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Behluli E, Preuer HM, Schiefermeier-Mach N, Hornung R, Küchler M, Prokopetz M. Patient-centric comparative analysis of experiences in open upright and conventional closed MRI scanners. Radiography (Lond) 2024; 30:1258-1264. [PMID: 38991328 DOI: 10.1016/j.radi.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/23/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION MRI often induces anxiety, leading to incomplete scans and claustrophobia-related distress. Open MRI systems aim to enhance patient comfort. This study examines how prior MRI experiences impact subsequent encounters in an open upright MRI scanner. METHODS In this cross-sectional study, 118 adult patients completed a self-administered questionnaire from August 2022 to October 2023. It covered previous MRI experiences, including questions about claustrophobia, premature scan terminations, sedative medication usage, general MRI experiences, and interactions with radiology technologists. RESULTS Patients in open upright MRI reported less claustrophobia compared to closed MRI systems (18.4% vs. 58.3%), fewer premature scan terminations (5.3% vs. 31.0%), and less sedative use (5.3% vs. 46.9%). Moderate positive correlations were found between past and current claustrophobic events and premature scan terminations. Effective communication with radiology technologists was essential for patient comfort and reduced claustrophobia. Scan duration and noise triggered discomfort in 26.1% and 21.6% of study participants respectively. Persons without prior MRI experience were more satisfied with the examination and expressed no clear preference for future MRI settings, contrasting those with previous exposure favoring the open MRI setup. CONCLUSION The study emphasizes the benefits of open upright MRI for high-risk claustrophobic patients. It identifies the lasting impact of negative MRI experience on future examinations and highlights the crucial role of radiology technologists. IMPLICATIONS FOR PRACTICE Integrating open MRI scanners in medical facilities and prioritizing effective communication with radiology technologists enhances patient comfort. Positive experiences with open MRI may improve patient compliance and offer greater flexibility for future examinations.
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Affiliation(s)
- E Behluli
- Department of Radiological Technologies, Health University of Applied Sciences Tyrol/ Fhg - Zentrum für Gesundheitsberufe Tirol, Innsbruck, Austria; Radiological Institute Zurich-Altstetten, Zurich, Switzerland
| | - H M Preuer
- Department of Radiological Technologies, Health University of Applied Sciences Tyrol/ Fhg - Zentrum für Gesundheitsberufe Tirol, Innsbruck, Austria
| | - N Schiefermeier-Mach
- Unit for Research and Innovation, Health University of Applied Sciences Tyrol/ Fhg - Zentrum für Gesundheitsberufe Tirol, Innsbruck, Austria
| | - R Hornung
- Radiological Institute Zurich-Altstetten, Zurich, Switzerland
| | - M Küchler
- Radiological Institute Zurich-Altstetten, Zurich, Switzerland
| | - M Prokopetz
- Department of Radiological Technologies, Health University of Applied Sciences Tyrol/ Fhg - Zentrum für Gesundheitsberufe Tirol, Innsbruck, Austria.
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Mizukoshi R, Yagi M, Yamada Y, Yokoyama Y, Yamada M, Watanabe K, Nakamura M, Nagura T, Jinzaki M. Gender differences in spinal mobility during postural changes: a detailed analysis using upright CT. Sci Rep 2024; 14:9154. [PMID: 38644423 PMCID: PMC11033253 DOI: 10.1038/s41598-024-59840-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024] Open
Abstract
Lumbar spinal alignment is crucial for spine biomechanics and is linked to various spinal pathologies. However, limited research has explored gender-specific differences using CT scans. The objective was to evaluate and compare lumbar spinal alignment between standing and sitting CT in healthy individuals, focusing on gender differences. 24 young and 25 elderly males (M) and females (F) underwent standing and sitting CT scans to assess lumbar spinal alignment. Parameters measured and compared between genders included lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), lordotic angle (LA), foraminal height (FH), and bony boundary area (BBA). Females showed significantly larger changes in SS and PT when transitioning from standing to sitting (p = .044, p = .038). A notable gender difference was also observed in the L4-S LA among the elderly, with females showing a significantly larger decrease in lordotic angle compared to males (- 14.1° vs. - 9.2°, p = .039*). Females consistently exhibited larger FH and BBA values, particularly in lower lumbar segments, which was more prominent in the elderly group (M vs. F: L4/5 BBA 80.1 mm2 [46.3, 97.8] vs. 109.7 mm2 [74.4, 121.3], p = .019 in sitting). These findings underline distinct gender-related variations in lumbar alignment and flexibility, with a focus on noteworthy changes in BBA and FH in females. Gender differences in lumbar spinal alignment were evident, with females displaying greater pelvic and sacral mobility. Considering gender-specific characteristics is crucial for assessing spinal alignment and understanding spinal pathologies. These findings contribute to our understanding of lumbar spinal alignment and have implications for gender-specific spinal conditions and treatments.
