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1.
PLoS Pathog ; 20(7): e1012257, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38950082

RESUMEN

An important aspect of how viruses spread and infect is the viral burst size, or the number of new viruses produced by each infected cell. Surprisingly, this value remains poorly characterized for influenza A virus (IAV), commonly known as the flu. In this study, we screened tens of thousands of cells using a microfluidic method called droplet quantitative PCR (dqPCR). The high-throughput capability of dqPCR enabled the measurement of a large population of infected cells producing progeny virus. By measuring the fully assembled and successfully released viruses from these infected cells, we discover that the viral burst sizes for both the seasonal H3N2 and the 2009 pandemic H1N1 strains vary significantly, with H3N2 ranging from 101 to 104 viruses per cell, and H1N1 ranging from 101 to 103 viruses per cell. Some infected cells produce average numbers of new viruses, while others generate extensive number of viruses. In fact, we find that only 10% of the single-cell infections are responsible for creating a significant portion of all the viruses. This small fraction produced approximately 60% of new viruses for H3N2 and 40% for H1N1. On average, each infected cell of the H3N2 flu strain produced 709 new viruses, whereas for H1N1, each infected cell produced 358 viruses. This novel method reveals insights into the flu virus and can lead to improved strategies for managing and preventing the spread of viruses.

2.
Eur Radiol ; 34(1): 260-269, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37542655

RESUMEN

OBJECTIVES: To evaluate posterior glenohumeral capsule edema compared to other MRI findings in adhesive capsulitis (AC). METHODS: This study was approved by the local Institutional Review Board and it is HIPAA compliant. A retrospective search identified subjects who received fluoroscopically guided intra-articular corticosteroid injections for AC and had an MRI within 6 months prior to injection. The study group was compared with an age-, sex-, and side-matched control group who underwent the same procedures but did not have AC. MRIs were evaluated for edema of posterior capsule, anterior capsule, axillary pouch, coracohumeral ligament (CHL) and rotator interval (RI), thickness of axillary pouch and CHL, thickness of anterior capsule, RI and subcoracoid fat replacement, and teres minor atrophy and edema. Multivariable analysis was performed. RESULTS: A total of 57 subjects with AC and 57 matched controls were studied: mean age 52 ± 7 (range 31-71) years, 37 female and 20 male, 22 right and 35 left. Posterior capsule edema was more common in the AC group vs. control group (66.7 vs 17.5%, p < 0.001). Multivariable analysis showed posterior capsule edema, CHL edema, and axillary pouch (glenoid) thickness (optimum cutoff = 4 mm) were significant independent predictors of AC. Simplified analysis using these three variables had an area under the curve of 0.860 (95%CI: 0.792-0.928). With all three variables present, the sensitivity and specificity for AC were 32% and 98%, respectively. CONCLUSIONS: Posterior joint capsule edema may be helpful to confirm AC. Posterior capsule edema, CHL edema, and axillary pouch (glenoid) thickness produce a strong model for distinguishing AC from controls. CLINICAL RELEVANCE STATEMENT: Edema involving the posterior shoulder joint capsule is an imaging marker of capsulitis and is useful in differentiating patients with adhesive capsulitis from those without in conjunction with other proven MRI findings. KEY POINTS: • Posterior capsule edema has a sensitivity of 66.7% and a specificity of 82.5% for the detection of adhesive capsulitis. • Posterior capsule edema, coracohumeral ligament (CHL) edema, and axillary pouch (glenoid) thickness were significant independent predictors of adhesive capsulitis, and combining these variables together produces a very strong model for distinguishing cases from controls (AUC = 0.860). • Optimal cutoff values for CHL, axillary pouch (humeral), axillary pouch (glenoid), and axillary pouch (total) thickness were 2.5, 2.6, 4, and 6.3 mm, respectively.


Asunto(s)
Bursitis , Articulación del Hombro , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Articulación del Hombro/diagnóstico por imagen , Bursitis/complicaciones , Bursitis/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Edema/diagnóstico por imagen
3.
Semin Musculoskelet Radiol ; 28(1): 78-91, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38330972

RESUMEN

The importance and impact of imaging biomarkers has been increasing over the past few decades. We review the relevant clinical and imaging terminology needed to understand the clinical and research applications of body composition. Imaging biomarkers of bone, muscle, and fat tissues obtained with dual-energy X-ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasonography are described.


