Radiological Changes Research Articles

Hand Osteoarthritis in Elderly Women with Primary Knee Osteoarthritis: Prevalence and Pattern in the Indian Population

Aim: The aim of this study was to estimate prevalence of hand osteoarthritis (HOA) and identify patterns in female patients with symptomatic primary knee osteoarthritis (KOA) presenting in a rheumatology outpatient department (OPD). Methods: A hospital-based cross-sectional study was done among 145 female patients with primary KOA, as per American College of Rheumatology (ACR) criteria, utilising the right knee as the index knee. The presence of Kellgren–Lawrence (K-L) grade ≥2 radiological changes in two of three groups of hand joints in dominant hand was used to identify hand arthritis (HOA). Symptomatic HOA (SHOA) was defined as existence of hand discomfort within preceding month. Hand disability was measured using the Health Assessment Questionnaire (HAQ); a mean score of >0.5 was deemed to be a significant disability. Global Hand Kellgren–Lawrence Score (KLTOT) was used to assess radiographic severity of HOA. Results: The prevalence of HOA was found in 96 (66%) patients, with a higher prevalence in patients above 60 years of age. At the individual joint level, 102 (71.7%) patients had DIP involvement, 96 (66.2%) had PIP involvement, 40 (27.5%) had metacarpophalangeal (MCP) involvement, and 57 (34.4%) had involvement in the base of the thumb. SHOA was found in 48 (33%) patients, and significant disability was noted in 38 (26.2%) patients. There was a significant positive correlation between global KLTOT and body mass index (BMI) ( P = .004) and between global KLTOT and HAQ ( P = .002). A significant difference was found between HOA and the radiographic severity of the KOA ( P = .003) in comparison to patients without HOA. Conclusion: HOA is common in elderly women, especially those with primary KOA.

Radiological assessment of pulmonary vascular changes and gastrointestinal changes in patients with COVID-19 referred to a tertiary health care center in Chennai, India: a prospective cross-sectional study

BACKGROUND: The coronavirus disease pandemic (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to significant morbidity and mortality worldwide since its emergence in 2019. Although primarily a respiratory illness, COVID-19 can also affect other organ systems, including the vascular and gastrointestinal systems. COVID-19 is linked to both venous and arterial thrombosis, and numerous studies have indicated a heightened risk of pulmonary embolism. Autopsies have revealed pulmonary vasculature thrombosis and bowel ischemia in patients with COVID-19. AIM: To assess radiological pulmonary vascular changes, specifically pulmonary embolism, and gastrointestinal changes in patients with COVID-19 referred to a tertiary healthcare center in Chennai, India. MATERIALS AND METHODS: Computed tomography pulmonary angiography and contrast-enhanced computed tomography of the abdomen were conducted in 100 patients with COVID-19 who met the selection criteria. A radiologist with 5 years of experience evaluated pulmonary vascular and bowel changes. Subsequently, statistical analysis was performed to determine the significance of the relationship between patients with COVID-19 and the occurrence of pulmonary vascular and bowel changes. RESULTS: In this study, 11 patients exhibited pulmonary thromboembolism, and 7 showed significant bowel changes such as bowel wall thickening, mesenteric ischemia, and omental infarction, indicative of potential gastrointestinal involvement of patients with COVID-19. A positive correlation was found between pulmonary embolism prevalence in patients with COVID-19. Pulmonary embolism was diagnosed at a mean of 11 days from disease onset. Of the 24 patients with severe acute respiratory illness, 7 showed pulmonary embolism, detected by computed tomography pulmonary angiography. In addition, of the 10 patients on mechanical ventilation, pulmonary embolism was found in 7. Among the seven patients with bowel changes, four had pulmonary embolism, as detected by computed tomography pulmonary angiography, indicating a significant association between the two concomitant complications. The observed bowel changes were attributed to intravascular thrombosis. CONCLUSIONS: Based on our findings, pulmonary emboli and bowel changes often occur in patients with COVID-19. Multivariate analyses also revealed a connection between invasive mechanical ventilation and pulmonary embolism. The results indicate that patients with severe COVID-19 may also experience concurrent acute pulmonary embolism. Thus, for these patients, the use of contrast-enhanced computed tomography instead of standard non-contrast computed tomography may aid in treatment decision-making.

