RESUMEN
OBJECTIVES: To review the clinical and imaging findings of patients with remote history of intramuscular (IM) in vitro fertilization (IVF) gluteal injections, presenting with signs and symptoms of a possible gluteal soft tissue sarcoma. METHODS AND METHODS: Retrospective review of consecutive patients with a history of prior IVF therapy referred for MRI evaluation of a gluteal soft tissue mass was performed. Six patients were reviewed, with 5 patients meeting study inclusion criteria. Imaging exams (ultrasound n = 3, MRI n = 5) were assessed for lesion location, morphology, and intrinsic imaging characteristics. One case proceeded to percutaneous biopsy with histopathologic correlation. RESULTS: Average patient age was 43 years (range 38-50). Mean time interval between IVF IM injections and MRI was 5.7 years (range 2.2-13 years). Clinical findings included palpable gluteal mass (5/5) and local pain (4/5). Ultrasound showed heterogeneous subcutaneous lesions with varying complex cystic/solid internal echogenicity. On MRI, each case illustrated an irregularly marginated lesion, mean maximal dimension 3.5 cm (range 1.5-5.9 cm), within the deep gluteal subcutaneous fat composed of solitary (1/5) or multifocal (4/5) lobules demonstrating internal areas of high T1 and homogeneous low T2 fat suppressed signal with surrounding peripheral reticular high T2 signal. Correlative histological assessment showed central areas with features of fat necrosis and a peripheral inflammatory rim. CONCLUSIONS: In the setting of prior IVF therapy, imaging features of an irregularly marginated, deep subcutaneous gluteal lesion with inflammatory soft tissue changes surrounding solitary or multifocal areas of loculated fat signal may be seen as an inflammatory response to previous inadvertent subcutaneous injection(s).
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Sarcoma , Neoplasias de los Tejidos Blandos , Adulto , Fertilización In Vitro , Granuloma , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Estudios Retrospectivos , Sarcoma/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/diagnóstico por imagenRESUMEN
OBJECTIVE: There is an increasing emphasis on the early identification and treatment of ankylosing spondylitis (AS) of which the hallmark is sacroiliitis. Patients with inflammatory bowel disease (IBD) are at increased risk of AS and often receive computed tomography (CT) scans of their abdomen, affording clinicians the opportunity to determine the presence of sacroiliitis. Previous studies using CT have relied only on the radiologist's gestalt or a nonvalidated adaptation of the modified New York criteria. Our aim is to assess the prevalence of sacroiliitis in IBD using a validated screening tool and to determine how frequently these patients are referred for rheumatologic evaluation. METHODS: Patients with IBD were recruited from an IBD clinic. Control patients were recruited from a urology clinic and were confirmed to be without back pain, spondylitis, psoriasis, colitis, or uveitis by chart review. CT scans were read by 2 blinded readers and sacroiliitis was defined by the presence of ankylosis or a total erosion score of ≥3. RESULTS: CT scans were available in 233 Crohn's disease (CD) patients, 83 ulcerative colitis (UC) patients, and 108 control patients, and sacroiliitis was seen in 15%, 16.9%, and 5.6% of patients, respectively. The prevalence was higher in patients with IBD than in controls (P = 0.007), with no significant difference between CD and UC patients. Of the 49 IBD patients found to have sacroiliitis by CT scan, only 5 had been referred to a rheumatologist. CONCLUSION: There is a 3-fold higher prevalence of sacroiliitis in IBD compared with controls. Despite a growing awareness of this increased prevalence, many patients are not referred to a rheumatologist.
