MyT3 5 - Musculoskeletal

MyT3 5-1
Diffusion-weighted magnetic resonance imaging of the normal bone marrow in children and the effects of local and systemic cancer therapies
To establish apparent diffusion coefficient (ADC) values for normal paediatric clival marrow and variation with age, gender, and puberty. To compare post-photon and proton-therapy clival ADC changes. To examine chemotherapy effects on ADC in the spine. To develop a longitudinal study to assess post-transplant bone marrow changes.
Methods: Inclusion criteria: 5-17 years old, iso-DW-MRI ISO, non-oncological population (aim 1). Exclusion criteria: drugs (aim 1), dental brace, DW-MRI artefacts. Image acquisition/analysis: 1.5 T scanner. DWI with b = 0 and 1000 s/mm2. A 4-6 mm region-of-interest drawn within the clivus (Adept®, The Institute of Cancer Research) and at L3-S1. ADC calculated on a voxel-by-voxel basis through a monoexponential fit of the data yielded mean, median, 10th, 25th, 75th, and 90th centile ADC values.
Results: With chemotherapy, a reduction in vertebral ADC at 3 months was stabilised or decreased by 6 months. Although no oedematous response developed, fat replacement of haematopoetic tissue still resulted.
Conclusion: As paediatric prospective studies to investigate normal bone marrow are ethically difficult, the work in this thesis was largely retrospective. A first innovative attempt to establish the influence of age, gender and puberty on ADC values of clival marrow in cancer-free children alongside an assessment of oncological local and systemic treatment-related effects have been made.
Limitations: Unnumerous cohorts. Non-standardised acquisition timing of the follow-up scans; different tumour types, photon/proton dose, and chemotherapy. PUMA (Paediatric osseoUs Marrow Assessment) trial recruitment still in progress.
Ethics: Service Evaluations (562 and 756) approved by The Marsden. Approval from the Joint Research Committee to import MR scans performed at St George?s Hospital. PUMA trial approved by the Health Research Authority.
Funding: Cancer Research United Kingdom grant (2013-2018).
MyT3 5-2
Application of Trigger Drop in patients enrolled for percutaneous treatment of symptomatic discal hernia: preliminary results
Purpose: Trigger drop® is a muscle mediator that reduces the pain due to articular and muscular etiology. The device acts on crossed muscular chains and on neuro-lymphatic points with antalgic effect. We performed ?dropping technique? applying inherit devices with different shapes in different positions on the body surface.
Methods: From January to June 2019, 19 symptomatic patients have been enrolled. All patients were candidates to either cervical (5 patients) or lumbar (14 patients) disc treatment. Primary and secondary endpoints have been evaluated: efficacy of Trigger-Drop® has been evaluated in stopping analgesic drugs assumption and reducing back-pain through the visual analogic scale (VAS) evaluated before and soon after the device positioning. We performed a clinical follow-up three weeks after Trigger-drop positioning.
Results: In 89,5% (17 Patients) the device had immediate pain relief with a VAS reduction >4 compared to the initial value. 87.5% of patients stopped painkillers therapy after the application of Trigger-Drop®. Only one minor side effect was reported (localised cutaneous erythema), which disappeared by itself.
Conclusion: In our experience the positioning of Trigger-drop®, in patients waiting for percutaneous disc treatment, has been effective and safe in relieving back pain for a short period (three weeks), improving the overall quality of life of patients. Trigger-Drop® therapy allowed the pharmacologic therapy suspension for pain management.
Limitations: Not a large cohort of patients included.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 5-3
Staging of osteochondral lesions of the talus: comparison of cone-beam CT arthrography with MR imaging
Purpose: An osteochondral lesion (OCL) is defined as damage involving both articular cartilage and subchondral bone. OCL of the talus is frequently detected by routine MRI by identification of bone marrow oedema as an indirect marker of overlying cartilage lesion. The articular cartilage of the talus and the distal tibia is thin compared to the knee joint hampering precise staging of osteochondral lesions of the talus on MRI. CBCT-arthrography has a better spatial resolution than MRI and visualises the articular cartilage more in detail. The purpose of this study was to compare the value of CBCT-arthrography as staging method of talar OCL.
Methods: 35 patients with a talar OCL underwent both MR imaging (1.5T) and CBCT-arthrography within a time frame of maximum 1 month to avoid significant lesion progression between both examinations. The following parameters were scored individually by two radiologists: depth of the cartilage lesion, degree of detachment (no, partial or complete), size and the presence of subchondral bone changes.
