scholarly journals Clinical utility of fat-suppressed 3-dimensional controlled aliasing in parallel imaging results in higher acceleration sampling perfection with application optimized contrast using different flip angle evolutions MRI of the knee in adults

2020 ◽  
Vol 93 (1112) ◽  
pp. 20190725
Author(s):  
Seungho Lee ◽  
Guen Young Lee ◽  
Sujin Kim ◽  
Yong-Beom Park ◽  
Han-Jun Lee
Keyword(s):  
Clinical Practice ◽  
Knee Joint ◽  
Diagnostic Performance ◽  
3D Mri ◽  
Scan Time ◽  
Imaging Results ◽  
The Mean ◽  
2D And 3D ◽  
Knee Pathology ◽  
And Cartilage

Objective: To compare htree-dimensional CAIPIRINHA SPACE and two-dimensional turbo spin echo (2D TSE) MRI in the diagnosis of knee pathology in symptomatic adult patients. Methods: From February to September in 2018, 120 patients who underwent a knee MRI using both 3D CAIPIRINHA SPACE and 2D TSE MRI were enrolled. The signal-to-noise ratios (SNRs) and contrast-to-noise ratio (CNR) of the 2D and 3D MRI were compared using a paired t-test. Two radiologists independently evaluated both 2D and 3D MRI images using scoring systems for the menisci, ligaments, and cartilage. Intermethod, inter- and intrareader agreements were determined using an intraclass correlation coefficient (ICC). The diagnostic performance of both methods was measured in 44 patients with arthroscopy. Results: The mean scan time of 3D CAIPIRINHA SPACE MRI (4’ 43”) was shorter than that of 2D TSE MRI (17’ 27”). The mean SNR and CNR of 3D CAIPIRINHA SPACE was higher than those of 2D TSE MRI (mean difference, 3.97 of SNR and 1.58 of CNR; p < 0.001 and p = .038, respectively). Intermethod (ICC, 0.84–1.0) and inter-reader (ICC, 0.75–0.97), and intra-reader agreements (ICC, 0.87–1.0) were good or excellent. The diagnostic accuracy of 3D CAIPIRINHA SPACE sequence was equal for ligament (95.5%) and better for meniscal and cartilage evaluation (84.1% each), compared to 2D TSE MRI (79.5% each). Conclusion: The fat-suppressed 3D CAIPIRINHA SPACE MRI maybe useful in clinical practice for the evaluation of the knee in place of the 2D conventional MRI protocol. Advances in knowledge: 1. The 3D CAIPIRINHA SPACE MRI of the knee joint may be acceptable to be used in clinical practice showing comparable imaging quality compared to conventional 2D TSE MRI. 2. Compared with arthroscopic findings as the gold-standard, the diagnostic performance of 3D CAIPIRINHA SPACE MRI was equal or better for knee joint evaluation than that of 2D TSE MRI, as well as with shorter scan time.

A Method to Compare Heterogeneous Types of Bone and Cartilage Meshes

2021 ◽  
Author(s):  
Nynke B. Rooks ◽  
Marco T. Y. Schneider ◽  
Ahmet Erdemir ◽  
Jason P. Halloran ◽  
Peter J. Laz ◽  
...  
Keyword(s):  
Knee Joint ◽  
Subchondral Bone ◽  
Joint Modeling ◽  
Bone Morphology ◽  
Research Teams ◽  
Mesh Topology ◽  
Function Fitting ◽  
The Mean ◽  
Nodal Density ◽  
And Cartilage

Abstract Accurately capturing the bone and cartilage morphology and generating a mesh remains a critical step in the workflow of computational knee joint modeling. Currently there is no standardized method to compare meshes of different element types and nodal densities, making comparisons across research teams a significant challenge. The aim of this paper is to describe a method to quantify differences in knee joint bone and cartilages meshes, independent of bone and cartilage mesh topology. Bone mesh-to-mesh distances, subchondral bone boundaries and cartilage thicknesses from meshes of any type of mesh are obtained using a series of steps involving registration, resampling, and radial basis function fitting after which the comparisons are performed. Subchondral bone boundaries and cartilage thicknesses are calculated and visualized in a common frame of reference for comparison. The established method is applied to models developed by five modeling teams. Our approach to obtain bone mesh-to-mesh distances decreased the divergence seen in selecting a reference mesh (i.e. comparing mesh A-to-B vs. mesh B-to-A). In general the bone morphology was similar across teams. The cartilage thicknesses for all models were calculated and the mean absolute cartilage thickness difference was presented, the articulating areas had the best agreement across teams. The teams showed disagreement on the subchondral bone boundaries. The method presented in this paper allows for objective comparisons of bone and cartilage geometry that is agnostic to mesh type and nodal density.