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Enfermedades Inflamatorias del Intestino/complicaciones , Sacroileítis/diagnóstico por imagen , Sacroileítis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Prevalencia , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Objective: To compare the antero-posterior (AP) pelvis view with the Ferguson view of the SI joint in order to resolve whether one modality has a clear advantage for grading of sacroiliitis. Methods: One hundred and nine patients fulfilling Assessment of SpondyloArthritis international Society (ASAS) criteria for axial spondyloarthritis who had AP pelvis and Ferguson views on the same day were identified from an axial spondyloarthritis clinic registry. Two rheumatologists independently scored the AP pelvis and Ferguson views according to modified New York (NY) criteria. Intra- and inter-reader agreements were obtained for both evaluations by using the kappa statistic and intraclass correlation coefficient (ICC). Any change in diagnostic category dictated by the Ferguson vs the AP pelvis views was also evaluated. Results: A total of 266 radiographs were read from 109 patients. Intra-observer reliability of the observers showed similar ICC scores; this was also reflected in the kappa for diagnosis of AS fulfilling modified NY criteria between the observers. The inter-rater agreement showed similar kappa values between the two modalities. When separately evaluating SI joints with score grading of 0-2, grade 2 showed the lowest kappa, reaching a low of 0.1 and 0.19 for the right SI joint for Ferguson and AP pelvis views, respectively. Both modalities were concordant diagnostically; reclassification from AS to non-AS and vice versa was in the range 5-11%. Conclusion: There was general agreement between the Ferguson and AP pelvis X-ray ICC and kappa scores. Either modality can be employed to evaluate the SI joint for sacroiliitis with the Ferguson view showing no clear superiority over the standard AP pelvis view.
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Pelvis/diagnóstico por imagen , Radiografía/estadística & datos numéricos , Articulación Sacroiliaca/diagnóstico por imagen , Sacroileítis/diagnóstico por imagen , Espondiloartritis/diagnóstico por imagen , Adulto , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Radiografía/métodos , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To develop a screening tool for the identification of sacroiliitis on abdominal computed tomography (CT) scan. METHODS: Variables including erosions (number and size), sclerosis (depths of > 0.3 cm or > 0.5 cm), and ankylosis were identified through a training exercise involving 12 CT scans containing the sacroiliac joints. Two blinded readers read 24 CT scans from a derivation cohort to propose a screening tool for identifying discriminating features of sacroiliitis. A test cohort of 68 patients was used to confirm the utility of this tool. Inter- and intraobserver values, sensitivity, specificity, and positive/negative likelihood ratios were calculated for individual as well as combinations of variables. Erosions were evaluated using receiver-operating characteristic curves. RESULTS: Analysis of the derivation cohort determined that counting the number of erosions on the worst coronal slice in each of 4 articular surfaces was not inferior to analyzing each individual slice in either transverse or coronal view. In the test cohort, interreader reliability for ankylosis and iliac and sacral erosions was very good (κ = 1, ICC = 0.989 and 0.995, respectively) whereas for sclerosis, it was moderate (κ = 0.39-0.96). A total erosion score of ≥ 3 was found to have the highest sensitivity and specificity for sacroiliitis (91% for each). The addition of a > 0.5 cm of iliac sclerosis or a > 0.3 cm of sacral sclerosis marginally increased the sensitivity (94%) but decreased specificity (85%). CONCLUSION: The presence of ankylosis or a total erosion score of ≥ 3 on CT is sufficient for identifying patients at high risk of sacroiliitis and may prompt more timely referrals to a rheumatologist.
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Abdomen/diagnóstico por imagen , Articulación Sacroiliaca/diagnóstico por imagen , Sacroileítis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
OBJECTIVE: Prevalence and impact of low bone mineral density (BMD) in psoriatic arthritis (PsA) is not well understood. We aimed to synthesize current evidence regarding the prevalence, impact, and risk factors for low BMD and fractures in PsA. METHODS: A systematic literature search limited to human studies was conducted without language restriction. Data on BMD, prevalence of osteoporosis, osteopenia and fractures, risk factors, morbidity, and mortality due to low BMD in PsA patients were collected. RESULT: A total of 21 studies (16 case-control, 4 cross-sectional, and 1 prospective cohort) were reviewed after screening 639 titles and abstracts. In all, 17 studies compared PsA patients with one or more control group (four normal controls, five psoriasis, and eight other rheumatic diseases with or without healthy controls). The number of PsA patients in the studies ranged from 8 to 2212 with a mean (standard deviation) age of 35 (10) to 63.4 (6.2), and mean PsA duration of 2.25-13.65 years. Reported prevalence of osteoporosis varied from 1.4% to 68.8%. Low BMD was identified as a significant problem in 13 of the 21 studies. Age, female sex, postmenopausal status, PsA duration, presence of erosions, and cumulative steroid dose were associated with lower BMD. Fractures (12-40%) were associated with postmenopausal status and axial disease. No studies reported on hospitalization and mortality due to low BMD. CONCLUSION: This systematic review synthesizes current evidence on BMD and its impact in PsA. High likelihood of bias and inconsistent results suggest a need for well-designed longitudinal studies on bone health in PsA.
