Effects of Bariatric Surgery on Knee Articular Cartilage and Osteoarthritis Symptoms-A 12-Month Follow-Up Using T2 Relaxation Time and WOMAC Osteoarthritis Index.

BACKGROUND: Obesity is a significant risk factor for osteoarthritis (OA). The most effective treatment for morbid obesity is bariatric surgery. PURPOSE: To study the effects of potential surgically induced weight loss on knee articular cartilage and OA symptoms of obese patients over a 12-month follow-up. STUDY TYPE: Prospective longitudinal cohort study. SUBJECTS: 45 obese patients (38 female, BMI = 42.3 ± 6.5 kg/m2) who underwent gastric bypass (intervention group), and 46 age-matched conservative-care controls (37 female, BMI = 39.8 ± 4.6 kg/m2). FIELD STRENGTH/SEQUENCE: Multiecho spin echo sequence at 3 T. ASSESSMENT: Knee cartilage T2 measurements and WOMAC Indices were measured presurgery and after 12 months. The intervention group was split into successful (≥20% total weight loss (TWL)) and unsuccessful (<20% TWL) weight loss groups. T2 and WOMAC indices were also measured in controls at baseline and after 12 months. Changes among the three groups were analyzed. STATISTICAL TESTS: Analysis of variance (significance level 0.05). RESULTS: Twenty-six (58%) intervention patients achieved ≥20% TWL. The <20% TWL group demonstrated significantly more T2 reduction in the deep lateral femur over 12 months compared with the ≥20% TWL group (-3.83 ± 8.18 msec vs. 2.47 ± 6.54 msec, respectively), whereas no significant differences were observed on the medial femoral compartment (P = 0.385, P = 0.551, and P = 0.511 for bulk, superficial and deep regions, respectively). Changes in WOMAC indices over 12 months were significantly greater in the ≥20% TWL group compared with controls. In the <20% TWL group, pain significantly improved over 12 months compared with controls, while stiffness and function changes were not statistically significant (P = 0.063 and P = 0.051, respectively). DATA CONCLUSION: Cartilage matrix, measured by T2, showed improvement on lateral femoral cartilage with <20% TWL compared with ≥20% TWL. Bariatric surgery provided significant improvements in knee symptoms with ≥20% TWL compared with conservative WL. This effect is also seen to some extent with <20% TWL compared with conservative WL. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 4.

Diagnostic utility of 3D MRI sequences in the assessment of central, recess and foraminal stenoses of the spine: a systematic review.

OBJECTIVE: To perform a systematic literature review on the diagnostic utility of 3D MRI sequences in the assessment of central canal, recess and foraminal stenosis in the spine. METHODS: The databases PubMed, MEDLINE (via OVID) and The Cochrane Central Register of Controlled Trials, were searched for studies that investigated the diagnostic use of 3D MRI to evaluate stenoses in various parts of the spine in humans. Three reviewers examined the literature and conducted systematic review according to PRISMA 2020 guidelines. RESULTS: Thirty studies were retrieved from 2 595 publications for this systematic review. The overall diagnostic performance of 3D MRI outperformed the conventional 2D MRI with reported sensitivities ranging from 79 to 100% and specificities ranging from 86 to 100% regarding the evaluation of central, recess and foraminal stenoses. In general, high level of agreement (both intra- and interrater) regarding visibility and pathology on 3D sequences was reported. Studies show that well-optimized 3D sequences allow the use of higher spatial resolution, similar scan time and increased SNR and CNR when compared to corresponding 2D sequences. However, the benefit of 3D sequences is in the additional information provided by them and in the possibility to save total protocol scan times. CONCLUSION: The literature on the spine 3D MRI assessment of stenoses is heterogeneous with varying MRI protocols and diagnostic results. However, the 3D sequences offer similar or superior detection of stenoses with high reliability. Especially, the advantage of 3D MRI seems to be the better evaluation of recess stenoses.

Medial meniscus extrusion is associated with meniscus tears in US and MRI: A case control study.

