ABSTRACT Objectives To assess the efficacy comparing methotrexate and leflunomide by hand magneti... more ABSTRACT Objectives To assess the efficacy comparing methotrexate and leflunomide by hand magnetic resonance imaging (h-MRI) in early RA patients. Methods A prospective cohort of patients with early RA (duration of symptoms <1 year), naïve to DMARD or biologic therapy, were randomly assigned to receive either methotrexate (MTX) and leflunomide (LF) treatment (1:1 ratio). Forty-one patients assigned to the MTX group received an initial dose of 12.5 mg/week that was increased to 20-25 mg if persistent clinical activity and 37 patients were randomized to receive leflunomide 20 mg/day. Low-dose of glucocorticoids and NSAID was allowed and doses were stable during the study period. 1.5T MRI of the dominant hand, clinical assessment, disability (HAQ) and laboratory analyses were obtained before starting treatment and 16 weeks after. MR images were read blind for clinical results and treatment group, without knowing chronological order by 2 experienced readers (MPL, AS) following RAMRIS recommendations. Tenosynovitis was also scored. Data evaluation and statistical analysis were performed using SPSS v.15. Results A total of 78 RA patients were included, of these 62 pacients had paired h-MRI (33 with MTX and 29 with LF). Sixteen patients withdrew treatment (6 patients moved residence, 6 declined to participate, 3 loss of compliance of treatment and 1 case of pregnancy desire). No patients showed inefficacy or adverse events. Baseline characteristics including MRI parameters were similar (no significantly different) between the 2 treatment groups. Significant improvement in all activity measures, HAQ and RAMRIS synovitis were observed in the LF- and MTX-treated patients after 16 weeks of therapy. MTX group showed significant reduction of tenosynovitis score. No statistically significant differences between 2 treatments were observed, except that the SDAI reduction was greater in the MTX group (table 1). Conclusions Methotrexate and leflunomide showed comparable clinical efficacy and reduction on MRI synovitis at week 16 without significant differences between the both active treatments. Disclosure of Interest None Declared
PURPOSE/AIM To determine the key role of MRI in the new classification of axial spondyloarthritis... more PURPOSE/AIM To determine the key role of MRI in the new classification of axial spondyloarthritis.To review the X-ray,CT and MRI findings in sacroiliitis.To determine the best MRI sequences to depict sacroiliitis.To show the best imaging techniques to quantify and follow inflammatory activity including diffusion and dynamic contrast-enhanced MRI. CONTENT ORGANIZATION Brief review of normal anatomy and anatomical variants.Evolution of diagnostic criteria.Examples of radiographic and CT findings.MRI:protocol (description of our protocol including discussion about the usefulness of T1 Fat Sat to depict joint borders,the use of T2 Fat Sat vs STIR,the need for/lack of contrast administration),examples of active and chronic lesions,definition of positive MRI,pitfalls and differential diagnosis,follow-up methods (SPARCC, diffusion and dynamic contrast MRI) SUMMARY With the new ASAS criteria MRI has a key role in the diagnosis of axial spondyloarthritis.It enables early detection and accura...
Revista Española de Cirugía Ortopédica y Traumatología (English Edition), 2007
ABSTRACT Objetivo Determinar la influencia de la versión protésica y la consolidación de la tuber... more ABSTRACT Objetivo Determinar la influencia de la versión protésica y la consolidación de la tuberosidad mayor en el resultado funcional final de las hemiartroplastias de hombro por fractura del tercio proximal de húmero. Material y método Estudio prospectivo de 32 hemiartroplastias con un seguimiento medio de 43,51 meses. Se ha efectuado un control radiológico en el postoperatorio inmediato y al final del seguimiento para evaluar la reducción obtenida del troquíter. También al final del seguimiento se ha realizado un estudio mediante tomografía axial computarizada (estudio de retroversión del implante), una evaluación funcional (escala funcional de Constant) y una valoración del estado de salud (EuroQol-5D). Resultados El valor global medio de la escala de Constant de la serie fue de 61,12. En cuanto a la retroversión, en 8 pacientes se obtuvo un valor entre 20-40°, en 20 pacientes un valor entre 0-20° y en 4 pacientes anteversión superior a 0°. Al comparar la variable versión protésica con el resultado funcional mediante la escala de Constant no se encontraron diferencias significativas (p = 0,558), aunque existe una tendencia hacia un mejor valor en la escala de Constant cuanto más anatómica sea la versión del implante. Conclusión Existe una correlación entre la calidad de la reducción postoperatoria inmediata de la tuberosidad mayor, la consolidación de la misma y el resultado funcional final. Existe una tendencia a presentar un peor resultado funcional en aquellas hemiartroplastias cuya colocación se aleja más de los valores considerados como normales de versión, aunque sin significación estadística.