Results: CBCT-arthrography led to an upstaging of the OCL in 28 cases. 13 patients subsequently underwent surgery of which 6 patients had an upstaging of the degree of detachment on CBCT-arthrography (upstaging to partial detachment in 2 cases and to complete detachment in 4 cases). Surgery was recommended in 3 cases of which 2 patients had an upstaging of the degree of detachment on CBCT-arthrography (1 patient with partial and 2 patients with complete detachment).
Conclusion: CBCT-arthrography is a very promising technique for staging of cartilage lesions of the ankle. Improved staging is very useful in those clinical scenarios where arthroscopic treatment of the lesion is considered.
Limitations: This stud is limited by the number of patients.
Ethics: Ethics committee approval.
Funding: No funding was received for this work.
MyT3 5-4
Diagnostic accuracy of dual-energy CT in assessment of traumatic bone marrow oedema of lower limb and its correlation with MRI
Purpose: To assess the diagnostic accuracy of dual-energy CT in detecting bone marrow oedema in patients of trauma of lower limb and correlate it with MRI.
Methods: The study included 40 patients aged between 15?70 years of either sex. All the patients of lower extremity trauma after clinical evaluation underwent DECT and MRI evaluation. All the images were postprocessed on a work station and were further evaluated by a radiologist.
Results: Mean attenuation at fractured site observed by dual-energy CT was found to be significantly higher as compared to that at the adjacent site (170.75±33.99 vs 19.73±22.50 HU). Sensitivity, the specificity of dual-energy CT as compared to MRI in detecting bone marrow oedema were 94.1%, 91.3% respectively. Out of 40 cases enrolled in the study, agreement of MRI and dual-energy CT was observed in 37 (92.5%).
Conclusion: Dual-energy CT can be an effective alternative to MRI in detection of bone marrow oedema in patients of lower limb trauma. Dual-energy CT can also be used in patients in whom MRI is contraindicated.
Limitations: Not applicable.
Ethics: Not applicable.
Funding: No funding was received for this work.
MyT3 5-5
The role of bone marrow lesions in acute joint injury
Purpose: Post-traumatic osteoarthritis (PTOA) mainly affects a younger population cohort and poses significant costs to healthcare systems. Recent developments have identified that joint injury is initiated in the sub-chondral region of the joint despite the initial intra-articular cartilage injury. Of particular interest is bone marrow oedema or lesions (BMLs) that appear in the sub-chondral region almost immediately after initial joint injury.
Methods: A review is undertaken on what is known about these phenomena (microcracks and BMLs) in the literature and discuss potential mechanisms by which they may be linked. Papers published in the last 10 years relating to bone remodeling in joint injury, subchondral microdamage, BMLs, bone-cartilage crosstalk and novel imaging models demonstrating acute knee injury were reviewed.
Results: The recent findings in this field have shown that microcracks in bone initiate targeted remodelling via RANKL expression in osteocytes. Other work has shown that subchondral microcracks co-localise with BMLs as viewed by MRI. Finally, BMLs are associated with and predict subsequent pain and structural joint degeneration.
Conclusion: This paper demonstrates that subchondral microcracks likely occur during acute joint injury, and are closely linked to BML that are seen by clinical MRI and thus are potentially involved in the subsequent joint degeneration that occurs after injury. BMLs could serve as a potential site of radiological monitoring and therapeutic intervention to better tailor patient management.
The precise way in which subchondral activities are linked with those in the articular compartment is not yet known but defining these events using additional imaging sequences (DWI-ADC/T1rho) will be an important next step in this field.
This article does not contain any studies with human or animal subjects performed by any of the authors.
Funding: No funding was received for this work.
MyT3 5-7
MRI evaluation to predict tendon size for knee ligament reconstruction
Purpose: The aim of this study is to evaluate a possible correlation between anthropometric parameters and sizes of knee tendons used for ACL reconstruction. We hypothesised that specific clinical and radiological knee measurements could be better tendon sizes predictors than anthropometric parameters.
Methods: 110 patients were enrolled and 80 patients met the inclusion criteria of the study. All patients underwent an MRI of the knee with a 1.5 T MRI. For each patient, anthropometric data such as gender, height, weight, body mass index (BMI) and knee circumference were recorded. MRI knee measurements were performed on each study: patellar tendon (PT) thickness and length, quadriceps tendon (QT) thickness, semitendinosus tendon (ST), gracilis tendon (GR) diameter, the largest patella and intercondylar width.
