Imaging the Posterior Elements of the Spine.

The posterior elements of the spine consist of the pedicles, laminae, facets (articular processes), transverse processes, and the spinous process. They are essential for spinal stability, protecting the spinal cord and nerve roots, and enabling movement of the spine. Pathologies affecting the posterior elements can cause significant pain and disability. Imaging techniques, such as conventional radiography, computed tomography, and magnetic resonance imaging, are crucial for the diagnosis and evaluation of pathology, enabling accurate localization, characterization, and staging of the disease.

Present Status of Musculoskeletal Radiology in Europe: International Survey by the European Society of Musculoskeletal Radiology.

No official data exist on the status of musculoskeletal (MSK) radiology in Europe. The Committee for National Societies conducted an international survey to understand the status of training, subspecialization, and local practice among the European Society of Musculoskeletal Radiology (ESSR) partner societies. This article reports the results of that survey. An online questionnaire was distributed to all 26 European national associations that act as official partner societies of the ESSR. The 24 questions were subdivided into six sections: society structure, relationship with the national radiological society, subspecialization, present radiology practice, MSK interventional procedures, and MSK ultrasound. The findings of our study show a lack of standardized training and/or accreditation methods in the field of MSK radiology at a national level. The European diploma in musculoskeletal radiology is directed to partly overcome this problem; however, this certification is still underrecognized. Using certification methods, a more homogeneous European landscape could be created in the future with a view to subspecialist training. MSK ultrasound and MSK interventional procedures should be performed by a health professional with a solid knowledge of the relevant imaging modalities and sufficient training in MSK radiology. Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology. KEY POINTS: · Standardized training and/or accreditation methods in the field of MSK radiology is lacking at a national level.. · With certification methods, such as the European diploma in musculoskeletal radiology, a more homogeneous European landscape could be created in the future with a view to subspecialist training.. · Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology..

Femoropatellar Joint Reaction Detected During a 4486 KM Ultramarathon with Mobile MRI.

Almost nothing is known about the condition of the knee joints of multistage ultra-marathon (MSUM) runner. This is first image-based investigation of the femoropatellar joint (FPJ) using a mobile 1.5T MRI accompanying the MSUM TransEurope Foot-Race (TEFR) 64 stages over 4486 km. Twenty-two (20 male) subjects got a knee MRI-protocol at defined measurement intervals during TEFR: T2*-mapping (FLASH T2*-GRE), TIRM, and fat saturated PD -sequence. In the FPJ 12 different regions were evaluated regarding cartilage T2* and thickness changes and cartilage lesions in course of TEFR and a test on possible compounding factors (running burden, BMI, age) was done if being appropriate. No significant changes in cartilage thickness- and T2*-values were found during TEFR. In 8 runners, at least one single cartilage lesion (Grade 2-3) was found at baseline, but no significant race-related adjacent T2*-changes or progress of the defects could be detected. Analyses on compounding factors were negative. In knees with MPP (5) significantly lower adjacent T2*-values were found. The extreme running burden of a MSUM seems not to have a relevant negative influence on the FPJ tissues, even if cartilage lesions are present.

Differential BPA levels in sewage wastewater effluents from metro Detroit communities.

The endocrine disruptor Bisphenol A (BPA) is ubiquitous in both aquatic and surface sediment environments because it is continuously released into sewage wastewater effluent. The measurement of BPA at wastewater treatment plants is rarely performed even though the United States Environmental Protection Agency (EPA) states that current levels of environmental BPA could be a threat to aquatic organisms. Therefore, the aims of this study were to measure BPA levels in sewage wastewater at different collection points over a 1-year period and to compare the levels of BPA to 8-isoprostane, a human derived fatty acid, found in sewage wastewater. We analyzed pre-treated sewage samples collected from three source points located in different communities in the metropolitan Detroit area provided by the Detroit Water and Sewerage Department. Human urine samples were also used in the study. BPA and 8-isoprostane were measured using ELISA kits from Detroit R&D, Inc. BPA levels from the same collection point oscillated more than 10-fold over 1 year. Also, BPA levels fluctuated differentially at each collection point. Highly fluctuating BPA values were confirmed by LC/MS/MS. The concentration of BPA in sewage wastewater was ~100-fold higher than the concentration of 8-isoprostane, while urinary concentration was ~20-fold higher. Thus, BPA levels discharged into the sewage network vary among communities, and differences are also observed within communities over time. The difference in BPA and 8-isoprostane levels suggest that most of the BPA discharged to sewage wastewater might be derived from industries rather than from human urine. Therefore, the continuous monitoring of BPA could account for a better regulation of BPA release into a sewage network.