OBJECTIVES: To study the medial meniscus extrusion (MME) in subjects with and without medial meniscal tears on magnetic resonance imaging (MRI), supine ultrasound (US), and weight-bearing US. METHODS: Forty-seven cases (mean age 43.7 years) with medial meniscus tears and 53 healthy controls (mean age 36.6 years) were assessed. Two experienced sonographers performed the US evaluations, and a fellowship-trained musculoskeletal radiologist assessed the menisci on MRI. Independent and paired T-tests and ICC were used for statistical analyses. RESULTS: On supine US, the mean MME was 3.9 mm for the cases and 2.3 mm for the controls (p < 0.001). On weight-bearing US, the values were 4.2 and 2.8 mm (p < 0.001), and on MRI 3.0 and 2.0 mm (p < 0.001), respectively. The mean difference between supine and weight-bearing US extrusion was 0.38 mm for the cases and 0.49 mm for the controls (p = 0.291). Correlation between supine US and MRI MME measurements was good (ICC = 0.660, CIs [0.533-0.758]). CONCLUSIONS: MME can be assessed using US with good correlation to MRI. US-observed extrusion was significantly increased in supine and standing positions for medial meniscus tears. The mean difference between examination positions was reduced with medial meniscus tears although this result was statistically insignificant.

High-resolution ultrasound approach to quadrangular joint in carpal boss: Everything musculoskeletal sonographer should know.

At the quadrangular joint (QAJ) of the carpus, a rare bony protuberance called carpal boss (CB) may occur. This bone abnormality may be due to osteophytes development or os styloideum. Symptomatic patients may complain pain, swelling, and restrictions in hand motion. These symptoms result from joint degenerative-inflammatory changes, development of ganglion cyst/bursitis, or tendons pathology. Correct diagnosis and appropriate management can be achieved through high-resolution ultrasonography (HR-US). The purpose of this review is to define the pathology spectrum around and within the QAJ in CB. The role of HR-US is highlighted and the standard technique for the QAJ assessment is described.

Deep-Learning-Based Contrast Synthesis From MRF Parameter Maps in the Knee Joint.

BACKGROUND: Magnetic resonance fingerprinting (MRF) is a method to speed up acquisition of quantitative MRI data. However, MRF does not usually produce contrast-weighted images that are required by radiologists, limiting reachable total scan time improvement. Contrast synthesis from MRF could significantly decrease the imaging time. PURPOSE: To improve clinical utility of MRF by synthesizing contrast-weighted MR images from the quantitative data provided by MRF, using U-nets that were trained for the synthesis task utilizing L1- and perceptual loss functions, and their combinations. STUDY TYPE: Retrospective. POPULATION: Knee joint MRI data from 184 subjects from Northern Finland 1986 Birth Cohort (ages 33-35, gender distribution not available). FIELD STRENGTH AND SEQUENCE: A 3 T, multislice-MRF, proton density (PD)-weighted 3D-SPACE (sampling perfection with application optimized contrasts using different flip angle evolution), fat-saturated T2-weighted 3D-space, water-excited double echo steady state (DESS). ASSESSMENT: Data were divided into training, validation, test, and radiologist's assessment sets in the following way: 136 subjects to training, 3 for validation, 3 for testing, and 42 for radiologist's assessment. The synthetic and target images were evaluated using 5-point Likert scale by two musculoskeletal radiologists blinded and with quantitative error metrics. STATISTICAL TESTS: Friedman's test accompanied with post hoc Wilcoxon signed-rank test and intraclass correlation coefficient. The statistical cutoff P <0.05 adjusted by Bonferroni correction as necessary was utilized. RESULTS: The networks trained in the study could synthesize conventional images with high image quality (Likert scores 3-4 on a 5-point scale). Qualitatively, the best synthetic images were produced with combination of L1- and perceptual loss functions and perceptual loss alone, while L1-loss alone led to significantly poorer image quality (Likert scores below 3). The interreader and intrareader agreement were high (0.80 and 0.92, respectively) and significant. However, quantitative image quality metrics indicated best performance for the pure L1-loss. DATA CONCLUSION: Synthesizing high-quality contrast-weighted images from MRF data using deep learning is feasible. However, more studies are needed to validate the diagnostic accuracy of these synthetic images. EVIDENCE LEVEL: 4. TECHNICAL EFFICACY: Stage 1.

