Evaluation of vertebral bone mineral density in scoliosis by using quantitative computed tomography.

PURPOSE: Scoliosis is described as a lateral curvature of the spine. We aimed to evaluate bone mineral density (BMD) in patients with scoliosis by using quantitative computed tomography (QCT) and compare the BMD of idiopathic and congenital scoliosis patients. MATERIAL AND METHODS: Forty-three patients aged 1 to 40 years with idiopathic, congenital, or neuromuscular scoliosis and 41 matched controls of the same sex and approximate age were included in the study. Measurements of BMD were performed by QCT analysis for each vertebral body from T12 to L5, and mean BMD was calculated for each case. RESULTS: Twenty-two of the patients with scoliosis were idiopathic, 15 were congenital, four were neuromuscular, and two were neurofibromatosis. The mean BMD values of patients with scoliosis were significantly lower compared with the control group (106.8 ± 33.4 mg/cm3 vs. 124.9 ± 29.1 mg/cm3, p = 0.009). No significant difference in BMD values was found between idiopathic and congenital scoliosis patients (p > 0.05). CONCLUSIONS: This study illustrated that the vertebral body BMD values of the patients with scoliosis were significantly lower than those seen in the control group.

Measurement of regional trabecular bone attenuation of the knee following anterior cruciate ligament rupture.

INTRODUCTION: The purpose of this study was to determine regional trabecular bone attenuation changes of the knee using computed tomography after anterior cruciate ligament rupture. MATERIALS AND METHODS: Thirty one patients'-computed tomography images of the injured knees were used to measure trabecular bone attenuation in seven predetermined regions. RESULTS: Trabecular bone attenuation at four of seven regions (anteromedial area of the proximal tibia, anterolateral area of the proximal tibia, posteromedial area of the proximal tibia, and posterocentral area of the proximal tibia) was negatively correlated with the duration after injury. Independent negative correlation between the duration after injury and the density in anteromedial area of the proximal tibia was detected. CONCLUSIONS: After anterior cruciate ligament injury, trabecular bone attenuation of the knee decreases by time in certain regions of proximal tibia. Anteromedial region is the most significantly effected of all, which it is the anterior cruciate ligament fixation area.

Evaluation of thyroid function status among postmenopausal women with and without osteoporosis.

OBJECTIVE: To investigate the relationship between thyroid function status and bone mineral density (BMD) among women with postmenopausal osteoporosis. METHODS: A retrospective study was performed among 1217 women aged 45-80years who attended the Department of Obstetrics and Gynecology at Dokuz Eylul University, Izmir, Turkey, between August 1, 2009, and June 1, 2013. Eligible participants were grouped according to the presence or absence of osteoporosis as defined by BMD measurements at the lumbar vertebrae (L1-L4), femoral neck, or trochanter of the femur. Serum levels of free tri-iodothyronine, free tetraiodothyronine, and thyroid-stimulating hormone (TSH) were assessed. RESULTS: The 303 women with osteoporosis had a lower mean TSH level (1.8mIU/L) than did the 914 women without osteoporosis (1.9mIU/L; P=0.01). A positive correlation between TSH level and measures of BMD was observed (P=0.01). The TSH level was associated with a protective effect in a regression model for development of osteoporosis; the odds ratio was 0.68 (95% confidence interval 0.53-0.86). CONCLUSION: Osteoporosis appeared to be independently associated with serum TSH level. Maintaining TSH levels within the upper limit of the reference range during treatment of hypothyroidism could be important to prevent osteoporosis among postmenopausal women.

Early and long-term changes in adjacent vertebral body bone mineral density determined by quantitative computed tomography after posterolateral fusion with transpedicular screw fixation.

