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Frush DP, Vassileva J, Brambilla M, Mahesh M, Rehani M, Samei E, Applegate K, Bourland J, Ciraj-Bjenlac O, Dahlstrom D, Gershan V, Gilligan P, Godthelp B, Hjemly H, Kainberger F, Mikhail-Lette M, Holmberg O, Paez D, Schrandt S, Valentin A, Van Deventer T, Wakeford R. Recurrent medical imaging exposures for the care of patients: one way forward. Eur Radiol 2024:10.1007/s00330-024-10659-x. [PMID: 38592419 DOI: 10.1007/s00330-024-10659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/17/2023] [Accepted: 01/23/2024] [Indexed: 04/10/2024]
Abstract
Medical imaging is both valuable and essential in the care of patients. Much of this imaging depends on ionizing radiation with attendant responsibilities for judicious use when performing an examination. This responsibility applies in settings of both individual as well as multiple (recurrent) imaging with associated repeated radiation exposures. In addressing the roles and responsibilities of the medical communities in the paradigm of recurrent imaging, both the International Atomic Energy Agency (IAEA) and the American Association of Physicists in Medicine (AAPM) have issued position statements, each affirmed by other organizations. The apparent difference in focus and approach has resulted in a lack of clarity and continued debate. Aiming towards a coherent approach in dealing with radiation exposure in recurrent imaging, the IAEA convened a panel of experts, the purpose of which was to identify common ground and reconcile divergent perspectives. The effort has led to clarifying recommendations for radiation exposure aspects of recurrent imaging, including the relevance of patient agency and the provider-patient covenant in clinical decision-making. CLINICAL RELEVANCE STATEMENT: An increasing awareness, generating some lack of clarity and divergence in perspectives, with patients receiving relatively high radiation doses (e.g., ≥ 100 mSv) from recurrent imaging warrants a multi-stakeholder accord for the benefit of patients, providers, and the imaging community. KEY POINTS: • Recurrent medical imaging can result in an accumulation of exposures which exceeds 100 milli Sieverts. • Professional organizations have different perspectives on roles and responsibilities for recurrent imaging. • An expert panel reconciles differing perspectives for addressing radiation exposure from recurrent medical imaging.
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Affiliation(s)
- Donald Paul Frush
- Department of Radiology, Duke University Medical Center, Durham, NC, 27705, USA.
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Marco Brambilla
- Department of Medical Physics, University Hospital of Novara, Novara, Italy
| | - Mahadevappa Mahesh
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Madan Rehani
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Ehsan Samei
- Department of Radiology, Duke University Medical Center, Durham, NC, 27705, USA
| | | | - John Bourland
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Vesna Gershan
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Paddy Gilligan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Barbara Godthelp
- Authority for Nuclear Safety and Radiation Protection, The Hague, The Netherlands
| | - Hakon Hjemly
- International Society of Radiographers and Radiological Technologists, London, UK
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Suz Schrandt
- ExPPect, Founder & CEO, and Patients for Patient Safety US, Champion (Affiliate, WHO PFPS Network), Arlington, VA, USA
| | - Andreas Valentin
- Department of Internal Medicine With Cardiology & Intensive Care Medicine Clinic Donaustadt Vienna Health Care Group, Vienna, Austria
| | | | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
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Faihs L, Neumann-Opitz C, Kainberger F, Druml C. Ethics teaching in medical school: the perception of medical students. Wien Klin Wochenschr 2024; 136:129-136. [PMID: 36547763 PMCID: PMC9774069 DOI: 10.1007/s00508-022-02127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In times of a pandemic, morals and ethics take center stage. Due to the challenges of the pandemic and ongoing discussions about the end of life, student teaching demands might have changed. This study aimed to evaluate teaching ethics, law, and decision-making skills in medical education via a survey to customize the curriculum to the students' needs. Furthermore, gender differences were examined to determine gender equality in medical education. METHODS The medical students at the Medical University of Vienna were requested to complete an anonymous online survey, providing feedback on the teaching of ethics, law, and decision-making skills. RESULTS Our study showed the students' strong demand for more teaching of ethics, law, and decision-making skills. Moreover, we found that students were afraid to encounter ethical and moral dilemmas. Gender differences could be found, with female students assessing their knowledge and the teaching as being more insufficient, resulting in greater fear of encountering ethical and moral dilemmas. CONCLUSION The fear of encountering ethical and moral dilemmas might be linked to medical students' self-perceived insufficient legal knowledge. The education should guarantee gender equality in medical training and be customized to the students to provide the future doctors with the ethical and legal expertise to preserve the patient's rights and protect their mental health.
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Affiliation(s)
- Lorenz Faihs
- Medical University of Vienna, Vienna, Austria.
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
| | | | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christiane Druml
- Unesco Chair on Bioethics at the Medical University of Vienna, Vienna, Austria
- Department of Ethics, Collections, and History of Medicine (Josephinum), Vienna, Austria
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Smolen J, Hermann J, Kainberger F, Schirmer M. Goodbye to a great clinician, scientist and role model: Winfried Graninger (1956-2023). Wien Klin Wochenschr 2023; 135:441-442. [PMID: 37555899 DOI: 10.1007/s00508-023-02255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Josef Smolen
- Clinical Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Josef Hermann
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Franz Kainberger
- Division of Neuroradiology and Muskuloskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Michael Schirmer
- Department of Medicine, Medical University of Innsbruck, Innsbruck, Austria
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Smolen J, Kainberger F, Hermann J, Aringer M, Schirmer M. [In memory of Winfried Graninger]. Z Rheumatol 2023:10.1007/s00393-023-01397-4. [PMID: 37470866 DOI: 10.1007/s00393-023-01397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Josef Smolen
- Klinische Abteilung für Rheumatologie, Klinik für Innere Medizin 3, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Franz Kainberger
- Klinische Abteilung für Neuroradiologie und Muskuloskeletale Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Österreich
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5
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Schwarz C, Schwarz M, Schmidbauer V, Kainberger F, Milos RI, Langenberger H, Gessl I, Funk G, Gschwantler M. Diffuse idiopathic skeletal hyperostosis as a cause for dysphagia in a patient with ankylosing spondylitis. Wien Klin Wochenschr 2023:10.1007/s00508-023-02205-4. [PMID: 37145247 DOI: 10.1007/s00508-023-02205-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/29/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ankylosing spinal alterations which are often asymptomatic but may typically cause back pain and spinal stiffness. Presence of DISH may complicate spinal trauma and lead to unstable fractures requiring surgical intervention. Treatment options include physical activity, symptomatic treatment, local heat application, and optimization of metabolic comorbidities. CASE A multimorbid older patient was admitted to the gastroenterological ward for the investigation of progressive dysphagia and weight loss. Gastroscopy revealed a dorsal impression of the esophagus at 25 cm from the incisor. Clinical work-up including computed tomography (CT) and magnetic resonance imaging (MRI) ruled out malignancy but showed ankylosing spondylophytes and non-recent fractures of vertebrae C5-C7, compatible with DISH of the cervicothoracic spine as a cause for the esophageal impression. Notably, imaging diagnostics showed ankylosing spine alterations extending to the lumbar spine and both sacroiliac joints, suggestive of ankylosing spondylitis (AS). Typical imaging characteristics, a history of psoriasis, and positive HLA*B27 status supported the diagnosis of underlying AS in this patient with dysphagia as an unusual primary symptom of DISH. Additionally, pulmonary alterations compatible with a usual interstitial pneumonia (UIP)-like pattern were seen on lung CT. CONCLUSION Overlaps among AS, DISH and pulmonary abnormalities including UIP have been described previously; however, they represent unexpected findings in this older patient. This case underlines the importance of interdisciplinary collaboration and consideration of DISH as a differential diagnosis in patients with atypical symptoms.
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Affiliation(s)
- Caroline Schwarz
- Department for Internal Medicine IV, Klinik Ottakring, Montleartstr. 37, 1160, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Schwarz
- Department for Internal Medicine IV, Klinik Ottakring, Montleartstr. 37, 1160, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Victor Schmidbauer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ruxandra-Iulia Milos
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Herbert Langenberger
- Institute for Diagnostic and Interventional Radiology, Klinik Ottakring, Vienna, Austria
| | - Irina Gessl
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Georg Funk
- Department for Internal Medicine II, Klinik Ottakring, Vienna, Austria
| | - Michael Gschwantler
- Department for Internal Medicine IV, Klinik Ottakring, Montleartstr. 37, 1160, Vienna, Austria.
- Sigmund Freud University, Vienna, Austria.
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Crevenna R, Hasenoehrl T, Wiltschke C, Kainberger F, Keilani M. Prescribing Exercise to Cancer Patients Suffering from Increased Bone Fracture Risk Due to Metastatic Bone Disease or Multiple Myeloma in Austria-An Inter- and Multidisciplinary Evaluation Measure. Cancers (Basel) 2023; 15:cancers15041245. [PMID: 36831587 PMCID: PMC9954683 DOI: 10.3390/cancers15041245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION In the current absence of specific functional fracture risk assessment technology, the planning of physical exercise interventions for cancer patients suffering from increased bone fracture risk remains a serious clinical challenge. Until a reliable, solely technical solution is available for the clinician, fracture risk assessment remains an inter- and multidisciplinary decision to be made by various medical experts. The aim of this short paper is depicting how this challenge should be approached in the clinical reality according to Austrian experts in cancer rehabilitation, presenting the best-practice model in Austria. Following referral from the specialist responsible for the primary cancer treatment (oncologist, surgeon, etc.), the physiatrist takes on the role of rehabilitation case manager for each individual patient. Fracture risk assessment is then undertaken by specialists in radiology, orthopedics, oncology, and radiation therapy, with the result that the affected bone regions are classified as being at highly/slightly/not increased fracture risk. Following internal clearance, exercise planning is undertaken by a specialist in exercise therapy together with the physiatrist based on the individual's fracture risk assessment. In the case in which the patient shows exercise limitations due to additional musculoskeletal impairments, adjuvant physical modalities such as physiotherapy should be prescribed to increase exercisability. CONCLUSION Exercise prescription for cancer patients suffering from increased fracture risk is an inter- and multidisciplinary team decision for each individual patient.
