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Liu WX, Wu H, Cai C, Lai QQ, Wang Y, Li YZ. Research on automatic recognition radiomics algorithm for early sacroiliac arthritis based on sacroiliac MRI imaging. J Orthop Surg Res 2024; 19:96. [PMID: 38287422 PMCID: PMC10826273 DOI: 10.1186/s13018-024-04569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE To create an automated machine learning model using sacroiliac joint MRI imaging for early sacroiliac arthritis detection, aiming to enhance diagnostic accuracy. METHODS We conducted a retrospective analysis involving 71 patients with early sacroiliac arthritis and 85 patients with normal sacroiliac joint MRI scans. Transverse T1WI and T2WI sequences were collected and subjected to radiomics analysis by two physicians. Patients were randomly divided into training and test groups at a 7:3 ratio. Initially, we extracted the region of interest on the sacroiliac joint surface using ITK-SNAP 3.6.0 software and extracted radiomic features. We retained features with an Intraclass Correlation Coefficient > 0.80, followed by filtering using max-relevance and min-redundancy (mRMR) and LASSO algorithms to establish an automatic identification model for sacroiliac joint surface injury. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curve (AUC) was calculated. Model performance was assessed by accuracy, sensitivity, and specificity. RESULTS We evaluated model performance, achieving an AUC of 0.943 for the SVM-T1WI training group, with accuracy, sensitivity, and specificity values of 0.878, 0.836, and 0.943, respectively. The SVM-T1WI test group exhibited an AUC of 0.875, with corresponding accuracy, sensitivity, and specificity values of 0.909, 0.929, and 0.875, respectively. For the SVM-T2WI training group, the AUC was 0.975, with accuracy, sensitivity, and specificity values of 0.933, 0.889, and 0.750. The SVM-T2WI test group produced an AUC of 0.902, with accuracy, sensitivity, and specificity values of 0.864, 0.889, and 0.800. In the SVM-bimodal training group, we achieved an AUC of 0.974, with accuracy, sensitivity, and specificity values of 0.921, 0.889, and 0.971, respectively. The SVM-bimodal test group exhibited an AUC of 0.964, with accuracy, sensitivity, and specificity values of 0.955, 1.000, and 0.875, respectively. CONCLUSION The radiomics-based detection model demonstrates excellent automatic identification performance for early sacroiliitis.
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Affiliation(s)
- Wen-Xi Liu
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China
| | - Hong Wu
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China
| | - Chi Cai
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China
| | - Qing-Quan Lai
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China
| | - Yi Wang
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China.
| | - Yuan-Zhe Li
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China.
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Di Dier K, Deppe D, Diekhoff T, Herregods N, Jans L. Clash of the titans: Current CT and CT-like imaging modalities in sacroiliitis in spondyloarthritis. Best Pract Res Clin Rheumatol 2023; 37:101876. [PMID: 37953120 DOI: 10.1016/j.berh.2023.101876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Sacroiliitis is characterised by active and structural changes of the joint. While the Assessment of Spondyloarthritis international Society (ASAS) classification criteria stress the importance of bone marrow inflammation, recent reports suggest that osteitis can occur in various diseases, mechanical conditions and healthy individuals. Thus, structural lesions such as joint surface erosion and ankylosis are important factors for differential diagnosis. Various imaging modalities are available to examine these changes. However, computed tomography (CT) is generally considered the reference standard. Nonetheless, recent advances in magnetic resonance imaging (MRI) allow for direct bone imaging and the reconstruction of CT-like images that can provide similar information. This way, the ability of MRI to detect and measure structural lesions is strengthened. The aim of this review is to provide an overview of the pros and cons of CT and CT-like imaging modalities in sacroiliitis.
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Affiliation(s)
- Kelly Di Dier
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Dominik Deppe
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität Zu Berlin, Freie Unversität Berlin, Charitéplaz 1, 10117, Berlin, Germany.
| | - Torsten Diekhoff
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität Zu Berlin, Freie Unversität Berlin, Charitéplaz 1, 10117, Berlin, Germany.
