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Khabyeh-Hasbani N, O’Brien DM, Meisel EM, Koehler SM. Current Concepts in Brachial Plexus Birth Injuries: A Comprehensive Narrative Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6083. [PMID: 39175516 PMCID: PMC11340930 DOI: 10.1097/gox.0000000000006083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/24/2024] [Indexed: 08/24/2024]
Abstract
Background Brachial plexus birth injury (BPBI) encompasses a spectrum of upper extremity paralysis cases following childbirth. The etiology of BPBI is multifactorial, involving maternal, obstetric, and neonatal associative factors. Despite opportunities for spontaneous recovery, recent literature demonstrates that a significant proportion of infants experience residual deficits and functional limitations as they age. Understanding the complex anatomy of the brachial plexus, clinical presentations of the pathology, diagnostic workup, current treatment options, and common secondary sequelae is instrumental for appropriate management of BPBI. Methods Following a comprehensive search strategy used by the authors to identify relevant literature relating to the progression, patho-anatomy, clinical presentation, management, and treatment of BPBI, this comprehensive narrative review outlines current approaches to assess, manage, and advance BPBI care. Results We advocate for prompt referral to specialized multicenter brachial plexus clinics for accurate diagnosis, timely intervention, and individualized patient-centered assessment. Further research is needed to elucidate mechanisms of injury, refine diagnostic protocols, and optimize long-term outcomes. Conclusions Collaboration between healthcare providers and families is paramount in providing comprehensive care for infants with BPBI. This review offers insights into the current understanding and management of BPBI, highlighting the importance of tailored approaches and intraoperative decision-making algorithms to optimize functional outcomes.
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Affiliation(s)
- Nathan Khabyeh-Hasbani
- From the Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, N.Y
| | - Devon M. O’Brien
- Department of Orthopaedic Surgery, Children’s Hospital of Los Angeles, Los Angeles, Calif
| | - Erin M. Meisel
- Department of Orthopaedic Surgery, Children’s Hospital of Los Angeles, Los Angeles, Calif
| | - Steven M. Koehler
- From the Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, N.Y
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Jiang JT, Wang X, Li J, Huang W. Ipsilateral talus and calcaneus fracture associated with deltoid ligament rupture and Peroneal tendon subluxion. Asian J Surg 2024; 47:2707. [PMID: 38609830 DOI: 10.1016/j.asjsur.2024.03.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/06/2024] [Indexed: 04/14/2024] Open
Affiliation(s)
- Jian-Tao Jiang
- Department of Orthopedics, ShaoXing Shangyu Traditional Chinese Medicine Hospital, ZheJiang, 312300, China
| | - Xiao Wang
- Department of Orthopedics, ShaoXing Shangyu Traditional Chinese Medicine Hospital, ZheJiang, 312300, China
| | - Jianwen Li
- Department of Orthopedics, ShaoXing Shangyu Traditional Chinese Medicine Hospital, ZheJiang, 312300, China
| | - Weijun Huang
- Department of Orthopedics, ShaoXing Shangyu Third Hospital, ZheJiang, 312300, China.
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Iamaguchi RB, Rosa de Rezende M. Functional Free Muscle Transfer for Reconstruction of Traumatic Adult Brachial Plexus Injuries. Hand Clin 2024; 40:259-267. [PMID: 38553097 DOI: 10.1016/j.hcl.2023.08.011] [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] [Indexed: 04/02/2024]
Abstract
Traumatic brachial plexus injury is the most common indication for functional free muscle transfer, and elbow flexion recovery is the functional target, followed by shoulder stability and hand reanimation. In this article, we provide a literature review of functional free muscle transfer (FFMT) for adult traumatic brachial plexus injuries and the surgical technical recommendations to achieve the best functional results with FFMT for adult traumatic brachial plexus injuries.
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Affiliation(s)
- Raquel Bernardelli Iamaguchi
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumatology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil.
| | - Marcelo Rosa de Rezende
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumatology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
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Nair PP, Mariappan YK, Paruthikunnan SM, Kamath A, Rolla NK, Saha I, Kadavigere R. Magnetic Resonance Neurography of the Brachial Plexus Using 3D SHINKEI: Comparative Evaluation with Conventional Magnetic Resonance Sequences for the Visualization of Anatomy and Detection of Nerve Injury at 1.5T. J Med Phys 2021; 46:140-147. [PMID: 34703097 PMCID: PMC8491319 DOI: 10.4103/jmp.jmp_13_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Purpose This work aims at optimizing and studying the feasibility of imaging the brachial plexus at 1.5T using 3D nerve-SHeath signal increased with INKed rest-tissue RARE imaging (3D SHINKEI) neurography sequence by comparing with routine sequences. Materials and Methods The study was performed on a 1.5T Achieva scanner. It was designed in two parts: (a) Optimization of SHINKEI sequence at 1.5T; and (b) Feasibility study of the optimized SHINKEI sequence for generating clinical quality magnetic resonance neurography images at 1.5T. Simulations and volunteer experiments were conducted to optimize the T2 preparation duration for optimum nerve-muscle contrast at 1.5T. Images from the sequence under study and other routine sequences from 24 patients clinically referred for brachial plexus imaging were scored by a panel of radiologists for diagnostic quality. Injury detection efficacy of these sequences were evaluated against the surgical information available from seven patients. Results T2 preparation duration of 50 ms gives the best contrast to noise between nerve and muscle. The images of 3D SHINKEI and short-term inversion recovery turbo spin-echo sequences are of similar diagnostic quality but significantly better than diffusion weighted imaging with background signal suppression. In comparison with the surgical findings, 3D SHINKEI has the lowest specificity; however, it had the highest sensitivity and predictive efficacy compared to other routine sequences. Conclusion 3D SHINKEI sequence provides a good nerve-muscle contrast and has high predictive efficacy of nerve injury, indicating that it is a potential screening sequence candidate for brachial plexus scans at 1.5T also.
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Affiliation(s)
- Prashant Prabhakaran Nair
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | | | - Samir M Paruthikunnan
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | - Asha Kamath
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Gurgaon, Haryana, India
| | | | | | - Rajagopal Kadavigere
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
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Hadinoto SA, Sumarwoto T, Trapsilantya ME. Brachial Plexus Injury Surgical Service in Time of Coronavirus Disease 2019 Pandemic Experience from a Single Tertiary Orthopaedic Hospital in Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Brachial plexus injury (BPI) is one of the most devastating nerve injuries to the extremities. BPI in adults is an increasingly common clinical problem due to road traffic accident. Injury patterns, the timing of surgery, priority on the recovery of function, and patient’s understanding about the expectations of the prognosis are things that are important to consider before deciding on surgical management. The coronavirus pandemic coronavirus disease 2019 (COVID-19) has significantly affected all sectors, one of which is a surgical practice both in terms of medical personnel and equipment, also patient perceptions of hospital services.
AIM: This study will analyze epidemiological data on BPI patients who underwent surgery during the COVID-19 pandemic.
METHODS: A retrospective descriptive study of BPI profile in Prof. Soeharso Orthopedic Hospital before (2019) and during (2020) the COVID-19 pandemic. Demographic data, the total number of surgery, type of surgical procedure, and patient origin were collected. We compared to the same period in 2019 before pandemic started.
