1
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Cellina M. Non-contrast magnetic resonance Lymphography and Indocyanine green Lymphography play a complementary role in the management of upper limb lymphedema. Magn Reson Imaging 2024; 109:187-188. [PMID: 38513787 DOI: 10.1016/j.mri.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Michaela Cellina
- Radiology Department, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20123 Milan, Italy.
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2
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Abu Awwad D, Ekpo E. Imaging of the adjacent upper limb: Outcomes and diagnostic yield. Radiography (Lond) 2024; 30:753-758. [PMID: 38432174 DOI: 10.1016/j.radi.2024.02.014] [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: 12/30/2023] [Revised: 02/02/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Injuries to extremities are a common presentation to emergency departments and may be associated with multiple abnormalities. Patients may be referred for X-ray imaging of multiple adjacent regions, but the diagnostic outcomes of these X-ray examinations have not been fully explored. The aim of this study was to assess the diagnostic efficacy of X-ray examinations of adjacent body regions in the upper limb. METHODS Upper limb X-rays examinations performed over six months were collected from two hospitals, and all patients who had adjacent regions X-rayed were included. Using the radiology reports as a reference standard, the diagnostic yield of these additional adjacent X-ray examinations was assessed. Descriptive statistics and Pearson's Chi Square were used for data analysis. RESULTS 591 patients had 1455 X-ray examinations, ranging from two to six X-ray requests. More than 80% of X-ray examinations were due to an injury, but less than 60% had symptoms mentioned in the clinical history. Overall, 39.1% of initial examinations reported a new finding but only 1.5% of all subsequent imaging had a new abnormality detected. Examinations with symptoms specified in the clinical history were more likely to detect new findings (p=<0.001). CONCLUSION Imaging is an essential diagnostic tool in medical settings, but all radiographic tests should be justified, and adjacent imaging has a low diagnostic yield, hence, all limbs should be carefully assessed individually to assess the need for imaging. Every request should be justified based on presentation and symptoms, particularly when multiple areas may be impacted. IMPLICATIONS FOR PRACTICE Radiographic imaging is easily accessible but adherence to guidelines and assessing the diagnostic yield of common examinations is important to ensure benefits to patients.
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Affiliation(s)
- D Abu Awwad
- Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building, Camperdown, Sydney, Australia.
| | - E Ekpo
- Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building, Camperdown, Sydney, Australia.
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3
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Boxall A. A pictorial guide for performing dynamic musculoskeletal ultrasound techniques of the Upper Limb. Radiography (Lond) 2024; 30:745-752. [PMID: 38428199 DOI: 10.1016/j.radi.2024.02.009] [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: 10/28/2023] [Revised: 01/13/2024] [Accepted: 02/14/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Dynamic techniques should be used to compliment static imaging in the field of Musculoskeletal ultrasound. Performing limb movements and imaging simultaneously, allows for diagnosing certain musculoskeletal conditions not otherwise confirmed by still images. This article aims to provide guidance on how to perform a selection of these dynamic musculoskeletal ultrasound techniques with a focus on the upper limb. METHODS This pictorial guide features techniques gathered from literature review and experience gained in the field. RESULTS Application of dynamic ultrasound techniques has been evidenced in the literature to diagnose conditions such as trigger finger, dislocating tendons and causes of peripheral neuropathy. CONCLUSION Musculoskeletal conditions only elicited during limb movement can be difficult to diagnose. Appropriate use of dynamic techniques increases likelihood of correct diagnosis of the described conditions. IMPLICATIONS FOR PRACTICE Ultrasound provides a unique opportunity to visualise these conditions thus ultrasound users should aim to familiarise themselves with dynamic ultrasound techniques to improve patient outcomes.
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Affiliation(s)
- A Boxall
- Royal Surrey NHS Foundation Trust, UK.
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4
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Patel V, Nguyen NP, Brown N, Mendenhall SD, Zoga AC, Nguyen JC. Return to Play in Youth Athletes: Role of the Radiologist with Focus on the Upper Extremity. Semin Musculoskelet Radiol 2024; 28:180-192. [PMID: 38484770 DOI: 10.1055/s-0043-1778029] [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: 03/19/2024]
Abstract
Increase in youth sports participation, longer duration of play, and earlier starting points have increased the prevalence of acute and repetitive overuse musculoskeletal injuries. This rise in injury rates has led to increased efforts to better understand the susceptible sites of injury that are unique to the growing immature skeleton. Upper extremity injuries are currently the best studied, particularly those that occur among pediatric baseball players and gymnasts. The weak link in skeletally immature athletes is the growth plate complex that includes those injuries located at the epiphyseal and apophyseal primary physes and the peripherally located secondary physes. This article reviews the anatomy and function of these growth plate complexes, followed by a discussion of the pathophysiologic mechanisms, spectrum of imaging findings, and existing evidence-based guidelines for injury prevention and return to play.
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Affiliation(s)
- Vandan Patel
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Drexel University College of Medicine, Philadelphia, Pennsylvania
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ngan P Nguyen
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Naomi Brown
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shaun D Mendenhall
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam C Zoga
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Jefferson, Philadelphia, Pennsylvania
| | - Jie C Nguyen
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Mirsch D, Jelic T, Prats MI, Dreyfuss A, Yates E, Kummer T, Stenberg B, Vlasica K, Nagdev A. Just the facts: brachial plexus blocks for upper extremity injuries in the emergency department. CAN J EMERG MED 2024; 26:228-231. [PMID: 38060159 DOI: 10.1007/s43678-023-00628-6] [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] [Received: 07/09/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
Ultrasound-guided nerve blocks (UGNBs) are becoming a more common method for pain control in the emergency department. Specifically, brachial plexus blocks have shown promise for acute upper extremity injuries as well as an alternative to procedural sedation for glenohumeral reductions. Unfortunately, there is minimal discussion in the EM literature regarding phrenic nerve paralysis (a well-known complication from brachial plexus blocks). The anatomy of the brachial plexus, its relationship to the phrenic nerve, and why ultrasound-guided brachial plexus blocks can cause phrenic nerve paralysis and resultant respiratory impairment will be discussed. The focus on patient safety is paramount, and those with preexisting respiratory conditions, extremes of age or weight, spinal deformities, previous neck injuries, and anatomical variations are at greater risk. We put forth different block strategies for risk mitigation, including patient selection, volume and type of anesthetic, block location, postprocedural monitoring, and specific discharge instructions. Understanding the benefits and risks of UGNBs is critical for emergency physicians to provide effective pain control while ensuring optimal patient safety.
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Affiliation(s)
| | - Tomislav Jelic
- Department of Emergency Medicine, Health Sciences Centre/St.Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada.
| | - Michael I Prats
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrea Dreyfuss
- Department at Hennepin Healthcare, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Evan Yates
- School of Medicine, Ronald O. Perelman Department of Emergency Medicine at NYU Grossman, NYU Langone Health, New York, NY, USA
| | | | - Bob Stenberg
- Northeast Ohio Medical School, Cleveland Clinic Akron General, Rootstown, OH, USA
| | | | - Arun Nagdev
- Highland Hospital/Alameda Health System, University of California, San Francisco, CA, USA
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6
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Qu M, Lv D, Zhou J, Wang Z, Zheng Y, Zhang G, Xie J. Sensing and Controlling Strategy for Upper Extremity Prosthetics Based on Piezoelectric Micromachined Ultrasound Transducer. IEEE Trans Biomed Eng 2024; 71:1161-1169. [PMID: 37922169 DOI: 10.1109/tbme.2023.3329826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
Surface electromyography (sEMG) is currently the primary method for user control of prosthetic manipulation. Its inherent limitations of low signal-to-noise ratio, limited specificity and susceptibility to noise, however, hinder successful implementation. Ultrasound provides a possible alternative, but current systems with medical probes are expense, bulky and non-wearable. This work proposes an innovative prosthetic control strategy based on a piezoelectric micromachined ultrasound transducer (PMUT) hardware system. Two PMUT-based probes were developed, comprising a 23×26 PMUT array and encapsulated in Ecoflex material. These compact and wearable probes represent a significant improvement over traditional ultrasound probes as they weigh only 1.8 grams and eliminate the need for ultrasound gel. A preliminary test of the probes was performed in non-disabled subjects performing 12 different hand gestures. The two probes were placed perpendicular to the flexor digitorum superficialis and brachioradialis muscles, respectively, to transmit/receive pulse-echo signals reflecting muscle activities. Hand gesture was correctly predicted 96% of the time with only these two probes. The adoption of the PMUT-based strategy greatly reduced the required number of channels, amount of processing circuit and subsequent analysis. The probes show promise for making prosthesis control more practical and economical.
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7
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Kageyama T, Shiko Y, Kawasaki Y, Miyazaki T, Sakai H, Tsukuura R, Yamamoto T. Three-dimensional non-contrast magnetic resonance lymphography severity stage for upper extremity lymphedema. Magn Reson Imaging 2024; 107:24-32. [PMID: 38181836 DOI: 10.1016/j.mri.2023.12.007] [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: 09/18/2023] [Revised: 12/17/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
PURPOSES Non-contrast magnetic resonance lymphography (NMRL) has recently shown the capability of evaluating anatomical fluid distribution in upper extremity lymphedema (UEL). However, there is still a lack of knowledge about the correlation between the characteristic three-dimensional (3D) NMRL findings and the indocyanine green lymphography (ICG-L) findings. Our goal was to clarify the relationship between the 3D NMRL findings and the ICG-L findings. METHODS Medical charts of patients with secondary UEL who underwent NMRL and ICG-L between January 2018 to October 2021 were reviewed. The upper extremities were divided into 6 regions; the hand, elbow, and the radial and ulnar aspects of the forearm and the upper arm. We investigated the prevalence of characteristic 3D NMRL patterns (Mist/Spray/Inky) in each region based on the ICG-L stage. We also examined the association between the 3D NMRL stage which we proposed and the ICG-L stage, and other clinical factors. RESULTS A total of 150 regions of 25 patients with upper extremities lymphedema were enrolled in the study. All of the characteristic patterns increased significantly as the ICG-L stage advanced (p < 0.001, < 0.001, and < 0.001, respectively). The predominant NMRL patterns changed significantly from the Early pattern (Mist pattern) to the Advanced pattern (Inky/Spray pattern) as the ICG-L stage progressed (p < 0.001). The higher Stage of 3D NMRL was significantly associated with the progression of the ICG-L stage (rs = 0.80, p < 0.001). CONCLUSIONS Characteristic 3D NMRL patterns and the 3D NMRL Stage had a significant relationship with the ICG-L stage and other clinical parameters. This information may be an efficient tool for a more precise and objective evaluation of various treatments for UEL patients.
