Dezidierte Knorpelbildgebung zur Detektion von Knorpelverletzungen und osteochondralen Läsionen

Zusammenfassung

Hintergrund

Osteochondrale Läsionen stellen einen Hauptrisikofaktor für die Entwicklung einer Arthrose am Sprunggelenk dar.

Ziel

Es sollen ein Überblick über therapierelevante klinische Bildgebungsverfahren zur Knorpelbildgebung an Fuß und Sprunggelenk gegeben und typische osteochondrale Verletzungen demonstriert werden.

Material und Methoden

Eine intensive Literaturrecherche wurde durchgeführt und mit persönlicher Erfahrung unterstrichen.

Ergebnisse

Die Knorpelbildgebung zur Detektion osteochondraler Läsionen an Fuß und Sprunggelenk bleibt eine Herausforderung. Dennoch können dezidierte morphologische und quantitative magnetresonanztomographische (MR-)Bildgebungsmethoden klinisch wichtige Informationen zur Verfügung stellen, die hilfreich bei Therapieentscheidungen z. B. hinsichtlich einer knorpelchirurgischen Maßnahme sind. Die Sensitivität der MR-Arthrographie (MR-A) und computertomographischen Arthrographie (CT-A) ist der nativen Magnetresonanztomographie (MRT) bezüglich der Detektion osteochondraler Läsionen überlegen. Im Bereich der kleineren Gelenke des Fußes werden vor allem fortgeschrittene degenerative Veränderungen mittels konventioneller Röntgendiagnostik detektiert; nur in ausgewählten Fällen spielt die MR- und CT-Diagnostik dieser kleineren Gelenken eine Rolle.

Diskussion

Während die dezidierte Knorpelbildgebung mit CT und MRT im Bereich der kleinen Fußgelenke eine geringere Rolle spielt, wird sie im Bereich des Sprunggelenks aufgrund der verfügbaren therapeutischen Optionen wie verschiedenen knorpelchirurgischen Verfahren immer wichtiger für die klinische Diagnostik.

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Delineation of two intracranial areas and the perpendicular intracranial width is sufficient for intracranial volume estimation

Abstract

Objectives

The aim of the present study is to determine if the delineation of one or two optimally chosen intracranial areas (ICA) is enough to achieve adequate estimates of intracranial volume (ICV) in magnetic resonance imaging.

Methods

The correlations of 62 fully delineated ICVs with four types of ICV estimates were calculated. The estimate types were: (1) a single midsagittal ICA, (2) single ICA multiplied by the intracranial width perpendicular to the ICA, (3) sum of two ICAs multiplied by the perpendicular intracranial width and (4) shape-preserving piecewise cubic interpolation using two ICAs. For methods 2–4, the fully delineated ICVs were randomly separated into an evaluation and a validation set of equal size. Method 1 was validated against all of the fully delineated ICVs.

Results

Estimates from method 1 had a Pearson correlation of 0.904 with fully delineated ICV. For method 2, the correlation was 0.986 when delineating the sagittal ICA at 31% of the sagittal intracranial width. For methods 3 and 4, the correlations were both 0.997 when delineating the sagittal ICAs at 17.5 and 64% and at 12 and 64% respectively.

Conclusions

Delineation of two specific intracranial areas is sufficient for intracranial volume estimation.

Main messages

• Delineation of two specific intracranial areas is sufficient for intracranial volume estimation.

• The estimates had a Pearson correlation of 0.997 with intracranial volume.

• The estimation should take no more than 5 min.

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Imaging of Spontaneous and Traumatic Cervical Artery Dissection

Abstract

Introduction

Cervical artery dissection (CAD) is an important etiology of ischemic stroke and early recognition is vital to protect patients from the major complication of cerebral embolization by administration of anticoagulants. The etiology of arterial dissections differ and can be either spontaneous or traumatic. Even though the historical gold standard is still catheter angiography, recent studies suggest a good performance of computed tomography angiography (CTA) for detection of CAD. We conducted this research to evaluate the variety and frequency of possible imaging signs of spontaneous and traumatic CAD and to guide neuroradiologists' decision making.

Methods

Retrospective review of the database of our multiple injured patients admitted to the Department of Trauma, Hand, and Reconstructive Surgery of the University Hospital Münster in Germany (a level 1 trauma center) for patients with traumatic CAD (tCAD) and of our stroke database (2008–2015) for patients with spontaneous CAD (sCAD) and CT/CTA on initial clinical work-up. All images were evaluated concerning specific and sensitive radiological features for dissection by two experienced neuroradiologists. Imaging features were compared between the two etiologies.

