the aim to determine if imaging ...could provide an incremental value to currently known prognostic factors (PF)—age and histological grade—to predict long-term overall survival (OS).
Methods
This retrospective multicenter study included consecutive pediatric and adult patients with synovial sarcomas of the extremities from December 2002 to August 2020. Inclusion criteria were (i) a follow-up greater than 5 years and (ii) available pre-therapeutic MRI. A subset analysis included MRI and CT-scan. Clinical, pathological, and imaging variables were collected in all patients. The primary endpoint was to evaluate the association of these variables with OS using univariate and multivariate Cox regressions.
Results
Out of 428 patients screened for eligibility, 98 patients (mean age: 37.1 ± 15.2 years) were included (MRI:
n
= 98/98, CT scan:
n
= 34/98; 35%). The median OS was 75.25 months (IQR = 55.50–109.12) and thirty-six patients (
n
= 36/98;37%) died during follow-up. The recurrence rate was 12.2% (
n
=12/98). SS lesions were mostly grade 2 (57/98; 58%). On MRI, SS had a mean long-axis diameter of 67.5 ± 38.3 mm. On CT scan, 44% (15/34) were calcified. Grade (hazard ratio HR = 2.71; 95%CI = 1.30–5.66;
p
= 0.008), size of the lesions evaluated on MRI (HR = 1.02; 95% CI = 1.01–1.03;
p
< 0.001), and calcifications on CT scan (HR = 0.10; 95% CI = 0.02–0.50;
p
= 0.005) were independent PF of OS.
Conclusions
This study demonstrated that imaging biomarkers can be used to predict long-term outcome in patients with SS. Strikingly, the presence of calcifications on CT scan is associated with favorable outcome and provides an incremental value over existing PF such as age, grade, and size.
Key points
• Beyond its diagnostic value, MRI is a pre-operative prognostic tool in synovial sarcomas of the extremities since the size of the lesion is an important prognostic factor.
• Calcifications on CT scans are independently and significantly associated with prolonged overall survival.
Objectives
To evaluate the diagnostic performance and interobserver agreement of a magnetic resonance imaging (MRI) protocol that only includes sagittal T2-weighted Dixon fat and water images as an ...alternative to a standard protocol that includes both sagittal T1-weighted sequence and T2-weighted Dixon water images as reference standard in lumbar degenerative disc disease with Modic changes.
Methods
From February 2017 to March 2019, 114 patients who underwent lumbar spine MRI for low back pain were included in this retrospective study. All MRI showed Modic changes at least at one vertebral level. Two radiologists read the standard protocol and 1 month later the alternative protocol. All MRI were assessed for Modic changes (types, location, extension) as well as structural changes (endplate defects, facet arthropathy, spinal stenosis, foraminal stenosis, Schmorl nodes, spondylolisthesis, disc bulges, and degeneration). Interobserver agreement was assessed, as well as diagnostic performance using the standard protocol as reference standard.
Results
Interobserver agreement was moderate to excellent (kappa ranging from 0.51 to 0.92). Diagnostic performance of the alternative protocol was good for detection of any Modic change (sensitivity = 100.00% 95% CI, 99.03–100.00; specificity = 98.89% 95% CI, 98.02–99.44), as well as for detection of each Modic subtype and structural variables (sensitivity respectively 100% and ranging from 88.43 to 99.75% ; specificity ranging respectively from 97.62 to 100% and 99.58 to 99.91% ).
Conclusions
Combined with T2-weighted Dixon water images, T2-weighted Dixon fat images provide good diagnostic performance compared to T1-weighted images in lumbar degenerative disc disease with Modic changes, and could therefore allow for a shortened protocol.
Key Points
• Combined with T2-weighted Dixon water images, T2-weighted Dixon fat images (in comparison to T1-weighted sequence) can provide good diagnostic performance in lumbar degenerative disc disease with Modic changes.
• Interobserver agreement of the alternative protocol including sagittal T2-weighted Dixon fat and water images was substantial to excellent for every studied variable except for facet arthropathy.
• A shortened MRI protocol including T2-weighted Dixon sequence without T1-weighted sequence could be proposed in this clinical setting.
