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Pintaric K, Salapura V, Snoj Z, Vovk A, Mijovski MB, Vidmar J. Assessment of short-term effect of platelet-rich plasma treatment of tendinosis using texture analysis of ultrasound images. Radiol Oncol 2023; 57:465-472. [PMID: 38038412 PMCID: PMC10690750 DOI: 10.2478/raon-2023-0054] [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: 06/14/2023] [Accepted: 08/06/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Computer-aided diagnosis (i.e., texture analyses) tools are becoming increasingly beneficial methods to monitor subtle tissue changes. The aim of this pilot study was to investigate short-term effect of platelet rich plasma (PRP) treatment in supraspinatus and common extensor of the forearm tendinosis by using texture analysis of ultrasound (US) images as well as by clinical questionnaires. PATIENTS AND METHODS Thirteen patients (7 male and 6 female, age 36-60 years, mean age 51.2 ± 5.2) were followed after US guided PRP treatment for tendinosis of two tendons (9 patients with lateral epicondylitis and 4 with supraspinatus tendinosis). Clinical and US assessment was performed prior to as well as 3 months after PRP treatment with validated clinical questionnaires. Tissue response in tendons was assessed by using gray level run length matrix method (GLRLM) of US images. RESULTS All patients improved of tendinosis symptoms after PRP treatment according to clinical questionnaires. Almost all GLRLM features were statistically improved 3 months after PRP treatment. GLRLM-long run high gray level emphasis (LRLGLE) revealed the best moderate positive and statistically significant correlation after PRP (r = 0.4373, p = 0.0255), followed by GLRLM-low gray level run emphasis (LGLRE) (r = 0.3877, p = 0.05). CONCLUSIONS Texture analysis of tendinosis US images was a useful quantitative method for the assessment of tendon remodeling after minimally invasive PRP treatment. GLRLM features have the potential to become useful imaging biomarkers to monitor spatial and time limited tissue response after PRP, however larger studies with similar protocols are needed.
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Affiliation(s)
- Karlo Pintaric
- Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vladka Salapura
- Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ziga Snoj
- Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Vovk
- Center of Clinical Physiology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Bozic Mijovski
- Laboratory for Haemostasis and Atherothrombosis, University Medical Center, Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Vidmar
- Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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2
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Harej N, Salapura V, Cvetko E, Snoj Ž. Sonographic assessment of the tarsal tunnel compared to cadaveric findings: a pictorial study. J Ultrason 2023; 23:e144-e150. [PMID: 37701055 PMCID: PMC10494809 DOI: 10.15557/jou.2023.0023] [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: 12/15/2022] [Accepted: 04/11/2023] [Indexed: 09/14/2023] Open
Abstract
Aim of the study To present the anatomy of the tarsal tunnel and demonstrate the utility of high-resolution ultrasound for tarsal tunnel examination. Materials and methods Anatomical dissection was performed on a defrosted cadaveric model to demonstrate relevant anatomical structures of the tarsal tunnel, namely tendons, vessels and nerves. The tibial nerve division was demonstrated; the bifurcation of the tibial nerve into the medial and lateral plantar nerve, two medial calcaneal nerve branches were identified originating from the tibial nerve and the Baxter's nerve was identified as the first branch of the lateral plantar nerve. An ultrasound examination of the tarsal tunnel region was performed on a healthy volunteer. A linear probe was used and sonographic images were obtained at different levels of the tarsal tunnel: the proximal tarsal tunnel, the tibial nerve division into the medial and lateral plantar nerves, the distal tarsal tunnel, the Baxter's nerve branching point and the Baxter's nerve crossing between the abductor hallucis and quadratus plantae muscle. Results Sonographic images were correlated with anatomical structures exposed during cadaveric dissection. Conclusions We presented the anatomic-sonographic correlation of the tarsal tunnel and showed that high-resolution ultrasound is a useful imaging modality for tarsal tunnel assessment.
