Effect of weight loss on knee joint synovitis over 48 months and mediation by subcutaneous fat around the knee: data from the Osteoarthritis Initiative

BACKGROUND

Obesity influences the development of osteoarthritis via low-grade inflammation. Progression of local inflammation (= synovitis) increased with weight gain in overweight and obese women compared to stable weight. Synovitis could be associated with subcutaneous fat (SCF) around the knee. Purpose of the study was to investigate the effect of weight loss on synovitis progression and to assess whether SCF around the knee mediates the relationship between weight loss and synovitis progression.

METHODS

We included 234 overweight and obese participants (body mass index [BMI] ≥ 25 kg/m2) from the Osteoarthritis Initiative (OAI) with > 10% weight loss (n = 117) or stable overweight (< ± 3% change, n = 117) over 48 months matched for age and sex. In magnetic resonance imaging (MRI) at baseline and 48 months, effusion-synovitis and Hoffa-synovitis using the MRI Osteoarthritis Knee Score (MOAKS) and average joint-adjacent SCF (ajSCF) were assessed. Odds-ratios (ORs) for synovitis progression over 48 months (≥ 1 score increase) were calculated in logistic regression models adjusting for age, sex, baseline BMI, Physical Activity Scale for the Elderly (PASE), and baseline SCF measurements. Mediation of the effect of weight loss on synovitis progression by local SCF change was assessed.

RESULTS

Odds for effusion-synovitis progression decreased with weight loss and ajSCF decrease (odds ratio [OR] = 0.61 and 0.56 per standard deviation [SD] change, 95% confidence interval [CI] 0.44, 0.83 and 0.40, 0.79, p = 0.002 and 0.001, respectively), whereas odds for Hoffa-synovitis progression increased with weight loss and ajSCF decrease (OR = 1.47 and 1.48, CI 1.05, 2.04 and 1.02, 2.13, p = 0.024 and 0.038, respectively). AjSCF decrease mediated 39% of the effect of weight loss on effusion-synovitis progression.

CONCLUSIONS

Effusion-synovitis progression was slowed by weight loss and decrease in local subcutaneous fat. Hoffa-synovitis characterized by fluid in the infrapatellar fat pad increased at the same time, suggesting a decreasing fat pad rather than active synovitis. Decrease in local subcutaneous fat partially mediated the systemic effect of weight loss on synovitis.

Discrimination of leptomeningeal carcinomatosis and meningeal inflammation/infection with internal acoustic canal enhancement

PURPOSE

The purpose of this study is to investigate whether the presence and pattern of enhancement at the internal acoustic canal (IAC) could help in discriminating between leptomeningeal carcinomatosis (LCa) and meningeal inflammation/infection (MMI).

METHODS

Magnetic resonance (MR) images of patients with leptomeningeal enhancement were retrospectively evaluated. MR images of the LCa group (n = 33), MMI group (n = 19) and control group (n = 33) were evaluated for the presence, type (moderate/prominent), and localization (unilateral/bilateral) of the IAC enhancement.

RESULTS

The presence of IAC enhancement was significantly more common in patients with LCa (p < 0.001). In 73.7 % of patients with MMI, no contrast enhancement was observed in the IAC. In patients with contrast enhancement in the IAC, the risk of LCa in the etiology is 20 times greater than the risk of having MMI. Seventy-five percent of the IAC enhancement seen in LCa patients and 20 % of the IAC enhancements seen in MMI patients was bilateral. This difference was statistically significant (p = 0.029).

CONCLUSION

Intense contrast enhancement of the IAC can be a marker for LCa.

Biomarkers of Cartilage Composition

Magnetic resonance imaging (MRI) has significantly advanced the understanding of osteoarthritis (OA) because it enables visualization of noncalcified tissues. Cartilage is avascular and nurtured by diffusion, so it has a very low turnover and limited capabilities of repair. Consequently, prevention of structural and detection of premorphological damage is key in maintaining cartilage health. The integrity of cartilage composition and ultrastructure determines its mechanical properties but is not accessible to morphological imaging. Therefore, various techniques of compositional MRI with and without use of intravenous contrast medium have been developed. Spin-spin relaxation time (T2) and spin-lattice relaxation time constant in rotating frame (T1rho) mapping, the most studied cartilage biomarkers, were included in the recent standardization effort by the Quantitative Imaging Biomarkers Alliance (QIBA) that aims to make compositional MRI of cartilage clinically feasible and comparable. Additional techniques that are less frequently used include ultrashort echo time with T2*, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), glycosaminoglycan concentration by chemical exchange-dependent saturation transfer (gagCEST), sodium imaging, and diffusion-weighted MRI.

