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Shariyate MJ, Kheir N, Caro D, Abbasian M, Rodriguez EK, Snyder BD, Nazarian A. Assessment of Bone Healing: Opportunities to Improve the Standard of Care. J Bone Joint Surg Am 2023; 105:1193-1202. [PMID: 37339171 DOI: 10.2106/jbjs.22.01224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
➤ Bone healing is commonly evaluated by clinical examination and serial radiographic evaluation. Physicians should be mindful that personal and cultural differences in pain perception may affect the clinical examination. Radiographic assessment, even with the Radiographic Union Score, is qualitative, with limited interobserver agreement.➤ Physicians may use serial clinical and radiographical examinations to assess bone healing in most patients, but in ambiguous and complicated cases, they may require other methods to provide assistance in decision-making.➤ In complicated instances, clinically available biomarkers, ultrasound, and magnetic resonance imaging may determine initial callus development. Quantitative computed tomography and finite element analysis can estimate bone strength in later callus consolidation phases.➤ As a future direction, quantitative rigidity assessments for bone healing may help patients to return to function earlier by increasing a clinician's confidence in successful progressive healing.
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Affiliation(s)
- Mohammad Javad Shariyate
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Edward K Rodriguez
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Brian D Snyder
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Yerevan State Medical University Yerevan, Armenia
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Dedouit F, Grabherr S, Heinze S, Scheurer E, Yen K. Forensic Imaging: A New Subspeciality of Radiology. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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What Can the Clinical Radiologist Learn from Forensic Imaging? Analogies and Differences Between Forensic and Clinical Imaging. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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4
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Viero A, Obertová Z, Cappella A, Messina C, Sconfienza LM, Sardanelli F, Tritella S, Montisci M, Gregori D, Tagliaro F, Cattaneo C. The problem of dating fractures: A retrospective observational study of radiologic features of fracture healing in adults. Forensic Sci Int 2021; 329:111058. [PMID: 34710653 DOI: 10.1016/j.forsciint.2021.111058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/11/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022]
Abstract
Accurate dating of bone fractures can be crucial in the context of forensic trauma analysis since it may provide essential information for the corroboration or contradiction of statements by victims or suspects in cases of domestic abuse or torture. The different stages of bone healing have been well described in the existing literature, and some previous studies attempted to define related timelines particularly in the paediatric population. However, the bone healing process can be very variable and despite the importance of the topic in the forensic field, so far little is known about the radiological appearance of bone fractures at different healing stages, and how this correlates with time, especially in an adult population. The aim of this retrospective observational study was to describe the temporal aspect of pre-defined healing stages as they appear on radiographs of tubular bone fractures in adults, and explore the effect of potential cofounding variables. A dynamic nomogram was developed as a user-friendly tool to be eventually applied in clinical or medico-legal settings. This study showed that the posttraumatic time interval (PTTI) increased progressively with the pre-defined healing stages. However, confounding factors, such as patients' age, sex, and location of the fracture need to be accounted for in the final estimation model. Further studies are needed to explore more potentially confounding variables to refine the presented outcomes. Better knowledge of the effect of different confounding variables in the dating of fracture healing will contribute to greater accuracy of PTTI estimation of bone fractures in adults.
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Affiliation(s)
- Alessia Viero
- Legal Medicine and Toxicology Unit, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy; Laboratorio di Antropologia e Odontologia Forense (LABANOF), Sezione di Medicina Legale, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro, 10-37134, Verona, Italy
| | - Zuzana Obertová
- Laboratorio di Antropologia e Odontologia Forense (LABANOF), Sezione di Medicina Legale, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Centre for Forensic Anthropology, School of Social Sciences, The University of Western Australia, Australia
| | - Annalisa Cappella
- U.O. Laboratorio di Morfologia Umana Applicata, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Carmelo Messina
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; IRCCS Policlinico San Donato, Milan, Italy
| | - Stefania Tritella
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology Unit, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health - Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Veneto, Italy
| | - Franco Tagliaro
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro, 10-37134, Verona, Italy; World-Class Research Center "Digital biodesign and personalized healthcare", Sechenov First Moscow State Medical University, Moscow, Russia
| | - Cristina Cattaneo
- Laboratorio di Antropologia e Odontologia Forense (LABANOF), Sezione di Medicina Legale, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Abstract
PURPOSE OF REVIEW This review discusses imaging modalities for fracture repair assessment, with an emphasis on pragmatic clinical and translational use, best practices for implementation, and challenges and opportunities for continuing research. RECENT FINDINGS Semiquantitative radiographic union scoring remains the clinical gold standard, but has questionable reliability as a surrogate indicator of structural bone healing, particularly in early-stage, complex, or compromised healing scenarios. Alternatively, computed tomography (CT) scanning enables quantitative assessment of callus morphometry and mechanics through the use of patient-specific finite-element models. Dual-energy X-ray absorptiometry (DXA) scanning and radiostereometric analysis (RSA) are also quantitative, but technically challenging. Nonionizing magnetic resonance (MR) and ultrasound imaging are of high interest, but require development to enable quantification of 3D mineralized structures. Emerging image-based methods for quantitative assessment of bone healing may transform clinical research design by displacing binary outcomes classification (union/nonunion) and ultimately enhance clinical care by enabling early nonunion detection.
