TMJ Arthritis Imaging: Conventional Radiograph vs. CT Scan - Is CT Actually Needed?

2019 ◽  
Vol 15 (2) ◽  
pp. 135-140
Author(s):  
Richa Modgil ◽  
Karandeep Singh Arora ◽  
Abhishek Sharma ◽  
Lalit Singh Negi ◽  
Shreeyam Mohapatra ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Ct Scan ◽  
Imaging Modality ◽  
Age Groups ◽  
Mandibular Condyle ◽  
Clinical History ◽  
Conventional Technique ◽  
Radiographic Examination ◽  
Conventional Radiograph ◽  
Osseous Changes

Objective: The present study was conducted to evaluate the efficacy of conventional TMJ imaging in depicting osseous changes in mandibular condyle and glenoid fossa in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) by comparing the finding against CT and with an objective that if conventional TMJ imaging modality can appreciate the osseous changes in RA and OA then what is the need for CT scan. Thus further reducing the patient’s radiation dose. Materials and Methods: A total of 70 patients (40 Rheumatoid Arthritis; 30 Osteoarthritis) were taken in the study aged between 40 - 60 years and divided in to age groups. Then according to clinical history they were divided according to being symptomatic and asymptomatic. Further radiographic examination was carried out. First the trans-cranial view was obtained (conventional view left and right TMJ) and subsequently a CT scan was obtained and the interpretation was carried out to note the osseous changes like erosion, flattening, sclerosis and osteophyte formation. Results: After comparison of the two radiographic methods it was observed that both were equally efficacious in evaluating the osseous changes in arthritic patients. Conclusion: Thus, it was concluded that when both the radiographic methods (conventional and CT scan) are equally efficacious in evaluating the osseous degenerative changes of TMJ in arthritis. Thus we should prefer the conventional technique so that the patient in not exposed to unnecessary radiation dosage.

scholarly journals Study of Traumatic Head Injuries Using Computed Tomography

2021 ◽  
Vol 11 (1) ◽  
pp. 82-86
Author(s):  
Samih Kajoak ◽  
H. Osman ◽  
Caroline Ayad ◽  
Alamin Musa ◽  
Mohammed Yousef ◽  
...  
Keyword(s):  
Ct Scan ◽  
Road Traffic ◽  
Head Injuries ◽  
Age Groups ◽  
Clinical History ◽  
Age Group ◽  
Early Assessment ◽  
Traumatic Head Injury ◽  
Ct Findings ◽  
Traumatic Head

The aim of this retrospective research was to study traumatic head injury (THI) using CT scan and to classify the types of head trauma fractures and types of hemorrhages. Methods and Results: The current study included 53 THI patients (43/81.1%) males and 10/18.9% females) with positive and negative CT scan findings. A complete clinical history and patients’ data were taken from CT reports, which included age, gender, type of trauma, associated injury, and CT findings with their percentages. The study was carried out in Taif city in King Abdelaziz Hospital and King Faisal Hospital. The distribution of various etiologies of THI has shown that the most common etiology was road traffic accident (RTA) (45.3%). The typical age for THI was between 21 to 30 years old (26.4%). The distribution of the traumatic causes for each age group is shown in Table 1. The typical age for RTA was the age group of 11-20 years (33.3%), for falls – the age groups of 0-10 years (33.3%) and over 60 years of age (33.3%). The frequency of various CT findings of THI was as follows: intracranial hemorrhage (56.6%), fracture (39.6%), pneumocephalus (22.6%), contusion (22.6%), foreign body (11.3%), and proptosis (3.8%). The distribution of fracture cases, according to their types, was as follows: a linear fracture (76.2%), comminuted fracture (23.8%), basilar fracture (14.3%), and depressed fracture (9.5%). The frontal bone was the most affected site with fractures (30.7%). Conclusion: CT is an appropriate clinical modality used in the management of THI patients in the emergency department. CT has the advantage of being fast, safe, available, sensitive to most acute post-traumatic injuries, accurate in identifying the head abnormalities such as fractures and hemorrhage during the first 24 hours after injury, which is beneficial in the early assessment, therapy planning, monitoring, and long-term patient care.

