RESUMO
OBJECTIVES: To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton's neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. RESULTS: Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. CONCLUSION: Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. KEY POINTS: ⢠Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. ⢠US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. ⢠US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area.
Assuntos
Sistema Musculoesquelético , Radiologia , Anestésicos Locais , Consenso , Humanos , Extremidade Inferior/diagnóstico por imagem , Radiografia , Ultrassonografia de IntervençãoRESUMO
OBJECTIVES: Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications. METHODS: In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications. RESULTS: Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts. CONCLUSIONS: This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip. KEY POINTS: ⢠Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip. ⢠The highest level of evidence was only reached for one statement. ⢠Strong consensus was obtained for all statements.
Assuntos
Sistema Musculoesquelético , Radiologia , Consenso , Humanos , Estudos Prospectivos , Radiografia , Radiologia Intervencionista , Ultrassonografia de IntervençãoRESUMO
OBJECTIVES: Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. METHODS: We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. RESULTS: A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. CONCLUSIONS: Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. KEY POINTS: ⢠A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. ⢠Strong consensus with 100% agreement was obtained for all statements. ⢠Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.
Assuntos
Radiologia , Consenso , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Estudos Prospectivos , Radiografia , Radiologia Intervencionista , Ultrassonografia de IntervençãoRESUMO
OBJECTIVES: Clarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around foot and ankle in order to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper that was shared with all panel members for final approval. RESULTS: A list of 16 evidence-based statements on clinical indications for image-guided musculoskeletal interventional procedures in the foot and ankle were drafted after a literature review. The highest level of evidence was reported for four statements, all receiving 100% agreement. CONCLUSION: According to this consensus, image-guided interventions should not be considered a first-level approach for treating Achilles tendinopathy, while ultrasonography guidance is strongly recommended to improve the efficacy of interventional procedures for plantar fasciitis and Morton's neuroma, particularly using platelet-rich plasma and corticosteroids, respectively. KEY POINTS: ⢠The expert panel of the ESSR listed 16 evidence-based statements on clinical indications of image-guided musculoskeletal interventional procedures in the foot and ankle. ⢠Strong consensus was obtained for all statements. ⢠The highest level of evidence was reached by four statements concerning the effectiveness of US-guided injections of corticosteroid for Morton's neuroma and PRP for plantar fasciitis.
Assuntos
Tendão do Calcâneo , Sistema Musculoesquelético , Radiologia , Tendinopatia , Tornozelo/diagnóstico por imagem , Consenso , HumanosRESUMO
Posterior cruciate ligament (PCL) ruptures are not common, but reconstruction is increasing because PCL-deficient knees are prone to develop osteoarthritis. Preoperative MRI may confirm a total or partial disruption of PCL fibers. An overstretched PCL is often mistaken for an intact PCL while the knee is functionally PCL deficient, resulting in false-negative MRI reports. Posterior translation of the medial condyle is a useful indirect sign on imaging. Preoperative stress radiographs are used to quantify the degree of PCL deficiency, and posterior translation determines whether to treat conservatively or with surgery. Early postoperative imaging is performed to evaluate tunnel placement and fixation devices. Late postoperative imaging is performed to assess graft rupture, arthrofibrosis, or tunnel widening. Pre- and postoperative imaging plays an important part in planning and treating functionally PCL-deficient knees and PCL ruptures.
Assuntos
Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/lesões , Complicações Pós-Operatórias/diagnóstico por imagem , Cuidados Pré-Operatórios , Ruptura/cirurgia , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , Ligamento Cruzado Posterior/cirurgia , Período Pós-Operatório , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios XRESUMO
This article reviews the normal postsurgical anatomy and appearance of PCL reconstructions on MDCT and MRI with the different operative techniques considering the type of tibial fixation, use of a single or double bundle, type of tendon graft and the fixation material. Tunnel positioning, appearance of the ligament graft and findings at the donor site are considered. Imaging signs of PCL graft failure and its possible causes are discussed. Imaging manifestations of other potential complications of both the PCL graft and donor sites are described, such as laxity, impingement, arthrofibrosis, ganglion cyst formation or complications related to the fixation material.