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Affiliation(s)
- Takashi Kageyama
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan; Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama, Japan
| | - Yuki Shiko
- Research Administration Center, Saitama Medical University, Saitama, Japan
| | - Yohei Kawasaki
- Research Administration Center, Saitama Medical University, Saitama, Japan
| | - Toko Miyazaki
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hayahito Sakai
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Reiko Tsukuura
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
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8
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Billy J, Bensamoun SF, Mercier J, Durand S. Applications of ultrasound elastography to hand and upper limb disorders. Hand Surg Rehabil 2024; 43:101636. [PMID: 38215880 DOI: 10.1016/j.hansur.2024.101636] [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] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024]
Abstract
Ultrasound elastography is a recently developed method for accurate measurement of soft tissue stiffness in addition to the clinician's subjective evaluation. The present review briefly describes the ultrasound elastography techniques and outlines clinical applications for tendon, muscle, nerve, skin and other soft tissues of the hand and upper limb. Strain elastography provides a qualitative evaluation of the stiffness, and shear-wave elastography generates quantitative elastograms superimposed on a B-mode image. The stiffness in degenerative tendinopathy and/or tendon injury was significantly lower than in a normal tendon in several studies. Elastography is also a reliable method to evaluate functional muscle activity, compared to conventional surface electromyography. The median nerve is consistently stiffer in patients with carpal tunnel syndrome than in healthy subjects, on whatever ultrasound elastography technique. Elastography distinguishes normal skin from scars and can be used to evaluate scar severity and treatment. Elastography has huge clinical applications in musculoskeletal tissues. Continued development of systems and increased training of clinicians will expand our knowledge of elastography and its clinical applications in the future.
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Affiliation(s)
- Jessica Billy
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sabine F Bensamoun
- Sorbonne University, Université de Technologie de Compiègne, CNRS UMR 7338, Biomechanics and Bioengineering, Compiègne, France
| | - Julie Mercier
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sébastien Durand
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland.
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Seyok T, Collins JE, Erikson SJ, Charles JF, Earp BE. Impact of an Outpatient Fracture Liaison Service on Osteoporosis Evaluation Among Patients With Upper Extremity Fragility Fracture. Hand (N Y) 2024; 19:256-262. [PMID: 36113071 PMCID: PMC10953516 DOI: 10.1177/15589447221120851] [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] [Indexed: 02/10/2023]
Abstract
BACKGROUND The purpose of this study was to assess the impact of implementation of an outpatient fracture liaison service (FLS) on completion rates of dual-energy x-ray absorptiometry (DXA) and screening labs including 25-OH vitamin D and parathyroid hormone (PTH) in patients with upper extremity (UE) fragility fractures. METHODS At our institution, 367 patients were treated in 2014-2015 for UE fragility fractures of the distal radius and proximal humerus before implementation of our outpatient FLS and 395 patients in 2017-2018 after implementation. Retrospective chart review was conducted to identify completed DXA scans within 2 years of fracture treatment and completed 25-OH vitamin D and PTH labs within 1 year of fracture treatment. RESULTS There were no statistical differences in the demographics of patients treated for distal radial and proximal humeral fragility fractures during the 2014-2015 and 2017-2018 time periods. Implementation of the FLS resulted in a 9.9% increase (P value = .021) in completed DXA scans within 2 years of fracture treatment. Completed 25-OH vitamin D and PTH labs saw a significant increase of 17.1% and 23.8%, respectively (P values < .001). CONCLUSIONS Implementation of an outpatient FLS can help to improve osteoporosis evaluation with completed DXA scans and 25-OH vitamin D and PTH labs.
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Affiliation(s)
- Thany Seyok
- Department of Medicine, Division of Rheumatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jamie E. Collins
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Samantha J. Erikson
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Julia F. Charles
- Department of Medicine, Division of Rheumatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Brandon E. Earp
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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10
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Kirby DJ, Duenes ML, Hacquebord JH, Borowski LE. Focus on POCUS Point of Care Ultrasound in the Upper Extremity. Bull Hosp Jt Dis (2013) 2024; 82:53-59. [PMID: 38431978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Ultrasound technologies are infrequently utilized in orthopedics as a first line diagnostic method, however, advances in technology and the applied techniques have opened the door for how and when ultrasound can be used. One specific avenue is the use of point of care ultrasound in which ultrasound is used at the time of initial patient evaluation by the evaluating physician. This use expedites time to diagnosis and can even guide therapeutic interventions. In the past two decades there have been numerous studies demonstrating the effectiveness of ultrasound for the diagnosis of many orthopedic conditions in the upper extremity, often demonstrating that it can be used in the place of and with greater diagnostic accuracy than magnetic resonance imaging. This review elaborates on these topics and lays a groundwork for how to incorporate point of care ultrasound into a modern orthopedic practice.
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11
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Wade RG, Tam W, Perumal A, Pepple S, Griffiths TT, Flather R, Haroon HA, Shelley D, Plein S, Bourke G, Teh I. Comparison of distortion correction preprocessing pipelines for DTI in the upper limb. Magn Reson Med 2024; 91:773-783. [PMID: 37831659 PMCID: PMC10952179 DOI: 10.1002/mrm.29881] [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: 04/08/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE DTI characterizes tissue microstructure and provides proxy measures of nerve health. Echo-planar imaging is a popular method of acquiring DTI but is susceptible to various artifacts (e.g., susceptibility, motion, and eddy currents), which may be ameliorated via preprocessing. There are many pipelines available but limited data comparing their performance, which provides the rationale for this study. METHODS DTI was acquired from the upper limb of heathy volunteers at 3T in blip-up and blip-down directions. Data were independently corrected using (i) FSL's TOPUP & eddy, (ii) FSL's TOPUP, (iii) DSI Studio, and (iv) TORTOISE. DTI metrics were extracted from the median, radial, and ulnar nerves and compared (between pipelines) using mixed-effects linear regression. The geometric similarity of corrected b = 0 images and the slice matched T1-weighted (T1w) images were computed using the Sörenson-Dice coefficient. RESULTS Without preprocessing, the similarity coefficient of the blip-up and blip-down datasets to the T1w was 0·80 and 0·79, respectively. Preprocessing improved the geometric similarity by 1% with no difference between pipelines. Compared to TOPUP & eddy, DSI Studio and TORTOISE generated 2% and 6% lower estimates of fractional anisotropy, and 6% and 13% higher estimates of radial diffusivity, respectively. Estimates of anisotropy from TOPUP & eddy versus TOPUP were not different but TOPUP reduced radial diffusivity by 3%. The agreement of DTI metrics between pipelines was poor. CONCLUSIONS Preprocessing DTI from the upper limb improves geometric similarity but the choice of the pipeline introduces clinically important variability in diffusion parameter estimates from peripheral nerves.
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Affiliation(s)
- Ryckie G. Wade
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
- Department of Plastic, Reconstructive and Hand SurgeryLeeds Teaching Hospitals TrustLeedsUK
| | - Winnie Tam
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
| | - Antonia Perumal
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
| | - Sophanit Pepple
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
| | - Timothy T. Griffiths
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
- Department of Plastic, Reconstructive and Hand SurgeryLeeds Teaching Hospitals TrustLeedsUK
| | - Robert Flather
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
- Department of Plastic, Reconstructive and Hand SurgeryLeeds Teaching Hospitals TrustLeedsUK
| | - Hamied A. Haroon
- Division of Psychology, Communication & Human NeuroscienceThe University of ManchesterManchesterUK
| | | | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUK
| | - Grainne Bourke
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
- Department of Plastic, Reconstructive and Hand SurgeryLeeds Teaching Hospitals TrustLeedsUK
| | - Irvin Teh
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUK
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12
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West NJ, Wadhwa S, Ayars C, Philips P, Martin RCG, Scoggins CR, McMasters KM, Egger ME. Interval Sentinel Lymph Nodes With the Use of Routine Lymphoscintigraphy in Extremity Melanoma. J Surg Res 2024; 293:613-617. [PMID: 37837816 PMCID: PMC10841403 DOI: 10.1016/j.jss.2023.08.055] [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: 03/02/2023] [Revised: 08/03/2023] [Accepted: 08/31/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Lymphoscintigraphy (LS) helps identify drainage to interval (epitrochlear or popliteal) lymph node basins for extremity melanomas. This study evaluated how often routine LS evaluation identified an interval sentinel lymph node (SLN) and how often that node was found to have metastasis. METHODS A single institution, retrospective study identified patients with an extremity melanoma who underwent routine LS and SLN biopsy over a 25-y period. Comparisons of factors associated with the identification of interval node drainage and tumor status were made. RESULTS In 634 patients reviewed, 5.7% of patients drained to an interval SLN. Of those biopsied, 29.2% were positive for micrometastases. Among patients with biopsies of both the traditional and interval nodal basins, nearly 20% had positive interval nodes with negative SLNs in the traditional basin. Sex, age, thickness, ulceration, and the presence of mitotic figures were not predictive of identifying an interval node on LS, nor for having disease in an interval node. Anatomic location of the primary melanoma was the only identifiable risk factor, as no interval nodes were identified in melanomas of the thigh or upper arm (P ≤ 0.001). CONCLUSIONS Distal extremity melanomas have a moderate risk of mapping to an interval SLN. Routine LS should be considered in these patients, especially as these may be the only tumor-positive nodes. However, primary extremity melanomas proximal to the epitrochlear or popliteal nodal basins do not map to interval nodes, and improved savings and workflow could be realized by selectively omitting routine LS in such patients.
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Affiliation(s)
- Natalie J West
- The Hiram C Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Shruti Wadhwa
- The Hiram C Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Carter Ayars
- The Hiram C Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Prejesh Philips
- The Hiram C Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Robert C G Martin
- The Hiram C Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Charles R Scoggins
- The Hiram C Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kelly M McMasters
- The Hiram C Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Michael E Egger
- The Hiram C Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
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13
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Huang Z, Zhao J, Sun L, Zhong W, Yin Y, Tian W. Morphological and radiological features of congenital muscular hypertrophy of the upper limb: experience from a tertiary institution. J Hand Surg Eur Vol 2023; 48:1144-1150. [PMID: 37751489 DOI: 10.1177/17531934231188973] [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] [Indexed: 09/28/2023]
Abstract
Congenital muscular hypertrophy is a rare overgrowth disorder in the phosphatidylinositol-3-kinase related spectrum. In the past 3 years, ten patients with 11 limbs involved were treated in our centre. The aim of the study was to describe the clinical and radiological deformities of these patients. We documented the characteristic clinical morphological changes, such as hypertrophy, loss of wrist flexion, thumb hyperabduction, finger deviation and skin crease changes in the palm. Radiologically, the mean first metacarpal radial deviation angle of the affected side measured 55° (range 34 to 67) compared to the normal contralateral side 42° (range 32 to 53). The mean intermetacarpal space ratio was 1.2 (range 1.1 to 1.4) and the mean palm width ratio was 1.2 (range 1.1 to 1.3). In this study, we were able to further characterize the radiological and morphological changes of congenital muscular hypertrophy of upper limbs, which would be helpful for establishing the diagnosis and monitor treatment of this rare condition.Level of evidence: IV.
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Affiliation(s)
- Zhifeng Huang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
| | - Junhui Zhao
- Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
| | - Liying Sun
- Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
| | - Wenyao Zhong
- Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
| | - Yuehan Yin
- Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
| | - Wen Tian
- Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, PR China
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Demino C, Koesarie K, Smith J, Fowler JR. Ultrasound Use by Upper Extremity Surgeons in 2020: A Survey of ASSH Members. Hand (N Y) 2023; 18:1222-1229. [PMID: 35373624 PMCID: PMC10798197 DOI: 10.1177/15589447221082170] [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] [Indexed: 02/10/2023]
Abstract
BACKGROUND The use of musculoskeletal ultrasound (US) among hand surgeons appears to be increasing. The purpose of this study was to determine the utilization patterns and attitudes regarding US among American Society for Surgery of the Hand (ASSH) members in 2020 as well as the changes in usage patterns since a previous survey in 2015. METHODS In 2020, an updated and expanded 27-question survey was distributed to 4852 members of the ASSH. Questions assessed respondent demographics, training, and practice patterns, and access, utilization, training, and opinions pertaining to US. RESULTS A total of 418 surveys (8.6%) were analyzed. Compared to 2015, there was an increase in the percentage of respondents using US for diagnostic purposes (51%-68%), as well as having personal access to US machines (43% to 58%). US use to assist in diagnosing carpal tunnel syndrome increased from 19% to 27%. The most common reason for using US was convenience and practice efficiency, while the most common reasons for not using US was no machine access. In 2020, 33% of respondents performed US-guided injections. CONCLUSIONS Compared to 2015, the majority of responding upper extremity surgeons now have personal access to US machines. Utilization of diagnostic US appears to be increasing, and two-thirds of respondents believed that US use will continue to increase among upper extremity surgeons.
