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Adams LC, Bressem KK, Ziegeler K, Vahldiek JL, Poddubnyy D. Artificial intelligence to analyze magnetic resonance imaging in rheumatology. Joint Bone Spine 2024; 91:105651. [PMID: 37797827 DOI: 10.1016/j.jbspin.2023.105651] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/29/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Rheumatic disorders present a global health challenge, marked by inflammation and damage to joints, bones, and connective tissues. Accurate, timely diagnosis and appropriate management are crucial for favorable patient outcomes. Magnetic resonance imaging (MRI) has become indispensable in rheumatology, but interpretation remains laborious and variable. Artificial intelligence (AI), including machine learning (ML) and deep learning (DL), offers a means to improve and advance MRI analysis. This review examines current AI applications in rheumatology MRI analysis, addressing diagnostic support, disease classification, activity assessment, and progression monitoring. AI demonstrates promise, with high sensitivity, specificity, and accuracy, achieving or surpassing expert performance. The review also discusses clinical implementation challenges and future research directions to enhance rheumatic disease diagnosis and management.
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Affiliation(s)
- Lisa C Adams
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Keno K Bressem
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Hematology, Oncology , and Cancer Immunology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Germany; Evidia Radiologie am Rheumazentrum Ruhrgebiet, Germany
| | - Janis L Vahldiek
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
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2
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Pohlner T, Deppe D, Ziegeler K, Proft F, Protopopov M, Rademacher J, Rios Rodriguez V, Torgutalp M, Braun J, Diekhoff T, Poddubnyy D. Diagnostic accuracy in axial spondyloarthritis: a systematic evaluation of the role of clinical information in the interpretation of sacroiliac joint imaging. RMD Open 2024; 10:e004044. [PMID: 38580341 PMCID: PMC11002347 DOI: 10.1136/rmdopen-2023-004044] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/16/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVES Radiography and MRI of the sacroiliac joints (SIJ) are relevant for the diagnosis and classification of patients with axial spondyloarthritis (axSpA). This study aimed to evaluate the impact of clinical information (CI) on the accuracy of imaging interpretation. METHODS Out of 109 patients referred because of suspicion of axSpA with complete imaging sets (radiographs and MRI of SIJ), 61 were diagnosed with axSpA (56%). Images were independently evaluated by three radiologists in four consecutive reading campaigns: radiographs and radiographs+MRI without and with CI including demographic data, SpA features, physical activity and pregnancy. Radiographs were scored according to the modified New York criteria, and MRIs for inflammatory and structural changes compatible with axSpA (yes/no). The clinical diagnosis was taken as reference standard. The compatibility of imaging findings with a diagnosis of axSpA (precision) before and after the provision of CI and radiologists' confidence with their findings (0-10) were evaluated. RESULTS The precision of radiographs evaluation without versus with CI increased from 70% to 78% (p=0.008), and for radiographs+MRI from 81% to 82% (p=1.0), respectively. For CR alone, the sensitivity and specificity of radiologic findings were 51% and 94% without and 60% and 100% with CI, while, for radiographs+MRI, they were 74% and 90% vs 71% and 98%, respectively. The diagnostic confidence of radiologists increased from 5.2±1.9 to 6.0±1.7 with CI for radiographs, and from 6.7±1.6 to 7.2±1.6 for radiographs+MRI, respectively. CONCLUSION The precision, specificity and diagnostic confidence of radiologic evaluation increased when CI was provided.
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Affiliation(s)
- Tim Pohlner
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Ruhr University Bochum, Bochum, Germany
- RVZ Steglitz, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
- Epidemiology Unit, DRFZ, Berlin, Germany
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Radny F, Ziegeler K, Eshed I, Greese J, Deppe D, Stelbrink C, Biesen R, Haibel H, Rios Rodriguez V, Rademacher J, Protopopov M, Proft F, Hermann KGA, Poddubnyy D, Diekhoff T, Ulas ST. Learning imaging in axial spondyloarthritis: more than just a matter of experience. RMD Open 2024; 10:e003944. [PMID: 38443089 DOI: 10.1136/rmdopen-2023-003944] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Reliable interpretation of imaging findings is essential for the diagnosis of axial spondyloarthritis (axSpA) and requires a high level of experience. We investigated experience-dependent differences in diagnostic accuracies using X-ray (XR), MRI and CT. METHODS This post hoc analysis included 163 subjects with low back pain. Eighty-nine patients had axSpA, and 74 patients had other conditions (mechanical, degenerative or non-specific low back pain). Final diagnoses were established by an experienced rheumatologist before the reading sessions. Nine blinded readers (divided into three groups with different levels of experience) scored the XR, CT and MRI of the sacroiliac joints for the presence versus absence of axSpA. Parameters for diagnostic performance were calculated using contingency tables. Differences in diagnostic performance between the reader groups were assessed using the McNemar test. Inter-rater reliability was assessed using Fleiss kappa. RESULTS Diagnostic performance was highest for the most experienced reader group, except for XR. In the inexperienced and semi-experienced group, diagnostic performance was highest for CT&MRI (78.5% and 85.3%, respectively). In the experienced group, MRI showed the highest performance (85.9%). The greatest difference in diagnostic performance was found for MRI between the inexperienced and experienced group (76.1% vs 85.9%, p=0.001). Inter-rater agreement was best for CT in the experienced group with κ=0.87. CONCLUSION Differences exist in the learnability of the imaging modalities for axSpA diagnosis. MRI requires more experience, while CT is more suitable for inexperienced radiologists. However, diagnosis relies on both clinical and imaging information.
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Affiliation(s)
- Felix Radny
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Department of Hematology, Oncology, Tumor Immunology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Iris Eshed
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Juliane Greese
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Carsten Stelbrink
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
| | - Sevtap Tugce Ulas
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
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Kreutzinger V, Pankow A, Boyadzhieva Z, Schneider U, Ziegeler K, Stephan LU, Kübke JC, Schröder S, Oberender C, le Coutre P, Stintzing S, Jelas I. VEXAS and Myelodysplastic Syndrome: An Interdisciplinary Challenge. J Clin Med 2024; 13:1049. [PMID: 38398362 PMCID: PMC10889042 DOI: 10.3390/jcm13041049] [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: 01/07/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a recently recognized systemic autoinflammatory disease caused by somatic mutations in hematopoietic progenitor cells. This case series of four patients with VEXAS syndrome and comorbid myelodysplastic syndrome (MDS) aims to describe clinical, imaging, and hematologic disease presentations as well as response to therapy. Four patients with VEXAS syndrome and MDS are described. A detailed analysis of imaging features, hemato-oncological presentation including bone marrow microscopy and clinical-rheumatological disease features and treatment outcomes is given. All patients were male; ages ranged between 64 and 81 years; all were diagnosed with MDS. CT imaging was available for three patients, all of whom exhibited pulmonary infiltrates of varying severity, resembling COVID-19 or hypersensitivity pneumonitis without traces of scarring. Bone marrow microscopy showed maturation-disordered erythropoiesis and pathognomonic vacuolation. Somatic mutation in the UBA1 codon 41 were found in all patients by next-generation sequencing. Therapy regimes included glucocorticoids, JAK1/2-inhibitors, nucleoside analogues, as well as IL-1 and IL-6 receptor antagonists. No fatalities occurred (observation period from symptom onset: 18-68 months). Given the potential underreporting of VEXAS syndrome, we highly recommend contemporary screening for UBA1 mutations in patients presenting with ambiguous signs of systemic autoinflammatory symptoms which persist over 18 months despite treatment. The emergence of cytopenia, especially macrocytic hyperchromic anemia, should prompt early testing for UBA1 mutations. Notably conspicuous, pulmonary alterations in CT imaging of patients with therapy-resistant systemic autoinflammatory symptoms should be discussed in interdisciplinary medical teams (Rheumatology, Hematology, Radiology and further specialist departments) to facilitate timely diagnosis during the clinical course of the disease.
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Affiliation(s)
- Virginie Kreutzinger
- Department of Radiology, Vivantes Klinikum im Friedrichshain, 10249 Berlin, Germany
| | - Anne Pankow
- Department of Rheumatology and Clinical Immunology, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Zhivana Boyadzhieva
- Department of Rheumatology and Clinical Immunology, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Udo Schneider
- Department of Rheumatology and Clinical Immunology, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Hematology, Oncology, and Cancer Immunology, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Lars Uwe Stephan
- Department of Hematology, Oncology, and Cancer Immunology, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Jan Carl Kübke
- Department of Hematology, Oncology, and Cancer Immunology, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian Schröder
- Department of Hematology, Oncology, and Cancer Immunology, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Christian Oberender
- Department of Hematology, Oncology, and Cancer Immunology, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Philipp le Coutre
- Department of Hematology, Oncology, and Cancer Immunology, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian Stintzing
- Department of Hematology, Oncology, and Cancer Immunology, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Ivan Jelas
- Department of Hematology, Oncology, and Cancer Immunology, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Liu S, Schmidt H, Ziegeler K, Zhang T, Yang D, Taheri N, Pumberger M, Becker L. Inter-software and inter-threshold reliability of quantitative paraspinal muscle segmentation. Eur Spine J 2024; 33:369-378. [PMID: 38055039 DOI: 10.1007/s00586-023-08050-3] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/17/2023] [Accepted: 11/12/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Changes in the cross-sectional area (CSA) and functional cross-sectional area (FCSA) of the lumbar multifidus (MF) and erector spinae muscles (ES) are factors that can contribute to low back pain. For the assessment of muscle CSA and composition there are various software and threshold methods used for tissue segmentation in quantitative analysis. However, there is currently no gold standard for software as well as muscle segmentation. This study aims to analyze the measurement error between different image processing software and different threshold methods for muscle segmentation. METHODS Magnetic resonance images (MRI) of 60 patients were evaluated. Muscle CSA and FCSA measurements were acquired from axial T2-weighted MRI of the MF and ES at L4/L5 and L5/S1. CSA, FCSA, and FCSA/CSA ratio were measured independently by two observers. The MRI images were measured using two different software programs (ImageJ and Amira) and with two threshold methods (Circle/Overlap method) for each software to evaluate FCSA and FCSA/CSA ratio. RESULTS Inter-software comparisons revealed high inter-rater reliability. However, poor inter-rater reliability were obtained with different threshold methods. CSA, FCSA, and FCSA/CSA showed excellent inter-software agreement of 0.75-0.99 regardless of the threshold segmentation method. The inter-rater reliability between the two observers ranged between 0.75 and 0.99. Comparison of the two segmentation methods revealed agreement between 0.19 and 0.84. FCSA and FCSA/CSA measured via the Overlap method were significantly higher than those measured via the Circle method (P < 0.01). CONCLUSION The present study showed a high degree of reliability with very good agreement between the two software programs. However, study results based on different threshold methods should not be directly compared.
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Affiliation(s)
- Sihai Liu
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Hendrik Schmidt
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Katharina Ziegeler
- Department for Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Tianwei Zhang
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Daishui Yang
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nima Taheri
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Luis Becker
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Diekhoff T, Deppe D, Poddubnyy D, Ziegeler K, Proft F, Radny F, Niedermeier C, Hermann KG, Makowski MR. Characterization of bone marrow lesions in axial spondyloarthritis using quantitative T1 mapping MRI. Skeletal Radiol 2024:10.1007/s00256-024-04583-w. [PMID: 38224381 DOI: 10.1007/s00256-024-04583-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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Conventional magnetic resonance imaging (MRI) uses T1-weighted and short-tau inversion recovery (STIR) sequences to characterize bone marrow in axial spondyloarthritis. However, quantification is restricted to estimating the extent of lesions because signal intensities are highly variable both within individuals and across patients and MRI scanners. This study evaluates the performance of quantitative T1 mapping for distinguishing different types of bone marrow lesions of the sacroiliac joints. MATERIALS AND METHODS In this prospective study, 62 patients underwent computed tomography (CT) and MRI of the sacroiliac joints including T1, STIR, and T1 mapping. Bone marrow lesions were characterized by three readers and assigned to one of four groups: sclerosis, osteitis, fat lesions, and mixed marrow lesions. Relaxation times on T1 maps were compared using generalized estimating equations and receiver operating characteristics (ROC) analysis. RESULTS A total of 119 lesions were selected (sclerosis: 38, osteitis: 27, fat lesions: 40; mixed lesions: 14). T1 maps showed highly significant differences between the lesions with the lowest values for sclerosis (1516±220 ms), followed by osteitis (1909±75 ms), and fat lesions (2391±200 ms); p<0.001. T1 mapping differentiated lesions with areas under the ROC curve of 99% (sclerosis vs. osteitis) and 100% (other comparisons). CONCLUSION T1 mapping allows accurate characterization of sclerosis, osteitis, and fat lesions at the sacroiliac joint but only for homogeneous, non-mixed lesions. Thus, further sequence development is needed before implementation in clinical routine.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Dominik Deppe
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Radny
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Niedermeier
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kay Geert Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany
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Diekhoff T, Poddubnyy D, Proft F, Ziegeler K, Deppe D, Niedermeier C, Hermann KGA. New bone formation at the sacroiliac joint in axial spondyloarthritis: characterization of backfill in MRI and CT. Rheumatology (Oxford) 2023; 62:3893-3898. [PMID: 37018132 PMCID: PMC10691921 DOI: 10.1093/rheumatology/kead142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE MRI findings of the SI joint space in axial SpA (axSpA) include inflammation and fat metaplasia inside an erosion; the latter is also termed 'backfill'. We compared such lesions with CT to better characterize whether they represent new bone formation. METHODS We identified patients with axSpA who underwent both CT and MRI of the SI joints in two prospective studies. MRI datasets were jointly screened by three readers for joint space-related findings and grouped into three categories: type A-high short tau inversion recovery (STIR) and low T1 signal; type B-high signal in both sequences; type C-low STIR and high T1 signal. Image fusion was used to identify MRI lesions in CT before we measured Hounsfield units (HU) in each lesion and surrounding cartilage and bone. RESULTS Ninety-seven patients with axSpA were identified and we included 48 type A, 88 type B, and 84 type C lesions (maximum 1 lesion per type and joint). The HU values were 73.6 (s.d. 15.0) for cartilage, 188.0 (s.d. 69.9) for spongious bone, 1086.0 (s.d. 100.3) for cortical bone, 341.2 (s.d. 96.7) for type A, 359.3 (s.d. 153.5) for type B and 446.8 (s.d. 123.0) for type C lesions. Lesion HU values were significantly higher than those for cartilage and spongious bone, but lower than those for cortical bone (P < 0.001). Type A and B lesions showed similar HU values (P = 0.93), whereas type C lesions were denser (P < 0.001). CONCLUSION All joint space lesions show increased density and might contain calcified matrix, suggesting new bone formation, with a gradual increase in the proportion of calcified matrix towards type C lesions (backfill).
