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Pandey A, Chopra S, Cleary SJ, López-Álvarez M, Quimby FM, Alanizi AAA, Sakhamuri S, Zhang N, Looney MR, Craik CS, Wilson DM, Evans MJ. Imaging the Granzyme Mediated Host Immune Response to Viral and Bacterial Pathogens In Vivo Using Positron Emission Tomography. ACS Infect Dis 2024; 10:2108-2117. [PMID: 38819300 DOI: 10.1021/acsinfecdis.4c00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Understanding how the host immune system engages complex pathogens is essential to developing therapeutic strategies to overcome their virulence. While granzymes are well understood to trigger apoptosis in infected host cells or bacteria, less is known about how the immune system mobilizes individual granzyme species in vivo to combat diverse pathogens. Toward the goal of studying individual granzyme function directly in vivo, we previously developed a new class of radiopharmaceuticals termed "restricted interaction peptides (RIPs)" that detect biochemically active endoproteases using positron emission tomography (PET). In this study, we showed that secreted granzyme B proteolysis in response to diverse viral and bacterial pathogens could be imaged with [64Cu]Cu-GRIP B, a RIP that specifically targets granzyme B. Wild-type or germline granzyme B knockout mice were instilled intranasally with the A/PR/8/34 H1N1 influenza A strain to generate pneumonia, and granzyme B production within the lungs was measured using [64Cu]Cu-GRIP B PET/CT. Murine myositis models of acute bacterial (E. coli, P. aeruginosa, K. pneumoniae, and L. monocytogenes) infection were also developed and imaged using [64Cu]Cu-GRIP B. In all cases, the mice were studied in vivo using mPET/CT and ex vivo via tissue-harvesting, gamma counting, and immunohistochemistry. [64Cu]Cu-GRIP B uptake was significantly higher in the lungs of wild-type mice that received A/PR/8/34 H1N1 influenza A strain compared to mice that received sham or granzyme B knockout mice that received either treatment. In wild-type mice, [64Cu]Cu-GRIP B uptake was significantly higher in the infected triceps muscle versus normal muscle and the contralateral triceps inoculated with heat killed bacteria. In granzyme B knockout mice, [64Cu]Cu-GRIP B uptake above the background was not observed in the infected triceps muscle. Interestingly, live L. monocytogenes did not induce detectable granzyme B on PET, despite prior in vitro data, suggesting a role for granzyme B in suppressing their pathogenicity. In summary, these data show that the granzyme response elicited by diverse human pathogens can be imaged using PET. These results and data generated via additional RIPs specific for other granzyme proteases will allow for a deeper mechanistic study analysis of their complex in vivo biology.
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Affiliation(s)
- Apurva Pandey
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Shalini Chopra
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Simon J Cleary
- Department of Medicine, University of California, San Francisco, San Francisco, California 94158, United States
| | - Marina López-Álvarez
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Fiona M Quimby
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Aryn A A Alanizi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Sasank Sakhamuri
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Ningjing Zhang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Mark R Looney
- Department of Medicine, University of California, San Francisco, San Francisco, California 94158, United States
| | - Charles S Craik
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California 94158, United States
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California 94158, United States
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Michael J Evans
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California 94158, United States
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California 94158, United States
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2
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Youn L, Kuta A, Shendrik KS. Metastatic Disease Mimicking Osteomyelitis in the Foot. Cureus 2024; 16:e61608. [PMID: 38962613 PMCID: PMC11221879 DOI: 10.7759/cureus.61608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Cervical cancer most commonly spreads hematogenously to the lungs, liver, and bone. However, it rarely metastasizes to the foot. There is only one other case of cervical cancer with metastasis to the foot. In addition, the initial imaging of metastatic disease has difficulty in differentiating from infectious or other inflammatory processes, particularly in a clinical setting highly suspicious of infectious sources. Here, we present a rare case of cervical cancer metastasizing to the calcaneus masquerading as osteomyelitis, highlighting the importance of diagnostic imaging in conjunction with histological confirmation.
