Imaging of gout

Gout is a systemic metabolic disease. The enzyme urate oxidase (uricase) that catalyses the oxidation of uric acid to the more soluble compound allantoin is inactive in humans. This may lead to hyperuricaemia. Hyperuricaemia is often present for many years prior to clinical signs of gout. Acute attacks occur as a result of an inflammatory response to monosodium urate (MSU) crystal deposition leading to intense pain and inflammation in the affected joints. Uncontrolled hyperuricaemia and resultant gout can evolve into a destructive arthritis. Imaging may be helpful in the diagnosis of gout as well as in monitoring the response to gout treatment. Plain X-rays are widely used for joint imaging in patients with gout. However, plain X-rays of joints affected by gout are frequently normal, especially early in the disease. In these cases, advanced imaging modalities may be useful. Advanced imaging can help evaluate inflammation, structural joint changes, and magnitude of tophaceous deposits. Advanced imaging modalities include computed tomography (CT), dual-energy CT (DECT), magnetic resonance imaging (MRI), and ultrasound (US). CT may be most suitable to evaluate bone changes in gouty joints and DECT to evaluate tophaceous deposits. MRI may best evaluate soft tissues and Inflammation. US is useful during patients’ visits to the rheumatologist and allows evaluation of cartilage, soft tissues, synovium, and tophaceous deposits. This chapter reviews imaging modalities used in gout patients and discusses their application in the diagnosis and management of gout.

Management and Outcomes of Clinical Scaphoid Fractures in Children

Hand ◽

10.1177/1558944720930293 ◽

2020 ◽

pp. 155894472093029

Author(s):

Aneesh Karir ◽

Minh N. Q. Huynh ◽

Sasha Carsen ◽

Kevin Smit ◽

Kevin Cheung

Keyword(s):

Scaphoid Fracture ◽

Clinical Signs ◽

Fracture Rate ◽

X Rays ◽

Advanced Imaging ◽

Scaphoid Fractures ◽

Fractures In Children ◽

Mean Time ◽

Pediatric Center

Background: Acute wrist trauma with clinical suspicion of a scaphoid fracture, but normal radiographs, is known as a clinical scaphoid fracture. Standard treatment involves immobilization and repeat radiographs in 10 to 14 days. When repeat radiographs are normal but a scaphoid fracture is still clinically suspected, the optimal management in children is unknown. This study retrospectively assessed the management and outcomes of pediatric patients diagnosed with clinical scaphoid fractures. Methods: A retrospective study was performed of all patients over a 2-year period treated for a clinical scaphoid fracture at a tertiary pediatric center. Patients were included if they had clinical signs of a scaphoid fracture and 2 negative x-rays 7 to 14 days apart postinjury. Results: Ninety-one patients with a mean age of 13.2 years (range: 7.8-17.7) were included. Sixteen patients (17.6%) underwent computed tomography (CT) or magnetic resonance imaging (MRI) at a mean time of 10.2 weeks postinjury. Five patients (5.5%) were diagnosed with a scaphoid fracture by x-ray or CT at an average of 4.5 weeks postinjury (range: 3-6). Six patients were diagnosed with other wrist fractures at a mean time postinjury of 3.1 (range: 3-6.5) weeks. Out of 195 total radiographs, the surgeon and radiologist disagreed on 59 (30.2%) images. No patients underwent surgery. Conclusions: Management of clinical scaphoid fractures at our institution was relatively uniform: nearly all patients were immobilized and less than 20% received advanced imaging. Our findings suggest a low but non-zero occult scaphoid fracture rate, discordance in radiologic interpretation, and lack of advanced imaging, providing an avenue for future prospective studies.

