Semiquantitative Scoring Systems Research Articles

Tenosynovitis Evaluation Using Image Fusion and B-Flow - A Pilot Study on New Imaging Techniques in Rheumatoid Arthritis Patients.

Aim The aim of this study was to compare the assessment of tenosynovitis by ultrasound (US) and magnetic resonance imaging (MRI) using the image fusion technique and to investigate whether US B-flow imaging (BFI) is an alternative to Doppler US when assessing tenosynovitis. Materials and Methods 15 patients with rheumatoid arthritis (RA) had US-verified tenosynovitis in the wrist/hand. An MRI was performed of the wrist/hand with subsequent repeated US and image fusion. Images were compared in three steps: 1. Visual image comparison, 2. Quantitative measurement of transverse areas of the affected tendon and tendon sheath, using two tendon measures on MRI, area 1 and area 2, excluding and including partial volume artifacts, respectively, 3. Assessment using the OMERACT semi-quantitative scoring systems for US and MRI. Furthermore, BFI was assessed as: 0: No flow, 1: Focal flow, 2: Multifocal flow, 3: Diffuse flow, in the tendon sheath. Results The median areas on US and MRI (areas 1 and 2) were 0.16 cm2 (25;75 pctl: 0.10; 0.25), 0.9 cm2 (0.06; 0.18) and 0.13 cm2 (0.10; 0.25), respectively, for included tendons and 0.18 cm2 (0.13; 0.26), 0.27 cm2 (0.20; 0.45) and 0.23 cm2 (0.16; 0.40) for tendon sheaths. No statistically significant difference was found between US tendon area and MRI tendon area 2 (Wilcoxon's test; p = 0.47). Overall, the agreement between grayscale and color Doppler (CD) US and MRI tenosynovitis visualization and scoring was good, but not between CD and BFI. Conclusion US and MRI have high agreement using image fusion for the assessment of tenosynovitis when partial volume artifacts are taken into account. BFI is not an alternative to CD for the measurement of slow flow in tenosynovitis.

Pathology of non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) covers a spectrum of lesions ranging from steatosis (Non-alcoholic Fatty Liver or NAFL) to a complex pattern with hepatocellular injury and inflammation (non-alcoholic steatohepatitis; NASH) in the absence of alcohol intake. However, it is increasingly clear that intermediate patterns may exist. The histopathological evaluation of liver biopsy samples is central in the diagnosis of NAFLD and NASH in the absence of sufficiently accurate non-invasive tests because a precise definition of each group is a key issue. When at least 5% of hepatocytes display steatosis, patients can be defined as having NAFLD in an appropriate clinical context. When, in addition, lobular inflammation and liver cell clarification/ballooning are present, then the lesion is usually defined as NASH. Evaluation of the stage of fibrosis is even more fundamental than necroinflammation since it is the main prognostic factor of this disease. Semi-quantitative histological scoring systems have been proposed for NAFLD, but they are not useful in clinical practice and each has certain limitations. For comprehensive purposes, we suggest describing histopathological lesions in NAFLD using the SAF (Steatosis, Activity, Fibrosis) score which assesses separately the grade of steatosis (S, from S0 to S3), the grade of activity (A from A0 to A4 by adding grades of ballooning and lobular inflammation, both from 0 to 2) and the stage of fibrosis (F from F0 to F4).

Contrast-Enhanced Computed Tomography Enables Quantitative Evaluation of Tissue Properties at Intrajoint Regions in Cadaveric Knee Cartilage.

