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11 pages, 1825 KiB

Open AccessArticle

Proof-of-Concept Double-Blind Placebo-Controlled Trial Measuring Cartilage Composition in Early Rheumatoid Arthritis under TNF-α-Inhibitor Therapy

by Miriam Frenken, Benedikt Ostendorf, Ralph Brinks, Christoph Schleich, Lena M. Wilms, Stefan Vordenbäumen, Anja Müller-Lutz, Jutta G. Richter, Oliver Sander, Gerald Antoch, Matthias Schneider, Xenofon Baraliakos, Daniel B. Abrar and Philipp Sewerin

J. Clin. Med. 2023, 12(6), 2306; https://doi.org/10.3390/jcm12062306 - 16 Mar 2023

Viewed by 1565

Abstract

Low levels of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) values are indicative of cartilage degeneration. Patients with early rheumatoid arthritis are known to have low dGEMRIC values due to inflammatory activity. The additional effect of biological disease-modifying antirheumatic drug (bDMARD) and [...] Read more.

Low levels of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) values are indicative of cartilage degeneration. Patients with early rheumatoid arthritis are known to have low dGEMRIC values due to inflammatory activity. The additional effect of biological disease-modifying antirheumatic drug (bDMARD) and conventional synthetic disease-modifying antirheumatic drug (csDMARD) treatment on cartilage status is still unclear. In this prospective, double-blinded, randomized proof-of-concept clinical trial, patients with early rheumatoid arthritis (disease duration less than 12 months from symptoms onset) were treated with methotrexate + adalimumab (10 patients: 6/4 (f/m)). A control group with methotrexate alone (four patients: 2/2 (f/m)) was used. Cartilage integrity in the metacarpophalangeal joints was compared using dGEMRIC at baseline, 12, and 24 weeks after treatment initiation. A statistically significant increase in dGEMRIC levels was found in the adalimumab group considering the results after 12 and 24 weeks of therapy (p < 0.05) but not in the control group (p: non-significant). After 24 weeks, a tendency towards increased dGEMRIC values under combination therapy was observed, whereas methotrexate alone showed a slight decrease without meeting the criteria of significance (dGEMRIC mean change: +85.8 ms [−156.2–+346.5 ms] vs. 30.75 ms [−273.0–+131.0 ms]; p: non-significant). After 24 weeks of treatment with a combination of methotrexate and adalimumab, a trend indicating improvement in cartilage composition is seen in patients with early rheumatoid arthritis. However, treatment with methotrexate alone showed no change in cartilage composition, as observed in dGEMRIC sequences of metacarpophalangeal joints. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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8 pages, 2878 KiB

Open AccessArticle

The Clinical Utility of Dual-Energy Computed Tomography in the Diagnosis of Gout—A Cross-Sectional Study

by Maria Sotniczuk, Anna Nowakowska-Płaza, Jakub Wroński, Małgorzata Wisłowska and Iwona Sudoł-Szopińska

J. Clin. Med. 2022, 11(17), 5249; https://doi.org/10.3390/jcm11175249 - 5 Sep 2022

Cited by 2 | Viewed by 2537

Abstract

Dual-energy computed tomography (DECT) is an imaging technique that detects monosodium urate (MSU) deposits. This study aimed to assess the clinical utility of DECT in the diagnosis of gout. A total of 120 patients with clinical suspicion of gout who underwent DECT were [...] Read more.

Dual-energy computed tomography (DECT) is an imaging technique that detects monosodium urate (MSU) deposits. This study aimed to assess the clinical utility of DECT in the diagnosis of gout. A total of 120 patients with clinical suspicion of gout who underwent DECT were retrospectively enrolled. The sensitivity and specificity of DECT alone, American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria without DECT, and ACR/EULAR criteria with DECT were assessed. Additionally, an analysis of gout risk factors was performed. When artifacts were excluded, any MSU volume provided the best diagnostic value of DECT (AUC = 0.872, 95% CI 0.806–0.938). DECT alone had a sensitivity of 90.4% and specificity of 74.5%. Although ACR/EULAR criteria without DECT provided better diagnostic accuracy than DECT alone (AUC = 0.926, 95% CI 0.878–0.974), the best value was obtained when combing both (AUC = 0.957, 95% CI 0.924–0.991), with 100% sensitivity and 76.6% specificity. In univariate analysis, risk factors for gout were male sex, presence of tophi, presence of MSU deposits on DECT, increased uric acid in serum (each p < 0.001), and decreased glomerular filtration rate (GFR) (p = 0.029). After logistic regression, only increased serum uric acid (p = 0.034) and decreased GFR (p = 0.018) remained independent risk factors for gout. Our results suggest that DECT significantly increases the sensitivity of the ACR/EULAR criteria in the diagnosis of gout. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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9 pages, 1169 KiB

Open AccessArticle

Intraobserver Assessment of Shear Wave Elastography in Tensor Fasciae Latae and Gluteus Maximus Muscle: The Importance of the Hip Abductor Muscles in Runners Knee Compared to Healthy Controls

by Andrea S. Klauser, Felix de-Koekkoek, Christoph Schwabl, Christian Fink, Miriam Friede and Robert Csapo

J. Clin. Med. 2022, 11(13), 3605; https://doi.org/10.3390/jcm11133605 - 22 Jun 2022

Cited by 3 | Viewed by 2685

Abstract

Background: Iliotibial band syndrome (ITBS) represents one of the most common running related injuries. The pathophysiology is postulated to be caused by excessive ITB tension, impingement and irritation of soft tissues at the lateral femoral epicondyle. However, direct evidence has yet to be [...] Read more.