Extensor carpi ulnaris tendon pathology and ulnar styloid bone marrow edema as diagnostic markers of peripheral triangular fibrocartilage complex tears on wrist MRI: a case-control study.

OBJECTIVES: To evaluate extensor carpi ulnaris (ECU) tendon pathology and ulnar styloid process bone marrow edema (BME) as diagnostic MRI markers for peripheral triangular fibrocartilage complex (TFCC) tears. METHODS: One hundred thirty-three patients (age range 21-75, 68 females) with wrist 1.5-T MRI and arthroscopy were included in this retrospective case-control study. The presence of TFCC tears (no tear, central perforation, or peripheral tear), ECU pathology (tenosynovitis, tendinosis, tear or subluxation), and BME at the ulnar styloid process were determined on MRI and correlated with arthroscopy. Cross-tabulation with chi-square tests, binary logistic regression with odds ratios (OR), and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were used to describe diagnostic efficacy. RESULTS: On arthroscopy, 46 cases with no TFCC tear, 34 cases with central perforations, and 53 cases with peripheral TFCC tears were identified. ECU pathology was seen in 19.6% (9/46) of patients with no TFCC tears, in 11.8% (4/34) with central perforations and in 84.9% (45/53) with peripheral TFCC tears (p < 0.001); the respective numbers for BME were 21.7% (10/46), 23.5% (8/34), and 88.7% (47/53) (p < 0.001). Binary regression analysis showed additional value from ECU pathology and BME in predicting peripheral TFCC tears. The combined approach with direct MRI evaluation and both ECU pathology and BME yielded a 100% positive predictive value for peripheral TFCC tear as compared to 89% with direct evaluation alone. CONCLUSIONS: ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to diagnose tears. KEY POINTS: • ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to confirm the presence of TFCC tears. • If there is a peripheral TFCC tear on direct MRI evaluation and in addition both ECU pathology and BME on MRI, the positive predictive value is 100% that there will be a tear on arthroscopy compared to 89% with direct evaluation alone. • If there is no peripheral TFCC tear on direct evaluation and neither ECU pathology nor BME on MRI, the negative predictive value is 98% that there will be no tear on arthroscopy compared to 94% with direct evaluation alone.

The ultrasound assessment of osteoarthritis: the current status.

Traditionally, osteoarthritis (OA) is diagnosed with the clinical examination supplemented by the conventional radiography (CR). In the research literature, the role of ultrasound (US) imaging in the diagnostics of OA has risen steadily during the last two decades. US imaging is cheap and globally widely available often already in primary healthcare. Here, we reviewed the most essential US literature focusing on OA diagnostics and progression prediction using the various search engines. Starting from the year 2000, our search provided 1 445 journal articles. After reviewing the abstracts, 89 articles were finally included. Most of the reviewed articles focused on the imaging of knee and hand OA, whereas only a minority dealt with the imaging of hip, ankle, midfoot, acromioclavicular, and temporomandibular joints. Overall, during the last 20 years, the use of US imaging for OA assessment has increased in the scientific literature. In knee and hand joints, US imaging has been reported to be a promising tool to evaluate OA changes. Furthermore, the reproducibility of US as well as its association to MRI findings are excellent. Importantly, US seems to even outperform CR in certain aspects, such as detection of osteophytes, joint inflammation, meniscus protrusion, and localized cartilage damage (especially at the medial femoral condyle and sulcus area). Based on the reviewed literature, US can be truly considered as a complementary tool to CR in the clinical setup for OA diagnostics. New technical developments may even enhance the diagnostic value of the US in the future.

Diagnostic Performance of Ultrasonography for Evaluation of Osteoarthritis of Ankle Joint: Comparison With Radiography, Cone-Beam CT, and Symptoms.