RESULTS: In the data obtained from patients treated or undergoing BPI surgery before pandemic (March 1, 2019 to December 31, 2019) and during the pandemic (March 1, 2020 to December 31, 2020), Indonesia first confirms case was on March 2, 2020, until today. There were 51 and 43 cases, respectively. Panplexal type before the pandemic there were 27 patients (52%), and during the pandemic were 20 patients (46%), the upper type before: during the pandemic was 24 (48%): 23 (54%), and lower type 0 cases. Primary reconstruction before: during the pandemic was 26 (55%): 27 (62%) case, and secondary reconstruction before: during the pandemic was 25 (49%): 16 (38%) case, respectively.
CONCLUSION: COVID-19 pandemic has no significant effect in the term of the number of BPI surgery performed. Better outcome in BPI surgery is influenced by the timing of the operation, therefore primary reconstruction remains the main choice for BPI patients with safety concern or health protocols. Pre-operative screening applied in our hospital includes laboratory examination, chest radiograph, and polymerase chain reaction swab test. Surgical personnel using personal protective equipment such as protective suit, face shield, google, shoes and medical mask during the COVID-19 pandemic. Patients with significant axon loss and limited clinical recovery are considered “urgent”, as surgery should be performed within 6 months or sooner (depending upon the distance to recipient’s muscle) to avoid irreversible muscle atrophy and degradation of motor endplates.
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Abouhanine O, Belgadir H, Ndayishimiye V, Amriss O, Merzem A, Moussali N, El Benna N. Amyotrophic Monoplegia Secondary to Posttraumatic Rupture of the Brachial Plexus's Roots: A Case Report and Review of the Literature. Case Rep Radiol 2021; 2021:6614881. [PMID: 37601337 PMCID: PMC10435315 DOI: 10.1155/2021/6614881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 08/22/2023] Open
Abstract
Brachial plexus lesions most often occur in multiple trauma. We report a case of a 37-year-old patient who presented an upper left limb total sensitivomotor deficit and amyotrophy after a cervical and upper limb trauma. Cervical magnetic resonance imaging (MRI) was performed. It noted pseudomeningoceles at the levels of C6-C7, C7-D1, and D1-D2 in T1 hyposignal , T2 and STIR hypersignal , not enhanced by the injection of Gadolinium extending in foraminal and extraforaminal spaces without visualization of the corresponding rootlets. Traumatic brachial plexus injury is a potentially serious debilitating injury which can be well explored on MRI.
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Affiliation(s)
- Oumniya Abouhanine
- Department of Radiology, Ibn Rochd University Hospital Center of Casablanca, Radiology Service of August 20, 1953 Hospital, Hassan II University of Casablanca, Morocco
| | - Hasnaa Belgadir
- Department of Radiology, Ibn Rochd University Hospital Center of Casablanca, Radiology Service of August 20, 1953 Hospital, Hassan II University of Casablanca, Morocco
| | - Vianney Ndayishimiye
- Department of Radiology, Ibn Rochd University Hospital Center of Casablanca, Radiology Service of August 20, 1953 Hospital, Hassan II University of Casablanca, Morocco
| | - Omar Amriss
- Department of Radiology, Ibn Rochd University Hospital Center of Casablanca, Radiology Service of August 20, 1953 Hospital, Hassan II University of Casablanca, Morocco
| | - Aicha Merzem
- Department of Radiology, Ibn Rochd University Hospital Center of Casablanca, Radiology Service of August 20, 1953 Hospital, Hassan II University of Casablanca, Morocco
| | - Nadia Moussali
- Department of Radiology, Ibn Rochd University Hospital Center of Casablanca, Radiology Service of August 20, 1953 Hospital, Hassan II University of Casablanca, Morocco
| | - Naima El Benna
- Department of Radiology, Ibn Rochd University Hospital Center of Casablanca, Radiology Service of August 20, 1953 Hospital, Hassan II University of Casablanca, Morocco
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Zheng G, Xia F, Yang S, Cui J. Application of medial column classification in treatment of intra-articular calcaneal fractures. World J Clin Cases 2020; 8:4400-4409. [PMID: 33083399 PMCID: PMC7559649 DOI: 10.12998/wjcc.v8.i19.4400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/03/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are many types of treatments for calcaneal fractures, including conservative treatment, conventional surgical treatment, and minimally invasive surgery. The choice of specific treatment options is still controversial. Open reduction and internal fixation are currently the most commonly used surgical procedures in the clinic. A good fracture reduction effect can be achieved by using the lateral extension incision of the calcaneus; however, many studies have reported a high incidence of postoperative incision complications. Although there are many methods for the classification of intra-articular calcaneal fractures, it is generally believed that the computed tomography (CT) classification proposed by Sanders has high application value in the selection of treatment methods and evaluation of prognosis of calcaneal fractures. However, this method has no clear guiding significance for the choice of surgical incision and surgical plan.
AIM To explore the application and clinical efficacy of medial column classification in the treatment of intra-articular calcaneal fractures.
METHODS From July 2017 to July 2018, 91 patients, including 60 males and 31 females aged 27 to 60 years, were enrolled. All participants had closed intra-articular calcaneal fracture, and their surgical options were selected under the guidance of medial column classification. The patients’ fractures were classified according to the Sanders classification: Type II, 35 cases; Type III, 33 cases; and Type IV, 23 cases. Among them, 53 patients had medial column displacement (shortened varus) and underwent open reduction and internal fixation with L-lateral incision of the calcaneus; 38 patients had no displacement of the medial column and underwent open reduction and internal fixation with tarsal sinus incision. The calcaneus Böhler angle, Gissane angle, length, width, height, and step thickness of the articular surface were evaluated by X-ray and three-dimensional CT before and after surgery and at the last follow-up. Foot function recovery was assessed by the Maryland foot scoring criteria.
RESULTS All patients were followed for 5 to 14 mo, with an average of 10.5 ± 2.9 mo. The fractures of all patients healed, and the healing time was 10 to 19 wk, with an average of 10.8 ± 1.5 wk. One patient developed wound infection 1 wk after surgery and was actively debrided and implanted with antibiotic calcium sulfate to control the infection. The patient's fracture healed 5 mo after surgery. One patient developed a sural nerve injury, and the symptoms disappeared 3 mo after surgery. The patients were assessed according to the Maryland foot scoring system: Excellent in 77 cases, good in 10, and fair in 4. The excellent and good rate was 95.6%.
CONCLUSION Medial column classification can effectively guide the surgical selection for intra-articular fractures of the calcaneus.