Pathomorphological & Radiological Changes Following Denosumab Treatment In Giant cell tumours

Introduction:- The introduction of denosumab has significantly impacted the treatment approach for giant cell tumors (GCTs) of bone, a locally aggressive osteolytic neoplasm. This study aimed to comprehensively investigate the pathomorphological and radiological changes observed in GCT patients following neoadjuvant denosumab therapy. Material methods: - A retrospective analysis of 12 cases was conducted, encompassing primary and recurrent GCT cases treated with denosumab. Clinical, radiological, and histopathological features were thoroughly examined. All cases displayed Campanacci grade 3 lesions with ambiguous borders. Results: - Neoadjuvant denosumab treatment led to distinct clinical benefits, including reduced intraoperative bleeding and increased bone density, facilitating surgical procedures. Histopathologically, denosumab-treated cases exhibited enhanced cellularity, prominent fibroblastic proliferation, spindle cell arrangement, osteoid formation, and fibro-osseous components. The number of osteoclast-type giant cells significantly diminished, sometimes approaching absence. Immunohistochemical analysis using P63 corroborated the diagnosis. Radiologically, denosumab-induced changes included marked osteosclerosis, sclerotic rim formation, and increased intralesional osteosclerosis. Conclusion: - These findings emphasize the significance of recognizing the diverse morphological and radiological alterations in denosumab-treated GCTs.

Long-Term Pulmonary Sequelae and Immunological Markers in Patients Recovering from Severe and Critical COVID-19 Pneumonia: A Comprehensive Follow-Up Study

Background and Objectives: Severe and critical COVID-19 pneumonia can lead to long-term complications, especially affecting pulmonary function and immune health. However, the extent and progression of these complications over time are not well understood. This study aimed to assess lung function, radiological changes, and some immune parameters in survivors of severe and critical COVID-19 up to 12 months after hospital discharge. Materials and Methods: This prospective observational cohort study followed 85 adult patients who were hospitalized with severe or critical COVID-19 pneumonia at a tertiary care hospital in Vilnius, Lithuania, for 12 months post-discharge. Pulmonary function tests (PFTs), including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and diffusion capacity for carbon monoxide (DLCO), were conducted at 3, 6, and 12 months. High-resolution chest computed tomography (CT) scans assessed residual inflammatory and profibrotic/fibrotic abnormalities. Lymphocyte subpopulations were evaluated via flow cytometry during follow-up visits to monitor immune status. Results: The median age of the cohort was 59 years (IQR: 51–64). Fifty-three (62.4%) patients had critical COVID-19 disease. Pulmonary function improved significantly over time, with increases in FVC, FEV1, VC, TLC, and DLCO. Residual volume (RV) did not change significantly over time, suggesting that some aspects of lung function, such as air trapping, remained stable and may require attention in follow-up care. The percentage of patients with restrictive spirometry patterns decreased from 24.71% at 3 months to 14.8% at 12 months (p < 0.05). Residual inflammatory changes on CT were present in 77.63% at 6 months, decreasing to 69.62% at 12 months (p < 0.001). Profibrotic changes remained prevalent, affecting 82.89% of patients at 6 months and 73.08% at 12 months. Lymphocyte counts declined significantly from 3 to 12 months (2077 cells/µL vs. 1845 cells/µL, p = 0.034), with notable reductions in CD3+ (p = 0.040), CD8+ (p = 0.007), and activated CD3HLA-DR+ cells (p < 0.001). This study found that higher CD4+ T cell counts were associated with worse lung function, particularly reduced total lung capacity (TLC), while higher CD8+ T cell levels were linked to improved pulmonary outcomes, such as increased forced vital capacity (FVC) and vital capacity (VC). Multivariable regression analyses revealed that increased levels of CD4+/CD28+/CD192+ T cells were associated with worsening lung function, while higher CD8+/CD28+/CD192+ T cell counts were linked to better pulmonary outcomes, indicating that immune dysregulation plays a critical role in long-term respiratory recovery. Conclusions: Survivors of severe and critical COVID-19 pneumonia continue to experience significant long-term impairments in lung function and immune system health. Regular monitoring of pulmonary function, radiological changes, and immune parameters is essential for guiding personalized post-COVID-19 care and improving long-term outcomes. Further research is needed to explore the mechanisms behind these complications and to develop targeted interventions for long COVID-19.

Assessment of Post-COVID-19 Changes in Brain-Clinical and Imaging Evaluation Using MRI Vessel Wall Imaging and Complementary MRI Methods.

Background/Objectives: The aim of the study was to evaluate the usefulness of vessel wall imaging and MRI in assessment of the post-COVID-19 changes in the brain. VWI is a progressive MRI technique that provides precise imaging of the pathological process in the wall of the vessel. It might help us to better understand the pathophysiology of COVID-19-related neurological lesions and may have an impact on management protocols. Methods: A total of 43 patients were included in the study; the post-COVID-19 group included 23 patients hospitalized for COVID-19 (mean age of the group: 53.52 years; 26% male, 74% female). The control group consisted of 20 patients from the general population who did not suffer from COVID-19 (mean age: 52.15 years; 35% male, 65% female). MRI examinations were performed on a 3T scanner (Biograph mMR, Siemens). The VW-MRI protocol included T1-weighted SPACE FS black-blood images, FLAIR images, SWI, and MRA. Results: Several radiological changes in post-COVID-19 patients were described: hyperintense foci in the white matter of the brain hemispheres, in the lower parts of the temporal lobes, and in the structures of the posterior cranial fossa; presence of engorgement of deep medullary veins or perivascular enhancement; presence of inflammatory vessel thickening in VWI images; changes in hippocampus size; presence of cortical atrophy; and thickening of the mucous membrane of the paranasal sinuses. The presence of atherosclerotic vessel thickening in VWI and the width of the third ventricle depended on the age of the patient. Conclusions: VWI and MRI may be useful in the assessment of post-COVID-19 lesions in the brain.

