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Gassert FT, Kufner A, Renz M, Gassert FG, Bollwein C, Kronthaler S, Feuerriegel GC, Kirschke JS, Ganter C, Makowski MR, Braun C, Schwaiger BJ, Woertler K, Karampinos DC, Gersing AS. Comparing CT-Like Images Based on Ultra-Short Echo Time and Gradient Echo T1-Weighted MRI Sequences for the Assessment of Vertebral Disorders Using Histology and True CT as the Reference Standard. J Magn Reson Imaging 2024; 59:1542-1552. [PMID: 37501387 DOI: 10.1002/jmri.28927] [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: 05/05/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Several magnetic resonance (MR) techniques have been suggested for radiation-free imaging of osseous structures. PURPOSE To compare the diagnostic value of ultra-short echo time and gradient echo T1-weighted MRI for the assessment of vertebral pathologies using histology and computed tomography (CT) as the reference standard. STUDY TYPE Prospective. SUBJECTS Fifty-nine lumbar vertebral bodies harvested from 20 human cadavers (donor age 73 ± 13 years; 9 male). FIELD STRENGTH/SEQUENCE Ultra-short echo time sequence optimized for both bone (UTEb) and cartilage (UTEc) imaging and 3D T1-weighted gradient-echo sequence (T1GRE) at 3 T; susceptibility-weighted imaging (SWI) gradient echo sequence at 1.5 T. CT was performed on a dual-layer dual-energy CT scanner using a routine clinical protocol. ASSESSMENT Histopathology and conventional CT were acquired as standard of reference. Semi-quantitative and quantitative morphological features of degenerative changes of the spines were evaluated by four radiologists independently on CT and MR images independently and blinded to all other information. Features assessed were osteophytes, endplate sclerosis, visualization of cartilaginous endplate, facet joint degeneration, presence of Schmorl's nodes, and vertebral dimensions. Vertebral disorders were assessed by a pathologist on histology. STATISTICAL TESTS Agreement between T1GRE, SWI, UTEc, and UTEb sequences and CT imaging and histology as standard of reference were assessed using Fleiss' κ and intra-class correlation coefficients, respectively. RESULTS For the morphological assessment of osteophytes and endplate sclerosis, the overall agreement between SWI, T1GRE, UTEb, and UTEc with the reference standard (histology combined with CT) was moderate to almost perfect for all readers (osteophytes: SWI, κ range: 0.68-0.76; T1GRE: 0.92-1.00; UTEb: 0.92-1.00; UTEc: 0.77-0.85; sclerosis: SWI, κ range: 0.60-0.70; T1GRE: 0.77-0.82; UTEb: 0.81-0.92; UTEc: 0.61-0.71). For the visualization of the cartilaginous endplate, UTEc showed the overall best agreement with the reference standard (histology) for all readers (κ range: 0.85-0.93). DATA CONCLUSIONS Morphological assessment of vertebral pathologies was feasible and accurate using the MR-based bone imaging sequences compared to CT and histopathology. T1GRE showed the overall best performance for osseous changes and UTEc for the visualization of the cartilaginous endplate. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Florian T Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Kufner
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Martin Renz
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Felix G Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christine Bollwein
- Department of Pathology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sophia Kronthaler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg C Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Carl Ganter
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Braun
- Institute of Forensic Medicine, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Neuroradiology, University Hospital of Munich, LMU Munich, Munich, Germany
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Hinterwimmer F, Serena RS, Wilhelm N, Breden S, Consalvo S, Seidl F, Juestel D, Burgkart RHH, Woertler K, von Eisenhart-Rothe R, Neumann J, Rueckert D. Recommender-based bone tumour classification with radiographs-a link to the past. Eur Radiol 2024:10.1007/s00330-024-10672-0. [PMID: 38488971 DOI: 10.1007/s00330-024-10672-0] [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: 10/20/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES To develop an algorithm to link undiagnosed patients to previous patient histories based on radiographs, and simultaneous classification of multiple bone tumours to enable early and specific diagnosis. MATERIALS AND METHODS For this retrospective study, data from 2000 to 2021 were curated from our database by two orthopaedic surgeons, a radiologist and a data scientist. Patients with complete clinical and pre-therapy radiographic data were eligible. To ensure feasibility, the ten most frequent primary tumour entities, confirmed histologically or by tumour board decision, were included. We implemented a ResNet and transformer model to establish baseline results. Our method extracts image features using deep learning and then clusters the k most similar images to the target image using a hash-based nearest-neighbour recommender approach that performs simultaneous classification by majority voting. The results were evaluated with precision-at-k, accuracy, precision and recall. Discrete parameters were described by incidence and percentage ratios. For continuous parameters, based on a normality test, respective statistical measures were calculated. RESULTS Included were data from 809 patients (1792 radiographs; mean age 33.73 ± 18.65, range 3-89 years; 443 men), with Osteochondroma (28.31%) and Ewing sarcoma (1.11%) as the most and least common entities, respectively. The dataset was split into training (80%) and test subsets (20%). For k = 3, our model achieved the highest mean accuracy, precision and recall (92.86%, 92.86% and 34.08%), significantly outperforming state-of-the-art models (54.10%, 55.57%, 19.85% and 62.80%, 61.33%, 23.05%). CONCLUSION Our novel approach surpasses current models in tumour classification and links to past patient data, leveraging expert insights. CLINICAL RELEVANCE STATEMENT The proposed algorithm could serve as a vital support tool for clinicians and general practitioners with limited experience in bone tumour classification by identifying similar cases and classifying bone tumour entities. KEY POINTS • Addressed accurate bone tumour classification using radiographic features. • Model achieved 92.86%, 92.86% and 34.08% mean accuracy, precision and recall, respectively, significantly surpassing state-of-the-art models. • Enhanced diagnosis by integrating prior expert patient assessments.
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Affiliation(s)
- Florian Hinterwimmer
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
- Institute for AI and Informatics in Medicine, Technical University of Munich, Munich, Germany.
| | - Ricardo Smits Serena
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Institute for AI and Informatics in Medicine, Technical University of Munich, Munich, Germany
| | - Nikolas Wilhelm
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Breden
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sarah Consalvo
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fritz Seidl
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Dominik Juestel
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Institute at Helmholtz: Institute of Computational Biology, Oberschleißheim, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Rainer H H Burgkart
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ruediger von Eisenhart-Rothe
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan Neumann
- Musculoskeletal Radiology Section, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Rueckert
- Institute for AI and Informatics in Medicine, Technical University of Munich, Munich, Germany
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Ebrahimi Ardjomand S, Meurer F, Ehmann Y, Pogorzelski J, Waschulzik B, Makowski MR, Siebenlist S, Heuck A, Woertler K, Neumann J. Evaluation of Conventional MR Imaging of the Shoulder in the Diagnosis of Lesions of the Biceps Pulley. Acad Radiol 2024:S1076-6332(24)00062-X. [PMID: 38448326 DOI: 10.1016/j.acra.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/20/2024] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
RATIONALE AND OBJECTIVES To determine the diagnostic accuracy and reproducibility of conventional MR imaging (MRI) of the shoulder in evaluating biceps pulley lesions using arthroscopy as the standard of reference. METHODS In a retrospective study, MR examinations of 68 patients with arthroscopically proven torn or intact biceps pulley were assessed for the presence of pulley lesions by three radiologists. The following criteria were evaluated: displacement of the long head of the biceps tendon (LHBT) relative to the subscapularis tendon (displacement sign), subluxation/dislocation of the LHBT, the integrity of the superior glenohumeral ligament (SGHL) and the coracohumeral ligament (CHL), lesions of the supraspinatus (SSP) and subscapularis (SSC) tendons adjacent to the rotator interval, presence of biceps tendinopathy and subacromial bursitis. RESULTS There were 42 patients with pulley lesions in the study group. Conventional MR imaging showed an overall sensitivity of 95.2%, 88.1% and 92.9%, a specificity of 61.5%, 73.1%, and 80.8% and an accuracy of 82.4%, 82.4% and 88.2% in the diagnosis of pulley lesions. Interobserver agreement was substantial (multirater k = 0.75). Biceps tendinopathy (97.6%, 95.2%, 97.6%), defects of the SGHL (86.3%, 81.0%, 88.1%) and the displacement sign (88.1%, 81.0%, 85.7%) were the most sensitive diagnostic criteria. Subluxation/dislocation of the LHBT was insensitive (78.6%, 42.9%, 33.3%), but specific (69.2%, 100,0%, 96.2%). CONCLUSION In the diagnosis of pulley lesions, conventional MR imaging is reproducible and shows high sensitivity and accuracy but moderate specificity.
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Affiliation(s)
- Saba Ebrahimi Ardjomand
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Felix Meurer
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Yannick Ehmann
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Birgit Waschulzik
- Institute for AI and Informatics in Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Andreas Heuck
- Clinic and Polyclinic of Radiology, Ludwig-Maximilian-University Hospital, Marchioninistraße 15, 81377 Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Jan Neumann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
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Klontzas ME, Vassalou EE, Spanakis K, Meurer F, Woertler K, Zibis A, Marias K, Karantanas AH. Deep learning enables the differentiation between early and late stages of hip avascular necrosis. Eur Radiol 2024; 34:1179-1186. [PMID: 37581656 PMCID: PMC10853078 DOI: 10.1007/s00330-023-10104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To develop a deep learning methodology that distinguishes early from late stages of avascular necrosis of the hip (AVN) to determine treatment decisions. METHODS Three convolutional neural networks (CNNs) VGG-16, Inception ResnetV2, InceptionV3 were trained with transfer learning (ImageNet) and finetuned with a retrospectively collected cohort of (n = 104) MRI examinations of AVN patients, to differentiate between early (ARCO 1-2) and late (ARCO 3-4) stages. A consensus CNN ensemble decision was recorded as the agreement of at least two CNNs. CNN and ensemble performance was benchmarked on an independent cohort of 49 patients from another country and was compared to the performance of two MSK radiologists. CNN performance was expressed with areas under the curve (AUC), the respective 95% confidence intervals (CIs) and precision, and recall and f1-scores. AUCs were compared with DeLong's test. RESULTS On internal testing, Inception-ResnetV2 achieved the highest individual performance with an AUC of 99.7% (95%CI 99-100%), followed by InceptionV3 and VGG-16 with AUCs of 99.3% (95%CI 98.4-100%) and 97.3% (95%CI 95.5-99.2%) respectively. The CNN ensemble the same AUCs Inception ResnetV2. On external validation, model performance dropped with VGG-16 achieving the highest individual AUC of 78.9% (95%CI 51.6-79.6%) The best external performance was achieved by the model ensemble with an AUC of 85.5% (95%CI 72.2-93.9%). No significant difference was found between the CNN ensemble and expert MSK radiologists (p = 0.22 and 0.092 respectively). CONCLUSION An externally validated CNN ensemble accurately distinguishes between the early and late stages of AVN and has comparable performance to expert MSK radiologists. CLINICAL RELEVANCE STATEMENT This paper introduces the use of deep learning for the differentiation between early and late avascular necrosis of the hip, assisting in a complex clinical decision that can determine the choice between conservative and surgical treatment. KEY POINTS • A convolutional neural network ensemble achieved excellent performance in distinguishing between early and late avascular necrosis. • The performance of the deep learning method was similar to the performance of expert readers.
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Affiliation(s)
- Michail E Klontzas
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
- Department of Medical Imaging, University Hospital of Heraklion, 71110, Voutes, Crete, Greece
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Nikolaou Plastira 100, 70013, Heraklion, Crete, Greece
| | - Evangelia E Vassalou
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Konstantinos Spanakis
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Felix Meurer
- Musculoskeletal Radiology Section, TUM School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, TUM School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Aristeidis Zibis
- Department of Anatomy, Medical School, University of Thessaly, Neofytou 9 St., 41223, Larissa, Greece
| | - Kostas Marias
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece
- Department of Electrical & Computer Engineering, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece.
- Department of Medical Imaging, University Hospital of Heraklion, 71110, Voutes, Crete, Greece.
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece.
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Nikolaou Plastira 100, 70013, Heraklion, Crete, Greece.
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Feuerriegel GC, Weiss K, Tu Van A, Leonhardt Y, Neumann J, Gassert FT, Haas Y, Schwarz M, Makowski MR, Woertler K, Karampinos DC, Gersing AS. Deep-learning-based image quality enhancement of CT-like MR imaging in patients with suspected traumatic shoulder injury. Eur J Radiol 2024; 170:111246. [PMID: 38056345 DOI: 10.1016/j.ejrad.2023.111246] [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: 10/16/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of CT-like MR images reconstructed with an algorithm combining compressed sense (CS) with deep learning (DL) in patients with suspected osseous shoulder injury compared to conventional CS-reconstructed images. METHODS Thirty-two patients (12 women, mean age 46 ± 14.9 years) with suspected traumatic shoulder injury were prospectively enrolled into the study. All patients received MR imaging of the shoulder, including a CT-like 3D T1-weighted gradient-echo (T1 GRE) sequence and in case of suspected fracture a conventional CT. An automated DL-based algorithm, combining CS and DL (CS DL) was used to reconstruct images of the same k-space data as used for CS reconstructions. Two musculoskeletal radiologists assessed the images for osseous pathologies, image quality and visibility of anatomical landmarks using a 5-point Likert scale. Moreover, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. RESULTS Compared to CT, all acute fractures (n = 23) and osseous pathologies were detected accurately on the CS only and CS DL images with almost perfect agreement between the CS DL and CS only images (κ 0.95 (95 %confidence interval 0.82-1.00). Image quality as well as the visibility of the fracture lines, bone fragments and glenoid borders were overall rated significantly higher for the CS DL reconstructions than the CS only images (CS DL range 3.7-4.9 and CS only range 3.2-3.8, P = 0.01-0.04). Significantly higher SNR and CNR values were observed for the CS DL reconstructions (P = 0.02-0.03). CONCLUSION Evaluation of traumatic shoulder pathologies is feasible using a DL-based algorithm for reconstruction of high-resolution CT-like MR imaging.
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Affiliation(s)
- Georg C Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | | | - Anh Tu Van
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Yannik Leonhardt
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Jan Neumann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Florian T Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Yannick Haas
- Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Markus Schwarz
- Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Department of Neuroradiology, University Hospital of Munich, LMU Munich, Munich, Germany.