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Affiliation(s)
- Gang Zheng
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Fan Xia
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Shuang Yang
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Jun Cui
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
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8
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Hung ND, Duc NM, Xoan NT, Doan NV, Huyen TTT, Dung LT. Diagnostic Function of 3-Tesla Magnetic Resonance Imaging for the Assessment of Brachial Plexus Injury. Ann Neurosci 2020; 27:124-130. [PMID: 34556950 PMCID: PMC8455017 DOI: 10.1177/0972753120963299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: This study aimed to evaluate the diagnostic function of 3-Tesla (T) magnetic resonance imaging (MRI) during the assessment of brachial plexus injury (BPI), in comparison with intraoperative findings. Methods: A retrospective study was performed on 60 patients (47 men and 13 women), who had clinical manifestations of BPI, underwent 3T MRI of the brachial plexus, and were surgically treated at the Viet Duc and Vinmec Times City hospitals, in Hanoi, Vietnam, from March 2016 to December 2019. Preganglionic and postganglionic lesion features were identified on MRI. The diagnostic function of MRI features for the determination of BPI was evaluated and correlated with intraoperative findings. Results: The root avulsion and pseudomeningocele preganglionic injuries were observed in 57% and 43% of MRIs, respectively, and were commonly observed at the C7 and C8 roots. Nerve disruption and never edema were observed in 47.56% and 33.53% of MRIs, respectively, and were commonly observed at the C5 and C6 roots. The sensitivity, specificity, accuracy, positive prognostic value, and negative prognostic value of 3T MRI were 64.12%, 92.90%, 80.33%, 87.50%, and 76.96%, respectively, for the diagnosis of total avulsion, and 68.52%, 83.33%, 80.67%, 47.44%, and 92.34%, respectively, for the diagnosis of nerve disruption. Conclusion: MRI offers valuable details regarding the location, morphology, and severity of both preganglionic and postganglionic injuries during the preoperative diagnosis of BPI. However, this modality played a moderate diagnostic role. Therefore, 3T MRI should be used as a supplemental evaluation, coupled with clinical tests and electromyography, to determine the most appropriate treatment strategies for BPI patients.
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Affiliation(s)
- Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam.,Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Xoan
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Ngo Van Doan
- Department of Radiology, Vinmec Times City Hospital, Hanoi, Vietnam
| | - Tran Thi Thanh Huyen
- Department of Maxillofacial Plastic and Aesthetic Surgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Le Thanh Dung
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
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Novel functional imaging technique for the brachial plexus based on magnetoneurography. Clin Neurophysiol 2019; 130:2114-2123. [PMID: 31542709 DOI: 10.1016/j.clinph.2019.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/02/2019] [Accepted: 08/12/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To visualize neural activity in the brachial plexus using magnetoneurography (MNG). METHODS Using a 124- or 132-channel biomagnetometer system with a superconducting quantum interference device, neuromagnetic fields above the clavicle and neck region were recorded in response to electrical stimulation of the median and ulnar nerves in five asymptomatic volunteers (four men and one woman; age, 27-45 years old). Equivalent currents were computationally reconstructed from neuromagnetic fields and visualized as pseudocolor maps. Reconstructed currents at the depolarization site and compound nerve action potentials (CNAPs) at Erb's point were compared. RESULTS Neuromagnetic fields were recorded in all subjects. The reconstructed equivalent currents propagated into the vertebral foramina, and the main inflow levels differed between the median nerve (C5/C6-C7/T1 vertebral foramen) and the ulnar nerve (C7/T1-T1/T2). The inward current peaks at the depolarization site and CNAPs showed high linear correlation. CONCLUSIONS MNG visualizes neural activity in the brachial plexus and can differentiate the conduction pathways after median and ulnar nerve stimulations. In addition, it can visualize not only the leading and trailing components of intra-axonal currents, but also inward currents at the depolarization site. SIGNIFICANCE MNG is a novel and promising functional imaging modality for the brachial plexus.
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Echalier C, Teboul F, Dubois E, Chevrier B, Soumagne T, Goubier JN. The value of preoperative examination and MRI for the diagnosis of graftable roots in total brachial plexus palsy. HAND SURGERY & REHABILITATION 2019; 38:246-250. [DOI: 10.1016/j.hansur.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/19/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
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Bruno F, Arrigoni F, Natella R, Maggialetti N, Pradella S, Zappia M, Reginelli A, Splendiani A, Di Cesare E, Guglielmi G, Miele V, Giovagnoni A, Brunese L, Masciocchi C, Barile A. MR Imaging of the Upper Limb: Pitfalls, Tricks, and Tips. Radiol Clin North Am 2019; 57:1051-1062. [PMID: 31351535 DOI: 10.1016/j.rcl.2019.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
MR imaging is the modality of choice to evaluate musculoskeletal pathologies of the upper limb in most settings. However, due to the complexity in anatomy, MR imaging can give a false pathologic appearance and lead to several errors in the interpretation of MR imaging findings. Also, several artifacts can be confused with pathologic entities. This article reviews the most frequently encountered conditions in shoulder, elbow, and wrist MR imaging that can represent diagnostic pitfalls mimicking true pathology, together with some possible tips and tricks that can be useful to solve these equivocal cases and achieve a correct diagnosis.
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Affiliation(s)
- Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio 1, L'Aquila 67100, Italy
| | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio 1, L'Aquila 67100, Italy
| | - Raffaele Natella
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli," via Pansini 5, Napoli 80131, Italy
| | - Nicola Maggialetti
- Department Life and Health "V. Tiberio," University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Marcello Zappia
- Department Life and Health "V. Tiberio," University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli," via Pansini 5, Napoli 80131, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio 1, L'Aquila 67100, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio 1, L'Aquila 67100, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, via Conca 71, Ancona 60121, Italy
| | - Luca Brunese
- Department Life and Health "V. Tiberio," University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio 1, L'Aquila 67100, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio 1, L'Aquila 67100, Italy.
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Mariniello G, De Liso M, Russo C, Del Vecchio W, De Divitiis O, Bruno F, Maggialetti N, Arrigoni F, Brunese L, Caranci F. Radiation-induced brain cavernomas in elderly: review of the literature and a rare case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:77-83. [PMID: 31085976 PMCID: PMC6625569 DOI: 10.23750/abm.v90i5-s.8328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 12/16/2022]
Abstract
Radiation-induced brain cavernomas have been mainly reported in children who underwent radiotherapy for medulloblastoma, leukemia, or low-grade glioma. Otherwise, the “de novo” appearance of a cavernoma in an elderly long-survivor patient after resection and radiotherapy of a glioblastoma is a rare event. We report the case of a 62-year-old female patient who underwent surgical resection of a right temporal glioblastoma, followed by radiation therapy of the operative field and surrounding brain and concomitant adjuvant temozolomide. Four years after the operation, a follow-up Magnetic Resonance revealed a good tumor control and a small round lesion at the superior surface of the right cerebellar hemisphere, close to the margins of the previous irradiation field. The radiological items were consistent with a cavernous angioma. Because of the small size of the malformation and the absence of related symptoms, no treatment was performed. The patient died for tumor progression 86 months after the initial operation, with unchanged cerebellar cavernoma. The occurrence of a cavernous angioma in an elderly patient after radiotherapy for brain glioblastoma is an exceptional event; the distribution of radiotherapy-induced cavernous malformations reported in current literature is presented and the mechanism of their formation is discussed. (www.actabiomedica.it)
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Affiliation(s)
- Giuseppe Mariniello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Neurosurgical Clinic, University of Naples Federico II, Naples, Italy.
