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Teodorescu B, Gilberg L, Melton PW, Hehr RM, Guzel HE, Koc AM, Baumgart A, Maerkisch L, Ataide EJG. A systematic review of deep learning-based spinal bone lesion detection in medical images. Acta Radiol 2024:2841851241263066. [PMID: 39033391 DOI: 10.1177/02841851241263066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Spinal bone lesions encompass a wide array of pathologies, spanning from benign abnormalities to aggressive malignancies, such as diffusely localized metastases. Early detection and accurate differentiation of the underlying diseases is crucial for every patient's clinical treatment and outcome, with radiological imaging being a core element in the diagnostic pathway. Across numerous pathologies and imaging techniques, deep learning (DL) models are progressively considered a valuable resource in the clinical setting. This review describes not only the diagnostic performance of these models and the differing approaches in the field of spinal bone malignancy recognition, but also the lack of standardized methodology and reporting that we believe is currently hampering this newly founded area of research. In line with their established and reliable role in lesion detection, this publication focuses on both computed tomography and magnetic resonance imaging, as well as various derivative modalities (i.e. SPECT). After conducting a systematic literature search and subsequent analysis for applicability and quality using a modified QUADAS-2 scoring system, we confirmed that most of the 14 identified studies were plagued by major limitations, such as insufficient reporting of model statistics and data acquisition, a lacking external validation dataset, and potentially biased annotation. Although we experienced these limitations, we nonetheless conclude that the potential of these methods shines through in the presented results. These findings underline the need for more stringent quality controls in DL studies, as well as model development to afford increased insight and progress in this promising novel field.
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Affiliation(s)
- Bianca Teodorescu
- Floy GmbH, Munich, Germany
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Leonard Gilberg
- Floy GmbH, Munich, Germany
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Philip William Melton
- Floy GmbH, Munich, Germany
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Munich, Germany
| | | | - Hamza Eren Guzel
- Floy GmbH, Munich, Germany
- University of Health Sciences İzmir Bozyaka Research and Training Hospital, Izmir, Turkey
| | - Ali Murat Koc
- Floy GmbH, Munich, Germany
- Ataturk Education and Research Hospital, Department of Radiology, Izmir Katip Celebi University, Izmir, Turkey
| | - Andre Baumgart
- Mannheim Institute of Public Health, Universität Medizin Mannheim, Mannheim, Germany
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Hascalovici J, Babb A, Norwood BA. Radiotracers in the Diagnosis of Pain: A Mini Review. Semin Musculoskelet Radiol 2023; 27:655-660. [PMID: 37935212 DOI: 10.1055/s-0043-1775743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The diagnosis and understanding of pain is challenging in clinical practice. Assessing pain relies heavily on self-reporting by patients, rendering it inherently subjective. Traditional clinical imaging methods such as computed tomography and magnetic resonance imaging can only detect anatomical abnormalities, offering limited sensitivity and specificity in identifying pain-causing conditions. Radiotracers play a vital role in molecular imaging that aims to identify abnormal biological processes at the cellular level, even in apparently normal anatomical structures. Therefore, molecular imaging is an important area of research as a prospective diagnostic modality for pain-causing pathophysiology. We present a mini review of the current knowledge base regarding radiotracers for identification of pain in vivo. We also describe radiocaine, a novel positron emission tomography imaging agent for sodium channels that has shown great potential for identifying/labeling pain-producing nerves and producing an objectively measurable pain intensity signal.
