The Reinforced Cementoplasty with Spindles Technique.

Reinforced cementoplasty with spindles is a recently introduced technique that is mainly used for pathological fractures or for bone metastases at risk of fracture in locations with shear stresses. The technique is less challenging to perform than percutaneous screw insertion and does not require equipment sterilization. No general anesthetic is required. A small trocar is all that is needed, and sutures are often unnecessary. Reinforced cementoplasty can therefore be considered as a technical evolution of cementoplasty with the simple addition of material within the trocar. This technique deserves more awareness so that it can be included in interventional radiologists' range of procedures.

A Feasibility Study of CT-Guided Osteosynthesis under Local Anesthesia.

BACKGROUND: Evaluation of local anesthesia for perioperative pain control in patients undergoing CT-guided percutaneous osteosynthesis. METHODS: A total of 12 patients underwent percutaneous osteosynthesis under local anesthesia. Intraoperative pain was assessed after the procedure using numerical rating scale (NRS). Patients were also asked to rate their overall experience of the operation using the following scale: "highly comfortable, comfortable, hardly comfortable, uncomfortable" and, finally, "Would you be willing to repeat this intervention again under the same conditions if necessary?" Patients were also clinically followed up at 1 month, 3 months, and 6 months using the EQ5D5L scale to assess their pain and quality of life. RESULTS: Patients underwent percutaneous osteosynthesis for osteoporotic (n = 9), pathological (n = 2), or traumatic fractures (n = 1), including the thoraco-lumbar spine (n = 8) or the pelvis (n = 4). The mean of NRS value experienced during the procedure was 3.4/10 (0-8). The overall feeling was highly comfortable (42%), comfortable (50%), hardly comfortable (8%), and uncomfortable (0%). Finally, 75% of patients answered "YES" to the question of repeating the operation under the same conditions if necessary. At follow-up, a significant reduction in pain was observed postoperatively. According to the EQ5D5L scale, there was a significant improvement in pain, mobility, self-activities, autonomy, and perceived quality of life at 3 and 6 months. CONCLUSION: Radiological percutaneous osteosynthesis is an effective technique that can be performed under local anesthesia with a comfortable experience for most of the patients.

Automatic segmentation of white matter hyperintensities: validation and comparison with state-of-the-art methods on both Multiple Sclerosis and elderly subjects.

Different types of white matter hyperintensities (WMH) can be observed through MRI in the brain and spinal cord, especially Multiple Sclerosis (MS) lesions for patients suffering from MS and age-related WMH for subjects with cognitive disorders and/or elderly people. To better diagnose and monitor the disease progression, the quantitative evaluation of WMH load has proven to be useful for clinical routine and trials. Since manual delineation for WMH segmentation is highly time-consuming and suffers from intra and inter observer variability, several methods have been proposed to automatically segment either MS lesions or age-related WMH, but none is validated on both WMH types. Here, we aim at proposing the White matter Hyperintensities Automatic Segmentation Algorithm adapted to 3D T2-FLAIR datasets (WHASA-3D), a fast and robust automatic segmentation tool designed to be implemented in clinical practice for the detection of both MS lesions and age-related WMH in the brain, using both 3D T1-weighted and T2-FLAIR images. In order to increase its robustness for MS lesions, WHASA-3D expands the original WHASA method, which relies on the coupling of non-linear diffusion framework and watershed parcellation, where regions considered as WMH are selected based on intensity and location characteristics, and finally refined with geodesic dilation. The previous validation was performed on 2D T2-FLAIR and subjects with cognitive disorders and elderly subjects. 60 subjects from a heterogeneous database of dementia patients, multiple sclerosis patients and elderly subjects with multiple MRI scanners and a wide range of lesion loads were used to evaluate WHASA and WHASA-3D through volume and spatial agreement in comparison with consensus reference segmentations. In addition, a direct comparison on the MS database with six available supervised and unsupervised state-of-the-art WMH segmentation methods (LST-LGA and LPA, Lesion-TOADS, lesionBrain, BIANCA and nicMSlesions) with default and optimised settings (when feasible) was conducted. WHASA-3D confirmed an improved performance with respect to WHASA, achieving a better spatial overlap (Dice) (0.67 vs 0.63), a reduced absolute volume error (AVE) (3.11 vs 6.2 mL) and an increased volume agreement (intraclass correlation coefficient, ICC) (0.96 vs 0.78). Compared to available state-of-the-art algorithms on the MS database, WHASA-3D outperformed both unsupervised and supervised methods when used with their default settings, showing the highest volume agreement (ICC = 0.95) as well as the highest average Dice (0.58). Optimising and/or retraining LST-LGA, BIANCA and nicMSlesions, using a subset of the MS database as training set, resulted in improved performances on the remaining testing set (average Dice: LST-LGA default/optimized = 0.41/0.51, BIANCA default/optimized = 0.22/0.39, nicMSlesions default/optimized = 0.17/0.63, WHASA-3D = 0.58). Evaluation and comparison results suggest that WHASA-3D is a reliable and easy-to-use method for the automated segmentation of white matter hyperintensities, for both MS lesions and age-related WMH. Further validation on larger datasets would be useful to confirm these first findings.

Validation of an automatic tool for the rapid measurement of brain atrophy and white matter hyperintensity: QyScore®.