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Affiliation(s)
- Ryo Mizukoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjyuku, Tokyo, Japan
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjyuku, Tokyo, Japan.
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan.
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi Shinjyuku, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi Shinjyuku, Tokyo, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi Shinjyuku, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjyuku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjyuku, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjyuku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi Shinjyuku, Tokyo, Japan.
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Manjila S, Alsalama AA, Medani K, Patel S, Prabhune A, Ramachandran SN, Mani S. Is foramen magnum decompression for acquired Chiari I malformation like putting a finger in the dyke? - A simplistic overview of artificial intelligence in assessing critical upstream and downstream etiologies. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:153-165. [PMID: 38957754 PMCID: PMC11216646 DOI: 10.4103/jcvjs.jcvjs_160_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/09/2024] [Indexed: 07/04/2024] Open
Abstract
Background Missed diagnosis of evolving or coexisting idiopathic (IIH) and spontaneous intracranial hypotension (SIH) is often the reason for persistent or worsening symptoms after foramen magnum decompression for Chiari malformation (CM) I. We explore the role of artificial intelligence (AI)/convolutional neural networks (CNN) in Chiari I malformation in a combinatorial role for the first time in literature, exploring both upstream and downstream magnetic resonance findings as initial screening profilers in CM-1. We have also put together a review of all existing subtypes of CM and discuss the role of upright (gravity-aided) magnetic resonance imaging (MRI) in evaluating equivocal tonsillar descent on a lying-down MRI. We have formulated a workflow algorithm MaChiP 1.0 (Manjila Chiari Protocol 1.0) using upstream and downstream profilers, that cause de novo or worsening Chiari I malformation, which we plan to implement using AI. Materials and Methods The PRISMA guidelines were used for "CM and machine learning and CNN" on PubMed database articles, and four articles specific to the topic were encountered. The radiologic criteria for IIH and SIH were applied from neurosurgical literature, and they were applied between primary and secondary (acquired) Chiari I malformations. An upstream etiology such as IIH or SIH and an isolated downstream etiology in the spine were characterized using the existing body of literature. We propose the utility of using four selected criteria for IIH and SIH each, over MRI T2 images of the brain and spine, predominantly sagittal sequences in upstream etiology in the brain and multiplanar MRI in spinal lesions. Results Using MaChiP 1.0 (patent/ copyright pending) concepts, we have proposed the upstream and downstream profilers implicated in progressive Chiari I malformation. The upstream profilers included findings of brain sagging, slope of the third ventricular floor, pontomesencephalic angle, mamillopontine distance, lateral ventricular angle, internal cerebral vein-vein of Galen angle, and displacement of iter, clivus length, tonsillar descent, etc., suggestive of SIH. The IIH features noted in upstream pathologies were posterior flattening of globe of the eye, partial empty sella, optic nerve sheath distortion, and optic nerve tortuosity in MRI. The downstream etiologies involved spinal cerebrospinal fluid (CSF) leak from dural tear, meningeal diverticula, CSF-venous fistulae, etc. Conclusion AI would help offer predictive analysis along the spectrum of upstream and downstream etiologies, ensuring safety and efficacy in treating secondary (acquired) Chiari I malformation, especially with coexisting IIH and SIH. The MaChiP 1.0 algorithm can help document worsening of a previously diagnosed CM-1 and find the exact etiology of a secondary CM-I. However, the role of posterior fossa morphometry and cine-flow MRI data for intracranial CSF flow dynamics, along with advanced spinal CSF studies using dynamic myelo-CT scanning in the formation of secondary CM-I is still being evaluated.