Background: Iliotibial band syndrome (ITBS) represents one of the most common running related injuries. The pathophysiology is postulated to be caused by excessive ITB tension, impingement and irritation of soft tissues at the lateral femoral epicondyle. However, direct evidence has yet to be found and the multifactorial etiology is under discussion. The purpose was to evaluate stiffness of ITB, gluteus maximus (GM) and tensor fasciae latae (TFL) muscles using shear wave elastography (SWE). Methods: In 14 patients with clinically verified ITBS and 14 healthy controls, three SWE measurements each of ITB, GM and TFL in both legs was performed to determine measurement reliability and between-group and -leg differences. Results: The mean value of ITB was 12.8 m/s with ICC of 0.76, whereas the values measured in the GM were 3.02 m/s with an ICC of 0.87. No statistically significant difference in controls compared to patients were found (p = 0.62). The mean value of TFL was 5.42 m/s in healthy participants, compared to 3.89 m/s patients with an ICC of 0.98 (p = 0.002). Conclusion: Although SWE showed no difference in ITB stiffness, significant differences for TFL muscle stiffness in runner’s knee was found, suggesting that the hip abductor muscles might play a bigger role in the pathophysiology of ITBS. We aimed to implement baseline values for stiffness assessments and prove reliability for further prospective studies of SWE in runner’s knee. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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8 pages, 2176 KiB

Open AccessArticle

Ultrasound of the Heel Improves Diagnosis—Tender Entheses in the Heel Region Rarely Corresponds to Inflammatory Enthesitis in Patients with Peripheral Spondyloarthritis

by Sara Kamp Felbo, Mikkel Østergaard, Inge Juul Sørensen and Lene Terslev

J. Clin. Med. 2022, 11(9), 2325; https://doi.org/10.3390/jcm11092325 - 21 Apr 2022

Cited by 4 | Viewed by 2017

Abstract

Enthesitis is a key pathology in spondyloarthritis (SpA), but diagnosis may be clinically challenging. The objective of this study was to investigate the prevalence of ultrasound enthesitis lesions in tender entheses in the heel region in patients with peripheral SpA. In 27 patients [...] Read more.

Enthesitis is a key pathology in spondyloarthritis (SpA), but diagnosis may be clinically challenging. The objective of this study was to investigate the prevalence of ultrasound enthesitis lesions in tender entheses in the heel region in patients with peripheral SpA. In 27 patients with tenderness upon palpation at the Achilles tendon or the plantar fascia insertion, ultrasound assessment of the affected enthesis was performed using greyscale and color Doppler mode. Images were evaluated using the Outcome Measures in Rheumatology (OMERACT) scoring system for enthesitis, scoring presence/absence of hypoechogenicity, thickening, calcifications/enthesophytes, and erosions, and color Doppler activity semi quantitatively from 0 to 3. A total enthesitis sum score was calculated. A second examiner scanned 10 patients for inter-reader reliability. Ultrasound signs of inflammatory enthesitis (thickening/hypoechogenicity and/or Doppler activity) were found in 48%, and 19% showed Doppler activity—all in the Achilles enthesis. Inflammatory pathologies other than enthesitis (e.g., tendinitis, arthritis, bursitis) were identified in 26% of tender heels. The ultrasound OMERACT scoring system for enthesitis lesions showed excellent intra- and inter-reader agreement in a clinical setting. In conclusion, less than 50% of clinically tender entheses are related to inflammatory enthesitis when assessed by ultrasound. Ultrasound is useful for diagnosing other pathologies that may explain tenderness in the area. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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12 pages, 1030 KiB

Open AccessArticle

Feasibility Trial to Evaluate Tendon Stiffness Obtained from Shear Wave Elastography Imaging as a Biomarker of Aromatase Inhibitor-Induced Arthralgias

by Jessica A. Martinez, Mihra S. Taljanovic, Andres A. Nuncio Zuniga, Betsy C. Wertheim, Denise J. Roe, Sima Ehsani, Sao Jiralerspong, Jennifer Segar and Pavani Chalasani

J. Clin. Med. 2022, 11(4), 1067; https://doi.org/10.3390/jcm11041067 - 18 Feb 2022

Cited by 3 | Viewed by 1878

Abstract

Aromatase inhibitor-induced arthralgia (AIA) comprises significant, activity-limiting musculoskeletal symptoms, including joint pain, myalgia, and joint stiffness. We conducted a prospective feasibility study in postmenopausal women diagnosed with early-stage (0–3) hormone receptor positive (HR+) breast cancer who were candidates for treatment with adjuvant AI [...] Read more.