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Affiliation(s)
- Linda Youn
- Department of Internal Medicine, St. Bernards Medical Center, Jonesboro, USA
| | - Amber Kuta
- Department of Internal Medicine, St. Bernards Medical Center, Jonesboro, USA
| | - Karina S Shendrik
- Department of Internal Medicine, St. Bernards Medical Center, Jonesboro, USA
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3
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Goetz PE, Dumitriu D, Galant C, Docquier PL. Osteofibrous dysplasia-like adamantinoma of isolated fibula in a child mimicking chronic osteomyelitis with pathological fracture. J Surg Case Rep 2022; 2022:rjac196. [PMID: 35685295 PMCID: PMC9173740 DOI: 10.1093/jscr/rjac196] [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: 02/24/2022] [Accepted: 04/16/2022] [Indexed: 11/18/2022] Open
Abstract
The occurrence of a pathological fracture in children requires a rigorous diagnostic approach in order to establish the etiology and to develop a precise therapeutic strategy. Several causes are associated with these fractures, the most frequent being benign tumors in children in developed countries and chronic osteomyelitis in developing countries. More rarely, malignant tumors must however always be considered. The differential diagnosis on imaging may be difficult to establish between bone tumors and chronic infection. Surgical biopsy is therefore often performed to establish the precise origin of the fracture. We report the case of an adamantinoma (osteofibrous dysplasia-like) of the fibula in a 7-year-old child, discovered during the management of a pathologic fracture. The presumed diagnosis before biopsy was chronic osteomyelitis. A 14-cm-resection of the affected fibula was performed with good functional result. Differential diagnosis between adamantinoma, osteofibrous dysplasia and osteofibrous dysplasia-like adamantinoma remains very challenging.
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Affiliation(s)
- Pierre-Emmanuel Goetz
- Cliniques Universitaires Saint-Luc , Service de Chirurgie Orthopédique et Traumatologique, Bruxelles, Belgium
| | - Dana Dumitriu
- Cliniques Universitaires Saint-Luc , Service d’Imagerie Médicale, Bruxelles, Belgium
| | - Christine Galant
- Cliniques Universitaires Saint-Luc , Service d’Anatomie Pathologique, Bruxelles, Belgium
| | - Pierre-Louis Docquier
- Cliniques Universitaires Saint-Luc , Service de Chirurgie Orthopédique et Traumatologique, Bruxelles, Belgium
- Secteur des Sciences de la Santé , Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Université Catholique de Louvain, Bruxelles, Belgique
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Radiological changes in the formation of Brodie's abscess by sequential magnetic resonance imaging: a case report. Radiol Case Rep 2021; 16:2993-2997. [PMID: 34401040 PMCID: PMC8353412 DOI: 10.1016/j.radcr.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022] Open
Abstract
Brodie's abscess is a relatively rare subacute form of osteomyelitis. Early diagnosis is challenging because of its insidious onset and vague symptoms. Magnetic resonance imaging is helpful in the diagnosis of Brodie's abscess; however, to date, no study has described the imaging findings of this disease in the early stage. Here, we present the case of a 14 year-old boy with Brodie's abscess in the proximal tibia. The lesion initially presented as a bone marrow edema in the proximal metaphysis of the left tibia on MRI and was misinterpreted as a bone bruise. Further radiological examination was performed 1 month later; this revealed the formation of an abscess cavity, which suggested Brodie's abscess. The patient was referred to our hospital and underwent curettage and debridement, which led to the definitive diagnosis of Brodie's abscess on histopathological findings and bacterial culture. On careful retrospective evaluation, the initial radiological findings suggested a microabscess on the metaphyseal side of the growth plate and bone marrow edema spreading from the lesion to the epiphysis. These radiological changes could be reliable evidence proving that the metaphyseal side of the growth plate is the origin of Brodie's abscess. Moreover, bone marrow edema with suspected microabscess in the metaphysis of the long bones can be the initial stage of the formation of Brodie's abscess and should be carefully followed up.
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El-Sobky T, Mahmoud S. Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills. EFORT Open Rev 2021; 6:584-592. [PMID: 34377550 PMCID: PMC8335954 DOI: 10.1302/2058-5241.6.200155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis.A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management.Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician's clinical judgment.Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve.The growing body of evidence on 'high-risk' children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets.Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis.Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155.