Asunto(s)
Composición Corporal , Imagen por Resonancia Magnética , Humanos , Composición Corporal/fisiología , Absorciometría de Fotón/métodos , Imagen por Resonancia Magnética/métodos , Ultrasonografía , Tomografía Computarizada por Rayos X/métodos
4.
Skeletal Radiol ; 53(3): 481-487, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37635152

RESUMEN

OBJECTIVE: The purposes of this study were (1) to establish the feasibility and safety of an imaging-guided technique for intraosseous pressure (IOP) measurement in a large cohort of patients, and (2) to compare IOP values between normal and diseased bone marrow. METHODS: Adult patients undergoing CT-guided marrow biopsy were prospectively and consecutively enrolled from November 2020 to February 2022. IOP measurements were obtained connecting the biopsy needle to a monitoring device using a standard arterial line setup. Clinical data including sex, age and pathology results were obtained. Student t test and Pearson correlation were used for continuous variables comparisons. Univariable analyses were performed using Fisher's exact test. A P value of .05 was considered statistically significant. RESULTS: A total of 139 participants were initially enrolled, and four were excluded during technique optimization. There were no complications related to the measurement technique. Ninety participants (90/135, 67%) had histology confirming marrow pathology. The participants in the diseased marrow group were older than those in the normal marrow group (63 ± 14 vs. 55 ± 14 years; P < .01). There was no difference in mean IOP between both groups (66 ± 23 vs. 64 ± 28 mmHg; P = .69). There was no correlation between mean arterial blood pressure and mean IOP (P = .08). CONCLUSION: There was no difference in IOP measurements between patients with normal and diseased marrow undergoing CT-guided biopsy. IOP does not appear to be influenced by systemic blood pressure. No complication occurred during the procedures.


Asunto(s)
Médula Ósea , Biopsia Guiada por Imagen , Adulto , Humanos , Médula Ósea/diagnóstico por imagen , Estudios de Factibilidad
5.
Skeletal Radiol ; 53(6): 1165-1172, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38133671

RESUMEN

OBJECTIVE: To better understand the current state of musculoskeletal fellowship program directors and identify opportunities for formal training that could increase job satisfaction, provide a broader knowledge base for mentoring/advising trainees and increase diversity in musculoskeletal radiology. MATERIALS AND METHODS: Eighty-one fellowship program directors who signed the Fellowship Match Memorandum of Understanding with the Society of Skeletal Radiology were sent a survey with questions about demographics, career, background, and training both for musculoskeletal radiology and for the fellowship director role. RESULTS: A 57/81 (70%) of program directors responded, representing 27 different states with a range of 1-9 fellowship positions. Nearly half are in their forties (48%) with most identifying as White (67%) followed by Asian (30%). The majority are male (72%) with over half (60%) remaining at the institution where they completed prior training. Over half plan to change roles within 5 years and do not feel adequately compensated. Top qualities/skills identified as important for the role include effective communication, being approachable, and clinical excellence. Other than clinical excellence, most do not report formal training in skills identified as important for the role. CONCLUSIONS: Given the high amount of interaction with trainees, program directors play a key role in the future of our subspecialty. The low diversity among this group, the lack of formal training, and the fact that most do not feel adequately compensated could limit mentorship and recruitment. Program directors identified effective communication, organizational/planning skills, and conflict resolution as the top skills they would benefit from formal training.


Asunto(s)
Internado y Residencia , Radiología , Humanos , Masculino , Femenino , Becas , Educación de Postgrado en Medicina , Radiología/educación , Encuestas y Cuestionarios
6.
Skeletal Radiol ; 53(3): 473-479, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37632549

RESUMEN

PURPOSE: To determine the added value of computed tomography (CT) to identify severe hip osteoarthritis (OA). MATERIALS AND METHODS: A retrospective query of all cases of hip or knee arthroplasty planning CTs between January 2018 and March 2022 was performed. Age, sex, and symptoms were collected from the medical record. CTs were evaluated for the degree of osteoarthritis and classified using an adapted Kellgren-Lawrence (KL) grading system in the anterior, posterior, superior, and superomedial hip. Frontal hip or pelvis radiographs within 1 year of the CT were also graded. RESULTS: There were 265 eligible hips in 178 subjects, age 66 ± 11 (range 31-93) years, with 85/178 (48%) males and 93/178 (52%) females, and 127/265 (48%) right and 138/265 (52%) left hips. The posterior hip joint was the most common location for grade 2/3 OA (20%), followed by superior hip joint (14%). Anterior or posterior grade 2/3 OA occurred concurrently with superior or superomedial grade 2/3 OA in 32/68 (47%) of hips. Grade 2/3 OA was detected on CT more commonly than on XR both in the superior (14 vs 8.6%, P = 0.0016) and superomedial (8.7 vs 4.8%, P = 0.016) hip joint. Of the 71 symptomatic hips, 22 (31%) hips demonstrated either anterior and/or posterior grade 2/3 OA on CT, and 9 (9/22, 41%) of these hips had superior or superomedial grade 0/1 OA. CONCLUSION: CT may be warranted when the patient has pain suggestive of osteoarthritis not detected on radiographs.