Musculoskeletal infections through direct inoculation

Musculoskeletal infections consist of different clinical conditions that are commonly encountered in daily clinical settings. As clinical findings and even laboratory tests cannot always be specific, imaging plays a crucial role in the diagnosis and treatment of these cases. Musculoskeletal infections most commonly occur secondary to direct inoculation into the skin involuntarily affected by trauma, microorganism, foreign bodies, or in diabetic ulcers; direct infections can also occur from voluntary causes due to surgery, vaccinations, or other iatrogenic procedures. Hematogenous spread of infection from a remote focus can also be a cause for musculoskeletal infections. Risk factors for soft tissue and bone infections include immunosuppression, old age, corticosteroid use, systemic illnesses, malnutrition, obesity, and burns. Most literature discusses musculoskeletal infections according to the diagnostic tools or forms of infection seen in different soft tissue anatomical planes or bones. This review article aims to evaluate musculoskeletal infections that occur due to direct inoculation to the musculoskeletal tissues, by focusing on the traumatic mechanism with emphasis on the radiological findings.

Thigh muscle and fat volumes are associated with knee cartilage abnormalities and bone marrow edema-like lesions: data from the osteoarthritis initiative

OBJECTIVE

To investigate the associations of thigh muscle and fat volumes with structural abnormalities on MRI related to knee osteoarthritis.

MATERIALS AND METHODS

MRI studies of the thighs and knees from 100 individuals were randomly selected from the Osteoarthritis Initiative Cohort. Whole Organ MR Scoring (WORMS) and effusion-synovitis scoring were performed in all knee MRI. Thigh muscles, intermuscular fat, and subcutaneous fat were manually segmented in 15 consecutive MR thigh images. Radiographic Kellgren-Lawrence grades (KLG) were also obtained in all knee radiographs. Independent t-tests were used to investigate the associations between thigh muscle and fat volumes, and sex. Mixed-effects analyses were obtained to investigate the associations between thigh muscle and fat volumes, KLG, WOMAC pain score, cartilage and bone marrow WORMS, as well as effusion-synovitis scores.

RESULTS

Women had higher subcutaneous fat volume than men (616.82 vs. 229.13 cm3, p < 0.01) and men had higher muscle volumes than women (p < 0.01). Quadriceps (coef = -2.15, p = 0.01) and vastus medialis (coef = -1.84, p = 0.03) volumes were negatively associated with the WORMS cartilage scores. Intermuscular fat volume (coef = 0.48, p = 0.01) was positively associated with WORMS bone marrow edema-like lesion (BMEL) scores. The quadriceps (coef = -0.99, p < 0.01) and hamstring (coef = -0.59, p = 0.01) volumes were negatively associated with WORMS BMEL scores. No evidence of an association was found between thigh muscle and fat volumes with KLG and effusion-synovitis grading (p > 0.05).

CONCLUSION

Increased quadriceps and hamstring volumes were negatively associated with cartilage lesion and BMEL scores while no evidence of an association was found between thigh muscle and fat volumes, and radiographic knee osteoarthritis or effusion-synovitis grading.

Lumbrical muscle enhancement on MRI and its association with rheumatoid arthritis

OBJECTIVE

To investigate the significance of lumbrical muscle enhancement (LME) on magnetic resonance imaging (MRI) in rheumatoid arthritis (RA).