Results: The ST, QT and PT thickness were higher in males than in females and no significant GT and knee circumference differences were. Significant, but weak correlations were found between patient anthropometric data and hamstrings diameter, PT length, and QT and PT thickness. Intercondylar and patellar width present a moderate correlation between PT thickness, PT length and ST diameter.
Conclusion: The intercondylar and patellar width presented a moderate correlation with PT thickness, PT length and ST diameter. Further, weak correlations were found between patient anthropometric data (gender, weight, height, BMI) and GR and ST diameter, PT length, and QT and PT thickness. This results may help surgeons during preoperative planning, specifically regarding graft choice and size.
Limitations: The study is preformed as a single centre study.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 5-8
Hand extensor compartments: how to study them and is it always their fault?
Purpose: To evaluate 100 patients with pain referred to the dorsal compartment, by grading the lesions in a three-way system (mild, moderate and high) and to examine the correlation between the physical exam and the ultrasound findings.
Methods: Hand ultrasound was done to 100 patients with evaluation of the dorsal and volar hand. A review of the literature was made.
Results: In 72% of cases, pathology was found in the dorsal hand: 48% tendinitis of the I compartment, 22% tendinitis of the III compartment and the rest of the patients with multicompartment extensor pathology. 28% of cases with tenosynovitis of the flexor compartment lesion - 75% of cases; median nerve compression - 15% of cases and other pathology. Physical exam was according in 80 % of cases and pain referred to the lateral compartment was found in 68 %.
Conclusion: Hand pathology is complex and demands a correct grading and evaluation by the radiologist.
Limitations: This study is limited by its sample and a one radiologist reader.
Ethics: N/A
Funding: No funding was received.
MyT3 5-9
Diffusion tensor imaging of annulus fibrosus in subjects with discogenic low back pain (recorded)
Purpose: Observe the morphology and integrity of annulus fibrosus by diffusion tensor imaging (DTI), and quantitatively analyse the annulus fibrosus by measuring the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in subjects with discogenic low-back pain (DLBP).
Methods: Subjects with DLBP confirmed by discography were selected as the DLBP group and healthy volunteers as the healthy control (HC) group. The ADC, FA and ?1, ?2, ?3 values were measured by axial DTI of L3-S1 levels. The differences of ADC, FA and ?1, ?2, ?3 values between two groups were compared. The data conforming to normal distribution were tested by t-test, while the data not conforming to normal distribution were tested by nonparametric test.
Results: 30 subjects in the DLBP group and 24 subjects in the HC group were included in the study. The ADC value of ROI in the DLBP group was significantly lower than that in the HC group (6.10 ± 3.17 vs 9.84 ± 4.01, P = 0.0002), and the FA value was significantly higher than that in the HC group (0.341 ± 0.201 vs 0.231 ± 0.150, P = 0.007). Compared with the HC group, the DLBP group showed significantly lower ?1 (4.44 ± 0.36 vs 4.75 ± 0.35), ?2 (4.19 ± 0.34 vs 4.50 ± 0.36), and ?3 values (3.97 ± 0.34 vs 4.27 ± 0.38; all P < 0.05).
Conclusion: Diffusion tensor imaging has guiding significance in the clinical diagnosis of DLBP and preoperative localisation of the responsible segment.
Limitations: Retrospective design and the small sample sizes.
Ethics: Peking University Third Hospital Medical Science Research Ethics Committee approved this study (16-45-QX-TTK).
Funding: No funding was received for this work.
MyT3 5-10
Accuracy of volumetric trabecular bone mineral density assessment using dual-source dual-energy CT: a prospective phantom study and comparison with quantitative CT
Purpose: To assess the accuracy of phantomless volumetric bone mineral density (BMD) assessment of trabecular bone using dual-source dual-energy computed tomography (DECT) in comparison to quantitative CT (QCT).
Methods: Data from a validated anthromorphic spine phantom consisting of three lumbar vertebra equivalents containing 50, 100 and 200 mg/cm³ calcium hydroxyapatite (HA) concentrations which had been scanned using third-generation dual-source DECT, QCT and dual x-ray absorptiometry (DXA) was analyzed. For volumetric BMD assessment based on DECT, dedicated postprocessing software using material decomposition was applied, which enables phantomless BMD assessment of the trabecular bone through semi-manual definition of the volume of interest (VOI). Scans of all modalities were repeated three times and measurements per vertebrae were also repeated three times, and averaged values were recorded. The accuracy of DECT and QCT for BMD assessment was compared; additionally, calculated BMD values were correlated with DXA, the standard of reference for BMD assessment according to the WHO.