scholarly journals OP0178 IMAGING NEOANGIOGENESIS IN RHEUMATOID ARTHRITIS (INIRA): WHOLE-BODY SYNOVIAL UPTAKE OF A 99MTC-LABELLED RGD PEPTIDE IS HIGHLY CORRELATED WITH POWER DOPPLER ULTRASOUND

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 110.2-111
Author(s):  
L. Attipoe ◽  
S. Subesinghe ◽  
C. Blanco-Gil ◽  
M. Opena ◽  
M. Rosser ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Correlation Coefficient ◽  
Doppler Ultrasound ◽  
Imaging Modality ◽  
Power Doppler ◽  
Whole Body ◽  
Total Power ◽  
Acquisition Time ◽  
Power Doppler Ultrasound ◽  
Highly Correlated

Background:Power Doppler ultrasound (PDUS) is superior to clinical examination in detecting synovitis in patients with rheumatoid arthritis (RA). Although dynamic and cheap it is impractical to scan large numbers of joints in routine clinical settings. MRI, whilst sensitive for synovitis, is expensive and routine use is limited to targeted joints. Bone scintigraphy produces whole body images but due to limited specificity is not routinely used.99mTc-maraciclatide (Serac Healthcare) is a radiolabelled tracer which binds with high affinity to integrin αvβ3, a cell-adhesion molecule up-regulated on neoangiogenic blood vessels. It therefore has the potential to image synovial inflammation at the whole-body level. We previously showed in a pilot study that uptake was seen in the inflamed joints of five RA patients and that this correlated with PDUS. This study explores correlation with PDUS in a larger groups of patients with varied disease activity.Objectives:To determine the correlation between ultrasound and99mTc-maraciclatide imaging in patients with rheumatoid arthritis.Methods:50 patients with RA fulfilling ACR 2010 classification criteria were recruited. Patients underwent an ultrasound scan of 40 joints with grey scale (GS) and PD quantification. Each joint was scored on a scale of 0-3 for GS and PD with a total score calculated for each patient. Within 3 hours of the ultrasound patients were injected with 740 MBq of99mTc-maraciclatide. Using a gamma camera, whole body planar views and dedicated hand and foot views were taken 2 hours after injection (Figure 1). Acquisition time was 20 minutes for whole body and 20 minutes for hand and foot views.99mTc-maraciclatide images were scored as positive or negative uptake for each joint (binary score). A quantitative score was also calculated for each joint where there was uptake with this corrected for background uptake. Total binary and quantitative scores per patient were calculated.Ultrasound and99mTc-maraciclatide scores were tested for correlation with Pearson’s correlation coefficient (r). Interrater agreement for 2 scorers was calculated using kappa (ĸ) and concordance correlation coefficient (Pc).Results:Strong correlation was seen when total PDUS was compared to binary scores (r=0.92, r2=0.85) (Figure 2) and quantitative scores (r=0.85, r2=0.72). ĸ was 0.82 and 0.79 for binary and ultrasound scores respectively.Pcwas 0.82 for quantitative scores. p was <0.0005 for all results.99mTc-maraciclatide uptake was also seen in inflamed tendons/tendon sheaths. The imaging procedure was well-tolerated. There were no tracer-related adverse events.Figure 1.99mTc-maraciclatide imaging with dedicated hand and foot viewsConclusion:99mTc-maraciclatide uptake was highly correlated with PDUS highlighting its potential as an alternative imaging modality.99mTc-based planar imaging has the unique capacity to image the whole body and hence the total synovial inflammatory load in a quick acquisition. The imaging equipment to perform these scans is already widely available in radiology departments. Interpretation of scans is also much simpler compared to US/MRI. It could therefore have a role in key decision-making points in pathways for diagnosis, treatment failure, and remission prior to dose tapering.Figure 2.Correlation between total power doppler and99mTc-maraciclatide binary scoresDisclosure of Interests:None declared

BMP2 Is Required for Postnatal Maintenance of Osteochondral Tissues of the Temporomandibular Joint