OBJECTIVES: To determine the diagnostic performance of ultrasonography (US) for evaluation of the ankle joint osteoarthritic (OA) changes. Cone-beam computed tomography (CT) was used as the gold standard and US performance was compared with conventional radiography (CR). As a secondary aim, associations between the imaging findings and ankle symptoms were assessed. METHODS: US was performed to 51 patients with ankle OA. Every patient had prior ankle CR and underwent cone-beam CT during the same day as US examination. On US, effusion/synovitis, osteophytes, talar cartilage damage, and tenosynovitis were evaluated. Comparison to respective imaging findings on CR and cone-beam CT was then performed. Single radiologist blinded to other modalities assessed all the imaging studies. Symptoms questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), was available for 48 patients. RESULTS: US detected effusion/synovitis of the talocrural joint with 45% sensitivity and 90% specificity. For the detection of anterior talocrural osteophytes, US sensitivity was 78% and specificity 79%. For the medial talocrural osteophytes, they were 39 and 83%, and for the lateral talocrural osteophytes 54 and 100%, respectively. Considering cartilage damage of the talus, US yielded a low sensitivity of 18% and high specificity of 97%. Overall, the performance of US was only moderate and comparable to CR. The imaging findings showed only weak associations with ankle symptoms. CONCLUSIONS: The ability of US to detect ankle OA is only moderate. Interestingly, performance of CR also remained moderate. The associations between imaging findings and WOMAC score seem to be weak in ankle OA.

Ultrasonographic Assessment of the Normal Femoral Articular Cartilage of the Knee Joint: Comparison with 3D MRI.

OBJECTIVE: Ultrasonography (US) has a promising role in evaluating the knee joint, but capability to visualize the femoral articular cartilage needs systematic evaluation. We measured the extent of this acoustic window by comparing standardized US images with the corresponding MRI views of the femoral cartilage. DESIGN: Ten healthy volunteers without knee pathology underwent systematic US and MRI evaluation of both knees. The femoral cartilage was assessed on the oblique transverse axial plane with US and with 3D MRI. The acoustic window on US was compared to the corresponding views of the femoral sulcus and both condyles on MRI. The mean imaging coverage of the femoral cartilage and the cartilage thickness measurements on US and MRI were compared. RESULTS: Mean imaging coverage of the cartilage of the medial femoral condyle was 66% (range 54%-80%) and on the lateral femoral condyle 37% (range 25%-51%) compared with MRI. Mean cartilage thickness measurement in the femoral sulcus was 3.17 mm with US and 3.61 mm with MRI (14.0% difference). The corresponding measurements in the medial femoral condyle were 1.95 mm with US and 2.35 mm with MRI (21.0% difference), and in the lateral femoral condyle, they were 2.17 mm and 2.73 mm (25.6% difference), respectively. CONCLUSION: Two-thirds of the articular cartilage of the medial femoral condyle, and one-third in the lateral femoral condyle, can be assessed with US. The cartilage thickness measurements seem to be underestimated by US. These results show promise for the evaluation of the weight-bearing cartilage of the medial femoral condyle with US.

Lumbosacral transitional vertebrae are associated with lumbar degeneration: retrospective evaluation of 3855 consecutive abdominal CT scans.

OBJECTIVES: To assess the prevalence of lumbosacral transitional vertebra (LSTV) and associated spinal degenerative changes on abdominal CT scans in Caucasian population. MATERIAL AND METHODS: A total of 3855 abdominal CT scans of the year 2017 from a single hospital were retrospectively assessed for LSTV, disc degeneration (DD), and facet joint degeneration (FD). An age- and sex-matched 150-subject control group without LSTV was picked at random. Multivariable logistic regression was used for the analysis. RESULTS: LSTV was found in 1101 (29%) scans: Castellvi type I in 68%, type II in 16%, type III in 13%, and type IV in 3% of scans. Age- and sex-adjusted prevalence of DD was significantly higher in Castellvi type II and III groups at multiple lumbar levels, and in IV group at L4/5 than in control group (p < 0.001-0.034). At L5/S1, the prevalence of DD was significantly higher in the control group than in type II, III, or IV groups (p < 0.001-0.017). After combining Castellvi types II, III, and IV into one group, significant differences were found at all lumbar levels except L2/3 (p < 0.001-0.016). Prevalence of FD was significantly higher at L4/5 in Castellvi groups I, II, and III than in the control group (p < 0.001-0.002). When Castellvi types II, III, and IV were combined into one group, significant differences were found at lumbar levels L2/3, L3/4, and L4/5 (p < 0.001-0.021). CONCLUSION: Lumbosacral vertebrae of Castellvi types II, III, and IV are associated with greater lumbar degeneration, warranting meticulous evaluation of spinal anatomy, even on CT. KEY POINTS: • Lumbosacral transitional vertebra is a common incidental finding on abdominal CT scans with a high prevalence of 29%. • When assessing whole lumbar spine, lumbosacral vertebrae of Castellvi types II, III, and IV were associated with greater lumbar degeneration, warranting careful evaluation of the lumbar spine on abdominal CT scans.

