scholarly journals OP0066 IMAGING-DETECTED FEATURES OF HAND OSTEOARTHRITIS ASSOCIATE WITH SYMPTOMS AND RADIOGRAPHIC CHANGE OVER TIME: A SYSTEMATIC REVIEW AND META-ANALYSIS OF OBSERVATIONAL STUDIES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 44-45
Author(s):  
A. Obotiba ◽  
S. Swain ◽  
J. Kaur ◽  
K. Yaseen ◽  
M. Doherty ◽  
...  
Keyword(s):  
Structural Changes ◽  
Power Doppler ◽  
Forest Plot ◽  
Hand Osteoarthritis ◽  
Imaging Features ◽  
Radiographic Change ◽  
Mri Features ◽  
Joint Tenderness ◽  
Over Time

Background:Osteoarthritis (OA) commonly affects joints in the hand. The natural history of hand OA is not well understood, and the local determinants of symptoms and structural changes over time remain unclear.Objectives:To investigate, in both cross-sectional and prospective studies, the association between imaging (ultrasound [US] and magnetic resonance imaging [MRI]) features and symptoms of hand OA, and to examine in prospective studies whether imaging-detected features at baseline predict subsequent clinical and radiographic outcomes.Methods:A systematic literature search was conducted in five databases including Medline, Web of Science, EMBASE, CINAHL and AMED in April 2018. The search was designed to capture published observational studies on the use of US and MRI in hand OA with no language restrictions. Odds ratios (OR), risk ratios (RR), and 95% confidence interval (CI) between [1] imaging features and hand OA symptoms at baseline, and [2] baseline-imaging features and follow-up outcomes were extracted and pooled using random effects model. Outcomes were defined as either incidence or progression of pre-existing features. Risk of bias assessment was performed using the Newcastle-Ottawa Scales. Heterogeneity and publication bias were assessed.Results:The search identified 2818 citations, which reduced to 2216 after duplicate removal. Screening of titles and abstracts found 140 articles which met the inclusion criteria. After full text screening, 25 were included for analysis, including 452 participants (87% women) for US and 298 participants (86% women) for MRI with mean ages 60.3 and 62.5, respectively. Imaging-detected structural OA features were preferentially found in distal interphalangeal joints (DIPJs) followed by carpometacarpal (CMCJ) and proximal interphalangeal (PIPJ) joints. Metacarpophalangeal joints were least affected. However, the distribution pattern was different for inflammatory features for which the CMCJ was the most affected, and with no clear difference between DIPJs and PIPJs (Figure 1).Figure 1.Hand map of grey-scale synovitis derived from pooled estimates of prevalence across studies (%[95% CI])Of 10 US and 5 MRI studies examining association at baseline, joint tenderness was associated with US osteophytes (pooled ORs 2.30, 95% CI 1.90-2.79), grey-scale synovitis (3.00, 2.33-3.84), synovial effusion (2.92, 2.29-3.72), and power Doppler (PD) (2.30, 1.68-3.15). Similar relationships were observed with MRI features (Figure 2). Six studies did not find any association between imaging features and self-reported outcomes. However, association was observed with US- and MRI-detected synovitis in one study each, and MRI-detected structural features in two. Statistical pooling was not possible for these outcomes due to heterogeneous data.Figure 2.Forest plot showing pooled odds ratio between baseline magnetic resonance imaging features of hand osteoarthritis and joint tenderness.Of the 9 US and 5 MRI studies for prediction, a dose-dependent relationship was observed between baseline PD and radiographic change at follow-up (Figure 3). Similar results were observed for MRI features and Kellgren-Lawrence change. The pooled ORs (95% CI) was 2.66 (1.88, 3.78) for bone marrow lesions, and 2.18 (1.53, 3.10) and 4.7 (3.08, 7.18) for grades 1 and 2 synovitis, respectively. Data to predict change in clinical outcomes however, were lacking.Figure 3.Forest plot showing pooled odds ratio between baseline power Doppler and radiographic change over timeConclusion:Imaging-detected inflammatory features and osteophytes associate with joint tenderness. In addition, imaging-detected inflammatory changes at baseline predict future development and progression of structural OA changes, indicating that inflammation may precede radiographically-detectable structural changes.Disclosure of Interests:Abasiama Obotiba: None declared, Subhashisa Swain: None declared, Jaspreet Kaur: None declared, Khalid Yaseen: None declared, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Weiya Zhang Consultant of: Grunenthal for advice on gout management, Speakers bureau: Bioiberica as an invited speaker for EULAR 2016 satellite symposium, Abhishek Abhishek Grant/research support from: AstraZeneca and OxfordImmunotech, Speakers bureau: Menarini pharmaceuticals

