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Piai A, Loria A, Tiberio P, Magnino S, Campoleoni M, Sconfienza LM, del Vecchio A. ASSESSMENT OF PCXMC MONTE CARLO SIMULATIONS IN SLOT-SCANNING-BASED EXAMINATIONS: COMPARISON WITH IN-PHANTOM THERMOLUMINESCENT DOSIMETRY. Radiat Prot Dosimetry 2023; 199:ncac273-234. [PMID: 36583519 PMCID: PMC9985171 DOI: 10.1093/rpd/ncac273] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/07/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
Slot-scanning technology is nowadays a valid solution for the follow-up of chronic musculoskeletal disorders on children and adolescent patients, but there is no commercial software designed for simulating this X-ray beam geometry. PC Program for X-ray Monte Carlo (PCXMC) is a widespread Monte Carlo software developed for dose computation in projection radiography. In this study, experimental measurements were performed to evaluate its applicability in examinations with a slit-beam device. Physical phantoms corresponding to an adult and a 5-y-old child with calibrated thermoluminescent dosemeters were used for experiments. Different simulation approaches were investigated. Differences between measured and calculated organ doses ranged from -95 to 67% and were statistically significant for almost all organs. For both patients, PCXMC underestimated the effective dose of about 25%. This study suggests that PCXMC is not suited for organ dose evaluation in examinations with slot-scanning devices. It is still a useful tool for effective dose estimation when a proper correction factor is applied.
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Affiliation(s)
| | - A Loria
- Medical Physics Department, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - P Tiberio
- Medical Physics Department, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - S Magnino
- Postgraduate School of Medical Physics, Università degli Studi di Milano, 20133 Milan, Italy
| | - M Campoleoni
- Medical Physics Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - L M Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20123 Milan, Italy
| | - A del Vecchio
- Medical Physics Department, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
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Sirotti S, Becce F, Sconfienza LM, Terslev L, Zanetti A, Naredo E, Zufferey P, Gutierrez M, Adinolfi A, Serban T, Maccarter D, Mouterde G, Scanu A, Möller I, Scirè CA, Sarzi-Puttini P, Novo-Rivas U, Abhishek A, Choi H, Dalbeth N, Tedeschi S, Iagnocco A, Pineda C, Keen H, D’agostino MA, Filippou G. POS0276 TRADITION VS INNOVATION! CONVENTIONAL RADIOGRAPHY AND ULTRASOUND IN THE DIAGNOSIS OF CPPD: INSTRUCTIONS FOR USE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundConventional radiography (CR) is widely used as the first-line investigation for calcium pyrophosphate deposition (CPPD) disease, given its widespread use and the low cost. Next to it a series of advanced imaging techniques have been evaluated for accuracy and reliability. Among them, ultrasound (US) has been thoroughly tested and demonstrated to be accurate and reliable for CPPD diagnosis. However, even if there are data on the diagnostic accuracy of US and CR alone, it is not clear if performing both diagnostic tests and in which sequential order provides an added value for the diagnosis of CPPD.ObjectivesThe aim of this study was to assess which diagnostic test performs better for the diagnosis of CPPD and if a combination of the two exams provides an additional value.MethodsThis is an ancillary study of the criterion validity of US in CPPD study1. Consecutive patients with knee osteoarthritis requiring total joint replacement were enrolled in 8 centres. Participants underwent US and CR of the affected knee prior to surgery. US was performed by experienced sonographers following the same scanning protocol described in the main study, while CR were performed in weight bearing AP and lateral views and were read by 2 experienced radiologists that reached a consensus on the presence/absence of CPPD. The evaluation of CPPD at the level of menisci and hyaline cartilage (HC) was based on the OMERACT definitions for US and on the new definitions developed by the ACR/EULAR CPPD classification criteria working group for CR [paper under submission]. Patients were classified as having CPPD considering histological examination as reference standard. Diagnostic indexes were calculated for US and CR alone and combined. Poisson models with robust estimation were used to estimate the best sequence of these diagnostic methods for a more accurate diagnosis of CPPD.Results51 pts were enrolled (63% F, mean age 74y ± 8). Diagnostic indexes of US and CR alone and combined are indicated in Table 1. Compared to histology, US demonstrated to be a sensitive tool for identification of CPPD at the knee, with a good sensitivity in all sites and in the overall evaluation. Instead, CR was less sensitive, but it was a highly specific exam for CPPD identification. Combining US and CR led to a higher sensitivity compared with CR alone, but a lower specificity compared to both CR and US alone, and it offered no additional increase in diagnostic accuracy. The Figure 1 shows the results of the appropriate sequence of use of US and CR in patients with suspected CPPD: in case of a positive CR at any of the 3 sites (menisci and HC) no additional exam is necessary, and the same in case of a positive US in at least two sites; however in case of a negative CR, US could help in a statistically significant way to identify CPPD patients, and further in case of a positive US in a single site CR can offer additional information.Table 1.diagnostic indexes of US, CR and US + CR in the identification of CPPD. MM: medial meniscus, LM: lateral meniscus, HC: hyaline cartilage, SN: sensitivity, SP: specificity, PPV: positive predictive value, NPV: negative predictive value, ACC: accuracy.USSNSPPPVNPVACCMM0.880.810.820.880.84LM0.880.730.760.860.80HC0.780.860.820.830.82Overall0.920.640.730.890.78CRMM0.32110.610.67LM0.400.960.910.630.69HC0.480.930.850.680.73Overall0.540.920.880.660.73US + CRMM0.880.810.820.880.84LM0.920.690.740.900.80HC0.870.820.800.890.84Overall0.920.560.670.880.75Figure 1.evaluation of sequence of US and CRConclusionUS confirmed a high diagnostic accuracy in identifying patients affected by CPPD at knee level, while CR demonstrated a high specificity but a low sensitivity. Performing both diagnostic tests could make sense in case of a negative CR or in case of an inconclusive US (only one positive site). To our knowledge, this is the first study that investigates the role of the combination of the two exams in CPPD. Further studies in a large number of patients and in different joints would be helpful to address this point.References[1]Filippou G. et al, Ann Rheum Dis, 2020Disclosure of InterestsNone declared
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Albano D, Schiaffino S, Cozzi A, Messina C, Gitto S, Vanzulli A, Carriero A, Sardanelli F, Sconfienza LM. CT-Derived Chest Muscle Metrics for Outcome Prediction in COVID-19 Patients. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731545] [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: 10/21/2022]