ObjectiveThe aim of this study was to investigate whether the concentration of the anionic contrast agent ioxaglate, as quantitated by contrast-enhanced computed tomography (CECT) using a clinical cone-beam CT (CBCT) instrument, reflects biochemical, histological, and biomechanical characteristics of articular cartilage imaged in an ex vivo, intact human knee joint.DesignAn osteoarthritic human cadaveric knee joint (91 years old) was injected with ioxaglate (36 mg I/mL) and imaged using CBCT over 61 hours of ioxaglate diffusion into cartilage. Following imaging, the joint surfaces were excised, rinsed to remove contrast agent, and compressive stiffness (equilibrium and instantaneous compressive moduli) was measured via indentation testing (n = 17 sites). Each site was sectioned for histology and assessed for glycosaminoglycan content using digital densitometry of Safranin-O stained sections, Fourier transform infrared spectroscopy for collagen content, and morphology using both the Mankin and OARSI semiquantitative scoring systems. Water content was determined using mass change after lyophilization.ResultsCECT attenuation at all imaging time points, including those <1 hour of ioxaglate exposure, correlated significantly (P < 0.05) with cartilage water and glycosaminoglycan contents, Mankin score, and both equilibrium and instantaneous compressive moduli. Early time points (<30 minutes) also correlated (P < 0.05) with collagen content and OARSI score. Differences in cartilage quality between intrajoint regions were distinguishable at diffusion equilibrium and after brief ioxaglate exposure.ConclusionsCECT with ioxaglate affords biochemical and biomechanical measurements of cartilage health and performance even after short, clinically relevant exposure times, and may be useful in the clinic as a means for detecting early signs of cartilage pathology.

Diabetes-accelerated experimental osteoarthritis is prevented by autophagy activation

Type 2 Diabetes (T2D) is a risk factor for osteoarthritis (OA). Autophagy, an essential homeostasis mechanism in articular cartilage, is defective in T2D and OA. However, how T2D may influence OA progression is still unknown. We aimed to determine how diabetes affects cartilage integrity and whether pharmacological activation of autophagy has efficacy in diabetic mice (db/db mice) with OA. Experimental OA was performed in the right knee of 9 weeks-old C57Bl/6J male mice (Lean group, N=8) and of 9 weeks-old B6.BKS (D)-Leprdb male mice (db/db group, N=16) by transection of medial meniscotibial and medial collateral ligaments. Left knee was employed as control knee. Rapamycin (2mg/kg weight/day) or Vehicle (dimethyl sulfoxide) were administered intraperitoneally three times a week for 10 weeks. Histopathology of articular cartilage and synovium was evaluated by using semiquantitative scoring and synovitis grading systems, respectively. Immunohistochemistry was employed to evaluate the effect of diabetes and Rapamycin on cartilage integrity and OA biomarkers. Cartilage damage was increased in db/db mice compared to Lean mice after experimental OA, while no differences are observed in the control knee. Cartilage damage and synovium inflammation were reduced by Rapamycin treatment of OA-db/db mice. This protection was accompanied with a decrease in MMP-13 expression and decreased interleukin 12 (IL-12) levels. Furthermore, autophagy was increased and cartilage cellularity was maintained, suggesting that mammalian target of rapamycin (mTOR) targeting prevents joint physical harm. Our findings indicate that diabetic mice exhibit increased joint damage after experimental OA, and that autophagy activation might be an effective therapy for diabetes-accelerated OA.

MIBG in Neuroblastoma Diagnostic Imaging and Therapy.

Neuroblastoma is a common malignancy observed in infants and young children. It has a varied prognosis, ranging from spontaneous regression to aggressive metastatic tumors with fatal outcomes despite multimodality therapy. Patients are divided into risk groups on the basis of age, stage, and biologic tumor factors. Multiple clinical and imaging tests are needed for accurate patient assessment. Iodine 123 ((123)I) metaiodobenzylguanidine (MIBG) is the first-line functional imaging agent used in neuroblastoma imaging. MIBG uptake is seen in 90% of neuroblastomas, identifying both the primary tumor and sites of metastatic disease. The addition of single photon emission computed tomography (SPECT) and SPECT/computed tomography to (123)I-MIBG planar images can improve identification and characterization of sites of uptake. During scan interpretation, use of MIBG semiquantitative scoring systems improves description of disease extent and distribution and may be helpful in defining prognosis. Therapeutic use of MIBG labeled with iodine 131 ((131)I) is being investigated as part of research trials, both as a single agent and in conjunction with other therapies. (131)I-MIBG therapy has been studied in patients with newly diagnosed neuroblastoma and those with relapsed disease. Development and implementation of an institutional (131)I-MIBG therapy research program requires extensive preparation with a focus on radiation protection.