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Affiliation(s)
- Peter Schwarzenberg
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA
| | - Salim Darwiche
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zürich, Zürich, Switzerland
| | - Richard S Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Hannah L Dailey
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA.
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Yoshida N, Tsuchida Y, Murakami H, Shirakawa T, Futamura K, Kohzuki M. Time-Dependent Magnetic Resonance Imaging Changes in Occult Femoral Neck Fracture During Conservative Treatment: A Case Report. JBJS Case Connect 2020; 10:e0570. [PMID: 32224676 DOI: 10.2106/jbjs.cc.19.00570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 53-year-old woman presented to the emergency department with persistent left hip pain after a fall while riding a bicycle. Although x-ray imaging revealed no evidence of fracture, an abnormal intensity vertical line along the left femoral neck was observed in the magnetic resonance imaging (MRI). Furthermore, 2 weeks after injury, MRI revealed a newly developed abnormal intensity oblique band at the femoral neck. After discussing several treatment options with the patients, she chose the conservative treatment. CONCLUSION Careful follow-ups and MRI were undertaken 6 times within 32 weeks. Bone union was observed 32 weeks after the injury, and no bone displacement was observed.
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Affiliation(s)
- Naoki Yoshida
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yoshihiko Tsuchida
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroko Murakami
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Tetsuya Shirakawa
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kentaro Futamura
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
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Obertová Z, Leipner A, Messina C, Vanzulli A, Fliss B, Cattaneo C, Sconfienza LM. Postmortem imaging of perimortem skeletal trauma. Forensic Sci Int 2019; 302:109921. [DOI: 10.1016/j.forsciint.2019.109921] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 12/30/2022]
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Cappella A, de Boer HH, Cammilli P, De Angelis D, Messina C, Sconfienza LM, Sardanelli F, Sforza C, Cattaneo C. Histologic and radiological analysis on bone fractures: Estimation of posttraumatic survival time in skeletal trauma. Forensic Sci Int 2019; 302:109909. [PMID: 31404812 DOI: 10.1016/j.forsciint.2019.109909] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/12/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
In antemortem fractures, the estimation of the amount of time that has lapsed between the traumatic event and eventual death (the socalled 'posttraumatic survival time' or PTST) can have substantial implications in legal proceedings. It might for instance help to corroborate witness testimonies, to reconstruct the chain of events leading to eventual death or to establish a sequence when multiple traumata in a single individual are encountered. However, PTST estimation of bone trauma is impeded by a myriad of theoretical and practical issues, and is therefore almost invariably considered challenging. A few years ago, a method that combines radiological and histological analysis of fractures to estimate the minimum amount of lapsed PTST in skeletonized remains was proposed. This study aims to test its accuracy on a set of five rib fractures and four skull lesions fractures with known and varying amounts of posttraumatic survival time. In addition, it explores the differences between the assessment on ribs and skull bones and it expands on the proposed method by including computed tomography (CT) scanning. Using conventional radiology and histology, the minimum amount of PTST was accurately estimated in 8 out of 9 of the cases (89%). The one discrepancy between the estimated and known PTST was minimal, being just one day. The precision of the method diminishes as healing advances. It was noted that skull lesions showed less advanced and less well-developed healing features than the lapsed PTST would suggest. Of the three used modalities, conventional radiology proved to be the least accurate. CT scanning proved to be a valuable, sometimes even superior alternative to conventional radiology. Histology was superior to both conventional radiology and CT scanning. The results of our study illustrate the potential of the combined application of radiology and histology to estimate the PSTS in skeletonized human fractures.
