ABSTRACT
Dual-energy computed tomography (DECT) is an imaging technique that detects monosodium urate (MSU) deposits. This study aimed to assess the clinical utility of DECT in the diagnosis of gout. A total of 120 patients with clinical suspicion of gout who underwent DECT were retrospectively enrolled. The sensitivity and specificity of DECT alone, American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria without DECT, and ACR/EULAR criteria with DECT were assessed. Additionally, an analysis of gout risk factors was performed. When artifacts were excluded, any MSU volume provided the best diagnostic value of DECT (AUC = 0.872, 95% CI 0.806−0.938). DECT alone had a sensitivity of 90.4% and specificity of 74.5%. Although ACR/EULAR criteria without DECT provided better diagnostic accuracy than DECT alone (AUC = 0.926, 95% CI 0.878−0.974), the best value was obtained when combing both (AUC = 0.957, 95% CI 0.924−0.991), with 100% sensitivity and 76.6% specificity. In univariate analysis, risk factors for gout were male sex, presence of tophi, presence of MSU deposits on DECT, increased uric acid in serum (each p < 0.001), and decreased glomerular filtration rate (GFR) (p = 0.029). After logistic regression, only increased serum uric acid (p = 0.034) and decreased GFR (p = 0.018) remained independent risk factors for gout. Our results suggest that DECT significantly increases the sensitivity of the ACR/EULAR criteria in the diagnosis of gout.
ABSTRACT
The cervical spine can be affected by many types of inflammatory arthropathies, and the most common autoimmune diseases with cervical spine involvement are rheumatoid arthritis (RA), spondyloarthritis (SpA), and juvenile idiopathic arthritis (JIA). The clinical symptoms of cervical spine pathologies are often nonspecific or absent; therefore, imaging plays a crucial diagnostic role. RA is the most prevalent autoimmune disease; it often leads to cervical spine instability and subsequent myelopathy. In SpA, due to new bone formation, the characteristic lesions include syndesmophytes, parasyndesmophytes, and bone ankylosis, but instabilities are rare. In JIA, early apophyseal bone ankylosis is characteristic, in addition to impaired spinal growth. The aim of this review article is to discuss the imaging pathologies found in patients with RA, SpA, and JIA in the early and advanced stages. This knowledge would be helpful in the proper diagnosis and treatment of these diseases.
ABSTRACT
Scleroderma is a rare, autoimmune, chronic condition that affects the connective tissue by excessive collagen production. If diagnosed before the age of 16, it is referred to as juvenile scleroderma. There are two major types of the condition: localized and generalized scleroderma. Localized scleroderma has a much higher incidence than the generalized type which is extremely rare among children and affects mostly adults. In either case, imaging can prove to be useful in both the diagnosis and monitoring of the disease. In this article, we aim to review the imaging findings that can be present in juvenile scleroderma, focusing on ultrasonography, magnetic resonance imaging, and classic radiography. Ultrasound provides high-resolution images in real-time dynamic examination. With high-frequency transducers, it may provide a considerable input into the imaging of skin and musculoskeletal involvement. Several findings might be present when using B-mode or Doppler modalities such as thickening and hypervascularization of the cutis and subcutaneous tissue, synovitis and tenosynovitis, as well as small calcifications. Magnetic resonance imaging is also useful to evaluate inflammatory skin infiltration or skin atrophy, as well as deeply located structures, including fasciae, muscles and joints that might not be seen on ultrasonography. This modality is, however, expensive and time-consuming, and might require sedition in children. Classic radiology can show soft tissue calcifications, acroosteolysis, contractures, and subluxations. Computed tomography, which requires a high dose of radiation, is generally avoided in children, except in very specific cases.
ABSTRACT
OBJECTIVES: Cesarean section is a lifesaving procedure with short and long-term consequences. Growing rates of cesareansections worldwide arise problems for subsequent birth. The aim of this study was to compare safety of vaginal birthafter two cesarean sections with repeat third cesarean section to help healthcare providers and patients make well informeddecisions about mode of subsequent delivery. MATERIAL AND METHODS: This was a retrospective cohort study conducted in a tertiary reference hospital. Database of alldeliveries (2010-2017) after two previous cesarean sections was created from electronic and paper medical records. Pretermdeliveries, abnormal karyotype and neonates with congenital anomalies were excluded from the study. The final analysisincluded 412 cases for maternal outcome analysis and 406 cases for neonatal outcome analysis. RESULTS: Trial of labor after two cesareans in comparison to repeat cesarean section increases the risk of hemorrhage(OR: 10.84) and unfavorable composite maternal outcome (OR: 2.58). Failed trial of labor increases this risk of hemorrhage(OR: 15.27) and unfavorable composite maternal outcome (OR: 4.59) even further. There were no significant differences in neonataloutcomes. 22 out of 35 trials of labor ended in successful delivery giving a success rate of 62.85%. 5 of 7 labor inductionsended in repeat cesarean section giving 28.6% success rate. There were no maternal deaths and emergency hysterectomies. CONCLUSIONS: Trial of labor, especially failed trial of labor, is associated with an increased risk of perinatal complications.