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Background: Geographic non-enhancing zones in diabetic foot magnetic resonance imaging (MRI) were first described in 2002. No previous report has described the impact and clinical significance of geographic non-enhancing tissue seen in the evaluation of diabetic foot MRI. Purpose: To evaluate the prevalence of devascularization areas on contrast-enhanced MRI in diabetic patients suspected of having foot osteomyelitis, the impact on the performance of the MRI assessment, and the possible pitfalls. Methods: A retrospective study was conducted between January 2016 and December 2017 during which 72 CE-MRIs of 1.5 and 3T were reviewed by 2 musculoskeletal radiologists for the presence of non-enhancing tissue areas and for osteomyelitis. A blinded third party collected clinical data including pathology reports, revascularization procedures, and surgical interventions. The prevalence of devascularization was calculated. Results: Among the 72 CE-MRIs (54 men, 18 women; mean age 64), 28 demonstrated non-enhancing areas (39%). All but 6 patients were found to have been correctly diagnosed on imaging (3 false positives, 2 false negatives, and 1 non-diagnostic). A greater discordance was also observed between the radiological and pathological diagnoses in the MRIs which showed non-enhancing tissue. Conclusion: Non-enhancing tissue is found in a non-negligible portion of diabetic foot MRIs and affects its diagnostic performance when looking for osteomyelitis. The recognition of these areas of devascularization may be helpful for the physician in planning the best treatment option for the patient.
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Diabetes Mellitus , Pé Diabético , Osteomielite , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Pé Diabético/diagnóstico por imagem , Pé Diabético/patologia , Estudos Retrospectivos , Osteomielite/diagnóstico por imagem , Osteomielite/patologia , Imageamento por Ressonância Magnética/métodos , RadiografiaRESUMO
OBJECTIVE: Evaluate the efficacy of ultrasound-guided dry needling and open-release surgery in reducing pain and improving function in workers with lateral epicondylosis refractory to at least 6 months of nonsurgical management. METHODS: We randomly assigned participants in a 1:1 ratio to receive dry needling or surgery. The primary outcome was the Patient Rated Tennis Elbow Evaluation (PRTEE) score at 6 months. Secondary outcome measures examined the impact of these techniques on professional activity, grip strength, and Global Rating of Change and Satisfaction scales. Statistical analyses included mixed-effects models and Fisher's exact tests. RESULTS: From October 2016 through June 2019, we enrolled 64 participants. Two participants were excluded, and data from 62 participants (48 ± 8 years, 33 men) with a mean duration of symptoms of 23 ± 21 months were analyzed. Baseline characteristics were similar in both groups. In the intention-to-treat analysis, no treatment-by-time interaction was observed (F(4,201) = 0.72; p = .58). The least-squares mean difference from baseline in PRTEE scores at 6 months was 33.4 (CI 25.2 - 41.5) in the surgery group and 26.9 (CI 19.4 - 34.4) in the dry needling group (p = .25). The proportion of successful treatment was 83% (CI 63 - 95%) and 81% (CI 63 - 93%) in the surgery and dry needling groups, respectively (p = 1.00). Changes in secondary outcomes were in the same direction as those of the primary outcome. No adverse event occurred. CONCLUSIONS: Ultrasound-guided dry needling resulted in comparable improvement in outcome scores on scales of pain, physical function, and global assessment of change and satisfaction than open-release surgery. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02710682 KEY POINTS: ⢠In patients with chronic lateral epicondylosis, ultrasound-guided tendon dry needling provides comparable therapeutic efficacy to open-release surgery. ⢠Ultrasound-guided tendon dry needling allows for an earlier return to work and may be less costly than open-release surgery. ⢠Care management guidelines should recommend treatment by ultrasound-guided tendon dry needling before open-release surgery.