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Affiliation(s)
- Annalisa Cappella
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione Medicina Legale, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 37, Milano, Italy; Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, Milano, Italy
| | - Hans H de Boer
- Dept. of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands; Dept. of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands.
| | - Paolo Cammilli
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione Medicina Legale, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 37, Milano, Italy
| | - Danilo De Angelis
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione Medicina Legale, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 37, Milano, Italy
| | - Carmelo Messina
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, Milano, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano, 20161, Italy
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, Milano, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano, 20161, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan, 20097, Italy
| | - Chiarella Sforza
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, Milano, Italy
| | - Cristina Cattaneo
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione Medicina Legale, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 37, Milano, Italy
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Nguyen JC, Lin B, Potter HG. Maturation-dependent findings in the shoulders of pediatric baseball players on magnetic resonance imaging. Skeletal Radiol 2019; 48:1087-1094. [PMID: 30607454 DOI: 10.1007/s00256-018-3130-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/15/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the prevalence and characteristics of shoulder osseous and soft tissue findings on magnetic resonance imaging (MRI) with respect to skeletal maturation in symptomatic pediatric baseball players without a history of acute trauma. METHODS The IRB-approved, HIPAA-compliant retrospective study analyzed 87 consecutive pediatric baseball players (86 boys and 1 girl; mean age, 15.4 ± 2.1 years) with shoulder MRI performed between March 1, 2012 and September 30, 2017. In consensus, two radiologists assessed the MRI studies for findings involving the humerus, the glenoid, the labrum, the rotator cuff, and the acromioclavicular joint. Exact Cochran-Armitage trend and Mantel-Haenszel Chi-square tests were used to investigate the association between these findings and skeletal maturation. RESULTS The mean ages between players who are skeletally immature (37 shoulders), maturing (26 shoulders), and matured (24 shoulders) were significantly different (p < 0.001). Bone marrow edema (p < 0.001) and sclerosis (p < 0.001) within the proximal humeral metaphysis decreased with skeletal maturation. Glenoid remodeling (p = 0.038) was more severe in the skeletally immature players and the prevalence of Bennett lesions (p = 0.048) increased with skeletal maturation. The prevalence of labral tears, rotator cuff tendinosis, and acromioclavicular joint separation did not significantly change with skeletal maturation. CONCLUSIONS The change in the prevalence of findings within the proximal humerus and glenoid with skeletal maturation suggest differences in the distribution of stress within the shoulders of pediatric baseball players during development.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th street, New York, NY, 10021, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th street, New York, NY, 10021, USA
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Hu S, Zhou Y, Zhao Y, Xu Y, Zhang F, Gu N, Ma J, Reynolds MA, Xia Y, Xu HH. Enhanced bone regeneration and visual monitoring via superparamagnetic iron oxide nanoparticle scaffold in rats. J Tissue Eng Regen Med 2018; 12:e2085-e2098. [DOI: 10.1002/term.2641] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 11/28/2017] [Accepted: 01/02/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Shuying Hu
- Jiangsu Key Laboratory of Oral DiseasesNanjing Medical University Nanjing P. R. China
| | - Yi Zhou
- Yixing People's Hospital Yixing P. R. China
| | - Yantao Zhao
- Beijing Engineering Research Center of Orthopaedic ImplantsFirst Affiliated Hospital of CPLA General Hospital Beijing P. R. China
| | - Yang Xu
- Affiliated Stomatology Hospital of Soochow University Suzhou P. R. China
| | - Feimin Zhang
- Jiangsu Key Laboratory of Oral DiseasesNanjing Medical University Nanjing P. R. China
| | - Ning Gu
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical EngineeringSoutheast University Nanjing P. R. China
- Suzhou Institute & Collaborative Innovation Center of Suzhou Nano Science and TechnologySoutheast University Suzhou P. R. China
| | - Junqing Ma
- Jiangsu Key Laboratory of Oral DiseasesNanjing Medical University Nanjing P. R. China
| | - Mark A. Reynolds
- Department of Advanced Oral Sciences & TherapeuticsUniversity of Maryland School of Dentistry Baltimore MD USA
| | - Yang Xia
- Jiangsu Key Laboratory of Oral DiseasesNanjing Medical University Nanjing P. R. China
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical EngineeringSoutheast University Nanjing P. R. China
- Department of Advanced Oral Sciences & TherapeuticsUniversity of Maryland School of Dentistry Baltimore MD USA
| | - Hockin H.K. Xu
- Department of Advanced Oral Sciences & TherapeuticsUniversity of Maryland School of Dentistry Baltimore MD USA
- Center for Stem Cell Biology & Regenerative MedicineUniversity of Maryland School of Medicine Baltimore MD USA
- Department of Mechanical EngineeringUniversity of Maryland Baltimore County Baltimore County MD USA
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11
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Temperature-corrected post-mortem 1.5 T MRI quantification of non-pathologic upper abdominal organs. Int J Legal Med 2017. [DOI: 10.1007/s00414-017-1622-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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12
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Kaunzner UW, Gauthier SA. MRI in the assessment and monitoring of multiple sclerosis: an update on best practice. Ther Adv Neurol Disord 2017; 10:247-261. [PMID: 28607577 DOI: 10.1177/1756285617708911] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/09/2017] [Indexed: 01/14/2023] Open
Abstract
Magnetic resonance imaging (MRI) has developed into the most important tool for the diagnosis and monitoring of multiple sclerosis (MS). Its high sensitivity for the evaluation of inflammatory and neurodegenerative processes in the brain and spinal cord has made it the most commonly used technique for the evaluation of patients with MS. Moreover, MRI has become a powerful tool for treatment monitoring, safety assessment as well as for the prognostication of disease progression. Clinically, the use of MRI has increased in the past couple decades as a result of improved technology and increased availability that now extends well beyond academic centers. Consequently, there are numerous studies supporting the role of MRI in the management of patients with MS. The aim of this review is to summarize the latest insights into the utility of MRI in MS.