Association between grayscale sonographic and clinical findings in severe knee osteoarthritis.

PURPOSE: To assess whether ultrasonographic (US) findings associate with clinical findings in severe knee osteoarthritis (OA). Association of US findings with side-of-knee pain and inter-reader agreement of knee US were also evaluated. METHODS: One-hundred-two patients (in total 123 knees) with severe knee OA were recruited for this cross-sectional study. US was performed by a single observer, and on 53 knees by two independent observers to assess inter-reader reliability. Preoperative clinical data was available for 69 knees. Cutoff values were applied to dichotomize US and clinical findings. The Chi-square test, Mann-Whitney test, and prevalence- and bias-adjusted kappa (PABAK) were applied for statistical analyses. RESULTS: Seven of 99 associations tested were statistically significant. Associations were observed between range of flexion and lateral femoral (P = .009) and tibial (P = .001) osteophytes, mediolateral instability and damage to the lateral femoral cartilage (P = .014) and damage to the lateral meniscus (P = .031), and alignment and damage to the lateral femoral cartilage (P < .001), lateral tibial osteophytes (P = .037), and damage to the lateral meniscus (P < .001). A strong association was observed between medial-sided pain and same-sided cartilage damage and osteophytes (P < .001). That inter-reader agreement was excellent on the medial side of the knee joint (PABAK = 0.811-0.887). CONCLUSIONS: US findings show a rather poor association with clinical OA findings. Inter-reader agreement of knee US is excellent on the medial side.

MRI of a painful carpal boss: variations at the extensor carpi radialis brevis insertion and imaging findings in regional traumatic and overuse injuries.

OBJECTIVE: To report patterns of MRI findings involving carpal boss and extensor carpi radialis brevis (ECRB) tendon insertion in individuals with overuse-related or post-traumatic wrist pain. MATERIALS AND METHODS: Eighty-four MRI cases with carpal bossing between December 2006 and June 2015 were analyzed by two fellowship-trained musculoskeletal radiologists. The following MRI findings were reviewed: type of carpal bossing (bony prominence, partial coalition, os styloideum), insertion of ECRB tendon (to the 3rd metacarpal, to carpal boss or to both), bone marrow edema (BME), insertion site, and tenosynovitis/tendinosis of ECRB tendon. Clinical information on wrist pain was available on 68 patients. RESULTS: Fused carpal bossing was detected in 21%, partial coalition in 35%, and os styloideum in 44% of the cases. Regional BME was observed in 64% of the cases. When BME specifically at the carpal boss was assessed, 78% of stable and 50% of unstable bosses showed BME (p = 0.035). ECRB tendon inserted on a carpal boss in 20%, on the 3rd metacarpal bone in 35%, and on both sites in 45% of the cases. As BME at the carpal boss was assessed, BME was detected at the respective insertion sites in 71%, 35%, and 66% of the cases (p = 0.015). Dorsal wrist pain was associated with BME as 75% of the patients had regional BME in the vicinity of the carpal boss (p = 0.006). CONCLUSION: A spectrum ranging from complete fusion of a boss to an entirely unfused os styloideum exists with a variable ECRB insertional anatomy. BME at the carpal boss is a consistent MRI finding.

Lumbosacral transitional vertebrae: significance of local bone marrow edema at the transverse processes.

OBJECTIVE: To evaluate the association between low back pain and bone marrow edema in lumbosacral transitional vertebra (LSTV) transverse processes, and to assess the prevalence of LSTV in a physically active population. MATERIALS AND METHODS: Individuals with LSTV on coronal MRI studies were identified in a retrospective review by keyword search from PACS. In total, 140 cases were reviewed by two fellowship-trained musculoskeletal radiologists. Data on associated low back pain were collected from patient records at the time of the imaging. RESULTS: Bone marrow edema was observed in 44% of the cases, but no correlation with low back pain was found. On coronal MRI, the prevalence of LSTV was 2.6%, with type II LSTV being the most common subtype. CONCLUSIONS: No correlation with bone marrow edema at the transverse processes of the LSTV and low back pain was observed. In our selected study population, the prevalence of LSTV was low.