Aromatase inhibitor-induced arthralgia (AIA) comprises significant, activity-limiting musculoskeletal symptoms, including joint pain, myalgia, and joint stiffness. We conducted a prospective feasibility study in postmenopausal women diagnosed with early-stage (0–3) hormone receptor positive (HR+) breast cancer who were candidates for treatment with adjuvant AI therapy (n = 16). Tendons of the hands and wrists and the median nerve were imaged using gray-scale and power Doppler ultrasound (US) and US SWE. Arthralgia symptoms were evaluated using the Breast Cancer Prevention Trial (BCPT) Symptom Checklist musculoskeletal subscale (MS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness subscales. At baseline, there were significant differences in the SW velocities of tendons between dominant and nondominant hands. Increased velocity in 2 of 6 tendons and the median nerve was associated with greater pain at baseline, whereas slower velocity of the extensor digitorum tendon (suggesting decreased stiffness) was associated with a higher WOMAC stiffness score. Increased SW velocity (suggestive of increased stiffness) at baseline in the abductor pollicis longus tendon was associated with a worsening of all three pain and stiffness measures by 6 months. Future studies should evaluate SWE scores related to AIA outcomes in a larger sample size. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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16 pages, 1340 KiB

Open AccessArticle

Ankle Magnetic Resonance Imaging in Juvenile Idiopathic Arthritis Versus Non-Juvenile Idiopathic Arthritis Patients with Arthralgia

by Monika Ostrowska, Emil Michalski, Piotr Gietka, Małgorzata Mańczak, Magdalena Posadzy and Iwona Sudoł-Szopińska

J. Clin. Med. 2022, 11(3), 760; https://doi.org/10.3390/jcm11030760 - 30 Jan 2022

Cited by 6 | Viewed by 7125

Abstract

This retrospective case–control study aimed to evaluate whether Magnetic Resonance Imaging (MRI) enables differentiation of ankle arthritis in Juvenile Idiopathic Afrthritis JIA from ankle arthralgia of unknown aetiology in patients clinically suspected of JIA. Forty-four children, at ages 5–16, who underwent MRI of [...] Read more.

This retrospective case–control study aimed to evaluate whether Magnetic Resonance Imaging (MRI) enables differentiation of ankle arthritis in Juvenile Idiopathic Afrthritis JIA from ankle arthralgia of unknown aetiology in patients clinically suspected of JIA. Forty-four children, at ages 5–16, who underwent MRI of the ankle from January 2016 to March 2021 for clinically suspected active ankle arthritis in the course of JIA were included. MRI findings in both groups—patients with the final diagnosis of JIA and without final diagnosis of JIA—were compared and scored. The sum of the scores of 22 ankle lesions in an individual patient (active, destructive and developmental), so-called the MRI summarized score, was calculated and tested in terms of the most optimal diagnosis of JIA. Interobserver agreement was calculated. Inflammatory features were seen on MRI in 38 out of all the included patients (86%). The most common lesions in both groups were effusion in the tibio-talar joint (68% in JIA and 64% in the arthralgia group) and effusion in subtalar joint (64% in JIA vs. 59% in the arthralgia group). In general, more lesions were identified in the JIA group than in non-JIA. However, only tenosynovitis was significantly more common in the JIA vs. non-JIA group (p = 0.031). The MRI summarized score did not allow for discrimination between ankle arthritis in JIA from non-JIA patients; the best levels of sensitivity (32%), specificity (91%), positive predictive value PPV (78%) and negative predictive value NPV (57%) were achieved only at the cut-off point of 10. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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12 pages, 1583 KiB

Open AccessArticle

Radiographs and MRI of the Cervical Spine in Juvenile Idiopathic Arthritis: A Cross-Sectional Retrospective Study

by Mateusz Kotecki, Piotr Gietka, Magdalena Posadzy and Iwona Sudoł-Szopińska

J. Clin. Med. 2021, 10(24), 5798; https://doi.org/10.3390/jcm10245798 - 11 Dec 2021

Cited by 12 | Viewed by 3012

Abstract

Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease among children. In some patients, cervical spine arthritis remains a serious and chronic manifestation of JIA. The aim of this study was to assess the frequency of cervical spine lesions on radiographs [...] Read more.

Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease among children. In some patients, cervical spine arthritis remains a serious and chronic manifestation of JIA. The aim of this study was to assess the frequency of cervical spine lesions on radiographs and MRI in JIA patients with clinical signs of cervical spine involvement and to verify if with the addition of MRI, the use of radiographs could be abandoned. Methods: This retrospective study evaluated consecutive 34 children (25 girls; aged 6–18 years, median 15.5 years) with JIA and with clinical involvement of cervical spine. In each patient, both radiographs and MRI of the cervical spine were performed. Imaging findings were correlated with clinical and laboratory data. Results: The cervical spine was affected in 35% of patients. The most frequent lesions were subaxial subluxations (SAS; 24%), apophyseal joint ankylosis (9%), and C1/C2 joint lesions (9%). Anterior atlanto-axial subluxation (AAS) was diagnosed only by radiography, and most of the SAS were seen on radiography, whereas only a few on MRI. Reversely, C1/C2 soft tissue involvement were seen on MRI only. Cervical spine involvement was associated with raised ESR (p = 0.012) and CRP (p = 0.014). Conclusions: The cervical spine lesions are still frequent complication of JIA affecting up to 35% of JIA patients. Most of them develop serious complications, such as AAS and ankylosis. Despite advantages of MRI in terms of the imaging of the atlanto-axial region radiography shows superiority in diagnosis of AAS and SAS. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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15 pages, 9087 KiB