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Bruno F, Arrigoni F, Mariani S, Patriarca L, Palumbo P, Natella R, Ma L, Guglielmi G, Galzio RJ, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Application of diffusion tensor imaging (DTI) and MR-tractography in the evaluation of peripheral nerve tumours: state of the art and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:68-76. [PMID: 31085975 PMCID: PMC6625568 DOI: 10.23750/abm.v90i5-s.8326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 12/18/2022]
Abstract
Peripheral nerves can be affected by a variety of benign and malignant tumour and tumour-like lesions. Besides clinical evaluation and electrophysiologic studies, MRI is the imaging modality of choice for the assessment of these soft tissue tumours. Conventional MR sequences, however, can fail to assess the histologic features of the lesions. Moreover, the precise topographical relationship between the peripheral nerve and the tumor must be delineated preoperatively for complete tumour resection minimizing nerve damage. Using Diffusion tensor imaging (DTI) and tractography, it is possible to obtain functional information on tumour and nerve structures, allowing the assess anatomy, function and biological features. In this article, we review the technical aspects and clinical application of DTI for the evaluation of peripheral nerve tumours. (www.actabiomedica.it)
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Affiliation(s)
- Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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Bruno F, Arrigoni F, Maggialetti N, Natella R, Reginelli A, Di Cesare E, Brunese L, Giovagnoni A, Masciocchi C, Splendiani A, Barile A. Neuroimaging in emergency: a review of possible role of pineal gland disease. Gland Surg 2019; 8:133-140. [PMID: 31183323 DOI: 10.21037/gs.2019.01.02] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The pineal gland can be involved in a variety of neoplastic and congenital masses and tumors. Pineal gland neoplasms occur more frequently in children, accounting for 3-8% of intracranial tumors in the pediatric population. Pineal cysts are small lesions usually asymptomatic and encountered incidentally. Pathologic processes involving the pineal region produce signs and symptoms related to the mass effect on the adjacent structures and invasion of surrounding structures. These include several acute symptoms, such as increased intracranial pressure syndrome from obstruction of the aqueduct and consequent hydrocephalus, and Parinaud syndrome. Pineal apoplexy is rare and refers to the sudden neurological deterioration following hemorrhage in the pineal gland, most commonly into a pineal cyst. Knowledge of the clinical presentation and imaging features of these lesions is essential to narrow the differential diagnosis, especially when presenting with acute onset.
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Affiliation(s)
- Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Nicola Maggialetti
- Department of Life and Health "V. Tiberio", University of Molise, Campobasso, Italy
| | - Raffaele Natella
- Radiology Department, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfonso Reginelli
- Radiology Department, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luca Brunese
- Department of Life and Health "V. Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Nwawka OK, Casaletto E, Wolfe SW, Feinberg JH. Ultrasound imaging of brachial plexus trauma in gunshot injury. Muscle Nerve 2019; 59:707-711. [PMID: 30847944 DOI: 10.1002/mus.26461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Brachial plexus trauma related to gunshot (GS) injury requires early examination and characterization to ensure appropriate treatment. Magnetic resonance imaging (MRI) may be contraindicated when there are metal fragments in a patient's body. Ultrasound (US) may present an alternative to imaging GS-related brachial plexus injury. METHODS Three patients with GS-related brachial plexus injury who underwent US imaging evaluation at our institution were identified. A retrospective review of the patients' medical records was performed. RESULTS US characterization of nerve abnormalities after GS injury to the brachial plexus was in agreement with electrodiagnostic and intraoperative findings. DISCUSSION Information from the US reports was useful in preparation for brachial plexus reconstruction surgery. As such, US has unique utility when MRI cannot be performed. US imaging can provide useful characterization of the brachial plexus after GS injury when performed by an experienced operator. Muscle Nerve 59:707-711, 2019.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, New York, 10021, USA
| | - Emily Casaletto
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, New York, 10021, USA
| | - Scott W Wolfe
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, New York 10021, USA
| | - Joseph H Feinberg
- Department of Physiatry, Hospital for Special Surgery, 535 E 70th Street, New York, New York 10021, USA
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Russo U, Sabatino V, Nizzoli R, Tiseo M, Cappabianca S, Reginelli A, Carrafiello G, Brunese L, De Filippo M. Transthoracic computed tomography-guided lung biopsy in the new era of personalized medicine. Future Oncol 2019; 15:1125-1134. [PMID: 30880466 DOI: 10.2217/fon-2018-0527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Computed tomography-guided lung biopsy is a valid and safe procedure for characterizing pulmonary nodules. In the past years, this technique has been mainly used to confirm the malignant nature of undetermined pulmonary lesions; however, today its role has been completely renewed. With the advent of target therapy and immunotherapy, it has arisen for lung cancer, in inoperable patients, the necessity to obtain adequate bioptical material to perform a correct molecular characterization of the lesion. Moreover, the possibility of acquired drug-resistance mechanisms makes it necessary in some cases to rebiopsy these lesions over time. For these reasons, it is likely that the request of computed tomography-guided lung biopsy will increase in the future, therefore every radiologist should be confident with its most important aspects.
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Affiliation(s)
- Umberto Russo
- Department of Medicine & Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
| | - Vittorio Sabatino
- Department of Medicine & Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
| | - Rita Nizzoli
- Medical Oncology Unit, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
| | - Salvatore Cappabianca
- Department of Radiology & Radiotherapy, University of Campania 'Luigi Vanvitelli', Napoli, Italy
| | - Alfonso Reginelli
- Department of Radiology & Radiotherapy, University of Campania 'Luigi Vanvitelli', Napoli, Italy
| | | | - Luca Brunese
- Department of Medicine & Health Sciences, University of Molise, Campobasso, Italy
| | - Massimo De Filippo
- Department of Medicine & Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
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Bruno F, Arrigoni F, Palumbo P, Natella R, Maggialetti N, Reginelli A, Splendiani A, Di Cesare E, Brunese L, Guglielmi G, Giovagnoni A, Masciocchi C, Barile A. New advances in MRI diagnosis of degenerative osteoarthropathy of the peripheral joints. Radiol Med 2019; 124:1121-1127. [PMID: 30771216 DOI: 10.1007/s11547-019-01003-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/04/2019] [Indexed: 12/31/2022]
Abstract
Degenerative osteoarthropathy is one of the leading causes of the pain and disability from musculoskeletal disease in the adult population. Magnetic resonance imaging (MRI) allows optimal visualization of all tissues involved in degenerative osteoarthritis disease process, mainly the articular cartilage. In addition to qualitative and semiquantitative morphologic assessment, several MRI-based advanced techniques have been developed to allow characterization and quantification of the biochemical cartilage composition. These include quantitative analysis and several compositional techniques (T1 and T2 relaxometry measurements and mapping, sodium imaging, delayed gadolinium-enhanced MRI of cartilage dGEMRIC, glycosaminoglycan-specific chemical exchange saturation transfer gagCEST, diffusion-weighted imaging DWI and diffusion tensor imaging DTI). These compositional MRI techniques may have the potential to serve as quantitative, reproducible, noninvasive and objective endpoints for OA assessment, particularly in diagnosis of early and pre-radiographic stages of the disease and in monitoring disease progression and treatment effects over time.
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Affiliation(s)
- Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Raffaele Natella
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Maggialetti
- Department Life and Health "V. Tiberio", University of Molise, Campobasso, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Luca Brunese
- Department Life and Health "V. Tiberio", University of Molise, Campobasso, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, University of Foggia, Foggia, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy.
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The Multidisciplinary Approach to the Diagnosis and Management of Nonobstetric Traumatic Brachial Plexus Injuries. AJR Am J Roentgenol 2018; 211:1319-1331. [DOI: 10.2214/ajr.18.19887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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19
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Miura Y, Fujita K, Nimura A, Miyamoto T, Wakabayashi Y, Okawa A. Successful Reconstruction of a Traumatic Complete Femoral Nerve Rupture with a Sural Nerve Cable Graft: A Case Report. JBJS Case Connect 2018; 8:e24. [PMID: 29697439 DOI: 10.2106/jbjs.cc.17.00157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a rare case of complete rupture of the right femoral nerve at the pelvic level, which was caused by a self-inflicted stab wound. The nerve was surgically reconstructed with use of an autologous sural nerve cable graft. Postoperatively, the patient's sensorimotor function returned to near normal. CONCLUSION Femoral nerve rupture caused by a laceration is very unusual. A bilateral sural nerve cable graft performed in collaboration with surgeons from other specialties achieved a good outcome in this otherwise healthy young patient.