Asunto(s)
Osteoartritis de la Cadera , Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/epidemiología , Osteoartritis de la Cadera/cirugía , Estudios Retrospectivos , Prevalencia , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Tomografía Computarizada por Rayos X
7.
Skeletal Radiol ; 53(4): 761-767, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-37875572

RESUMEN

OBJECTIVE: To compare rotator cuff (RC) muscle cross-sectional areas (CSA) in subjects with adhesive capsulitis (AC) to age- and sex-matched controls. MATERIALS AND METHODS: We retrospectively analyzed 97 shoulder MRIs or MR arthrography studies, of which 42 were clinically diagnosed with AC (27 female, 15 male) and 55 were age- and sex-matched controls (38 female, 17 male). All AC subjects underwent imaging ≥ 6 months after symptom onset. All imaging was examined to exclude RC full-thickness tears and prior surgery. A standardized T1 sagittal MR image was segmented in each subject to obtain the CSA of subscapularis (SSC), supraspinatus (SSP), and infraspinatus (ISP) muscles. Differences in CSAs between AC and control subjects were analyzed by sex (females and males separately) and all subjects combined. RESULTS: AC females had significantly decreased SSC (P = 0.002) and total (P = 0.006) CSAs compared to controls. Male AC subjects showed decreased SSC (P = 0.044), SSP (P = 0.001), and total (P = 0.005) CSAs. Across all subjects, male and female, the AC cohort had significantly decreased SSC (P = 0.019) and total (P = 0.029) CSAs compared to controls. CONCLUSION: Decreased RC muscle CSAs were present in AC subjects with ≥ 6 months of symptom duration, with decreased SSC and total CSAs in male and female subjects, and decreased SSP CSA in males.


Asunto(s)
Bursitis , Lesiones del Manguito de los Rotadores , Articulación del Hombro , Humanos , Masculino , Femenino , Manguito de los Rotadores/diagnóstico por imagen , Estudios Retrospectivos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Bursitis/diagnóstico por imagen
8.
Skeletal Radiol ; 53(6): 1135-1144, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38097764

RESUMEN

PURPOSE: To evaluate success rates of computed tomography (CT)-guided lumbar facet synovial cyst (LFC) rupture. MATERIALS AND METHODS: We retrospectively reviewed all LFC ruptures performed by a single musculoskeletal radiologist with > 10 years of experience, using posterior facet approach and/or direct puncture by ipsilateral/contralateral interlaminar, or transforaminal approach. All patients also received a corticosteroid injection. Rupture rates were calculated, and clinical success rate was determined through medical record review. Pre-procedure magnetic resonance imaging (MRI) images and CT procedure images were also reviewed for LFC and facet joint imaging features that may predict rupture. RESULTS: There were 37 patients, 17 (46%) female and 20 (54%) male, ages 62 ± 12 (range 39-87) years. Thirty-four (92%) of LFC were successfully ruptured, 17 (50%) by facet approach and 17 (50%) by direct cyst puncture. At least one direct puncture approach was possible in 35 (95%) patients. No MRI or CT LFC or facet joint features predicted cyst rupture. Thirty-one (91%) of patients reported immediate pain relief, and 19 (53%) did not have further intervention for LFC-related pain. Sixteen (84%) of these patients remained pain-free for an average follow-up time period of 28 months. Fourteen (39%) of patients required surgical intervention. There were no complications. CONCLUSION: Our systematic approach to CT-guided LFC rupture is safe and has high technical and clinical success rates similar to prior studies. Since there are no definitive imaging features that determine rupture success, this procedure can almost always be attempted as a first-line treatment for LFC.


Asunto(s)
Quistes , Articulación Cigapofisaria , Humanos , Masculino , Femenino , Estudios Retrospectivos , Corticoesteroides/uso terapéutico , Tomografía Computarizada por Rayos X/métodos , Articulación Cigapofisaria/patología , Dolor , Rotura , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía
9.
Skeletal Radiol ; 53(8): 1495-1506, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38351410