Open AccessArticle

MRI Findings in Hip in Juvenile Idiopathic Arthritis

by Monika Ostrowska, Piotr Gietka, Małgorzata Mańczak, Emil Michalski and Iwona Sudoł-Szopińska

J. Clin. Med. 2021, 10(22), 5252; https://doi.org/10.3390/jcm10225252 - 11 Nov 2021

Cited by 5 | Viewed by 3295

Abstract

The aim of this study was to evaluate if magnetic resonance imaging allows hip arthritis in JIA to be differentiated from hip arthralgia of unknown etiology in juveniles clinically suspected for hip arthritis. This was a retrospective observational study which included 97 children [...] Read more.

The aim of this study was to evaluate if magnetic resonance imaging allows hip arthritis in JIA to be differentiated from hip arthralgia of unknown etiology in juveniles clinically suspected for hip arthritis. This was a retrospective observational study which included 97 children with clinically suspected hip arthritis. Each hip was assessed and scored in MRI for signs of active and destructive inflammatory lesions and developmental lesions. MRI findings between JIA-confirmed patients and without final diagnosis of JIA were compared and the MRI summarized score was calculated, as the sum of scorings of all 24 hip lesions in an individual patient (i.a., effusion, synovitis, bone marrow edema, enthesitis). MRI showed at least one lesion in the majority of patients (95 patients; 98%). Effusion was the most common feature, followed by bone marrow oedema and synovitis. All lesions were more common in patients with a final diagnosis of JIA, especially synovitis and enthesitis (p = 0.037 and p = 0.047). The MRI summarized score was significantly higher in the JIA group than the non-JIA group: 3 (2–5) vs. 2 (2–2), respectively, p = 0.002. Using a cut-off score of 6, the MRI summarized score showed 25% sensitivity and 100% specificity indicating a good ability in discriminating hip arthritis during JIA from non-JIA patients. MRI allows hip arthritis in JIA to be differentiated from hip arthralgia of unknown etiology with good specificity, thus, may be helpful in confirming the diagnosis of JIA. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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12 pages, 1100 KiB

Open AccessArticle

Radiological Evaluation of Cervical Spine Involvement in Rheumatoid Arthritis: A Cross-Sectional Retrospective Study

by Mateusz Kotecki, Robert Gasik, Piotr Głuszko and Iwona Sudoł-Szopińska

J. Clin. Med. 2021, 10(19), 4587; https://doi.org/10.3390/jcm10194587 - 5 Oct 2021

Cited by 10 | Viewed by 3299

Abstract

Background: Cervical spine lesions are a common manifestation of rheumatoid arthritis (RA). The purpose of this study was to conduct a retrospective analysis of radiological lesions in cervical spine in patients with RA and to correlate findings with clinical and laboratory parameters. Methods: [...] Read more.

Background: Cervical spine lesions are a common manifestation of rheumatoid arthritis (RA). The purpose of this study was to conduct a retrospective analysis of radiological lesions in cervical spine in patients with RA and to correlate findings with clinical and laboratory parameters. Methods: Overall, 240 consecutive patients with RA were referred for imaging by clinicians based on symptoms suggesting cervical spine involvement and/or long disease duration. In each patient, lateral radiographs and MRI of the cervical spine were performed. The imaging data were correlated with clinical records and laboratory data. Results: The cervical spine was affected in 179 patients (75%). The most common lesions were anterior atlanto-axial subluxation (AAS; 58%), subaxial subluxation (58%), and demineralization (48%). Cervical spine involvement was linked to longer disease duration (p = 0.007), the presence of rheumatoid factor (RF; p = 0.010), elevated C-reactive protein (CRP) levels (p = 0.016), and accelerated erythrocyte sedimentation rate (ESR; p = 0.025). Longer disease duration was associated with anterior AAS (p = 0.005), subaxial subluxation (p = 0.005), and basilar settling (p = 0.003). Conclusions: As many as 75% of RA patients develop lesions that can be observed on radiographs and through MRI. The most frequent radiological findings include anterior AAS and subaxial subluxation. Long disease duration, RF seropositivity, and elevated inflammatory markers were risk factors for cervical spine involvement. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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16 pages, 1263 KiB

Open AccessFeature PaperArticle

Reliability of the Preliminary OMERACT Juvenile Idiopathic Arthritis MRI Score (OMERACT JAMRIS-SIJ)

by Tarimobo M. Otobo, Nele Herregods, Jacob L. Jaremko, Iwona Sudol-Szopinska, Walter P. Maksymowych, Arthur B. Meyers, Pamela Weiss, Shirley Tse, Joel Paschke, Rahim Moineddin, Nigil Haroon, Nikolay Tzaribachev, Simone Appenzeller, Olympia Papakonstantinou, Eva Kirkhus, Marion A. J. van Rossum, John Carrino, Philip G. Conaghan, Mirkamal Tolend, Jennifer Stimec, Lennart Jans, Robert G. Lambert, Dax Rumsey and Andrea S. Doria Show full author list Hide full author list

J. Clin. Med. 2021, 10(19), 4564; https://doi.org/10.3390/jcm10194564 - 30 Sep 2021

Cited by 11 | Viewed by 2391

Abstract

This study reports the reliability of the juvenile idiopathic arthritis magnetic resonance imaging scoring system (JAMRIS-SIJ). The study comprised of eight raters—two rheumatologists and six radiologists—and 30 coronal T1 and Short-Tau Inversion Recovery (STIR) MRI scans of patients with enthesitis-related juvenile spondylarthritis. The [...] Read more.