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Affiliation(s)
- Sunil Manjila
- Department of Neurosurgery, Insight Institute of Neurosurgery and Neuroscience, Flint, MI, USA
| | | | - Khalid Medani
- Department of Occupational Medicine, Kaiser Permanente, Los Angeles, CA
| | - Shlok Patel
- Department of Orthopedic Surgery, BJ Medical College, Ahmedabad, Gujarat, India
| | - Anagha Prabhune
- Department of Neurosurgery, Sahyadri Medical Center, Pune, Maharashtra, India
| | | | - Sudhan Mani
- Department of Neurosurgery, Insight Institute of Neurosurgery and Neuroscience, Flint, MI, USA
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Chinniah S, Deisher AJ, Herman MG, Johnson JE, Mahajan A, Foote RL. Rotating Gantries Provide Individualized Beam Arrangements for Charged Particle Therapy. Cancers (Basel) 2023; 15:cancers15072044. [PMID: 37046705 PMCID: PMC10093456 DOI: 10.3390/cancers15072044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/12/2023] [Accepted: 03/25/2023] [Indexed: 04/14/2023] Open
Abstract
PURPOSE This study evaluates beam angles used to generate highly individualized proton therapy treatment plans for patients eligible for carbon ion radiotherapy (CIRT). METHODS AND MATERIALS We retrospectively evaluated patients treated with pencil beam scanning intensity modulated proton therapy from 2015 to 2020 who had indications for CIRT. Patients were treated with a 190° rotating gantry with a robotic patient positioning system. Treatment plans were individualized to provide maximal prescription dose delivery to the tumor target volume while sparing organs at risk. The utilized beam angles were grouped, and anatomic sites with at least 10 different beam angles were sorted into histograms. RESULTS A total of 467 patients with 484 plans and 1196 unique beam angles were evaluated and characterized by anatomic treatment site and the number of beam angles utilized. The most common beam angles used were 0° and 180°. A wide range of beam angles were used in treating almost all anatomic sites. Only esophageal cancers had a predominantly unimodal grouping of beam angles. Pancreas cancers showed a modest grouping of beam angles. CONCLUSIONS The wide distribution of beam angles used to treat CIRT-eligible patients suggests that a rotating gantry is optimal to provide highly individualized beam arrangements.
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Affiliation(s)
- Siven Chinniah
- Mayo Clinic Alix School of Medicine, Jacksonville, FL 32224, USA
| | - Amanda J Deisher
- Department of Radiation Oncology, Division of Medical Physics, Rochester, MN 55905, USA
| | - Michael G Herman
- Department of Radiation Oncology, Division of Medical Physics, Rochester, MN 55905, USA
| | - Jedediah E Johnson
- Department of Radiation Oncology, Division of Medical Physics, Rochester, MN 55905, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Compagnon R, Brun-Cottan B, Assemat P, Vial J, Sales de Gauzy J, Swider P. Diffusion properties of asymptomatic lumbar intervertebral discs in a pediatric cohort: a preliminary study of apparent diffusion coefficient. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2943-2949. [PMID: 35939067 DOI: 10.1007/s00586-022-07342-4] [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: 04/05/2022] [Revised: 07/05/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To explore the apparent diffusion coefficients of intervertebral discs in an asymptomatic pediatric cohort. METHODS We conducted a prospective MRI study of the lumbar spine from below the thoracolumbar junction to the lumbosacral junction on 12 subjects (mean age 13 y.o.) with no spinal pathology or spinal posture disorder. MRI was carried out using a 1.5 T machine with acquisitions realized both in sagittal and coronal planes. First, disc hydration was determined, and then, diffusion-weighted images were obtained using an SE single-shot echo-planar sequence. Apparent diffusion coefficients (ADC) of anterior annulus fibrosus (AAF), nucleus pulposus (NP) and posterior annulus fibrosus (PAF) were measured in the sagittal plane. RESULTS Averaged hydration of 0.27 SD 0.03 confirmed the asymptomatic nature of discs. Average scaled values of ADC were 0.46 SD 0.01, 0.22 SD 0.09 and 0.18 SD 0.03 for NP, AAF and PAF, respectively. ADC of NP were almost constant along the spine; PAF values show a slight increase in the thorax-sacrum direction, while AAF values showed a pronounced decrease. Locally, ADC of AAF was higher compared to ADC PAF values below the thoracolumbar junction and it reversed for subjacent discs. CONCLUSIONS In our knowledge, our study provided the first diffusive properties of asymptomatic intervertebral discs in an adolescent cohort. ADC of NP was slightly higher than adults'. ADC evolutions of AAF were correlated with lordosis concavity which pointed out the role of compressive strain on fluid transport properties. This study could furnish information about segment homeostasis for exploration of pediatric spinal pathologies.