| | - Nele Herregods
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Lennart Jans
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
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Huang K, Lin X, Luo Y, Hu Q, Guo B, Ouyang F, Ouyang Y, Song C, Chen H. Image quality and evaluation ability of magnetic resonance imaging techniques for thyroid-associated ophthalmopathy: Dixon fat-suppression technique vs. spectral attenuated inversion recovery. Front Med (Lausanne) 2023; 10:1154828. [PMID: 37502355 PMCID: PMC10368892 DOI: 10.3389/fmed.2023.1154828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Purpose We aimed to compare two magnetic resonance imaging (MRI) techniques, Dixon and spectral attenuated inversion recovery (SPAIR) fat-suppression, in terms of image quality and suitability for evaluating thyroid-associated ophthalmopathy (TAO) lesion characteristics. Methods This cross-sectional, retrospective study involved 70 patients with TAO (140 eyes) who underwent orbital coronal MRI examinations, including Dixon-transverse relaxation (T2)-weighted imaging (T2WI) and SPAIR-T2WI, between 2020 and 2022. We compared the fat-suppression quality and artifacts, noise (N), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), signal intensity ratio (SIR) of extraocular muscles (SIR-EOM) and lacrimal glands (SIR-LG), and TAO activity evaluation efficiency. Results Dixon-T2WI showed a higher frequency of better subjective image quality and suitability for evaluating the characteristics of TAO lesions (65.7% vs. 14.3%) than SPAIR-T2WI. Fat-suppression quality and artifact scores were lower for Dixon-T2WI than for SPAIR-T2WI (p < 0.001). The N, SNR, and CNR values, EOM-SIR, and LG-SIR were higher for orbital coronal Dixon-T2WI than for SPAIR-T2WI (all p < 0.001). Clinical activity scores (CASs) showed positive correlations with SIR. The correlation between EOM-SIR and LG-SIR of orbital coronal Dixon-T2WI with CAS was higher than that of SPAIR-T2WI (0.590 vs. 0.493, all p < 0.001; 0.340 vs. 0.295, all p < 0.01). EOM-SIR and LG-SIR of Dixon-T2WI yielded a higher area under the curve than SPAIR-T2WI for evaluating TAO activity (0.865 vs. 0.760, p < 0.001; 0.695 vs. 0.617, p = 0.017). Conclusion Dixon-T2WI yields higher image quality than SPAIR-T2WI. Furthermore, it has a stronger ability to evaluate TAO inflammation than SPAIR, with higher sensitivity and specificity in active TAO staging.
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Affiliation(s)
- Kai Huang
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Xiaoxin Lin
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yaosheng Luo
- Department of Endocrinology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Qiugen Hu
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Baoliang Guo
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Fusheng Ouyang
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yufeng Ouyang
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Cheng Song
- Department of Endocrinology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Haixiong Chen
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
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Yang JZ, Murphy R, Lu J. A fat fraction phantom for establishing new convolutional neural network to determine the pancreatic fat deposition. Heliyon 2022; 8:e12478. [PMID: 36593841 PMCID: PMC9803836 DOI: 10.1016/j.heliyon.2022.e12478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/20/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
The determination of fat fraction based on Magnetic Resonance Imaging (MRI) requires extremely accurate data reconstruction for the assessment of pancreatic fat accumulation in medical diagnostics and biological research. In this study, the signal model of the oil and water emulsion was created with a 3.0 T field strength. We examined the quantification of the fat fraction from phantom and the intrapancreatic fat fraction using the techniques of magnetic resonance spectroscopy (MRS) and Iterative Decomposition with Echo Asymmetry and Least-Squares estimate (IDEAL) in magnetic resonance imaging (MRI). Additionally, we contrasted expert manual pancreatic fat assessment with MRS and IDEAL pancreatic fat fraction quantification. There was a strong connection between the true fat volume fraction and the fat fraction from IDEAL and MRS (R2 = 0.99 and 0.99, respectively). For both phantom and in vivo measurements, Pearson's correlation and linear regression analysis were used. The findings of the in vivo assessment revealed a variable correlation between the pancreatic fat fraction MRI readings. We also used MR-opsy for manual pancreatic fat fraction segmentation since it read pancreatic fat fractions more accurately than IDEAL and MRS, which aided in the development of machine learning's ability to assess pancreatic fat automatically.
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Affiliation(s)
- John Zhiyong Yang
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand,Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand,Auckland Diabetes Centre, Auckland District Health Board, Auckland, New Zealand,Whitiora Diabetes Department, Counties Manukau District Health Board, Auckland, New Zealand,Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand
| | - Jun Lu
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand,Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand,College of Food Engineering and Nutrition Sciences, Shanxi Normal University, Xi'an, 710119, Shanxi Province, China,Key Laboratory of Forest Plant Ecology, Ministry of Education, Northeast Forestry University, Harbin 150040, China,Corresponding author.