Abstract B050: Frequent monitoring of NSCLC immunotherapy using an mDETECT liquid biopsy reveals unexpected complexity and opportunities

Abstract We have developed a version of our "methylation DETection of Circulating Tumour" DNA (mDETECT) assay that is able to sensitively and quantitatively monitor Non-Small Cell Lung Cancer (NSCLC). We used this assay to frequently assess the tumour burden of a small cohort (17 individuals) of patients undergoing first line monotherapy with pembrolizumab for metastatic disease. Patients were tested weekly or biweekly in the period immediately after initiation of treatment with radiological assessment being done at approximately 3 months. Radiologically non-responding patients showed constant or increased mDETECT levels over the 3 month time frame. Responding patients showed 2 different patterns, with some showing dramatically increasing mDETECT levels for a short period of time followed by a rapid decrease. Other responders showed an immediate decrease within the first few week of treatment. In both responder groups these decreases were associated with a longer term response. Continued monitoring did reveal eventual progression in some of these patients with increasing mDETECT levels being seen 4 to 6 months before radiological changes. In some non-responding patients complex responses were seen, with mDETECT levels varying significantly over time. In one non-responding patient the addition of carboplatin to their treatment regime did produce a temporary improvement in their mDETECT levels. Frequent assessment of tumour burden by a liquid biopsy such as mDETECT offers the opportunity to rapidly determine a patient's response to therapy and potentially modify treatments to improve responses. Citation Format: Christopher R Mueller, Keira Parr, Mihaela Mates, Andrew Robinson, Harriet Feilotter, Keira Frosst. Frequent monitoring of NSCLC immunotherapy using an mDETECT liquid biopsy reveals unexpected complexity and opportunities [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr B050.

Pharmacology and Articular Cartilage Regeneration: A New Strategy for Osteoarthritis

ABSTRACT Background: Osteoarthrosis is a slowly progressive, multifactorial, and non-inflammatory degenerative disease affecting synovial joints and is typically associated with aging or previous joint damage. Method: Fifty male Sprague Dawley rats were utilized in the study and divided into five groups, with ten rats in each group. The experiment was divided into two phases: in Phase 1, ten animals received 50 μL of saline in the left tibiotarsal joint and served as the control group (SAL), while the other four groups (n = 40) received a single dose of 50 μL complete Freund’s adjuvant (CFA) to induce monoarthritis. In Phase II, after the induction of monoarthritis, from the fourth week onward, the rats in the four CFA-induced monoarthritis groups were treated with 20 μl of gamma-amino butyric acid (GABA), serotonin (SERO), or a neurotransmitter cocktail (NTC) which were given intra-articularly once for three consecutive weeks, while one group was kept as an experimental control. The animals were monitored throughout the experiment, for ankle diameter, gait, and radiological assessment, and were then euthanized and subjected to histopathological evaluation at the conclusion of the study. Results: The study found that there were statistically significant differences in the degree of inflammation between the CFA group and the groups treated with GABA, SERO, and NTC. The CFA group exhibited the most severe and persistent inflammation, whereas the NTC group showed a milder and shorter inflammatory response than the control group (SAL). In terms of gait score, the NTC treatment resulted in a significant reduction in score compared to the treatments with GABA and SERO administered separately. The radiological scores revealed that NTC was the most effective treatment in mitigating radiographic evidence of joint damage, with a significant decrease in bone destruction. The histopathological examination showed that the NTC group had minimal tissue damage or inflammation and had a regenerative effect compared to the other treatment groups. Conclusions: In conclusion, the local administration of neurotransmitters was found to be effective in reversing inflammation, improving gait score, and mitigating radiological changes in CFA-induced arthritis in the murine model.

Bone remodelling after scaphoid fractures: HR-pQCT, clinical and laboratory data from a prospective 1-year follow-up study

IntroductionThe exact mechanisms of bone remodelling after scaphoid fractures are not fully understood. Blood supply may lead to delayed consolidation and non-unions as challenging long-term problems. The aim of this study was to follow-up the microstructure during the scaphoid bone remodelling process using High Resolution peripheral Quantitative Computed Tomography (HR-pQCT) and compare the results with clinical and laboratory data. Patients and methodsIn this monocentric, prospective, controlled, clinical trial 39 patients with an unilateral conservatively treated scaphoid fracture at the level of the waist or the distal pole were followed up over one year (2, 4, 6, 12, 26 and 52 weeks after trauma). Fracture healing was monitored by clinical examination, blood bone remodelling markers and HR-pQCT. ResultsThe HR-pQCT showed significant changes in trabecular number, trabecular thickness, trabecular separation and bone mineral density until the 52 week follow-up. Complete bony consolidation on HR-pQCT was evident in half of the fractures at 12 weeks and in all fractures at 52 weeks after trauma. None of the patients developed a non-union. Carboxy-terminal collagen crosslinks as resorption marker showed significant changes until the 52 week follow-up. ConclusionThis study shows detailed clinical, laboratory and radiologic changes during follow-up of uncomplicated fracture healing of conservative scaphoids. Bony consolidation is highly variable and can take up to one year after fracture. Larger studies are warranted, as HR-pQCT might provide detailed microstructural information to better predict fracture healing processes, thus acting as a high-resolution and low-radiation alternative to standard conventional CT.