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Affiliation(s)
- Nežka Harej
- University Medical Centre Ljubljana, Clinical Radiology Institute, Ljubljana, Slovenia
| | - Vladka Salapura
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Erika Cvetko
- Institute of Anatomy, Faculty of Medicine, Ljubljana, Slovenia
| | - Žiga Snoj
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
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3
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Zupan A, Salapura V, Šekoranja D, Pižem J. Subcutaneous chondromyxoid fibroma with a novel PNISR::GRM1 fusion-report of a primary soft tissue tumour without connection to an underlying bone. Virchows Arch 2023; 482:917-921. [PMID: 36810795 PMCID: PMC10156755 DOI: 10.1007/s00428-023-03519-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
Chondromyxoid fibroma (CMF) is a rare benign bone tumour. While CMF located entirely on the surface of a bone (i.e. juxtacortical CMF) has been well characterised, CMF has not so far been convincingly documented to arise in soft tissues without connection to an underlying bone.We report a subcutaneous CMF in a 34-year-old male, located on the distal medial aspect of the right thigh without any connection with the femur. The tumour measured 15 mm, it was well-circumscribed and displayed typical morphological features of a CMF. At the periphery, there was a small area of metaplastic bone. Immunohistochemically, the tumour cells were diffusely positive for smooth muscle actin and GRM1, and negative for S100 protein, desmin and cytokeratin AE1AE3. Whole transcriptome sequencing revealed a novel PNISR::GRM1 gene fusion.Our case indicates that CMF should be included in the differential diagnosis of soft tissue (including subcutaneous) tumours composed of spindle/ovoid cells, with a lobular architecture and chondromyxoid matrix. The diagnosis of CMF arising in soft tissues can be confirmed by identifying a GRM1 gene fusion or GRM1 expression by immunohistochemistry.
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Affiliation(s)
- Andrej Zupan
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Vladka Salapura
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Daja Šekoranja
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Jože Pižem
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia.
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Snoj Ž, Salapura V. Ultrasound‐guided transforaminal approach for nusinersen delivery in adult
SMA
patients with challenging access. Muscle Nerve 2022; 65:585-589. [DOI: 10.1002/mus.27518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Ž. Snoj
- Radiology Institute, University Medical Centre Ljubljana, Zaloška 7 Ljubljana Slovenia
- Faculty of Medicine University of Ljubljana, Vrazov trg 2 Ljubljana Slovenia
| | - V. Salapura
- Radiology Institute, University Medical Centre Ljubljana, Zaloška 7 Ljubljana Slovenia
- Faculty of Medicine University of Ljubljana, Vrazov trg 2 Ljubljana Slovenia
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Meglic U, Salapura V, Zupanc O. MRI Findings of Early Osteoarthritis in Patients Who Sustained Septic Arthritis of the Knee After ACL Reconstruction. Orthop J Sports Med 2021; 9:23259671211052519. [PMID: 34778482 PMCID: PMC8573493 DOI: 10.1177/23259671211052519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Although a rare complication, septic arthritis (SA) after anterior cruciate ligament (ACL) reconstruction has potentially devastating consequences for the knee joint. Purpose: To prospectively analyze, at a mean 4-year follow-up, subjective, clinical, radiographic, and magnetic resonance imaging (MRI) findings between patients with SA and those with no septic complication after ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Of 2006 ACL reconstructions performed between 2004 and 2014, a total of 20 patients experienced SA. All patients were treated with arthroscopic irrigation and graft-retaining debridement immediately after diagnosis and at least 6 weeks of antibiotic treatment. After the exclusion process, 18 patients were included in the SA group and 20 in the control group. At final follow-up at a mean 48 months, a physical examination, KT-1000 arthrometer laxity test, Lysholm knee score, Tegner activity score, and International Knee Documentation Committee radiographic score were completed and then compared with preoperative data. The Boston-Leeds Osteoarthritis Knee Score was used for MRI evaluation at final follow-up to note chondral changes. Results: No significant differences between the SA and control groups were observed in pre- and perioperative variables that could indicate a higher incidence of early osteoarthritis (OA). Although range of motion and knee stability were not significantly different between the groups at final follow-up, the Lysholm score (mean ± SD, 79.8 ± 13.1 vs 90.9 ± 8.6; P < .01) and Tegner score (6.0 ± 1.1 vs 7.0 ± 1.4; P = .03) were significantly lower in the SA group as compared with the control group. MRI evaluation at final follow-up demonstrated a significantly higher degree of early knee OA in the SA group versus the control group. However, no differences in the degree of OA were seen on plain radiographs at final follow-up between the groups. Conclusion: MRI evaluation provided signs of worsened chondral state in the SA group, which could be associated with reduced functional outcome and return to sports. In contrast to radiograph analyses, MRI was excellent at distinguishing damage to the cartilage and can be useful in early follow-up evaluation of patients with SA after ACL reconstruction.
