ABSTRACT
We aimed to investigate whether there is clinical and MRI evidence of healing of lateral ligaments 6 weeks after acute lateral ankle sprain (LAS). We prospectively enrolled 18 participants (age 32.7 ± 7.5 years) who sustained an acute LAS and underwent conservative treatment. An ankle MRI was acquired up to 48 hours and 6 weeks following the LAS. A partial tear of the anterior talofibular ligament (ATFL) was observed in 10/18 and a complete tear in 8/18 of the patients. The calcaneofibular ligament (CFL) was partially torn in 11/18 and completely torn in 1/18 of the patients. The healing status, intensity, and thickness of the ligaments, Anterior Drawer Test (ADT), and FAOS scale were assessed. A control group (CG) was composed by 17 participants (age 40 ± 13.9 years). Six weeks after the LAS, 89% of the participants presented MRI evidence of ATFL healing. The repaired ATFL was thicker in comparison with the CG (p < .001). The cut-off of 2.5 mm for ATFL thickness in the 6th week maximized sensitivity (62.5%) and specificity (100%). CFL and PTFL presented 94% and 100% of healing signs, respectively. In the 6th week, 11/18 (61%) participants showed mild residual instability and a mean FAOS of 80 ± 11. The MRI revealed signs of the repair process in 89% of ATFL and 94% of CFL tears, 6 weeks after a moderate or severe LAS. The MRI findings were concomitant with enhancements in mechanical ankle stability and function.
ABSTRACT
INTRODUCTION/AIMS: Leprosy is the most common treatable peripheral neuropathy worldwide. The detection of peripheral nerve impairment is essential for its diagnosis and treatment, in order to prevent stigmatizing deformities and disabilities. This study was performed to identify neural thickening through multisegmental ultrasound (US). METHODS: We assessed US measurements of cross-sectional areas (CSAs) of ulnar, median and tibial nerves at two points (in the osteofibrous tunnel and proximal to the tunnel), and also of the common fibular nerve at the fibular head level in 53 leprosy patients (LP), and compared with those of 53 healthy volunteers (HV), as well as among different clinical forms of leprosy. RESULTS: US evaluation detected neural thickening in 71.1% (38/53) of LP and a mean number of 3.6 enlarged nerves per patient. The ulnar and tibial were the most frequently affected nerves. All nerves showed significantly higher measurements in LP compared with HV, and also greater asymmetry, with significantly higher values for ulnar and tibial nerves. We found significant CSAs differences between tunnel and pre-tunnel points for ulnar and tibial nerves, with maximum values proximal to the tunnel. All clinical forms of leprosy evaluated showed neural enlargement through US. DISCUSSION: Our findings support the role of multisegmental US as a useful method for diagnosing leprosy neuropathy, revealing that asymmetry, regional and non-uniform thickening are characteristics of the disease. Furthermore, we observed that neural involvement is common in different clinical forms of leprosy, reinforcing the importance of including US evaluation of peripheral nerves in the investigation of all leprosy patients.
Subject(s)
Leprosy , Peripheral Nervous System Diseases , Ultrasonography , Humans , Leprosy/diagnostic imaging , Leprosy/diagnosis , Male , Female , Ultrasonography/methods , Adult , Middle Aged , Peripheral Nervous System Diseases/diagnostic imaging , Peripheral Nervous System Diseases/diagnosis , Aged , Tibial Nerve/diagnostic imaging , Young Adult , Ulnar Nerve/diagnostic imaging , Ulnar Nerve/pathology , Case-Control Studies , Median Nerve/diagnostic imagingABSTRACT
ABSTRACT Introduction: Osteoarthritis (OA) is a chronic inflammatory degenerative disease, characterized by progressive degeneration of the articular cartilage, affecting mostly the knee joint. The elderly population is the most affected, intensifying the aging process. The concentration of intramuscular adipose tissue in the thigh muscles and knee OA at different ages remains under investigation. Objective: Investigate the cross-sectional area of thigh muscles at different ages with the relationship of the presence of intramuscular fat and knee OA. Methods: 80 participants were paired into 4 groups: Young Osteoarthritis Group and Old Osteoarthritis Group, both sedentary with knee OA diagnosis II or III; Healthy Young Group and Healthy Old Group, both healthy and sedentary. The groups were paired according to gender and body mass index, submitted to physiotherapeutic evaluation, WOMAC questionnaire, knee X-ray and thigh CT scans. Morphometric analysis was performed manually with ITK-SNAP software (version 3.6), by a single evaluator. Statistical analysis used the one-way ANOVA test followed by Bonferroni post-hoc for dependent variables (p≤0.05). Results: Comparison of the cross-sectional area of the rectus femoris, vastus lateralis, semitendinosus, sartorius and gracilis muscles between the groups indicated no significant differences (p>0.05). The study of attenuation for muscle adipose tissue indicated no significant difference in the values of between the OA-Young and Aged-S groups for all the muscles evaluated. Conclusion: Young individuals with knee OA present muscle morphological characteristics similar to those found during the aging process, characterizing early aging of the thigh muscles. Level of Evidence III; Retrospective cross-sectional and observational study.
RESUMEN Introducción: La artrosis (OA) es una enfermedad inflamatoria degenerativa crónica, caracterizada por la degeneración progresiva del cartílago articular, que afecta principalmente a la articulación de la rodilla. La población anciana es la más afectada, intensificándose el proceso de envejecimiento. La concentración de tejido adiposo intramuscular en los músculos del muslo y la OA de rodilla a diferentes edades sigue siendo objeto de investigación. Objetivo: Investigar el área transversal de los músculos del muslo a diferentes edades con la relación de la presencia de grasa intramuscular y la OA de rodilla. Métodos: Se emparejó a 80 participantes en 4 grupos: Grupo de jóvenes con osteoartritis y Grupo de mayores con osteoartritis, ambos sedentarios y con diagnóstico de OA de rodilla II o III; Grupo de jóvenes sanos y Grupo de mayores sanos, ambos sanos y sedentarios. Los grupos fueron emparejados según sexo e índice de masa corporal, sometidos a evaluación fisioterapéutica, cuestionario WOMAC, exámenes radiográficos de las rodillas y tomografía computarizada del muslo. El análisis morfométrico se realizó manualmente con el software ITK-SNAP (versión 3.6), por un único evaluador. En el análisis estadístico se utilizó la prueba ANOVA unidireccional seguida del post-hoc de Bonferroni para las variables dependientes (p≤0,05). Resultados: La comparación del área transversal de los músculos recto femoral, vasto lateral, semitendinoso, sartorio y gracilis entre los grupos no indicó diferencias significativas (p>0,05). El estudio de la atenuación para el tejido adiposo muscular no indicó diferencias significativas en los valores de entre los grupos OA-Young y Aged-S para todos los músculos evaluados. Conclusión: Individuos jóvenes con OA de rodilla presentan características morfológicas musculares similares a las encontradas durante el proceso de envejecimiento, caracterizando el envejecimiento precoz de los músculos del muslo. Nivel de Evidencia III; Estudio transversal y observacional retrospectivo.