Predictive value of semi-quantitative MRI-based scoring systems for future knee replacement: data from the osteoarthritis initiative.

To evaluate, in a confirmatory fashion, whether baseline and change from baseline to 24-month follow-up in cartilage damage, bone marrow lesions and meniscal damage are predictors of knee replacement (KR) in subjects with a high risk of osteoarthritis (OA), independent of the level of physical activity, symptom severity and radiographic abnormalities. Data from the Osteoarthritis Initiative's (OAI) baseline and 24-month follow-up knee MRIs of 115 patients (age range: 45-78 years; 48% female; BMI: 20.9-48.7) were analyzed. Cartilage, bone marrow and menisci were semi-quantitatively scored according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS) and Boston-Leeds Osteoarthritis Knee Score (BLOKS) systems in all compartments. Baseline and 24-month interval changes in structural tissue damage assessed by BLOKS and WORMS were used as predictors of KR independent of clinical and radiographic parameters using Cox hazard analysis. Adjustments were performed for age, gender, BMI and physical activity (Physical Activity Scale for the Elderly: PASE), Western Ontario and McMaster Questionnaire (WOMAC) total score and radiographic Kellgren-Lawrence (KL) score. BLOKS and WORMS baseline cartilage scores were predictors of KR independent of the PASE, WOMAC and KL score. One score increase in the average baseline BLOKS full-thickness cartilage defect score was associated with a [hazard ratio (95% CI)] 13.55 (3.61-50.89) times greater risk of KR independent of the PASE, WOMAC and KL score. Net reclassification improvements (NRIs) of the additional evaluation of 24-month follow-up MRI scores and assessment of changes were not significant for prediction of KR (NRI range: -7.23-24.8%). The BLOKS cartilage score for full-thickness cartilage defects had the highest hazard for KR. Follow-up MRI changes in structural tissue damage, detected by BLOKS and WORMS cartilage, bone marrow or meniscus scores (up to 24months) had no significant predictive value in addition to the baseline MRI.

The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review

Despite a growing organ shortage in the United States, many deceased donor kidneys removed for transplantation are discarded. Kidney biopsy findings often play a role in these discards, although it is not clear whether biopsies reliably inform acceptance decisions. Therefore, we carried out a systematic review of the medical literature on the utility of both procurement and implantation biopsies for predicting posttransplant outcomes. Between January 1, 1994 and July 1, 2014, 47 studies were published in the English language literature that examined the association between pretransplant donor biopsy findings from 50 or more donors (with more than half being from deceased donors) and either posttransplant graft failure, delayed graft function, or graft function. In general, study quality was poor. All were retrospective or did not indicate if they were prospective. Results were heterogeneous, with authors as often as not concluding that biopsy results did not predict posttransplant outcomes. The percent glomerular sclerosis was most often examined, and failed to predict graft failure in 7 of 14 studies. Of 15 semiquantitative scoring systems proposed, none consistently predicted posttransplant outcomes across studies. Routine use of biopsies to help determine whether or not to transplant a kidney should be reexamined.

Assessment of liver fibrosis: the relationship between point shear wave elastography and quantitative histological analysis.

