Degeneration of the sacroiliac joints (SIJs) is a common finding, while its underlying cause and development remain incompletely understood. The aim of this investigation was to describe the spatial ...distribution of degenerative SIJ changes across age groups and to investigate for the first time their relationship to anatomical form and sex. For this IRB-approved investigation, demographic data of 818 patients without SIJ disease were retrieved from electronic patient records. High-resolution computed tomography (CT) datasets of all patients were analysed retrospectively for seven predefined age groups (ten-year increments, from < 25 to ≥ 75). A structured scoring system was applied to assess sclerosis, osteophytes, joint space alterations, and anatomical form. Chi-square tests were used to compare frequencies of degenerative lesions, and logistic regression analyses were performed to investigate associations between demographic data, anatomical form, and the presence of structural lesions. Sclerosis and osteophytes were common findings, with an overall prevalence of 45.7% and 46.8%, respectively. Female sex had an odds ratio (OR) of 0.15 (95% CI: 0.08-0.27) for the presence of ventral osteophytes and of 4.42 (95% CI: 2.77-7.04) for dorsal osteophytes. Atypical joint forms were significantly more prevalent in women with 62.1% vs. 14.1% in men (p < 0.001). Accessory joints increased the likelihood of dorsal sclerosis (OR 2.735; 95% CI 1.376-5.436) while a typical joint form decreased its likelihood (OR 0.174; 95% CI 0.104-0.293). Sex and anatomical joint form have a major impact on the development of degenerative lesions of the SIJs and their spatial distribution.
Objectives
To evaluate ESR eGUIDE—the European Society of Radiology (ESR) e-Learning tool for appropriate use of diagnostic imaging modalities—for learning purposes in different clinical scenarios.
...Methods
This anonymized evaluation was performed after approval of ESR Education on Demand leadership. Forty clinical scenarios were developed in which at least one imaging modality was clinically most appropriate, and the scenarios were divided into sets 1 and 2. These sets were provided to medical students randomly assigned to group A or B to select the most appropriate imaging test for each scenario. Statistical comparisons were made within and across groups.
Results
Overall, 40 medical students participated, and 31 medical students (78%) answered both sets. The number of correctly chosen imaging methods per set in these 31 paired samples was significantly higher when answered with versus without use of ESR eGUIDE (13.7 ± 2.6 questions vs. 12.1 ± 3.2,
p
= 0.012). Among the students in group A, who first answered set 1 without ESR eGUIDE (11.1 ± 3.2), there was significant improvement when set 2 was answered with ESR eGUIDE (14.3 ± 2.5,
p
= 0.013). The number of correct answers in group B did not drop when set 2 was answered without ESR eGUIDE (12.4 ± 2.6) after having answered set 1 first with ESR eGUIDE (13.0 ± 2.7,
p
= 0.66).
Conclusion
The clinical decision support tool ESR eGUIDE is suitable for training medical students in choosing the best radiological imaging modality in typical scenarios, and its use in teaching radiology can thus be recommended.
Key Points
• ESR eGUIDE improved the number of appropriately selected imaging modalities among medical students.
• This improvement was also seen in the group of students which first selected imaging tests without ESR eGUIDE.
• In the student group which used ESR eGUIDE first, appropriate selection remained stable even without the teaching tool.
Objectives
To evaluate the influence of audio-guided self-hypnosis on claustrophobia in a high-risk cohort undergoing magnetic resonance (MR) imaging.
Methods
In this prospective observational ...2-group study, 55 patients (69% female, mean age 53.6 ± 13.9) used self-hypnosis directly before imaging. Claustrophobia included premature termination, sedation, and coping actions. The claustrophobia questionnaire (CLQ) was completed before self-hypnosis and after MR imaging. Results were compared to a control cohort of 89 patients examined on the same open MR scanner using logistic regression for multivariate analysis. Furthermore, patients were asked about their preferences for future imaging.