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Artritis Psoriásica/epidemiología , Densidad Ósea/fisiología , Enfermedades Óseas Metabólicas/epidemiología , Osteoporosis/epidemiología , Comorbilidad , Humanos , Prevalencia , Factores de RiesgoRESUMEN
OBJECTIVE: In this randomized controlled trial, we compared the effect of celecoxib and acetaminophen on pain and magnetic resonance imaging (MRI) scores in patients with chronic nonspecific low back pain. METHODS: A total of 50 patients with chronic nonspecific low back pain were blindly randomized into 2 groups treated with celecoxib (200 mg twice daily) or acetaminophen (500 mg twice daily). Outcome measures included total back pain, nocturnal back pain, Oswestry Disability Index (ODI) scores, the Short Form 36 health survey to assess physical and mental status, and patient global assessment. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index, and Bath Ankylosing Spondylitis Metrology Index scores were also assessed before and after the therapy. The Spondyloarthritis Research Consortium of Canada scoring method was used to evaluate spinal MRI changes. RESULTS: Celecoxib showed a superior effect on total back pain, ODI, BASDAI, nocturnal back pain, and patient global assessment, compared to acetaminophen (P < 0.05). The number of patients with a significant change in back pain scales was higher in the celecoxib arm (ODI 34.8% versus 4.5%, nocturnal back pain 41.7% versus 9.1%, total back pain 33.3% versus 9.1%, and BASDAI 30.4% versus 9.1%; P < 0.01 for all). The responsiveness to celecoxib, calculated by Guyatt's Responsiveness Index, was 1.62, 1.28, 1.27, and 0.58 for the ODI, total back pain, BASDAI, and nocturnal back pain, respectively. The MRI scores for sacroiliac joints and spine showed no significant change with either treatment when compared with baseline values (P > 0.05). CONCLUSION: There was superior efficacy of celecoxib compared with acetaminophen in chronic nonspecific low back pain. Inflammatory lesions of sacroiliac joints and spine are commonly seen in nonspecific low back pain, but these lesions did not change with either celecoxib or acetaminophen treatments and were not associated with clinical response to either agent.
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Acetaminofén/uso terapéutico , Analgésicos no Narcóticos/uso terapéutico , Celecoxib/uso terapéutico , Dolor de la Región Lumbar/tratamiento farmacológico , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Resultado del TratamientoRESUMEN
The imaging findings of periprosthetic soft tissue lesions (pseudotumours) have been typically defined in the context of newer second-generation metal-on-metal hip arthroplasty. More recently, similar findings have been described in the setting of non-metal-on-metal prostheses. Although uncommon, wear and corrosion between the metal surfaces at the head-neck ('trunnionosis') and neck-stem interfaces are the potential culprits. With modular junctions containing at least one cobalt chromium component frequently present in hip arthroplasty prostheses, the incidence of this mode of adverse wear may be higher than previously thought (irrespective of the specific bearing couple used). In the present report, we described a case of a severe adverse local tissue reaction secondary to suspected corrosion at the head-neck taper in a metal-on-polyethylene total hip arthroplasty and reviewed the literature. Knowledge of this topical entity should help radiologists facilitate early diagnosis and ensure early management of this potentially serious complication.
