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Ross L, Costello B, Lindqvist A, Hansen D, Brown Z, Stevens W, Burns A, Prior D, Pianta M, Perera W, La Gerche A, Nikpour M. Disease specific determinants of cardiopulmonary fitness in systemic sclerosis. Semin Arthritis Rheum 2023; 58:152137. [PMID: 36434894 DOI: 10.1016/j.semarthrit.2022.152137] [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: 08/25/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to quantify the burden of exercise intolerance in systemic sclerosis (SSc) and explore the disease features that contribute to impaired exercise capacity (measured as peak oxygen uptake, peak VO2) to provide novel mechanistic insights into the causes of physical disability in SSc. METHODS Thirty-three SSc patients with no history of cardiac disease and no active myositis underwent cardiac and skeletal muscle MRI, transthoracic echocardiography, pulmonary function tests and cardiopulmonary exercise testing (CPET). CPET results were compared to an age-, sex-, and weight-matched controls with no overt cardiopulmonary disease. Native T1 and T2-mapping sequences were used to quantify diffuse fibroinflammatory myocardial disease and qualitative assessment of skeletal muscle oedema was performed. The associations between parameters of cardiorespiratory function and skeletal muscle abnormalities and peak VO2 were evaluated with linear regression analysis. RESULTS Exercise capacity was markedly impaired in SSc and significantly reduced when compared to control subjects (percent predicted peak VO2: 70% vs 98%, p < 0⋅01). Diffuse myocardial fibroinflammatory disease (p < 0⋅01) and skeletal muscle oedema (p = 0⋅01) were significantly associated with reduced exercise capacity. There was no association between impaired exercise capacity and left ventricular ejection fraction. CONCLUSION SSc is associated with marked functional impairment that is not explained by commonly used parameters of cardiac function such as left ventricular ejection fraction. Rather, only more sensitive measures of organ involvement are associated with impaired exercise tolerance. Our results show diffuse interstitial changes of the myocardium and skeletal muscle affect oxygen uptake and are important contributors to functional limitation in SSc.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
| | - Benedict Costello
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Anniina Lindqvist
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Zoe Brown
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Andrew Burns
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - David Prior
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Marcus Pianta
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Warren Perera
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - André La Gerche
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
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Ross L, Lindqvist A, Costello B, Hansen D, Brown Z, Day JA, Stevens W, Burns A, Perera W, Pianta M, La Gerche A, Nikpour M. Using magnetic resonance imaging to map the hidden burden of muscle involvement in systemic sclerosis. Arthritis Res Ther 2022; 24:84. [PMID: 35410246 PMCID: PMC8996589 DOI: 10.1186/s13075-022-02768-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Skeletal muscle can be directly affected by systemic sclerosis (SSc); however, a significant burden of SSc-associated myopathy is undetected because clinical parameters such as weakness and creatine kinase (CK) are unreliable biomarkers of muscle involvement. This study presents qualitative and quantitative magnetic resonance imaging (MRI) findings that quantify the prevalence of myopathy and evaluate any association between skeletal and cardiac muscle involvement in SSc. METHODS Thirty-two patients with SSc who fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria underwent skeletal muscle MRI in addition to cardiac MRI. Skeletal muscles were independently assessed by two musculoskeletal radiologists for evidence of oedema, fatty infiltration and atrophy. Skeletal muscle T2 mapping times and percentage fat fraction were calculated. Linear regression analysis was used to evaluate the clinical and myocardial associations with skeletal muscle oedema and fatty infiltration. Cardiac MRI was performed using post gadolinium contrast imaging and parametric mapping techniques to assess focal and diffuse myocardial fibrosis. RESULTS Thirteen participants (40.6%) had MRI evidence of skeletal muscle oedema. Five (15.6%) participants had fatty infiltration. There was no association between skeletal muscle oedema and muscle strength, creatine kinase, inflammatory markers or fibroinflammatory myocardial disease. Patients with skeletal muscle oedema had higher T2-mapping times; there was a significant association between subjective assessments of muscle oedema and T2-mapping time (coef 2.46, p = 0.02) and percentage fat fraction (coef 3.41, p = 0.02). Diffuse myocardial fibrosis was a near-universal finding, and one third of patients had focal myocardial fibrosis. There was no association between skeletal myopathy detected by MRI and burden of myocardial disease. CONCLUSIONS MRI is a sensitive measure of muscle oedema and systematic assessment of SSc patients using MRI shows that myopathy is highly prevalent, even in patients without symptoms or other signs of muscle involvement. Similarly, cardiac fibrosis is highly prevalent but occurs independently of skeletal muscle changes. These results indicate that novel quantitative MRI techniques may be useful for assessing sub-clinical skeletal muscle disease in SSc.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Anniina Lindqvist
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Benedict Costello
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Zoe Brown
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Jessica A Day
- Inflammation Division, Walter and Eliza Hall Institute, Parkville, VIC, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Andrew Burns
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Warren Perera
- Department of Radiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Marcus Pianta
- Department of Radiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - André La Gerche
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia. .,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia.