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15
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Di Angelo L, Di Stefano P, Guardiani E, Neri P, Paoli A, Razionale AV. Automatic Multiview Alignment of RGB-D Range Maps of Upper Limb Anatomy. Sensors (Basel) 2023; 23:7841. [PMID: 37765897 PMCID: PMC10534679 DOI: 10.3390/s23187841] [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] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/04/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
Digital representations of anatomical parts are crucial for various biomedical applications. This paper presents an automatic alignment procedure for creating accurate 3D models of upper limb anatomy using a low-cost handheld 3D scanner. The goal is to overcome the challenges associated with forearm 3D scanning, such as needing multiple views, stability requirements, and optical undercuts. While bulky and expensive multi-camera systems have been used in previous research, this study explores the feasibility of using multiple consumer RGB-D sensors for scanning human anatomies. The proposed scanner comprises three Intel® RealSenseTM D415 depth cameras assembled on a lightweight circular jig, enabling simultaneous acquisition from three viewpoints. To achieve automatic alignment, the paper introduces a procedure that extracts common key points between acquisitions deriving from different scanner poses. Relevant hand key points are detected using a neural network, which works on the RGB images captured by the depth cameras. A set of forearm key points is meanwhile identified by processing the acquired data through a specifically developed algorithm that seeks the forearm's skeleton line. The alignment process involves automatic, rough 3D alignment and fine registration using an iterative-closest-point (ICP) algorithm expressly developed for this application. The proposed method was tested on forearm scans and compared the results obtained by a manual coarse alignment followed by an ICP algorithm for fine registration using commercial software. Deviations below 5 mm, with a mean value of 1.5 mm, were found. The obtained results are critically discussed and compared with the available implementations of published methods. The results demonstrate significant improvements to the state of the art and the potential of the proposed approach to accelerate the acquisition process and automatically register point clouds from different scanner poses without the intervention of skilled operators. This study contributes to developing effective upper limb rehabilitation frameworks and personalized biomedical applications by addressing these critical challenges.
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Affiliation(s)
- Luca Di Angelo
- Department of Industrial and Information Engineering and Economics, University of L’Aquila, 67100 L’Aquila, Italy; (L.D.A.); (P.D.S.)
| | - Paolo Di Stefano
- Department of Industrial and Information Engineering and Economics, University of L’Aquila, 67100 L’Aquila, Italy; (L.D.A.); (P.D.S.)
| | - Emanuele Guardiani
- Department of Industrial and Information Engineering and Economics, University of L’Aquila, 67100 L’Aquila, Italy; (L.D.A.); (P.D.S.)
| | - Paolo Neri
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy; (P.N.); (A.P.); (A.V.R.)
| | - Alessandro Paoli
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy; (P.N.); (A.P.); (A.V.R.)
| | - Armando Viviano Razionale
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy; (P.N.); (A.P.); (A.V.R.)
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16
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Yang Y, Lin N, Xu Y, Niu Z, Meng F, Zhang K, Wang Y, Ruan L, Zhang L. Calcification detection on upper extremity arteries: a comparison of ultrasonic and X-ray methods. PeerJ 2023; 11:e15855. [PMID: 37637162 PMCID: PMC10460149 DOI: 10.7717/peerj.15855] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/16/2023] [Indexed: 08/29/2023] Open
Abstract
Background Vascular calcification (VC) has been observed in patients with hemodialysis, whereas few studies have investigated calcification in the upper extremity vasculature. Both ultrasound and X-ray are used to investigate the calcification of arteries in patients. However, there is a lack of data on the consistency between these two methods. The aim of this study was to investigate the occurrence of VC in the radial and ulnar arteries of hemodialysis patients and investigate the detection consistency in VC between ultrasound and X-ray. Methods Ultrasound and X-ray examinations were performed in the radial and ulnar arteries of both the left and right upper extremities of 40 patients on hemodialysis. The calcification status of arteries was evaluated by the calcification index from ultrasound and X-ray respectively. Clinical variables of patients were collected from all the involved patients. Results Of the 40 patients, VC was detected in 31 patients by ultrasound, while X-ray detected VC in 22 patients. Compared to ultrasound assessment, X-ray assessment was 73.21% sensitive but only 66.35% specific with a positive predictive value of 53.95% for detecting calcifications in the radial or ulnar artery. The level of agreement between ultrasound and X-ray results was fair. In addition, our data showed that more ulnar arteries had VCs than the corresponding radial arteries. Conclusion Ultrasound is more sensitive in detecting the presence of calcified atherosclerotic lesions. Ultrasound and X-ray exhibited fair consistency. Ultrasound screening for upper extremity radial and ulnar arteries in hemodialysis patients may deserve attention to explore its clinical significance.
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Affiliation(s)
- Yanli Yang
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Na Lin
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuankai Xu
- Department of Nephrology, Zhejiang Hospital, Hangzhou, China
| | - Zheli Niu
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fulei Meng
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kaidi Zhang
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuhuan Wang
- Department of Nephrology, The First Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Lin Ruan
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lihong Zhang
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
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17
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Jardon M, Nguyen J, Casaletto E, Ko L, Wolff A, Daluiski A, Nwawka OK. Utilization of shear wave elastography to quantify and predict response to upper extremity botulinum toxin injections in patients with cerebral palsy: A pilot study. Clin Neurol Neurosurg 2023; 230:107798. [PMID: 37236005 DOI: 10.1016/j.clineuro.2023.107798] [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: 01/15/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Shear wave elastography (SWE) was used to quantify change in upper extremity muscle stiffness in patients with unilateral spastic cerebral palsy (USCP) following botulinum toxin A (BTX-A) therapy. We hypothesized that SWE measures would decrease following ultrasound-guided BTX-A injection, and correlate with functional improvement. METHODS SWE measures of BTX-A treated muscles were recorded immediately pre-injection, and at 1-, 3- and 6-months post-injection. At the same timepoints, functional assessment was performed using the Modified Ashworth Scale (MAS), and passive and active range of motion (PROM and AROM) measures. Correlation of SWE with MAS, PROM and AROM, as well as the relationship between change in SWE and change in MAS, PROM and AROM was determined using Spearman's rank correlation coefficient and generalized estimating equation modeling. RESULTS 16 muscles were injected and longitudinally assessed. SWE and MAS scores decreased following BTX-A injection (p = 0.030 and 0.004, respectively), reflecting decreased quantitative and qualitative muscle stiffness. Decreased SWE reached statistical significance at 1- and 3-months, and 1-, 3- and 6-months for MAS. When comparing relative change in SWE to relative change in AROM, larger change in SWE strongly correlated with positive change in AROM (p-value range:<0.001-0.057). BTX-A responders also demonstrated lower baseline SWE (1.4 m/s) vs. non-responders (1.9 m/s), p = 0.035. CONCLUSION Ultrasound-guided BTX-A injections in patients with USCP resulted in decreased quantitative and qualitative muscle stiffness. Strong correlation between change in SWE and AROM, as well as the significant difference in baseline SWE for BTX-A responders and non-responders, suggests SWE may provide a useful tool to predict and monitor BTX-A response.
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Affiliation(s)
- Meghan Jardon
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Joseph Nguyen
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, NY, USA
| | - Emily Casaletto
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Lydia Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Aviva Wolff
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Aaron Daluiski
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
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18
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Hooijmans MT, Habets LE, van den Berg‐Faay SAM, Froeling M, Asselman F, Strijkers GJ, Jeneson JAL, Bartels B, Nederveen AJ, van der Pol WL. Multi-parametric quantitative magnetic resonance imaging of the upper arm muscles of patients with spinal muscular atrophy. NMR Biomed 2022; 35:e4696. [PMID: 35052014 PMCID: PMC9286498 DOI: 10.1002/nbm.4696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/24/2021] [Accepted: 01/17/2022] [Indexed: 06/09/2023]
Abstract
Quantitative magnetic resonance imaging (qMRI) is frequently used to map the disease state and disease progression in the lower extremity muscles of patients with spinal muscular atrophy (SMA). This is in stark contrast to the almost complete lack of data on the upper extremity muscles, which are essential for carrying out daily activities. The aim of this study was therefore to assess the disease state in the upper arm muscles of patients with SMA in comparison with healthy controls by quantitative assessment of fat fraction, diffusion indices, and water T2 relaxation times, and to relate these measures to muscle force. We evaluated 13 patients with SMA and 15 healthy controls with a 3-T MRI protocol consisting of DIXON, diffusion tensor imaging, and T2 sequences. qMRI measures were compared between groups and related to muscle force measured with quantitative myometry. Fat fraction was significantly increased in all upper arm muscles of the patients with SMA compared with healthy controls and correlated negatively with muscle force. Additionally, fat fraction was heterogeneously distributed within the triceps brachii (TB) and brachialis muscle, but not in the biceps brachii muscle. Diffusion indices and water T2 relaxation times were similar between patients with SMA and healthy controls, but we did find a slightly reduced mean diffusivity (MD), λ1, and λ3 in the TB of patients with SMA. Furthermore, MD was positively correlated with muscle force in the TB of patients with SMA. The variation in fat fraction further substantiates the selective vulnerability of muscles. The reduced diffusion tensor imaging indices, along with the positive correlation of MD with muscle force, point to myofiber atrophy. Our results show the feasibility of qMRI to map the disease state in the upper arm muscles of patients with SMA. Longitudinal data in a larger cohort are needed to further explore qMRI to map disease progression and to capture the possible effects of therapeutic interventions.
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Affiliation(s)
- Melissa T. Hooijmans
- Department of Radiology and Nuclear Medicine, Amsterdam Movement SciencesAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Laura E. Habets
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Sandra A. M. van den Berg‐Faay
- Department of Radiology and Nuclear Medicine, Amsterdam Movement SciencesAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Martijn Froeling
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Fay‐Lynn Asselman
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Gustav J. Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam Movement SciencesAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Jeroen A. L. Jeneson
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Bart Bartels
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam Movement SciencesAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - W. Ludo van der Pol
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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Perez CS, Mestriner C, Ribeiro LTN, Grillo FW, Lemos TW, Carneiro AA, Guirro RRDJ, Guirro ECO. Relationship between lymphedema after breast cancer treatment and biophysical characteristics of the affected tissue. PLoS One 2022; 17:e0264160. [PMID: 35442985 PMCID: PMC9020674 DOI: 10.1371/journal.pone.0264160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/04/2022] [Indexed: 12/24/2022] Open
Abstract
The treatment of breast cancer is often complicated by lymphedema of the upper limbs. Standard lymphedema evaluation methodologies are not able to measure tissue fibrosis. The ultrasound aspects related to tissue microstructures of lymphedema are neglected in clinical evaluations. The objective of this study was to identify and measure the degree of impairment, topography, and biophysical alterations of subcutaneous lymphedema tissue secondary to the treatment of breast cancer by ultrasonography. Forty-two women at a mean age of 58 (±9.7) years, with unilateral lymphedema due to breast cancer treatment, were evaluated. The upper limbs were divided into affected (affected by lymphedema) and control (contralateral limb). Each limb was subdivided into seven areas, defined by perimetry, evaluated in pairs. The biophysical characteristics thickness, entropy, and echogenicity were evaluated by ultrasonography. The results showed a significant difference in the echogenicity and thickness variables between the affected and unaffected upper limb, in all the extent of the upper limb, while entropy showed no significant difference. The findings indicate that the data presented were consistent both in identifying and measuring the degree of impairment and biophysical changes in the subcutaneous tissue of lymphedema secondary to the treatment of breast cancer.