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Artroplastia de Reemplazo de Cadera/efectos adversos , Granuloma de Células Plasmáticas/inducido químicamente , Granuloma de Células Plasmáticas/diagnóstico por imagen , Prótesis de Cadera/efectos adversos , Metales/efectos adversos , Adulto , Humanos , Masculino , RadiografíaRESUMEN
OBJECTIVE: To assess the usefulness of the MAdrid Sonographic Enthesitis Index (MASEI) in classifying patients as having psoriatic arthritis (PsA) and comparing entheseal abnormalities between patients with PsA, psoriasis alone (PsC), and healthy controls (HC). METHODS: Patients with PsC were assessed to exclude inflammatory arthritis. The MASEI scoring system was used to quantify the extent of ultrasonographic (US) entheseal abnormalities. The total MASEI score was categorized into items that reflected inflammatory abnormalities (MASEI-inflammatory) and chronic damage (MASEI-damage). Nonparametric tests were used to compare MASEI scores across the groups. A cutoff point of MASEI ≥ 20 was used to calculate the sensitivity and specificity of the MASEI to classify patients as having PsA. RESULTS: Patients with PsA (n = 50), PsC (n = 66), and HC (n = 60) were assessed. Total MASEI scores were higher in patients with PsA than in those with PsC, and both those groups were higher than HC (p < 0.0001). MASEI-inflammatory showed a similar trend (p < 0.0001). MASEI-damage was higher in patients with PsA compared to both patients with PsC and HC (p < 0.0001); however, no difference was observed between patients with PsC and HC. No significant difference in MASEI scores was found across the 3 groups in patients with a body mass index > 30. The sensitivity of the MASEI score to correctly classify patients as having PsA was 30% and the specificity was 95% when compared to HC and 89% when compared to PsC. CONCLUSION: The severity of US entheseal abnormalities is highest in patients with PsA followed by PsC and is lowest in healthy controls. MASEI can specifically classify patients as having PsA.
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Artritis Psoriásica/diagnóstico por imagen , Psoriasis/diagnóstico por imagen , Adulto , Anciano , Estudios de Casos y Controles , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , UltrasonografíaRESUMEN
OBJECTIVE: To develop and validate a reference image module aimed at calibration of readers using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) to assess radiographic progression in spondyloarthritis. METHODS: Our working group comprised 6 rheumatologists and 3 musculoskeletal radiologists. The following developmental steps were conducted: (1) review of the literature to identify aspects of the mSASSS requiring methodologic clarity; (2) independent assessment of baseline and 2-year radiographs from 25 patients using the mSASSS (pilot exercise); (3) development of a training module (the Spondyloarthritis Radiography [SPAR] module) that clarifies definitions, rules, and scoring methodology and a set of reference radiographic images; (4) scoring exercise 1 by 6 readers on 39 patients, where baseline and 2-year radiographs were scored blinded to time point; and (5) revision of the SPAR module followed by scoring exercise 2 conducted by the same 6 readers on 35 patients. Reliability of status and 2-year change scores was assessed by the intraclass correlation coefficient (ICC) method. RESULTS: ICCs for change scores for the radiologist reader pair improved from 0.46 to 0.62 after minimal calibration with the SPAR module. Recalibration from exercise 1 to exercise 2 with the SPAR module led to substantial improvement in interreader reliability for change in mSASSS score from ICC 0.44 (range 0.31-0.62) to ICC 0.62 (range 0.34-0.84). Simultaneous assessment of anteroposterior and lateral lumbar radiographs did not enhance reliability or detection of progression. CONCLUSION: Calibration according to the SPAR module led to improved reliability in the scoring of the mSASSS, even for expert readers.
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Progresión de la Enfermedad , Índice de Severidad de la Enfermedad , Espondiloartritis/diagnóstico por imagen , Calibración , Vértebras Cervicales/diagnóstico por imagen , Humanos , Vértebras Lumbares/diagnóstico por imagen , Variaciones Dependientes del Observador , Radiografía , Reproducibilidad de los ResultadosRESUMEN
Spondyloarthropathies (SpA) are a group of disorders that primarily affect the synovial joints of the axial and appendicular skeleton of variable predilections. Plain radiography is the initial and standard method of investigation in axial SpAs. Careful evaluation of the radiographs through developing a systematic approach is indispensible in reaching the correct diagnosis. Cross-sectional imaging, in particular magnetic resonance imaging, has been increasingly used in evaluating SpAs during the early phases of the disease or when radiographic findings are equivocal. Different types of SpAs demonstrate different imaging characteristics that are important to identify to reach the correct diagnosis.