RESUMEN

BACKGROUND: Phosphaturic mesenchymal tumor (PMT) is a rare tumor that causes tumor-induced osteomalacia. Patients present with non-specific symptoms secondary to renal phosphate wasting and decreased bone mineralization. We sought to assess: (1) What are the common presenting features, laboratory and imaging findings, histologic findings of phosphaturic mesenchymal tumors? (2) What are the available treatment strategies for phosphaturic mesenchymal tumors and their long-term outcomes in terms of local recurrence and symptom control after treatment? METHODS: We retrospectively identified patients with a histologic diagnosis of PMT located in the axial or appendicular skeleton, or surrounding soft tissues. A total of 10 patients were finally included in our study. RESULTS: Median tumor size was 1.9 cm (range, 1.1 to 6.1) and median time from symptom onset to diagnosis was 3 years (range, 0.5 to 15 years). All patients but one presented with hypophosphatemia (median 1.9 mg/dL, range 1.2 to 3.2). Pre-operative FGF-23 was elevated in all cases (median 423.5 RU/mL, range 235 to 8950). Six patients underwent surgical resection, three were treated percutaneously (radiofrequency ablation or cryoablation), and one refused treatment. Only one patient developed local recurrence and no patients developed metastatic disease. At last follow-up, nine patients showed no evidence of disease and one was alive with disease. CONCLUSION: Phosphaturic mesenchymal tumor is a rare tumor presenting with non-specific symptoms. Surgery is the standard treatment when negative margins can be achieved without significant morbidity. In patients with small tumors in surgically-inaccessible areas, radiofrequency ablation or cryoablation can be performed successfully.


Asunto(s)
Osteomalacia , Humanos , Masculino , Femenino , Estudios Retrospectivos , Adulto , Osteomalacia/diagnóstico por imagen , Persona de Mediana Edad , Mesenquimoma/diagnóstico por imagen , Mesenquimoma/cirugía , Adolescente , Resultado del Tratamiento , Neoplasias de Tejido Conjuntivo/diagnóstico por imagen , Neoplasias de Tejido Conjuntivo/cirugía , Síndromes Paraneoplásicos/diagnóstico por imagen , Factor-23 de Crecimiento de Fibroblastos , Niño , Anciano , Hipofosfatemia/etiología , Adulto Joven , Imagen por Resonancia Magnética/métodos
10.
Skeletal Radiol ; 2024 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-38459983

RESUMEN

PURPOSE: To report osteoporosis screening utilization rates among Asian American (AsA) populations in the USA. METHODS: We retrospectively assessed the use of dual-energy X-ray absorptiometry (DXA) screening using the Medicare 5% Research Identifiable Files. Using Current Procedural Terminology (CPT) codes indicative of a DXA scan, we identified patients recommended for DXA screening according to the ACR-SPR-SSR Practice Parameters (females ≥ 65 years, males ≥ 70 years). Sociodemographic factors and their association with screening were evaluated using chi-square tests. RESULTS: There were 80,439 eligible AsA beneficiaries, and 12,102 (15.1%) received osteoporosis screening. DXA rate for women was approximately four times greater than the rate for men (19.8% vs. 5.0%; p < 0.001). AsA beneficiaries in zip codes with higher mean household income (MHI) were more likely to have DXA than those in lower MHI areas (17.6% vs. 14.3%, p < 0.001). AsA beneficiaries aged < 80 were more likely to receive DXA (15.5%) than those aged ≥ 80 (14.1%, p < 0.001). There were 2,979,801 eligible non-AsA beneficiaries, and 496,957 (16.7%) received osteoporosis screening during the study period. Non-Hispanic white beneficiaries had the highest overall screening rate (17.5%), followed by North American Native (13.0%), Black (11.8%), and Hispanic (11.1%) beneficiaries. Comparing AsA to non-AsA populations, there were significantly lower DXA rates among AsA beneficiaries when controlling for years of Medicare eligibility, patient age, sex, location, and mean income (p < 0.001). CONCLUSION: We found lower than expected DXA screening rates for AsA patients. A better understanding of the barriers and facilitators to AsA osteoporosis screening is needed to improve patient care.

