Relationships between diagnostic imaging of first carpometacarpal osteoarthritis and pain, functional status, and disease progression: A systematic review.

OBJECTIVE: To systematically review the association of pain, function, and progression in first carpometacarpal (CMC) osteoarthritis (OA) with imaging biomarkers and radiography-based staging. DESIGN: Database searches in PubMed, Embase, and the Cochrane Library, along with citation searching were conducted in accordance with published guidance. Data on the association of imaging with pain, functional status, and disease progression were extracted and synthesized, along with key information on study methodology such as sample sizes, use of control subjects, study design, number of image raters, and blinding. Methodological quality was assessed using National Heart, Lung, and Blood Institute tools. RESULTS: After duplicate removal, a total of 1969 records were screened. Forty-six articles are included in this review, covering a total of 28,202 study participants, 7263 with first CMC OA. Osteophytes were found to be one of the strongest biomarkers for pain across imaging modalities. Radiographic findings alone showed conflicting relationships with pain. However, Kellgren-Lawrence staging showed consistent associations with pain in various studies. Radiographic, sonographic, and MRI findings and staging showed little association to tools evaluating functional status across imaging modalities. The same imaging methods showed limited ability to predict progression of first CMC OA. A major limitation was the heterogeneity in the study base, limiting synthesis of results. CONCLUSION: Imaging findings and radiography-based staging systems generally showed strong associations with pain, but not with functional status or disease progression. More research and improved imaging techniques are needed to help physicians better manage patients with first CMC OA.

Total-Body 18F-FDG PET/CT in Autoimmune Inflammatory Arthritis at Ultra-Low Dose: Initial Observations.

Autoimmune inflammatory arthritides (AIA), such as psoriatic arthritis and rheumatoid arthritis, are chronic systemic conditions that affect multiple joints of the body. Recently, total-body (TB) PET/CT scanners exhibiting superior technical characteristics (total-body coverage, geometric sensitivity) that could benefit AIA evaluation, compared with conventional PET/CT systems, have become available. The objectives of this work were to assess the performance of an ultra-low-dose, 18F-FDG TB PET/CT acquisition protocol for evaluating systemic joint involvement in AIA and to report the association of TB PET/CT measures with joint-by-joint rheumatologic examination and standardized rheumatologic outcome measures. Methods: Thirty participants (24 with AIA and 6 with osteoarthritis) were prospectively enrolled in this single-center, observational study. All participants underwent a TB PET/CT scan for 20 min starting at 40 min after intravenous injection of 78.1 ± 4.7 MBq of 18F-FDG. Qualitative and quantitative evaluation of 18F-FDG uptake and joint involvement were performed from the resulting images and compared with the rheumatologic assessments. Results: TB PET/CT enabled the visualization of 18F-FDG uptake at joints of the entire body, including those of the hands and feet, in a single bed position, and in the same phase of radiotracer uptake. A range of pathologies consistent with AIA (and non-AIA in the osteoarthritis group) were visualized, and the feasibility of extracting PET measures from joints examined by rheumatologic assessments was demonstrated. Of 1,997 evaluable joints, there was concordance between TB PET qualitative assessments and joint-by-joint rheumatologic evaluation in the AIA and non-AIA cohorts for 69.9% and 91.1% joints, respectively, and an additional 20.1% and 8.8% joints, respectively, deemed negative on rheumatologic examination showed PET positivity. On the other hand, 10.0% and 0% joints in the AIA and non-AIA cohorts, respectively, were positive on rheumatologic evaluation but negative on TB PET. Quantitative measures from TB PET in the AIA cohort demonstrated a moderate-to-strong correlation (Spearman ρ = 0.53-0.70, P < 0.05) with the rheumatologic outcome measures. Conclusion: Systemic joint evaluation in AIA (and non-AIA) is feasible with a TB PET/CT system and an ultra-low-dose protocol. Our results provide the foundation for future larger studies to evaluate the possible improvements in AIA joint assessment via the TB PET/CT technology.

Assessment of Myofascial Trigger Points via Imaging: A Systematic Review.

ABSTRACT: This study systematically reviewed the published literature on the objective characterization of myofascial pain syndrome and myofascial trigger points using imaging methods. PubMed, Embase, Ovid, and the Cochrane Library databases were used, whereas citation searching was conducted in Scopus. Citations were restricted to those published in English and in peer-reviewed journals between 2000 and 2021. Of 1762 abstracts screened, 69 articles underwent full-text review, and 33 were included. Imaging data assessing myofascial trigger points or myofascial pain syndrome were extracted, and important qualitative and quantitative information on general study methodologies, study populations, sample sizes, and myofascial trigger point/myofascial pain syndrome evaluation were tabulated. Methodological quality of eligible studies was assessed based on the Quality Assessment of Diagnostic Accuracy Studies criteria. Biomechanical properties and blood flow of active and latent myofascial trigger points assessed via imaging were found to be quantifiably distinct from those of healthy tissue. Although these studies show promise, more studies are needed. Future studies should focus on assessing diagnostic test accuracy and testing the reproducibility of results to establish the best performing methods. Increasing methodological consistency would further motivate implementing imaging methods in larger clinical studies. Considering the evidence on efficacy, cost, ease of use and time constraints, ultrasound-based methods are currently the imaging modalities of choice for myofascial pain syndrome/myofascial trigger point assessment.

