Skeletal Radiology最新文献

Objective: Transcatheter arterial embolization (TAE) is a novel minimally invasive therapy for painful tendinopathy in patients with pain refractory to conservative management. The purpose of this study was to evaluate evidence on the efficacy of TAE for tendinopathy related pain.

Materials and methods: Using Embase, PubMed, and Web of Science, a systematic review and meta-analysis was performed to identify studies evaluating TAE for painful tendinopathy. The primary outcome measure was change in pain scale score at 6 months. A Ratio of Means (ROM) was used to compare the effect size post treatment as compared to baseline. The Visual Analog Scale (VAS) was used as the metric for comparison.

Results: After screening titles, abstracts, and the full text, 5 studies met inclusion criteria. A total of 97 tendinopathy embolization procedures performed in 74 patients were included. Patients who underwent TAE demonstrated declines in VAS ROM at 1 day 0.53 [95% CI 0.31,0.88], 1 week (0.51 [95% CI 0.32,0.79]), 1 month (0.45 [95% CI 0.29, 0.71]), 3-4 months (0.33 [95% CI 0.22,0.48]), and 6 months following embolization (0.18[95% CI 0.13,0.26]), respectively.

Discussion: TAE provides substantial short-term reductions in pain scores for patients suffering with refractory tendinopathy related pain of the rotator cuff, elbow extensor and flexor, Achilles, and patellar tendons.

Objectives: To correlate the cross-sectional area (CSA) and elasticity of the median nerve (MN) measured at carpal tunnel inlet between healthy controls and various degrees of carpal tunnel syndrome (CTS) graded as per nerve conduction studies (NCS).

Materials and methods: A total of 53 patients (with 81 wrists) presenting with clinical symptoms characteristic of CTS, having their diagnosis confirmed and severity graded by NCS, and 48 healthy controls (with 96 wrists) were included in the study. All the study participants underwent wrist ultrasound which included initial Grey-scale USG followed by strain and shear wave elastography. The CSA and elasticity (in terms of strain ratio and shear modulus) of MN were measured at the carpal tunnel inlet. Statistical analysis was performed using the Mann-Whitney U test to compare between the two groups and for subgroup analysis of cases. The diagnostic performance of each variable was evaluated using the receiver operating characteristic curves.

Results: The mean CSA was 9.20 ± 1.64, 11.48 ± 1.05, 14.83 ± 1.19 and 19.87 ± 2.68 mm², the mean shear modulus was 17.93 ± 2.81, 23.59 ± 2.63, 32.99 ± 4.14 and 54.26 ± 9.24 kPa and the mean strain ratio was 5.26 ± 0.68, 5.56 ± 0.70, 7.03 ± 0.47 and 8.81 ± 0.94 in control, mild, moderate and severe grades of CTS, respectively (p < 0.001).

Conclusion: The combined utility of Grey-scale USG and Elastography may serve as a painless and cost-effective alternative to NCS in grading the severity of CTS.

In the world of elite soccer, or football as we call it in the UK, a player who cannot play for any length of time costs the team money and team performance. The time to return to play (RTP) is crucial in any player's career, and the use of ultrasound-guided ultrasound injections has become important in the management of injury. In this article, I will explain the importance of good practice when performing these procedures and the use of steroids, sodium hyaluronic acid, platelet-rich plasma (PRP), and other therapies in achieving the goal of decreasing the time of RTP for the footballer. KEY POINTS: •Injection therapies are routine practice in maintaining and treating soccer injuries. •Injection therapies can be safely performed under ultrasound guidance.

Objectives: Knowledge about the long-term outcome of patients with lumbar spondylolysis (LS) is limited. This study assessed the frequency of bone fusion in conservatively treated lumbar spondylolysis with photon counting detector computed tomography.