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Affiliation(s)
- Jacob Hascalovici
- Relief Medical Group PA, New York, New York
- Saul R. Korey Department of Neurology, The Arthur S. Abramson Department of Physical Medicine and Rehabilitation, Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York
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Katal S, Taubman K, Han J, Gholamrezanezhad A. Aging Muscles, Myositis, Pain, and Peripheral Neuropathies: PET Manifestations in the Elderly. PET Clin 2023; 18:149-160. [DOI: 10.1016/j.cpet.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Annunziata S, Panagiotidis E. Hybrid positron emission tomography/magnetic resonance imaging in musculoskeletal conditions: be hybrid! THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:1-2. [PMID: 35362695 DOI: 10.23736/s1824-4785.21.03430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Salvatore Annunziata
- Unit of Nuclear Medicine, TracerGLab, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Emmanouil Panagiotidis
- Department of Nuclear Medicine - PET/CT, Theageneio Oncology Center, Thessaloniki, Greece -
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Spriet M, Edwards L, Arndt S, Wilson SS, Galuppo LD, Stepanov P, Beylin D. Validation of a dedicated positron emission tomography scanner for imaging of the distal limb of standing horses. Vet Radiol Ultrasound 2022; 63:469-477. [PMID: 35188701 DOI: 10.1111/vru.13078] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 01/08/2023] Open
Abstract
A positron emission tomography (PET) scanner, with an openable ring of detectors, was specifically designed to image the distal limb of standing horses. The goals of this prospective, preclinical, experimental, methods comparison study were to validate the safety of the scanner, assess image quality, and optimize scanning protocols. Six research horses were imaged three times (twice standing, once anesthetized) and six horses in active race training were imaged once under standing sedation. Multiple scans of both front fetlocks were obtained with different scan durations and axial fields of view. A total of 94 fetlock scans were attempted and 90 provided images of diagnostic value. Radiotracer uptake was the main factor affecting image quality, while motion did not represent a major issue. Scan duration and field of view also affected image quality. Eight specific lesions were identified on PET images from anesthetized horses and were all also independently recognized on the PET images obtained on standing horses. Maximal standardized uptake values (SUVmax) had good repeatability for the assessment of specific lesions among different scans. Three feet and six carpi were also successfully imaged. This study validated the safety and practicality of a PET scanner specifically designed to image the distal limb in standing horses. Proper preparation of horses, similar to bone scintigraphy, is important for image quality. A 4-min scan with 12 cm field of view was considered optimal for clinical fetlock imaging. Evaluation of a larger clinical population is the next step for further assessment of the clinical utility of PET imaging in horses.
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Affiliation(s)
- Mathieu Spriet
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Lisa Edwards
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Stefanie Arndt
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Sabrina S Wilson
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Larry D Galuppo
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Pavel Stepanov
- LONGMILE Veterinary Imaging, A Division of Brain Biosciences Inc., Rockville, Maryland, USA
| | - David Beylin
- LONGMILE Veterinary Imaging, A Division of Brain Biosciences Inc., Rockville, Maryland, USA
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Klontzas ME, Papadakis GZ, Marias K, Karantanas AH. Musculoskeletal trauma imaging in the era of novel molecular methods and artificial intelligence. Injury 2020; 51:2748-2756. [PMID: 32972725 DOI: 10.1016/j.injury.2020.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 02/08/2023]
Abstract
Over the past decade rapid advancements in molecular imaging (MI) and artificial intelligence (AI) have revolutionized traditional musculoskeletal radiology. Molecular imaging refers to the ability of various methods to in vivo characterize and quantify biological processes, at a molecular level. The extracted information provides the tools to understand the pathophysiology of diseases and thus to early detect, to accurately evaluate the extend and to apply and evaluate targeted treatments. At present, molecular imaging mainly involves CT, MRI, radionuclide, US, and optical imaging and has been reported in many clinical and preclinical studies. Although originally MI techniques targeted at central nervous system disorders, later on their value on musculoskeletal disorders was also studied in depth. Meaningful exploitation of the large volume of imaging data generated by molecular and conventional imaging techniques, requires state-of-the-art computational methods that enable rapid handling of large volumes of information. AI allows end-to-end training of computer algorithms to perform tasks encountered in everyday clinical practice including diagnosis, disease severity classification and image optimization. Notably, the development of deep learning algorithms has offered novel methods that enable intelligent processing of large imaging datasets in an attempt to automate decision-making in a wide variety of settings related to musculoskeletal trauma. Current applications of AI include the diagnosis of bone and soft tissue injuries, monitoring of the healing process and prediction of injuries in the professional sports setting. This review presents the current applications of novel MI techniques and methods and the emerging role of AI regarding the diagnosis and evaluation of musculoskeletal trauma.