CT and MR findings in synovial chondromatosis of the temporo-mandibular joint: our experience and review of literature.

OBJECTIVE: To compare Computed Tomography (CT) and Magnetic Resonance (MR) features and their diagnostic potential in the assessment of Synovial Chondromatosis (SC) of the Temporo-Mandibular Joint (TMJ). MATERIALS AND METHODS: Eight patients with symptoms and signs compatible with dysfunctional disorders of the TMJ underwent CT and MR scan. We considered the following parameters: soft tissue involvement (disk included), osteostructural alterations of the joints, loose bodies and intra-articular fluid. These parameters were evaluated separately by two radiologists with a "double blinded method" and then, after agreement, definitive assessment of the parameters was given. CT and MR findings were compared. RESULTS: Histopathological results showed metaplastic synovia in all patients and therefore confirmed diagnosis of SC. MR resulted better than CT in the evaluation of all parameters except the osteostructural alterations of the joints, estimated with more accuracy by CT scan. CONCLUSIONS: CT scan is excellent to define bony surfaces of the articular joints and flogistic tissue but it fails in the detection of loose bodies when these are not yet calcified. MR scan therefore is the gold standard when SC is suspected since it can visualize loose bodies at early stage and also evaluate disk condition and eventual extra-articular tissues involvement. The use of T2-weighted images and contrast medium allows identifying intra-articular fluid, estimating its entity and discriminating from sinovial tissue.

Diffusion-weighted MRI in cervical lymph nodes: differentiation between benign and malignant lesions.

OBJECTIVE: Purpose of our study was to assess the potential role of diffusion-weighted imaging (DWI) in the differential diagnosis between benign and malignant nodes. SUBJECT AND METHODS: We enrolled 32 subjects: 14 with benign lymphadenopathy, 17 patients with histologically proved malignant disease before beginning treatment and 1 patient with lymphoma after chemotherapeutic treatment. In all patients we used fast spin echo T2-weighted images in axial and coronal planes, fast spin echo T1-weighted images before and after contrast medium of administration in axial and coronal planes. Before contrast administration diffusion sequences were acquired on the axial and coronal plane (b factor of 0.500 and 1000 s/mm(2)) and then apparent diffusion coefficient (ADC) maps were reconstructed. RESULTS: On diffusion images, 13/14 patients with benign nodes showed low signal intensity and had high signal on ADC maps, whereas all patients with malignant diseases appeared hyperintense on diffusion images and with low signal intensity on ADC maps. Only a patient with tuberculosis showed a low ADC value. The mean ADC value of malignant nodes was about 0.85 × 10(-3)mm(2)/s, the mean value of benign nodes was 1.448 × 10(-3)mm(2)/s; this difference was statistically significant (p < 0.01). The mean ADC value of treated nodes was 1.75 × 10(-3)mm(2)/s. The best threshold value was 1.03 × 10(-3)mm(2)/s, obtaining a sensitivity of 100% and a specificity of 92.9%. CONCLUSIONS: Diffusion imaging could be considered an important supportive tool for the diagnosis of enlarged cervical lymphadenopathies.

Atypical localization and atypical magnetic resonance imaging findings of a paraganglioma at the mouth mucosa.

We present a case of a paraganglioma located at the cheek. The benign nature of the lesion was certainly suggested by the patient's anamnesis, ecotomography, and needle biopsy; nevertheless, before the excision, the surgeon requested magnetic resonance imaging with contrast stain only to better evaluate the relationship between the lesion and the surrounding structures and not to have a precise diagnosis.Under magnetic resonance examination by using T1, T2, and T1 before and after contrast sequences, it showed an aspect different from the conventionally described features for this kind of lesion. After excision, the mass showed a yellowish color and a liquid content. Histologic examination described it as having the features of a glomus tumor.

Anatomic examination of the upper head of the lateral pterygoid muscle using magnetic resonance imaging and clinical data.