Results

This study included 145 patients (99 male, 46 female; 45 ± 18.8 years of age), consisting of 126 dissected arteries with a traumatic and 43 with spontaneous etiology. Intimal flaps were more frequently observed after traumatic etiology (58.1% tCADs, 6.9% sCADs; p < 0.001); additionally, multivessel dissections were much more frequent in trauma patients (3 sCADs, 21 tCADs) and only less than half (42%) of the patients with traumatic dissections showed cervical spine fractures.

Conclusion

Neuroradiologists should be aware that intimal flaps and multivessel dissections are more common after a traumatic etiology. In addition, it seems important to conduct a CTA in a trauma setting, even if no cervical spine fracture is detected.

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Bedeutung der Virchow-Robin-Räume

Zusammenfassung

Virchow-Robin-Räume (VRR) sind perivaskuläre, flüssigkeitsgefüllte Hohlräume um perforierende Arterien und Venen im Hirnparenchym. In der Regel sind sie bei gesunden Menschen etwa 5 mm im Durchmesser. Typische Lokalisationen sind Stammganglien, Mesencephalon sowie die weiße Substanz. Bildmorphologische Charakteristika der VRR sind runde oder tubuläre, glatt begrenzte, in den T2-gewichteten Sequenzen hyperintense Areale. VRR stellen eine physiologische Struktur im normalen Hirnparenchym dar. Es wird angenommen, dass sie mit interstitieller Flüssigkeit gefüllte Makrophagen beinhalten und eine wichtige Rolle für die Drainage der interstitiellen Flüssigkeit in Richtung zervikales Lymphsystem darstellen. Bei vielen Erkrankungen, wie z. B. der Alzheimer-Krankheit, zerebrovaskulären Erkrankungen oder Schädelhirntraumata, wird ein Zusammenhang mit VRR gesehen. Differenzialdiagnostisch müssen lakunäre Infarkte, zystische Raumforderungen, niedriggradige maligne Tumoren oder Arachnoidalzysten bedacht werden. In einzelnen Studien wurde ein Zusammenhang von gehäuft auftretenden erweiterten perivaskulären Räumen bei Patienten mit arterieller Hypertonie und bei Patienten mit CADASIL-Erkrankung festgestellt. Selten sind VRR so stark erweitert, dass es zu einer Kompression des Aquädukts oder der Foramina Monroi mit konsekutivem Hydrozephalus kommt.

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BTB/POZ domain-containing protein 7 is inversely associated with fibronectin expression in salivary adenoid cystic carcinoma.

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BTB/POZ domain-containing protein 7 is inversely associated with fibronectin expression in salivary adenoid cystic carcinoma.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Dec 28;:

Authors: Liu Y, Song J, Zhang J, Yang L, Liu Z, Wang X

Abstract
OBJECTIVE: This study aimed to investigate the relationship between BTB/POZ domain-containing protein 7 (BTBD7) and fibronectin (FN) expression in salivary adenoid cystic carcinoma (SACC) and the function of BTBD7 in proliferation, migration, and invasion of SACC cells.
STUDY DESIGN: The BTBD7 and FN expression in SACC and nontumor salivary tissues as well as SACC cells were characterized by immunohistochemistry and immunofluorescence. The effect of BTBD7 silencing on the proliferation, migration, and invasion of SACC-LM cells were determined by wound healing and transwell invasion assays.
RESULTS: The percentages of SACC with positive BTBD7 expression were significantly higher than those of SACC with FN expression. BTBD7 silencing significantly increased the relative levels of FN expression and inhibited the proliferation, migration, and invasion of SACC-LM cells.
CONCLUSIONS: The study data indicated that BTBD7 was inversely associated with FN expression in SACC. BTBD7 may inhibit FN expression, but it promotes the proliferation, migration, and invasion of SACC-LM cells. Hence, BTBD7 may be associated with metastasis and a new therapeutic target for intervention of SACC.

PMID: 29366608 [PubMed - as supplied by publisher]

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The role of a palliative care intervention in moderating the relationship between depression and survival among individuals with advanced cancer.

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The role of a palliative care intervention in moderating the relationship between depression and survival among individuals with advanced cancer.

