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Palot Manzil FF, Eichhorn J, Kaur H. Systemic and Neurosarcoidosis With Rare Involvement of the Extremities' Peripheral Nerves. Clin Nucl Med 2024; 49:e292-e294. [PMID: 38557810 DOI: 10.1097/rlu.0000000000005176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
ABSTRACT We present a case of sarcoidosis with a rare presentation of involvement of peripheral nerves of the lower limbs and subcutaneous nodules detected on 18 F-FDG PET/CT. The patient also had involvement of the spinal nerves and dura, histologically proven to be sarcoidosis. There were other manifestations of systemic sarcoidosis like metabolically active cervical and mediastinal lymphadenopathy. This case highlights the role of 18 F-FDG PET/CT in evaluating the uncommon sites of sarcoid involvement. Although many cases of sarcoid involvement of central nervous system have been reported, peripheral nerves involvement in the extremities was not found on a literature search.
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Fleury AS, Zhuang H. Recurrent Metastatic Ewing Sarcoma Involving Only in the Muscles of Extremities Shown on FDG PET/CT. Clin Nucl Med 2024; 49:589-591. [PMID: 38537215 DOI: 10.1097/rlu.0000000000005202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
ABSTRACT Ewing sarcoma is the second most common osseous malignancy in pediatric patient. Metastasis is common due to its aggressive nature, with 25% of patients with metastasis at diagnosis, commonly to the lungs, bone, or bone marrow. Muscle metastasis is uncommon. We report FDG PET/CT findings of multifocal muscle metastases of recurrent Ewing sarcoma in the extremities without lung and bone involvement in a 6-year-old boy.
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Li A, Hu Y, Cui XW, Ye XH, Peng XJ, Lv WZ, Zhao CK. Predicting the malignancy of extremity soft-tissue tumors by an ultrasound-based radiomics signature. Acta Radiol 2024; 65:470-481. [PMID: 38321752 DOI: 10.1177/02841851231217227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Accurate differentiation of extremity soft-tissue tumors (ESTTs) is important for treatment planning. PURPOSE To develop and validate an ultrasound (US) image-based radiomics signature to predict ESTTs malignancy. MATERIAL AND METHODS A dataset of US images from 108 ESTTs were retrospectively enrolled and divided into the training cohort (78 ESTTs) and validation cohort (30 ESTTs). A total of 1037 radiomics features were extracted from each US image. The most useful predictive radiomics features were selected by the maximum relevance and minimum redundancy method, least absolute shrinkage, and selection operator algorithm in the training cohort. A US-based radiomics signature was built based on these selected radiomics features. In addition, a conventional radiologic model based on the US features from the interpretation of two experienced radiologists was developed by a multivariate logistic regression algorithm. The diagnostic performances of the selected radiomics features, the US-based radiomics signature, and the conventional radiologic model for differentiating ESTTs were evaluated and compared in the validation cohort. RESULTS In the validation cohort, the area under the curve (AUC), sensitivity, and specificity of the US-based radiomics signature for predicting ESTTs malignancy were 0.866, 84.2%, and 81.8%, respectively. The US-based radiomics signature had better diagnostic predictability for predicting ESTT malignancy than the best single radiomics feature and the conventional radiologic model (AUC = 0.866 vs. 0.719 vs. 0.681 for the validation cohort, all P <0.05). CONCLUSION The US-based radiomics signature could provide a potential imaging biomarker to accurately predict ESTT malignancy.
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Fu T, Viswanathan V, Attia A, Zerbib-Attal E, Kosaraju V, Barger R, Vidal J, Bittencourt LK, Faraji N. Assessing the Potential of a Deep Learning Tool to Improve Fracture Detection by Radiologists and Emergency Physicians on Extremity Radiographs. Acad Radiol 2024; 31:1989-1999. [PMID: 37993303 DOI: 10.1016/j.acra.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the standalone performance of a deep learning (DL) based fracture detection tool on extremity radiographs and assess the performance of radiologists and emergency physicians in identifying fractures of the extremities with and without the DL aid. MATERIALS AND METHODS The DL tool was previously developed using 132,000 appendicular skeletal radiographs divided into 87% training, 11% validation, and 2% test sets. Stand-alone performance was evaluated on 2626 de-identified radiographs from a single institution in Ohio, including at least 140 exams per body region. Consensus from three US board-certified musculoskeletal (MSK) radiologists served as ground truth. A multi-reader retrospective study was performed in which 24 readers (eight each of emergency physicians, non-MSK radiologists, and MSK radiologists) identified fractures in 186 cases during two independent sessions with and without DL aid, separated by a one-month washout period. The accuracy (area under the receiver operating curve), sensitivity, specificity, and reading time were compared with and without model aid. RESULTS The model achieved a stand-alone accuracy of 0.986, sensitivity of 0.987, and specificity of 0.885, and high accuracy (> 0.95) across stratification for body part, age, gender, radiographic views, and scanner type. With DL aid, reader accuracy increased by 0.047 (95% CI: 0.034, 0.061; p = 0.004) and sensitivity significantly improved from 0.865 (95% CI: 0.848, 0.881) to 0.955 (95% CI: 0.944, 0.964). Average reading time was shortened by 7.1 s (27%) per exam. When stratified by physician type, this improvement was greater for emergency physicians and non-MSK radiologists. CONCLUSION The DL tool demonstrated high stand-alone accuracy, aided physician diagnostic accuracy, and decreased interpretation time.
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Fastner S, Creveling P, Shen N, Horns JJ, Bowles TL, Hyngstrom J, Asare EA. Single-Photon Emission Computed Tomography/Computed Tomography Utilization for Extremity Melanomas at a High-Volume Center. J Surg Res 2024; 296:196-202. [PMID: 38277957 DOI: 10.1016/j.jss.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/22/2023] [Accepted: 12/23/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Planar lymphoscintigraphy (PL) is commonly used in mapping before sentinel lymph node biopsy (SLNB) for invasive cutaneous melanoma. Recently, single-photon emission computed tomography (SPECT)/ computed tomography (CT) has been utilized, in addition to PL, for detailed anatomic information and detection of sentinel lymph nodes (SLNs) outside of the primary nodal basin in truncal and head and neck melanoma. Following a protocol change due to COVID-19, our institution began routinely obtaining both PL and SPECT-CT imaging for all melanoma SLN mapping. We hypothesized that SPECT-CT is associated with higher instances of SLNBs from "nontraditional" nodal basins (NTNB) for extremity melanomas. METHODS Patients with extremity melanoma (2017-2022) who underwent SLNB were grouped into SPECT-CT with PL versus PL alone. Outcomes were total SLNs removed, + or-SLN status, total NTNB sampled, and postoperative complication rate. Poisson regression and logistic regression models were used to assess association of SPECT-CT with patient outcomes. RESULTS Of 380 patients with extremity melanoma, 42.11% had SPECT-CT. There were no differences between the groups with regards to age at diagnosis or sex. From 2020 to 2022, all patients underwent SPECT-CT. SPECT-CT was associated with increased odds of SLNB from an NTNB, (odds ratio = 2.39 [95% confidence interval: 1.25-4.67]). There was no difference in odds of number of SLNs sampled, SLN positivity rate, or postoperative complication rate with SPECT-CT. CONCLUSIONS Routine SPECT-CT was associated with higher incidence of SLNB in NTNB but did not increase number of SLNs removed or SLN positivity rate. The added value of routine SPECT-CT in cutaneous melanoma of the extremities remains to be defined.
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Priester JI, Simister SK, Sario M, Choi J, Pina D, Theriault R, Bateni C, Ghasemiesfe A, Carr-Ascher J, Monjazeb AM, Canter RJ, Randall RL, Thorpe SW. Scrutinizing the use of contrasted chest CTs in extremity sarcoma staging and surveillance. J Surg Oncol 2024; 129:523-530. [PMID: 37997294 DOI: 10.1002/jso.27510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/18/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Since 2015, the American College of Radiology (ACR) has recommended staging for lung metastasis via chest computed tomography (CT) without contrast for extremity sarcoma staging and surveillance. The purpose of this study was to determine our institutional compliance with this recommendation. METHODS This was a retrospective chart review of patients diagnosed with sarcoma in the extremities who received CT imaging of the chest for pulmonary staging and surveillance at our institution from 2005 to 2023. A total of 1916 CT studies were included for analysis. We scrutinized ordering patterns before and after 2015 based on the ACR-published metastasis staging and screening guidelines. An institutional and patient cost analysis was performed between CT modalities. RESULTS The prevalence of CT scans ordered and performed with contrast was greater than those without contrast both prior and post-ACR 2015 guidelines. Furthermore, 79.2% of patient's final surveillance CTs after 2015 were performed with contrast. A cost analysis was performed and demonstrated an additional $297 704 in patient and institutional costs. CONCLUSIONS At our institution, upon review of CT chest imaging for pulmonary staging and surveillance in patients with extremity sarcoma the use of contrast has been routinely utilized despite a lack of evidence for its necessity and contrary to ACR guidelines.
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Pitman J, Endo Y. Neurovascular structures to avoid during musculoskeletal ultrasound-guided intervention in the extremities. Skeletal Radiol 2024; 53:1-17. [PMID: 37318586 DOI: 10.1007/s00256-023-04372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
Ultrasound is a useful modality for guiding injections and other procedures in the extremities. Its portability and the ability to adjust the probe and needle in real time, as well as lack of radiation exposure make it preferable for many routine procedures. However, ultrasound is highly operator dependent and a firm understanding of regional anatomy is important, including neurovascular structures that are in close proximity during many of these procedures. Knowledge of the characteristic location and appearance of neurovascular structures in the extremities allows safe needle advancement and prevention of iatrogenic complications.