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Affiliation(s)
- Yugo Miura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Fujita
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Miyamoto
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiaki Wakabayashi
- Department of Orthopaedic Surgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Galluzzo M, Greco F, Pietragalla M, De Renzis A, Carbone M, Zappia M, Maggialetti N, D'andrea A, Caracchini G, Miele V. Calcaneal fractures: radiological and CT evaluation and classification systems. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:138-150. [PMID: 29350643 PMCID: PMC6179077 DOI: 10.23750/abm.v89i1-s.7017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/31/2022]
Abstract
Background and aim of the work: The calcaneus, the more lower bone of the body, has the task of supporting the axial load from the weight of the body. Calcaneal fractures represent about 1-2% of all fractures and 60% of the tarsal bones fractures. The articular involvement has been associated with a poor functional outcome. The aim of this work is to describe the radiologic evaluation, the classification systems, the morphological preoperative diagnostic imaging features of calcaneal fractures, highlighting the correlation with the choice of treatment and predictive capacity for the fracture surgical outcome. Methods: A PubMed search was performed for the terms Imaging calcaneus fracture, selecting articles in English language, published in the last two years, where preoperatively diagnostic imaging of fractures of the calcaneus are described. Case reports have not been included. Results: We have collected a number of data that provide important help in preoperative evaluation of calcaneal fractures, such as the new classification system created by Harnroongroj et al, the association of calcaneal fractures with fractures of other bone structures or soft tissue impairment, the use of calcaneotalar ratio in assessing the length of heel. Conclusions: These data suggest an approach geared to the specific choice of treatment and to improving patient outcomes. (www.actabiomedica.it)
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21
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Mattera M, Reginelli A, Bartollino S, Russo C, Barile A, Albano D, Mauri G, Messina C, Cappabianca S, Guglielmi G. Imaging of metabolic bone disease. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:197-207. [PMID: 29350648 PMCID: PMC6179066 DOI: 10.23750/abm.v89i1-s.7023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/25/2022]
Abstract
Osteoporosis is the most important metabolic bone disease, with a wide distribution among the elderly. It is characterized by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Identify bone weakening with an appropriate and accurate use of diagnostic imaging is of critical importance in the diagnosis and follow-up of osteoporotic patients. The aim of this review is to evaluate the detection rates of the different imaging modalities in the evaluation of bone strength, in the assessment of fracture risk and in the management of fragility fractures. (www.actabiomedica.it)
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22
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D'Aprile P, Nasuto M, Tarantino A, Cornacchia S, Guglielmi G, Jinkins JR. Magnetic Resonance Imaging in degenerative disease of the lumbar spine: Fat Saturation technique and contrast medium. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:208-219. [PMID: 29350649 PMCID: PMC6179082 DOI: 10.23750/abm.v89i1-s.7024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/12/2022]
Abstract
Purpose: To examine both anterior and posterior elements of the lumbar spine in patients with low back pain using MRI T2-weighted sequences with Fat Saturation (FS) and contrast enhanced T1-weighted sequences with FS.Materials and methods: Two thousand eight hundred and twenty (2820) patients (1628 male, 1192 female, mean age 54) presenting low back pain underwent MRI standard examination (Sagittal T1w TSE and T2w TSE, axial T1 SE) with the addition of sagittal and axial T2w Fat Sat (FS) sequences. Among all the patients, 987 (35%) have been studied adding Contrast Enhanced (CE) T1w FS sequences after administration of contrast medium. Results: Among 987 patients studied with contrast medium, we found: active-inflammatory intervertebral osteochondrosis in 646 (65%) patients; degenerative-inflammatory changes in facet joints (facet joint effusion, synovitis, synovial cysts) in 462 (47%); spondylolysis in 69 (7%); degenerative-inflammatory changes of the flava, interspinous and supraspinous ligaments in 245 (25%); inflammatory changes of posterior perispinal muscles in 84 (8%) patients. Conclusions: In patients with suspected no-disc-related low back pain, the implementation of T2w FS and CE T1w FS sequences to the standard MR protocol could allow a better identification of degenerative-inflammatory changes more likely associated to the pain. (www.actabiomedica.it)
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Bruno F, Barile A, Arrigoni F, Laporta A, Russo A, Carotti M, Splendiani A, Di Cesare E, Masciocchi C. Weight-bearing MRI of the knee: a review of advantages and limits. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:78-88. [PMID: 29350638 PMCID: PMC6179065 DOI: 10.23750/abm.v89i1-s.7011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/20/2022]
Abstract
Standard knee imaging with MRI is usually performed with patient in recumbent position under non-weight-bearing conditions. Recently, magnetic resonance imaging systems to scan the knee joint under weight bearing conditions has been proposed as an approach to improve the clinical utility of musculoskeletal MRI. Imaging under loading can be useful to understand the natural motion behavior of the knee joint and to identify conditions that are challenging to diagnose by using standard position. We reviewed the literature on weight-bearing MR imaging of the knee to describe the current state of use of such MRI technologies, evaluating the advantages and the potential limitations of these technologies.
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Pinto A, Berritto D, Russo A, Riccitiello F, Caruso M, Belfiore MP, Papapietro VR, Carotti M, Pinto F, Giovagnoni A, Romano L, Grassi R. Traumatic fractures in adults: missed diagnosis on plain radiographs in the Emergency Department. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:111-123. [PMID: 29350641 PMCID: PMC6179080 DOI: 10.23750/abm.v89i1-s.7015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/31/2022]
Abstract
Radiography remains the imaging standard for fracture detection after trauma. The radiographic diagnosis of most fractures and dislocations poses little difficulty to radiologists: however, occasionally these injuries are quite subtle or even impossible to detect on radiographs. Missed diagnoses of fracture potentially have important consequences for patients, clinicians, and radiologists. Radiologists play a pivot role in the diagnostic assessment of the trauma patients: emergency radiologists who are more practiced at seeking out and discerning traumatic fractures can provide an invaluable service to their clinical colleagues by ensuring that patients do not endure delayed diagnoses. This is a narrative review article aims to highlight the spectrum of fractures in adults potentially missed on plain radiographs, the causes of error in diagnosis of fractures in the emergency setting and the key elements to reduce misdiagnosis of fractures.
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Nocerino EA, Cucchi D, Arrigoni P, Brioschi M, Fusi C, Genovese EA, Messina C, Randelli P, Masciocchi C, Aliprandi A. Acute and overuse elbow trauma: radio-orthopaedics overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:124-137. [PMID: 29350642 PMCID: PMC6179073 DOI: 10.23750/abm.v89i1-s.7016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
The correct management of acute, subacute and overuse-related elbow pathologies represents a challenging diagnostic and therapeutic problem. While major trauma frequently requires a rapid surgical intervention, subluxation and minor trauma allow taking more time for diagnostics and planning the correct elective treatment after careful clinical and radiological investigation. In these conditions, communication between orthopaedic surgeon and radiologist allow to create a detailed radiology report, tailored to the patient's and surgeon's needs and optimal to plan proper management. Imaging technique as X-Ray, CT, US, MRI, CTA and MRA all belong to the radiologist's portfolio in elbow diagnostics. Detailed knowledge of elbow pathology and its classification and of the possibilities and limits of each imaging technique is of crucial importance to reach the correct diagnosis efficiently. The aim of this review is to present the most frequent elbow pathologies and suggest a suitable diagnostic approach for each of them.