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Artrografía , Imagen por Resonancia Magnética , Cintigrafía , Espondiloartropatías/diagnóstico , Tomografía Computarizada por Rayos X , HumanosRESUMEN
Hip and groin pain is a common condition in professional athletes and may result from an acute injury or from chronic, repetitive trauma. It is responsible for significant morbidity, which leads to time away from training and competition, and may result in a career-ending injury. The anatomic and biomechanical causes for hip and groin injuries are among the most complex and controversial in the musculoskeletal system. This makes clinical differentiation and subsequent management difficult because of the considerable overlap of symptoms and signs. This review article will evaluate several pathologic conditions of the hip and groin in athletes, divided into acute (secondary to single event) and chronic (secondary to altered biomechanical load or repetitive microtrauma) injuries, with an emphasis on imaging in the diagnosis of these injuries. Appropriate use of imaging along with clinical findings can allow accurate diagnosis and subsequent appropriate management of these patients to ultimately allow return to athletic activity.
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Atletas , Traumatismos en Atletas/diagnóstico , Diagnóstico por Imagen , Ingle/lesiones , Lesiones de la Cadera/diagnóstico , Traumatismos en Atletas/fisiopatología , Fenómenos Biomecánicos , Medios de Contraste , Trastornos de Traumas Acumulados/diagnóstico , Trastornos de Traumas Acumulados/fisiopatología , Ingle/fisiopatología , Lesiones de la Cadera/fisiopatología , Humanos , Dimensión del Dolor , Medicina DeportivaRESUMEN
We asked what the incidence of asymptomatic filling defects is on routine multidetector computed tomography (MDCT) in primary hip (total hip arthroplasty [THA]) and knee arthroplasties (TKA) patients. We prospectively performed MDCT scans on the first postoperative day for THA (n = 21)/TKA (n = 27). Patients underwent routine postoperative care, and data were collected for symptoms such as tachycardia or shortness of breath. More patients undergoing TKA had positive computed tomography scans than those undergoing THA: 11 (41%) vs 1 (5%), respectively. All patients diagnosed with a filling defect were discharged from the hospital without treatment of symptomatic pulmonary embolism. Our study demonstrates a high rate of abnormal MDCT early after lower extremity arthroplasty, the clinical importance of which may be benign.
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Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/epidemiología , Taquicardia/epidemiología , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Causalidad , Dolor en el Pecho/diagnóstico por imagen , Dolor en el Pecho/epidemiología , Comorbilidad , Femenino , Fiebre/epidemiología , Humanos , Hipoxia/diagnóstico por imagen , Hipoxia/epidemiología , Incidencia , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Taquicardia/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Three morbidly obese women were referred to us with suspected soft-tissue sarcomas. All lesions arose from the medial subcutaneous tissues of the thigh, and were shown to represent massive localised lymphoedema (MLL), a rare condition occurring in morbidly obese adults. MR imaging typically demonstrates a sharply demarcated, pedunculated mass consisting of fat partitioned by fibrous septae surrounded by a thickened dermis. There is oedema both within the mass and tracking along the subcutaneous septae in a "lace-like" fashion outwards from the pedicle, outlining large lobules of fat. Minimal enhancement is observed within the dermis of the lesion following intravenous gadolinium administration. Obesity is a growing problem that is likely to result in an increase in the prevalence of this condition; therefore, familiarity with the radiological appearance is important in establishing a correct diagnosis in this condition that may mimic a soft-tissue sarcoma.