RESUMO Introdução: A osteoartrite (OA) é uma doença inflamatória crônico-degenerativa, caracterizada pela degeneração progressiva da cartilagem articular, acometendo em maior parte a articulação do joelho. A população idosa é a mais atingida, intensificando o processo de envelhecimento. A concentração de tecido adiposo intramuscular nos músculos da coxa e a OA de joelho em diferentes idades permanece em investigação. Objetivo: Investigar a área de secção transversa dos músculos da coxa em diferentes idades com a relação da presença de gordura intramuscular e OA de joelho. Métodos: 80 participantes foram pareados em 4 grupos: Grupo Osteoartrite Jovem e Grupo Osteoartrite Idoso, ambos sedentários com diagnóstico de OA de joelho II ou III; Grupo Jovem Saudável e Grupo Idoso Saudável, ambos saudáveis e sedentários. Os grupos foram pareados de acordo com sexo e índice de massa corporal, submetidos à avaliação fisioterapêutica, questionário WOMAC, exames de raio-x dos joelhos e tomografia computadorizada da coxa. A análise morfométrica foi realizada manualmente com software ITK-SNAP (versão 3.6), por um único avaliador. Análise estatística utilizou o teste ANOVA one-way seguido pelo post-hoc de Bonferroni, para variáveis dependentes (p≤0,05). Resultados: A comparação da área de secção transversa dos músculos reto femoral, vasto lateral, semitendinoso, sartório e grácil, entre os grupos, não indicou diferenças significativas (p>0,05). O estudo da atenuação para o tecido adiposo muscular não indicou diferença significativa nos valores de entre os grupos OA-Jovem e Idoso-S para todos os músculos avaliados. Conclusão: Indivíduos jovens com OA de joelho apresentam características morfológicas musculares semelhantes às encontradas durante o processo de envelhecimento, caracterizando um envelhecimento precoce dos músculos da coxa.Nível de Evidência III; Estudo retrospectivo transversal e observacional.
ABSTRACT
Leprosy household contacts (HC) represent a high-risk group for the development of the disease. Anti-PGL-I IgM seropositivity also increases the risk of illness. Despite significant advances in leprosy control, it remains a public health problem; and early diagnosis of this peripheral neuropathy represents one of the main goals of leprosy programs. The present study was performed to identify neural impairment in leprosy HC by analyzing differences in high-resolution ultrasonographic (US) measurements of peripheral nerves between leprosy HC and healthy volunteers (HV). Seventy-nine seropositive household contacts (SPHC) and 30 seronegative household contacts (SNHC) underwent dermato-neurological examination and molecular analysis, followed by high-resolution US evaluation of cross-sectional areas (CSAs) of the median, ulnar, common fibular and tibial nerves. In addition, 53 HV underwent similar US measurements. The US evaluation detected neural thickening in 26.5% (13/49) of the SPHC and only in 3.3% (1/30) among the SNHC (p = 0.0038). The CSA values of the common fibular and tibial nerves were significantly higher in SPHC. This group also had significantly greater asymmetry in the common fibular and tibial nerves (proximal to the tunnel). SPHC presented a 10.5-fold higher chance of neural impairment (p = 0.0311). On the contrary, the presence of at least one scar from the BCG vaccine conferred 5.2-fold greater protection against neural involvement detected by US (p = 0.0184). Our findings demonstrated a higher prevalence of neural thickening in SPHC and support the role of high-resolution US in the early diagnosis of leprosy neuropathy. The combination of positive anti-PGL-I serology and absence of a BCG scar can identify individuals with greater chances of developing leprosy neuropathy, who should be referred for US examination, reinforcing the importance of including serological and imaging methods in the epidemiological surveillance of leprosy HC.
Subject(s)
Cicatrix , Leprosy , Humans , Tibial Nerve , Early Diagnosis , Antibodies , UltrasonographyABSTRACT
PURPOSE: Bone quality of non-ambulatory patients with cerebral palsy (CP) is a matter of concern for proximal femoral varus derotational osteotomies (VDRO). Locking plates (LCP) have been designed to compensate this biological downfall. Little data exist comparing the LCP with the conventional femoral blade plate. METHODS: We retrospectively studied 32 patients submitted to VDRO (40 hips), operated with blade plates or LCP. Groups were matched, and the minimal follow-up was 36 months. Clinical (age at surgery, sex, GMFCS class, CP patterns) and radiological characteristics (neck shaft angle [NSA], acetabular index [AI], Reimers migration index [MP] and time until bone healing), as well as postoperative complications and the cost of treatment, were evaluated. RESULTS: Preoperative clinical characteristics and radiographic measurements were comparable, except for a higher AI in the BP group (p < 0.01). Mean follow-up was longer in the LCP group (57.35 vs 34.6 months). Mean NSA, AI and MP had comparable correction with surgery (p < 0.01). At final follow-up, dislocation recurrence speed was higher in BP group although not statistically significant (0.56% vs 0.35%/month; p = 0.29). The complication rate was similar in both groups (p > 0.05). Finally, the cost of the treatment was 62% higher in the LCP group (p = 0.01). CONCLUSION: Our cohorts showed LCP or BP equivalence clinically and radiographically in mid-term follow-up, with the former increasing the cost of treatment by a mean of 62%. This may raise a question on the real necessity of locked implants for these operations. LEVEL OF EVIDENCE: Level III-Retrospective comparative study.