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Affiliation(s)
- Michail E Klontzas
- Department of Medical Imaging, Heraklion University Hospital, Crete, 70110, Greece; Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), N. Plastira 100, Vassilika Vouton 70013, Heraklion, Crete, Greece.
| | - Georgios Z Papadakis
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), N. Plastira 100, Vassilika Vouton 70013, Heraklion, Crete, Greece; Computational Biomedicine Laboratory (CBML), Foundation for Research and Technology Hellas (FORTH), 70013, Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, 70110 Greece.
| | - Kostas Marias
- Computational Biomedicine Laboratory (CBML), Foundation for Research and Technology Hellas (FORTH), 70013, Heraklion, Crete, Greece; Department of Electrical and Computer Engineering, Hellenic Mediterranean University, 71410, Heraklion, Crete, Greece.
| | - Apostolos H Karantanas
- Department of Medical Imaging, Heraklion University Hospital, Crete, 70110, Greece; Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), N. Plastira 100, Vassilika Vouton 70013, Heraklion, Crete, Greece; Computational Biomedicine Laboratory (CBML), Foundation for Research and Technology Hellas (FORTH), 70013, Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, 70110 Greece.
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Paez D, Sathekge MM, Douis H, Giammarile F, Fatima S, Dhal A, Puri SK, Erba PA, Lazzeri E, Ferrando R, Filho PA, Magboo VP, Morozova O, Núñez R, Pellet O, Mariani G. Comparison of MRI, [ 18F]FDG PET/CT, and 99mTc-UBI 29-41 scintigraphy for postoperative spondylodiscitis-a prospective multicenter study. Eur J Nucl Med Mol Imaging 2020; 48:1864-1875. [PMID: 33210240 PMCID: PMC8113215 DOI: 10.1007/s00259-020-05109-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022]
Abstract
Purpose Postoperative infection still constitutes an important complication of spine surgery, and the optimal imaging modality for diagnosing postoperative spine infection has not yet been established. The aim of this prospective multicenter study was to assess the diagnostic performance of three imaging modalities in patients with suspected postoperative spine infection: MRI, [18F]FDG PET/CT, and SPECT/CT with 99mTc-UBI 29-41. Methods Patients had to undergo at least 2 out of the 3 imaging modalities investigated. Sixty-three patients enrolled fulfilled such criteria and were included in the final analysis: 15 patients underwent all 3 imaging modalities, while 48 patients underwent at least 2 imaging modalities (MRI + PET/CT, MRI + SPECT/CT, or PET/CT + SPECT/CT). Final diagnosis of postoperative spinal infection was based either on biopsy or on follow-up for at least 6 months. The MRI, PET/CT, and SPECT/CT scans were read blindly by experts at designated core laboratories. Spine surgery included metallic implants in 46/63 patients (73%); postoperative spine infection was diagnosed in 30/63 patients (48%). Results Significant discriminants between infection and no infection included fever (P = 0.041), discharge at the wound site (P < 0.0001), and elevated CRP (P = 0.042). There was no difference in the frequency of infection between patients who underwent surgery involving spinal implants versus those who did not. The diagnostic performances of MRI and [18F]FDG PET/CT analyzed as independent groups were equivalent, with values of the area under the ROC curve equal to 0.78 (95% CI: 0.64–0.92) and 0.80 (95% CI: 0.64–0.98), respectively. SPECT/CT with 99mTc-UBI 29-41 yielded either unacceptably low sensitivity (44%) or unacceptably low specificity (41%) when adopting more or less stringent interpretation criteria. The best diagnostic performance was observed when combining the results of MRI with those of [18F]FDG PET/CT, with an area under the ROC curve equal to 0.938 (95% CI: 0.80–1.00). Conclusion [18F]FDG PET/CT and MRI both possess equally satisfactory diagnostic performance in patients with suspected postoperative spine infection, the best diagnostic performance being obtained by combining MRI with [18F]FDG PET/CT. The diagnostic performance of SPECT/CT with 99mTc-UBI 29-41 was suboptimal in the postoperative clinical setting explored with the present study. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-020-05109-x.