OBJECTIVE: The aim of this study is to investigate vertebral body bone mineral density (BMD) changes following posterolateral fusion with transpedicular screw fixation using quantitative computerized tomography (QCT) in short and relatively long-term periods. PATIENTS AND METHODS: A retrospective study was performed to investigate vertebral body BMD changes in the patients who underwent posterolateral fusion with transpedicular screw fixation at thoracic and lumbar spine. A total of 160 patients were enrolled into the study. According to the follow-up period, patients were divided into two subgroups (group 1, early follow-up, mean follow-up period, 279.3±162.3 days and group 2, later follow-up, mean follow-up period, 969.1±274.2 days). The trabecular BMDs (mg/cm³) were measured from T12 to L5 as screw free levels by using QCT measurement software. Comparisons between preoperative and postoperative BMD values were assessed using paired t-test. RESULTS: The mean postoperative BMD values of both group 1 and 2 weresignificantly lower, compared with the preoperative values (79.2±31.3mg/cm³ vs. 91.5±31.4mg/cm(3), 76.1±25.5mg/cm(3) vs. 89.3±30.4mg/cm(3), p<0.001 and p<0.001, respectively). There was no significant correlation between BMD loss and number of fused segments. Vertebral BMD loss was significantly higher in the L3 vertebra when located caudally to the operation site than when located cranially (-27.7±19.8% vs. -12.8±27.1%; p<0.01). CONCLUSIONS: The vertebral body BMD values are decreased at the adjacent of the posterolateral fusion with transpedicular screw fixation levels in both cephalad and caudad sides at an average of 9-months-follow-up postoperatively. This BMD loss persisted, but not worsened at an average of 32-months-follow-up. Vertebral BMD loss was significantly higher in the L3 vertebra when located caudally versus cranially to the surgery site.

Paget's Disease Mimicking Bone Metastasis in a Patient with Neuroendocrine Tumor on 68Ga-DOTANOC PET/CT.

Somatostatin (SST) is a neuropeptide present in neurons, endocrine cells, and a wide range of neuroendocrine tumors (NETs). 68Ga-DOTATOC, 68Ga-DOTANOC, and 68Ga-DOTATATE are current SST analogues used for PET/CT which bind to SST receptors expressed in NETs. These SST analogues have been used successfully for diagnosis of SST-expressing tumors with a more sensitive detection technique than conventional scintigraphy. However, there is a lack of clinical data on the differentiation between NETs and other malignant tumors or benign pathological conditions. Here, we report a case of Paget's disease mimicking bone metastasis of NET on PET/CT due to increased 68Ga-DOTANOC uptake and review examples of similar cases in the literature.

Cervical digits: a report of 3 cases.

The occurence of digit like structures around vertebral column is a rare and only one case in the cervical region has been reported before. Here we report three more cases of cervical digits with computed tomography and magnetic resonance imaging correlations as the first cases of the literature.

Wrist fractures: sensitivity of radiography, prevalence, and patterns in MDCT.

The aims of this study are to evaluate diagnostic performance of conventional radiographs for wrist fractures using multidetector computerized tomography (MDCT) as a reference standard, to determine prevalence, demographic risk factors including age and sex, and associations among various wrist fractures. A retrospective study was performed, finding a total 455 patients (457 wrists) who had wrist trauma and who had undergone a radiography and subsequent MDCT examination during a 45-month period. The MDCT and radiographs of the patients were reviewed by two radiologists, and a consensus was obtained for the presence of fracture. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of radiographs were calculated using MDCT findings as reference standard. The correlation of both age and sex between the presence of fracture was also analyzed. Of the 455 patients, 223 (49.0 %) had one or more fractures in wrist. A total of 302 (160 patients had one, 50 had two, 10 had three, and 3 had four) fractures were diagnosed in the wrist region. In 457 wrists, MDCT revealed 128 occult fractures missed by radiography. The overall sensitivity, specificity, PPV, and NPV of radiography for the detection of all wrist fractures were 57.8, 99.5, 87.4, and 97.4 %, respectively. The sensitivities of radiography ranged 0-41.2 % for other carpal bone except scaphoid (66 %) fractures and 66.7-80 % for the proximal metacarpus, distal ulna, and radius fractures. Wrist fractures appear to be overlooked on radiography. Further imaging should be warranted for patients who are clinically suspicious for wrist fracture in emergency rooms.