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Linfedema/diagnóstico , Imagen por Resonancia Magnética , Femenino , Gadolinio , Humanos , Persona de Mediana Edad , Obesidad MórbidaRESUMEN
Skiing and snowboarding are ever increasing in popularity, with participation across a wide patient demographic. This article focuses on common skiing and snowboarding injuries, with an emphasis on unique mechanisms of injury and discusses the contribution of equipment design to evolving patterns of injury. Knowledge of mechanisms of injury and injury patterns allows a targeted approach to the interpretation of imaging modalities in this patient population.
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Traumatismos en Atletas/diagnóstico , Imagen por Resonancia Magnética/métodos , Radiografía/métodos , Esquí/lesiones , Traumatismos en Atletas/etiología , Traumatismos del Antebrazo/diagnóstico , Traumatismos del Antebrazo/etiología , Fracturas Óseas/diagnóstico , Fracturas Óseas/etiología , Humanos , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/etiología , Traumatismos de la Pierna/diagnóstico , Traumatismos de la Pierna/etiología , Ligamentos Articulares/lesiones , Lesiones del Hombro , Traumatismos Vertebrales/diagnóstico , Traumatismos Vertebrales/etiología , Pulgar/lesiones , Traumatismos de la Muñeca/diagnóstico , Traumatismos de la Muñeca/etiología , Lesiones de CodoRESUMEN
OBJECTIVE: To evaluate the influence of low-dose infliximab (IFX) on spinal inflammation scored by magnetic resonance imaging (MRI). The dose recommended for rheumatoid arthritis (3 mg/kg) is also clinically effective for ankylosing spondylitis (AS), although effects on spinal inflammation as defined by MRI have yet to be described in a placebo-controlled trial. METHODS: In a 12-week double-blind period, patients were randomized 1:1 to receive either IFX 3 mg/kg at 0, 2, and 6 weeks, or placebo. Spinal inflammation in discovertebral units (DVU) was measured by the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI Index at baseline and 12 weeks by 3 readers blinded to timepoint and treatment allocation. We also compared reliability and discrimination of the SPARCC MRI index based on evaluation of the entire spine (23 DVU score) compared to assessment of only the 6 most severely affected DVU (6 DVU score). RESULTS: At Week 12, patients treated with IFX experienced mean reductions of 55.1% and 57.2% in the 6 DVU and 23 DVU SPARCC scores, respectively, compared with a mean increase of 5.8% and decrease of 3.4% in 6 DVU and 23 DVU scores, respectively, for patients taking placebo (p < 0.001). A large treatment effect (Guyatt's effect size >or= 1.7) and high reliability was evident and comparable between 6 DVU and 23 DVU scoring methods. CONCLUSION: Treatment with low-dose IFX leads to a large treatment effect on spinal inflammation as measured by MRI. Scoring for inflammation of only the most severely affected regions of the spine by MRI is comparable to assessment of the entire spine.
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Anticuerpos Monoclonales/uso terapéutico , Antirreumáticos/uso terapéutico , Inflamación/tratamiento farmacológico , Columna Vertebral/patología , Espondilitis Anquilosante/tratamiento farmacológico , Adulto , Enfermedades de la Médula Ósea/patología , Ensayos Clínicos como Asunto , Evaluación de la Discapacidad , Progresión de la Enfermedad , Relación Dosis-Respuesta a Droga , Edema/patología , Femenino , Estado de Salud , Humanos , Inflamación/patología , Inflamación/fisiopatología , Infliximab , Disco Intervertebral/patología , Imagen por Resonancia Magnética , Masculino , Recuperación de la Función , Índice de Severidad de la Enfermedad , Espondilitis Anquilosante/patología , Espondilitis Anquilosante/fisiopatología , Resultado del TratamientoRESUMEN
INTRODUCTION: Ex-PRESS mini glaucoma shunt is a miniature, stainless steel, nonvalved device used for the treatment of glaucoma. The purpose of this study was to evaluate the safety of the Ex-PRESS glaucoma shunt during magnetic resonance (MR) imaging. METHODS: The effect of a magnetic field on the Ex-PRESS glaucoma shunt was evaluated in 4 scenarios. (1) Wet dish test: the device was placed floating in a dish filled with water and exposed to magnetic fields of 1.5 and 3 Tesla for 30 seconds. (2) Dry dish test: the device was placed on a dry dish and exposed to a magnetic field of 3 Tesla MR for 30 seconds. (3) Intracameral test: the device was floating freely in the anterior chamber of a human cadaver eye and was exposed to a magnetic field of 3 Tesla MR. (4) Scleral fixation test: the device was implanted through the sclera of a human cadaver eye and was exposed to a magnetic field of 3 Tesla MR. RESULTS: During the wet dish test the Ex-PRESS glaucoma shunt immediately moved across the dish with both 1.5 and 3 Tesla MR. No movements were noted during the dry dish test, intracameral test, or the scleral fixation test. CONCLUSIONS: Although the Ex-PRESS glaucoma shunt is influenced by magnetic field forces, it is likely MR of up to 3 Tesla is safe due to resistance provided by the ocular tissue.