Cartilage ◽  
2020 ◽  
pp. 194760352098015
Author(s):  
Mara H. O’Brien ◽  
Eliane H. Dutra ◽  
Shivam Mehta ◽  
Po-Jung Chen ◽  
Sumit Yadav
Keyword(s):  
Age Groups ◽  
Mandibular Condyle ◽  
Bone Morphogenetic Protein 2 ◽  
Matrix Synthesis ◽  
Cartilage Growth ◽  
Chondrocyte Proliferation ◽  
Conditional Deletion ◽  
Morphogenetic Protein

Objective Bone morphogenetic protein 2 (BMP2) plays important roles in cartilage growth and development. Paradoxically, elevated levels of BMP2 leads to hypertrophic differentiation and osteoarthritis of cartilage. We examined the in vivo loss of BMP2 in cells expressing aggrecan of the mandibular condyle and knee. Design Three-week-old BMP2 flox/flox- CreER-positive mice and their Cre-negative littermates were treated with tamoxifen and raised until 3 or 6 months. We also investigated the direct effects of BMP2 on chondrocytes in vitro. Cells from the mandibular condyle of mice were treated with recombinant human BMP2 (rhBMP2) or rhNoggin (inhibitor of BMP2 signaling). Results Conditional deletion of BMP2 caused breakage of the cartilage integrity in the mandibular condyle of mice from both age groups, accompanied by a decrease in cartilage thickness, matrix synthesis, mineralization, chondrocyte proliferation, and increased expression of degeneration markers, while the effects at articular cartilage were not significant. In vitro results revealed that rhBMP2 increased chondrocyte proliferation, mineralization, and differentiation, while noggin induced opposite effects. Conclusions In conclusion, BMP2 is essential for postnatal maintenance of the osteochondral tissues of the mandibular condyle.

scholarly journals OP0248 PREMATURE MORTALITY BURDEN FOR SYSTEMIC SCLEROSIS: NATIONWIDE POPULATION-BASED STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 156.1-156
Author(s):  
E. Yen ◽  
D. Singh ◽  
M. Wu ◽  
R. Singh
Keyword(s):  
Rheumatoid Arthritis ◽  
United States ◽  
Disease Burden ◽  
Age Groups ◽  
Premature Mortality ◽  
Population Based ◽  
Age Group ◽  
Population Based Study ◽  
Mortality Burden ◽  
Over Time

Background:Premature mortality is an important way to quantify disease burden. Patients with systemic sclerosis (SSc) can die prematurely of disease, however, the premature mortality burden of SSc is unknown. The years of potential life lost (YPLL), in addition to age-standardized mortality rate (ASMR) in younger ages, can be used as measures of premature death.Objectives:To evaluate the premature mortality burden of SSc by calculating: 1) the proportions of SSc deaths as compared to deaths from all other causes (non-SSc) by age groups over time, 2) ASMR for SSc relative to non-SSc-ASMR by age groups over time, and 3) the YPLL for SSc relative to other autoimmune diseases.Methods:This is a population-based study using a national mortality database of all United States residents from 1968 through 2015, with SSc recorded as the underlying cause of death in 46,798 deaths. First, we calculated the proportions of deaths for SSc and non-SSc by age groups for each of 48 years and performed joinpoint regression trend analysis1to estimate annual percent change (APC) and average APC (AAPC) in the proportion of deaths by age. Second, we calculated ASMR for SSc and non-SSc causes and ratio of SSc-ASMR to non-SSc-ASMR by age groups for each of 48 years, and performed joinpoint analysis to estimate APC and AAPC for these measures (SSc-ASMR, non-SSc-ASMR, and SSc-ASMR/non-SSc-ASMR ratio) by age. Third, to calculate YPLL, each decedent’s age at death from a specific disease was subtracted from an arbitrary age limit of 75 years for years 2000 to 2015. The years of life lost were then added together to yield the total YPLL for each of 13 preselected autoimmune diseases.Results:23.4% of all SSc deaths as compared to 13.5% of non-SSc deaths occurred at <45 years age in 1968 (p<0.001, Chi-square test). In this age group, the proportion of annual deaths decreased more for SSc than for non-SSc causes: from 23.4% in 1968 to 5.7% in 2015 at an AAPC of -2.2% (95% CI, -2.4% to -2.0%) for SSc, and from 13.5% to 6.9% at an AAPC of -1.5% (95% CI, -1.9% to -1.1%) for non-SSc. Thus, in 2015, the proportion of SSc and non-SSc deaths at <45 year age was no longer significantly different. Consistently, SSc-ASMR decreased from 1.0 (95% CI, 0.8 to 1.2) in 1968 to 0.4 (95% CI, 0.3 to 0.5) per million persons in 2015, a cumulative decrease of 60% at an AAPC of -1.9% (95% CI, -2.5% to -1.2%) in <45 years old. The ratio of SSc-ASMR to non-SSc-ASMR also decreased in this age group (cumulative -20%, AAPC -0.3%). In <45 years old, the YPLL for SSc was 65.2 thousand years as compared to 43.2 thousand years for rheumatoid arthritis, 18.1 thousand years for dermatomyositis,146.8 thousand years for myocarditis, and 241 thousand years for type 1 diabetes.Conclusion:Mortality at younger ages (<45 years) has decreased at a higher pace for SSc than from all other causes in the United States over a 48-year period. However, SSc accounted for more years of potential life lost than rheumatoid arthritis and dermatomyositis combined. These data warrant further studies on SSc disease burden, which can be used to develop and prioritize public health programs, assess performance of changes in treatment, identify high-risk populations, and set research priorities and funding.References:[1]Yen EY….Singh RR. Ann Int Med 2017;167:777-785.Disclosure of Interests:None declared