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3
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Jaremko JL, Lambert RG, Pedersen SJ, Weber U, Lindsay D, Al-Ani Z, Steer K, Pianta M, Wichuk S, Maksymowych WP. OMERACT Hip Inflammation Magnetic Resonance Imaging Scoring System (HIMRISS) Assessment in Longitudinal Study. J Rheumatol 2019; 46:1239-1242. [DOI: 10.3899/jrheum.181043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2018] [Indexed: 11/22/2022]
Abstract
Objective.To assess reliability, feasibility, and responsiveness of Hip Inflammation Magnetic resonance imaging Scoring System (HIMRISS) for bone marrow lesions (BML) in hip osteoarthritis (OA).Methods.HIMRISS was scored by 8 readers in 360 hips of 90 patients imaged pre/post-hip steroid injection. Pre-scoring, new readers trained online to achieve intraclass correlation coefficient (ICC) > 0.80 versus experts.Results.HIMRISS reliability was excellent for BML status (ICC 0.83–0.92). Despite small changes post-injection, reliability of BML change scores was high in femur (0.76–0.81) and moderate in acetabulum (0.42–0.56).Conclusion.HIMRISS should be a priority for further assessment of hip BML in OA, and evaluated for use in other arthropathies.
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Pianta M, McCombe D, Slavin J, Hendry S, Perera W. Dual-energy contrast-enhanced CT to evaluate scaphoid osteonecrosis with surgical correlation. J Med Imaging Radiat Oncol 2018; 63:69-75. [PMID: 30183133 DOI: 10.1111/1754-9485.12796] [Citation(s) in RCA: 3] [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] [Received: 05/13/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022]
Abstract
To evaluate the validity of contrast enhanced dual energy CT using a lung perfusion algorithm in assessing for post-traumatic scaphoid proximal pole avascular necrosis. From Aug 2013 to Aug 2016, 18 patients (19 wrists, 16 males, 2 females, mean age 28 years) were assessed as high-risk for proximal pole scaphoid avascular necrosis by a single surgeon following a scaphoid fracture and were referred for contrast-enhanced dual energy CT. 8 wrists had specimens sent for correlative histological analysis and 11 were correlated with operative notes. Eight surgical specimens were sent to histology and showed a 100% correlation (8/8) with the DECT findings. The remaining 11 wrists that did not have a specimen sent had in-surgery findings that also correlated with DECT. A single case was discrepant (1/11) due to presence of an intra-osseous ganglion, which was reported as osteonecrosis on CT, but considered viable at surgery. No case was called viable on CT that proved to be necrotic at either surgery or histologically. Contrast-enhanced dual energy CT using a perfusion algorithm is an innovative and promising method in evaluating viability of the post-trauma proximal pole of scaphoid.