Increasing synovitis and bone marrow lesions are associated with incident joint tenderness in hand osteoarthritis

2015 ◽  
Vol 75 (4) ◽  
pp. 702-708 ◽  
Author(s):  
Ida K Haugen ◽  
Barbara Slatkowsky Christensen ◽  
Pernille Bøyesen ◽  
Sølve Sesseng ◽  
Désirée van der Heijde ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Bone Marrow ◽  
Longitudinal Study ◽  
Hand Osteoarthritis ◽  
Bone Marrow Lesions ◽  
Contrast Enhanced ◽  
Joint Tenderness ◽  
Structural Progression ◽  
Generalised Estimating Equations

ObjectivesTo explore whether changes of MRI-defined synovitis and bone marrow lesions (BMLs) are related to changes in joint tenderness in a 5-year longitudinal study of the Oslo hand osteoarthritis (OA) cohort.MethodsWe included 70 patients (63 women, mean (SD) age 67.9 (5.5) years). BMLs and contrast-enhanced synovitis in the distal and proximal interphalangeal joints were evaluated on 0–3 scales in n=69 and n=48 patients, respectively. Among joints without tenderness at baseline, we explored whether increasing/incident synovitis and BMLs were associated with incident joint tenderness using generalised estimating equations. Among joints with tenderness at baseline, we explored whether decreasing or resolution of synovitis and BMLs were associated with loss of joint tenderness. We adjusted for age, sex, body mass index, follow-up time and changes in radiographic OA.ResultsAmong joints without tenderness at baseline, increasing/incident synovitis and BMLs were seen in 45 of 220 (20.5%) and 47 of 312 (15.1%) joints, respectively. Statistically significant associations to incident joint tenderness were found for increasing/incident synovitis (OR=2.66, 95% CI 1.38 to 5.11) and BMLs (OR=2.85, 95% CI 1.23 to 6.58) independent of structural progression. We found a trend that resolution of synovitis (OR=1.72, 95% CI 0.80 to 3.68) and moderate/large decreases of BMLs (OR=1.90, 95% CI 0.57 to 6.33) were associated with loss of joint tenderness, but these associations were non-significant.ConclusionsThe Oslo hand OA cohort is the first study with longitudinal hand MRIs. Increasing synovitis and BMLs were significantly associated with incident joint tenderness, whereas no significant associations were found for decreasing or loss of synovitis and BMLs.

scholarly journals Pure Fibrocystic Change Diagnosed at MRI-guided Vacuum-assisted Breast Biopsy: Imaging Features and Follow-up Outcomes

2020 ◽  
Vol 2 (2) ◽  
pp. 141-146
Author(s):  
Shu-Tian Chen ◽  
Satoko Okamoto ◽  
Bruce L Daniel ◽  
James Covelli ◽  
Wendy B DeMartini ◽  
...  
Keyword(s):  
Breast Biopsy ◽  
Breast Mri ◽  
Lesion Size ◽  
Imaging Features ◽  
Mri Features ◽  
Fibrocystic Change ◽  
Mri Guided ◽  
Lesion Regression ◽  
Mri Characteristics