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Christoph Niedermeier
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
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8
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Ulas ST, Deppe D, Ziegeler K, Diekhoff T. New Bone Formation in Axial Spondyloarthritis: A Review. ROFO-FORTSCHR RONTG 2023. [PMID: 37944938 DOI: 10.1055/a-2193-1970] [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: 11/12/2023]
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the sacroiliac joints (SIJs) and the spine. Imaging plays a crucial role in the diagnosis of axSpA, with magnetic resonance imaging (MRI) and radiography being the primary modalities used in clinical practice. New bone formation occurs in both the spine (non-bridging and bridging syndesmophytes, transdiscal ankylosis, and ankylosis of small joints and posterior elements) and the SIJs (backfill and ankylosis). New bone formation indicates advanced axSpA. METHOD This review explores the role of imaging in the diagnosis and monitoring of axSpA, focusing on the significance of new bone formation, and provides an overview of the characteristic imaging findings of new bone formation in axSpA in each imaging modality. CONCLUSION Imaging methods, such as X-ray, MRI, and CT, have different diagnostic accuracies for detecting structural lesions and new bone formation. Each modality has its strengths and weaknesses, and the choice depends on the specific clinical context. Imaging is crucial for the diagnosis and monitoring of axSpA, particularly for the detection of new bone formation. Different imaging techniques provide valuable information about disease progression and treatment response. Understanding the significance of new bone formation and its detection using imaging modalities is essential for the accurate diagnosis and effective management of patients with axSpA. KEY POINTS · New bone formation is a hallmark feature of advanced axial spondyloarthritis.. · New bone formation occurs both in the spine and in the sacroiliac joints.. · Differentiation of new bone formation in axial spondyloarthritis from that in other conditions such as diffuse idiopathic skeletal hyperostosis and from osteophytes is essential.. · Imaging methods, such as X-ray, MRI, and CT, have different diagnostic accuracies for detecting new bone formation..
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
- Charité - Universitätsmedizin, Berlin Institute of Health at Charite, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
- Charité - Universitätsmedizin, Berlin Institute of Health at Charite, Berlin, Germany
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9
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Ulas ST, Radny F, Ziegeler K, Eshed I, Greese J, Deppe D, Stelbrink C, Biesen R, Haibel H, Rios Rodriguez V, Rademacher J, Protopopov M, Proft F, Poddubnyy D, Diekhoff T. Self-reported diagnostic confidence predicts diagnostic accuracy in axial spondyloarthritis imaging. Rheumatology (Oxford) 2023:kead564. [PMID: 37882740 DOI: 10.1093/rheumatology/kead564] [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: 07/30/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES Reporting diagnostic confidence (DC) in axial spondyloarthritis (axSpA) imaging is recommended by the ASAS guidelines. Our aim was to investigate whether self-reported DC predicts diagnostic accuracy in axSpA imaging using X-ray (XR), computed tomography (CT) and magnetic resonance imaging (MRI). METHODS We performed a post hoc analysis including 163 patients with low back pain (89 axSpA and 56 non-axSpA). Nine blinded readers with different experience levels (inexperienced (< 1 year), semi-experienced (3-8 years) and experienced (> 12 years)) scored the sacroiliac joint images for compatibility with axSpA. DC was reported on a scale from 1 (not sure) to 10 (very sure). Mean DC scores and standard deviations were calculated for correct and incorrect responses using XR, CT, MRI, XR+MRI and CT+MRI. Differences in DC were assessed using the Mann-Whitney U test. RESULTS DC scores were higher for correct axSpA diagnoses and differed significantly between correct and incorrect responses for all modalities (p< 0.001), with a mean DC of 7.1 ± 2.1 and 6.3 ± 2.1 for XR, 8.3 ± 1.8 and 6.7 ± 2.0 for CT, 8.1 ± 1.9 and 6.2 ± 1.9 for MRI, 8.2 ± 1.8 and 6.7 ± 1.8 for XR+MRI and 8.4 ± 1.8 and 6.8 ± 1.8 for CT+MRI, respectively. This was also the case when looking at the results by experience group, except for XR in the inexperienced group. CONCLUSION Providing self-reported DC in radiological reports is useful information to predict diagnostic reliability in axSpA imaging.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Radny
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Juliane Greese
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Carsten Stelbrink
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Hildrun Haibel
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Judith Rademacher
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
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10
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Busch F, Keller S, Rueger C, Kader A, Ziegeler K, Bressem KK, Adams LC. Mapping gender and geographic diversity in artificial intelligence research: Editor representation in leading computer science journals. Acta Radiol Open 2023; 12:20584601231213740. [PMID: 38034076 PMCID: PMC10685787 DOI: 10.1177/20584601231213740] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
Background The growing role of artificial intelligence (AI) in healthcare, particularly radiology, requires its unbiased and fair development and implementation, starting with the constitution of the scientific community. Purpose To examine the gender and country distribution among academic editors in leading computer science and AI journals. Material and Methods This cross-sectional study analyzed the gender and country distribution among editors-in-chief, senior, and associate editors in all 75 Q1 computer science and AI journals in the Clarivate Journal Citations Report and SCImago Journal Ranking 2022. Gender was determined using an open-source algorithm (Gender Guesser™), selecting the gender with the highest calibrated probability. Result Among 4,948 editorial board members, women were underrepresented in all positions (editors-in-chief/senior editors/associate editors: 14%/18%/17%). The proportion of women correlated positively with the SCImago Journal Rank indicator (ρ = 0.329; p = .004). The U.S., the U.K., and China comprised 50% of editors, while Australia, Finland, Estonia, Denmark, the Netherlands, the U.K., Switzerland, and Slovenia had the highest women editor representation per million women population. Conclusion Our results highlight gender and geographic disparities on leading computer science and AI journal editorial boards, with women being underrepresented in all positions and a disproportional relationship between the Global North and South.
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Affiliation(s)
- Felix Busch
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Division of Operative Intensive Care Medicine, Department of Anesthesiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Sarah Keller
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Christopher Rueger
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Avan Kader
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Keno K Bressem
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa C Adams
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
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Ulas ST, Proft F, Diekhoff T, Rios V, Rademacher J, Protopopov M, Greese J, Eshed I, Adams LC, Hermann KGA, Ohrndorf S, Poddubnyy D, Ziegeler K. Sex-specific diagnostic efficacy of MRI in axial spondyloarthritis: challenging the 'One Size Fits All' notion. RMD Open 2023; 9:e003252. [PMID: 37899091 PMCID: PMC10619004 DOI: 10.1136/rmdopen-2023-003252] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES Sex-specific differences in the presentation of axial spondyloarthritis (axSpA) may contribute to a diagnostic delay in women. The aim of this study was to investigate the diagnostic performance of MRI findings comparing men and women. METHODS Patients with back pain from six different prospective cohorts (n=1194) were screened for inclusion in this post hoc analysis. Two blinded readers scored the MRI data sets independently for the presence of ankylosis, erosion, sclerosis, fat metaplasia and bone marrow oedema. Χ2 tests were performed to compare lesion frequencies. Contingency tables were used to calculate markers for diagnostic performance, with clinical diagnosis as the standard of reference. The positive and negative likelihood ratios (LR+/LR-) were used to calculate the diagnostic OR (DOR) to assess the diagnostic performance. RESULTS After application of exclusion criteria, 526 patients (379 axSpA (136 women and 243 men) and 147 controls with chronic low back pain) were included. No major sex-specific differences in the diagnostic performance were shown for bone marrow oedema (DOR m: 3.0; f: 3.9). Fat metaplasia showed a better diagnostic performance in men (DOR 37.9) than in women (DOR 5.0). Lower specificity was seen in women for erosions (77% vs 87%), sclerosis (44% vs 66%), fat metaplasia (87% vs 96%). CONCLUSION The diagnostic performance of structural MRI markers is substantially lower in female patients with axSpA; active inflammatory lesions show comparable performance in both sexes, while still overall inferior to structural markers. This leads to a comparably higher risk of false positive findings in women.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Rios
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Berlin Institute of Health, Berlin, Germany
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Juliane Greese
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Iris Eshed
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lisa C Adams
- Department of Radiology, Technische Universität München, Munich, Germany
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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12
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Ulas ST, Proft F, Diekhoff T, Rios Rodriguez V, Rademacher J, Poddubnyy D, Ziegeler K. HLA-B27 status and inflammatory MRI lesions of the sacroiliac joints: a post hoc analysis in patients without axial spondyloarthritis. RMD Open 2023; 9:e003357. [PMID: 37739448 PMCID: PMC10533781 DOI: 10.1136/rmdopen-2023-003357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE The assessment of inflammatory and structural lesions in the sacroiliac joint (SIJ) is crucial in axial spondyloarthritis (axSpA). HLA-B27 status plays an important role in axSpA diagnosis and has been linked to MRI lesion burden in the general population. We aimed to investigate the sex-specific influence of HLA-B27 status on inflammatory and structural MRI findings in patients with low back pain of non-inflammatory origin. METHODS This post hoc analysis included 139 non-axSpA patients (90 women) with chronic low back pain. Two readers scored MRIs of the SIJ for the presence of sclerosis, erosion, fat metaplasia, bone marrow oedema (BMO) and ankylosis. Frequencies and extent of lesions were compared regarding the HLA-B27 status using χ2 tests and t-tests. Regression models to assess the sex-dependent influence of HLA-B27 on lesion burden were computed. RESULTS HLA-B27 was positive in 33 women (36.7%) and 23 men (46.9%). The overall occurrence of all SIJ lesions did not differ in HLA-B27 negative and positive individuals. There were no significant differences in the extent of lesions considering the HLA-B27 positivity, for erosion (mean sum score (MSS) of 0.91 vs 0.48; p=0.144), sclerosis (MSS 1.65 vs 1.88; p=0.576), fat metaplasia (MSS 0.56 vs 0.27; p=0.425), BMO (MSS 0.75 vs 0.59; p=0.460) and ankylosis (MSS 0.06 vs 0.04; p=0.659). CONCLUSION HLA-B27 status has no significant influence on the occurrence and extent of SIJ lesions in patients with low back pain of non-inflammatory origin in either men or women.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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13
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Ulas ST, Pochandke L, Ohrndorf S, Diekhoff T, Ziegeler K. Four-dimensional computed tomography detects dynamic three-dimensional pathologies of the wrist in patients with calcium pyrophosphate deposition disease. Front Med (Lausanne) 2023; 10:1231667. [PMID: 37601771 PMCID: PMC10436592 DOI: 10.3389/fmed.2023.1231667] [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: 05/30/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives Crystal deposits in ligaments of the wrist are typical findings in patients with calcium pyrophosphate deposition (CPPD) disease. CPPD crystals trigger inflammation and ultimately result in ligament tears with scapholunate (SL) advanced collapse (SLAC). This study aimed to investigate carpal instabilities in patients with CPPD using four-dimensional computed tomography (4D-CT) of the wrist. Methods This IRB-approved prospective feasibility study investigated patients with CPPD of the hand. All patients underwent a static 3D-CT and two dynamic 4D-CT in ulnar- and radial abduction and in supination and pronation movements to analyze instabilities of the SL region and of the distal radioulnar joint (DRUJ). Two independent readers scored the images for the presence of SL ligament and triangular fibrocartilage complex (TFCC) calcifications. Furthermore, the readers assessed the dynamic images for SL and DRUJ instabilities. Descriptive analyses were performed. Inter-rater reliability was assessed using Cohen's kappa (κ). Results Nine patients were included. SL ligament calcifications and instabilities were found in all patients. Of these, dynamic SL instability was detected in 77.8% of the patients, while 22.2% had a SLAC wrist. TFCC calcifications were found in 87.5% of the patients. Four patients had DRUJ instability (50%). No patient showed DRUJ instability without the presence of TFCC calcifications. Agreement between readers for calcifications was excellent (κ = 1) and almost perfect (κ = 0.89) for instabilities. Conclusion This study provides the first evidence of relevant dynamic carpal instability in CPPD patients using advanced imaging techniques with 4D-CT, offering unique insights into wrist biomechanics.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt – Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Louise Pochandke
- Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt – Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt – Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt – Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt – Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
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Kotlyarov M, Mews J, Ulas ST, Ziegeler K, Hamm B, Diekhoff T. Influence of contrast medium on tophus detection using dual-energy CT: phantom study and clinical illustration. Eur Radiol Exp 2023; 7:43. [PMID: 37486463 PMCID: PMC10366067 DOI: 10.1186/s41747-023-00348-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/25/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND To investigate the influence of iodinated contrast medium (ICM) on detection of monosodium urate (MSU) with dual-energy computed tomography (DECT) in two types of phantoms and demonstrate an example patient for clinical illustration. METHODS Approval is by the institutional review board, and written informed consent was obtained. A grid-like and a biophantom with 25 suspensions containing different concentrations of ICM (0 to 2%) and MSU (0 to 50%) were prepared and scanned with sequential single-source DECT using established methodology. Ascending orders of tube currents were applied at 80 kVp (16.5 to 220.0 mAs) and 135 kVp (2.75 to 19.25 mAs). Volume and mass measurements were performed using clinical gout software (dual-energy decomposition analysis). Numbers of true-positive and false-positive MSU detections were recorded and compared for different ICM concentrations. We demonstrate a patient with gouty arthritis for clinical illustration. RESULTS Effects of ICM on MSU detection varied with the amount of iodine. Lower ICM concentrations (0.25 and 0.50%) improved detection of small uric acid concentrations of 35 to 45% in comparison to scans without ICM. However, high ICM concentrations (1 and 2%) almost completely precluded MSU detection for all MSU concentrations investigated. In a patient with gouty arthritis, tophi in the wrist were only detected after intravenous ICM administration. CONCLUSIONS Exploring multimodal DECT for arthritis imaging, enhancement of ICM influences tophus detection. It can help in visualizing previously undetected MSU depositions but, with too strong enhancement, also obscure tophi. RELEVANCE STATEMENT Use of iodinated contrast media in dual-energy CT might help in visualizing previously undetected uric acid depositions but, with too strong enhancement, obscure gouty tophi. KEY POINTS • Iodine significantly influences the uric acid crystal detection in systematic phantom studies. • Lower iodine concentrations improved detection of low and medium uric acid concentrations. • High concentrations of iodine hampered detection of all uric acid concentrations.