Methods: Patients with lumbar spondylolysis diagnosed with CT or MRI were prospectively enrolled and underwent CT 5-10 years after initial imaging. Image assessment included evaluation of Meyerding grade, listhesis size, measurement of the lysis gap, and disc integrity on the lysis level. Comparisons were made between bone fusion as the primary endpoint and sex, body mass index, age at diagnosis, follow-up interval, size of listhesis, Meyerding grade, size of the lysis gap, sports activity, and presence of pain.

Results: A total of 39 patients (26.0 ± 3.1 years, 15 female) with lumbar spondylolysis on 41 levels were included after a mean follow-up period of 9.1 ± 2.2 years. Nine patients (22.0%, four female) showed complete fusion of the lysis gap. Patients with bone fusion of the lysis gap had a significantly lower Meyerding grade (p = 0.01), smaller size of the listhesis (p = 0.019), and smaller anterior and posterior lysis gap size (p = 0.046 and p = 0.011, respectively). Unilateral lyses showed significantly higher fusion rates than bilateral lyses (40.0% vs. 16.1%, p = 0.01). No statistically significant difference was found for pain at follow-up between patients with and without bone fusion (p = 0.253).

Conclusion: Bone fusion occurred in about a fifth of conservatively treated lumbar spondylolysis after a follow-up period of 9 years. Factors associated with a successful fusion were a lower Meyerding grade, minimal listhesis, and a small lysis gap.

Objective: To determine the association between joint structure and gait in patients with knee osteoarthritis (OA).

Methods: IMI-APPROACH recruited 297 clinical knee OA patients. Gait data was collected (GaitSmart®) and OA-related joint measures determined from knee radiographs (KIDA) and MRIs (qMRI/MOAKS). Patients were divided into those with/without radiographic OA (ROA). Principal component analyses (PCA) were performed on gait parameters; linear regression models were used to evaluate whether image-based structural and demographic parameters were associated with gait principal components.

Results: Two hundred seventy-one patients (age median 68.0, BMI 27.0, 77% female) could be analyzed; 149 (55%) had ROA. PCA identified two components: upper leg (primarily walking speed, stride duration, hip range of motion [ROM], thigh ROM) and lower leg (calf ROM, knee ROM in swing and stance phases). Increased age, BMI, and radiographic subchondral bone density (sclerosis), decreased radiographic varus angle deviation, and female sex were statistically significantly associated with worse lower leg gait (i.e. reduced ROM) in patients without ROA (R² = 0.24); in ROA patients, increased BMI, radiographic osteophytes, MRI meniscal extrusion and female sex showed significantly worse lower leg gait (R² = 0.18). Higher BMI was significantly associated with reduced upper leg function for non-ROA patients (R² = 0.05); ROA patients with male sex, higher BMI and less MRI synovitis showed significantly worse upper leg gait (R² = 0.12).

Conclusion: Structural OA pathology was significantly associated with gait in patients with clinical knee OA, though BMI may be more important. While associations were not strong, these results provide a significant association between OA symptoms (gait) and joint structure.

Background: Objective measures from imaging studies have the potential to assist in timely diagnosis of atraumatic shoulder hypermobility to better guide management. The aim of this scoping review is to examine imaging modalities and techniques used to characterize atraumatic shoulder hypermobility.

Methods: MEDLINE, EMBASE, SPORTDiscus, Cochrane Library, and Web of Science were searched up to May 2024 for any primary study investigating imaging findings seen in atraumatic shoulder hypermobility. Patients with unilateral instability were excluded given its frequent association with traumatic origin.

Results: Eighteen observational studies met inclusion criteria. Results were divided into outcomes relating to capsular redundancy, glenohumeral anatomy, and muscle activation. Five studies using magnetic resonance arthrography (MRA) demonstrated statistically significant increases in capsular cross-sectional area (CSA), while a significant superior capsular elongation was reported by two studies in patients with multidirectional instability (MDI). Labrocapsular distance, glenocapsular ratio, and the presence of a combined sail and triangle sign on MRA were highly sensitive and specific parameters for identifying MDI. There were inconsistent findings for alterations of glenohumeral anatomy. Ultrasound assessments of acromiohumeral distance (AHD) were significantly increased in patients with MDI, but not in shoulders with hypermobility alone. Similarly, muscle activity measured by electromyography or glenohumeral translations differed significantly in patients with MDI, but not in those with hypermobility alone.