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Sirotti S, Becce F, Sconfienza LM, Pineda C, Gutierrez M, Serban T, Maccarter D, Adinolfi A, Naredo E, Scanu A, Scirè CA, Möller I, Sarzi-Puttini P, Abhishek A, Choi H, Dalbeth N, Tedeschi S, D’agostino MA, Keen H, Terslev L, Iagnocco A, Filippou G. POS1132 DIAGNOSTIC ACCURACY OF CONVENTIONAL RADIOGRAPHY OF THE KNEE FOR CALCIUM PYROPHOSPHATE DEPOSITION DISEASE: AN ANCILLARY STUDY OF THE OMERACT ULTRASOUND – CPPD GROUP. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Conventional Radiography (CR) has been widely used in the assessment of knee chondrocalcinosis (CC) and is still considered one of the most important diagnostic methods for the diagnosis. However, there are very few studies that examine the diagnostic accuracy of CR compared to histology of the knee tissues.Objectives:To assess the diagnostic accuracy of CR of the knee in Calcium Pyrophosphate Deposition Disease (CPPD) by using the recently created definitions for CPPD in CR of the ACR/EULAR taskforce for the new classification criteria for CPPD.Methods:This is an ancillary study of the Criterion Validity of Ultrasound in CPPD study [1]. Consecutive patients with osteoarthritis (OA) awaiting total knee replacement were enrolled in 4 centres from Romania, Italy, USA and Mexico. All patients underwent CR of the knees taken maximum 6 months before surgery, in posterior-anterior weight baring and lateral projections. DICOM files of the radiographs were anonymised and read independently by two musculoskeletal radiologists with experience in microcrystalline arthropathies. For each patient, a dichotomic score was used (absence/presence of CC) at the level of the menisci and tibiofemoral hyaline cartilage by each reader. The definitions of the ACR/EULAR taskforce for identification of CPPD in CR were used in this study [paper in preparation]. According to these definitions CPPD in CR appears as “linear or punctate opacities in the region of fibro- or hyaline articular cartilage/synovial membrane or joint capsule/within tendons or entheses that are distinct from denser, nummular radio-opaque deposits due to basic calcium phosphate deposition”. In case of disagreement a consensus decision was taken by both radiologists after discussion of the case. Menisci and the hyaline cartilage were analysed using compensated polarized light microscopy as described previously [1], patients were considered positive for CPPD if at least one of their tissue specimens revealed the presence of calcium pyrophosphate crystals. All examiners were blind to each other’s findings.Results:We enrolled 33 patients with OA (61% female, mean age 69yo). The accuracy values of CR in the various sites of the knee are indicated in Table 1. CR demonstrated to be a specific exam for identification of CPPD at the knee, but sensitivity remains low in all sites and in the overall evaluation. Identification of CPPD appears challenging and this could be due to the advanced grade of OA in our cohort of patients. Advanced degeneration, dislocation of the menisci and thinning of the hyaline cartilage in these patients is frequent and the eventual presence of calcific deposits in one of these structures could overlap with other anatomical structures making the exact localisation difficult. According to the results of the predictive values, the presence of typical deposition on CR allows a definite confirmation of the diagnosis, but a negative radiography does not exclude CPPD as testified by the low negative predictive value.Table 1.Sensitivity, specificity, PPV, NPV, accuracy and AUC of CR for identification of CPPD by using the new ACR/EULAR taskforce definitions.Medial meniscusLateral meniscusHyaline cartilageOverallSensitivity22%33%31%42%Specificity100%100%85%90%Positive predictive value100%100%67%80%Negative predictive value56%60%55%61%Accuracy61%68%58%66%AUC0.60.70.60.7Conclusion:CR has been extensively used for the diagnosis of OA and CPPD and has been tested previously for diagnostic accuracy. The results of our study confirm that the presence of typical CPPD calcifications, as defined by the ACR/EULAR task force, are highly specific but have low sensitivity for disease identification when using CR. Absence of CPPD on CR does not exclude the diagnosis.References:[1]Filippou G, et al. Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study. Ann Rheum Dis 2020. doi:10.1136/annrheumdis-2020-217998Disclosure of Interests:None declared.
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Sirotti S, Becce F, Sconfienza LM, Pineda C, Gutierrez M, Serban T, Maccarter D, Adinolfi A, Naredo E, Scanu A, Möller I, Sarzi-Puttini P, Abhishek A, Choi H, Dalbeth N, Tedeschi S, D’agostino MA, Keen H, Terslev L, Iagnocco A, Filippou G. POS1133 RELIABILITY OF CONVENTIONAL RADIOGRAPHY OF THE KNEE FOR THE ASSESSMENT OF CHONDROCALCINOSIS: AN ANCILLARY STUDY OF THE OMERACT ULTRASOUND – CPPD GROUP. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Conventional Radiography (CR) has been widely used in the assessment of knee chondrocalcinosis (CC) and is still considered one of the most important diagnostic methods for the diagnosis. However, there are no studies on the reliability of CR for CC.Objectives:To assess the reliability of CR of the knee in the assessment of chondrocalcinosis (CC).Methods:This is an ancillary study of the Criterion Validity of Ultrasound in Calcium Pyrophosphate Deposition Disease (CPPD) study [1]. Consecutive patients with knee osteoarthritis (OA) that were planned for total knee replacement surgery were enrolled in 4 centres from Romania, Italy, USA and Mexico. All patients underwent CR of the knees taken maximum 6 months before surgery, in posterior-anterior weight baring and lateral projections. DICOM files of the radiographs were retrieved, anonymised and read independently by two musculoskeletal radiologists with experience in microcrystalline arthropathies. Each reader performed a second evaluation 3 weeks after the first one to calculate the inter- and intra-reader agreement. For each patient a dichotomic score was assigned (absence/presence of CC) at the level of the medial and lateral menisci, tibiofemoral hyaline cartilage, quadriceps and patella tendons, synovial membrane/joint capsule. The definitions of the ACR/EULAR taskforce for identification of CPPD in conventional radiography were used in this study [paper in preparation]. According to these definitions CPPD in CR appears as “linear or punctate opacities in the region of fibro- or hyaline articular cartilage/synovial membrane or joint capsule/within tendons or entheses that are distinct from denser, nummular radio-opaque deposits due to basic calcium phosphate deposition”. Cohen’s kappa was used to calculate the agreement between the two readers.Results:We enrolled 33 patients with knee OA (60.6% female, mean age 69yo ± 8). The kappa values of the inter-reader and intra-reader agreement in the various sites of the knee are indicated in Table 1. Inter-reader agreement was substantial at the level of both menisci but only moderate or fair at the other sites of assessment. This had a negative impact on the overall evaluation of the knee joint that proved to be unreliable (k of 0.16 – none to slight agreement) if all anatomical structures are included for assessment, and moderately reliable (kappa 0.41) when both menisci and hyaline cartilage are considered. On the other hand, intra-reader kappa values were substantial or higher in all sites (except for synovial membrane/joint capsule for one reader). The striking difference of the intra-reader compared to the inter-reader kappa values, highlight a different interpretation and application of the definitions used for most of the sites with the exception of the menisci.Table 1.kappa values for intra- and inter-reader agreement. Values from 0.01–0.20 are considered as none to slight agreement, 0.21–0.40 as fair, 0.41– 0.60 as moderate, 0.61–0.80 as substantial, and 0.81–1.00 as almost perfect agreement.Medial meniscusLateral meniscusHyaline cartilageQuadriceps tendonPatellar tendonCapsule/ synoviaMenisci + cartilageEntire jointInter-reader0.670.710.340.47NA0.370.400.17Intra-reader 1st assessor0.670.900.840.65NA(insufficient number of categories)0.530.710.76Intra-reader 2nd assessor10.801110.910.860.94Conclusion:CR has been extensively used for diagnosis of OA and CPPD. The results of our study raise some concerns on the reliability of CR in identification of CPPD. Assessment of calcium crystals at the menisci level should be used for identification of CC as other sites of the knee seem to present low reliability.References:[1]Filippou G et al. Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study. Ann Rheum Dis 2020. doi:10.1136/annrheumdis-2020-217998Disclosure of Interests:None declared.