To evaluate the association of synovitis, bone marrow edema (BME), and tenosynovitis in the progr... more To evaluate the association of synovitis, bone marrow edema (BME), and tenosynovitis in the progression of erosions quantified by hand magnetic resonance imaging (MRI) at 1 year in patients with early rheumatoid arthritis (RA) in remission. A total of 56 of 196 patients with early RA in remission at 1 year and with available MRI data at baseline and at 12 months were included. MRI images were assessed according to the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) system. Persistent remission was defined as 28-joint Disease Activity Score-erythrocyte sedimentation rate ≤ 2.6 and/or Simplified Disease Activity Index ≤ 3.3 and/or the new boolean American College of Rheumatology/European League Against Rheumatism remission criteria for a continuous period of at least 6 months. Progression of bone erosions was defined as an increase of 1 or more units in annual RAMRIS score for erosions compared to baseline. At 1 year, the majority of patients with RA in sustained remi...
To monitor repair of bone erosions using magnetic resonance imaging (MRI) in patients with rheuma... more To monitor repair of bone erosions using magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) during etanercept combination therapy. The study population comprised 29 RA patients [biologic-naïve, 28-joint Disease Activity Score (DAS28) ≥ 3.2] starting etanercept combination therapy with disease-modifying anti-rheumatic drugs (DMARDs) and completing the 1-year study period with the same treatment. Clinical and laboratory assessments and MRI of the hand were performed at baseline and at 1 year. MRI findings were scored by two readers using the Rheumatoid Arthritis MRI Scoring System (RAMRIS). Both readers were blind to the chronological order of the MRI scans, the identity of the patients, and clinical and other imaging data. Tenosynovitis was also scored. The intra- and inter-reader intraclass correlation coefficients (ICCs) were calculated, along with the sensitivity to change with the smallest detectable difference (SDD). Repair of erosions was defined as a R...
To analyse the morphology of the scapula relative to the reverse shoulder prosthesis. Scapulas of... more To analyse the morphology of the scapula relative to the reverse shoulder prosthesis. Scapulas of 46 women and 27 men aged 16 to 84 (mean, 53) years with proximal humeral fractures (n=52) or recurrent antero-inferior instability (n=21) were assessed using 3-dimensional computed tomography (CT). For comparison, 108 cadaveric scapulas with unknown epidemiology were assessed using a goniometer and a caliper. The length of the glenoid neck, the angle between the glenoid surface and the upper posterior column of the scapula, and the angles between the major craneocaudal glenoid axis and (1) the base of the coracoid process and (2) the upper posterior column of the scapula were assessed. The length of the glenoid neck was classified into short and long. In the respective CT and cadaveric groups, the anterior glenoid neck was short in 42% and 18% of scapulas and long in 58% and 82%, whereas the posterior glenoid neck was short in 34% and 60% of scapulas and long in 66% and 40%. The angle b...
