Quantitative Imaging in Medicine and Surgery最新文献

Background: Total knee arthroplasty (TKA) is an effective surgical procedure for managing advanced osteoarthritis of the knee, significantly reducing pain and improving function. However, some patients experience complications leading to revision surgery, often caused by periprosthetic joint infection (PJI) in early failures and adverse local tissue reactions (ALTR) or aseptic loosening in late failures. Differentiating between PJI and ALTR is crucial because their clinical presentations can overlap, yet their treatments are distinct. While traditional imaging like radiography is useful for assessing alignment and detecting osteolysis, it may miss subtle pathological changes. Computed tomography (CT) has been increasingly utilized to provide additional diagnostic detail, especially regarding lymphadenopathy, which has been linked to septic complications in hip prostheses. However, the role of popliteal lymphadenopathy (PLN) in knee prosthesis complications remains unexplored.

Case description: We present three cases of knee prosthesis complications, diagnosed as either septic or aseptic, where CT imaging revealed distinct patterns of PLN. In the first case, which involved septic loosening, three enlarged PLNs with rounded morphology, normal density, and an absent fatty hilum were observed. The second case, complicated by ALTR and a periprosthetic fracture, showed six PLNs with increased cortical density but a preserved fatty hilum. The third and final case of aseptic loosening revealed three PLNs with increased cortical density and prosthetic debris in the popliteal recess. These findings suggest a range of PLN characteristics depending on the underlying complication, with distinct differences in morphology and cortical density observed between septic and aseptic cases.

Conclusions: The presence and characteristics of PLN may serve as a valuable imaging biomarker for diagnosing and differentiating knee prosthesis complications. CT evaluation of PLNs could enhance diagnostic accuracy, particularly in distinguishing between PJI and ALTR, prompting further research to validate these findings and explore their diagnostic potential.

Background: The appropriate use of imaging methods in bone and soft tissue tumours of the hand is well established in the radiological literature. However, since most of the tumoral conditions of the hand are benign, the use of imaging methods may be based on clinician preferences and technical availability. The aim of this work is to present the experience in our institution in the management of tumours and pseudo-tumours of the hand and to review the utility of different imaging methods in their diagnosis.

Methods: We present a retrospective and consecutive case series of patients referred to Hospital Universitario Virgen de las Nieves due to clinical suspicion of hand tumour in the last 10 years. We assessed the accuracy of clinical and imaging diagnoses, matching the final pathological or surgical results, considering a diagnosis as "correct" if it was included in the differential diagnosis suggested in the clinical (including all provided diagnoses) or radiological report (only the first 2 diagnoses), respectively. Biopsy accuracy was contrasted with surgical findings.

Results: We included 175 patients with a pathological or microbiological diagnosis of hand tumors, obtained through surgery (n=124) and/or core needle biopsy (n=62), or puncture-drainage (n=30). Among these, 21 cases were identified as infectious, metabolic, or inflammatory processes, while 154 were classified as hand tumours or pseudotumours (101 in soft tissues and 53 in bone). The overall diagnostic accuracy (95% confidence interval) for each approach was as follows: clinical diagnosis, 26.3% (19.8-32.8%); ultrasound, 72.6% (64.3-80.8%); magnetic resonance imaging (MRI), 80.6% (73.8-87.4%); computed tomography (CT), 84.6% (74.8-94.4%); and radiography, 46.8% (38.6-55.0%). The overall accuracy of imaging was 81.1% (75.3-86.9%). For soft tissue masses, the diagnostic accuracy was: clinical, 30.7% (25.5-42.1%); ultrasound, 69.8% (62.9-80.1%); MRI, 73.9% (65.5-83.4%); CT, 75.0% (30-92%); and radiography, 20.3% (14-33%), with an overall imaging accuracy of 75.2% (69.2-84.1%). For bone tumours, the accuracy was: clinical, 10.9% (5.2-21.8%); ultrasound, 75.0% (46.8-91.1%); MRI, 90.7% (78.4-96.3%); CT, 92.3% (79.7-97.3%); and radiography, 83.3% (71.3-91%), with an overall imaging accuracy of 89.1% (78.2-94.9%). Biopsy accuracy was 90.7% (83-98.5%) overall, 86.4% (74-98%) for soft tissue masses, and 100% (81.5-100%) for bone tumours.

Conclusions: Imaging outperforms clinical diagnosis in terms of accuracy and should be mandatory before any interventional procedure. Imaging-guided biopsy is an efficient complementary technique when doubts persist about the nature or potential malignancy of a hand tumour.

Background and objective: Spondylolysis is a lysis of the pars interarticularis, a component of the posterior arch of the vertebral body, in the face of repeated overuse and stress phenomena generally associated with sports in children and adolescent patients. This entity is one of the most common causes of low back pain in this age group. The diagnosis can be made using various imaging techniques, with computed tomography (CT) being considered the gold standard, as it provides the best visualization of the fracture, its extension and orientation, as well as an assessment of the entire bony skeleton. It is essential to understand the physiopathology and natural evolution of the disease as well as to know the typical findings of this disease in each imaging technique in order to be able to make a diagnosis in early stages of the disease. In this paper, we will review the clinical manifestations and typical radiologic findings of spondylolisthesis and spondylolisthesis, which allow a correct and early diagnosis.

