Demographic and clinical differences between ankylosing spondylitis and non-radiographic axial spondyloarthritis: results from a multicentre retrospective study in the Lazio region of Italy.

OBJECTIVES: Axial spondyloarthritides (axSpA) are a group of disorders that share similar pathogenetic mechanisms and clinical picture. The aim of this retrospective multicentric study was to evaluate demographic and clinical differences between ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA) patients. METHODS: Patients from 7 rheumatological centres in the Lazio region of Italy were included from January 1st, 2010 to April 1st, 2018, if they had undergone pelvic and/or spine radiographs or magnetic resonance imaging (MRI). Images were evaluated by one experienced radiologist in each centre who already had the clinical suspicion of axSpA. Clinical and therapeutic data were collected at the last observation visit. Categorical variables were presented with percentages and analysed by Chi squared test. Continuous variables were expressed as mean ± standard deviation and compared using the parametric unpaired t-test or the non-parametric Mann-Whitney U-test, when appropriate. p-values <0.05 were considered significant. RESULTS: 210 axSpA patients were included: 65.2% with AS and 34.7% with nr-axSpA. When comparing the two groups, AS patients had longer disease duration, were older, were more frequently males, had a greater diagnostic delay and a higher body mass index than the nr-axSpA patients (p<0.0001, p<0.0001, p=0.003 p=0.007, and p=0.04, respectively). The peripheral joints of the nr-axSpA patients were more frequently involved, had higher frequency of inflammatory bowel disease, higher C-reactive protein levels and lower frequency of HLA-B27 positivity (p=0.005, p=0.007, p=0.01, and p=0.01, respectively). TNF inhibitors were used in 87.8% patients with AS and 78.3% with nr-axSpA (p=0.04). More fat metaplasia was observed on MRI in the nr-axSpA group than in the AS group at sacroiliac joints (p=0.003), and more backfills were detected in the AS group on spine-MRI (p=0.003). Spine-bone marrow oedema was more prevalent in AS than in nr-axSpA (p=0.04), and more sclerosis and backfill were found in AS (p=0.003 and p=0.01, respectively). CONCLUSIONS: In clinical practice, distinctive features in AS and nr-axSpA patients emerged. Imaging is crucial in guiding the choice of treatment in order to control disease activity and inflammation.

Advanced MR Imaging for Knee Osteoarthritis: A Review on Local and Brain Effects.

Knee osteoarthritis is one of the leading causes of chronic disability worldwide and is a significant social and economic burden on healthcare systems; hence it has become essential to develop methods to identify patients at risk for developing knee osteoarthritis at an early stage. Standard morphological MRI sequences are focused mostly on alterations seen in advanced stages of osteoarthritis. However, they possess low sensitivity for early, subtle, and potentially reversible changes of the degenerative process. In this review, we have summarized the state of the art with regard to innovative quantitative MRI techniques that exploit objective and quantifiable biomarkers to identify subtle alterations that occur in early stages of osteoarthritis in knee cartilage before any morphological alteration occurs and to capture potential effects on the brain. These novel MRI imaging tools are believed to have great potential for improving the current standard of care, but further research is needed to address limitations before these compositional techniques can be robustly applied in research and clinical settings.

Quantitative Evaluation of Meniscal Healing Process of Degenerative Meniscus Lesions Treated with Hyaluronic Acid: A Clinical and MRI Study.

PURPOSE: We aimed to evaluate clinical efficacy and healing effects of conservative management of degenerative meniscus lesions (DMLs) with a hyaluronic acid (HA) hydrogel. METHODS: Patients were subjected to two HA injections two weeks apart. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient's Global Assessment (PtGA) and Clinical Observer Global Assessment (CoGA) of the disease were assessed at baseline, 30, and 60 days after treatment. Short Form (36) Health Survey (SF-36) was assessed at baseline and 60 days after treatment. One year after treatment, patients were called to know whether any of them had undergone arthroscopic partial meniscectomy (APM). All patients underwent magnetic resonance imaging using a 1.5-T Magnetic Resonance Imaging (MRI) scanner (Siemens Aera), which included a T2 mapping pulse sequence with multiple echoes at baseline and 60 days after treatment. RESULTS: 40 patients were enrolled. WOMAC score, physical function subscale, PtGA and CoGA, and SF-36 showed a statistically significant difference between baseline and follow-up. One year after treatment, only one patient had undergone APM. A decrease in the T2 measurement was detected in the posterior horn medial meniscus in 39% of cases in both the red and red-white zone, and in 60% of cases in the white zone; in the posterior horn lateral meniscus in 55% of cases in both the red and white zones, and in 65% of cases in the red-white zone. Only for the latter, there was a statistically significant difference between baseline and posttreatment T2 measurements. CONCLUSION: This study supports the use of HA in the conservative management of DML as it is clinically effective and enhances meniscus healing as demonstrated by T2 measurements. Moreover, it reduces the need for APM at 1-year follow-up.

Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial.

BACKGROUND: Restoring the anatomical footprint may improve the healing and mechanical strength of repaired tendons. A double row of suture anchors increases the tendon-bone contact area, reconstituting a more anatomical configuration of the rotator cuff footprint. HYPOTHESIS: There is no difference in clinical and imaging outcome between single-row and double-row suture anchor technique repairs of rotator cuff tears. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: The authors recruited 60 patients. In 30 patients, rotator cuff repair was performed with a single-row suture anchor technique (group 1). In the other 30 patients, rotator cuff repair was performed with a double-row suture anchor technique (group 2). RESULTS: Eight patients (4 in the single-row anchor repair group and 4 in the double-row anchor repair group) did not return at the final follow-up. At the 2-year follow-up, no statistically significant differences were seen with respect to the University of California, Los Angeles score and range of motion values. At 2-year follow-up, postoperative magnetic resonance arthrography in group 1 showed intact tendons in 14 patients, partial-thickness defects in 10 patients, and full-thickness defects in 2 patients. In group 2, magnetic resonance arthrography showed an intact rotator cuff in 18 patients, partial-thickness defects in 7 patients, and full-thickness defects in 1 patient. CONCLUSION: Single- and double-row techniques provide comparable clinical outcome at 2 years. A double-row technique produces a mechanically superior construct compared with the single-row method in restoring the anatomical footprint of the rotator cuff, but these mechanical advantages do not translate into superior clinical performance.

Combined diagnostic imaging of adenomyomatosis of the gallbladder.

The consistency of a request for liver MRI and MR-cholangiopancreatography in a patient with an occasional US-finding of mural thickening of gallbladder fundus > or = 3 mm in size was assessed. The differential US diagnosis in case of focal mural thickening was analyzed in combination with the other findings to justify the radiologicoclinical reliability of the request. Overall, these findings suggested the diagnostic hypothesis of adenomyomatosis, then confirmed by a second level in-depth examination, namely liver MRI and MR-cholangiopancreatography.

Combined diagnostic imaging of transitional cell carcinoma of the upper urinary tract.

The case of a female patient with recurrent macroscopic hematuria and negative vesical and renal ultrasonography, is discussed. On urography a gross pyelocaliceal filling defect was visualized. Urographic findings were suggestive of the diagnosis of transitional cell carcinoma of the upper urinary. CT was performed to confirm the diagnosis and stage the tumor: it showed the presence of an advanced lesion. At histology the diagnosis of transitional cell carcinoma of the upper urinary tract was confirmed.

T1ρ magnetic resonance imaging quantification of early lumbar intervertebral disc degeneration in healthy young adults.

STUDY DESIGN: Cross-sectional study using T1ρ magnetic resonance imaging (MRI) of lumbar spine in healthy young adults. OBJECTIVE: To evaluate early intervertebral disc degeneration (IDD) quantified by T1ρ- and T2-weighted MRI in asymptomatic young adults and to correlate T1ρ value with Pfirrmann degenerative grade, sex, and body mass index (BMI). SUMMARY OF BACKGROUND DATA: Intervertebral disc starts early to degenerate losing proteoglycan content in the nucleus pulposus (NP). A potential tool for the study of early stage of IDD is T1ρ MRI. T1ρ relaxation time of human discs has been correlated to proteoglycan content in previous studies. METHODS: T1ρ- and T2-weighted images of the lumbar spine were obtained for 63 asymptomatic young subjects (34 men and 29 women; mean age, 22.95 ± 1.8 yr), with a 1.5-T MRI scanner. T1ρ mapping and values in the NP and anulus fibrosus (n = 315) were obtained. Degenerative grade was assessed using T2-weighted images, according to the Pfirrmann scale. Differences in T1ρ value between sexes, BMI, and linear regression analyses with degenerative grade were determined. RESULTS: T1ρ values of NPs were significantly higher than those of anulus fibrosus at all levels. T1ρ values were significantly lower in women at L3-L4 and L4-L5 discs (P < 0.05). T1ρ values decreased linearly with degenerative grade. However, nondegenerated discs (Pfirrmann grades 1 and 2) showed a wide range of T1ρ relaxation time. No significant correlation was observed between T1ρ value and BMI. CONCLUSION: The data of this study showed a significant difference in IDD onset between sexes. T1ρ values correlate with Pfirrmann degenerative grade in young adults. However, the wide distribution of T1ρ values in healthy intervertebral disc highlights the low sensitivity of Pfirrmann grade to detect the early IDD changes. T1ρ can be potentially used as a clinical tool to identify early IDD and to create a reliable quantitative scale.