This study reports the reliability of the juvenile idiopathic arthritis magnetic resonance imaging scoring system (JAMRIS-SIJ). The study comprised of eight raters—two rheumatologists and six radiologists—and 30 coronal T1 and Short-Tau Inversion Recovery (STIR) MRI scans of patients with enthesitis-related juvenile spondylarthritis. The median age of patients was 15 years with a mean disease duration of 5 years and 22 (73.3%) of the sample were boys. The inter-rater agreement of scores for each of the JAMRIS-SIJ items was calculated using a two-way random effect, absolute agreement, and single rater intraclass correlation coefficient (ICC 2.1). The ICC was interpreted together with kurtosis, since the ICC is also affected by the distribution of scores in the sample. The eight-rater, single measure inter-rater ICC (and kurtosis) values for JAMRIS-SIJ inflammation and damage components were the following: bone marrow edema (BME), 0.76 (1.2); joint space inflammation, 0.60 (1.8); capsulitis, 0.58 (9.2); enthesitis, 0.20 (0.1); ankylosis, 0.89 (35); sclerosis, 0.53 (4.6); erosion, 0.50 (6.5); fat lesion, 0.40 (21); backfill, 0.38 (38). The inter-rater reliability for BME and ankylosis scores was good and met the a priori set ICC threshold, whereas for the other items it was variable and below the selected threshold. Future directives should focus on refinement of the scores, definitions, and methods of interpretation prior to validation of the JAMRIS-SIJ through the assessment of its measurement properties. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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17 pages, 867 KiB

Open AccessArticle

Assessing the Reliability of the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Scoring System for Temporomandibular Joints (JAMRIS-TMJ)

by Mirkamal Tolend, Andrea S. Doria, Arthur B. Meyers, Tore A. Larheim, Shelly Abramowicz, Julien Aguet, Simone Appenzeller, Linda Z. Arvidsson, Lauren W. Averill, Brian M. Feldman, Saurabh Guleria, Emilio J. Inarejos Clemente, Jacob L. Jaremko, Thitiporn Junhasavasdikul, Thekla von Kalle, Eva Kirkhus, Bernd Koos, Elka Miller, Rahim Moineddin, Jyoti Panwar, Zachary S. Peacock, Cory M. Resnick, Marion A. van Rossum, Jennifer Stimec, George Tomlinson, Nikolay Tzaribachev and Christian J. Kellenberger Show full author list Hide full author list

J. Clin. Med. 2021, 10(18), 4047; https://doi.org/10.3390/jcm10184047 - 7 Sep 2021

Cited by 17 | Viewed by 2804

Abstract

Contrast-enhanced magnetic resonance imaging (MRI) remains the most comprehensive modality to assess juvenile idiopathic arthritis (JIA)-related inflammation and osteochondral damage in the temporomandibular joints (TMJ). This study tested the reliability of a new JIA MRI scoring system for TMJ (JAMRIS-TMJ) and the impact [...] Read more.

Contrast-enhanced magnetic resonance imaging (MRI) remains the most comprehensive modality to assess juvenile idiopathic arthritis (JIA)-related inflammation and osteochondral damage in the temporomandibular joints (TMJ). This study tested the reliability of a new JIA MRI scoring system for TMJ (JAMRIS-TMJ) and the impact of variations in calibration and reader specialty. Thirty-one MRI exams of bilateral TMJs were scored independently using the JAMRIS-TMJ by 20 readers consisting of radiologists and non-radiologist clinicians in three reading groups, with or without a calibrating atlas and/or tutorial. The inter-reader reliability in the multidisciplinary cohort assessed by the generalizability coefficient was 0.61–0.67 for the inflammatory and 0.66–0.74 for the damage domain. The atlas and tutorial did not improve agreement within radiologists, but improved the agreement between radiologist and non-radiologist groups. Agreements between different calibration levels were 0.02 to 0.08 lower by the generalizability coefficient compared to agreement within calibration levels; agreement between specialty groups was 0.04 to 0.10 lower than within specialty groups. Averaging two radiologists raised the reliability above 0.8 for both domains. Therefore, the reliability of JAMRIS-TMJ was moderate-to-good depending on the presence of specialty and calibration differences. The atlas and tutorial are necessary to improve reliability when the reader cohort consists of multiple specialties. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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14 pages, 2636 KiB

Open AccessArticle

MR Imaging Biomarkers for Clinical Impairment and Disease Progression in Patients with Shoulder Adhesive Capsulitis: A Prospective Study

by Romain Gillet, François Zhu, Pierre Padoin, Aymeric Rauch, Gabriela Hossu, Pedro Augusto Gondim Teixeira and Alain Blum

J. Clin. Med. 2021, 10(17), 3882; https://doi.org/10.3390/jcm10173882 - 29 Aug 2021

Cited by 5 | Viewed by 2573

Abstract

Background: MRI diagnostic criteria of shoulder adhesive capsulitis (AC) are nowadays widely used, but there is little information available on the association between MRI findings and clinical impairment. Purpose: To determine the correlation of MRI findings with the Constant–Murley Score (CMS), pain duration [...] Read more.