ABSTRACT Purpose To determine the influence of the prosthesis used and of greater tuberosity heal... more ABSTRACT Purpose To determine the influence of the prosthesis used and of greater tuberosity healing on the final functional result of shoulder hemiarthroplasties due to fracture of the proximal third of the humerus. Materials and methods This was a prospective study of 32 hemiarthroplasties with a mean followup of 43.51 months. X-ray control was carried immediately after surgery and at the end of the followup to assess the reduction of the greater tuberosity. Also at the end of the followup axial CAT scans (implant retroversion study), a functional assessment (Constant functional scale), and a health status determination (EuroQol-5D) were performed. Results The mean global value of the Constant scale for this series was 61.12. As to retroversion: values of 20–40° were seen in 8 patients, 0–20° in 20 patients and anteversion >0 in 4 patients. When the prosthesis model variable was compared using the Constant scale to determine functional outcome, no significant differences were seen (p=0.558). However, there was a trend to a better value in the Constant scale when the version of implant used was more anatomical, but this was not statistically significant. Conclusions There was a correlation between the quality of immediate postoperative reduction of the greater tuberosity, healing of the greater tuberosity and final functional outcome. There was a trend towards worse functional outcome in hemiarthroplasties with retro and anteversion values that were further from normal, but this was not statistically significant.
The sacroiliac joints are involved in most cases of axial spondyloarthropathy, the first manifest... more The sacroiliac joints are involved in most cases of axial spondyloarthropathy, the first manifestation usually being sacroiliitis. A finding of sacroiliitis at radiography is the classic diagnostic hallmark of axial spondyloarthropathy. However, radiographic changes reflect structural damage rather than active inflammation, which may delay the diagnosis by several years. In the past decade, the field of spondyloarthropathy has undergone major changes, largely driven by the development of new drugs for the treatment of ankylosing spondylitis. In recent years, the Assessment of SpondyloArthritis international Society has focused on the reassessment of existing classification criteria and the development and validation of diagnostic tools to facilitate early diagnosis and assessment of treatment response. Magnetic resonance (MR) imaging is the most recent innovation and the important change with respect to the previously established classification criteria. This modality has become an integral part of managing patients with sacroiliitis. MR imaging can serve as a biomarker of disease activity, allows monitoring, and can provide guidance for the treatment of affected patients, and it will likely become even more central to the care of these patients. Familiarity with the anatomy, anatomic variants, and physiologic changes of the sacroiliac joints is important for correctly interpreting findings and avoiding misdiagnosis.
The Journal of Trauma: Injury, Infection, and Critical Care, 2009
Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for The Journal of Tr... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for The Journal of Trauma. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to ...
Fracture-separation of the distal humeral epiphysis in newborn is a rare entity, usually the resu... more Fracture-separation of the distal humeral epiphysis in newborn is a rare entity, usually the result of a traumatic delivery. It can mimic elbow dislocation and, due to the absence of ossification of the epiphysis at that time, cannot be diagnosed radiographically. However, ultrasound is an important diagnostic tool for this purpose because it is able to clearly visualize the cartilaginous epiphysis. In addition, it allows the differential diagnosis with posterior elbow dislocation whose therapeutic management and prognosis are different. We report the case of a preterm newborn in which a fracture-separation of the distal humeral epiphysis was diagnosed with the help of sonography. The purpose of this report is to emphasize the utility of echography as a cheap, available, and noninvasive tool for the evaluation of the nonossified epiphysis in the newborn elbow.
Bone scintigraphy used as a diagnostic technique frequently yields non-specific intense uptake by... more Bone scintigraphy used as a diagnostic technique frequently yields non-specific intense uptake by vertebrae. Bone biopsy may therefore be required to establish a diagnosis in cases of Paget's disease of bone. The aim of the study was to ascertain the sensitivity and specificity of two new images-heart sign and clover sign-in Paget's disease of bone. Two expert rheumatologists analyzed 294 bone scintigraphies of patients with vertebral involvement: 204 without and 90 with Paget's disease. The presence or absence of the clover or heart signs was determined in each scintigraphy. A specificity and sensitivity study was performed with the data obtained. A study of concordance was made between two radiologists blinded to the real diagnosis. Each one analyzed 120 scintigraphies for the presence and absence of the signs: 40 with Paget's disease and clover and/or heart signs (selected from the initial 90 cases), 40 with Paget's disease with neither sign and 40 selected from the pool of 4000 scintigraphies of patients with vertebral involvement, with images easily mistaken for these signs (vertebral collapse, osteoarthritis and bone metastases). Kappa statistics were calculated. Sensitivity of both signs for Paget's disease of bone was low: 44% (95% CI 34.0 to 55.3). However, specificity was excellent: 100% (95% CI 98.2 to 100). Inter-radiologist concordance was almost perfect: Kappa 0.86 (95% CI 0.77 to 0.95). The heart and clover signs are highly specific (probably pathognomonic) of Paget's disease of bone. In cases with doubtful radiologic images, these findings on scintigraphic vertebral images may afford a definitive diagnosis of Paget's disease of bone and thus obviate further confirmatory invasive diagnostic procedures.