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Affiliation(s)
- Roxane Compagnon
- Children Hospital, Toulouse, France
- IMFT UMR CNRS 5502, Toulouse University, CHU Purpan, 2 Allées C. Soula, 31400, Toulouse, France
- Clinique Médipôle Garonne, Toulouse, France
| | - Baptiste Brun-Cottan
- IMFT UMR CNRS 5502, Toulouse University, CHU Purpan, 2 Allées C. Soula, 31400, Toulouse, France
| | - Pauline Assemat
- IMFT UMR CNRS 5502, Toulouse University, CHU Purpan, 2 Allées C. Soula, 31400, Toulouse, France
| | | | - Jérôme Sales de Gauzy
- Children Hospital, Toulouse, France
- IMFT UMR CNRS 5502, Toulouse University, CHU Purpan, 2 Allées C. Soula, 31400, Toulouse, France
| | - Pascal Swider
- IMFT UMR CNRS 5502, Toulouse University, CHU Purpan, 2 Allées C. Soula, 31400, Toulouse, France.
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Iyengar KP, Zaw Pe E, Jalli J, Shashidhara MK, Jain VK, Vaish A, Vaishya R. Industry 5.0 technology capabilities in Trauma and Orthopaedics. J Orthop 2022; 32:125-132. [DOI: 10.1016/j.jor.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 12/29/2022] Open
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Faruqi T, Padget W, Patel N. Utility of Weight-Bearing MRI in the Lumbar Spine: A Novel Indication. Cureus 2022; 14:e23930. [PMID: 35535292 PMCID: PMC9078698 DOI: 10.7759/cureus.23930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
For decades MRI has been utilized for diagnosing spine pathology. However, like many imaging modalities utilized today, a conventional MRI is a static study. The spine is a complex, dynamic structure whose loading characteristics change with the position of the spine and the type and direction of force applied. This gives rise to dynamic pathologies that are often masked if attempted to be imaged using conventional MRIs. This is where a weight-bearing MRI (WBMRI) shines. We report the case of a 66-year-old female in whom an L3-L4 synovial facet cyst was diagnosed on a WBMRI.
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Affiliation(s)
- Taha Faruqi
- Orthopaedic Surgery, Beaumont Health, Dearborn, USA
| | | | - Nilesh Patel
- Orthopaedic Surgery, Beaumont Health, Dearborn, USA
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Doktor K, Hartvigsen J, Hancock M, Christensen HW, Fredberg U, Boyle E, Kindt M, Brix L, Jensen TS. Reliability of reporting differences in degenerative MRI findings of the lumbar spine from the supine to the upright position. Skeletal Radiol 2022; 51:2141-2154. [PMID: 35536357 PMCID: PMC9463326 DOI: 10.1007/s00256-022-04060-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the inter-rater reliability of identifying differences and types of differences in lumbar degenerative findings comparing supine and upright MRI. MATERIALS AND METHODS Fifty-nine participants, low back pain patients (LBP) with or without leg pain and no-LBP individuals were consecutively enrolled to receive supine and upright MRI of the lumbar spine. Three raters independently evaluated the MRIs for degenerative spinal pathologies and compared for differences. Presence/absence of degenerative findings were recorded for all supine and upright images, and then differences from the supine to the upright positions were classified into no-change, appeared, disappeared, worsened, or improved at each individual disc level. Reliability and agreement were calculated using Gwet's agreement coefficients (AC1 or AC2) and absolute agreement. RESULTS Inter-rater reliability of evaluating differences in eight degenerative lumbar findings comparing the supine and upright MRI position, ranged from 0.929 to 0.996 according to Gwet's agreement coefficients (AC2). The total number of positive MRI findings in the supine position ranged from 270 to 453, with an average of 366 per rater. Observed differences from supine to upright MRI ranged from 18 to 80, with an average of 56 per rater. CONCLUSION Inter-rater reliability was found overall acceptable for classification of differences in eight types of degenerative pathology observed with supine and upright MRI of the lumbar spine. Results were primarily driven by high numbers and high reliability of rating negative findings, whereas agreement regarding positive findings and positive positional differences was lower.