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Messina C, Rinaudo L, Cesana BM, Maresca D, Piodi LP, Sconfienza LM, Sardanelli F, Ulivieri FM. Prediction of osteoporotic fragility re-fracture with lumbar spine DXA-based derived bone strain index: a multicenter validation study. Osteoporos Int 2021; 32:85-91. [PMID: 32936366 DOI: 10.1007/s00198-020-05620-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022]
Abstract
UNLABELLED A new qualitative index of bone strength, based on finite element analysis and named bone strain index, has been recently developed from lumbar DXA scan. This study shows that BSI predicts subsequent re-fracture in osteoporotic patients affected by fragility fractures. INTRODUCTION Dual-energy X-ray absorptiometry (DXA) can provide quantitative (bone mineral density, BMD) and qualitative (trabecular bone score, TBS) indexes of bone status, able to predict fragility fractures in most osteoporotic patients. A new qualitative index of bone strength, based on finite element analysis and named bone strain index (BSI), has been recently developed from lumbar DXA scan. This study presents the validation results of BSI prediction for re-fracture in osteoporotic patients with fragility fractures. METHODS In three academic hospitals, 234 consecutive fractured patients with primary osteoporosis (209 females) performed a spine X-ray for the calculation of spine deformity index (SDI) and DXA densitometry for BMD, TBS and BSI at the basal time and in the follow-up at each clinical check. A subsequent fracture was considered as one unity increase of SDI. RESULTS For each unit increase of the investigated indexes, the univariate hazard ratio of re-fracture, 95% CI, p value and proportionality test p value are for age 1.040, 1.017-1.064, 0.0007 and 0.2529, respectively, and for BSI 1.372, 1.038-1.813, 0.0261 and 0.5179, respectively. BSI remained in the final multivariate model as a statistically significant independent predictor of a subsequent re-fracture (1.332, 1.013-1.752 and 0.0399) together with age (1.039, 1.016-1.064 and 0.0009); for this multivariate model proportionality test, p value is 0.4604. CONCLUSIONS BSI appears to be a valid DXA index of prediction of re-fracture, and it can be used for a more refined risk assessment of osteoporotic patients.
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Affiliation(s)
- C Messina
- Unità di Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy
| | - L Rinaudo
- TECHNOLOGIC Srl, Lungo Dora Voghera 34/36, 10153, Torino, Italy
| | - B M Cesana
- Unità di Statistica Medica, Biometria e Bioinformatica "Giulio A. Maccacaro", Dipartimento di Scienze Cliniche e Salute della Comunità, Università degli Studi di Milano, Via Vanzetti 5, 20100, Milano, Italy
| | - D Maresca
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | | | - L M Sconfienza
- Unità di Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy
| | - F Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy
- Unità di Radiologia, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, MI, Italy
| | - F M Ulivieri
- Unità di Medicina Nucleare, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy.
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Messina C, Buzzoni AC, Gitto S, Almolla J, Albano D, Sconfienza LM. Disruption of bone densitometry practice in a Northern Italy Orthopedic Hospital during the COVID-19 pandemic. Osteoporos Int 2021; 32:199-203. [PMID: 32778933 PMCID: PMC7416993 DOI: 10.1007/s00198-020-05587-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/04/2020] [Indexed: 11/06/2022]
Abstract
UNLABELLED We report the impact of the COVID-19 pandemic on bone densitometry practice in a Northern Italy Orthopedic Hospital, comparing the first 4 months of 2020 with the corresponding period of 2019. COVID-19 pandemic had a disruptive effect on the daily practice of bone densitometry (about - 50% of examinations). INTRODUCTION The Coronavirus Disease 2019 (COVID-19) pandemic radically changes hospital organization to guarantee patient and staff safety, with the unavoidable cessation of normal outpatient activities. We report the impact of the COVID-19 pandemic on dual energy x-ray absorptiometry (DXA) testing in a Northern Italy Orthopedic Hospital. METHODS We analyzed the number of DXA examinations performed at our Institution before, during the lockdown, and immediately after outpatient practice reopening (January 24th to May 27th, 2020), comparing them with the corresponding period of 2019. RESULTS The number of DXA examinations showed a tremendous reduction from n = 1247 performed from January to May 2019 to n = 623 of 2020 (- 49.9%). No exams were performed in April 2020 (- 100%). On May 2020, a faint resume was observed, with n = 43 DXA (- 84.4% compared to 2019). CONCLUSION COVID-19 pandemic had a disruptive effect on the daily practice of bone densitometry with DXA. After reopening, we observed a persistence of DXA examination reduction, confirming the fact that returning to normality will probably be a slow process.
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Affiliation(s)
- C Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milan, Italy.
| | - A C Buzzoni
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy
| | - S Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milan, Italy
| | - J Almolla
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy
| | - D Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - L M Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milan, Italy
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Castellini G, Iannicelli V, Briguglio M, Corbetta D, Sconfienza LM, Banfi G, Gianola S. Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument. BMC Health Serv Res 2020; 20:970. [PMID: 33092579 PMCID: PMC7583191 DOI: 10.1186/s12913-020-05827-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/07/2020] [Accepted: 10/15/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded. METHODS Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. RESULTS A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31-84%), Scope and Purpose (median 64%, IQR 22-83%), Rigour of Development (median 50%, IQR 21-72%), Clarity and Presentation (median 50%, IQR 28-79%), Stakeholder Involvement (median 36%, IQR 10-74%), and Applicability (median 11%, IQR 0-46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88-0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches. CONCLUSIONS We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. LEVEL OF EVIDENCE 1 TRIAL REGISTRATION: REGISTRATION PROSPERO DETAILS: CRD42019127619 .