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Srinivasan S, Keerthivasagam S, Kumar S, Puri A. Impact of Surveillance Imaging in Detecting Local and Metastatic Lung Recurrences Among Patients with Sarcomas of the Extremities: A Systematic Review and Meta-analysis. Ann Surg Oncol 2024; 31:213-227. [PMID: 37865942 DOI: 10.1245/s10434-023-14429-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The surveillance guidelines following treatment completion for patients with high-grade sarcomas of the extremities are based largely upon expert opinions and consensus. In the current meta-analysis, we aim to study the utility of surveillance imaging to diagnose local and metastatic pulmonary relapses among patients with extremity soft tissue sarcomas and primary bone sarcomas. PATIENTS AND METHODS A meta-analysis was performed to assess the sensitivity, specificity and diagnostic odds ratio (DOR) of surveillance imaging to diagnose local and metastatic pulmonary relapse among patients with sarcoma of the extremities. In addition, impact of surveillance imaging on overall survival was assessed. Heterogeneity among eligible studies was evaluated by I2 statistics. Sensitivity analysis was assessed using influence plots and Baujat plots. RESULTS Ten studies including 2160 patients with sarcoma were found eligible. For diagnoses of local recurrence based on surveillance imaging (nine studies, 1917 patients), the estimated sensitivity, specificity, and DOR were 13.6%, 99.5%, and 78.15, respectively. Only 16.7% of local recurrences were diagnosed based on imaging. For diagnoses of metastatic pulmonary recurrence (eight studies; 1868 patients), estimated sensitivity, specificity, and DOR were 76.1%, 99.3%, and 1059.9, respectively. A sensitivity analysis showed significant heterogeneity among included studies. None of the included studies showed an overall-survival benefit with the use of surveillance imaging. CONCLUSION The current meta-analysis challenges the notion of routine use of imaging to detect local relapse, while favoring chest imaging, using either chest radiography or computed tomography scan, for surveillance. Further studies are required to study the ideal surveillance strategy including timing and imaging modality.
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De Lamarliere MG, Lusque A, Khalifa JA, Esteyrie V, Chevreau C, Valentin T, Gangloff D, Meresse T, Courtot L, Rochaix P, Boulet B, Graulieres E, Ducassou A. Management of tumor volume changes during preoperative radiotherapy for extremity soft tissue sarcoma: a new strategy of adaptive radiotherapy. Radiol Oncol 2023; 57:507-515. [PMID: 38038424 PMCID: PMC10690743 DOI: 10.2478/raon-2023-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/25/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Using adaptive radiotherapy (ART), to determine objective clinical criteria that identify extremity soft tissue sarcoma (ESTS) patients requiring adaptation of their preoperative radiotherapy (RT) plan. PATIENTS AND METHODS We included 17 patients with a lower extremity ESTS treated between 2019 and 2021 with preoperative RT, using helicoidal intensity-modulated RT (IMRT) tomotherapy, before surgical resection. We collected clinical, tumor parameters and treatment data. Repositioning was ascertained by daily Megavoltage computed tomography (MVCT) imaging. Using the PreciseART technology we retrospectively manually delineated at least one MVCT for each patient per week and recorded volume and dosimetric parameters. A greater than 5% change between target volume and planned target volume (PTV) dosimetric coverage from the initial planning CT scan to at least one MVCT was defined as clinically significant. RESULTS All 17 patients experienced significant tumor volume changes during treatment; 7 tumors grew (41%) and 10 shrank (59%). Three patients (18%), all undifferentiated pleomorphic sarcomas (UPS) with increased volume changes, experienced significant reductions in tumor dose coverage. Seven patients required a plan adaptation, as determined by practical criteria applied in our departmental practice. Among these patients, only one ultimately experienced a significant change in PTV coverage. Three patients had a PTV decrease of coverage. Among them, 2 did not receive plan adaptation according our criteria. None of the patients with decreased tumor volumes had reduced target volume coverage. Monitoring volume variations by estimating gross tumor volume (GTV) on MVCT, in addition to axial and sagittal linear tumor dimensions, appeared to be most effective for detecting reductions in PTV coverage throughout treatment. CONCLUSIONS Variations in ESTS volume are evident during preoperative RT, but significant dosimetric variations are rare. Specific attention should be paid to grade 2-3 UPSs during the first 2 weeks of treatment. In the absence of dedicated software in routine clinical practice, monitoring of tumor volume changes by estimating GTV may represent a useful strategy for identifying patients whose treatment needs to be replanned.
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Allen V, Tofighi S, Davis DL. Extra-capsular floating fat at the extremity: a review. Skeletal Radiol 2023; 52:2367-2376. [PMID: 37133516 DOI: 10.1007/s00256-023-04356-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/04/2023]
Abstract
Extra-capsular floating fat may present in a variety of non-articular locations at the extremity. Manifestation of floating fat or fat-fluid level(s) outside of a joint is a marker of trauma or infection. Recognizing radiologic sign(s) of extra-capsular floating fat can aid radiologists to provide an informed differential diagnosis and facilitate clinical care. This review discusses the etiology, mechanisms, and imaging appearance of extracapsular floating fat in specific anatomic and non-anatomic locations at the extremity.
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Yoon HJ, Woo KJ, Kim JY, Kang SY, Moon BS, Kim BS. The added value of SPECT/CT lymphoscintigraphy in the initial assessment of secondary extremity lymphedema patients. Sci Rep 2023; 13:19494. [PMID: 37945581 PMCID: PMC10636025 DOI: 10.1038/s41598-023-44471-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Abstract
An added value of SPECT/CT over planar lymphoscintigraphy for initial staging in patients with secondary extremity lymphedema was investigated. Furthermore, we developed a hybrid SPECT/CT classification combining dermal backflow (DBF) of SPECT and honeycomb pattern (HP) of CT, correlated it with lymphoscintigraphic staging and clinical severity. Forty-one patients with secondary extremity lymphedema who underwent lymphoscintigraphy with SPECT/CT were included retrospectively. The severity of extremity lymphedema was assessed using CT volumetry. Lymphoscintigraphic findings were evaluated using the Taiwan Lymphoscintigraphy Staging (TLS), and CT-based and SPECT-based quantitative analysis were performed. TLS was performed by planar scintigraphy only and with SPECT/CT, respectively. The SPECT/CT findings were classified into DBF-/HP-, DBF+/HP-, DBF+/HP+, and DBF-/HP+. Based on these findings, patients were categorized into five classes: Class 1 = DBF-HP- entire limb, Class 2 = DBF+/HP- proximal/distal limb without DBF+/HP+ or DBF-/HP+, Class 3 = DBF+/HP+ proximal/distal limb without DBF-/HP+, Class 4 = Mixed DBF+/HP+ and DBF-/HP+ in proximal/distal limb, Class 5 = DBF-/HP+ entire limb. Adding SPECT/CT to planar scintigraphy showed a 15.4% modification rate in lymphoscintigraphic staging. HP volume ratio significantly increased as clinical severity and lymphoscintigraphic staging increased, while DBF volume ratio increased with severity and followed expected patterns according to lymphoscintigraphic staging. Hybrid SPECT/CT lymphoscintigraphic classification showed strong positive correlation with clinical severity and TLS. Our results demonstrated substantial modification of lymphoscintigraphic staging by adding SPECT/CT to a conventional planar scintigraphy. In addition, a hybrid SPECT/CT is expected to provide new indicators reflecting lymphoscintigraphic staging and clinical severity by providing both of functional DBF and anatomical HP information.
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Nagata S, Tanaka N, Kuhara A, Kugiyama T, Tanoue S, Koganemaru M, Uchiyama Y, Fujimoto K, Abe T. Value of fat-suppressed T2-weighted imaging for predicting short-term pain relief after sclerotherapy for venous malformations in the extremities. Jpn J Radiol 2023; 41:1157-1163. [PMID: 37170024 PMCID: PMC10543150 DOI: 10.1007/s11604-023-01442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE This study aimed to evaluate the value of fat-suppressed T2-weighted imaging (FS-T2WI) for predicting short-term pain relief after polidocanol sclerotherapy for painful venous malformations (VMs) in the extremities. MATERIALS AND METHODS This retrospective study included patients with painful VMs in the extremities between October 2014 and September 2021, had their first sclerotherapy without history of surgical therapy, and underwent magnetic resonance imaging before sclerotherapy. Pain relief was assessed 2 months after 3% polidocanol sclerotherapy and was categorized as follows: progression, no change, partial relief, or free of pain. The associations between pain relief and imaging features on FS-T2WI were analyzed. RESULTS The study included 51 patients. The no change, partial relief, and free of pain groups included 6 (11.8%), 25 (49.0%), and 20 (39.2%) patients, respectively. No patient experienced progressive pain. The lesion diameter was ≤ 50 mm in 13 (65.0%) patients in the free of pain group, whereas it was > 50 mm in all patients in the no change group (p = 0.019). The lesions showed well-defined margin in 15 (75.0%) patients in the free of pain group, whereas they showed ill-defined margin in 5 (83.3%) patients in the no change group (p = 0.034). The most common morphological type was cavitary in the free of pain group (14 [70.0%] patients), whereas there was no patient with cavitary type lesion in the no change group (p = 0.003). Drainage vein was demonstrated in 6 (100%), 22 (88.0%), and 11 (55.0%) patients in the no change, partial relief, and free of pain group, respectively (p = 0.011). CONCLUSION A lesion size of 50 mm or less, a well-defined margin, a cavitary type, and no drainage vein on FS-T2WI were significant features for predicting short-term pain relief after polidocanol sclerotherapy for painful VMs in the extremities.