Objective
To investigate ultrasonographic (US) hand features in systemic sclerosis (SSc) patients and their relationship with clinical, biologic, and radiographic data.
Methods
Fifty‐two consecutive ...SSc patients were included in a cross‐sectional observational study together with 24 rheumatoid arthritis (RA) patients enrolled as controls. All patients underwent clinical examination, including tender and swollen joint counts, measurement of disability indices, and hand/wrist radiographs. US was performed on the hand and wrist joints and was aimed at the detection of synovitis, tenosynovitis, and calcinosis.
Results
Synovitis and tenosynovitis were more frequently detected with US in SSc patients (46% and 27%, respectively) than with clinical examination (15% and 6%, respectively; P < 0.01 for both comparisons). Fifty‐seven percent of patients had inflammatory synovitis (mostly Doppler grade 1), and tenosynovitis was either inflammatory or fibrotic. Calcifications were observed using US and radiographs in 40% and 36% of SSc patients, respectively (P = 0.8). As compared to RA, US features specific to SSc were sclerosing tenosynovitis (P < 0.01) and soft tissue calcifications (P = 0.01).
Conclusion
Our study confirms that articular involvement in SSc is underestimated by a single clinical examination. It is characterized by mild inflammatory changes and the specific findings include sclerotic US aspects together with calcinosis. Further prospective studies are warranted to evaluate the predictive value of these findings and determine whether they should be considered for adapting a therapeutic strategy.
Active discopathy is associated with a specific phenotype of chronic low back pain (LBP). Local inflammation has a role in active discopathy-associated symptoms.
To assess the efficacy of a single ...glucocorticoid intradiscal injection (GC IDI) in patients with chronic LBP with active discopathy.
Prospective, parallel-group, double-blind, randomized, controlled study. (ClinicalTrials.gov: NCT00804531).
3 tertiary care centers in France.
135 patients with chronic LBP with active discopathy on magnetic resonance imaging (MRI).
A single GC IDI (25 mg prednisolone acetate) during discography (n = 67) or discography alone (n = 68).
The primary outcome was the percentage of patients with LBP intensity less than 40 on an 11-point numerical rating scale (0 no pain to 100 maximum pain in 10-point increments) in the previous 48 hours at 1 month after the intervention. The main secondary outcomes were LBP intensity and persistent active discopathy on MRI at 12 months and spine-specific limitations in activities, health-related quality of life, anxiety and depression, employment status, and use of analgesics and nonsteroidal anti-inflammatory drugs at 1 and 12 months.
All randomly assigned patients were included in the primary efficacy analysis. At 1 month after the intervention, the percentage of responders (LBP intensity <40) was higher in the GC IDI group (36 of 65 55.4%) than the control group (21 of 63 33.3%) (absolute risk difference, 22.1 percentage points 95% CI, 5.5 to 38.7 percentage points; P = 0.009). The groups did not differ in LBP intensity at 12 months and in most secondary outcomes at 1 and 12 months.
Tertiary care setting.
In chronic LBP associated with active discopathy, a single GC IDI reduces LBP at 1 month but not at 12 months.
French Ministry of Health.
Metastatic disease, myeloma, and lymphoma are the most common malignant spinal tumors. Hemangioma is the most common benign tumor of the spine. Other primary osseous lesions of the spine are more ...unusual but may exhibit characteristic imaging features that can help the radiologist develop a differential diagnosis. Radiologic evaluation of a patient who presents with osseous vertebral lesions often includes radiography, computed tomography (CT), and magnetic resonance (MR) imaging. Because of the complex anatomy of the vertebrae, CT is more useful than conventional radiography for evaluating lesion location and analyzing bone destruction and condensation. The diagnosis of spinal tumors is based on patient age, topographic features of the tumor, and lesion pattern as seen at CT and MR imaging. A systematic approach is useful for recognizing tumors of the spine with characteristic features such as bone island, osteoid osteoma, osteochondroma, chondrosarcoma, vertebral angioma, and aneurysmal bone cyst. In the remaining cases, the differential diagnosis may include other primary spinal tumors, vertebral metastases and major nontumoral lesions simulating a vertebral tumor, Paget disease, spondylitis, echinococcal infection, and aseptic osteitis. In many cases, vertebral biopsy is warranted to guide treatment.