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Implantes de Drenaje de Glaucoma , Imagen por Resonancia Magnética , Acero Inoxidable , Humor Acuoso/metabolismo , Campos Electromagnéticos , Seguridad de Equipos , HumanosRESUMEN
We report the case of a 64-year-old man who initially presented with a maculopapular rash followed several weeks later by bilateral shin pain and infiltrative cutaneous lesions over the lower legs. The plain radiographs were not contributory, and the patient was referred for a whole-body bone scan, which demonstrated multifocal osseous lesions, including such lesions in the lower legs, skull and facial bones. Magnetic resonance imaging (MRI) demonstrated numerous small tibial and fibular nodular lesions involving the medullary cavity and the cortex. A diagnosis of acquired syphilis was made, based on skin biopsy. Results of serological testing were consistent with recent infection. The patient was treated with intramuscular injection of penicillin, and follow-up MRI demonstrated gradual resolution of the osseous lesions. Bone involvement is a relatively rare manifestation of early acquired syphilis. Although the plain radiographic features of the bony changes in acquired syphilis are well documented, there have been no reports of the magnetic resonance imaging findings in the appendicular skeleton.
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Enfermedades Óseas/etiología , Enfermedades Óseas/patología , Imagen por Resonancia Magnética/métodos , Sífilis Cutánea/complicaciones , Sífilis Cutánea/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: Rheumatologists base many clinical decisions regarding the management of inflammatory joint diseases on joint counts performed at clinic. We investigated the reliability and accuracy of physically examining the metacarpophalangeal (MCP) joints to detect inflammatory synovitis using magnetic resonance imaging (MRI) as the gold standard. METHODS: MCP joints 2 to 5 in both hands of 5 patients with rheumatoid arthritis (RA) and 5 with psoriatic arthritis (PsA) were assessed by 5 independent examiners for joint-line swelling (visually and by palpation); joint-line tenderness by palpation (tender joint count, TJC) and stress pain; and by MRI (1.5 Tesla superconducting magnet). Interrater reliability was assessed using kappa statistics, and agreement between examination and corresponding MRI assessment was assessed by Fisher's exact tests (p < 0.05 considered statistically significant). RESULTS: Interrater agreement was highest for visual assessment of swelling (kappa = 0.55-0.63), slight-fair for assessment of swelling by palpation (kappa = 0.19-0.41), and moderate (kappa = 0.41-0.58) for assessment of joint tenderness. In patients with RA, TJC, stress pain, and visual swelling assessment were strongly associated with MRI evaluation of synovitis. Visual swelling assessment demonstrated high specificity (> 0.8) and positive predictive value (= 0.8). For PsA, significant associations exist between TJC and MRI synovitis scores (p < 0.01) and stress pain and MRI edema scores (p < 0.04). Assessment of swelling by palpation was not significantly associated with synovitis or edema as determined by MRI in RA or PsA (p = 0.54-1.0). CONCLUSION: In inflammatory arthritis, disease activity in MCP joints can be reliably assessed at the bedside by examining for joint-line tenderness (TJC) and visual inspection for swelling. Clinical assessment may have to be complemented by other methods for evaluating disease activity in the joint, such as MRI, particularly in patients with PsA.