Subject(s)
Cerebral Palsy , Hip Dislocation , Humans , Hip Dislocation/diagnostic imaging , Hip Dislocation/etiology , Hip Dislocation/surgery , Retrospective Studies , Cerebral Palsy/complications , Cerebral Palsy/surgery , Cohort Studies , Acetabulum , Femur/diagnostic imaging , Femur/surgeryABSTRACT
Objective: Verify interobserver and intraobserver agreement of malignant compressive vertebral fractures (MCVF) diagnosis using magnetic resonance imaging (MRI). Methods: We retrospectively included a lumbar spine MRI of 63 patients with non-traumatic compressive vertebral fracture diagnoses. Each lumbar vertebra was classified as: without fracture, with fracture of benign characteristics, or with fracture of malignant characteristics. Two medical residents in radiology, one musculoskeletal radiologist fellow, one musculoskeletal radiologist, and two spine surgeons evaluated MRI exams, independently and blindly. Each observer performed two readings, with a 15-day interval between evaluations. A simple Kappa coefficient was used to calculate the intra and interobserver agreement. The reference standard classification was based on bone biopsy or clinical, and imaging follow-up of at least two years, for diagnostic performance analysis. Diagnostic performance was assessed by calculating sensitivity, specificity, accuracy, and positive and negative predictive values with a 95% confidence interval (CI). Results: We observed substantial to perfect intraobserver agreement (kappa: 0.80 to 1.00) and substantial interobserver agreement (kappa 0.64 to 0.77). In general, the sensitivity for the detection of MCVF was moderate, except for the second-year radiology resident that achieved a lower sensitivity. The specificity, accuracy, and negative predictive value were high for all observers. Conclusion: MCVF diagnosis using MRI showed substantial interobserver agreement. The second-year medical resident achieved lower sensitivity but high specificity for MCVF. Regarding the seniors, there was no statistical significance between spine surgeons and the musculoskeletal radiologist. Level of Evidence III; Diagnostic.
Objetivo: Verificar a concordância interobservador e intraobservador no diagnóstico de fraturas vertebrais compressivas malignas (MCVF) por meio de ressonância magnética (MRI). Métodos: Incluiu-se retrospectivamente a ressonância magnética da coluna lombar de 63 pacientes com diagnóstico de fratura vertebral compressiva não traumática. Cada vértebra lombar foi classificada da seguinte forma: sem fratura, com fratura de características benignas ou com fratura de características malignas. Dois médicos residentes em radiologia, um pesquisador radiologista musculoesquelético, um radiologista musculoesquelético e dois cirurgiões da coluna vertebral avaliaram os exames de ressonância magnética, independentemente e cegamente. Cada observador realizou duas leituras, com um intervalo de 15 dias entre as avaliações. O coeficiente Kappa simples foi utilizado para calcular o acordo intra e interobservador. A classificação padrão de referência foi baseada em biópsia óssea ou clínica, e acompanhamento por imagem de pelo menos dois anos, para análise de desempenho diagnóstico. O desempenho diagnóstico foi avaliado através do cálculo de sensibilidade, especificidade, precisão, valores preditivos positivos e negativos com um intervalo de confiança de 95% (IC). Resultados: Foi observada concordância substancial a perfeita intraobservador (kappa: 0,80 a 1,00) e concordância substancial interobservador (kappa 0,64 a 0,77). Em geral, a sensibilidade para a detecção de MCVF foi moderada, exceto para o segundo ano de residência radiológica que alcançou uma sensibilidade menor. A especificidade, precisão e valor preditivo negativo foram altos para todos os observadores. Conclusão: O diagnóstico de MCVF por ressonância magnética mostrou uma concordância substancial entre observadores. O residente médico do segundo ano alcançou uma sensibilidade menor, mas alta especificidade para MCVF. Com relação aos veteranos, não houve significância estatística entre os cirurgiões da coluna vertebral e o radiologista músculo-esquelético. Nível de Evidencia III; Diagnóstico .
ABSTRACT
BACKGROUND: Few studies have investigated the association between vertebral fragility fractures and lower limb muscle strength and physical performance in women with low bone mass. OBJECTIVES: To explore whether the presence of vertebral fracture is independently associated with poor physical performance and decreased lower limb muscle strength. To understand whether lower limb muscle strength is associated with physical performance in women with vertebral fracture. METHODS: Older women with low bone mass were divided into 2 groups: no vertebral fracture (NF) and presence of vertebral fragility fracture (VFF). Physical performance was evaluated using the Five Times Sit to Stand (5TSS) test, the Timed Up and Go (TUG) test and a 5m walk test (5MWT). Lower limb muscle strength was assessed using an isokinetic dynamometer. RESULTS: We included 94 women with low bone mass (mean age 71.6 [SD 5.7] years, time since menopause 24.4 [7.1] years, mean BMI 27.5 [5.1] kgm-2). VFF was only associated with low peak hip abductor torque (p = 0.001) after adjustments. In the VFF group (n= 47), each 1 Nmkg-1 increase: in knee extensor torque was associated with improved 5MWT (p = 0.005), TUG (p = 0.002) and 5TSS (p = 0.005) performances; in knee flexor torque was associated with improved 5MWT speed (p = 0.003) and TUG time (p = 0.006); in hip abductor torque was associated with improved 5MWT speed (p = 0.003); and in hip extensor torque with improved TUG time (p = 0.046). CONCLUSION: VFF was associated with reduced hip abductor strength in older women. However, the number of vertebral fractures influenced the association. Additionally, lower limb muscle strength was associated with physical performance, regardless of the clinical characteristics of the fractures. Therefore, strength and power training programs for the lower limbs could improve physical performance.