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Affiliation(s)
- Carla S. Perez
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
- Departamento de Ciências das Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de são Paulo, Ribeirão Preto, São Paulo, Brasil
- * E-mail: , (CSP); (ECOG)
| | - Carolina Mestriner
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Leticia T. N. Ribeiro
- Departamento de Física, Faculdade de Filosofia, ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Felipe W. Grillo
- Departamento de Física, Faculdade de Filosofia, ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Tenysson W. Lemos
- Departamento de Ciências das Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de são Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Antônio A. Carneiro
- Departamento de Física, Faculdade de Filosofia, ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Rinaldo Roberto de Jesus Guirro
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
- Departamento de Ciências das Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de são Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Elaine C. O. Guirro
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
- Departamento de Ciências das Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de são Paulo, Ribeirão Preto, São Paulo, Brasil
- * E-mail: , (CSP); (ECOG)
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20
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Cristiano L, Brogna C, Tasca G, Verdolotti T, Pane M, Mercuri E. Muscle-MRI and Functional Levels for the Evaluation of Upper Limbs in Duchenne Muscular Dystrophy: A Critical Review of the Literature. Medicina (B Aires) 2022; 58:medicina58030440. [PMID: 35334617 PMCID: PMC8954550 DOI: 10.3390/medicina58030440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022] Open
Abstract
Many qualitative and quantitative Magnetic Resonance Imaging (MRI) techniques have been applied to evaluate muscle fat degeneration in Duchenne muscular dystrophy (DMD) subjects, but only few studies have focused on the upper limbs. We reviewed the literature in order to evaluate the association between muscle MRI findings and motor function levels in the upper limbs of DMD patients. Ten studies with upper limb muscle MRI data were available. Four explored all upper limb segments, while six explored only the forearm. Functional assessments were performed in nine of the ten studies. All of the studies showed a significant correlation between muscle MRI changes and motor function levels in both ambulant and non-ambulant DMD patients.
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Affiliation(s)
- Lara Cristiano
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (L.C.); (M.P.); (E.M.)
| | - Claudia Brogna
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (L.C.); (M.P.); (E.M.)
- Nemo Clinical Centre, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-30155340; Fax: +39-06-30154363
| | - Giorgio Tasca
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy;
| | - Tommaso Verdolotti
- Institute of Radiology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy;
| | - Marika Pane
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (L.C.); (M.P.); (E.M.)
- Nemo Clinical Centre, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (L.C.); (M.P.); (E.M.)
- Nemo Clinical Centre, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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21
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Brogna C, Cristiano L, Verdolotti T, Norcia G, Ficociello L, Ruiz R, Coratti G, Fanelli L, Forcina N, Petracca G, Chieppa F, Tartaglione T, Colosimo C, Pane M, Mercuri E. Longitudinal Motor Functional Outcomes and Magnetic Resonance Imaging Patterns of Muscle Involvement in Upper Limbs in Duchenne Muscular Dystrophy. Medicina (B Aires) 2021; 57:medicina57111267. [PMID: 34833484 PMCID: PMC8624281 DOI: 10.3390/medicina57111267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: The aim of this study was to evaluate longitudinal changes using both upper limb muscle Magnetic Resonance Imaging (MRI) at shoulder, arm and forearm levels and Performance of upper limb (PUL) in ambulant and non-ambulant Duchenne Muscular Dystrophy (DMD) patients. We also wished to define whether baseline muscle MRI could help to predict functional changes after one year. Materials and Methods: Twenty-seven patients had both baseline and 12month muscle MRI and PUL assessments one year later. Results: Ten were ambulant (age range 5–16 years), and 17 non ambulant (age range 10–30 years). Increased abnormalities equal or more than 1.5 point on muscle MRI at follow up were found on all domains: at shoulder level 12/27 patients (44%), at arm level 4/27 (15%) and at forearm level 6/27 (22%). Lower follow up PUL score were found in 8/27 patients (30%) at shoulder level, in 9/27 patients (33%) at mid-level whereas no functional changes were found at distal level. There was no constant association between baseline MRI scores and follow up PUL scores at arm and forearm levels but at shoulder level patients with moderate impairment on the baseline MRI scores between 16 and 34 had the highest risk of decreased function on PUL over a year. Conclusions: Our results confirmed that the integrated use of functional scales and imaging can help to monitor functional and MRI changes over time.
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Affiliation(s)
- Claudia Brogna
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy;
- Nemo Clinical Centre, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (G.N.); (G.C.); (L.F.); (N.F.); (M.P.)
| | - Lara Cristiano
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.C.); (R.R.); (G.P.); (F.C.)
| | - Tommaso Verdolotti
- Institute of Radiology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (T.V.); (L.F.); (C.C.)
| | - Giulia Norcia
- Nemo Clinical Centre, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (G.N.); (G.C.); (L.F.); (N.F.); (M.P.)
| | - Luana Ficociello
- Institute of Radiology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (T.V.); (L.F.); (C.C.)
| | - Roberta Ruiz
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.C.); (R.R.); (G.P.); (F.C.)
| | - Giorgia Coratti
- Nemo Clinical Centre, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (G.N.); (G.C.); (L.F.); (N.F.); (M.P.)
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.C.); (R.R.); (G.P.); (F.C.)
| | - Lavinia Fanelli
- Nemo Clinical Centre, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (G.N.); (G.C.); (L.F.); (N.F.); (M.P.)
| | - Nicola Forcina
- Nemo Clinical Centre, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (G.N.); (G.C.); (L.F.); (N.F.); (M.P.)
| | - Giorgia Petracca
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.C.); (R.R.); (G.P.); (F.C.)
| | - Fabrizia Chieppa
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.C.); (R.R.); (G.P.); (F.C.)
| | - Tommaso Tartaglione
- Department of Radiology, Istituto Dermatologico Italiano, IRCCS, 00167 Rome, Italy;
| | - Cesare Colosimo
- Institute of Radiology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (T.V.); (L.F.); (C.C.)
- Institute of Radiology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marika Pane
- Nemo Clinical Centre, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (G.N.); (G.C.); (L.F.); (N.F.); (M.P.)
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.C.); (R.R.); (G.P.); (F.C.)
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy;
- Nemo Clinical Centre, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (G.N.); (G.C.); (L.F.); (N.F.); (M.P.)
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.C.); (R.R.); (G.P.); (F.C.)
- Correspondence: ; Tel.: +39-06-30155340; Fax: +39-06-30154363
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22
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Wu C, Bao H, Xu Q. Hourglass-Like Constriction Neuropathy of the Upper Limb Nerve: Diffusion-Weighted Magnetic Resonance Neurography Imaging Findings. J Comput Assist Tomogr 2021; 45:759-764. [PMID: 34546681 DOI: 10.1097/rct.0000000000001236] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purposes of this study were to determine reliable diffusion-weighted magnetic resonance neurography (DW-MRN) features of hourglass-like constriction of the upper limb nerve and to evaluate the application value of DW-MRN compared with ultrasonography (US). METHODS We retrospectively reviewed MRN studies of 13 patients. Qualitative and quantitative image analyses were carried out. The number of constrictions based on DW-MRN and US findings was compared. RESULTS Of the 13 cases, there were 7 cases with radial nerve abnormalities, 4 with median nerve abnormalities, and 2 with radial and median nerve abnormalities. Diffusion-weighted MRN showed a single-segmental constriction in 7 of 13 cases and multisegmental constrictions in 6 of 13 cases; the hourglass-like constriction appeared in all cases (13 of 13). Thirty-three nerve constrictions were found in DW-MRN, and 29 nerve constrictions were found in US. CONCLUSIONS Diffusion-weighted MRN is a noninvasive and helpful diagnostic for hourglass-like constriction of the upper limb nerve.
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Affiliation(s)
- Chao Wu
- From the Department of Radiology, General Hospital of Tianjin Medical University, Tianjin
| | | | - Qiang Xu
- From the Department of Radiology, General Hospital of Tianjin Medical University, Tianjin
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23
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Soni NJ, Le MPT, Velez MI, Proud KC. Incidental catheter-associated upper extremity deep venous thrombosis detected by point-of-care ultrasound. BMJ Case Rep 2021; 14:e244357. [PMID: 34446517 PMCID: PMC8395361 DOI: 10.1136/bcr-2021-244357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- Nilam J Soni
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Minh-Phuong T Le
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Maria Inez Velez
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Kevin C Proud
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
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24
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van Dam LF, Dronkers CEA, Gautam G, Eckerbom Å, Ghanima W, Gleditsch J, van Haren GR, von Heijne A, Huisman MV, Stöger JL, Westerlund E, Kroft LJM, Klok FA. Detection of upper extremity deep vein thrombosis by magnetic resonance non-contrast thrombus imaging. J Thromb Haemost 2021; 19:1973-1980. [PMID: 34018662 PMCID: PMC8361740 DOI: 10.1111/jth.15394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Compression ultrasonography (CUS) is the first-line imaging test for diagnosing upper extremity deep vein thrombosis (UEDVT), but often yields inconclusive test results. Contrast venography is still considered the diagnostic standard but is an invasive technique. OBJECTIVES We aimed to determine the diagnostic accuracy of magnetic resonance noncontrast thrombus imaging (MR-NCTI) for the diagnosis of UEDVT. METHODS In this international multicenter diagnostic study, we prospectively included patients with clinically suspected UEDVT who were managed according to a diagnostic algorithm that included a clinical decision rule (CDR), D-dimer test, and diagnostic imaging. UEDVT was confirmed by CUS or (computed tomography [CT]) venography. UEDVT was excluded by (1) an unlikely CDR and normal D-dimer, (2) a normal serial CUS or (3) a normal (CT) venography. Within 48 h after the final diagnosis was established, patients underwent MR-NCTI. MR-NCTI images were assessed post hoc by two independent radiologists unaware of the presence or absence of UEDVT. The sensitivity, specificity, and interobserver agreement of MR-NCTI for UEDVT were determined. RESULTS Magnetic resonance noncontrast thrombus imaging demonstrated UEDVT in 28 of 30 patients with UEDVT and was normal in all 30 patients where UEDVT was ruled out, yielding a sensitivity of 93% (95% CI 78-99) and specificity of 100% (95% CI 88-100). The interobserver agreement of MR-NCTI had a kappa value of 0.83 (95% CI 0.69-0.97). CONCLUSIONS Magnetic resonance noncontrast thrombus imaging is an accurate and reproducible method for diagnosing UEDVT. Clinical outcome studies should determine whether MR-NCTI can replace venography as the second-line imaging test in case of inconclusive CUS.