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Affiliation(s)
- Uros Meglic
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vladka Salapura
- Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Oskar Zupanc
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Matičič UB, Šumak R, Omejec G, Salapura V, Snoj Ž. Ultrasound-guided injections in pelvic entrapment neuropathies. J Ultrason 2021; 21:e139-e146. [PMID: 34258039 PMCID: PMC8264816 DOI: 10.15557/jou.2021.0023] [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: 02/20/2021] [Accepted: 04/09/2021] [Indexed: 11/22/2022] Open
Abstract
Pelvic entrapment neuropathies represent a group of chronic pain syndromes that significantly impede the quality of life. Peripheral nerve entrapment occurs at specific anatomic locations. There are several causes of pelvic entrapment neuropathies, such as intrinsic nerve abnormality or inflammation with scarring of surrounding tissues, and surgical interventions in the abdomen, pelvis and the lower limbs. Entrapment neuropathies in the pelvic region are not widely recognized, and still tend to be underdiagnosed due to numerous differential diagnoses with overlapping symptoms. However, it is important that entrapment neuropathies are correctly diagnosed, as they can be successfully treated. The lateral femoral cutaneous nerve, ischiadic nerve, genitofemoral nerve, pudendal nerve, ilioinguinal nerve and obturator nerve are the nerves most frequently causing entrapment neuropathies in the pelvic region. Understanding the anatomy as well as nerve motor and sensory functions is essential in recognizing and locating nerve entrapment. The cornerstone of the diagnostic work-up is careful physical examination. Different imaging modalities play an important role in the diagnostic process. Ultrasound is a key modality in the diagnostic work-up of pelvic entraptment neuropathies, and its use has become increasingly widespread in therapeutic procedures. In the article, the authors describe the background of pelvic entrapment neuropathies with special focus on ultrasound-guided injections.
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Affiliation(s)
- Urša Burica Matičič
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia
| | - Rok Šumak
- Department of General Gynaecology and Urogynaecology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Gregor Omejec
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Zaloška 7, Ljubljana, Slovenia
| | - Vladka Salapura
- Radiology Institute, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, Slovenia
| | - Žiga Snoj
- Radiology Institute, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, Slovenia
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7
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Snoj Ž, Hebar T, Sconfienza LM, Vanhoenacker FMH, Shahabpour M, Salapura V, Isaac A, Drakonaki E, Vasilev Y, Drape JL, Adriaensen M, Friedrich K, Guglielmi G, Vieira A, Sanal HT, Kerttula L, Hellund JC, Nagy J, Heuck A, Rutten M, Tzalonikou M, Hansen U, Niemunis-Sawicka J, Becce F, Silvestri E, Juan ELS, Wörtler K. Erratum: Present Status of Musculoskeletal Radiology in Europe: International Survey by the European Society of Musculoskeletal Radiology (ESSR). Semin Musculoskelet Radiol 2020; 24:e1. [DOI: 10.1055/s-0040-1722564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Žiga Snoj
- Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Timea Hebar
- Radiology Institute, University Medical Centre Maribor, Slovenia
| | - Luca Maria Sconfienza
- IRCCS IstitutoOrtopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Universität degli studi di Milano, Italy
| | - Filip Maria H.M. Vanhoenacker
- Department of Radiology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
- University of Ghent, Ghent, Belgium
| | - Maryam Shahabpour
- Department of Radiology, UniversitairZiekenhuis Brussel, Brussels, Belgium
| | - Vladka Salapura
- Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Amanda Isaac
- Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
- Kings College London (KCL), London, United Kingdom
| | - Eleni Drakonaki
- Private Institution of Ultrasonography and MSK Radiology, Heraklion, Greece
- Department of Anatomy, Medical School of the European University of Cyprus, Nicosia, Cyprus
| | - Yurii Vasilev
- Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, The Netherlands
| | - Klaus Friedrich
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Wien, Austria
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Alberto Vieira
- São João University Hospital, Porto Medical School - FMUP, Porto, Portugal
| | - Hatice Tuba Sanal
- Department of Radiology, Health Sciences University, Gülhane Medical School, Ankara, Turkey
| | | | | | - Judit Nagy
- Innomed Medical, Inc., Budapest, Hungary
| | - Andreas Heuck
- Radiologisches Zentrum München Pasing RZM, Munich, Germany
| | - Matthieu Rutten
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen
| | | | - Ulrich Hansen
- Copenhagen University Hospital Bispebjerg-Frederiksberg, Frederiksberg
| | | | - Fabio Becce
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Enzo Silvestri
- Department of Radiology, OspedaleEvangelicoInternazionale, Genoa, Italy
| | | | - Klaus Wörtler
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