Gastrointestinal complications and visceral circulation changes after intentional celiac artery embolization during complex endovascular aortic repair

Intentional celiac artery embolization (CAE) is an oft-used strategy to extend proximal or distal seal during complex endovascular aortic repair. Prior reports document a wide range of GI-related complications. However, associated changes in collateral circulation are poorly defined. We sought to report the long-term outcomes and adaptive changes in collateral visceral circulation following CAE during complex endovascular aortic repair. All patients undergoing complex endovascular aortic procedures (EVAR and TEVAR) with CAE at a single-institution over a 12-year period were included. Pre- and post-operative clinical, radiologic, and laboratory data were reviewed to identify mesenteric complications related to CAE and to assess long-term survival and radiologic changes in collateral anatomy. Multivariable logistic regression was used to determine the association between collateral vessel diameter change and mesenteric complications. From 2011 to 2023, 70 patients underwent planned CAE during complex endovascular aortic repair. With regards to mesenteric complications not attributable to the SMA stent, 11.4% had 30-day mesenteric complications, including upper gastrointestinal bleed (UGIB) or perforated ulcer (n=3), cholecystitis (n=2), pancreatitis (n=2) and ischemic hepatitis (n=1). During 31-90 days after CAE, 2 additional patients (2.9%) had UGIB. With regards to 90-day mesenteric complications related to the SMA stent, 4 additional patients (5.7%) had SMA stent complications leading to mesenteric ischemia. On Kaplan-Meier analysis, patients with any 90-day mesenteric complication had significantly lower overall 2-year survival (42.5% vs 75.0%; P=.002). On pre-operative imaging, 20% of patients had variant SMA anatomy with the GDA as the dominant SMA-celiac collateral pathway in 68.6%. Post-operatively, patients without mesenteric complications had a greater increase in the collateral diameter at both SMA and celiac junctions at 1, 3-6, 12, and 24 months with a statistically significant difference in diameter at 1 month compared to patients with complications (median: 16.2% vs -2.1% at celiac, P=.006 and 20.8% vs 7.7% at SMA, P=.021). On adjusted multivariate regression, increase in collateral diameter at the SMA junction on first post-operative CT was significantly protective of 90-day mesenteric complications (OR: 0.93, 95% CI: 0.87-0.96; P=.046). CAE during complex endovascular aortic repair is a useful adjunct to increase seal zone in select patients; however, mesenteric complications occur in 14% of the patients over a 90-day post-operative period and patients with mesenteric complications have a higher long-term all-cause mortality. CAE should be a technique within the toolbox of vascular surgeons for urgent circumstances that do not allow for celiac preservation. Careful selection of candidates for CAE and early postoperative surveillance of collateral pathways may help with prevention and early identification of long-term visceral complications.

Effects of Neoadjuvant Denosumab on Radiological and Histological Responses in Patients Undergoing En Bloc Resection for Giant Cell Tumor of Bone: A Systematic Review

Background: Giant cell tumor of bone (GCTB) is a rare primary bone tumor. The standard treatment is en bloc resection, which can be challenging due to tumor size or location. Denosumab, a monoclonal antibody, has emerged as a promising neoadjuvant therapy for GCTB, potentially facilitating surgical resection. However, its optimal use remains unclear, with debate surrounding its impact on local recurrence. This systematic review aims to synthesize evidence on the histological and radiological changes induced by neoadjuvant denosumab and its impact on surgical outcomes. Methods: This review followed PRISMA guidelines. The medical term "denosumab", "neoadjuvant", "GCTB", "radiological", and "histological" were used in PubMed (423 articles) and Google Scholar (18,100 articles), totaling 18,523 articles to discover studies of the effect of neoadjuvant denosumab on radiological and histological response up to July 2023. Six remaining studies were reviewed and screened for inclusion criteria based on their relevance to the study subject and clinical outcomes. Results: Based on six studies in this review, five showed histological response by decreasing the multinucleated giant cells and osteoclasts after neoadjuvant DT. Six studies showed increased significant bone reconstitution as a radiological response in the GCTB locale, replaced the extending tumor into soft tissue by abundant bone production with peripheral shell, and increased ease of en bloc resection. Conclusions: Neoadjuvant denosumab therapy shows promise in managing giant cell tumors of bone (GCTB) by reducing osteoclasts, shrinking tumor volume, and promoting cortical bone formation, thus facilitating en bloc resection. However, further research is needed to confirm these findings.