scholarly journals Fast in vivo 23Na imaging and T2* mapping using accelerated 2D-FID magnetic resonance spectroscopic imaging at 3 T: Proof of concept and reliability study

2020 ◽  
Author(s):  
Ahmad A. Alhulail ◽  
Pingyu Xia ◽  
Xin Shen ◽  
Miranda Nichols ◽  
Srijyotsna Volety ◽  
...  
Keyword(s):  
High Reliability ◽  
T2 Mapping ◽  
Single Shot ◽  
3D Mri ◽  
Absolute Concentration ◽  
Reliable Technique ◽  
Scan Time ◽  
The Mean ◽  
Calf Muscles

AbstractPurposeTo implement an accelerated MR-acquisition method allowing to map sodium T2* relaxation and absolute concentration within skeletal muscles at 3T.MethodsA fast-2D density-weighted concentric-ring-trajectory 23Na-MRSI technique was used to acquire 64 time-points of FID with a spectral bandwidth of 312.5 Hz from a 2.5 x 2.5 mm2 in-plane resolution within about 15 minutes. The fast relaxing 23Na signal was localized with a single-shot, inversion-recovery based, non-echo (SIRENE) OVS method. The sequence was verified using simulation and phantom studies before implementing it in human calf muscles. Within two same-day sessions, 2D-SIRENE-MRSI (UTE = 0.55 ms) and 3D-MRI (UTE = 0.3 ms) data were acquired. The T2* values were fitted voxel-by-voxel using a bi-exponential model for the 2D-MRSI data. Within-subject coefficients of variation were estimated for both acquisition methods.ResultsThe MRSI-FID data allowed for fast and slow T2* mapping of the calf muscles in vivo with minimal sensitivity reduction. The spatial-distributions of 23Na concentration for both in vivo MRSI and 3D-MRI acquisitions were significantly correlated (r = 0.7, P<0.001). The test-retest results rendered high reliability for both MRSI (CV = 5%) and 3D MRI (CV = 6%). The mean in calf muscles was 0.7 ± 0.1 (contribution fraction = 37%), while was 13.2 ± 0.2 ms (63%). The mean absolute muscle 23Na concentration calculated from the T2*-corrected data was 28.6 ± 3.3 mM.ConclusionThe proposed MRSI technique is a reliable technique to map sodium’s absolute concentration and T2* within a clinically acceptable scan time at 3T.

scholarly journals Feasibility of MRI for the evaluation of interosseous ligament vertical segment via subtalar arthroscopy correlation: comparison of 2D and 3D MR images

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hong-Geun Jung ◽  
Sung Gyu Moon ◽  
Deuk Young Yoon ◽  
Hyemin Jang ◽  
Ji Hee Kang
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Vertical Segment ◽  
3D Mri ◽  
Mr Images ◽  
Interosseous Ligament ◽  
3D Sequences ◽  
2D And 3D

Abstract Background Interosseous ligament vertical segment (IOLV) and calcaneofibular ligament (CFL) have been reported to be important in stabilizing the subtalar joint. Unlike CFL, there is not much information regarding the comparison of MRI results with surgical evaluation of IOLV and the comparison between 2D and 3D MRI on IOLV evaluation. The feasibility of MRI in IOLV evaluation has yet to be reported. The purpose of this study was to evaluate the validity and reliability of MRI in IOLV tear detection via correlation with arthroscopic results. We also compared the diagnostic performance of 2D and 3D MR images. Methods In this retrospective study, 52 patients who underwent subtalar arthroscopy after ankle MRI were enrolled. Arthroscopic results confirmed IOLV tear in 25 cases and intact IOLV in 27 cases. Two radiologists independently evaluated the IOLV tears using only conventional 2D images, followed by isotropic 3D images, and comparison with arthroscopic results. Results Only the 2D sequences interpreted by two readers showed a sensitivity of 64.0–96.0%, a specificity of 29.6–44.4%, a positive predictive value of 51.6–56.4%, and a negative predictive value of 57.1–88.9%. Addition of isotropic 3D sequences changed the sensitivity to 60.0–80.0%, specificity to 63.0–77.8%, positive predictive value to 64.3–76.9%, and negative predictive value to 66.7–80.8%. The overall diagnostic performance of isotropic 3D sequences (AUC values: 0.679–0.816) was higher than that of 2D sequences (AUC values: 0.568–0.647). Inter-observer and intra-observer agreement between the two readers was moderate-to-good for both 2D and 3D sequences. The diagnostic accuracy in 19 patients with tarsal sinus fat obliteration tended to increase from 26.3–42.1% to 57.9–73.7% with isotropic 3D sequences compared with 2D sequences. Conclusions Isotropic 3D MRI was feasible for the assessment of IOLV tear prior to subtalar arthroscopy. Additional 3D sequences showed higher diagnostic accuracy compared with conventional 2D sequences in IOLV evaluation. Isotropic 3D sequences may be more valuable in detecting IOLV tear in case of tarsal sinus fat obliteration.