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Affiliation(s)
- Maximilian Kotlyarov
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, 10117, Berlin, Germany.
| | - Jürgen Mews
- Canon Medical Systems, Europe BV, Zoetermeer, Netherlands
| | - Sevtap Tugce Ulas
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, 10117, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, 10117, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, 10117, Berlin, Germany
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Muellner M, Ziegeler K, Diekhoff T, Haffer H, Schömig F, Leopold VJ, Pumberger M, Göhler F. Clustered Occurrence of Osteitis Condensans Ilii in Patients with Symptomatic Hip Dysplasia. Diagnostics (Basel) 2023; 13:diagnostics13101701. [PMID: 37238185 DOI: 10.3390/diagnostics13101701] [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: 03/15/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Osteitis condensans ilii (OCI) is a relatively rare benign disease of the lower anterior sacroiliac joint (SIJ) region that can cause symptoms such as low back pain (LBP), lateral hip pain and nonspecific hip or thigh pain. Its exact pathoetiology remains to be clarified. The aim of this study is to determine the prevalence of OCI in patients with symptomatic developmental dysplasia of the hip (DDH) undergoing periacetabular osteotomy (PAO) to identify potential clustering of OCI in a with altered biomechanics of hip and SIJs. METHODS A retrospective investigation of all patients who underwent periacetabular osteotomy in a tertiary reference hospital from January 2015 to December 2020. Clinical and demographic data were retrieved from the hospital's internal medical records. Radiographs and magnetic resonance images (MRIs) were reviewed for the presence of OCI. A t-test for independent variables was conducted to identify differences between patients with and without OCI. A binary logistic regression model was established to determine the influence of age, sex and body mass index (BMI) on the presence of OCI. RESULTS The final analysis included 306 patients (81% female). In 21.2% of the patients (f: 22.6%; m: 15.5%), OCI was present. BMI was significantly higher in patients with OCI (23.7 kg/m2 vs. 25.0 kg/m2; p = 0.044). Binary logistic regression revealed that a higher BMI increased the likelihood of sclerosis in typical osteitis condensans locations, OR = 1.104 (95%-CI [1.024, 1.191]), as did female sex, OR = 2.832 (95%-CI [1.091, 7.352]. CONCLUSIONS Our study revealed a considerably higher prevalence of OCI in patients with DDH than in the general population. Furthermore, BMI was shown to have an influence on the occurrence of OCI. These results support the theory that OCI is attributable to altered mechanical loading of the SIJs. Clinicians should be aware that OCI is common in patients with DDH and a potential cause of LBP, lateral hip pain and nonspecific hip or thigh pain.
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Affiliation(s)
- Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Vincent Justus Leopold
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Friedemann Göhler
- Department of Radiology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Becker L, Adl Amini D, Ziegeler K, Muellner M, Diekhoff T, Hughes AP, Pumberger M. Approach-related anatomical differences in patients with lumbo-sacral transitional vertebrae undergoing lumbar fusion surgery at level L4/5. Arch Orthop Trauma Surg 2023; 143:1753-1759. [PMID: 34999995 PMCID: PMC10030414 DOI: 10.1007/s00402-021-04303-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/10/2021] [Accepted: 12/08/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Lumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. MATERIAL AND METHODS We assessed the CTs of 819 patients. Of these, 53 had LSTV from which 11 had six (6LV) and 9 four free lumbar vertebrae (4LV). We matched them for sex and age to a control group. RESULTS Patients with LSTV had a higher iliac crest and vena cava bifurcation, a greater distance between the common iliac veins and an anterior translation of the psoas muscle at level L4/5. In contrast, patients with 6LV had a lower iliac crest and aortic bifurcation, no differences in vena cava bifurcation and distance between the iliac veins compared to the control group. CONCLUSIONS For patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dominik Adl Amini
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th S, New York, NY, 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Ziegeler K, Ulas ST, Poddubnyy D, Proft F, Rios Rodriguez V, Rademacher J, Hermann KGA, Diekhoff T. Anatomical variation of the sacroiliac joint carries an increased risk for erosion and bone marrow oedema in axial spondyloarthritis. Rheumatology (Oxford) 2023; 62:1117-1123. [PMID: 35532084 DOI: 10.1093/rheumatology/keac282] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/05/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the impact of joint shape variations on inflammatory lesions on SI joint MRIs in patients with axial spondyloarthritis (axSpA). METHODS A total of 1194 patients from four different prospective cohorts were evaluated, with 684 (57.3%) having sufficient imaging data for inclusion (379 axSpA, 305 controls). All images were evaluated for joint form, erosion, sclerosis, fat metaplasia and bone marrow oedema (BMO) by two independent readers. Logistic regression analyses were used to assess the association of joint form and lesions on imaging for axSpA patients and controls. RESULTS Atypical joint forms were common in both axSpA (43.5% [154/354]) and control patients (44.2% [134/303]); both intra-articular variants and a crescent joint shape were significantly more common in axSpA patients (18.4% vs 11.6% and 11.0% vs 5.3.%, respectively; P < 0.001). The axSpA patients with intra-articular joint form variants had 2-fold higher odds of exhibiting erosions [odds ratio (OR) 2.09 (95% CI 1.18, 3.69)] and BMO [OR 1.79 (95% CI 1.13, 2.82)]; this association was not observed in controls. Accessory joints increased the odds for sclerosis in axSpA patients [OR 2.54 (95% CI 1.10, 5.84)] and for sclerosis [OR 17.91 (95% CI 6.92, 46.37)] and BMO [OR 2.05 (95% CI 1.03, 4.07)] in controls. CONCLUSIONS Joint form variations are associated with the presence of inflammatory lesions on SI joint MRIs of axSpA patients. This should be taken into consideration in future research on the interplay of mechanical strain and inflammation in axSpA.
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Affiliation(s)
| | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin.,Berlin Institute of Health, Berlin, Germany
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18
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Deppe D, Ziegeler K, Hermann KGA, Proft F, Poddubnyy D, Radny F, Makowski MR, Muhle M, Diekhoff T. Dual-Energy-CT for Osteitis and Fat Lesions in Axial Spondyloarthritis: How Feasible Is Low-Dose Scanning? Diagnostics (Basel) 2023; 13:diagnostics13040776. [PMID: 36832264 PMCID: PMC9955853 DOI: 10.3390/diagnostics13040776] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND To assess the ability of low-dose dual-energy computed tomography (ld-DECT) virtual non-calcium (VNCa) images for detecting bone marrow pathologies of the sacroiliac joints (SIJs) in patients with axial spondyloarthritis (axSpA). Material and Methods: Sixty-eight patients with suspected or proven axSpA underwent ld-DECT and MRI of the SIJ. VNCa images were reconstructed from DECT data and scored for the presence of osteitis and fatty bone marrow deposition by two readers with different experience (beginner and expert). Diagnostic accuracy and correlation (Kohen's k) with magnetic resonance imaging (MRI) as the reference standard were calculated for the overall and for each reader separately. Furthermore, quantitative analysis was performed using region-of-interest (ROI) analysis. Results: Twenty-eight patients were classified as positive for osteitis, 31 for fatty bone marrow deposition. DECT's sensitivity (SE) and specificity (SP) were 73.3% and 44.4% for osteitis and 75% and 67.3% for fatty bone lesions, respectively. The expert reader achieved higher diagnostic accuracy for both osteitis (SE 93.33%; SP: 51.85%) and fatty bone marrow deposition (SE: 65%; SP: 77.55%) than the beginner (SE: 26.67%; SP: 70.37% for osteitis; SE: 60%; SP: 44.9% for fatty bone marrow deposition). Overall correlation with MRI was moderate (r = 0.25, p = 0.04) for osteitis and fatty bone marrow deposition (r = 0.25, p = 0.04). Fatty bone marrow attenuation in VNCa images (mean: -129.58 HU; ±103.61 HU) differed from normal bone marrow (mean: 118.84 HU, ±99.91 HU; p < 0.01) and from osteitis (mean: 172 HU, ±81.02 HU; p < 0.01) while osteitis did not differ significantly from normal bone marrow (p = 0.27). Conclusion: In our study, low-dose DECT failed to detect osteitis or fatty lesions in patients with suspected axSpA. Thus, we conclude that higher radiation might be needed for DECT-based bone marrow analysis.
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Affiliation(s)
- Dominik Deppe
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Kay Geert A. Hermann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Felix Radny
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Marcus R. Makowski
- Department of Radiology, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Maximilian Muhle
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-627-176; Fax: +49-30-450-7-527941
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19
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Ulas ST, Diekhoff T, Ziegeler K. Sex Disparities of the Sacroiliac Joint: Focus on Joint Anatomy and Imaging Appearance. Diagnostics (Basel) 2023; 13:diagnostics13040642. [PMID: 36832130 PMCID: PMC9955570 DOI: 10.3390/diagnostics13040642] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
The sacroiliac joint (SIJ) is an anatomically complex joint which, as a functional unit with the pelvis and spine, is of decisive biomechanical importance for the human body. It is also a commonly overlooked source of lower back pain. Like the entire bony pelvis, the SIJ exhibits major sexual dimorphisms; thus, the sex-dependent evaluation of this joint is becoming increasingly important in clinical practice, both anatomically with joint shape variations and biomechanical differences as well as in terms of image appearance. The influence of the SIJ shape, which differs in women and men, is crucial for the different biomechanical joint properties. These differences are important in the development of joint diseases at the SIJ, which shows a specific difference between the sexes. This article aims to provide an overview of sex disparities of the SIJ regarding different anatomical and imaging appearances to further understand the insights into the interplay of sex differences and SIJ disease.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
- Correspondence: ; Tel.: +0049-30-450-627044
| | - Torsten Diekhoff
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
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20
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Pfau A, López-Cayuqueo KI, Scherer N, Wuttke M, Wernstedt A, González Fassrainer D, Smith DE, van de Kamp JM, Ziegeler K, Eckardt KU, Luft FC, Aronson PS, Köttgen A, Jentsch TJ, Knauf F. SLC26A1 is a major determinant of sulfate homeostasis in humans. J Clin Invest 2023; 133:161849. [PMID: 36719378 PMCID: PMC9888379 DOI: 10.1172/jci161849] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023] Open
Abstract
Sulfate plays a pivotal role in numerous physiological processes in the human body, including bone and cartilage health. A role of the anion transporter SLC26A1 (Sat1) for sulfate reabsorption in the kidney is supported by the observation of hyposulfatemia and hypersulfaturia in Slc26a1-knockout mice. The impact of SLC26A1 on sulfate homeostasis in humans remains to be defined. By combining clinical genetics, functional expression assays, and population exome analysis, we identify SLC26A1 as a sulfate transporter in humans and experimentally validate several loss-of-function alleles. Whole-exome sequencing from a patient presenting with painful perichondritis, hyposulfatemia, and renal sulfate wasting revealed a homozygous mutation in SLC26A1, which has not been previously described to the best of our knowledge. Whole-exome data analysis of more than 5,000 individuals confirmed that rare, putatively damaging SCL26A1 variants were significantly associated with lower plasma sulfate at the population level. Functional expression assays confirmed a substantial reduction in sulfate transport for the SLC26A1 mutation of our patient, which we consider to be novel, as well as for the additional variants detected in the population study. In conclusion, combined evidence from 3 complementary approaches supports SLC26A1 activity as a major determinant of sulfate homeostasis in humans. In view of recent evidence linking sulfate homeostasis with back pain and intervertebral disc disorder, our study identifies SLC26A1 as a potential target for modulation of musculoskeletal health.