Background: MRI diagnostic criteria of shoulder adhesive capsulitis (AC) are nowadays widely used, but there is little information available on the association between MRI findings and clinical impairment. Purpose: To determine the correlation of MRI findings with the Constant–Murley Score (CMS), pain duration and symptoms at the one-year follow-up in AC patients. Materials and methods: This monocentric prospective study included 132 patients with a clinical diagnosis of shoulder AC who underwent shoulder MRI. Mean patient age was 54.1 ± 9.3 years, and there were 55 men and 77 women. A radiologist examined all patients and completed the CMS just prior to MRI. Pain duration was assessed along with the signal intensity and measured the maximal thickness of the inferior glenohumeral ligament (IGHL) by two radiologists. Medical record analysis was performed in a sub-group of 49 patients to assess prognosis approximately one year after the MRI examination. Linear regression analysis with the Pearson test and the Fisher exact test were used to determine the association between MRI findings and clinical impairment. Results: There was a significant difference in mean pain duration score (3.8 ± 1.2 versus 3.2 ± 0.9 and 3.8 ± 1.2 versus 3.2 ± 0.9, respectively, for readers 1 and 2) and in mean mobility scores (15.7 ± 8 points versus 19.6 ± 10.1 points and 15.8 ± 8.2 points versus 19.4 ± 10 points, respectively, for readers 1 and 2) in patients with a high IGHL signal compared to those with a low IGHL signal (p < 0.05). IGHL was thicker in patients with clinical improvement at one-year follow-up compared to those presenting clinical stability or worsening (p < 0.05). Conclusions: In patients with shoulder AC, the degree of signal intensity at the IGHL was inversely related to shoulder pain duration and range of motion, and a thickened IGHL indicated a favorable outcome at one-year follow-up. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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9 pages, 2766 KiB

Open AccessArticle

Shear Wave Elastography of the Plantar Fascia: Comparison between Patients with Plantar Fasciitis and Healthy Control Subjects

by Daniel Baur, Christoph Schwabl, Christian Kremser, Mihra S. Taljanovic, Gerlig Widmann, Luca Maria Sconfienza, Judith Sztankay, Gudrun Feuchtner and Andrea S. Klauser

J. Clin. Med. 2021, 10(11), 2351; https://doi.org/10.3390/jcm10112351 - 27 May 2021

Cited by 16 | Viewed by 3696

Abstract

Background: The purpose of this study was to evaluate plantar fasciae of healthy subjects and patients with plantar fasciitis by shear wave velocity (SWV) and stiffness with correlation to B-Mode and color Doppler ultrasonography (CDUS) and to establish cut-off values. Methods: This observational [...] Read more.

Background: The purpose of this study was to evaluate plantar fasciae of healthy subjects and patients with plantar fasciitis by shear wave velocity (SWV) and stiffness with correlation to B-Mode and color Doppler ultrasonography (CDUS) and to establish cut-off values. Methods: This observational study was conducted with the approval of the Institutional Review Boards (IRBs) of our institution. 108 unilateral plantar fasciae were evaluated by including 87 consecutive patients (mean age 51.7; range: 29–82) (66 women and 21 men) with plantar fasciitis and 21 asymptomatic age matched healthy volunteers (mean age 47.3; range: 32–58) (15 women and 6 men). All patients were prospectively imaged between July 2018 and March 2019. B-mode US was used to measure thickness and CDUS to grade vascularity. SWE measurements were repeated 3 times and mean was used for statistical analysis. Results: Mean SWV value in healthy subjects was 6.94 m/s and in patients 4.98 m/s with a mean stiffness value of 152.88 kPa and 93.54 kPa respectively (p < 0.001). For SWV a cut-off value of 6.16 m/s had a specificity of 80.95% and sensitivity of 79.31%. For stiffness a cut-off value of 125.57 kPa had a specificity of 80.95% and sensitivity of 80.46%. No correlation to CDUS was found. The mean thickness of healthy fascias was 3.3 mm (range 2.4–3.9) compared to 6.1 mm (range 2.0–22.0) in plantar fasciitis (p < 0.001) with no correlation to SWV or to stiffness (r² = 0.02, p = 0.06). Conclusion: SWE allows quantitative assessment of plantar fascia stiffness, which decreases in patients with plantar fasciitis. No correlation to the thickness of the plantar fascia was found, therefore it represents an independent factor for the diagnosis of plantar fasciitis and could be helpful in addition to thickness measurement in unclear cases. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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Review

Jump to: Research

19 pages, 7616 KiB

Open AccessReview

Imaging in Hip Arthroplasty Management—Part 1: Templating: Past, Present and Future

by Edouard Germain, Charles Lombard, Fatma Boubaker, Mathias Louis, Alain Blum, Pedro Augusto Gondim-Teixeira and Romain Gillet

J. Clin. Med. 2022, 11(18), 5465; https://doi.org/10.3390/jcm11185465 - 16 Sep 2022

Cited by 7 | Viewed by 3082

Abstract

Hip arthroplasty is a frequently used procedure with high success rates. Its main indications are primary or secondary advanced osteoarthritis, due to acute fracture, osteonecrosis of the femoral head, and hip dysplasia. The goals of HA are to reduce pain and restore normal [...] Read more.