Assuntos
Procedimentos de Cirurgia Plástica , Ligamento Cruzado Posterior/anatomia & histologia , Ligamento Cruzado Posterior/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/patologia , Humanos , Instabilidade Articular/diagnóstico , Articulação do Joelho/anatomia & histologia , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Ligamento Cruzado Posterior/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
The scars produced by the surgical approaches commonly used for neck dissection in patients with malignant tumors of the head and neck are generally very evident and unaesthetic, especially when performed on young patients or on patients with a tendency to form keloids. There are multiple alternative approaches and techniques that attempt to eliminate or conceal these cervical scars, but they have been used almost exclusively in benign or congenital processes. Amid these aesthetic and/or minimally invasive cervical techniques, we highlight rhytidectomy/facelift, intraoral, endoscopic, and robotic approaches, among others. We present the novel application of a facelift approach for selective neck dissection in a young patient with a lateral tongue squamous cell carcinoma, with excellent cosmetic and oncologic results.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Esvaziamento Cervical/métodos , Ritidoplastia/métodos , Neoplasias da Língua/cirurgia , Carcinoma de Células Escamosas/patologia , Cicatriz/cirurgia , Endoscopia , Estética , Feminino , Humanos , Linfonodos/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Reoperação , Língua/patologia , Língua/cirurgia , Neoplasias da Língua/patologiaRESUMO
The use of a temporalis muscle flap for reconstruction of the maxilla is a common technique at the moment. One of the disadvantages of applying this technique is the anesthetic scar generated in the temporalis fossa and the depression of this area. We present a new method for endoscopically harvesting the muscle flap, through minimal incisions situated in the temporalis fossa and preauricular region. This endoscopic technique has not been described in the literature for a hemimaxillary reconstruction. We present the first case of a maxillary reconstruction with an endoscopically assisted temporalis muscle flap with excellent results.
Assuntos
Endoscopia , Neoplasias Maxilares/cirurgia , Músculo Esquelético/transplante , Mixoma/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adulto , Biópsia , Humanos , Masculino , Recidiva Local de Neoplasia/cirurgiaRESUMO
Radiologic imaging is essential for diagnosing pediatric facial fractures and selecting the optimal therapeutic approach. Trauma-induced maxillofacial injuries in children may affect functioning as well as esthetic appearance, and they must be diagnosed promptly and accurately and managed appropriately to avoid disturbances of future growth and development. However, these fractures may be difficult to detect on images, and they are frequently underreported. The interpretation of facial radiographs is particularly challenging, and computed tomography (CT) is necessary in many cases to achieve an accurate diagnosis. To keep the radiation dose as low as reasonably achievable, ultrasonography may be used instead of radiography for the initial imaging evaluation when the clinical suspicion of fracture is low; if evidence of fracture is found, CT then may be performed for a more detailed evaluation. Regardless of the modality used, a familiarity with the characteristic imaging features of pediatric facial fractures is necessary for accurate image interpretation. In addition, knowledge of the epidemiologic and anatomic distribution of pediatric facial fractures is helpful. Particular kinds of fracture (nondisplaced, greenstick, displaced, comminuted) tend to occur at specific anatomic sites in children, with the severity and extent of the fracture varying according to the patient's age and the stage of skeletal development. Midfacial fractures and fractures that are severely displaced and comminuted may be accompanied by neurocranial injuries or other complications and should be evaluated at CT with multiplanar reformatting of image data.
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Traumatismos Maxilofaciais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Fatores de Risco , UltrassonografiaRESUMO
Traumatic neuromas are rare entities which characteristically arise subsequently to surgery and are usually accompanied by pain, typically neuralgic. We present an unusual case of an intraosseous traumatic neuroma of the inferior alveolar nerve following tooth extraction. A 56-year-old man consulted for paresthesias and hyperesthesia in the left mandibular region following extraction of the left mandibular third molar (#38). The panoramic radiograph revealed a radiolucent lesion in the inferior alveolar nerve canal, and CT demonstrated the existence of a mass within the canal, producing widening of the same. Nerve-sparing excisional biopsy was performed. Histopathology and immunohistochemistry were consistent with traumatic neuroma of the left inferior alveolar nerve. After 3 years of follow-up, the patient is asymptomatic and there are no signs of recurrence.
Assuntos
Neoplasias dos Nervos Cranianos/etiologia , Nervo Mandibular , Dente Serotino , Neuroma/etiologia , Extração Dentária/efeitos adversos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Extramedullary hematopoiesis (EMH) is a rare disease characterized by the presence of hematopoietic elements outside the bone marrow as a compensatory phenomenon in several hematological diseases, including thalassemia. We report a 64-year-old man with epigastric pain of 3-months' duration radiated to the back. Imaging workup showed multiple paravertebral, retrosternal and presacral masses. Cytology findings obtained by CT-guided FNAC were compatible with the diagnosis of EMH. Peripheral blood smear confirmed the presence of ß-thalassemia.