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Affiliation(s)
- Anja Pfau
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karen I. López-Cayuqueo
- Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP) and Max-Delbrück-Centrum für Molekulare Medizin (MDC), Berlin, Germany
| | - Nora Scherer
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center and,Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Freiburg, Germany
| | - Matthias Wuttke
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center and
| | | | | | - Desiree E.C. Smith
- Metabolic Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience and
| | - Jiddeke M. van de Kamp
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Katharina Ziegeler
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich C. Luft
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter S. Aronson
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center and,CIBSS – Centre for Integrative Biological Signalling Studies, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Thomas J. Jentsch
- Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP) and Max-Delbrück-Centrum für Molekulare Medizin (MDC), Berlin, Germany.,NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA
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21
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Dahlmann S, Bressem KK, Bashian B, Ulas ST, Rattunde M, Busch F, Makowski MR, Ziegeler K, Adams LC. ASO Visual Abstract: Sex Differences in Renal Cell Carcinoma: The Importance of Body Composition. Ann Surg Oncol 2023; 30:1277-1278. [PMID: 36418798 DOI: 10.1245/s10434-022-12802-8] [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: 11/27/2022]
Affiliation(s)
| | - Keno K Bressem
- Department of Radiology, Charité, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Felix Busch
- Department of Radiology, Charité, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Technical University of Munich, Munich, Germany
| | | | - Lisa C Adams
- Department of Radiology, Charité, Berlin, Germany.
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Department of Radiology, Stanford University, Stanford, CA, USA.
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22
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Dahlmann S, Bressem K, Bashian B, Ulas ST, Rattunde M, Busch F, Makowski MR, Ziegeler K, Adams L. Sex Differences in Renal Cell Carcinoma: The Importance of Body Composition. Ann Surg Oncol 2023; 30:1269-1276. [PMID: 36352298 PMCID: PMC9807489 DOI: 10.1245/s10434-022-12738-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To examine sex-specific differences in renal cell carcinoma (RCC) in relation to abdominal fat accumulation, psoas muscle density, tumor size, pathology, and survival, and to evaluate possible associations with RCC characteristics and outcome. METHODS A total of 470 patients with RCC who underwent nephrectomy between 2006 and 2019 were included in this retrospective study. Specific characteristics of RCC patients were collected, including sex, height, tumor size, grade, and data on patient survival, if available. Abdominal fat measurements and psoas muscle area were determined at the level of L3 (cm2). RESULTS Women had a higher subcutaneous (p < 0.001) and men had a higher visceral fat area, relative proportion of visceral fat area (p < 0.001), and psoas muscle index (p < 0.001). Logistic regression analysis showed an association between higher psoas muscle index and lower grade tumors [women: odds ratio (OR) 0.94, 95% confidence interval (CI) 0.89-0.99, p = 0.011; men: OR 0.97 (95% CI, 0.95-0.99, p = 0.012]. Univariate regression analysis demonstrated an association between psoas muscle index and overall survival (women: OR 1.41, 95% CI 1.03-1.93, p = 0.033; men: OR 1.62 (95% CI, 1.33-1.97, p < 0.001). In contrast, there were no associations between abdominal fat measurements and tumor size, grade, or survival. Also, there were no sex-specific differences in tumor size or tumor grades. CONCLUSIONS A higher preoperative psoas muscle index was independently associated with overall survival in RCC patients, with a stronger association in men compared with women. In addition, the psoas muscle index showed an inverse association with tumor grade, whereby this association was slightly more pronounced in women than in men.
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Affiliation(s)
| | - Keno Bressem
- Department of Radiology, Charité, Berlin, Germany ,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Felix Busch
- Department of Radiology, Charité, Berlin, Germany
| | - Marcus R. Makowski
- Department of Radiology, Technical University of Munich, Munich, Germany
| | | | - Lisa Adams
- Department of Radiology, Charité, Berlin, Germany ,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany ,Department of Radiology, Stanford University, Stanford, CA USA
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23
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Wittig TM, Ziegeler K, Kreutzinger V, Golchev M, Ponsel S, Diekhoff T, Ulas ST. Dual-Energy Computed Tomography Collagen Density Mapping of the Cranio-Cervical Ligaments-A Retrospective Feasibility Study. Diagnostics (Basel) 2022; 12:diagnostics12122966. [PMID: 36552973 PMCID: PMC9776840 DOI: 10.3390/diagnostics12122966] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The objectives of this study were to investigate the mean collagen content of the atlanto-axial joint (AAJ) ligaments in a cohort without inflammatory disease and to analyze clinical confounders such as age, sex, and presence of ligamentous calcifications. A total of 153 patients who underwent dual-energy computed tomography (DECT) due to various reasons (e.g., suspected cancer or infection) were included in this retrospective study. Reconstruction of collagen density maps from the DECT dataset was performed. Region of interest (ROI) analysis was performed to assess densities in the following regions: ligamentum transversum atlantis (LTA), ligamenta alaria, fasciculi longitudinales, ligamentum nuchae, and retro-odontoid soft tissue (RDS). Osteoarthritis (OA) and the presence of calcifications were assessed by two experienced readers blinded to clinical data. Subgroup comparisons were performed using unpaired t-tests. The correlation of collagen density and clinical factors was investigated using Pearson's correlation coefficient. Mean LTA collagen density was 141.7 (SD 35.7). Ligamentous calcifications were rare (14.4 %). OA of the AAJ was common (91.5 %). LTA collagen density was not associated with age (Pearson's r of 0.109; p = 0.180) and was not significantly higher in patients with OA (p = 0.070). No correlations between RDS thickness, collagen density or calcifications were found. Our results show collagen density mapping of the cranio-cervical joint ligaments to be feasible; collagen densities are not significantly associated with age, sex, AAJ degeneration, or asymptomatic ligamentous calcification.
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Affiliation(s)
- Thomas Matthias Wittig
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Virginie Kreutzinger
- Department of Radiology, Vivantes Klinikum im Friedrichshain, 10249 Berlin, Germany
| | - Milen Golchev
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Simon Ponsel
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Sevtap Tugce Ulas
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-627044
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Becker L, Taheri N, Haffer H, Muellner M, Hipfl C, Ziegeler K, Diekhoff T, Pumberger M. Lumbosacral Transitional Vertebrae Influence on Acetabular Orientation and Pelvic Tilt. J Clin Med 2022; 11:jcm11175153. [PMID: 36079079 PMCID: PMC9457479 DOI: 10.3390/jcm11175153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Lumbosacral transitional vertebrae (LSTV) are common congenital variances with a prevalence found in the population up to 35.6%. The literature demonstrates an influence of LSTV on bony pelvic anatomy. The influence on the anatomical acetabular orientation, which is important for cup positioning in total hip arthroplasty, has not yet been described for patients with LSTV. A total of 53 patients with LSTV were identified from a CT Database including 819 subjects. Fifty patients with LSTV could be included and were matched for age and sex against a control group. We examined the influence of LSTV, classified according to Castellvi, on acetabular orientation and pelvic tilt in the supine position. Functional acetabular anteversion and inclination, assessed against the table plane, were compared against anatomical acetabular anteversion and inclination, assessed against the anterior pelvic plane. The anatomical acetabular inclination correlated with the pelvic tilt (r = 0.363, p < 0.001). The anatomical acetabular inclination was significantly larger than the functional acetabular inclination in the supine position (p < 0.001). Castellvi grading of LSTV correlated negatively with pelvic tilt (ρ = −0.387, p = 0.006). Castellvi grading correlated significantly with functional acetabular anteversion (ρ = 0.324, p = 0.022) and anatomical acetabular anteversion (ρ = 0.306, p = 0.022). A higher Castellvi grading was accompanied by a reduced pelvic tilt in the supine position. The functional acetabular anteversion and anatomical acetabular anteversion increased in parallel to the higher Castellvi grading. Therefore, LSTV and Castellvi grading might be assessed on pre-operative X-rays prior to hip arthroplasty and surgeons might consider adjusting cup positioning accordingly.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité—University Medicine, Augustenburger Pl. 1, 13353 Berlin, Germany
- Correspondence:
| | - Nima Taheri
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Christian Hipfl
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department for Radiology, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Diekhoff
- Department for Radiology, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
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Röglin J, Ziegeler K, Kube J, König F, Hermann KG, Ortmann S. Improving classification results on a small medical dataset using a GAN; An outlook for dealing with rare disease datasets. Front Comput Sci 2022. [DOI: 10.3389/fcomp.2022.858874] [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: 11/13/2022] Open
Abstract
For clinical decision support systems, automated classification algorithms on medical image data have become more important in the past. For such computer vision problems, deep convolutional neural networks (DCNNs) have made breakthroughs. These often require large, annotated, and privacy-cleared datasets as a prerequisite for gaining high-quality results. This proves to be difficult with rare diseases due to limited incidences. Therefore, it is hard to sensitize clinical decision support systems to identify these diseases at an early stage. It has been shown several times, that synthetic data can improve the results of clinical decision support systems. At the same time, the greatest problem for the generation of these synthetic images is the data basis. In this paper, we present four different methods to generate synthetic data from a small dataset. The images are from 2D magnetic resonance tomography of the spine. The annotation resulted in 540 healthy, 47 conspicuously non-pathological, and 106 conspicuously pathological vertebrae. Four methods are presented to obtain optimal generation results in each of these classes. The obtained generation results are then evaluated with a classification net. With this procedure, we showed that adding synthetic annotated data has a positive impact on the classification results of the original data. In addition, one of our methods is appropriate to generate synthetic image data from <50 images. Thus, we found a general approach for dealing with small datasets in rare diseases, which can be used to build sensitized clinical decision support systems to detect and treat these diseases at an early stage.