Radiological follow-up of cemento-osseous dysplasia on cone-beam computed tomography.

This study investigated the natural course of cemento-osseous dysplasia (COD) on cone-beam computed tomography (CBCT). Retrospectively, 104 CBCT scans from 36 patients (mean age, 44.5 years; 33 female and three male) with mandibular COD (10 florid, seven focal, 19 periapical) were included, based upon clinico-radiological features, without complications such as infection and related surgery. Changes in maximum diameter and morphology (lytic, mixed lytic-sclerotic, sclerotic) were evaluated in 83 lesions, with a mean follow-up of 28.3 months. The occurrence of a diameter increase was assessed by time-to-event analysis; interreader agreement for diameter and morphological evaluation by intraclass correlation coefficient and weighted κ statistics, respectively. Fifteen of 83 (18.1%) lesions (eight florid, one focal, six periapical) in 10 patients increased in diameter; 12 of 83 (14.5%) lesions (five florid, seven periapical) in 11 patients changed morphologically. The median period until a diameter increase was longest (120 months) for periapical COD, and shortest (66 months) for florid COD (p = 0.023). There was high reader agreement (ICC = 0.891; weighted κ = 0.901). In conclusion, CBCT is an effective tool with which to follow-up COD. If any, the natural progress in uncomplicated COD is prolonged, which underlines its non-surgical character and aids in its long-term management.

Circoviridae Survey in Captive Non-Human Primates, Italy.

Circoviruses (CVs) and cycloviruses (CyVs), members of the family Circoviridae, have been identified only occasionally in non-human primates (NHPs). In this study, we investigated the presence and genetic features of these viruses in 48 NHPs housed in the Bioparco-Rome Zoological Garden (Italy) and in the Anima Natura Wild Sanctuary Semproniano (Grosseto, Italy), testing fecal, saliva, and serum samples with a broadly reactive consensus nested PCR able of amplifying a partial region of the replicase (Rep) gene of members of the family Circoviridae. Viral DNA was detected in a total of 10 samples, including a saliva swab and 9 fecal samples collected, respectively from five Japanese macaques (Macaca fuscata) and four mandrills (Mandrillus sphinx), with an overall prevalence of 18.7% (9/48). On genome sequencing, five strains revealed the highest nucleotide identity (98.3-98.6%) to a CyV strain (RI196/ITA) detected in the intestinal content of a Maltese wall lizard (Podarcis filfolensis) in Italy. Although the origin of the Italian NHP strains, genetically distant from previously detected NHP CyVs, is uncertain, our results also highlight that the virome of captive animals is modulated by the different dietary and environmental sources of exposure.

Histiocytic Sarcoma in a Captive Hybrid Orangutan (Pongo sp.): Morphological and Immunohistochemical Features.

Histiocytic sarcoma (HS), an infrequent highly aggressive hematopoietic tumor, has been observed in diverse animal species, with isolated occurrences in non-human primates. This study describes the first case of disseminated HS in a 45-year-old female hybrid captive orangutan. The clinical profile mirrored symptoms seen in human HS cases, encompassing anorexia and ascites. Detailed histopathological examination demonstrated characteristic features of this tumor and immunohistochemistry, using markers such as Iba-1 and HLA-DR, confirmed the diagnosis. Significantly, the absence of CD163 and CD204 expression challenges their diagnostic utility in non-human primates. This investigation enhances our understanding of HS diagnosis in non-human primates, underscoring the necessity for standardized markers and diagnostic protocols.

12-channel receive array with a volume transmit coil for hand/wrist imaging at 7 T.