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6
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Feuerriegel GC, Kronthaler S, Weiss K, Haller B, Leonhardt Y, Neumann J, Pfeiffer D, Hesse N, Erber B, Schwaiger BJ, Makowski MR, Woertler K, Karampinos DC, Wurm M, Gersing AS. Assessment of glenoid bone loss and other osseous shoulder pathologies comparing MR-based CT-like images with conventional CT. Eur Radiol 2023; 33:8617-8626. [PMID: 37453986 PMCID: PMC10667374 DOI: 10.1007/s00330-023-09939-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/20/2022] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To evaluate and compare the diagnostic performance of CT-like images based on a 3D T1-weighted spoiled gradient-echo sequence (T1 GRE), an ultra-short echo time sequence (UTE), and a 3D T1-weighted spoiled multi-echo gradient-echo sequence (FRACTURE) with conventional CT in patients with suspected osseous shoulder pathologies. MATERIALS AND METHODS Patients with suspected traumatic dislocation of the shoulder (n = 46, mean age 40 ± 14.5 years, 19 women) were prospectively recruited and received 3-T MR imaging including 3D T1 GRE, UTE, and 3D FRACTURE sequences. CT was performed in patients with acute fractures and served as standard of reference (n = 25). Agreement of morphological features between the modalities was analyzed including the glenoid bone loss, Hill-Sachs interval, glenoid track, and the anterior straight-line length. Agreement between the modalities was assessed using Bland-Altman plots, Student's t-test, and Pearson's correlation coefficient. Inter- and intrareader assessment was evaluated with weighted Cohen's κ and intraclass correlation coefficient. RESULTS All osseous pathologies were detected accurately on all three CT-like sequences (n = 25, κ = 1.00). No significant difference in the percentage of glenoid bone loss was found between CT (mean ± standard deviation, 20.3% ± 8.0) and CT-like MR images (FRACTURE 20.6% ± 7.9, T1 GRE 20.4% ± 7.6, UTE 20.3% ± 7.7, p > 0.05). When comparing the different measurements on CT-like images, measurements performed using the UTE images correlated best with CT. CONCLUSION Assessment of bony Bankart lesions and other osseous pathologies was feasible and accurate using CT-like images based on 3-T MRI compared with conventional CT. Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT. CLINICAL RELEVANCE STATEMENT In an acute trauma setting, CT-like images based on a T1 GRE, UTE, or FRACTURE sequence might be a useful alternative to conventional CT scan sparing associated costs as well as radiation exposure. KEY POINTS • No significant differences were found for the assessment of the glenoid bone loss when comparing measurements of CT-like MR images with measurements of conventional CT images. • Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT whereas the FRACTURE sequence appeared to be the most robust regarding motion artifacts. • The T1 GRE sequence had the highest resolution with high bone contrast and detailed delineation of even small fractures but was more susceptible to motion artifacts.
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Affiliation(s)
- Georg C Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Sophia Kronthaler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | | | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Yannik Leonhardt
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jan Neumann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Bernd Erber
- Department of Radiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital of Munich, LMU Munich, Munich, Germany
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7
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Feuerriegel GC, Weiss K, Kronthaler S, Leonhardt Y, Neumann J, Wurm M, Lenhart NS, Makowski MR, Schwaiger BJ, Woertler K, Karampinos DC, Gersing AS. Evaluation of a deep learning-based reconstruction method for denoising and image enhancement of shoulder MRI in patients with shoulder pain. Eur Radiol 2023; 33:4875-4884. [PMID: 36806569 PMCID: PMC10289918 DOI: 10.1007/s00330-023-09472-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 12/02/2022] [Revised: 01/07/2023] [Accepted: 01/22/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of an automated reconstruction algorithm combining MR imaging acquired using compressed SENSE (CS) with deep learning (DL) in order to reconstruct denoised high-quality images from undersampled MR images in patients with shoulder pain. METHODS Prospectively, thirty-eight patients (14 women, mean age 40.0 ± 15.2 years) with shoulder pain underwent morphological MRI using a pseudo-random, density-weighted k-space scheme with an acceleration factor of 2.5 using CS only. An automated DL-based algorithm (CS DL) was used to create reconstructions of the same k-space data as used for CS reconstructions. Images were analyzed by two radiologists and assessed for pathologies, image quality, and visibility of anatomical landmarks using a 4-point Likert scale. RESULTS Overall agreement for the detection of pathologies between the CS DL reconstructions and CS images was substantial to almost perfect (κ 0.95 (95% confidence interval 0.82-1.00)). Image quality and the visibility of the rotator cuff, articular cartilage, and axillary recess were overall rated significantly higher for CS DL images compared to CS (p < 0.03). Contrast-to-noise ratios were significantly higher for cartilage/fluid (CS DL 198 ± 24.3, CS 130 ± 32.2, p = 0.02) and ligament/fluid (CS DL 184 ± 17.3, CS 141 ± 23.5, p = 0.03) and SNR values were significantly higher for ligaments and muscle of the CS DL reconstructions (p < 0.04). CONCLUSION Evaluation of shoulder pathologies was feasible using a DL-based algorithm for MRI reconstruction and denoising. In clinical routine, CS DL may be beneficial in particular for reducing image noise and may be useful for the detection and better discrimination of discrete pathologies. Assessment of shoulder pathologies was feasible with improved image quality as well as higher SNR using a compressed sensing deep learning-based framework for image reconstructions and denoising. KEY POINTS • Automated deep learning-based reconstructions showed a significant increase in signal-to-noise ratio and contrast-to-noise ratio (p < 0.04) with only a slight increase of reconstruction time of 40 s compared to CS. • All pathologies were accurately detected with no loss of diagnostic information or prolongation of the scan time. • Significant improvements of the image quality as well as the visibility of the rotator cuff, articular cartilage, and axillary recess were detected.
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Affiliation(s)
- Georg C Feuerriegel
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | | | - Sophia Kronthaler
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Yannik Leonhardt
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jan Neumann
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nicolas S Lenhart
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital of Munich, LMU Munich, Munich, Germany
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8
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Lacheta L, Siebenlist S, Scheiderer B, Beitzel K, Woertler K, Imhoff AB, Buchmann S, Willinger L. Intact revision rotator cuff repair stabilizes muscle atrophy and fatty infiltration after minimum follow up of two years. BMC Musculoskelet Disord 2023; 24:515. [PMID: 37353825 DOI: 10.1186/s12891-023-06616-2] [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: 08/14/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The extent of fatty infiltration and rotator cuff (RC) atrophy is crucial for the clinical results after rotator cuff repair (RCR). The purpose of this study was to evaluate changes in fatty infiltration and RC atrophy after revision RCR and to correlate them with functional outcome parameters. METHODS Patients who underwent arthroscopic revision RCR for symptomatic recurrent full-thickness tear of the supraspinatus tendon between 2008 and 2014 and were retrospectively reviewed with a minimum follow up of 2 years. Magnetic resonance imaging (MRI) was performed pre- and postoperatively to assess 1) tendon integrity after revision RCR according to Sugaya classification, (2) RC atrophy according to Thomazeau classification, and (3) fatty infiltration according to Fuchs MRI classification. Constant score (CS) and the American Shoulder and Elbow Surgeon (ASES) score were used to correlate functional outcome, tendon integrity, and muscle degeneration. RESULTS 19 patients (17 males and 2 females) with a mean age of 57.5 years (range, 34 to 72) were included into the study at a mean follow-up of 50.3 months (range, 24 - 101). At final evaluation, 9 patients (47%) presented with intact RCR and 10 patients (53%) suffered a re-tear after revision repair. No progress of fatty infiltration was observed postoperatively in the group with intact RC, atrophy progressed in only 1 out of 9 patient (11%). Fatty infiltration progressed in 5/10 patients (50%) and RC atrophy increased in 2/10 patients (20%) within the re-tear group. CS (42.7 ± 17.7 preop, 65.2 ± 20.1 postop) and ASES (47.7 ± 17.2 preop, 75.4 ± 23.7 postop) improved significantly from pre- to postoperatively (p < 0.001). A positive correlation between fatty infiltration and RC integrity was detected (r = 0.77, p < 0.01). No correlation between clinical outcome and tendon integrity or RC atrophy was observed. CONCLUSION Arthroscopic revision RCR leads to reliable functional outcomes even in case of a recurrent RC retear. An intact RCR maintains the preoperative state of fatty infiltration and muscle atrophy but does not lead to muscle regeneration. LEVEL OF EVIDENCE Level IV; Therapeutic study.
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Affiliation(s)
- Lucca Lacheta
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- ATOS Orthoparc Klinik, Cologne, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stefan Buchmann
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Orthopaedisches Fachzentrum (OFZ) Weilheim/Garmisch/Starnberg/Penzberg, Weilheim, Germany
| | - Lukas Willinger
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Foreman SC, Llorián-Salvador O, David DE, Rösner VKN, Rischewski JF, Feuerriegel GC, Kramp DW, Luiken I, Lohse AK, Kiefer J, Mogler C, Knebel C, Jung M, Andrade-Navarro MA, Rost B, Combs SE, Makowski MR, Woertler K, Peeken JC, Gersing AS. Development and Evaluation of MR-Based Radiogenomic Models to Differentiate Atypical Lipomatous Tumors from Lipomas. Cancers (Basel) 2023; 15:cancers15072150. [PMID: 37046811 PMCID: PMC10093205 DOI: 10.3390/cancers15072150] [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] [Received: 01/17/2023] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
Background: The aim of this study was to develop and validate radiogenomic models to predict the MDM2 gene amplification status and differentiate between ALTs and lipomas on preoperative MR images. Methods: MR images were obtained in 257 patients diagnosed with ALTs (n = 65) or lipomas (n = 192) using histology and the MDM2 gene analysis as a reference standard. The protocols included T2-, T1-, and fat-suppressed contrast-enhanced T1-weighted sequences. Additionally, 50 patients were obtained from a different hospital for external testing. Radiomic features were selected using mRMR. Using repeated nested cross-validation, the machine-learning models were trained on radiomic features and demographic information. For comparison, the external test set was evaluated by three radiology residents and one attending radiologist. Results: A LASSO classifier trained on radiomic features from all sequences performed best, with an AUC of 0.88, 70% sensitivity, 81% specificity, and 76% accuracy. In comparison, the radiology residents achieved 60–70% accuracy, 55–80% sensitivity, and 63–77% specificity, while the attending radiologist achieved 90% accuracy, 96% sensitivity, and 87% specificity. Conclusion: A radiogenomic model combining features from multiple MR sequences showed the best performance in predicting the MDM2 gene amplification status. The model showed a higher accuracy compared to the radiology residents, though lower compared to the attending radiologist.
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Affiliation(s)
- Sarah C. Foreman
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Oscar Llorián-Salvador
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
- Department of Informatics, Bioinformatics and Computational Biology—i12, Technische Universität München, Boltzmannstr. 3, 85748 Munich, Germany
- Institute of Organismic and Molecular Evolution, Johannes Gutenberg University Mainz, Hanns-Dieter-Hüsch-Weg 15, 55128 Mainz, Germany
| | - Diana E. David
- Department of Informatics, Bioinformatics and Computational Biology—i12, Technische Universität München, Boltzmannstr. 3, 85748 Munich, Germany
| | - Verena K. N. Rösner
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Jon F. Rischewski
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany
| | - Georg C. Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Daniel W. Kramp
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Ina Luiken
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Ann-Kathrin Lohse
- Department of Radiology, University Hospital Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany
| | - Jurij Kiefer
- Department of Plastic Surgery, University Hospital Freiburg, University of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Carolin Mogler
- Institute of Pathology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Carolin Knebel
- Department of Orthopedics and Sport Orthopedics, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Matthias Jung
- Department of Radiology, University Hospital Freiburg, University of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Miguel A. Andrade-Navarro
- Institute of Organismic and Molecular Evolution, Johannes Gutenberg University Mainz, Hanns-Dieter-Hüsch-Weg 15, 55128 Mainz, Germany
| | - Burkhard Rost
- Department of Informatics, Bioinformatics and Computational Biology—i12, Technische Universität München, Boltzmannstr. 3, 85748 Munich, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Marcus R. Makowski
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Jan C. Peeken
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Radiation Medicine Neuherberg, 85764 Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, 69120 Heidelberg, Germany
| | - Alexandra S. Gersing
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany
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10
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Woertler K, Neumann J. Atraumatic Bone Marrow Edema Involving the Epiphyses. Semin Musculoskelet Radiol 2023; 27:45-53. [PMID: 36868244 DOI: 10.1055/s-0043-1761498] [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: 03/05/2023]
Abstract
Bone marrow edema (BME)-like signal intensity involving the epiphyses of tubular bones represents a frequent magnetic resonance imaging finding associated with a wide spectrum of bone and joint disorders. It is important to distinguish this finding from cellular infiltration of bone marrow and to be aware of the differential diagnosis of underlying causes. With a general focus on the adult musculoskeletal system, this article reviews the pathophysiology, clinical presentation, histopathology, and imaging findings of nontraumatic conditions associated with epiphyseal BME-like signal intensity: transient bone marrow edema syndrome, subchondral insufficiency fracture, avascular necrosis, osteoarthritis, arthritis, and bone neoplasms.