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Affiliation(s)
- Marcus Pianta
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - David McCombe
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - John Slavin
- Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Shona Hendry
- Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Warren Perera
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, Victoria, Australia
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5
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Imanishi J, Slavin J, Pianta M, Jackett L, Ngan SY, Tanaka T, Charoenlap C, DI Bella C, Choong PFM. Tail of Superficial Myxofibrosarcoma and Undifferentiated Pleomorphic Sarcoma After Preoperative Radiotherapy. Anticancer Res 2016; 36:2339-2344. [PMID: 27127141] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/31/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND/AIM Superficial myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS) are highly associated with infiltrative growth (tail sign) and local recurrence, but the impact of preoperative radiotherapy is uncertain. PATIENTS AND METHODS Eight consecutive superficial MFS and 10 superficial UPS cases treated with preoperative radiotherapy and surgery were reviewed. Pathological response, surgical margin and magnetic resonance imaging (MRI) were retrospectively evaluated. Oncological events were reported in a descriptive form. RESULTS Pathologically, nearly-complete response was observed in six UPS cases. Tail sign was pathologically detected in 13 cases, eight of which remained viable. Among the eight cases with viable tail, three cases, including two with positive margin, locally recurred. No major discrepancy was observed between tail length on pre-treatment T1-weighted post-contrast, fat-saturated MRI and pathological tail length. CONCLUSION Tail of superficial MFS and UPS can retain viability even after radiotherapy and cause local recurrence unless they respond to radiotherapy well. Wider resection including the tail on MRI is recommended.
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Affiliation(s)
- Jungo Imanishi
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Saitama, Japan Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia
| | - John Slavin
- Department of Pathology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Marcus Pianta
- Department of Medical Imaging, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Louise Jackett
- Department of Pathology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Samuel Y Ngan
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, East Melbourne, Victoria, Australia
| | - Takaaki Tanaka
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Chris Charoenlap
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Claudia DI Bella
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia
| | - Peter F M Choong
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia Bone and Soft Tissue Tumour Unit, Peter MacCallum Cancer Centre, East Melbourne, East Melbourne, Victoria, Australia
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6
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Parathithasan N, Lee WK, Pianta M, Oon S, Perera W. Gouty arthropathy: Review of clinico-pathologic and imaging features. J Med Imaging Radiat Oncol 2015; 60:9-20. [PMID: 26439321 DOI: 10.1111/1754-9485.12356] [Citation(s) in RCA: 8] [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] [Received: 06/01/2015] [Accepted: 07/30/2015] [Indexed: 12/27/2022]
Abstract
Gout is a common inflammatory arthropathy in adults, with the prevalence increasing in males of older age. It occurs when monosodium urate (MSU) crystals are deposited in joints and connective tissue causing inflammation. The gold standard for the diagnosis of gout is the demonstration of negatively birefringent, needle-shaped MSU crystals through synovial fluid aspiration. However, this is an invasive technique and may not always be conclusive or feasible. Imaging techniques have been developed to aid in diagnosis of gout non-invasively. Radiography has a low utility in the early diagnosis of gout and demonstrates erosions in late stages. Ultrasound (US) has a high overall sensitivity in diagnosing gout with the 'double contour' sign having a high specificity. Magnetic resonance imaging is good at detecting tophi, bone marrow oedema and erosions, but has a limited role in diagnosis because of its high cost and limited availability. Conventional computed tomography (CT) has no role in the routine diagnosis of gout before development of erosions and tophi. A newer technology, dual-energy CT (DECT) has been shown to be able to detect MSU crystals burden with high accuracy. It has a higher specificity and lower sensitivity that US in gout diagnosis. However, because of radiation exposure and cost, it has a better utility in diagnosing clinically suspected gout complicated by other concurrent rheumatologic conditions or if radiography, US and synovial aspiration are inconclusive or not feasible. This paper will review the clinico-pathologic and imaging features of gouty arthropathy.