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Archer H, Ashikyan O, Pezeshk P, Guirguis M, Gowda P, Hoang D, Xi Y, Chhabra A. Predictive Value of Radiographic and Magnetic Resonance Imaging Characteristics on Patient Outcomes in Confirmed Acute Osteomyelitis of the Extremities. J Comput Assist Tomogr 2023; 47:759-765. [PMID: 37707406 DOI: 10.1097/rct.0000000000001483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether imaging characteristics on plain radiography, magnetic resonance imaging (MRI), and diffusion-weighted imaging are predictive of patient outcomes in cases of confirmed osteomyelitis (OM). MATERIALS AND METHODS In this cross-sectional study, 3 experienced musculoskeletal radiologists evaluated pathologically proven cases of acute extremity OM and recorded imaging characteristics on plain radiographs, MRI, and diffusion-weighted imaging. These characteristics were then compared with the patient outcomes after a 3-year follow-up using length of stay, amputation-free survival, readmission-free survival, and overall survival using multivariate Cox regression analysis. Hazard ratio and corresponding 95% confidence intervals are reported. False discovery rate-adjusted P values were reported. RESULTS For the 75 consecutive cases of OM in this study, multivariate Cox regression analysis adjusting for sex, race, age, body mass index, erythrocyte sedimentation rate, C-reactive protein, and white blood cell count showed no correlation among any of the recorded characteristics on imaging and patient outcomes. Despite the high sensitivity and specificity of MRI for diagnosing OM, there was no correlation between MRI characteristics and patient outcomes. Furthermore, patients with coexistent abscess of the soft tissue or bone with OM had comparable outcomes using the previously mentioned metrics of length of stay, amputation-free survival, readmission-free survival, and overall survival. CONCLUSION Neither radiography nor MRI features predict patient outcomes in extremity OM.
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Longo C, Pampena R, Moscarella E, Chester J, Starace M, Cinotti E, Piraccini BM, Argenziano G, Peris K, Pellacani G. Dermoscopy of melanoma according to different body sites: Head and neck, trunk, limbs, nail, mucosal and acral. J Eur Acad Dermatol Venereol 2023; 37:1718-1730. [PMID: 37210653 DOI: 10.1111/jdv.19221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/21/2023] [Indexed: 05/22/2023]
Abstract
Effective cancer screening detects early-stage tumours, leading to a lower incidence of late-stage disease over time. Dermoscopy is the gold standard for skin cancer diagnosis as diagnostic accuracy is improved compared to naked eye examinations. As melanoma dermoscopic features are often body site specific, awareness of common features according to their location is imperative for improved melanoma diagnostic accuracy. Several criteria have been identified according to the anatomical location of the melanoma. This review provides a comprehensive and contemporary review of dermoscopic melanoma criteria according to specific body sites, including frequently observed melanoma of the head/neck, trunk and limbs and special site melanomas, located on the nail, mucosal and acral region.
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Gorelik N, Rula EY, Pelzl CE, Hemingway J, Christensen EW, Brophy JM, Gyftopoulos S. Imaging Utilization Patterns in the Follow-Up of Extremity Soft Tissue Sarcomas in the United States. Curr Probl Diagn Radiol 2023; 52:357-366. [PMID: 37236841 DOI: 10.1067/j.cpradiol.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/17/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
This study aimed to describe patterns of imaging utilization after resection of extremity soft tissue sarcoma in the United States, assess for potential disparities, and evaluate temporal trends. A retrospective cohort study using a national database of private payer claims data was performed to determine the utilization rate of extremity and chest imaging in a 5-year postoperative follow-up period for patients with extremity soft tissue sarcoma treated between 2007 and 2019. Imaging utilization was assessed according to patient demographics (age, sex, race and ethnicity, and region of residency), calendar year of surgery, and postoperative year. Associations of demographic variables with imaging use were assessed using chi-square tests, trends in imaging use were analyzed using the Cochran-Armitage trend test or linear regression, and associations of postoperative year with imaging use were evaluated with the Pearson Correlation coefficient. A total of 3707 patients were included. Most patients received at least 1 chest (74%) and extremity (53%) imaging examination during their follow-up period. The presence of surveillance imaging was significantly associated with age (P < 0.0001) and region (P = 0.0029). Over the study period, there was an increase in use of extremity MRI (P < 0.05) and ultrasound (P < 0.01) and chest CT (P < 0.0001) and a decrease in use of chest radiographs (P < 0.0001). Imaging use declined over postoperative years (decrease by 85%-92% from year 1-5). In conclusion, the use of surveillance imaging varied according to patient demographics and has increased for extremity MRI and ultrasound and chest CT over the study period.
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AIUM Practice Parameter for the Performance of Physiologic Evaluation of Extremity Arteries. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:E49-E54. [PMID: 37132482 DOI: 10.1002/jum.16246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023]
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Niziolek GM, Keating J, Bailey J, Klingensmith NJ, Moren AM, Skarupa DJ, Loria A, Vella MA, Maher Z, Moore SA, Smith MC, Leung A, Shuster KM, Seamon MJ. Rethinking protocolized completion angiography following extremity vascular trauma: A prospective observational multicenter trial. J Trauma Acute Care Surg 2023; 95:105-110. [PMID: 37038254 DOI: 10.1097/ta.0000000000003925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Completion angiography (CA) is commonly used following repair of extremity vascular injury and is recommended by the Eastern Association for the Surgery of Trauma practice management guidelines for extremity trauma. However, it remains unclear which patients benefit from CA because only level 3 evidence exists. METHODS This prospective observational multicenter (18LI, 2LII) analysis included patients 15 years or older with extremity vascular injuries requiring operative management. Clinical variables and outcomes were analyzed with respect to with our primary study endpoint, which is need for secondary vascular intervention. RESULTS Of 438 patients, 296 patients required arterial repair, and 90 patients (30.4%) underwent CA following arterial repair. Institutional protocol (70.9%) was cited as the most common reason to perform CA compared with concern for inadequate repair (29.1%). No patients required a redo extremity vascular surgery if a CA was performed per institutional protocol; however, 26.7% required redo vascular surgery if the CA was performed because of a concern for inadequate repair. No differences were observed in hospital mortality, length of stay, extremity ischemia, or need for amputation between those who did and did not undergo CA. CONCLUSION Completion angiogram following major extremity injury should be considered in a case-by-case basis. Limiting completion angiograms to those patients with concern for an inadequate vascular repair may limit unnecessary surgery and morbidity. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Bello HR, Heilbrun ME, Kallas ON, Thongkham DW, Powell CD, Moreno CC. Ultrasound Evaluation for Extremity Deep Vein Thrombus in COVID-19-Positive Patients: Exam Positivity Rate and Association With D-Dimer Level. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1475-1481. [PMID: 34562041 PMCID: PMC8661823 DOI: 10.1002/jum.15832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/16/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Determine the rate of positive extremity ultrasound exams for DVT in patients with COVID-19 and assess for differences in laboratory values in patients with and without DVT, which could be used as a surrogate to decide the need for further evaluation with ultrasound. METHODS Retrospective case control study with 1:2 matching of cases (COVID-19+ patients) to controls (COVID-19- patients) based on age, gender, and race. Laboratory values assessed were serum D-dimer, fibrinogen, prothrombin time, international normalized ratio, and C-reactive protein. Demographic variables, comorbidities, and clinical variables including final disposition were also evaluated. P-values for categorical variables were calculated with the chi-square test or Fisher's exact test. P-values for continuous variables were compared with the use of a two-tailed unpaired t-test. RESULTS The rate of extremity ultrasound exams positive for DVT were similar in patients with (14.7%) and without (19.3%) COVID-19 (P = .423). No significant difference was observed in laboratory values including the D-dimer level in COVID-19 patients without (mean 9523.9 ng/mL (range 339 to >60,000)) or with DVT (mean 13,663.7 ng/mL (range 1193->60,000)) (P = .475). No differences were found in demographic variabilities or co-morbidities among COVID-19 patients with and without extremity DVT. CONCLUSIONS We found no statistically significant difference in rate of positive DVT studies between COVID-19+ and COVID-19- patients. D-dimer levels are elevated, in some cases markedly, in COVID-19 patients with and without DVTs and therefore these data do not support their use as a surrogate when assessing the need for ultrasound evaluation.
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Edo H, Matsunaga A, Matsukuma S, Mikoshi A, Susa M, Horiuchi K, Shinmoto H. Angioleiomyoma of the extremities: correlation of magnetic resonance imaging with histopathological findings in 25 cases. Skeletal Radiol 2022; 51:837-848. [PMID: 34463813 DOI: 10.1007/s00256-021-03888-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify the characteristic magnetic resonance imaging (MRI) findings in angioleiomyoma and to clarify its relationship with histopathological findings. MATERIALS AND METHODS We retrospectively analyzed the MRI findings and pathological subtypes in 25 patients with subcutaneous angioleiomyoma of the extremities. Based on the previous reports, MRI findings that could be characteristic of angioleiomyoma were extracted. According to the World Health Organization classification, all cases were classified into three pathological subtypes: solid, venous, and cavernous. The relationship between MRI findings and pathological subtypes was analyzed. RESULTS The pathological subtypes were solid (n = 10), venous (n = 11), and cavernous (n = 4). The following MRI findings were observed: (a) hypo- or iso-intense linear and/or branching structures on a T2-weighted image (positive total/solid/venous/cavernous: 19/5/10/4, respectively), which we defined as "dark reticular sign"; (b) peripheral hypointense rim on a T2-weighted image (positive total/solid/venous/cavernous: 19/7/8/4, respectively); and (c) presence of any adjacent vascular structures (positive total/solid/venous/cavernous: 6/3/3/0, respectively). Chi-square test showed a significant relationship between dark reticular sign and pathological subtypes (p = 0.0426). The dark reticular sign was found more frequently in the venous and cavernous types than in the solid type. The other MRI findings did not reveal a significant relationship between pathological subtypes. CONCLUSION We present the largest case series exploring MRI findings in angioleiomyoma. The dark reticular sign was a characteristic MRI finding of angioleiomyoma and was seen in most of the venous and cavernous types, which may facilitate preoperative diagnosis.