Traditional pathological scoring systems for liver fibrosis progression are predominantly based on the description of architectural changes with no consideration of the amount of collagen fiber deposition. Our purpose was to explore a true histological standard in accordance with the liver stiffness measured by point shear wave elastography (PSWE) in patients with chronic hepatitis B. A total of 78 patients with liver neoplasms underwent liver stiffness measurements with PSWE as well as biochemical investigations within 3 days before partial hepatectomy. One tissue section of the liver specimens was stained with HE trichrome and evaluated traditionally with the Scheuer scoring system. The other tissue section was stained with picroSirius red and was evaluated according to the semiquantitative Chevallier et al. scoring system. In addition, this second tissue section was evaluated for the collagen proportionate area (CPA) with computer-assisted digital image analysis. The reproducibility of PSWE technology was explored through the intra-class correlation coefficient of a reliability analysis. The PSWE technology revealed good reproducibility in liver stiffness measurements, and the PSWE values increased with the pathological severity of liver fibrosis on both the Scheuer scoring system and the semiquantitative Chevallier et al. scoring system. PSWE values exhibited more reasonable relationships with CPA (r = 0.628, P = 0.00 < 0.05) than with the Scheuer scoring system (r = 0.473, P = 0.00 < 0.05) or the Chevallier et al. semiquantitative scoring system (r = 0.487, P = 0.00 < 0.05). CPA is a better pathological parameter than traditional semiquantitative scoring systems in accordance with liver stiffness measured by PSWE technology.

Response: Expression of Glucagon-Like Peptide-1 Receptor in Papillary Thyroid Carcinoma and Its Clinicopathologic Significance (Endocrinol Metab 2014;29:536-44, Min Jung Jung et al.).

Thank you for your interest and comments on our article entitled Expression of glucagon-like peptide-1 receptor in papillary thyroid carcinoma and its clinicopathologic significance, which was published in Endocrinology and Metabolism [1]. We reported the expression of the glucagon-like peptide-1 receptor (GLP-1R) in papillary thyroid carcinoma (PTC) tissues based on immunohistochemical (IHC) staining. However, we could not find a meaningful relationship between clinical prognostic markers and GLP-1R expression in PTC, but the less multifocality of GLP-1R expression in PTC tissues. These findings were unexpected and interesting because previous studies reported that GLP-1R is not expressed in thyroid follicular cells and GLP-1 plays a possible role in cell proliferation and apoptosis in pancreatic β-cells. IHC staining is well-established and used widely for identifying specific pathological processes, including protein expression nevertheless, the pathologist's interpretation is subjective. To convert the subjective perception of IHC marker expression into quantitative data, various semiquantitative scoring systems have been suggested. For example, in breast cancer, representative tumors were subjected to several IHC stains, including estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki67. Pathologists use the modified H-score, immunoreactive score and Allred score [2,3] as generally accepted standard interpretation guidelines for IHC staining of ER and PR. In Allred score, pathologists score the proportions of ER-positive immunoreactive cells into six categories (0, no cells are ER-positive; 1, ≤1%; 2, 1% to 10%; 3, 11% to 33%; 4, 34% to 66%; and 5, 67% to 100% are ER-positive) and intensity into four categories (0, negative; 1, weak; 2, intermediate; and 3, strong). The final score is the sum of these two scores, where the minimal standard hormone receptor-positive score is 3 and the mandatory minimum of tumor cells is 1% regardless of intensity. A similar approach was demonstrated in quickscore, modified H-score system, with the differences in values in proportion category A from 1 to 6 (1, 0% to 4%; 2, 5% to 9%; 3, 20% to 39%; 4, 40% to 59%; 5, 60% to 79%; and 6, 80% to 100%) and using multiplication for final scoring [2]. However, the generally accepted interpretation guideline for IHC staining of HER2 is different. Pathologists evaluate the immunoreactive pattern (complete vs. incomplete circumferential membrane staining), intensity (none, weak, moderate, and intense), and proportion of immunoreactive cells (≤10%, >10%). The final interpretation is based on the combination of these three results [4]. In the general guideline for interpreting the IHC staining for Ki67, pathologists evaluate only the proportion of immunoreactive cells (low, Ki67 index <14%; high, Ki67 index ≥14%) [5]. Furthermore, investigators have used various interpretation methods to compensate for the equivocal immunoreactivity with many IHC stains [6]. Even among researchers using there are various interpretation methods and criteria based on the proportion and intensity scores, calculation method (addition vs. multiplication), and what is interpreted as a positive immunoreaction. These differences in the IHC interpretation system are considered a major cause of discordant results among studies. In our study, we interpreted the results of IHC staining using both intensity and the proportion of GLP-1R immunoreactive cells. Negative immunoreactivity was defined as no staining or ambiguous staining and strong immunoreactivity was defined as any cells with strong staining intensity regardless of the distribution. However, weak intensity was interpreted according to the distribution of immunoreactive cells in the entire tumor with a minimum cutoff value of 5%. This interpretation system focuses more on the intensity of stained cells compared to the breast tumor in which the proportion of stained cells is more important. Our study is pioneering research on GLP-1R expression in PTC based on IHC expression. Therefore, we focused on the existence of aberrant GLP-1R expression in PTC, rather than the differences between expressed or non-expressed GLP1-R in PTC or differences among various degrees of GLP-1R expressed in PTC. Moreover, the distribution of GLP-1R immunoreactive cells was diffuse and spread over 50% of the entire tumor in all except two of 18 cases, which showed moderately intense immunoreactivity in 20% of the tumor. Therefore, fine separation of immunoreactive cell proportion is considered as less meaningful. To date, there is insufficient information to determine the best interpretation method for GLP-1R expression in PTC. We hope to obtain more objective and validated results in future studies including a more quantitative scoring system for IHC staining, such as the quickscore method. We sincerely appreciate Park et al. for their interest in our study and knowledgeable comments.