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Affiliation(s)
| | - Wai-Kit Lee
- Department of Medical Imaging, St Vincent's Hospital, University of Melbourne, Victoria, Australia
| | - Marcus Pianta
- Department of Medical Imaging, St Vincent's Hospital, University of Melbourne, Victoria, Australia
| | - Shereen Oon
- Department of Rheumatology, St Vincent's Hospital, University of Melbourne, Victoria, Australia
| | - Warren Perera
- Department of Medical Imaging, St Vincent's Hospital, University of Melbourne, Victoria, Australia
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7
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Pianta M, Chock E, Schlicht S, McCombe D. Accuracy and complications of CT-guided core needle biopsy of peripheral nerve sheath tumours. Skeletal Radiol 2015; 44:1341-9. [PMID: 26078215 DOI: 10.1007/s00256-015-2185-6] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 04/23/2015] [Accepted: 05/28/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This single-centre study retrospectively reviews the complications in patients that have occurred following peripheral nerve sheath tumour biopsy, and assesses whether there is an association with biopsy technique or underlying lesion characteristics. MATERIALS AND METHODS 41 consecutive core needle biopsies of proven peripheral nerve sheath tumours over a 2-year period in a tertiary teaching hospital were reviewed. Patient demographics and symptoms, tumour characteristics and radiological appearances were recorded. Biopsy and surgical histology were correlated, and post-biopsy and surgical complications analyzed. RESULTS 41 biopsies were performed in 38 patients. 68% schwannomas, 24% neurofibromas and 7% malignant peripheral nerve sheath tumours. Biopsy histology correlated with surgery in all cases. 71% of lesions were surgically excised. 60% of patients reported pain related to their lesion. Following the biopsy, 12% reported increased pain, which resolved in all cases. Pain exacerbation was noted in tumours smaller in size, more superficial and in closer proximity of the biopsy needle tip to the traversing nerve. Number of biopsy needle passes was not associated with an increased incidence of procedure-related pain. CONCLUSION Core biopsy of a suspected peripheral nerve sheath tumour may be performed safely before excisional surgery to confirm lesion histology and assist prognosis. There is excellent correlation between core biopsy and excised surgical specimen histology. The most common complication of pain exacerbation is seen in a minority and is temporary, and more likely with smaller, more superficial lesions and a closer needle-tip to traversing nerve distance during biopsy.
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Affiliation(s)
- Marcus Pianta
- St Vincent's Hospital, 41 Victoria Parade, Fitzroy, 3065, VIC, Australia,
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8
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Trieu J, Sinnathamby M, Di Bella C, Pianta M, Perera W, Slavin JL, Schlicht SM, Choong PFM. Biopsy and the diagnostic evaluation of musculoskeletal tumours: critical but often missed in the 21st century. ANZ J Surg 2015; 86:133-8. [PMID: 26235443 DOI: 10.1111/ans.13251] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 11/29/2022]
Abstract
Bone and soft-tissue sarcomas are rare and heterogeneous malignancies arising from tissues of mesenchymal origin. Treatment planning is informed by accurate diagnosis for which biopsy is the diagnostic standard. Biopsy in the setting of suspected malignancy is a technically challenging procedure that should only be performed at specialist institutions. Without the requisite expertise, they can compromise the viability of reconstructive procedures and may make necessary amputation to achieve adequate surgical margins. The risk of complications arising from the procedure must be minimized and therefore biopsy should always be preceded by imaging. There must be no attempt at biopsy or excision prior to referral if there is any suspicion of malignancy. Patients with suspected bone and soft-tissue tumours are best evaluated and treated at specialist sarcoma centres under the care of expert multidisciplinary teams. Prompt referral to a specialist sarcoma centre should always be made prior to biopsy for any suspicious mass that is painful, progressively increasing in size, greater than 5 cm in diameter, deep to deep fascia or recurs following inadvertent excision.