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Affiliation(s)
- Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-43300; Fax: +43-1-40400-52810
| | - Timothy Hasenoehrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Wiltschke
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Franz Kainberger
- Department of Radiology and Osteology, Medical University of Vienna, 1090 Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, 1090 Vienna, Austria
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Gnant M, Frantal S, Pfeiler G, Steger GG, Egle D, Greil R, Fitzal F, Wette V, Balic M, Haslbauer F, Melbinger-Zeinitzer E, Bjelic-Radisic V, Artner-Matuschek S, Kainberger F, Ritter M, Rinnerthaler G, Sevelda P, Bergh J, Kacerovsky-Strobl S, Suppan C, Brunner C, Deutschmann C, Gampenrieder SP, Fohler H, Jakesz R, Fesl C, Singer C. Long-Term Outcomes of Adjuvant Denosumab in Breast Cancer. NEJM Evid 2022; 1:EVIDoa2200162. [PMID: 38319865 DOI: 10.1056/evidoa2200162] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Outcomes of Adjuvant Denosumab in Breast CancerIn this long-term report of a prospective, double-blind, placebo-controlled, phase 3 trial of adjuvant aromatase inhibitor in postmenopausal patients with early hormone receptor-positive breast cancer, adjuvant denosumab therapy improved disease-free survival by 3.5 percentage points, bone metastasis-free survival by 2.5 percentage points, and overall survival by 1.0 percentage point at 9 years of follow-up.
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Affiliation(s)
- Michael Gnant
- Medical University of Vienna, Comprehensive Cancer Center, Vienna
- ABCSG (Austrian Breast & Colorectal Cancer Study Group), Vienna
| | - Sophie Frantal
- ABCSG (Austrian Breast & Colorectal Cancer Study Group), Vienna
| | - Georg Pfeiler
- Department of Gynecology and Gynecological Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - Guenther G Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials; Cancer Cluster Salzburg, Salzburg, Austria
| | - Florian Fitzal
- Department of General Surgery and Breast Health Center of the Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | | | - Marija Balic
- Division of Oncology, Department of Internal Medicine, and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Ferdinand Haslbauer
- Department of Internal Medicine, Salzkammergut Klinikum Hospital Vöcklabruck, Vöcklabruck, Austria
| | | | - Vesna Bjelic-Radisic
- Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
- Breast Unit, Helios University Hospital Wuppertal, Wuppertal Germany, University Witten/Herdecke, Germany
| | | | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna
| | - Magdalena Ritter
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials; Cancer Cluster Salzburg, Salzburg, Austria
| | - Paul Sevelda
- Department of Gynecology, Karl Landsteiner Institute for Gynecologic Oncology and Senology, Hospital Hietzing, Vienna
| | - Jonas Bergh
- Department of Oncology-Pathology, Cancer Research Karolinska Institutet, Stockholm
| | - Stephanie Kacerovsky-Strobl
- Department of General Surgery and Breast Health Center of the Comprehensive Cancer Center, Medical University of Vienna, Vienna
- Breast Health Center, St. Francis Hospital Vienna, Vienna
| | - Christoph Suppan
- Division of Oncology, Department of Internal Medicine, and Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Christine Brunner
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christine Deutschmann
- Department of Gynecology and Gynecological Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - Simon P Gampenrieder
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials; Cancer Cluster Salzburg, Salzburg, Austria
| | - Hannes Fohler
- ABCSG (Austrian Breast & Colorectal Cancer Study Group), Vienna
| | - Raimund Jakesz
- Department of General Surgery and Breast Health Center of the Comprehensive Cancer Center, Medical University of Vienna, Vienna
| | - Christian Fesl
- ABCSG (Austrian Breast & Colorectal Cancer Study Group), Vienna
| | - Christian Singer
- Department of Gynecology and Gynecological Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna
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Sunk IG, Amoyo-Minar L, Niederreiter B, Soleiman A, Kainberger F, Smolen JS, Aletaha D, Bobacz K. Dorso-ventral osteophytes of interphalangeal joints correlate with cartilage damage and synovial inflammation in hand osteoarthritis: a histological/radiographical study. Arthritis Res Ther 2022; 24:226. [PMID: 36175909 PMCID: PMC9520866 DOI: 10.1186/s13075-022-02911-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/07/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To detect dorsally located osteophytes (OP) on lateral x-ray views and to correlate their presence with the extent of structural joint damage, determined by histologic grading (cartilage damage and synovial inflammation) and radiographic scoring in hand osteoarthritis (HOA). Methods Distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints were obtained from post mortem specimens (n = 40). Multiplanar plain x-rays were taken (dorso/palmar (dp) and lateral views). Radiographic OA was determined by the Kellgren and Lawrence classification. Joint samples were prepared for histological analysis and cartilage damage was graded according to the Mankin scoring system. Inflammatory changes of the synovial membrane were scored using the general synovitis score (GSS). Spearman’s correlation was applied to examine the relationship between histological and radiographical changes. Differences between groups were determined by Mann-Whitney test. Results Bony proliferations that were only detectable on lateral views but reminiscent of OPs on dp images were termed dorso-ventral osteophytes (dvOPs). All joints displaying dvOPs were classified as OA and the presence of dvOPs in DIP and PIP joints correlated with the extent of histological and radiographic joint damage, as well as with patient age. Joint damage in osteoarthritic DIP and PIP joints without any dvOPs was less severe compared to joints with dvOPs. Synovial inflammation was mainly present in joints displaying dvOPs and correlated with joint damage. Conclusion dvOPs are associated with increasing structural alterations in DIP and PIP joints and can be seen as markers of advanced joint damage. Detecting dvOPs can facilitate the diagnosis process and improve damage estimation in HOA.
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Affiliation(s)
- Ilse-Gerlinde Sunk
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Love Amoyo-Minar
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Birgit Niederreiter
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Afschin Soleiman
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Radiology and Osteology, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Klaus Bobacz
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Hirtler L, Kainberger F, Röhrich S. The intercondylar fossa-A narrative review. Clin Anat 2021; 35:2-14. [PMID: 34374453 PMCID: PMC9291140 DOI: 10.1002/ca.23773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/22/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022]
Abstract
The intercondylar fossa (“intercondylar notch,” IN) is a groove at the distal end of the femur, housing important stabilizing structures: cruciate ligaments and meniscofemoral ligaments. As the risk for injury to these structures correlates with changes to the IN, exact knowledge of its morphology, possible physiological and pathological changes and different approaches for evaluating it are important. The divergent ways of assessing the IN and the corresponding measurement methods have led to various descriptions of its possible shapes. Ridges at the medial and lateral wall are considered clinically important because they can help with orientation during arthroscopy, whereas ridges at the osteochondral border could affect the risk of ligament injury. Changes related to aging and sex differences have been documented, further emphasizing the importance of individual assessment of the knee joint. Overall, it is of the utmost importance to remember the interactions between the osseous housing and the structures within.
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Affiliation(s)
- Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Radiology and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Röhrich
- Department of Radiology and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
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Kainberger F, Hahn D. History Page: Leaders in MSK Radiology. Semin Musculoskelet Radiol 2021; 25:274-276. [PMID: 34082453 DOI: 10.1055/s-0041-1727094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Robert Kienböck (1871-1953) may be regarded as one of the first musculoskeletal radiologists who began his clinical and scientific work 2 years after the discovery of X-rays. He lent his name to Kienböck's disease, a traumatic malacia and osteonecrosis of the lunate, and to several other eponyms of diseases, devices, and parameters in radiology and radiation oncology. With his meticulous analysis of radiographic images of the highest quality, he anticipated many theories that were proposed in later decades.
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Affiliation(s)
- Franz Kainberger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Daniela Hahn
- Josephinum - Ethics, Collections and History of Medicine, Medical University of Vienna, Vienna, Austria
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11
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Thajer A, Skacel G, Truschner K, Jorda A, Vasek M, Horsak B, Strempfl J, Kautzky-Willer A, Kainberger F, Greber-Platzer S. Comparison of Bioelectrical Impedance-Based Methods on Body Composition in Young Patients with Obesity. Children (Basel) 2021; 8:children8040295. [PMID: 33920492 PMCID: PMC8070058 DOI: 10.3390/children8040295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Abstract
(1) Background: The determination of body composition is an important method to investigate patients with obesity and to evaluate the efficacy of individualized medical interventions. Bioelectrical impedance-based methods are non-invasive and widely applied but need to be validated for their use in young patients with obesity. (2) Methods: We compiled data from three independent studies on children and adolescents with obesity, measuring body composition with two bioelectrical impedance-based devices (TANITA and BIACORPUS). For a small patient group, additional data were collected with air displacement plethysmography (BOD POD) and dual-energy X-ray absorptiometry (DXA). (3) Results: Our combined data on 123 patients (age: 6–18 years, body mass index (BMI): 21–59 kg/m²) and the individual studies showed that TANITA and BIACORPUS yield significantly different results on body composition, TANITA overestimating body fat percentage and fat mass relative to BIACORPUS and underestimating fat-free mass (p < 0.001 for all three parameters). A Bland–Altman plot indicated little agreement between methods, which produce clinically relevant differences for all three parameters. We detected gender-specific differences with both methods, with body fat percentage being lower (p < 0.01) and fat-free mass higher (p < 0.001) in males than females. (4) Conclusions: Both bioelectrical impedance-based methods provide significantly different results on body composition in young patients with obesity and thus cannot be used interchangeably, requiring adherence to a specific device for repetitive measurements to ascertain comparability of data.