MATERIALS AND METHODS

Blinded to the diagnoses, contrast-enhanced bilateral hand MRIs of patients with suspected early RA between 2014 and 2019 were reviewed by two observers for the presence and degree (weak/strong) of LME. The presence of other inflammatory findings was also noted. The patients were then stratified into RA (n = 41), control (n = 31), and other arthritides groups(n = 28) based on their final diagnoses in the hospital records within the following 12 months. Categorical variables were compared by chi-square test or Fisher's exact test. Differences among the groups were evaluated by one-way ANOVA or Kruskal-Wallis tests. When the p-value from the Kruskal-Wallis test was statistically significant, multiple comparison test was used to identify group differences. Correlations between LME and flexor tenosynovitis were evaluated by Spearman rank correlation test. The agreement between two observers was assessed by Cohen's Kappa (κ) statistic. P-value < 0.05 was considered as statistically significant.

RESULTS

There were 100 patients (88 females) with mean age of 47.2 ± 11.2. There were no significant differences for age or sex between groups (p = 0.17, p = 0.84, respectively). RA patients showed significantly more frequent (p < 0.001) and stronger LME (p = 0.001). There were no correlations between LME and flexor tenosynovitis (p > 0.05). Interrater agreement for the degree of LME on right and left sides was substantial (κ = 0.74, κ = 0.67, respectively).

CONCLUSION

RA patients demonstrated significantly more frequent and stronger LME with substantial interrater agreement. LME could constitute a subtle radiological clue for early RA.

ISSLS Prize in Bioengineering Science 2023: Age- and sex-related differences in lumbar intervertebral disc degeneration between patients with chronic low back pain and asymptomatic controls

PURPOSE

Clinical management of disc degeneration in patients with chronic low back pain (cLBP) is hampered by the challenge of distinguishing pathologic changes relating to pain from physiologic changes related to aging. The goal of this study was to use imaging biomarkers of disc biochemical composition to distinguish degenerative changes associated with cLBP from normal aging.

METHODS

T1ρ MRI data were acquired from 133 prospectively enrolled subjects for this observational study (80 cLBP, 53 controls; mean ± SD age = 43.9 ± 13.4 years; 61 females, 72 males). The mean T1ρ relaxation time in the nucleus pulposus (NP-T1ρ; n = 650 discs) was used as a quantitative biomarker of disc biochemical composition. Linear regression was used to assess associations between NP-T1ρ and age, sex, spinal level, and study group, and their interactions.

RESULTS

NP-T1ρ values were lower in cLBP patients than controls (70.8 ± 22.8 vs. 76.4 ± 22.2 ms, p = 0.009). Group differences were largest at L5-S1 (ΔT1ρcLBP-control = -11.3 ms, p < 0.0001), representing biochemical deterioration typically observed over a 9-12 year period (NP-T1ρ declined by 0.8-1.1 ms per year [95% CI]). Group differences were large in younger patients and diminished with age. Finally, the age-dependence of disc degeneration was stronger in controls than cLBP patients.

CONCLUSION

Aging effects on the biochemical composition of the L5-S1 disc may involve a relatively uniform set of factors from which many cLBP patients deviate. NP-T1ρ values at L5-S1 may be highly relevant to clinical phenotyping, particularly in younger individuals.

Multifocal concomitant scapulothoracic and subgluteal-ischiofemoral elastofibromas

PURPOSE

To evaluate the frequency, imaging findings, and patient demographics of synchronous elastofibroma dorsi (ED) and pelvic elastofibromas.

METHODS

Image archives between 2011 and 2021 were retrospectively searched for CT and MRI reports including the keyword "elastofibroma". Patients with concomitant CT and/or MRI of the chest and pelvic regions were included. The greatest thickness and side of ED were noted. Subsequently, pelvic soft tissues were evaluated for a soft tissue mass with similar radiological features to ED. When detected, its location, greatest transverse diameter, and ischiofemoral space widths were noted. Wilcoxon matched-pairs signed-rank and Mann-Whitney U-tests were performed when appropriate. Pearson's correlations were used to assess the association of presence of subgluteal-ischiofemoral elastofibromas (SGIFE) and ED thickness. The model discrimination of ED thickness was evaluated by calculating the AUC of the ROC.