PURPOSE: To develop a coil configuration for high-resolution imaging of different regions of the hand and wrist at 7 T. MATERIALS AND METHODS: A quadrature bandpass birdcage and a 12-channel high density receive array were developed for imaging metacarpus and wrist. Workbench and magnetic resonance imaging (MRI) measurements were done to characterize the coil and obtain in vivo images. Electromagnetic simulations were performed to assess the uniformity of transmit profile and calculate the specific absorption rate (SAR). RESULTS: The results obtained show that the constructed transmit coil can be used in combination with receive arrays, without the need to retune the same. The developed wrist array was used to produce images of ultrahigh resolution (0.19 × 0.19 × 0.5 mm(3) ), revealing fine anatomical details. Simulations show that a near-uniform transmit profile is possible throughout the hand. No inhomogeneities were observed in the transmit profile, unlike a human head or abdomen at 7 T, due to the small volume of the hand and its low conductive regions. CONCLUSION: While transceive arrays are usually preferred at 7 T due to issues related to decrease in wavelength, it is shown in this study that with regard to hand-imaging optimized high-density receive arrays are a good solution to obtain images of extremely fine resolution of different regions.

Assessment of glycosaminoglycan content in intervertebral discs using chemical exchange saturation transfer at 3.0 Tesla: preliminary results in patients with low-back pain.

OBJECTIVES: To evaluate glycosaminoglycan-dependent chemical exchange saturation transfer (gagCEST) imaging at 3-T magnetic resonance imaging (MRI) for quantification of glycosaminoglycan (GAG) content in intervertebral discs (IVDs) in patients with low-back pain (LBP). METHODS: Sixteen patients with LBP were examined in this Institutional Review Board-approved study using a clinical whole-body system. The MRI protocol included standard morphological imaging, sagittal T2-mapping and gagCEST imaging. IVD grading according to the Pfirrmann score and region-of-interest analysis of the annulus fibrosus (AF) and the nucleus pulposus (NP) in gagCEST and T2 maps were performed before data were statistically tested for correlations between imaging techniques and quantitative differences between different grades of IVD degeneration. RESULTS: GagCEST values of the NP were significantly (P < 0.001) lower in degenerative IVDs (Pfirrmann 3 + 4) compared with non-degenerative IVDs (Pfirrmann 1 + 2), but only a weak linear correlation (r = 0.299) with the T2 relaxation times was found. GagCEST values of the NP exhibited a moderate negative correlation with Pfirrmann grades (r = -0.449). CONCLUSIONS: The known loss of GAG in the NP with increasing grade of morphological degeneration can be assessed using gagCEST imaging at 3.0 T. The correlation with single Pfirrmann grades and T2 relaxation times only seems to be moderate, indicating a substantial difference in information provided by the techniques.

Serological and Molecular Survey on Domestic Dog Hepadnavirus in Household Dogs, Italy.

The discovery of hepadnaviruses in cats (domestic cat hepadnavirus, DCH) and of a DCH-like virus in dogs has raised several questions regarding the role of these viruses in pets, with particular emphasis on their potential impact on animal health and epidemiology, as well as possible zoonotic implications. In this study, by screening an age-stratified collection of 600 canine serum samples for DCH with an ELISA assay based on the recombinant core antigen (DCHCAg), specific antibodies were found with an overall prevalence of 10.0% (60/600), with a higher prevalence in younger and older dogs. By retesting the canine DCHCAbs-positive sera with an ELISA test based on the recombinant surface protein of DCH (DCHSAg), a total of 18 sera (30%, 18/60) also contained IgG anti-DCHSAg. All the sera were also assessed molecularly using either a consensus hepadnavirus PCR or a specific real-time PCR for DCH. Hepadnavirus DNA was detected in four seronegative dogs, with a prevalence rate of 0.7% (4/600). On sequence analysis of the polymerase region amplified with pan-hepadnavirus primers, the amplicons displayed the highest nucleotide identity (97.3-99.6%) to DCH sequences detected in cats and to the domestic dog hepadnavirus recently identified in a canine serum sample from Italy.

Sodium MR imaging of the lumbar intervertebral disk at 7 T: correlation with T2 mapping and modified Pfirrmann score at 3 T--preliminary results.