Objective
To describe clinical and early shoulder-girdle MR imaging findings in severe COVID-19–related intensive care unit-acquired weakness (ICU-AW) after ICU discharge.
Methods
A single-center ...prospective cohort study of all consecutive patients with COVID-19–related ICU-AW from November 2020 to June 2021. All patients underwent similar clinical evaluations and shoulder-girdle MRI within the first month and then 3 months (± 1 month) after ICU discharge.
Results
We included 25 patients (14 males; mean SD age 62.4 12.5). Within the first month after ICU discharge, all patients showed severe proximal predominant bilateral muscular weakness (mean Medical Research Council total score = 46.5/60 10.1) associated with bilateral, peripheral muscular edema-like MRI signals of the shoulder girdle in 23/25 (92%) patients. At 3 months, 21/25 (84%) patients showed complete or quasi-complete resolution of proximal muscular weakness (mean Medical Research Council total score > 48/60) and 23/25 (92%) complete resolution of MRI signals of the shoulder girdle, but 12/20 (60%) patients experienced shoulder pain and/or shoulder dysfunction.
Conclusions
Early shoulder-girdle MRI findings in COVID-19–related ICU-AW included muscular edema-like peripheral signal intensities, without fatty muscle involution or muscle necrosis, with favorable evolution at 3 months. Precocious MRI can help clinicians distinguish critical illness myopathy from alternative, more severe diagnoses and can be useful in the care of patients discharged from intensive care with ICU-AW.
Key Points
•
We describe the clinical and shoulder-girdle MRI findings of COVID-19–related severe intensive care unit-acquired weakness.
•
This information can be used by clinicians to achieve a nearly specific diagnosis, distinguish alternative diagnoses, assess functional prognosis, and select the more appropriate health care rehabilitation and shoulder impairment treatment.
Objectives
We aimed to compare the reliability and performance of MRI measures enhanced with intravenous (IV) injection of gadolinium contrast versus non-enhanced MRI measures for the diagnosis of ...adhesive capsulitis (AC). We also aimed to examine the association between MRI findings and clinical features in patients with AC.
Methods
MRI of 42 patients with a clinical diagnosis of AC confirmed by arthrography and that of 42 patients in a control group were retrospectively studied by 2 blinded readers. Reliability and performance of MRI findings were compared between IV contrast-enhanced measures and non-enhanced MRI measures in T2-weighted fat-saturated and T1-weighted images. MRI findings were correlated with clinical stage, etiology, and pain.
Results
Sensitivity (97.6%) and specificity (97.6%) of axillary-recess capsule signal enhancement for AC diagnosis were significantly superior (
p
= 0.02) to hyperintense signals on T2-weighted fat-suppressed images (sensitivity 90.5%, specificity 92.7%). Measures of the intensity signal in the area of the rotator interval were less performant for AC diagnosis but could be improved with joint capsule enhancement. Moreover, we found very high specificity (100%) of enhancement of the coracohumeral ligament signal for AC diagnosis. The early stage of adhesive capsulitis was positively correlated with joint capsule enhancement in the rotator interval. Secondary etiology of capsulitis was correlated with joint capsule hyperintensity signals of the rotator interval on T2-weighted fat-suppressed images.
Conclusion
IV contrast injection with MRI can be helpful for AC diagnosis in difficult cases. The stage of AC seems related to joint capsule enhancement in the rotator interval.
Key Points
•
IV gadolinium-enhanced MRI can improve the analysis of signal changes in the shoulder synovium and capsule of the shoulder that are related to adhesive capsulitis.
•
As an original finding, we observed that coracohumeral ligament enhancement had a 100% specificity for the diagnosis of adhesive capsulitis.
•
The intensity of enhanced signals in the rotator interval seems to be related to the early stage of frozen shoulder.
Objectives
The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.
Methods
...Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors’ clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of ‘0’, ‘5’ and ‘10’ reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of ‘8’ or higher for 80% or more of the panellists.
Results
Ten of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available.
Conclusions
Delphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability.
Key Points
•
Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability
.
•
Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability
.
•
Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects
.
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