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Agulhamento Seco , Cotovelo de Tenista , Masculino , Humanos , Resultado do Tratamento , Tendões , Cotovelo de Tenista/cirurgia , Dor , Ultrassonografia de IntervençãoRESUMO
OBJECTIVE: To determine if T1- and T2*-mapping of the gluteal tendons can discriminate between participants with and without clinical findings of gluteal tendinopathy (GT) and if they correlate with clinical assessment. MATERIALS AND METHODS: This prospective study was conducted between January and December 2016. MRI of the hip included spin echo, short-T1 inversion recovery, variable-flip angle, and variable echo-time gradient echo sequences. MRI studies were reviewed independently by two radiologists. Two other readers segmented the gluteal tendons and T1, mono- (T2*m) and bi-exponential T2* (short (T2*s) and long (T2*l) components) were computed. RESULTS: Ten participants with GT (median age; interquartile range: 63 (57-67) years, all women) and 9 participants without GT (57 (55-59) years, 8 women) (P = 0.06) were enrolled. The sensitivity and specificity of reader 1 for disease classification were 40% (95% confidence interval (CI): 17-61%) and 70% (CI: 47-91%), and those of reader 2 were 70% (CI: 43-86%) and 80% (CI: 53-96%), with fair inter-reader agreement (Kappa = .38). T1 values could not discriminate between the two groups. The gluteal tendons T2*m and T2*s showed diagnostic accuracy ranging from .80 to .89. The posterior gluteus medius tendon T2*m and T2*s respectively showed sensitivity and specificity of 90%, and strong correlation (Spearman's rho = -.71; P = 0.02) with the Lower Extremity Functional Scale score. CONCLUSION: Quantitative MRI could help gain new insight into healthy and diseased gluteal tendons to allow better diagnosis and treatment stratification for patients.
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Tendinopatia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Tendinopatia/diagnóstico por imagem , TendõesRESUMO
OBJECTIVE. The purpose of this article is to show the sonographic anatomy of the extremities relevant to various ligamentous, tendinous, and articular injuries occurring in the hand, wrist, and ankle. A brief discussion and depiction of the specific elements relevant to the pathophysiologic mechanism of these entities is followed by demonstrations of the dynamic ultrasound techniques that can be used to diagnose these injuries. The schematics and video clips illustrate the normal and pathologic features of these injuries. The first two videos discuss soft-tissue injuries to the hand and wrist, and the third addresses ankle injuries. CONCLUSION. After clinical assessment, dynamic ultrasound examination is a useful tool for diagnosing and assessing the degree of severity of several soft-tissue injuries to the extremities, some of which can be detected only during active movement. Familiarity with these specific dynamic techniques will enhance the value of the ultrasound examination.
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Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos da Mão/diagnóstico por imagem , Lesões dos Tecidos Moles/diagnóstico por imagem , Ultrassonografia/métodos , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Tornozelo/fisiopatologia , Traumatismos da Mão/fisiopatologia , Humanos , Lesões dos Tecidos Moles/fisiopatologia , Traumatismos do Punho/fisiopatologiaRESUMO
OBJECTIVES: To evaluate lesion filling and other factors that could affect the clinical outcomes of cementoplasty for pelvic bone metastases. METHODS: We retrospectively reviewed the files of 40 patients treated for 44 pelvic bone metastases, collected the parameters related to patients (pain relief evaluated on a visual analog scale, subsequent fractures, and need for surgery), lesions (size, cortical breach score, fracture, soft-tissue extension), and cementoplasty procedures (number of needles, volume of cement, percentage of lesion filling, cement leaks, residual acetabular roof defect), and performed a statistical analysis. RESULTS: The lesions were on average 43.2 mm in diameter and the mean cortical breach score was 2.5 out of 6, with a pathological fracture in 14 lesions. The number of needles inserted was one in 32 out of 44, two in 10 out of 44, and three in 2 out of 44. On average, the volume of cement injected per lesion was 10.3 ml and the filling was 54.8%. Mild or moderate asymptomatic cement leakage occurred in 20 lesions (45.5%). The mean pain score was 84.2 mm before the procedure (with no correlation with lesion size, cortical breach score or fracture) and 45.6 mm at follow-up. The pain relief of 38.6 mm was statistically significant (p < 0.001) and did not correlate with the filling percentage. There were no fractures of the treated lesions at a mean follow-up of 355 days. CONCLUSIONS: Cementoplasty of pelvic bone metastases appears effective for providing pain relief and may prevent subsequent fractures. We were unable to demonstrate a correlation between the lesion filling and the degree of pain relief.