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Affiliation(s)
- Jason Trieu
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Claudia Di Bella
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Marcus Pianta
- Department of Radiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Warren Perera
- Department of Radiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - John L Slavin
- Department of Pathology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Stephen M Schlicht
- Department of Radiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Liu D, Perera W, Schlicht S, Choong P, Slavin J, Pianta M. Musculoskeletal desmoid tumours: Diagnostic imaging appearances. J Med Imaging Radiat Oncol 2015; 59:461-467. [DOI: 10.1111/1754-9485.12318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/29/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Daniel Liu
- RadiologySt. Vincent's Hospital Melbourne Victoria Australia
| | - Warren Perera
- RadiologySt. Vincent's Hospital Melbourne Victoria Australia
| | | | - Peter Choong
- RadiologySt. Vincent's Hospital Melbourne Victoria Australia
| | - John Slavin
- RadiologySt. Vincent's Hospital Melbourne Victoria Australia
| | - Marcus Pianta
- RadiologySt. Vincent's Hospital Melbourne Victoria Australia
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Liu D, Perera W, Schlicht S, Choong P, Slavin J, Pianta M. Musculoskeletal desmoid tumours: Pre- and post-treatment radiological appearances. J Med Imaging Radiat Oncol 2015; 59:480-485. [PMID: 26094882 DOI: 10.1111/1754-9485.12323] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/11/2015] [Indexed: 12/01/2022]
Abstract
This study was aimed to illustrate the pre- and post-treatment imaging findings of musculoskeletal desmoid tumours and describe current treatment methods. Imaging of histologically proven cases of desmoid tumours at St. Vincent's Hospital, Melbourne, were obtained via picture archiving communication system (PACS) and then assessed by two musculoskeletal radiologists. Suitable imaging both pre- and post-treatment were then obtained from PACS. All imaging chosen were de-identified. Ninety-two patients were found to have histologically proven cases of desmoid tumours between January 2000 and December 2013. Six patients with extra-abdominal tumours were selected, where pre- and post-treatment imaging was available. Desmoid tumours can occur in many areas of the body. Treatment of desmoids are varied. Although wide-margin surgery has been the traditional form of treatment, it still cannot guarantee absence of tumour recurrence despite microscopically tumour-free margins. Other forms of treatment such as non-steroidal anti-inflammatory drugs, radiotherapy, chemotherapy, tyrosine kinase inhibitors and also the conservative 'watch and wait' approach have been suggested, which show varying results.
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Affiliation(s)
- Daniel Liu
- Radiology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Warren Perera
- Radiology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Stephen Schlicht
- Radiology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter Choong
- Radiology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - John Slavin
- Radiology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Marcus Pianta
- Radiology, St. Vincent's Hospital, Melbourne, Victoria, Australia
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11
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Maksymowych WP, Pitts M, Budak MJ, Gracey D, Lambert RG, McDougall D, Pianta M, Rennie WJ, Wichuk S, Winn N, Jaremko JL. Development and Preliminary Validation of a Digital Overlay-based Learning Module for Semiquantitative Evaluation of Magnetic Resonance Imaging Lesions in Osteoarthritis of the Hip. J Rheumatol 2015; 43:232-8. [DOI: 10.3899/jrheum.141574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To develop and validate a knowledge transfer (KT) module aimed at enhancing feasibility and reliability of semiquantitative assessment of bone marrow lesions (BML) and synovitis-effusion using the Hip Inflammation Magnetic Resonance Imaging Scoring System (HIMRISS).Methods.Three radiologists naive to the HIMRISS method reviewed the manuscript describing the method and then scored MRI scans from 16 patients with hip OA obtained at baseline and 8 weeks after intraarticular injection of corticosteroid. Readers then reviewed a KT module comprising an instructional presentation and 8 reference DICOM (digital imaging and communications in medicine) cases scored by 3 readers with expertise in the HIMRISS method, and then used electronic overlay software to score scans from 23 patients with OA. The same format was followed with a second group of 3 readers naive to HIMRISS using a KT module revised to incorporate the overlay with a Web-based DICOM viewer to enhance feasibility. Interobserver reliability was assessed with the intraclass correlation coefficient (ICC).Results.In both exercises, reliability for baseline scores was excellent for femoral BML, very good for acetabular BML, and good for synovitis-effusion (overall ICC = 0.91, 0.89, 0.62, respectively) even without prior calibration using the KT module. However, reliability for detecting change was substantially worse than for expert readers, especially for acetabular BML and synovitis-effusion (overall ICC = 0.59 vs 0.19, and 0.42 vs 0.25, respectively). Reliability improved for detection of change in these lesions, especially after reader calibration with the revised KT module.Conclusion.Development and validation of a systematic method for KT may enhance external validation of certain imaging instruments.
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Anderson N, DiBella C, Pianta M, Slavin J, Choong P. Aggressive aneurysmal bone cyst in association with polyostotic fibrous dysplasia: A case report. Int J Surg Case Rep 2015; 12:52-6. [PMID: 26011801 PMCID: PMC4486103 DOI: 10.1016/j.ijscr.2015.05.019] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/10/2015] [Accepted: 05/11/2015] [Indexed: 11/26/2022] Open
Abstract
Aneurysmal bone cyst occurring in the setting of previously diagnosed fibrous dysplasia is a rare occurrence. Repeat investigation with imaging and biopsy was required to obtain accurate diagnosis and exclude malignancy. Due to the aggressive nature of the disease and the patient’s medical comorbidities, an above knee amputation was required for disease control.