Conclusion: Radiographic markers of capsular redundancy (e.g., CSA, labrocapsular distance, glenocapsular ratio), AHD, and muscular activity are useful in the diagnosis of MDI. However, there are no definitive imaging markers for diagnosing atraumatic shoulder hypermobility without MDI.

Objective: To determine the cost-effectiveness of different imaging modalities for initial detection of multiple myeloma (MM)-defining bone lesions.

Methods: A Markov model from the health care system perspective for patients with MGUS was used to evaluate the incremental cost-effectiveness of five imaging techniques: skeletal survey (SS), low-dose computed tomography (LDCT), positron emission computed tomography (PETCT), and whole-body magnetic resonance imaging (WBMRI) with and without diffusion (DIFF). Model inputs, including probabilities, utilities, and costs were obtained from comprehensive literature review. Costs were estimated in 2024 U.S. dollars, effectiveness was measured in quality adjusted life years (QALYs), willingness-to-pay (WTP) threshold was set to $100,000/QALY, and timeframe of the simulation was 20 years. Model analyses included Monte Carlo microsimulation and probabilistic sensitivity analysis (PSA).

Results: The most cost-effective imaging strategy was dependent on the number of patient risk factors for progression from MGUS to myeloma. At a WTP threshold of $100,000, for patients with no risk factors for progression, LDCT amassed the greatest net monetary benefit (NMB) ($1,030,913.57) while incurring the second lowest costs ($44,870.73). For patients with 1 or 2 risk factors for progression, WBMRI + DIFF amassed the greatest NMB (1 risk factor: $802,637.30, 2 risk factors: $664,430.36). WBMRI and PETCT were absolutely dominated in all cases. PSA also found that the most cost-effective strategy was dependent on the WTP threshold.

Conclusion: Our model suggests that LDCT and WBMRI + DIFF can be the most cost-effective imaging strategies for the initial diagnosis of MM in patients, depending on the number of risk factors for progression.

Objective: To present a case series with a long-term follow-up of CT-guided cryoablation procedure for the minimally invasive treatment of symptomatic lumbar facet synovial cyst with a mean follow-up of 38 months (range, 15-55).

Materials and methods: We present a retrospective, uncontrolled clinical case series in a single institution on patients treated with CT-guided cryoablation for symptomatic lumbar facet joint synovial cyst refractory to or not suitable for imaging-guided rupture procedure. In two cases, patients underwent cryoablation and cyst rupture within a 2-week period. Outcome measures were post-procedural radiologic studies and clinical examinations up to the end of the follow-up. Selected patients underwent post-procedural clinical and CT and MRI imaging which were reviewed up to the conclusion of the follow-up. All patients were clinically assessed and evaluated by spine surgery team. Technical success was complete resolution of patient's symptoms.

Results: We treated 3 females and 3 males (mean age 64 years). Four patients had cysts located at L4-L5, and the remaining two at L5-S1. We used two cryoprobes in five patients, and three in one. Clinical and/or technical success was documented in all cases (mean follow-up, 38 months [range, 15-55]). We found no major complications related to the cryoablation itself.

Conclusion: Our initial experience with CT-guided cryoablation for symptomatic lumbar facet synovial cysts describes a less invasive alternative treatment option to surgery for the management of such lesions. Our long-term outcome experience showed low recurrence and complication rates. CT-guided cryoablation may be a reasonable alternative approach to treat lumbar synovial cysts that are refractory or contraindicated to the rupture procedure and where surgical management is unfeasible.