Body composition in patients with rheumatoid arthritis is not different than healthy subjects.

OBJECTIVE: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). Increased body fat, particularly its central distribution, is a well-known risk factor for CVD. A change in body composition in RA has been described previously. However, in most of these studies, age- and sex- but not body mass index (BMI)-matched controls were used. The aim of this study was to evaluate body composition in RA patients and compare it with age-, sex-, and BMI-matched controls. MATERIAL AND METHODS: Sixty-five RA patients (55 females and 10 males; mean age 54.9 ± 10.8) and 31 healthy controls (25 females, 6 males; 53.8±8.6) were included in this study. Mean disease duration was 9.2±9.6 years. Body composition was assessed by anthropometric methods (skinfold thicknesses, body circumferences), bioimpedance analysis, and dual-energy X-ray absorptiometry (DXA). Visceral adipose tissue (VAT) was assessed with computed tomography. RESULTS: There were no significant differences for total body fatness, regional fat distribution, and total body water and fat-free mass between RA patients and control subjects. Bone mineral content (BMC), assessed by DXA, was significantly lower in RA patients (p=0.004). Clinical disease activity indices and steroid treatment do not affect soft tissue body composition or BMC. CONCLUSION: At least some RA patients do not have soft tissue composition alterations and may have similar health risks in comparison with subjects with similar age, sex, and total adiposity.

Comparative evaluation of serum levels of main minerals and postmenopausal osteoporosis.

OBJECTIVE: The purpose of this study was to determine the relationship between serum main minerals and postmenopausal osteoporosis. STUDY DESIGN: A total of 728 postmenopausal women were included in this study. Women were separated into two groups according to presence or absence of osteoporosis (OP). BMD was measured in total femur (TF), femoral neck (FN) and lumbar spine (L1-L4) by dual-energy X-ray absorptiometry. Risk factors for OP were recorded by using a structured questionnaire. MAIN OUTCOME MEASURES: Women's blood were collected and serum concentrations of iron, copper, zinc, sodium, potassium, magnesium, calcium, ionized calcium, inorganic phosphorus were measured. RESULTS: Low serum copper levels were significantly associated with OP according to BMD values for TF, FN and L1-L4. There was a significant relationship between low serum zinc levels and OP for L1-L4 spines. Low iron serum levels were also significantly associated with OP in BMD measurements of TF. Low serum magnesium levels had significant association with OP of L1-L4 spines and TF. Serum levels of calcium, ionized calcium, potassium, sodium and inorganic phosphorus were not associated with OP. CONCLUSIONS: In postmenopausal women, the low serum levels of copper, zinc, iron and magnesium appear to be an important risk factor for OP.

Scapholunate dissociation associated with distal radius fractures.

OBJECTIVE: The exact prevalence of scapholunate dissociation (SLD) associated with distal radius fracture (DRF) and the effect of persistent SLD on the function of the wrist are not known. So, we examined the association between SLD and DRF and the effects of treatment on clinical outcomes. METHODS: Eight hundred and twenty-nine patients with 839 DRF were included in the study. The radiographs of the patients were examined with special reference to SLD both in pre- and post-reduction period. Persistent SLD cases were evaluated by the scoring system of Green and O'Brien at least 2 years after the fracture. RESULTS: Of the 839 fractures, 215 had SLD after the injury. When post-reduction radiographs were examined, SLD persisted in 98, but in 14 SLD was detected in the post-reduction period while not apparent in initial radiographs. So, a total of 112 patients (13.4%) had persistent SLD. Nineteen patients were lost to follow-up and remaining 93 wrists examined clinically. Seventy-nine had pain on the scapholunate joint and 14 had not. When these patients were evaluated by Green and O'Brien system, symptomatic patients had fair or poor results but asymptomatic had good. The association between DRF and SLD is 13.4%. CONCLUSIONS: Severity of the distal radius fractures is not associated with SLD. Intra-articular fractures were associated with significant increase in the prevalence of SLD. In some cases, SLD may appear after reduction in distal radius. Most cases with SLD are symptomatic, and this may be the reason of poor cases following distal radius fracture.

