RESUMO
OBJECTIVE: The medical world is continuously evolving, with techniques being created or improved almost daily. Immersive virtual reality (VR) is a technology that could be harnessed to develop tools that meet the educational challenges of this changing environment. We previously described the immersive tutorial, a 3D video (filmed from the first-person point of view), displayed on a VR application. This tool offers access to supplementary educational data in addition to the video. Here we attempt to assess improvement in learning a technique using this new educational format. MATERIAL AND METHODS: We selected a single neurosurgical technique for the study: external ventricular drainage. We wrote a technical note describing this procedure and produced the corresponding immersive tutorial. We conducted a prospective randomized comparative study with students. All participants read the technical note, and one group used the immersive tutorial as a teaching supplement. The students completed a multiple-choice questionnaire immediately after the training and again at six months. RESULTS: One hundred seventy-six fourth-year medical students participated in the study; 173 were included in assessing the immediate learning outcomes and 72 were included at the six-month follow-up. The VR group demonstrated significantly better short-term results than the control group (P=0.01). The same trend was seen at six months. CONCLUSION: To our knowledge, this study presents one of the largest cohorts for VR. The use of the immersive tutorial could enable a large number of healthcare professionals to be trained without the need for expensive equipment.
Assuntos
Neurocirurgia/educação , Realidade Virtual , Adulto , Ventrículos Cerebrais , Competência Clínica , Drenagem/métodos , Avaliação Educacional , Feminino , Humanos , Masculino , Aprendizagem Baseada em Problemas , Estudos Prospectivos , Treinamento por Simulação , Estudantes de Medicina , Inquéritos e Questionários , Gravação em VídeoRESUMO
PURPOSE: The goal of this data challenge was to create a structured dynamic with the following objectives: (1) teach radiologists the new rules of General Data Protection Regulation (GDPR), while building a large multicentric prospective database of ultrasound, computed tomography (CT) and MRI patient images; (2) build a network including radiologists, researchers, start-ups, large companies, and students from engineering schools, and; (3) provide all French stakeholders working together during 5 data challenges with a secured framework, offering a realistic picture of the benefits and concerns in October 2018. MATERIALS AND METHODS: Relevant clinical questions were chosen by the Société Francaise de Radiologie. The challenge was designed to respect all French ethical and data protection constraints. Multidisciplinary teams with at least one radiologist, one engineering student, and a company and/or research lab were gathered using different networks, and clinical databases were created accordingly. RESULTS: Five challenges were launched: detection of meniscal tears on MRI, segmentation of renal cortex on CT, detection and characterization of liver lesions on ultrasound, detection of breast lesions on MRI, and characterization of thyroid cartilage lesions on CT. A total of 5,170 images within 4 months were provided for the challenge by 46 radiology services. Twenty-six multidisciplinary teams with 181 contestants worked for one month on the challenges. Three challenges, meniscal tears, renal cortex, and liver lesions, resulted in an accuracy>90%. The fourth challenge (breast) reached 82% and the lastone (thyroid) 70%. CONCLUSION: Theses five challenges were able to gather a large community of radiologists, engineers, researchers, and companies in a very short period of time. The accurate results of three of the five modalities suggest that artificial intelligence is a promising tool in these radiology modalities.
Assuntos
Inteligência Artificial , Conjuntos de Dados como Assunto , Neoplasias da Mama/diagnóstico por imagem , Comunicação , Segurança Computacional , Humanos , Relações Interprofissionais , Córtex Renal/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Invasividade Neoplásica/diagnóstico por imagem , Cartilagem Tireóidea/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Lesões do Menisco Tibial/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
PURPOSE: To assess the distribution of bone lesions in patients with prostate cancer (PCa) and those with multiple myeloma (MM) using whole-body magnetic resonance imaging (MRI); and to assess the added value of four anatomical regions located outside the thoraco-lumbo-pelvic area to detect the presence of bone lesions in a patient-based perspective. MATERIALS AND METHODS: Fifty patients (50 men; mean age, 67±10 [SD] years; range, 59-87 years) with PCa and forty-seven patients (27 women, 20 men; mean age, 62.5±9 [SD] years; range, 47-90 years) with MM were included. Three radiologists assessed bone involvement in seven anatomical areas reading all MRI sequences. RESULTS: In patients with PCa, there was a cranio-caudal increasing prevalence of metastases (22% [11/50] in the humeri and cervical spine to 60% [30/50] in the pelvis). When the thoraco-lumbo-pelvic region was not involved, the prevalence of involvement of the cervical spine, proximal humeri, ribs, or proximal femurs was 0% in patients with PCa and≥4% (except for the cervical spine, 0%) in those with MM. CONCLUSION: In patients with PCa, there is a cranio-caudal positive increment in the prevalences of metastases and covering the thoraco-lumbo-pelvic area is sufficient to determine the metastatic status of a patient with PCa. In patients with MM, there is added value of screening all regions, except the cervical spine, to detect additional lesions.
Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Imageamento por Ressonância Magnética/métodos , Mieloma Múltiplo/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário , Imagem Corporal Total/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/secundário , Humanos , Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/diagnóstico por imagemRESUMO
INTRODUCTION: Coracoid bone graft transfer has become the gold standard in patients with recurrent anterior shoulder instability associated with bony defect. Several studies have shown that the main stabilizing component of this procedure is the sling effect by the conjoint tendon and the lower portion of subscapularis (SS). The purpose of this study was to determine whether a larger SS volume below the bone block was correlated to greater postoperative shoulder stability. MATERIALS AND METHODS: This prospective study included a cohort of patients who underwent open coracoid bone graft transfer for post-traumatic recurrent anterior shoulder instability. Forty patients were reviewed at 2 years with a clinical and CT scan evaluation. A correlation analysis assessed the relation between the SS volume index (ratio of SS volume below the bone block to volume over the bone block) and Rowe and Walch-Duplay instability scores. RESULTS: There exists a positive and significant correlation between SS volume index and postoperative Rowe score, r=0.37 (P=0.03). The same trend was observed for Walch-Duplay score without statistical significance. A larger inferior SS volume did not result in a limitation of external rotation, greater fatty infiltration, or malposition of the coracoid graft. CONCLUSION: A larger SS volume below the bone block is related to greater postoperative shoulder stability. We recommend performing the split in the middle of the SS or higher instead of the junction of the superior two-thirds and inferior one-third as usually reported. LEVEL OF EVIDENCE: III, prospective study.
Assuntos
Transplante Ósseo/métodos , Processo Coracoide/transplante , Instabilidade Articular/cirurgia , Osteotomia , Manguito Rotador/cirurgia , Luxação do Ombro/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Manguito Rotador/anatomia & histologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVE: The primary goal of this study was to determine the prevalence and topographic distribution of spinal lesions in lower thoracic and lumbar spine on magnetic resonance imaging (MRI) in patients with recently diagnosed with spondyloarthritis. The secondary goal was to identify variables associated with vertebral patterns consistent with spondyloarthritis on MRI. PATIENTS AND METHODS: A total of 112 HLA-B27 positive patients with recently diagnosed spondyloarthritis were retrospectively included. There were 70 women and 42 men, with a mean age of 41 years±12 (SD) (range: 17-70years). Mean symptom duration was 1year (range: 0-7years). MRI examinations of sacroiliac joints and thoracolumbar spine were reviewed for the presence of bone marrow edema, chronic structural abnormalities, and vertebral patterns consistent with spondyloarthritis. Age, gender and disease duration of patients with vertebral patterns on MRI consistent with spondyloarthritis were compared with those without MRI signs of spondyloarthritis. RESULTS: Thirty-six patients (32.1%) showed spinal patterns of spondyloarthritis, including 16 patients (14.3%) with no associated inflammatory sacroiliitis. Posterior inflammatory lesions were present in 20.5% of patients. Posterior spinal inflammatory lesions were significantly associated with vertebral corner inflammatory lesions (P=0.03). There were no differences in age, sex or mean duration of symptoms between the two groups of patients. CONCLUSION: Spinal involvement is observed in 32.1% of HLA-B27 positive patients with recently diagnosed spondyloarthritis and is not associated with sacroiliitis in 14.3%. Age, gender or symptom duration are not associated with spinal involvement on MRI.
Assuntos
Vértebras Lombares/diagnóstico por imagem , Articulação Sacroilíaca/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/epidemiologia , Vértebras Torácicas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Antígeno HLA-B27/análise , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
Tumors and tumor-like lesions of the knee are common conditions. Because the synovial membrane covers a large part of the knee, tumors and tumor-like lesions of the knee are mostly synovial. Magnetic resonance imaging (MRI) plays a major role in the assessment and characterization of these lesions. However, the diagnostic approach of these lesions must be performed systematically. First, the lesion must be precisely located, and then the anatomical structure involved must be determined. Finally, clinical background that includes the age of the patient, frequency of the disease and, if any, associated signs as well as MRI characteristics must be analyzed. In this review, we describe the anatomy of the knee and its compartments and provide a description of the main tumors and tumor-like lesions of the knee. We present a diagnostic approach based on the location within the knee of the lesions and the anatomical structures involved.