Sternal Fracture in Children: Diagnosis by Ultrasonography

European Journal of Pediatric Surgery Reports ◽

10.1055/s-0037-1606197 ◽

2017 ◽

Vol 05 (01) ◽

pp. e39-e42 ◽

Cited By ~ 6

Author(s):

Sergio Sesia ◽

Friederike Prüfer ◽

Johannes Mayr

Keyword(s):

Soft Tissues ◽

Imaging Modality ◽

The Body ◽

X Rays ◽

Sternal Fracture ◽

Concomitant Injuries ◽

Second Child ◽

First Child ◽

Displaced Fracture

Because of its subcutaneous location, the sternum can be examined sonographically using a linear scanner. We report about two children who experienced blunt chest trauma. Anterior–posterior chest X-rays were normal. Ultrasonic imaging confirmed a fracture of the sternum with dorsal displacement of the distal fragment (by 0.97 cm) in the first child and a transverse fracture of the body of the sternum without displacement in the second child. In both children, pericardial effusion was excluded by sonography. The displaced fracture of the sternum was confirmed by magnetic resonance imaging (MRI), which ruled out concomitant injuries of the soft tissues adjacent to the sternum. Both sternum fractures were managed nonoperatively. These cases serve to emphasize the importance of sonography that represents an ionizing radiation free, noninvasive, efficient, and safe imaging modality to diagnose fractures of the sternum in children while also enabling the assessment of the pericardium.

Assessment of Cardiac Sarcoidosis with Advanced Imaging Modalities

BioMed Research International ◽

10.1155/2014/897956 ◽

2014 ◽

Vol 2014 ◽

pp. 1-15 ◽

Cited By ~ 10

Author(s):

Makoto Orii ◽

Toshio Imanishi ◽

Takashi Akasaka

Keyword(s):

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Systemic Disease ◽

Imaging Modalities ◽

Unknown Etiology ◽

Advanced Imaging ◽

Multiple Organs ◽

Positron Emission ◽

Diagnostic Modalities

Sarcoidosis is a chronic systemic disease of unknown etiology that is characterized by the presence of noncaseating epithelioid granulomas, usually in multiple organs. Several studies have shown that sarcoidosis might be the result of an exaggerated granulomatous reaction after exposure to unidentified antigens in genetically susceptible individuals. Cardiac involvement may occur and lead to an adverse outcome: the heart mechanics will be affected and that causes ventricular failure, and the cardiac electrical system will be disrupted and lead to third degree atrioventricular block, malignant ventricular tachycardia, and sudden cardiac death. Thus, early diagnosis and treatment of this potentially devastating disease is critically important. However, sensitive and accurate imaging modalities have not been established. Recent studies have demonstrated the promising potential of cardiac magnetic resonance imaging (MRI) and18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET) in the diagnosis and assessment of cardiac sarcoidosis (CS). In this review, we discuss the epidemiology, etiology, histological findings, and clinical features of sarcoidosis. We also introduce advanced imaging including18F-FDG PET and cardiac MRI as more reliable diagnostic modalities for CS.

Magnetic resonance imaging technology in evaluating the presence and integrity of the anterior oblique ligament of the thumb

Orthopedic Reviews ◽

10.4081/or.2012.e23 ◽

2012 ◽

Vol 4 (2) ◽

pp. 23 ◽

Cited By ~ 1

Author(s):

Evan D. Collins

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Soft Tissues ◽

X Rays ◽

Resonance Imaging ◽

Degenerative Arthritis ◽

Imaging Protocol ◽

Mri Protocol ◽

Anterior Oblique Ligament ◽

The investigation examines the reliability and reproducibility of magnetic resonance imaging (MRI) technology in evaluating the anterior oblique ligament (AOL) of the trapeziometacarpal joint (TMC) of the thumb, in order to establish an effective imaging protocol to use in the early identification of conditions leading to degenerative arthritis. We used cadaver specimens, three hand surgeons independently rated from X-rays each specimen. The specimens were then scanned in a General Electric MRI machine with a standard wrist coil. An effort was made to reproduce the image of the AOL - with a unique technique to obtain images of the obliquely oriented thumb and its ligaments. Following the MRI, the specimens were dissected to expose the AOL and visualize the TMC joint. A standard MRI fiducial was sewn to the proximal and distal extent of the volar side of the AOL. The soft tissues were replaced and the skin was closed. They were then rescanned following the same protocol, and pre and post-dissection ligamentlabeled specimens were compared. Following dissection and tagging of the AOL ligament, a repeat MRI confirmed its location and validated the protocol in all cases. The open dissection and ligament tagging confirmed that what was visualized was in fact the structure of interest. This investigation demonstrated that with an appropriate MRI protocol it is feasible to guide the scanner to catch appropriate images of a ligament that is closely correlated with degenerative arthritis.