11.
Skeletal Radiol ; 2024 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-38413401

RESUMEN

OBJECTIVES: To retrospectively evaluate the correlation between intradiscal gas and infection in patients percutaneously biopsied for suspected discitis-osteomyelitis. MATERIALS AND METHODS: We retrospectively reviewed all CT-guided discitis-osteomyelitis biopsies performed between 2002 and 2022. Two independent trained musculoskeletal radiologists evaluated for presence of gas on CT and/or MRI within 1 week of the biopsy. Disagreements were resolved by a third musculoskeletal radiologist. CT was considered the gold standard for the detection of intradiscal gas. Pathology, microbiology, and imaging and clinical follow-up were used as the gold standard for presence of infection. Interrater agreement on CT and MRI, sensitivity, and positive predictive value were calculated, using the presence of gas as an indicator (test positive) for "no infection." RESULTS: There were 284 biopsies in 275 subjects (mean age 58 ± 1.0 (range 4-99) years; 101 (37%) females and 174 (63%) males). Of the biopsies, 12 (4%) were cervical, 80 (28%) were thoracic, 192 (68%) were lumbar, and 200 (70%) were considered true discitis-osteomyelitis based on pathology, imaging, and clinical follow-up. Interrater agreement was excellent for CT (kappa = 0.83) and poor for MRI (kappa = - 0.021). The presence of gas had a 94% specificity and 76% negative predictive value for the absence of infection. CONCLUSION: CT is the preferred method for detecting intradiscal gas. The presence of gas means that discitis-osteomyelitis is unlikely. If intradiscal gas is present in the setting of discitis-osteomyelitis, the gas bubbles tend to be smaller and fewer in number.

12.
Radiology ; 306(1): 237-243, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-35787202

RESUMEN

Background Corticosteroids injected for the treatment of musculoskeletal pain are systemically absorbed and can affect the immune response to viral infections. Purpose To determine the incidence of symptomatic COVID-19 disease in individuals receiving image-guided corticosteroid injections for musculoskeletal pain compared with the general population during the pandemic recovery period. Materials and Methods In this prospective cohort multicenter study, adults with a history of musculoskeletal pain who underwent imaging-guided intra-articular and spine corticosteroid injections from April 2020 to February 2021 were consecutively enrolled. Participants were followed for a minimum of 28 days through their electronic medical record (EMR) or by direct phone communication to screen for COVID-19 test results or symptoms. Clinical data, including body mass index (BMI), were also obtained from the EMR. The incidence of COVID-19 in the state was obtained using the Massachusetts COVID-19 Response Reporting website. The Student t test was used for continuous variable comparisons. Univariable analyses were performed using the Fisher exact test. Results A total of 2714 corticosteroid injections were performed in 2190 adult participants (mean age, 59 years ± 15 [SD]; 1031 women). Follow-up was available for 1960 participants (89%) who received 2484 injections. Follow-up occurred a mean of 97 days ± 33 (range, 28-141 days) after the injection. Of the 1960 participants, 10 had COVID-19 within 28 days from the injection (0.5% [95% CI: 0.24, 0.94]) and 43 had COVID-19 up to 4 months after the injection (2.2% [95% CI: 1.6, 2.9]). These incidence rates were lower than that of the population of Massachusetts during the same period (519 195 of 6 892 503 [7.5%], P < .001 for both 28 days and 4 months). Participants diagnosed with COVID-19 (n = 10) within 28 days from the injection had a higher BMI than the entire cohort (n = 1960) (mean, 32 kg/m2 ± 10 vs 28 kg/m2 ± 6; P = .04). Conclusion Adults who received image-guided corticosteroid injections for pain management during the pandemic recovery period had a lower incidence of symptomatic COVID-19 compared with the general population. © RSNA, 2022 Online supplemental material is available for this article.


Asunto(s)
COVID-19 , Dolor Musculoesquelético , Adulto , Humanos , Femenino , Persona de Mediana Edad , Incidencia , Pandemias , Estudios Prospectivos , Inyecciones Intraarticulares/métodos , Corticoesteroides
13.
Int J Gynecol Pathol ; 42(1): 101-107, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-35191427

RESUMEN

Endometriosis is a common condition in reproductive age women that is defined as the presence of endometrial tissue (epithelial and/or stromal) outside the uterine corpus. While not a premalignant lesion, it is a condition with a potential for malignancy, especially in the ovaries. Notable endometriosis-associated neoplasms include clear cell carcinoma and endometrioid adenocarcinoma of the ovaries. There have been recent reports of mesonephric-like adenocarcinoma (MLA) of the ovary, a very rare neoplasm with similar morphologic and immunophenotypic characteristics as mesonephric adenocarcinoma, however, without an association with mesonephric remnants. Some of these cases have been associated with endometriosis. Here, we describe 2 cases of MLA arising directly from endometriosis. In both cases, there was evidence of endometriosis contiguous with the tumor and invasion from other sources was excluded. The immunophenotypes of both tumors were typical of mesonephric adenocarcinoma except PAX-8 was strongly positive suggesting a Mullerian origin. Molecular testing on one of the cases revealed KRAS and P53 mutations. We review published findings of MLA and associated endometriosis. This report describes the sixth and seventh reported cases of MLA associated with endometriosis and the first reported cases of MLA arising directly from endometriosis and associated with other forms of epithelial proliferation within endometriosis. These 2 cases provide potential evidence that MLA should be considered an endometriosis-associated neoplasms.