Quantitative computed tomography BMD reference values in women of Izmir, Turkey.

UNLABELLED: In quantitative computed tomography applications for the diagnosis of osteoporosis, the bone mineral density value obtained has to be compared with a reference data. This data is influenced by several factors including sex, age, and ethnicity. Therefore, reference data that accurately represent the population at large is essential. We established age-based quantitative computed tomography bone mineral density reference values for healthy women residing in Izmir, Turkey. We recruited 396 healthy women from 20 to 83 years old (mean age, 51.08 years). Quantitative computed tomography bone mineral density measurements were performed using the GE 9800 Highlight Advantage scanner at the L1, L2, and L3 lumbar vertebrae. The mean bone mineral density (mg/cm) +/- standard deviation of the normal reference group of women from 20 to 39 years old was 168.86 mmg/cm3 +/- 21.59. The threshold bone mineral density value for osteoporosis at a T score < -2.5 was 114.83 mg/cm3. The slope, intercept, and r values at bone mineral density versus age linear regression test were -2.44, 251.1, and 0.70, respectively. The percentage of annual bone mineral density loss was 1.6%. The bone mineral density values of Turkish women were not distinct from most countries' reference values. LEVEL OF EVIDENCE: Diagnostic study, Level II (Development of diagnostic criteria on consecutive patients [with universally applied reference "gold" standard]). See the Guidelines for Authors for a complete description of the levels of evidence.

Extraarticular pigmented villonodular synovitis of the hip.

Pigmented villonodular synovitis of any joint in the extraarticular region is very rare. Its clinical and radiological differential diagnosis is difficult due to exhibiting findings of any soft tissue tumor. Here we report an extrarticular pigmented villonodular synovitis case of the hip of a five-year-old boy, with its radiological and histopathological aspects. The mass was completely extraarticular and was identified histologically and radiologically as pigmented villonodular synovitis. Six months after marginal excision, the lesion recurred. The physicians can face such cases of pigmented villonodular synovitis presenting with unusual extraarticular location, and the preferred excision should be wide to avoid possible recurrences.

Factors affecting reduction in low-grade lumbosacral spondylolisthesis.

OBJECT: Lumbosacral spondylolisthesis (LSS) is a common disorder that often requires a stabilization and fusion procedure. The aim of this study was to determine the early neuroimaging-detected results of instrumentation-assisted (in situ) fusion with no attempt at surgical reduction of the deformity in patients with low-grade LSS. The neuroimaging results were evaluated to determine the extent of reduction and its correlation with different parameters. METHODS: Thirty patients with low-grade LSS underwent short-segment transpedicular screw fixation; surgical reduction was not attempted. All patients underwent plain anteroposterior and lateral lumbar radiography, flexion-extension lateral lumbar radiography, and computerized tomography and magnetic resonance imaging of the lumbar spine before and after surgery. Postoperative measurements were determined on the late (9 to 12-month) postoperative radiographs. The findings were recorded and grouped. Correlation analysis was performed among the radiological findings, body mass index, age, and sex. Paired-sample t-tests were performed for each paired group to determine statistically significant differences. There was no significant difference in extent of deformity reduction in patients with different lordotic angles, sagittal-plane rotation angles, and intervertebral disc heights. The extent of reduction was statistically significant at the L4-5 level (p < 0.05), in patients younger than 50 years of age (p < 0.05), and in those in whom the facet joint angle was increased (p < 0.05). CONCLUSIONS: The authors found that in cases of low-grade LSS, short-segment posterior stabilization (in situ fusion and fixation) does not require surgical reduction and in fact is associated with a measurable reduction when used as the sole treatment.