Asunto(s)
Artritis Psoriásica/patología , Artritis Reumatoide/patología , Articulación Metacarpofalángica/patología , Sinovitis/patología , Artritis Psoriásica/inmunología , Artritis Reumatoide/inmunología , Humanos , Imagen por Resonancia Magnética/métodos , Sinovitis/inmunologíaRESUMEN
INTRODUCTION: Ankylosing spondylitis (AS) is a chronic rheumatic disease associated with spinal inflammation that subsequently leads to progression of structural damage and loss of function. The fully human anti-tumor necrosis factor (anti-TNF) antibody adalimumab reduces the signs and symptoms and improves overall quality of life in patients with active AS; these benefits have been maintained through 2 years of treatment. Our objective was to compare the progression of structural damage in the spine in patients with AS treated with adalimumab for up to 2 years versus patients who had not received TNF antagonist therapy. METHODS: Radiographs from patients with AS who received adalimumab 40 mg every other week subcutaneously were pooled from the Adalimumab Trial Evaluating Long-Term Efficacy and Safety for Ankylosing Spondylitis (ATLAS) study and a Canadian AS study (M03-606). Radiographic progression from baseline to 2 years in the spine of adalimumab-treated patients from these two studies (adalimumab cohort, n = 307) was compared with an historic anti-TNF-naïve cohort (Outcome in AS International Study [OASIS], n = 169) using the modified Stoke AS Spine Score (mSASSS) method. RESULTS: mSASSS results were not significantly different between the adalimumab cohort and the OASIS cohort, based on baseline and 2-year radiographs. Mean changes in mSASSS from baseline to 2 years were 0.9 for the OASIS cohort and 0.8 for the adalimumab cohort (P = 0.771), indicating similar radiographic progression in both groups. When results for patients in the OASIS cohort who met the baseline disease activity criteria for the ATLAS and Canadian studies (OASIS-Eligible cohort) were analyzed, there was no significant difference in mean change in mSASSS from baseline to 2 years between OASIS-Eligible patients and adalimumab-treated patients; the mean changes in mSASSS were 0.9 for the OASIS-Eligible cohort and 0.8 for the adalimumab cohort (P = 0.744). CONCLUSIONS: Two years of treatment with adalimumab did not slow radiographic progression in patients with AS, as assessed by the mSASSS scoring system, when compared with radiographic data from patients naïve to TNF antagonist therapy.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antirreumáticos/uso terapéutico , Columna Vertebral/diagnóstico por imagen , Espondilitis Anquilosante/diagnóstico por imagen , Espondilitis Anquilosante/tratamiento farmacológico , Adalimumab , Adulto , Anticuerpos Monoclonales Humanizados , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Radiografía , Ensayos Clínicos Controlados Aleatorios como Asunto , Columna Vertebral/efectos de los fármacosRESUMEN
BACKGROUND: A 49-year-old man presented to a rheumatology clinic with a 2-month history of low back pain. The pain seemed to be inflammatory in origin, with nocturnal occurrence and substantial early morning stiffness. The patient was previously well, with no history of psoriasis, inflammatory bowel disease or iritis. INVESTIGATIONS: Physical examination, anteroposterior X-ray of the pelvis, isotope bone scan, CT and MRI of the sacroiliac joints, measurement of serum inflammatory markers, HLA-B27 testing, routine and mycobacterial culture of the sacroiliac joint fluid aspirate, tuberculosis skin testing and chest X-ray. DIAGNOSIS: An HLA-B27-negative patient with chronic unilateral sacroiliitis refractory to conventional management. MANAGEMENT: After unsuccessful treatment with various NSAIDs and physical therapy, local corticosteroid injections on two occasions in the affected sacroiliac joint provided transient relief. A subsequent 20 mg injection of infliximab into the affected joint resulted in clinical and radiological improvement that has been sustained for more than 2 years.