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Affiliation(s)
- Lisette F. van Dam
- Department of Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Charlotte E. A. Dronkers
- Department of Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
- Department of Internal MedicineHaaglanden Medical CenterThe HagueThe Netherlands
| | - Gargi Gautam
- Department of Clinical SciencesKarolinska InstituteDanderyd HospitalStockholmSweden
| | - Åsa Eckerbom
- Department of Clinical SciencesKarolinska InstituteDanderyd HospitalStockholmSweden
| | - Waleed Ghanima
- Internal Medicine ClinicØstfold Hospital TrustØstfoldNorway
- Department of HaematologyOslo University Hospital and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | | | - Guido R. van Haren
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Anders von Heijne
- Department of Clinical SciencesKarolinska InstituteDanderyd HospitalStockholmSweden
| | - Menno V. Huisman
- Department of Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - J. Lauran Stöger
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Eli Westerlund
- Department of Clinical SciencesKarolinska InstituteDanderyd HospitalStockholmSweden
| | - Lucia J. M. Kroft
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Frederikus A. Klok
- Department of Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
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25
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Abstract
Musculoskeletal disorders affect the locomotor system and are the leading contributor to disability worldwide. Patients suffer chronic pain and limitations in mobility, dexterity, and functional ability. Musculoskeletal (bone) X-ray is an essential tool in diagnosing the abnormalities. In recent years, deep learning algorithms have increasingly been applied in musculoskeletal radiology and have produced remarkable results. In our study, we introduce a new calibrated ensemble of deep learners for the task of identifying abnormal musculoskeletal radiographs. Our model leverages the strengths of three baseline deep neural networks (ConvNet, ResNet, and DenseNet), which are typically employed either directly or as the backbone architecture in the existing deep learning-based approaches in this domain. Experimental results based on the public MURA dataset demonstrate that our proposed model outperforms three individual models and a traditional ensemble learner, achieving an overall performance of (AUC: 0.93, Accuracy: 0.87, Precision: 0.93, Recall: 0.81, Cohen's kappa: 0.74). The model also outperforms expert radiologists in three out of the seven upper extremity anatomical regions with a leading performance of (AUC: 0.97, Accuracy: 0.93, Precision: 0.90, Recall:0.97, Cohen's kappa: 0.85) in the humerus region. We further apply the class activation map technique to highlight the areas essential to our model's decision-making process. Given that the best radiologist performance is between 0.73 and 0.78 in Cohen's kappa statistic, our study provides convincing results supporting the utility of a calibrated ensemble approach for assessing abnormalities in musculoskeletal X-rays.
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Affiliation(s)
- Minliang He
- Gabelli School of Business, Fordham University, New York, NY, 10023, USA
| | - Xuming Wang
- Gabelli School of Business, Fordham University, New York, NY, 10023, USA
| | - Yijun Zhao
- Computer and Information Science Department, Fordham University, 113 W 60th St., New York, NY, 10023, USA.
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26
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Azad A, De Tolla J, Walter W, Paksima N, Melamed E. Musculoskeletal Ultrasonography of the Extremities: Clinical and Ultrasonographic Correlation. Instr Course Lect 2021; 70:637-650. [PMID: 33438941] [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: 06/12/2023]
Abstract
Ultrasonography as a diagnostic and therapeutic tool has become a resource for musculoskeletal injuries. It can be a useful imaging modality for clinical correlation of physical examination findings as well as an aid for image-guided procedures. Understanding the settings in which it is a helpful adjunct will have implications on efficiency and cost utility. The objectives of this chapter are to provide a background of ultrasonography as a musculoskeletal imaging modality, provide clinical correlation for ultrasonographic findings for common upper extremity pathology, review the diagnostic efficacy of ultrasonography for image-guided procedures, and provide insight into the cost utility of ultrasonography guidance for therapeutic injections.
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27
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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 1 upper limb. Eur J Radiol 2020; 131:109234. [PMID: 32949858 DOI: 10.1016/j.ejrad.2020.109234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/15/2019] [Revised: 06/21/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This article aims to review the pertinent anatomy, etiopathogenesis, current clinical and radiological concepts and principles of management in case of upper limb entrapment neuropathies. METHODS The review is based on critical analysis of the existing literature as well as our experience in dealing with entrapment neuropathies. RESULTS Entrapment neuropathies of the upper limb peripheral nerves are common conditions that are often misdiagnosed because of their varying clinical presentations and lack of standardized diagnostic methods. Clinical assessment and electrodiagnostic studies have been the mainstay; however, imaging techniques have provided newer insights into the pathophysiology of these entities, leading to a paradigm shift in their diagnosis and management. The current best practice protocols for entrapment syndromes are constantly evolving with increasing emphasis on the role high-resolution ultrasound and magnetic resonance imaging. Many imaging criteria are described and we have tried to present the most validated measurements for diagnosing entrapment neuropathies. CONCLUSION It is imperative for a clinical radiologist to be familiar with the etiopathogenesis and clinical features of these conditions, in addition to being thorough with the anatomy and the latest imaging strategies.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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28
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Li L, Martin T, Xu X. A novel vision-based real-time method for evaluating postural risk factors associated with musculoskeletal disorders. Appl Ergon 2020; 87:103138. [PMID: 32501254 DOI: 10.1016/j.apergo.2020.103138] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/31/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
Real-time risk assessment for work-related musculoskeletal disorders (MSD) has been a challenging research problem. Previous methods such as using depth cameras suffered from limited visual range and wearable sensors could cause intrusiveness to the workers, both of which are less feasible for long-run on-site applications. This document examines a novel end-to-end implementation of a deep learning-based algorithm for rapid upper limb assessment (RULA). The algorithm takes normal RGB images as input and outputs the RULA action level, which is a further division of RULA grand score. Lifting postures collected in laboratory and posture data from Human 3.6 (a public human pose dataset) were used for training and evaluating the algorithm. Overall, the algorithm achieved 93% accuracy and 29 frames per second efficiency for detecting the RULA action level. The results also indicate that using data augmentation (a strategy to diversify the training data) can significantly improve the robustness of the model. The proposed method demonstrates its high potential for real-time on-site risk assessment for the prevention of work-related MSD. A demo video can be found at https://github.com/LLDavid/RULA_2DImage.
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Affiliation(s)
- Li Li
- Edward P.Fitts Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC 27695, USA
| | - Tara Martin
- Edward P.Fitts Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC 27695, USA
| | - Xu Xu
- Edward P.Fitts Department of Industrial & Systems Engineering, North Carolina State University, Raleigh, NC 27695, USA.
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29
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Medina-Rodríguez ME, de-la-Casa-Almeida M, Mena-Rodríguez A, González-Martín JM, Medrano-Sánchez EM. Relationship between perimetric increase and fluoroscopic pattern type in secondary upper limb lymphedema observed by Indocyanine green lymphography. Medicine (Baltimore) 2020; 99:e20432. [PMID: 32541464 PMCID: PMC7302654 DOI: 10.1097/md.0000000000020432] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To ascertain the relationship between the perimetric differences obtained between the limbs and the type of fluoroscopic pattern observed by Indocyanine green (ICG) lymphography in patients with upper limb lymphedema.A correlational descriptive study was carried out in 19 patients with upper limb lymphedema secondary to breast cancer. The perimetric increase was recorded in 11 anatomical regions after ICG injection, fluoroscopic patterns were identified using an infrared camera. The ICG patterns were categorized into worse (stardust, diffuse) or better (linear, splash) patterns.The pattern coincidence between the anterior and posterior regions of the edematous extremities was 45%. At the wrist level, a difference of 2 cm was associated with the presence of a worse fluoroscopic pattern, whereas perimeter differences of 4.25 cm in the elbow and 2.25 cm in the arm (12 cm from the epicondyle) were associated with the presence of a better fluoroscopic pattern.The perimetric differences observed between the healthy and affected upper limbs in 4 specific anatomical areas allowed us to predict the type of fluoroscopic pattern. ICG lymphography has facilitated the study of the posterior regions of edema, which are difficult to visualize using other imaging techniques.
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30
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Desjardins B, Hanley M, Steigner ML, Aghayev A, Azene EM, Bennett SJ, Chandra A, Hedgire SS, Lo BM, Mauro DM, Ptak T, Singh-Bhinder N, Suranyi PS, Verma N, Dill KE. ACR Appropriateness Criteria® Suspected Upper Extremity Deep Vein Thrombosis. J Am Coll Radiol 2020; 17:S315-S322. [PMID: 32370975 DOI: 10.1016/j.jacr.2020.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 01/13/2023]
Abstract
This publication includes the appropriate imaging modalities to assess suspected deep vein thrombosis in the upper extremities. Ultrasound duplex Doppler is the most appropriate imaging modality to assess upper-extremity deep vein thrombosis. It is a noninvasive test, which can be performed at the bedside and used for serial evaluations. Ultrasound can also directly identify thrombus by visualizing echogenic material in the vein and by lack of compression of the vein walls from manual external pressure. It can indirectly identify thrombus from altered blood-flow patterns. It is most appropriate in the evaluation of veins peripheral to the brachiocephalic vein. CT venography and MR venography are not first-line imaging tests, but are appropriate to assess the central venous structures, or to assess the full range of venous structures from the hand to the right atrium. Catheter venography is appropriate if therapy is required. Radionuclide venography and chest radiography are usually not appropriate to assess upper-extremity deep vein thrombosis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Michael Hanley
- Panel Chair, University of Virginia Health System, Charlottesville, Virginia
| | | | - Ayaz Aghayev
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Ankur Chandra
- Scripps Green Hospital, La Jolla, California; Society for Vascular Surgery
| | - Sandeep S Hedgire
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bruce M Lo
- Sentara Norfolk General/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - David M Mauro
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Thomas Ptak
- University of Maryland Medical Center, Baltimore, Maryland
| | | | - Pal S Suranyi
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Karin E Dill
- Specialty Chair, UMass Memorial Medical Center, Worcester, Massachusetts
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31
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Baik JW, Kim JY, Cho S, Choi S, Kim J, Kim C. Super Wide-Field Photoacoustic Microscopy of Animals and Humans In Vivo. IEEE Trans Med Imaging 2020; 39:975-984. [PMID: 31484110 DOI: 10.1109/tmi.2019.2938518] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Acoustic-resolution photoacoustic micro-scopy (AR-PAM) is an emerging biomedical imaging modality that combines superior optical sensitivity and fine ultrasonic resolution in an optical quasi-diffusive regime (~1-3 mm in tissues). AR-PAM has been explored for anatomical, functional, and molecular information in biological tissues. Heretofore, AR-PAM systems have suffered from a limited field-of-view (FOV) and/or slow imaging speed, which have precluded them from routine preclinical and clinical applications. Here, we demonstrate an advanced AR-PAM system that overcomes both limitations of previous AR-PAM systems. The new AR-PAM system demonstrates a super wide-field scanning that utilized a 1-axis water-proofing microelectromechanical systems (MEMS) scanner integrated with two linear stepper motor stages. We achieved an extended FOV of 36 ×80 mm2 by mosaicking multiple volumetric images of 36 ×2.5 mm2 with a total acquisition time of 224 seconds. For one volumetric data (i.e., 36 ×2.5 mm2), the B-scan imaging speed over the short axis (i.e., 2.5 mm) was 83 Hz in humans. The 3D volumetric image was also provided by using MEMS mirror scanning along the X-axis and stepper-motor scanning along the Y-axis. The super-wide FOV mosaic image was realized by registering and merging all individual volumetric images. Finally, we obtained multi-plane whole-body in-vivo PA images of small animals, illustrating distinct multi-layered structures including microvascular networks and internal organs. Importantly, we also visualized microvascular networks in human fingers, palm, and forearm successfully. This advanced MEMS-AR-PAM system could potentially enable hitherto not possible wide preclinical and clinical applications.