Hip arthroplasty is a frequently used procedure with high success rates. Its main indications are primary or secondary advanced osteoarthritis, due to acute fracture, osteonecrosis of the femoral head, and hip dysplasia. The goals of HA are to reduce pain and restore normal hip biomechanics, allowing a return to the patient’s normal activities. To reach those goals, the size of implants must suit, and their positioning must meet, quality criteria, which can be determined by preoperative imaging. Moreover, mechanical complications can be influenced by implant size and position, and could be avoided by precise preoperative templating. Templating used to rely on standard radiographs, but recently the use of EOS^® imaging and CT has been growing, given the 3D approach provided by these methods. However, there is no consensus on the optimal imaging work-up, which may have an impact on the outcomes of the procedure. This article reviews the current principles of templating, the various imaging techniques used for it, as well as their advantages and drawbacks, and their expected results. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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17 pages, 6790 KiB

Open AccessReview

Update on Current Imaging of Systemic Lupus Erythematous in Adults and Juveniles

by Iwona Sudoł-Szopińska, Ewa Żelnio, Marzena Olesińska, Piotr Gietka, Sylwia Ornowska, Deborah Jane Power and Mihra S. Taljanovic

J. Clin. Med. 2022, 11(17), 5212; https://doi.org/10.3390/jcm11175212 - 3 Sep 2022

Cited by 5 | Viewed by 5061

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organs and organ systems. Musculoskeletal (MSK) involvement is one of the most frequent and the earliest locations of disease. This disease affects joints and periarticular soft tissues, tendon sheaths and tendons, bones, and [...] Read more.

Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organs and organ systems. Musculoskeletal (MSK) involvement is one of the most frequent and the earliest locations of disease. This disease affects joints and periarticular soft tissues, tendon sheaths and tendons, bones, and muscles. Multimodality imaging, including radiography, ultrasound (US), and magnetic resonance imaging (MRI), plays a significant role in the initial evaluation and treatment follow up of MSK manifestations of the SLE. In this paper, we illustrate MSK imaging features in three clinical forms of SLE, including nondeforming nonerosive arthritis, deforming nonerosive arthropathy, and erosive arthropathy, as well as the other complications and features of SLE within the MSK system in adults and juveniles. Advances in imaging are included. Conventional radiography primarily shows late skeletal lesions, whereas the US and MRI are valuable in the diagnosis of the early inflammatory changes of the soft tissues and bone marrow, as well as late skeletal manifestations. In nondeforming nonerosive arthritis, US and MRI show effusions, synovial and/or tenosynovial hypertrophy, and vascularity, whereas radiographs are normal. Deforming arthritis clinically resembles that observed in rheumatoid arthritis, but it is reversible, and US and MRI show features of inflammation of periarticular soft tissues (capsule, ligaments, and tendons) without the pannus and destruction classically observed in RA. Erosions are rarely seen, and this form of disease is called rhupus syndrome. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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38 pages, 19425 KiB

Open AccessReview

Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy

by Charles Lombard, Pierre Gillet, Edouard Germain, Fatma Boubaker, Alain Blum, Pedro Augusto Gondim Teixeira and Romain Gillet

J. Clin. Med. 2022, 11(15), 4416; https://doi.org/10.3390/jcm11154416 - 29 Jul 2022

Cited by 4 | Viewed by 8872

Abstract

Hip arthroplasty (HA) is a frequently used procedure with high success rates, but 7% to 27% of the patients complain of persistent postsurgical pain 1 to 4 years post-operation. HA complications depend on the post-operative delay, the type of material used, the patient’s [...] Read more.

Hip arthroplasty (HA) is a frequently used procedure with high success rates, but 7% to 27% of the patients complain of persistent postsurgical pain 1 to 4 years post-operation. HA complications depend on the post-operative delay, the type of material used, the patient’s characteristics, and the surgical approach. Radiographs are still the first imaging modality used for routine follow-up, in asymptomatic and painful cases. CT and MRI used to suffer from metallic artifacts but are nowadays central in HA complications diagnosis, both having their advantages and drawbacks. Additionally, there is no consensus on the optimal imaging workup for HA complication diagnosis, which may have an impact on patient management. After a brief reminder about the different types of prostheses, this article reviews their normal and pathologic appearance, according to each imaging modality, keeping in mind that few abnormalities might be present, not anyone requiring treatment, depending on the clinical scenario. A diagnostic imaging workup is also discussed, to aid the therapist in his imaging studies prescription and the radiologist in their practical aspects. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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28 pages, 9970 KiB

Open AccessReview

Gouty Arthropathy: Review of Clinical Manifestations and Treatment, with Emphasis on Imaging

by Jennifer S. Weaver, Ernest R. Vina, Peter L. Munk, Andrea S. Klauser, Jamie M. Elifritz and Mihra S. Taljanovic

J. Clin. Med. 2022, 11(1), 166; https://doi.org/10.3390/jcm11010166 - 29 Dec 2021

Cited by 22 | Viewed by 14565

Abstract

Gout, a crystalline arthropathy caused by the deposition of monosodium urate crystals in the articular and periarticular soft tissues, is a frequent cause of painful arthropathy. Imaging has an important role in the initial evaluation as well as the treatment and follow up [...] Read more.