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Affiliation(s)
- G Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - V Iannicelli
- Vita-Salute San Raffaele University, Milan, Italy
| | - M Briguglio
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - D Corbetta
- Vita-Salute San Raffaele University, Milan, Italy.,Rehabilitation and Functional Recovery Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - L M Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - G Banfi
- Vita-Salute San Raffaele University, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - S Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
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Passeri E, Sansone VA, Sconfienza LM, Messina C, Meola G, Corbetta S. Fragility fractures and bone mineral density in male patients affected by type 1 and type 2 myotonic dystrophy. Neuromuscul Disord 2019; 30:28-34. [PMID: 31902642 DOI: 10.1016/j.nmd.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022]
Abstract
Myotonic dystrophy is a multisystemic disorder affecting skeletal muscle. Male patients have an increased risk of fractures and develop a number of endocrine/metabolic impairments known to adversely affect bone health. The aim of this study was primarily to determine the occurrence of fragility fractures and the bone mineralization status (lumbar spine, hip and total body by dual X-ray absorptiometry) in 36 male patients affected with type 1 myotonic dystrophy and 13 male patients affected with type 2 myotonic dystrophy. Fragility fractures occurred in 15 type 1 and 7 type 2 myotonic dystrophy in non-classical osteoporotic sites, such as metatarses. Hip osteopenia was the most frequent finding, particularly in type 2 (n = 6) than type 1 myotonic dystrophy patients (n = 1), while osteoporosis was rare. Patients with type 1 myotonic dystrophy presented higher total body bone mass density than patients with type 2 myotonic dystrophy and healthy controls and lumbar spine was associated positively with the severity of the disease. Gonadic failure, with low testosterone and reduced INSL3 levels, visceral adiposity and insulin resistance correlated with reduced body mass index in both type 1 and type 2 myotonic dystrophic patients. The independent determinant of fragility fractures were low total body mass index, low blood testosterone and low global muscle mass.
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MESH Headings
- Absorptiometry, Photon
- Adult
- Body Mass Index
- Bone Density
- Bone Diseases, Metabolic/diagnostic imaging
- Bone Diseases, Metabolic/etiology
- Bone Diseases, Metabolic/metabolism
- Bone Diseases, Metabolic/pathology
- Fractures, Bone/diagnostic imaging
- Fractures, Bone/etiology
- Fractures, Bone/metabolism
- Fractures, Bone/pathology
- Humans
- Male
- Middle Aged
- Muscle, Skeletal/pathology
- Myotonic Dystrophy/complications
- Myotonic Dystrophy/metabolism
- Myotonic Dystrophy/pathology
- Osteoporosis/diagnostic imaging
- Osteoporosis/etiology
- Osteoporosis/metabolism
- Osteoporosis/pathology
- Pelvic Bones/diagnostic imaging
- Pelvic Bones/pathology
- Testosterone/blood
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Affiliation(s)
- E Passeri
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan 20161, Italy
| | - V A Sansone
- Neurorehabilitation Unit, University of Milan, The NEMO (NEuroMuscular Omniservice) Clinical Center, Milan 20162, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan 20133, Italy
| | - L M Sconfienza
- Department of Biomedical Sciences for Health, University of Milan, Milan 20133, Italy; Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan 20161, Italy
| | - C Messina
- Department of Biomedical Sciences for Health, University of Milan, Milan 20133, Italy; Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan 20161, Italy
| | - G Meola
- Department of Biomedical Sciences for Health, University of Milan, Milan 20133, Italy; Neurology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan 20097, Italy
| | - S Corbetta
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan 20161, Italy; Department of Biomedical, Surgical and Odontoiatric Sciences, University of Milan, Milan 20122, Italy.
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10
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Messina C, Piodi LP, Rinaudo L, Emili I, Porro F, Buonomenna C, Sconfienza LM, Vergani L, Ulivieri FM. Bone strain index reproducibility and soft tissue thickness influence: a dual x-ray photon absorptiometry phantom study. Eur Radiol Exp 2019; 3:33. [PMID: 31410624 PMCID: PMC6692807 DOI: 10.1186/s41747-019-0110-9] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/02/2019] [Indexed: 02/07/2023] Open
Abstract
Background Bone strain index (BSI) is a tool measuring bone strain, derived from dual x-ray photon absorptiometry. It is able to characterise an aspect of bone quality that, joined to the quantity and quality parameters of bone mineral density (BMD) and trabecular bone score (TBS), permits an accurate definition of fracture risk. As no data are available about BSI precision, our aim was to assess its in vitro reproducibility. Methods A Hologic spine phantom was used to perform BSI scans with three different scan modes: fast array (FA), array (A), and high definition (HD). Different soft tissue thicknesses (1, 3, 6 cm) of fresh pork rind layers as a surrogate of abdominal fat were interposed. For each scan mode, the phantom was consecutively scanned 25 times without repositioning. Results In all scan modes (FA, A, HD) and at every fat thickness, BSI reproducibility was lower than that of BMD. The highest reproducibility was found using HD-mode with 1 cm of pork rind and the lowest one using HD-mode with 6 cm of pork rind. Increasing fat thickness, BSI reproducibility tended to decrease. BSI least significant change appeared to be about three times that of BMD in all modalities and fat thicknesses. Without pork rind superimposition and with 1-cm fat layer, BSI reproducibility was highest with HD-mode; with 3 or 6 cm fat thickness, it was higher with A-mode. Conclusions BSI reproducibility was worse than that of BMD, but it is less sensitive to fat thickness increase, similarly to TBS.
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Affiliation(s)
- C Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal, 36, 20100, Milano, Italy
| | - L P Piodi
- Former: Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Digestive Endoscopy Unit, Via Francesco Sforza 35, 20122, Milano, Italy
| | - L Rinaudo
- TECHNOLOGIC Srl, Lungo Dora Voghera 34/36A, 10153, Torino, Italy
| | - I Emili
- Postgraduate School of Radiodiagnostic, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
| | - F Porro
- Postgraduate School of Physical Medicine and Rehabilitation Therapy, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
| | - C Buonomenna
- Postgraduate School of Radiodiagnostic, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
| | - L M Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal, 36, 20100, Milano, Italy
| | - L Vergani
- Department of Mechanical Engineering Politecnico di Milano, Via Giuseppe La Masa 1, 20156, Milano, Italy
| | - F M Ulivieri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Nuclear Medicine, Bone Metabolic Unit, Via Francesco Sforza 35, 20122, Milano, Italy.