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Affiliation(s)
- Tamer El-Sobky
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shady Mahmoud
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Youlden DJ, Le B, Narulla R, Sehgol H, Molnar R, Sivakumar B, Symes M. Things are not always what they seem. A case of gastric adenocarcinoma metastasis to the toe. ANZ J Surg 2021; 92:267-269. [PMID: 34097334 DOI: 10.1111/ans.16999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel J Youlden
- Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Brian Le
- Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Rajpal Narulla
- Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Haider Sehgol
- Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Robert Molnar
- The Orthopaedic Research Institute & Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Brahman Sivakumar
- Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia.,Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael Symes
- The Orthopaedic Research Institute & Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales Medicine, Sydney, New South Wales, Australia
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Longitudinal time-lapse in vivo micro-CT reveals differential patterns of peri-implant bone changes after subclinical bacterial infection in a rat model. Sci Rep 2020; 10:20901. [PMID: 33262377 PMCID: PMC7708479 DOI: 10.1038/s41598-020-77770-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023] Open
Abstract
Subclinical infection associated with orthopedic devices can be challenging to diagnose. The goal of this study was to evaluate longitudinal, microcomputed tomography (microCT) imaging in a rat model of subclinical orthopedic device-related infection caused by Staphylococcus epidermidis and four different Cutibacterium (previously Propionibacterium) acnes strains, and compare outcomes with non-inoculated and historical S. aureus-inoculated controls. Sterile screws or screws colonized with bacteria were placed in the tibia of 38 adult Wistar rats [n = 6 sterile screws; n = 6 S. epidermidis-colonized screws; n = 26 C. acnes-colonized screws (covering all three main subspecies)]. Regular microCT scans were taken over 28 days and processed for quantitative time-lapse imaging with dynamic histomorphometry. At euthanasia, tissues were processed for semiquantitative histopathology or quantitative bacteriology. All rats receiving sterile screws were culture-negative at euthanasia and displayed progressive bony encapsulation of the screw. All rats inoculated with S. epidermidis-colonized screws were culture-positive and displayed minor changes in peri-implant bone, characteristic of subclinical infection. Five of the 17 rats in the C. acnes inoculated group were culture positive at euthanasia and displayed bone changes at the interface of the screw and bone, but not deeper in the peri-implant bone. Dynamic histomorphometry revealed significant differences in osseointegration, bone remodeling and periosteal reactions between groups that were not measurable by visual observation of still microCT images. Our study illustrates the added value of merging 3D microCT data from subsequent timepoints and producing inherently richer 4D data for the detection and characterization of subclinical orthopedic infections, whilst also reducing animal use.
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8
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Bansal K, Nambi P. A Rare Case of Brodie's Abscess in HIV Patient Caused by Mycobacterium kansasii. Cureus 2020; 12:e10153. [PMID: 33014651 PMCID: PMC7526972 DOI: 10.7759/cureus.10153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/31/2020] [Indexed: 11/05/2022] Open
Abstract
We report a rare case of Brodie's abscess caused by Mycobacterium kansasii (M. kansasii). Our patient is a 39-year-old male who presented with right foot pain a month after a new diagnosis of HIV infection. X-ray and MRI were done, and the diagnosis of Brodie's abscess was confirmed. Surgical debridement was done, and bone cultures grew M. kansasii after five weeks. Brodie's abscess is a subacute form of osteomyelitis usually caused by Staphylococcus. Some other bacteria have been implicated in several case reports. To best of our knowledge, this is the first case of Brodie's abscess caused by M. kansasii. M. kansasii is the atypical mycobacteria causing infections in immunocompromised hosts as in HIV patients with low CD4 count. M. kansasii is usually associated with lung infections with rare extrapulmonary manifestations as in our case.