Methods: The literature available in English from 1976 (when the first publications on the diagnosis of this pathology appeared) up to the present day has been used for this review.

Key content and findings: In this review we will review the etiology, etiopathogenesis and natural evolution of spondylolysis and spondylolisthesis, we will place special emphasis on the radiological findings in magnetic resonance imaging with a view to an early diagnosis that allows us to slow down the evolution of the disease in its initial stages and we will look at the advantages and disadvantages of each technique.

Conclusions: Spondylolysis is an increasingly frequent entity due to the increase in sporting activity at younger and younger ages, so radiologists should consider its existence in patients with low back pain and know the radiological signs that allow us to make an early diagnosis.

Background: Gastric cancer (GC) is the fifth most common cancer globally and the third leading cause of cancer-related deaths. While it predominantly metastasizes to the liver, peritoneum, and lungs, bone metastasis (BM) is a rare but severe complication. BM occurs in 1-20% of GC cases and is associated with a poor prognosis. Typically, BM in GC presents at advanced stages, often with non-specific symptoms, making early detection challenging.

Case description: This retrospective study analyzed 118 GC patients treated at our institution from 2010 to 2020. Among them, eight patients (6.8%) developed BM, with an equal split between osteoblastic and osteolytic types. Osteoblastic BM was observed exclusively in men, with a mean age of 72.25 years. The median time from GC diagnosis to BM onset was 27.5 months. BM was primarily detected through periodic thoracoabdominal CT scans, and bone scintigraphy confirmed the osteoblastic nature of the lesions. All patients had advanced GC and were under palliative care at the time of BM diagnosis. The average survival time from BM diagnosis was 8.5 months.

Conclusions: BM in GC patients is rare but significantly worsens the prognosis. The findings suggest that osteoblastic BM may be more common in GC than previously reported, potentially due to improved imaging techniques and extended patient survival. This study underscores the importance of vigilant radiological monitoring in GC patients, particularly those with non-specific symptoms suggestive of BM. Enhanced collaboration between oncology and palliative care teams is essential to manage symptoms effectively and improve patient quality of life. Future research should focus on the incidence and management of BM in GC, particularly the role of targeted therapies in improving patient quality of life.

Keywords: Bone metastasis (BM); gastric cancer (GC); osteoblastic; disease progression; case report.

The development and evolution of high-frequency probes in current ultrasound systems have enabled us to obtain more detailed information about small and superficial structures, such as the fingers, which are frequently injured in a significant portion of the population (traumatic injuries account for 28% of musculoskeletal system injuries) and can result in substantial disability for affected patients. Due to its superior accessibility, resolution, and ability to perform dynamic studies, ultrasound has become the imaging technique of choice for evaluating these conditions. It covers a range of pathologies, including tendinous, ligamentous, and articular injuries, as well as soft tissue tumors and pseudotumors, which will be described in detail in the main body of the article. However, given the complexity and small size of these structures, along with the necessity for early diagnosis to enable surgical treatment and minimize functional impairment, it is essential to be well-versed in the anatomy, examination techniques, and basic pathologies of the fingers to perform a thorough evaluation and achieve an accurate diagnosis. Therefore, the primary objective of this article is to present this content in a practical and straightforward manner, making it useful not only for radiology professionals but also for other specialists, since ultrasound is the most commonly used imaging method outside of radiology.

Bone marrow is a dynamic organ with variable composition in relation to age or pathophysiological changes. Magnetic resonance imaging (MRI) is the technique of choice to assess the different components of the bone marrow based on the different information provided by the different characteristics of the MRI sequences. This article provides an overview of the MRI appearances of normal and abnormal bone marrow. We review the MRI features of normal developmental red marrow- to yellow-conversion, reconversion and physiologic conditions. We review the key imaging techniques used in assessing bone marrow pathology in MRI, including T1-weighted, T2-weighted, Dixon chemical shift imaging and diffusion-weighted imaging, as well as dynamic contrast-enhanced (DCE) MRI. It is discussed the bone marrow characteristics in the different morphological and functional MRI sequences from the normal or abnormal conditions such as; infiltration (metastases), proliferation [multiple myeloma (MM)], vascular edema/necrosis and postreatment changes. We show the different MRI features to differentiate physiological processes from pathological processes in order to provide effective diagnoses, as well as to evaluate the optimal therapeutic monitoring assessment. Insights from recent advancements in imaging technology and emerging MRI techniques are also discussed, providing a comprehensive overview of bone marrow MRI and its clinical implications. This review provides a useful tool for radiologist to decide normal or abnormal findings from the analysis of bone marrow MRI; in order to manage and take decisions that will depend on the imaging findings. The optimal analysis of bone marrow MRI requires knowledge of the physiology of the bone marrow to interpret properly the pathology and avoid diagnostic errors.