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Affiliation(s)
- Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
| | - Mike M Sathekge
- Nuclear Medicine Department, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
| | - Hassan Douis
- University Hospital Birmigham, NHS Foundation Trust, Birmingham, UK
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria.
| | - Shazia Fatima
- Department of Nuclear Medicine, Nuclear Medicine, Oncology & Radiotherapy Institute (NORI), Islamabad, Pakistan
| | - Anil Dhal
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | - Sunil K Puri
- Department of Radiology, GB Pant Hospital, Maulana Azad Medical College, New Delhi, India
| | - Paola A Erba
- Regional Centre of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Elena Lazzeri
- Regional Centre of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Rodolfo Ferrando
- Ferrari Ferrando-Paez Nuclear Medicine Clinic and Uruguayan Center of Molecular Imaging (CUDIM), Montevideo, Uruguay
| | | | | | - Olga Morozova
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
| | - Rodolfo Núñez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
- Excel Diagnostics and Nuclear Oncology Center, Houston, TX, USA
| | - Olivier Pellet
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
| | - Giuliano Mariani
- Regional Centre of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Manhas NS, Salehi S, Joyce P, Guermazi A, Ahmadzadehfar H, Gholamrezanezhad A. PET/Computed Tomography Scans and PET/MR Imaging in the Diagnosis and Management of Musculoskeletal Diseases. PET Clin 2020; 15:535-545. [DOI: 10.1016/j.cpet.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ultrasonographic features of acute Charcot neuroarthropathy of the foot: a pilot study. Clin Rheumatol 2020; 39:3787-3793. [PMID: 32447605 DOI: 10.1007/s10067-020-05107-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/06/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Our aim was to characterize the ultrasonographic features of patients with acute Charcot neuroarthropathy (CN) of the foot. METHODS In this prospective study, 26 patients with CN of the foot proved by MRI were enrolled. All patients were in early stage of CN with normal radiography (grade 0 modified Eichenholtz classification system). Ultrasonographic examination of mid-tarsal and ankle joints was performed with a 7-15 MHz linear probe. RESULTS Ages of our patients ranged from 38 to 67 years (57.3 ± 6.4). About 96.2% of our patients (25 patients) had diabetes mellitus. Ultrasonographic findings were as follows: effusion/synovitis (100%) with high Doppler activity (92.3%) in the mid-tarsal joints, and effusion/synovitis (92.3%) and high Doppler activity (84.6%) in the ankle joints. Bone erosions were present in the distal fibula in 23 patients (79.3%), while in distal tibia in 9 patients (34.6%). Tendonitis was found in tibialis posterior tendons in 23 patients (88.4%), and in peroneal tendons in 22 patients (84.6%). A combination of active synovitis (in mid-tarsal joints and ankle joints), active tendonitis (of tibialis posterior and peroneal tendons), and erosions in the distal end of fibula was present in 21 patients (80.8%). CONCLUSIONS Ultrasonography is able to detect soft tissue inflammation and pre-radiographic bony changes in early stages of CN. Key Points •Ultrasound is a useful diagnostic tool for pre-radiographic stages of Charcot joint. •High-grade synovitis, high-grade tenosynovitis, and bony erosions are highly suggestive of Charcot arthropathy.
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