CHANGES IN LIPID AND CARBOHYDRATE METABOLISM IN PATIENTS WITH OSTEOARTHRITIS WITH ACCOMPANYING ARTERIAL HYPERTENSION AND TYPE 2 DIABETES, DEPENDING ON BSMI VDR GENE POLYMORPHISM

It is known that Osteoarthritis (OA) is a common chronic disease of the musculoskeletal system, which leads to a significant loss of working capacity and disability of people of working age, which worsens the quality of life of the population and causes economic burden and losses to all countries of the world. In addition, OA is known as a disease with an inherent high level of comorbidity. Scientists single out diseases of cardiovascular diseases, digestive systems and metabolic disorders as those that are most often combined with OA and complicate the course of each other in manifestations, diagnostic and treatment processes. Today, modern science needs to understand the presence of a common genetic origin. It is known that the polymorphic variant of the VDR vitamin D receptor gene has a predisposition to common osteochondral diseases. However, the issue of participation in pathogenetic mechanisms of development and progression remains controversial. A polymorphic variant of the VDR gene has a predisposition to osteochondral diseases. However, its involvement in the pathogenetic mechanisms of the development and progression of osteoarthritis remains controversial, therefore The aim of the study is to investigate the specifics of the impact of comorbid pathology on carbohydrate and lipid metabolism and the state of the vascular wall in patients with osteoarthritis, taking into account the polymorphic variant of the VDR gene (Bsml, rs1544410). Object and research methods. 100 patients were examined and also divided into groups: 1st group – patients with OA; II – OA with arterial hypertension; ІІІ – OA, arterial hypertension (AG) and type 2 diabetes mellitus, a blood sample was taken and, depending on age, comorbidity, the presence of the polymorphic variant BsmI (rs1544410) of the VDR gene, indicators of carbohydrate and lipid metabolism, the level of end metabolites of nitric oxide and endothelin-1 were studied and the impact on radiological changes and the functional state of the knee joints was evaluated. Control – 30 people. Results of the study and their discussion. It has been established that osteoarthritis is characteristic of persons of working age. With increasing age, it is characteristic to be burdened by comorbid pathologies with worsening of the course of the main disease. Expected violation of carbohydrate metabolism was observed in the III group of patients, although dynamic probable changes were also in the II group (p<0.05). Lipid metabolism in the I group was probably higher than the group of control, but was within the physiological norm, while groups II and III had significant pathological changes compared to the indicators of the I group and practically healthy persons. Hypercholesterolemia became a trigger for a decrease in the total level of stable total nitrogen monoxide metabolites and an increase in endothelin-1, which forms endothelial dysfunction and leads to the progression of AG and worsening of the course of OA. After the genotyping and division into genotypes of the polymorphic variant BsmI of the VDR gene, conclusions were obtained about the unfavorable allele A in the exchange processes of the above indicators. Conclusions. Features of violations of carbohydrate and lipid metabolism, the condition of the endothelium, against the background of comorbidity and the presence of an unfavorable allele A of the BsmI polymorphic variant of the VDR gene should be taken into account in the complex diagnostic and treatment process of patients with OA.

An Evaluation of Intra-articular Pathologies Accompanying Tibial Plateau Fractures Postoperatively.

Tibial plateau fractures are one of the most complex and common intra-articular fractures encountered in trauma surgery. This study aimsto evaluate the MRI intra-articular findings of patients with tibial plateau fractures treated surgically and the functional and radiological changes after surgical treatment. A total of 91 patients admitted to our clinic between 2010 and 2019 and operated for tibial plateau fracture were identified from the hospital information system. Patients were excluded fromthe study if aged <18 years, if the radiographs and MRIs were not suitable for the measurements, or if they could not be contacted by telephone. The study was completed with 49 operated knees and 49 healthy knees of 49 patients. The patients were evaluated with respect to demographic characteristics, KneeSocietyKneeScore (KSKS), KneeSocietyFunction Score (KSFS), KneeInjuryandOsteoarthritisOutcomeScore (KOOS) functional and clinical scores, Rasmussen, Kellgren-Lawrence, and Whole-OrganMagneticResonanceImagingScore (WORMS) radiological scoring, and meniscus and ligament pathologies examined on the follow-up MR images. The patients comprised 39 males and 10 females with a mean age of 45.9±11.89 years, and a mean follow-up of 58.2±30.7 months. The fractures were seen to be 49% (n=24)in the lateral plateau, 6.1% (n=4) in the medial plateau, and 42.9% (n=21) were bicondylar fractures involving both plateaux. The KSKS knee score was satisfactory in 85.7% of the patients, the KSFS functional score in 89.7%, and the Rassmussen radiological score in 93.8%. In the KOOS subjective questionnaire, the mean points obtained were 430.7, and the mean total WORMS points were 34.2. According to the Kellgren-Lawrence grades, severe osteoarthritis (grade 3-4) developed in 18.3% (n=9) of the patients. Meniscus injuries that are overlooked at the time of the first injury or which may develop in the subsequent process were not found to seriously affect the functional outcomes of tibial plateau fractures. It can be considered that even if a ligament injury is seen to be accompanying the fracture at the time of the first trauma, the effect is not great in terms of prognosis, and the treatment can remain conservative, especially for collateral ligament injuries.