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Affiliation(s)
- Klaus Woertler
- Musculoskeletal Radiology Section, TUM, Munich, Germany.,Interdisciplinary Musculoskeletal Tumor Center, TUM, Munich, Germany
| | - Jan Neumann
- Musculoskeletal Radiology Section, TUM, Munich, Germany
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11
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Themessl A, Wagner T, Rupp MC, Degenhardt H, Woertler K, Hatter KA, Imhoff AB, Siebenlist S, Pogorzelski J. "Functional outcomes and MRI-based tendon healing after (antero-) superior rotator cuff repair among patients under 50 years: retrospective analysis of traumatic versus non-traumatic rotator cuff tears". BMC Musculoskelet Disord 2023; 24:52. [PMID: 36670374 PMCID: PMC9862981 DOI: 10.1186/s12891-023-06174-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Rotator cuff tears among patients under 50 years either result from an adequate trauma or are considered non-traumatic due to work-related or athletic overuse. The impact of these different mechanisms on postoperative functional outcomes and tendon healing has not yet been fully understood. Therefore, it was the purpose of this study to investigate the influence of etiology of (antero-)superior rotator cuff tears on postoperative outcomes and the healing rates after arthroscopic rotator cuff repair in a young patient population. METHODS Patients under 50 years who underwent arthroscopic rotator cuff repair between 2006-2017 for an anterosuperior rotator cuff tear with a minimum follow up of 24 months were included in this study. Revision surgeries or reconstructive concomitant procedures other than long head of the biceps tenodesis were excluded. Patients were divided into two groups according to the etiology of their rotator cuff tear (traumatic vs. non-traumatic). Demographic and outcome scores including the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score (CS), bilateral strength measurements and postoperative tendon integrity evaluated on magnetic resonance imaging (MRI) were assessed and compared between both groups. RESULTS The mean follow up for this study was 55.6 months (24 - 158). Twenty-one patients (50.0%) had a traumatic RCT and 21 patients (50.0%) had a non-traumatic tear. Outcome scores did not differ significantly between groups. Strength measurements of the supraspinatus revealed significantly decreased force of the affected side as opposed to the contralateral side (p = 0.001), regardless of etiology. Retear rates were similar in both groups (37.5% and 33.3%, p = n.s.). Cuff integrity at follow-up was not predictive of superior scores or strength. CONCLUSION Surgical treatment of traumatic and non-traumatic RCT yields good clinical results in patients under the age of 50. The etiology of the rotator cuff tear did not significantly affect postoperative outcomes or healing rates. About one third of the patients suffered from a retear postoperatively, however retears were not predictive of inferior outcomes at midterm follow-up. STUDY DESIGN Level III. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Alexander Themessl
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Timon Wagner
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marco-Christopher Rupp
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Hannes Degenhardt
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Klaus Woertler
- grid.6936.a0000000123222966Department of Radiology, Technical University of Munich, Munich, Germany
| | - Kate A. Hatter
- grid.189509.c0000000100241216Department of Surgery/ Emergency Medicine, Duke University Hospital, Durham, NC USA
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jonas Pogorzelski
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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12
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Stacchiotti S, Dürr HR, Schaefer IM, Woertler K, Haas R, Trama A, Caraceni A, Bajpai J, Baldi GG, Bernthal N, Blay JY, Boye K, Broto JM, Chen WWT, Dei Tos PA, Desai J, Emhofer S, Eriksson M, Gronchi A, Gelderblom H, Hardes J, Hartmann W, Healey J, Italiano A, Jones RL, Kawai A, Leithner A, Loong H, Mascard E, Morosi C, Otten N, Palmerini E, Patel SR, Reichardt P, Rubin B, Rutkowski P, Sangalli C, Schuster K, Seddon BM, Shkodra M, Staals EL, Tap W, van de Rijn M, van Langevelde K, Vanhoenacker FMM, Wagner A, Wiltink L, Stern S, Van de Sande VM, Bauer S. Best clinical management of tenosynovial giant cell tumour (TGCT): A consensus paper from the community of experts. Cancer Treat Rev 2023; 112:102491. [PMID: 36502615 DOI: 10.1016/j.ctrv.2022.102491] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
Tenosynovial giant cell tumour (TGCT) is a rare, locally aggressive, mesenchymal tumor arising from the joints, bursa and tendon sheaths. TGCT comprises a nodular- and a diffuse-type, with the former exhibiting mostly indolent course and the latter a locally aggressive behavior. Although usually not life-threatening, TGCT may cause chronic pain and adversely impact function and quality of life (QoL). CSFR1 inhibitors are effective with benefit on symptoms and QoL but are not available in most countries. The degree of uncertainty in selecting the most appropriate therapy and the lack of guidelines on the clinical management of TGCT make the adoption of new treatments inconsistent across the world, with suboptimal outcomes for patients. A global consensus meeting was organized in June 2022, involving experts from several disciplines and patient representatives from SPAGN to define the best evidence-based practice for the optimal approach to TGCT and generate the recommendations presented herein.
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Affiliation(s)
- Silvia Stacchiotti
- Department of cancer medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Hans Roland Dürr
- Department of Orthopaedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Inga-Marie Schaefer
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - Klaus Woertler
- Department of Radiology, Technische Universität München, Munich, Germany
| | - Rick Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Jyoti Bajpai
- Department of Medical Oncology, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Jean-Yves Blay
- Department of Medical Oncology, Université Centre Léon Bérard, Lyon, France
| | - Kjetil Boye
- Department of Medical Oncology, Oslo University Hospital, Oslo, Norway
| | - Javier-Martin Broto
- Oncology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Wei-Wu Tom Chen
- Department of Medical Oncology, National Taiwan University Hospital and Cancer Center, Taiwan
| | | | - Jayesh Desai
- Peter MacCallum Cancer Centre/Royal Melbourne Hospital, Melbourne, Australia
| | | | - Mikael Eriksson
- Department of Medical Oncology, LUCC - Lund University Cancer Centre, Lund, Sweden
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jendrik Hardes
- Department of Orthopaedic Oncology, Uniklinik Essen, Essen, Germany
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute for Pathology, Uniklinik Münster, Münster, Germany
| | - John Healey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden, London, United Kingdom
| | - Akira Kawai
- Department of Muscoloskeletal Oncology, National Cancer Center Hospital (NCCH), Tokyo, Japan
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medizinische Universität Graz, Graz, Austria
| | - Herbert Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - Eric Mascard
- Department of Paediatric Orthopaedic Surgery, Clinique Arago, Paris, France
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Emanuela Palmerini
- Department of Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Peter Reichardt
- Department of Medical Oncology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Brian Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute and Department of Cancer Biology, Cleveland Clinic, Cleveland, USA
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Claudia Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Beatrice M Seddon
- Department of Oncology, University College Hospital London, London, United Kingdom
| | - Morena Shkodra
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Eric L Staals
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - William Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, USA
| | | | | | | | - Andrew Wagner
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - Lisette Wiltink
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sydney Stern
- Patient Representative, Life Raft Group, and Pharmacokinetics, University of Maryland Baltimore, USA
| | | | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, Uniklinik Essen, Essen, Germany
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13
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Muench LN, Achtnich A, Krivec L, Diermeier T, Woertler K, Braun S, Imhoff AB, Willinger L. Clinical outcome and healing rate after meniscal bucket handle tear repair. BMC Musculoskelet Disord 2022; 23:1063. [PMID: 36471335 PMCID: PMC9721037 DOI: 10.1186/s12891-022-06037-7] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Reports combining patient-reported outcome measures, clinical evaluation, and radiographic assessment of postoperative healing after arthroscopic repair of bucket-handle meniscal tears (BHMT) are scarce. METHODS Patients who underwent arthroscopic repair for acute traumatic BHMTs between October 2011 and March 2016 with a minimum follow-up of two years were included. Postoperative outcome scores comprised the International Knee Documentation Society Score (IKDC), Lysholm score, Tegner activity score (TAS), and visual analog scale (VAS) for pain. Clinical meniscal healing failure was assessed according to Barrett's criteria. Side-to-side difference in knee laxity was measured using KT-2000. Radiographic healing was assessed by 3-Tesla magnetic resonance imaging (MRI) and classified according to Henning's criteria at final follow-up. RESULTS Forty patients with a mean age of 32.0 ± 11.5 years were available for follow-up after 51.8 ± 14.3 months. Revision surgery by means of arthroscopic partial meniscectomy was performed in four patients (10%) prior to the follow-up visit. The clinical healing rate was 83.3% at final follow-up. Mean IKDC score was 82.8 ± 13.8 and Lysholm score was 77.4 ± 24.8. Of all patients, 87.5% reached or exceeded the patient-acceptable symptomatic state (PASS) criteria for the IKDC score at final follow-up. The median TAS was 6 and VAS for pain was 0.46 ± 0.9. Side-to-side difference in knee laxity was higher in patients with concomitant ACL reconstruction (2.1 ± 2.7 mm) compared to isolated BHMTs (1.0 ± 2.0 mm). MR examination showed 69.4% healed, 25.0% partially healed, and 5.6% unhealed menisci. CONCLUSION Patients who underwent repair for acute traumatic BHMTs achieved good to excellent clinical outcome along with a high rate of meniscal healing at a minimum follow-up of two years. Clinical and radiological healing rates were similarly satisfactory and most patients exceeded the PASS criteria for the IKDC score. Patients were able to reach a high postoperative activity level. LEVEL OF EVIDENCE Case Series; IV.
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Affiliation(s)
- Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Andrea Achtnich
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Lukas Krivec
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Theresa Diermeier
- grid.460088.20000 0001 0547 1053Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Klaus Woertler
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, TU Munich, Munich, Germany
| | - Sepp Braun
- grid.487341.dGelenkpunkt - Sports- and Joint Surgery Innsbruck, Innsbruck, Austria ,UMIT - OSMI- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University UMIT, Hall/ Tirol, Austria
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Lukas Willinger
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
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14
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Prexler C, Knape MS, Erlewein-Schweizer J, Roll W, Specht K, Woertler K, Weichert W, von Luettichau I, Rossig C, Hauer J, Richter GHS, Weber W, Burdach S. Correlation of Transcriptomics and FDG-PET SUVmax Indicates Reciprocal Expression of Stemness-Related Transcription Factor and Neuropeptide Signaling Pathways in Glucose Metabolism of Ewing Sarcoma. Cancers (Basel) 2022; 14:cancers14235999. [PMID: 36497479 PMCID: PMC9735504 DOI: 10.3390/cancers14235999] [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: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In Ewing sarcoma (EwS), long-term treatment effects and poor survival rates for relapsed or metastatic cases require individualization of therapy and the discovery of new treatment methods. Tumor glucose metabolic activity varies significantly between patients, and FDG-PET signals have been proposed as prognostic factors. However, the biological basis for the generally elevated but variable glucose metabolism in EwS is not well understood. METHODS We retrospectively included 19 EwS samples (17 patients). Affymetrix gene expression was correlated with maximal standardized uptake value (SUVmax) using machine learning, linear regression modelling, and gene set enrichment analyses for functional annotation. RESULTS Expression of five genes correlated (MYBL2, ELOVL2, NETO2) or anticorrelated (FAXDC2, PLSCR4) significantly with SUVmax (adjusted p-value ≤ 0.05). Additionally, we identified 23 genes with large SUVmax effect size, which were significantly enriched for "neuropeptide Y receptor activity (GO:0004983)" (adjusted p-value = 0.0007). The expression of the members of this signaling pathway (NPY, NPY1R, NPY5R) anticorrelated with SUVmax. In contrast, three transcription factors associated with maintaining stemness displayed enrichment of their target genes with higher SUVmax: RNF2, E2F family, and TCF3. CONCLUSION Our large-scale analysis examined comprehensively the correlations between transcriptomics and tumor glucose utilization. Based on our findings, we hypothesize that stemness may be associated with increased glucose uptake, whereas neuroectodermal differentiation may anticorrelate with glucose uptake.
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Affiliation(s)
- Carolin Prexler
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, 80804 Munich, Germany
| | - Marie Sophie Knape
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, 80804 Munich, Germany
| | | | - Wolfgang Roll
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Munster, Germany
| | - Katja Specht
- Institute of Pathology, Technische Universität München, 81675 Munich, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, Technische Universität München, 81675 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 81675 Munich, Germany
| | - Irene von Luettichau
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, 80804 Munich, Germany
- ERN PaedCan, 1090 Vienna, Austria
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Muenster, 48149 Muenster, Germany
- Cells-in-Motion Cluster of Excellence (EXC 1003-CiM), University of Muenster, 48149 Muenster, Germany
| | - Julia Hauer
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, 80804 Munich, Germany
| | - Guenther H. S. Richter
- Department of Pediatrics, Division of Oncology and Hematology, Charite–Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, 13353 Berlin, Germany
| | - Wolfgang Weber
- German Cancer Consortium (DKTK), Partner Site Munich, 81675 Munich, Germany
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Stefan Burdach
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, 80804 Munich, Germany
- Institute of Pathology, Technische Universität München, 81675 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 81675 Munich, Germany
- Academy of Translational Medicine and Department of Molecular Oncology–British Columbia Cancer Research Centre, University of British Columbia, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada
- Correspondence:
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15
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Winkler PW, Geyer S, Walzl D, Woertler K, Paul J, Siebenlist S, Imhoff AB, Achtnich A. Favorable long-term clinical and radiologic outcomes with high survivorship after autologous osteochondral transplantation of the talus. Knee Surg Sports Traumatol Arthrosc 2022; 31:2166-2173. [PMID: 36394584 PMCID: PMC10183420 DOI: 10.1007/s00167-022-07237-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate long-term clinical and radiologic outcomes of patients undergoing autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and to perform a correlation analysis between clinical and radiologic outcomes. METHODS Thirty-five patients with a mean age of 32.2 ± 8.9 years undergoing AOT for OLT between 1997 and 2003 were available for follow-up after an average of 19.1 ± 1.4 years. Demographic, surgical, and injury-related data were collected. After a minimum 18-year follow-up, patient-reported outcome scores (PROs) were collected, including the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot and Ankle Outcome Score (FAOS), Tegner Activity Scale, and Visual Analogue Scale (VAS) for pain of the ankle. The Lysholm Score and VAS for pain of the knee were collected to assess donor-site morbidity. Magnetic resonance imaging scans were obtained to conduct an assessment of the replaced cartilage using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scoring system. Any revision surgery (except symptomatic hardware removal and arthroscopic debridement) was defined as clinical failure. RESULTS Favorable clinical and radiologic (MOCART score, 73.7 ± 16.7 points) outcomes without any donor-site morbidities were observed. Twenty-three (65.7%) patients were satisfied or very satisfied with the surgical treatment. Fourteen (40.0%) and 25 (71.4%) patients had no or minor limitations in their athletic and working performance, respectively. A significant correlation between the MOCART and the FAOS Sport and Recreational activities subscale was found (rs, 0.491; p = 0.033). Six (17.1%) patients met the criteria for clinical failure an average of 12.2 ± 6.6 years after AOT. Survival analysis demonstrated a mean estimated time of survival of 21.3 years (95% CI [19.55, 22.96]) and a 20-year survival rate of 77.9%. CONCLUSION Autologous osteochondral transplantation to treat OLT achieves high patient satisfaction and favorable PROs with a 20-year survival rate of almost 80%. Given the high clinical efficacy of AOT, this procedure can be recommended as a safe and promising technique for the long-term therapy of OLT. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Philipp W Winkler
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniela Walzl
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | | | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Andrea Achtnich
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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16
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Boxberg M, Langer R, Woertler K, Knebel C, Rechl H, von Eisenhart-Rothe R, Weichert W, Combs SE, Hadjamu M, Röper B, Specht K. Neoadjuvant Radiation in High-Grade Soft-Tissue Sarcomas: Histopathologic Features and Response Evaluation. Am J Surg Pathol 2022; 46:1060-1070. [PMID: 35687332 DOI: 10.1097/pas.0000000000001922] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this study, we sought to determine the prognostic value of both the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group (EORTC-STBSG) score and the histologic parameters viable tumor, coagulative necrosis, hyalinization/fibrosis, and infarction in patients (n=64) with localized, nonmetastatic high-grade soft-tissue sarcomas after preoperative radiomonotherapy. A standardized macroscopic workup for pretreated surgical specimen including evaluation of a whole section of high-grade soft tissue sarcomas in the largest diameter, was used. Association with overall survival and disease-free survival was assessed. Limb salvage could be accomplished in 98.4% of patients. Overall, 90.6% tumors had negative resection margins. The median postoperative tumor diameter was 9 cm. Undifferentiated pleomorphic sarcoma (42.2%) and myxofibrosarcoma (17.2%) were the most common diagnoses. In all, 9.4% of patients had local recurrence despite clear resection margins, and 50% had distant metastases. Morphologic mapping suggests an overall heterogenous intratumoral response to radiotherapy, with significant differences among histologic subtypes. Complete regression (0% vital tumor cells) was not seen. Categorizing the results according to the proposed EORTC-STBSG 5-tier response score, <1% viable tumor cells were seen in 3.1%, ≥1% to <10% viable tumor cells in 20.4%, ≥10% to <50% viable tumor cells in 35.9% and ≥50% viable tumor cells in 40.6% of cases. Mean values for viable tumor cells were 40% (range: 1% to 100%), coagulative necrosis 5% (0% to 60%), hyalinization/fibrosis 25% (0% to 90%) and infarction 15% (0% to 79%). Hyalinization/fibrosis was a significant independent prognostic factor for overall survival (hazard ratio=4.4; P =0.047), while the other histologic parameters including the EORTC-STBSG score were not prognostic.