Assuntos
Articulação do Joelho/diagnóstico por imagem , Condromatose Sinovial/diagnóstico por imagem , Cistos/diagnóstico por imagem , Hemangioma/diagnóstico por imagem , Humanos , Lipoma/diagnóstico por imagem , Imageamento por Ressonância Magnética , Sarcoma Sinovial/diagnóstico por imagem , Membrana Sinovial/diagnóstico por imagem , Membrana Sinovial/patologia , Sinovite Pigmentada Vilonodular/diagnóstico por imagemRESUMO
Various types of knee arthroplasty implants are available depending on the number of knee compartments to be replaced and ligament stability. Unlike unicompartmental arthroplasty, the aim of total knee replacement is to maintain normal knee alignment. EOS X-ray imaging in the coronal and sagittal planes is the best modality for measuring the reference axes of the knee, but may by complemented by CT scans in the transverse plane. In addition to implant-related complications such as loosening and polyethylene wear, complications of the knee extensor mechanism are sometimes observed. Conventional radiography remains the first-line diagnostic modality in the event of post-knee replacement pain or instability. Ultrasound and CT imaging may also be helpful to make diagnosis.
Assuntos
Artroplastia do Joelho/efeitos adversos , Prótese do Joelho/efeitos adversos , Bursite/diagnóstico por imagem , Fibrose/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Humanos , Instabilidade Articular/diagnóstico por imagem , Ossificação Heterotópica/diagnóstico por imagem , Osteólise/diagnóstico por imagem , Patela/diagnóstico por imagem , Patela/lesões , Complicações Pós-Operatórias/diagnóstico por imagem , Desenho de Prótese , Falha de Prótese , Infecções Relacionadas à Prótese/diagnóstico por imagem , Membrana Sinovial/diagnóstico por imagem , Membrana Sinovial/patologia , Sinovite/diagnóstico por imagem , Tendinopatia/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico por imagemRESUMO
Posttraumatic carpal and carpometacarpal dislocations represent a heterogeneous group of disorders resulting from high-energy wrist trauma. Perilunate injury is the most common and best-known manifestation of carpal dislocation, typically occurring after hyperextension trauma. Other forms are very rare and have different causative mechanisms. Carpometacarpal (CMC) dislocations are also uncommon and may affect isolated or multiple CMC joints. These lesions are prone to wrist instability if not treated promptly. The aim of this article is to provide a systematic radiologic approach to the evaluation of wrist injury and to present two acute cases of rare CMC dislocations.
Assuntos
Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/lesões , Luxações Articulares/diagnóstico por imagem , Articulação Metacarpofalângica/diagnóstico por imagem , Articulação Metacarpofalângica/lesões , Acidentes de Trânsito , Adulto , Pinos Ortopédicos , Articulações Carpometacarpais/cirurgia , Feminino , Humanos , Luxações Articulares/cirurgia , Masculino , Articulação Metacarpofalângica/cirurgia , Pessoa de Meia-IdadeRESUMO
On sagittal images after anterior cruciate ligament (ACL) reconstructions, the femoral tunnel aperture should be at the junction of the line drawn along the posterior femoral cortex and the line drawn along the roof of the intercondylar notch (Bluemensaat line). The tibial tunnel aperture should be in the anterior portion of the second third, i.e. anterior aspect of the middle of the tibial epiphysis. An inaccurate placement of the femoral tunnel affects the graft isometry. A tibial tunnel too anteriorly placed results in intercondylar notch roof impingement. After meniscus surgery, first-line MRI is often sufficient to diagnose new tears; however, sometimes it is necessary to perform CT arthrography or MR arthrography. Surgical cartilage repair is evaluated based on articular congruity and on the appearance of the subchondral bone.
Assuntos
Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroplastia Subcondral , Transplante Ósseo , Enxerto Osso-Tendão Patelar-Osso , Cartilagem/transplante , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Fibrose/diagnóstico por imagem , Fraturas de Cartilagem/diagnóstico por imagem , Fraturas de Cartilagem/cirurgia , Humanos , Articulação do Joelho/patologia , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Tendões/transplanteRESUMO
There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis.