Analysis of a Steerable Needle for Fine Needle Aspiration and Biopsy: Efficiency and Radiation Dose Compared With a Conventional Straight Needle.

PURPOSE: Percutaneous computed tomography (CT)-guided needle biopsy has proven to be an efficacious method for sampling of many soft tissue lesions, especially deep-seated masses in the abdomen and pelvis. This study sought to test the potential for a novel steerable needle to improve localization and to reduce procedure duration and radiation dose compared with a conventional straight needle. MATERIAL AND METHODS: A fresh, raw meat sample (lean bovine flank) was imbedded with cylindrical radiopaque and radiolucent obstacles designed to simulate vessels (radiolucent objects) and bones (radiopaque objects) on CT. A pit-containing olive (partially radiopaque) was imbedded beyond the obstacles to represent the target. Two sites on the surface of the meat were selected and marked to determine initial needle placement. Two radiologists with different levels of experience proceeded to position a straight needle and the steerable needle from each skin site to the target using CT guidance as efficiently as possible, avoiding the obstacles. The total positioning time, the number of CT scans required for positioning, and the number of repositioning events (partial withdrawal followed by advancement) were tracked for the straight and steerable needles. RESULTS: For the straight needle, total time to reach the target was 499 to 667 seconds (mean, 592 seconds); for the steerable needle, total time to reach the target was 281 to 343 seconds (mean, 309 seconds), on average, 48% lower. The number of CT scans needed for needle positioning averaged 6.25 for the straight needle and 3.5 for the steerable needle, which is 44% lower. Repositioning events (withdrawing and readvancing the needle) ranged from 3 to 10 for the straight needle (mean, 6.5) and 0 for the steerable needle. CONCLUSIONS: Using an in vitro model embedded with obstacles, the steerable needle performed better than a straight needle with regard to procedure time, needle repositioning events, and CT scans required for placement.

Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball Players.

Purpose To evaluate a combined imaging approach with both ultrasonography (US; conventional US and valgus stress US) and magnetic resonance (MR) arthrography in baseball players with medial elbow pain. Materials and Methods Institutional review board approval was obtained and the requirement for informed consent was waived. The study is compliant with HIPAA. Baseball players with medial elbow pain underwent US in addition to MR arthrography. Findings were assessed with each modality alone and both combined in this retrospective investigation. For the evaluation of ulnar collateral ligament (UCL) tears with stress US, the interval gapping of the medial elbow joint was measured between rest and valgus stress both at the injured and at the uninjured (contralateral) elbow. Surgical or arthroscopic correlation was available as the so-called gold standard. McNemar tests compared the accuracies of the imaging modalities. Results In this study, 144 baseball players had 191 findings of medial elbow pain, including 53 UCL tears. With stress US, joint gapping at the injured elbow greater than 1.0 mm compared with the contralateral elbow yielded a sensitivity, specificity, and accuracy of 96%, 81%, and 87%, respectively, for diagnosing UCL tears. With MR arthrography, the sensitivity, specificity, and accuracy for UCL tears were 81%, 91%, and 88%, respectively, and increased to 96% (P = .013, McNemar test), 99% (P = .023), and 98% (P < .001), respectively, when combined with US to a dual modality MR and US approach. For 31 patients with ulnar neuritis, the sensitivity, specificity, and accuracy increased from 74%, 92%, and 88%, respectively, with MR arthrography alone to 90% (P = .07, McNemar test), 100% (P < .001), and 98% (P < .001) combined with US. For the 59 myotendinous and the 48 osteochondral diagnoses, the sensitivity, specificity, and accuracy with MR arthrography alone were 93%, 93%, and 93%, and 94%, 98%, and 97%, respectively, with no additional diagnostic value from US. Conclusion The combined approach with both MR arthrography and US shows higher accuracy than each modality alone for the assessment of medial elbow pain. (©) RSNA, 2016.

Distal clavicular osteolysis in adults: association with bench pressing intensity.

