Baseline cartilage T1ρ and T2 predicted patellofemoral joint cartilage lesion progression and patient-reported outcomes after ACL reconstruction.

This study aims to determine if baseline T1ρ and T2 will predict cartilage morphological lesion progression in the patellofemoral joint (PFJ) and patient-reported outcomes at 2-year after anterior cruciate ligament (ACL) reconstruction (ACLR). Thirty-nine ACL-injured patients were studied at baseline and two-year after ACLR. 3 T MR T1ρ and T2 images and Knee Injury and Osteoarthritis Outcome Score (KOOS) were acquired at both time points. Voxel-based relaxometry (VBR) technique was used to detect local cartilage abnormalities. Patients were divided into progression and non-progression groups based on changes of the whole-organ magnetic resonance imaging scoring (WORMS) grading of cartilage in PFJ from baseline to 2-year, and into lower (more pain) and higher (less pain) KOOS pain groups based on 2-year KOOS pain scores, separately. Voxel-based analyses of covariance were used to compare T1ρ and T2 values at baseline between the defined groups. Using VBR analysis, the progression group at 2-year showed higher T1ρ and T2 compared with the non-progression group at baseline, with the medial femoral condyle showing the largest areas with significant differences. At two-year, 56% of patients were able to recover with respect to KOOS pain. The lower KOOS pain group at 2-year showed significantly elevated T1ρ and T2 in the patella at baseline compared with the higher KOOS pain group. In conclusion, baseline T1ρ and T2 mapping, combined with VBR analysis, may help identify ACLR patients at high risk of developing progressive PFJ cartilage lesions and worse clinical symptoms 2-year after surgery.

Lung Ultrasound in Patients With SARS-COV-2 Pneumonia: Correlations With Chest Computed Tomography, Respiratory Impairment, and Inflammatory Cascade.

OBJECTIVES: Lung ultrasound (LUS) might be comparable to chest computed tomography (CT) in detecting parenchymal and pleural pathology, and in monitoring interstitial lung disease. We aimed to describe LUS characteristics of patients during the hospitalization for COVID-19 pneumonia, and to compare the extent of lung involvement at LUS and chest-CT with inflammatory response and the severity of respiration impairment. METHODS: During a 2-week period, we performed LUS and chest CT in hospitalized patients affected by COVID-19 pneumonia. Dosages of high sensitivity C-reactive protein (HS-CRP), d-dimer, and interleukin-6 (IL-6) were also obtained. The index of lung function (P/F ratio) was calculated from the blood gas test. LUS and CT scoring were assessed using previously validated scores. RESULTS: Twenty-six consecutive patients (3 women) underwent LUS 34 ± 14 days from the early symptoms. Among them, 21 underwent CT on the same day of LUS. A fair association was found between LUS and CT scores (R = 0.45, P = .049), which became stronger if the B-lines score on LUS was not considered (R = 0.57, P = .024). LUS B-lines score correlated with IL-6 levels (R = 0.75, P = .011), and the number of involved lung segments detected by LUS correlated with the P/F ratio (R = 0.60, P = .019) but not with HS-CRP and d-Dimer levels. No correlations were found between CT scores and inflammations markers or P/F. CONCLUSION: In patients with COVID-19 pneumonia, LUS was correlated with both the extent of the inflammatory response and the P/F ratio.

Beneficial Effects of Melatonin on Apolipoprotein-E Knockout Mice by Morphological and 18F-FDG PET/CT Assessments.

Atherosclerosis represents one of the main risk factors for the development of cardiovascular diseases. Their etiologies have been studied in recent years in order to better define therapeutic targets for intervention and to identify diagnostic methods. Two different subtypes of macrophages, M1 and M2, have been described in physiological conditions. They can also be found in the atherosclerotic process, where they both have opposite roles in disease progression. Perivascular brown adipose tissue is also involved in inflammation and endothelial damage. In this work, we provide insights into the protective role of melatonin in the atherosclerotic process by morphological and 18F-FDG-PET/CT analyses. In particular, we examined the effects of melatonin on pathways that are linked to atherosclerosis development. We showed that melatonin, by suppressing M1 activity, reduced inflammation and directed macrophage polarization toward the M2 macrophage subtype. Moreover, melatonin preserved the activity of perivascular brown adipose tissue. In addition, 18F-FDG uptake is very high in mice treated with melatonin, confirming that other factors may alter 18F-FDG distribution. In conclusion, we showed that melatonin affects inflammatory pathways that have been linked to atherosclerosis, assessed the relationships of the 18F-FDG PET/CT parameters with macrophage markers and the production of their cytokines, which that have been defined by morphological evaluations.