Contraceptive arm implants provide long-acting contraception through a subdermal rod. The device is intended to be placed on the medial side of the non-dominant upper arm. There are two main types of implants: etonogestrel (ENG)-releasing devices, such as Implanon NXT^®/Nexplanon^®, and levonorgestrel (LNG)-releasing devices, including Sino-implant II^® and Jadelle^®. Since the rods are not biodegradable, the implants must be removed after the device's licensed duration. When the implant is palpable and located in subcutaneous tissue, it can be removed with a small skin incision, without the need for imaging. If the implant is not palpable, imaging techniques must be used for precise localization. Ultrasound (US) is the first-line imaging modality for non-palpable implants, allowing quick and accurate localization in the vast majority of cases. The patient can usually indicate the implant insertion site, which speeds up the localization process. If the implant cannot be located using US, other imaging techniques should be used. X-ray can also be useful for a quick localization assessment of radiopaque implants. Magnetic resonance imaging (MRI) is valuable for locating deep or migrated implants, especially if the device has not been locatable through US or X-ray. In case of suspected pulmonary migration, a thoracic computed tomography (CT) should be performed for arterial implant detection. In this article, we review the imaging techniques used for implant localization. We also present an algorithm that recommends a sequential approach to implant localization, integrating imaging modalities based on implant characteristics and patient presentation.

Background: Hamstring stiffness varies among individuals and can influence athletic performance and injury risk. Sex-based differences in hamstring stiffness among football players have not been thoroughly investigated. This study aimed to assess these differences using shear wave elastography (SWE), a non-invasive ultrasound technique that quantifies tissue stiffness.

Methods: The study recruited 30 football players (15 male, 15 female) in June 2022 during their annual medical check-up. Participants were aged 18-40 years, engaged in regular training, and had no history of lower limb musculoskeletal injury in the six weeks preceding the study. SWE was used to measure shear wave velocity (SWV) in the hamstring muscles: semitendinosus (ST), semimembranosus (SM), and biceps femoris (BF). Independent t-tests were used to compare the SWV values of the hamstring muscles between sexes and between dominant and non-dominant legs.

Results: ST muscle had a statistically significant difference in SWV based on gender and leg dominance with marked differences particularly in the non-dominant leg across both genders (P=0.02; Bonferroni corrected P=0.05). SWV for ST in male group was significantly higher than that in female group; the mean elasticity of the male group for dominant and non-dominant leg were 3.8±1.5 and 4.1±1.2 m/s, respectively; and the mean elasticity of the female group for dominant and non-dominant leg were 2.9±0.7 and 2.8±0.7 m/s respectively. In contrast, SWV differences in the SM and BF muscles were not statistically significant (P=0.187 and 0.760, respectively).

Conclusions: The study revealed significant sex-based differences in hamstring stiffness among football players, as assessed by SWE. ST muscle stiffness was associated with higher SWV in male group and show stronger correlation with non-dominance leg. These findings can contribute to individualized training programs and injury prevention strategies.

Myosteatosis has emerged as an important concept in muscle health as it is associated with an increased risk of adverse health outcomes, a higher rate of complications, and increased mortality associated with ageing, chronic systemic and neuromuscular diseases, cancer, metabolic syndromes, degenerative events, and trauma. Myosteatosis involves ectopic infiltration of fat into skeletal muscle, and it exhibits a negative correlation with muscle mass, strength, and mobility representing a contributing factor to decreased muscle quality. While myosteatosis serves as an additional biomarker for sarcopenia, cachexia, and metabolic syndromes, it is not synonymous with sarcopenia. Myosteatosis induces proinflammatory changes that contribute to decreased muscle function, compromise mitochondrial function, and increase inflammatory response in muscles. Imaging techniques such as computed tomography (CT), particularly opportunistic abdominal CT scans, and magnetic resonance imaging (MRI) or magnetic resonance spectroscopy (MRS), have been used in both clinical practice and research. And in recent years, ultrasound has emerged as a promising bedside tool for measuring changes in muscle tissue. Various techniques, including CT-based muscle attenuation (MA) and intermuscular adipose tissue (IMAT) quantification, MRI-based proton density fat fraction (PDFF) and T1-T2 mapping, and musculoskeletal ultrasound (MSUS)-based echo intensity (EI) and shear wave elastography (SWE), are accessible in clinical practice and can be used as adjunct biomarkers of myosteatosis to assess various debilitating muscle health conditions. However, a stan¬dard definition of myosteatosis with a thorough understanding of the pathophysiological mechanisms, and a consensus in assessment methods and clinical outcomes has not yet been established. Recent developments in image acquisition and quantification have attempted to develop an appropriate muscle quality index for the assessment of myosteatosis. Additionally, emerging studies on artificial intelligence (AI) may provide further insights into quantification and automated assessment, including MRS analysis. In this review, we discuss the pathophysiological aspects of myosteatosis, all the current imaging techniques and recent advances in imaging assessment as potential biomarkers of myosteatosis, and the most common clinical conditions involved.