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Ulas ST, Proft F, Diekhoff T, Rios Rodriguez V, Rademacher J, Protopopov M, Ohrndorf S, Poddubnyy D, Ziegeler K. OP0073 NEW PERSPECTIVES IN AXIAL SPONDYLOARTHRITIS - FIRST RESULTS OF GENDER-SPECIFIC ASSESSMENT OF MRI IMAGING CRITERIA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1784] [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: 11/04/2022]
Abstract
BackgroundGender-specific differences in patients with axial spondyloarthritis (axSpA) are often seen in the clinical presentation and may differ in MRI findings1. Male axSpA patients tend to show structural changes earlier, whereas in female axSpA patients the peripheral joints are more often affected2. This can lead to a delay in axSpA diagnosis in women. For this reason, gender-specific data collection and establishment of gender-specific imaging criteria are of particular importance.ObjectivesTo evaluate the diagnostic performance of different combinations of imaging markers to derive data-driven imaging criteria for MRI in axSpA, separately for men and women.MethodsA total of 1194 patients were included in the study. Considering the exclusion criteria (available MRI image data sets, confirmed diagnoses), 684 patients (379 axSpA and 305 control group) were included for further statistical analysis. Two trained readers scored the MRI images separately for the presence of ankylosis, as well as erosion, sclerosis, fat metaplasia, and bone marrow edema differentiated for 3 regions (ventral/mid/dorsal) for sacral-sided and iliac-sided sacroiliac joint. Chi^2 test was applied to compare lesion frequencies per group. Contingency table analysis was performed to assess diagnostic performances. The diagnostic performances were compared using the diagnostic odd ratio (DOR).ResultsOverall, 136 female and 243 male axSpA patients were included. Higher prevalence for ankylosis (24.3 vs. 7.4%) and fat metaplasia (58.8 vs. 42.6%) was shown in male axSpA patients; in contrast, sclerosis was more common in female axSpA patients (75.0 vs. 57.6%). No sex differences in frequency were shown for bone marrow edema and erosion. In male axSpA patients, the most significant difference in individual parameters was shown for ankylosis (DOR 40.1) compared with females (DOR 4.7). The detection of erosion and fat metaplasia as markers was also better in male axSpA patients (DOR 17.6 vs. 11.1 and 18.6 vs. 6.3). Sclerosis and bone marrow edema were better suited in female axSpA patients (DOR 3.0 vs. 2.5 and 5.0 vs. 3.7). Overall, diagnostic accuracy was improved when only lesions in the middle and dorsal articular compartments were considered.ConclusionThe diagnostic performance of established image markers on MRI is significantly lower in female axSpA patients. This is especially true for ankylosis, which provides the risk for false-positive findings in women. Based on these findings, future revisions of imaging criteria may include gender-specific recommendations to improve diagnostic accuracy for male and female axSpA patients.References[1]Braun J, Baraliakos X, Bülow R, et al. Striking sex differences in magnetic resonance imaging findings in the sacroiliac joints in the population. Arthritis Res Ther. 2022 Jan 20;24(1):29. doi: 10.1186/s13075-021-02712-7.[2]Mease PJ, McLean RR, Dube B, et al. Comparison of Men and Women With Axial Spondyloarthritis in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol 2021;48(10):1528-36. doi: 10.3899/jrheum.201549 [published Online First: 2021/04/17]Disclosure of InterestsSevtap Tugce Ulas: None declared, Fabian Proft Speakers bureau: Novartis, Lilly and UCB, as well as personal fees from AbbVie, AMGEN, BMS, Hexal, Janssen, MSD, Pfizer and Roche, Grant/research support from: Novartis, Eli Lilly and UCB., Torsten Diekhoff Speakers bureau: MSD, Novartis and Eli Lilly., Valeria Rios Rodriguez Speakers bureau: AbbVie and Falk e.V., Judith Rademacher Grant/research support from: Berlin Institute of Health (BIH) during the conduct of this study (Clinician Scientist Programme)., Mikhail Protopopov Grant/research support from: UCB, Sarah Ohrndorf: None declared, Denis Poddubnyy Speakers bureau: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Bristol-Myers Squibb, Roche, UCB, Biocad, GlaxoSmithKline and Gilead, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis and Pfizer., Katharina Ziegeler Grant/research support from: Assessment of Spondyloarthritis international Society (ASAS) during the conduct of this study.
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Ziegeler K, Ulas ST, Poddubnyy D, Proft F, Rios Rodriguez V, Rademacher J, Hermann KG, Diekhoff T. POS0973 INFLUENCE OF ANATOMICAL VARIATION OF THE SACROILIAC JOINTS ON INFLAMMATORY LESIONS ON MAGNETIC RESONANCE IMAGING. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2150] [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: 11/04/2022]
Abstract
BackgroundAnatomical variation of the sacroiliac (SI) joints is more common among patients with LBP than healthy controls; increased biomechanical strain to the joint may play a role in axial spondyloarthritis (axSpA).ObjectivesTo assess the association of lesions joint shape variation on inflammatory lesions on SI joint magnetic resonance imaging (MRI) in patients with axSpA.MethodsIn this post-hoc analysis a total of 684 patients from four different prospective cohorts were evaluated (379 axSpA). Two readers independently scored all patients for joint form, erosion, sclerosis, fat metaplasia and bone marrow edema (BME). Logistic regression analyses were used to assess the association of lesions on imaging joint form; this analysis was performed separately for axSpA patients and controls.ResultsTypical joints were observed in 56.5% of axSpA patients (200/354) and 55.7% of control patients (169/303); in axSpA patients exhibited a significantly higher proportion of intra-articular variants (18.4% vs. 11.6%; p<0.001) and crescent joint shapes (11.0% vs. 5.3.%; p<0.001) than controls. AxSpA patients with intraarticular joint form variants had increased odds for erosions (OR 2.09; 95%CI 1.18-3.69) and BME (OR 1.79; 95%CI 1.13-2.82); this association was not seen in controls. Accessory joints increased the odds for sclerosis in axSpA patients (OR 2.54;95%CI 1.10-5.84) and for BME (2.05; 95%CI 1.03-4.07) and sclerosis (OR 17.91; 95%CI 6.92-46.37) in controls.ConclusionJoint form variations are associated with inflammatory lesions on SI joint MRI of axSpA patients but not controls; this indicates a role for atypical joint forms in sacroiliitis.References[1]Ziegeler, K., Kreutzinger, V., Proft, F., Poddubnyy, D., Hermann, K. G. A., & Diekhoff, T. (2021). Joint anatomy in axial spondyloarthritis: strong associations between sacroiliac joint form variation and symptomatic disease. Rheumatology (Oxford). doi:10.1093/rheumatology/keab318Disclosure of InterestsKatharina Ziegeler Grant/research support from: Received research grant from the Assessment of Spondyloarthritis international Society (ASAS)., Sevtap Tugce Ulas: None declared, Denis Poddubnyy Speakers bureau: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Bristol-Myers Squibb, Roche, UCB, Biocad, GlaxoSmithKline and Gilead, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Fabian Proft Speakers bureau: Novartis, Eli Lilly, UCB, AbbVie, AMGEN, BMS, Hexal, Janssen, MSD, Pfizer and Roche, Grant/research support from: Novartis, Eli Lilly and UCB, Valeria Rios Rodriguez Speakers bureau: AbbVie and Falk e.V, Judith Rademacher: None declared, Kay-Geert Hermann Speakers bureau: AbbVie, MSD, and Novartis, Employee of: Co-owner of the BerlinFlame GmbH, Torsten Diekhoff Speakers bureau: MSD, Novartis and Eli Lilly
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Diekhoff T, Deppe D, Poddubnyy D, Ziegeler K, Proft F, Hermann KG, Protopopov M, Radny F, Makowski M. AB0796 Quantitative bone marrow lesion characterization at the sacroiliac joint with T1-mapping. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1537] [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: 11/04/2022]
Abstract
BackgroundConventional magnetic resonance imaging (MRI) uses T1-weighted and short-tau inversion recovery (STIR) sequences to characterize bone marrow lesions in axial spondyloarthritis. However, quantification is restricted to the extent of marrow lesions because signal intensities are highly variable within and across patients and scanners. Furthermore, some marrow lesions are less visible in MRI and need further characterization with computed tomography (CT), e.g. sclerosis. Quantitative MRI in form of mapping sequences might help to better characterize bone marrow lesions.ObjectivesTo evaluate the performance of T1-mapping for differentiating different bone marrow lesions at the sacroiliac joints in patients with suspected axial spondyloarthritis.MethodsSixty-two patients (mean age 41±12.5; thirty-two were finally diagnosed with axial spondyloarthritis and 30 with another condition) underwent CT and MRI of the sacroiliac joints. Besides standard oblique coronal T1 and STIR sequences a T1-mapping sequence (Modified Look-Locker Inversion Recovery) was added to the protocol. Bone marrow lesions (maximum 4 lesions per patient, 1 lesion of the same type per joint) were characterized by an expert radiologist into four groups, namely sclerosis (lesion type (LT) 1), osteitis (LT2), fat lesion (LT3) and mixed marrow lesions (LTm). Relaxation times on T1-maps were compared using Kruskal-Wallis test correcting for multiple comparisons and correlated to quantitative measures from conventional MRI sequences and CT.Results119 lesions were selected (LT1: 38, LT2: 27, LT3: 40; LTm: 14). T1-map showed highly significant differences between LT1-3 with the lowest values for sclerosis (1522±227 ms), followed by osteitis (1906±82 ms) and fat lesions (2391±200 ms); p<0.0005. However, mixed lesions showed a broad distribution of values (1869±670), irrespective of their characteristics. T1-map correlated to a high degree with conventional T1-values (r = 0.74) and Hounsfield units in CT (r = -0.69) with p < 0.0001, respectively, but not with STIR (p = 0.8).ConclusionT1-Mapping allows for accurately characterizing lesions at the sacroiliac joint in patients with suspected axial spondyloarthritis and, thus, may combine information from two conventional sequences and CT into one in the future while providing superior capacity for quantification. However, in our study mixed lesions and inhomogeneous bone marrow remained problematic. Thus, further sequence development is needed before its implementation in clinical routine.Figure 1.T1-mapping values of the different lesions, LT1: Sclerosis, LT2: Osteitis, LT3: Fat lesion, LTm: Mixed lesion. Differences are highly significant, which allows T1-mapping to characterize those different lesions in one sequence.Disclosure of InterestsTorsten Diekhoff Speakers bureau: Novartis, Eli Lilly, MSD, Canon MS, Consultant of: Novartis, Dominik Deppe: None declared, Denis Poddubnyy: None declared, Katharina Ziegeler: None declared, Fabian Proft: None declared, Kay-Geert Hermann: None declared, Mikhail Protopopov: None declared, Felix Radny: None declared, Marcus Makowski: None declared
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Diekhoff T, Deppe D, Ziegeler K, Proft F, Hermann KGA, Protopopov M, Radny F, Makowski M. Quantitative Bone Marrow Lesion Characterization at the Sacroiliac Joint with T1 Mapping. Semin Musculoskelet Radiol 2022. [DOI: 10.1055/s-0042-1750660] [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: 10/17/2022]
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Hermann KG, Protopopov M, Serfaty A, Hmamouchi I, Sommerfleck F, Macori F, Ziegeler K, Diekhoff T, Poddubnyy D, Sieper J. POS1460 CONTRIBUTING TO THE TRAINING OF IMAGING IN RHEUMATOLOGY BY EXPERTS WORLDWIDE VIA INTERACTIVE MOBILE E-TEACHING: BERLINCASEVIEWER. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4885] [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: 11/04/2022]
Abstract
BackgroundRheumatology education today can be very diverse, and you can find everything from structured textbooks to YouTube channels to social media accounts. Peer-reviewed content is still recognized as a very high-quality source of information. App-based content has the advantage of bundling information in one place, always available on the go. However, the majority of offerings are only available in English.ObjectivesAn app was to be created to learn about imaging in rheumatology in a very easy to understand way in different languages, with experts being able to create translated content very easily.MethodsUsing mySQL, Java, Objective C and JavaScript, a case database with specific structure and numerous interactive elements was created for academic teaching. Special functions for the annotation of images were provided. The development was initially for devices with the iOS operating system, and later for Android. Rheumatologists and radiologists worldwide were invited to participate via the social media channels LinkedIn, Instagram, Facebook, Twitter, and TikTok.ResultsThe app, called BerlinCaseViewer, was developed for smartphones, tablets and Mac computers. All information is entered and processed in a web-based database. Using XML files and ZIP archives, the relevant data is then transferred to the mobile apps. Case of the month and learning modules on rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis are available, many in English, Spanish, French, Italian, Portuguese, German, and other languages (Figure 1). In addition to the medical image data, the patient’s medical history is also presented in an exciting way with the help of multiple-choice questions. Only when all questions are answered, the diagnosis becomes visible. Timeline functions can be used to visualize medical courses as well. Colored overlays are used to annotate images and can be placed with pixel precision. The user can decide whether these should be displayed as aids. Content is peer-reviewed before publication.Figure 1.Multi-lingual presentation of medical training cases.ConclusionBerlinCaseViewer is a new approach not only to train medical professionals, but also to connect colleagues and overcome language barriers. As a platform, BerlinCaseViewer is open to all medical professionals to collaborate, whether to contribute their own cases or translate existing cases for use in the local language.References[1]BerlinCaseViewer home page: https://www.berlincaseviewer.de/Disclosure of Interests:Kay-Geert Hermann Shareholder of: Co-founder of BerlinFlame GmbH, Mikhail Protopopov: None declared, Aline Serfaty: None declared, Ihsane Hmamouchi: None declared, Fernando Sommerfleck: None declared, Fabio Macori: None declared, Katharina Ziegeler: None declared, Torsten Diekhoff: None declared, Denis Poddubnyy Shareholder of: Co-founder of BerlinFlame GmbH, Joachim Sieper Shareholder of: Co-founder of BerlinFlame GmbH
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Dahlmann S, Ziegeler K, Mau-Möller A, Mittelmeier W, Bergschmidt P. Patellar Tracking in Total Knee Arthroplasty-Influence on Clinical and Functional Outcome. Diagnostics (Basel) 2022; 12:diagnostics12051082. [PMID: 35626238 PMCID: PMC9139248 DOI: 10.3390/diagnostics12051082] [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: 03/03/2022] [Revised: 03/22/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
Anterior knee pain is a common problem after primary total knee arthroplasty (TKA). The aim of this study was to find parameters in patellar positioning which influence the clinical and functional outcome after TKA. Included were 59 patients who underwent TKA, of which three patients were treated bilaterally (n = 62 included knees). In a periodical follow-up of up to 5 years, each patient had to answer three questionnaires (HSS, WOMAC, SF-36) and underwent three radiographies of the knee (including merchant view) and a clinical examination, including Range Of Motion (ROM). All radiographs were evaluated by a single observer blinded to clinical data, who collected multiple parameters of sagittal and axial patellar alignment including newly developed methods for measuring patellar shift and tilt. Depending on the measurement results, three groups were built for each parameter and the influence on the outcome was determined. A lateral patellar tilt of more than 4° resulted in lower scores for both the HSS and WOMAC. The rarely investigated patellar facet angle showed a significantly inferior clinical and functional outcome in late follow-up of >24 months if lower than 142°, possibly due to progressive osteosclerotic changes of the patella caused by increased contact stress with corresponding patellar morphology. No significant difference was found for all other parameters. The newly developed method for measuring patellar shift has proven to be a valuable and easy instrument in the postoperative setting.