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Damanti S, Cilla M, Tuscano B, De Lorenzo R, Manganaro G, Merolla A, Pacioni G, Pomaranzi C, Tiraferri V, Martinenghi S, Vitali G, Bosi E, Conte C, Giustina A, Tresoldi M, Rovere Querini P. Evaluation of Muscle Mass and Stiffness with Limb Ultrasound in COVID-19 Survivors. Front Endocrinol (Lausanne) 2022; 13:801133. [PMID: 35250860 PMCID: PMC8892603 DOI: 10.3389/fendo.2022.801133] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND acute illnesses, like COVID-19, can act as a catabolic stimulus on muscles. So far, no study has evaluated muscle mass and quality through limb ultrasound in post-COVID-19 patients. METHODS cross sectional observational study, including patients seen one month after hospital discharge for SARS-CoV-2 pneumonia. The patients underwent a multidimensional evaluation. Moreover, we performed dominant medial gastrocnemius ultrasound (US) to characterize their muscle mass and quality. RESULTS two hundred fifty-nine individuals (median age 67, 59.8% males) were included in the study. COVID-19 survivors with reduced muscle strength had a lower muscle US thickness (1.6 versus 1.73 cm, p =0.02) and a higher muscle stiffness (87 versus 76.3, p = 0.004) compared to patients with normal muscle strength. Also, patients with reduced Short Physical Performance Battery (SPPB) scores had a lower muscle US thickness (1.3 versus 1.71 cm, p = 0.01) and a higher muscle stiffness (104.9 versus 81.07, p = 0.04) compared to individuals with normal SPPB scores. The finding of increased muscle stiffness was also confirmed in patients with a pathological value (≥ 4) at the sarcopenia screening tool SARC-F (103.0 versus 79.55, p < 0.001). Muscle stiffness emerged as a significant predictor of probable sarcopenia (adjusted OR 1.02, 95% C.I. 1.002 - 1.04, p = 0.03). The optimal ultrasound cut-offs for probable sarcopenia were 1.51 cm for muscle thickness (p= 0.017) and 73.95 for muscle stiffness (p = 0.004). DISCUSSION we described muscle ultrasound characteristics in post COVID-19 patients. Muscle ultrasound could be an innovative tool to assess muscle mass and quality in this population. Our preliminary findings need to be confirmed by future studies comparing muscle ultrasound with already validated techniques for measuring muscle mass and quality.
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Park H, Yoon Y, Kim E, Jeong H, Kim J. Monitoring clinical exposure index and deviation index for dose optimization based on national diagnostic reference level: Focusing on general radiography of extremities. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:419-432. [PMID: 35124635 DOI: 10.3233/xst-211084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The International Electrotechnical Commission established the concept of the exposure index (EI), target exposure index (EIT) and deviation index (DI). Some studies have conducted to utilize the EI as a patient dose monitoring tool in the digital radiography (DR) system. OBJECTIVE To establish the appropriate clinical EIT, this study aims to introduce the diagnostic reference level (DRL) for general radiography and confirm the usefulness of clinical EI and DI. METHODS The relationship between entrance surface dose (ESD) and clinical EI is obtained by exposure under the national radiography conditions of Korea for 7 extremity examinations. The EI value when the ESD is the DRL is set as the clinical EIT, and the change of DI is then checked. RESULTS The clinical EI has proportional relationship with ESD and is affected by the beam quality. When the clinical EIT is not adjusted according to the revision of DRLs, there is a difference of up to 2.03 in the DI value and may cause an evaluation error of up to 1.6 times for patient dose. CONCLUSIONS If the clinical EIT is periodically managed according to the environment of medical institution, the appropriate patient dose and image exposure can be managed based on the clinical EI, EIT, and DI.
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Roccaro M, Diana A, Linta N, Rinnovati R, Freo M, Peli A. Limb development in skeletally-immature large-sized dogs: A radiographic study. PLoS One 2021; 16:e0254788. [PMID: 34297750 PMCID: PMC8301671 DOI: 10.1371/journal.pone.0254788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/04/2021] [Indexed: 11/18/2022] Open
Abstract
Despite the extreme morphological variability of the canine species, data on limb development are limited and the time windows for the appearance of the limb ossification centres (OCs) reported in veterinary textbooks, considered universally valid for all dogs, are based on dated studies. The aim of this study was to acquire up-to-date information regarding the arm, forearm and leg bone development in skeletally-immature large-sized dogs from 6 weeks to 16 weeks of age. Nine litters of 5 large-sized breeds (Boxer, German Shepherd, Labrador Retriever, Saarloos Wolfdog, White Swiss Shepherd Dog) were included, for a total of 54 dogs, which were subject to radiographic examination on a bi-weekly basis. The appearance of 18 limb OCs was recorded and 14 radiographic measurements were performed; their relationship with age and body weight was investigated and any breed differences were analysed using different statistical non-parametric tests. The number of OCs present was significantly different at 6 and 8 weeks of age between the investigated breeds. The appearance of the OCs occurred earlier in the Saarloos Wolfdog, while the Labrador Retriever was the later breed. In Boxers and Labrador Retrievers, various OCs showed a delayed appearance compared to the data reported in the literature. The number of OCs was strongly and positively correlated to body weight. Breed differences were also observed in the relative increase of the measured OCs and were not limited to dogs of different morphotypes. Statistically significant differences were most frequently observed between Saarloos Wolfdogs and the other breeds. The OCs that showed a greater variability in their development were the olecranon tuber, the patella and the tibial tuberosity. Their increase was more strongly correlated with the dog’s age and body weight. Our data strongly suggest that differences in limb development exist in dog breeds of similar size and morphotype.
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Yang Y, Ma X, Wang Y, Ding X. Prognosis prediction of extremity and trunk wall soft-tissue sarcomas treated with surgical resection with radiomic analysis based on random survival forest. Updates Surg 2021; 74:355-365. [PMID: 34003477 DOI: 10.1007/s13304-021-01074-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/29/2021] [Indexed: 02/05/2023]
Abstract
Many researches have applied machine learning methods to find associations between radiomic features and clinical outcomes. Random survival forests (RSF), as an accurate classifier, sort all candidate variables as the rank of importance values. There was no study concerning on finding radiomic predictors in patients with extremity and trunk wall soft-tissue sarcomas using RSF. This study aimed to determine associations between radiomic features and overall survival (OS) by RSF analysis. To identify radiomic features with important values by RSF analysis, construct predictive models for OS incorporating clinical characteristics, and evaluate models' performance with different method. We collected clinical characteristics and radiomic features extracted from plain and contrast-enhanced computed tomography (CT) from 353 patients with extremity and trunk wall soft-tissue sarcomas treated with surgical resection. All radiomic features were analyzed by Cox proportional hazard (CPH) and followed RSF analysis. The association between radiomics-predicted risks and OS was assessed by Kaplan-Meier analysis. All clinical features were screened by CPH analysis. Prognostic clinical and radiomic parameters were fitted into RSF and CPH integrative models for OS in the training cohort, respectively. The concordance indexes (C-index) and Brier scores of both two models were evaluated in both training and testing cohorts. The model with better predictive performance was interpreted with nomogram and calibration plots. Among all 86 radiomic features, there were three variables selected with high importance values. The RSF on these three features distinguished patients with high predicted risks from patients with low predicted risks for OS in the training set (P < 0.001) using Kaplan-Meier analysis. Age, lymph node involvement and grade were incorporated into the combined models for OS (P < 0.05). The C-indexes in both two integrative models fluctuated above 0.80 whose Brier scores maintained less than 15.0 in the training and testing datasets. The RSF model performed little advantages over the CPH model that the calibration curve of the RSF model showed favorable agreement between predicted and actual survival probabilities for the 3-year and 5-year survival prediction. The multimodality RSF model including clinical and radiomic characteristics conducted high capacity in prediction of OS which might assist individualized therapeutic regimens. Level III, prognostic study.
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Summer SS, Wong BL, Rutter MM, Horn PS, Tian C, Rybalsky I, Shellenbarger KC, Kalkwarf HJ. Age-related changes in appendicular lean mass in males with Duchenne muscular dystrophy: A retrospective review. Muscle Nerve 2020; 63:231-238. [PMID: 33104257 DOI: 10.1002/mus.27107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Appendicular lean mass (ALM) trajectory in males with Duchenne muscular dystrophy (DMD) has potential applicability for treatment and research and has not been characterized. METHODS This chart review included longitudinal data on 499 males with DMD receiving glucocorticoids and 693 controls, ages 5 to 22.9 y. ALM (kg) was measured by dual energy x-ray absorptiometry (DXA). Appendicular lean mass index (ALMI, kg/m2 ) was calculated for height adjustment. Reference centiles were generated using data from healthy controls, and ALM and ALMI Z-scores were calculated for patients with DMD. Generalized linear models were used to estimate median Z-scores by age and functional mobility status (FMS) score. ALM velocity by age was modeled using superimposition, translation and rotation (SITAR). RESULTS Compared to controls, males with DMD had lower ALM from an early age. ALMI Z-scores dropped below 0 at age 8 y or FMS of 2, and below -2.0 at age 13 y or FMS of 3 (P < .05). Age at peak ALM velocity was similar in both groups, but the magnitude was higher in controls (3.5 vs. 0.7 kg/y, P < .0001). Patients with DMD had a transient loss of ALM around age 12 y, an increase at age 14 y, then a further decline at age 16 y, remaining low thereafter. CONCLUSIONS Males with DMD have progressive decline in lean mass with age and worsening functional mobility. DXA measurement of ALM may be useful for monitoring lean mass status in patients with DMD, providing valuable information for individual treatment plans and research endeavors.