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Plut D, Faganel Kotnik B, Preložnik Zupan I, Ključevšek D, Vidmar G, Snoj Ž, Salapura V. Detection and evaluation of haemophilic arthropathy: Which tools may be considered more reliable. Haemophilia 2020; 27:156-163. [PMID: 33164312 DOI: 10.1111/hae.14153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/23/2020] [Revised: 08/06/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Progressive arthropathy is the main cause of morbidity in patients with severe haemophilia. Diagnostic imaging can detect even subclinical arthropathy and impact prophylactic treatment. However, in most clinical settings the regular joint evaluation and follow-up are based on clinical evaluation and patient's personal reporting of problems, while diagnostic imaging is not regularly employed. AIM The aim of our prospective study was to assess how ultrasound (US), clinical examination, patient's subjective assessment and certain laboratory biomarkers correlate with magnetic resonance imaging (MRI) for detection and evaluation of haemophilic arthropathy in order to determine which tool is the most reliable. METHODS The study included 30 patients with severe haemophilia (age range 16-49 years). MRI (IPSG), US (HEAD-US), clinical examination (HJHS 2.1) and patient's subjective assessment of elbows, knees and ankles were performed; additionally, blood samples for laboratory analysis were taken (s-25-OH vitamin D, s-ferritin, s-C-terminal telopeptide of type I collagen, s-N-terminal propeptide of type I procollagen and s-cartilage oligomeric matrix protein). MRI results were used as a reference standard for joint status. Pearson's r was used to assess correlation of other methods with MRI. RESULTS The correlation with MRI was the highest for US (r = .92), considerably higher than for clinical evaluation (r = .62) and patient's subjective assessment (r = .66). There was no correlation between the presence or degree of haemophilic arthropathy and any of the laboratory biomarkers. CONCLUSION The results of our study warrant the inclusion of US into the regular follow-up of patients with severe haemophilia, where the equipment and staffing permit.
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Affiliation(s)
- Domen Plut
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Faganel Kotnik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Irena Preložnik Zupan
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Damjana Ključevšek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gaj Vidmar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia.,FAMNIT, University of Primorska, Koper, Slovenia
| | - Žiga Snoj
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vladka Salapura
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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9
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Snoj Ž, Hebar T, Sconfienza LM, Vanhoenacker FMHM, Shahabpour M, Salapura V, Isaac A, Drakonaki E, Vasilev Y, Drape JL, Adriaensen M, Friedrich K, Guglielmi G, Vieira A, Sanal HT, Kerttula L, Hellund JC, Nagy J, Heuck A, Rutten M, Tzalonikou M, Hansen U, Niemunis-Sawicka J, Becce F, Silvestri E, Juan ELS, Wörtler K. Present Status of Musculoskeletal Radiology in Europe: International Survey by the European Society of Musculoskeletal Radiology. Semin Musculoskelet Radiol 2020; 24:323-330. [PMID: 32987429 DOI: 10.1055/s-0040-1713119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
No official data exist on the status of musculoskeletal (MSK) radiology in Europe. The Committee for National Societies conducted an international survey to understand the status of training, subspecialization, and local practice among the European Society of Musculoskeletal Radiology (ESSR) partner societies. This article reports the results of that survey. An online questionnaire was distributed to all 26 European national associations that act as official partner societies of the ESSR. The 24 questions were subdivided into six sections: society structure, relationship with the national radiological society, subspecialization, present radiology practice, MSK interventional procedures, and MSK ultrasound. The findings of our study show a lack of standardized training and/or accreditation methods in the field of MSK radiology at a national level. The European diploma in musculoskeletal radiology is directed to partly overcome this problem; however, this certification is still underrecognized. Using certification methods, a more homogeneous European landscape could be created in the future with a view to subspecialist training. MSK ultrasound and MSK interventional procedures should be performed by a health professional with a solid knowledge of the relevant imaging modalities and sufficient training in MSK radiology. Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology. KEY POINTS: · Standardized training and/or accreditation methods in the field of MSK radiology is lacking at a national level.. · With certification methods, such as the European diploma in musculoskeletal radiology, a more homogeneous European landscape could be created in the future with a view to subspecialist training.. · Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology..