OBJECTIVES: QyScore® is an imaging analysis tool certified in Europe (CE marked) and the US (FDA cleared) for the automatic volumetry of grey and white matter (GM and WM respectively), hippocampus (HP), amygdala (AM), and white matter hyperintensity (WMH). Here we compare QyScore® performances with the consensus of expert neuroradiologists. METHODS: Dice similarity coefficient (DSC) and the relative volume difference (RVD) for GM, WM volumes were calculated on 50 3DT1 images. DSC and the F1 metrics were calculated for WMH on 130 3DT1 and FLAIR images. For each index, we identified thresholds of reliability based on current literature review results. We hypothesized that DSC/F1 scores obtained using QyScore® markers would be higher than the threshold. In contrast, RVD scores would be lower. Regression analysis and Bland-Altman plots were obtained to evaluate QyScore® performance in comparison to the consensus of three expert neuroradiologists. RESULTS: The lower bound of the DSC/F1 confidence intervals was higher than the threshold for the GM, WM, HP, AM, and WMH, and the higher bounds of the RVD confidence interval were below the threshold for the WM, GM, HP, and AM. QyScore®, compared with the consensus of three expert neuroradiologists, provides reliable performance for the automatic segmentation of the GM and WM volumes, and HP and AM volumes, as well as WMH volumes. CONCLUSIONS: QyScore® represents a reliable medical device in comparison with the consensus of expert neuroradiologists. Therefore, QyScore® could be implemented in clinical trials and clinical routine to support the diagnosis and longitudinal monitoring of neurological diseases. KEY POINTS: • QyScore® provides reliable automatic segmentation of brain structures in comparison with the consensus of three expert neuroradiologists. • QyScore® automatic segmentation could be performed on MRI images using different vendors and protocols of acquisition. In addition, the fast segmentation process saves time over manual and semi-automatic methods. • QyScore® could be implemented in clinical trials and clinical routine to support the diagnosis and longitudinal monitoring of neurological diseases.

Percutaneous Image-Guided Anterior Screw Fixation of the Odontoid Process.

PURPOSE: To describe the technique of percutaneous image-guided anterior screw fixation of the odontoid process in five patients using hydrodissection of the jugulo-carotid and pre-vertebral spaces. METHODS AND MATERIALS: Between 03/2018 and 03/2020, five patients from two university hospitals underwent a percutaneous image-guided anterior screw fixation of the odontoid process for one pathological fracture, two impending fractures and two traumatic fractures of the dens. Technical success was defined as a satisfactory positioning of the screw in the odontoid. Detailed data with the number and type of needles required, the time to perform hydrodissection, the volume of fluid used, the time for bone access, the size and lengths of the screws used, technical success, complications, clinical outcomes and follow-up were retrospectively assessed. RESULTS: Technical success was achieved in 100% (5/5 cases), with a mean volume of hydrodissection of 218 ± 8.4 mL (range 210-230). Mean total procedure time was 112 ± 34 min (range 70-160). The lengths of the screws ranged from 30 mm to 55 mm. Additional cementoplasty was performed in the three malignant cases. VAS scores dropped on a 10-point scale from mean 5.8 ± 2.2 pre-procedure to 0.8 ± 0.4 after the procedure. No major complication occurred. CONCLUSION: Percutaneous image-guided anterior screw fixation of the odontoid process using hydrodissection of the jugulo-carotid and pre-vertebral spaces is technically feasible and seems safe.

Diagnostic value of 3DFLAIR in clinical practice for the detection of infratentorial lesions in multiple sclerosis in regard to dual echo T2 sequences.

BACKGROUND AND PURPOSE: The aim of this prospective study is to investigate and evaluate in clinical practice the diagnostic impact of 3DFLAIR in regards to 2DT2/PD in terms of infratentorial lesions detection in multiple sclerosis (MS). MATERIAL AND METHODS: 164 MS patients from the OFSEP database were reviewed retrospectively. MR examinations were performed on 1.5T or 3T systems from four different centers. Infratentorial lesions were counted and allocated to different regions of the posterior fossa by three raters independently (junior resident, resident with an expertise in neuroradiology, and senior neuro-radiologist) on the 3DFLAIR and 2DT2/PD. Both sequences do not have the same spatial resolution but reflect what is recommended by most of the consensus and done in clinical practice. RESULTS: With an overall number of 528 for Rater-1 and 798 for Rater-2 infratentorial lesions, 3DFLAIR had a significantly higher number of lesions detected than 2DT2/PD (303 for Rater-1 and 370 for Rater-2). The prevalence of trigeminal lesions detected by using 3DFLAIR was also significantly higher than 2DT2/PD. ROC analysis showed 3DFLAIR to be more specific and sensitive than 2DT2/PD. An overall difference between all three Raters has been observed. The more the Rater is experienced the more lesions he detects. CONCLUSION: Along with the radiologist ability to detect lesions based on his level of experience, the OFSEP optimized 3DFLAIR can significantly improve infratentorial lesion detection in MS compared to 2DT2/PD. This is important in MS follow-up that takes into account new lesions number to adapt patients' treatment.

Late-onset hemophagocytic lymphohistiocytosis with neurological presentation.

Missense mutations in genes involved in familial hemophagocytic lymphohistiocytosis can delay the onset of this life-threatening disease. In children and adults, early recognition of aspecific features as neurological symptoms is crucial as urgent treatment is required.