A Stereological Method for the Quantitative Evaluation of Cartilage Repair Tissue.

ObjectiveTo implement stereological principles to develop an easy applicable algorithm for unbiased and quantitative evaluation of cartilage repair.DesignDesign-unbiased sampling was performed by systematically sectioning the defect perpendicular to the joint surface in parallel planes providing 7 to 10 hematoxylin–eosin stained histological sections. Counting windows were systematically selected and converted into image files (40-50 per defect). The quantification was performed by two-step point counting: (1) calculation of defect volume and (2) quantitative analysis of tissue composition. Step 2 was performed by assigning each point to one of the following categories based on validated and easy distinguishable morphological characteristics: (1) hyaline cartilage (rounded cells in lacunae in hyaline matrix), (2) fibrocartilage (rounded cells in lacunae in fibrous matrix), (3) fibrous tissue (elongated cells in fibrous tissue), (4) bone, (5) scaffold material, and (6) others. The ability to discriminate between the tissue types was determined using conventional or polarized light microscopy, and the interobserver variability was evaluated.ResultsWe describe the application of the stereological method. In the example, we assessed the defect repair tissue volume to be 4.4 mm3 (CE = 0.01). The tissue fractions were subsequently evaluated. Polarized light illumination of the slides improved discrimination between hyaline cartilage and fibrocartilage and increased the interobserver agreement compared with conventional transmitted light.ConclusionWe have applied a design-unbiased method for quantitative evaluation of cartilage repair, and we propose this algorithm as a natural supplement to existing descriptive semiquantitative scoring systems. We also propose that polarized light is effective for discrimination between hyaline cartilage and fibrocartilage.

Different approaches for interpretation and reporting of immunohistochemistry analysis results in the bone tissue - a review.

BackgroundImmunohistochemistry (IHC) is a well-established, widely accepted method in both clinical and experimental parts of medical science. It allows receiving valuable information about any process in any tissue, and especially in bone. Each year the amount of data, received by IHC, grows in geometric progression. But the lack of standardization, especially on the post-analytical stage (interpreting and reporting of results), makes the comparison of the results of different studies impossible.MethodsComprehensive PubMED literature search with a combination of search words “immunohistochemistry” and “scoring system” was performed and 773 articles describing IHC results were identified. After further manual analysis 120 articles were selected for detailed evaluation of used approaches.ResultsSix major approaches to the interpretation and presentation of IHC analysis results were identified, analyzed and described.ConclusionsThe overview of the existing approaches in evaluation and interpretation of IHC data, which are provided in the article, can be used in bone tissue research and for either better understanding of existing scoring systems or developing a new one. Standard multiparametric, semiquantitative IHC scoring systems should simplify and clarify the process of interpretation and reporting of received data.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_221

An update on risk factors for cartilage loss in knee osteoarthritis assessed using MRI-based semiquantitative grading methods.