OBJECTIVES: To investigate the association between distal clavicular osteolysis (DCO) and bench pressing intensity. METHODS: From a retrospective review of MRI shoulder reports of individuals between 20 and 40 years of age, 262 male patients with DCO and 227 age-matched male patients without DCO were selected. All patients had completed a bench pressing questionnaire. The patients' bench pressing frequency (times per week), duration (years of bench pressing), bench pressing weight (maximum bench pressing weight with one repetition = 1RM) and the ratio of bench pressing weight to body weight were compared between both groups using Chi-square and Mann-Whitney tests. RESULTS: The results showed that 56 % (146/262) of patients with DCO were high-intensity bench pressers (1RM more than 1.5 times the body weight) compared to 6 % (14/227) in patients without DCO. High-intensity bench pressing was a risk factor for DCO (OR = 19; 95 %CI = 11-35; p < 0.001). Low-intensity bench pressing (1RM less than 1.5 times the body weight) was not a risk factor for DCO (OR = 0.6; 95 % CI = 0.4-0.8). High frequency (>1×/week) and duration (>5 years) of bench pressing were risk factors. In bench pressers who suffered from DCO, the mean 1RM was 283 lbs (±SD 57) compared to 209 lbs (±SD 60) in bench pressers not affected by DCO (p < 0.001, Mann-Whitney). CONCLUSIONS: High-intensity, but not low-intensity bench pressing is a risk factor for DCO.

Fluvastatin delays propagation of viral infection in isolated rat FDB myofibers but does not affect exocytic membrane trafficking.

We have utilized the enveloped viral model to study the effect of fluvastatin on membrane trafficking in isolated rat myofibers. Our immunofluorescence studies constantly showed that infections in myofibers, which were treated with fluvastatin prior and during the infection with either vesicular stomatitis virus (VSV) or influenza A virus, propagated more slowly than in control myofibers without drug treatment. Experiments with a virus expressing Dad1 tagged with green fluorescent protein (GFP-Dad1) showed that fluvastatin did not affect its distribution within the ER/SR network and immunofluorescence staining for GM130 did not show any marked effect on the structure of the Golgi components. Furthermore, fluvastatin did not inhibit trafficking of the chimeric transport marker VSV temperature sensitive G protein (tsG-GFP) from the ER to the Golgi. We next subjected VSV infected myofibers for pulse-chase labeling experiments and found that fluvastatin did not slow down the ER-to-Golgi trafficking or Golgi to plasma membrane trafficking of the viral glycoprotein. These studies show that fluvastatin inhibited the propagation of viral infection in skeletal myofibers but no adverse effect on the exocytic trafficking could be demonstrated. These results suggest that other effects of statins rather than inhibition of ER-to-Golgi trafficking might be behind the myotoxic effects of the statins.

Frequency, imaging findings, risk factors, and long-term sequelae of distal clavicular osteolysis in young patients.

OBJECTIVE: Atraumatic distal clavicular osteolysis (DCO) has been described in adult male weightlifters. Our purpose was to investigate the frequency, magnetic resonance imaging (MRI) characteristics, risk factors, and long-term sequelae of DCO in young patients. MATERIALS AND METHODS: Individuals with atraumatic DCO were identified in a retrospective review of 1,432 consecutive MRI shoulder reports in patients between 13 and 19 years of age. MRI findings of DCO, association with athletic activity, short-term clinical outcome after 3-6 months, and long-term clinical and MRI outcome after 2 years were analyzed. A pre-MRI questionnaire assessed the patients' athletic history including overhead activity and weightlifting. RESULTS: At a mean age of 15.9 years, 6.5 % (93/1432) of patients had atraumatic DCO, and 24 % were females. The combination of an overhead sport (basketball, volleyball, tennis, swimming) and supplemental weight training was a risk factor for DCO (odds ratio = 38, p = 0.01). Ninety-three percent of patients responded to conservative therapy. On follow-up imaging, 71 % of DCO patients had acromioclavicular (AC) joint osteoarthritis (vs. 35 % in controls, p = 0.006); 79 % had flattening of the distal clavicle and interval widening of the AC joint to a mean of 5.0 mm (compared to 2.4 mm in controls, p < 0.001). Severity of DCO edema was associated with pain (p < 0.02) at initial presentation and with AC joint osteoarthritis (p = 0.004) on follow-up. CONCLUSION: In athletic teenagers, the combination of weightlifting and overhead activity is a risk factor for atraumatic DCO, and females are affected in 24 %. Long-term sequelae include widening of the AC joint and AC joint osteoarthritis.