PURPOSE/AIM The purpose of this exhibit is: 1. To review the staging of Hodgkin Disease (HD). 2. ... more PURPOSE/AIM The purpose of this exhibit is: 1. To review the staging of Hodgkin Disease (HD). 2. To show typical images on CT and Chest X-ray of thoracic involvement in HD. 3. To show atypical X-ray, CT, PET-CT and MRi findings in thoracic HD. CONTENT ORGANIZATION 1. Staging of HD. 2. Review of imaging findings in thoracic HD: a. Mediastinal adenopathies. b. Lungs (direct extension, nodules, masses). c. Pleural (effusions, solid pleural masses). d. Heart and pericardium (cardiac masses and pericardial effusion). e. Thymus (thymic enlargement, thymic cysts). f. Chest wall (involvement of paraesternal soft tissues, internal mammary nodes, masses between pectoral muscles). SUMMARY The major teaching points of this exhibit are: 1. To emphasize about the typical findings in thoracic HD as mediastinal adenopathies, direct extension to lung, pleural effusions, chest wall involvement and thymic enlargement. 2. To show atypical findings that may suggest thoracic HD involvement. Radiologist h...
ABSTRACT Objectives To assess the efficacy comparing methotrexate and leflunomide by hand magneti... more ABSTRACT Objectives To assess the efficacy comparing methotrexate and leflunomide by hand magnetic resonance imaging (h-MRI) in early RA patients. Methods A prospective cohort of patients with early RA (duration of symptoms <1 year), naïve to DMARD or biologic therapy, were randomly assigned to receive either methotrexate (MTX) and leflunomide (LF) treatment (1:1 ratio). Forty-one patients assigned to the MTX group received an initial dose of 12.5 mg/week that was increased to 20-25 mg if persistent clinical activity and 37 patients were randomized to receive leflunomide 20 mg/day. Low-dose of glucocorticoids and NSAID was allowed and doses were stable during the study period. 1.5T MRI of the dominant hand, clinical assessment, disability (HAQ) and laboratory analyses were obtained before starting treatment and 16 weeks after. MR images were read blind for clinical results and treatment group, without knowing chronological order by 2 experienced readers (MPL, AS) following RAMRIS recommendations. Tenosynovitis was also scored. Data evaluation and statistical analysis were performed using SPSS v.15. Results A total of 78 RA patients were included, of these 62 pacients had paired h-MRI (33 with MTX and 29 with LF). Sixteen patients withdrew treatment (6 patients moved residence, 6 declined to participate, 3 loss of compliance of treatment and 1 case of pregnancy desire). No patients showed inefficacy or adverse events. Baseline characteristics including MRI parameters were similar (no significantly different) between the 2 treatment groups. Significant improvement in all activity measures, HAQ and RAMRIS synovitis were observed in the LF- and MTX-treated patients after 16 weeks of therapy. MTX group showed significant reduction of tenosynovitis score. No statistically significant differences between 2 treatments were observed, except that the SDAI reduction was greater in the MTX group (table 1). Conclusions Methotrexate and leflunomide showed comparable clinical efficacy and reduction on MRI synovitis at week 16 without significant differences between the both active treatments. Disclosure of Interest None Declared
PURPOSE/AIM To determine the key role of MRI in the new classification of axial spondyloarthritis... more PURPOSE/AIM To determine the key role of MRI in the new classification of axial spondyloarthritis.To review the X-ray,CT and MRI findings in sacroiliitis.To determine the best MRI sequences to depict sacroiliitis.To show the best imaging techniques to quantify and follow inflammatory activity including diffusion and dynamic contrast-enhanced MRI. CONTENT ORGANIZATION Brief review of normal anatomy and anatomical variants.Evolution of diagnostic criteria.Examples of radiographic and CT findings.MRI:protocol (description of our protocol including discussion about the usefulness of T1 Fat Sat to depict joint borders,the use of T2 Fat Sat vs STIR,the need for/lack of contrast administration),examples of active and chronic lesions,definition of positive MRI,pitfalls and differential diagnosis,follow-up methods (SPARCC, diffusion and dynamic contrast MRI) SUMMARY With the new ASAS criteria MRI has a key role in the diagnosis of axial spondyloarthritis.It enables early detection and accura...