Arthroscopy-based semiquantitative scoring systems such as Outerbridge and Noyes' scores were the first to be developed for the purpose of grading cartilage defects. As magnetic resonance imaging (MRI) became available for evaluation of the osteoarthritic knee joint, these systems were adapted for use with MRI. Later on, grading methods such as the Whole Organ Magnetic Resonance Score, the Boston-Leeds Osteoarthritis Knee Score and the MRI Osteoarthritis Knee Score were designed specifically for performing whole-organ assessment of the knee joint structures, including cartilage. Cartilage grades on MRI obtained with these scoring systems represent optimal outcome measures for longitudinal studies, and are designed to enhance understanding of the knee osteoarthritis disease process. The purpose of this narrative review is to describe cartilage assessment in knee osteoarthritis using currently available MRI-based semiquantitative whole-organ scoring systems, and to provide an update on the risk factors for cartilage loss in knee osteoarthritis as assessed with these scoring systems.

Association between quantitative MRI and ICRS arthroscopic grading of articular cartilage.

To investigate the association of quantitative magnetic resonance imaging (qMRI) parameters with arthroscopic grading of cartilage degeneration. Arthroscopy of the knee is considered to be the gold standard of osteoarthritis diagnostics; however, it is operator-dependent and limited to the evaluation of the articular surface. qMRI provides information on the quality of articular cartilage and its changes even at early stages of a disease. qMRI techniques included T 1 relaxation time, T 2 relaxation time, and delayed gadolinium-enhanced MRI of cartilage mapping at 3 T in ten patients. Due to a lack of generally accepted semiquantitative scoring systems for evaluating severity of cartilage degeneration during arthroscopy, the International Cartilage Repair Society (ICRS) classification system was used to grade the severity of cartilage lesions. qMRI parameters were statistically compared to arthroscopic grading conducted with the ICRS classification system. qMRI parameters were not linearly related to arthroscopic grading. Spearman's correlation coefficients between qMRI and arthroscopic grading were not significant. The relative differences in qMRI parameters of superficial and deep cartilage varied with degeneration, suggesting different macromolecular alterations in different cartilage zones. Results suggest that loss of cartilage and the quality of remaining tissue in the lesion site may not be directly associated with each other. The severity of cartilage degeneration may not be revealed solely by diagnostic arthroscopy, and thus, qMRI can have a role in the investigation of cartilage degeneration.

Cartilage Lesion Score: Comparison of a Quantitative Assessment Score with Established Semiquantitative MR Scoring Systems

To describe a scoring system for quantification of cartilage lesions (Cartilage Lesion Score [CaLS]), to determine its reproducibility, to examine the association of CaLS-detected longitudinal change with known risk factors for osteoarthritis (OA) progression by comparing a group of subjects with OA risk factors with a group of subjects without OA risk factors, and to compare the CaLS system with the established semiquantitative Whole-Organ Magnetic Resonance Imaging Score (WORMS) and Boston-Leeds Osteoarthritis Knee Score (BLOKS) systems in terms of detection of cartilage defect progression. All subjects provided written informed consent, and the local institutional review board approved this HIPAA-compliant study. Fifty-two subjects with and 25 subjects without risk factors for knee OA were randomly selected from the Osteoarthritis Initiative. Inclusion criteria were age of 45-60 years, body mass index of 19-27 kg/m(2), and no knee pain or OA on radiographs at baseline. Baseline and 24-month follow-up right knee 3-T magnetic resonance images were analyzed with WORMS, BLOKS, and CaLS systems. Progression of cartilage lesions with each scoring system was compared by using multilevel mixed-effects linear-regression models. κ values were calculated to determine reliability. Intraclass coefficient values for inter- and intraobserver reliability of the CaLS system were 0.86 and 0.91, respectively. Interobserver κ value range for individual features was 0.81-0.94. The CaLS system enabled significantly higher detection of cartilage lesion progression than did WORMS or BLOKS systems (P < .001); 51.8% (56 of 108), 17.6% (19 of 108), and 13.0% (14 of 108) of the lesions progressed when analyzed with the CaLS, WORMS, and BLOKS systems, respectively. With the CaLS system, subjects with OA risk factors had significantly higher odds of progression than did subjects without risk factors (odds ratio, 2.78; P = .005). The CaLS system is a reproducible scoring system for cartilage lesions that yields an improved detection rate for monitoring progression when compared with detection rates of semiquantitative WORMS and BLOKS systems.