How much does an MRI change over a period of up to 2 years in patients with chronic low back pain? Is a repeated MRI really necessary in the follow-up of patients with chronic low back pain?

PurposeClinical practices vary between healthcare providers when it comes to asking for a Magnetic Resonance Imaging (MRI) during follow-up for chronic low-back pain (LBP). The association between progressive changes on the MRI and the clinical relevance of these findings is not clearly defined. The objective of our study is to investigate to what extent do MRI findings change during a period less than or equal to two years in patients with chronic LBP. We question the efficacy of its routinary use as a tool for follow-up and we also study the correlation between new changes on MRI and modifications in therapeutic attitude.MethodsData was collected from 468 lumbar spine MRIs from 209 patients undergoing two or more MRIs between January 2015 and December 2019 with a mean of 2.24 MRIs per patient. The evaluated data included diagnosis, reason for request, MRI findings and treatment offered post-MRI. MRIs were assessed according to a standardized scoring system from 0 to 14 points according to the severity in findings (modified Babinska Score). Radiological changes were defined as increased severity of findings in the most affected segment.Results51.06% of MRI requests had no documented reason to be asked for. The average score of the findings on the first MRI was 5,733 (SD 2,462) and 6,131 (SD 2,376) on the second, not reaching a statistically significant difference (p = 0.062). There was no difference on the findings between the first and the second MRI in 40, 15% (n = 104) and up to 89, 96% with only mild changes (−1/ + 2 points over 14 possibles). After repeating the MRI, no modification to the treatment plan was made in 44, 79% of patients (n = 116) and only in 11.58% (n = 30) was surgical treatment indicated. ConclusionThe rate of lumbar MRI has risen to an alarming pace without evidence of consequent improvements in patient outcomes. A significant number of repeated MRIs did not show radiological changes, nor did they give rise to further surgical treatment after obtaining these images. This study should help to review the real applications of clinical guides on the appropriate use for image tests.

Salvage reirradiation for recurrent glioblastoma: a retrospective case series analysis.

To assess the clinical outcome of patients with recurrent glioblastoma treated with salvage reirradiation. Between 2005 and 2022, data from adult patients with glioblastoma treated with surgery and radio-chemotherapy Stupp regimen who developed a local in-field relapse and received stereotactic radiotherapy (SRT) were retrospectively reviewed. The study population included 44 patients with recurrent glioblastoma (median of 9.5 months after the first radiotherapy). Reirradiation alone was given to 47.7% of patients. The median maximum diameter of the recurrence was 13.5 mm. The most common SRT regimen (52.3%) was 35 Gy in 10 fractions. Acute toxicity was mild, with transient worsening of previous neurological symptoms in only 15% of patients. After a median follow-up of 15 months, 40% presented radiological response, but a remarkable number of early distant progressions were recorded (32.5%). The median time to progression was 4.8 months, being the dose, the scheme, the size of the recurrence or the strategy (exclusive RT vs. combined) unrelated factors. The median overall survival (OS) was 14.9 months. Karnofsky index < 70 and the size of the recurrence (maximum diameter < 25 mm) were significant factors associated with OS. Radiological changes after reirradiation were commonly seen (> 50% of patients) hindering the response assessment. Reirradiation is a feasible and safe therapeutic option to treat localized glioblastoma recurrences, able to control the disease for a few months in selected patients, especially those with good functional status and small lesions. Hypofractionated schemes provided a suitable toxicity profile. Radiological changes were common.

Differential Diagnosis of Tuberculosis and Sarcoidosis by Immunological Features Using Machine Learning.