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11
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Ferrari F, Messina C, Orlandi D, Albano D, Chianca V, Corazza A, Gitto S, Sconfienza LM. Potential Use of a Diluted High-relaxivity Gadolinium-based Intra-articular Contrast Agent for Magnetic Resonance Arthrography: An In-vitro Study. Semin Musculoskelet Radiol 2019. [DOI: 10.1055/s-0039-1692589] [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: 10/26/2022]
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12
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Coppola A, Platania G, Gitto S, Cortese MC, Albano D, Messina C, Sconfienza LM. Precision of Periprosthetic Bone Mineral Density Around Total Ankle Replacement Using Dual-Energy X-ray Absorptiometry. Semin Musculoskelet Radiol 2019. [DOI: 10.1055/s-0039-1692563] [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: 10/26/2022]
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13
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Chianca V, Albano D, Cuocolo R, Messina C, Gitto S, Corazza A, Sconfienza LM. Machine Learning Classification of Spinal Lesions: Compared Accuracy of Texture Parameters Extracted by Different Software. Semin Musculoskelet Radiol 2019. [DOI: 10.1055/s-0039-1692578] [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: 10/26/2022]
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14
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Gitto S, Albano D, Chianca V, Cuocolo R, Ugga L, Messina C, Sconfienza LM. Machine Learning Classification of Low-grade and High-grade Chondrosarcomas Based on MRI-based Texture Analysis. Semin Musculoskelet Radiol 2019. [DOI: 10.1055/s-0039-1692575] [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: 10/26/2022]
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15
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Albano D, Bignone R, Chianca V, Cuocolo R, Messina C, Sconfienza LM, Ciccia F, Brunetti A, Midiri M, Galia M. T2 Mapping of the Sacroiliac Joints at 1.5 T can Identify Patients with Spondyloarthritis. Semin Musculoskelet Radiol 2019. [DOI: 10.1055/s-0039-1692570] [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: 10/26/2022]
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16
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Vicentin I, Buonomenna C, Gitto S, Albano D, Messina C, Sconfienza LM. The Fat Mass Does Not Influence Precision Error of Trabecular Bone Score: An in Vivo Study. Semin Musculoskelet Radiol 2019. [DOI: 10.1055/s-0039-1692564] [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: 10/26/2022]
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17
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Filippou G, Adinolfi A, Iagnocco A, Filippucci E, Cimmino MA, Bertoldi I, Di Sabatino V, Picerno V, Delle Sedie A, Sconfienza LM, Frediani B, Scirè CA. Ultrasound in the diagnosis of calcium pyrophosphate dihydrate deposition disease. A systematic literature review and a meta-analysis. Osteoarthritis Cartilage 2016; 24:973-81. [PMID: 26826301 DOI: 10.1016/j.joca.2016.01.136] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 01/07/2016] [Accepted: 01/19/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Ultrasonography (US) demonstrated to be a promising tool for the diagnosis of calcium pyrophosphate dihydrate deposition disease (CPPD). The aim of this systematic literature review (SLR) was to collect the definitions for the US elementary lesions and to summarize the available data about US diagnostic accuracy in CPPD. METHODS We systematically reviewed all the studies that considered US as the index test for CPPD diagnosis without restrictions about the reference test or that provided definitions about US identification of CPPD. Sensitivity and specificity were calculated for each study and definitions were extrapolated. Subgroup analyses were planned by anatomical site included in the index text and different reference standards. RESULTS Thirty-seven studies were included in this review. All the studies were eligible for the collection of US findings and all definitions were summarized. US description of elementary lesions appeared heterogeneous among the studies. Regarding US accuracy, 13 articles entered in the meta-analysis. Considering each joint structure, the sensitivity ranged between 0.77 (0.63-0.87) and 0.34 (0.16-0.58) while the specificity varies between 1.00 (0.89-1.00) and 0.92 (0.16-1.00). Considering the reference standards used, the sensibility ranged between 0.34 (0.02-0.65) and 0.87 (0.76-0.99) while specificity ranged between 0.84 (0.52-1.00) and 1.00 (0.99-1.00). CONCLUSION US is potentially a useful tool for the diagnosis of CPPD but universally accepted definitions and further testing are necessary in order to assess the role of the technique in the diagnostic process.
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Affiliation(s)
- G Filippou
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena, Italy.
| | - A Adinolfi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena, Italy
| | - A Iagnocco
- Rheumatology Unit, Sapienza Università di Roma, Rome, Italy
| | - E Filippucci
- Rheumatology Department, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - M A Cimmino
- Research Laboratory and Academic Division of Clinical Rheumatology, Dipartimento di Medicina Interna, University of Genoa, Genova, Italy
| | - I Bertoldi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena, Italy
| | - V Di Sabatino
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena, Italy
| | - V Picerno
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena, Italy
| | | | - L M Sconfienza
- Unit of Radiology, San Donato Hospital, San Donato Milanese, Milan, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena, Italy
| | - C A Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
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18
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Filippou G, Adinolfi A, Delle Sedie A, Filippucci E, Iagnocco A, Porta F, Sconfienza LM, Tormenta S, Di Sabatino V, Picerno V, Frediani B. Radiologists and rheumatologists on performing and reporting shoulder ultrasound: from disagreement to consensus. Reumatismo 2014; 66:233-9. [PMID: 25376958 DOI: 10.4081/reumatismo.2014.739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 08/16/2014] [Accepted: 08/18/2014] [Indexed: 11/22/2022] Open
Abstract
Shoulder pain is a common condition in the rheumatologist's practice, yet there are no guidelines on how to report shoulder ultrasound (US) examinations. The aim of this study was to compare scanning and reporting techniques performed by radiologists and rheumatologists and identify any discrepancies between the two. The participants in this study were five rheumatologists and two radiologists specialized in musculoskeletal US. The study was divided in 2 phases. In the first phase, each participant performed an US of 3 patients and reported the findings without knowing the patient diagnosis and the findings reported by the other operators. Other three investigators reported the US technique of each operator. Reports and images were subsequently compared to identify any discrepancies and reach consensus on a common approach. In the second phase, a US scan was performed on a fourth patient in a plenary session to assess feasibility and efficacy of the common approach The US scanning technique was similar for all operators. The differences in reporting emerged in the description of the rotator cuff disease. Radiologists provided a detailed description of lesions (measurements along 2 axis and scoring of lesions), whereas rheumatologists described carefully the inflammatory changes. The experts concluded that lesions should be measured along 2 axes and the grade of degeneration and the age of the lesion should be reported. Another difference emerged in the description of the irregularities of the bone surface. The experts concluded that the term erosion should be used only when an inflammatory joint disease is suspected. This study led to the clarification of some inconsistencies in US reporting, and represented an interesting collaborative experience between radiologists and rheumatologists.