Revista Española de Cirugía Ortopédica y Traumatología (English Edition), 2007
ABSTRACT Objetivo Determinar la influencia de la versión protésica y la consolidación de la tuber... more ABSTRACT Objetivo Determinar la influencia de la versión protésica y la consolidación de la tuberosidad mayor en el resultado funcional final de las hemiartroplastias de hombro por fractura del tercio proximal de húmero. Material y método Estudio prospectivo de 32 hemiartroplastias con un seguimiento medio de 43,51 meses. Se ha efectuado un control radiológico en el postoperatorio inmediato y al final del seguimiento para evaluar la reducción obtenida del troquíter. También al final del seguimiento se ha realizado un estudio mediante tomografía axial computarizada (estudio de retroversión del implante), una evaluación funcional (escala funcional de Constant) y una valoración del estado de salud (EuroQol-5D). Resultados El valor global medio de la escala de Constant de la serie fue de 61,12. En cuanto a la retroversión, en 8 pacientes se obtuvo un valor entre 20-40°, en 20 pacientes un valor entre 0-20° y en 4 pacientes anteversión superior a 0°. Al comparar la variable versión protésica con el resultado funcional mediante la escala de Constant no se encontraron diferencias significativas (p = 0,558), aunque existe una tendencia hacia un mejor valor en la escala de Constant cuanto más anatómica sea la versión del implante. Conclusión Existe una correlación entre la calidad de la reducción postoperatoria inmediata de la tuberosidad mayor, la consolidación de la misma y el resultado funcional final. Existe una tendencia a presentar un peor resultado funcional en aquellas hemiartroplastias cuya colocación se aleja más de los valores considerados como normales de versión, aunque sin significación estadística.
To evaluate the association of synovitis, bone marrow edema (BME), and tenosynovitis in the progr... more To evaluate the association of synovitis, bone marrow edema (BME), and tenosynovitis in the progression of erosions quantified by hand magnetic resonance imaging (MRI) at 1 year in patients with early rheumatoid arthritis (RA) in remission. A total of 56 of 196 patients with early RA in remission at 1 year and with available MRI data at baseline and at 12 months were included. MRI images were assessed according to the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) system. Persistent remission was defined as 28-joint Disease Activity Score-erythrocyte sedimentation rate ≤ 2.6 and/or Simplified Disease Activity Index ≤ 3.3 and/or the new boolean American College of Rheumatology/European League Against Rheumatism remission criteria for a continuous period of at least 6 months. Progression of bone erosions was defined as an increase of 1 or more units in annual RAMRIS score for erosions compared to baseline. At 1 year, the majority of patients with RA in sustained remi...
