The AMANDUS Project PART II—Advanced Microperfusion Assessed Non-Union Diagnostics with Contrast-Enhanced Ultrasound (CEUS): A Reliable Diagnostic Tool for the Management and Pre-operative Detection of Infected Upper-Limb Non-unions

Abstract Purpose To assess the value of CEUS in the evaluation of tibial fracture perfusion and its ability to differentiate between physiologic and abnormal fracture healing. Materials and Methods From 2014 to 2017, 107 patients with tibial fractures or tibial non-unions underwent CEUS examination. CEUS was performed at the regular follow-up examination 26 weeks after osteosynthesis or before non-union surgery. Time-intensity curves (TICs) of the contrast enhancement in the fracture gap were generated, and volume parameters such as wash-in rate (WiR), peak enhancement (PE) and wash-in perfusion index (WiPI) were quantified. Results A total of 34 patients met the inclusion criteria of this study, including 14 consolidated fractures, 12 aseptic non-unions and 8 infected non-unions. WiR, PE and WiPI showed significantly lower values in aseptic non-unions compared to unions (p = 0.009, 0.009, 0.012, resp.). In contrast, infected non-unions showed higher values of WiR, PE and WiPI when compared to unions (p = 0.034, 0.056, 0.029, resp.). Conclusion CEUS represents a feasible method in the assessment of tibial fracture perfusion. Perfusion differences between aseptic and infected tibial non-unions as well as healing tibial fractures could be detected. The deviation of physiologic fracture perfusion seems to be associated with disturbed osseous regeneration leading to non-union.

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A Preliminary Study of Contrast-Enhanced Ultrasound (CEUS) and Cytokine Expression Analysis (CEA) as Early Predictors for the Outcome of Tibial Non-Union Therapy

Diagnostics ◽

10.3390/diagnostics8030055 ◽

2018 ◽

Vol 8 (3) ◽

pp. 55 ◽

Cited By ~ 2

Author(s):

Patrick Haubruck ◽

Raban Heller ◽

Michael Tanner ◽

Volker Daniel ◽

Gerhard Schmidmaier ◽

...

Keyword(s):

Expression Analysis ◽

Cytokine Expression ◽

Outcome Evaluation ◽

Contrast Enhanced Ultrasound ◽

Non Union ◽

Early Predictors ◽

Contrast Enhanced ◽

Serum Cea ◽

Group 2 ◽

Diagnostic Modalities

The current study investigates if contrast-enhanced ultrasound (CEUS) or cytokine expression analysis (CEA) evaluating vascularization are capable of predicting the outcome of non-union therapy. Patients with tibial non-unions were surgically treated and participated in our follow-up program including perioperative collection of blood as well as CEUS analysis. Two groups were formed: Responders in group 1 (G1, N = 8) and Non-Responders in group 2 (G2, N = 5). Serum cytokine expression and local microperfusion were compared and correlated to the radiologic outcome. Evaluation of TNF-α expression revealed significantly lower values prior to first surgery in G1 (G1: 9.66 ± 0.96 pg/mL versus G2: 12.63 ± 1.2 pg/mL; p = 0.045); whereas after treatment both CEA and CEUS indicated a higher potential for angiogenesis in Responders. Logistic regression modelling revealed the highest predictive power regarding eventual osseous consolidation for the combination of both CEUS and serum CEA. The results provide first evidence regarding a link between changes in the serum expression of distinct pro-angiogenic cytokines and alterations in the local microperfusion assessed via both non-invasive and radiation-free diagnostic modalities. In addition, a combination of CEUS and CEA is a promising novel tool in early prediction of the outcome of non-union therapy.

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The AMANDUS Project—Advanced Microperfusion Assessed Non-Union Diagnostics With Contrast-Enhanced Ultrasound (CEUS) for the Detection of Infected Lower Extremity Non-Unions

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2019.05.007 ◽

2019 ◽

Vol 45 (9) ◽

pp. 2281-2288 ◽

Cited By ~ 9

Author(s):

Julian Doll ◽

Sascha Gross ◽

Marc-André Weber ◽

Gerhard Schmidmaier ◽

Christian Fischer

Keyword(s):

Lower Extremity ◽

Contrast Enhanced Ultrasound ◽

Non Union ◽

Contrast Enhanced

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A Rare Case of Unilateral Renal Cortical Necrosis

Case Reports in Nephrology and Dialysis ◽

10.1159/000512228 ◽

2021 ◽

pp. 63-68

Author(s):

Yngvar Lunde Haaskjold ◽

Kim Nylund ◽

Rannveig Skrunes

Keyword(s):

Antiphospholipid Syndrome ◽

Diagnostic Tool ◽

Rare Case ◽

Case Reports ◽

Rare Condition ◽

Primary Antiphospholipid Syndrome ◽

Contrast Enhanced Ultrasound ◽

Cortical Necrosis ◽

Renal Cortical Necrosis ◽

Contrast Enhanced

Unilateral cortical necrosis is a rare condition, and only described in a few case reports. We present a case of a previously healthy 24-year-old male with acute unilateral cortical necrosis, where contrast-enhanced ultrasound (CEUS) became a valuable diagnostic tool. Antiphospholipid syndrome was subsequently diagnosed. Primary antiphospholipid syndrome is a well-known, but rare cause of cortical necrosis. It promotes thrombosis in renal arteries, capillaries and veins, and usually affects both kidneys. Unilateral cortical necrosis due to antiphospholipid syndrome has, to our knowledge, not been previously described.

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