The aim of this work was to ascertain the different kinds of insertion of the upper head of the lateral pterygoid muscle (LPM) on the temporomandibular joint and to clarify its physiology to understand its possible role in the dysfunction at the temporomandibular joint. Magnetic resonance imaging examinations were used in this work to achieve a direct view of the LPM on a large number of selected patients with dysfunction at the temporomandibular joint.The study population was composed of 92 patients, of whom 74 were women and 18 were men. Their age range was from 19 to 53 years (mean age, 31 years). The images were analyzed using the following parameters: symmetry of morphologic insertions of the upper head of the LPM, types of muscular insertion divided into 3 groups (A, single bundle on the capsule and condyle; B, one bundle on the disk and a second bundle on the condyle; and C, one bundle only on the disk), and relationship between disk position regarding the condyle in patients with disk dislocations with or without reduction and upper head of the LPM. The chi-square test was used to measure the magnitude of the results.It is possible to impute to the C-type insertion morphology a negative prognostic value for a long-term improvement of disk pathology and to consider the possibility that this muscle may contribute to dislocating the disk when its insertion was directed only on the disk itself. When the upper head of the LPM was inserted on the disk, the percentage of disk dislocation without reduction was greater.

[MRI evaluation of morpho-structural alterations of the retrodiscal tissue in condylo-meniscal incoordination of the TMJ: usefulness of individualised T2-weighted TSE sequences].

PURPOSE: To assess and evaluate morpho-structural alterations of the retrodiscal tissue of the temporomandibular joint (TMJ) that may be seen in chronic trauma of the condylo-meniscal incoordination through magnetic resonance (MR), using T2-weighted TSE sequences. MATERIALS AND METHODS: The study included 40 patients, 6 male and 34 female, age range 12-66 years, mean age 28.5 years. According to the Wilkes classification, TMJs of patients were graded as follows: 10 grade 1 TMJs; 28 grade 2, 16 grade 3, and 26 grade 4. Scans were obtained with a 1.5 T MRI unit, and a dedicated surface coil, using T2-weighted TSE sequences (TR 3000-3500, TE 90-100), 2 acquisitions, 256x256 matrix, 3-mm section thickness, with a 0-mm interval, and 2'30" duration for a single acquisition. Scans were obtained both during opening and during closure of the mouth, on 3 planes: sagittal oblique, perpendicular to the condylar long axis; coronal oblique, perpendicular to the anteroposterior axis of the discs; and axial, perpendicular to coronal scans. Parameters used were the following: presence or absence of retrodiscal fibrosis; morphology of the retrodiscal fibrosis in scans taken during mouth opening in the four grades of the Wilkes classification; dimensions of the retrodiscal fibrosis in scans taken during mouth opening, in the four grades of the Wilkes classification, in an anteroposterior direction, measuring the longest distance on parasagittal planes on a horizontal line touching the outer edge of the disc and the most-distal point of fibrosis, and in a vertical direction, measuring the distance between the highest and lowest points of fibrosis; signal intensity features within the fibrotic area. RESULTS: In all TMJs analysed, it was possible to confirm the presence of retrodiscal tissue fibrosis, which was more or less evident according to the grading of the dysfunction/disease, to the extent of mouth opening, and to displacement with or without reduction of the articular disc. In grade 1 TMJs, fibrosis looked like a truncated cone; in grade 2, fibrosis looked like a cone; in grade 3, it was either shaped like a mushroom placed horizontally, with the stalk towards the disc, or else ribbon-shaped; in grade 4, it had an inhomogeneous, irregular ribbon shape. CONCLUSIONS: MR studies of TMJ dysfunction through T2-weighted TSE sequences allowed us to evidence in all cases the sclerotic alterations of the retrodiscal tissue, and to assess their form and dimensions. Furthermore, it was possible to evidence both the pathognomonic features of retrodiscal tissue fibrosis resembling a mushroom, and the characteristic brace-shape the upper and lower layers take on during mouth opening in TMJs with a disc displacement with reduction.

Thiophenes as traps for benzyne. 3. Diaryl sulfides and the role of dipolar intermediates.

The reactions of seven thiophenes with benzyne generated from diphenyliodonium-2-carboxylate (DPIC) under a standard set of conditions led among other products to the formation of alpha- and beta-naphthyl phenyl sulfides 2a and 2b from thiophene (1a) and of 2c and 2d from 2-methylthiophene (1b). Dithienyl sulfides 4a-f were produced from the halothiophenes 1c-g. The structures of the naphthyl sulfides were proven by comparison with authentic samples of 2a-f, thus eliminating one of two possible mechanisms of formation. The remaining mechanism involves [4+2]-cycloaddition of benzyne to thiophene or to an S-phenylthiophenium ylide 10 to give the dipolar 2:1 benzyne/thiophene adduct 8 followed by ring-opening. Stevens-like rearrangements of 11, formed from 10 by proton transfer, may also explain the origin of arylated thiophenes such as 12 and 3 found in some reactions of benzynes with thiophene.