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Affiliation(s)
- Ulrike W Kaunzner
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, New York, NY, USA
| | - Susan A Gauthier
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, 1305 York Avenue, New York, NY 10021, USA
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14
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Baron K, Neumayer B, Amerstorfer E, Scheurer E, Diwoky C, Stollberger R, Sprenger H, Weinberg AM. Time-Dependent Changes in T1 during Fracture Healing in Juvenile Rats: A Quantitative MR Approach. PLoS One 2016; 11:e0164284. [PMID: 27832068 PMCID: PMC5104481 DOI: 10.1371/journal.pone.0164284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/22/2016] [Indexed: 01/08/2023] Open
Abstract
Quantitative magnetic resonance imaging (qMRI) offers several advantages in imaging and determination of soft tissue alterations when compared to qualitative imaging techniques. Although applications in brain and muscle tissues are well studied, its suitability to quantify relaxation times of intact and injured bone tissue, especially in children, is widely unknown. The objective observation of a fracture including its age determination can become of legal interest in cases of child abuse or maltreatment. Therefore, the aim of this study is the determination of time dependent changes in intact and corresponding injured bones in immature rats via qMRI, to provide the basis for an objective and radiation-free approach for fracture dating. Thirty-five MR scans of 7 Sprague-Dawley rats (male, 4 weeks old, 100 ± 5 g) were acquired on a 3T MRI scanner (TimTrio, Siemens AG, Erlangen, Germany) after the surgical infliction of an epiphyseal fracture in the tibia. The images were taken at days 1, 3, 7, 14, 28, 42 and 82 post-surgery. A proton density-weighted and a T1-weighted 3D FLASH sequence were acquired to calculate the longitudinal relaxation time T1 of the fractured region and the surrounding tissues. The calculation of T1 in intact and injured bone resulted in a quantitative observation of bone development in intact juvenile tibiae as well as the bone healing process in the injured tibiae. In both areas, T1 decreased over time. To evaluate the differences in T1 behaviour between the intact and injured bone, the relative T1 values (bone-fracture) were calculated, showing clear detectable alterations of T1 after fracture occurrence. These results indicate that qMRI has a high potential not only for clinically relevant applications to detect growth defects or developmental alterations in juvenile bones, but also for forensically relevant applications such as the dating of fractures in cases of child abuse or maltreatment.
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Affiliation(s)
- Katharina Baron
- Ludwig Boltzmann Institute for Clinical-Forensic Imaging (LBI CFI), Graz, Austria
- BioTechMed-Graz, Graz, Austria
- * E-mail:
| | - Bernhard Neumayer
- Ludwig Boltzmann Institute for Clinical-Forensic Imaging (LBI CFI), Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Eva Amerstorfer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Eva Scheurer
- Ludwig Boltzmann Institute for Clinical-Forensic Imaging (LBI CFI), Graz, Austria
- Institute of Forensic Medicine, University of Basel – Health Department Basel, Basel, Switzerland
| | - Clemens Diwoky
- Institute of Molecular Biosciences, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Rudolf Stollberger
- Institute of Medical Engineering, Graz University of Technology, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Hanna Sprenger
- Ludwig Boltzmann Institute for Clinical-Forensic Imaging (LBI CFI), Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Annelie M. Weinberg
- Department of Orthopedics and Orthopedic Surgery, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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