Financial impact of incorporating deep learning reconstruction into magnetic resonance imaging routine.

PURPOSE: Artificial intelligence and deep learning solutions are increasingly utilized in healthcare and radiology. The number of studies addressing their enhancement of productivity and monetary impact is, however, still limited. Our hospital has faced a need to enhance MRI scanner throughput, and we investigate the utility of new commercial deep learning reconstruction (DLR) algorithm for this purpose. In this work, a multidisciplinary team evaluated the impact of the widespread deployment of a new commercial deep learning reconstruction (DLR) algorithm for our magnetic resonance imaging scanner fleet. METHODS: Our analysis centers on the DLR algorithm's effects on patient throughput and investment costs, contrasting these with alternative strategies for capacity expansion-namely, acquiring additional MRI scanners and increasing device utilization on weekends. We provide a framework for assessing the financial implications of new technologies in a trial phase, aiding in informed decision-making for healthcare investments. RESULTS: We demonstrate substantial reductions in total operating costs compared to other capacity-enhancing methods. Specifically, the cost of adopting the deep learning technology for our entire scanner fleet is only 11 % compared to procuring an additional scanner and 20 % compared to the weekend utilization costs of existing devices. CONCLUSIONS: Procuring DLR for our existing five-scanner fleet allows us to sustain our current MRI service levels without the need for an additional scanner, thereby achieving considerable cost savings. These reductions highlight the efficiency and economic viability of DLR in optimizing MRI service delivery.

Semiautomatic Assessment of Facet Tropism From Lumbar Spine MRI Using Deep Learning: A Northern Finland Birth Cohort Study.

STUDY DESIGN: This is a retrospective, cross-sectional, population-based study that automatically measured the facet joint (FJ) angles from T2-weighted axial magnetic resonance imagings (MRIs) of the lumbar spine using deep learning (DL). OBJECTIVE: This work aimed to introduce a semiautomatic framework that measures the FJ angles using DL and study facet tropism (FT) in a large Finnish population-based cohort. SUMMARY OF DATA: T2-weighted axial MRIs of the lumbar spine (L3/4 through L5/S1) for (n=1288) in the NFBC1966 Finnish population-based cohort were used for this study. MATERIALS AND METHODS: A DL model was developed and trained on 430 participants' MRI images. The authors computed FJ angles from the model's prediction for each level, that is, L3/4 through L5/S1, for the male and female subgroups. Inter-rater and intrarater reliability was analyzed for 60 participants using annotations made by two radiologists and a musculoskeletal researcher. With the developed method, we examined FT in the entire NFBC1966 cohort, adopting the literature definitions of FT thresholds at 7° and 10°. The rater agreement was evaluated both for the annotations and the FJ angles computed based on the annotations. FJ asymmetry ( - was used to evaluate the agreement and correlation between the raters. Bland-Altman analysis was used to assess the agreement and systemic bias in the FJ asymmetry. The authors used the Dice score as the metric to compare the annotations between the raters. The authors evaluated the model predictions on the independent test set and compared them against the ground truth annotations. RESULTS: This model scored Dice (92.7±0.1) and intersection over union (87.1±0.2) aggregated across all the regions of interest, that is, vertebral body (VB), FJs, and posterior arch (PA). The mean FJ angles measured for the male and female subgroups were in agreement with the literature findings. Intrarater reliability was high, with a Dice score of VB (97.3), FJ (82.5), and PA (90.3). The inter-rater reliability was better between the radiologists with a Dice score of VB (96.4), FJ (75.5), and PA (85.8) than between the radiologists and the musculoskeletal researcher. The prevalence of FT was higher in the male subgroup, with L4/5 found to be the most affected region. CONCLUSION: The authors developed a DL-based framework that enabled us to study FT in a large cohort. Using the proposed method, the authors present the prevalence of FT in a Finnish population-based cohort.