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Affiliation(s)
- G Filippou
- Rheumatology Unit, University of Siena, Siena.
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19
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Bertolotto M, Serafini G, Sconfienza LM, Lacelli F, Cavallaro M, Coslovich A, Tognetto D, Cova MA. The use of CEUS in the diagnosis of retinal/choroidal detachment and associated intraocular masses - preliminary investigation in patients with equivocal findings at conventional ultrasound. Ultraschall Med 2014; 35:173-180. [PMID: 23450377 DOI: 10.1055/s-0032-1330321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To investigate whether contrast-enhanced ultrasound (CEUS) may help to diagnose retinal/choroidal detachment and may help to differentiate intraocular lumps in cases with equivocal features on conventional grayscale and Doppler modes. MATERIALS AND METHODS The institutional review board approved this retrospective study. The need for informed consent was waived. A computerized data search was performed in the database of our institution for patients with vitreous hemorrhage who underwent CEUS of the eye to assess retinal/choroidal detachment and/or associated masses. This process yielded a total of 31 patients (18 men, 13 women, age range: 39 - 88 years) in whom CEUS was performed because the findings on conventional grayscale and Doppler modes were equivocal. CEUS was performed using low acoustic power contrast-specific modes. A 2.4 - 4.8 mL bolus of SonoVue was injected, followed by a saline flush. All examinations were digitally recorded for retrospective analysis. Confirmation of CEUS findings was obtained at surgery (n = 20) or with binocular indirect fundoscopy performed after clearance of the ocular media (n = 11). Two readers with different levels of ultrasound experience independently reviewed the imaging features. A five-degree scale ranging from definitely absent (score 1) to definitely present (score 5) was used to assess the presence or absence of retinal/choroidal detachment on conventional ultrasound modes alone and with the addition of CEUS. ROC curve analysis was performed to assess the diagnostic accuracy of both methods. The inter-reader agreement was also evaluated. In patients with associated intraocular lumps, conventional Doppler modes and CEUS were used to differentiate non-tumor masses from tumor masses. RESULTS According to the reference standard, 13 patients had retinal detachment, 4 had choroidal detachment, and 3 had both retinal and choroidal detachment. There were 8 associated intraocular lumps (4 subretinal hemorrhages, 3 malignant melanomas, 1 metastasis). The inter-reader agreement was good (K = 0.644) and very good (K = 0.833) for conventional modes and CEUS, respectively. The diagnostic performance of CEUS was high for both readers (area ± standard error under the ROC curve: 0.966 ± 0.031 and 0.900 ± 0.055 for readers 1 and 2, respectively). There were 2 false-positive results and 1 false-negative result in patients with proliferative diabetic retinopathy. CEUS was effective in differentiating subretinal hemorrhage from hypovascular tumors. CONCLUSION CEUS can be used as a problem-solving technique when conventional ultrasound modes are not diagnostic for retinal/choroidal detachment and when intraocular lumps cannot be characterized as tumor or non-tumor masses on conventional modes. The evaluation of patients with proliferative diabetic retinopathy, however, may be problematic.
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Affiliation(s)
| | | | | | | | | | - A Coslovich
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano
| | - D Tognetto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano
| | - M A Cova
- Radiology, University of Trieste
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20
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Israel O, Sconfienza LM, Lipsky BA. Diagnosing diabetic foot infection: the role of imaging and a proposed flow chart for assessment. Q J Nucl Med Mol Imaging 2014; 58:33-45. [PMID: 24231797] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Diabetes mellitus, a major current epidemic, is frequently complicated by foot infections that are associated with high morbidity. Diagnosing these infections, especially whether or not underlying bone is involved, poses clinical challenges, but is crucial to making proper decisions regarding therapeutic strategies. The most effective means of managing patients with a diabetic foot infection is within the framework of a multidisciplinary team. Present diagnostic efforts are aimed at developing better methods to differentiate uninfected from infected soft tissue wounds, to determine when bone infection is present, and to more clearly define when infection has resolved with treatment. Imaging studies play a major role in diagnosis. This usually begins with plain radiographs, but when advanced imaging is needed, magnetic resonance imaging (MRI) is considered the modality of choice. Newer techniques, such as molecular hybrid imaging, positron emission tomography (PET)/computed tomography (CT) and single photon emission (SPECT)/CT using various radiotracers, play an increasing role. These tests may redefine the non-invasive diagnostic work-up of diabetic foot wounds, potentially leading to substantial improvements in patient management. As experts in infectious diseases, radiology and nuclear medicine, we reviewed the available literature on diagnosing diabetic foot infections, especially the currently available imaging techniques, and developed a proposed diagnostic flow chart, for evaluating patients with a diabetic foot wound.
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Affiliation(s)
- O Israel
- Department of Nuclear Medicine Rambam Health Care Campus, Haifa, Israel -
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21
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Jutte P, Lazzeri E, Sconfienza LM, Cassar-Pullicino V, Trampuz A, Petrosillo N, Signore A. Diagnostic flowcharts in osteomyelitis, spondylodiscitis and prosthetic joint infection. Q J Nucl Med Mol Imaging 2014; 58:2-19. [PMID: 24469568] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Infections of the bone, spine and prosthetic joints are serious and complex conditions to diagnose and to treat. Structured diagnostic workup may very well improve the accuracy and speed of diagnosis, thereby improving the outcome since treatment may very well be more successful and less harmful if timely management is started. Literature shows no uniform advise on diagnosis. The EANM organized a consensus meeting with representatives from the involved disciplines in order to develop common flowcharts for the diagnosis of osteomyelitis, spondylodiscitis and prosthetic joint infections. In this report the proceedings of this consensus meeting, including the proposed flowcharts for diagnosis, are published.