Subject(s)
Muscle Strength , Spinal Fractures , Humans , Female , Aged , Cross-Sectional Studies , Muscle Strength/physiology , Lower Extremity , Knee Joint , Exercise Therapy , Spinal Fractures/etiologyABSTRACT
ABSTRACT Objective: Verify interobserver and intraobserver agreement of malignant compressive vertebral fractures (MCVF) diagnosis using magnetic resonance imaging (MRI). Methods: We retrospectively included a lumbar spine MRI of 63 patients with non-traumatic compressive vertebral fracture diagnoses. Each lumbar vertebra was classified as: without fracture, with fracture of benign characteristics, or with fracture of malignant characteristics. Two medical residents in radiology, one musculoskeletal radiologist fellow, one musculoskeletal radiologist, and two spine surgeons evaluated MRI exams, independently and blindly. Each observer performed two readings, with a 15-day interval between evaluations. A simple Kappa coefficient was used to calculate the intra and interobserver agreement. The reference standard classification was based on bone biopsy or clinical, and imaging follow-up of at least two years, for diagnostic performance analysis. Diagnostic performance was assessed by calculating sensitivity, specificity, accuracy, and positive and negative predictive values with a 95% confidence interval (CI). Results: We observed substantial to perfect intraobserver agreement (kappa: 0.80 to 1.00) and substantial interobserver agreement (kappa 0.64 to 0.77). In general, the sensitivity for the detection of MCVF was moderate, except for the second-year radiology resident that achieved a lower sensitivity. The specificity, accuracy, and negative predictive value were high for all observers. Conclusion: MCVF diagnosis using MRI showed substantial interobserver agreement. The second-year medical resident achieved lower sensitivity but high specificity for MCVF. Regarding the seniors, there was no statistical significance between spine surgeons and the musculoskeletal radiologist. Level of Evidence III; Diagnostic.
RESUMO Objetivo: Verificar a concordância interobservador e intraobservador no diagnóstico de fraturas vertebrais compressivas malignas (MCVF) por meio de ressonância magnética (MRI). Métodos: Incluiu-se retrospectivamente a ressonância magnética da coluna lombar de 63 pacientes com diagnóstico de fratura vertebral compressiva não traumática. Cada vértebra lombar foi classificada da seguinte forma: sem fratura, com fratura de características benignas ou com fratura de características malignas. Dois médicos residentes em radiologia, um pesquisador radiologista musculoesquelético, um radiologista musculoesquelético e dois cirurgiões da coluna vertebral avaliaram os exames de ressonância magnética, independentemente e cegamente. Cada observador realizou duas leituras, com um intervalo de 15 dias entre as avaliações. O coeficiente Kappa simples foi utilizado para calcular o acordo intra e interobservador. A classificação padrão de referência foi baseada em biópsia óssea ou clínica, e acompanhamento por imagem de pelo menos dois anos, para análise de desempenho diagnóstico. O desempenho diagnóstico foi avaliado através do cálculo de sensibilidade, especificidade, precisão, valores preditivos positivos e negativos com um intervalo de confiança de 95% (IC). Resultados: Foi observada concordância substancial a perfeita intraobservador (kappa: 0,80 a 1,00) e concordância substancial interobservador (kappa 0,64 a 0,77). Em geral, a sensibilidade para a detecção de MCVF foi moderada, exceto para o segundo ano de residência radiológica que alcançou uma sensibilidade menor. A especificidade, precisão e valor preditivo negativo foram altos para todos os observadores. Conclusão: O diagnóstico de MCVF por ressonância magnética mostrou uma concordância substancial entre observadores. O residente médico do segundo ano alcançou uma sensibilidade menor, mas alta especificidade para MCVF. Com relação aos veteranos, não houve significância estatística entre os cirurgiões da coluna vertebral e o radiologista músculo-esquelético. Nível de Evidencia III; Diagnóstico.
ABSTRACT
Objective: To establish peripheral nerve cross-sectional area (CSA) reference values (absolute values, measures of asymmetry, and measures of focality) for healthy individuals in Brazil. Materials and Methods: Sixty-six healthy volunteers underwent high-resolution ultrasound of the peripheral nerves. We obtained CSA measurements for three peripheral nerves, at specific locations: the median nerve, in the carpal tunnel (MT); the ulnar nerve, at the cubital tunnel site (UT) and at the pre-tunnel site (UPT); and the common fibular nerve, near the fibular head (FH). We calculated the CSA indices between the same sites on different sides (ΔCSAs) and between the ulnar nerve tunnel and pre-tunnel sites on the same side (ΔTPT). Results: A total of 132 neural sites were analyzed, and the following CSA values (mean ± SD, median) were obtained: MT (6.3 ± 1.9 mm2, 6.0 mm2); UT (6.2 ± 1.6 mm2, 6.1 mm2); UPT (5.6 ± 1.7 mm2, 5.4 mm2); and FH (10.0 ± 3.7 mm2, 9.9 mm2). The ΔCSA values (mean ± SD, median) were as follows: MT (0.85 ± 0.7 mm2, 0.95); UT (0.81 ± 0.62 mm2, 0.95); UPT (0.61 ± 0.51 mm2, 0.5); and FH (1.0 ± 0.77 mm2, 1.0). The ΔTPT (mean ± SD, median) was (1.0 ± 0.8 mm2, 1.0). Conclusion: Among individuals in Brazil, peripheral nerve CSA values tend to be higher among males and to increase with aging. However, the same does not appear to hold true for the ΔCSA or the ΔTPT, the exception being the difference between the right and left UT. Differences in CSA values greater than 2.5 mm2 between sides or between sites along the same nerve can indicate asymmetry or focal thickening in neuropathy, respectively.
Objetivo: Estabelecer valores de referência da área de secção transversa (AST) dos nervos periféricos (valores absolutos e medidas de assimetria e de espessamento focal) para amostra de indivíduos brasileiros saudáveis. Materiais e Métodos: Sessenta e seis voluntários brasileiros saudáveis foram submetidos a ultrassonografia de alta resolução de nervos periféricos. As medidas da AST dos seguintes nervos periféricos foram obtidas em: mediano no túnel do carpo (MT), ulnar no túnel cubital (UT), pré-túnel ulnar (UPT) e fibular comum na cabeça da fíbula (FH). Os índices CSA foram obtidos entre os mesmos sítios em lados diferentes (ΔCSA) e entre os sítios distal e proximal do nervo ulnar (ΔTPT). Resultados: As seguintes médias ± desvio-padrão e mediana da AST foram obtidas para os 132 sítios dos nervos periféricos analisados: MT (6,3 ± 1,9 mm2; 6,0 mm2), UT (6,2 ± 1,6 mm2; 6,1 mm2), UPT (5,6 ± 1,7 mm2; 5,4 mm2) e FH (10,0 ± 3,7 mm2; 9,9 mm2). A média ± desvio-padrão e as respectivas medianas do ΔCSA em mm2 foram: 0,85 ± 0,7 [0,95] para MT, 0,81 ± 0,62 [0,95] para UT, 0,61 ± 0,51 [0,5] para UPT, 1,0 ± 0,77 [1] para FH, e 1,0 ± 0,8 [1,0] para ΔTPT. Conclusão: Os valores de AST tendem a ser maiores no sexo masculino, aumentando os valores absolutos das medianas das ASTs com o envelhecimento, mas não nos seus índices, ΔCSA e ΔTPT, exceto a diferença entre a AST dos nervos ulnares nos lados direito e esquerdo. Diferenças de valores de AST entre lados ou pontos no mesmo nervo maior que 2,5 mm2 podem significar neuropatia com assimetria e espessamento focal.