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32
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Sconfienza LM, Adriaensen M, Albano D, Allen G, Aparisi Gómez MP, Bazzocchi A, Beggs I, Bignotti B, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gielen J, Gitto S, Gupta H, Klauser AS, Lalam R, Martin S, Martinoli C, Mauri G, McCarthy C, McNally E, Melaki K, Messina C, Mirón Mombiela R, Neubauer B, Obradov M, Olchowy C, Orlandi D, Gonzalez RP, Rutkauskas S, Snoj Z, Tagliafico AS, Talaska A, Vasilevska-Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Plagou A. Clinical indications for image guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part III, nerves of the upper limb. Eur Radiol 2019; 30:1498-1506. [PMID: 31712960 DOI: 10.1007/s00330-019-06479-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 07/16/2019] [Revised: 08/30/2019] [Accepted: 09/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Image-guided interventional procedures of the nerves are commonly performed by physicians from different medical specialties, although there is a lack of clinical indications for these types of procedures. This Delphi-based consensus provided a list of indications on image-guided interventional procedures for nerves of the upper limb based on updated published evidence. METHODS An expert panel of 45 members of the Ultrasound and Interventional Subcommittees of the ESSR participated in this Delphi-based consensus study. After revision of the published papers on image-guided interventional procedures for nerves of the upper limb updated to September 2018, the experts drafted a list of statements according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus on statements regarding clinical indications was considered as strong when more than 95% of experts agreed, and broad if more than 80% agreed. RESULTS Ten statements were drafted on procedures for nerves of the upper limb. Only two statements reached the highest level of evidence (ultrasound guidance is a safe and effective method for brachial plexus block; ultrasound-guided non-surgical approaches are safe and effective methods to treat carpal tunnel syndrome in the short term, but there is sparse evidence on the mid- and long-term effectiveness of these interventions). Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%). CONCLUSIONS This Delphi-based consensus study reported poor evidence on image-guided interventional procedures for nerves of the upper limb. Sixty percent of statements on clinical indications provided by the expert board reached a strong consensus. KEY POINTS • An expert panel of the ESSR provided 10 evidence-based statements on clinical indications for image-guided interventional procedures for nerves of the upper limb • Two statements reached the highest level of evidence • Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%).
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, 20161, Milano, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, The Netherlands
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, 20161, Milano, Italy
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127, Palermo, Italy
| | - Georgina Allen
- St Luke's Radiology Oxford Ltd, Oxford, UK
- University of Oxford, Oxford, UK
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, 1023, New Zealand
- Department of Radiology, Hospital Vithas Nueve de Octubre, 46015, Valencia, Spain
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Ian Beggs
- Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | | | - Vito Chianca
- IRCCS Istituto Ortopedico Galeazzi, 20161, Milano, Italy
| | - Angelo Corazza
- IRCCS Istituto Ortopedico Galeazzi, 20161, Milano, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Danoob Dalili
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Miriam De Dea
- UOC Radiologia, Ospedale di Feltre, AULSS1 Dolomiti, Veneto, Italy
| | - Jose Luis Del Cura
- Department of Radiology, Donostia University Hospital, 20014, Donostia/San Sebastian, Spain
- University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Francesco Di Pietto
- Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, (CE), Italy
| | - Eleni Drakonaki
- Private Institution of Ultrasonography and MSK Radiology, Heraklion, Greece
- Department of Anatomy, Medical School of the European University of Cyprus, Engomi, Cyprus
| | - Fernando Facal de Castro
- IBERORAD 1895 S.L., 08021, Barcelona, Spain
- Department of Radiology, General University Hospital of Valencia, Valencia, Spain
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jan Gielen
- University of Antwerp, Antwerp, Belgium
- University of Antwerp Hospital (UZA), Edegem, Belgium
| | | | | | - Andrea S Klauser
- Medical University Innsbruck, Innsbruck, Austria
- Department of Radiology, Innsbruck, Austria
| | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Silvia Martin
- Hospital Son Llatzer, Palma de Mallorca, Spain
- Universidad de las Islas Baleares Medicine, Palma, Balearic Islands, Spain
| | - Carlo Martinoli
- Ospedale Policlinico San Martino, 16132, Genoa, Italy
- University of Genoa - DISSAL Department of Health Sciences, Genoa, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Catherine McCarthy
- The Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
- Oxford Musculoskeletal Radiology, Oxford, UK
| | | | - Kalliopi Melaki
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, 20161, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Rebeca Mirón Mombiela
- Department of Physiology, Universidad de Valencia/INCLIVA, 46010, Valencia, Spain
- Herlev og Gentofte Hospital Radiologisk Afdeling, Herlev Ringvej 75, opgang 51, Herlev, Denmark
| | - Benedikt Neubauer
- Radiology, Medical University of Vienna, Vienna, Austria
- Ordensklinikum Linz, Linz, Austria
| | - Marina Obradov
- Sint Maartenskliniek, 9011, Nijmegen, 6500GM, The Netherlands
| | - Cyprian Olchowy
- Department of Oral Surgery, Wroclaw Medical University, Wrocław, Poland
| | | | | | - Saulius Rutkauskas
- Radiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ziga Snoj
- Department of Radiology, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, 1000, Slovenia
| | - Alberto Stefano Tagliafico
- Ospedale Policlinico San Martino, 16132, Genoa, Italy
- Department of Health Sciences, University of Genoa, 16132, Genoa, Italy
| | | | - Violeta Vasilevska-Nikodinovska
- Medical Faculty, University "Ss.Cyril and Methodius", Skopje, North Macedonia
- University Surgical Clinic "St.Naum Ohridski", Skopje, North Macedonia
| | - Jelena Vucetic
- Department of Radiology, General University Hospital of Valencia, Valencia, Spain
- Department of Physiology, Universidad de Valencia/INCLIVA, 46010, Valencia, Spain
| | - David Wilson
- St Luke's Radiology Oxford Ltd, Oxford, UK
- University of Oxford, Oxford, UK
| | - Federico Zaottini
- University of Genoa - DISSAL Department of Health Sciences, Genoa, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
- Varelli Institute, Naples, Italy
| | - Athena Plagou
- Department of Radiology, Private Institution of Ultrasonography, Athens, Greece
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Aparisi Gómez MP, Aparisi F, Battista G, Guglielmi G, Faldini C, Bazzocchi A. Functional and Surgical Anatomy of the Upper Limb: What the Radiologist Needs to Know. Radiol Clin North Am 2019; 57:857-881. [PMID: 31351538 DOI: 10.1016/j.rcl.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/20/2022]
Abstract
The anatomy of the upper limb is complex and allows for exceptional functionality. The movements of the joints of the shoulder, elbow, and wrist represent a complex dynamic interaction of muscles, ligaments, and bony articulations. A solid understanding and of the characteristics and reciprocal actions of the anatomic elements of the joints of the upper limb helps explain the mechanisms and patterns of injury. This article focuses on the anatomy and functionality of the shoulder, elbow, and wrist, with emphasis on the stabilizing mechanisms, to set the foundation for understanding the occurrence of pathologic conditions.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, National Women's Hospital, Auckland City Hospital, Greenlane Clinical Center, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Radiology, Hospital Nisa Nueve de Octubre, Calle Valle de la Ballestera, 59, Valencia 46015, Spain.
| | - Francisco Aparisi
- Department of Radiology, Hospital Nisa Nueve de Octubre, Calle Valle de la Ballestera, 59, Valencia 46015, Spain
| | - Giuseppe Battista
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Via U. Foscolo 7, Bologna 40123, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
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Abstract
Ultrasound has been reported to be a quick, cheap, and effective imaging modality to guide the interventional procedures in the musculoskeletal system. The use of ultrasound results in increased accuracy of needle placement associated with a reduction of complications. In the upper limb, ultrasound-guided procedures are applied to joints and soft tissues around the shoulder, elbow, wrist, and hand. This article reviews the clinical and technical aspects of the most common procedures performed in this anatomic area.
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, Milano 20122, Italy.
| | - Vito Chianca
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, Milano 20122, Italy
| | - Domenico Albano
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Via del Vespro, 129, 90127 Palermo, Italy
| | - Grazia Pozzi
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
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Woo T, Lalam R, Cassar-Pullicino V, Degrieck B, Verstraete K, Donati DM, Guglielmi G, Vanel D, Bazzocchi A. Imaging of Upper Limb Tumors and Tumorlike Pathology. Radiol Clin North Am 2019; 57:1035-1050. [PMID: 31351534 DOI: 10.1016/j.rcl.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 12/22/2022]
Abstract
Bone and soft tissue sarcomas are uncommon tumors that can occur within the upper extremity as well as elsewhere within the body. However, certain histopathological subtypes have increased affinity for the upper limb and even certain sites within the arm and hand. Other benign masses and tumor mimics, such as infection and traumatic lesions, are more common and imaging appearances can sometimes overlap with malignant lesions making diagnosis difficult. In this article, we explore the current options for imaging of these lesions as well as typical imaging appearances of the more common upper limb tumors.
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Affiliation(s)
- Timothy Woo
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - Radhesh Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK.
| | - Victor Cassar-Pullicino
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - Bert Degrieck
- Department of Radiology, Ghent University UZ-Gent, MR -1 K12, C. Heymanslaan 10, Gent B-9000, Belgium
| | - Koenraad Verstraete
- Department of Radiology, Ghent University UZ-Gent, MR -1 K12, C. Heymanslaan 10, Gent B-9000, Belgium
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Via U. Foscolo 7, Bologna 40123, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Daniel Vanel
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna 40136, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna 40136, Italy
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Kutáč P, Bunc V, Sigmund M. Whole-body dual-energy X-ray absorptiometry demonstrates better reliability than segmental body composition analysis in college-aged students. PLoS One 2019; 14:e0215599. [PMID: 31009495 PMCID: PMC6476531 DOI: 10.1371/journal.pone.0215599] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/04/2019] [Indexed: 01/17/2023] Open
Abstract
Dual-energy X-ray absorptiometry (DXA) is rapidly becoming more accessible and popular as a technique to monitor body composition. The reliability of DXA has been examined extensively using a number of different methodological approaches. This study sets up to investigate the accuracy of measuring the parameters of body composition (BC) by means of the whole-body and the segmental DXA method analysis with the typical error of measurement (TEM) that allows for expressing the error in the units of measure. The research was implemented in a group of 63 participants, all of whom were university students. Thirty-eight males (22.6±2.9 years, average body mass 77.5±8.4 kg) and 25 females (21.4±2.0 years, average body mass 58.6±7.2 kg) were recruited. The measured parameters included body mass (BM), fat-free mass (FFM), body fat (BF), bone mineral content (BMC), bone mineral density (BMD). For the whole-body analysis, the determined TEM was: BM at the level of 0.12 kg in females and 0.29 kg in males; BF 0.25kg and 0.44% females, 0.52 kg and 0.66% males; FFM 0.24 kg females and 0.42 kg males; BMC 0.02 kg females and males; BMD 0.01g/cm2 females and males. The TEM values in the segmental analysis were: BF within the range of 0.04-0.28 kg and 0.68-1.20% in females, 0.10-0.36 kg and 0.72-1.94% in males; FFM 0.08-0.41 kg females and 0.17-0.86 males, BMC 0.00-0.02 kg females and 0.01-0.02 kg males in relation to the body segment (upper limb, trunk, lower limb). The BMD value was at the level of 0.01-0.02g/cm2. The study results showed high reliability in measuring body composition parameters using the DXA method. The whole-body analysis showed a higher accuracy of measurement than the segmental. Only the changes that are greater than the TEM, or the upper bound (95%) of the confidence interval of the measurement can be considered demonstrable when interpreting repeated measurements.