Abstract Objective Fibrocystic change (FCC) is considered one of the most common benign findings in the breast and may be commonly seen on breast MRI. We performed this study to identify MRI characteristics of pure FCC on MRI-guided vacuum-assisted breast biopsy (VABB) without other associated pathologies and describe the findings on MRI follow-up and outcomes. Methods A retrospective review was performed for 598 lesions undergoing 9-gauge MRI-guided VABB at our institution from January 2015 to April 2018, identifying 49 pure FCC lesions in 43 patients. The associations between variables and lesion changes on follow-up MRI were analyzed using exact Mann-Whitney tests and Fisher’s exact tests. Results MRI features of pure FCC are predominantly clumped nonmass enhancement (19/49, 39%) or irregular masses with initial fast/late washout kinetics (9/49, 18%). There was no upgrade to high-risk or cancerous lesions among the 11 patients (25.6%) who underwent surgery. There were 22 pure FCC lesions in 19 (44.2%) patients who had follow-up MRI (mean 18.0 months, range 11–41 months) showing regression (13, 59%), stability (8, 36%), or progression (1, 5%) of the lesion size, and no cancers were found on follow-up at the site of the MRI biopsy for fibrocystic changes. No patient demographics or lesion features were associated with lesion regression or stability (P > 0.05). Conclusion Our study shows that MRI features of VABB-proven FCC lesions may mimic malignancy. After VABB of pure FCC, given that adequate sampling has been performed, a 12-month follow-up MRI may be reasonable.

scholarly journals FRI0424 PROGRESSION OF PAIN, STIFFNESS, FUNCTION CHANGES AND ULTRASOUND DETECTED CHANGES IN THE GROUP OF 151 PATIENTS WITH HAND OSTEOARTHRITIS OVER THREE YEARS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 810.1-810
Author(s):  
O. Sleglova ◽  
O. Růžičková ◽  
K. Pavelka ◽  
L. Šenolt
Keyword(s):  
Joint Pain ◽  
Clinical Symptoms ◽  
Power Doppler ◽  
Joint Stiffness ◽  
Hand Osteoarthritis ◽  
Gray Scale ◽  
Erosive Disease ◽  
Osteophyte Formation ◽  
The Third

Background:Hand osteoarthritis (HOA) is a common and frequent cause of pain. HOA is a heterogeneous group of disorders with two main subsets including non-erosive and erosive disease. Few studies demonstrated inflammatory ultrasound changes and more severe clinical symptoms in patients with erosive compared with non-erosive disease, however the results are inconsistent.Objectives:The aim of this study was to evaluate progression of pain, stiffness, physical impairment and ultrasound features in patients with erosive and non-erosive HOA in a three years longitudinal study.Methods:Consecutive patients with symptomatic HOA fulfilling the American College of Rheumatology (ACR) criteria were included in this study. Joint pain and swelling were assessed. Patients reported joint pain on 100 mm visual analogue scale (VAS). Pain, joint stiffness and disability were assessed by the Australian/Canadian OA hand index (AUSCAN). Erosive disease was defined by at least one erosive interphalangeal joint. Synovial hypertrophy and power Doppler signal (PDS) were scored with ultrasound. Synovitis was graded on a scale of 0–3 and osteophytes were defined as cortical protrusions seen in two planes. Patients were examined at baseline and at the first, second and third year of follow-up.Results:Altogether, 151 patients (16 male) with symptomatic nodal HOA were included in this study and followed between April 2012 and January 2020. Out of these patients, 84 (4 male) had erosive disease. The disease duration (p<0.05) was higher in patients with erosive compared with non-erosive disease.Pain reported on VAS was significantly higher (p<0.01) in patients with erosive compared with non-erosive disease at baseline. Progression of pain after the third year of follow up was significantly higher in patients with erosive disease (p<0.01). The number of painful and clinically swollen joints (p<0.05) was significantly higher in patients with erosive compared with non-erosive disease at baseline. It fluctuated over the second and third year of follow up, but it still remained statistically higher (p<0.01) at the third year of follow up in patients with erosive disease.According to the AUSCAN, patients with erosive compared with non-erosive disease had more pain (p<0.01) and stiffness (p<0.01) at baseline. Pain (p<0.05), stiffness and also function (p<0.05) worsened in patients with erosive compared with non-erosive disease at the third year of follow up.US-detected pathologies such as gray-scale synovitis (p<0.001), intensity of PDS (p<0.01) and number of osteophytes (p<0.01) were significantly higher in patients with erosive compared with non-erosive disease at baseline. There were improvements in gray-scale synovitis total score and intensity of PDS in patients with non-erosive disease while patients with erosive disease worsened after the second and third year of follow up. US-detected gray-scale synovitis (p<0.001), intensity of PDS (p<0.01) remained significantly higher in patients with erosive compared with non-erosive disease after the third year of follow up. On the other hand, the progression of US-determined osteophyte formation was observed in both groups but was significantly higher (p<0.05) in patients with erosive compared with non-erosive disease after the third year of follow up. .Conclusion:The findings of this study show that pain and number of painful and clinically swollen joints associated with US-detected synovial changes and osteophyte formation is more severe in patients with erosive HOA than in patients with non-erosive disease. In addition, osteophyte formation is more likely to progress independent of synovial inflammation.References:[1]Meersseman P, Van de Vyver C, Verbruggen G, et al. Clinical and radiological factors associated with erosive radiographic progression in hand osteoarthritis. Osteoarthritis and Cartilage 2015;23:2129-2133.Acknowledgments:This work was supported by the project MHCR 023728 and AZV No. 18-00542.Disclosure of Interests:Olga Sleglova: None declared, Olga Růžičková: None declared, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Ladislav Šenolt: None declared

