Imaging evaluation of inflammation in the musculoskeletal system: current concepts and perspectives

Ultrasound guidance in the surgical removal of internal fixators after complete healing of limb fractures

PURPOSE

The aim of this study was to determine whether ultrasound guidance can reduce the duration, blood loss volume and invasiveness of surgery for internal fixator removal.

METHODS

The clinical data from 35 adults patients who underwent ultrasound-guided surgical removal of internal fixators after complete healing of limb fractures between June 2019 and April 2023 were retrospectively analysed and compared with those from 34 controls who underwent the procedure without ultrasound guidance. Data concerning the patients' demographic and clinical characteristics and surgical sites were collected. Differences in the patients' demographic and clinical characteristics were compared between the two groups.

RESULTS

Sixty-nine patients were enrolled in the study. Thirty-five patients underwent surgical removal of internal fixators with ultrasound guidance, and the average intraoperative blood loss volume was 15.17 ± 18.54 ml, average difference between the incision length and scar length was 4.24 ± 1.38 cm, average operation time was 60.66 ± 24.30 min, and average ultrasound assessment time was 10.00 ± 3.90 min. Thirty-four patients underwent surgical removal of internal fixators without ultrasound guidance, and the average blood loss volume was 46.76 ± 90.74 ml, average difference between the incision length and scar length was 2.68 ± 1.04 cm, and average operation time was 80.15 ± 58.84 min. The difference between the incision length and scar length was significant (P < 0.01), as was the difference in the intraoperative blood loss volume (P < 0.05) between the two groups.

CONCLUSION

Ultrasound is a convenient, noninvasive, radiation-free technique that allows dynamic scanning of multiple sections regardless of patient position. Ultrasound-assisted removal of internal fixators might reduce bleeding and therefore the invasiveness of the procedure. Physicians can use ultrasound for preoperative patient positioning, intraoperative monitoring, and postoperative confirmation of complete removal of internal fixators if necessary.

Novel positron emission tomography tracers for imaging of rheumatoid arthritis

Positron emission tomography (PET) is a nuclear imaging modality that relies on visualization of molecular targets in tissues, which is nowadays combined with a structural imaging modality such as computed tomography (CT) or Magnetic Resonance Imaging (MRI) and referred to as hybrid PET imaging. This technique allows to image specific immunological targets in rheumatoid arthritis (RA). Moreover, quantification of the PET signal enables highly sensitive monitoring of therapeutic effects on the molecular target. PET may also aid in stratification of the immuno-phenotype at baseline in order to develop personalized therapy. In this systematic review we will provide an overview of novel PET tracers, investigated in the context of RA, either pre-clinically, or clinically, that specifically visualize immune cells or stromal cells, as well as other factors and processes that contribute to pathology. The potential of these tracers in RA diagnosis, disease monitoring, and prediction of treatment outcome will be discussed. In addition, novel PET tracers established within the field of oncology that may be of use in RA will also be reviewed in order to expand the future opportunities of PET imaging in RA.

Periodontal evaluation using a non-invasive imaging method (ultrasonography)

The periodontal disease and gingival bleeding are highly prevalent in the adult population worldwide. The World Health Organization (WHO) data shows that 90–100% of the 34-year-old adults present gingival inflammation. Therefore, an investigation method is required to allow the assessment of the periodontal disease as well as the monitoring of the evolution of the gingival inflammation after periodontal treatments. Non-invasive and operator-independent methods for periodontal examination are necessary for diagnosing and monitoring the periodontal disease. The periodontal ultrasonography is a reliable technique for visualizing the anatomical elements which are necessary to diagnose the periodontal status. Using this imaging technique the dentino-enamel junction, the cortical bone, the radicular surface from the crown to the alveolar bone, the gingival tissue can be seen without interfering with those elements during the examination. Also, calculus visualization is possible before and after scaling in order to evaluate the quality of the treatment.

Using 2D ultrasonography is not feasible in dental practice as it requires extensive experience and is also time consuming. The reproducibility of the 2D slices is very difficult in order to have the possibility to compare different investigations efficiently. 3D reconstructions of the periodontal tissue can be a very good alternative to eliminate the operator dependence.

Ultrasonography allows the practitioner to visualize the anatomic elements involved in making a periodontal diagnosis. It also allows tracking of subsequent changes. This method is not commonly used for periodontal examination and further studies are required. Previous studies show that ultrasonography can be a reliable non-invasive method to diagnose and monitor the periodontal disease.

Detection of pediatric musculoskeletal pathology using the fluid-sensitive sequence

BACKGROUND

Musculoskeletal complaints are common among children, and magnetic resonance (MR) is increasingly used to supplement the clinical assessment. The validation of a short triage protocol could reduce the number of unnecessary contrast-enhanced MR studies that sometimes also require the need for sedation.

OBJECTIVE

To compare the diagnostic accuracy between fluid-sensitive sequence and contrast-enhanced MR study in the detection of musculoskeletal pathology in the pelvis and the appendicular skeleton in children older than 2 years.

MATERIALS AND METHODS

We performed a retrospective review between Feb. 1, 2016, and Oct. 31, 2016, and identified 99 studies from 96 patients (48 boys and 48 girls; mean age ± standard deviation, 11.1±4.6 years) without syndromic deformity, recent trauma, a history of infectious or inflammatory arthropathy, prior instrumentation or incomplete records. Two radiologists reviewed each study twice, at least 1 month apart, first using only the fluid-sensitive sequences (triage study) and later using the contrast-enhanced study. Readers rated the presence or absence of pathology independently and generated final impressions in consensus. We used Cohen's kappa (κ) and percentage agreement to compare agreement between readers and between studies, respectively.

RESULTS

Inter-reader agreement was overall higher for the contrast-enhanced studies (κ range = 0.91-1) than for the triage studies (κ range = 0.49-1). Percentage agreement between studies was high for the detection of pathology (97-100%) and for the impressions (93%). Clinical diagnoses were stress reaction or overuse in 31%, infection in 21%, space-occupying process in 17%, normal in 15%, inflammatory in 14%, and both inflammatory and overuse in 1%. The full study increased diagnostic confidence in five studies and accuracy in two but did not alter management.

CONCLUSION

The fluid-sensitive sequence had a near-perfect percentage of agreement with the contrast-enhanced study in the detection of musculoskeletal pathology and could possibly be used to screen children who need a contrast-enhanced MR study.

Advances in noninvasive functional imaging of bone

The demand for functional imaging in clinical medicine is comprehensive. Although the gold standard for the functional imaging of human bones in clinical settings is still radionuclide-based imaging modalities, nonionizing noninvasive imaging technology in small animals has greatly advanced in recent decades, especially the diffuse optical imaging to which Britton Chance made tremendous contributions. The evolution of imaging probes, instruments, and computation has facilitated exploration in the complicated biomedical research field by allowing longitudinal observation of molecular events in live cells and animals. These research-imaging tools are being used for clinical applications in various specialties, such as oncology, neuroscience, and dermatology. The Bone, a deeply located mineralized tissue, presents a challenge for noninvasive functional imaging in humans. Using nanoparticles (NP) with multiple favorable properties as bioimaging probes has provided orthopedics an opportunity to benefit from these noninvasive bone-imaging techniques. This review highlights the historical evolution of radionuclide-based imaging, computed tomography, positron emission tomography, and magnetic resonance imaging, diffuse optics-enabled in vivo technologies, vibrational spectroscopic imaging, and a greater potential for using NPs for biomedical imaging.