PURPOSE: To compare sodium imaging of lumbar intervertebral disks in asymptomatic volunteers at 7-T magnetic resonance (MR) imaging with quantitative T2 mapping and morphologic scoring at 3 T. MATERIALS AND METHODS: Following ethical board approval and informed consent, the L2-3 to L5-S1 disks were examined in 10 asymptomatic volunteers (nine men, one woman; mean age, 30 years; range, 23-43 years). At 7 T, normalized sodium signal-to-noise ratios were calculated, by using region-of-interest analysis. At 3 T, T2 mapping was performed with a multiecho spin-echo sequence (repetition time msec/echo times msec, 1500/24, 36, 48, 60, 72, 84, 96, 108, 120, 132, 144, 156). T2 values were calculated over the nucleus, with a pixelwise, monoexponential nonnegative least-squares-fit analysis. Morphologic grading according to a modified Pfirrmann score was assessed independently by three experienced musculoskeletal radiologists, and Pearson correlation analysis of the covariates was performed. RESULTS: The mean normalized sodium signal intensity was 275.5±115.4 (standard deviation). The T2 mapping showed a mean value of 89.8 msec±19.34. The median modified Pfirrmann score was 2b (90% had score≤3c). The Pearson correlation coefficient showed a cubic function between sodium imaging and the modified Pfirrmann score, a moderate inverse correlation between T2 mapping and the modified Pfirrmann score (r=-0.62), and no correlation between sodium imaging and T2 mapping (r=0.06). CONCLUSION: The results suggest that MR imaging of the intervertebral disk, using sodium imaging and T2 mapping, can help characterize different component changes and that both of these methods are to some degree related to the Pfirrmann score.

Advanced MR methods at ultra-high field (7 Tesla) for clinical musculoskeletal applications.

OBJECTIVES: This article provides an overview of the initial clinical results of musculoskeletal studies performed at 7 Tesla, with special focus on sodium imaging, new techniques such as chemical exchange saturation transfer (CEST) and T2* imaging, and multinuclear MR spectroscopy. METHODS: Sodium imaging was clinically used at 7 T in the evaluation of patients after cartilage repair procedures because it enables the GAG content to be monitored over time. Sodium imaging and T2* mapping allow insights into the ultra-structural composition of the Achilles tendon and help detect early disease. Chemical exchange saturation transfer was, for the first time, successfully applied in the clinical set-up at 7 T in patients after cartilage repair surgery. The potential of phosphorus MR spectroscopy in muscle was demonstrated in a comparison study between 3 and 7 T, with higher spectral resolution and significantly shorter data acquisition times at 7 T. RESULTS: These initial clinical studies demonstrate the potential of ultra-high field MR at 7 T, with the advantage of significantly improved sensitivity for other nuclei, such as (23)Na (sodium) and (31)P (phosphorus). CONCLUSIONS: The application of non-proton imaging and spectroscopy provides new insights into normal and abnormal physiology of musculoskeletal tissues, particularly cartilage, tendons, and muscles. KEY POINTS : • 7 T magnetic resonance provides significantly improved sensitivity for ( 23 ) Na and ( 31 ) P. • Initial clinical studies have now demonstrated ultra-high field MR operating at 7 T. • 7 T provides new insights into normal and abnormal physiology of musculoskeletal tissues.

7T imaging of the wrist.

Ultra-high-field magnetic resonance (MR) imaging provides a high signal-to-noise ratio and thus is expected to be superior to 1.5T and 3T MR systems that are currently used in daily routine. For use in the musculoskeletal system, expectations are high, particularly for smaller joints such as the wrist, because of the small size of the visualized anatomical structures, where high spatial resolution imaging is mandatory. However, there are technical challenges associated with ultra-high-field MR, and much of the necessary basic research has been done. This article reviews the literature of the past 10 years of research in this field, which reveals a promising pattern of continuing improvements and further developments. For this reason, it is likely that, in the near future, studies with larger study populations and more clinically driven research questions will follow.

Anatomy and variants of the triangular fibrocartilage complex and its MR appearance at 3 and 7T.