ABSTRACT
Abstract Objective: To establish peripheral nerve cross-sectional area (CSA) reference values (absolute values, measures of asymmetry, and measures of focality) for healthy individuals in Brazil. Materials and Methods: Sixty-six healthy volunteers underwent high-resolution ultrasound of the peripheral nerves. We obtained CSA measurements for three peripheral nerves, at specific locations: the median nerve, in the carpal tunnel (MT); the ulnar nerve, at the cubital tunnel site (UT) and at the pre-tunnel site (UPT); and the common fibular nerve, near the fibular head (FH). We calculated the CSA indices between the same sites on different sides (∆CSAs) and between the ulnar nerve tunnel and pre-tunnel sites on the same side (∆TPT). Results: A total of 132 neural sites were analyzed, and the following CSA values (mean ± SD, median) were obtained: MT (6.3 ± 1.9 mm2, 6.0 mm2); UT (6.2 ± 1.6 mm2, 6.1 mm2); UPT (5.6 ± 1.7 mm2, 5.4 mm2); and FH (10.0 ± 3.7 mm2, 9.9 mm2). The ∆CSA values (mean ± SD, median) were as follows: MT (0.85 ± 0.7 mm2, 0.95); UT (0.81 ± 0.62 mm2, 0.95); UPT (0.61 ± 0.51 mm2, 0.5); and FH (1.0 ± 0.77 mm2, 1.0). The ∆TPT (mean ± SD, median) was (1.0 ± 0.8 mm2, 1.0). Conclusion: Among individuals in Brazil, peripheral nerve CSA values tend to be higher among males and to increase with aging. However, the same does not appear to hold true for the ∆CSA or the ∆TPT, the exception being the difference between the right and left UT. Differences in CSA values greater than 2.5 mm2 between sides or between sites along the same nerve can indicate asymmetry or focal thickening in neuropathy, respectively.
Resumo Objetivo: Estabelecer valores de referência da área de secção transversa (AST) dos nervos periféricos (valores absolutos e medidas de assimetria e de espessamento focal) para amostra de indivíduos brasileiros saudáveis. Materiais e Métodos: Sessenta e seis voluntários brasileiros saudáveis foram submetidos a ultrassonografia de alta resolução de nervos periféricos. As medidas da AST dos seguintes nervos periféricos foram obtidas em: mediano no túnel do carpo (MT), ulnar no túnel cubital (UT), pré-túnel ulnar (UPT) e fibular comum na cabeça da fíbula (FH). Os índices CSA foram obtidos entre os mesmos sítios em lados diferentes (∆CSA) e entre os sítios distal e proximal do nervo ulnar (∆TPT). Resultados: As seguintes médias ± desvio-padrão e mediana da AST foram obtidas para os 132 sítios dos nervos periféricos analisados: MT (6,3 ± 1,9 mm2; 6,0 mm2), UT (6,2 ± 1,6 mm2; 6,1 mm2), UPT (5,6 ± 1,7 mm2; 5,4 mm2) e FH (10,0 ± 3,7 mm2; 9,9 mm2). A média ± desvio-padrão e as respectivas medianas do ∆CSA em mm2 foram: 0,85 ± 0,7 [0,95] para MT, 0,81 ± 0,62 [0,95] para UT, 0,61 ± 0,51 [0,5] para UPT, 1,0 ± 0,77 [1] para FH, e 1,0 ± 0,8 [1,0] para ∆TPT. Conclusão: Os valores de AST tendem a ser maiores no sexo masculino, aumentando os valores absolutos das medianas das ASTs com o envelhecimento, mas não nos seus índices, ∆CSA e ∆TPT, exceto a diferença entre a AST dos nervos ulnares nos lados direito e esquerdo. Diferenças de valores de AST entre lados ou pontos no mesmo nervo maior que 2,5 mm2 podem significar neuropatia com assimetria e espessamento focal.
ABSTRACT
Objective The purpose of the present study was to evaluate the rate of patency in the postoperative period of arterial injuries of the forearm secondary to penetrating trauma. The injuries were subjected to primary repair and examined with the Allen test and a handheld Doppler device, and the results were later confirmed with Doppler ultrasonography. Methods Eighteen patients were included, with a total of 19 arterial lesions, 14 ulnar lesions, and 5 radial lesions; one patient had lesions on both forearms. All patients underwent surgery and three clinical evaluations: the Allen test and assessment of arterial blood flow by a handheld Doppler device at 4 and 16 weeks after surgery and Doppler ultrasonography performed at 12 weeks after surgery. Results At the first clinical evaluation, 77% of the patients had patency based on the Allen test, and 72% had a pulsatile sound identified by the handheld Doppler device. In the second evaluation, 61% of the patients had patency based on the Allen test, and the rate of pulsatile sound by the handheld Doppler device was 72%, similar to that observed 2 months earlier. Based on the Doppler ultrasonography evaluation (â¼12 weeks after surgery), the success rate for arteriorrhaphy was 88%. Regarding the final patency (Doppler ultrasonography evaluation) and trauma mechanism, all patients with penetrating trauma had patent arteries. Conclusion We conclude that clinical evaluation using a handheld Doppler device and the Allen test is reliable when a patent artery can be palpated. However, if a patent artery cannot be located during a clinical examination, ultrasonography may be required.