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Baig MS, Habib W, Attard V, Sharif B, Lindsay D, Upadhyay B, Saifuddin A. The value of re-staging chest CT at first local recurrence of extremity and trunk soft tissue sarcoma. Eur Radiol 2020; 31:2377-2383. [PMID: 33037910 DOI: 10.1007/s00330-020-07366-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/06/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the prevalence of pulmonary metastases on re-staging chest CT at the time of first local recurrence (LR) of trunk or extremity soft tissue sarcoma (STS). MATERIALS AND METHODS Retrospective review of all patients diagnosed with recurrent STS between May 2007 and April 2018. Data collected included patient age and sex, site of primary STS, time to LR, recurrence site, initial tumour grade, recurrent tumour grade, findings of initial staging chest CT, and prevalence of pulmonary metastases on re-staging chest CT. RESULTS The study included 109 patients (males = 68, females = 41; mean age 56 years, range 9-92 years). The commonest tumour sub-types were myxofibrosarcoma (27.5%), undifferentiated pleomorphic/spindle cell sarcoma (20.2%), synovial sarcoma (10.1%), and malignant peripheral nerve sheath tumour (10.1%). Initial staging chest CT demonstrated pulmonary metastases in 1 of 77 (1.3%) patients for whom CT was available for review. The mean time to LR was 30.8 months (range 3-224 months). Pulmonary metastases were diagnosed on re-staging chest CT in 26 of 109 cases (23.9%), being commonest with grade 3 STS (36.1%). Pleomorphic sarcoma (85.7%) and undifferentiated spindle cell sarcoma (33.3%) were the 2 commonest tumour sub-types associated with pulmonary metastases at first LR. CONCLUSION Re-staging chest CT at the time of first LR of STS identified a prevalence of 23.9% pulmonary metastases, which supports the need for chest CT at the time of LR in line with the UK guidelines for the management of bone and soft tissue sarcoma. KEY POINTS • Pulmonary metastases were diagnosed in 1.3% of soft tissue sarcomas at presentation. • Pulmonary metastases were identified in ~ 24% of patients at first local recurrence of soft tissue sarcoma, most commonly with pleomorphic sarcoma and Trojani grade tumours. • No patient with a low-grade recurrence had pulmonary metastases.
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Abu-Ghname A, Trost J, Davis MJ, Sutton VR, Zhang C, Guillen DE, Carvalho CMB, Maricevich RS. Extremity anomalies associated with Robinow syndrome. Am J Med Genet A 2020; 185:3584-3592. [PMID: 32974972 DOI: 10.1002/ajmg.a.61884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
Robinow syndrome, a rare genetic disorder, is characterized by skeletal dysplasia with, among other anomalies, extremity and hand anomalies. There is locus heterogeneity and both dominant and recessive inheritance. A detailed description of associated extremity and hand anomalies does not currently exist due to the rarity of this syndrome. This study seeks to document the hand anomalies present in Robinow syndrome to allow for improved rates of timely and accurate diagnosis. A focused assessment of the extremities and stature was performed using clinical examination and standard photographic images. A total of 13 patients with clinical and molecular diagnosis consistent with dominant Robinow syndrome or recessive Robinow syndrome were evaluated. All patients had limb shortening, the most common of which was mesomelia; however, rhizomelia and micromelia were also seen. These findings are relevant to clinical characterization, particularly as Robinow syndrome has classically been defined as a "mesomelic disorder." A total of eight distinct hand anomalies were identified in 12 patients with both autosomal recessive and dominant forms of Robinow syndrome. One patient did not present with any hand differences. The most common hand findings included brachydactyly, broad thumbs, and clinodactyly. A thorough understanding of the breadth of Robinow syndrome-associated extremity and hand anomalies can aid in early patient identification, improving rates of timely diagnosis and allowing for proactive management of sequelae.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/diagnostic imaging
- Abnormalities, Multiple/genetics
- Abnormalities, Multiple/physiopathology
- Adolescent
- Child
- Child, Preschool
- Craniofacial Abnormalities/diagnosis
- Craniofacial Abnormalities/diagnostic imaging
- Craniofacial Abnormalities/genetics
- Craniofacial Abnormalities/physiopathology
- Dwarfism/diagnosis
- Dwarfism/diagnostic imaging
- Dwarfism/genetics
- Dwarfism/physiopathology
- Extremities/diagnostic imaging
- Extremities/physiopathology
- Female
- Hand/diagnostic imaging
- Hand/physiopathology
- Hand Deformities, Congenital/diagnosis
- Hand Deformities, Congenital/genetics
- Hand Deformities, Congenital/physiopathology
- Humans
- Limb Deformities, Congenital/diagnosis
- Limb Deformities, Congenital/diagnostic imaging
- Limb Deformities, Congenital/genetics
- Limb Deformities, Congenital/physiopathology
- Male
- Phenotype
- Urogenital Abnormalities/diagnosis
- Urogenital Abnormalities/diagnostic imaging
- Urogenital Abnormalities/genetics
- Urogenital Abnormalities/physiopathology
- Young Adult
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Coffey H, Chanopensiri V, Ly B, Nguyen D. Comparing 10 kVp and 15% Rules in Extremity Radiography. Radiol Technol 2020; 91:516-524. [PMID: 32606229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/30/2019] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate the viability of the 10 kVp rule as a substitute for the 15% rule in obtaining extremity radiographs of high diagnostic quality while lowering patient radiation dose. The intention of this substitution is to allow technologists a simpler and quicker calculation for use in clinical settings to benefit patients without disrupting workflow. METHODS Three anteroposterior or posteroanterior exposures were made on 3 anthropomorphic phantom extremities: hand, knee, and shoulder. Thermoluminescent dosimeters (TLDs) were placed at the center of each phantom; a new TLD was used for each exposure. Exposures were made on a Defininium 8000 digital radiography system (General Electric) using the unaltered, system-preset techniques used by the authors' imaging department, techniques adapted from the 10 kVp rule, and techniques adapted from the 15% rule. The detector exposure indicator from each image was used to compare image quality among the 3 exposures in each group. Entrance skin dose measured from the TLDs also were compared among the 3 exposures for each extremity. One TLD was used as a control to determine the amount of background radiation to which the TLDs were exposed. RESULTS The detector exposure indicator remained in optimal range for every exposure with both applied rules as well as the system-preset techniques. Entrance skin dose was lower for both rules in the shoulder and hand trials, with the possibility of error during exposure and reading of the system-preset technique used on the knee phantom. Entrance skin dose also was lower for the shoulder and hand exposures when using the 10 kVp techniques compared with the 15% rule techniques. DISCUSSION Aside from unknown entrance skin dose errors during knee imaging, no failures of the tested rules were found. Using manual technique selection rather than automatic exposure control allowed for consistent manipulation of technical factors. TLDs allowed for relatively reliable and quick readings from each exposure, although they could have been the cause of an error in the exposure reading of the preset technique of the knee. Environment and equipment were unchanged to maintain consistency. CONCLUSION Results demonstrated that both the 15% rule and the 10 kVp rule successfully maintained or slightly improved image quality according to the detector exposure indicators. The results also demonstrated lowered patient dose according to the entrance skin doses. Based on these results, the 10 kVp rule might be a reasonable substitute for the 15% rule. Further research should be conducted with more repetitions that include digital radiography equipment for a wider range of examinations.
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Shinomiya R, Sunagawa T, Nakashima Y, Kodama A, Hayashi Y, Tokumoto M, Adachi N. Monitoring Vascular Compromise Using Ultrasound After Free Tissue Transfer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1213-1222. [PMID: 31880342 DOI: 10.1002/jum.15210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To report the clinical utility of high-resolution ultrasound (US) for monitoring vascular compromise after free tissue transfer. METHODS Fifty-two tissue transfers in the extremities were included in this study. Blood flow around the anastomotic pedicle and subcutaneous tissue of the grafted flap was monitored with pulsed color and power Doppler US whenever the conventional monitoring method, comprising the bedside assessment of the temperature, capillary refill, and flap color, showed abnormalities until 1 week after reconstruction. RESULTS All flaps were indicated for US monitoring, with 44 flaps showing Doppler signals in each position, even though conventional flap monitoring showed an abnormality. Forty of the 44 flaps showed no flap failure, whereas the remaining 4 flaps developed partial necrosis. Abnormal US findings were noted in 8 of the 52 flaps. Ultrasound revealed interruption of venous blood flow around the anastomotic pedicle in 6 of 8 flaps. Emergent exploration revealed venous occlusion at the anastomotic pedicle, similar to the US finding. In 2 of the 8 flaps, US showed no blood flow to either the anastomotic pedicle or subcutaneous tissue. Emergent exploration revealed arterial occlusion at the anastomotic pedicle. Seven of the 8 reexplored flaps were salvaged after revision surgery with complete flap survival. Partial flap survival was noted in 1 case, but complete flap failure was avoided. CONCLUSIONS Ultrasound is a useful adjunct that enables a direct assessment of perfusion in grafted tissues, which may reduce unnecessary exploration when conventional flap monitoring shows an abnormality.
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Sedivy P, Dezortova M, Drobny M, Dubsky M, Dusilova T, Kovar J, Hajek M. Origin of the 31 P MR signal at 5.3 ppm in patients with critical limb ischemia. NMR IN BIOMEDICINE 2020; 33:e4295. [PMID: 32180296 DOI: 10.1002/nbm.4295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 06/10/2023]
Abstract
An unknown intense signal (Pun ) with a mean chemical shift of 5.3 ppm was observed in 31 P MR spectra from the calf muscles of patients with the diabetic foot syndrome. The aim of the study was to identify the origin of this signal and its potential as a biomarker of muscle injury. Calf muscles of 68 diabetic patients (66.3 ± 8.6 years; body mass index = 28.2 ± 4.3 kg/m2 ) and 12 age-matched healthy controls were examined by (dynamic) 31 P MRS (3 T system, 31 P/1 H coil). Phantoms (glucose-1-phosphate, Pi and PCr) were measured at pH values of 7.05 and 7.51. At rest, Pun signals with intensities higher than 50% of the Pi intensity were observed in 10 of the 68 examined diabetic subjects. We tested two hypothetical origins of the Pun signal: (1) phosphorus from phosphoesters and (2) phosphorus from extra- and intracellular alkaline phosphate pools. 2,3-diphosphoglycerate and glucose-1-phosphate are the only phosphoesters with signals in the chemical shift region close to 5.3 ppm. Both compounds can be excluded: 2,3-diphosphoglycerate due to the missing second signal component at 6.31 ppm; glucose-1-phosphate because its chemical shifts are about 0.2 ppm downfield from the Pi signal (4.9 ppm). If the Pun signal is from phosphate, it represents a pH value of 7.54 ± 0.05. Therefore, it could correspond to signals of Pi in mitochondria. However, patients with critical limb ischemia have rather few mitochondria and so the Pun signal probably originates from interstitia. Our data suggest that the increased Pun signal observed in patients with the diabetic foot syndrome is a biomarker of severe muscular damage.