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Affiliation(s)
- Žiga Snoj
- Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Timea Hebar
- Radiology Institute, University Medical Centre Maribor, Slovenia
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Universität degli studi di Milano, Italy
| | - Filip Maria H M Vanhoenacker
- Department of Radiology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium.,University of Ghent, Ghent, Belgium
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Vladka Salapura
- Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Amanda Isaac
- Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.,Kings College London (KCL), London, United Kingdom
| | - Eleni Drakonaki
- Private Institution of Ultrasonography and MSK Radiology, Heraklion, Greece.,Department of Anatomy, Medical School of the European University of Cyprus, Nicosia, Cyprus
| | - Yurii Vasilev
- Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, The Netherlands
| | - Klaus Friedrich
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Wien, Austria
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Alberto Vieira
- São João University Hospital, Porto Medical School - FMUP, Porto, Portugal
| | - Hatice Tuba Sanal
- Department of Radiology, Health Sciences University, Gülhane Medical School, Ankara, Turkey
| | | | | | - Judit Nagy
- Innomed Medical, Inc., Budapest, Hungary
| | - Andreas Heuck
- Radiologisches Zentrum München Pasing RZM, Munich, Germany
| | - Matthieu Rutten
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Ulrich Hansen
- Copenhagen University Hospital Bispebjerg-Frederiksberg, Frederiksberg, Denmark
| | | | - Fabio Becce
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Enzo Silvestri
- Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy
| | | | - Klaus Wörtler
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
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10
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Šekoranja D, Zupan A, Mavčič B, Martinčič D, Salapura V, Snoj Ž, Limpel Novak AK, Pižem J. Novel ASAP1-USP6, FAT1-USP6, SAR1A-USP6, and TNC-USP6 fusions in primary aneurysmal bone cyst. Genes Chromosomes Cancer 2020; 59:357-365. [PMID: 32011035 DOI: 10.1002/gcc.22836] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 12/16/2019] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 12/24/2022] Open
Abstract
Aneurysmal bone cyst (ABC) is a benign but locally aggressive neoplasm, with a tendency for local recurrence. In contrast to other bone tumors with secondary cystic change, ABC is characterized by USP6 gene rearrangement. There is a growing list of known USP6 fusion partners, characterization of which has been enabled with the advent of next-generation sequencing (NGS). The list of known fusion partners includes CDH11, CNBP, COL1A1, CTNNB1, EIF1, FOSL2, OMD, PAFAH1B1, RUNX2, SEC31A, SPARC, STAT3, THRAP3, and USP9X. Using NGS, we analyzed a series of 11 consecutive ABCs and identified USP6 fusions in all cases, providing further evidence that USP6 fusions are universally present in primary ABCs. We identified four novel fusion partners in five ABCs and confirmed them by RT-PCR and Sanger sequencing, ASAP1, FAT1, SAR1A, and TNC (in two cases). Because of high sensitivity and specificity, detection of a USP6 fusion by NGS may assist in differentiating between ABC and its mimics, especially in small biopsy samples when a definite diagnosis cannot be achieved on morphological grounds alone. Further studies with a large number of cases and follow-up are needed to determine whether different fusion partners are associated with specific clinical and pathologic features of ABCs.
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Affiliation(s)
- Daja Šekoranja
- Institute of Pathology, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Andrej Zupan
- Institute of Pathology, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Blaž Mavčič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - David Martinčič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Vladka Salapura
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Žiga Snoj
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Ana K Limpel Novak
- Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jože Pižem
- Institute of Pathology, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
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11
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Snoj Ž, Vidmar J, Gergar M, Plut D, Salapura V. T2 distribution profiles are a good way to show cartilage regional variabilities and cartilage insufficiency. Skeletal Radiol 2020; 49:137-145. [PMID: 31270567 DOI: 10.1007/s00256-019-03256-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To use T2 relaxation time distribution profiles to assess inter-group regional differences along articular surfaces and to evaluate the feasibility of this analysis for comparison of cartilage insufficiency. MATERIALS AND METHODS Twelve pairs matched according to age and gender (12 healthy volunteers and 12 patients after anterior cruciate ligament reconstruction (ACLR)) underwent 3-T MRI. T2 maps were calculated from six time echo images of the mid-sagittal slice in the lateral and medial compartment. The femoral and tibial cartilage was analyzed by measuring T2 distribution profiles along the articular surfaces. RESULTS T2 distribution profiles were generated along the length of the articular surface in the femorotibial compartments. Differences in the T2 distribution profiles between the tibial and femoral cartilage as well as between the cartilage of the femoral condyles were identified in healthy individuals. T2 distribution profiles clearly demonstrated cartilage insufficiency in the weight-bearing areas for subjects in the ACLR group. CONCLUSIONS T2 distribution profiles can identify regional differences in femoral and tibial cartilage. The T2 distribution profile pattern is preserved with cartilage insufficiency, however, with important differences in T2 values for the ACLR group in weight-bearing areas.