scholarly journals OP0083 DORSAL ROOT GANGLIA INFILTRATING MACROPHAGES MAINTAIN OSTEOARTHRITIS PAIN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 55.2-56
Author(s):  
R. Raoof ◽  
C. Martin ◽  
H. De Visser ◽  
J. Prado ◽  
S. Versteeg ◽  
...  
Keyword(s):  
Knee Joint ◽  
Dorsal Root Ganglia ◽  
Immune Cells ◽  
Dorsal Root ◽  
Weight Bearing ◽  
Joint Damage ◽  
Osteoarthritis Pain ◽  
Knee Pathology ◽  
Femoral Condyles ◽  
Over Time

Background:Pain is a major debilitating symptom of knee osteoarthritis (OA). However, the extent of joint damage in OA does not correlate well with the severity of pain. The mechanisms that govern OA pain are poorly understood. Immune cells infiltrating nervous tissue may contribute to pain maintenance.Objectives:Here we investigated the role of macrophages in the initiation and maintenance of OA pain.Methods:Knee joint damage was induced by an unilateral injection of mono-iodoacetate (MIA) or after application of a groove at the femoral condyles of rats fed on high fat diet. Pain-like behaviors were followed over time using von Frey test and dynamic weight bearing. Joint damage was assessed by histology. Dorsal root ganglia (DRG) infiltrating immune cells were assessed over time using flow cytometry. To deplete monocytes and macrophages, Lysmcrex Csfr1-Stop-DTR were injected intrathecal or systemically with diptheria toxin (DT).Results:Intraarticular monoiodoacetate injection induced OA and signs of persistent pain, such as mechanical hyperalgesia and deficits in weight bearing. The persisting pain-like behaviors were associated with accumulation of F4/80+macrophages with an M1-like phenotype in the lumbar DRG appearing from 1 week after MIA injection, and that persisted till at least 4 weeks after MIA injection. Macrophages infiltrated DRG were also observed in the rat groove model of OA, 12 weeks after application of a groove at the femoral condyles. Systemic or local depletion of DRG macrophages during established MIA-induced OA completely ablated signs of pain, without affecting MIA-induced knee pathology. Intriguingly when monocytes/macrophages were depleted prior to induction of osteoarthritis, pain-like behaviors still developed, however these pain-like behaviors did not persist over time.In vitro,sensory neurons innervating the affected OA joint programmed macrophages into a M1 phenotype. Local repolarization of M1-like DRG macrophages towards M2 by intrathecal injection of M2 macrophages or anti-inflammatory cytokines resolved persistent OA-induced pain.Conclusion:Overall we show that macrophages infiltrate the DRG after knee damage and acquire a M1-like phenotype and maintain pain independent of the lesions in the knee joint. DRG-infiltrating macrophages are not required for induction of OA pain. Reprogramming M1-like DRG-infiltrating macrophages may represent a potential strategy to treat OA pain.Acknowledgments:This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreements No 814244 and No 642720. Dutch Arthritis SocietyDisclosure of Interests:Ramin Raoof: None declared, Christian Martin: None declared, Huub de Visser: None declared, Judith Prado: None declared, Sabine Versteeg: None declared, Anne Heinemans: None declared, Simon Mastbergen: None declared, Floris Lafeber Shareholder of: Co-founder and shareholder of ArthroSave BV, Niels Eijkelkamp: None declared