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Affiliation(s)
| | - Rupert Langer
- Institute of Clinical Pathology and Molecular Pathology, Johannes Kepler University and Kepler University Hospital Linz, Linz, Austria
| | | | | | | | | | | | - Stephanie E Combs
- Radiation Oncology, rechts der Isar Hospital, Technical University of Munich
- German Cancer Consortium (DKTK), Partner Site Munich
- Institute of Radiation Medicine (IRM), Helmholtz Munich, Ober-schleißheim, Germany
| | - Miriam Hadjamu
- Radiation Oncology, rechts der Isar Hospital, Technical University of Munich
- Ambulatory Health Care Centre "Radiotherapy" Harlaching/Bogenhausen, Munich
| | - Barbara Röper
- Radiation Oncology, rechts der Isar Hospital, Technical University of Munich
- Ambulatory Health Care Centre "Radiotherapy" Harlaching/Bogenhausen, Munich
| | - Katja Specht
- Institute of Pathology, Technical University of Munich
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17
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Foreman SC, Neumann J, Han J, Harrasser N, Weiss K, Peeters JM, Karampinos DC, Makowski MR, Gersing AS, Woertler K. Deep learning-based acceleration of Compressed Sense MR imaging of the ankle. Eur Radiol 2022; 32:8376-8385. [PMID: 35751695 DOI: 10.1007/s00330-022-08919-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/13/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate a compressed sensing artificial intelligence framework (CSAI) to accelerate MRI acquisition of the ankle. METHODS Thirty patients were scanned at 3T. Axial T2-w, coronal T1-w, and coronal/sagittal intermediate-w scans with fat saturation were acquired using compressed sensing only (12:44 min, CS), CSAI with an acceleration factor of 4.6-5.3 (6:45 min, CSAI2x), and CSAI with an acceleration factor of 6.9-7.7 (4:46 min, CSAI3x). Moreover, a high-resolution axial T2-w scan was obtained using CSAI with a similar scan duration compared to CS. Depiction and presence of abnormalities were graded. Signal-to-noise and contrast-to-noise were calculated. Wilcoxon signed-rank test and Cohen's kappa were used to compare CSAI with CS sequences. RESULTS The correlation was perfect between CS and CSAI2x (κ = 1.0) and excellent for CS and CSAI3x (κ = 0.86-1.0). No significant differences were found for the depiction of structures between CS and CSAI2x and the same abnormalities were detected in both protocols. For CSAI3x the depiction was graded lower (p ≤ 0.001), though most abnormalities were also detected. For CSAI2x contrast-to-noise fluid/muscle was higher compared to CS (p ≤ 0.05), while no differences were found for other tissues. Signal-to-noise and contrast-to-noise were higher for CSAI3x compared to CS (p ≤ 0.05). The high - resolution axial T2-w sequence specifically improved the depiction of tendons and the tibial nerve (p ≤ 0.005). CONCLUSIONS Acquisition times can be reduced by 47% using CSAI compared to CS without decreasing diagnostic image quality. Reducing acquisition times by 63% is feasible but should be reserved for specific patients. The depiction of specific structures is improved using a high-resolution axial T2-w CSAI scan. KEY POINTS • Prospective study showed that CSAI enables reduction in acquisition times by 47% without decreasing diagnostic image quality. • Reducing acquisition times by 63% still produces images with an acceptable diagnostic accuracy but should be reserved for specific patients. • CSAI may be implemented to scan at a higher resolution compared to standard CS images without increasing acquisition times.
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Affiliation(s)
- Sarah C Foreman
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Jan Neumann
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Jessie Han
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Norbert Harrasser
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Kilian Weiss
- Philips GmbH, Röntgenstrasse 22, 22335, Hamburg, Germany
| | - Johannes M Peeters
- Philips Healthcare, Veenpluis 4-6, Building QR-0.113, 5684, Best, PC, Netherlands
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Neuroradiology, University Hospital Munich (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
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Abstract
Cruciate ligament reconstruction and meniscal surgery are frequently performed for restoration of knee joint stability and function after cruciate ligament and meniscus injuries, and they contribute to the prevention of secondary osteoarthritis. In cruciate ligaments, the most common procedure is anterior cruciate ligament (ACL) reconstruction. Meniscal surgery most frequently consists of partial meniscectomy and suture repair, rarely of a meniscus transplant. In patients with symptoms following surgery, imaging reevaluation for a suspected intra-articular source of symptoms is indicated and mainly consists of radiography and magnetic resonance imaging. For proper imaging assessment of cruciate ligament grafts and the postoperative meniscus, it is crucial to understand the surgical techniques applied, to be familiar with normal posttreatment imaging findings, and to be aware of patterns and specific findings of recurrent lesions and typical complications. This article presents an updated review of the techniques and the imaging of cruciate ligament reconstruction and meniscus surgery, recurrent lesions, treatment failure, and potential complications.
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Affiliation(s)
- Andreas Heuck
- Radiologische Klinik und Poliklinik, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Klaus Woertler
- Institut für Diagnostische und Interventionelle Radiologie, Technical University of Munich, Munich, Germany
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19
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Bodden J, Neumann J, Rasper M, Fingerle AA, Knebel C, von Eisenhart-Rothe R, Specht K, Mogler C, Bollwein C, Schwaiger BJ, Gersing AS, Woertler K. Diagnosis of joint invasion in patients with malignant bone tumors: value and reproducibility of direct and indirect signs on MR imaging. Eur Radiol 2022; 32:4738-4748. [PMID: 35258673 PMCID: PMC9213276 DOI: 10.1007/s00330-022-08586-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: 09/12/2021] [Revised: 12/15/2021] [Accepted: 01/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the performance and reproducibility of MR imaging features in the diagnosis of joint invasion (JI) by malignant bone tumors. METHODS MR images of patients with and without JI (n = 24 each), who underwent surgical resection at our institution, were read by three radiologists. Direct (intrasynovial tumor tissue (ITT), intraarticular destruction of cartilage/bone, invasion of capsular/ligamentous insertions) and indirect (tumor size, signal alterations of epiphyseal/transarticular bone (bone marrow replacement/edema-like), synovial contrast enhancement, joint effusion) signs of JI were assessed. Odds ratios, sensitivity, specificity, PPV, NPV, and reproducibilities (Cohen's and Fleiss' κ) were calculated for each feature. Moreover, the diagnostic performance of combinations of direct features was assessed. RESULTS Forty-eight patients (28.7 ± 21.4 years, 26 men) were evaluated. All readers reliably assessed the presence of JI (sensitivity = 92-100 %; specificity = 88-100%, respectively). Best predictors for JI were direct visualization of ITT (OR = 186-229, p < 0.001) and destruction of intraarticular bone (69-324, p < 0.001). Direct visualization of ITT was also highly reliable in assessing JI (sensitivity, specificity, PPV, NPV = 92-100 %), with excellent reproducibility (κ = 0.83). Epiphyseal bone marrow replacement and synovial contrast enhancement were the most sensitive indirect signs, but lacked specificity (29-54%). By combining direct signs with high specificity, sensitivity was increased (96 %) and specificity (100 %) was maintained. CONCLUSION JI by malignant bone tumors can reliably be assessed on preoperative MR images with high sensitivity, specificity, and reproducibility. Particularly direct visualization of ITT, destruction of intraarticular bone, and a combination of highly specific direct signs were valuable, while indirect signs were less predictive and specific. KEY POINTS • Direct visualization of intrasynovial tumor was the single most sensitive and specific (92-100%) MR imaging sign of joint invasion. • Indirect signs of joint invasion, such as joint effusion or synovial enhancement, were less sensitive and specific compared to direct signs. • A combination of the most specific direct signs of joint invasion showed best results with perfect specificity and PPV (both 100%) and excellent sensitivity and NPV (both 96 %).
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Affiliation(s)
- Jannis Bodden
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA, 94107, USA.
| | - Jan Neumann
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Rasper
- Department of Radiology, Kantonsspital Muensterlingen, Spitalcampus 1, 8596, Muensterlingen, Switzerland
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Carolin Knebel
- Department of Orthopaedic Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedic Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Katja Specht
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Institute of Pathology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Carolin Mogler
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Institute of Pathology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christine Bollwein
- Institute of Pathology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Klaus Woertler
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Degenhardt H, Pogorzelski J, Themessl A, Muench LN, Wechselberger J, Woertler K, Siebenlist S, Imhoff AB, Scheiderer B. Reliable Clinical and Sonographic Outcomes of Subpectoral Biceps Tenodesis Using an All-Suture Anchor Onlay Technique. Arthroscopy 2022; 38:729-734. [PMID: 34508820 DOI: 10.1016/j.arthro.2021.08.033] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/14/2021] [Accepted: 08/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes and structural integrity of primary subpectoral biceps tenodesis using an all-suture anchor onlay technique for long head of the biceps (LHB) tendon pathology. METHODS We conducted a retrospective case series with prospectively collected data of patients who underwent primary, isolated subpectoral biceps tenodesis with a single all-suture anchor onlay fixation between March 2017 and March 2019. Outcomes were recorded at a minimum follow-up of 12 months based on assessments of the American Shoulder and Elbow Surgeons (ASES) score, LHB score, and elbow flexion strength and supination strength measurements. The integrity of the tenodesis construct was evaluated using ultrasound. RESULTS Thirty-four patients were available for clinical and ultrasound examination at a mean follow-up of 18 ± 5 months. The mean ASES score significantly improved from 51.0 ± 14.2 points preoperatively to 89.8 ± 10.5 points postoperatively (P < .001). The minimal clinically important difference for the ASES score was 8.7 points, which was exceeded by 31 patients (91.2%). The mean postoperative LHB score was 92.2 ± 8.3 points. Regarding subcategories, an average of 47.2 ± 6.3 points was reached for "pain/cramps"; 26.4 ± 6.1 points, "cosmesis"; and 18.6 ± 2.6 points, "elbow flexion strength." Both elbow flexion strength and supination strength were similar compared with the nonoperated side (P = .169 and P = .210, respectively). In 32 patients, ultrasound examination showed an intact tenodesis construct, whereas 2 patients (5.9%) sustained failure of the all-suture anchor fixation requiring revision. CONCLUSIONS Primary subpectoral biceps tenodesis using an all-suture anchor onlay technique for pathology of the LHB tendon provides reliable clinical results and a relatively low failure rate (5.9%). LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Hannes Degenhardt
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Themessl
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | - Klaus Woertler
- Department of Radiology, Technical University of Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
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21
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Feuerriegel GC, Kopp FK, Pfeiffer D, Pogorzelski J, Wurm M, Leonhardt Y, Boehm C, Kronthaler S, Karampinos DC, Neumann J, Schwaiger BJ, Makowski MR, Woertler K, Gersing AS. Evaluation of MR-derived simulated CT-like images and simulated radiographs compared to conventional radiography in patients with shoulder pain: a proof-of-concept study. BMC Musculoskelet Disord 2022; 23:122. [PMID: 35123466 PMCID: PMC8818249 DOI: 10.1186/s12891-022-05076-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate the diagnostic value of MR-derived CT-like images and simulated radiographs compared with conventional radiographs in patients with suspected shoulder pathology. Methods 3 T MRI of the shoulder including a 3D T1-weighted gradient echo sequence was performed in 25 patients (mean age 52.4 ± 18 years, 13 women) with suspected shoulder pathology. Subsequently a cone-beam forward projection algorithm was used to obtain intensity-inverted CT-like images and simulated radiographs. Two radiologists evaluated the simulated images separately and independently using the conventional radiographs as the standard of reference, including measurements of the image quality, acromiohumeral distance, critical shoulder angle, degenerative joint changes and the acromial type. Additionally, the CT-like MR images were evaluated for glenoid defects, subcortical cysts and calcifications. Agreement between the MR-derived simulated radiographs and conventional radiographs was calculated using Cohen’s Kappa. Results Measurements on simulated radiographs and conventional radiographs overall showed a substantial to almost perfect inter- and intra-rater agreement (κ = 0.69–1.00 and κ = 0.65–0.85, respectively). Image quality of the simulated radiographs was rated good to excellent (1.6 ± 0.7 and 1.8 ± 0.6, respectively) by the radiologists. A substantial agreement was found regarding diagnostically relevant features, assessed on Y- and anteroposterior projections (κ = 0.84 and κ = 0.69 for the measurement of the CSA; κ = 0.95 and κ = 0.60 for the measurement of the AHD; κ = 0.77 and κ = 0.77 for grading of the Samilson-Prieto classification; κ = 0.83 and κ = 0.67 for the grading of the Bigliani classification, respectively). Conclusion In this proof-of-concept study, clinically relevant features of the shoulder joint were assessed reliably using MR-derived CT-like images and simulated radiographs with an image quality equivalent to conventional radiographs. MR-derived CT-like images and simulated radiographs may provide useful diagnostic information while reducing the amount of radiation exposure.