Results
There was significantly fewer claustrophobia in the self-hypnosis group (16%; 9/55), compared with the control group (43%; 38/89; odds ratio .14;
p
= .001). Self-hypnosis patients also needed less sedation (2% vs 16%; 1/55 vs 14/89; odds ratio .1;
p
= .008) and non-sedation coping actions (13% vs 28%; 7/55 vs 25/89; odds ratio .3;
p
= .02). Self-hypnosis did not influence the CLQ results measured before and after MR imaging (
p
= .79). Self-hypnosis reduced the frequency of claustrophobia in the subgroup of patients above an established CLQ cut-off of .33 from 47% (37/78) to 18% (9/49;
p
= .002). In the subgroup below the CLQ cut-off of 0.33, there were no significant differences (0% vs 9%, 0/6 vs 1/11;
p
= 1.0). Most patients (67%; 35/52) preferred self-hypnosis for future MR examinations.
Conclusions
Self-hypnosis reduced claustrophobia in high-risk patients undergoing imaging in an open MR scanner and might reduce the need for sedation and non-sedation coping actions.
Key Points
•
Forty percent of the patients at high risk for claustrophobia may also experience a claustrophobic event in an open MR scanner.
•
Self-hypnosis while listening to an audio in the waiting room before the examination may reduce claustrophobic events in over 50% of patients with high risk for claustrophobia.
•
Self-hypnosis may also reduce the need for sedation and other time-consuming non-sedation coping actions and is preferred by high-risk patients for future examinations.
Lumbar foraminal stenosis may be caused by osseous and soft tissue structures. Thus, both computed tomography (CT) and magnetic resonance imaging (MRI) play a role in the diagnostic algorithm. ...Recently, dual-energy CT (DECT) has been introduced for the detection of spinal disorders. Our study's aim was to investigate the diagnostic accuracy of collagen-sensitive maps derived from DECT in detecting lumbar foraminal stenosis compared with standard CT and MRI. We retrospectively reviewed CT, DECT, and MRI datasets in patients with vertebral fractures between January 2015 and February 2017. Images were scored for presence and type of lumbar neuroforaminal stenosis. Contingency tables were calculated to determine diagnostic accuracy and interrater agreement was evaluated. 612 neuroforamina in 51 patients were included. Intraclass correlation coefficients for interrater reliability in detecting foraminal stenoses were 0.778 (95%-CI 0.643-0.851) for DECT, 0.769 (95%-CI 0.650-0.839) for CT, and 0.820 (95%-CI 0.673-0.888) for MRI. Both DECT and conventional CT showed good diagnostic accuracy in detecting lumbar foraminal stenosis but low sensitivities in detecting discoid stenosis. Thus, even though previous studies suggest that DECT has high diagnostic accuracy in assessing lumbar disc pathologies, we show that DECT does not provide additional information for detecting discoid stenosis compared with conventional CT.
Objective
Even though lumbosacral transitional vertebrae (LSTV) are one of the most common congenital anomalies of the spine, their effect on surrounding soft tissues is not well-studied. We ...therefore aimed at analyzing the association between LSTV and changes in volume, mass, symmetry, and degeneration of lumbar and trunk muscles.
Materials and methods
Abdomen–pelvis CT scans were analyzed in patients with LSTV and a matched control group. LSTV were classified according to the Castellvi classification. Muscles were segmented from the remaining soft tissue and their cross-sectional area and volume were examined at five defined levels. Threshold segmentation was used to differentiate between muscle fibers and fat tissue. Matched pairs were compared using Wilcoxon rank sum tests. For comparison of categorical data, chi-squared tests were performed and for associations between the degree of fusion and muscle size and degeneration, Spearman’s correlation coefficients were calculated. Inter- and intrarater reliabilities were evaluated by computing intraclass correlation coefficients.
Results
Forty-six patients with LSTV and 46 controls were included. Muscle volume of the paraspinal and trunk muscles was significantly lower (707.0 cm
3
vs. 809.7 cm
3
,
p
< 0.001) and fatty muscle changes were significantly increased in all but the caudal paravertebral muscles of LSTV patients (M. psoas
p
< 0.04, M. quadratus lumborum
p
< 0.001, paravertebral muscles
p
= 0.011, M. rectus abdominis
p
< 0.001, M. obliquus abdominis
p
< 0.001). Correlations between the degree of Castellvi classification and muscle volume were significant (
p
= 0.001).