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Affiliation(s)
- Ž Snoj
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
| | - J Vidmar
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Institute of Physiology, Faculty of Medicine Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia
| | - M Gergar
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - D Plut
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - V Salapura
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
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Šekoranja D, Boštjančič E, Salapura V, Mavčič B, Pižem J. Primary aneurysmal bone cyst with a novel SPARC-USP6 translocation identified by next-generation sequencing. Cancer Genet 2018; 228-229:12-16. [DOI: 10.1016/j.cancergen.2018.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/01/2018] [Accepted: 07/11/2018] [Indexed: 12/15/2022]
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Sudoł-Szopińska I, Znajdek M, Gietka P, Vasilevska-Nikodinovska V, Patrovic L, Salapura V. Imaging of juvenile spondyloarthritis. Part II: Ultrasonography and magnetic resonance imaging. J Ultrason 2017; 17:176-181. [PMID: 29075522 PMCID: PMC5647612 DOI: 10.15557/jou.2017.0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/28/2017] [Revised: 06/13/2017] [Accepted: 06/18/2017] [Indexed: 12/26/2022] Open
Abstract
Juvenile spondyloarthropathies are mainly manifested by symptoms of peripheral arthritis and enthesitis. Early involvement of sacroiliac joints and spine is exceptionally rare in children; this usually happens in adulthood. Conventional radiographs visualize late inflammatory lesions. Early diagnosis is possible with the use of ultrasonography and magnetic resonance imaging. The first part of the article presented classifications and radiographic presentation of juvenile spondyloarthropathies. This part discusses changes seen on ultrasonography and magnetic resonance imaging. In patients with juvenile spondyloarthropathies, these examinations are conducted to diagnose inflammatory lesions in peripheral joints, tendon sheaths, tendons and bursae. Moreover, magnetic resonance also shows subchondral bone marrow edema, which is considered an early sign of inflammation. Ultrasonography and magnetic resonance imaging do not show specific lesions for any rheumatic disease. Nevertheless, they are conducted for early diagnosis, treatment monitoring and identifying complications. This article presents a spectrum of inflammatory changes and discusses the diagnostic value of ultrasonography and magnetic resonance imaging.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Medical Imaging, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Michał Znajdek
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Piotr Gietka
- Clinic of Pediatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Lukas Patrovic
- MRI Department, Jessenius, Diagnostic Center, Špitálska 6, Nitra, Slovakia
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14
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Snoj Ž, Zupanc O, Stražar K, Salapura V. A descriptive study of potential effect of anterior tibial translation, femoral tunnel and anterior cruciate ligament graft inclination on clinical outcome and degenerative changes. Int Orthop 2017; 41:789-796. [PMID: 28064350 DOI: 10.1007/s00264-016-3386-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/20/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is no evidence that anatomically correct anterior cruciate ligament reconstruction (ACLR) offers lower rate of degenerative changes development or that it would lead to a better outcome. The significance and understanding of the abnormal anterior tibial translation (ATT) in ACLR patients is yet to be established. METHODS Sixty subjects (40 patients at 5.9 years after ACLR, 20 healthy controls) underwent 3 T MRI. Quantitative cartilage T2 mapping and morphological whole organ magnetic resonance imaging score (WORMS) evaluation was performed. Self-reported questionnaires were used for subjective clinical evaluation. Correlations were calculated with the following MRI measurements; femoral tunnel inclination, ACL graft inclination, lateral and medial compartment ATT. RESULTS In the ACLR group positive correlation was found between the patellar cartilage T2 values and sagittal ACL graft inclination. In the ACLR group lateral compartment ATT showed negative correlation with ACL graft inclination and subjective clinical evaluation, and positive correlation with morphological degenerative changes. Femoral tunnel showed positive correlation with ACL graft inclination in the same plane. CONCLUSIONS Increased ATT offers worse clinical outcome and increased rate of degenerative changes. Furthermore, ATT is affected by the ACL inclination. Inclination of the drilling tunnel affects ACL graft inclination; thereby independent drilling techniques provide superior results of anatomical ACL graft positioning.