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Affiliation(s)
- Petr Kutáč
- Human Motion Diagnostics Center, University of Ostrava, Ostrava, Czech Republic
| | - Václav Bunc
- Faculty of Physical Education and Sport, Charles University, Praha, Czech Republic
| | - Martin Sigmund
- Application Centre BALUO, Faculty of Physical Culture, Palacký University, Olomouc, Czech Republic
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Wang Y, Liu T, Song L, Zhang Z, Zhang Y, Ni J, Lu L. Spontaneous peripheral nerve palsy with hourglass-like fascicular constriction in the upper extremity. J Neurosurg 2019; 131:1876-1886. [PMID: 30611131 DOI: 10.3171/2018.8.jns18419] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 02/23/2018] [Accepted: 08/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spontaneous paralysis from hourglass-like fascicular constriction of peripheral nerves is rare, its clinical manifestations are not well documented, and its pathogenesis remains unknown. The unclear origin of this disorder and difficulty in diagnosis result in its uncertain management. The authors sought to gain a more thorough understanding of this condition through describing the anatomy, clinical features, etiology, and treatment of hourglass-like constriction. METHODS The authors retrospectively reviewed 20 patients (22 nerves) with hourglass-like constriction. The patients' clinical information was reviewed. Preoperative sonographic assessment and electrophysiological examination of involved nerves were performed. Surgical treatments included interfascicular neurolysis and neurorrhaphy. Samples of tissue subjected to resected constriction were sent for pathological analysis. The patients had regular face-to-face follow-up visits. RESULTS Acute pain was always the first symptom and was followed by paralysis. Paralysis progression was rapid and serious. Surgical exploration indicated an hourglass-like constricted segment completely unrelated to the compressive structures. Electrophysiological analysis showed severe denervation, and histopathological examination showed inflammatory cell infiltration, demyelination, and reduction of nerve fibers. CONCLUSIONS Hourglass-like fascicular constrictive neuropathy has an integrative effect from multiple different mechanisms. Surgical intervention is beneficial for selected patients who do not recover in a timely fashion and have hourglass-like lesions confirmed by preoperative ultrasound imaging. The authors recommend that early surgical intervention of the nerve be offered to patients who do not show any signs of recovery 3 months after onset. Both interfascicular neurolysis and neurorrhaphy are effective treatment methods. Mild to moderate constriction can usually be treated successfully by interfascicular neurolysis alone, whereas more advanced lesions with loss of fascicle continuity (severe constriction) may be best treated with resection and direct neurorrhaphy.
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Affiliation(s)
| | | | | | | | | | - Jinsong Ni
- 3Pathology, the First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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Ichino Y, Yamaguchi T, Tani Y. [2. Upper Limb (Elbow, Forearm, Wrist, Hand)]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:1489-1494. [PMID: 30568101 DOI: 10.6009/jjrt.2018_jsrt_74.12.1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Gilbert F, Schneemann C, Scholz CJ, Kickuth R, Meffert RH, Wildenauer R, Lorenz U, Kellersmann R, Busch A. Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma. BMC Musculoskelet Disord 2018; 19:404. [PMID: 30458745 PMCID: PMC6247697 DOI: 10.1186/s12891-018-2333-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Vascular damage in polytrauma patients is associated with high mortality and morbidity. Therefore, specific clinical implications of vascular damage with fractures in major trauma patients are reassessed. METHODS This comprehensive nine-year retrospective single center cohort study analyzed demography, laboratory, treatment and outcome data from 3689 patients, 64 patients with fracture-associated vascular injuries were identified and were compared to a control group. RESULTS Vascular damage occurred in 7% of patients with upper and lower limb and pelvic fractures admitted to the trauma room. Overall survival was 80% in pelvic fracture and 97% in extremity fracture patients and comparable to non-vascular trauma patients. Additional arterial damage required substantial fluid administration and was visible as significantly anemia and disturbed coagulation tests upon admission. Open procedures were done in over 80% of peripheral extremity vascular damage. Endovascular procedures were predominant (87%) in pelvic injury. CONCLUSION Vascular damage is associated with high mortality rates especially in combination with pelvic fractures. Initial anemia, disturbed coagulation tests and the need for extensive pre-clinical fluid substitution were observed in the cohort with vascular damage. Therefore, fast diagnosis and early interventional and surgical procedures are necessary to optimize patient-specific outcome.
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Affiliation(s)
- F. Gilbert
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany
- Department of Trauma Hand Plastic and Reconstructive Surgery, University Munich Germany, Julius-Maximilians-University of Würzburg Oberdürrbacherstr, 6 D-, 97080 Würzburg, Germany
| | - C. Schneemann
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - C. J. Scholz
- Core Unit Systems Medicine IZKF, University Hospital Würzburg, Würzburg, Germany
| | - R. Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - R. H. Meffert
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany
| | - R. Wildenauer
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - U. Lorenz
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - R. Kellersmann
- Department of Vascular Surgery, Klinikum Fulda, Fulda, Germany
| | - A. Busch
- Department for General Visceral, Vascular & Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Andersen CA, Ponticello M, Byerley N, Marmolejo V. Insulated Offloading Provides Offloading Protection and Enhanced Skin Perfusion. Wounds 2018; 30:300-305. [PMID: 30212375] [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: 06/08/2023]
Abstract
INTRODUCTION Locally and neurally mediated vasodilation of the cutaneous vasculature has been shown to occur in response to locally and systemically applied heat stresses. The resultant shunting of blood to the periphery can be upwards of 7 L/min to 8 L/min when profound heat stresses are applied. The increased cutaneous circulation from local heat stress may benefit extremities afflicted with a wound or area of compromised arterial supply. Insulating the extremity also may increase local cutaneous perfusion. OBJECTIVE This study aims to determine if increased local warmth from an insulated offloading boot or mitt (designed to protect an extremity from trauma, offload the extremity to prevent pressure ulcers, and insulate the extremity to minimize heat loss) also results in increased local cutaneous perfusion using indocyanine green fluorescence angiography (ICGFA). MATERIALS AND METHODS Nine patients from an outpatient wound care clinic with a wound or area of compromised arterial supply on the upper or lower extremity were studied prior to and following a minimum of a single 60-minute session of insulated offloading boot or mitt use utilizing ICGFA. Measurements taken were time to first onset of fluorescence (seconds) and ingress and egress rates for the area of concern and the remainder of the area imaged. RESULTS All 9 patients exhibited signs of increased local warmth by a mean of 3.1ºF while body temperature decreased by a mean of 1.2ºF. Local cutaneous perfusion increased with a mean change of 1 for the ingress rate to the area of concern and a mean change of 0.1 to the remainder of the area imaged. Also, ICGFA was able to demonstrate preferential shunting of the increased cutaneous perfusion to the site of most need. CONCLUSIONS These findings suggest enhanced skin perfusion may be an additional advantage of insulated offloading boot or mitt use.
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Gao J, He W, Du LJ, Chen J, Park D, Wells M, Fowlkes B, O'Dell M. Quantitative Ultrasound Imaging to Assess the Biceps Brachii Muscle in Chronic Post-Stroke Spasticity: Preliminary Observation. Ultrasound Med Biol 2018; 44:1931-1940. [PMID: 29398131 DOI: 10.1016/j.ultrasmedbio.2017.12.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/04/2017] [Accepted: 12/13/2017] [Indexed: 05/19/2023]
Abstract
We prospectively investigated the feasibility of using quantitative ultrasound imaging (QUI) to assess the biceps brachii muscle (BBM) in individuals with chronic post-stroke spasticity. To quantify muscle echogenicity and stiffness, we measured QUI parameters (gray-scale pixel value and shear wave velocity [SWV, m/s]) of the BBM in three groups: 16 healthy BBMs; 12 post-stroke, non-spastic BBMs; and 12 post-stroke, spastic BBMs. The QUI results were compared with the Modified Ashworth Scale and Tardieu Scale. A total of 20 SWVs were measured in each BBM, once at elbow in 90° flexion and again at maximally achievable extension using acoustic radiation force impulse imaging. BBM pixel value was measured in gray-scale images captured at 90° elbow flexion using ImageJ software. Statistical analyses included analysis of variance for examining the difference in SWV and pixel values among the three groups; Bonferroni correction for testing the difference in SWV and pixel values in a paired group; t-test for examining the difference in SWV values measured at two elbow angles; and Pearson correlation coefficient for analyzing the correlation of QUI to Modified Ashworth Scale and Tardieu Scale. SWV significantly differed between spastic BBMs and non-spastic or healthy BBMs. For pixel values, each of the three groups significantly differed from the others at elbow 90° flexion. The difference in SWV measured between the two elbow angles was also significant (p <0.01). A strong negative correlation was found between SWV and passive range of motion (R2 = -0.88, p <0.0001) in spastic upper limbs. These results suggest that the use of QUI is feasible in quantitative assessment of spastic BBM.
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Affiliation(s)
- Jing Gao
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA; Rocky Vista University, Ivins, Utah, USA.
| | - Wen He
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Juan Du
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Johnson Chen
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - David Park
- Rocky Vista University, Ivins, Utah, USA
| | | | - Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York, USA
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Carry PM, Nguyen AK, Merritt GR, Ciarallo C, Chatterjee D, Park J, Miller NH, Scott FA. Prevalence of Persistent Median Arteries in the Pediatric Population on Ultrasonography. J Ultrasound Med 2018; 37:2235-2242. [PMID: 29480530 PMCID: PMC6109622 DOI: 10.1002/jum.14576] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To use real-time ultrasonography to estimate the prevalence of persistent median arteries in a cohort of pediatric orthopedic patients. METHODS With Institutional Review Board approval, patients between the ages of 3 months and 19 years were recruited for this cross-sectional study. Variables of interest included demographics, underlying diagnoses, and the presence of a Doppler-confirmed median artery. Ultrasonographic examinations were performed on both upper extremities by a single investigator. Patient- and limb-level analyses were performed. A multivariable generalized logistic regression analysis was used to test the association between the prevalence of limb-specific persistent median arteries and age. A generalized estimating equation was used to adjust for the inclusion of multiple limbs from the same patient. RESULTS A total of 135 patients (270 limbs) were evaluated. The patient-specific prevalence rate (persistent median arteries present in 1 or both limbs) was 26.7%. Among these patients (n = 36), a persistent median artery was present bilaterally in 55.6% (n = 20). The limb-specific prevalence rate (proportion of limbs with a persistent median artery) was 20.7%. After adjusting for race, for every 1-year increase in age, the odds of a persistent median artery decreased by 4.4%. After adjusting for age, African Americans were significantly more likely to present with a persistent median artery (odds ratio, 3.78; 95% confidence interval, 1.25-11.48). CONCLUSIONS Ultrasonography can effectively visualize anatomic variants, such as persistent median arteries, in the pediatric population. The prevalence of persistent median arteries was higher than anticipated, especially among African American patients.