Due to the small size and complexity of its constituents, the triangular fibrocartilage complex (TFCC) has been a challenging structure for magnetic resonance (MR) imaging. Higher-field MR units, at 3T and 7T, with increased spatial resolution and the development of novel MR sequences, are promising tools for an improved visualization of the ulnocarpal complex. Anatomically, the TFCC consists of the TFC proper, the ulnomeniscal homolog, the ulnar collateral ligament, the ulnotriquetral and ulnolunate ligament, and radioulnar ligaments at the volar (palmar) and the dorsal side, as well as the sheath of the extensor carpi ulnaris tendon and the capsule of the distal radioulnar joint. This article describes the normal anatomy of the TFCC and its appearance on high-field MRI. Anatomical variants, such as the positive ulnar variance, and changes during pronation and supination are addressed.

Systemic Infection by Angiostrongylus vasorum in a Fennec (Vulpeszerda) in an Italian Zoological Garden.

This paper reported a case of a metastrongyloid nematode Angiostrongylus vasorum infection in a fennec (Vulpes zerda) kept in a zoo in central Italy. The fennec had shown paralysis of the hind limbs, anorexia, weakness and respiratory signs before death. Cardiomegaly and granulomatous pneumonia were the major anatomopathological findings. Inflammatory lesions associated with parasitic larvae were observed in the lungs, brain, liver, heart, spinal cord and kidney of the fennec at histology. A. vasorum diagnosis was confirmed by both morphological and molecular identification of adult worms recovered at necropsy. Fennecs are active predators and maintain their hunting behaviour in captivity. Hence, it is likely that the animal was exposed to infection by preying on parasitised gastropods, intermediate hosts of A. vasorum, entering zoo enclosures from the surrounding environment. This is the first report of A. vasorum systemic infection in a captive fennec (V. zerda) in a zoo in Italy.

Quantitative in vivo MRI evaluation of lumbar facet joints and intervertebral discs using axial T2 mapping.

OBJECTIVES: To assess the feasibility of T2 mapping of lumbar facet joints and intervertebral discs in a single imaging slab and to compare the findings with morphological grading. METHODS: Sixty lumbar spine segments from 10 low back pain patients and 5 healthy volunteers were examined by axial T2 mapping and morphological MRI at 3.0 Tesla. Regions of interest were drawn on a single slice for the facet joints and the intervertebral discs (nucleus pulposus, anterior and posterior annulus fibrosus). The Weishaupt grading was used for facet joints and the Pfirrmann score was used for morphological disc grading ("normal" vs. "abnormal" discs). RESULTS: The inter-rater agreement was excellent for the facet joint T2 evaluation (r = 0.85), but poor for the morphological Weishaupt grading (kappa = 0.15). The preliminary results show similar facet joint T2 values in segments with normal and abnormal Pfirrmann scores. There was no difference in mean T2 values between facet joints in different Weishaupt grading groups. Facet joint T2 values showed a weak correlation with T2 values of the posterior annulus (r = 0.32) CONCLUSIONS: This study demonstrates the feasibility of a combined T2 mapping approach for the facet joints and intervertebral discs using a single axial slab.

The Vienna morphological Achilles tendon score-VIMATS : Description, reproducibility and initial clinical results.

OBJECTIVE: The purpose was to introduce the Vienna morphological Achilles tendon score (VIMATS), to evaluate its reproducibility and to assess its clinical application. METHODS: In 38 patients a total number of 40 painful ATs and 20 volunteers were examined on a 3T magnetic resonance imaging (MRI) scanner using a standard MRI protocol. In 20 patients clinical scoring according to the Achilles tendon rupture score was available. Two observers independently assessed the thickness, continuity, signal intensity, and associated pathologies of the Achilles tendon (AT) according to the newly created VIMATS. Intraobserver and interobserver agreements were calculated and the clinical application of the VIMATS regarding its potential to differentiate between patients and volunteers was tested. RESULTS: An analysis of the Intraclass correlation coefficient (ICC) yielded an excellent intraobserver (ICC 0.925) and interobserver agreement (ICC 0.946) for the total VIMAT score. A significant difference in total VIMATS was found between patients (47.6 ± StD 21.1 points) and volunteers (91.5 ± SD 10.9 points; p < 0.01) as well as a moderate correlation between morphological and clinical scoring (Pearson correlation 0.644). CONCLUSION: The VIMAT score is the first MRI score for the semiquantitative morphological evaluation of AT injuries and was shown to be an easy, fast and reproducible tool for assessing injuries of the AT.