Asunto(s)
Adenocarcinoma de Células Claras , Carcinoma Endometrioide , Endometriosis , Humanos , Femenino , Carcinoma Endometrioide/patología , Mesonefro/patología , Adenocarcinoma de Células Claras/patología , Endometriosis/complicaciones , Endometriosis/patología , Mutación
14.
AJR Am J Roentgenol ; 220(4): 499-511, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36222488

RESUMEN

BACKGROUND. The reported sensitivity and yield of image-guided biopsies for diskitis-osteomyelitis vary widely. OBJECTIVE. The purpose of this study was to perform a systematic review of the literature and meta-analysis of pooled sensitivity data to elucidate strategies for optimal image-guided biopsies among patients suspected to have diskitis-osteomyelitis. EVIDENCE ACQUISITION. A comprehensive literature search was performed for studies of patient populations with proven or suspected diskitis-osteomyelitis that included percutaneous image-guided biopsy as part of the workup algorithm. Type of pathogens, imaging modality used for biopsy guidance, tissue targeted, antibiotic administration at the time of biopsy, true microbiology positives, true microbiology negatives, false microbiology positives, false microbiology negatives, disease (i.e., diskitis-osteomyelitis) positives as determined by reference standard, true infection positives (i.e., positive microbiology or pathology results), and total number of biopsies performed were extracted from the studies. Microbiology sensitivity, microbiology biopsy yield, and infection sensitivity were calculated from the pooled data. These terms and the data required to calculate them were also defined in detail. EVIDENCE SYNTHESIS. Thirty-six articles satisfied inclusion criteria and were used for analysis. The pooled microbiology sensitivity, infection sensitivity, and microbiology biopsy yields were 46.6%, 70.0%, and 26.7%, respectively. Mycobacterium tuberculosis-only microbiology sensitivity was significantly higher than both pyogenic bacteria and mixed-organism microbiology sensitivity (p < .001). Staphylococcus aureus was the most common causative organism (28.6%). Pooled microbiology sensitivity was not significantly different for CT guidance and fluoroscopy guidance (p = .16). There was a statistically significant difference between pooled microbiology sensitivity of bone/end plate (45.5%) and disk/paravertebral soft-tissue (64.8%) image-guided biopsies (p < .001). There was no statistically significant difference in pooled microbiology sensitivities for patients who received antibiotics before the procedure (46.2%) and those who did not (44.6%) (p = .70). CONCLUSION. Image guidance by CT or fluoroscopy does not affect microbiology yield, disk and paravertebral soft-tissue biopsies should be considered over bone and end plate biopsies, and preprocedural antibiotic administration does not appear to impact biopsy results. CLINICAL IMPACT. Understanding and correctly applying reported statistics contribute to appropriate interpretation of the abundant literature on this topic and optimization of care for patients with diskitis-osteomyelitis.


Asunto(s)
Discitis , Osteomielitis , Humanos , Discitis/tratamiento farmacológico , Biopsia Guiada por Imagen/métodos , Biopsia , Osteomielitis/microbiología , Huesos/patología , Antibacterianos/uso terapéutico , Estudios Retrospectivos
15.
Acta Radiol ; 64(3): 1086-1092, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35581686

RESUMEN

BACKGROUND: Previous studies suggest an overall decrease of Paget's disease of bone (PDB) prevalence. However, a large number of asymptomatic patients make previously reported prevalence likely underrepresented. PURPOSE: To evaluate the prevalence of PDB in our patient population. MATERIAL AND METHODS: We retrospectively identified 1295 (mean age = 59 years; age range = 18-98 years) consecutive abdominopelvic computed tomography (CT) scans over a 15-day period in 2014. Abdominopelvic CT images were reviewed to assess for the presence of PDB in the lower thoracic spine, lumbar spine, pelvis, or proximal femora. This prevalence was compared with prevalence reported in earlier literature using Fisher's exact test. RESULTS: Of the included patients, 5/1295 (0.39%) patients had imaging findings of PDB on abdominopelvic CT. Those five patients were all aged ≥55 years and had pelvic bone involvement, with one patient having additional involvement of multiple lower thoracic vertebral bodies. In our studied cohort, 812/1295 (62.7%) patients were aged ≥55 years, which corresponds to a prevalence of 0.62% (5/812) of PDB in patients aged ≥55 years. When accounting for fact that bones of the pelvis are involved in 40%-91% of patients with PDB, the prevalence is estimated at 0.43%-0.98% in the total adult population and estimated at 0.68%-1.55% in older adults. The prevalence was greater than two studies before 1960, and less than some studies during 1960-2019. CONCLUSION: We found that the prevalence of PDB on abdominopelvic CTs was 0.39% of all adult patients with an increase after the age of 55 years.