Early outcomes of novel Temren atherectomy device combined with drug-coated balloon angioplasty for treatment of femoropopliteal lesions

Vascular ◽  
2021 ◽  
pp. 170853812110298
Author(s):  
Görkem Yiğit
Keyword(s):  
Critical Limb Ischemia ◽  
Bypass Graft ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Rotational Atherectomy ◽  
Total Occlusion ◽  
The Mean ◽  
Knee Pathology ◽  
Drug Coated Balloon

Objectives In this study, perioperative properties and early outcomes of patients who underwent combined Temren rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty treatment for complex femoropopliteal lesions in a single center were reported. Methods Between June 2019 and February 2020, 40 patients who underwent combined Temren RA and DCB treatment due to critical lower limb ischemia or claudication-limiting daily living activities were retrospectively evaluated. Results The mean age of patients was 73.2 ± 7.8 years and the majority of the patients were male (65%). Of the patients, 17 had critical limb ischemia and 23 had lifestyle-limiting claudication. Pathologies were total occlusion in 33 limbs and critical stenosis in seven limbs. Nine patients previously underwent endovascular intervention or surgery. The mean total occlusion length was 140.9 ± 100.9 (range, 20–360) mm in patients with chronic total occlusion. There was an additional iliac artery pathology in 5 and below the knee pathology in 8 patients. Rotational atherectomy was possible in all cases. Flow-limiting dissection was seen in six patients (15%). Provisional stent was performed to these patients. Following Temren RA, all patients underwent DCB. Adequate vascular lumen (less than 30% stenosis) was provided in all patients and the symptoms regressed. No distal embolization was encountered. Access site complications (17.5%) were small hematoma in four patients, ecchymosis in two patients, and pseudoaneurysm of the femoral artery in one patient. The mean follow-up was 13.55 ± 4.2 (range, 1–18) months. Re-occlusion was seen in three patients (7.5%) ( n = 2 at 2 months and n = 1 at 4 months). Of these patients, two had required open revascularization via femoropopliteal bypass graft with common, superficial femoral, and popliteal artery endarterectomy and one had required femoro-posterior tibial artery bypass. Four minor toe amputations (10%) were performed to reach complete wound healing in the critical limb ischemia patients. A below-knee amputation was performed in a 94-year-old patient with long segment stenosis at the end of a 1-month follow-up period. There was no mortality after follow-ups. The Kaplan–Meier estimator estimated the rate of freedom from target lesion revascularization (TLR) which was 92.3%. The decrease in the Rutherford levels after the procedure was found to be statistically significant in 36 patients ( p < 0.001). The increase in the ankle–brachial index after the procedure was found to be statistically significant in 36 patients ( p < 0.001). Conclusions Combined use of Temren RA with adjunctive DCB is safe and effective method with high rates of primary patency and freedom from TLR and low rates of complication in the treatment of femoropopliteal lesions.

scholarly journals Impact on actual clinical practice of the latest evidence for percutaneous closure of patent foramen ovale associated with stroke. A single center experience

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Carnero Montoro ◽  
M Ruiz Ortiz ◽  
N Paredes Hurtado ◽  
M Delgado Ortega ◽  
A Rodriguez Almodovar ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Percutaneous Closure ◽  
Publication Date ◽  
Foramen Ovale ◽  
Complex Anatomy ◽  
The Mean ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background and aims Since september 14th, 2017. Three large clinical trials demonstrated that, in selected patients, percutaneous closure of patent foramen ovale (PFO) was associated with lower recurrence in patients with cryptogenic stroke (CS). Our aim was to determine the impact of these findings on routine  clinical practice in a tertiary hospital. Methods Patients with percutaneous closure of PFO due to CS (January 2001-January 2020) were included. The clinical characteristics were analyzed individually and grouped in the RoPE score, before and after the publication date. Complex anatomy (CA) defined as interatrial septum aneurysm or basal wide bubble passage was evaluated in both periods. Results 293 patients were included. The mean age was 49 ± 11 years, 15% were older than 60 years, 60% men, 26% hypertensive, 28% smokers and 7%diabetics. The median RoPEscore was 6 [p25-75, 5-7] and 75% met CA criteria. Since september 14th, 2017, the frequency of CA and the mean age of the patients were significantly higher (89% vs. 69% p &lt;0.0005 and 51 ± 11 vs. 48 ± 11 years, p = 0.02, respectively), and RoPEscore, significantly lower (5 [5-7] vs. 6 [5-7], p = 0.02). Conclusion The publication of clinical trials wich demonstrated the benefit of percutaneous closure of PFO in CS had a significant impact on the daily clinical practice of our institution, with an increase in indications for CA, despite a clinical profile suggestive of lower causal probability of PFO.