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Affiliation(s)
- Kamna Bansal
- Family and Community Medicine, Baylor College of Medicine, Houston, USA
| | - Preethi Nambi
- Family and Community Medicine, Baylor College of Medicine, Houston, USA
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9
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Lex JR, Gregory J, Allen C, Reid JP, Stevenson JD. Distinguishing bone and soft tissue infections mimicking sarcomas requires multimodal multidisciplinary team assessment. Ann R Coll Surg Engl 2019; 101:405-410. [PMID: 31155889 PMCID: PMC6554572 DOI: 10.1308/rcsann.2019.0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The aims of this study were to report the presenting characteristics and identify how best to distinguish bone and soft-tissue infections that mimic sarcomas. MATERIALS AND METHODS A total of 238 (211 osteomyelitis and 27 soft-tissue infections) patients referred to a tertiary sarcoma multidisciplinary team with suspected sarcoma who were ultimately diagnosed with a bone or soft tissue infection were included. Data from a prospectively collated database was analysed retrospectively. RESULTS Of all possible bone and soft-tissue sarcoma referrals, a diagnosis of infection was made in 2.1% and 0.7%, respectively. Median age was 18 years in the osteomyelitis group and 46 years in the soft-tissue infection group. In the osteomyelitis group, the most common presenting features were pain (85.8%) and swelling (32.7%). In the soft-tissue infection group, the most common clinical features were swelling (96.3%) and pain (70.4%). Those in the soft-tissue group were more likely to have raised inflammatory markers. Radiological investigations were unable to discern between tumour or infection in 59.7% of osteomyelitis and 81.5% of soft-tissue infection cases. No organism was identified in 64.9% of those who had a percutaneous biopsy culture. CONCLUSIONS This study has highlighted that infection is frequently clinically indistinguishable from sarcoma and remains a principle non-neoplastic differential diagnosis. When patients are investigated for suspected sarcoma, infections can be missed due to falsely negative radiological investigations and percutaneous biopsy. As no single clinical, biochemical or radiological feature or investigation can be relied upon for diagnosis, clinicians should have a low threshold for tissue biopsy and discussion in a sarcoma multidisciplinary team meeting.
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Affiliation(s)
- JR Lex
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - C Allen
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - JP Reid
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - JD Stevenson
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
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Korhonen TK, Salokorpi N, Niinimäki J, Serlo W, Lehenkari P, Tetri S. Quantitative and qualitative analysis of bone flap resorption in patients undergoing cranioplasty after decompressive craniectomy. J Neurosurg 2019; 130:312-321. [PMID: 29473777 DOI: 10.3171/2017.8.jns171857] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/21/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE: Autologous bone cranioplasty after decompressive craniectomy entails a notable burden of difficult postoperative complications, such as infection and bone flap resorption (BFR), leading to mechanical failure. The prevalence and significance of asymptomatic BFR is currently unclear. The aim of this study was to radiologically monitor the long-term bone flap survival and bone quality change in patients undergoing autologous cranioplasty. METHODS: The authors identified all 45 patients who underwent autologous cranioplasty at Oulu University Hospital, Finland, between January 2004 and December 2014. Using perioperative and follow-up CT scans, the volumes and radiodensities of the intact bone flap prior to surgery and at follow-up were calculated. Relative changes in bone flap volume and radiodensity were then determined to assess cranioplasty survival. Sufficient CT scans were obtainable from 41 (91.1%) of the 45 patients. RESULTS: The 41 patients were followed up for a median duration of 3.79 years (25th and 75th percentiles = 1.55 and 6.66). Thirty-seven (90.2%) of the 41 patients had some degree of BFR and 13 (31.7%) had a remaining bone flap volume of less than 80%. Patients younger than 30 years of age had a mean decrease of 15.8% in bone flap volume compared with the rest of the cohort. Bone flap volume was not found to decrease linearly with the passing of time, however. The effects of lifestyle factors and comorbidities on BFR were nonsignificant. CONCLUSIONS: In this study BFR was a very common phenomenon, occurring at least to some degree in 90% of the patients. Decreases in bone volume were especially prominent in patients younger than 30 years of age. Because the progression of resorption during follow-up was nonlinear, routine follow-up CT scans appear unnecessary in monitoring the progression of BFR; instead, clinical follow-up with mechanical stability assessment is advised. Partial resorption is most likely a normal physiological phenomenon during the bone revitalization process.