ABSTRACT
Abstract Objective The purpose of the present study was to evaluate the rate of patency in the postoperative period of arterial injuries of the forearm secondary to penetrating trauma. The injuries were subjected to primary repair and examined with the Allen test and a handheld Doppler device, and the results were later confirmed with Doppler ultrasonography. Methods Eighteen patients were included, with a total of 19 arterial lesions, 14 ulnar lesions, and 5 radial lesions; one patient had lesions on both forearms. All patients underwent surgery and three clinical evaluations: the Allen test and assessment of arterial blood flow by a handheld Doppler device at 4 and 16 weeks after surgery and Doppler ultrasonography performed at 12 weeks after surgery. Results At the first clinical evaluation, 77% of the patients had patency based on the Allen test, and 72% had a pulsatile sound identified by the handheld Doppler device. In the second evaluation, 61% of the patients had patency based on the Allen test, and the rate of pulsatile sound by the handheld Doppler device was 72%, similar to that observed 2 months earlier. Based on the Doppler ultrasonography evaluation (~12 weeks after surgery), the success rate for arteriorrhaphy was 88%. Regarding the final patency (Doppler ultrasonography evaluation) and trauma mechanism, all patients with penetrating trauma had patent arteries. Conclusion We cde that clinical evaluation using a handheld Doppler device and the Allen test is reliable when a patent artery can be palpated. However, if a patent artery cannot be located during a clinical examination, ultrasonography may be required.
Resumo Objetivo O objetivo deste estudo foi avaliar a taxa de perviedade pós-operatória de lesões arteriais do antebraço secundárias a traumatismo penetrante. As lesões foram submetidas a reparo primário e examinadas com o teste de Allen e um dispositivo Doppler portátil; posteriormente, os resultados foram confirmados à ultrassonografia com Doppler. Métodos Dezoito pacientes foram incluídos, com um total de 19 lesões arteriais, 14 lesões ulnares e 5 lesões radiais; um paciente tinha lesões em ambos os antebraços. Todos os pacientes foram submetidos à cirurgia e três avaliações clínicas: o teste de Allen e a avaliação do fluxo sanguíneo arterial com um dispositivo portátil de Doppler na 4ª e 16ª semanas após a cirurgia e ultrassonografia com Doppler 12 semanas após o procedimento. Resultados Na primeira avaliação clínica, 77% dos pacientes apresentavam perviedade segundo o teste de Allen e 72% apresentavam som pulsátil identificado pelo Doppler portátil. Na segunda avaliação, 61% dos pacientes apresentaram perviedade com base no teste de Allen e a taxa de som pulsátil ao Doppler portátil foi de 72%, semelhante à observada 2 meses antes. À ultrassonografia com Doppler (cerca de 12 semanas após a cirurgia), a taxa de sucesso da arteriorrafia foi de 88%. Em relação à perviedade final (avaliação por ultrassonografia com Doppler) e mecanismo de trauma, todos os pacientes com traumatismo penetrante apresentavam artérias pérvias. Conclusão Concluímos que a avaliação clínica com um dispositivo Doppler portátil e o teste de Allen é confiável caso a artéria pérvia possa ser palpada. No entanto, a ultrassonografia pode ser necessária em caso de impossibilidade de localização de uma artéria pérvia durante o exame clínico.
Subject(s)
Humans , Ulnar Artery/injuries , Ultrasonography, Doppler , Forearm InjuriesABSTRACT
Vertebral Compression Fracture (VCF) occurs when the vertebral body partially collapses under the action of compressive forces. Non-traumatic VCFs can be secondary to osteoporosis fragility (benign VCFs) or tumors (malignant VCFs). The investigation of the etiology of non-traumatic VCFs is usually necessary, since treatment and prognosis are dependent on the VCF type. Currently, there has been great interest in using Convolutional Neural Networks (CNNs) for the classification of medical images because these networks allow the automatic extraction of useful features for the classification in a given problem. However, CNNs usually require large datasets that are often not available in medical applications. Besides, these networks generally do not use additional information that may be important for classification. A different approach is to classify the image based on a large number of predefined features, an approach known as radiomics. In this work, we propose a hybrid method for classifying VCFs that uses features from three different sources: i) intermediate layers of CNNs; ii) radiomics; iii) additional clinical and image histogram information. In the hybrid method proposed here, external features are inserted as additional inputs to the first dense layer of a CNN. A Genetic Algorithm is used to: i) select a subset of radiomic, clinical, and histogram features relevant to the classification of VCFs; ii) select hyper-parameters of the CNN. Experiments using different models indicate that combining information is interesting to improve the performance of the classifier. Besides, pre-trained CNNs presents better performance than CNNs trained from scratch on the classification of VCFs.
Subject(s)
Fractures, Compression , Spinal Fractures , Computers , Diagnosis, Computer-Assisted , Fractures, Compression/diagnostic imaging , Humans , Neural Networks, Computer , Spinal Fractures/diagnostic imagingABSTRACT
Spondyloarthritis (SpA) is a group of diseases primarily involving chronic inflammation of the spine and peripheral joints, as evaluated by magnetic resonance imaging (MRI). Considering the complexity of SpA, we performed a retrospective study to discover quantitative/radiomic MRI-based features correlated with SpA. We also investigated different fat-suppression MRI techniques to develop detection models for inflammatory sacroiliitis. Finally, these model results were compared with those of experienced musculoskeletal radiologists, and the concordance level was evaluated. Examinations of 46 consecutive patients were obtained using SPAIR (spectral attenuated inversion recovery) and STIR (short tau inversion recovery) MRI sequences. Musculoskeletal radiologists manually segmented the sacroiliac joints for further extraction of 230 MRI features from gray-level histogram/matrices and wavelet filters. These features were associated with sacroiliitis, SpA, and the current biomarkers of ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), BASDAI (Bath Ankylosing Spondylitis Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), and MASES (Maastricht Ankylosing Spondylitis Enthesis Score). The Mann-Whitney U test showed that the radiomic markers from both MRI sequences were associated with active sacroiliitis and with SpA and its axial and peripheral subtypes (p < 0.05). Spearman's coefficient also identified a correlation between MRI markers and data from clinical practice (p < 0.05). Fat-suppression MRI models yielded performances that were statistically equivalent to those of specialists and presented strong concordance in identifying inflammatory sacroiliitis. SPAIR and STIR acquisition protocols showed potential for the evaluation of sacroiliac joints and the composition of a radiomic model to support the clinical assessment of SpA.