Results: Significantly higher correlations between actual and measured HA concentrations were found for DECT (r=0.98) compared to QCT (r=0.93, P<.001). Mean error for all measurements was -2.8 ± 3.3 mg/cm³ (DECT) and ?8.3 ± 9.5 mg/cm³ (QCT) (P<.001). There was significantly higher correlation between BMD values of DECT and DXA (r=0.99) compared to BMD values of QCT and DXA (r=0.96, P<.001).
Conclusion: Phantomless volumetric BMD assessment of trabecular bone using dedicated DECT material decomposition achieves substantially improved accuracy and significantly higher correlation with DXA in comparison to QCT.
Limitations: Small number of BMD measurements in this phantom study.
Ethics: This study was approved by the local IRB. Written informed consent was waived.
Funding: No funding was received for this work.
MyT3 5-11
Complex radiological diagnosis of osteonecrosis in desomorphine dependence patients on the pre-operative stage of treatment
Purpose: To determine the diagnostic efficiency of methods of complex radiological diagnosis (ortopantomography, conventional radiography, MSCT, CBCT) in the evaluation of osteonecrosis in patients on the preoperative stage.
Methods: In the period from 2014 to 2018, a total of 108 drug addicts with a history of abuse desomorphine were evaluated at the clinics of the Sechenov University. The age of patients varied from 18 to 48 years. The median age was 28 years. Among the patients, the number of women was 11 (10,1%), men ? 97 (89,9%). The duration of administration of desomorphine in this group of patients ranged from 2 months to 10 years. Orthopantomography, radiography of the skull, MSCT and CBCT were performed on 108 patients (100%) in the preoperative stage. Also 25 patients (21%) underwent radionuclide diagnostics: planar bone scan, SPECT.
Results: The application of complex highly informative radiological methods (MSCT, CBCT, radionuclide diagnostics) in desomorphine dependence patients at the preoperative stage of treatment enables full investigation of character and the prevalence of the pathological process, to plan further tactics of surgical treatment.
Conclusion: The diagnostic efficiency parameters at the preoperative stage for MSCT were: the sensitivity ? 98,1%, the specificity ? 99,6%, the accuracy ? 98,8%, for CBCT were: the sensitivity ? 97,3%, the specificity ? 99,1%, the accuracy ? 98,4%, for orthopantomography: the sensitivity ? 78,6%, the specificity ? 76,3%, the accuracy ? 77,4%, for skull xray: the sensitivity ? 61,1%, the specificity ? 59,2%, the accuracy ? 60,2%.
Limitations: No limitations.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 5-12
Long-term comparison between blind and ultrasound-guided injection in Morton neuroma
Purpose: This study aims to compare the effectiveness of blind vs ultrasound-guided injections in Morton neuroma until one year of follow-up.
Methods: This is an evaluator blinded randomised trial. 31 patients with Morton neuroma were injected based on anatomic landmarks and 33 patients under ultrasound guidance. Patients were clinically assessed by the VAS score (0-10), and by the Manchester Foot Pain and Disability Index (MFPDI) ?17 items; total score: 17 (best state) - 51 (worst state). Injections containing 1 ml of 2% mepivacaine and 40 mg triamcinolone were administered in the web space. Follow-up was performed at 15 days, 1 month, 45 days, 2 months, 3 months, 6 months and 1 year.
Results: Improvement in the VAS score was superior in the ultrasound group at all points of follow-up (p<0.05) except at 1 year when differences did not reach statistical significance (VAS: 4.6 ± 0.6 vs 5.9 ± 0.6, p=0.16). The improvement according to the MFDI was superior in the ultrasound group from 45 days to one-year follow-up (31.4± 1.7 vs 36.8± 1.9, p<0.05).
Conclusion: Ultrasound-guided injections in Morton neuroma led to greater long-term clinical improvement than blind injections. Although differences in pain tend to disappear at one-year follow-up, the disability index remains statistically improved in the ultrasound-guided group in comparison with the blind group.
Limitations: MN was not confirmed by histological examination in all our patients, but the overall accuracy of clinical and imaging diagnosis altogether has been reported to be very high, over 95%. Another limitation of the study is the sample size, which may have prevented differences from reaching stronger statistical significance.
Ethics: The study was approved by the local ethics committee (code: 0565-N-16).
Funding: No funding was received for this work.
MyT3 5-13
Shoulder stability: where does it fail?