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Affiliation(s)
| | | | | | - Willy Serlo
- 3PEDEGO Research Unit; and
- 5Department of Children and Adolescents, Oulu University Hospital, MRC Oulu, Finland
| | - Petri Lehenkari
- 4Department of Anatomy and Cell Biology, University of Oulu; and
| | - Sami Tetri
- 1Department of Neurosurgery, Oulu University Hospital
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Oñate Miranda M, Moser TP. A practical guide for planning pelvic bone percutaneous interventions (biopsy, tumour ablation and cementoplasty). Insights Imaging 2018; 9:275-285. [PMID: 29564836 PMCID: PMC5991000 DOI: 10.1007/s13244-018-0600-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/12/2018] [Accepted: 01/19/2018] [Indexed: 12/24/2022] Open
Abstract
Percutaneous approaches for pelvic bone procedures (bone biopsies, tumour ablation and cementoplasty) are multiple and less well systematised than for the spine or extremities. Among the different imaging techniques that can be used for guidance, computed tomography (CT) scan is the modality of choice because of the complex pelvic anatomy. In specific cases, such as cementoplasty where real-time evaluation is a determinant, a combination of CT and fluoroscopy is highly recommended. The objective of this article is to propose a systematic approach for image-guided pelvic bone procedures, as well as to provide some technical tips. We illustrate the article with multiple examples, and diagrams of the approaches and important structures to avoid to perform these procedures safely. TEACHING POINTS • Pelvic bone procedures are safe to perform if anatomical landmarks are recognised. • The safest approach varies depending on the pelvic level. • CT is the modality of choice for guiding pelvic percutaneous procedures. • Fluoroscopy is recommended when real-time monitoring is mandatory. • MRI can also be used for guiding pelvic percutaneous procedures.
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Affiliation(s)
- Marta Oñate Miranda
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue St-Denis, Montréal, QC, H2X 0C1, Canada
| | - Thomas P Moser
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue St-Denis, Montréal, QC, H2X 0C1, Canada.
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Gabbott B, Faria G, Lawson G, Daly K. A Brodie’s abscess with soft tissue collection—complicating an already difficult diagnosis. J Surg Case Rep 2018; 2018:rjx263. [PMID: 29383243 PMCID: PMC5786206 DOI: 10.1093/jscr/rjx263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022] Open
Abstract
A healthy 14-year-old boy with a 3-month history of thigh pain and swelling is referred to a specialist centre with an uncertain diagnosis. After extensive tests and imaging a Brodie’s abscess is diagnosed. The abscess is complicated by a fistula (cloaca) through the cortical bone of the femur, resulting in a large complex soft tissue collection. This is a presentation, we are unaware has been documented in any literature. After specialist multi-team combined management (Paediatric Trauma and Orthopaedic and Paediatric Infectious Diseases), the patient undergoes two surgical procedures, and extensive antibiotic cover. The patient makes a good recovery with no long lasting sequelae to date.
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Affiliation(s)
- Ben Gabbott
- Junior Orthopaedic Educational Fellow, Trauma and Orthopaedic Department, St Georges University Hospital, London SW17 0QT, UK
- Correspondence address. Junior Orthopaedic Educational Fellow, Trauma and Orthopaedic Department, St Georges University Hospital, London SW17 0QT, UK. Tel: +07515712743; E-mail:
| | - Giles Faria
- Trauma and Orthopaedics (Foundation Trainee), Trauma and Orthopaedic Department, Epsom and St Hellier Hospital, London KT18 7EG, UK
| | - George Lawson
- Paediatric Infectious Diseases (Foundation Trainee), Paediatric Infectious Diseases Department, St Georges University Hospital, London SW17 0QT, UK
| | - Karen Daly
- Consultant Paediatric Orthopaedics, Trauma and Orthopaedic Department, St Georges University Hospital, London SW17 0QT
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13