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Čivrný J, Karhanová M, Hübnerová P, Schovánek J, Heřman M. MRI in the assessment of thyroid-associated orbitopathy activity. Clin Radiol 2022; 77:925-934. [PMID: 36116966 DOI: 10.1016/j.crad.2022.08.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Abstract
Management of patients with thyroid-associated orbitopathy (also called Graves' disease) is dependent on the assessment of the disease activity. Evaluation of disease activity is based on ophthalmological examination. Magnetic resonance imaging (MRI) is an auxiliary method that may help quantify the activity and is also helpful in obtaining anatomical information concerning muscle thickness, exophthalmos, or optic neuropathy. We present a review of MRI techniques of the orbits with emphasis on the evaluation of disease activity. The most convincing seems to be the group of T2-weighted techniques such as conventional T2 weighting, T2 relaxometry, and T2 mapping. Dynamic contrast-enhanced MRI is another promising method.
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Affiliation(s)
- J Čivrný
- Department of Radiology, Palacky University and University Hospital, Olomouc, Czech Republic.
| | - M Karhanová
- Department of Ophthalmology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - P Hübnerová
- Department of Ophthalmology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - J Schovánek
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - M Heřman
- Department of Radiology, Palacky University and University Hospital, Olomouc, Czech Republic
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Morbée L, Jans LBO, Herregods N. Novel imaging techniques for sacroiliac joint assessment. Curr Opin Rheumatol 2022; 34:187-194. [PMID: 35699310 DOI: 10.1097/bor.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Imaging of the sacroiliac joints is one of the cornerstones in the diagnosis and monitoring of axial spondyloarthritis. We aim to present an overview of the emerging imaging techniques for sacroiliac joint assessment and provide an insight into their relevant benefits and pitfalls. RECENT FINDINGS Evaluation of structural and active inflammatory lesions in sacroiliitis are both important for understanding the disease process. Dual-energy computed tomography (CT) can detect inflammatory bone marrow edema in the sacroiliac joints and provides an alternative for magnetic resonance imaging (MRI). Three-dimensional gradient echo sequences improve the visualization of erosions on MRI. Susceptibility weighted MRI and deep learning-based synthetic CT are innovative MRI techniques that allow for generating 'CT-like' images and better depict osseous structural lesions than routine MRI sequences. SUMMARY New imaging innovations and developments result in significant improvements in the imaging of spondyloarthritis. Advanced MRI techniques enhance its potential for the accurate detection of structural and active inflammatory lesions of sacroiliitis in one single imaging session.
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Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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Cereser L, Zancan G, Giovannini I, Cicciò C, Tinazzi I, Variola A, Bramuzzo M, Murru FM, Marino M, Tullio A, De Vita S, Girometti R, Zabotti A. Asymptomatic sacroiliitis detected by magnetic resonance enterography in patients with Crohn's disease: prevalence, association with clinical data, and reliability among radiologists in a multicenter study of adult and pediatric population. Clin Rheumatol 2022; 41:2499-2511. [PMID: 35389115 DOI: 10.1007/s10067-022-06143-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/11/2022] [Accepted: 03/19/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Patients with Crohn's disease (CD) usually undergo magnetic resonance enterography (MRE) for evaluating small bowel involvement. Musculoskeletal symptoms are the most frequent extraintestinal manifestation in inflammatory bowel diseases, especially in CD, with sacroiliitis at imaging occurring in about 6-46% of patients and possibly correlating with axial spondyloarthritis. The primary study aim was to assess the prevalence of sacroiliitis in adult and pediatric patients with CD performing an MRE. We also evaluated the inter-rater agreement for MRE sacroiliitis and the association between sacroiliitis and patients' clinical data. METHOD We retrospectively identified 100 adult and 30 pediatric patients diagnosed with CD who performed an MRE between December 2012 and May 2020 in three inflammatory bowel disease centers. Two radiologists assessed the prevalence of sacroiliitis at MRE. We evaluated the inter-rater agreement for sacroiliitis with Cohen's kappa and intraclass correlation coefficient statistics and assessed the correlation between sacroiliitis and demographic, clinical, and endoscopic data (Chi-square and Fisher's tests). RESULTS The prevalence of sacroiliitis at MRE was 20% in adults and 6.7% in pediatric patients. The inter-rater agreement for sacroiliitis was substantial (k = 0.62, p < 0.001) in the adults and moderate (k = 0.46, p = 0.011) in the pediatric cohort. Age ≥ 50 years and the time between CD diagnosis and MRE (≥ 86.5 months) were significantly associated with sacroiliitis in adult patients (p = 0.049 and p = 0.038, respectively). CONCLUSIONS Sacroiliitis is a frequent and reliable abnormality at MRE in adult patients with CD, associated with the age of the patients ≥ 50 years and CD duration.