Purpose: To evaluate the stability of the upper limb when pathology is present. Shoulder findings when there's elbow pathology and vice-versa. Grading of interstitial oedema in muscle for compensations/stability.
Methods: 80 patients with elbow or shoulder pathology confirmed with ultrasound. When elbow pathology was found the integrity of the biceps anchor, conjoined tendon and pectoral major were evaluated with a 3 stage system (mild, moderate and high-grade oedema). When shoulder pathology was found, common insertion of the biceps, distal coracobrachial insertion and triceps distal insertion were evaluated with a 3 grade system ( mild, moderate and high-grade oedema).
Results: Shoulder pathology was documented in 40 cases: Common insertion of the biceps- stage II oedema in 85% of cases, distal coracobrachial insertion- stage II oedema in 70% of cases, and triceps distal insertion- stage II oedema in 50% of cases. Elbow pathology was documented in 40 cases: biceps anchor- stage II oedema in 90% of cases, conjoined tendon- stage II oedema in 81% of cases, and pectoral major - stage II oedema in 72 % of cases. Complete tear of the tendon was found in 6 cases involving the biceps anchor and common insertion. Shoulder assimetry was found in 75% of cases. In 54% of cases cervical and dorsal spine x-ray was done with scoliosis found in only 10 %.
Conclusion: Upper limb stability is a hard problem with compensations consituting a common difficulty.
Limitations: This study is limited by its sample and one radiologist bias.
Ethics: N/A
Funding: No funding was received for this work.
MyT3 5-14
Pitfalls in imaging of TFCC
Purpose: The triangular fibrocartilage complex plays an important role in wrist biomechanics and is prone to traumatic and degenerative injury, making it a common source of ulnar-sided wrist pain. Diagnosis of injuries to the ligamentous structures of the wrist can be a challenge, particularly when there is involvement of the small, complex structures of the proximal wrist. A detailed understanding of the triangular fibrocartilage complex anatomy and injury patterns is critical in generating an accurate report to help guide treatment.
Methods: A retrospective review of MR wrists done in our institution over a two-year period was performed and illustrative cases were selected. A review of the normal anatomy of TFCC, imaging technique, normal MR appearance, Palmer classification, variant anatomy that mimic TFCC disease and spectrum of imaging findings in TFCC injury are discussed in the study.
Results: Advances in magnetic resonance imaging have facilitated a better visualisation of the triangular fibrocartilage complex structures. However, there are a number of pitfalls that may cause difficulty in diagnosis of injuries to the triangular fibrocartilage complex, lunotriquetral ligament, and scapholunate ligament. The accuracy of diagnosis of injuries to the TFCC and wrist ligaments may decrease due to use of inappropriate MR imaging sequences or MR imaging artifacts, whereas variant anatomy of the proximal wrist structures may mimic disease of the TFCC and wrist ligaments.
Conclusion: Knowledge of the detailed anatomy of the wrist, as well as variant patterns of structure morphology and signal intensity, can help differentiate actual disease from normal or variant appearances at the assessment with MR imaging.
Limitations: None.
Ethics: N/A
Funding: No funding was received for this work.
MyT3 5-15
Sarcopenia in total hip replacement and its effects on complications
Purpose: The aim of this study was to evaluate the psoas muscle and paravertebral muscle in terms of sarcopenia in patients with total hip replacement and to investigate the effect of sarcopenia on prosthetic complications.
Methods: The area of the bilateral paravertebral and psoas muscles and the density of the software-selected area were independently calculated by the prosthesis of the patients. In addition, normal or possible complications of the final prosthesis were noted in each patient. While evaluating the images, paravertebral and psoas muscle boundaries were drawn at level of the L3 or L4 vertebrae in accordance with the previously accepted studies and maximum area measurement was performed.
Results: Although there was no significant difference in bilateral paravertebral muscle areas, there was a decrease in muscle density when hip prosthesis patients were compared with normal group regardless of side. There was a statistically significant decrease in left psoas muscle area and density in patients with left hip replacement compared to normal group. There was a statistically significant decrease in the right psoas muscle area and density in patients with right hip replacement compared to the normal group. Although there was no significant difference in the right psoas muscle area, there was a decrease in the psoas muscle density complications in patients with the right hip prosthesis. Although there was no significant difference in the right psoas muscle area in patients with left hip prosthesis compared to patients with prosthesis complications and healthy prosthesis, there was a decrease in the psoas muscle density complications.
Conclusion: We concluded that the prevalence of sarcopenia is higher in patients with prosthesis compared to the normal population and that sarcopania may be one of the reasons that increase at the prosthesis complications.