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Lee MI, Kwak HH, Kim JH, Shin HS, Woo HM, Kang BJ. Surgical Ectrodactyly Repair Using Limb-lengthening and Bone Tissue Engineering Techniques in a Toy Dog Breed. In Vivo 2020; 34:815-824. [PMID: 32111789 PMCID: PMC7157858 DOI: 10.21873/invivo.11843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/05/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIM Bone tissue engineering is an emerging field of regenerative medicine that holds promise for the restoration of bones affected by trauma, neoplastic diseases, and congenital deformity. During the past decade, bone tissue engineering has evolved from the use of biomaterials that can only replace small areas of damaged bone, to the use of scaffolds in which grafts can be seeded before implantation. This case report proposes an alternative option for a veterinary patient suffering from ectrodactyly, which is one of several congenital deformities in dogs. A 2-month-old male toy poodle dog with ectrodactyly was treated using several stages of surgery involving pancarpal arthrodesis, limb lengthening, and bone tissue engineering techniques. RESULTS AND CONCLUSION Over a period of 2 years, the operated limb gained almost the same function as the contralateral limb. Bone tissue engineering techniques can be used for the treatment of congenital deformities in dogs.
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Simões R, Miles E, Yang H, Le Grange F, Bhat R, Forsyth S, Seddon B. IMRiS phase II study of IMRT in limb sarcomas: Results of the pre-trial QA facility questionnaire and workshop. Radiography (Lond) 2020; 26:71-75. [PMID: 31902458 DOI: 10.1016/j.radi.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Soft tissue sarcomas of the extremities (STSE) are rare malignancies. We report current UK practice for immobilisation of soft tissue sarcoma of STSE, as part of the initial study set-up within the IMRiS trial, a phase II study of intensity modulated radiotherapy (IMRT) in primary bone and soft tissue sarcoma. METHODS A facility questionnaire (FQ) was circulated to 29 IMRiS centres investigating the variation in immobilisation devices, planning techniques, and imaging protocols. A workshop was held to address concerns raised by centres. It focused on STSE immobilisation and patient set-up. Robustness of patient set-up at each centre was evaluated based on the following criteria: evidence of local set-up audit, calculation of margins based on set-up audit results, imaging frequency, and number of patients treated per centre per annum. RESULTS Twenty-seven (93%) questionnaires were returned. 30% (8/27) of responders routinely treated STSE with IMRT. The remaining 70% (19/27) had little or no experience with IMRT for STSE. Vacuum bags were the most frequent immobilisation device (9/27), followed by thermoplastic shells (7/27). Nine centres had audited their local set-up; however, only 4 had calculated margins in response to the results. Ten centres were classified as having high level of robustness. CONCLUSIONS Immobilisation devices and planning techniques for STSE are inconsistent across centres. Robustness of set-up is an important tool to ensure quality of results in a multicentre trial setting with such different levels of experience. The IMRiS trial Quality Assurance programme encourages centres to assess robustness of set-up through local audit and subsequent calculation of treatment margins. IMPLICATIONS FOR PRACTICE This is the first study that used robustness criteria to tailor QA support to individual centres.
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Schimmoeller T, Neumann EE, Owings TM, Nagle TF, Colbrunn RW, Landis B, Jelovsek JE, Hing T, Ku JP, Erdemir A. Reference data on in vitro anatomy and indentation response of tissue layers of musculoskeletal extremities. Sci Data 2020; 7:20. [PMID: 31941894 PMCID: PMC6962198 DOI: 10.1038/s41597-020-0358-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/20/2019] [Indexed: 12/05/2022] Open
Abstract
The skin, fat, and muscle of the musculoskeletal system provide essential support and protection to the human body. The interaction between individual layers and their composite structure dictate the body's response during mechanical loading of extremity surfaces. Quantifying such interactions may improve surgical outcomes by enhancing surgical simulations with lifelike tissue characteristics. Recently, a comprehensive tissue thickness and anthropometric database of in vivo extremities was acquired using a load sensing instrumented ultrasound to enhance the fidelity of advancing surgical simulations. However detailed anatomy of tissue layers of musculoskeletal extremities was not captured. This study aims to supplement that database with an enhanced dataset of in vitro specimens that includes ultrasound imaging supported by motion tracking of the ultrasound probe and two additional full field imaging modalities (magnetic resonance and computed tomography). The additional imaging datasets can be used in conjunction with the ultrasound/force data for more comprehensive modeling of soft tissue mechanics. Researchers can also use the image modalities in isolation if anatomy of legs and arms is needed.
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Đurović Sarajlić V, Totić D, Bičo Osmanagić A, Gojak R, Lincender L. Is 64-Row Multi-Detector Computed Tomography Angiography Equal to Digital Subtraction Angiography in Treatment Planning in Critical Limb Ischemia? PSYCHIATRIA DANUBINA 2019; 31:814-820. [PMID: 32160177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease (PAD). It is defined as a chronic ischemic rest pain, ulcers or gangrene, attributable to proven arterial occlusive disease. Intra-arterial digital subtraction angiography (IA DSA) still represents the gold standard for the evaluation of steno-occlusive lesions, but it has greatly been replaced with non-invasive multi-detector computed tomography angiography (MDCTA). The purpose of this prospective study was to compare diagnostic performance of MDCTA versus DSA in treatment planning in patients with CLI according to TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial disease (TASC II). SUBJECTS AND METHODS The study was designed as prospective; it was conducted from March 2014 to August 2016, and included 60 patients with symptoms of CLI, Fontaine stage III and IV. MDCTA of the peripheral arteries was performed first, followed by DSA. The lesions of aorto-iliac, femoro-popliteal and infra-popliteal regions were classified according to the TASC II guidelines, and inter-modality agreement between MDCTA and DSA was determined by using Kendall's tau-b statistics. RESULTS Inter-modality agreement was statistically significant in all three vascular beds, with excellent agreement >0.81 in aortoiliac and femoropopliteal regions, and a very good agreement >0.61 in infrapopliteal region. Treatment recommendations based on MDCTA findings and DSA findings were identical in 54 (90%) patients. In one patient (1.7%), CTA was not interpretable. In five patients (8.3%), CTA findings disagreed with DSA findings in regard to the preferable treatment option. CONCLUSION 64-row MDCT angiography is highly competitive to DSA in evaluation of steno-occlusive disease and treatment planning in patients with critical limb ischemia.
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Bianchi S, Becciolini M, Urigo C. Ultrasound Imaging of Disorders of Small Nerves of the Extremities: Less Recognized Locations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2821-2842. [PMID: 31025409 DOI: 10.1002/jum.15014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/29/2019] [Accepted: 04/09/2019] [Indexed: 06/09/2023]
Abstract
Ultrasound is a well-proven imaging modality for showing peripheral nerve disorders and guiding perineural injections. The aim of this review is to focus on small peripheral nerve abnormalities, which are usually not recognized by sonologists. In fact, most of these small nerves have a tiny diameter (<2 mm), and their anatomy is less familiar. We describe the most common causes of small peripheral nerve disorders, providing an accurate description of their anatomic locations and relationships with adjacent structures; we also focus on technical hints that may help in their evaluation.
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Zhou C, Yahathugoda C, De Silva L, Rathnapala U, Owen G, Weerasooriya M, Rao RU, Weil GJ, Budge PJ. Portable infrared imaging for longitudinal limb volume monitoring in patients with lymphatic filariasis. PLoS Negl Trop Dis 2019; 13:e0007762. [PMID: 31584959 PMCID: PMC6795459 DOI: 10.1371/journal.pntd.0007762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/16/2019] [Accepted: 09/08/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Global Programme to Eliminate Lymphatic Filariasis (LF) emphasizes hygiene, exercise, and other measures to reduce morbidity and disability related to LF. We recently reported that a portable, three-dimensional, infrared imaging system (3DIS) provides accurate limb volume measurements in patients with filarial lymphedema. To assess the practical utility of repeated 3DIS measurements for longitudinal lymphedema management, we examined intraday and day-to-day leg volume changes in adults with filarial lymphedema in southern Sri Lanka. METHODOLOGY AND PRINCIPAL FINDINGS We assessed 41 participants with lower extremity lymphedema (stages 1-6) in their homes in the mornings (6:00-9:00 AM) and afternoons (2:00-6:00 PM) of three days within one calendar week. Two examiners performed replicate 3DIS volume measurements at each visit. Median coefficient of variation among replicate volume measurements was 1.7% (IQR 1.1% - 2.3%) for left legs and 2.2% (IQR 1.6% - 2.8%) for right legs. Median intraday volume increase was 3.0%. Range among daily volume measurements tended to be lower for afternoon measurements (median 2.25%, IQR 1.4%- 5.4%) than for morning measurements (median 3.0%, IQR 1.4% - 8.4%). CONCLUSIONS AND SIGNIFICANCE Limb volume measurements by 3DIS are accurate and reproducible, and this technique is feasible for use in patients' homes. We have developed practical suggestions for optimal outcomes with 3DIS. Duplicate measurements should be performed and repeat assessments should be done at approximately the same time of day to minimize bias. Duplicate measures that vary by more than 8% should prompt review of scanning technique with a repeat measurement. With proper training and attention to technique, 3DIS can be a valuable tool for healthcare workers who work with lymphedema patients.
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Zhai D, Williams M, Siveter DJ, Harvey THP, Sansom RS, Gabbott SE, Siveter DJ, Ma X, Zhou R, Liu Y, Hou X. Variation in appendages in early Cambrian bradoriids reveals a wide range of body plans in stem-euarthropods. Commun Biol 2019; 2:329. [PMID: 31508504 PMCID: PMC6722085 DOI: 10.1038/s42003-019-0573-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/02/2019] [Indexed: 11/08/2022] Open
Abstract
Traditionally, the origin and evolution of modern arthropod body plans has been revealed through increasing levels of appendage specialisation exhibited by Cambrian euarthropods. Here we show significant variation in limb morphologies and patterns of limb-tagmosis among three early Cambrian arthropod species conventionally assigned to the Bradoriida. These arthropods are recovered as a monophyletic stem-euarthropod group (and sister taxon to crown-group euarthropods, i.e. Chelicerata, Mandibulata and their extinct relatives), thus implying a radiation of stem-euarthropods where trends towards increasing appendage specialisation were explored convergently with other euarthropod groups. The alternative solution, where bradoriids are polyphyletic, representing several independent origins of a small, bivalved body plan in lineages from diverse regions of the euarthropod and mandibulate stems, is only marginally less parsimonious. The new data reveal a previously unknown disparity of body plans in stem-euarthropods and both solutions support remarkable evolutionary convergence, either of fundamental body plans or appendage specialization patterns.