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Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy.
| | - Giovanni Zancan
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Carmelo Cicciò
- Department of Diagnostic Imaging and Interventional Radiology, IRCCS Sacro Cuore Don Calabria Hospital, via don A. Sempreboni, 5-37024, Negrar di Valpolicella, Verona, Italy
| | - Ilaria Tinazzi
- Department of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, via don A. Sempreboni, 5-37024, Negrar di Valpolicella, Verona, Italy
| | - Angela Variola
- Department of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, via don A. Sempreboni, 5-37024, Negrar di Valpolicella, Verona, Italy
| | - Matteo Bramuzzo
- Gastroenterology, Digestive Endoscopy, and Nutrition Unit Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Via dell Istria 65/1-34137, Trieste, Italy
| | - Flora Maria Murru
- Pediatric Radiology, IRCSS Burlo Garofolo, Via dell'Istria 65/1-34137, Trieste, Italy
| | - Marco Marino
- Department of Gastroenterology, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital S. Maria Della Misericordia, p.le S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Annarita Tullio
- Institute of Hygiene and Clinical Epidemiology, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Alen Zabotti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
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Tenório APM, Ferreira-Junior JR, Dalto VF, Faleiros MC, Assad RL, Louzada-Junior P, Nogueira-Barbosa MH, Rangayyan RM, de Azevedo-Marques PM. Radiomic Quantification for MRI Assessment of Sacroiliac Joints of Patients with Spondyloarthritis. J Digit Imaging 2022; 35:29-38. [PMID: 34997373 PMCID: PMC8854535 DOI: 10.1007/s10278-021-00559-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023] Open
Abstract
Spondyloarthritis (SpA) is a group of diseases primarily involving chronic inflammation of the spine and peripheral joints, as evaluated by magnetic resonance imaging (MRI). Considering the complexity of SpA, we performed a retrospective study to discover quantitative/radiomic MRI-based features correlated with SpA. We also investigated different fat-suppression MRI techniques to develop detection models for inflammatory sacroiliitis. Finally, these model results were compared with those of experienced musculoskeletal radiologists, and the concordance level was evaluated. Examinations of 46 consecutive patients were obtained using SPAIR (spectral attenuated inversion recovery) and STIR (short tau inversion recovery) MRI sequences. Musculoskeletal radiologists manually segmented the sacroiliac joints for further extraction of 230 MRI features from gray-level histogram/matrices and wavelet filters. These features were associated with sacroiliitis, SpA, and the current biomarkers of ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), BASDAI (Bath Ankylosing Spondylitis Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), and MASES (Maastricht Ankylosing Spondylitis Enthesis Score). The Mann-Whitney U test showed that the radiomic markers from both MRI sequences were associated with active sacroiliitis and with SpA and its axial and peripheral subtypes (p < 0.05). Spearman's coefficient also identified a correlation between MRI markers and data from clinical practice (p < 0.05). Fat-suppression MRI models yielded performances that were statistically equivalent to those of specialists and presented strong concordance in identifying inflammatory sacroiliitis. SPAIR and STIR acquisition protocols showed potential for the evaluation of sacroiliac joints and the composition of a radiomic model to support the clinical assessment of SpA.