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Zappia M, Reginelli A, Chianca V, Carfora M, Di Pietto F, Iannella G, Mariani PP, Di Salvatore M, Bartollino S, Maggialetti N, Cappabianca S, Brunese L. MRI of popliteo-meniscal fasciculi of the knee: a pictorial review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:7-17. [PMID: 29350634 PMCID: PMC6179070 DOI: 10.23750/abm.v89i1-s.7007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 01/13/2023]
Abstract
The popliteomeniscal fascicules (PMFs) provide the attachment of the lateral meniscus to the popliteus musculotendinous region, forming the floor and the roof the popliteal hiatus. In the second half of 1900's, some anatomic studies claim the important function of the PMF as stabilizers of the lateral meniscus; these anatomical structures work in conjunction with the popliteus musculotendinous unit to prevent excessive lateral meniscal movement and possible meniscus subluxation. A correct diagnosis of the PMFs pathology is crucial to establish the suitable surgical treatment for each patient. MRI is a well-established imaging technique in the musculoskeletal system and the frequency of recognition of normal PMF in the normal knees is high in almost all MRI studies. At day, the gold standard for diagnosis is the arthroscopic evaluation that allows the direct visualization of the popliteo-meniscal ligaments at popliteal hiatus and evaluation of lateral meniscal movements. For this reason if unstable condition of meniscus was suspected, arthroscopic observation with probing into the popliteo-meniscal fascicle area is essential for the identification of the fascicle tears. Despite many treatments have being proposed in literature since now there is high recurrence of knee locking after repair and it is fundamental to develop new surgical techniques in order to achieve better outcome.
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Michelini G, Corridore A, Torlone S, Bruno F, Marsecano C, Capasso R, Caranci F, Barile A, Masciocchi C, Splendiani A. Dynamic MRI in the evaluation of the spine: state of the art. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:89-101. [PMID: 29350639 PMCID: PMC6179074 DOI: 10.23750/abm.v89i1-s.7012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Degenerative disease of the spine is a generic term encompassing a wide range of different disease processes, which leads to spinal instability; traumatic/neoplastic events can accelerate this aging process. Therefore, the dynamic nature of the spine and its mobility across multiple segments is difficult to depict with any single imaging modality. METHODS A review of PubMed databases for articles published about kMRI in patients with cervical and lumbar spinal desease was performed. We focused on the physiopathological changes in the transition from supine to upright position in spine instability. DISCUSSION Until a few years ago, X-ray was the only imaging modality for the spine in the upright position. Of the imaging techniques currently available, MRI provides the greatest range of information and the most accurate delineation of soft-tissue and osseous structures. Conventional MRI examinations of the spine usually are performed in supine position, in functional rest, but the lumbar spine instability is often shown only by upright standing. This can result in negative findings, even in the presence of symptoms. Regardless, the final result is distorted. To overcome this limitation, Kinetic MRI (kMRI) can image patients in a weight-bearing position and in flexed and extended positions, thus revealing abnormalities that are missed by traditional MRI studies. CONCLUSION Despite some limitations, the upright MRI can be a complementary investigation to the traditional methods when there are negative results in conventional MRI in symptomatic patients or when surgical therapy is scheduled.
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Liguori A, Galli F, Gurgitano M, Borelli A, Pandolfi M, Caranci F, Magenta Biasina AM, Pompili GGM, Piccolo CL, Miele V, Masciocchi C, Carrafiello G. Clinical and instrumental assessment of herniated discs after nucleoplasty: a preliminary study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:220-229. [PMID: 29350650 PMCID: PMC6179072 DOI: 10.23750/abm.v89i1-s.7025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The therapy for low back pain boasts different approaches; one of these is nucleoplasty. We wanted to assess the effectiveness of nucleoplasty both by clinical response both by MR imaging evaluation, including even extrusions larger than one third of the spinal canal. METHODS Fifty-seven patients were treated with nucleoplasty in our hospital, 11 of these patients accepted both clinical and MRI evaluation after six months from treatment. The clinical evaluation was performed with Visual Analogue Scale (VAS) of pain, scored before and after the procedure. MRI evaluation consisted of analysing some imaging parameters of disc protrusions before and after the treatment. RESULTS In 10 out of 11 (91%) patients, VAS was reduced and only 1 out of 11 (9%) had the same pain after procedure. The mean of decrease of VAS score was 64%. In our population 8/11 (72%) patients had a herniation larger than 1/3 of the sagittal diameter of spinal canal and 100% of them had an improvement with a mean VAS reduction value of 75%. With MRI evaluation, the mean percentage of expulsion before and after treatment was respectively 40% and 34%. The expulsion decreased in 7/13 discs, remained equal in 4/13, and increased in 2/13 discs. Among the 9 larger protrusions, 3 didn't change, 6 reduced with a decrease mean value of 13%. Other MRI parameters didn't change significantly. CONCLUSIONS Our preliminary experience supports the success of coblation on pain relief, aiming to show progressively that this treatment is suitable even in case of great extrusions, which are generally treated only with surgical approach. It's not clear the usefulness of MRI control yet, even if in most of cases we could have found a certain reduction of expulsion degree.