Health Psychol. 2017 Dec;36(12):1140-1146

Authors: Prescott AT, Hull JG, Dionne-Odom JN, Tosteson TD, Lyons KD, Li Z, Li Z, Dragnev KH, Hegel MT, Steinhauser KE, Ahles TA, Bakitas MA

Abstract
OBJECTIVE: Randomized controlled trials (RCTs) of early palliative care interventions in advanced cancer have positively impacted patient survival, yet the mechanisms remain unknown. This secondary analysis of 2 RCTs assessed whether an early palliative care intervention moderates the relationship between depressive symptoms and survival.
METHOD: The relationships among mood, survival, and early palliative care intervention were studied among 529 advanced cancer patients who participated in 2 RCTs. The first (N = 322) compared intervention versus usual care. The second (N = 207) compared early versus delayed intervention (12 weeks after enrollment). The interventions included an in-person consultation, weekly nurse coach-facilitated phone sessions, and monthly follow-up. Mood was measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. Cox proportional hazard analyses were used to examine the effects of baseline CES-D scores, the intervention, and their interaction on mortality risk while controlling for demographic variables, cancer site, and illness severity.
RESULTS: The combined sample was 56% male (M = 64.7 years). Higher baseline CES-D scores were significantly associated with greater mortality risk (hazard ratio [HR] = 1.042, 95% confidence interval [CI] [1.017, 1.067], p = .001). However, participants with higher CES-D scores who received the intervention had a lower mortality risk (HR = .963, CI [0.933, 0.993], p = .018) even when controlling for demographics, cancer site, and illness-related variables.
CONCLUSION: This study is the first to demonstrate that patients with advanced cancer who also have depressive symptoms benefit the most from early palliative care. Future research should be devoted to exploring the mechanisms responsible for these relationships. (PsycINFO Database Record

PMID: 29048177 [PubMed - indexed for MEDLINE]

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Validity of utility measures for women with pelvic organ prolapse.

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Validity of utility measures for women with pelvic organ prolapse.

Am J Obstet Gynecol. 2018 01;218(1):119.e1-119.e8

Authors: Harvie HS, Lee DD, Andy UU, Shea JA, Arya LA

Abstract
BACKGROUND: Pelvic organ prolapse is a common condition that frequently coexists with urinary and fecal incontinence. The impact of prolapse on quality of life is typically measured through condition-specific quality-of-life instruments. Utility preference scores are a standardized generic health-related quality-of-life measure that summarizes morbidity on a scale from 0 (death) to 1 (optimum health). Utility preference scores quantify disease severity and burden and are widely used in cost-effectiveness research. The validity of utility preference instruments in women with pelvic organ prolapse has not been established.
OBJECTIVE: The objective of this study was to evaluate the construct validity of generic quality-of-life instruments for measuring utility scores in women with pelvic organ prolapse. Our hypothesis was that women with multiple pelvic floor disorders would have worse (lower) utility scores than women with pelvic organ prolapse only and that women with all 3 pelvic floor disorders would have the worst (lowest) utility scores.
STUDY DESIGN: This was a prospective observational study of 286 women with pelvic floor disorders from a referral female pelvic medicine and reconstructive surgery practice. All women completed the following general health-related quality-of-life questionnaires: Health Utilities Index Mark 3, EuroQol, and Short Form 6D, as well as a visual analog scale. Pelvic floor symptom severity and condition-specific quality of life were measured using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire, respectively. We measured the relationship between utility scores and condition-specific quality-of-life scores and compared utility scores among 4 groups of women: (1) pelvic organ prolapse only, (2) pelvic organ prolapse and stress urinary incontinence, (3) pelvic organ prolapse and urgency urinary incontinence, and (4) pelvic organ prolapse, urinary incontinence, and fecal incontinence.
RESULTS: Of 286 women enrolled, 191 (67%) had pelvic organ prolapse; mean age was 59 years and 73% were Caucasian. Among women with prolapse, 30 (16%) also had stress urinary incontinence, 39 (20%) had urgency urinary incontinence, and 42 (22%) had fecal incontinence. For the Health Utilities Index Mark 3, EuroQol, and Short Form 6D, the pattern in utility scores was noted to be lowest (worst) in the prolapse + urinary incontinence + fecal incontinence group (0.73-0.76), followed by the prolapse + urgency urinary incontinence group (0.77-0.85) and utility scores were the highest (best) for the prolapse only group (0.80-0.86). Utility scores from all generic instruments except the visual analog scale were significantly correlated with the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire total scores (r values -0.26 to -0.57), and prolapse, bladder, and bowel subscales (r values -0.16 to -0.50). Utility scores from all instruments except the visual analog scale were highly correlated with each other (r = 0.53-0.69, P < .0001).
CONCLUSION: The Health Utilities Index Mark 3, EuroQol, and Short Form 6D, but not the visual analog scale, provide valid measurements for utility scores in women with pelvic organ prolapse and associated pelvic floor disorders and could potentially be used for cost-effectiveness research.

PMID: 28988907 [PubMed - indexed for MEDLINE]

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