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22
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von Schacky CE, Wilhelm NJ, Schäfer VS, Leonhardt Y, Jung M, Jungmann PM, Russe MF, Foreman SC, Gassert FG, Gassert FT, Schwaiger BJ, Mogler C, Knebel C, von Eisenhart-Rothe R, Makowski MR, Woertler K, Burgkart R, Gersing AS. Development and evaluation of machine learning models based on X-ray radiomics for the classification and differentiation of malignant and benign bone tumors. Eur Radiol 2022; 32:6247-6257. [PMID: 35396665 PMCID: PMC9381439 DOI: 10.1007/s00330-022-08764-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/03/2022] [Accepted: 02/17/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To develop and validate machine learning models to distinguish between benign and malignant bone lesions and compare the performance to radiologists. METHODS In 880 patients (age 33.1 ± 19.4 years, 395 women) diagnosed with malignant (n = 213, 24.2%) or benign (n = 667, 75.8%) primary bone tumors, preoperative radiographs were obtained, and the diagnosis was established using histopathology. Data was split 70%/15%/15% for training, validation, and internal testing. Additionally, 96 patients from another institution were obtained for external testing. Machine learning models were developed and validated using radiomic features and demographic information. The performance of each model was evaluated on the test sets for accuracy, area under the curve (AUC) from receiver operating characteristics, sensitivity, and specificity. For comparison, the external test set was evaluated by two radiology residents and two radiologists who specialized in musculoskeletal tumor imaging. RESULTS The best machine learning model was based on an artificial neural network (ANN) combining both radiomic and demographic information achieving 80% and 75% accuracy at 75% and 90% sensitivity with 0.79 and 0.90 AUC on the internal and external test set, respectively. In comparison, the radiology residents achieved 71% and 65% accuracy at 61% and 35% sensitivity while the radiologists specialized in musculoskeletal tumor imaging achieved an 84% and 83% accuracy at 90% and 81% sensitivity, respectively. CONCLUSIONS An ANN combining radiomic features and demographic information showed the best performance in distinguishing between benign and malignant bone lesions. The model showed lower accuracy compared to specialized radiologists, while accuracy was higher or similar compared to residents. KEY POINTS • The developed machine learning model could differentiate benign from malignant bone tumors using radiography with an AUC of 0.90 on the external test set. • Machine learning models that used radiomic features or demographic information alone performed worse than those that used both radiomic features and demographic information as input, highlighting the importance of building comprehensive machine learning models. • An artificial neural network that combined both radiomic and demographic information achieved the best performance and its performance was compared to radiology readers on an external test set.
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Affiliation(s)
- Claudio E. von Schacky
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Nikolas J. Wilhelm
- Department for Orthopedics and Orthopedic Sports Medicine, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Valerie S. Schäfer
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Yannik Leonhardt
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Matthias Jung
- grid.7708.80000 0000 9428 7911Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Pia M. Jungmann
- grid.7708.80000 0000 9428 7911Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Maximilian F. Russe
- grid.7708.80000 0000 9428 7911Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Sarah C. Foreman
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Felix G. Gassert
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Florian T. Gassert
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Benedikt J. Schwaiger
- grid.6936.a0000000123222966Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Munich, Germany
| | - Carolin Mogler
- grid.15474.330000 0004 0477 2438Institute of Pathology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Carolin Knebel
- Department for Orthopedics and Orthopedic Sports Medicine, Ismaninger Strasse 22, 81675 Munich, Germany
| | | | - Marcus R. Makowski
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Klaus Woertler
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Rainer Burgkart
- Department for Orthopedics and Orthopedic Sports Medicine, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Alexandra S. Gersing
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany ,grid.5252.00000 0004 1936 973XDepartment of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
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23
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Lutz PM, Achtnich A, Schütte V, Woertler K, Imhoff AB, Willinger L. Anterior cruciate ligament autograft maturation on sequential postoperative MRI is not correlated with clinical outcome and anterior knee stability. Knee Surg Sports Traumatol Arthrosc 2022; 30:3258-3267. [PMID: 34739559 PMCID: PMC9464175 DOI: 10.1007/s00167-021-06777-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/18/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Magnetic resonance imaging (MRI) signal intensity is correlated to structural postoperative changes of the anterior cruciate ligament (ACL) autograft. The purpose of this study was to investigate the ACL autograft maturation process via MRI over 2 years postoperatively, compare it to a native ACL signal and correlate the results with clinical outcome, return to preinjury sports levels, and knee laxity measurements. METHODS ACL autograft signal intensity was measured in 17 male patients (age, 28.3 ± 7.0 years) who underwent ACL reconstruction with hamstring autograft at 6 weeks, 3-, 6-, 12-, and 24 months postoperatively by 3 Tesla MRI. Controls with an intact ACL served as control group (22 males, 8 females; age, 26.7 ± 6.8 years). An ACL/PCL ratio (APR) and ACL/muscle ratio (AMR) was calculated to normalize signals to soft tissue signal. APR and AMR were compared across time and to native ACL signal. Clinical outcome scores (IKDC, Lysholm), return to preinjury sports levels (Tegner activity scale), and knee laxity measurement (KT-1000) were obtained and correlated to APR and AMR at the respective time points. RESULTS The APR and AMR of the ACL graft changed significantly from the lowest values at 6 weeks to reach the highest intensity after 6 months (p < 0.001). Then, the APR and AMR were significantly different from a native ACL 6 months after surgery (p < 0.01) but approached the APR and AMR of the native ACL at 1- and 2 years after surgery (p < 0.05). The APR changed significantly during the first 2 years postoperatively in the proximal (p < 0.001), mid-substance (p < 0.001), and distal (p < 0.01) intraarticular portion of the ACL autograft. A hypo-intense ACL MRI signal was associated with return to the preinjury sports level (p < 0.05). No correlation was found between ACL MRI graft signal and clinical outcome scores or KT-1000 measurements. CONCLUSION ACL grafts undergo a continuous maturation process in the first 2 years after surgery. The ACL graft signals became hyper-intense 6 months postoperatively and approximated the signal of a native intact ACL at 12- and 24 months. Patients with a hypo-intense ACL graft signal at 2 years follow-up were more likely to return to preinjury sports levels. The results of the present study provide a template for monitoring the normal ACL maturation process via MRI in case of prolonged clinical symptoms. However, subjective outcome and clinical examination of knee laxity remain important to assess the treatment success and to allow to return to sports. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Patricia M. Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Andrea Achtnich
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Vincent Schütte
- Department for Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
| | - Klaus Woertler
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Lukas Willinger
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
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24
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von Schacky CE, Wilhelm NJ, Schäfer VS, Leonhardt Y, Gassert FG, Foreman SC, Gassert FT, Jung M, Jungmann PM, Russe MF, Mogler C, Knebel C, von Eisenhart-Rothe R, Makowski MR, Woertler K, Burgkart R, Gersing AS. Multitask Deep Learning for Segmentation and Classification of Primary Bone Tumors on Radiographs. Radiology 2021; 301:398-406. [PMID: 34491126 DOI: 10.1148/radiol.2021204531] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background An artificial intelligence model that assesses primary bone tumors on radiographs may assist in the diagnostic workflow. Purpose To develop a multitask deep learning (DL) model for simultaneous bounding box placement, segmentation, and classification of primary bone tumors on radiographs. Materials and Methods This retrospective study analyzed bone tumors on radiographs acquired prior to treatment and obtained from patient data from January 2000 to June 2020. Benign or malignant bone tumors were diagnosed in all patients by using the histopathologic findings as the reference standard. By using split-sample validation, 70% of the patients were assigned to the training set, 15% were assigned to the validation set, and 15% were assigned to the test set. The final performance was evaluated on an external test set by using geographic validation, with accuracy, sensitivity, specificity, and 95% CIs being used for classification, the intersection over union (IoU) being used for bounding box placements, and the Dice score being used for segmentations. Results Radiographs from 934 patients (mean age, 33 years ± 19 [standard deviation]; 419 women) were evaluated in the internal data set, which included 667 benign bone tumors and 267 malignant bone tumors. Six hundred fifty-four patients were in the training set, 140 were in the validation set, and 140 were in the test set. One hundred eleven patients were in the external test set. The multitask DL model achieved 80.2% (89 of 111; 95% CI: 72.8, 87.6) accuracy, 62.9% (22 of 35; 95% CI: 47, 79) sensitivity, and 88.2% (67 of 76; CI: 81, 96) specificity in the classification of bone tumors as malignant or benign. The model achieved an IoU of 0.52 ± 0.34 for bounding box placements and a mean Dice score of 0.60 ± 0.37 for segmentations. The model accuracy was higher than that of two radiologic residents (71.2% and 64.9%; P = .002 and P < .001, respectively) and was comparable with that of two musculoskeletal fellowship-trained radiologists (83.8% and 82.9%; P = .13 and P = .25, respectively) in classifying a tumor as malignant or benign. Conclusion The developed multitask deep learning model allowed for accurate and simultaneous bounding box placement, segmentation, and classification of primary bone tumors on radiographs. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Carrino in this issue.
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Affiliation(s)
- Claudio E von Schacky
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Nikolas J Wilhelm
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Valerie S Schäfer
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Yannik Leonhardt
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Felix G Gassert
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Sarah C Foreman
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Florian T Gassert
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Matthias Jung
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Pia M Jungmann
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Maximilian F Russe
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Carolin Mogler
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Carolin Knebel
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Rüdiger von Eisenhart-Rothe
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Marcus R Makowski
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Klaus Woertler
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Rainer Burgkart
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
| | - Alexandra S Gersing
- From the Department of Radiology (C.E.v.S., V.S.S., Y.L., F.G.G., S.C.F., F.T.G., M.R.M., K.W., A.S.G.), Department for Orthopedics and Orthopedic Sports Medicine (N.J.W., C.K., R.v.E., R.B.), and Institute of Pathology (C.M.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany; and the Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (M.J., P.M.J., M.F.R.)
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Gassert FG, Gassert FT, Specht K, Knebel C, Lenze U, Makowski MR, von Eisenhart-Rothe R, Gersing AS, Woertler K. Soft tissue masses: distribution of entities and rate of malignancy in small lesions. BMC Cancer 2021; 21:93. [PMID: 33482754 PMCID: PMC7825232 DOI: 10.1186/s12885-020-07769-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 09/28/2020] [Accepted: 12/25/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Small soft tissue masses are often falsely assumed to be benign and resected with failure to achieve tumor-free margins. Therefore, this study retrospectively investigated the distribution of histopathologic diagnosis to be encountered in small soft tissue tumors (≤ 5 cm) in a large series of a tertiary referral center. METHODS Patients with a soft tissue mass (STM) with a maximum diameter of 5 cm presenting at our institution over a period of 10 years, who had undergone preoperative Magnetic resonance imaging and consequent biopsy or/and surgical resection, were included in this study. A final histopathological diagnosis was available in all cases. The maximum tumor diameter was determined on MR images by one radiologist. Moreover, tumor localization (head/neck, trunk, upper extremity, lower extremity, hand, foot) and depth (superficial / deep to fascia) were assessed. RESULTS In total, histopathologic results and MR images of 1753 patients were reviewed. Eight hundred seventy patients (49.63%) showed a STM ≤ 5 cm and were therefore included in this study (46.79 +/- 18.08 years, 464 women). Mean maximum diameter of the assessed STMs was 2.88 cm. Of 870 analyzed lesions ≤ 5 cm, 170 (19.54%) were classified as superficial and 700 (80.46%) as deep. The malignancy rate of all lesions ≤ 5 cm was at 22.41% (superficial: 23.53% / deep: 22.14%). The malignancy rate dropped to 16.49% (20.79% / 15.32%) when assessing lesions ≤ 3 cm (p = 0.007) and to 15.0% (18.18% / 13.79%) when assessing lesions ≤ 2 cm (p = 0.006). Overall, lipoma was the most common benign lesion of superficial STMs (29.41%) and tenosynovial giant cell tumor was the most common benign lesion of deep STMs (23.29%). Undifferentiated pleomorphic sarcoma was the most common malignant diagnosis among both, superficial (5.29%) and deep (3.57%) STMs. CONCLUSIONS The rate of malignancy decreased significantly with tumor size in both, superficial and deep STMs. The distribution of entities was different between superficial and deep STMs, yet there was no significant difference found in the malignancy rate.