Prevalence and real-world management of vedolizumab-associated enthesitis in successfully treated IBD patients

Rheumatology ◽  
2021 ◽  
Author(s):  
Mirko Di Ruscio ◽  
Ilaria Tinazzi ◽  
Angela Variola ◽  
Andrea Geccherle ◽  
Antonio Marchetta ◽  
...  
Keyword(s):  
De Novo ◽  
Severe Disease ◽  
Power Doppler ◽  
Case Series ◽  
Imaging Features ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Power Doppler Signal ◽  
Sonographic Imaging

Abstract Background Some studies have reported the development of moderate and severe de novo SpA-associated disease under vedolizumab (VDZ) treatment for IBD. Herein, we report a case series who developed severe enthesitis under VDZ therapy from a cohort of 90 treated cases. Methods In a single Italian IBD Unit in which 90 cases were on VDZ therapy, we identified 11 cases who developed severe enthesitis. The onset of disease in relationship to VDZ initiation, clinical and sonographic imaging features, and outcomes (including therapy switches) was described. Results A total of 11 cases, including 8 prior anti-TNF failures, with new-onset entheseal pathology were identified: multifocal (n = 4), unifocal (n = 6), and enthesitis/synovitis/dactylitis (n = 1). The mean duration of symptoms was 46 weeks (range 6–119), the mean CRP was 5.1 mg/dl, and the majority were HLA-B27 negative and showed good clinical response for gut disease. Clinical features and US showed severe enthesitis, including power Doppler change in 7 patients. All patients were initially treated with NSAIDs, and 5 patients underwent local steroid injections. At 12 months, 5/7 cases continued VDZ and 2 were switched to ustekinumab. At 12 months follow-up of 7 cases, 5 patients were in clinical remission and 2 patients had mild enthesitis with minimal increase of power Doppler signal. In addition, 4/7 severe patients developed marked post-inflammatory entheseal calcifications Conclusions A predominant isolated severe enthesitis pattern of SpA may develop under VDZ therapy with severe disease in 8% of cases. Most cases continued VDZ therapy.