Effect of Mechanical Stress on Rheumatoid Arthritis of the Temporomandibular Joint: a Morphological and Histological Evaluation

2021 ◽  
Author(s):  
Kohei Nagai ◽  
Takenobu Ishii ◽  
Yasushi Nishii
Keyword(s):  
Rheumatoid Arthritis ◽  
T Cell ◽  
Mechanical Stress ◽  
Temporomandibular Joint ◽  
Mandibular Condyle ◽  
Γδ T Cells ◽  
Histological Evaluation ◽  
Control Group ◽  
Condylar Cartilage ◽  
Layer Width

Abstract Background Rheumatoid arthritis of the temporomandibular joint (TMJ-RA) has been reported to have a larger incidence range than systemic rheumatoid arthritis (RA). The presence or absence of mechanical stress (MS) is considered a factor in this. In this study, we hypothesized that TMJ-RA develops or worsens when excessive MS is applied to the temporomandibular joint of RA mouse models. We aimed to clarify the relationship between TMJ-RA and MS through morphological and histological evaluation. Methods Collagen antibody-induced arthritis (CAIA) was induced in male DBA/1JNCrlj 9–12 weeks old mice by administering Type II collagen antibody and lipopolysaccharide to produce RA model mice. MS was applied to the mandibular condyle. The group was separated into non-RA (control group (N = 5) and MS group (N = 5)), and RA group (CAIA group (N = 5)and CAIA MS group (N = 5)). To confirm the morphological changes in the mandibular condyle, micro-CT imaging was performed. Histological evaluation of the TMJ was performed by hematoxylin and eosin staining for condylar cartilage cell layer thickness, Safranin O staining for proteoglycans, and tartrate-resistant acidic phosphatase staining for osteoclast count. Immunohistochemical evaluation was performed to assess the localization of cartilage destruction enzymes using ADAMTS-5 (a disintegrin and metalloproteinase with thrombospondin motifs) antibody. Additionally, CD3 (cluster of differentiation), CD45, and γδ TCR (T cell receptor) antibodies were used to localize and identify the type of lymphocytes. Results In the CAIA MS model, a three-dimensional analysis of the temporomandibular joint by microcomputer tomography showed a crude change in the surface of the mandibular condyle. Histological examination revealed a decrease in the chondrocyte layer width and an increase in the number of osteoclasts in the mandibular condyle. T cell accumulation was observed, and γδ T cell involvement was confirmed. Conclusions In the CAIA model, the TMJ was less sensitive to the initiation of RA. However, the results suggested that it was exacerbated by MS, and that γδ T cells may be involved in TMJ-RA.