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Berritto D, Pinto A, Russo A, Urraro F, Laporta A, Belfiore MP, Grassi R. Scapular fractures: a common diagnostic pitfall. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:102-110. [PMID: 29350640 PMCID: PMC6179069 DOI: 10.23750/abm.v89i1-s.7014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 11/23/2022]
Abstract
Scapular fractures are one of the most difficult fractures to diagnose on radiographs. Detection can be challenging because of the obscuration by the overlying structures or incomplete imaging due to difficult patient collaboration. Familiarity with imaging characteristics of these abnormalities will allow radiologists to better diagnose and characterize scapular fractures. Three-dimensional computed tomographic scans are considered the gold standard for scapular diagnoses. Treatment strategies differ depending on the type of scapular fractures, but the site and degree of displacement will determine whether surgical intervention should be considered. Complications can occur in fractures that are undiagnosed or improperly evaluated. The purpose of this article is to describe imaging features of traumatic scapular injury, and discuss the role of diagnostic imaging in clinical decision making after shoulder trauma. (www.actabiomedica.it)
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Chianca V, Albano D, Messina C, Midiri F, Mauri G, Aliprandi A, Catapano M, Pescatori LC, Monaco CG, Gitto S, Pisani Mainini A, Corazza A, Rapisarda S, Pozzi G, Barile A, Masciocchi C, Sconfienza LM. Rotator cuff calcific tendinopathy: from diagnosis to treatment. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:186-196. [PMID: 29350647 PMCID: PMC6179075 DOI: 10.23750/abm.v89i1-s.7022] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/15/2022]
Abstract
Rotator cuff calcific tendinopathy (RCCT) is a very common condition caused by the presence of calcific deposits in the rotator cuff (RC) or in the subacromial-subdeltoid (SASD) bursa when calcification spreads around the tendons. The pathogenetic mechanism of RCCT is still unclear. It seems to be related to cell-mediated disease in which metaplastic transformation of tenocytes into chondrocytes induces calcification inside the tendon of the RC. RCCT is a frequent finding in the RC that may cause significant shoulder pain and disability. It can be easily diagnosed with imaging studies as conventional radiography (CR) or ultrasound (US). Conservative management of RCCT usually involves rest, physical therapy, and oral NSAIDs administration. Imaging-guided treatments are currently considered minimally-invasive, yet effective methods to treat RCCT with about 80% success rate. Surgery remains the most invasive treatment option in chronic cases that fail to improve with other less invasive approaches. (www.actabiomedica.it)
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De Filippo M, Russo U, Papapietro VR, Ceccarelli F, Pogliacomi F, Vaienti E, Piccolo C, Capasso R, Sica A, Cioce F, Carbone M, Bruno F, Masciocchi C, Miele V. Radiofrequency ablation of osteoid osteoma. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:175-185. [PMID: 29350646 PMCID: PMC6179079 DOI: 10.23750/abm.v89i1-s.7021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/24/2023]
Abstract
Osteoid osteoma is a benign bone neoplasm with a reported incidence of 2-3% among all bone primary tumors. Although it is a small and benign lesion, it is often cause of patient complaint and discomfort. It is generally characterized by a long lasting, unremitting pain that typically exacerbates at night, often leading to sleep deprivation and functional limitation of the skeletal segment involved, with a significant reduction of patient daily life activities and consequent worsening of the overall quality of life. Over decades, complete surgical resection has represented the only curative treatment for symptomatic patients. In the last years, new percutaneous ablation techniques, especially radiofrequency ablation, have been reported to be a safe and effective alternative to classical surgery, with a low complication and recurrence rate, and a significant reduction in hospitalization cost and duration. The aim of this article is to provide an overview about the radiofrequency thermal ablation procedure in the treatment of osteoid osteoma. (www.actabiomedica.it)
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Caracchini G, Pietragalla M, De Renzis A, Galluzzo M, Carbone M, Zappia M, Russo A, Greco F, Miele V. Talar fractures: radiological and CT evaluation and classification systems. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:151-165. [PMID: 29350644 PMCID: PMC6179081 DOI: 10.23750/abm.v89i1-s.7019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The talus is the second largest bone of the foot. It is fundamental to ensure normal ankle-foot movements as it connects the leg and the foot. Talar fractures are usually due to high energy traumas (road accidents, high level falls). They are not common as they account for 3-5% of ankle and foot fractures and 0.85% of all body fractures. However, talar fractures not correctly diagnosed and treated can lead to avascular necrosis of the astragalus, pseudoarthrosis, early osteoarthrisis and ankle instability, declining the quality of life of patients. METHODS A PubMed search was performed using the terms "talus" "talus AND radiology", "talar fractures", and "talar fractures classification", selecting articles published in the last 98 years. We selected articles about pre-treatment and post-surgery talar fractures diagnostic imaging. We also selected articles about talar fractures complications and traumatic talar dislocations. Case reports have not been included. AIM OF THE WORK to describe radiological evaluations, classification systems, and biomechanical patterns involved in talar fractures. Also we will briefly describe talar fractures complications and treatment option and strategies. CONCLUSIONS This work suggests a radiological approach aimed to classify talar fractures and guide treatment strategies, improving patient outcomes.
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Reginelli A, Russo A, Turrizziani F, Picascia R, Micheletti E, Galeazzi V, Russo U, Sica A, Cioce F, Aliprandi A, Giovagnoni A, Cappabianca S. Imaging of pediatric foot disorders. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:34-47. [PMID: 29350636 PMCID: PMC6179076 DOI: 10.23750/abm.v89i1-s.7009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/02/2022]
Abstract
Infants and children undergo imaging studies to evaluate a wide variety of congenital and acquired disorders. Imaging protocols have to consider the patient’s comfort, level of anxiety, and smaller size. The first imaging study is usually made with plain radiographs. The routine radiographic examination of the foot includes the anteroposterior (AP), lateral, and oblique projections. Magnetic Resonance Imaging (RMI) provides excellent anatomic detail of cartilage, vasculature and soft tissue thanks to superior soft tissue contrast and spatial resolution, so is valuable in many cases. According to the clinical and objective signs, guided by the radiographs images, we can be oriented to perform Computed Tomography (CT), CT imaging or MRI imaging. CT imaging is useful to observe the bones but it has the disadvantage of using radiation and doesn’t adequately define the bone’s non-ossified portions. On the contrary, MRI imaging is very useful in identifying the cartilaginous parts and vascular and soft tissues, thanks to its superior contrast and spatial resolution. Finally, it is important to orientate the diagnostic process keeping in mind the clinical sign of the patient and to use the most appropriate diagnostic technique. (www.actabiomedica.it)
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Arrigoni F, Bruno F, Zugaro L, Natella R, Cappabianca S, Russo U, Papapietro VR, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Developments in the management of bone metastases with interventional radiology. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:166-174. [PMID: 29350645 PMCID: PMC6179078 DOI: 10.23750/abm.v89i1-s.7020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/08/2023]
Abstract
Interventional radiology has known an exponential growth in the last years. Technological advances of the last decades, have made it possible to use new treatments on a larger scale, with safe and effective results. They could be considered as palliative treatments for painful lesions but also curative procedures, as single treatment or specially in combination with other techniques (surgery, radiation and oncology therapies, etc.).The main diffuse techniques are those of thermal ablation that destroy the target lesion through the heat; however there are also endovascular therapies that destroy the target tissue thanks to devascularization. Finally the is also the possibility to stabilize pathological fractures or impending fractures. In this paper all the most diffuse and effective techniques are reviewed and also a discussion of the main indications is done, with an analisys of the success and complications rates.
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Caranci F, Tedeschi E, Ugga L, D'Amico A, Schipani S, Bartollino S, Russo C, Splendiani A, Briganti F, Zappia M, Melone MAB, Masciocchi C, Brunese L. Magnetic Resonance Imaging correlates of benign and malignant alterations of the spinal bone marrow. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:18-33. [PMID: 29350635 PMCID: PMC6179071 DOI: 10.23750/abm.v89i1-s.7008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Bone marrow (BM) abnormalities in the spine are a common, sometimes unexpected, finding on Magnetic Resonance Imaging (MRI), which is the most sensitive imaging modality to evaluate the marrow, and their interpretation can be difficult for the unexperienced radiologist. In this review, the MRI appearance of normal age-related BM changes, as well as the imaging features of benign and malignant diseases, are presented. DISCUSSION A large variety of BM signal alterations has been identified and described, including normal variants, BM reconversion, degenerative changes, infections, spondyloarthritis and osteonecrosis, trauma, neoplastic lesions (both primary or metastatic), post-radiation and chemotherapy sequelae. CONCLUSIONS Knowledge of normal age-related BM appearance, normal variants and patterns of involvement in focal and diffuse bone diseases is essential, together with clinical and laboratory data, to narrow the list of the possible differential diagnoses. The radiologist should be familiar with these signal changes, as they can sometimes be discovered incidentally. In this context, it is equally important not to attribute pathological significance to benign alterations and to promptly detect signs of malignant diseases.