Primary lymphoma of the distal radius of a child: imaging features.

Primary lymphoma of bone (PLB) is a rare entity, defined as a lymphoma confined to the bone without evidence of systemic involvement. The disease commonly affects middle-aged to elderly population and it accounts for less than 1% of all malignant lymphomas. We present a case of a 10-year-old child affected by PLB of the forearm and the frontal bone. Characteristic imaging features of PLB and the main differential diagnosis were discussed.

Trabecular bone microstructure is impaired in the proximal femur of human immunodeficiency virus-infected men with normal bone mineral density.

BACKGROUND: There is evidence that human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) are independent risk factors for osteoporosis and fracture which is not solely explained by changes in bone mineral density. Thus, we hypothesized that the assessment of trabecular microstructure might play an important role for bone quality in this population and might explain the increased fracture risk. In this study, we have assessed bone microstructure in the proximal femur using high-resolution magnetic resonance imaging (MRI) as well as in the extremities using high resolution peripheral quantitative computed tomography (HR-pQCT) in HIV-infected men and healthy controls and compared these findings to those based on areal bone mineral density (aBMD) derived from dual X-ray absorptiometry (DXA) which is the standard clinical parameter for the diagnosis of osteoporosis. METHODS: Eight HIV-infected men and 11 healthy age-matched controls were recruited and informed consent was obtained before each scan. High-resolution MRI of the proximal femur was performed using fully balanced steady state free precession (bSSFP) on a 3T system. Three volumes of interest at corresponding anatomic locations across all subjects were defined based on registrations of a common template. Four MR-based trabecular microstructural parameters were analyzed at each region: fuzzy bone volume fraction (f-BVF), trabecular number (Tb.N), thickness (Tb.Th), and spacing (Tb.Sp). In addition, the distal radius and distal tibia were imaged with HR-pQCT. Four HR-pQCT-based microstructural parameters were analyzed: trabecular bone volume fraction (BV/TV), Tb.N, Tb.Th, and Tb.Sp. Total hip and spine aBMD were determined from DXA. RESULTS: Microstructural bone parameters derived from MRI at the proximal femur and from HR-pQCT at the distal tibia showed significantly lower bone quality in HIV-infected patients compared to healthy controls. In contrast, DXA aBMD data showed no significant differences between HIV-infected patients and healthy controls. CONCLUSIONS: Our results suggest that high-resolution imaging is a powerful tool to assess trabecular bone microstructure and can be used to assess bone health in HIV-infected men who show no differences to healthy males by DXA aBMD. Advances in MRI technology have made microstructural imaging at the proximal femur possible. Further studies in larger patient cohorts are clearly warranted.

Natural evolution of popliteomeniscal fascicle tears over 2 years and its association with lateral articular knee cartilage degeneration in patients with traumatic anterior cruciate ligament tear.