Introduction Aneurysmal bone cyst occurring in the setting of previously diagnosed fibrous dysplasia is rare. While both are benign processes, pain, compression of nearby structures and risk of fracture can require treatment. Presentation of case In this report, we describe a 56 year old male who developed an aggressive aneurysmal bone cyst secondary to fibrous dysplasia in the proximal tibia over a period of 8 months. He required an above knee amputation for disease and symptom control due to the aggressive nature of disease and medical comorbidities. Discussion The diagnosis of a secondary lesion can prove difficult. It is important to exclude a malignant disease process, particularly when imaging demonstrates an aggressive appearance. In this case, repeat imaging, CT guided biopsies and an open biopsy were performed to exclude malignancy prior to definitive surgical management. Conclusion In order to exclude secondary lesions, we suggest further investigation for new onset pain in the setting of a benign lesion.
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Affiliation(s)
- Nathan Anderson
- Department of Orthopaedics, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065 Australia; Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Institute, Melbourne, Victoria 3002, Australia.
| | - Claudia DiBella
- Department of Orthopaedics, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065 Australia; Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Institute, Melbourne, Victoria 3002, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria 3002, Australia.
| | - Marcus Pianta
- Department of Radiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
| | - John Slavin
- Department of Pathology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
| | - Peter Choong
- Department of Orthopaedics, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065 Australia; Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Institute, Melbourne, Victoria 3002, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria 3002, Australia.
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Learmont JP, Powell G, Slavin J, Facey M, Pianta M. A case of benign periosteal chondroma seeding into humeral medullary bone via percutaneous needle biopsy tract. BJR Case Rep 2015; 1:20150104. [PMID: 30363208 PMCID: PMC6159157 DOI: 10.1259/bjrcr.20150104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/09/2015] [Indexed: 11/05/2022] Open
Abstract
We report an occurrence of periosteal chondroma seeding into the medulla of humerus via percutaneous needle biopsy tract. To our knowledge, this is the first described case of benign cartilage tumour biopsy tract seeding in the literature. We discuss the clinical, radiological and histological features of periosteal chondroma, as well as the diagnostic challenges associated with distinguishing this entity from periosteal chondrosarcoma. Finally, we briefly discuss the safety of imaging-guided percutaneous needle biopsy and methods to minimize the risk of iatrogenic tumour seeding.
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Jaremko JL, Lambert RGW, Zubler V, Weber U, Loeuille D, Roemer FW, Cibere J, Pianta M, Gracey D, Conaghan P, Ostergaard M, Maksymowych WP. Methodologies for semiquantitative evaluation of hip osteoarthritis by magnetic resonance imaging: approaches based on the whole organ and focused on active lesions. J Rheumatol 2013; 41:359-69. [PMID: 24241486 DOI: 10.3899/jrheum.131082] [Citation(s) in RCA: 22] [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] [Indexed: 11/22/2022]
Abstract
OBJECTIVE As a wider variety of therapeutic options for osteoarthritis (OA) becomes available, there is an increasing need to objectively evaluate disease severity on magnetic resonance imaging (MRI). This is more technically challenging at the hip than at the knee, and as a result, few systematic scoring systems exist. The OMERACT (Outcome Measures in Rheumatology) filter of truth, discrimination, and feasibility can be used to validate image-based scoring systems. Our objective was (1) to review the imaging features relevant to the assessment of severity and progression of hip OA; and (2) to review currently used methods to grade these features in existing hip OA scoring systems. METHODS A systematic literature review was conducted. MEDLINE keyword search was performed for features of arthropathy (such as hip + bone marrow edema or lesion, synovitis, cyst, effusion, cartilage, etc.) and scoring system (hip + OA + MRI + score or grade), with a secondary manual search for additional references in the retrieved publications. RESULTS Findings relevant to the severity of hip OA include imaging markers associated with inflammation (bone marrow lesion, synovitis, effusion), structural damage (cartilage loss, osteophytes, subchondral cysts, labral tears), and predisposing geometric factors (hip dysplasia, femoral-acetabular impingement). Two approaches to the semiquantitative assessment of hip OA are represented by Hip OA MRI Scoring System (HOAMS), a comprehensive whole organ assessment of nearly all findings, and the Hip Inflammation MRI Scoring System (HIMRISS), which selectively scores only active lesions (bone marrow lesion, synovitis/effusion). Validation is presently confined to limited assessment of reliability. CONCLUSION Two methods for semiquantitative assessment of hip OA on MRI have been described and validation according to the OMERACT Filter is limited to evaluation of reliability.