Assuntos
Osteomielite/diagnóstico , Osteomielite/etiologia , Ossos Pélvicos , Úlcera por Pressão/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Idoso , Anti-Infecciosos/uso terapêutico , Biomarcadores , Comorbidade , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Ossos Pélvicos/microbiologia , Ossos Pélvicos/patologia , Úlcera por Pressão/complicações , Estudos Prospectivos , Fatores de RiscoAssuntos
Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo/patologia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Recidiva Local de Neoplasia , Condicionamento Pré-Transplante , Transplante Homólogo , Resultado do TratamentoAssuntos
Angiomioma/diagnóstico , Cotovelo/diagnóstico por imagem , Cotovelo/patologia , Neoplasias Musculares/diagnóstico , Adulto , Angiomioma/cirurgia , Biópsia/métodos , Meios de Contraste , Diagnóstico Diferencial , Cotovelo/cirurgia , Gadolínio , Humanos , Aumento da Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Neoplasias Musculares/cirurgia , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia de Intervenção/métodosRESUMO
We report the case of five patients referred to our department with Hoffa's disease: three patients were at the initial stage of the disease and the two others had reached the chronic stage. This condition is one of the less well-documented causes of pain in the anterior compartment of the knee. The pathophysiological mechanism is still unclear. It is probably caused by repetitive micro trauma resulting in inflammatory, haemorrhagic and fibrous changes to Hoffa's fat pad. The final outcome of the disease is an osteochondroma. The diagnosis is established by MRI, which demonstrates inflammation of the fat pat. At the chronic stage, a standard X-ray is sufficient to demonstrate ossification of the fat pad.
Assuntos
Tecido Adiposo/patologia , Artralgia/etiologia , Artropatias/diagnóstico , Articulação do Joelho/patologia , Patela/patologia , Adulto , Feminino , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico , Tomografia Computadorizada por Raios X/métodosAssuntos
Traumatismos em Atletas/complicações , Traumatismos em Atletas/fisiopatologia , Exercício Físico/fisiologia , Músculo Esquelético/fisiopatologia , Mialgia/diagnóstico , Mialgia/fisiopatologia , Dor Aguda/sangue , Dor Aguda/etiologia , Dor Aguda/fisiopatologia , Traumatismos em Atletas/sangue , Creatina Quinase Forma MM/sangue , Diagnóstico Diferencial , Feminino , Humanos , Perna (Membro)/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Mialgia/etiologia , Fatores de Tempo , Adulto JovemRESUMO
The authors propose a pictorial review illustrating the imaging features of chest wall tumors and their specific features that discusses the main differential diagnoses. This review is based on published information and on our own experience.
Assuntos
Neoplasias Ósseas/diagnóstico , Costelas , Adulto , Idoso , Criança , Diagnóstico por Imagem , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Cartilaginous tumours of the extremities are commonly seen in radiographs. Enchondroma is the most frequently encountered tumour. Since the vast majority of enchondromas are asymptomatic, they are typically discovered as incidental findings or along with a pathologic fracture. The authors propose a pictorial review to illustrate the imaging features of cartilaginous bone lesions of the hand and their specificities, and discuss the main differential diagnoses.
Assuntos
Neoplasias Ósseas/patologia , Calcinose/patologia , Cartilagem/patologia , Condroma/patologia , Condrossarcoma/patologia , Encondromatose/patologia , Ossos da Mão/patologia , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Falanges dos Dedos da Mão/patologia , Fraturas Espontâneas/patologia , Gota/patologia , Humanos , Osteocondromatose/patologia , Periósteo/patologiaRESUMO
Fractures of the hip and pelvis are frequent and serious injuries in elderly patients. Due to the aging population, their incidence should double by 2050. Therefore, the social and economical implications of these fractures are significant. Delay in diagnosis increases the associated morbidity and mortality. The purpose is to review the imaging features of these fractures, the imaging techniques (projections, CT) to depict them and their classification based on severity.
Assuntos
Fraturas Ósseas/diagnóstico , Fraturas do Quadril/diagnóstico , Ossos Pélvicos/lesões , Idoso , Diagnóstico por Imagem , Fraturas Ósseas/classificação , Fraturas do Quadril/classificação , HumanosRESUMO
Total hip arthroplasty is a frequent procedure with functional outcome that generally is excellent and lasting. Routine imaging follow-up is necessary to detect complications such as loosening and wearing out. Additional imaging with scintigraphy, CT, ultrasound or MRI may be necessary.
Assuntos
Artroplastia de Quadril , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Articulação do Quadril/cirurgia , Humanos , Imageamento por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/patologia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Surgical management of lesions of the knee has exponentially increased over the last several years. MRI plays a major role in postoperative follow-up and evaluation of patients with residual symptoms. Familiarity with the different surgical procedures and potential complications and knowledge of normal and abnormal postoperative MRI findings are essential for evaluation of the postoperative knee. The main purpose of this article is to review the postoperative imaging features of ligaments, menisci and cartilage of the knee joint since these MRI features may lead the surgeon to consider repeat surgery.