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Affiliation(s)
- Felix G. Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Florian T. Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Katja Specht
- Department of Pathology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carolin Knebel
- Department of Orthopaedic Surgery, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopaedic Surgery, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marcus R. Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedic Surgery, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexandra S. Gersing
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Klaus Woertler
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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Schwaiger BJ, Schneider C, Kronthaler S, Gassert FT, Böhm C, Pfeiffer D, Baum T, Kirschke JS, Karampinos DC, Makowski MR, Woertler K, Wurm M, Gersing AS. CT-like images based on T1 spoiled gradient-echo and ultra-short echo time MRI sequences for the assessment of vertebral fractures and degenerative bone changes of the spine. Eur Radiol 2021; 31:4680-4689. [PMID: 33443599 PMCID: PMC8213670 DOI: 10.1007/s00330-020-07597-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 09/06/2020] [Revised: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022]
Abstract
Objectives To evaluate the performance of 3D T1w spoiled gradient-echo (T1SGRE) and ultra-short echo time (UTE) MRI sequences for the detection and assessment of vertebral fractures and degenerative bone changes compared with conventional CT. Methods Fractures (n = 44) and degenerative changes (n = 60 spinal segments) were evaluated in 30 patients (65 ± 14 years, 18 women) on CT and 3-T MRI, including CT-like images derived from T1SGRE and UTE. Two radiologists evaluated morphological features on both modalities: Genant and AO/Magerl classifications, anterior/posterior vertebral height, fracture age; disc height, neuroforaminal diameter, grades of spondylolisthesis, osteophytes, sclerosis, and facet joint degeneration. Diagnostic accuracy and agreement between MRI and CT and between radiologists were assessed using crosstabs, weighted κ, and intraclass correlation coefficients. Image quality was graded on a Likert scale. Results For fracture detection, sensitivity, specificity, and accuracy were 0.95, 0.98, and 0.97 for T1SGRE and 0.91, 0.96, and 0.95 for UTE. Agreement between T1SGRE and CT was substantial to excellent (e.g., Genant: κ, 0.92 [95% confidence interval, 0.83–1.00]; AO/Magerl: κ, 0.90 [0.76–1.00]; osteophytes: κ, 0.91 [0.82–1.00]; sclerosis: κ, 0.68 [0.48–0.88]; spondylolisthesis: ICCs, 0.99 [0.99–1.00]). Agreement between UTE and CT was lower, ranging from moderate (e.g., sclerosis: κ, 0.43 [0.26–0.60]) to excellent (spondylolisthesis: ICC, 0.99 [0.99–1.00]). Inter-reader agreement was substantial to excellent (0.52–1.00), respectively, for all parameters. Median image quality of T1SGRE was rated significantly higher than that of UTE (p < 0.001). Conclusions Morphologic assessment of bone pathologies of the spine using MRI was feasible and comparable to CT, with T1SGRE being more robust than UTE. Key Points • Vertebral fractures and degenerative bone changes can be assessed on CT-like MR images, with 3D T1w spoiled gradient-echo–based images showing a high diagnostic accuracy and agreement with CT. • This could enable MRI to precisely assess bone morphology, and 3D T1SGRE MRI sequences may substitute additional spinal CT examinations in the future. • Image quality and robustness of T1SGRE sequences are higher than those of UTE MRI for the assessment of bone structures.
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Affiliation(s)
- Benedikt J Schwaiger
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany. .,Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Charlotte Schneider
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sophia Kronthaler
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian T Gassert
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christof Böhm
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus Woertler
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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27
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Gersing AS, Holwein C, Suchowierski J, Feuerriegel G, Gassert FT, Baum T, Karampinos DC, Schwaiger BJ, Makowski MR, Burgkart R, Woertler K, Imhoff AB, Jungmann PM. Cartilage T 2 Relaxation Times and Subchondral Trabecular Bone Parameters Predict Morphological Outcome After Matrix-Associated Autologous Chondrocyte Implantation With Autologous Bone Grafting. Am J Sports Med 2020; 48:3573-3585. [PMID: 33200942 DOI: 10.1177/0363546520965987] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Quantitative magnetic resonance (MR) imaging techniques are established for evaluation of cartilage composition and trabecular bone microstructure at the knee. It remains unclear whether quantitative MR parameters predict the midterm morphological outcome after matrix-associated chondrocyte implantation (MACI) with autologous bone grafting (ABG). PURPOSE To assess longitudinal changes and associations of the biochemical composition of cartilage repair tissue, the subchondral bone architecture, and morphological knee joint abnormalities on 3-T MR imaging after MACI with ABG at the knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS Knees of 18 patients (28.7 ± 8.4 years [mean ± SD]; 5 women) were examined preoperatively and 3, 6, 12, and 24 months after MACI and ABG using 3-T MR imaging. Cartilage composition was assessed using T2 relaxation time measurements. Subchondral bone microstructure was quantified using a 3-dimensional phase-cycled balanced steady-state free precision sequence. Trabecular bone parameters were calculated using a dual threshold algorithm (apparent bone fraction, apparent trabecular number, and apparent trabecular separation). Morphological abnormalities were assessed using the MOCART (magnetic resonace observation of cartilage repair tissue) score, the WORMS (Whole-Organ Magnetic Resonance Imaging Score), and the CROAKS (Cartilage Repair Osteoarthritis Knee Score). Clinical symptoms were assessed using the Tegner activity and Lysholm knee scores. Statistical analyses were performed by using multiple linear regression analysis. RESULTS Total WORMS (P = .02) and MOCART (P = .001) scores significantly improved over 24 months after MACI. Clinical symptoms were significantly associated with the presence of bone marrow edema pattern abnormalities 24 months after surgery (P = .035). Overall there was a good to excellent radiological outcome found after 24 months (MOCART score, 88.8 ± 10.1). Cartilage repair T2 values significantly decreased between 12 and 24 months after MACI (P = .009). Lower global T2 values after 3 months were significantly associated with better MOCART scores after 24 months (P = .04). Moreover, trabecular bone parameters after 3 months were significantly associated with the total WORMS after 24 months (apparent bone fraction, P = .048; apparent trabecular number, P = .013; apparent trabecular separation, P = .013). CONCLUSION After MACI with ABG, early postoperative quantitative assessment of biochemical composition of cartilage and microstructure of subchondral bone may predict the outcome after 24 months. The perioperative global joint cartilage matrix quality is essential for proper proliferation of the repair tissue, reflected by MOCART scores. The subchondral bone quality of the ABG site is essential for proper maturation of the cartilage repair tissue, reflected by cartilage T2 values.
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Affiliation(s)
- Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Neuroradiology, University Hospital of Munich (LMU), Munich, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Joachim Suchowierski
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian T Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Pia M Jungmann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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28
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Roski F, Hammel J, Mei K, Haller B, Baum T, Kirschke JS, Pfeiffer D, Woertler K, Pfeiffer F, Noël PB, Gersing AS, Schwaiger BJ. Opportunistic osteoporosis screening: contrast-enhanced dual-layer spectral CT provides accurate measurements of vertebral bone mineral density. Eur Radiol 2020; 31:3147-3155. [PMID: 33052464 PMCID: PMC8043862 DOI: 10.1007/s00330-020-07319-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 07/02/2020] [Revised: 08/04/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
Objectives Osteoporosis remains under-diagnosed, which may be improved by opportunistic bone mineral density (BMD) measurements on CT. However, correcting for the influence of intravenous iodine-based contrast agent is challenging. The purpose of this study was to assess the diagnostic accuracy of iodine-corrected vertebral BMD measurements derived from non-dedicated contrast-enhanced phantomless dual-layer spectral CT (DLCT) examinations. Methods Vertebral volumetric DLCT-BMD was measured in native, arterial, and portal-venous scans of 132 patients (63 ± 16 years; 32% women) using virtual monoenergetic images (50 and 200 keV). For comparison, conventional BMD was determined using an asynchronous QCT calibration. Additionally, iodine densities were measured in the abdominal aorta (AA), inferior vena cava, and vena portae (VP) on each CT phase to adjust for iodine-related measurement errors in multivariable linear regressions and a generalized estimated equation, and conversion equations were calculated. Results BMD values derived from contrast-enhanced phases using conversion equations adjusted for individual vessel iodine concentrations of VP and/or AA showed a high agreement with those from non-enhanced scans in Bland-Altman plots. Mean absolute errors (MAE) of DLCT-BMD were 3.57 mg/ml for the arterial (R2 = 0.989) and 3.69 mg/ml for the portal-venous phase (R2 = 0.987) (conventional BMD: 4.70 [R2 = 0.983] and 5.15 mg/ml [R2 = 0.981]). In the phase-independent analysis, MAE was 4.49 mg/ml for DLCT (R2 = 0.989) (conventional BMD: 4.82 mg/ml [R2 = 0.981]). Conclusions Converted BMD derived from contrast-enhanced DLCT examinations and adjusted for individual vessel iodine concentrations showed a high agreement with non-enhanced DLCT-BMD, suggesting that opportunistic BMD measurements are feasible even in non-dedicated contrast-enhanced DLCT examinations. Key Points • Accurate BMD values can be converted from contrast-enhanced DLCT scans, independent from the used scan phase. • DLCT-BMD measurements from contrast-enhanced scans should be adjusted with iodine concentrations of portal vein and/or abdominal aorta, which significantly improves the goodness-of-fit of conversion models.
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Affiliation(s)
- Ferdinand Roski
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Johannes Hammel
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Kai Mei
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Franz Pfeiffer
- Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Peter B Noël
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Alexandra S Gersing
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81675, Munich, Germany
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Abstract
The diagnosis of tumors and tumorlike lesions of bone is a routine part of both general and specialist radiologic practices. The spectrum of disorders ranges from the small incidental lesion to the potentially life-limiting malignancies whether primary or secondary. In this review, authored by experts from several European orthopaedic oncology centers, we present a collection of pieces of advice in the form of 10 commandments. Adherence in daily practice to this guidance should help minimize adverse patient experiences and outcomes.
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Affiliation(s)
- Mark Davies
- Department of Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Radhesh Lalam
- Department of Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Klaus Woertler
- Department of Imaging, Technische Universitat Munchen, Munich, Germany
| | - Johan L Bloem
- Department of Imaging, Leiden University Medical Center, Leiden, The Netherlands
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and Department of Surgical Sciences (Radiology), Uppsala University Hospital, Uppsala, Sweden
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30
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Berthold DP, Willinger L, Muench LN, Forkel P, Schmitt A, Woertler K, Imhoff AB, Herbst E. Visualization of Proximal and Distal Kaplan Fibers Using 3-Dimensional Magnetic Resonance Imaging and Anatomic Dissection. Am J Sports Med 2020; 48:1929-1936. [PMID: 32407130 DOI: 10.1177/0363546520919986] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 01/31/2023]
Abstract
BACKGROUND In current magnetic resonance imaging (MRI) of the knee, injuries to the anterolateral ligament complex (ALC) and the Kaplan fibers (KFs) are not routinely assessed. As ruptures of the KFs contribute to anterolateral rotatory instability in the anterior cruciate ligament-deficient knee, detecting these injuries on MRI may help surgeons to individualize treatment. PURPOSE To visualize the KFs on 3-T MRI and to conduct a layer-by-layer dissection of the ALC. STUDY DESIGN Descriptive laboratory study. METHODS Ten fresh-frozen human cadaveric knees (mean ± SD age, 72 ± 8.5 years) without history of ligament injury were used in this study. Before layer-by-layer dissection of the ALC, MRI was performed to define the radiologic anatomy of the KFs. A coronal T1-weighted 3-dimensional turbo spin echo sequence and a transverse T2-weighted turbo spin echo sequence were obtained. Three-dimensional data sets were used for multiplanar reconstructions. RESULTS KFs were identified in 100% of cases on MRI and in anatomic dissection. The mean length of the proximal and distal KFs was 17.9 ± 3.6 mm and 12.4 ± 6.5 mm, respectively. On MRI, the distance from the lateral femoral epicondyle to the proximal KFs was 35.9 ± 6.9 mm and to the distal KFs, 16.6 ± 4.1 mm; in anatomic dissection, the distances were 41.4 ± 8.1 mm for proximal KFs and 28.2 ± 8.1 mm for distal KFs. The distance from the lateral joint line to the proximal KFs was 63.5 ± 7.6 mm and to the distal KFs, 45.3 ± 3.7 mm. Interobserver reliability for image analysis was excellent for all measurements. CONCLUSION KFs can be consistently identified on MRI with use of 3-dimensional sequences. Subsequent anatomic dissection confirmed their close topography to the superior lateral genicular artery. For clinical implications, the integrity of the KFs should be routinely reviewed on MRI scans. CLINICAL RELEVANCE As ruptures of the KFs contribute to anterolateral rotatory instability, accurate visualization of the KFs on MRI may facilitate surgical decision making for additional anterolateral procedures in the anterior cruciate ligament-deficient knee.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas Willinger
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Philipp Forkel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas Schmitt
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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31
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Gersing AS, Cervantes B, Knebel C, Schwaiger BJ, Kirschke JS, Weidlich D, Claudi C, Peeters JM, Pfeiffer D, Rummeny EJ, Karampinos DC, Woertler K. Diffusion tensor imaging and tractography for preoperative assessment of benign peripheral nerve sheath tumors. Eur J Radiol 2020; 129:109110. [PMID: 32559592 DOI: 10.1016/j.ejrad.2020.109110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/29/2020] [Revised: 05/14/2020] [Accepted: 05/30/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the diagnostic value of fiber tractography and diffusivity analysis generated from 3D diffusion-weighted (DW) sequences for preoperative assessment of benign peripheral nerve sheath tumors. METHOD MR imaging at 3 T was performed in 22 patients (mean age 41.9 ± 17.1y, 13 women) with histologically confirmed schwannomas (N = 18) and histologically confirmed neurofibromas (N = 11), including a 3D DW turbo spin echo sequence with fat suppression. Diffusion tensor parameters were computed and fiber tracks were determined. Evaluation was performed by two radiologists and one orthopedic surgeon blinded for final diagnosis. Mean diffusivity was computed to allow further assessment of tumor microstructure. Preoperative fascicle visualization was graded, fascicles were categorized regarding anatomical location and amount of fascicles surrounding the tumor. The agreement of imaging findings with intraoperative findings was assessed. RESULTS On 78.3 % of the DTI images, the fascicle visualization was rated as good or very good. Tractography differences were observed in schwannomas and neurofibromas, showing schwannomas to be significantly more often located eccentrically to the nerve (94.8 %) than neurofibromas (0 %, P < 0.01). Fascicles were significantly more often continuous (87.5 %) in schwannomas, while in neurofibromas, none of the tracks was graded to be continuous (0 %, P = 0.014). A substantial agreement between fiber tracking and surgical anatomy was found regarding the fascicle courses surrounding the tumor (κ = 0.78). Mean diffusivity of schwannomas (1.5 ± 0.2 × 10-3 mm2/s) was significantly lower than in neurofibromas (1.8 ± 0.2 × 10-3 mm2/s; P < 0.001). The Youden index showed an optimal cutoff at 1.7 × 10-3 mm2/s (sensitivity, 0.91; specificity, 0.78; J = 0.69). CONCLUSIONS Preoperative diffusion tensor imaging allowed to accurately differentiate between schwannomas and neurofibromas and to describe their location in relation to the nerve fascicles for preoperative planning.
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Affiliation(s)
- Alexandra S Gersing
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Barbara Cervantes
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Carolin Knebel
- Department of Orthopaedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dominik Weidlich
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Carolin Claudi
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | | | - Daniela Pfeiffer
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany; Chair for Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Ernst J Rummeny
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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Imhoff FB, Funke V, Muench LN, Sauter A, Englmaier M, Woertler K, Imhoff AB, Feucht MJ. Correction to: The complexity of bony malalignment in patellofemoral disorders: femoral and tibial torsion, trochlear dysplasia, TT-TG distance, and frontal mechanical axis correlate with each other. Knee Surg Sports Traumatol Arthrosc 2020; 28:905. [PMID: 31227864 DOI: 10.1007/s00167-019-05564-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The original article can be found online.