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Diagnostic value of 99mTc-ubiquicidin scintigraphy in differentiation between osteomyelitis and bone tumors. Nucl Med Commun 2017; 38:885-890. [PMID: 29016425 DOI: 10.1097/mnm.0000000000000744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The differentiation of osteomyelitis from bone tumors is of great importance in clinical decision-making; however, the features of both osteomyelitis and bone tumors are noncontributory. Tc-ubiquicidin scintigraphy is a new promising method with the ability to specifically localize the infection site by bacterial cell membrane binding. This study aimed to evaluate the ability of this radiopeptide for the differentiation of these two entities. PATIENTS AND METHODS Thirty consecutive patients (mean age=20.9 years) suspected of having either osteomyelitis or bone tumor were included in this prospective study. A Tc-UBI scan was performed in both dynamic and static phases and the images were assessed qualitatively and semiquantitatively. The final diagnosis was established for 29 patients on the basis of surgical findings and microbiological and pathology assessments as well as any other clinical, laboratory, or imaging findings during patient follow-up. RESULTS The final diagnosis was infectious and noninfectious processes in 19 and 10 patients, respectively. Visual assessment could not distinguish between osteomyelitis and bone tumors. However, the time-activity pattern of the images proved to be promising. The sensitivity, specificity, negative and positive predictive value, and accuracy of the time-activity curve for osteomyelitis were 73.6 (54-93), 100, 66.6 (43-91), 100, and 82%, respectively. The mean±SD tumor/nontumor (T/NT) ratios for 30 min images were 2.22±0.45 and 2.02±0.51 for infectious and noninfectious processes, respectively (P=0.29). Using a cutoff value of 0.97 for the T/NT ratio, the sensitivity and specificity were calculated to be 78.9 and 50%, respectively. CONCLUSION Although Tc-UBI scintigraphy in the dynamic imaging format was very useful with high accuracy in differentiating between infectious and tumoral lesions, it was not useful to distinguish these two entities on the basis of visual assessment or T/NT ratio measurement on static images. The study also showed the high accuracy of this noninvasive modality in acute osteomyelitis with low diagnostic value in chronic infectious processes.
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14
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Kwee TC, de Klerk JMH, Nix M, Heggelman BGF, Dubois SV, Adams HJA. Benign Bone Conditions That May Be FDG-avid and Mimic Malignancy. Semin Nucl Med 2017; 47:322-351. [PMID: 28583274 DOI: 10.1053/j.semnuclmed.2017.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Positron emission tomography with the radiotracer 18F-fluoro-2-deoxy-d-glucose (FDG) plays an important role in the evaluation of bone pathology. However, FDG is not a cancer-specific agent, and knowledge of the differential diagnosis of benign FDG-avid bone alterations that may resemble malignancy is important for correct patient management, including the avoidance of unnecessary additional invasive tests such as bone biopsy. This review summarizes and illustrates the spectrum of benign bone conditions that may be FDG-avid and mimic malignancy, including osteomyelitis, bone lesions due to benign systemic diseases (Brown tumor, Erdheim-Chester disease, Gaucher disease, gout and other types of arthritis, Langerhans cell histiocytosis, and sarcoidosis), benign primary bone lesions (bone cysts, chondroblastoma, chondromyxoid fibroma, desmoplastic fibroma, enchondroma, giant cell tumor and granuloma, hemangioma, nonossifying fibroma, and osteoid osteoma and osteoblastoma), and a group of miscellaneous benign bone conditions (post bone marrow biopsy or harvest status, bone marrow hyperplasia, fibrous dysplasia, fractures, osteonecrosis, Paget disease of bone, particle disease, and Schmorl nodes). Several ancillary clinical and imaging findings may be helpful in discriminating benign from malignant FDG-avid bone lesions. However, this distinction is sometimes difficult or even impossible, and tissue acquisition will be required to establish the final diagnosis.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
| | - John M H de Klerk
- Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Maarten Nix
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ben G F Heggelman
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Stefan V Dubois
- Department of Pathology, Meander Medical Center, Amersfoort, The Netherlands
| | - Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Deventer, The Netherlands
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Epidemiology and Management of Acute, Uncomplicated Septic Arthritis and Osteomyelitis: Spanish Multicenter Study. Pediatr Infect Dis J 2016; 35:1288-1293. [PMID: 27455444 DOI: 10.1097/inf.0000000000001309] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acute osteoarticular infection (OAI) is a potentially severe disease. The aim of this study was to evaluate the etiology, clinical characteristics and therapeutic approach of OAI in children in Spain. METHODS Medical records from children <14 years with OAI from 25 hospitals between 2008 and 2012 were reviewed. Confirmed osteomyelitis (OM) and septic arthritis (SA) required a positive bacterial isolate; otherwise, they were considered probable. Probable SA with <40,000 cells/mm in joint