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Affiliation(s)
- Žiga Snoj
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
| | - Oskar Zupanc
- Department of Orthopaedic Surgery of the Ljubljana University Medical Centre, Zaloška 9, 1000, Ljubljana, Slovenia
| | - Klemen Stražar
- Department of Orthopaedic Surgery of the Ljubljana University Medical Centre, Zaloška 9, 1000, Ljubljana, Slovenia
| | - Vladka Salapura
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
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15
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Kocutar T, Snoj Ž, Salapura V. Complicated acute haematogenous osteomyelitis with fatal outcome following a closed clavicle fracture-a case report and literature review. BJR Case Rep 2016; 2:20150389. [PMID: 30363605 PMCID: PMC6180849 DOI: 10.1259/bjrcr.20150389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/23/2015] [Accepted: 12/30/2015] [Indexed: 12/18/2022] Open
Abstract
Among adults, post-traumatic osteomyelitis following a closed fracture is a rarely described entity in the literature, with the involvement of the clavicle bone being particularly uncommon. Early diagnosis and treatment of clavicular osteomyelitis is crucial to prevent serious consequences such as sepsis, mediastinitis and haemorrhage from the great vessels. A 54-year-old male patient presented to the emergency department complaining of fatigue and limited mobility after having fallen and hit his head and right shoulder 10 days previously. No major injury was found during the diagnostic procedure, and the patient was discharged. 2 weeks later, the patient returned with clinical signs of right upper arm cellulitis and probable sepsis. Diagnostic ultrasound imaging and MRI of the right upper arm, as well as re-examination of the X-ray image, confirmed acute complex osteomyelitis of the right clavicle following an overlooked clavicle fracture. Microbiological analysis confirmed clavicular osteomyelitis caused by Escherichia coli septicaemia. Despite prompt treatment with i.v. antibiotics and surgery, the patient's condition rapidly deteriorated and he passed away. Our case demonstrates the critical importance of early diagnosis and appropriate treatment of a closed fracture. Late diagnosis may lead to severe complications, such as complicated osteomyelitis and sepsis, and even a fatal outcome. Furthermore, a brief literature review is presented of previously reported acute osteomyelitis following a closed fracture, including evidence of affected bone and isolated pathogens. Although uncommon, osteomyelitis should be considered a possible cause of a deteriorating clinical condition in patients with a history of recent trauma.
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Affiliation(s)
- Tina Kocutar
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Žiga Snoj
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vladka Salapura
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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16
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Salapura V, Jeromel M. Minimally invasive (percutaneous) treatment of metastatic spinal and extraspinal disease--a review. Acta Clin Croat 2014; 53:44-54. [PMID: 24974666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Metastatic tumors are the most common malignancy of bone. Many patients with spinal metastases present with pain and pathologic fractures. The advent of interventional radiology resulted in alternative and less invasive treatment of these patients. This article presents minimally invasive (percutaneous) procedures that are currently in use, i.e. vertebroplasty, kyphoplasty, osteoplasty, radiofrequency ablation, cryoablation, and transarterial embolization. Indications, contraindications, results and complications are also discussed. According to our current knowledge of the results reported in the literature, minimally invasive techniques are successful methods for the treatment of metastatic spinal and extraspinal disease and can be used as alternative treatment to standard surgical or non-surgical procedures.
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Abstract
BACKGROUND The introduction of stent grafts for thoracic and abdominal aorta (T / EVAR) has raised the demand for percutaneous closure devices for larger femoral arterial access sites. The aim of our study was to evaluate the success and complication rate of completely percutaneous T / EVAR with Prostar XL® and surgical haemostasis over a 50- month period. PATIENTS AND METHODS Between December 16th 2005 and February 17th 2010 T / EVAR was performed in 306 patients with 568 arterial access sites with diameters of 12 to 24 Fr. The exclusion criteria for percutaneous haemostasis were a calcified anterior wall at the puncture site and / or a stenotic common femoral artery, seen on computed tomographic angiography. RESULTS Surgical haemostasis was performed in 184 (32.4 %, o-T / EVAR group) while percutaneous haemostasis was attempted at 384 sites (67.6 %, p-T / / EVAR group). Most of the procedures were elective; five of twelve emergency patients had percutaneous haemostasis that was successful in all. Percutaneous haemostasis failed at 23 sites. No data about follow-up was recorded for 54 sites (9,5 %). The technical success rate of percutaneous haemostasis was 93.6 % (338 / 361 sites). A larger size of the access site resulted in significantly more complications of haemostasis in both groups (p-T / EVAR group p = 0.019; o-T / EVAR group p = 0.003). p-T / EVAR caused more mild complications compared to o-T / EVAR (p = 0.03). No deaths as consequence of failed haemostasis were recorded. CONCLUSIONS Complete percutaneous T / EVAR is technically feasible and safe in a majority of patients. Good patient selection based on adequate pre-procedural imaging and technical expertise of the operators are key to success. Surgical back-up is strongly recommended to assist in those patients in whom p-T / EVAR fails.
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Affiliation(s)
| | | | - Nina Boc
- Clinical Radiology Institute, UMC Ljubljana, Slovenia
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18
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Popovic P, Lukic S, Mijailovic M, Salapura V, Garbajs M, Surlan Popovic K. Percutaneous radiofrequency ablation of small renal cell carcinoma: technique, complications, and outcomes. J BUON 2012; 17:621-626. [PMID: 23335516] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Imaging-guided radiofrequency ablation (RFA) is an option for treatment in patients with early-stage small renal cell carcinomas (RCCs). RFA has been introduced to treat focal renal tumors, particularly incidental lesions <3 cm in elderly patients and those with comorbid conditions. Other uses have included treatment in patients with von Hippel-Lindau syndrome and other diseases that predispose patients to multiple renal carcinomas, where renal parenchymal preservation is desired. It appears that this technique has a low complication rate, preserves renal function, is well tolerated by the patients, and, in a high percentage of patients, can eradicate small renal tumors. Techniques, patient selection, complications, and results are discussed.