RESULTS

Eighty-eight patients (Male:Female = 8:80) with a mean age of 70.6 (±10.3) years were included. 96.6 % of patients had bilateral ED. 18.2 % of patients (all females) had at least one concomitant SGIFE. Patients with SGIFE had significantly thicker ED (p < 0.001 right; p = 0.049 left). There was a significant positive correlation between the thickness of ED and presence of SGIFE (r = 0.43, p < 0.001 right; r = 0.25, p = 0.019 left). An AUC of 0.781 (p < 0.001, 95 %-CI:0.675-0.887) and 0.659 (p = 0.049, 95 %-CI:0.523-0.794) were revealed regarding the presence of ipsilateral right and left SGIFE, respectively.

CONCLUSION

Concomitant SGIFE may accompany ED in up to 18.2% of cases, particularly in women with thick ED. Knowledge of this co-occurrence and the described SGIFE characteristics can facilitate correct diagnosis.

Paraspinal Muscle in Chronic Low Back Pain: Comparison Between Standard Parameters and Chemical Shift Encoding-Based Water-Fat MRI

BACKGROUND

Paraspinal musculature (PSM) is increasingly recognized as a contributor to low back pain (LBP), but with conventional MRI sequences, assessment is limited. Chemical shift encoding-based water-fat MRI (CSE-MRI) enables the measurement of PSM fat fraction (FF), which may assist investigations of chronic LBP.

PURPOSE

To investigate associations between PSM parameters from conventional MRI and CSE-MRI and between PSM parameters and pain.

STUDY TYPE

Prospective, cross-sectional.

POPULATION

Eighty-four adults with chronic LBP (44.6 ± 13.4 years; 48 males).

FIELD STRENGTH/SEQUENCE

3-T, T1-weighted fast spin-echo and iterative decomposition of water and fat with echo asymmetry and least squares estimation sequences.

ASSESSMENT

T1-weighted images for Goutallier classification (GC), muscle volume, lumbar indentation value, and muscle-fat index, CSE-MRI for FF extraction (L1/2-L5/S1). Pain was self-reported using a visual analogue scale (VAS). Intra- and/or interreader agreement was assessed for MRI-derived parameters.

STATISTICAL TESTS

Mixed-effects and linear regression models to 1) assess relationships between PSM parameters (entire cohort and subgroup with GC grades 0 and 1; statistical significance α = 0.0025) and 2) evaluate associations of PSM parameters with pain (α = 0.05). Intraclass correlation coefficients (ICCs) for intra- and/or interreader agreement.

RESULTS

The FF showed excellent intra- and interreader agreement (ICC range: 0.97-0.99) and was significantly associated with GC at all spinal levels. Subgroup analysis suggested that early/subtle changes in PSM are detectable with FF but not with GC, given the absence of significant associations between FF and GC (P-value range: 0.036 at L5/S1 to 0.784 at L2/L3). Averaged over all spinal levels, FF and GC were significantly associated with VAS scores.

DATA CONCLUSION

In the absence of FF, GC may be the best surrogate for PSM quality. Given the ability of CSE-MRI to detect muscle alterations at early stages of PSM degeneration, this technique may have potential for further investigations of the role of PSM in chronic LBP.

LEVEL OF EVIDENCE

2 TECHNICAL EFFICACY STAGE: 2.

Radiological maturation and clinical results of double-bundle and single-bundle anterior cruciate ligament reconstruction. A 5-year prospective case-controlled trial

INTRODUCTION

The aim of the study was to make a prospective comparison of the radiological and clinical outcomes of patients undergoing single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction.

METHOD

This prospective, case-controlled study included 65 patients, separated into 2 groups as 33 patients undergoing single bundle (SB), and 32 patients undergoing double bundle (DB) ACL reconstruction. The patients were evaluated clinically using the International Knee Documentation Committee (IKDC) and the Lysholm knee scores. Stability was evaluated with the KT-1000 Arthrometer Measurement, the Lachman and pivot shift tests. Magnetic resonance images (MRI) at 1 and 5 years postoperatively were evaluated by a musculoskeletal radiologist. All the operations were performed by a single surgeon and the clinical evaluations were made by an independent researcher.