OBJECTIVES: To assess (i) normal imaging anatomy of the popliteomeniscal fascicles, (ii) prevalence and natural evolution of popliteomeniscal fascicle tears (PMFT) in subjects with traumatic anterior cruciate ligament (ACL) tears over 2 years and (iii) compare knee cartilage degeneration in subjects with and without PMFT longitudinally. METHODS: 57 subjects with ACL tears were screened for PMFT. Morphological (high-resolution 3D fast spin-echo) and compositional (T1ρ and T2 mapping) MR imaging was performed prior to and 2 years after ACL reconstruction. Differences of morphological and compositional parameters were compared between subjects with and without PMFT using logistic regression, adjusting for age, sex and BMI. RESULTS: In 24% (n = 14) of the subjects with ACL tear a PMFT was detected on baseline MRI. One subject with PMFT developed a meniscal tear over 2 years. Cartilage ∆T1ρ of the lateral femur increased significantly more in subjects with isolated PMFT compared to controls (mean difference, 2.0 ± 2.9 vs. -1.3 ± 1.6, p = 0.027). CONCLUSION: PMFT detected by MRI are a common finding in subjects with ACL tears. Subjects with these defects showed higher compositional cartilage deterioration compared to controls, over 2 years in the lateral femoral compartment, indicating accelerated cartilage degeneration. KEY POINTS: • Popliteomeniscal fascicle lesions are a common finding in subjects with ACL tears. • Progression to a meniscal tear over 2 years is not frequent. • Anteroinferior popliteomeniscal fascicle is injured most frequently. • Patients with popliteomeniscal fascicle lesions showed accelerated cartilage degeneration.

Hyperintense signal alteration in the suprapatellar fat pad on MRI is associated with degeneration of the patellofemoral joint over 48 months: data from the Osteoarthritis Initiative.

OBJECTIVE: To analyze associations of suprapatellar fat pad (SPFP) hyperintense signal alterations and mass effect with progression of patellofemoral osteoarthritis (OA) and clinical symptoms over 48 months. MATERIALS AND METHODS: Subjects from the Osteoarthritis Initiative (n = 426; 51.8 ± 3.8 years; 49.8% women) without radiographic tibiofemoral OA underwent 3T-MRI of their right knees and clinical evaluation using the Knee Injury and Osteoarthritis Outcome Score at baseline and at 48 months. Elevated SPFP signal was assessed on intermediate-weighted, fat-saturated turbo spin-echo (TSE) images. Mass effect was defined as a convex posterior contour. Patellofemoral cartilage, bone marrow lesions (BML), and subchondral cysts were assessed using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Associations of SPFP imaging findings with MRI and clinical progression were assessed using general linear models and logistic regressions. RESULTS: Baseline SPFP signal alterations were found in 51% of the subjects (n = 217), of whom 11% (n = 23) additionally had a mass effect. Progression of cartilage lesions was significantly higher in subjects with signal alteration versus without (adjusted mean increases, 95% CI; patella: 0.29, -0.07 to 0.64 vs -0.04, -0.40 to 0.31; p < 0.001; trochlea: 0.47, 0.16 to 0.77 vs 0.31, 0.01 to 0.61; p = 0.007). BML progression was also more likely in subjects with signal alteration (OR 1.75, 95% CI 1.09 to 2.82; p = 0.021). Mass effect was not associated with joint degeneration and SPFP findings were not associated with clinical worsening (p > 0.18 for all). CONCLUSION: Patellofemoral joint degeneration over 48 months was significantly increased in subjects with SPFP signal alteration, suggesting an association between SPFP abnormalities and the progression of patellofemoral OA.

Sporadic Inclusion Body Myositis: MRI Findings and Correlation With Clinical and Functional Parameters.

OBJECTIVE: The purpose of this prospective study is to assess MRI findings in patients with sporadic inclusion body myositis (IBM) and correlate them with clinical and functional parameters. SUBJECTS AND METHODS: This study included 12 patients with biopsy-proven sporadic IBM. All patients underwent MRI of the bilateral upper and lower extremities. The images were scored for muscle atrophy, fatty infiltration, and edema pattern. Clinical data included onset and duration of disease. Muscle strength was measured using the Medical Research Council (MRC) scale, and functional status was assessed using the Modified Rankin Scale. Correlation between MRI and different clinical and functional parameters was calculated using the Spearman rank test and Pearson correlation. RESULTS: All patients showed MRI abnormalities, which were more severe within the lower limbs and the distal segments. The most prevalent MRI finding was fat infiltration. There was a statistically significant correlation between disease duration and number of muscles infiltrated by fat (r = 0.65; p = 0.04). The number of muscles with fat infiltration correlated with the sum of the scores of MRC (r = -0.60; p = 0.04) and with the Modified Rankin Scale (r = 0.48; p = 0.03). CONCLUSION: Our findings suggest that most patients with biopsy-proven sporadic IBM present with a typical pattern of muscle involvement at MRI, more extensively in the lower extremities. Moreover, MRI findings strongly correlated with clinical and functional parameters, because both the extent and severity of muscle involvement assessed by MRI and clinical and functional parameters are associated with the early onset of the disease and its duration.

Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations.

PURPOSE: Bone fracture risk assessed ancillary to positron emission tomography with computed tomography co-registration (PET/CT) could provide substantial clinical value to oncology patients with elevated fracture risk without introducing additional radiation dose. The purpose of our study was to investigate the feasibility of obtaining valid measurements of bone mineral density (BMD) and finite element analysis-derived bone strength of the hip and spine using PET/CT examinations of prostate cancer patients by comparing against values obtained using routine multidetector-row computed tomography (MDCT) scans-as validated in previous studies-as a reference standard. MATERIALS AND METHODS: Men with prostate cancer (n=82, 71.6±8.3 years) underwent Fluorine-18 NaF PET/CT and routine MDCT within three months. Femoral neck and total hip areal BMD, vertebral trabecular BMD and femur and vertebral strength based on finite element analysis were assessed in 63 paired PET/CT and MDCT examinations using phantomless calibration and Biomechanical-CT analysis. Men with osteoporosis or fragile bone strength identified at either the hip or spine (vertebral trabecular BMD ≤80mg/cm3, femoral neck or total hip T-score ≤-2.5, vertebral strength ≤6500N and femoral strength ≤3500N, respectively) were considered to be at high risk of fracture. PET/CT- versus MDCT-based BMD and strength measurements were compared using paired t-tests, linear regression and by generating Bland-Altman plots. Agreement in fracture-risk classification was assessed in a contingency table. RESULTS: All measurements from PET/CT versus MDCT were strongly correlated (R2=0.93-0.97; P<0.0001 for all). Mean differences for total hip areal BMD (0.001g/cm2, 1.1%), femoral strength (-60N, 1.3%), vertebral trabecular BMD (2mg/cm3, 2.6%) and vertebral strength (150N; 1.7%) measurements were not statistically significant (P>0.05 for all), whereas the mean difference in femoral neck areal BMD measurements was small but significant (-0.018g/cm2; -2.5%; P=0.007). The agreement between PET/CT and MDCT for fracture-risk classification was 97% (0.89 kappa for repeatability). CONCLUSION: Ancillary analyses of BMD, bone strength, and fracture risk agreed well between PET/CT and MDCT, suggesting that PET/CT can be used opportunistically to comprehensively assess bone integrity. In subjects with high fracture risk such as cancer patients this may serve as an additional clinical tool to guide therapy planning and prevention of fractures.

Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years.

OBJECTIVES: To assess the impact of cyclops lesions with MRI in patients treated for anterior cruciate ligament (ACL) tears on clinical outcome. METHODS: In 113 patients (age 29.8 ± 10.5y; 55 females; BMI 24.8 ± 3.7 kg/m2) with complete ACL tear, 3 T-MRI scans were obtained before, 6-months, 1-year (n = 75) and 2-years (n = 33) after ACL reconstruction. Presence and volume of cyclops lesions were assessed. Clinical outcomes were measured using the Knee injury and Osteoarthritis Outcome Score (KOOS) and differences between time points (∆KOOS) were calculated. Changes of KOOS subscales were compared between patients with and without cyclops lesion. KOOS was also correlated with lesion volume. RESULTS: Cyclops lesions were found in 25% (28/113), 27% (20/75) and 33% (11/33) of patients after 6-months, 1- and 2-years, respectively. The lesion volume did not change significantly (P > 0.05) between time points, measuring 0.65 ± 0.59, 0.81 ± 0.70 and 0.72.9 ± 0.96 cm3, respectively. Clinical outcomes based on KOOS subscales were not significantly different in patients with cyclops lesions compared to those without cyclops lesions (each comparison P > 0.05), and no significant associations of clinical outcomes with lesion volume were found (P > 0.05). CONCLUSIONS: Neither presence nor size of cyclops lesions within the first 2-years after ACL surgery were associated with inferior clinical outcome. KEY POINTS: • Cyclops lesions had a prevalence of 25% in patients after ACL reconstruction. • Subjects with cyclops lesions did not have an inferior clinical outcome. • Cyclops lesions developed within the first 6 months after surgery. • The size of cyclops lesions did not significantly change over a period of 2 years.