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Pearce B, Turnbull R, Mandarano G. Radiographer Comment on Extremity Trauma Imaging in Australia: Educational Intervention Improves Diagnostic Accuracy. Radiol Technol 2019; 90:611-621. [PMID: 31270261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Cao C, Zhou X, Xue M, Han C, Feng W, Li F. Dual Near-Infrared-Emissive Luminescent Nanoprobes for Ratiometric Luminescent Monitoring of ClO - in Living Organisms. ACS APPLIED MATERIALS & INTERFACES 2019; 11:15298-15305. [PMID: 30977992 DOI: 10.1021/acsami.9b02008] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The difficulty of near-infrared (NIR) ratiometric detection imaging lies in the lack of high-efficiency NIR probes and the overlapping interference between two emission peaks. To achieve more accurate detection in living organisms, dual NIR-emissive luminescent nanoprobes were designed under the same excitation at 808 nm. The Er3+ ion-doped nanoparticles were employed as a reference with their fluorescence emission at 1525 nm. Meanwhile, a cyanine dye molecule (Cy925) was combined on the surface of nanoparticles as the ClO- recognition site with its NIR emission at 925 nm. The ratiometric nanoprobe relied on the ratio of aforementioned two separated NIR peaks ( I925nm/ I1525nm), featuring deeper imaging penetration depth and low autofluorescence. This nanoprobe was verified to be sensitive and highly selective to ClO- through photoluminescence titration. The in vitro detection experiment developed reasonable work curves, guaranteeing that we can detect the change in concentration of ClO- in mice limbs with arthritis through in vivo imaging experiments.
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Kang BS, Shim HS, Kim JH, Kim YM, Bang M, Lim S, Park GM, Lee TY, Ha ND, Kwon WJ. Angioleiomyoma of the Extremities: Findings on Ultrasonography and Magnetic Resonance Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1201-1208. [PMID: 30208227 DOI: 10.1002/jum.14798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/03/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The purpose of this study was to describe the features of angioleiomyomas of the extremities on ultrasonography (US) and magnetic resonance imaging (MRI). METHODS We retrospectively reviewed the US and MRI findings of 29 pathologically confirmed cases of angioleiomyomas of the extremities in 29 patients. Twenty patients underwent only US; 7 patients underwent only MRI; and 2 patients underwent US and MRI. Clinical data and histopathologic specimens were reviewed. RESULTS There were 19 women and 10 men. The mean patient age was 48.9 years (range, 23-80 years). On US, angioleiomyomas were located primarily in the subcutaneous fat layer (n = 20 [91%]), were oval (n = 17 [77%]), had well-circumscribed margins (n = 22 [100%]), had hypoechoic protrusions on one or both ends (n = 9 [41%]), had a homogeneous echo texture (n = 17 [ 77%]), had posterior acoustic enhancement (n = 20 [91%]), and had color Doppler flow (n = 20 [91%]). On MRI, the masses showed heterogeneous enhancement (n = 7 [88%]) and enhancing structures on one or both ends (n = 4 [50%]) on contrast-enhanced T1-weighted images. CONCLUSIONS Angioleiomyoma of the extremities is usually a well-circumscribed oval mass with a homogeneous echo texture and occasionally hypoechoic protrusions on US and shows heterogeneous enhancement with occasionally enhancing structures on one or both ends of the mass on MRI. Therefore, it should be included in the differential diagnosis of a soft tissue mass that has protruding structures from one or both ends.
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von Lübken F, Achatz G, Friemert B, Mauser M, Franke A, Kollig E, Bieler D. [Update on gunshot wounds to extremities]. Unfallchirurg 2019; 121:59-72. [PMID: 29260242 DOI: 10.1007/s00113-017-0449-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Due to recent rampage and terror attacks in Europe, gunshot wounds have become a focus of attention even though they are still rare in Europe. Approximately 50% of gunshot wounds affect the extremities and to understand the sequelae, a basic knowledge of wound ballistics is indispensable. The energy transmitted from the bullet to the tissue is responsible for the severity of the injury and is dependent on the type of weapon and ammunition. A differentiation is made between low-energy injuries caused, e.g. by pistols and high-energy injuries mostly caused by rifles. The higher energy transfer to the tissue in high-energy injuries, results in a temporary wound cavity in addition to the permanent wound channel with extensive soft tissue damage. High-energy gunshot fractures are also more extensive compared to those of low energy injuries. Debridement seems to be necessary for almost all gunshot wounds. Fractures should be temporarily stabilized with an external fixator due to contamination.
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Moll J, Kexel C, Milanchian H, Bhavsar MB, Barker JH. Ultrasound Bone Fracture Sensing and Data Communication: Experimental Results in a Pig Limb Sample. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:605-611. [PMID: 30553585 DOI: 10.1016/j.ultrasmedbio.2018.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/28/2018] [Accepted: 09/18/2018] [Indexed: 06/09/2023]
Abstract
Approximately 6.3 million fractures occur each year in the United States alone. Accurately monitoring the progression of fracture healing is essential to be able to advise patients when it is safe to return to normal activity. The most common method used to confirm and monitor fracture healing is the acquisition of multiple radiographic images over the many months required for healing. This imaging method uses large expensive equipment and exposes patients to high levels of ionizing radiation. In the study described here, we tested another technology for monitoring fracture healing that could minimize the need for multiple radiographic images. We tested a piezoelectric transducer fixed to the surface of a bone that uses electromechanical impedance spectroscopy to measure simulated fractures and transmits the measurement data to an acoustic receiver located externally on the skin surface.
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Ranger BJ, Feigin M, Zhang X, Moerman KM, Herr H, Anthony BW. 3D Ultrasound Imaging of Residual Limbs With Camera-Based Motion Compensation. IEEE Trans Neural Syst Rehabil Eng 2019; 27:207-217. [PMID: 30676967 DOI: 10.1109/tnsre.2019.2894159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Ultrasound is a cost-effective, readily available, and non-ionizing modality for musculoskeletal imaging. Though some research groups have pursued methods that involve submerging the transducer and imaged body segment into a water bath, many limitations remain in regards to acquiring an unloaded volumetric image of an entire human limb in a fast, safe, and adequately accurate manner. A 3D dataset of a limb is useful in several rehabilitative applications including biomechanical modeling of soft tissue, prosthetic socket design, monitoring muscle condition and disease progression, bone health, and orthopedic surgery. This paper builds on previous work from our group and presents the design, prototyping, and preliminary testing of a novel multi-modal imaging system for rapidly acquiring volumetric ultrasound imagery of human limbs, with a particular focus on residual limbs for improved prosthesis design. Our system employs a mechanized water tank setup to scan a limb with a clinical ultrasound transducer and 3D optical imagery to track motion during a scan. The iterative closest point algorithm is utilized to compensate for motion and stitch the images into a final dataset. The results show preliminary 2D and 3D imaging of both a tissue-mimicking phantom and residual limbs. A volumetric error compares the ultrasound image data obtained to a previous MRI method. The results indicate potential for future clinical implementation. Concepts presented in this paper could reasonably transfer to other imaging applications such as acoustic tomography, where motion artifact may distort image reconstruction.
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He P, Cui LG, Wang JR, Zhao B, Chen W, Xu Y. Trichilemmal Cyst: Clinical and Sonographic Features. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:91-96. [PMID: 29708283 DOI: 10.1002/jum.14666] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES In this study, we retrospectively reviewed the clinical and sonographic features of patients with trichilemmal cysts. METHODS Sonographic findings of 54 cases of trichilemmal cysts were retrospectively analyzed from 50 patients, including 4 cases of proliferating trichilemmal cysts. Associated factors of internal calcification-positive cases were also evaluated. RESULTS The mean age of the 50 patients was 43.4 years (range, 15-80 years) and the female-to-male ratio was 1.3. Overall, 68% of the trichilemmal cysts in the 54 lesions were located in the scalp, and 15% were located in the extremities. All 54 lesions were preoperatively examined by sonography and showed well-defined, oval-shaped structures located in subcutaneous soft tissues close to the dermis. Of the 54 lesions, 72% were hypoechoic masses, 89% were heterogeneous, and 65% had internal calcification. Among the internal calcification-positive cases, the mean age of the patients was 43.4 years, and the female-to-male ratio was 0.6. Of these lesions, 83% were located in the scalp. We did not find any significant association between calcification, age, or sex (P = .993 and P = .99); however, lesions present in the scalp were significantly associated with internal calcification (P = .005). 81% of the 54 lesions displayed posterior enhancement. but the color Doppler sonography of all lesions revealed no vascularization. CONCLUSIONS Trichilemmal cysts should be considered to diagnose of well-defined, hypoechoic lesions with internal calcification and posterior sound enhancement in the subcutaneous soft tissues of the scalp or extremities upon sonography.