Severe Alterations of Bone Mass and Bone Structure after Allogeneic Stem Cell Transplantation: An Osteopathologic Analysis.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3025-3025
Author(s):  
Gero Massenkeil ◽  
Cornelia Fiene ◽  
Oliver Rosen ◽  
Bernd Doerken ◽  
Renate Arnold ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Bone Density ◽  
Bone Mass ◽  
Structural Changes ◽  
Trabecular Thickness ◽  
Bone Marrow Biopsies ◽  
Number Of Patients ◽  
Over Time

Abstract Prolonged survival after allogeneic SCT has led to an increased awareness of late complications in these patients. Loss of bone density after SCT has been reported in radiologic analyses (Ebeling 1999, Schulte 2000, Massenkeil 2001). We have studied bone mass and structure alterations in bone marrow biopsies after SCT. Patients and Methods: 67 patients after allogeneic SCT were included in this analysis. Median age was 36 years (range 17–56), 35 male, 32 female. Diagnoses were: ALL 27 patients, AML 14, MDS 6, CML 20. 38 patients were in 1. CR or 1. cP, 29 were transplanted with advanced disease. 64 received standard high-dose conditioning and 3 were transplanted after reduced intensity conditioning. 42 received bone marrow and 25 mobilized peripheral blood as stem cell source.40 patients were transplanted from HLA-identical related and 27 from unrelated donors. 31 bone marrow biopsies underwent Micro-CT (Scanco, Zürich, CH) and were analysed after 3-D reconstruction. Usual parameters of trabecular structure were investigated. Results: Median bone volume/tissue volume (BV/TV), which serves as a parameter of histopathologic bone mass was 13.7% before SCT (range 8.6–44.4%), well below 18%, which are considered the osteopathologic threshold for osteoporosis. At first follow-up 6–9 months after SCT, BV/TV had dropped to 10.1% (5.9–24.6%) and at 1–2 years after SCT BV/TV was still below the pre-SCT values at 12.2% (6.1–19.3%). Number of trabecules (Tb.N.) dropped from 1.63/mm (range 0.93–2.32/mm) to 1.34 (1.01–5.61/mm) after 6–9 months and slightly increased to 1.54 (1.26–1.88/mm) after 1–2 years. Trabecular thickness (Tb. Th.) fell from 0.20 mm before SCT (normal Tb. Th. 0.20–0.30 mm) (range 0.16–0.49 mm) to a minimum of 0.16 mm (0.14–0.25 mm). As a consequence, intertrabecular space (Tb.Sp., normal appx. 0.60 mm) increased from 0.60 mm (0.36–1.11 mm) to 0.73 mm (0.23–1.04 mm) after SCT. Discussion: Independently from underlying diagnosis trabecular parameters changed within the first 6 months after SCT, indicating early loss of bone mass and structure. Afterwards, they showed some tendency to normalization, however, none of the parameters went back to baseline values. Number of patients analysed over time was to small to find out causative clinical parameters like chronic GvHD. Radiologic bone density was available for these patients and showed synchronous variations over time. Conclusions: Structural changes of trabecular bone develop early after allogeneic SCT and underscore the severeness of bone loss observed in these patients. Even after prolonged follow-up, structural changes and diminished bone mass persist and indicate a long-term cause of morbidity in these patients.

Sacroiliitis in Axial Spondyloarthritis: Assessing Morphology and Activity

2018 ◽  
Vol 22 (02) ◽  
pp. 180-188 ◽  
Author(s):  
Niels Egund ◽  
Iris Eshed ◽  
Iwona Sudoł-Szopińska ◽  
Anne Jurik ◽  
Lennart Jans
Keyword(s):  
Structural Changes ◽  
Bone Marrow Edema ◽  
Axial Spondyloarthritis ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Mri Features ◽  
Magnetic Resonance Imaging Mri ◽  
Active Inflammation ◽  
Marrow Edema