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Neoplasias Ósseas/complicações , Cementoplastia/métodos , Fraturas Ósseas/cirurgia , Manejo da Dor/métodos , Ossos Pélvicos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos Ósseos/uso terapêutico , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Corticosteroids are routinely injected into soft tissues, tendon sheaths, bursae, and joints. These anti-inflammatory agents have different potency and solubility, and solubility is inversely correlated with the duration of action. Corticosteroids carry a low risk of complications but commonly cause systemic and local adverse effects. The use of intra-articular corticosteroid injections in the treatment of inflammatory arthritis and osteoarthritis is well established. Evidence also supports the use of injectable corticosteroids in the treatment of inflammatory tenosynovitis and bursitis associated with rheumatic diseases, trigger finger and de Quervain disease, and carpal tunnel syndrome. The role of corticosteroid injections in the management of rotator cuff disease remains unclear. Strong scientific evidence indicates that corticosteroid injections for lateral epicondylosis worsen the long-term outcomes of patients. This review article discusses the considerations related to the use of corticosteroid injections in the management of nonspinal musculoskeletal conditions.
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Corticosteroides/administração & dosagem , Doenças Musculoesqueléticas/tratamento farmacológico , Corticosteroides/efeitos adversos , Corticosteroides/farmacologia , Humanos , Injeções Intra-Articulares , Injeções IntramuscularesRESUMO
OBJECTIVES: To evaluate the feasibility of ultrasound (US)-guided cervical facet injections and to identify the potential obstacles to routine use of this technique. METHODS: After Institutional Review Board approval, 4 cadavers were used in this study. Age, sex, body mass index, and neck circumference were recorded. A total of 40 facet injections were performed from C2-C3 to C6-C7 under US guidance with radiodense colored latex. Visibility of cervical tissues and the needle was graded as complete, partial, or null (no injection was performed in this case). Frontal and lateral radiographs were taken, followed by cadaveric dissection to assess contrast and the latex distribution, which were recorded as intra-articular (success), peri-articular (success), or absent (failure). A 2-tailed Fisher exact test and Pearson χ(2)test were used to evaluate difference between success and failure rates for qualitative variables. RESULTS: Seventy-eight percent (31 of 40) of US-guided facet joint injections were successful. No statistically significant differences were found regarding body mass index, neck circumference, needle caliber, operators, and between left and right sides. All failures involved C2-C3 and C6-C7 levels, and this result was statistically significant (Pearson χ(2) = 20.645; P < .001). CONCLUSIONS: Although US-guided cervical facet joint injections are feasible, substantial obstacles may prevent their routine use. The main obstacle is to effectively identify and target the correct cervical level in a prone position.