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Affiliation(s)
- Alexandra Thajer
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (G.S.); (K.T.); (A.J.); (M.V.); (S.G.-P.)
- Correspondence:
| | - Gabriele Skacel
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (G.S.); (K.T.); (A.J.); (M.V.); (S.G.-P.)
| | - Katharina Truschner
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (G.S.); (K.T.); (A.J.); (M.V.); (S.G.-P.)
| | - Anselm Jorda
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (G.S.); (K.T.); (A.J.); (M.V.); (S.G.-P.)
| | - Martin Vasek
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (G.S.); (K.T.); (A.J.); (M.V.); (S.G.-P.)
| | - Brian Horsak
- Institute of Health Sciences, St. Pölten University of Applied Sciences, Matthias-Corvinus-Straße 15, 3100 St. Pölten, Austria;
| | - Johanna Strempfl
- Department of Physiotherapy, St. Pölten University of Applied Sciences, Matthias-Corvinus-Straße 15, 3100 St. Pölten, Austria;
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria;
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria;
| | - Susanne Greber-Platzer
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (G.S.); (K.T.); (A.J.); (M.V.); (S.G.-P.)
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12
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Chiari C, Grgurevic L, Bordukalo-Niksic T, Oppermann H, Valentinitsch A, Nemecek E, Staats K, Schreiner M, Trost C, Kolb A, Kainberger F, Pehar S, Milosevic M, Martinovic S, Peric M, Sampath TK, Vukicevic S, Windhager R. Recombinant Human BMP6 Applied Within Autologous Blood Coagulum Accelerates Bone Healing: Randomized Controlled Trial in High Tibial Osteotomy Patients. J Bone Miner Res 2020; 35:1893-1903. [PMID: 32543706 PMCID: PMC7689741 DOI: 10.1002/jbmr.4107] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/02/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022]
Abstract
Bone morphogenetic proteins (BMPs) are potent osteogenic proteins that induce new bone formation in vivo. However, their effect on bone healing in the trabecular bone surfaces remains challenging. We evaluated the safety and efficacy of recombinant human BMP6 (rhBMP6) applied within an autologous blood coagulum (ABC) in a surgically created wedge defect of the proximal tibia in patients undergoing high tibial osteotomy (HTO) for varus deformity and medial osteoarthritis of the knee. We enrolled 20 HTO patients in a randomized, placebo-controlled, double-blinded phase I/II clinical trial. RhBMP6/ABC (1.0 mg/10 mL ABC prepared from peripheral blood) or placebo (10 mL ABC containing excipients) was administered into the tibial wedge defects. Patients were followed for 0 to 24 months by clinical examination (safety) and computed tomography (CT) and serial radiographic analyses (efficacy). The results show that there were no detectable anti-rhBMP6 antibodies in the blood of any of the 20 patients at 14 weeks after implantation. During the 24 months of follow-up, there were no serious adverse reactions recorded. The CT scans from defects of patients treated with rhBMP6/ABC showed an accelerated bone healing compared with placebo at 9 weeks (47.8 ± 24.1 versus 22.2 ± 12.3 mg/cm3 ; p = 0.008) and at 14 weeks (89.7 ± 29.1 versus 53.6 ± 21.9 mg/cm3 ; p = 0.006) follow-up. Radiographic analyses at weeks 6 and 24 and months 12 and 24 suggested the advanced bone formation and remodeling in rhBMP6/ABC-treated patients. In conclusion, we show that rhBMP6/ABC at a dose of 100 μg/mL accelerated bone healing in patients undergoing HTO without serious adverse events and with a good tolerability compared with placebo alone. Overall, for the first time, a BMP-based osteogenic implant was examined against a placebo for bone healing efficacy in the trabecular bone surface, using an objective bone mineral density measurement system. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
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Affiliation(s)
- Catharina Chiari
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Lovorka Grgurevic
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Tatjana Bordukalo-Niksic
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | | | - Elena Nemecek
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Kevin Staats
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Schreiner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Carmen Trost
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexander Kolb
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Sanja Pehar
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Milan Milosevic
- Department of Environmental and Occupational Health and Sports, School of Public Health, "Andrija Stampar,", University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - Mihaela Peric
- Department for Intracellular Communication, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - Slobodan Vukicevic
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
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13
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Giraudo C, Kainberger F, Boesen M, Trattnig S. Quantitative Imaging in Inflammatory Arthritis: Between Tradition and Innovation. Semin Musculoskelet Radiol 2020; 24:337-354. [PMID: 32992363 DOI: 10.1055/s-0040-1708823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Radiologic imaging is crucial for diagnosing and monitoring rheumatic inflammatory diseases. Particularly the emerging approach of precision medicine has increased the interest in quantitative imaging. Extensive research has shown that ultrasound allows a quantification of direct signs such as bone erosions and synovial thickness. Dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography (CT) contribute to the quantitative assessment of secondary signs such as osteoporosis or lean mass loss. Magnetic resonance imaging (MRI), using different techniques and sequences, permits in-depth evaluations. For instance, the perfusion of the inflamed synovium can be quantified by dynamic contrast-enhanced imaging or diffusion-weighted imaging, and cartilage injury can be assessed by mapping (T1ρ, T2). Furthermore, the increased metabolic activity characterizing the inflammatory response can be reliably assessed by hybrid imaging (positron emission tomography [PET]/CT, PET/MRI). Finally, advances in intelligent systems are pushing forward quantitative imaging. Complex mathematical algorithms of lesions' segmentation and advanced pattern recognition are showing promising results.
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Affiliation(s)
- Chiara Giraudo
- Department of Medicine, DIMED, Radiology Institute, University of Padova, Padova, Italy
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Frederiksberg, Denmark
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-Guided Therapy, High-Field MR Centre, Medical University of Vienna, Vienna, Austria
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14
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Diekhoff T, Kainberger F, Oleaga L, Dewey M, Zimmermann E. Effectiveness of the clinical decision support tool ESR eGUIDE for teaching medical students the appropriate selection of imaging tests: randomized cross-over evaluation. Eur Radiol 2020; 30:5684-5689. [PMID: 32435929 PMCID: PMC7476994 DOI: 10.1007/s00330-020-06942-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/17/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate ESR eGUIDE-the European Society of Radiology (ESR) e-Learning tool for appropriate use of diagnostic imaging modalities-for learning purposes in different clinical scenarios. METHODS This anonymized evaluation was performed after approval of ESR Education on Demand leadership. Forty clinical scenarios were developed in which at least one imaging modality was clinically most appropriate, and the scenarios were divided into sets 1 and 2. These sets were provided to medical students randomly assigned to group A or B to select the most appropriate imaging test for each scenario. Statistical comparisons were made within and across groups. RESULTS Overall, 40 medical students participated, and 31 medical students (78%) answered both sets. The number of correctly chosen imaging methods per set in these 31 paired samples was significantly higher when answered with versus without use of ESR eGUIDE (13.7 ± 2.6 questions vs. 12.1 ± 3.2, p = 0.012). Among the students in group A, who first answered set 1 without ESR eGUIDE (11.1 ± 3.2), there was significant improvement when set 2 was answered with ESR eGUIDE (14.3 ± 2.5, p = 0.013). The number of correct answers in group B did not drop when set 2 was answered without ESR eGUIDE (12.4 ± 2.6) after having answered set 1 first with ESR eGUIDE (13.0 ± 2.7, p = 0.66). CONCLUSION The clinical decision support tool ESR eGUIDE is suitable for training medical students in choosing the best radiological imaging modality in typical scenarios, and its use in teaching radiology can thus be recommended. KEY POINTS • ESR eGUIDE improved the number of appropriately selected imaging modalities among medical students. • This improvement was also seen in the group of students which first selected imaging tests without ESR eGUIDE. • In the student group which used ESR eGUIDE first, appropriate selection remained stable even without the teaching tool.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Franz Kainberger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Laura Oleaga
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Charitéplatz 1, 10117, Berlin, Germany
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15
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Crevenna R, Kainberger F. Musculoskeletal medicine: an Austrian perspective part II. Wien Klin Wochenschr 2019; 131:585-586. [PMID: 31832815 DOI: 10.1007/s00508-019-01581-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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16
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Affiliation(s)
- Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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17
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Luger M, Kruschitz R, Winzer E, Schindler K, Grabovac I, Kainberger F, Krebs M, Hoppichler F, Langer F, Prager G, Marculescu R, Ludvik B. Changes in Bone Mineral Density Following Weight Loss Induced by One-Anastomosis Gastric Bypass in Patients with Vitamin D Supplementation. Obes Surg 2019; 28:3454-3465. [PMID: 29968187 DOI: 10.1007/s11695-018-3353-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Little is known about changes in bone mineral density (BMD) following weight loss after one-anastomosis gastric bypass (OAGB) and the role of serum vitamin D and its supplementation on bone metabolism. We evaluated BMD after OAGB as a function of vitamin D supplementation with respect to a minimum threshold of 25-hydroxy-vitamin-D [25(OH)D] concentration, which could prevent or decelerate an eventual bone loss. METHODS Fifty bariatric patients who participated in the randomized controlled trial were included in this analysis. BMD and anthropometric measurements by DXA and laboratory parameters were assessed before (T0), at 6 (T6), and 12 months (T12) after surgery. RESULTS OAGB resulted in a 36% total body weight loss with a decrease in body fat and an increase in lean body mass. A significant decrease in BMD was seen in lumbar spine by 7%, left hip 13%, and total body 1%, but not in forearm. Bone turnover markers increased significantly but with normal parathyroid hormone concentrations. Weight loss was not associated with changes in BMD. A serum 25(OH)D concentration > 50 nmol/l at T6 and T12 (adequate-vitamin-D-group; AVD) showed a significant lower bone loss, compared to the inadequate-vitamin-D-group (IVD; < 50 nmol/l). Lower bone loss in the left hip showed a strong correlation with higher 25(OH)D concentrations (r = 0.635, p = 0.003). CONCLUSION These findings support a dose effect of vitamin D supplementation on bone health and suggest that 25(OH)D concentrations need to be above 50 nmol/l at least during the first postoperative year to decelerate bone loss in patients undergoing OAGB. CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE Clinicaltrials.gov (NCT02092376) at https://clinicaltrials.gov /. EudraCT (2013-003546-16) at https://eudract.ema.europa.eu /.