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Chin B, Ramji M, Farrokhyar F, Bain JR. Efficient Imaging: Examining the Value of Ultrasound in the Diagnosis of Traumatic Adult Brachial Plexus Injuries, A Systematic Review. Neurosurgery 2017; 83:323-332. [DOI: 10.1093/neuros/nyx483] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 08/28/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Brian Chin
- Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maleka Ramji
- Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Surgery and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - James R Bain
- Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Caranci F, Leone G, Ugga L, Cesarano E, Capasso R, Schipani S, Bianco A, Fonio P, Briganti F, Brunese L. Imaging of post-surgical treatment and of related complications in spinal trauma. Musculoskelet Surg 2017; 101:63-73. [PMID: 28168635 DOI: 10.1007/s12306-017-0457-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 11/26/2022]
Abstract
Spinal trauma is a devastating event with a high morbidity and mortality. The rationale of imaging is to diagnose the traumatic abnormalities and characterize the type of injury, to estimate the severity of the lesions, to evaluate the potential spinal instability. In case of spinal instability, the goals of operative treatment are decompression of the spinal cord canal and stabilization of the disrupted vertebral column. Particularly, diagnostic imaging, mainly by CT and MR, has a main role in the post-treatment evaluation. The neuroradiological evaluation of the postoperative spine requires a general knowledge of the surgical approach to each spinal region and of the normal temporal evolution of expected postoperative changes. The neuroradiologist should evaluate the devices implanted, their related complications and promptly alert the surgeon of acute complications, mainly vascular and infective. During the follow-up, it is mandatory to know and search chronic complications as pseudomeningocele, accelerated degenerative disease, arachnoiditis, peridural fibrosis. Knowledge of specific complications relating to each surgical approach will assist the neuroradiologist in interpretation of postoperative images.
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Affiliation(s)
- F Caranci
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy.
| | - G Leone
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Ugga
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - E Cesarano
- Radiology Section, Health Service, Navy Command of Brindisi, Brindisi, Italy
| | - R Capasso
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - S Schipani
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - A Bianco
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - P Fonio
- Radiology Unit, Department of Surgical Sciences, University of Torino, Turin, Italy
| | - F Briganti
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
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Karalija A, Novikova LN, Orädd G, Wiberg M, Novikov LN. Differentiation of Pre- and Postganglionic Nerve Injury Using MRI of the Spinal Cord. PLoS One 2016; 11:e0168807. [PMID: 28036395 PMCID: PMC5201258 DOI: 10.1371/journal.pone.0168807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/06/2016] [Indexed: 01/09/2023] Open
Abstract
Brachial plexus injury (BPI) is a devastating type of nerve injury, potentially causing loss of motor and sensory function. Principally, BPI is either categorized as preganglionic or postganglionic, with the early establishment of injury level being crucial for choosing the correct treatment strategy. Despite diagnostic advances, the need for a reliable, non-invasive method for establishing the injury level remains. We studied the usefulness of in vivo magnetic resonance imaging (MRI) of the spinal cord for determination of injury level. The findings were related to neuronal and glial changes. Rats underwent unilateral L4 & L5 ventral roots avulsion or sciatic nerve axotomy. The injuries served as models for pre- and postganglionic BPI, respectively. MRI of the L4/L5 spinal cord segments 4 weeks after avulsion showed ventral horn (VH) shrinkage on the injured side compared to the uninjured side. Axotomy induced no change in the VH size on MRI. Following avulsion, histological sections of L4/L5 revealed shrinkage in the VH grey matter area occupied by NeuN-positive neurons, loss of microtubular-associated protein-2 positive dendritic branches (MAP2), pan-neurofilament positive axons (PanNF), synaptophysin-positive synapses (SYN) and increase in immunoreactivity for the microglial OX42 and astroglial GFAP markers. Axotomy induced no changes in NeuN-reactivity, modest decrease of MAP2 immunoreactivity, no changes in SYN and PanNF labelling, and a modest increase in OX42 and SYN labeling. Histological and radiological findings were congruent when assessing changes after axotomy, while MRI somewhat underestimated the shrinkage. This study indicates a potential diagnostic value of structural spinal cord MRI following BPI.
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Affiliation(s)
- Amar Karalija
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Science, Section of Hand and Plastic Surgery, Umeå University, Umeå, Sweden
- * E-mail:
| | - Liudmila N. Novikova
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, Umeå, Sweden
| | - Greger Orädd
- Department of Integrative Medical Biology, Section of Physiology, Umeå University, Umeå, Sweden
- Umeå Centre for Comparative Biology, Umeå University, Umeå, Sweden
| | - Mikael Wiberg
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Science, Section of Hand and Plastic Surgery, Umeå University, Umeå, Sweden
| | - Lev N. Novikov
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, Umeå, Sweden
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Diagnostic Value and Surgical Implications of the 3D DW-SSFP MRI On the Management of Patients with Brachial Plexus Injuries. Sci Rep 2016; 6:35999. [PMID: 27782162 PMCID: PMC5080541 DOI: 10.1038/srep35999] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 10/07/2016] [Indexed: 01/09/2023] Open
Abstract
Three-dimensional diffusion-weighted steady-state free precession (3D DW-SSFP) of high-resolution magnetic resonance has emerged as a promising method to visualize the peripheral nerves. In this study, the application value of 3D DW-SSFP brachial plexus imaging in the diagnosis of brachial plexus injury (BPI) was investigated. 33 patients with BPI were prospectively examined using 3D DW-SSFP MR neurography (MRN) of brachial plexus. Results of 3D DW-SSFP MRN were compared with intraoperative findings and measurements of electromyogram (EMG) or somatosensory evoked potentials (SEP) for each injured nerve root. 3D DW-SSFP MRN of brachial plexus has enabled good visualization of the small components of the brachial plexus. The postganglionic section of the brachial plexus was clearly visible in 26 patients, while the preganglionic section of the brachial plexus was clearly visible in 22 patients. Pseudomeningoceles were commonly observed in 23 patients. Others finding of MRN of brachial plexus included spinal cord offset (in 16 patients) and spinal cord deformation (in 6 patients). As for the 3D DW-SSFP MRN diagnosis of preganglionic BPI, the sensitivity, the specificity and the accuracy were respectively 96.8%, 90.29%, and 94.18%. 3D DW-SSFP MRN of brachial plexus improve visualization of brachial plexus and benefit to determine the extent of injury.
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Abstract
Approximately 4 % of radiologic interpretation in daily practice contains errors and discrepancies that should occur in 2-20 % of reports. Fortunately, most of them are minor degree errors, or if serious, are found and corrected with sufficient promptness; obviously, diagnostic errors become critical when misinterpretation or misidentification should significantly delay medical or surgical treatments. Errors can be summarized into four main categories: observer errors, errors in interpretation, failure to suggest the next appropriate procedure, failure to communicate in a timely and a clinically appropriate manner. Misdiagnosis/misinterpretation percentage should rise up in emergency setting and in the first moments of the learning curve, as in residency. Para-physiological and pathological pitfalls in neuroradiology include calcification and brain stones, pseudofractures, and enlargement of subarachnoid or epidural spaces, ventricular system abnormalities, vascular system abnormalities, intracranial lesions or pseudolesions, and finally neuroradiological emergencies. In order to minimize the possibility of error, it is important to be aware of various presentations of pathology, obtain clinical information, know current practice guidelines, review after interpreting a diagnostic study, suggest follow-up studies when appropriate, communicate significant abnormal findings appropriately and in a timely fashion directly with the treatment team.
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