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Fluoroscopia , Ultrassonografia de Intervenção/métodos , Articulação Zigapofisária/diagnóstico por imagem , Idoso , Cadáver , Estudos de Viabilidade , Feminino , Humanos , Injeções Intra-Articulares/métodos , MasculinoRESUMO
OBJECTIVES: Patients with axial SpA experience repeated spine imaging. EOS is a new low-dose imaging system with significantly lower irradiation than conventional radiography (CR). The objective was to explore the EOS performances compared with CR for the classification and follow-up of SpA. METHODS: We performed an observational, cross-sectional, single-centre study including SpA patients (definite diagnosis by expert opinion) and control patients [definite chronic mechanical low back pain (cLBP)]. All patients underwent pelvic and frontal and lateral CR of the entire spine and two-dimensional (2D) EOS imaging on the same day. Images were blindly assessed for sacroiliitis [modified New York criteria (mNY)] and for ankylosis of the spine [modified Stoke AS Spine Score (mSASSS)]. Global ease of interpretation was rated on a scale of 0-10. The primary outcome was intermodality agreement, with an a priori defined non-inferiority limit of 0.7. Interobserver, intra-observer and intermodality agreement were measured by kappa, weighted kappa, intraclass correlation coefficient and Bland-Altman plots. RESULTS: Forty-eight SpA patients [mean age 47.6 years (s.d. 14.9), symptom duration 21.4 years (s.d. 13.3), 35 (70%) men] and 48 cLBP controls [mean age 49.1 years (s.d. 10.7), 9 (22.5%) men] were included. Intermodality agreement between EOS and CR was 0.50 (95% CI 0.26, 0.75) and 0.97 (95% CI 0.95, 0.98) for sacroiliitis and mSASSS, respectively. Ease of interpretation was greater for CR [8.2 (s.d. 0.9)] compared with EOS [7.2 (s.d. 0.8), P < 0.0001). CONCLUSION: Our results suggest that EOS could replace CR for the follow-up of structural damage of the spine, but its place in the classification of sacroiliitis needs to be further explored.
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Espondilartrite/diagnóstico por imagem , Adulto , Estudos Transversais , Feminino , Humanos , Dor Lombar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Reprodutibilidade dos Testes , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To evaluate the usefulness of dynamic gadolinium-enhanced magnetic resonance imaging (MRI) for assessing the viability of the proximal pole of the scaphoid in patients with acute scaphoid fractures. METHODS: Eighteen consecutive patients with acute scaphoid fracture who underwent dynamic gadolinium-enhanced MRI 7 days or less before surgery were prospectively included between August 2011 and December 2012. All patients underwent MR imaging with unenhanced images, enhanced images, and dynamic enhanced images. A radiologist first classified the MRI results as necrotic or viable based on T1- and T2-weighted images only, followed by a second blinded interpretation, this time including analysis of pre- and post-gadolinium administration images and a third blinded interpretation based on the time-intensity curve of the dynamic enhanced study. The standard of reference was the histologic assessment of a cylindrical specimen of the proximal pole obtained during surgery in all patients. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for unenhanced, enhanced, and dynamic gadolinium-enhanced MRI studies. RESULTS: The sensitivity, specificity, PPV, and NPV were 67, 67, 50, and 80 % for unenhanced images, 83, 100, 100, and 92 for enhanced images, and 83, 92, 83, and 92 for dynamic contrast-enhanced images. CONCLUSIONS: Our data are consistent with previously reported data supporting contrast-enhanced MRI for assessment of viability, and showing that dynamic imaging with time-intensity curve analysis does not provide additional predictive value over standard delayed enhanced imaging for acute scaphoid fracture.
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Meios de Contraste , Fraturas Ósseas/diagnóstico , Aumento da Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Osso Escafoide/lesões , Traumatismos do Punho/diagnóstico , Doença Aguda , Adolescente , Adulto , Feminino , Gadolínio , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Osso Escafoide/patologia , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJECTIVE: To investigate the structural alterations, neovascularity, and elasticity of tendons and the relationship between elasticity and the Patient Rated Tennis Elbow Evaluation score after undergoing US-guided fenestration or surgery in patients with chronic lateral elbow tendinopathy. METHODS: Participants from the per-protocol population of a randomized trial conducted between October 2016 and June 2020 were included. The surgery and fenestration groups included 24 (mean age, 50 ± 7 years [standard deviation], 10 men) and 29 (47 ± 8 years, 18 men) participants, respectively. Ultrasound exams were performed at baseline, 6 months, and 12 months. Statistical analyses included linear mixed effects and generalized equation estimation models. RESULTS: Fenestration had no significant impact on tendon thickness (p = 0.46). Conversely, surgery significantly increased tendon thickness at 6 months (p < 0.0001) and remained elevated at 12 months (p = 0.04). Tendon echostructure exhibited a group effect (p = 0.03), indicating a higher proportion of pathological scores in the surgery group post-intervention compared to the fenestration group. Both groups showed a similar reduction in neovascularity from 6 to 12 months postintervention (p = 0.006). Shear-wave velocity increased in the fenestration group at 6 months (p = 0.04), while the surgery group experienced a nonsignificant decrease at 6 months, with some improvement at 12 months (p = 0.08). Changes in shear-wave velocity did not correlate with clinical outcome. CONCLUSIONS: Fenestration and surgery reduced tendon neovascularity over time. Unlike surgery, fenestration did not impact tendon size while improving tendon echostructure and elasticity. CRITICAL RELEVANCE STATEMENT: Fenestration and surgery equally alleviated symptoms and decreased tendon neovascularity in lateral elbow tendinopathy; however, fenestration did not alter tendon thickness and improved echostructure and shear-wave velocity, suggesting shear-wave velocity's potential for quantitatively monitoring tendon elasticity during healing. KEY POINTS: Reliable markers for monitoring healing response and informing treatment protocols in elbow tendinopathy are lacking. Fenestration and surgery reduced tendon neovascularity, while fenestration improved tendon echostructure and shear-wave velocity. Shear-wave velocity may provide quantitative measures to monitor tendon elasticity in response to treatment.