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Affiliation(s)
- Klaus Doktor
- Department of Sport Sciences and Clinical Biomechanics, Research Unit of Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ,Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark ,Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark
| | - Jan Hartvigsen
- Department of Sport Sciences and Clinical Biomechanics, Research Unit of Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ,Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark
| | - Mark Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Ulrich Fredberg
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark ,The Rheumatology Research Unit, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Department of Sport Sciences and Clinical Biomechanics, Research Unit of Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Morten Kindt
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark
| | - Lau Brix
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark ,Department of Procurement and Clinical Engineering, Region Midt, Aarhus, Denmark
| | - Tue Secher Jensen
- Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark ,Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark ,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Liegnell R, Wessman F, Shalabi A, Harringe M. Validity of ultrasonography-derived predictions for estimating skeletal muscle volume: a systematic literature review. BMC Med Imaging 2021; 21:106. [PMID: 34229618 PMCID: PMC8258927 DOI: 10.1186/s12880-021-00638-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background The amount of muscle volume (MV) varies between individuals and is important for health, well-being and performance. Therefore, the monitoring of MV using different imaging modalities is important. Magnetic resonance imaging (MRI) is considered the gold standard, but is not always easily accessible, and the examinations are expensive. Ultrasonography (US) is a much less expensive imaging method widely used to measure changes in muscle thickness (MT). Whether MT may translate into MV needs further investigation. Purpose The aim of this review is to clarify whether US-derived equations based on MT predict MV based on MRI. Methods A systematic literature review was conducted according to the PRISMA statement, searching the electronic databases PubMed, CINAHL and Web of Science, for currently published equations to estimate MV with US. Results The literature search resulted in 363 citations. Twelve articles met the eligibility criteria. Ten articles scored eight out of eleven on QUADAS and two scored nine. Thirty-six prediction equations were identified. R values ranged between 0.53 and 0.961 and the standard error of the estimate (SEE) ranged between 6 and 12% for healthy adult populations, and up to 25.6% for children with cerebral palsy. Eight studies evaluated the results with a Bland–Altman plot and found no systematic errors. The overall strength and quality of the evidence was rated “low quality” as defined by the GRADE system. Conclusions The validity of US-derived equations based on MT is specific to the populations from which it is developed. The agreement with MV based on MRI is moderate with the SEE ranging between 6 and 12% in healthy adult populations. Suggestions for future research include investigations as to whether testing positions or increasing the number of measuring sites could improve the validity for prediction equations.