Is anterior and posterior ankle impingement under-diagnosed? A review

Journal of Arthroscopic Surgery and Sports Medicine ◽

10.25259/jassm_50_2020 ◽

2021 ◽

Vol 2 ◽

pp. 58-65

Author(s):

Ankit Khurana ◽

Inderjeet Singh ◽

Maninder Shah Singh

Keyword(s):

Early Diagnosis ◽

Clinical Signs ◽

Return To Sport ◽

Invasive Procedure ◽

X Rays ◽

Early Management ◽

Ankle Impingement ◽

Soft Tissue Impingement ◽

Posterior Ankle Impingement ◽

The impingement of the ankle is diagnosed based on history, clinical signs, physical examination, and conventional radiographic observations and is often a diagnosis of exclusion. Normal X-rays may display spurs, but are mainly useful in the evaluation of other osseous and articular diseases, which may masquerade impingement symptoms. Orthopedic literature seems to embrace the idea that magnetic resonance imaging (MRI) plays a significant role in pre-operative imaging of impingement lesions and MRI is a highly useful method for evaluating acute and chronic foot and ankle disorders. Arthroscopy of the ankle is an important minimally invasive procedure for the treatment of this disease. The majority of patients who have refractory symptoms are treated for ankle impingement using debridement through arthroscopy or an open procedure. According to recent reports, arthroscopic patients for osseous impingement had done better than soft-tissue impingement arthroscopic patients. Ankle arthroscopy has outstanding functional outcomes with few complications and reproducible results. Diagnosis and treatment should be initiated immediately in sportsmen so that the competing athlete can return to sport in an expedient way. The surgeon’s increased suspicion of this disorder is necessary to avoid substantial loss of time and early management. This review highlights the author’s arthroscopic method of impingement resection and discusses the latest available literature on etiopathogenesis, diagnosis, and management of both anterior and posterior ankle impingement. A greater understanding of this disorder can assist the clinician in the early diagnosis and intervention of impingement in sportsmen and dancers. Early diagnosis and intervention are the foundation for successful return to the profession and daily activities.

State-of-the-art pulmonary arterial imaging – Part 1

VASA ◽

10.1024/0301-1526/a000708 ◽

2018 ◽

Vol 47 (5) ◽

pp. 345-359 ◽

Cited By ~ 5

Author(s):

Yuki Tanabe ◽

Luis Landeras ◽

Abed Ghandour ◽

Sasan Partovi ◽

Prabhakar Rajiah

Keyword(s):

State Of The Art ◽

Pulmonary Arteries ◽

Pulmonary Angiography ◽

Imaging Modalities ◽

Nuclear Medicine Imaging ◽

Multiple State ◽

Pulmonary Arterial ◽

Acquired Abnormalities ◽

Arterial Imaging

Abstract. The pulmonary arteries are affected by a variety of congenital and acquired abnormalities. Multiple state-of-the art imaging modalities are available to evaluate these pulmonary arterial abnormalities, including computed tomography (CT), magnetic resonance imaging (MRI), echocardiography, nuclear medicine imaging and catheter pulmonary angiography. In part one of this two-part series on state-of-the art pulmonary arterial imaging, we review these imaging modalities, focusing particularly on CT and MRI. We also review the utility of these imaging modalities in the evaluation of pulmonary thromboembolism.

Development of a new endoscopic classification and first international validation (FACILE Group) of colonic lesions using advanced imaging modalities in IBD patients

10.26226/morressier.59a6b347d462b80290b54bbb ◽

2017 ◽

Author(s):

Marietta Iacucci

Keyword(s):

Imaging Modalities ◽

Advanced Imaging ◽

Endoscopic Classification

Desmoid tumour of the distal forearm involving the distal radioulnar joint

BMJ Case Reports ◽

10.1136/bcr-2020-237097 ◽

2020 ◽

Vol 13 (11) ◽

pp. e237097

Author(s):

Apoorv Sehgal ◽

Pratyush Shahi ◽

Avijeet Prasad ◽

Manoj Bhagirathi Mallikarjunaswamy

Keyword(s):