Subject(s)
Sacroiliitis , Spondylarthritis , Spondylitis, Ankylosing , Biomarkers , Humans , Magnetic Resonance Imaging/methods , Retrospective Studies , Sacroiliac Joint/diagnostic imaging , Sacroiliitis/complications , Sacroiliitis/diagnostic imaging , Spondylarthritis/complications , Spondylarthritis/diagnostic imaging , Spondylitis, Ankylosing/complications , Spondylitis, Ankylosing/diagnosisABSTRACT
OBJECTIVE: To evaluate qualitative and quantitative magnetic resonance imaging (MRI) criteria for injury of the common peroneal nerve (CPN) in patients with acute or subacute injuries in the posterolateral corner (PLC) of the knee, as well as to evaluate the reproducibility of MRI evaluation of CPN alterations. MATERIALS AND METHODS: This was a retrospective study of 38 consecutive patients submitted to MRI and diagnosed with acute or subacute injury to the PLC of the knee (patient group) and 38 patients with normal MRI results (control group). Two musculoskeletal radiologists (designated radiologist A and radiologist B, respectively) evaluated the images. Nerve injury was classified as neurapraxia, axonotmesis, or neurotmesis. Signal strength was measured at the CPN, the tibial nerve (TN), and a superficial vein (SV). The CPN/TN and CPN/SV signal ratios were calculated. The status of each PLC structure, including the popliteal tendon, arcuate ligament, lateral collateral ligament, and biceps tendon, was classified as normal, partially torn, or completely torn, as was that of the cruciate ligaments. For the semiquantitative analysis of interobserver agreement, the kappa statistic was calculated, whereas a receiver operating characteristic (ROC) curve was used for the quantitative analysis. RESULTS: In the patient group, radiologist A found CPN abnormalities in 15 cases (39.4%)-neurapraxia in eight and axonotmesis in seven-whereas radiologist B found CPN abnormalities in 14 (36.8%)-neurapraxia in nine and axonotmesis in five. The kappa statistic showed excellent interobserver agreement. In the control group, the CPN/TN signal ratio ranged from 0.63 to 1.1 and the CPN/SV signal ratio ranged from 0.16 to 0.41, compared with 1.30-4.02 and 0.27-1.08, respectively, in the patient group. The ROC curve analysis demonstrated that the CPN/TN signal ratio at a cutoff value of 1.39 had high (93.3%) specificity for the identification of nerve damage, compared with 81.3% for the CPN/SV signal ratio at a cutoff value of 0.41. CONCLUSION: CPN alterations are common in patients with PLC injury detected on MRI, and the level of interobserver agreement for such alterations was excellent. Calculating the CPN/TN and CPN/SV signal ratios may increase diagnostic confidence. We recommend systematic analysis of the CPN in cases of PLC injury.
OBJETIVO: Avaliar critérios de identificação de lesão no nervo fibular comum (NFC) por ressonância magnética (RM) em pacientes com lesão aguda e subaguda no canto posterolateral (CPL) e avaliar a reprodutibilidade na identificação de alterações do NFC. MATERIAIS E MÉTODOS: Foram incluídos, retrospectivamente, 38 pacientes consecutivos submetidos a RM e com diagnóstico de lesão aguda ou subaguda no CPL do joelho, constituindo o grupo de pacientes. Outros 38 pacientes com RM normal foram utilizados como grupo controle. Dois radiologistas musculoesqueléticos (A e B) analisaram as imagens. A lesão neural foi classificada em neuropraxia, axoniotmese ou neurotmese. Foi medida a intensidade do sinal no NFC, no nervo tibial (NT) e em uma veia superficial (VS), e calculadas as razões de sinal NFC/NT e NFC/VS. Estruturas do CPL, incluindo tendão poplíteo, ligamento arqueado, ligamento colateral lateral e tendão do bíceps, foram classificadas como normal, rotura parcial ou rotura completa. Os ligamentos cruzados também foram avaliados segundo os mesmos critérios. O teste kappa foi utilizado para avaliar a concordância interobservador para as classificações semiquantitativas. Curva ROC foi utilizada para análise quantitativa. RESULTADOS: O radiologista A encontrou alterações no NFC em 15 casos (39,4%): 8 neuropraxias, 7 axoniotmeses e nenhuma neurotmese. O radiologista B encontrou alterações no NFC em 14 casos (36,8%): 9 neuropraxias, 5 axoniotmeses e nenhuma neurotmese. O teste kappa mostrou alta concordância interobservador. No grupo controle, a razão NFC/NT variou entre 0,63-1,1 e a razão NFC/VS variou entre 0,16-0,41. Para o grupo de pacientes, a razão NFC/NT variou entre 1,30-4,02 e a razão NFC/VS variou entre 0,27-1,08. A análise com curva ROC demonstrou alta especificidade (93,3%) com relação à razão NFC/NT, usando um valor de corte de 1,39. Houve boa especificidade (81,3%) para a razão NFC/VS usando um valor de corte de 0,41. CONCLUSÃO: As alterações do NFC são detectadas com frequência nas lesões do CPL nas imagens de RM, com concordância interobservadores quase perfeita. Usando as razões de intensidade de sinal entre o NFC e o NT e entre o NFC e a VS, aumenta a confiança no diagnóstico. Recomendamos a análise sistemática do NFC nos casos de lesão do CPL.