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Ludlow JB, Johnson BK, Ivanovic M. Estimation of effective doses from MDCT and CBCT imaging of extremities. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:1371-1383. [PMID: 30255853 DOI: 10.1088/1361-6498/aae44b] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Little research has been published on the radiation burden of cone beam computed tomography (CBCT) in comparison with multi-row detector computed tomography (MDCT) for extremity imaging. This manuscript reports effective doses produced by standard and reduced dose imaging protocols for a 128-slice MDCT unit and a dedicated extremity imaging device using CBCT technology. Anthropomorphic phantoms with x-ray attenuation characteristics simulating adult hand-wrist, foot-ankle, and knee areas were modified to receive optically stimulated luminescent dosimeters (OSL). Standard and lower kVp reduced dose (Lite) exposures were compared. Effective doses for four age groups (five years old to adult) were calculated following 2007 recommendations of the ICRP. Standard CBCT imaging protocols produced effective doses (1.3-21.1 μSv) that were on the order of daily US ubiquitous background radiation doses. CBCT doses were on average 90% less than comparable MDCT views of the same anatomy (9.1-204 μSv). Child doses were significantly greater than adult doses (p = 0.0001). CBCT doses could be further reduced by 36%-51% with Lite exposure protocols. These protocols can be recommended for children and in cases where increased image noise will not interfere with the diagnostic task.
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Nagae K, Asao Y, Sudo Y, Murayama N, Tanaka Y, Ohira K, Ishida Y, Otsuka A, Matsumoto Y, Saito S, Furu M, Murata K, Sekiguchi H, Kataoka M, Yoshikawa A, Ishii T, Togashi K, Shiina T, Kabashima K, Toi M, Yagi T. Real-time 3D Photoacoustic Visualization System with a Wide Field of View for Imaging Human Limbs. F1000Res 2018; 7:1813. [PMID: 30854189 PMCID: PMC6396844 DOI: 10.12688/f1000research.16743.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 01/22/2023] Open
Abstract
Background: A breast-specific photoacoustic imaging (PAI) system prototype equipped with a hemispherical detector array (HDA) has been reported as a promising system configuration for providing high morphological reproducibility for vascular structures in living bodies. Methods: To image the vasculature of human limbs, a newly designed PAI system prototype (PAI-05) with an HDA with a higher density sensor arrangement was developed. The basic device configuration mimicked that of a previously reported breast-specific PAI system. A new imaging table and a holding tray for imaging a subject's limb were adopted. Results: The device's performance was verified using a phantom. Contrast of 8.5 was obtained at a depth of 2 cm, and the viewing angle reached up to 70 degrees, showing sufficient performance for limb imaging. An arbitrary wavelength was set, and a reasonable PA signal intensity dependent on the wavelength was obtained. To prove the concept of imaging human limbs, various parts of the subject were scanned. High-quality still images of a living human with a wider size than that previously reported were obtained by scanning within the horizontal plane and averaging the images. The maximum field of view (FOV) was 270 mm × 180 mm. Even in movie mode, one-shot 3D volumetric data were obtained in an FOV range of 20 mm in diameter, which is larger than values in previous reports. By continuously acquiring these images, we were able to produce motion pictures. Conclusion: We developed a PAI prototype system equipped with an HDA suitable for imaging limbs. As a result, the subject could be scanned over a wide range while in a more comfortable position, and high-quality still images and motion pictures could be obtained.
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Coroneos CJ, Wong FC, DeSnyder SM, Shaitelman SF, Schaverien MV. Correlation of L-Dex Bioimpedance Spectroscopy with Limb Volume and Lymphatic Function in Lymphedema. Lymphat Res Biol 2018; 17:301-307. [PMID: 30388062 DOI: 10.1089/lrb.2018.0028] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Bioimpedance spectroscopy (BIS) is an established tool for the measurement of extracellular fluid in lymphedema. This study assesses the validity of BIS measurements using the l-Dex® for evaluating the effectiveness of interventions to treat lymphedema. Measurements are correlated with limb volume, assessment of pitting edema, physiologic measures of lymphatic function, and response to surgical intervention. Three l-Dex BIS metrics are compared. Methods and Results: This retrospective study of prospectively collected data identified consecutive patients with lymphedema. l-Dex BIS measurements, limb volume measurements using perometry, transport index (TI) evaluation using radioisotope lymphoscintigraphy, staging using indocyanine green (ICG) fluorescent lymphography, and clinical evaluation of degree of pitting edema were compared to examine correlations. l-Dex BIS metrics included the l-Dex ratio, absolute difference between the affected and unaffected extremities, and their unadjusted ratio. The study included 26 patients with 70 sets of evaluations. There were significant correlations between the l-Dex ratio and limb volume ratio (LVR) using perometry, the degree of pitting edema, TI evaluation using lymphoscintigraphy, and staging using ICG lymphography. Of the l-Dex BIS metrics, the l-Dex ratio correlated most closely with all measures (ρ = 0.71-0.94, p < 0.0001). Following complete decongestive therapy, the mean decrease in the l-Dex ratio was 48.3% whereas the corresponding mean reduction in limb volume was 13.8% (ρ = 0.19; p = 0.65); subsequent physiological surgery including lymphovenous bypass and vascularized lymph node transfer resulted in an average reduction in l-Dex ratio of 36.1% and mean limb volume reduction of 25.2% (ρ = 0.38; p = 0.27). Conclusions: L-Dex BIS measurements demonstrate face, construct, and criterion validity, and correlate with clinical assessment, LVR, physiologic measures of lymphatic function, and response to conservative and surgical intervention. The L-Dex ratio correlates most closely with all measures and is the recommended metric when using BIS.
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Park JW, Yoo HJ, Kim HS, Choi JY, Cho HS, Hong SH, Han I. MRI surveillance for local recurrence in extremity soft tissue sarcoma. Eur J Surg Oncol 2018; 45:268-274. [PMID: 30352764 DOI: 10.1016/j.ejso.2018.08.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/07/2018] [Accepted: 08/31/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The role of MRI in surveillance for local recurrence (LR) remains uncertain in extremity soft tissue sarcoma (STS). The aims of this study were 1) to examine the usefulness of MRI in detecting LR, 2) to identify the characteristics of LR detected by MRI, and 3) to examine whether MRI surveillance is associated with oncologic outcome. MATERIALS AND METHODS 477 patients who had regular surveillance for LR after surgery for extremity STS were reviewed. Surveillance was performed by routine MRI in 325 patients or other imaging modalities in 152 patients. RESULTS The rate of MRI-detected LR, defined as clinically undetectable LR identified on MRI, was 10.5% in the MRI surveillance cohort. The detection rates of MRI-detected LR were significantly higher in the patients with high risk of LR. MRI-detected LRs were more commonly located in the thigh or buttock (p = 0.005), were smaller (p = 0.001) and had LRs without mass formation (p = 0.007) than non-MRI-detected LRs. On Kaplan-Meier analysis, patients with MRI-detected LR tended to have better post-LR survival (p = 0.104). CONCLUSION Routine MRI surveillance can detect a significant number of clinically undetectable LRs in extremity STS especially for LRs in the thigh or buttock, small LRs or LRs without mass formation.
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Zaleska MT, Olszewski WL. Imaging lymphatics in human normal and lymphedema limbs-Usefulness of various modalities for evaluation of lymph and edema fluid flow pathways and dynamics. JOURNAL OF BIOPHOTONICS 2018; 11:e201700132. [PMID: 28858432 DOI: 10.1002/jbio.201700132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
The human lymphatic system morphology and function still remain largely unknown to clinicians and biologists. How does the lymphatic vascular system look like in comparison to the blood transport system, how does lymph flow, where does capillary filtrate accumulate in cases with lymphatic obstruction caused by inflammation, trauma, and cancer therapy, remain as basic questions. Visualization of the lymphatic pathways and dynamics of lymph flow, and in cases of obstruction, the localization of the capillary filtrate/edema fluid accumulation becomes indispensable. The contemporary methods only partly meet these requirements. Since the early 1950s of the 20th century only few specific clinical methods of imaging of limb lymphatics are being used in human clinic. Each of the applied modalities provides different images due to different physical chemistry and distribution of tracer, methods used for its detection in tissues, their sensitivity and specificity and clinical type of lymph vessel pathology. Here, the advantages and disadvantages of the most commonly used 3 methods of imaging: the iodinated oil X-ray, isotopic, and fluorescent lympangiographies are presented. The study is based on retrospective and recent collections of lymphangiograms from large cohorts of patients. Imaging of lymph nodes has not been included as it is requiring different interpretation compared with vessels. Composite evaluation of X-ray, isotopic, and fluorescent lymphographic images or, as it is practiced now the isotope and indocyanine green near infrared lymphographies, provide most clinically important information. Special attention was directed at methods enabling early diagnosis of imminent lymphedema especially in cases with cancer therapy-related lymphedema. Groups of typical images obtained with the 3 methods are presented.
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Desai KI. The Surgical Management of Symptomatic Benign Peripheral Nerve Sheath Tumors of the Neck and Extremities: An Experience of 442 Cases. Neurosurgery 2018; 81:568-580. [PMID: 28475798 DOI: 10.1093/neuros/nyx076] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 02/06/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The occurrence of benign peripheral nerve sheath tumors (PNSTs) is not uncommon. The surgical excision of symptomatic benign PNSTs along with preservation of the affected nerve and its function is an ideal treatment option. OBJECTIVE To analyze the outcome with respect to morbidity, extent of resection, and recurrence, and to review and compare our results with those reported in literature. METHODS A retrospective review of clinical and radiological findings of 442 patients with benign PNSTs involving the neck and extremities treated surgically from 2000 to 2014 was performed. RESULTS In our series, benign PNSTs involved the extremities in 290 (65.6%) patients and the brachial plexus in 146 (33%) patients, and 6 (1.4%) patients had tumors of the extracranial portion of the vagus and hypoglossal nerves in the neck. The mean age of patients was 38 yr. The presenting features were painful mass and paresthesia. Preoperative motor weakness in the extremity was noted in 15.6% of patients. The common nerves involved by the tumors were the ulnar nerve (15.8%), sciatic nerve (12.7%), and upper cervical roots (11.5%). The excision was total in 81.2%, gross total (>90%) in 17.9%, and subtotal (>50%) in 0.9% patients. In 17.6% of patients, there was severe postoperative neurogenic pain. In 28 (6.3%) patients, a new motor deficit was noted following surgery. Recurrence was seen in 2 patients in our series. The mean follow-up was 30.2 mo. CONCLUSION Benign PNSTs have excellent clinical outcome, and the goal for surgical treatment is total to gross total excision of the tumor with neural preservation.
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