Collagen proportionate area is superior to other histological methods for sub-classifying cirrhosis and determining prognosis

One-year survival in cirrhosis ranges from 1 to 57% depending on the clinical stage. Accurate sub-classification has important prognostic implications but there is no stage beyond cirrhosis using current qualitative histological systems. We compared the performance of all histological semi-quantitative and quantitative methods specifically developed for sub-classifying cirrhosis that have been described to date, with collagen proportionate area (CPA), to evaluate how well they distinguish patients with and without hepatic clinical decompensation at presentation, and in predicting future decompensating events. We included consecutive patients with a histological diagnosis of cirrhosis that had a suitable liver biopsy between 2003 and 2007. We used semi-quantitative histological scoring systems proposed by Laennec, Kumar, and Nagula. We also measured quantitatively nodule size, septal width and fibrous tissue expressed in CPA. Sixty-nine patients, mean age 52.3±11years, mean MELD 11.8±5.8, median follow-up 56months. Main aetiologies were alcohol (38%) and hepatitis C (27.5%). Twenty-four patients (34.8%) had had a previous episode of clinical decompensation. Amongst the 45 patients who were compensated, 11 (24%) decompensated on follow-up. In Cox regression, amongst all histological parameters, CPA was the only variable independently associated with clinical decompensation up to the time of biopsy, with an odds ratio that ranged from 1.245 to 1.292. Furthermore, only CPA was significantly associated with future decompensation (OR: 1.117, 95% CI 1.020-1.223; p=0.017). Cirrhosis can be accurately sub-classified using quantification of fibrosis with CPA, and furthermore CPA is the only independent predictor of clinical decompensation amongst all other histological sub-classification systems described to date.

What has imaging contributed to the epidemiological understanding of osteoarthritis?

OsteoarthritisOsteoarthritis (OA) is a leading cause of disability among theelderly.Kneesandhipsaremostcommonlyaffected;OAalsooccurs in the hands, shoulders, spine, and other joints. Symp-tomatic OA is defined by the American College of Rheuma-tology as a heterogeneous group of conditions that lead tojoint symptoms and signs, which are associated with thedefective integrity of articular cartilage, in addition to relatedchangesintheunderlyingboneatthejointmargins[1,2].OAis differentiated into primary (idiopathic) and secondary(caused by a known medical condition or event) [1]. Clinicalsymptoms (pain, stiffness, and limited function) and radio-graphic features are frequently discrepant, particularly in theknee[3],shoulder[4],hand[5],andhipjoint[6].Moststudiesdefine OA status and outcome with imaging findings only [7,8]. The goal of this review is to explore the contributions ofimaging to the epidemiological understanding of OA, giventhe recent advancement in imaging technologies.Large cohort studiesThere are several longitudinal cohort OA studies that includeextensive imaging data. Most focus on the knees and/or hips.A few of the largest studies (in terms of imaging data) are theOA Initiative (OAI) (http://oai.epi-ucsf.org)[9], theFramingham OA Study [10–12], the Multicenter OA Study(MOST; http://most.ucsf.edu/), and the Boston Osteoarthritisof the Knee Study (BOKS; [13]). The Osteoporotic Fracturesin Men Study (MrOS; [14]) and the Study of OsteoporoticFractures for Women (SOF;http://sof.ucsf.edu/)bothanalyzed measures of OA as secondary aims. Other studiesinclude the Beijing [15], NHANES [16], COPCORD [17],Wuchuan [ 18], and the ESORDIG [19]OAstudies.Imaging techniquesConventionalradiography isthecurrent goldstandardforOAdiagnosis. It is commonly assessed using semi-quantitativescoring systems such as the Kellgren and Lawrence (K/L),Croft, and OARSI classifications. These systems grade jointspace narrowing, osteophytes, and other radiographic fea-tures.Otherradiographictechniquesmeasureriskfactorssuchas knee alignment or hip femoro-acetabular impingement.Novel quantitative approaches (trabecular structure, shapemodeling, fractal signature analysis) aim to complement goldstandard techniques to better detect or monitor disease usingnew software tools.Ultrasound and scintigraphy have only limited applicationin OA. MRI provides most detailed information on pre-symptomatic and pre-radiographic changes and other associ-atedjointpathologies[20].TheseMRIfindingsareassociatedwithonsetofkneesymptoms,OAprogression,andtotal knee