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Affiliation(s)
- Rasmus Liegnell
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
| | - Fredrik Wessman
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Adel Shalabi
- Centre for Medical Imaging, University Hospital, Uppsala University, Uppsala, Sweden
| | - Marita Harringe
- Stockholm Sports Trauma Research Centre, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Development of Upright Computed Tomography With Area Detector for Whole-Body Scans: Phantom Study, Efficacy on Workflow, Effect of Gravity on Human Body, and Potential Clinical Impact. Invest Radiol 2020; 55:73-83. [PMID: 31503082 PMCID: PMC6948833 DOI: 10.1097/rli.0000000000000603] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Multiple human systems are greatly affected by gravity, and many disease symptoms are altered by posture. However, the overall anatomical structure and pathophysiology of the human body while standing has not been thoroughly analyzed due to the limitations of various upright imaging modalities, such as low spatial resolution, low contrast resolution, limited scan range, or long examination time. Recently, we developed an upright computed tomography (CT), which enables whole-torso cross-sectional scanning with 3-dimensional acquisition within 15 seconds. The purpose of this study was to evaluate the performance, workflow efficacy, effects of gravity on a large circulation system and the pelvic floor, and potential clinical impact of upright CT. MATERIALS AND METHODS We compared noise characteristics, spatial resolution, and CT numbers in a phantom between supine and upright CT. Thirty-two asymptomatic volunteers (48.4 ± 11.5 years) prospectively underwent both CT examinations with the same scanning protocols on the same day. We conducted a questionnaire survey among these volunteers who underwent the upright CT examination to determine their opinions regarding the stability of using the pole throughout the acquisition (closed question), as well as safety and comfortability throughout each examination (both used 5-point scales). The total access time (sum of entry time and exit time) and gravity effects on a large circulation system and the pelvic floor were evaluated using the Wilcoxon signed-rank test and the Mann-Whitney U test. For a large circulation system, the areas of the vena cava and aorta were evaluated at 3 points (superior vena cava or ascending aorta, at the level of the diaphragm, and inferior vena cava or abdominal aorta). For the pelvic floor, distances were evaluated from the bladder neck to the pubococcygeal line and the anorectal junction to the pubococcygeal line. We also examined the usefulness of the upright CT in patients with functional diseases of spondylolisthesis, pelvic floor prolapse, and inguinal hernia. RESULTS Noise characteristics, spatial resolution, and CT numbers on upright CT were comparable to those of supine CT. In the volunteer study, all volunteers answered yes regarding the stability of using the pole, and most reported feeling safe (average rating of 4.2) and comfortable (average rating of 3.8) throughout the upright CT examination. The total access time for the upright CT was significantly reduced by 56% in comparison with that of supine CT (upright: 41 ± 9 seconds vs supine: 91 ± 15 seconds, P < 0.001). In the upright position, the area of superior vena cava was 80% smaller than that of the supine position (upright: 39.9 ± 17.4 mm vs supine: 195.4 ± 52.2 mm, P < 0.001), the area at the level of the diaphragm was similar (upright: 428.3 ± 87.9 mm vs supine: 426.1 ± 82.0 mm, P = 0.866), and the area of inferior vena cava was 37% larger (upright: 346.6 ± 96.9 mm vs supine: 252.5 ± 93.1 mm, P < 0.001), whereas the areas of aortas did not significantly differ among the 3 levels. The bladder neck and anorectal junction significantly descended (9.4 ± 6.0 mm and 8.0 ± 5.6 mm, respectively, both P < 0.001) in the standing position, relative to their levels in the supine position. This tendency of the bladder neck to descend was more prominent in women than in men (12.2 ± 5.2 mm in women vs 6.7 ± 5.6 mm in men, P = 0.006). In 3 patients, upright CT revealed lumbar foraminal stenosis, bladder prolapse, and inguinal hernia; moreover, it clarified the grade or clinical significance of the disease in a manner that was not apparent on conventional CT. CONCLUSIONS Upright CT was comparable to supine CT in physical characteristics, and it significantly reduced the access time for examination. Upright CT was useful in clarifying the effect of gravity on the human body: gravity differentially affected the volume and shape of the vena cava, depending on body position. The pelvic floor descended significantly in the standing position, compared with its location in the supine position, and the descent of the bladder neck was more prominent in women than in men. Upright CT could potentially aid in objective diagnosis and determination of the grade or clinical significance of common functional diseases.
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Frič R. Upright magnetic resonance imaging in diagnostics of Chiari malformation type 1 - cui bono? Acta Neurochir (Wien) 2020; 162:1549-1550. [PMID: 32215741 DOI: 10.1007/s00701-020-04297-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Radek Frič
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O. Box 4950 Nydalen, N-0424, Oslo, Norway.