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Affiliation(s)
- Sebastian Dahlmann
- Department of Radiology, Charité Universitätsmedizin Berlin, Luisenstraße 7, 10117 Berlin, Germany;
- Correspondence:
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Luisenstraße 7, 10117 Berlin, Germany;
| | - Anett Mau-Möller
- Orthopaedic Clinic and Outpatient Department, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany; (A.M.-M.); (W.M.); (P.B.)
| | - Wolfram Mittelmeier
- Orthopaedic Clinic and Outpatient Department, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany; (A.M.-M.); (W.M.); (P.B.)
| | - Philipp Bergschmidt
- Orthopaedic Clinic and Outpatient Department, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany; (A.M.-M.); (W.M.); (P.B.)
- Department for Orthopaedic Surgery, Trauma Surgery and Hand Surgery, Südstadt Hospital Rostock, Südring 81, 18059 Rostock, Germany
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Ulas ST, Ziegeler K, Richter ST, Ohrndorf S, Poddubnyy D, Makowski MR, Diekhoff T. CT-like images in MRI improve specificity of erosion detection in patients with hand arthritis: a diagnostic accuracy study with CT as standard of reference. RMD Open 2022; 8:rmdopen-2021-002089. [PMID: 35177555 PMCID: PMC8860086 DOI: 10.1136/rmdopen-2021-002089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/06/2021] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare the diagnostic accuracy of susceptibility-weighted imaging (SWI), standard T1-weighted (T1w) images and high-resolution 3D-gradient echo sequences (volumetric interpolated breath-hold examination (VIBE)) for detection of erosions in patients with peripheral arthritis using CT as standard of reference. MATERIALS AND METHODS A total of 36 patients were included in the study. All patients underwent CT and MRI, including SWI, VIBE and T1w sequences of the clinically more affected hand. Two trained readers scored all imaging datasets separately for erosions in a blinded fashion. Specificity, sensitivity and diagnostic accuracy of MRI sequences were calculated on a per-patient level. RESULTS CT was positive for erosion in 16 patients and 77 bones (Rheumatoid Arthritis MRI Score >0), T1w in 28 patients, VIBE in 25 patients and SWI in 17 patients. All MRI sequences performed with comparably high sensitivities (T1w 100%, VIBE 94% and SWI 94%). SWI had the highest specificity of 90%, followed by VIBE (50%) and T1w (40%). Both T1w and VIBE produced significantly higher sum scores than CT (341 and 331 vs 148, p<0.0001), while the sum score for SWI did not differ from CT (119 vs 148; p=0.411). CONCLUSION Specificity for erosion detection remains a challenge for MRI when conventional and high-resolution sequences are used but can be improved by direct bone depiction with SWI. Both T1w and VIBE tend to overestimate erosions, when CT is used as the standard of reference.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Sophia-Theresa Richter
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Sarah Ohrndorf
- Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Department of Radiology, Klinikum rechts der Isar der Technischen Universität München, Munchen, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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Kolck J, Ziegeler K, Walter-Rittel T, Hermann KGA, Hamm B, Beck A. Clinical utility of postprocessed low-dose radiographs in skeletal imaging. Br J Radiol 2022; 95:20210881. [PMID: 34919419 PMCID: PMC8822553 DOI: 10.1259/bjr.20210881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/27/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Radiography remains the mainstay of diagnostic and follow-up imaging. In view of the risks and the increasing use of ionizing radiation, dose reduction is a key issue for research and development. The introduction of digital radiography and the associated access to image postprocessing have opened up new opportunities to minimize the radiation dosage. These advances are contingent upon quality controls to ensure adequate image detail and maintenance of diagnostic confidence. The purpose of this study was to investigate the clinical applicability of postprocessed low-dose images in skeletal radiography. METHODS In our study setting, the median radiation dose for full dose X-rays was 9.61 dGy*cm2 for pelvis, 1.20 dGy*cm2 for shoulder and 18.64 dGy*cm2 for lumbar spine exams. Based on these values, we obtained 200 radiographs for each anatomic region in four consecutive steps, gradually reducing the dose to 84%, 71%, 60% and 50% of the baseline using an automatic exposure control (AEC). 549 patients were enrolled for a total of 600 images. All X-rays were postprocessed with a spatial noise reduction algorithm. Two radiologists assessed the diagnostic value of the radiographs by rating the visualization of anatomical landmarks and image elements on a five-point Likert scale. A mean-sum score was calculated by averaging the two reader's total scores. Given the non-parametric distribution, we used the Mann-Whitney U test to evaluate the scores. RESULTS Median dosage at full dose accounted for 38.4%, 48 and 53.2% of the German reference dose area product for shoulder, pelvis and lumbar spine, respectively. The applied radiation was incrementally reduced to 21.5%, 18.4% and 18.7% of the respective reference value for shoulder, pelvis and lumbar spine. Throughout the study, we observed an estimable tendency of superior quality at higher dosage in overall image quality. Statistically significant differences in image quality were restricted to the 50% dose groups in shoulder and lumbar spine images. Regardless of the applied dosage, 598 out of 600 images were of sufficient diagnostic value. CONCLUSION In digital radiography image postprocessing allows for extensive reduction of radiation dosage. Despite a trend of superior image detail at higher dose levels, overall quality and, more importantly, diagnostic utility of low-dose images was not significantly affected. Therefore, our results not only confirm the clinical utility of postprocessed low-dose radiographs, but also suggest a widespread deployment of this advanced technology to ensure further dose limitations in clinical practice. ADVANCES IN KNOWLEDGE The diagnostic image quality of postprocessed skeletal radiographs is not significantly impaired even after extensive dose reduction by up to 20% of the reference value.
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Affiliation(s)
- Johannes Kolck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thula Walter-Rittel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Beck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Hermann KGA, Ziegeler K, Kreutzinger V, Poddubnyy D, Proft F, Deppe D, Greese J, Sieper J, Diekhoff T. What amount of structural damage defines sacroiliitis: a CT study. RMD Open 2022; 8:rmdopen-2021-001939. [PMID: 35064092 PMCID: PMC8785200 DOI: 10.1136/rmdopen-2021-001939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/15/2021] [Accepted: 11/25/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To propose a data-driven definition for structural changes of sacroiliac (SI) joints in the context of axial spondyloarthritis (axSpA) imaging on a large collective of CT datasets. METHODS 546 individuals (102 axSpA, 80 non-axSpA low back pain and 364 controls without back pain) with SI joint CTs were evaluated for erosions, sclerosis and ankylosis using a structured scoring system. Lesion frequencies and spatial distribution were compared between groups. Diagnostic performance (sensitivity (SE), specificity (SP), positive predictive values, negative predictive values and positive and negative likelihood ratios) was calculated for different combinations of imaging findings. Clinical diagnosis served as standard of reference. RESULTS Ankylosis and/or erosions of the middle and dorsal joint portions yielded the best diagnostic performance with SE 67.6% and SP 96.3%. Inclusion of ventral erosions and sclerosis resulted in lower diagnostic performance with SE 71.2%/SP 92.5% and SE 70.6%/SP 90.0%, respectively. CONCLUSIONS Sclerosis and ventrally located erosions of SI joints have lower specificity on CT of the SI joint in the context of axSpA imaging. Ankylosis and/or erosions of the middle and dorsal joint portions show a strong diagnostic performance and are appropriate markers of a positive SI joint by CT.
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Affiliation(s)
- Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Denis Poddubnyy
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Juliane Greese
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Diekhoff T, Eshed I, Radny F, Ziegeler K, Proft F, Greese J, Deppe D, Biesen R, Hermann KG, Poddubnyy D. OP0256 CHOOSE WISELY: IMAGING FOR DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:To date, the European Alliance of Associations for Rheumatology (EULAR) guidelines recommend X-ray (XR) as first line imaging in axial Spondyloarthritis (axSpA) and magnetic resonance imaging (MR) if the diagnosis cannot be established by XR and clinical features. However, much knowledge has been gained recently strengthening the applicability of MR for the detection of structural lesions and raising the question, whether XR is still necessary. Also, several publications used low-dose computed tomography (CT) as reference standard and imaging test.Objectives:In light of this complex diagnostic situation, the aim of this study was to compare the three major modalities, XR, MR and CT of SIJ, in their diagnostic performance of axSpA and differential diagnosis in a cohort of patients with low back pain using the final judgment of the rheumatologist as standard of reference.Methods:163 patients (89 with axSpA; 74 with degenerative diseases) underwent XR, CT and MR. Three blinded experts categorized the imaging into axSpA, other diseases or normal in 5 separate reading rounds (XR, CT, MR, XR+MR, CT+MR, respectively). The results were compared to the clinical diagnosis. Sensitivity and specificity values for axSpA and interrater reliability were compared.Results:XR showed lower sensitivity and specificity (66.3%/67.6% respectively) compared to MR (82.0%/86.5%) and CT (77.5%/97.3%). Sensitivity and specificity of XR+MR was similar to MR alone (77.5% / 87.8%). However, CT+MR was superior to MR alone (75.6% / 97.3%) (see Figure). CT had the best interrater reliability (kappa = 0.875) followed by MR (0.665) and XR (0.517). CR+MR reliability was similar (0.662) compared to MR alone, while CT+MR reliability (0.732) was superior.Figure 1.Frequency of positive and negative findings in radiography (XR), computed tomography (CT), magnetic resonance imaging (MR) and combinations and resulting diagnostic accuracy values. SE: Sensitivity, SP: Specificity, LR-/+: negative/positive likelihood ratio.Conclusion:In conclusion, XR is inferior to cross-sectional imaging and should be replaced by MR or CT for differential diagnosis. While MR is the most sensitive imaging technique, it lacks specificity when compared to CT. CT alone has high diagnostic accuracy, despite being insensitive to bone marrow lesions such as fatty metaplasia or osteitis. Adding CT to MR leads to an increase in specificity at a minor expense of sensitivity.References:[1]Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68 Suppl 2:ii1-44.[2]Mandl P, Navarro-Compán V, Terslev L, et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis. 2015;74(7):1327-39.[3]Diekhoff T, Hermann KA, Greese J, et al. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis. 2017.[4]Diekhoff T, Greese J, Sieper J, Poddubnyy D, Hamm B, Hermann KA. Improved detection of erosions in the sacroiliac joints on MRI with volumetric interpolated breath-hold examination (VIBE): results from the SIMACT study. Ann Rheum Dis. 2018;77(11):1585-89.[5]Baraliakos X, Hoffmann F, Deng X, Wang YY, Huang F, Braun J. Detection of Erosions in Sacroiliac Joints of Patients with Axial Spondyloarthritis Using the Magnetic Resonance Imaging Volumetric Interpolated Breath-hold Examination. The Journal of rheumatology. 2019;46(11):1445-49.[6]Wu H, Zhang G, Shi L, et al. Axial Spondyloarthritis: Dual-Energy Virtual Noncalcium CT in the Detection of Bone Marrow Edema in the Sacroiliac Joints. Radiology. 2019;290(1):157-64.Disclosure of Interests:Torsten Diekhoff Speakers bureau: Canon MS, Roche, Novartis, MSD, Grant/research support from: Assessment of Spondyloarthritis International Society, Iris Eshed: None declared, Felix Radny: None declared, Katharina Ziegeler: None declared, Fabian Proft: None declared, Juliane Greese: None declared, Dominik Deppe: None declared, Robert Biesen: None declared, Kay-Geert Hermann: None declared, Denis Poddubnyy: None declared
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Diekhoff T, Eshed I, Radny F, Ziegeler K, Proft F, Greese J, Deppe D, Biesen R, Hermann KG, Poddubnyy D. Choose wisely: imaging for diagnosis of axial spondyloarthritis. Ann Rheum Dis 2021; 81:237-242. [PMID: 34049855 PMCID: PMC8762031 DOI: 10.1136/annrheumdis-2021-220136] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/24/2021] [Indexed: 11/04/2022]
Abstract
Objective To assess the diagnostic accuracy of radiography (X-ray, XR), CT and MRI of the sacroiliac joints for diagnosis of axial spondyloarthritis (axSpA). Methods 163 patients (89 with axSpA; 74 with degenerative conditions) underwent XR, CT and MR. Three blinded experts categorised the imaging findings into axSpA, other diseases or normal in five separate reading rounds (XR, CT, MR, XR +MR, CT +MR). The clinical diagnosis served as reference standard. Sensitivity and specificity for axSpA and inter-rater reliability were compared. Results XR showed lower sensitivity (66.3%) than MR (82.0%) and CT (76.4%) and also an inferior specificity of 67.6% vs 86.5% (MR) and 97.3% (CT). XR +MR was similar to MR alone (sensitivity 77.5 %/specificity 87.8%) while CT+MR was superior (75.3 %/97.3%). CT had the best inter-rater reliability (kappa=0.875), followed by MR (0.665) and XR (0.517). XR +MR was similar (0.662) and CT+MR (0.732) superior to MR alone. Conclusions XR had inferior diagnostic accuracy and inter-rater reliability compared with cross-sectional imaging. MR alone was similar in diagnostic performance to XR+MR. CT had the best accuracy, strengthening the importance of structural lesions for the differential diagnosis in axSpA.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Iris Eshed
- Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Felix Radny
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Juliane Greese