ABSTRACT
Abstract Objective: To evaluate qualitative and quantitative magnetic resonance imaging (MRI) criteria for injury of the common peroneal nerve (CPN) in patients with acute or subacute injuries in the posterolateral corner (PLC) of the knee, as well as to evaluate the reproducibility of MRI evaluation of CPN alterations. Materials and Methods: This was a retrospective study of 38 consecutive patients submitted to MRI and diagnosed with acute or subacute injury to the PLC of the knee (patient group) and 38 patients with normal MRI results (control group). Two musculoskeletal radiologists (designated radiologist A and radiologist B, respectively) evaluated the images. Nerve injury was classified as neurapraxia, axonotmesis, or neurotmesis. Signal strength was measured at the CPN, the tibial nerve (TN), and a superficial vein (SV). The CPN/TN and CPN/SV signal ratios were calculated. The status of each PLC structure, including the popliteal tendon, arcuate ligament, lateral collateral ligament, and biceps tendon, was classified as normal, partially torn, or completely torn, as was that of the cruciate ligaments. For the semiquantitative analysis of interobserver agreement, the kappa statistic was calculated, whereas a receiver operating characteristic (ROC) curve was used for the quantitative analysis. Results: In the patient group, radiologist A found CPN abnormalities in 15 cases (39.4%)-neurapraxia in eight and axonotmesis in seven-whereas radiologist B found CPN abnormalities in 14 (36.8%)-neurapraxia in nine and axonotmesis in five. The kappa statistic showed excellent interobserver agreement. In the control group, the CPN/TN signal ratio ranged from 0.63 to 1.1 and the CPN/SV signal ratio ranged from 0.16 to 0.41, compared with 1.30-4.02 and 0.27-1.08, respectively, in the patient group. The ROC curve analysis demonstrated that the CPN/TN signal ratio at a cutoff value of 1.39 had high (93.3%) specificity for the identification of nerve damage, compared with 81.3% for the CPN/SV signal ratio at a cutoff value of 0.41. Conclusion: CPN alterations are common in patients with PLC injury detected on MRI, and the level of interobserver agreement for such alterations was excellent. Calculating the CPN/TN and CPN/SV signal ratios may increase diagnostic confidence. We recommend systematic analysis of the CPN in cases of PLC injury.
Resumo Objetivo: Avaliar critérios de identificação de lesão no nervo fibular comum (NFC) por ressonância magnética (RM) em pacientes com lesão aguda e subaguda no canto posterolateral (CPL) e avaliar a reprodutibilidade na identificação de alterações do NFC. Materiais e Métodos: Foram incluídos, retrospectivamente, 38 pacientes consecutivos submetidos a RM e com diagnóstico de lesão aguda ou subaguda no CPL do joelho, constituindo o grupo de pacientes. Outros 38 pacientes com RM normal foram utilizados como grupo controle. Dois radiologistas musculoesqueléticos (A e B) analisaram as imagens. A lesão neural foi classificada em neuropraxia, axoniotmese ou neurotmese. Foi medida a intensidade do sinal no NFC, no nervo tibial (NT) e em uma veia superficial (VS), e calculadas as razões de sinal NFC/NT e NFC/VS. Estruturas do CPL, incluindo tendão poplíteo, ligamento arqueado, ligamento colateral lateral e tendão do bíceps, foram classificadas como normal, rotura parcial ou rotura completa. Os ligamentos cruzados também foram avaliados segundo os mesmos critérios. O teste kappa foi utilizado para avaliar a concordância interobservador para as classificações semiquantitativas. Curva ROC foi utilizada para análise quantitativa. Resultados: O radiologista A encontrou alterações no NFC em 15 casos (39,4%): 8 neuropraxias, 7 axoniotmeses e nenhuma neurotmese. O radiologista B encontrou alterações no NFC em 14 casos (36,8%): 9 neuropraxias, 5 axoniotmeses e nenhuma neurotmese. O teste kappa mostrou alta concordância interobservador. No grupo controle, a razão NFC/NT variou entre 0,63-1,1 e a razão NFC/VS variou entre 0,16-0,41. Para o grupo de pacientes, a razão NFC/NT variou entre 1,30-4,02 e a razão NFC/VS variou entre 0,27-1,08. A análise com curva ROC demonstrou alta especificidade (93,3%) com relação à razão NFC/NT, usando um valor de corte de 1,39. Houve boa especificidade (81,3%) para a razão NFC/VS usando um valor de corte de 0,41. Conclusão: As alterações do NFC são detectadas com frequência nas lesões do CPL nas imagens de RM, com concordância interobservadores quase perfeita. Usando as razões de intensidade de sinal entre o NFC e o NT e entre o NFC e a VS, aumenta a confiança no diagnóstico. Recomendamos a análise sistemática do NFC nos casos de lesão do CPL.
ABSTRACT
OBJECTIVE: To evaluate the anatomical variations of the attachment of the inferior glenohumeral ligament (IGHL) to the anterior glenoid rim. MATERIALS AND METHODS: This was a retrospective review of 93 magnetic resonance arthrography examinations of the shoulder. Two radiologists, who were blinded to the patient data and were working independently, read the examinations. Interobserver and intraobserver agreement were evaluated. The pattern of IGHL glenoid attachment and its position on the anterior glenoid rim were recorded. RESULTS: In 50 examinations (53.8%), the glenoid attachment was classified as type I (originating from the labrum), whereas it was classified as type II (originating from the glenoid neck) in 43 (46.2%). The IGHL emerged at the 4 o'clock position in 58 cases (62.4%), at the 3 o'clock position in 14 (15.0%), and at the 5 o'clock position in 21 (22.6%). The rates of interobserver and intraobserver agreement were excellent. CONCLUSION: Although type I IGHL glenoid attachment is more common, we found a high prevalence of the type II variation. The IGHL emerged between the 3 o'clock and 5 o'clock positions, most commonly at the 4 o'clock position.
OBJETIVO: Avaliar variações anatômicas da inserção do ligamento glenoumeral inferior (LGUI) na margem anterior da glenoide. MATERIAIS E MÉTODOS: Avaliação retrospectiva de 93 exames de artrorressonância magnética de ombro. Foram realizadas leituras por dois radiologistas para calcular a concordância interobservador e intraobservador. O padrão de inserção glenoidal do LGUI e o seu nível foram registrados. RESULTADOS: Em 50 exames (53,8%) o LGUI inseria no lábio (tipo 1) e em 43 (46,2%) foi demonstrada uma variação tipo 2. O LGUI emergiu na posição de 4 horas em 58 casos (62,4%), na posição de 3 horas em 14 (15%) e na posição de 5 horas 21 (22,6%). A concordância interobservador e intraobservador para a classificação das variações anatômicas da inserção do LGUI foi excelente. CONCLUSÃO: Embora seja mais comum o LGUI inserir diretamente no lábio anteroinferior, encontramos alta prevalência do LGUI inserindo diretamente na borda óssea da glenoide. O LGUI originou-se entre as posições de 3 e 5 horas, mais frequentemente na posição 4 horas.