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Affiliation(s)
- Jacob L Jaremko
- From the Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada; Department of Radiology and Department of Rheumatology, Balgrist University Hospital, Zurich, Switzerland; Department of Medicine, CHU de NANCY-Brabois, Vandoeuvre, France; Department of Radiology, Klinikum Augsburg, Augsburg, Germany; Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada; St. Vincent's Hospital, Victoria, Australia; Radiology Department, Craigavon Area Hospital, Southern Health and Social Care Trust, Portadown, Northern Ireland; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Maksymowych W, Weber U, Pianta M, Lambert R. SAT0335 Semi-quantitative assessment of bone marrow edema and synovitis-effusion in osteoarthritis with the knee inflammation MRI scoring system (KIMRISS): A target lesion based methodology:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3281] [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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Pianta M, Crowther S, McNally D, Panu A, Lambert RGW. Proximal femoral intra-capsular osteoid osteoma in a 16-year-old male with epiphyseal periostitis contributing to Cam-type deformity relating to femoro-acetabular impingement. Skeletal Radiol 2013; 42:129-33. [PMID: 22760819 DOI: 10.1007/s00256-012-1463-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 04/22/2012] [Accepted: 05/30/2012] [Indexed: 02/02/2023]
Affiliation(s)
- Marcus Pianta
- Medical Imaging Department, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, 3065 Vic, Australia.
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Gillam B, Pianta M. Relative and absolute stereo slant. J Vis 2010. [DOI: 10.1167/1.3.269] [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: 11/24/2022] Open
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Abstract
Bilateral adrenal haemorrhage is an event that mandates prompt diagnosis and treatment to prevent primary adrenocortical insufficiency and potential death. Presentation can be non-specific and incidentally diagnosed with imaging alone, primarily CT. We present a case of acute pancreatitis with spontaneous bilateral adrenal haemorrhage and briefly discuss imaging and treatment implications.
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Affiliation(s)
- M Pianta
- Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia.
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Abstract
Spontaneous retropharyngeal hemorrhage from a cervical parathyroid adenoma is a rare complication of primary hyperparathyroidism. Because of its rarity, it has seldom been documented in the radiologic or ENT literature. Patients may present with a variety of manifestations, ranging from dysphagia to dysphonia to life-threatening dyspnea or hemorrhage. Awareness of a possible thyroid or parathyroid etiology may expedite treatment and prevent unnecessary interventions. We present a case of spontaneous retropharyngeal hemorrhage in which the “sentinel clot” sign enabled us to identify the lesion of origin.
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Affiliation(s)
- George Koulouris
- From the Department of Radiology, The Alfred Hospital, Victoria, Australia
| | - Marcus Pianta
- From the Department of Radiology, The Alfred Hospital, Victoria, Australia
| | - Stephen Stuckey
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia
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Koulouris G, Pianta M, Stuckey S. The 'sentinel clot' sign in spontaneous retropharyngeal hematoma secondary to parathyroid apoplexy. Ear Nose Throat J 2006; 85:606-8. [PMID: 17044430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Spontaneous retropharyngeal hemorrhage from a cervical parathyroid adenoma is a rare complication of primary hyperparathyroidism. Because of its rarity, it has seldom been documented in the radiologic or ENT literature. Patients may present with a variety of manifestations, ranging from dysphagia to dysphonia to life-threatening dyspnea or hemorrhage. Awareness of a possible thyroid or parathyroid etiology may expedite treatment and prevent unnecessary interventions. We present a case of spontaneous retropharyngeal hemorrhage in which the "sentinel clot" sign enabled us to identify the lesion of origin.
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Affiliation(s)
- George Koulouris
- Department of Radiology, The Alfred Hospital, Victoria, Australia.
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