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PURPOSE: To characterize ultrasonographic (US) features in the hand of patients with systemic sclerosis (SSc) and to evaluate the sensitivity of US in the detection of calcinosis and acroosteolysis. MATERIALS AND METHODS: The local ethics committee approved this study, and oral informed consent was obtained. A total of 44 consecutive patients with SSc (34 women; mean age, 56.1 years ± 12.1 [standard deviation]; 10 men; mean age, 45.0 years ± 14.0) and 30 healthy control subjects (20 women; mean age, 46.3 years ± 12.1; 10 men; mean age, 39.6 years ± 10.8) were included between October 2010 and December 2011. Bilateral US, including Doppler assessment of the wrists, hands, and fingers, was performed, and presence of synovitis, tenosynovitis with or without a layered appearance, calcifications, acroosteolysis, and distal vascularization was recorded. Radiography of both hands was performed to assess for acroosteolysis and calcinosis. Frequency of US features, sensitivity of US for calcinosis and acroosteolysis, and respective confidence intervals were calculated. RESULTS: Synovitis was found in 17 patients (39%). Tenosynovitis was found in 12 patients (27%), and it had a layered pattern in 15 (41%) of 37 cases. Calcinosis was found in 17 patients (39%) with US, with a sensitivity of 89%. Acroosteolysis was found in nine (20%) patients with US and in 10 (23%) patients with radiography, with 90% sensitivity for US. Distal vascularization was detected in 26 patients (59%) and 30 control subjects (100%) and was in contact with the acroosteolysis bed in seven (78%) of nine patients with SSc. CONCLUSION: US can be used to assess features of SSc, including synovitis, tenosynovitis, calcinosis, acroosteolysis, and distal vascularization and is sensitive for calcinosis and acroosteolysis detection. A layered pattern (similar to the appearance of an artichoke heart) of tenosynovitis was seen commonly. Online supplemental material is available for this article.