EP.FRI.390 Improving care for patients with acute bowel obstruction: A closed loop audit

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Benjamin Clayphan ◽  
Anna Fairclough ◽  
Jeff Lim ◽  
Roderick Alexander
Keyword(s):  
Ct Scan ◽  
Patient Outcomes ◽  
Bowel Obstruction ◽  
Care Pathway ◽  
Imaging Modality ◽  
Ct Scans ◽  
Abdominal Ct ◽  
Retrospective Audit ◽  
Raising Awareness ◽  
Time To Diagnosis

Abstract Aims Acute Bowel Obstruction (ABO) accounts for 10% of emergency surgical admissions and when surgery is required mortality can exceed 10%. Early diagnosis is associated with improved patient outcomes and timely acquisition of abdominal CT scans can help prevent delays. The NCEPOD 2020 report on ABO identified ‘delays in imaging’ as a key area for improvement in the care of these patients, with these delays being exacerbated if an abdominal X-ray (AXR) was performed as well as an abdominal CT. This study looks at ways to expedite the diagnosis of patients presenting with ABO.   Methods A retrospective audit of 77 patients admitted from A&E or SAU with ABO from April 2019 to February 2020 was conducted. Imaging modality, time-to-CT scan and time-to-diagnosis was recorded. Results and recommendations were presented locally and an evidence based ABO care pathway was implemented and publicised. 20 patients were audited prospectively, post care pathway implementation.  Results 70.1% of patients from the initial audit received a CT-scan and 42% of these patients received an AXR before their eventual CT-scan. The average wait for a definitive radiological diagnosis was 27.8hr. After implementation of the pathway only 18% of patients audited received both modes of imaging and the average time to diagnosis has been reduced to 10.7hr.  Conclusions Raising awareness of the appropriate and timely use of CT-scans in the diagnosis of ABO has reduced the number of concomitant AXR for these patients, expediting the making of a definitive diagnosis and improving patient outcomes. 

scholarly journals Unresectable Carcinoma Pancreas : Efficacy of Imaging in Diagnosing and Labeling them as ‘Unresectable’

2013 ◽  
Vol 12 (3) ◽  
pp. 23-26 ◽  
Author(s):  
Md Abdullah Al Farooq ◽  
MA Mushfiqur Rahman ◽  
Tania Tajreen ◽  
Eqramur Rahman ◽  
Md Minhajuddin Sajid ◽  
...  
Keyword(s):  
Ct Scan ◽  
Pancreatic Carcinoma ◽  
Imaging Modality ◽  
Preoperative Imaging ◽  
Mri Imaging ◽  
Medical College ◽  
Magnetic Resonance Imaging Mri ◽  
Carcinoma Pancreas ◽  
Operative Findings ◽  
Better Than

Background: Carcinoma pancreas is being diagnosed increasingly with the help of conventional imaging like ultrasonography (USG), computerized tomography (CT) scan and magnetic resonance imaging (MRI).Imaging also gives the opportunity to assess resectability. In our country MRI and CT scan are not widely available and most of the pancreatic carcinoma is too advanced for curative surgical resection when diagnosed. These are unresectable carcinoma pancreas (UCP). Objectives: To evaluate the efficacy of imaging in diagnosing carcinoma pancreas and to assess resectability after comparing them with peroperative findings. Methods: This retrospective study was carried out in the department of Hepato-Biliary-Pancreatic Surgery in Bangladesh Institute for Research and Rehabilitation in Diabetic Endocrine and Metabolic disorders (BIRDEM) hospital, Dhaka, Bangladesh from July 2004 to June 2006 (2 years). After laparotomy findings and histopathological confirmation 50 patients were labeled as UCP. Among 50 patients male were 28 & female patients were 22. Imaging modalities used before surgery was assessed and compared with per operative findings. USG were done in all patients and CTscan in 45 patients. MRI was done in 08 patients suspected clinically as pancreatic carcinoma where USG /CT scan had failed to reach a conclusion. Findings of the various imaging studies regarding diagnosis and unresectability were compared with per operative findings. Results: USG was able to diagnose 42 (84%) pancreatic carcinoma patients with unresectibility in 29 (69%). Forty five patients (90%) were diagnosed by CT scan and could label 38 (84.44%) as unresectable. MRI was 100% accurate to diagnose and label the entire 08 patient as unresectable carcinoma pancreas. Cumulative multimodal preoperative imaging was 91.33% accurate in diagnosing carcinoma pancreas and could tell the features of unresectibility in 73.59% patients. Conclusion: CT scan should be the primary imaging modality for diagnosing pancreatic carcinoma and its resectability. MRI is very promising for diagnosing and assessing UCP. Multimodal imaging is better than single imaging. Chattagram Maa-O-Shishu Hospital Medical College Journal Volume 12, Issue 3, September 2013: 23-26