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Affiliation(s)
- Maria Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Special Institute for Preventive Cardiology And Nutrition-SIPCAN, Rabenfleckweg 8, Elsbethen, 5061, Salzburg, Austria.,Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Renate Kruschitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Division of Internal Medicine, General public hospital of the Order of Saint Elisabeth, Völkermarkter Straße 15-19, 9020, Klagenfurt, Austria
| | - Eva Winzer
- Special Institute for Preventive Cardiology And Nutrition-SIPCAN, Rabenfleckweg 8, Elsbethen, 5061, Salzburg, Austria. .,Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Franz Kainberger
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Friedrich Hoppichler
- Special Institute for Preventive Cardiology And Nutrition-SIPCAN, Rabenfleckweg 8, Elsbethen, 5061, Salzburg, Austria.,Division of Internal Medicine, Krankenhaus der Barmherzigen Brüde Salzburgr, Kajetanerplatz 1, 5010, Salzburg, Austria
| | - Felix Langer
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Rodrig Marculescu
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Bernhard Ludvik
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Medicine 1 and Karl Landsteiner Institute for Obesity and Metabolic Diseases, Rudolfstiftung Hospital, Juchgasse 25, 1030, Vienna, Austria
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18
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Nemecek E, Chiari C, Valentinitsch A, Kainberger F, Hobusch G, Kolb A, Hirtler L, Trost C, Vukicevic S, Windhager R. Analysis and quantification of bone healing after open wedge high tibial osteotomy. Wien Klin Wochenschr 2019; 131:587-598. [PMID: 31502065 PMCID: PMC6908562 DOI: 10.1007/s00508-019-01541-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/11/2019] [Accepted: 08/05/2019] [Indexed: 12/04/2022]
Abstract
Background The aim of this study was to analyze radiographic imaging techniques and to quantify bone ossification in the osteotomy gap after high tibial osteotomy. Material and methods Study phase 1: high tibial osteotomy was performed on six lower extremities of human body donors and experimental X‑rays and computed tomography (CT) scans were applied. Different techniques were evaluated by three specialists for best representation of the osteotomy gap. Study phase 2: optimized radiological techniques were used for follow-up on 12 patients. The radiographs were examined by 3 specialists measuring 10 different parameters. The CT scans were analyzed with semiautomatic computer software for quantification of bone ossification. Results The osteotomy gap was best represented in 30° of flexion in the knee and 20° internal rotation of the leg. There were significant changes of the medial width over time (p < 0.019) as well as of the length of fused osteotomy, the Schröter score, sclerosis, trabecular structure and zone area measurements. Sclerosis, medial width of the osteotomy and area measurements were detected as reproducible parameters. Bone mineral density was calculated using CT scans, showing a significantly higher value 12 weeks postoperatively (112.5 mg/cm3) than at baseline (54.6 mg/cm3). The ossification of the gap was visualized by color coding. Conclusion Sclerosis and medial width of the osteotomy gap as well as area measurements were determined as reproducible parameters for evaluation of bone healing. Quantification of bone ossification can be calculated with CT scans using a semiautomatic computer program and should be used for research in bone healing.
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Affiliation(s)
- Elena Nemecek
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Catharina Chiari
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Franz Kainberger
- Department for Radiology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Hobusch
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexander Kolb
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Carmen Trost
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Slobodan Vukicevic
- Center for Translational and Clinical Research, University of Zagreb, Zagreb, Croatia
| | - Reinhard Windhager
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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19
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Benca E, Synek A, Amini M, Kainberger F, Hirtler L, Windhager R, Mayr W, Pahr DH. QCT-based finite element prediction of pathologic fractures in proximal femora with metastatic lesions. Sci Rep 2019; 9:10305. [PMID: 31311994 PMCID: PMC6635505 DOI: 10.1038/s41598-019-46739-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 07/04/2019] [Indexed: 11/17/2022] Open
Abstract
Predicting pathologic fractures in femora with metastatic lesions remains a clinical challenge. Currently used guidelines are inaccurate, especially to predict non-impeding fractures. This study evaluated the ability of a nonlinear quantitative computed tomography (QCT)-based homogenized voxel finite element (hvFE) model to predict patient-specific pathologic fractures. The hvFE model was generated highly automated from QCT images of human femora. The femora were previously loaded in a one-legged stance setup in order to assess stiffness, failure load, and fracture location. One femur of each pair was tested in its intact state, while the contralateral femur included a simulated lesion on either the superolateral- or the inferomedial femoral neck. The hvFE model predictions of the stiffness (0.47 < R2 < 0.94), failure load (0.77 < R2 < 0.98), and exact fracture location (68%) were in good agreement with the experimental data. However, the model underestimated the failure load by a factor of two. The hvFE models predicted significant differences in stiffness and failure load for femora with superolateral- and inferomedial lesions. In contrast, standard clinical guidelines predicted identical fracture risk for both lesion sites. This study showed that the subject-specific QCT-based hvFE model could predict the effect of metastatic lesions on the biomechanical behaviour of the proximal femur with moderate computational time and high level of automation and could support treatment strategy in patients with metastatic bone disease.
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Affiliation(s)
- Emir Benca
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090, Vienna, Austria.
| | - Alexander Synek
- Institute for Lightweight Design and Structural Biomechanics, TU Wien, 1060, Vienna, Austria
| | - Morteza Amini
- Institute for Lightweight Design and Structural Biomechanics, TU Wien, 1060, Vienna, Austria
| | - Franz Kainberger
- Department of Radiology, Medical University of Vienna, 1090, Vienna, Austria
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090, Vienna, Austria
| | - Winfried Mayr
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090, Vienna, Austria
| | - Dieter H Pahr
- Institute for Lightweight Design and Structural Biomechanics, TU Wien, 1060, Vienna, Austria
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20
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Keilani M, Kainberger F, Pataraia A, Hasenöhrl T, Wagner B, Palma S, Cenik F, Crevenna R. Typical aspects in the rehabilitation of cancer patients suffering from metastatic bone disease or multiple myeloma. Wien Klin Wochenschr 2019; 131:567-575. [PMID: 31267163 PMCID: PMC6851044 DOI: 10.1007/s00508-019-1524-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/17/2019] [Indexed: 12/13/2022]
Abstract
Background The aim of this study was to present a practical concept focusing on typical aspects of regular physical activity, exercise and physical modalities for patients suffering from metastatic bone disease or multiple myeloma. Methods A narrative review of the relevant scientific literature and presentation of clinical experiences. Results In cancer patients with metastatic bone disease or multiple myeloma, pain is treated in an interdisciplinary and multimodal setting by using medication, radiotherapy and physical medical modalities (e.g. transcutaneous electrical nerve stimulation); however, modalities increasing local blood flow, such as ultrasound therapy, thermotherapy, massage, various electrotherapy options, are not performed at the site of the tumor. For physical activity and exercise, a suitable indication of the static and dynamic capacity of the affected skeletal structures is essential. This process includes strategies to maintain and improve mobility and independence. Individually tailored and adapted physical activity and exercise concepts (programs) within a multidisciplinary and interdisciplinary setting (tumor board) are used to manage the condition and bone load-bearing capacity of the patient. Typical clinical features and complications, such as pathological fractures in patients suffering from metastatic bone disease and additionally hypercalcemia, monoclonal gammopathy with bone marrow aplasia and risk of renal failure in patients with multiple myeloma have to be considered when planning supportive strategies and rehabilitation. Conclusion In order to ensure the safety and effectiveness of regular physical activity, exercise, and physical modalities in patients with metastatic bone disease or multiple myeloma, typical contraindications and considerations should be noted.
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Affiliation(s)
- Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Anna Pataraia
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Timothy Hasenöhrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Barbara Wagner
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stefano Palma
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Fadime Cenik
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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21
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Kainberger F. Guidelines for imaging reach a new quality level towards computer-assisted diagnosis. Wien Klin Wochenschr 2018; 130:635-636. [PMID: 30430287 DOI: 10.1007/s00508-018-1414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria. .,AKH, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Crevenna R, Kainberger F, Wiltschke C, Marosi C, Wolzt M, Cenik F, Keilani M. Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center. Disabil Rehabil 2018; 42:2-7. [PMID: 30328719 DOI: 10.1080/09638288.2018.1514665] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well.Methods: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria.Results: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning.Conclusions: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation.Implications for rehabilitationCancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participationCancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workabilityThe field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitationInterventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum.