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Affiliation(s)
- Florian B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Victor Funke
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Andreas Sauter
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaningerstr 22, Munich, 81675, Germany
| | - Maximilian Englmaier
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaningerstr 22, Munich, 81675, Germany
| | - Klaus Woertler
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaningerstr 22, Munich, 81675, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Matthias J Feucht
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
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Gersing AS, Woertler K, Jungmann PM, Bollwein C, Schwaiger BJ. Vertebrae, Vertebral End Plates, and Disks: Concepts and Specific Pathologies. Semin Musculoskelet Radiol 2019; 23:489-496. [DOI: 10.1055/s-0039-1693976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AbstractVertebral end plates cover the osseous vertebral body. The integrity of the cartilaginous end plates is of great importance for the entire vertebral segment because the vascularized end plate provides the nutrition for the avascular disk. Yet several pathologies may occur at these end plates at the embryonic stage, in childhood to adolescence (e.g., ossification and segmentation disorders of the spine, persistent notochord, slippage of the growth plate), as well as in the mature spine of an adult (degenerative disk disease), that may impact the integrity of the cartilaginous end plate and therefore lead to severe diseases of the spine. This article reviews specific congenital, developmental, and degenerative disorders of the vertebral end plate as well as both established and newly introduced imaging techniques, such as ultrashort echo time imaging based on magnetic resonance imaging, that are suitable for imaging of the end plate.
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Affiliation(s)
- Alexandra S. Gersing
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Pia M. Jungmann
- Department of Radiology, University of Freiburg, Freiburg, Germany
| | - Christine Bollwein
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt J. Schwaiger
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
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Gersing AS, Bodden J, Neumann J, Diefenbach MN, Kronthaler S, Pfeiffer D, Knebel C, Baum T, Schwaiger BJ, Hock A, Rummeny EJ, Woertler K, Karampinos DC. Accelerating anatomical 2D turbo spin echo imaging of the ankle using compressed sensing. Eur J Radiol 2019; 118:277-284. [DOI: 10.1016/j.ejrad.2019.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/11/2019] [Accepted: 06/10/2019] [Indexed: 11/27/2022]
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Knebel C, Neumann J, Schwaiger BJ, Karampinos DC, Pfeiffer D, Specht K, Lenze U, von Eisenhart-Rothe R, Rummeny EJ, Woertler K, Gersing AS. Differentiating atypical lipomatous tumors from lipomas with magnetic resonance imaging: a comparison with MDM2 gene amplification status. BMC Cancer 2019; 19:309. [PMID: 30943944 PMCID: PMC6448188 DOI: 10.1186/s12885-019-5524-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 09/12/2018] [Accepted: 03/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background To evaluate the diagnostic value of MR imaging for the differentiation of lipomas and atypical lipomatous tumors (ALT) in comparison with histology and MDM2 amplification status. Methods Patients with well-differentiated lipomatous tumors (n = 113), of which 66 were diagnosed as lipoma (mean age 53 years (range, 13–82); 47% women) and 47 as atypical lipomatous tumor (ALT; mean age 60 years (range, 28–88); 64% women), were included into this study using histology and MDM2 amplification status by fluorescence in situ hybridization (FISH) as standard of reference. Preoperative MR images were retrospectively assessed by two radiologists for the following imaging features: maximum tumor diameter (mm) as well as the affected compartment (intramuscular, intermuscular or subcutaneous), septa (absent, thin (< 2 mm) or thick septa (> 2 mm) with nodular components); contrast enhancing areas within the lipomatous tumor (< 1/3 of the tumor volume, > 1/3 of the tumor volume); Results Of the 47 patients with ALT, 40 (85.1%) presented thick septa (> 2 mm) and this finding significantly increased the likelihood of ALT (OR 6.24, 95% CI 3.36–11.59; P < 0.001). The likelihood of ALT was increased if the tumor exceeded a maximum diameter of 130.0 mm (OR 2.74, 95% CI 1.82–4.11, P < 0.001). The presence of contrast enhancement in lipomatous tumors significantly increased the likelihood of ALT (Odds ratio (OR) 2.95, 95% confidence interval (CI) 2.01–4.31; P < 0.001). Of the lipomas, 21.1% were located subcutaneously, 63.6% intramuscularly and 15.2% intermuscularly. On the other hand, none of the ALTs were located subcutaneously, the majority was located intermuscularly (87.3%) and a small number of ALTs was located intramuscularly (12.7%). Conclusions Our results suggest that using specific morphological MR imaging characteristics (maximum tumor diameter, thick septa and contrast enhancement) and the information on the localization of the lipomatous tumor, a high sensitivity and substantial specificity can be achieved for the diagnosis of lipomas and ALTs.
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Affiliation(s)
- Carolin Knebel
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Jan Neumann
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dimitris C Karampinos
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Katja Specht
- Institute of Pathology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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Gersing AS, Feuerriegel G, Holwein C, Suchowierski J, Karampinos DC, Haller B, Baum T, Schwaiger BJ, Kirschke JS, Rummeny EJ, Imhoff AB, Woertler K, Jungmann PM. T2-relaxation time of cartilage repair tissue is associated with bone remodeling after spongiosa-augmented matrix-associated autologous chondrocyte implantation. Osteoarthritis Cartilage 2019; 27:90-98. [PMID: 30248504 DOI: 10.1016/j.joca.2018.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 08/02/2018] [Accepted: 08/30/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether T2 relaxation time measurements of cartilage repair tissue and structural changes of the knee joint are associated with subchondral bone architecture after spongiosa-augmented matrix-associated autologous chondrocyte implantation (MACI). DESIGN Both knees of 25 patients (25.5 ± 7.8y; 10 women) were examined preoperatively and 2.7 years after unilateral spongiosa-augmented MACI with 3T magnetic resonance (MR) imaging. Cartilage composition was assessed using T2 relaxation time measurements, subchondral trabecular bone microstructure was quantified using a 3D phase-cycled balanced steady state free-precision sequence. Structural knee joint changes were assessed using the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used for the postoperative description of the area that underwent MACI. Correlations were assessed using Spearman's rank correlation coefficients. RESULTS Hypertrophy of the cartilage repair tissue was found in 2 of 25 patients, both after a MACI procedure at the patella, 21 patients showed congruent filling. In subchondral bone of the cartilage repair compartment, apparent trabecular thickness was significantly higher in compartments with elevated cartilage T2 (n = 17; 0.37 ± 0.05 mm) compared to those showing no difference in cartilage T2 compared to the same compartment in the contralateral knee (n = 8; 0.27 ± 0.05 mm; P = 0.042). Significant correlations were found between the overall progression of WORMS and the ipsilateral vs contralateral ratio of average trabecular thickness (r = 0.48, P = 0.031) and bone fraction (r = 0.57, P = 0.007). CONCLUSIONS After spongiosa-augmented MACI, T2 values of cartilage repair tissue and structural knee joint changes correlated with the quality of the underlying trabecular bone.
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Affiliation(s)
- A S Gersing
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - G Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - C Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Murnau, Murnau, Germany.
| | - J Suchowierski
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - D C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - B Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany.
| | - T Baum
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - B J Schwaiger
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - J S Kirschke
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - E J Rummeny
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - A B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - K Woertler
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - P M Jungmann
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland.
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Willinger L, Lacheta L, Beitzel K, Buchmann S, Woertler K, Imhoff AB, Scheiderer B. Clinical Outcomes, Tendon Integrity, and Shoulder Strength After Revision Rotator Cuff Reconstruction: A Minimum 2 Years' Follow-up. Am J Sports Med 2018; 46:2700-2706. [PMID: 30084649 DOI: 10.1177/0363546518786006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The retear rate after primary rotator cuff (RC) reconstruction is high and commonly leads to poorer clinical outcomes and shoulder function. In the case of primary failure, revision RC reconstruction (RCR) has become increasingly important to re-create RC integrity and improve outcomes. To date, clinical and structural outcomes after RCR have not been sufficiently investigated and described at midterm follow-up. Hypothesis/Purpose: The purpose was to evaluate the clinical and radiological outcomes after revision RCR. It was hypothesized that revision RCR significantly improves clinical outcomes and that the outcomes positively correlate with tendon integrity on magnetic resonance imaging (MRI). STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent revision RCR between 2008 and 2014 were retrospectively evaluated with a minimum follow-up of 2 years. Outcomes were assessed by a clinical examination, a visual analog scale for pain (VAS), the Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Tendon integrity was determined using 3-T MRI and graded according to the Sugaya classification. RESULTS Thirty-one of 40 patients (77.5%) were available for the final assessment at a mean follow-up of 50.3 ± 20.4 months. Clinical outcome scores significantly improved from preoperatively to postoperatively for the CS (39.7 ± 16.7 to 65.1 ± 19.7; P < .001), ASES (44.2 ± 17.7 to 75.2 ± 24.8; P < .001), and DASH (68.6 ± 15.1 to 21.5 ± 19.1; P < .001). The VAS score decreased from 6.1 ± 1.8 preoperatively to 1.3 ± 1.8 at final follow-up ( P < .001). MRI demonstrated a retear rate of 55.5%. No differences in CS, ASES, and DASH scores were detected between patients with an intact repair and failure. Abduction strength was not significantly different in patients with an intact repair and retears (55.5 N vs 44.0 N, respectively, P = .52). CONCLUSION Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. The clinical outcome scores were comparable in patients with an intact repair and those with failed RC healing. Therefore, tendon integrity was not correlated with better clinical outcomes after revision RCR at final follow-up.
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Affiliation(s)
- Lukas Willinger
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lucca Lacheta
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefan Buchmann
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Orthopaedisches Fachzentrum Weilheim-Garmisch-Starnberg-Penzberg, Weilheim, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Jungmann PM, Gersing AS, Woertler K, Dietrich TJ, Baum T, Baumann F, Bensler S. Reliable semiquantitative whole‐joint MRI score for the shoulder joint: The shoulder osteoarthritis severity (SOAS) score. J Magn Reson Imaging 2018; 49:e152-e163. [DOI: 10.1002/jmri.26251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/22/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Pia M. Jungmann
- Department of NeuroradiologyUniversity Hospital Zurich, University of Zurich Zurich Switzerland
- Department of RadiologyTechnical University of Munich Munich Germany
| | | | - Klaus Woertler
- Department of RadiologyTechnical University of Munich Munich Germany
| | - Tobias J. Dietrich
- Radiology and Nuclear MedicineKantonsspital St. Gallen St. Gallen Switzerland
| | - Thomas Baum
- Department of NeuroradiologyTechnical University of Munich Munich Germany
| | - Frederic Baumann
- Clinical and Interventional AngiologyUniversity Hospital Zurich, University of Zurich Zurich Switzerland
| | - Susanne Bensler
- Institute of RadiologyCantonal Hospital Baden Baden Switzerland
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Schlegel M, Zeumer M, Prodinger PM, Woertler K, Steinborn M, von Eisenhart-Rothe R, Burdach S, Rechl H, von Luettichau I. Impact of Pathological Fractures on the Prognosis of Primary Malignant Bone Sarcoma in Children and Adults: A Single-Center Retrospective Study of 205 Patients. Oncology 2018; 94:354-362. [PMID: 29656296 DOI: 10.1159/000487142] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/23/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The purpose of this study was to investigate whether pathological fractures (PF) influence the prognosis of patients with osteosarcoma (OS) or Ewing tumor (ET) regarding 5-year survival, occurrence of metastases, and local recurrence. METHODS We retrospectively analyzed 205 patients with metastatic and nonmetastatic OS or ET. Survival analysis was performed for all patients and differentiated for patients with OS (n = 127) and ET (n = 78) as well as for adults (n = 101) and children (n = 104). RESULTS Patients with PF showed survival rates of 64% compared to 83% for those without PF (p = 0.023). Local recurrence occurred in 7% of the patients without and in 24% of those with PF (p = 0.023). In patients with ET and in children, survival analysis showed no significant difference between patients with and without PF in survival and local recurrence rates. In patients with OS, survival rate decreased from 83 to 59% (p = 0.024) and local recurrence rate increased from 13 to 30% (p = 0.042). In adults, survival rate decreased from 78 to 51% (p = 0.004) and local recurrence rate increased from 13 to 42% (p < 0.001). In multivariate analysis, age and PF were associated with inferior survival. CONCLUSION This study suggests that the occurrence of PF has a negative impact on survival and implicates an increased risk of local recurrence. In children and in patients with ET, PF did not have a prognostic impact.
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Affiliation(s)
- Miriam Schlegel
- Department of Pediatrics, Wilhelm Sander Sarcoma Unit, Kinderklinik München Schwabing, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Martina Zeumer
- Department of Pediatrics, Wilhelm Sander Sarcoma Unit, Kinderklinik München Schwabing, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Peter Michael Prodinger
- Department of Orthopedic Surgery, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marc Steinborn
- Department of Radiology, Klinikum Schwabing, Comprehensive Cancer Center Munich, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedic Surgery, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan Burdach
- Department of Pediatrics, Wilhelm Sander Sarcoma Unit, Kinderklinik München Schwabing, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Hans Rechl
- Department of Orthopedic Surgery, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Irene von Luettichau
- Department of Pediatrics, Wilhelm Sander Sarcoma Unit, Kinderklinik München Schwabing, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
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Gersing A, Muenzel D, Kopp F, Schwaiger B, Knebel C, Haller B, Noël P, Settles M, Rummeny E, Woertler K. MR-Derived CT-Like Images and Simulated Radiographs versus Conventional Radiography in Patients with Benign and Malignant Bone Tumors. Semin Musculoskelet Radiol 2018. [DOI: 10.1055/s-0038-1639518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alexandra Gersing
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Muenzel
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Chair for Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Felix Kopp
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Schwaiger
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carolin Knebel
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Peter Noël
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Chair for Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Marcus Settles
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Klaus Woertler
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Schwaiger B, Gersing A, Muenzel D, Dangelmaier J, Prodinger P, Suren C, Rummeny E, Woertler K. MR Imaging with Metal Artifact Reduction to Differentiate between Patients with and without Infected Total Hip Arthroplasty. Semin Musculoskelet Radiol 2018. [DOI: 10.1055/s-0038-1639537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Benedikt Schwaiger
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Alexandra Gersing
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Daniela Muenzel
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Julia Dangelmaier
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Peter Prodinger
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Christian Suren
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Klaus Woertler
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
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Abstract
The rotator interval is an anatomically complex region of the shoulder joint that is difficult to evaluate on clinical examination and by imaging. Abnormalities of its components may contribute to instability, shoulder stiffness, and pain and are challenging to diagnose and treat. This article gives an overview of the anatomy, MR anatomy, and normal variants of the rotator interval, together with basic technical aspects of MR imaging of this area. Pathologic conditions of the rotator interval capsule, the long head of biceps tendon, and the pulley system are reviewed and illustrated with several clinical examples.