Evaluation of Chondrocalcinosis and Associated Knee Joint Degeneration Using MR Imaging: Data from the Osteoarthritis Initiative.

OBJECTIVES: To evaluate the ability of different MRI sequences to detect chondrocalcinosis within knee cartilage and menisci, and to analyze the association with joint degeneration. METHODS: Subjects with radiographic knee chondrocalcinosis (n = 90, age 67.7 ± 7.3 years, 50 women) were selected from the Osteoarthritis Initiative and matched to controls without radiographic chondrocalcinosis (n = 90). Visualization of calcium-containing crystals (CaC) was compared between 3D T1-weighted gradient-echo (T1GE), 3D dual echo steady-state (DESS), 2D intermediate-weighted (IW), and proton density (PD)-weighted fast spin-echo (FSE) sequences obtained with 3T MRI and correlated with a semiquantitative CaC score obtained from radiographs. Structural abnormalities were assessed using Whole-Organ MRI Score (WORMS) and logistic regression models were used to compare cartilage compartments with and without CaC. RESULTS: Correlations between CaC counts of MRI sequences and degree of radiographic calcifications were highest for GE (rT1GE = 0.73, P < 0.001; rDESS = 0.68, P < 0.001) compared to other sequences (P > 0.05). Meniscus WORMS was significantly higher in subjects with chondrocalcinosis compared to controls (P = 0.005). Cartilage defects were significantly more frequent in compartments with CaC than without (patella: P = 0.006; lateral tibia: P < 0.001; lateral femur condyle: P = 0.017). CONCLUSIONS: Gradient-echo sequences were most useful for the detection of chondrocalcinosis and presence of CaC was associated with higher prevalence of cartilage and meniscal damage. KEY POINTS: • Magnetic resonance imaging is useful for assessing burden of calcium-containing crystals (CaC). • Gradient-echo sequences are superior to fast spin echo sequences for CaC imaging. • Presence of CaC is associated with meniscus and cartilage degradation.

Pitfalls in [¹8F]FDG PET imaging in gynecological malignancies.

Gynecologic malignancies are the leading causes of cancer in women and they represent about 10 to 20% of all solid tumors. During the past few decades, technological advancements in the detection and staging have gained a pivotal role in all oncological processes, including the gynecological ones. Beyond ultrasound, computed tomography (CT) and magnetic resonance (MR) imaging that are conventionally used for anatomical imaging, [18F]FDG imaging and its hybrid further development as PET/CT has become a crucial tool due of its ability to combine functional metabolic and anatomic information, and the ability to image the entire whole body in a single examination. Since the introduction of integrated hybrid PET/CT systems into clinical practice the accurate analysis of the images has detected a number of limitations and pitfalls. The purpose of this review was to describe in detail the different pitfalls related to the use of [18F]FDG PET/CT in the gynecological malignancies, providing imaging examples and discussing possible ways to avoid misinterpretations.

Bone marrow edema-like lesions (BMELs) are associated with higher T1ρ and T2 values of cartilage in anterior cruciate ligament (ACL)-reconstructed knees: a longitudinal study.