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Mãos/diagnóstico por imagem , Escleroderma Sistêmico/diagnóstico por imagem , Ultrassonografia Doppler , Punho/diagnóstico por imagem , Acro-Osteólise/diagnóstico por imagem , Adulto , Idoso , Calcinose/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Sensibilidade e Especificidade , Sinovite/diagnóstico por imagem , Tenossinovite/diagnóstico por imagemRESUMO
OBJECTIVES: Radiological cervical spine involvement in JIA has already been assessed with a large range of prevalence (5-80%), but most studies were performed a long time ago, in symptomatic JIA and without differentiating subsets of JIA. We set out to describe structural cervical spine involvement in young adults with polyarticular JIA (pJIA) regardless of the cervical symptoms and to compare lesions with those observed in adult RA. METHODS: All consecutive pJIAs followed in a transition programme were included. Standard radiographs of the cervical spine, hands, feet and hip were analysed by two independent radiologists blinded to the diagnosis. An RA control group (<55 years), matched for sex and disease duration, was recruited. RESULTS: Fifty-seven pJIA and 58 RA patients were included. Radiographs showed cervical lesions in 65% of pJIA and 67% of RA patients. In total, 51% of pJIA with radiographic abnormalities had no clinical symptoms. In pJIA, the most frequent structural lesions were anterior atlantoaxial subluxation (33%), erosion of the odontoid process (19%), C1-C2 arthritis (17%) and apophyseal joint arthritis (16%). Cervical lesions in pJIA were similar to those in RA except for ankylosis and hypotrophia (P < 0.05). The presence of cervical lesions correlated with a more severe disease. CONCLUSION: Structural cervical spine involvement is common in pJIA persisting into adulthood, frequently asymptomatic and associated with a more severe disease. We suggest that radiographic assessment of the cervical spine should be done systematically at onset of the disease and regularly during its course regardless of clinical symptoms.
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Artrite Juvenil/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Adolescente , Adulto , Artrite Juvenil/sangue , Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico por imagem , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Criança , Estudos de Coortes , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Radiografia , Índice de Gravidade de Doença , Doenças da Coluna Vertebral/sangue , Adulto JovemRESUMO
Hip pain is a common clinical presentation of elderly patients in the emergency department. We report the clinical and imaging findings in 4 elderly patients with iliopsoas tendon tears who presented at our institution between October 2009 and June 2010. In 2 patients, the imaging diagnosis was significantly delayed. This injury is uncommon, and the clinical presentation in these patients may be misleading. Magnetic resonance is the imaging modality of choice after radiographs to assess these patients, and knowledge of the complex anatomy of the iliopsoas myotendinous unit helps in making the correct diagnosis. With aging of the population, the incidence of iliopsoas tendon tear is likely to increase.
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Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Imageamento por Ressonância Magnética/métodos , Traumatismos dos Tendões/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Dor/etiologia , Estudos Retrospectivos , Traumatismos dos Tendões/complicaçõesRESUMO
OBJECTIVE: Ganglion cysts are common hand masses. This article will answer three questions that the radiologist is often asked: A mass is palpable; is it a cyst? Pain or neurologic symptoms are present; are they related to a cyst? Surgery is being considered; where precisely are the cyst and its origin located? CONCLUSION: Ultrasound is often sufficient for assessing typical cysts. MRI is performed when atypical features or neurologic symptoms are present and in specific preoperative settings.
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Cistos/diagnóstico , Diagnóstico por Imagem , Mãos , Punho , Diagnóstico Diferencial , HumanosRESUMO
Vertebroplasty is a minimally invasive treatment option for osteolytic spinal lesions. It provides pain relief and stability with established good results. In this paper, we describe a new CT guided percutaneous vertebroplasty technique using a direct lateral approach between the carotid sheath and the vertebral artery, that can be safely performed under conscious sedation in an outpatient setting. We report the case of a patient presenting a lytic lesion of C2 treated using the CT guided percutaneous vertebroplasty under conscious sedation. Local anesthesia using approximately 10 mL of lidocaine 1% was delivered in the skin, soft tissues and to the periosteum of C2. With the patient in dorsal decubitus on the CT table, a bone biopsy needle was introduced laterally, through the parotid and between the carotid artery and vertebral artery. The entry point on C2 was right under the lateral mass of C1 and anterolaterally to the vertebral vascular foramen. The procedure was well tolerated by the patient. No neurological changes were noted per-operatively. No immediate or short-term complications were noted. Patient was observed on a stretcher for 2 hours with nursing supervision before being discharged home. Patient reported satisfactory pain control at 6-month follow-up. CT guided percutaneous vertebroplasty under conscious sedation can be safely performed in an outpatient setting.