fluid was not included. RESULTS A total of 641 children were evaluated. Two hundred and ninety-nine cases (46%) were OM, 232 (36%) SA, 77 (12%) osteoarthritis and 33 (5%) spondylodiscitis. Children with OM were older (63 vs. 43 months for SA; P < 0.001). Magnetic resonance imaging and bone scintigraphy had the highest yield for OM diagnosis (94%). Arthrocentesis was performed in 96% of SA. A microorganism was isolated in 246 patients (38%: 33% OM vs. 55% SA; P < 0.001): Staphylococcus aureus was the most common (63%), followed by Kingella kingae (15%) and Streptococcus pyogenes (9%). Ninety-five percent of children initially received IV antibiotics, mostly cefotaxime + cloxacillin (60%) or cloxacillin (40%). Total treatment duration was 38 (±31) days for OM and 28 (±16) days for SA (P < 0.0001). Twenty percent of children with OM (46% because of complications) and 53% with SA (95% initial arthrotomy) underwent surgery. Patients with SA were compared according to initial arthrotomy (n = 123) versus arthrocentesis (n = 109), and no clinical differences were observed, except for higher rate of hip SA in the former (50% vs. 9%; P < 0.001). Children with arthrocentesis had less sequelae [6.6% vs. 1%; P = 0.03, odds ratio = 0.58 (95% confidence interval: 0.45-0.76)], but not in the multivariate analysis. CONCLUSIONS This is the largest pediatric cohort of OAI in Spain. S. aureus was the most common isolate, although K. kingae was recovered in a high proportion of cases. Conservative management was applied in half of the patients. There was a low rate of sequelae, even with nonsurgical approaches.
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16
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Saavedra-Lozano J, Calvo C, Huguet Carol R, Rodrigo C, Núñez E, Pérez C, Merino R, Rojo P, Obando I, Downey F, Colino E, García J, Cilleruelo M, Torner F, García L. Documento de Consenso SEIP-SERPE-SEOP sobre etiopatogenia y diagnóstico de la osteomielitis aguda y artritis séptica no complicadas. An Pediatr (Barc) 2015; 83:216.e1-10. [DOI: 10.1016/j.anpedi.2014.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022] Open
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17
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Saavedra-Lozano J, Calvo C, Huguet Carol R, Rodrigo C, Núñez-Cuadros E, Pérez Méndez C, Merino R, Rojo P, Obando I, Downey F, Colino E, García J, Cilleruelo M, Torner F, García L. SEIP-SERPE-SEOP consensus document on aetiopathogenesis and diagnosis of uncomplicated acute osteomyelitis and septic arthritis. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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18
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Wong A, Grando H, Fliszar E, Pathria M, Chang EY, Resnick D. Intramedullary fat globules related to bone trauma: a new MR imaging finding. Skeletal Radiol 2014; 43:1713-9. [PMID: 25186251 DOI: 10.1007/s00256-014-1988-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 07/22/2014] [Accepted: 08/07/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study is to describe intraosseous fat globules related to bone trauma that are detectable with magnetic resonance imaging (MRI), to define the relationship of this finding to fracture and bone contusion, to establish the frequency and associated findings. A proposed pathogenesis is presented. MATERIALS AND METHODS We retrospectively reviewed 419 knee MRI examinations in patients with a history of recent injury and MRI findings of fracture or bone contusion. As a control population, 268 knee MRI examinations in patients without MRI findings of recent bone injury were also reviewed. RESULTS Eight of 419 (1.9%) patients with acute or subacute knee injury with positive findings of osseous trauma on MRI demonstrated intraosseous fat globules. The mean age of patients with fat globules was greater than that of those without fat globules, and the finding was more commonly seen in women. Fat globules were hyperintense to the normal fatty marrow present elsewhere in the bone on TI-weighted imaging and had a surrounding halo of high signal intensity on fluid-sensitive imaging. CONCLUSIONS Intramedullary fat globules related to bone injury visible on MRI are thought to be due to coalesced fat released by the necrosis of fatty marrow cells. The pathogenesis is supported by histologic studies of fat globules related to osteomyelitis, bone contusions and fractures. As the medullary cavity of long bones in older patients contains more fat than hematopoetic bone marrow, it is likely that this finding is more common with advancing age.
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Affiliation(s)
- Adelaine Wong
- UCSD Radiology, Musculoskeletal Division, 8899 University Center Lane Suite 370, San Diego, CA, 92122, USA,
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