Objective To review the strengths, limitations, and new insights in the anatomy and magnetic resonance imaging (MRI) features of active and structural lesions of sacroiliitis in spondyloarthritis. Discussion MRI plays a key role in the diagnosis and follow-up of sacroiliitis in spondyloarthritis. MRI of the sacroiliac joints in affected patients may show active lesions such as bone marrow edema, capsulitis, enthesitis, or synovitis as well as structural changes such as erosion, fat infiltration, sclerosis, backfill, and ankylosis. Active lesions of sacroiliitis on MRI are particularly important for the diagnosis and assessment of ongoing active inflammation. Structural lesions increasingly gain importance for diagnosis and follow-up. Conclusion Active lesions remain the hallmark for assessment of inflammation in sacroiliitis. Structural lesions increasingly play a role in the diagnosis of spondyloarthritis.

Significance of incidentally detected oval, circumscribed enhancing lesions on preoperative breast MRI.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 12-12
Author(s):  
Jong Yoon Lee ◽  
Mi Jung Jang ◽  
Sun Mi Kim ◽  
Bo La Yun ◽  
Ja Yoon Jang
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Breast Mri ◽  
Imaging Features ◽  
Tubular Carcinoma ◽  
Interval Change ◽  
Mri Features ◽  
Significant Difference ◽  
Preoperative Breast Mri

12 Background: To evaluate the characteristics and malignancy rate of oval, circumscribed enhancing lesions seen on preoperative breast MRI in patients with breast cancer. Methods: From January 2010 through May 2013, a total number of 502 oval, circumscribed mass was incidentally found in 326 patients with breast cancer who had undergone preoperative breast MRI. Seventy-eight lesions were excluded due to the lack of follow-up imaging or total mastectomy. Biopsy was performed when suspicious enhancing kinetics or interval change were detected on MRI. Otherwise, MRI or ultrasound follow up for correlated lesion were performed at least 2 years. Clinical and imaging features were recorded for analysis. Results: Of the 424 oval, circumscribed enhancing lesions detected on MRI, twelve (2.8%) were malignant and 412 (97.2%) were benign. There was no significant difference in size between malignant (0.72±0.26 cm) and benign (0.71±0.34 cm) lesions (p = 0.932). Among 424 lesions, 43 lesions (10.1%) were pathologically confirmed and twelve were malignant. Positive predictive value (PPV) of malignancy for the biopsy was 27.9%. Among 12 malignant lesions, 7 (58.3%) were invasive ductal carcinoma, 4 (33.3%) were ductal carcinoma in situ, and 1 (8.3%) was tubular carcinoma. Of the pathologically confirmed benign lesions, 8 (25.8%) were fibroadenoma, 7 (22.6%) were intraductal papilloma. Interestingly, there were significantly frequent MRI features with early fast enhancement and delayed washout pattern in malignant (11/12) compared to benign (29/412) lesions (p < 0.001). PPV of malignancy for early fast enhancement and delayed washout pattern in MRI was 27.5%. Conclusions: Cancer yield in patients with oval, circumscribed enhancing lesion on preoperative breast MRI was 12 (2.8%) of 424. MRI features with early fast enhancement and delayed washout pattern strongly suggested malignancy.

The diagnosis of hepatitis C viral infection

2014 ◽  
Vol 155 (26) ◽  
pp. 1019-1023
Author(s):  
Judit Gervain
Keyword(s):  
Hepatitis C ◽  
Nucleic Acid ◽  
Viral Infection ◽  
Structural Changes ◽  
Viral Infections ◽  
Transient Elastography ◽  
Viral Nucleic Acid ◽  
Length Of Treatment ◽  
Subtype B