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BACKGROUND: Diabetic foot infections are frequent and associated with substantial morbidity and substantial cost to the healthcare system. Up to 34% of diabetic patients will develop an ulcer potentially leading to osteomyelitis. Imaging plays a crucial role in the diagnostic process. Imaging modalities to investigate the diabetic foot infection are many and imaging prescription habits remain heterogeneous across physicians. We aimed to improve the appropriateness of imaging examination requested, and performed, for diabetic foot osteomyelitis and we aimed to reduce the overall imaging-related cost. METHODS: Local committee was created to develop an algorithm for suspected diabetic foot osteomyelitis. Best practices were defined by the local algorithm. The algorithm was shared with our physicians. Pre- and post-intervention analysis was conducted retrospectively. All adult diabetic patients with suspected foot osteomyelitis were included. Adherence to best practices was measured. Statistical analysis with Chi-Square and two tailed unpaired t-test was performed. RESULTS: Pre-intervention cohort had 223 patients (mean age: 63; 168 men). Adherence to best practice was 43%. Scintigraphy (48%) preferred over MRI (44%) and performed simultaneously in 15 patients. Post-intervention cohort had 73 patients (mean age: 66; 62 men). Adherence to best practice was 78%, improved by 35% (p < 0.001). MRI (51%) preferred over scintigraphy (23%) and performed simultaneously in three patients. Scintigraphy examinations decreased by 25% (p < 0.001). MRI examinations increased by 7% (p = 0.32). Hospital imaging related fees decreased by 22% per patient (p = 0.002). CONCLUSION: Interval improvement in adequate adherence while reducing unnecessary examinations for patients and decreasing costs for the healthcare system was observed.
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Cystic Fibrosis (CF) is the most common lethal genetic disorder in Caucasian populations, affecting roughly 70,000 individuals worldwide. This autosomal recessive disorder causes a wide spectrum of multisystemic manifestations, most of which are either directly or indirectly related to defective epithelial chloride secretion. The current median life expectancy is 44 years; however, a significant proportion of the CF population now live into the 5th decade and beyond due to advances in treatment. As life expectancy of CF patients increases, there is a newly emerging adult CF population with unique radiological manifestations spanning multiple organ systems, which often require follow-up imaging. The goal of this article is to review the multiple systemic manifestations and complications of CF on different imaging modalities and explore the appropriate radiological follow up recommended.
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Fibrose Cística , Adulto , Fibrose Cística/complicações , Fibrose Cística/diagnóstico por imagem , Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Humanos , Radiografia , RadiologistasAssuntos
Traumatismos dos Dedos , Tendões , Humanos , Tendões/cirurgia , Dedos , Ruptura , Traumatismos dos Dedos/cirurgiaRESUMO
Musculoskeletal calcifications are frequent on radiographs and sometimes problematic. The goal of this article is to help radiologists to make the correct diagnosis when faced with an extraosseous musculoskeletal calcification. One should first differentiate a calcification from an ossification or a foreign body and then locate the calcification correctly. Each location has a specific short differential diagnosis, with minimal further investigation necessary. Intra-tendon calcifications are most frequently associated with hydroxyapatite deposition disease (HADD). In most cases, intra-articular calcifications are caused by calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. Soft tissue calcification can be caused by secondary tumoural calcinosis from renal insufficiency, or collagen vascular diseases and by vascular calcifications, either arterial or venous (phlebolith). TEACHING POINTS: ⢠Calcifications have to be differentiated form ossification and foreign body. ⢠A musculoskeletal MRI study must always be correlated with a radiograph. ⢠The clinical manifestations of calcifications may sometimes mimic septic arthritis or sarcoma. ⢠HADD and CPPD crystal deposition have a distinct appearance on radiograph. ⢠Calcinosis is more frequently caused by chronic renal failure and scleroderma.
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We report a case of painful and disabling anterior acetabular bone metastasis treated with bipolar radiofrequency ablation and cementoplasty. Due to the high risk of complications related to the proximity of the femoral neurovascular structures with a direct approach, we successfully performed a retrograde transpubic approach under combined CT and fluoroscopic guidance. In the present report, we describe this approach detailing its indications, advantages, and the technical tips to achieve a safe and satisfactory procedure.