Gout, a crystalline arthropathy caused by the deposition of monosodium urate crystals in the articular and periarticular soft tissues, is a frequent cause of painful arthropathy. Imaging has an important role in the initial evaluation as well as the treatment and follow up of gouty arthropathy. The imaging findings of gouty arthropathy on radiography, ultrasonography, computed tomography, dual energy computed tomography, and magnetic resonance imaging are described to include findings of the early, acute and chronic phases of gout. These findings include early monosodium urate deposits, osseous erosions, and tophi, which may involve periarticular tissues, tendons, and bursae. Treatment of gout includes non-steroidal anti-inflammatories, colchicine, glucocorticoids, interleukin-1 inhibitors, xanthine oxidase inhibitors, uricosuric drugs, and recombinant uricase. Imaging is critical in monitoring response to therapy; clinical management can be modulated based on imaging findings. This review article describes the current standard of care in imaging and treatment of gouty arthropathy. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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16 pages, 4260 KiB

Open AccessReview

Imaging and Treatment of Posttraumatic Ankle and Hindfoot Osteoarthritis

by Tetyana Gorbachova, Yulia V. Melenevsky, L. Daniel Latt, Jennifer S. Weaver and Mihra S. Taljanovic

J. Clin. Med. 2021, 10(24), 5848; https://doi.org/10.3390/jcm10245848 - 13 Dec 2021

Cited by 9 | Viewed by 8436

Abstract

Posttraumatic osteoarthritis of the ankle and hindfoot is a common and frequently debilitating disorder. 70% to 90% of ankle osteoarthritis is related to prior trauma that encompasses a spectrum of disorders including fractures and ligamentous injuries that either disrupt the articular surface or [...] Read more.

Posttraumatic osteoarthritis of the ankle and hindfoot is a common and frequently debilitating disorder. 70% to 90% of ankle osteoarthritis is related to prior trauma that encompasses a spectrum of disorders including fractures and ligamentous injuries that either disrupt the articular surface or result in instability of the joint. In addition to clinical evaluation, imaging plays a substantial role in the treatment planning of posttraumatic ankle and hindfoot osteoarthritis. Imaging evaluation must be tailored to specific clinical scenarios and includes weight bearing radiography that utilizes standard and specialty views, computed tomography which can be performed with a standard or a weight bearing technique, magnetic resonance imaging, and ultrasound evaluation. This review article aims to familiarize the reader with treatment rationale, to provide a brief review of surgical techniques and to illustrate expected imaging appearances of common operative procedures performed in the setting of posttraumatic ankle and hindfoot osteoarthritis, such as joint-preserving procedures, ankle fusion, subtalar fusion, tibiotalarcalcaneal fusion and ankle arthroplasty. Preoperative findings will be discussed along with the expected postoperative appearance of various procedures in order to improve detection of their complications on imaging and to provide optimal patient care. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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16 pages, 5474 KiB

Open AccessReview

Elbow Stiffness Imaging: A Practical Diagnostic and Pretherapeutic Approach

by Charles Lombard, Pedro Teixeira, Edouard Germain, Gauthier Dodin, Mathias Louis, Alain Blum and Romain Gillet

J. Clin. Med. 2021, 10(22), 5348; https://doi.org/10.3390/jcm10225348 - 17 Nov 2021

Cited by 1 | Viewed by 6478

Abstract

Loss of elbow motion can lead to disability in everyday gestures, recreational activities, and work. Unfortunately, the elbow joint is particularly prone to stiffness because of its complex anatomy and biomechanics. The etiology of elbow stiffness is varied and must be diagnosed accurately [...] Read more.

Loss of elbow motion can lead to disability in everyday gestures, recreational activities, and work. Unfortunately, the elbow joint is particularly prone to stiffness because of its complex anatomy and biomechanics. The etiology of elbow stiffness is varied and must be diagnosed accurately in order to allow optimal treatment, which may be challenging for surgeons and physiotherapists. Its treatment can be either conservative, arthroscopic or surgical, with a trend for arthroscopic procedures when conservative treatment fails. There is no consensus on the optimal imaging workup for elbow joint stiffness, which may have an impact on patient management. This article reviews the current classification systems of elbow stiffness and the various imaging techniques used for diagnosis. Report checklists and clarifications on the role of each imaging method, as well as the imaging findings of normal and stiff elbows, are presented, leading to a proposed diagnostic algorithm. The main concern in imaging is to determine the cause of elbow stiffness, as many concomitant abnormalities might be present depending on the clinical scenario. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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