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Affiliation(s)
- Klaus Woertler
- Department of Radiology, Technische Universität München, Munich, Germany
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Jungmann PM, Baum T, Schaeffeler C, Sauerschnig M, Brucker PU, Mann A, Ganter C, Bieri O, Rummeny EJ, Woertler K, Bauer JS. 3.0T MR imaging of the ankle: Axial traction for morphological cartilage evaluation, quantitative T2 mapping and cartilage diffusion imaging-A preliminary study. Eur J Radiol 2015; 84:1546-1554. [PMID: 26003193 DOI: 10.1016/j.ejrad.2015.04.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 06/24/2014] [Revised: 04/21/2015] [Accepted: 04/26/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE To determine the impact of axial traction during high resolution 3.0T MR imaging of the ankle on morphological assessment of articular cartilage and quantitative cartilage imaging parameters. MATERIALS AND METHODS MR images of n=25 asymptomatic ankles were acquired with and without axial traction (6kg). Coronal and sagittal T1-weighted (w) turbo spin echo (TSE) sequences with a driven equilibrium pulse and sagittal fat-saturated intermediate-w (IMfs) TSE sequences were acquired for morphological evaluation on a four-point scale (1=best, 4=worst). For quantitative assessment of cartilage degradation segmentation was performed on 2D multislice-multiecho (MSME) SE T2, steady-state free-precession (SSFP; n=8) T2 and SSFP diffusion-weighted imaging (DWI; n=8) images. Wilcoxon-tests and paired t-tests were used for statistical analysis. RESULTS With axial traction, joint space width increased significantly and delineation of cartilage surfaces was rated superior (P<0.05). Cartilage surfaces were best visualized on coronal T1-w images (P<0.05). Differences for cartilage matrix evaluation were smaller. Subchondral bone evaluation, motion artifacts and image quality were not significantly different between the acquisition methods (P>0.05). T2 values were lower at the tibia than at the talus (P<0.001). Reproducibility was better for images with axial traction. CONCLUSION Axial traction increased the joint space width, allowed for better visualization of cartilage surfaces and improved compartment discrimination and reproducibility of quantitative cartilage parameters.
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Affiliation(s)
- Pia M Jungmann
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Thomas Baum
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Christoph Schaeffeler
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany; Musculoskeletal Imaging, Kantonsspital Graubuenden, Loestrasse 170, CH-7000 Chur, Switzerland.
| | - Martin Sauerschnig
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany; Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Peter U Brucker
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Alexander Mann
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany; Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Carl Ganter
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Petersgraben 4, 4031 Basel, Switzerland.
| | - Ernst J Rummeny
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Klaus Woertler
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Jan S Bauer
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany; Department of Neuroradiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
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Holzapfel K, Regler J, Baum T, Rechl H, Specht K, Haller B, von Eisenhart-Rothe R, Gradinger R, Rummeny EJ, Woertler K. Local Staging of Soft-Tissue Sarcoma: Emphasis on Assessment of Neurovascular Encasement—Value of MR Imaging in 174 Confirmed Cases. Radiology 2015; 275:501-9. [DOI: 10.1148/radiol.14140510] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Jungmann PM, Ganter C, Schaeffeler CJ, Bauer JS, Baum T, Meier R, Nittka M, Pohlig F, Rechl H, von Eisenhart-Rothe R, Rummeny EJ, Woertler K. View-Angle Tilting and Slice-Encoding Metal Artifact Correction for Artifact Reduction in MRI: Experimental Sequence Optimization for Orthopaedic Tumor Endoprostheses and Clinical Application. PLoS One 2015; 10:e0124922. [PMID: 25909472 PMCID: PMC4409347 DOI: 10.1371/journal.pone.0124922] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 01/04/2015] [Accepted: 03/10/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND MRI plays a major role in follow-up of patients with malignant bone tumors. However, after limb salvage surgery, orthopaedic tumor endoprostheses might cause significant metal-induced susceptibility artifacts. PURPOSES To evaluate the benefit of view-angle tilting (VAT) and slice-encoding metal artifact correction (SEMAC) for MRI of large-sized orthopaedic tumor endoprostheses in an experimental model and to demonstrate clinical benefits for assessment of periprosthetic soft tissue abnormalities. METHODS In an experimental setting, tumor endoprostheses (n=4) were scanned at 1.5T with three versions of optimized high-bandwidth turbo-spin-echo pulse sequences: (i) standard, (ii) VAT and (iii) combined VAT and SEMAC (VAT&SEMAC). Pulse sequences included coronal short-tau-inversion-recovery (STIR), coronal T1-weighted (w), transverse T1-w and T2-w TSE sequences. For clinical evaluation, VAT&SEMAC was compared to conventional metal artifact-reducing MR sequences (conventional MR) in n=25 patients with metal implants and clinical suspicion of tumor recurrence or infection. Diameters of artifacts were measured quantitatively. Qualitative parameters were assessed on a five-point scale (1=best, 5=worst): "image distortion", "artificial signal changes at the edges" and "diagnostic confidence". Imaging findings were correlated with pathology. T-tests and Wilcoxon-signed rank tests were used for statistical analyses. RESULTS The true size of the prostheses was overestimated on MRI (P<0.05). A significant reduction of artifacts was achieved by VAT (P<0.001) and VAT&SEMAC (P=0.003) compared to the standard group. Quantitative scores improved in the VAT and VAT&SEMAC group (P<0.05). On clinical MR images, artifact diameters were significantly reduced in the VAT&SEMAC-group as compared with the conventional-group (P<0.001). Distortion and artificial signal changes were reduced and diagnostic confidence improved (P<0.05). In two cases, tumor-recurrence, in ten cases infection and in thirteen cases other pathologies were diagnosed. CONCLUSIONS Significant reduction of metallic artifacts was achieved by VAT and SEMAC. Clinical results suggest, that these new techniques will be beneficial for detecting periprosthetic pathologies during postoperative follow-up.
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Affiliation(s)
- Pia M. Jungmann
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
- * E-mail:
| | - Carl Ganter
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Christoph J. Schaeffeler
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
- Musculoskeletal Imaging, Kantonsspital Graubuenden, Loestrasse 170, CH-7000, Chur, Switzerland
| | - Jan S. Bauer
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Thomas Baum
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Reinhard Meier
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Mathias Nittka
- Siemens AG, Healthcare Sector, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Florian Pohlig
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Hans Rechl
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ruediger von Eisenhart-Rothe
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ernst J. Rummeny
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany
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Mueller D, Schaeffeler C, Baum T, Walter F, Rechl H, Rummeny EJ, Woertler K. Magnetic resonance perfusion and diffusion imaging characteristics of transient bone marrow edema, avascular necrosis and subchondral insufficiency fractures of the proximal femur. Eur J Radiol 2014; 83:1862-9. [PMID: 25129825 DOI: 10.1016/j.ejrad.2014.07.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/03/2014] [Accepted: 07/20/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate magnetic resonance (MR) perfusion and diffusion imaging characteristics in patients with transient bone marrow edema (TBME), avascular necrosis (AVN), or subchondral insufficiency fractures (SIF) of the proximal femur. MATERIALS AND METHODS 29 patients with painful hip and bone marrow edema pattern of the proximal femur on non-contrast MR imaging were examined using diffusion-weighted and dynamic gadolinium-enhanced sequences. Apparent diffusion coefficients (ADCs) and perfusion parameters were calculated for different regions of the proximal femur. Regional distribution and differences in ADC values and perfusion parameters were evaluated. RESULTS Seven patients presented with TBME, 15 with AVN and seven with SIF of the proximal femur. Perfusion imaging showed significant differences for maximum enhancement values (Emax), slope (Eslope) and time to peak (TTP) between the three patient groups (p<0.05). In contrast, no significant differences for ADC values were calculated when comparing TBME, AVN, and SIF patients. CONCLUSION Diffusion weighted imaging of bone marrow of the proximal femur did not show significant differences between patients with TBME, AVN or SIF. In contrast, MR perfusion imaging demonstrated significant differences for the different patient groups and may as a complementary imaging technique add information to the understanding of the pathophysiology of diseases associated with bone marrow edema.
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Affiliation(s)
- Dirk Mueller
- Department of Radiology, University of Cologne, Germany; Department of Radiology, Technische Universität München, Germany.
| | - Christoph Schaeffeler
- Department of Radiology, Cantonal Hospital Graubuenden, Chur, Switzerland; Department of Radiology, Cantonal Hospital Graubuenden, Chur, Switzerland.
| | - Thomas Baum
- Department of Radiology, Technische Universität München, Germany.
| | - Flavia Walter
- Department of Radiology, Technische Universität München, Germany.
| | - Hans Rechl
- Department of Orthopaedics, Technische Universität München, Germany.
| | - Ernst J Rummeny
- Department of Radiology, Technische Universität München, Germany.
| | - Klaus Woertler
- Department of Radiology, Technische Universität München, Germany.
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Sauerschnig M, Bauer JS, Kohn L, Hinterwimmer S, Landwehr S, Woertler K, Jungmann PM, Koestler W, Niemeyer P, Imhoff AB, Salzmann GM. Alignment does not influence cartilage T2 in asymptomatic knee joints. Knee Surg Sports Traumatol Arthrosc 2014; 22:1396-403. [PMID: 24292942 DOI: 10.1007/s00167-013-2756-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 10/28/2013] [Indexed: 01/23/2023]
Abstract
PURPOSE To investigate whether the static knee alignment affects articular cartilage ultrastructures when measured using T2 relaxation among asymptomatic subjects. METHODS Both knee joints (n = 96) of 48 asymptomatic volunteers (26 females, 22 males; 25.4 ± 1.7 years; no history of major knee trauma or surgery) were evaluated clinically (Lysholm, Tegner) and by MRI (hip-knee-ankle angle, standard knee protocol, T2 mapping). Group (n = 4) division was as follows: neutral (<1° varus/valgus), mild varus (2°-4° varus), severe varus (>4° varus) and valgus (2°-4° valgus) deformity with n = 12 subjects/group; n = 24 knees/group. Regions of interest (ROI) for T2 assessment were placed within full-thickness cartilage across the whole joint surface and were divided respecting compartmental as well as functional joint anatomy. RESULTS Leg alignment was 0.7° ± 0.5° varus among neutral, 3.0° ± 0.6° varus among mild varus, 5.0° ± 1.1° varus among severe varus and 2.5° ± 0.7° valgus among valgus group subjects and thus significantly different. No differences between the groups emerged from clinical measures. No morphological pathology was detected in any knee joint. Global T2 values (42.3 ± 2.3; 37.7-47.9 ms) of ROIs placed within every knee joint per subject were not different between alignment groups or between genders, respectively. CONCLUSION Static frontal plane leg malalignment does not affect cartilage ultrastructure among young, asymptomatic individuals as measured by T2 quantitative imaging. LEVEL OF EVIDENCE Cross-sectional study, Level II-III.
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Affiliation(s)
- M Sauerschnig
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 69, 81675, Munich, Germany
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Meier R, Kraus TM, Schaeffeler C, Torka S, Schlitter AM, Specht K, Haller B, Waldt S, Rechl H, Rummeny EJ, Woertler K. Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head. Eur Radiol 2014; 24:2271-8. [DOI: 10.1007/s00330-014-3216-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/17/2014] [Accepted: 05/02/2014] [Indexed: 12/13/2022]
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Schaeffeler C, Waldt S, Woertler K. Traumatic instability of the elbow - anatomy, pathomechanisms and presentation on imaging. Eur Radiol 2013; 23:2582-93. [DOI: 10.1007/s00330-013-2855-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 02/27/2013] [Accepted: 03/10/2013] [Indexed: 11/28/2022]
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Gruber M, Bauer JS, Dobritz M, Beer AJ, Wolf P, Woertler K, Rummeny EJ, Baum T. Bone mineral density measurements of the proximal femur from routine contrast-enhanced MDCT data sets correlate with dual-energy X-ray absorptiometry. Eur Radiol 2012; 23:505-12. [PMID: 22932742 DOI: 10.1007/s00330-012-2629-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/13/2012] [Accepted: 07/25/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate the utility of femoral bone mineral density (BMD) measurements in routine contrast-enhanced multi-detector computed tomography (ceMDCT) using dual-energy X-ray absorptiometry (DXA) as the reference standard. METHODS Forty-one patients (33 women, 8 men) underwent DXA measurement of the proximal femur. Subsequently, transverse sections of routine ceMDCT of these patients were used to measure BMD of the femoral head and femoral neck. The MDCT-to-DXA conversion equations for BMD and T-score were calculated using linear regression analysis. The conversion equations were applied to the MDCT data sets of 382 patients (120 women, 262 men) of whom 74 had osteoporotic fractures. RESULTS A correlation coefficient of r = 0.84 (P < 0.05) was calculated for BMD(MDCT) values of the femoral head and DXA T-scores of the total proximal femur using the conversion equation T-score = 0.021 × BMD(MDCT) - 5.90. The correlation coefficient for the femoral neck was r = 0.79 (P < 0.05) with the conversion equation T-score = 0.016 × BMD(MDCT) - 4.28. Accordingly, converted T-scores for the femoral neck in patients with versus those without osteoporotic fractures were significantly different (female, -1.83 versus -1.47; male, -1.86 versus -1.47; P < 0.05). CONCLUSION BMD measurements of the proximal femur were computed in routine contrast-enhanced MDCT and converted to DXA T-scores, which adequately differentiated patients with and without osteoporotic fractures.
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Affiliation(s)
- M Gruber
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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