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Affiliation(s)
- Patrick M Carry
- Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amy K Nguyen
- Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Glenn R Merritt
- Department of Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Christopher Ciarallo
- Department of Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jung Park
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Nancy H Miller
- Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Frank A Scott
- Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
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Tsukita K, Sakamaki-Tsukita H. Hirayama disease: oblique amyotrophy and characteristic magnetic resonance imaging findings. QJM 2018. [PMID: 29518243 DOI: 10.1093/qjmed/hcy048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Tsukita
- Department of General Internal Medicine and Department of Neurology, Tenri Hospital, Tenri, Nara, Japan
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Lieba-Samal D, van Eijk JJJ, van Rosmalen MHJ, van Balken IMF, Verrips A, Mostert J, Pillen S, van Alfen N. Extremely Painful Multifocal Acquired Predominant Axonal Sensorimotor Neuropathy of the Upper Limb. J Ultrasound Med 2018; 37:1565-1574. [PMID: 29159899 DOI: 10.1002/jum.14492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 06/07/2023]
Abstract
The differential diagnosis of upper extremity mononeuritis multiplex includes neuralgic amyotrophy, vasculitic neuropathy, and Lewis-Sumner syndrome. We describe 3 patients initially suspected of neuralgic amyotrophy, who had an extremely painful, protracted, progressive disease course, not fitting one of these established diagnoses. Nerve ultrasonography showed focal caliber changes of the roots, plexus, and limb nerves. Electromyography showed predominant multifocal axonopathy. Ongoing autoimmune neuropathy was suspected. Steroid treatment provided temporary relief, and intravenous immunoglobulin A sustained pain decrease and functional improvement. These patients appear to have extremely painful axonal inflammatory neuropathy, with a good response to immune-modulating treatment.
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Affiliation(s)
- Doris Lieba-Samal
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jeroen J J van Eijk
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
- Department of Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Marieke H J van Rosmalen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Irene M F van Balken
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Aad Verrips
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Jop Mostert
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Sigrid Pillen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
- Kempenhaeghe, Sleep Medicine Center, Heeze, the Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
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Rusu GM, Ciuce C, Fodor L, Manole S, Dudea SM. Ultrasonographic and Imaging Appearance of Peripheral Intraneural Vascular Anomalies: Report of Two Cases and Review of the Literature. Med Ultrason 2018; 20:237-246. [PMID: 29730692 DOI: 10.11152/mu-1459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of the paper is to present the ultrasonographic and imaging appearance of two cases of peripheral nerve intraneural vascular anomalies and provide a comprehensive review of the publications on this subject.The clinical presentation, ultrasonographic appearance, corresponding imaging and outcome of a case of ulnar nerve venous malformation and a case of median nerve arteriovenous malformation are presented.Literature search revealed 35 papers presenting 52 cases of vascular anomalies involving the peripheral nerves. The ultrasonographic appearance was described only in ten cases. Our review suggests that peripheral intraneural vascular anomalies are twice more frequent in women. About three quarters of them are located in the upper limb, with the median nerve involved in one third and the ulnar nerved involved in a quarter of all cases. Most of the cases are hemangiomas. Peripheral neural compartment syndromes in patients with coexisting vascular anomalies may prompt for vascular neural involvement, requiring diagnostic imaging studies. Gray-scale and Doppler ultrasound are the methods of first choice, as they provide not only direct visual proof of neural involvement but also contribute to the differential diagnosis between hemangiomas and vascular malformations.
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Affiliation(s)
| | - Constantin Ciuce
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Lucian Fodor
- Division of Plastic and Reconstructive Surgery, Emergency Clinical County Hospital, Cluj-Napoca,.
| | - Simona Manole
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Sorin Marian Dudea
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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Stolz LA, Acuna JG, Gaskin K, Murphy AM, Friedman L, Stears-Ellis S, Javedani P, Stolz U, Adhikari S. Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity. Med Ultrason 2018; 20:199-204. [PMID: 29730687 DOI: 10.11152/mu-1240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM Regional anesthesia with ultrasound-guidance is an excellent option for pain control if nerves are adequately visualized. Gender, body mass index (BMI), history of diabetes, neck and forearm circumference may affect echotexture and visualization. This study evaluates patient characteristics for their ability to predict the echogenicity or visibility of upper extremity peripheral nerves. MATERIAL AND METHODS This is a prospective observational study. A convenience sample of adult emergency department patients were enrolled. Gender, BMI, history of diabetes, neck circumference and arm circumference were recorded. Sonographic images of the brachial plexus at interscalene and supraclavicular levels, the median, the radial and ulnar nerves were recorded. Three reviewers independently graded the echogenicity and visibility using subjective scales. RESULTS 395 peripheral nerves were included. Nerves of the forearm (median, ulnar, radial nerves) were found to be more echogenic (OR=9.3; 95% CI: 5.7, 15.3) and visible (OR=10.0; 6.3, 16.0) than more proximal nerves (brachial plexus at interscalene and supraclavicular levels). Gender, BMI, and history of diabetes mellitus were not significantly related to nerve visibility (p=0.9, 0.2, 0.2, respectively) or echogenicity (p=0.3, 0.8, 0.3). Neck circumference was not related to visibility or echogenicity of proximal nerves. Increased forearm circumference improved echogenicity (OR=1.25; 1.09, 1.43) but not visibility of forearm nerves. CONCLUSIONS Gender, BMI and presence of diabetes were not related to echogenicity or visibility of upper extremity nerves. Increasing forearm circumference was associated with increased echogenicity of the adjacent nerves, but not visibility. Neck circumference was not associated with either nerve visibility or echogenicity of brachial plexus nerve bundles.
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Affiliation(s)
- Lori A Stolz
- Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona.
| | - Josie Galarza Acuna
- Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona.
| | - Kevin Gaskin
- Upstate Medical University, State University of New York, Syracuse, NY.
| | - Amanda M Murphy
- Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona.
| | - Lucas Friedman
- Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona.
| | | | | | - Uwe Stolz
- Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona.
| | - Srikar Adhikari
- Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona.
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Abstract
Objective Pre-operative venous mapping has increased dramatically in most dialysis units since the Dialysis Outcome Quality Initiative (DOQI) guidelines recommended a native arteriovenous venous fistula (AVF) rather than a graft for hemodialysis (HD) access procedures. However, there are conflicting consequences as a result of this policy. Some studies have showed that routine mapping has resulted in a marked increase in maturation rate while others have observed the reverse. This study aimed to evaluate the impact of pre-operative venography on the planning and outcome of AVF for our HD patients. Patients and methods A prospective study was performed on all patients with end-stage renal disease (ESRD) who had HD access procedures and pre-operative venography between October 2003 and November 2005. Upper limb venography was done for all patients except those that required primary access and had visible veins. All patients had HD immediately after the venography. Access procedure selection was based on the result of the venography. The complications of venography, the surgical procedure and the outcome were recorded. Results One hundred and twenty-nine patients with ESRD who had pre-operative venography were included in this study. They were mostly middle age (mean age ± SD = 41 ± 15.5 yrs) with a high rate of diabetes mellitus (53%). No single complication was reported. A graft was placed in six patients (5%) only. Unsuccessful surgical exploration was 0%. Early failure was in 10 patients (8%). Conclusion Pre-operative venography resulted in an increase in the number of AVFs. It can improve the results of HD access procedures by selecting the most suitable veins.
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Affiliation(s)
- M A Elsharawy
- Surgical Department, College of Medicine, King Faisal University, Saudi Arabia.
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Tani Y. [1. Initial Start of This Series / Upper Limb (1) Clavicle, Shoulder, Upper Arm, Scapula]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:1236-1241. [PMID: 30344224 DOI: 10.6009/jjrt.2018_jsrt_74.10.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Mogali SR, Yeong WY, Tan HKJ, Tan GJS, Abrahams PH, Zary N, Low-Beer N, Ferenczi MA. Evaluation by medical students of the educational value of multi-material and multi-colored three-dimensional printed models of the upper limb for anatomical education. Anat Sci Educ 2018; 11:54-64. [PMID: 28544582 DOI: 10.1002/ase.1703] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/19/2017] [Accepted: 05/04/2017] [Indexed: 05/25/2023]
Abstract
For centuries, cadaveric material has been the cornerstone of anatomical education. For reasons of changes in curriculum emphasis, cost, availability, expertise, and ethical concerns, several medical schools have replaced wet cadaveric specimens with plastinated prosections, plastic models, imaging, and digital models. Discussions about the qualities and limitations of these alternative teaching resources are on-going. We hypothesize that three-dimensional printed (3DP) models can replace or indeed enhance existing resources for anatomical education. A novel multi-colored and multi-material 3DP model of the upper limb was developed based on a plastinated upper limb prosection, capturing muscles, nerves, arteries and bones with a spatial resolution of ∼1 mm. This study aims to examine the educational value of the 3DP model from the learner's point of view. Students (n = 15) compared the developed 3DP models with the plastinated prosections, and provided their views on their learning experience using 3DP models using a survey and focus group discussion. Anatomical features in 3DP models were rated as accurate by all students. Several positive aspects of 3DP models were highlighted, such as the color coding by tissue type, flexibility and that less care was needed in the handling and examination of the specimen than plastinated specimens which facilitated the appreciation of relations between the anatomical structures. However, students reported that anatomical features in 3DP models are less realistic compared to the plastinated specimens. Multi-colored, multi-material 3DP models are a valuable resource for anatomical education and an excellent adjunct to wet cadaveric or plastinated prosections. Anat Sci Educ 11: 54-64. © 2017 American Association of Anatomists.
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Affiliation(s)
| | - Wai Yee Yeong
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Heang Kuan Joel Tan
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Gerald Jit Shen Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Peter H Abrahams
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Nabil Zary
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Naomi Low-Beer
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Iordache SD, Goldberg N, Paz L, Peylan J, Hur RB, Steinmetz A. Radiation Exposure From Computed Tomography Of The Upper Limbs. Acta Orthop Belg 2017; 83:581-588. [PMID: 30423665] [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: 06/09/2023]
Abstract
To investigate exposure to radiation we identified a cohort of 312 patients who underwent standardized CT of an upper limb within a three years period. The effective dose per dose length product coefficient was used to calculate the effective doses of radiation. Mean effective doses were as follows: shoulder CT, 10.83 (SD 6.36) mSv; wrist CT, 0.15 (SD 0.07) mSv; elbow CT performed with the arm above the head, 0.21 (SD 0.11) mSv and with the arm adjacent to the torso, 13.1 (SD 10.8) mSv. The corresponding lifetime attributable risk of cancer was 0.6/1000 for males and 0.73/1000 for females for shoulder CT and 0.75/1000 for males and 0.96/1000 for females for elbow CT with the arm adjacent to torso. The effective doses for CT scans of the wrist and of the elbow performed with the arm above the head were low. For elbow CT scans, elevating the arm above the head decreases the radiation doses.
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