Assuntos
Medula Óssea/diagnóstico por imagem , Hematopoese Extramedular , Sacro , Vértebras Torácicas , Talassemia beta/diagnóstico , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Ischemic brainstem strokes constitute 10% of all ischemic brain strokes. Hemorrhagic complications are associated with an especially poor prognosis. Associated symptomatology includes vertigo, cranial nerve symptoms, and crossed or uncrossed corticospinal tract findings. Advanced neuroimaging techniques have become essential in the decision-making process of brainstem stroke management and may provide a means to identify those patients who may benefit from thrombolysis. Because many of the recommendations are based on limited data, additional research on treatment of acute brainstem stroke is needed.
Assuntos
Angiografia/métodos , Infartos do Tronco Encefálico/complicações , Infartos do Tronco Encefálico/diagnóstico , Aumento da Imagem/métodos , Neuroimagem/métodos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , HumanosRESUMO
Intraosseous haemangioma are rare, benign tumours, and only rarely do they involve the facial bones. We present a singular case of zygomatic intraosseous haemangioma treated surgically and reconstructed with a methyl-methacrylate alloplastic prosthesis designed from a computed tomography (CT)-based 3D model. This is the first case described in the literature of a zygomatic reconstruction with a predesigned prosthesis. After 1 year of follow-up, aesthetical results are good, and the patient presents correct functional rehabilitation.
Assuntos
Hemangioma/cirurgia , Imageamento Tridimensional/métodos , Procedimentos de Cirurgia Plástica/métodos , Implantação de Prótese/métodos , Neoplasias Cranianas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Zigoma , Adulto , Cimentos Ósseos , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço , Hemangioma/diagnóstico por imagem , Humanos , Metilmetacrilato , Satisfação do Paciente , Desenho de Prótese , Neoplasias Cranianas/diagnóstico por imagem , Fatores de TempoAssuntos
Neoplasias Ósseas/complicações , Dispneia/etiologia , Fêmur , Osteossarcoma/complicações , Embolia Pulmonar/etiologia , Doença Aguda , Biópsia com Agulha de Grande Calibre , Neoplasias Ósseas/diagnóstico , Diagnóstico Diferencial , Dispneia/diagnóstico , Evolução Fatal , Humanos , Masculino , Estadiamento de Neoplasias , Osteossarcoma/diagnóstico , Embolia Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
The anterior iliac crest is the most common donor site for autologous nonvascularized bone because of the great amount of bone available and easy access. Documented donor-site complications include arterial, nerve, or urethral injury; herniation; chronic donor-site pain; sacroiliac joint instability; pelvic fractures; gait disturbances; hematoma; infection; peritoneal perforation; cosmetic defects; and hip subluxation. We present the case of a pathologic fracture of the right anterior iliac crest during the immediate postoperative period in a patient with a bisphosphonate-related osteochemonecrosis with pathological fracture of mandibular body. The patient was managed with nonoperative treatment.
Assuntos
Transplante Ósseo/efeitos adversos , Fraturas do Quadril/etiologia , Ílio/transplante , Osteonecrose/cirurgia , Complicações Pós-Operatórias/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Feminino , Fraturas do Quadril/diagnóstico por imagem , Humanos , Ílio/diagnóstico por imagem , Ílio/lesões , Fraturas Mandibulares/etiologia , Fraturas Mandibulares/cirurgia , Pessoa de Meia-Idade , Osteonecrose/etiologia , Radiografia , Resultado do TratamentoRESUMO
The symptomatic presentation of cerebral schistosomiasis is uncommon. The case of a 25-year-old woman from Equatorial Guinea with headache and seizures secondary to cerebral neuroschistosomiasis, as confirmed by histopathological examination and microbiological study, is presented. A review of the literature on this subject is also provided.
RESUMO
BACKGROUND: Angiosarcomas are rare soft tissue malignant tumors with dismal prognosis. Head and neck involvement is uncommon (5%) and usually affects the scalp or facial skin. METHODS AND RESULTS: We present the case of an inferior lip mucosal low-grade angiosarcoma in a 15-year-old boy treated exclusively with surgery. One and a half years after treatment, the patient was free of signs of recurrence. Prompt and accurate diagnosis with adequate imaging modalities and multidisciplinary treatment are crucial for optimal management of these neoplasms. CONCLUSION: Lip mucosal involvement is exceptional with only a few cases described in the literature, all in patients older than 60 years To our knowledge, this is the youngest patient ever reported.