BACKGROUND: To evaluate the longitudinal changes of bone marrow edema-like lesions (BMELs) in patients after anterior cruciate ligament (ACL) reconstruction and to investigate the effect of BMELs on cartilage matrix composition changes measured using MR T1ρ and T2 mapping. METHODS: Patients with acute ACL tear were enrolled in a prospective study. MR imaging was performed at baseline (before surgeries) and at 6-month, 1-year and 2-year after ACL reconstruction. MR imaging included sagittal high-resolution, 3D fast spin-echo (CUBE) sequences for BMEL evaluation, and 3D T1ρ mapping and T2 mapping for cartilage assessment. BMELs were assessed using whole-organ magnetic resonance imaging score (WORMS), and the volume of BMELs was measured by a semi-automatic method. Generalized estimating equation (GEE) was used to explore association between BMELs at baseline and cartilage changes during follow-up. RESULTS: Fifty four patients were included in the present study and 39 patients had completed 2-year follow-up. BMELs were noted in 42 injured knees (77.8%) with 105 lesions and in 7 contralateral knees (13.0%) with 9 lesions (χ2=45.763, P<0.001) at the baseline. The WORMS and volume of BMELs of the injured knees were 2.36±0.65 and 386.98±382.54 mm3 (r=0.681, P<0.001), respectively. 87 BMELs were found at baseline in 34 patients (87.2%) of the 39 patients who had completed 2 years follow-up. During the follow-up, 18 (20.7%), 12 (13.8%), and 5 (5.7%) baseline lesions were still seen at 6-month, 1-year and 2-year, respectively. The changes of BMELs prevalence regarding bone compartments over time points were statistically significant (χ2=163.660, P<0.001). Except T2 value at 6 months, T1ρ and T2 values of cartilage overlying baseline BMELs in the injured knees were higher than that of anatomically matched cartilage in the contralateral knees at baseline and each follow-up time-point. In the injured knees, GEE analysis showed that baseline BMELs were significantly associated with higher T1ρ and T2 values of cartilage after adjustment of age, gender, body mass index (BMI), effusion and meniscus tear. The association between BMELs and Knee Injury and Osteoarthritis Outcome Scores (KOOS) scores was not statistically significant. CONCLUSIONS: BMEL is a common finding in patients with acute ACL injury and resolves rapidly over time after ACL reconstruction. It is often associated with increased T1ρ and T2 values of cartilage. BMEL at baseline is an independent predictor for faster cartilage degeneration during follow-up.

Post-treatment Evaluation of Paranasal Sinuses After Treatment of Sinonasal Neoplasms.

The aim of imaging in the follow-up of asymptomatic patients treated for sinonasal neoplasms is to detect submucosal relapsing lesions. The challenge is to discriminate recurrent tissue within the changes resulting from unpredictable healing of tissue after surgery and radiotherapy. Scar, inflammation, and recurrence can be better separated with a multisequence MR imaging approach. The choice of the field of view should take into account the risk of in-field intracranial recurrences, craniofacial bone metastases, and perineural spread. Fluorodeoxyglucose-PET has a role in assessing distant metastasis. Its usefulness in local and regional surveillance has yet to be established.

Can sinogram-affirmed iterative reconstruction improve the detection of small hypervascular liver nodules with dual-energy CT?

OBJECTIVE: To optimize a dual-energy computed tomographic protocol with sinogram-affirmed iterative reconstruction algorithms for improving small nodules detection. METHODS: The raw data of a dual-energy computed tomographic arterial acquisition of a cirrhotic patient were reconstructed with a standard filtered back projection (B20f) and 3 iterative (I26, I30, I31) kernels with different strength (S3-S5). The 80-kilovolt (peak) (kVp) and the linear blended (DE_0.5) images (80-140 kVp) were analyzed. For each series, 8-subcentimeter low-contrast lesions were simulated within the liver. Four radiologists performed a detectability test and rated the image quality (5-point scales) in all images. RESULTS: The sensitivity increased from 31% (B20f) to 87.5% with sinogram-affirmed iterative reconstruction S5 kernels without a difference between 80-kVp and DE_0.5 series (W test, P = 0.062). The highest image quality rating was 3.8 (B20 DE_0.5), without difference from DE_0.5 I30-S5 and I26-S3. CONCLUSIONS: Iterative reconstructions increase the sensitivity for detecting abdominal lesions, even in the 80-kVp series. The kernel I30-S5 was considered the best.