RESULTS

Evaluation was made of a total of 53 patients (SB: 28, DB: 25). No statistically significant difference was determined between the groups regarding the postoperative IKDC and Lysholm scores. The pivot shift tests were negative in the DB group and positive in two patients of the SB group. The Lachman test was negative in all the patients. No significant difference was determined between the groups. No statistically significant difference was determined between the two groups in respect of the arthrometer measurements. In the SB group, revision surgery was performed in two patients due to graft failure. No graft failure findings were determined in the DB group, and no statistically significant difference was determined between the groups in respect of graft failure. On the MRIs taken at 1 year postoperatively, the ACL was seen to be hyperintense in 16 patients in the DB group and 6 patients in the SB group (p = 0.004). On the 5-year MRIs, ACL hypointensity could not be seen in three patients of the SB group and two of the DB group, with no difference determined between the groups (p > 0.05).

CONCLUSION

In the 5-year follow-up period, no difference was determined between patients undergoing SB ACL reconstruction and those undergoing DB ACL reconstruction regarding clinical scores, knee stability, and MRI findings, but graft maturation occurs later the patients undergoing DB reconstruction.

Effects of delayed breast reconstruction on the thoracolumbar vertebrae in patients undergoing unilateral mastectomy: A retrospective cohort study

BACKGROUND

Post-mastectomy changes vertebral column alignment. There is limited data assessing spine curvature after breast reconstruction. In this study, the effects of delayed breast reconstruction on the Cobb angle and quality of life indicator (Oswestry disability index [ODI]) were evaluated in patients undergoing unilateral mastectomy.

METHODS

This study was performed as a retrospective review of 40 patients who had delayed reconstruction for breast cancer at a single center between 2015 and 2018. Patients completed a standardized questionnaire, the ODI, at the beginning and 12 months after the operation. The Cobb angles of the vertebral columns and spinal curve directions were determined using posteroanterior chest radiographs obtained pre- and postoperatively.

RESULTS

Mean age and body mass index (BMI) were 49.9 ± 9 years and 30.1 kg/m², respectively. The Cobb angles were found to differ before and after the reconstruction; the difference was statistically significant, and the average change in Cobb angle was 4.3° (p = 0.03). The Cobb angles were also found to be significantly different between patients with implants and those who underwent autologous tissue reconstruction (p = 0.026). Although delayed reconstruction performed with autologous tissue or implant improves post-mastectomy scoliosis, autologous tissue reconstruction yields better outcomes. The mean preoperative ODI score was 21.6%, and 8.8% patients presented no back pain. The mean score was 3.2% at 12 months postoperation. These results are statistically significant (p<0.001).

CONCLUSIONS

Breast reconstruction positively affects vertebral alignment and leads to better posture, physical function and decreased back pain in breast cancer survivors, significantly improving their quality of life.

Superficial Acral Fibromyxoma

Superficial acral fibromyxoma is a rare, benign, slow-growing, soft-tissue tumor commonly located in the acral regions, with a predilection for the great toe, developing from the nail unit. Because of its nonspecific features and rarity, clinical diagnosis is difficult. In this article, we present a case of superficial acral fibromyxoma located in the nail unit with new dermatoscopic and radiologic findings that have not been previously reported in the literature.

Prognostic implications of visceral obesity on gastric adenocarcinoma: does it really matter?

PURPOSE

To evaluate the association of visceral adiposity measured on computed tomography (CT) in preoperative period with lymph node (LN) metastasis and overall survival in gastric adenocarcinoma patients.

METHODS

Preoperative CT scans of 246 gastric adenocarcinoma patients who did not receive neoadjuvant chemoradiotherapy were evaluated. Visceral fat area (VFA), subcutaneous fat area (SFA) and Total fat area (TFA), VFA/TFA ratio were quantified by CT. VFA/TFA > 29% was defined as visceral obesity. The differentiation, t-stage, n-stage and the number of harvested-metastatic LNs were noted. The maximum thickness of tumor and localization were recorded from CT. Chi-square, Student's t-test, multiple Cox regression, Spearman's correlation coefficient, and Kaplan-Meier algorithm were performed.