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Affiliation(s)
- P Jutte
- Department of Orthopaedic Surgery University Medical Center Groningen Groningen, The Netherlands -
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22
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Bandirali M, Messina C, Di Leo G, Sconfienza LM, Aliprandi A, Ulivieri FM, Sardanelli F. Bone mineral density differences between femurs of scoliotic patients undergoing dual-energy X-ray absorptiometry. Clin Radiol 2013; 68:e511-5. [PMID: 23756109 DOI: 10.1016/j.crad.2013.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/15/2013] [Accepted: 03/29/2013] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether a difference exists in the bone mineral density (BMD) between femurs in scoliotic patients undergoing dual-energy X-ray absorptiometry (DXA) and whether this difference is related to spine convexity. MATERIALS AND METHODS Of 1080 consecutive patients who underwent DXA, 127 had lumbar scoliosis seen at DXA. Further, after excluding 30 patients with previous osteoporotic fractures, metallic/image artefacts, soft-tissue calcifications, the BMD differences between femurs of 97 scoliotic patients (94 females; mean age 67 ± 11 years) were analysed. Femurs were classified as ipsilateral or contralateral to the spine convexity. Least significant change was used as a threshold of measurement precision. Differences between femoral neck BMD in respect of and regardless of spine convexity were calculated for each patient. Student's t-test and Wilcoxon's signed-rank test were used to assess significance. RESULTS Fifty-nine of 97 patients (61%) had left-sided scoliosis. Osteoporosis was found in 32/97 patients (33%), osteopenia in 54/97 (56%), and 11/97 (11%) had a normal T-score. Of 97 patients, 46 (47%) had ipsilateral BMD < contralateral BMD. Regardless of spine convexity, 66/97 patients (68%) had different BMD values between femurs. Among them, variation of densitometric diagnosis was seen in 29/66 patients (44%), and in 29/97 patients overall (30%). CONCLUSION Differences in the femoral neck BMD exist between femurs of scoliotic patients undergoing DXA. Thus, bilateral femoral DXA acquisition is recommended.
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Affiliation(s)
- M Bandirali
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy.
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23
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Adinolfi A, Filippou G, Delle Sedie A, Filippucci E, Iagnocco A, Porta F, Sconfienza LM, Tormenta S, Frediani B. FRI0475 Radiologists against rheumatologists on technical aspects of shoulder ultrasound: from the disagreement to final consensus. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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24
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Delnevo A, Bandirali M, Di Leo G, Messina C, Sconfienza LM, Aliprandi A, Ulivieri FM, Sardanelli F. Differences among array, fast array, and high-definition scan modes in bone mineral density measurement at dual-energy x-ray absorptiometry on a phantom. Clin Radiol 2013; 68:616-9. [PMID: 23351778 DOI: 10.1016/j.crad.2012.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/23/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022]
Affiliation(s)
- A Delnevo
- Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
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25
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Orlandi D, Fabbro E, Ferrero G, Martini C, Lacelli F, Serafini G, Silvestri E, Sconfienza LM. High-resolution ultrasound of the extrinsic carpal ligaments. J Ultrasound 2012; 15:267-72. [PMID: 23730393 DOI: 10.1016/j.jus.2012.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thanks to its intrinsic high spatial resolution, ultrasound is an ideal imaging modality for examining very thin, superficial structures, and this makes it very helpful in the evaluation of extrinsic carpal ligaments. These structures, which arise from the radius and ulna and insert on the carpal bones, are extremely important for wrist stability. Previous studies have assessed the use of ultrasound to study the extrinsic carpal ligaments in cadavers, healthy asymptomatic subjects, and patients with rheumatoid arthritis. In the present report, we review the normal anatomy, biomechanics, and ultrasound appearance of these ligaments.
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Affiliation(s)
- D Orlandi
- Scuola di Specializzazione in Radiodiagnostica, Dipartimento di Medicina Interna, Università degli Studi di Genova, Italy
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Mauri G, Sconfienza LM, Fiore B, Brambilla G, Pedicini V, Poretti D, Lutman RF, Montorsi M, Sardanelli F. Post-surgical enteric fistula treatment with image-guided percutaneous injection of cyanoacrylic glue. Clin Radiol 2012; 68:59-63. [PMID: 22613168 DOI: 10.1016/j.crad.2012.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/22/2012] [Accepted: 04/03/2012] [Indexed: 12/13/2022]
Affiliation(s)
- G Mauri
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Italy.
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Orlandi D, Sconfienza LM, Fabbro E, Ferrero G, Martini C, Lacelli F, Serafini G, Silvestri E. Preliminary ultrasound evaluation of the rotator cable in asymptomatic volunteers(). J Ultrasound 2012; 15:16-9. [PMID: 23396940 DOI: 10.1016/j.jus.2012.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To characterize the rotator cable high-resolution ultrasound appearance in asymptomatic shoulders of volunteers of different age. MATERIALS AND METHODS IRB approval and volunteers' written consent was obtained. Excluding subjects with known shoulder affections, we screened 24 asymptomatic volunteers. Supraspinatus and infraspinatus tendons high-resolution ultrasound evaluation was performed according to standard scan protocols, further excluding shoulders with partial/full-thickness cuff tears. Thus, we studied 24 shoulders in 12 young volunteers (age range 21-39 years, mean age 33 ± 8 years) and 21 shoulders in 11 elderly volunteers (age range 62-83 years, mean age 75 ± 45 years). For each shoulder, we noted rotator cable visibility and its thickness and width. Fisher's and U Mann-Whitney statistics were used. RESULTS Rotator cable was less frequently detected in young than in elderly volunteers (5/24 vs. 11/21 shoulders; P = 0.034). When detected, rotator cable was significantly thicker in young (range 1.2-1.5 mm, mean thickness 1.3 ± 0.1 mm) than in elderly (range 0.9-1.4 mm, mean thickness 1.2 ± 0.1 mm) volunteers (P = 0.025), while its width was not significantly different in young (range 4.5-7.1 mm, mean 5.6 ± 1.1 mm) compared to elderly (range 2.5-7.1 mm, mean 4.2 ± 1.4 mm) volunteers (P = 0.074) although a tendency can be highlighted. CONCLUSIONS Ultrasound demonstrated the different consistency of rotator cable in young and elderly asymptomatic patients, with high interobserver reproducibility.
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Affiliation(s)
- D Orlandi
- Scuola di Specializzazione in Radiodiagnostica, Genova University, Italy
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Sconfienza LM, Lacelli F, Ardemagni A, Perrone N, Bertolotto M, Padolecchia R, Serafini G. High-resolution, three-dimensional, and contrast-enhanced ultrasonographic findings in diseases of the eye(). J Ultrasound 2010; 13:143-9. [PMID: 23396709 DOI: 10.1016/j.jus.2010.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To review the contrast-enhanced ultrasound (CEUS) and 3D ultrasound findings (3D-US) in various pathologies involving the eye and orbit and to compare them with high-resolution US (HRUS) findings. BACKGROUND CEUS is a valid diagnostic tool for study several districts. There are numerous pathological conditions of the eye in which CEUS can be very helpful or detrimental. IMAGE FINDINGS: We review a wide range of ocular lesions, traumatic (retinal and choroidal detachments) and malignant (choroidal melanoma, tumors inside and outside the muscle cone) evaluated alternatively with CEUS and 3D and compare these findings with those obtained with HRUS. Dysthyroid orbitopathy is not included in this review. CONCLUSION CEUS plays a central role in the differentiation of detached retina (vascular) and vitreous membranes (avascular). It is also helpful in the assessment of tumor of the eye, in planning treatment for choroidal melanoma, and in assessing orbital masses for neovascularization. HRUS is highly effective in the detection of traumatic and non-traumatic lesions of the eye, but it is less effective for the assessment of orbital lesions. The 3D module has increased the diagnostic value of CEUS. CEUS is cost-effective and can be used when CT and MR cannot be performed.