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kay Geert Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Becker L, Schömig F, Haffer H, Ziegeler K, Diekhoff T, Pumberger M. Safe Zones for Spinopelvic Screws in Patients With Lumbosacral Transitional Vertebra. Global Spine J 2021; 13:1089-1096. [PMID: 34044627 DOI: 10.1177/21925682211019354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective matched-pair analysis. OBJECTIVES Lumbosacral transitional vertebrae (LSTV) have a reported prevalence of 4-36% in the population. The safe zones for screw placement for spinopelvic fusion in adult spinal deformity surgery for patients with LSTV have not been described in the literature. Our study aimed to assess the safety of S1-pedicle screw (S1PS), S2-alar screw (S2AS), S2-alar-iliac screw (S2AIS), and iliac screw (IS) placement in patients with LSTV. METHODS Out of the 819 examined patients, 49 patients with LSTV were included in our retrospective analysis with a matched pair control group. We used the 3-dimensional planning tool mediCAD for screw placement of S1PS, S2AS, S2AIS, IS with different angles, length and diameters. RESULTS We evaluated a total of 10 192 screw trajectories. No serious complications occurred due to the trajectories used for S1PS. LSTV increased the risk of vessel injury for S2AS trajectories (P = .001) but not for S2AIS (P = .526). Besides the presence of an LSTV, the screw trajectory had a major influence on the frequency of serious complications. CONCLUSIONS Sacral anchoring of long spinal constructions using S1PS, S2AS, S2AIS and IS is also possible in the presence of LSTV. For S2AS the trajectory with 30° lateral and caudal angulation of 10° showed the least vascular injuries and the least sacro-iliac-joint violations in patients with LSTV. S2AIS trajectories with 40° lateral and 0° sagittal angulation reduced the risk of serious complications in our patients collective with LSTV.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz, Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz, Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz, Berlin, Germany
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Ziegeler K, Kreutzinger V, Proft F, Poddubnyy D, Hermann KGA, Diekhoff T. Joint anatomy in axial spondyloarthritis: strong associations between sacroiliac joint form variation and symptomatic disease. Rheumatology (Oxford) 2021; 61:388-393. [PMID: 33822902 DOI: 10.1093/rheumatology/keab318] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 12/21/2022] Open
Abstract
OBJECTIVES The aim of this investigation was to determine the prevalence of variant sacroiliac joint forms in symptomatic patients with mechanical joint disease (MJD) and axial spondyloarthritis (axSpA) compared with control patients. METHOD A total of 973 patients were included in this cross-sectional study (95 axSpA; 61 MJD; 817 controls); clinical diagnosis, age and gender were noted. An established scoring system was used to classify joint forms on computed tomography scans of the pelvis. Frequencies of joint forms were compared between groups (axial spondyloarthritis; mechanical joint disease; controls). RESULTS Patients with MJD exhibited the highest proportion of atypical joints (80.3% in MJD vs 44.1% in axSpA and 37.5% in controls; p< 0.001). Overall, females had a significantly higher proportion of atypical joints than men (65.0% vs 17.8%; p< 0.001); proportions of atypical joints were significantly higher in males with symptomatic joint disease than in male controls: 32.2% in axSpA, 55.0% in MJD, 13.9% in controls; p≤ 0.001. Two specific joint forms were significantly more prevalent in symptomatic patients than in controls: the iliosacral complex (16.2% vs 4.2%; p< 0.001) and the crescent-shaped ilium (9.1% vs 2.8%; p< 0.05). CONCLUSIONS Our data demonstrate a strong association between atypical joint forms and symptomatic joint disease.
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Affiliation(s)
- Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Fabian Proft
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Ziegeler K, Kreutzinger V, Diekhoff T, Roehle R, Poddubnyy D, Pumberger M, Hamm B, Hermann KGA. Impact of age, sex, and joint form on degenerative lesions of the sacroiliac joints on CT in the normal population. Sci Rep 2021; 11:5903. [PMID: 33723315 PMCID: PMC7960989 DOI: 10.1038/s41598-021-85303-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/23/2020] [Accepted: 02/26/2021] [Indexed: 01/10/2023] Open
Abstract
Degeneration of the sacroiliac joints (SIJs) is a common finding, while its underlying cause and development remain incompletely understood. The aim of this investigation was to describe the spatial distribution of degenerative SIJ changes across age groups and to investigate for the first time their relationship to anatomical form and sex. For this IRB-approved investigation, demographic data of 818 patients without SIJ disease were retrieved from electronic patient records. High-resolution computed tomography (CT) datasets of all patients were analysed retrospectively for seven predefined age groups (ten-year increments, from < 25 to ≥ 75). A structured scoring system was applied to assess sclerosis, osteophytes, joint space alterations, and anatomical form. Chi-square tests were used to compare frequencies of degenerative lesions, and logistic regression analyses were performed to investigate associations between demographic data, anatomical form, and the presence of structural lesions. Sclerosis and osteophytes were common findings, with an overall prevalence of 45.7% and 46.8%, respectively. Female sex had an odds ratio (OR) of 0.15 (95% CI: 0.08-0.27) for the presence of ventral osteophytes and of 4.42 (95% CI: 2.77-7.04) for dorsal osteophytes. Atypical joint forms were significantly more prevalent in women with 62.1% vs. 14.1% in men (p < 0.001). Accessory joints increased the likelihood of dorsal sclerosis (OR 2.735; 95% CI 1.376-5.436) while a typical joint form decreased its likelihood (OR 0.174; 95% CI 0.104-0.293). Sex and anatomical joint form have a major impact on the development of degenerative lesions of the SIJs and their spatial distribution.
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Affiliation(s)
- Katharina Ziegeler
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | | | - Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Kreutzinger V, Diekhoff T, Liefeldt L, Poddubnyy D, Hermann KGA, Ziegeler K. Asymptomatic secondary hyperparathyroidism can mimic sacroiliitis on computed tomography. Sci Rep 2021; 11:4323. [PMID: 33619346 PMCID: PMC7900245 DOI: 10.1038/s41598-021-83989-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/23/2020] [Accepted: 02/10/2021] [Indexed: 11/09/2022] Open
Abstract
Secondary hyperparathyroidism (sHPT) as a result of chronic kidney disease (CKD) is a common health problem and has been reported to manifest at the sacroiliac joints (SIJ). The aim of this investigation was to systematically assess sacroiliac joint changes in asymptomatic sHPT as detected by high-resolution CT. Included in this IRB-approved retrospective case-control study were 56 patients with asymptomatic sHPT as well as 259 matched controls without SIJ disease. Demographic data were retrieved from electronic patient records. High-resolution computed tomography datasets of all patients were subjected to a structured scoring, including erosions, sclerosis, osteophytes, joint space alterations and intraarticular calcifications. Chi2 tests were used to compare frequencies of lesions. Erosions were significantly more prevalent in patients with sHPT, and were found mainly in the ventral (28.6% vs. 13.9%; p = 0.016) and middle (17.9% vs. 7.7%; p = 0.040) iliac portions of the SIJ. Partial ankylosis was rare in both cohorts (3.6% vs. 5.0%; p > 0.999); complete ankylosis was not observed. Neither extent not prevalence of sclerosis or calcifications differed significantly between groups. Joint lesions reminiscent of sacroiliitis can be found in a substantial portion of asymptomatic patients with secondary hyperparathyroidism. Further investigations into the clinical significance of these findings are warranted.
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Affiliation(s)
| | - Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lutz Liefeldt
- Department of Nephrology and Internal Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Ziegeler K, Richter ST, Hermann S, Hermann KGA, Hamm B, Diekhoff T. Correction to: Dual-energy CT collagen density mapping of wrist ligaments reveals tissue remodeling in CPPD patients: first results from a clinical cohort. Skeletal Radiol 2021; 50:2315. [PMID: 34254171 PMCID: PMC8449762 DOI: 10.1007/s00256-021-03833-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A Correction to this paper has been published: 10.1007/s00256-021-03833-5
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Affiliation(s)
- Katharina Ziegeler
- Department of Radiology, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Sophia-Theresa Richter
- Department of Radiology, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sandra Hermann
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
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Ziegeler K, Richter ST, Hermann S, Hermann KGA, Hamm B, Diekhoff T. Dual-energy CT collagen density mapping of wrist ligaments reveals tissue remodeling in CPPD patients: first results from a clinical cohort. Skeletal Radiol 2021; 50:417-423. [PMID: 32803375 PMCID: PMC8189950 DOI: 10.1007/s00256-020-03580-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate differences in collagen density as detected by dual-energy computed tomography (DECT) of wrist ligaments between patients with calcium pyrophosphate-dihydrate deposition disease (CPPD) and a control group in order to gain insight into changes of the extracellular matrix in response to crystal deposition. MATERIALS AND METHODS This retrospective study included 28 patients (18 with CPPD, 10 controls) who underwent DECT of the wrist. Collagen density maps were reconstructed from the DECT datasets and used to measure densities in regions of interest (ROIs) placed in the scapholunate (SL) ligament (dorsal, palmar, proximal), lunotriquetral (LT) ligament, and extensor carpi radialis (ECR) tendon, (n = 260 measurements). The presence of calcifications on standard CT images in these regions was assessed by a blinded reader. Densities were compared with nonparametric tests, and linear regression analysis was performed to investigate the impact of age, sex, and CT- detected calcium deposition on collagen density. RESULTS Collagen density in the SL ligament was significantly higher in CPPD patients than in controls (overall mean: 265.4 ± 32.1 HU vs. 196.3 ± 33.8 HU; p < 0.001). In the ECR tendon, collagen densities did not differ significantly (p = 0.672): 161.3 ± 20.1 HU in CPPD vs. 163.6 ± 12.0 HU in controls. Regression analysis showed that diagnosis, but not age or calcification, had a significant impact on collagen density. CONCLUSION Collagen density of the SL ligament is significantly higher in CPPD patients than in control patients. Further research is needed to understand these changes in the extracellular matrix of ligaments in CPPD.
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Affiliation(s)
- Katharina Ziegeler
- Department of Radiology, Charité–Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sophia-Theresa Richter
- Department of Radiology, Charité–Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sandra Hermann
- Department of Rheumatology and Clinical Immunology, Charité–Universitätsmedizin, Charitéplatz 1, Berlin, 10117 Germany
| | - Kay Geert A. Hermann
- Department of Radiology, Charité–Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité–Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité–Universitätsmedizin, Charitéplatz 1, 10117 Berlin, Germany
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Becker L, Ziegeler K, Diekhoff T, Palmowski Y, Pumberger M, Schömig F. Musculature adaption in patients with lumbosacral transitional vertebrae: a matched-pair analysis of 46 patients. Skeletal Radiol 2021; 50:1697-1704. [PMID: 33533964 PMCID: PMC8208907 DOI: 10.1007/s00256-021-03722-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/23/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Even though lumbosacral transitional vertebrae (LSTV) are one of the most common congenital anomalies of the spine, their effect on surrounding soft tissues is not well-studied. We therefore aimed at analyzing the association between LSTV and changes in volume, mass, symmetry, and degeneration of lumbar and trunk muscles. MATERIALS AND METHODS Abdomen-pelvis CT scans were analyzed in patients with LSTV and a matched control group. LSTV were classified according to the Castellvi classification. Muscles were segmented from the remaining soft tissue and their cross-sectional area and volume were examined at five defined levels. Threshold segmentation was used to differentiate between muscle fibers and fat tissue. Matched pairs were compared using Wilcoxon rank sum tests. For comparison of categorical data, chi-squared tests were performed and for associations between the degree of fusion and muscle size and degeneration, Spearman's correlation coefficients were calculated. Inter- and intrarater reliabilities were evaluated by computing intraclass correlation coefficients. RESULTS Forty-six patients with LSTV and 46 controls were included. Muscle volume of the paraspinal and trunk muscles was significantly lower (707.0 cm3 vs. 809.7 cm3, p < 0.001) and fatty muscle changes were significantly increased in all but the caudal paravertebral muscles of LSTV patients (M. psoas p < 0.04, M. quadratus lumborum p < 0.001, paravertebral muscles p = 0.011, M. rectus abdominis p < 0.001, M. obliquus abdominis p < 0.001). Correlations between the degree of Castellvi classification and muscle volume were significant (p = 0.001). CONCLUSION LSTV are associated with a reduction in muscle volume and an increase in muscle degeneration of both lumbar and trunk muscles.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité – University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany
| | - Yannick Palmowski
- Center for Musculoskeletal Surgery, Charité – University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité – University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité – University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Ziegeler K, Eshed I, Diekhoff T, Hermann KG. Imaging of Joints and Bones in Autoinflammation. J Clin Med 2020; 9:E4074. [PMID: 33348664 PMCID: PMC7766736 DOI: 10.3390/jcm9124074] [Citation(s) in RCA: 4] [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: 11/21/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022] Open
Abstract
Autoinflammatory disorders are commonly characterized by seemingly unprovoked systemic inflammation mainly driven by cells and cytokines of the innate immune system. In many disorders on this spectrum, joint and bone involvement may be observed and imaging of these manifestations can provide essential diagnostic information. This review aimed to provide a comprehensive overview of the imaging characteristics for major diseases and disease groups on the autoinflammatory spectrum, including familial Mediterranean fever (FMF), Behçet disease (BD), crystal deposition diseases (including gout), adult-onset Still's disease (AoSD), and syndromatic synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO)/chronic recurrent multifocal osteomyelitis (CRMO). Herein, we discuss common and distinguishing imaging characteristics, phenotypical overlaps with related diseases, and promising fields of future research.