To monitor repair of bone erosions using magnetic resonance imaging (MRI) in patients with rheuma... more To monitor repair of bone erosions using magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) during etanercept combination therapy. The study population comprised 29 RA patients [biologic-naïve, 28-joint Disease Activity Score (DAS28) ≥ 3.2] starting etanercept combination therapy with disease-modifying anti-rheumatic drugs (DMARDs) and completing the 1-year study period with the same treatment. Clinical and laboratory assessments and MRI of the hand were performed at baseline and at 1 year. MRI findings were scored by two readers using the Rheumatoid Arthritis MRI Scoring System (RAMRIS). Both readers were blind to the chronological order of the MRI scans, the identity of the patients, and clinical and other imaging data. Tenosynovitis was also scored. The intra- and inter-reader intraclass correlation coefficients (ICCs) were calculated, along with the sensitivity to change with the smallest detectable difference (SDD). Repair of erosions was defined as a R...
To analyse the morphology of the scapula relative to the reverse shoulder prosthesis. Scapulas of... more To analyse the morphology of the scapula relative to the reverse shoulder prosthesis. Scapulas of 46 women and 27 men aged 16 to 84 (mean, 53) years with proximal humeral fractures (n=52) or recurrent antero-inferior instability (n=21) were assessed using 3-dimensional computed tomography (CT). For comparison, 108 cadaveric scapulas with unknown epidemiology were assessed using a goniometer and a caliper. The length of the glenoid neck, the angle between the glenoid surface and the upper posterior column of the scapula, and the angles between the major craneocaudal glenoid axis and (1) the base of the coracoid process and (2) the upper posterior column of the scapula were assessed. The length of the glenoid neck was classified into short and long. In the respective CT and cadaveric groups, the anterior glenoid neck was short in 42% and 18% of scapulas and long in 58% and 82%, whereas the posterior glenoid neck was short in 34% and 60% of scapulas and long in 66% and 40%. The angle b...
ABSTRACT Purpose To determine the influence of the prosthesis used and of greater tuberosity heal... more ABSTRACT Purpose To determine the influence of the prosthesis used and of greater tuberosity healing on the final functional result of shoulder hemiarthroplasties due to fracture of the proximal third of the humerus. Materials and methods This was a prospective study of 32 hemiarthroplasties with a mean followup of 43.51 months. X-ray control was carried immediately after surgery and at the end of the followup to assess the reduction of the greater tuberosity. Also at the end of the followup axial CAT scans (implant retroversion study), a functional assessment (Constant functional scale), and a health status determination (EuroQol-5D) were performed. Results The mean global value of the Constant scale for this series was 61.12. As to retroversion: values of 20–40° were seen in 8 patients, 0–20° in 20 patients and anteversion >0 in 4 patients. When the prosthesis model variable was compared using the Constant scale to determine functional outcome, no significant differences were seen (p=0.558). However, there was a trend to a better value in the Constant scale when the version of implant used was more anatomical, but this was not statistically significant. Conclusions There was a correlation between the quality of immediate postoperative reduction of the greater tuberosity, healing of the greater tuberosity and final functional outcome. There was a trend towards worse functional outcome in hemiarthroplasties with retro and anteversion values that were further from normal, but this was not statistically significant.
The sacroiliac joints are involved in most cases of axial spondyloarthropathy, the first manifest... more The sacroiliac joints are involved in most cases of axial spondyloarthropathy, the first manifestation usually being sacroiliitis. A finding of sacroiliitis at radiography is the classic diagnostic hallmark of axial spondyloarthropathy. However, radiographic changes reflect structural damage rather than active inflammation, which may delay the diagnosis by several years. In the past decade, the field of spondyloarthropathy has undergone major changes, largely driven by the development of new drugs for the treatment of ankylosing spondylitis. In recent years, the Assessment of SpondyloArthritis international Society has focused on the reassessment of existing classification criteria and the development and validation of diagnostic tools to facilitate early diagnosis and assessment of treatment response. Magnetic resonance (MR) imaging is the most recent innovation and the important change with respect to the previously established classification criteria. This modality has become an integral part of managing patients with sacroiliitis. MR imaging can serve as a biomarker of disease activity, allows monitoring, and can provide guidance for the treatment of affected patients, and it will likely become even more central to the care of these patients. Familiarity with the anatomy, anatomic variants, and physiologic changes of the sacroiliac joints is important for correctly interpreting findings and avoiding misdiagnosis.