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Affiliation(s)
- Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Christoph Wiltschke
- Department of Internal Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Internal Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Fadime Cenik
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
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Röhrich S, Kainberger F, Hirtler L. Evaluation of age-dependent morphometrics of the meniscofemoral ligaments in reference to the posterior cruciate ligament in routine MRI. Eur Radiol 2018; 28:2369-2379. [PMID: 29322332 PMCID: PMC5938306 DOI: 10.1007/s00330-017-5128-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/03/2017] [Accepted: 10/11/2017] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To quantify the morphological correlation between the posterior cruciate ligament (PCL) and the meniscofemoral ligaments (MFLs), to propose normal ranges for different age populations, and to define guidelines for correct identification and differentiation of MFLs in routine MRI. METHODS Three hundred forty-two subjects were included retrospectively and subdivided into five age groups. Morphometrics of the PCL and the MFLs were measured on standard MRI in the sagittal, coronal, and axial planes. Student's t test, Mann-Whitney U test, and ANOVA and Kruskal-Wallis tests with Bonferroni correction were used for comparison. RESULTS The MFLs did not vary significantly between sexes (p > 0.05) or in those older than 10 years (p > 0.05). Longitudinal MFL growth is completed before age 11 years, with cross-sectional area (CSA) increasing until age 20. The CSA of the PCL was significantly (p = 0.028) larger in knees without a pMFL (Mdn = 39.7 mm2) than with a pMFL (Mdn = 35.4 mm2). MFLs were more often detected on sagittal than coronal images. CONCLUSIONS This study describes the morphometric relation between the PCL and the MFLs on routine MRI. When reporting imaging findings in preparation for arthroscopic knee surgery, evaluation of MFLs, first in the sagittal and then the coronal plane, will achieve the best results. KEY POINTS • The MFLs and the PCL have distinct morphological patterns throughout life. • These patterns show intimate anatomical relationships and a potential biomechanical impact. • Those patterns and relationships can be quantified with MRI. • A correlation exists between age and morphometrics of the MFLs. • Recommendations for correct identification of the MFLs are provided.
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Affiliation(s)
- Sebastian Röhrich
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lena Hirtler
- Division of Anatomy, Centre for Anatomy and Cell Biology, Medical University of Vienna, Währingerstraße 13, 1090, Vienna, Austria.
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Hirtler L, Schreiner M, Röhrich S, Hirtler A, Kainberger F. Changes of the Intercondylar Notch and their impact on the morphology of the cruciate ligaments in osteoarthritis. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.644.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hirtler L, Toader I, Röhrich S, Kainberger F. Morphological Changes to the Cruciate Ligaments and Menisci in Relation to ageing. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.644.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hirtler L, Schreiner M, Röhrich S, Hirtler A, Kainberger F. Intercondylar Notch and Cruciate Ligaments in Osteoarthritis. Semin Musculoskelet Radiol 2018. [DOI: 10.1055/s-0038-1639534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lena Hirtler
- Abteilung für Anatomie, Zentrum für Anatomie und Zellbiologie, Medizinische Universität Wien
| | - Markus Schreiner
- University Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien
| | - Sebastian Röhrich
- University Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien
| | - Arno Hirtler
- Abteilung für Anatomie, Zentrum für Anatomie und Zellbiologie, Medizinische Universität Wien
| | - Franz Kainberger
- University Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien
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Hipfl C, Titz M, Chiari C, Schöpf V, Kainberger F, Windhager R, Domayer S. Detecting cam-type deformities on plain radiographs: what is the optimal lateral view? Arch Orthop Trauma Surg 2017; 137:1699-1705. [PMID: 28918517 DOI: 10.1007/s00402-017-2793-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Radial magnetic resonance imaging (MRI) is the most accurate diagnostic tool in assessing cam-type femoroacetabular impingement. Plain radiographs, however, are useful for the initial diagnosis in the daily practice and there is still debate regarding the optimal lateral view. The purpose of this study was to investigate the reliability of detecting cam deformities using the frog-leg view or the 45° Dunn view by comparison with radial MRI. MATERIAL 66 consecutive hips with plain radiographs (36 with AP and frog-leg views, 30 with AP and 45° Dunn views) and radial MRI were assessed. Alpha angle measurements were obtained both for radiographs and for radial MRI reformats by two investigators. Statistics included frequency analysis, bivariate linear correlation analyses, and cross-table analyses testing the sensitivity and specificity of the radiographic projections for detecting an alpha angle larger than 55°. RESULTS The intra-class correlation revealed excellent agreement between the two raters [ICC = 0.959, CI (0.943; 0.972)]. 50% (33/66) had the maximum alpha angle in the superior-anterior aspect of the femoral head-neck junction. Cam deformity was found in 40/66 cases (61%) in radial MRI. Pearson correlation demonstrated that the 45° Dunn view was most accurate for the superior-anterior aspect (0.730, p < 0.05). The frog-leg view was best suited for the anterior aspect (0.703, p < 0.05). The sensitivity for detecting cam deformities in the 45° Dunn view was 84 vs 62% in the frog-leg view. CONCLUSION The frog-leg lateral radiograph does not provide reliable measurements of the alpha angle. This study highlights the importance of the 45° Dunn view for early detection of femoroacetabular cam-type impingement.
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Affiliation(s)
- Christian Hipfl
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Markus Titz
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Catharina Chiari
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Veronika Schöpf
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Franz Kainberger
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stephan Domayer
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Huber FA, Hirtler L, Kainberger F. Muscle ruptures in posterior hip dislocation-a case report. BJR Case Rep 2017; 3:20170020. [PMID: 30363242 PMCID: PMC6159191 DOI: 10.1259/bjrcr.20170020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/03/2017] [Accepted: 03/13/2017] [Indexed: 11/23/2022] Open
Abstract
Posterior hip dislocations are the most common luxation types of the hip joint and a well-known and well-described condition. However, we report a case of posterior hip luxation with a series of posttraumatic muscular disorders that were difficult to identify and have not been described previously in scientific literature. We performed clinical and radiological follow-up of an individual for a period of over 19 months post trauma. Informed consent for the anonymized publication of this case was received from the patient. The presented patient is a 20-year-old female, athletic individual in generally good health condition. Our patient suffered from a posterior hip dislocation after a skiing accident on an iced slope. Posttraumatic follow-up was performed owing to persistent moderate hip pain. The patient underwent several experts’ consultations as well as two MRI examinations at 2 months and 19 months after the skiing trauma. Both of the MRIs showed several ruptured parts of the periarticular musculature. At the second MRI, additional compensatory hypertrophy of the piriformis muscle was detected. This report clearly illustrates the importance of profound anatomical knowledge of the surrounding structures of the hip joint, especially as the high psychological strain on the patient could have been reduced by a swifter and appropriate diagnosis.
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Affiliation(s)
- Florian Alexander Huber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Patsch JM, Rasul S, Huber FA, Leitner K, Thomas A, Kocijan R, Boutroy S, Weber M, Resch H, Kainberger F, Schüller-Weidekamm C, Kautzky-Willer A. Similarities in trabecular hypertrophy with site-specific differences in cortical morphology between men and women with type 2 diabetes mellitus. PLoS One 2017; 12:e0174664. [PMID: 28384358 PMCID: PMC5383225 DOI: 10.1371/journal.pone.0174664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 03/13/2017] [Indexed: 01/13/2023] Open
Abstract
The goal of our study was to investigate interactions between sex and type 2 diabetes mellitus (T2DM) with regard to morphology of the peripheral skeleton. We recruited 85 subjects (mean age, 57±11.4 years): women with and without T2DM (n = 17; n = 16); and men with and without T2DM (n = 26; n = 26). All patients underwent high-resolution, peripheral, quantitative, computed tomography (HR-pQCT) imaging of the ultradistal radius (UR) and tibia (UT). Local bone geometry, bone mineral density (BMD), and bone microarchitecture were obtained by quantitative analysis of HR-pQCT images. To reduce the amount of data and avoid multi-collinearity, we performed a factor-analysis of HR-pQCT parameters. Based on factor weight, trabecular BMD, trabecular number, cortical thickness, cortical BMD, and total area were chosen for post-hoc analyses. At the radius and tibia, diabetic men and women exhibited trabecular hypertrophy, with a significant positive main effect of T2DM on trabecular number. At the radius, cortical thickness was higher in diabetic subjects (+20.1%, p = 0.003). Interestingly, there was a statistical trend that suggested attenuation of tibial cortical hypertrophy in diabetic men (cortical thickness, pinteraction = 0.052). Moreover, we found an expected sexual dichotomy, with higher trabecular BMD, Tb.N, cortical BMD, Ct.Th, and total area in men than in women (p≤ 0.003) at both measurement sites. Our results suggest that skeletal hypertrophy associated with T2DM is present in men and women, but appears attenuated at the tibial cortex in men.