Conclusion
LSTV are associated with a reduction in muscle volume and an increase in muscle degeneration of both lumbar and trunk muscles.
Secondary hyperparathyroidism (sHPT) as a result of chronic kidney disease (CKD) is a common health problem and has been reported to manifest at the sacroiliac joints (SIJ). The aim of this ...investigation was to systematically assess sacroiliac joint changes in asymptomatic sHPT as detected by high-resolution CT. Included in this IRB-approved retrospective case-control study were 56 patients with asymptomatic sHPT as well as 259 matched controls without SIJ disease. Demographic data were retrieved from electronic patient records. High-resolution computed tomography datasets of all patients were subjected to a structured scoring, including erosions, sclerosis, osteophytes, joint space alterations and intraarticular calcifications. Chi
tests were used to compare frequencies of lesions. Erosions were significantly more prevalent in patients with sHPT, and were found mainly in the ventral (28.6% vs. 13.9%; p = 0.016) and middle (17.9% vs. 7.7%; p = 0.040) iliac portions of the SIJ. Partial ankylosis was rare in both cohorts (3.6% vs. 5.0%; p > 0.999); complete ankylosis was not observed. Neither extent not prevalence of sclerosis or calcifications differed significantly between groups. Joint lesions reminiscent of sacroiliitis can be found in a substantial portion of asymptomatic patients with secondary hyperparathyroidism. Further investigations into the clinical significance of these findings are warranted.
Objectives
To assess how modifying multiple protocol parameters affects the dose and diagnostic performance of a neck CT protocol using patient-mimicking phantoms and task-based methods.
Methods
Six ...patient-mimicking neck phantoms containing hypodense lesions of 1 cm diameter and 30 HU contrast and one non-lesion phantom were examined with 36 CT protocols. All possible combinations of the following parameters were investigated: 100- and 120-kVp tube voltage; tube current modulation (TCM) noise levels of SD 7.5, 10, and 14; pitches of 0.637, 0.813, and 1.388; filtered back projection (FBP); and iterative reconstruction (AIDR 3D). Dose-length products (DLPs) and lesion detectability (assessed by 14 radiologists) were compared with the clinical standard protocol (120 kVp, TCM SD 7.5, 0.813 pitch, AIDR 3D).
Results
The DLP of the standard protocol was 25 mGy•cm; the area under the curve (AUC) was 0.839 (95%CI: 0.790–0.888). Combined effects of tube voltage reduction to 100 kVp and TCM noise level increase to SD 10 optimized protocol performance by improving dose (7.3 mGy•cm) and detectability (AUC 0.884, 95%CI: 0.844–0.924). Diagnostic performance was significantly affected by the TCM noise level at 120 kVp (AUC 0.821 at TCM SD 7.5 vs. 0.776 at TCM SD 14,
p
= 0.003), but not at 100-kVp tube voltage (AUC 0.839 at TCM SD 7.5 vs. 0.819 at TCM SD 14,
p
= 0.354), the reconstruction method at 100 kVp (AUC 0.854 for AIDR 3D vs. 0.806 for FBP,
p
< 0.001), but not at 120-kVp tube voltage (AUC 0.795 for AIDR 3D vs. 0.793 for FBP,
p
= 0.822), and the tube voltage for AIDR 3D reconstruction (
p
< 0.001), but not for FBP (
p
= 0.226).
Conclusions
Combined effects of 100-kVp tube voltage, TCM noise level of SD 10, a pitch of 0.813, and AIDR 3D resulted in an optimal neck protocol in terms of dose and diagnostic performance. Protocol parameters were subject to complex interactions, which created opportunities for protocol improvement.
Key Points
• A task-based approach using patient-mimicking phantoms was employed to optimize a CT system for neck imaging through systematic testing of protocol parameters.