RESULTS

The overall survival (OS) rates and N-stage were not different significantly between viscerally obese and non-obese group (p = 0.994, p = 0.325). The number of metastatic LNs were weakly inversely correlated with VFA (r = -0.144, p = 0.024). Univariate analysis revealed no significant association between visceral obesity and OS or LN metastasis (p = 0.377, p = 0.736). In multivariate analyses, OS was significantly associated with poorly differentiation (HR = 1.72, 95% CI =1.04-2.84, p = 0.035), higher pathologic T and N stage (T4 vs T1 + T2 HR = 2.67, 95% CI =1.18-6.04, p = 0.019; T3 vs T1 + T2 HR = 1.98, 95% CI = 0.90-4.33, p = 0.089; N3b vs N0 HR = 2.97, 95% CI1.45-6.0, p = 0.003; N3 (3a+ 3b) vs N0 HR = 2.24 95% CI =1.15-4.36, p = 0.018).

CONCLUSION

Visceral obesity may not be a prognostic factor in resectable gastric adenocarcinoma patients.

A New Clinical Sign for Diagnosing Medial Meniscus Posterior Root Tear

Background

In the presence of medial meniscus posterior root tear (MMPRT), there is a possibility of reduced compression of meniscal tissue in hyperflexion as the intra-articular mobility of the meniscus increases. This phenomenon can be mimicked during clinical examination.

Purpose

To describe, evaluate, and validate the diagnostic performance of a new clinical indicator, the Akmese sign, for the diagnosis of an MMPRT.

Study Design

Cohort study (diagnosis); Level of evidence, 2.

Methods

In this study, we prospectively enrolled patients aged 18 to 55 years who were scheduled for arthroscopic surgery after a diagnosis of medial meniscal lesion at a single institution between January 2016 and January 2018. All of the patients underwent preoperative examination for the Akmese sign. All surgeries were performed by a single surgeon with more than 5 years of experience in sports injury surgery, who was blinded to the Akmese sign results.

Results

A total of 273 patients with a mean age of 42.4 ± 5.3 years met the study criteria. The Akmese sign was identified as positive in 33 patients, and MMPRT was confirmed during arthroscopy in 36 cases. The performance parameters of the Akmese sign were a sensitivity of 86.1%, specificity of 99.1%, Youden index of 0.85, and kappa index of 0.88.

Conclusion

This study showed that the Akmese sign is a useful new physical examination test that can help clinicians distinguish MMPRTs from other meniscal medial meniscal pathology.

The relation of CT quantified pancreatic fat index with visceral adiposity and hepatic steatosis

Objectives

The purpose of this study was to investigate the relation between pancreatic steatosis and visceral adiposity. Furthermore, the study sought to explore the association between pancreatic steatosis, pancreas volume, hepatic steatosis, age, and sex in adults without prior history of pancreatic disease. The research also served to define a cut-off value of visceral fat tissue area (VFA) predicting fatty pancreas.

Material and Methods

CT scans of 98 living-liver donor transplant patients without prior history of pancreatic disease were evaluated for the presence of fatty pancreas. Pancreas volume, VFA, subcutaneous-total FA, VFA/TFA ratios of the patients with and without fatty pancreas were quantified with a semi-automated model on CT. Coexistence of hepatic steatosis was also recorded.

Results

VFA, TFA and VFA/TFA were significantly greater in the fatty group (p<0.001, p<0.001, p<0.001; respectively), and pancreatic steatosis was moderately correlated with VFA, VFA/TFA and TFA with the highest correlation coefficient with VFA (r=-0.715, r=-0.605, r=-0.573, respectively; p<0.001 for all). A cut-off value of VFA ≥ 107.2 cm2 estimates pancreatic steatosis with a sensitivity and specificity of 90% (95% CI=77-96%) and 87.9% (95% CI=77%-94%), respectively. Pancreas volume was higher in the fatty-group with a mean value of 86.5±17.3 mL (range; 58-119.2 mL, p=0.097). In multiple logistic regression analyses, pancreatic steatosis was significantly associated with VFA and the male sex (OR=58.2, 95% CI=12.2-277.1, p<0.001; OR=11.4, 95% CI=2.1-63.4, p<0.001; respectively). 77.5% of the fatty pancreas subjects had co-existing hepatic steatosis.

Conclusion

Pancreatic steatosis is related to higher VFA, VFA/TFA and hepatic steatosis. A cut-off value of VFA ≥ 107.2 cm² may predict pancreatic steatosis.