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Affiliation(s)
- Katharina Ziegeler
- Department of Radiology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (T.D.); (K.G.H.)
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Giborim Affiliated with the Sackler School of Medicine, Tel Aviv University, 52621 Tel Aviv, Israel;
| | - Torsten Diekhoff
- Department of Radiology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (T.D.); (K.G.H.)
| | - Kay Geert Hermann
- Department of Radiology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (T.D.); (K.G.H.)
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Fahlenkamp UL, Ziegeler K, Adams LC, Böker SM, Engel G, Makowski MR. Native T1 mapping for assessment of the perilesional zone in metastases and benign lesions of the liver. Sci Rep 2020; 10:12889. [PMID: 32733016 PMCID: PMC7393097 DOI: 10.1038/s41598-020-69819-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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/20/2020] [Indexed: 11/21/2022] Open
Abstract
Adjacent to hepatic metastases, liver parenchyma is often histopathologically altered even if its visual appearance on native magnetic resonance (MR) images is blunt. Yet, relaxation properties in MR imaging may show structural changes prior to visual alteration, and therefore, the aim of this study was to investigate whether T1 relaxation times in the perilesional zone differ between metastases and benign lesions. A total of 113 patients referred for MRI were included prospectively. Images were assessed for metastases, solid benign lesions and cysts, and regions-of-interest were drawn on T1 maps including the focal lesion and a close (inner perilesional zone = IPZ) and a larger perilesional zone (outer perilesional zone = OPZ). Simple ratios between these zones, as well as a gradient ratio between the IPZ and the entire perilesional zone (EPZ) were calculated. Within the collective, 44 patients had lesions of one or two entities. For metastases, the simple ratio between IPZ and OPZ as well as the mean EPZ gradient was significantly higher than for both solid benign lesions and cysts. Lesion size was not a significant covariate. We conclude, that native T1 properties of the perilesional zones differ significantly between malignant and both solid and cystic benign lesions.
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Affiliation(s)
- Ute Lina Fahlenkamp
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lisa Christine Adams
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Maria Böker
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Günther Engel
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marcus Richard Makowski
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Radiology, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, Munich, Germany
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Ziegeler K, Siepmann S, Hermann S, Beck A, Lembcke A, Hamm B, Hermann KGA. Application of an advanced noise reduction algorithm for imaging of hands in rheumatic diseases: evaluation of image quality compared to standard-dose images. Rheumatol Int 2020; 40:893-899. [PMID: 32240350 DOI: 10.1007/s00296-020-04560-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES X-ray is the fundamental imaging technique in both diagnosis and follow-up of rheumatic diseases. As patients often require sequential X-rays over many years, dose reduction is of great importance. New advanced noise reduction algorithms allow for a dose reduction of up to 50%. The aim of this study was to evaluate whether quality of low-dose images is non-inferior to standard-dose images and, therefore, application of this technique is possible in the context of imaging of rheumatic diseases. METHODS A total of 298 patients with known or suspected rheumatic disease were enrolled prospectively into this study, separated into three consecutive groups: 80%, 64% and 50% tube charge reduction. All patients received imaging of one hand (laterality randomly assigned) with low-dose technique and imaging of the contralateral hand with standard-dose protocol. Images were evaluated by two independent readers who scored (on a scale of 1-5) the visualization of bony cortex, trabeculae and joint spaces of fingers and wrist separately. Additionally, soft tissue and overall contrast were evaluated on the same scale. RESULTS Overall image quality (expressed by mean sum score out of 40) of the 50% low-dose images was 31.52 (SD 1.94) vs. 31.66 (SD 1.82) for standard images (p = 0.068). Bony contours as well as trabeculae were equally well visualized in both image sets. Median scores for soft tissue visualization was slightly lower for low dose compared to standard images [4 (IQR 3.5-4) vs. 4 (IQR 3.88-4); p = 0.001]. CONCLUSIONS Overall image quality of low-dose images was not inferior to standard-dose images. Therefore, the application of low-dose technology based on advanced noise estimation algorithms in the context of imaging of rheumatic diseases is possible.
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Affiliation(s)
- Katharina Ziegeler
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Stefan Siepmann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sandra Hermann
- Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Beck
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander Lembcke
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Bastian H, Ziegeler K, Hermann KGA, Feist E. [Rheumatoid arthritis-mimics : When appearances are deceptive]. Z Rheumatol 2019; 78:6-13. [PMID: 30191389 DOI: 10.1007/s00393-018-0527-1] [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] [Indexed: 11/29/2022]
Abstract
Rheumatology represents a discipline full of differential diagnoses. Even for classical diseases, such as rheumatoid arthritis as the most frequent chronic inflammatory joint disease and described so clearly in many textbooks, it is not uncommon that it can be a diagnostic challenge in daily practice. This applies to arthritic joint involvement and also to frequently associated extra-articular manifestations. The patient history and results of the clinical examination are essential; however, laboratory and imaging findings often make a significant contribution to confirming the diagnosis, especially in early phases of the disease. This article, which makes no claims to completeness, focuses on diseases that in the opinion of the authors can imitate rheumatoid arthritis due to similar joint and other organ manifestations. These include metabolic, inflammatory infective and non-infective as well as tumorous diseases. A misinterpretation as rheumatoid arthritis as a rule leads to long-term and severe consequences for affected patients. Thus, the diagnosis of rheumatoid arthritis should be questioned and re-evaluated in cases of unusual accompanying symptoms, atypical course of disease and a lack of response to standard treatment approaches.
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Affiliation(s)
- H Bastian
- Abteilung Rheumatologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Standort Berlin-Wannsee, Berlin, Deutschland
| | - K Ziegeler
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - K G A Hermann
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - E Feist
- Klinik für Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Ziegeler K, Diekhoff T, Hermann S, Hamm B, Hermann KGA. Low-dose computed tomography as diagnostic tool in calcium pyrophosphate deposition disease arthropathy: focus on ligamentous calcifications of the wrist. Clin Exp Rheumatol 2019; 37:826-833. [PMID: 31025927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To identify specific morphologic features of calcium pyrophosphate deposition disease (pseudogout, CPPD) manifestations of the wrist as detected using low-dose CT-scans. METHODS In this retrospective study 46 patients with arthritis of the wrist were included. All patients underwent a low dose CT scan of both wrists on a 320-row detector in volume scan mode. Individual radiation exposure was recorded for all patients. Two blinded raters independently evaluated osteoarthritis, cysts, erosions, calcifications (cartilage and ligaments separately) and carpal misalignment in 33 specified locations. An expert rheumatologist classified the patients as CPPD positive or negative. Fisher's exact test was applied to identify differences between both groups. Receiver operating characteristics (ROC) analyses with calculations of area under the curve (AUC) were carried out for both in the literature established and newly identified imaging findings for each rater individually. RESULTS Twenty-seven patients were classified as CPPD, 19 patients as other diagnoses. Ligamentous calcifications were significantly more prevalent in the CPPD group (p<0.05). All non-ligamentous findings revealed no difference in frequency. AUC analysis for established findings (0.675; 0.619 - rater 1; 2) vs. ligamentous calcifications (0.786 both raters) showed a markedly higher diagnostic accuracy for the latter. Effective radiation exposure was determined to be 0.019-0.095 mSv per patient. CONCLUSIONS Calcifications of carpal ligaments are highly specific morphologic features of CPPD arthropathy. Low-dose CT is a useful tool to detect these calcifications at a radiation exposure similar to a standard radiograph.
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Affiliation(s)
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Sandra Hermann
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
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Nötzel A, Hermann KG, Feist E, Kedor C, Ziegeler K, Stroux A, Mews J, Schnorfeil M, Hamm B, Diekhoff T. Diagnostic accuracy of dual-energy computed tomography and joint aspiration: a prospective study in patients with suspected gouty arthritis. Clin Exp Rheumatol 2018; 36:1061-1067. [PMID: 30418110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To validate the diagnostic benefit of dual-energy computed tomography (DECT) and synovial fluid aspiration in suspected gout. METHODS A total of 43 patients with suspected gout underwent aspiration and DECT (320-row CT; Canon Medical Systems, Japan). The patients were assessed (gout vs. non-gout) based on the 2015 ACR/EULAR gout classification criteria using clinical and laboratory findings. The results were analysed by comparing two scenarios using McNemar test: Scenario A: ACR/EULAR criteria, followed by DECT results and aspiration findings. Scenario B: ACR/EULAR criteria, followed by aspiration and DECT results. RESULTS 15/43 patients (34.9%) were positive for MSU crystals, and 16/43 patients (37.2%) for gouty tophi (DECT). 26/43 patients (60.5%) were diagnosed with gout and fulfilled the ACR/EULAR criteria. The diagnostic performance of either synovial fluid aspiration or DECT was similar with sensitivity of 58% and specificity of 100% and 94%, respectively. Combination of both modalities (at least one of them positive), resulted in increased sensitivity of 85% and unchanged specificity (94%). Based only on clinical and laboratory findings, 13/43 patients (30.2%) were classified as gout according to ACR/EULAR criteria. In scenario A, additional 8 out of 30 (26.7%) patients were diagnosed as gout by DECT findings, and another 5/22 (22.7%) patients by aspiration findings. In scenario B, initial consideration of aspiration findings resulted in 10 out of 30 (33.3%) additionally identified patients, and another 3 (15%) patients by DECT findings. There was no relevant difference between scenarios A and B (p=0.508). CONCLUSIONS Combination of joint aspiration and DECT improves the diagnostic algorithm for gout. In our attempt to establish an optimal sequence of diagnostic tests, we did not identify an advantage for either synovial fluid analysis or DECT as the initially better modality after clinical examination and analysis of blood tests.
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Affiliation(s)
- Anica Nötzel
- Department of Radiology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Germany
| | - Kay-Geert Hermann
- Department of Radiology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Germany
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Germany
| | - Claudia Kedor
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Germany
| | - Andrea Stroux
- Department of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Germany
| | - Jürgen Mews
- Canon Medical Systems Europe, Zoetermeer, The Netherlands
| | | | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Germany.
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Mann C, Ziegeler K, Mews J, Plaschke M, Issever AS. Bone mineral density assessment using iterative reconstruction compared with quantitative computed tomography as the standard of reference. Sci Rep 2018; 8:15095. [PMID: 30305658 PMCID: PMC6179993 DOI: 10.1038/s41598-018-33444-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/15/2018] [Accepted: 09/28/2018] [Indexed: 12/13/2022] Open
Abstract
This study examines the influence of iterative reconstruction on bone mineral density (BMD) measurement by comparison with standard quantitative computed tomography (QCT; reference) and two other protocols based on filtered back projection. Ten human cadaver specimens of the lumbar spine with a hydroxyapatite calibration phantom underneath, were scanned with 4 protocols: 1. standard QCT, 2. volume scan with FBP, 3. helical scan with FBP, and 4. helical scan with IR (Adaptive Iterative Dose Reduction 3D (AIDR3D)). Radiation doses were recorded as CT dose index (CTDIvol) and BMD, signal-to-noise and contrast-to-noise ratio were calculated. Mean hydroxyapatite concentration (HOA) did not differ significantly between protocols, ranging from 98.58 ± 31.09 mg cm3 (protocol 4) to 100.47 ± 30.82 mg cm3 (protocol 2). Paired sample correlations of HOA values for protocol 4 and protocols 1, 2 and 3 were nearly perfect with coefficients of 0.980, 0.979 and 0.982, respectively (p < 0.004). CTDIvol were 7.50, 5.00, 6.82 (±2.03) and 1.72 (±0.50) mGy for protocols 1, 2, 3 and 4 respectively. Objective image quality was highest for protocol 4. The use of IR for BMD assessment significantly lowers radiation exposure compared to standard QCT and protocols with FBP while not degrading BMD measurement.
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Affiliation(s)
- Constanze Mann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Mews
- Canon Medical Systems Europe BV, Zoetermeer, Netherlands
| | - Martina Plaschke
- Department of Anatomy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ahi Sema Issever
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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