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Affiliation(s)
- L M Sconfienza
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Sconfienza LM, Silvestri E, Bartolini B, Garlaschi G, Cimmino MA. Sonoelastography may help in the differential diagnosis between rheumatoid nodules and tophi. Clin Exp Rheumatol 2010; 28:144-145. [PMID: 20346257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Sconfienza LM, Lacelli F, Caldiera V, Perrone N, Piscopo F, Gandolfo N, Serafini G. Three-dimensional sonohysterography for examination of the uterine cavity in women with abnormal uterine bleeding: Preliminary findings. J Ultrasound 2009; 13:16-21. [PMID: 23396822 DOI: 10.1016/j.jus.2009.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION To compare the diagnostic values of three-dimensional sonohysterography (3DSH), transvaginal ultrasound (TVUS), and 2-dimensional sonohysterography (2DSH) in the work-up of abnormal uterine bleeding (AUB), in particular the ability of each method to identify intracavitary lesions arising from the endometrium or uterine wall. MATERIALS AND METHODS 24 patients referred for AUB underwent TVUS followed by 2-D and 3-D HS in the same session. Three-dimensional data were acquired with a free-hand technique during maximal distention of the uterus. Within 10 days of the sonographic session, each patient underwent hysteroscopy, which was considered the reference standard. For each of the 3 imaging methods, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. RESULTS Hysteroscopy demonstrated the presence of an intrauterine lesion in 21/24 patients (87.5%). In 3/24 patients hysteroscopy was negative. For TVUS, 2DSH, and 3DSH, sensitivity was 76% (16/21), 90% (19/21), 100% (21/21), respectively; specificity was 100% (3/3), 100% (19/19), 100% (21/21); PPV was 100%, 100%, 100%; NPV was 37%, 60%, 100%; accuracy was 76%, 90%, 100%. CONCLUSIONS 3DSH is more sensitive that 2DSH or TVUS in the detection of intrauterine lesions. If these preliminary results are confirmed in larger studies, 3DSH could be proposed as a valuable alternative to diagnostic hysteroscopy.
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Affiliation(s)
- L M Sconfienza
- Unit of Radiology, IRCCS Policlinico San Donato, University of Milan School of Medicine, San Donato Milanese (MI), Italy
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Sconfienza LM, Lacelli F, Bruno A, Serafini G. Ultrasound guidance can improve the outcome of botulinum toxin A injection. Eur J Phys Rehabil Med 2009; 45:153; author reply 153. [PMID: 19282806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Sconfienza LM, Lacelli F, Gandolfo N, Gazzo P, Perrone N, Serafini G. Contrast-enhanced ultrasound (CEUS) assessment of superselective uterine fibroid embolization (SUFE): Preliminary experience(). J Ultrasound 2008; 11:158-61. [PMID: 23396952 DOI: 10.1016/j.jus.2008.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The use of superselective uterine fibroid embolization (SUFE) requires imaging techniques that can be used to verify the success of the procedure. The purpose of our study was to analyze the potential value of pre- and post-treatment contrast-enhanced ultrasonography (CEUS) for assessing the outcome of SUFE and for posttreatment follow-up. MATERIALS AND METHODS We studied twelve women undergoing SUFE for uterine fibroids. In those with multiple fibroids, only the three largest were considered in this study. A total of 21 lesions (size range 3.5-9.0 cm, mean 5.2 cm) were examined. Each myoma was examined immediately before and after SUFE (while the patient was still in the angiography room) with transabdominal CEUS performed after intravenous administration of a single bolus of contrast agent. The follow-up protocol included CEUS evaluation one month after treatment and CEUS plus dynamic magnetic resonance (MR) studies six months after treatment. RESULTS In 20/21 cases, postembolization CEUS revealed total fibroid devascularization. The remaining lesion (in a woman with multiple lesions) showed persistent vascularization after SUFE. These findings were all consistent with angiographic data. No recurrences were observed during the six-month follow-up. One patient reported the reappearance of symptoms 18 months after SUFE, and CEUS showed the persistence of intralesional vascularization. CONCLUSIONS CEUS is effective for assessing the completeness of vascular occlusion following SUFE for uterine fibroids. CEUS findings correlate with clinical results observed one and six months after treatment. Compared with dynamic MR, CEUS is reliable and cost-effective.
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Affiliation(s)
- L M Sconfienza
- Sezione di Radiodiagnostica, Dipartimento di Medicina Sperimentale - Università degli Studi, Genova, Italy
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Sconfienza LM, Perrone N, Lacelli F, Lentino C, Serafini G. Ultrasound-guided injection of botulinum toxin A in the treatment of iliopsoas spasticity. J Ultrasound 2008; 11:113-7. [PMID: 23396653 DOI: 10.1016/j.jus.2008.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Intramuscular injection of botulinum toxin A (BTX-A) is a common treatment for iliopsoas muscle spasticity, but it is not easy to position the needle in this muscle without guidance. In this paper we describe an ultrasound-guided technique for the intramuscular injection of BTX-A to treat spasticity of the iliopsoas muscle. Its effectiveness was assessed in 10 patients. METHOD AND MATERIALS The ultrasound-guided technique for BTX-A injection was used on 10 patients. The needle was inserted into the muscle belly at an angle of 45° along the longitudinal axis of the muscle when allowed by patient's condition. RESULTS In all cases, the iliopsoas muscle was easily identified and both the iliac and psoas components were assessed. Introduction of the needle and drug injection were entirely carried out under ultrasonographic guidance. The procedure was successful in all patients, even in those with a high-grade spasticity, and general anesthesia was not required. CONCLUSIONS This ultrasound-guided technique allows accurate guidance for the injection of BTX-A, and it can be considered as an alternate supportive therapy in patients with spasticity and dystonia.
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Affiliation(s)
- L M Sconfienza
- Di.Me.S. Sezione di Radiodiagnostica, Università degli Studi di Genova, Genova, Italy
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Lacelli F, Muda A, Sconfienza LM, Schettini D, Garlaschi G, Silvestri E. High-resolution ultrasound anatomy of extrinsic carpal ligaments. Radiol Med 2008; 113:504-16. [DOI: 10.1007/s11547-008-0269-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Accepted: 09/18/2007] [Indexed: 10/22/2022]
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