Asunto(s)
Adenocarcinoma , Osteítis Deformante , Humanos , Anciano , Recién Nacido , Lactante , Persona de Mediana Edad , Estudios Retrospectivos , Osteítis Deformante/diagnóstico por imagen , Osteítis Deformante/epidemiología , Prevalencia , Tomografía Computarizada por Rayos X , Vértebras Torácicas
16.
Skeletal Radiol ; 52(7): 1377-1384, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-36651936

RESUMEN

OBJECTIVE: To develop, train, and test a convolutional neural network (CNN) for detection of spinal lytic lesions in chest, abdomen, and pelvis CT scans. MATERIALS AND METHODS: Cases of malignant spinal lytic lesions in CT scans were identified. Images were manually segmented for the following classes: (i) lesion, (ii) normal bone, (iii) background. If more than one lesion was on a single slice, all lesions were segmented. Images were stored as 128×128 pixel grayscale, with 10% segregated for testing. The training pipeline of the dataset included histogram equalization and data augmentation. A model was trained on Keras/Tensorflow using an 80/20 training/validation split, based on U-Net architecture. Additional testing of the model was performed on 1106 images of healthy controls. Global sensitivity measured detection of any lesion on a single image. Local sensitivity and positive predictive value (PPV) measured detection of all lesions on an image. Global specificity measured false positive rate in non-pathologic bone. RESULTS: Six hundred images were obtained for model creation. The training set consisted of 540 images, which was augmented to 20,000. The test set consisted of 60 images. Model training was performed in triplicate. Mean Dice scores were 0.61 for lytic lesion, 0.95 for normal bone, and 0.99 for background. Mean global sensitivity was 90.6%, local sensitivity was 74.0%, local PPV was 78.3%, and global specificity was 63.3%. At least one false positive lesion was noted in 28.8-44.9% of control images. CONCLUSION: A task-trained CNN showed good sensitivity in detecting spinal lytic lesions in axial CT images.


Asunto(s)
Redes Neurales de la Computación , Tomografía Computarizada por Rayos X , Humanos , Tomografía Computarizada por Rayos X/métodos , Huesos , Pelvis
17.
Skeletal Radiol ; 52(11): 2297-2308, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36517614

RESUMEN

PURPOSE: The purpose of this systematic review is to evaluate the current literature on the use of image-guided corticosteroid injections in the treatment of patients with knee and hip OA. EVIDENCE ACQUISITION: We conducted a comprehensive literature search through June 30, 2022. Publication type, study design, imaging guidance modality, osteoarthritis severity, number of injections, steroid type and dose, anesthetic type and dose, the total number of patients, follow-up intervals, and measured outcomes were extracted from the included studies. EVIDENCE SYNTHESIS: There were 23 included studies (10 hips, 12 knees, 1 both hip and knee). Hip injections were found to be effective in treating short- and long-term pain and more effective than hyaluronic acid, Mepivacaine, NSAIDs, and normal saline in terms of improvement in pain and/or function. There was less impact on QoL. Knee injections were found either to have little or no impact or were similar or inferior to comparison injections (intra-articular hyaluronic acid, PRP, NSAIDs, normal saline, adductor canal blocks). Study data could not be aggregated because the corticosteroid types and doses, methods of outcome assessment, and follow-up time points varied widely. CONCLUSION: Our systematic review found generally positive outcomes for the hip, but overall negative outcomes for the knee, although hip injections may carry a risk of serious adverse outcomes. A larger trial with uniform methodology is warranted. Specific studies on the adverse effects of corticosteroid injections are also warranted.


Asunto(s)
Osteoartritis de la Cadera , Osteoartritis de la Rodilla , Humanos , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/tratamiento farmacológico , Ácido Hialurónico , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/tratamiento farmacológico , Solución Salina/uso terapéutico , Calidad de Vida , Resultado del Tratamiento , Corticoesteroides/uso terapéutico , Dolor/tratamiento farmacológico , Antiinflamatorios no Esteroideos/uso terapéutico , Inyecciones Intraarticulares
18.
Skeletal Radiol ; 52(1): 99-109, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35876864

RESUMEN

PURPOSE: To compare diagnostic yield and utility of a novel core biopsy needle (NCBN) with shortened tip dead space for percutaneous musculoskeletal biopsies with an established core biopsy needle (ECBN). METHODS: This study was IRB approved and HIPAA compliant. All percutaneous biopsies using an NCBN performed between July 2020 and August 2021 were retrospectively reviewed. Data on patient demographics, biopsy technique, biopsy needle, and histopathology were collated. RESULTS: Thirty-six patients were included in this study, 16 (44%) undergoing biopsy with both an NCBN and an ECBN, and 20 (56%) with an NCBN only. All 36 NCBN biopsies were 16 gauge. Fifteen (94%) of the ECBN biopsies were 14 gauge, and 1 (6%) was 16 gauge. Thirty-four (94%) of the NCBN and 15 (94%) of the ECBN biopsies were diagnostic. No adverse events were identified. CONCLUSION: Both the NCBN and ECBN have high diagnostic rates. No adverse events were identified. NCBN could be considered for biopsy of lesions limited by anatomic location or near adjacent critical structures.