Despite the achievements of modern medicine, tuberculosis remains one of the leading causes of mortality globally. The difficulties in differential diagnosis have particular relevance in the case of suspicion of tuberculosis with other granulomatous diseases. The most similar clinical and radiologic changes are sarcoidosis. The aim of this study is to apply mathematical modeling to determine diagnostically significant immunological parameters and an algorithm for the differential diagnosis of tuberculosis and sarcoidosis. Materials and methods: The serum samples of patients with sarcoidosis (SD) (n = 29), patients with pulmonary tuberculosis (TB) (n = 32) and the control group (n = 31) (healthy subjects) collected from 2017 to 2022 (the average age 43.4 ± 5.3 years) were examined. Circulating 'polarized' T-helper cell subsets were analyzed by multicolor flow cytometry. A symbolic regression method was used to find general mathematical relations between cell concentrations and diagnosis. The parameters of the selected model were finally fitted through multi-objective optimization applied to two conflicting indices: sensitivity to sarcoidosis and sensitivity to tuberculosis. Results: The difference in Bm2 and CD5-CD27- concentrations was found to be more significant for the differential diagnosis of sarcoidosis and tuberculosis than any individual concentrations: the combined feature Bm2 - [CD5-CD27-] differentiates sarcoidosis and tuberculosis with p < 0.00001 and AUC = 0.823. An algorithm for differential diagnosis was developed. It is based on the linear model with two variables: the first variable is the difference Bm2 - [CD5-CD27-] mentioned above, and the second is the naïve-Tregs concentration. The algorithm uses the model twice and returns "dubious" in 26.7% of cases for patients with sarcoidosis and in 16.1% of cases for patients with tuberculosis. For the remaining patients with one of these two diagnoses, its sensitivity to sarcoidosis is 90.5%, and its sensitivity to tuberculosis is 88.5%. Conclusions: A simple algorithm was developed that can distinguish, by certain immunological features, the cases in which sarcoidosis is likely to be present instead of tuberculosis. Such cases may be further investigated to rule out tuberculosis conclusively. The mathematical model underlying the algorithm is based on the analysis of "naive" T-regulatory cells and "naive" B-cells. This may be a promising approach for differential diagnosis between pulmonary sarcoidosis and pulmonary tuberculosis. The findings may be useful in the absence of clear differential diagnostic criteria between pulmonary tuberculosis and sarcoidosis.

Radiological changes in the thymus in patients who have had COVID-19 and in vaccinated persons who have not had COVID-19: a CT study.

There are very few and limited studies on the role of the thymus in COVID-19 infection. It is known that thymus morphology changes in individuals vaccinated against COVID-19 although they do not have active infection. Our study aims to evaluate these differences in detail. This research was conducted in atotal of 141 people, 75women and 66men. The research consisted of three groups: unvaccinated persons who have had the disease (n = 49), vaccinated persons who have not had the disease (n = 37), and unvaccinated persons who have not had the disease (control group, n = 55). In the study, the thymus volume, structure, and fat content were investigated and the differences between groups were evaluated. Thymus volume was greatest (0.43 ± 0.11) in the vaccinated group that had not had the disease and smallest (0.15 ± 0.07) in the unvaccinated group that had had the disease, and asignificant difference was found between the groups. Thymus steatosis was seen mostly in the unvaccinated group that had had the disease (72%; p = 0.04). The diffuse nodular pattern was only present in the diseased group. This research is the first study in the literature to date on the effect of COVID-19 and vaccines on the thymus. In addition to the acute consequences of the virus, the possibility of negative symptoms after COVID-19 should also be kept in mind, especially in unvaccinated people. Further studies are needed to confirm the results reported herein.

Radiosynoviorthesis with [90Y] Yttrium citrate in refractory synovitis of the knee: Experience of 2 reference hospitals

IntroductionTo describe the therapeutic efficacy of radiosynoviorthesis with [90Y]Yttrium citrate (90Y), in patients with chronic knee synovitis refractory to systemic treatments and/or infiltrations, correlating the results with the different etiologies and degenerative changes that they showed, in order to optimize the indication of the technique. Material and methodsObservational retrospective study with 32 patients (22 men and 10 women) and 34 knees, with refractory chronic knee synovitis, who underwent radiosynoviorthesis between January 2013 and December 2022. Its efficacy was described and analyzed by the subjective improvement referred by the patients and its relationship with the existing etiologies and radiological degenerative changes, expressed by the Kellgren-Lawrence (K-L) scale. ResultsA statistically significant subjective improvement was observed in 70.6% of the cases (p < 0.001). There were 92.3% of cases with absent, doubtful or mild degenerative changes (K-L 0-2) who improved, while only 50% with moderate or severe changes (K-L 3-4) improved, showing statistically significant differences (p = 0.03). Among patients with chronic inflammatory origin of synovitis (spondyloarthropathies and rheumatoid arthritis), 80% improved, while in those with osteoarthritis (degenerative) origin, only 25% improved with statistically significant differences (p = 0.006). ConclusionsRadiosynoviorthesis with 90Y is an effective treatment in patients with knee refractory chronic synovitis, especially in the presence of mil degenerative joint changes and chronic inflammatory origin. We must ensure the appropiate selection of patients according to these criteria.