Primary Hypertrophic Osteoarthropathy Mimicking Juvenile Idiopathic Arthritis: A Novel SLCO2A1 Mutation and Imaging Findings

Primary hypertrophic osteoarthropathy (PHO), also known as pachydermoperiostosis, is a rare, multisystemic, autosomal recessive condition typically presenting with digital clubbing, osteoarthropathy, and various skin manifestations. Radiographs show distinctive periosteal reaction and thickening along the long bones. PHO is caused by homozygous mutations in the HPGD gene in chromosome 4q34.1 or the SLCO2A1 gene in 3q22.1q22.2. Here, we report on a 20-year-old male with enlarged and swollen joints with arthralgia, palmoplantar hyperhidrosis, and large hands and feet with marked digital clubbing. We also present radiographic, MRI, and ultrasonographic features of the case. These clinical and imaging findings were compatible with the diagnosis of PHO, and a novel homozygous mutation, c.576C>G, p.Ile192Met, was found in SLCO2A1.

Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies

PURPOSE

We aimed to evaluate the diagnostic accuracy and safety of computed tomography (CT)-guided biopsy of pulmonary lesions with fine needle aspiration (FNA) using non-coaxial technique.

METHODS

We analyzed 442 patients who underwent CT-guided lung biopsy with FNA and non-coaxial technique to determine the diagnostic outcomes, complication rates, and independent risk factors for diagnostic failure and pneumothorax.

RESULTS

Diagnostic accuracy, sensitivity, and specificity were 97.6%, 97.3%, and 100%, respectively. Age and >35 mm lesion size were significant risk factors for diagnostic failure. The rates of pneumothorax and chest tube placement were 19% and 2.9%, respectively. Middle and lower lobe location, lesion to pleura distance >7.5 mm, and >45° needle trajectory angle were significant risk factors for pneumothorax.

CONCLUSION

CT-guided FNA of pulmonary lesions with non-coaxial technique is a safe and reliable method with a relatively low pneumothorax rate and an acceptably high diagnostic accuracy.

CT and MRI Findings in a Rare Case of Renal Primitive Neuroectodermal Tumor

BACKGROUND

Primary renal primitive neuroectodermal tumor/extraskeletal Ewing's sarcoma (PNET/EES) is a very rare renal tumor.

CASE REPORT

We report a case of primary renal PNET/EES of the kidney in an adult patient and describe its computed tomography and magnetic resonance imaging findings, including diffusion weighted images along with a review of the current medical literature.

CONCLUSIONS

Although very rare, a relatively large renal mass which shows very infiltrative growth pattern on CT and MR imaging and striking diffusion restriction should raise the suspicion of a renal primitive neuroectodermal tumor, in a young adult.

Intranodal Palisaded Myofibroblastoma: Radiological and Cytological Overview

Background

Intranodal palisaded myofibroblastoma is a benign and very rare mesenchymal neoplasm of the lymph nodes originating from differentiated smooth muscle cells and myofibroblasts.

Case Report

We report a case of intranodal palisaded myofibroblastoma in an 84-year-old woman with Parkinson’s disease that presented as a left inguinal mass. The diagnosis was made using ultrasound-guided fine needle aspiration biopsy and consequent cytopathological examination that included immunohistochemical analysis. Herein, we discuss the presentation of a rare intranodal palisaded myofibroblastoma with emphasis on its ultrasonographic and cytopathologic features.

Conclusions

Intranodal palisaded myofibroblastoma should be considered in the differential diagnosis of inguinal lymphadenopathy and the diagnosis is possible with cytopathologic exam and immunohistochemical analysis using ultrasound-guided FNA biopsy, guiding the clinician to nodal excision rather than aggressive measures.

Trifurcation of the Left Common Carotid Artery

Background

Trifurcation of the common carotid artery is an unusual variation.

Case Report

We report a case of left common carotid artery trifurcation in a 74-year-old man. The left common carotid artery divided into the internal carotid, external carotid and facial arteries. Herein, the anatomy of the carotid arteries and the Doppler sonography and CT angiography findings of the left common carotid artery trifurcation were described with images.

Conclusions

The variations of the carotid arteries should be known to avoid and reduce the complications during the invasive procedures.