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Affiliation(s)
- Janina M. Patsch
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Sazan Rasul
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian A. Huber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Karoline Leitner
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
| | - Anita Thomas
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
| | - Roland Kocijan
- Department of Internal Medicine II, Karl Landsteiner Institute for Rheumatology and Gastroenterology, St. Vincent Hospital Vienna, Vienna, Austria
| | | | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Heinrich Resch
- Department of Internal Medicine II, Karl Landsteiner Institute for Rheumatology and Gastroenterology, St. Vincent Hospital Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Claudia Schüller-Weidekamm
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
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Teh J, Grainger A, Schueller-Weidekamm C, Sudoł-Szopińska I, Rennie W, Åström G, Feydy A, Giraudo C, Guerini H, Guglielmi G, Isaac A, Jans L, Jurik A, Kainberger F, Maas M, Martinoli C, Mascarenhas V, Miese F, O'Connor P, Oei E, Østergaard M, Peetrons P, Platzgummer H, Reijnierse M, Robinson P, Rupreht M, Simoni P, Wick M, Zejden A, Klauser A, Plagou A. Recommendations of the ESSR Arthritis Subcommittee on Ultrasonography in Inflammatory Joint Disease. Semin Musculoskelet Radiol 2016; 20:496-506. [DOI: 10.1055/s-0036-1593533] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- James Teh
- Department of Musculoskeletal Radiology, University of Oxford, Oxford, United Kingdom
| | - Andrew Grainger
- Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals, Leeds, United Kingdom
| | | | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Winston Rennie
- Department of Musculoskeletal Radiology, University of Loughborough, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Gunnar Åström
- Department of Radiology, University Hospital, Uppsala, Sweden
| | - Antoine Feydy
- Department of Radiology B, Hôpital Cochin, APHP, Paris, France
| | - Chiara Giraudo
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Henri Guerini
- Department of Radiology B, Cochin Hospital, Paris, France
| | | | - Amanda Isaac
- Department of Musculoskeletal Radiology, Guys and St Thomas' Hospitals Foundation Trust, Kings College London and GKT, London, United Kingdom
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Anne Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Franz Kainberger
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mario Maas
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Carlo Martinoli
- Department of Radiology, Università degli Studi di Genova, Genova, Italy
| | - Vasco Mascarenhas
- Unidade de Imagem Musculoesquelética (UIME), Hospital da Luz, Lisbon, Portugal
| | - Falk Miese
- Department of Diagnostic and Interventional Radiology, Institute of Radiology, Nuclear Medicine and Radiotherapy, Bottrop, Denmark
| | - Philip O'Connor
- The NIHR Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Edwin Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mikkel Østergaard
- Department of Rheumatology, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | | | - Hannes Platzgummer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Monique Reijnierse
- Department of Musculoskeletal Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philip Robinson
- Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Mitja Rupreht
- Department of Radiology, University Medical Center Maribor, Maribor, Slovenia
| | - Paolo Simoni
- Department of Radiology, Université Libre de Bruxelles (ULB), “Reine Fabiola” Children's University Hospital, Brussels, Belgium
| | - Marius Wick
- Functional Unit for Diagnostic and Interventional Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Zejden
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrea Klauser
- Section Rheumatology and Sports Imaging, Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Athena Plagou
- Department of Radiology, Private Institution of Ultrasonography, Athens, Greece
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Mandl P, Kainberger F, Friberg Hitz M. Imaging in osteoporosis in rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:751-765. [PMID: 27931966 DOI: 10.1016/j.berh.2016.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/06/2016] [Accepted: 08/04/2016] [Indexed: 12/25/2022]
Abstract
Osteoporosis is a common comorbidity of all major rheumatic diseases, and manifests itself both systemically and locally. Systemic bone loss manifests because of several factors, primarily inflammation, immobility, and commonly used medical treatment for rheumatic diseases. Local bone loss manifests as periarticular demineralization and bone erosion due to local release of inflammatory agents and cytokines, which promote bone resorption. All these factors contribute to the phenomenon of arthritis-associated osteoporosis. This review summarized the currently available and used methods that play a role in the diagnosis and monitoring of osteoporosis and in the detection of osteoporotic fractures.
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Affiliation(s)
- Peter Mandl
- Division of Rheumatology, 3rd Department of Internal Medicine, Medical University of Vienna, 18-20 Währinger Gürtel, 1090 Vienna, Austria.
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Radiology and Nuclear Medicine, Medical University of Vienna, 18-20 Währinger Gürtel, 1090 Vienna, Austria.
| | - Mette Friberg Hitz
- Department of Medicine, Endocrinology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark.
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Kainberger F. Defensive medicine and overutilization of imaging-an issue of radiation protection. Wien Klin Wochenschr 2016; 129:157-158. [PMID: 27670856 DOI: 10.1007/s00508-016-1089-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Franz Kainberger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuro- and Muskuloskeletal Radiology, Medical University of Vienna, AKH, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Ebenbichler GR, Pieber K, Kainberger F, Funovics M, Resch KL. Long-Term Outcome of Ultrasound Therapy for Calcific Tendinitis of the Shoulder: Results of a RCT. PM R 2016; 8:S156. [PMID: 27672757 DOI: 10.1016/j.pmrj.2016.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hübsch P, Kocanda H, Youssefzadeh S, Schneider B, Kainberger F, Seidl G, Kurtaran A, Gruber S. Comparison of Dual Energy X-Ray Absorptiometry of the Proximal Femur with Morphologic Data. Acta Radiol 2016. [DOI: 10.1177/028418519203300522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Measurements of bone mineral density (BMD) of the proximal femur (including femoral neck, Ward's triangle and trochanteric region) were compared with the Singh index grading in 40 normal subjects (20 male, 20 female) and in 116 patients (18 male, 98 female) referred for assessment of possible osteoporosis. Additionally, the BMD and the Singh index of 12 cadaver specimens (6 male, 6 female) of the proximal femur were compared with each other and with the histomorphology of the femoral necks of the specimens. Although there was a good correlation of Singh index with BMD in the group of male patients with suspected osteoporosis and in the series of bone specimens, there was a poor correlation in the group of female patients as well as in the normal controls and in the patient population as a whole. There was also poor correlation of Singh index values with histomorphologic data, whereas the BMD measurements correlated well with the amount of calcified bone found histologically in the femoral necks of the bone specimens. We conclude that the Singh index cannot be used to predict BMD of the proximal femur accurately.
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Abstract
Thirty-five patients with normal renal allografts as well as 10 healthy volunteers with normal native kidneys were examined by duplex sonography. Blood flow measurements were performed in the main renal artery as well as in segmental, interlobar and arcuate arteries. In both groups the normal range of variation in blood flow was defined by using the resistive index (RI). Doppler wave forms and RI of main renal arteries were both similar to those of their branches. In renal allografts as well as in native kidneys the blood flow pattern showed a rapid up-slope in systole followed by a gradual down-slope in early diastole, with a persistent flow throughout diastole. In addition, there was no significant difference in the RI between allografted and native kidneys. The interobserver variability was less than 10 per cent. The mean RI was 0.68 using all data points. Vascular rejection in 11 patients could be discriminated significantly (p<0.001). Duplex sonography is useful in evaluating renal blood flow. This simple and non-invasive technique seems to be useful in long-term follow-up of renal allograft recipients.
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Abstract
The parathyroid hormone concentration in the blood measured by the ‘two-site radioimmunoassay’, which is specific for the biologically active parathyroid molecule (parathyrine), was compared with the radiological manifestations of secondary hyperparathyroidism (HPT) on magnification radiographs of the phalanges in patients undergoing maintenance hemodialysis and in patients with renal allografts. Sensitivity of radiology for the diagnosis of HPT proved to be high (88%), whereas specificity was low (30%). Statistical analysis showed that there was a good correlation between the parathyrine levels and the intensity of radiological changes in the phalanges in patients with renal allografts (coefficient of Krueger-Spearman = 0.65). In patients undergoing hemodialysis the correlation between laboratory parameters and radiological changes was poor.
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Kainberger F, Seidl G, Traindl O, Trattnig S, Breitenseher M, Schneider B, Gisinger C. Ultrasonography of the Achilles Tendon in Hypercholesterolemia. Acta Radiol 2016. [DOI: 10.1177/028418519303400421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The ultrasonographic (US) appearance of Achilles tendon was examined in 34 patients with hypercholesterolemia (10 with familial (FH), and 24 with secondary hypercholesterolemia (SH)), and in 22 patients with normal tendons. US findings were compared with clinical, laboratory, and radiologic results. In patients with FH, typical xanthomas in the form of hyperechoic tendinal tumors were found in only 15% while various forms of inhomogeneity of tendon structure without xanthoma formation were found in 75%. The high rate of tendon inhomogeneity may be due to the concomitant occurrence of both xanthomas and degeneration of tendon fibers. Physical examination revealed abnormalities in 60% of these patients. At CT of the tendons, abnormalities were found in 65% of the FH patients and in 40%, abnormalities were shown by plain radiography. In SH, the results did not differ significantly from normal controls. In our opinion US should be used to prove or rule out Achilles tendon abnormalities in patients with FH for prophylaxis and treatment of tendinitis and tendon rupture.