The successful therapy of hepatitis C viral infection requires that the illness is diagnosed before the development of structural changes of the liver. Testing is stepwise consisting of screening, diagnosis, and anti-viral therapy follow-up. For these steps there are different biochemical, serological, histological and molecular biological methods available. For screening, alanine aminotransferase and anti-HCV tests are used. The diagnosis of infection is confirmed using real-time polymerase chain reaction of the viral nucleic acid. Before initiation of the therapy liver biopsy is recommended to determine the level of structural changes in the liver. Alternatively, transient elastography or blood biomarkers may be also used for this purpose. Differential diagnosis should exclude the co-existence of other viral infections and chronic hepatitis due to other origin, with special attention to the presence of autoantibodies. The outcome of the antiviral therapy and the length of treatment are mainly determined by the viral genotype. In Hungary, most patients are infected with genotype 1, subtype b. The polymorphism type that occurs in the single nucleotide located next to the interleukin 28B region in chromosome 19 and the viral polymorphism type Q80K for infection with HCV 1a serve as predictive therapeutic markers. The follow-up of therapy is based on the quantitative determination of viral nucleic acid according to national and international protocols and should use the same method and laboratory throughout the treatment of an individual patient. Orv. Hetil., 2014, 155(26), 1019–1023.

Effectiveness of the Chiari Health Index for Pediatrics instrument in measuring postoperative health-related quality of life in pediatric patients with Chiari malformation type I

2020 ◽  
pp. 1-6
Author(s):  
Georgina E. Sellyn ◽  
Alan R. Tang ◽  
Shilin Zhao ◽  
Madeleine Sherburn ◽  
Rachel Pellegrino ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Type I ◽  
Health Related Quality ◽  
Health Index ◽  
Chiari Malformation Type I ◽  
Related Quality ◽  
Health Related ◽  
Over Time

OBJECTIVEThe authors’ previously published work validated the Chiari Health Index for Pediatrics (CHIP), a new instrument for measuring health-related quality of life (HRQOL) for pediatric Chiari malformation type I (CM-I) patients. In this study, the authors further evaluated the CHIP to assess HRQOL changes over time and correlate changes in HRQOL to changes in symptomatology and radiological factors in CM-I patients who undergo surgical intervention. Strong HRQOL evaluation instruments are currently lacking for pediatric CM-I patients, creating the need for a standardized HRQOL instrument for this patient population. This study serves as the first analysis of the CHIP instrument’s effectiveness in measuring short-term HRQOL changes in pediatric CM-I patients and can be a useful tool in future CM-I HRQOL studies.METHODSThe authors evaluated prospectively collected CHIP scores and clinical factors of surgical intervention in patients younger than 18 years. To be included, patients completed a baseline CHIP captured during the preoperative visit, and at least 1 follow-up CHIP administered postoperatively. CHIP has 2 domains (physical and psychosocial) comprising 4 components, the 3 physical components of pain frequency, pain severity, and nonpain symptoms, and a single psychosocial component. Each CHIP category is scored on a scale, with 0 indicating absent and 1 indicating present, with higher scores indicating better HRQOL. Wilcoxon paired tests, Spearman correlations, and linear regression models were used to evaluate and correlate HRQOL, symptomatology, and radiographic factors.RESULTSSixty-three patients made up the analysis cohort (92% Caucasian, 52% female, mean age 11.8 years, average follow-up time 15.4 months). Dural augmentation was performed in 92% of patients. Of the 63 patients, 48 reported preoperative symptoms and 42 had a preoperative syrinx. From baseline, overall CHIP scores significantly improved over time (from 0.71 to 0.78, p < 0.001). Significant improvement in CHIP scores was seen in patients presenting at baseline with neck/back pain (p = 0.015) and headaches (p < 0.001) and in patients with extremity numbness trending at p = 0.064. Patients with syringomyelia were found to have improvement in CHIP scores over time (0.75 to 0.82, p < 0.001), as well as significant improvement in all 4 components. Additionally, improved CHIP scores were found to be significantly associated with age in patients with cervical (p = 0.009) or thoracic (p = 0.011) syrinxes.CONCLUSIONSThe study data show that the CHIP is an effective instrument for measuring HRQOL over time. Additionally, the CHIP was found to be significantly correlated to changes in symptomatology, a finding indicating that this instrument is a clinically valuable tool for the management of CM-I.

Sign in / Sign up

Export Citation Format

Share Document