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Almeer G, Azzopardi C, Kho J, Gupta H, James SL, Botchu R. Anatomy and pathology of facet joint. J Orthop 2020; 22:109-117. [PMID: 32322140 DOI: 10.1016/j.jor.2020.03.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 12/26/2022] Open
Abstract
Facet joints are the only synovial joints in the spine and can be involved in a large number of pathological processes including arthropathy, infection, inflammation, trauma and tumour. In this review article, we present a spectrum of pathologies that arise from or involve facet joints that we have encountered in our tertiary orthopaedic and spinal centre. The objective of this review is to create an aide memoire for the general radiologist who may encounter facet joint pathology, which they may not be familiar with.
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Affiliation(s)
- G Almeer
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J Kho
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - H Gupta
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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Elmaazi A, Morse CI, Lewis S, Qureshi S, McEwan I. The acute response of the nucleus pulposus of the cervical intervertebral disc to three supine postures in an asymptomatic population. Musculoskelet Sci Pract 2019; 44:102038. [PMID: 31536882 DOI: 10.1016/j.msksp.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 05/30/2019] [Accepted: 07/04/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The dynamic disc model refers to the ability of a spinal disc's position to be manipulated by body postures and movements. Research on lumbar discs has indicated movement of the anterior and posterior disc that correlates with posture of the spine. The aim of this study was to assess whether, despite its structural differences, the cervical disc responds to flexed and extended postures in a similar fashion to the lumbar disc. METHOD A repeated measures study. Twenty five asymptomatic participants (age: 33.7 ± 9.1 years) volunteered. Scans were performed in supine using an Esaote 0.2T magnetic resonance imaging scanner. Participants lay with their cervical spine initially placed in neutral, followed by flexion and finally extension. The position of the posterior disc nucleus pulposus at C5-6 and C6-7 was measured against a vertical line connecting the posterior vertebral bodies above and below each disc. RESULTS Changes in cervical spine position were associated with significant changes in posterior disc nucleus pulposus position at both C5-6 and C6-7 (p < 0.01 for both). Post hoc testing showed a significant difference in posterior disc nucleus pulposus position at C5-6 between flexion and extension (p = 0.02). There was similarly a significant change at C6-7 between neutral and flexion (p = 0.001), and between flexion and extension (p = 0.02). CONCLUSIONS These results indicate that the cervical posterior nucleus pulposus is affected by spinal loading, consistent with the concept of the dynamic disc model.
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Affiliation(s)
- Areej Elmaazi
- Department of Exercise and Sport Science, Manchester Metropolitan University, Crewe Green Rd, Crewe, Cheshire, CW1 5DU, UK
| | - Christopher I Morse
- Department of Exercise and Sport Science, Manchester Metropolitan University, Crewe Green Rd, Crewe, Cheshire, CW1 5DU, UK.
| | - Sandra Lewis
- Department of Exercise and Sport Science, Manchester Metropolitan University, Crewe Green Rd, Crewe, Cheshire, CW1 5DU, UK
| | - Salman Qureshi
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Islay McEwan
- Department of Exercise and Sport Science, Manchester Metropolitan University, Crewe Green Rd, Crewe, Cheshire, CW1 5DU, UK
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Oh JK. Do Not Think to See One Side and Know the Whole - We Have to Understand Cervical Spine Dynamics Not Only Static State. Neurospine 2019; 16:454-455. [PMID: 31607077 PMCID: PMC6790733 DOI: 10.14245/ns.19edi.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jae Keun Oh
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
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The Michel Benoist and Robert Mulholland yearly European Spine Journal review: a survey of the "surgical and research" articles in the European Spine Journal, 2018. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1-9. [PMID: 30604293 DOI: 10.1007/s00586-018-5856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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Answer to the Letter to the Editor of Miao Yu et al. concerning "Is L5-S1 motion segment different from the rest? A radiographic kinematic assessment of 72 patients with chronic low back pain" by AB Sabnis et al. (Eur. Spine J; 27(5):1127-1135). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:1249. [PMID: 29934709 DOI: 10.1007/s00586-018-5675-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
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