scholarly journals Outcomes with Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) in Older Patients Treated for Rheumatoid Arthritis

2020 ◽  
Vol 23 (2) ◽  
pp. 184-189
Author(s):  
Ripa Akter ◽  
Walter P. Maksymowych ◽  
M. Liam Martin ◽  
David B. Hogan
Keyword(s):  
Rheumatoid Arthritis ◽  
Older Patients ◽  
Treatment Effectiveness ◽  
Remission Rate ◽  
Age Groups ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Intention To Treat ◽  
Disease Modifying ◽  
Treat Analysis

Background Biological disease-modifying antirheumatic drugs (bDMARDs) are recommended for rheumatoid arthritis (RA), but older patients reportedly experience more adverse events (AEs) and show variable treatment response. The objective of this study was to evaluate AEs and effectiveness of bDMARDs in a cohort of older patients. Methods AE and treatment effectiveness (based on DAS28 scores) data from a prospective provincial pharmacovigilance program for the years 2006–2009 in patients 55–64, 65–74, and 75+ years of age were compared. An intention to treat analysis with chisquare and unpaired t-testing for significance was performed. Results There were a total of 333 patients (156 were aged 55–64, 125 were 65–74, 52 were 75+). Those 75+ had higher disease activity and worse functional status at baseline. Among those 75+, AEs with bDMARDs were more common and likely to lead to discontinuation of therapy, be graded as severe, and classified as infectious (p < .05). Remission rate among those 75+ was significantly higher than patients 65–74. Etanercept was the most commonly used drug in all age groups. Conclusion Patients 75+ treated with bDMARDs are at a significantly greater risk of AEs, including infectious ones. The higher remission found in the oldest age group warrants further study.

scholarly journals Diagnostic value of research methods in diagnostics of chronic pancreatitis

2021 ◽  
Vol 102 (4) ◽  
pp. 528-536
Author(s):  
G R Aliyeva
Keyword(s):  
Chronic Pancreatitis ◽  
Early Stage ◽  
Imaging Modality ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Clinical History ◽  
Diagnostic Value ◽  
Diagnostic Tools ◽  
Invasive Approach ◽  
Pancreas Function ◽  
Function Testing

Chronic pancreatitis remains an unsolved problem for clinicians. One of the biggest dilemmas is to establish a clear diagnosis. Diagnosis can be particularly elusive in patients with early chronic pancreatitis. Many studies have been undertaken to improve diagnostics in chronic pancreatitis, but this has been significantly limited by the lack of a gold standard. The evaluation of patients with suspected chronic pancreatitis should follow a progressively non-invasive to more invasive approach. Computed tomography is the best primary imaging modality to obtain as it has good sensitivity for severe chronic pancreatitis and may exclude the need for other diagnostic tests. When ambiguous results are obtained, a magnetic resonance cholangiopancreatography may require for a more detailed evaluation of both the pancreatic parenchyma and ducts. If the diagnosis remains in doubt, endoscopic ultrasound with or without pancreas function testing becomes the preferred method. Endoscopic retrograde cholangiopancreatography remains a last line diagnostic test and generally should be used only for diagnostic purposes. Future researches in the field of diagnosis of early-stage chronic pancreatitis should purpose optimizing current diagnostic tools. A definitive diagnosis of chronic pancreatitis may not be made simply by clinical history, imaging or function testing alone, but rather by the data gathered by a combination of these diagnostic tools.

Sign in / Sign up

Export Citation Format

Share Document