Hemophilic Arthropathy: A Review of Imaging and Staging

Hemophilic arthropathy (HA) contributes the greatest morbidity and cost in the hemophilic population. Imaging plays a crucial role in accurately monitoring the disease process in all phases and evaluating treatment. It has been shown that prophylactic factor VIII replacement therapy, if given early in life, can prevent or delay the progression of HA and reduce the frequency of hemarthroses. This review evaluates the role of the different imaging modalities used in the staging of HA. It is noteworthy that a new refined consensus magnetic resonance imaging scale for assessment of HA has recently been published which together with introduction of semiquantitative scoring systems in ultrasound will help to provide a more tailored approach to the management of HA in the future.

SAT0404 Active synovitis in clinical sustained remission: A cross sectional ultrasound study of rheumatoid arthritis patients treated with traditional and biological dmards

BackgroundSome rheumatoid arthritis (RA) patients considered in clinical remission undergo structural and functional worsening, due to residual subclinical inflammation 1. However, it is unknown if traditional DMARDs and biological agents...

SP0093 Role of imaging in osteoarthritis: Biomarker, prognostic factor, outcome measure in RCT?

A biomarker of structural integrity seems essential in understanding the natural and post-therapy progression of osteoarthritis (OA), perhaps even more so at a time when a new wave of pharmacological...

Iodine-123 Metaiodobenzylguanidine Scintigraphy Scoring Allows Prediction of Outcome in Patients With Stage 4 Neuroblastoma: Results of the Cologne Interscore Comparison Study

Radioiodinated metaiodobenzylguanidine ((123)I-mIBG) scintigraphy is an established imaging method in neuroblastoma. Semiquantitative scoring systems have been developed to assess the extent of disease and response to chemotherapy. We present the results of the comparison between the SIOPEN [International Society of Pediatric Oncology Europe Neuroblastoma Group] score and the modified Curie score. We retrospectively analyzed 147 mIBG scans of 58 patients older than 1 year of age with stage 4 neuroblastoma from German Neuroblastoma Trial NB97 that were assessed according to the SIOPEN and the Curie scoring method. mIBG examinations were performed at diagnosis and after four and six cycles of chemotherapy. Scoring results were highly correlated between both methods, and interobserver reliability was excellent. A Curie score ≤ 2 and a SIOPEN score ≤ 4 (best cutoff) at diagnosis were correlated to significantly better event-free and overall survival compared with higher scores. After four cycles of chemotherapy, overall survival was significantly better for mIBG-negative patients compared with those with any residual mIBG-positive metastases. After six cycles of chemotherapy, there was no difference in survival between mIBG-negative patients and patients with residual mIBG-positive metastases. Patients without mIBG-positive metastases after four and six cycles of chemotherapy had a better overall survival, but late clearance of mIBG-positive metastases did not improve outcome. Higher mIBG scores at diagnosis and occurrence of any residual mIBG-positive metastases after four cycles of chemotherapy predicted unfavorable outcome for patients with stage 4 neuroblastoma. Later clearance of metastases did not improve prognosis. The Curie and the SIOPEN score were equally reliable and predictive.