The Journal of Trauma: Injury, Infection, and Critical Care, 2009
Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for The Journal of Tr... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for The Journal of Trauma. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to ...
Fracture-separation of the distal humeral epiphysis in newborn is a rare entity, usually the resu... more Fracture-separation of the distal humeral epiphysis in newborn is a rare entity, usually the result of a traumatic delivery. It can mimic elbow dislocation and, due to the absence of ossification of the epiphysis at that time, cannot be diagnosed radiographically. However, ultrasound is an important diagnostic tool for this purpose because it is able to clearly visualize the cartilaginous epiphysis. In addition, it allows the differential diagnosis with posterior elbow dislocation whose therapeutic management and prognosis are different. We report the case of a preterm newborn in which a fracture-separation of the distal humeral epiphysis was diagnosed with the help of sonography. The purpose of this report is to emphasize the utility of echography as a cheap, available, and noninvasive tool for the evaluation of the nonossified epiphysis in the newborn elbow.
Bone scintigraphy used as a diagnostic technique frequently yields non-specific intense uptake by... more Bone scintigraphy used as a diagnostic technique frequently yields non-specific intense uptake by vertebrae. Bone biopsy may therefore be required to establish a diagnosis in cases of Paget's disease of bone. The aim of the study was to ascertain the sensitivity and specificity of two new images-heart sign and clover sign-in Paget's disease of bone. Two expert rheumatologists analyzed 294 bone scintigraphies of patients with vertebral involvement: 204 without and 90 with Paget's disease. The presence or absence of the clover or heart signs was determined in each scintigraphy. A specificity and sensitivity study was performed with the data obtained. A study of concordance was made between two radiologists blinded to the real diagnosis. Each one analyzed 120 scintigraphies for the presence and absence of the signs: 40 with Paget's disease and clover and/or heart signs (selected from the initial 90 cases), 40 with Paget's disease with neither sign and 40 selected from the pool of 4000 scintigraphies of patients with vertebral involvement, with images easily mistaken for these signs (vertebral collapse, osteoarthritis and bone metastases). Kappa statistics were calculated. Sensitivity of both signs for Paget's disease of bone was low: 44% (95% CI 34.0 to 55.3). However, specificity was excellent: 100% (95% CI 98.2 to 100). Inter-radiologist concordance was almost perfect: Kappa 0.86 (95% CI 0.77 to 0.95). The heart and clover signs are highly specific (probably pathognomonic) of Paget's disease of bone. In cases with doubtful radiologic images, these findings on scintigraphic vertebral images may afford a definitive diagnosis of Paget's disease of bone and thus obviate further confirmatory invasive diagnostic procedures.
PURPOSE/AIM The purpose of this exhibit is: 1. To review the staging of Hodgkin Disease (HD). 2. ... more PURPOSE/AIM The purpose of this exhibit is: 1. To review the staging of Hodgkin Disease (HD). 2. To show typical images on CT and Chest X-ray of thoracic involvement in HD. 3. To show atypical X-ray, CT, PET-CT and MRi findings in thoracic HD. CONTENT ORGANIZATION 1. Staging of HD. 2. Review of imaging findings in thoracic HD: a. Mediastinal adenopathies. b. Lungs (direct extension, nodules, masses). c. Pleural (effusions, solid pleural masses). d. Heart and pericardium (cardiac masses and pericardial effusion). e. Thymus (thymic enlargement, thymic cysts). f. Chest wall (involvement of paraesternal soft tissues, internal mammary nodes, masses between pectoral muscles). SUMMARY The major teaching points of this exhibit are: 1. To emphasize about the typical findings in thoracic HD as mediastinal adenopathies, direct extension to lung, pleural effusions, chest wall involvement and thymic enlargement. 2. To show atypical findings that may suggest thoracic HD involvement. Radiologist h...
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