• Combined effects of 100-kVp tube voltage, TCM noise level of SD 10, a pitch of 0.813, and AIDR 3D reconstruction resulted in an optimal protocol in terms of dose and diagnostic performance.
• Interactions of protocol parameters affect diagnostic performance and should be considered when optimizing CT techniques.
In times of globalization there is an increasing use of English in the medical literature. The aim of this study was to analyze the influence of English-language articles in multi-language medical ...journals on their international recognition--as measured by a lower rate of self-citations and higher impact factor (IF).
We analyzed publications in multi-language journals in 2008 and 2009 using the Web of Science (WoS) of Thomson Reuters (former Institute of Scientific Information) and PubMed as sources of information. The proportion of English-language articles during the period was compared with both the share of self-citations in the year 2010 and the IF with and without self-citations. Multivariable linear regression analysis was performed to analyze these factors as well as the influence of the journals' countries of origin and of the other language(s) used in publications besides English. We identified 168 multi-language journals that were listed in WoS as well as in PubMed and met our criteria. We found a significant positive correlation of the share of English articles in 2008 and 2009 with the IF calculated without self-citations (Pearson r=0.56, p = <0.0001), a correlation with the overall IF (Pearson r = 0.47, p = <0.0001) and with the cites to years of IF calculation (Pearson r = 0.34, p = <0.0001), and a weak negative correlation with the share of self-citations (Pearson r = -0.2, p = 0.009). The IF without self-citations also correlated with the journal's country of origin--North American journals had a higher IF compared to Middle and South American or European journals.
Our findings suggest that a larger share of English articles in multi-language medical journals is associated with greater international recognition. Fewer self-citations were found in multi-language journals with a greater share of original articles in English.
Purpose
Even though spinal infections are associated with high mortality and morbidity, their therapy remains challenging due to a lack of established classification systems and widely accepted ...guidelines for surgical treatment. This study’s aim therefore was to propose a comprehensive classification system for spinal instability based on the Spinal Instability Neoplastic Score (SINS) aiding spine surgeons in choosing optimal treatment for spontaneous spondylodiscitis.
Methods
Patients who were treated for spontaneous spondylodiscitis and received computed tomography (CT) imaging were included retrospectively. The Spinal Instability Spondylodiscitis Score (SISS) was developed by expert consensus. SINS and SISS were scored in CT-images by four readers. Intraclass correlation coefficients (ICCs) and Fleiss’ Kappa were calculated to determine interrater reliabilities. Predictive validity was analyzed by cross-tabulation analysis.
Results
A total of 127 patients were included, 94 (74.0%) of which were treated surgically. Mean SINS was 8.3 ± 3.2, mean SISS 8.1 ± 2.4. ICCs were 0.961 (95%-CI: 0.949–0.971) for total SINS and 0.960 (95%-CI: 0.946–0.970) for total SISS. SINS yielded false positive and negative rates of 12.5% and 67.6%, SISS of 15.2% and 40.0%, respectively.
Conclusion
We show high reliability and validity of the newly developed SISS in detecting unstable spinal lesions in spontaneous spondylodiscitis. Therefore, we recommend its use in evaluating treatment choices based on spinal biomechanics. It is, however, important to note that stability is merely one of multiple components in making surgical treatment decisions.
The sacroiliac joint (SIJ) is an anatomically complex joint which, as a functional unit with the pelvis and spine, is of decisive biomechanical importance for the human body. It is also a commonly ...overlooked source of lower back pain. Like the entire bony pelvis, the SIJ exhibits major sexual dimorphisms; thus, the sex-dependent evaluation of this joint is becoming increasingly important in clinical practice, both anatomically with joint shape variations and biomechanical differences as well as in terms of image appearance. The influence of the SIJ shape, which differs in women and men, is crucial for the different biomechanical joint properties. These differences are important in the development of joint diseases at the SIJ, which shows a specific difference between the sexes. This article aims to provide an overview of sex disparities of the SIJ regarding different anatomical and imaging appearances to further understand the insights into the interplay of sex differences and SIJ disease.
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