Distal Radioulnar Joint ◽

Treatment Modalities ◽

Desmoid Tumour ◽

X Rays ◽

Distal Forearm ◽

Left Wrist ◽

Radioulnar Joint ◽

Epidemiology Investigation

A 32-year-old woman presented with progressive pain and swelling of the left wrist for 6 months. Physical examination revealed a firm, tender, oval swelling over the left wrist. X-rays showed a pressure effect on the distal radius and ulna. Magnetic Resonance Imaging (MRI) revealed a well-defined, asymmetrical, dumbbell-shaped soft-tissue lesion involving the interosseous region of the distal forearm and extending until the distal radioulnar joint (DRUJ). Core needle biopsy confirmed the diagnosis of desmoid tumour. Marginal excision of the tumour was done. At the 2-year follow-up, the patient was doing well and had painless and improved left wrist motion. Desmoid tumour involving the DRUJ has not been previously reported. We, through this case, report new observation and discuss the epidemiology, investigation of choice, treatment modalities, and the need for a regular follow-up for appendicular desmoid tumours.

Differentiating Glioblastomas from Solitary Brain Metastases: An Update on the Current Literature of Advanced Imaging Modalities

Cancers ◽

10.3390/cancers13122960 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2960

Author(s):

Austin-John Fordham ◽

Caitlin-Craft Hacherl ◽

Neal Patel ◽

Keri Jones ◽

Brandon Myers ◽

...

Keyword(s):

Magnetic Resonance ◽

Brain Metastases ◽

Clinical Assessment ◽

Volume Fraction ◽

Imaging Modalities ◽

Current Evidence ◽

Dynamic Susceptibility ◽

Advanced Imaging ◽

Imaging Protocol ◽

Solitary Brain Metastases

Differentiating between glioblastomas and solitary brain metastases proves to be a challenging diagnosis for neuroradiologists, as both present with imaging patterns consisting of peritumoral hyperintensities with similar intratumoral texture on traditional magnetic resonance imaging sequences. Early diagnosis is paramount, as each pathology has completely different methods of clinical assessment. In the past decade, recent developments in advanced imaging modalities enabled providers to acquire a more accurate diagnosis earlier in the patient’s clinical assessment, thus optimizing clinical outcome. Dynamic susceptibility contrast has been optimized for detecting relative cerebral blood flow and relative cerebral blood volume. Diffusion tensor imaging can be used to detect changes in mean diffusivity. Neurite orientation dispersion and density imaging is an innovative modality detecting changes in intracellular volume fraction, isotropic volume fraction, and extracellular volume fraction. Magnetic resonance spectroscopy is able to assist by providing a metabolic descriptor while detecting variable ratios of choline/N-acetylaspartate, choline/creatine, and N-acetylaspartate/creatine. Finally, radiomics and machine learning algorithms have been devised to assist in improving diagnostic accuracy while often utilizing more than one advanced imaging protocol per patient. In this review, we provide an update on all the current evidence regarding the identification and differentiation of glioblastomas from solitary brain metastases.

Acute Mesenteric Vein Thrombosis in a Pregnant Patient at 10 Weeks Gestation: A Case Report

Diagnostics ◽

10.3390/diagnostics11081348 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1348

Author(s):

Ying-Ying Chen ◽

Sheng-Mao Wu ◽

Russell Oliver Kosik ◽

Yi-Chien Hsieh ◽

Tzu-I Wu ◽

...

Keyword(s):

Acute Abdominal Pain ◽

Clinical Manifestations ◽

Pregnant Patient ◽

Resonance Imaging ◽

Advanced Imaging ◽

Mesenteric Vein Thrombosis ◽

Mesenteric Vein ◽

Vein Thrombosis ◽

Management Perspective ◽

Acute abdominal pain during pregnancy is challenging, both from a diagnostic and management perspective. A non-localized, persistent pain out of proportion to physical examination is a sign that advanced imaging may be necessary. Mesenteric venous thrombosis in a pregnant patient is extremely rare, but if diagnosis is delayed, can be potentially fatal to both the mother and the fetus. We present here a pregnant patient in the tenth week of gestation with classic clinical manifestations of mesenteric vein thrombosis and the corresponding findings on magnetic resonance imaging (MRI) and computed tomography (CT).