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Affiliation(s)
| | - José Raniery Ferreira-Junior
- Ribeirão Preto Medical School, University of São Paulo, Av. dos Bandeirantes, 3900 Ribeirão Preto, SP 14049-900 São Paulo, Brazil
| | - Vitor Faeda Dalto
- Ribeirão Preto Medical School, University of São Paulo, Av. dos Bandeirantes, 3900 Ribeirão Preto, SP 14049-900 São Paulo, Brazil
| | - Matheus Calil Faleiros
- Ribeirão Preto Medical School, University of São Paulo, Av. dos Bandeirantes, 3900 Ribeirão Preto, SP 14049-900 São Paulo, Brazil
| | - Rodrigo Luppino Assad
- Ribeirão Preto Medical School, University of São Paulo, Av. dos Bandeirantes, 3900 Ribeirão Preto, SP 14049-900 São Paulo, Brazil
| | - Paulo Louzada-Junior
- Ribeirão Preto Medical School, University of São Paulo, Av. dos Bandeirantes, 3900 Ribeirão Preto, SP 14049-900 São Paulo, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- Ribeirão Preto Medical School, University of São Paulo, Av. dos Bandeirantes, 3900 Ribeirão Preto, SP 14049-900 São Paulo, Brazil ,Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, MO USA
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Marconi GF, Simão MN, Fogagnolo F, Nogueira-Barbosa MH. Magnetic resonance imaging evaluation of common peroneal nerve injury in acute and subacute posterolateral corner lesion: a retrospective study. Radiol Bras 2021; 54:303-310. [PMID: 34602665 PMCID: PMC8475171 DOI: 10.1590/0100-3984.2020.0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/10/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate qualitative and quantitative magnetic resonance imaging (MRI) criteria for injury of the common peroneal nerve (CPN) in patients with acute or subacute injuries in the posterolateral corner (PLC) of the knee, as well as to evaluate the reproducibility of MRI evaluation of CPN alterations. Materials and Methods This was a retrospective study of 38 consecutive patients submitted to MRI and diagnosed with acute or subacute injury to the PLC of the knee (patient group) and 38 patients with normal MRI results (control group). Two musculoskeletal radiologists (designated radiologist A and radiologist B, respectively) evaluated the images. Nerve injury was classified as neurapraxia, axonotmesis, or neurotmesis. Signal strength was measured at the CPN, the tibial nerve (TN), and a superficial vein (SV). The CPN/TN and CPN/SV signal ratios were calculated. The status of each PLC structure, including the popliteal tendon, arcuate ligament, lateral collateral ligament, and biceps tendon, was classified as normal, partially torn, or completely torn, as was that of the cruciate ligaments. For the semiquantitative analysis of interobserver agreement, the kappa statistic was calculated, whereas a receiver operating characteristic (ROC) curve was used for the quantitative analysis. Results In the patient group, radiologist A found CPN abnormalities in 15 cases (39.4%)-neurapraxia in eight and axonotmesis in seven-whereas radiologist B found CPN abnormalities in 14 (36.8%)-neurapraxia in nine and axonotmesis in five. The kappa statistic showed excellent interobserver agreement. In the control group, the CPN/TN signal ratio ranged from 0.63 to 1.1 and the CPN/SV signal ratio ranged from 0.16 to 0.41, compared with 1.30-4.02 and 0.27-1.08, respectively, in the patient group. The ROC curve analysis demonstrated that the CPN/TN signal ratio at a cutoff value of 1.39 had high (93.3%) specificity for the identification of nerve damage, compared with 81.3% for the CPN/SV signal ratio at a cutoff value of 0.41. Conclusion CPN alterations are common in patients with PLC injury detected on MRI, and the level of interobserver agreement for such alterations was excellent. Calculating the CPN/TN and CPN/SV signal ratios may increase diagnostic confidence. We recommend systematic analysis of the CPN in cases of PLC injury.
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Affiliation(s)
- Gustavo Felix Marconi
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Marcelo Novelino Simão
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Fabricio Fogagnolo
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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Simão MN, Kobayashi MJ, Hernandes MDA, Nogueira-Barbosa MH. Evaluation of variations of the glenoid attachment of the inferior glenohumeral ligament by magnetic resonance arthrography. Radiol Bras 2021; 54:148-154. [PMID: 34108761 PMCID: PMC8177672 DOI: 10.1590/0100-3984.2020.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the anatomical variations of the attachment of the inferior glenohumeral ligament (IGHL) to the anterior glenoid rim. Materials and Methods This was a retrospective review of 93 magnetic resonance arthrography examinations of the shoulder. Two radiologists, who were blinded to the patient data and were working independently, read the examinations. Interobserver and intraobserver agreement were evaluated. The pattern of IGHL glenoid attachment and its position on the anterior glenoid rim were recorded. Results In 50 examinations (53.8%), the glenoid attachment was classified as type I (originating from the labrum), whereas it was classified as type II (originating from the glenoid neck) in 43 (46.2%). The IGHL emerged at the 4 o'clock position in 58 cases (62.4%), at the 3 o'clock position in 14 (15.0%), and at the 5 o'clock position in 21 (22.6%). The rates of interobserver and intraobserver agreement were excellent. Conclusion Although type I IGHL glenoid attachment is more common, we found a high prevalence of the type II variation. The IGHL emerged between the 3 o'clock and 5 o'clock positions, most commonly at the 4 o'clock position.
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Affiliation(s)
- Marcelo Novelino Simão
- Central Diagnóstico de Ribeirão Preto (Cedirp), Ribeirão Preto, SP, Brazil.,Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | | | - Matheus de Andrade Hernandes
- Central Diagnóstico de Ribeirão Preto (Cedirp), Ribeirão Preto, SP, Brazil.,Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
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