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Wagner A, Kermer C, Zettinig G, Lang S, Schicho K, Noebauer I, Kainberger F, Selzer E, Leitha T. Validity of Sentinel Lymph Node (SLN) Detection following Adjuvant Radiochemotherapy (RCT) in Head and Neck Squamous Cell Carcinoma (HNSCC). Technol Cancer Res Treat 2016; 6:655-60. [DOI: 10.1177/153303460700600610] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The effect of preoperative radio chemotherapy on lymphatic drainage and intraoperative gamma probe-guided sentinel lymph node detection has yet not been investigated. In this study, we study 13 patients with SCC. Sentinel lymph node (SLN) imaging of the patients was performed using SPECT-CT. Special care was taken to use identical injection sites for both studies. Imaging comprised planar and SPECT, iterative reconstruction and were viewed with the co-registered CT image. The results were validated by comparison with the histological results of intraoperative gamma probe detection and histology of the completed neck dissection. Identical SLNs were found in 6/13 patients. In 2/13 cases SLN biopsies were false-negative. In 4/13 patients preoperative SLN imaging identified more/additional nodes than the initial imaging, whereas fewer nodes were seen in 3/13 patients. Neither the primary tumor site nor the TNM stage was predictive for changes in the lymphatic drainage pattern. No constant effect of irradiation could be demonstrated. Preoperative radio chemotherapy has an unpredictable influence on the lymphatic drainage pattern in HNSCC. Consequently, the intraoperative gamma probe-guided sentinel lymph node detection after radio chemotherapy does not reveal the SLN of carcinogenesis. Thus, we advise fused functional/anatomical imaging (SPECT-CT) before and after radiochemotherapy if the SLN concept is utilized in HNSCC.
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Affiliation(s)
- Arne Wagner
- University Hospital of Cranio-Maxillofacial and Oral Surgery University of Vienna Waehringer Guertel 18-20 A-1090 Vienna, Austria
| | - Christian Kermer
- University Hospital of Cranio-Maxillofacial and Oral Surgery University of Vienna Waehringer Guertel 18-20 A-1090 Vienna, Austria
| | - Georg Zettinig
- University Clinic of Nuclear Medicine Medical University of Vienna Waehringer Guertel 18-20 A-1090 Vienna, Austria
| | - Susanna Lang
- Clinical Institute of Pathology University of Vienna Waehringer Guertel 18-20 A-1090 Vienna, Austria
| | - Kurt Schicho
- University Hospital of Cranio-Maxillofacial and Oral Surgery University of Vienna Waehringer Guertel 18-20 A-1090 Vienna, Austria
| | - Iris Noebauer
- Department of Diagnostic Radiology Division of Osteoradiology University of Vienna Waehringer Guertel 18-20 A-1090 Vienna, Austria
| | - Franz Kainberger
- Department of Diagnostic Radiology Division of Osteoradiology University of Vienna Waehringer Guertel 18-20 A-1090 Vienna, Austria
| | - Edgar Selzer
- Department of Radiotherapy and Radiobiology Medical University of Vienna Waehringer Guertel 18-20 A-1090 Vienna, Austria
| | - Thomas Leitha
- Department of Nuclear Medicine Danube Hospital Langobardenstrasse 122 1220 Vienna, Austria
- University Clinic of Nuclear Medicine Medical University of Vienna Waehringer Guertel 18-20 A-1090 Vienna, Austria
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Ebenbichler GR, Leitgeb J, Amtmann G, König F, Schernthaner M, Resch KL, Kainberger F. Degeneration and Instability and the Relation to Patients' Function Late After Lumbar Disc Surgery: Data from a 12-Year Follow-Up. Am J Phys Med Rehabil 2016; 95:871-879. [PMID: 27149592 DOI: 10.1097/phm.0000000000000522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the excess risk of degeneration and segmental instability in operated segments late after lumbar disc surgery in patients with presurgically stable segments, and whether local pathological findings relate to patients' back health. DESIGN This retrospective analysis reports on 69 patients 12 years after first-time, uncomplicated lumbar disc surgery. Two independent radiologists evaluated the patients' lumbar functional x-rays; the Back Pain Rating Score (LBP-RS) assessed back-specific function. RESULTS At 12 years after lumbar disc surgery, degenerative changes as well as segmental instability occurred significantly more frequently in the operated than nonoperated lumbar segments, but there was no association between increased degeneration and segmental instability rates. The risk for acquiring segmental instability was significantly associated with surgery (odds ratio, 6.5; 95% confidence interval, 1.5-28.8). Prevalence of segmental instabilities was associated with better LBP-RS scores. Analyses of LBP-RS subscores revealed a clear association of segmental instability with physical function, but not with pain or activities of daily living. CONCLUSIONS Lumbar disc surgery seems to be associated with an increased risk of degeneration and segmental instability in the long term. This structural impairment, however, seems functionally well compensated and does not seem to be a relevant causal factor for a chronic back pain syndrome. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Describe the impact of lumbar disc surgery on segmental instability and degenerative changes; (2) Recognize the lack of association between degenerative changes and segmental instability after lumbar disc surgery; and (3) State the value of lumbar spinal functional tests in the evaluation of patients after lumbar disc surgery. LEVEL Advanced ACCREDITATION:: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Gerold R Ebenbichler
- From the Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria (GRE); Vienna Medical University, Vienna, Austria (JL, GA); Section for Medical Statistics, Institute for Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria (F König); Department of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria (MS, F Kainberger); and German Institute of Health Research, Bad Elster and Dresden, Germany (KLR)
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Arnoldner MA, Gruber M, Syré S, Kristen KH, Trnka HJ, Kainberger F, Bodner G. Imaging of posterior tibial tendon dysfunction—Comparison of high-resolution ultrasound and 3T MRI. Eur J Radiol 2015; 84:1777-81. [DOI: 10.1016/j.ejrad.2015.05.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 12/28/2022]
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Gnant M, Pfeiler G, Dubsky PC, Hubalek M, Greil R, Jakesz R, Wette V, Balic M, Haslbauer F, Melbinger E, Bjelic-Radisic V, Artner-Matuschek S, Fitzal F, Marth C, Sevelda P, Mlineritsch B, Steger GG, Manfreda D, Exner R, Egle D, Bergh J, Kainberger F, Talbot S, Warner D, Fesl C, Singer CF. Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2015; 386:433-43. [PMID: 26040499 DOI: 10.1016/s0140-6736(15)60995-3] [Citation(s) in RCA: 349] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adjuvant endocrine therapy compromises bone health in patients with breast cancer, causing osteopenia, osteoporosis, and fractures. Antiresorptive treatments such as bisphosphonates prevent and counteract these side-effects. In this trial, we aimed to investigate the effects of the anti-RANK ligand antibody denosumab in postmenopausal, aromatase inhibitor-treated patients with early-stage hormone receptor-positive breast cancer. METHODS In this prospective, double-blind, placebo-controlled, phase 3 trial, postmenopausal patients with early hormone receptor-positive breast cancer receiving treatment with aromatase inhibitors were randomly assigned in a 1:1 ratio to receive either denosumab 60 mg or placebo administered subcutaneously every 6 months in 58 trial centres in Austria and Sweden. Patients were assigned by an interactive voice response system. The randomisation schedule used a randomly permuted block design with block sizes 2 and 4, stratified by type of hospital regarding Hologic device for DXA scans, previous aromatase inhibitor use, and baseline bone mineral density. Patients, treating physicians, investigators, data managers, and all study personnel were masked to treatment allocation. The primary endpoint was time from randomisation to first clinical fracture, analysed by intention to treat. As an additional sensitivity analysis, we also analysed the primary endpoint on the per-protocol population. Patients were treated until the prespecified number of 247 first clinical fractures was reached. This trial is ongoing (patients are in follow-up) and is registered with the European Clinical Trials Database, number 2005-005275-15, and with ClinicalTrials.gov, number NCT00556374. FINDINGS Between Dec 18, 2006, and July 22, 2013, 3425 eligible patients were enrolled into the trial, of whom 3420 were randomly assigned to receive denosumab 60 mg (n=1711) or placebo (n=1709) subcutaneously every 6 months. Compared with the placebo group, patients in the denosumab group had a significantly delayed time to first clinical fracture (hazard ratio [HR] 0·50 [95% CI 0·39-0·65], p<0·0001). The overall lower number of fractures in the denosumab group (92) than in the placebo group (176) was similar in all patient subgroups, including in patients with a bone mineral density T-score of -1 or higher at baseline (n=1872, HR 0·44 [95% CI 0·31-0·64], p<0·0001) and in those with a bone mineral density T-score of less than -1 already at baseline (n=1548, HR 0·57 [95% CI 0·40-0·82], p=0·002). The patient incidence of adverse events in the safety analysis set (all patients who received at least one dose of study drug) did not differ between the denosumab group (1366 events, 80%) and the placebo group (1334 events, 79%), nor did the numbers of serious adverse events (521 vs 511 [30% in each group]). The main adverse events were arthralgia and other aromatase-inhibitor related symptoms; no additional toxicity from the study drug was reported. Despite proactive adjudication of every potential osteonecrosis of the jaw by an international expert panel, no cases of osteonecrosis of the jaw were reported. 93 patients (3% of the full analysis set) died during the study, of which one death (in the denosumab group) was thought to be related to the study drug. INTERPRETATION Adjuvant denosumab 60 mg twice per year reduces the risk of clinical fractures in postmenopausal women with breast cancer receiving aromatase inhibitors, and can be administered without added toxicity. Since a main side-effect of adjuvant breast cancer treatment can be substantially reduced by the addition of denosumab, this treatment should be considered for clinical practice. FUNDING Amgen.