Radiological and spirometric changes in relation to drugs used in post COVID pulmonary fibrosis in a cohort of COVID-19 survivors

BackgroundIt has been proposed that prolonged use of anti-inflammatory and anti-fibrotic drugs diminish the probability of development of lung fibrosis. Prolonged low-dose corticosteroid may prevent remodeling of the lung in survivors. Pirfenidone and colchicine may exhibit anti-fibrotic and anti-inflammatory properties as well.MethodsThis retrospective observational study was conducted at post COVID-19 clinic, Mansoura University Hospitals, during the period between October 2020 and March 2022. This study included 104 patients who had COVID-19 pneumonia confirmed either by RT-PCR or radiologically by CT scan and divided into 3 groups; group A (corticosteroids only) included 33 (31.7%) patients, group B (corticosteroids and colchicine) included 56 (53.8%) patients, and group C (corticosteroids, colchicine, and pirfenidone) included 15 (14.4%) patients. All patients were assessed during follow-up visits in post COVID-19 clinic 1 and 3 months after discharge by evaluation of resting SpO2, spirometry, and radiological assessment. Patients’ data during hospitalization was collected from hospital electronic systems.ResultsThere was non-statistically significant improvement in FEV1 in group A while there was statistically significant improvement in FEV1 in groups B and C (P value = 0.002 and 0.041, respectively) 1 month and 3 months after discharge. Group B exhibited more statistically significant improvement in FVC as well compared to group C (P value = 0.003 and 0.025, respectively) while group A showed non-statistically significant improvement in FVC. There was a statistically significant decrease in CT severity score in all the groups during follow-up with P value < 0.001 in groups A and B and to less extent less statistically significant decrease in group C comparing the 3 groups to each other.ConclusionThe use of colchicine added to corticosteroids after acute phase of COVID-19 pneumonia resulted in statistically significant improvement regarding functional and radiological changes during follow-up when compared to corticosteroids alone. The addition of pirfenidone (which is a relatively expensive drug) to corticosteroids and colchicine did not add more statistically significant improvement in functional or radiological changes.

Nontuberculous mycobacterial pulmonary disease presenting as bronchiolitis pattern on CT without cavity or bronchiectasis

BackgroundThis study aimed to investigate the radiological changes in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) having bronchiolitis patterns on computed tomography (CT).MethodsWe retrospectively reviewed the final diagnosis and radiologic changes of patients suspected of having NTM-PD without cavity or bronchiectasis on CT image, between January 1, 2005 and March 31, 2021. NTM-PD was diagnosed based on the American Thoracic Society and Infectious Diseases Society of America criteria. The initial and final CT findings (bronchiectasis, cellular bronchiolitis, cavity formation, nodules, and consolidation) were compared between patients diagnosed with and without NTM-PD.ResultsThis study included 96 patients and 515 CT images. The median CT follow-up duration was 1510.5 (interquartile range: 862.2–3005) days. NTM-PD was recognized in 43 patients. The clinical variables were not significantly different between patients with and without NTM-PD, except for underlying chronic airway disease (P < 0.001). Nodule and consolidation were more frequently observed on the initial CT scans of patients with NTM-PD compared with those without (P < 0.05). On the final follow-up CT scan, bronchiectasis (P < 0.001), cavity (P < 0.05), nodule (P < 0.05), and consolidation (P < 0.05) were more frequently observed in patients with NTM-PD. Among the 43 patients with NTM-PD, 30 showed a radiological progression on CT, with bronchiectasis (n = 22) being the most common finding. The incidence of bronchiectasis increased over time.ConclusionThe bronchiolitis pattern on CT images of patients with NTM-PD showed frequent radiological progression during the follow-up period.

Development of a mouse model of chronic ventral spinal cord compression: Neurobehavioral, radiological, and pathological changes.

The main objective of this study was to establish a mouse model of spinal ligament ossification to simulate the chronic spinal cord compression observed in patients with ossification of the posterior longitudinal ligament (OPLL). The study also aimed to examine the mice's neurobiological, radiological, and pathological changes. In the previous study, a genetically modified mouse strain was created using Crispr-Cas9 technology, namely, Enpp1 flox/flox /EIIa-Cre (C57/B6 background), to establish the OPLL model. Wild-type (WT) mice without compression were used as controls. Functional deficits were evaluated through motor score assessment, inclined plate testing, and gait analysis. The extent of compression was determined using CT imaging. Hematoxylin and eosin staining, luxol fast blue staining, TUNEL assay, immunofluorescence staining, qPCR, and Western blotting were performed to evaluate levels of apoptosis, inflammation, vascularization, and demyelination in the study. The results demonstrated a gradual deterioration of compression in the Enpp1 flox/flox /EIIa-Cre mice group as they aged. The progression rate was more rapid between 12 and 20 weeks, followed by a gradual stabilization between 20 and 28 weeks. The scores for spinal cord function and strength, assessed using the Basso Mouse Scale and inclined plate test, showed a significant decline. Gait analysis revealed a noticeable reduction in fore and hind stride lengths, stride width, and toe spread. Chronic spinal cord compression resulted in neuronal damage and activated astrocytes and microglia in the gray matter and anterior horn. Progressive posterior cervical compression impeded blood supply, leading to inflammation and Fas-mediated neuronal apoptosis. The activation of Bcl2 and Caspase 3 was associated with the development of progressive neurological deficits (p < 0.05). The study presents a validated model of chronic spinal cord compression, enabling researchers to explore clinically relevant therapeutic approaches for OPLL.