[Diagnosis and treatment of fracture-related infections]. / Diagnostiek en behandeling van fractuur-gerelateerde infecties.

Fracture-related infection (FRI) is a serious complication after fracture care and can lead to severe morbidity with loss of quality of life, a significant increase in medical expenses and loss of participation in work and social life. Early recognition, adequate surgical debridement, deep uncontaminated tissue cultures with (if indicated) soft tissue reconstruction and fracture stabilization followed by antibiotic therapy are the cornerstones of the successful management of FRI. Recently, in 2018, the AO/EBJIS consensus definition for FRI was published and both national and international working groups are being assembled and provide guidelines and tools for the care of patients with FRI. This paper is a synopsis of the Dutch guideline on FRI (2018), illustrated by a clinical case, and is aiming to provide an overview of the current knowledge on diagnosis and treatment of this disease.

Evaluation of accuracy and precision of CT-guidance in Radiofrequency Ablation for osteoid osteoma in 86 patients.

BACKGROUND AND PURPOSE: Osteoid osteoma is a benign skeletal tumour that accounts for 2-3% of all bone tumours. The male-to-female ratio is around 4:1 and it predominates in children and young adults. The most common symptom is pain, frequently at night-time. Historically the main form of treatment has been surgical excision. With the development of Radiofrequency Ablation (RFA) there is a percutaneus alternative. Success rates of RFA are lower but the main advantage is the minimal invasive character of the therapy and the low complication rate. As a result of the minimal invasiveness the hospitalization- and rehabilitation periods are relatively short. However, in current literature no values for accuracy and precision are known for the CT-guided positioning. METHODS: Accuracy and precision of the needle position are determined for 86 procedures. Furthermore the population is divided into groups based on tumour diameter, location and procedure outcome. RESULTS: The clinical success rate was 81.4%. In 79% of procedures complete ablation was achieved. Accuracy was 2.84 mm on average, precision was 2.94 mm. Accuracy was significantly lower in more profound lesions. Accuracy in tibia and fibula was significantly higher compared to the femur. No significant difference was found between different tumour diameters. INTERPRETATION: The accuracy and precision found are considered good. Needle position is of major importance for procedure outcomes. The question however rises how the results of this therapy will turn out in treatment of larger tumours.

Comparison of (semi-)automatic and manually adjusted measurements of left ventricular function in dual source computed tomography using three different software tools.

To assess the accuracy of (semi-)automatic measurements of left ventricular (LV) functional parameters in cardiac dual-source computed tomography (DSCT) compared to manually adjusted measurements in three different workstations. Forty patients, who underwent cardiac DSCT, were included (31 men, mean age 58 ± 14 years). Multiphase reconstructions were made with ten series at every 10% of the RR-interval. LV function analysis was performed on three different, commercially available workstations. On all three workstations, end-systolic volume (ESV), end-diastolic volume (EDV), LV ejection fraction (LVEF) and myocardial mass (MM) were calculated as automatically as possible. With the same DSCT datasets, LV functional parameters were also calculated with as many manual adjustments as needed for accurate assessment for all three software tools. For both semi-automatic as well as manual methods, time needed for evaluation was recorded. Paired t-tests were employed to calculate differences in LV functional parameters. Repeated measurements were performed to determine intra-observer and inter-observer variability. (Semi-)automatic measurements revealed a good correlation with manually adjusted measurements for Vitrea (LVEF r = 0.93, EDV r = 0.94, ESV r = 0.98 and MM r = 0.94) and Aquarius (LVEF r = 0.96, EDV r = 0.94, ESV r = 0.98 and MM r = 0.96). Also, good correlation was obtained for Circulation, except for LVEF (LVEF r = 0.45, EDV r = 0.93, ESV r = 0.92 and MM r = 0.86). However, statistically significant differences were found between (semi-)automatically and manually adjusted measurements for LVEF (P < 0.05) and ESV (P < 0.001) in Vitrea, all LV functional parameters in Circulation (P < 0.001) and EDV, ESV and MM (<0.001) in Aquarius Workstation. (Semi-)automatic measurement of LV functional parameters is feasible, but significant differences were found for at least two different functional parameters in all three workstations. Therefore, expert manual correction is recommended at all times.

Semi-automatic measurement of left ventricular function on dual source computed tomography using five different software tools in comparison with magnetic resonance imaging.

PURPOSE: To compare left ventricular (LV) function assessment using five different software tools on the same dual source computed tomography (DSCT) datasets with the results of MRI. MATERIALS AND METHODS: Twenty-six patients, undergoing cardiac contrast-enhanced DSCT were included (20 men, mean age 59±12 years). Reconstructions were made at every 10% of the RR-interval. Function analysis was performed with five different, commercially available workstations. In all software tools, semi-automatic LV function measurements were performed, with manual corrections if necessary. Within 0-22 days, all 26 patients were scanned on a 1.5 T MRI-system. Bland-Altman analysis was performed to calculate limits of agreement between DSCT and MRI. Pearson's correlation coefficient was calculated to assess the correlation between the different DSCT software tools and MRI. Repeated measurements were performed to determine intraobserver and interobserver variability. RESULTS: For all five DSCT workstations, mean LV functional parameters correlated well with measurements on MRI. Bland-Altman analysis of the comparison of DSCT and MRI showed acceptable limits of agreement. Best correlation and limits of agreement were obtained by DSCT software tools with software algorithms comparable to MRI software. CONCLUSION: The five different DSCT software tools we examined have interchangeable results of LV functional parameters compared to regularly analysed results by MRI. The best correlation and the narrowest limits of agreement were found when the same software algorithm was used for both DSCT and MRI examinations, therefore our advice for clinical practice is to always evaluate images with the same type of post-processing tools in follow-up.

Iron accumulation in deep brain nuclei in migraine: a population-based magnetic resonance imaging study.

A small magnetic resonance imaging (MRI) study showed increased iron depositions in the periaqueductal grey matter in migraineurs, suggestive of a disturbed central antinociceptive neuronal network. With 1.5-T MRI, we assessed iron concentrations in seven deep brain nuclei in a large population-based cohort. We compared T2 values between migraineurs (n = 138) and controls (n = 75), with multivariate regression analysis. Analyses were conducted in age strata (< 50, n = 112; > or = 50) because iron measures are increasingly influenced by non-iron-related factors in the older group. Overall, migraineurs and controls did not differ, nor did migraineurs with vs. without aura. In the younger migraineurs compared with controls, T2 values were lower in the putamen (P = 0.02), globus pallidus (P = 0.03) and red nucleus (P = 0.03). Similarly, in these younger migraineurs, controlling for age, those with longer migraine history had lower T2 values in the putamen (P = 0.01), caudate (P = 0.04) and red nucleus (P = 0.001). Repeated migraine attacks are associated with increased iron concentration/accumulation in multiple deep nuclei that are involved in central pain processing and migraine pathophysiology. It remains unclear whether iron accumulation in the antinociceptive network has a causative role in the development of (chronic) migraine headache.