Plasmodium matutinum Transmitted by Culex pipiens as a Cause of Avian Malaria in Captive African Penguins (Spheniscus demersus) in Italy.

Avian malaria is a parasitic disease of birds caused by protozoa belonging to the genus Plasmodium, within the order Haemosporida. Penguins are considered particularly susceptible, and outbreaks in captive populations can lead to high mortality. We used a multidisciplinary approach to investigate the death due to avian malaria, occurred between 2015 and 2019, in eight African penguins (Spheniscus demersus) kept in two Italian zoos located in central Italy, and situated about 30 km apart. We also provided information about the presence and circulation of Plasmodium spp. in mosquitoes in central Italy by sampling mosquitoes in both zoos where penguin mortalities occurred. In the eight dead penguins, gross and histopathological lesions were consistent with those previously observed by other authors in avian malaria outbreaks. Organs from dead penguins and mosquitoes collected in both zoos were tested for avian malaria parasites by using a PCR assay targeting the partial mitochondrial conserved region of the cytochrome b gene. Identification at species level was performed by sequencing analysis. Plasmodium matutinum was detected in both dead penguins and in mosquitoes (Culex pipiens), while Plasmodium vaughani in Culex pipiens only. Parasites were not found in any of the PCR tested Aedes albopictus samples. Based on our phylogenetic analysis, we detected three previously characterized lineages: Plasmodium matutinum LINN1 and AFTRU5, P. vaughani SYAT05. In Culex pipiens we also identified two novel lineages, CXPIP32 (inferred morphospecies Plasmodium matutinum) and CXPIP33 (inferred morphospecies P. vaughani). Significantly, LINN1 and AFTRU5 were found to be associated to penguin deaths, although only LINN1 was detected both in penguins (along the years of the study) and in Culex pipiens, while AFTRU5 was detected in a single penguin dead in 2017. In conclusion, in our study Plasmodium matutinum was found to cause avian malaria in captive penguins kept in Europe, with Culex pipiens being its most probable vector. Our results are in agreement with previous studies suggesting that Culex pipiens is one of the main vectors of Plasmodium spp. in Europe and the Northern Hemisphere. Zoos maintaining captive penguins in temperate areas where Culex pipiens is abundant should be well aware of the risks of avian malaria, and should put every effort to prevent outbreaks, in particular during the periods when the number of vectors is higher.

MRI of the wrist at 7 tesla using an eight-channel array coil combined with parallel imaging: preliminary results.

PURPOSE: To determine the feasibility of performing MRI of the wrist at 7 Tesla (T) with parallel imaging and to evaluate how acceleration factors (AF) affect signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and image quality. MATERIALS AND METHODS: This study had institutional review board approval. A four-transmit eight-receive channel array coil was constructed in-house. Nine healthy subjects were scanned on a 7T whole-body MR scanner. Coronal and axial images of cartilage and trabecular bone micro-architecture (3D-Fast Low Angle Shot (FLASH) with and without fat suppression, repetition time/echo time = 20 ms/4.5 ms, flip angle = 10 degrees , 0.169-0.195 x 0.169-0.195 mm, 0.5-1 mm slice thickness) were obtained with AF 1, 2, 3, 4. T1-weighted fast spin-echo (FSE), proton density-weighted FSE, and multiple-echo data image combination (MEDIC) sequences were also performed. SNR and CNR were measured. Three musculoskeletal radiologists rated image quality. Linear correlation analysis and paired t-tests were performed. RESULTS: At higher AF, SNR and CNR decreased linearly for cartilage, muscle, and trabecular bone (r < -0.98). At AF 4, reductions in SNR/CNR were:52%/60% (cartilage), 72%/63% (muscle), 45%/50% (trabecular bone). Radiologists scored images with AF 1 and 2 as near-excellent, AF 3 as good-to-excellent (P = 0.075), and AF 4 as average-to-good (P = 0.11). CONCLUSION: It is feasible to perform high resolution 7T MRI of the wrist with parallel imaging. SNR and CNR decrease with higher AF, but image quality remains above-average.