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Affiliation(s)
- P Popovic
- Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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Božič-Mijovski M, Bedenčič M, Stegnar M, Salapura V, Ježovnik MK, Kozak M, Blinc A. Nurr1 haplotypes are associated with femoropopliteal restenosis/re-occlusion after percutaneous transluminal angioplasty. Eur J Vasc Endovasc Surg 2012; 43:337-8. [PMID: 22230598 DOI: 10.1016/j.ejvs.2011.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 12/02/2011] [Indexed: 11/16/2022]
Abstract
Restenosis/re-occlusion remains a frequent complication in the first year after percutaneous transluminal angioplasty (PTA). In this study, association of nuclear receptor related 1 protein (Nurr1) haplotypes to the restenosis/re-occlusion rate after femoropopliteal PTA was investigated. Patients (n = 142) with disabling claudication or critical limb ischaemia, who had undergone technically successful femoropopliteal PTA, were prospectively followed up by vascular ultrasound imaging 12 months after the procedure. Nurr1 haplotypes 2 and 3 were associated significantly with the restenosis/re-occlusion rate (adjusted odds ratio 1.6, 95% confidence interval (CI) 1.1-2.3 and 2.0, 1.3-2.8, respectively) on univariate analysis.
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Affiliation(s)
- M Božič-Mijovski
- Department of Vascular Diseases, University Medical Centre, Zaloska 7, Ljubljana, Slovenia
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Kuhelj D, Zdesar U, Jevtic V, Skrk D, Omahen G, Zontar D, Surlan M, Glusic M, Popovic P, Kocijancic IJ, Salapura V. Risk of deterministic effects during endovascular aortic stent graft implantation. Br J Radiol 2010; 83:958-63. [PMID: 20965906 DOI: 10.1259/bjr/64623458] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Since the 1990s, stent graft implantation for aortic pathology has become an alternative to extensive surgical procedures in some patients. Indeed, many patients with such pathology are now treated endovascularly. Only limited data concerning the risk of a deterministic effect during aortic stent graft implantation are available Accordingly, 179 consecutive patients treated in our institute between October 2002 and July 2008 with endovascular aortic stent grafts were included in this study. Dosimetric data (kerma area product (KAP) and cumulative dose at the interventional reference point (CD(irp))) from radiograph reports were analysed for 172 patients. On a group of 19 patients, GAFCHROMIC XR type dosimetric films were also used to verify the automatic measurements. Readings from the integrated KAP meter were found to be too high and were therefore corrected - KAP to dose area product (DAP) and CD(irp) to entrance skin dose (ESD). Median DAP was 153 Gy cm² (35-700 Gy cm²) and median ESD was 0.44 Gy (0.12-2.73 Gy). Recorded dosimetric quantities were found to be good predictors of the skin dose and highlighted 4 patients (2.3%) who received skin doses that might cause possible deterministic effects. Endovascular stent graft implantation is less invasive than a surgical procedure and is widely used; mid-term results are encouraging. In a small number of patients, deterministic effects can occur even in departments with well-trained staff. Operators should inform the patients of possible skin injury after receiving high doses of ionising radiation and proper support must be available should that occur.
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Affiliation(s)
- D Kuhelj
- Clinical Radiology Institute, University Medical Center, Ljubljana, Slovenia.
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Allen F, Almasi G, Andreoni W, Beece D, Berne BJ, Bright A, Brunheroto J, Cascaval C, Castanos J, Coteus P, Crumley P, Curioni A, Denneau M, Donath W, Eleftheriou M, Flitch B, Fleischer B, Georgiou CJ, Germain R, Giampapa M, Gresh D, Gupta M, Haring R, Ho H, Hochschild P, Hummel S, Jonas T, Lieber D, Martyna G, Maturu K, Moreira J, Newns D, Newton M, Philhower R, Picunko T, Pitera J, Pitman M, Rand R, Royyuru A, Salapura V, Sanomiya A, Shah R, Sham Y, Singh S, Snir M, Suits F, Swetz R, Swope WC, Vishnumurthy N, Ward TJC, Warren H, Zhou R. Blue Gene: A vision for protein science using a petaflop supercomputer. ACTA ACUST UNITED AC 2001. [DOI: 10.1147/sj.402.0310] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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