Asunto(s)
Biopsia Guiada por Imagen , Tomografía Computarizada por Rayos X , Humanos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Biopsia Guiada por Imagen/métodos , Biopsia con Aguja Gruesa/efectos adversos
19.
AJR Am J Roentgenol ; 219(5): 717-723, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-35642759

RESUMEN

BACKGROUND. It is unclear which, MRI or ultrasound (US), is the most useful imaging tool to diagnose rotator cuff retears. OBJECTIVE. The objective of this study was to evaluate MRI and US in terms of diagnosing retear of a repaired rotator cuff tendon using a systematic review and meta-analysis. EVIDENCE ACQUISITION. A comprehensive literature search was performed on the main concepts of MRI (including noncontrast MRI and MR arthrography), US, and rotator cuff repairs. Inclusion criteria consisted of original research studies that assessed the diagnostic accuracy of MRI and US (index tests) for the diagnosis of rotator cuff tendon retear after prior rotator cuff repair using surgical findings as the reference standard. QUADAS-2 was used to assess methodologic quality. Meta-analyses were performed to compare MRI and US studies in the diagnosis of all retears and of full-thickness retears. Study variation was analyzed using the Cochran Q test and I2 statistic. EVIDENCE SYNTHESIS. Eight studies (MRI, n = 6; US, n = 2) satisfied inclusion and exclusion criteria, consisting of 304 total patients (MRI, n = 221; US, n = 83) and 309 shoulders (MRI, n = 226; US, n = 83). Years of publication ranged from 1993 to 2006 for the MRI studies and from 2003 to 2018 for the US studies. Two studies had high risk of bias in terms of applicability to clinical practice because of patient selection. Five studies had potential risk of bias in two categories, whereas two had potential risk of bias in three categories. For all retears, mean sensitivity and specificity for MRI were 81.4% (95% CI, 73.3-87.5%) and 82.6% (95% CI, 76.3-87.5%) and 83.7% (95% CI, 67.4-92.7%) and 90.7% (95% CI, 73.6-97.1%) for US. For full-thickness retears, mean sensitivity and specificity for MRI were 85.9% (95% CI, 80.2-90.2%) and 89.1% (95% CI, 84.6-92.4%) and 89.7% (95% CI, 75.6-96.1%) and 91.0% (95% CI, 75.5-97.1%) for US. There was no significant difference in terms of sensitivity or specificity for either comparison (p = .28-.76). CONCLUSION. Our analyses revealed no significant difference between US and MRI for the diagnosis of rotator cuff tendon tears after prior cuff repair. CLINICAL IMPACT. Either MRI or US can be considered a first-line imaging option to assess suspected rotator cuff retear after prior repair.


Asunto(s)
Lesiones del Manguito de los Rotadores , Manguito de los Rotadores , Humanos , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/cirugía , Artrografía , Ultrasonografía , Imagen por Resonancia Magnética , Artroscopía , Resultado del Tratamiento
20.
Skeletal Radiol ; 51(12): 2237-2244, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35761094

RESUMEN

OBJECTIVE: Carbon fiber/poly-ether-ether-ketone implants are increasingly being used in orthopedic oncology. An understanding of how to evaluate the normal appearance of these implants is critical for detecting any failures or complications that may arise. The purpose of this manuscript is to provide primarily a radiographic review of the normal radiographic appearance of carbon fiber-reinforced poly-ether-ether-ketone implants in the appendicular skeleton with some cross-sectional imaging discussion. We additionally aim to highlight some of the unique clinical benefits compared to metal implants, review the unique appearance of failures of these implants, and propose a standardized radiologic method for their evaluation. Our review is based on a retrospective case review of 31 patients with carbon fiber-reinforced poly-ether-ether-ketone implants placed in a single center orthopedic oncology practice from 2017 to 2021.


Asunto(s)
Polietilenglicoles , Polímeros , Benzofenonas , Carbono , Fibra de Carbono , Éteres , Humanos , Cetonas , Estudios Retrospectivos
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