Digital goniometric measurement of knee joint motion. Evaluation of usefulness for research settings and clinical practice

The Knee ◽  
2007 ◽  
Vol 14 (5) ◽  
pp. 385-389 ◽  
Author(s):  
Berry Cleffken ◽  
Gerard van Breukelen ◽  
Peter Brink ◽  
Henk van Mameren ◽  
Steven Olde Damink
Keyword(s):  
Clinical Practice ◽  
Knee Joint ◽  
Joint Motion ◽  
Knee Joint Motion

scholarly journals A cadaveric study of the location and morphology of the central patellar ridge for bone-patellar tendon-bone graft

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Thanathep Tanpowpong ◽  
Thun Itthipanichpong ◽  
Thanasil Huanmanop ◽  
Nonn Jaruthien ◽  
Nattapat Tangchitcharoen
Keyword(s):  
Patellar Tendon ◽  
Cancellous Bone ◽  
Average Distance ◽  
Cadaveric Study ◽  
Anterior Cortex ◽  
Length Width ◽  
Central Ridge ◽  
The Mean ◽  
Bone Patellar Tendon ◽  
And Cartilage

Abstract Introduction The central ridge of the patella is the thickest area of patella and varies among patients. This cadaveric study identified the location and thickness of the bone at the central patella ridge for bone-patellar tendon-bone (BPTB) harvesting. Materials and methods Fifty cadaveric knees were assessed. First, the morphology, length, width, and location of the central patellar ridge were recorded. Then, we transversely cut the patella 25 mm from the lower pole and measured the thickness of the anterior cortex, cancellous bone, and cartilage from both the mid-patella and the central ridge location. Finally, the depth of the remaining cancellous bone at the mid-patella was compared to the bone at the central ridge. Results The location of the central-patellar ridge deviated medially from the mid-patella in 46 samples with an average distance of 4.36 ± 1 mm. Only 4 samples deviated laterally. The mean patella length was 41.19 ± 4.73 mm, and the width was 42.8 ± 5.25 mm. After a transverse cut, the remaining cancellous bone was significantly thicker at the central ridge compared to the bone at the mid-patella. Conclusions Most of the central patellar ridge deviated medially, approximately 4 mm from the mid-patella. Harvesting the graft from the central ridge would have more remaining bone compared to the mid-patella.

Abstract 65: Timing of Complications Related to Current Post tPA Protocol

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Katja Bryant ◽  
Kim Anda ◽  
Leslie Busby ◽  
Deborah Camp ◽  
Kerrin Connely ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Practice Guidelines ◽  
Vital Signs ◽  
Current Clinical Practice ◽  
Neurological Assessment ◽  
Symptomatic Intracranial Hemorrhage ◽  
The Mean ◽  
Q 30 ◽  
Assessment Frequency ◽  
Mean Time

The current clinical practice guidelines (CPG) based on the NINDS trial from 1995 recommend that vital signs and neuro checks are completed Q15 min x 2 hrs., Q 30 min x 6 hrs., Q 1 hour x 16 hrs. post administration of IV t-PA. The half-life (t ½α ) of Alteplase is <5 min, therefore the current vigilance of neurological assessments may not be necessary. The purpose of this study was to evaluate the timing of when a symptomatic intracranial hemorrhage (sICH) occured in relation to the administration of IV t-PA. Results: A total of 569 patients who received IV t-PA were reviewed. Nine patients, with a mean age of 70 ± 17 years and mean NIHSS of 11, were diagnosed with a sICH within 36 hrs. post IV t-PA administration. The mean time of detecting sICH post IV t-PA administration was 294 minutes. The shortest time was 77 min and the longest time was 814 min (13 hrs and 34 min). The vast majority (77%) of the sICH complications were diagnosed in less than 6 hrs. Conclusions: This analysis suggests that sICH occurs early in the course after administration of IV t-PA. Future guidelines may consider reducing the neurological assessment frequency after 12 hours from IV t-PA administration. Prospective controlled studies are required to validate these results.

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