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Affiliation(s)
- Michael Gnant
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Georg Pfeiler
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Peter C Dubsky
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Hubalek
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute, Salzburg, Austria
| | - Raimund Jakesz
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Viktor Wette
- Doctor's Office Wette, Breast Center, St Veit an der Glan, Austria
| | - Marija Balic
- Department of Oncology, Medical University of Graz, Graz, Austria
| | | | | | | | | | - Florian Fitzal
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Breast Health Center, Hospital of Sisters of Mercy Linz, Linz, Austria
| | - Christian Marth
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Paul Sevelda
- Department of Gynecology, Hospital Hietzing, Vienna, Austria
| | - Brigitte Mlineritsch
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Günther G Steger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Ruth Exner
- Department of Surgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Daniel Egle
- Department of Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - Jonas Bergh
- Department of Oncology/Radiumhemmet, Karolinska Oncology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | | | - Christian Fesl
- Department of Statistics, Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - Christian F Singer
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
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Hirtler L, Hadrovic‐Avdic M, Kainberger F. Influence of the torsion of femur and tibia on the torsion of the calcaneal tendon. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.545.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lena Hirtler
- Center for Anatomy and Cell BiologyDepartment of Systematic Anatomy Medical University of ViennaAustria
| | - Merisa Hadrovic‐Avdic
- Center for Anatomy and Cell BiologyDepartment of Systematic Anatomy Medical University of ViennaAustria
| | - Franz Kainberger
- Department of RadiologyDivision of Neuroradiology and Musculosceletal Radiology Medical University of ViennaAustria
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Hirtler L, Röhrich S, Kainberger F. Influence of the meniscofemoral ligaments on the morphology of the posterior cruciate ligaments ‐ an MRI assisted morphometric analysis of different phases in life. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.545.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lena Hirtler
- Center for Anatomy and Cell BiologyDepartment of Systematic AnatomyMedical University of ViennaAustria
| | - Sebastian Röhrich
- Center for Anatomy and Cell BiologyDepartment of Systematic AnatomyMedical University of ViennaAustria
| | - Franz Kainberger
- Department of RadiologyDivision of Neuroradiology and Musculosceletal Radiology Medical University of ViennaAustria
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Fischer L, Valentinitsch A, DiFranco MD, Schueller-Weidekamm C, Kienzl D, Resch H, Gross T, Weber M, Jaksch P, Klepetko W, Zweytick B, Pietschmann P, Kainberger F, Langs G, Patsch JM. High-Resolution Peripheral Quantitative CT Imaging: Cortical Porosity, Poor Trabecular Bone Microarchitecture, and Low Bone Strength in Lung Transplant Recipients. Radiology 2015; 274:473-81. [DOI: 10.1148/radiol.14140201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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45
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Duftner C, Dejaco C, Kainberger F, Machold K, Mandl P, Nothnagl T, DeZordo T, Husic R, Schüller-Weidekamm C, Schirmer M. Empfehlungen der Österreichische Gesellschaft für Rheumatologie und Rehabilitation/Austrian Radiology-Rheumatology Initiative for Musculoskeletal Ultrasound zur Anwendung des Ultraschalls bei rheumatischen Erkrankungen in der klinischen Praxis. Wien Klin Wochenschr 2014; 126:809-14. [DOI: 10.1007/s00508-014-0606-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/24/2014] [Indexed: 12/01/2022]
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Mascarenhas V, Sudol-Szopinska I, Boutry N, Plagou A, Klauser A, Wick M, Platzgummer H, Jans L, Mester A, Kainberger F, Aström G, Guglielmi G, Eshed I, Schueller-Weidekamm C. Imaging and Interpretation of Axial Spondylarthritis: The Radiologist's Perspective—Consensus of the Arthritis Subcommittee of the ESSR. Semin Musculoskelet Radiol 2014. [DOI: 10.1055/s-0034-1395421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Iwona Sudol-Szopinska
- Department of Radiology, Institute of Rheumatology, Warsaw and Department of Diagnostic Imaging, Warsaw Medical University, Warsaw, Poland
| | - Nathalie Boutry
- Department of Musculoskeletal Radiology, Centre Hospitalier Universitaire de Lille and Hôpital Roger Salengro, Lille, France
| | | | - Andrea Klauser
- Department of Radiology, Innsbruck Medical University, Section Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Marius Wick
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Hannes Platzgummer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Beligium
| | - Adam Mester
- Department of Radiology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Franz Kainberger
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Gunnar Aström
- Department of Radiology, Oncology and Radiation Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | | | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Sackler School of Medical, Tel Aviv, Israel
| | - Claudia Schueller-Weidekamm
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
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Kaipel M, Schützenberger S, Farr S, Gergely I, Vlcek A, Kainberger F, Boszotta H, Pretterklieber M. Reliability of radiographic landmarks in medial patello-femoral ligament reconstruction in relation to the anatomical femoral torsion. Int Orthop 2014; 39:423-8. [PMID: 25248860 DOI: 10.1007/s00264-014-2523-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/30/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE Anatomically correct graft positioning at the femoral insertion site is a key factor in surgical reconstruction of the medial patello-femoral ligament (MPFL). Basically there are two techniques to define this point in fluoroscopy during surgery. The role of the anatomical femoral torsion on the accuracy and reproducibility of both procedures has not been clarified. METHODS Twenty human anatomical leg specimens were dissected. The femoral insertion of the MPFL was marked by two K-wires. The position of the ligament insertion was determined fluoroscopically in the true lateral view as used in routine clinical practice. The anatomical MPFL insertion was compared to the radiographic landmarks which were recommended by two previous studies. The anatomical femoral torsion of the specimens was assessed by computed tomography scans. RESULTS In true lateral view fluoroscopy, the mean distance of the femoral MPFL insertion was -0.2 mm distal to the vertical reference line intersecting the posterior point of Blumensaat's line. In the anteroposterior direction, the mean distance was -2.0 mm posterior to the femoral cortex reference line. There was no correlation between anatomical femoral torsion and the distance of the femoral MPFL insertion to the posterior cortex. CONCLUSIONS The results of this study strongly recommend use of a vertical line intersecting the most posterior point of Blumensaat's line as a reference to identify the MPFL insertion in the craniocaudal direction. In the anteroposterior direction, the femoral MPFL insertion showed distinctive variation and was found -2.0 mm posterior to the femoral cortex reference line without being influenced by the anatomical femoral torsion.
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Affiliation(s)
- Martin Kaipel
- Department of Traumatology, Barmherzige Brüder Hospital, Johannes von Gott Platz 1, 7000, Eisenstadt, Austria,
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Cejka D, Weber M, Diarra D, Reiter T, Kainberger F, Haas M. Inverse association between bone microarchitecture assessed by HR-pQCT and coronary artery calcification in patients with end-stage renal disease. Bone 2014; 64:33-8. [PMID: 24709688 DOI: 10.1016/j.bone.2014.03.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 03/11/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
It is a matter of debate whether vascular calcification and bone loss are simultaneously occurring but largely independent processes or whether poor bone health predisposes to vascular calcification, especially in patients with kidney disease. Here we investigated the association between the changes of microarchitecture in weight bearing bone and the extent of coronary artery calcification in patients with chronic renal failure. The bone microarchitecture of the tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT), bone mineral density using dual X-ray absorptiometry (DXA) of the lumbar spine, femoral neck and distal radius as well as coronary artery calcification using multi-slice CT and reported as Agatston score were measured in 66 patients with end-stage renal disease on chronic hemodialysis. Markers of bone turnover, vitamin D status and intact parathyroid hormone (iPTH) were assessed. CAC score was found to be <100 in 39% and ≥100 in 61% of patients. The median [95% CI] total CAC score was 282 [315-2587]. By univariate analysis, significant correlations between CAC and age (R=0.52, p<0.001), weight (R=0.3, p<0.01) and serum cross laps (CTX, R=-0.39, p<0.01) were found, and parameters of bone microarchitecture were numerically but not significantly lower in patients with CAC scores ≥100. In multivariate analysis stratifying for gender and correcting for age, tibial density (Dtot) and bone volume/total volume (BV/TV) were significantly lower in patients with CAC scores ≥100 (p<0.05 for both). Low trabecular bone volume and decreased cortical bone density are associated with coronary artery calcification in dialysis patients.
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Affiliation(s)
- Daniel Cejka
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria; Medical University Vienna, Vienna, Austria.
| | - Michael Weber
- Medical University Vienna, Vienna, Austria; Department of Radiology, Medical University Vienna, Vienna, Austria.
| | - Danielle Diarra
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria; Medical University Vienna, Vienna, Austria.
| | - Thomas Reiter
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria; Medical University Vienna, Vienna, Austria.
| | - Franz Kainberger
- Medical University Vienna, Vienna, Austria; Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University Vienna, Vienna, Austria.
| | - Martin Haas
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria; Medical University Vienna, Vienna, Austria.
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Mascarenhas V, Sudol-Szopinska I, Boutry N, Plagou A, Klauser A, Wick M, Platzgummer H, Jans L, Mester A, Kainberger F, Aström G, Guglielmi G, Eshed I, Schueller-Weidekamm C. Imaging and Interpretation of Axial Spondylarthritis: The Radiologist's Perspective—Consensus of the Arthritis Subcommittee of the ESSR. Semin Musculoskelet Radiol 2014; 18:265-79. [DOI: 10.1055/s-0034-1375569] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Iwona Sudol-Szopinska
- Department of Radiology, Institute of Rheumatology, Warsaw and Department of Diagnostic Imaging, Warsaw Medical University, Warsaw, Poland
| | - Nathalie Boutry
- Department of Musculoskeletal Radiology, Centre Hospitalier Universitaire de Lille and Hôpital Roger Salengro, Lille, France
| | | | - Andrea Klauser
- Department of Radiology, Innsbruck Medical University, Section Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Marius Wick
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Hannes Platzgummer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Beligium
| | - Adam Mester
- Department of Radiology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Franz Kainberger
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Gunnar Aström
- Department of Radiology, Oncology and Radiation Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | | | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Sackler School of Medical, Tel Aviv, Israel
| | - Claudia Schueller-Weidekamm
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
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Kainberger F, Komorowski A, Friedrich K. Handgelenk und Hand. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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