Calcium pyrophosphate dihydrate crystal deposition disease mimicking malignant soft tissue tumor.

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease has multiple clinical features with variable courses creating several pitfalls in clinical diagnosis. There are number of reported cases mimicking malignant skeletal tumors such as chondrosarcoma. However, no case of CPPD disease with radiographic noncalcified soft tissue mass has been reported in the literature. Here we report a case of CPPD disease clinically mimicking soft tissue tumor with its magnetic resonance imaging appearance and histopathology.

Bone mineral density reference values in the normal female and male population of Izmir, Turkey.

In this study we aimed to establish the dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) reference values of healthy Turkish women and men residing in Izmir, western Turkey. We examined 347 women and 119 men (age range 20-80 years) who did not have any known risk factor that might affect bone mass. The BMD measurements were performed by Hologic QDR 4500 W Elite DXA instrument from the lumbar spine (L1-L4) and non-dominant hip. In women the mean BMD (g/cm(2))+/-standard deviation (SD) of the normal reference group between 20 and 39 years of age was 0.963+/-0.121 g/cm(2) in the lumbar spine and 0.891+/-0.119 g/cm(2) in total femoral region. The percentages of annual and total BMD losses in women between 30 and 80 years of age were 0.74 and 29% at spinal level and 0.65 and 26% in femoral region, respectively. The average BMD of the normal men's group between 20 and 39 years of age was 0.996+/-0.111 g/cm(2) in the lumbar spine and 1.025+/-0.110 g/cm(2) in femoral region. The percentages of annual and total BMD losses were 0.33 and 13% at spinal level and 0.50 and 20% in femoral region, respectively. In conclusion, like the values reported from mid-Anatolian region of Turkey, the BMD values of Turkish women and men residing in Izmir, western Anatolia, are also lower than in most European countries with regard to US and preinstalled Hologic values.

Lung parenchyma changes in ankylosing spondylitis: demonstration with high resolution CT and correlation with disease duration.

OBJECTIVE: To analyze the spectrum of the lung parenchyma changes in ankylosing spondylitis (AS) with high resolution computed tomography (HRCT) and correlate the findings with disease duration. MATERIAL AND METHODS: Twenty patients (18 male, 2 female) with the diagnosis of AS according to New York criteria were included in the study. None of the patients had history of tuberculosis, prolonged inorganic dust exposure and hospitalization for pneumonia. Seven of the patients were smokers, three patients were ex-smokers, and 10 patients were nonsmokers. The patients were assigned to three groups depending on disease duration. Group 1: patients with disease duration or=6 years but or=11 years (N: 12 patients). HRCT and pulmonary function tests (PFT) were performed in all patients. RESULTS: HRCT demonstrated pathology in 17 patients (85%). Two patients in group 1, 4 patients in group 2 and 11 patients in group 3 had pulmonary parenchyma changes. Emphysema (9/20), septal thickening (9/20) and pleural thickening (9/20) were the most common changes followed by nodule (8/20) and subpleural band formation (7/20). Three patients had apical fibrosis (AF). Septal and pleural thickening (both 4/10) were the most common changes when only nonsmokers were considered. Among nine patients with emphysema three were nonsmokers. CONCLUSION: There is a wide spectrum in pulmonary parenchyma changes in AS. These changes begin in early stages of the disease and increase with disease duration. Although smoking complicates the spectrum of changes in pulmonary parenchyma, they are predominately in the form of interstitial inflammation.

Congenital anterior dislocation of the radial head: a case with radiographic findings identical to traumatic dislocation.

Differentiation of congenital unilateral dislocation of the radial head from a traumatic dislocation depends mainly on the radiographic findings. Here, we report a case of congenital unilateral anterior radial head dislocation with radiographic findings identical to traumatic dislocation.