Limitations: No limitations.
Ethics: N/A
Funding: N/A
MyT3 5-16
MRI findings and their correlations in patients with symptomatic subtle cavovarus hindfoot deformity
Purpose: To find significant associations of ligamentous, tendon, osseous abnormalities in patients with symptomatic subtle cavovarus hindfoot deformity.
Methods: Ankle MRI of 35 patients (18 male; mean age 52±5,6) with clinical and radiographic evidence of subtle cavovarus hindfoot deformity was assessed by 2 musculoskeletal radiologists. Pearson's, Spearman's Rank correlation coefficients were used for analysing.
Results: All patients with cavovarus hindfoot deformity underwent weight-bearing radiographic measurement of Cobey angle, a measurement of the modified Cobey angle on MRI. All patients were divided into the groups according to Cobey angle range. Group I: 19 patients with Cobey angle of 1-4°, group II: 10 patients - 5-9°, group III - 6 patients ? >9°. Signs of peroneal tendinopathy were found in all patients. The severity of the peroneal tendons tears (according to Sobel classification) correlated with the hindfoot varus severity. III-IV grade of the peroneal tendons tears was observed more often in patients of II-III groups (p=0.0065). Hypertrophy and degenerative changes of the peroneal tubercle were revealed in 18 patients (fig.1). Oedematous changes of the peroneal tubercle were found mostly in the patients with the highest rates of calcaneus deviation (group III) (p=0.0016). In all the patients with symptomatic idiopathic cavovarus hindfoot, chronic lateral ligaments tears were found. Other pathologic conditions of ankle structures in these patients had no significant associations between them and hindfoot varus severity (p>0.05).
Conclusion: Painful peroneal tubercle hypertrophy associated with peroneal tendinopathy is evident in patients with more pronounced cavovarus hindfoot deformity. The grade of peroneal tendons tears also increases with an increasing of hindfoot varus severity. Such pathologic conditions exacerbate chronic pain and the degree of ankle lateral instability and often require surgical correction.
Limitations: n/a
Ethics: n/a
Funding: No funding was received.
MyT3 5-17
The role of diffusion-weighted MRI in the assessment of treatment response to chemotherapy in osteosarcoma
Purpose: To investigate whether DWI is useful for monitoring the therapeutic response after chemotherapy in osteosarcoma by comparing the ADC values pre and post-treatment. And to determine if osteosarcomas change their water diffusion during preoperative chemotherapy in relation to the amount of tumour necrosis.
Methods: Inclusion criteria: osteosarcoma patients coming to the National Cancer Institue (NCI). Exclusion criteria: patients who have implanted electric and electronic devices and those who are intolerant to contrast administration. MRI techniques: conventional MRI, DWI and postgadolinium DTPA MR imaging initially and 3-6 months after chemotherapy administration. DWI analysis: qualitative analysis was done by studying the signal intensity of different lesions on both the DWIs (at the highest b value i.e. at 800sec/mm2) and the ADC map. Quantitative analysis: ADC calculation by using the electronic cursor on the ADC map in 3 different ROI of the lesion which was placed on the solid and preferably enhancing parts of the lesion excluding necrotic, fibrotic and haemorrhagic areas as well as adjacent fat, normal tissue and bone.
Results: The study showed 17 patients with regressive response, 7 with a progressive response and only one case remained stationary. Follow-up MR after treatment showed increased intra-tumoural breaking down in (52%) of patients.
Conclusion: DWI and ADC value in following-up the treatment of osteosarcoma revealed to increase the mean ADC value in regressive cases and vice versa in progressive cases. Following-up by MRI revealed increased in tumour breaking down in post-therapeutic conventional MRI.
Limitations: None.
Ethics: Informed written consent was obtained from the patients after explanation of the procedure.
Funding: No funding was received for this work.
MyT3 5-18
Immediate morphological spine modification after positioning of removable interspinous spacer for unifocal lumbar canal stenosis
Purpose: To evaluate the immediate morphological modifications on pre and post-procedural CT scan after percutaneous positioning of a removable interspinous spacer (ISS) for unifocal lumbar canal stenosis under fluoroscopic and CT guidance.
Methods: Patients treated in our centre between 12/2018 and 09/2019 with a percutaneous removable interspinous spacer (LobsterProject®, Techlamed®) for symptomatic unifocal lumbar stenosis were retrospectively selected. After general or epidural anaesthesia, under fluoroscopic and CT guidance, the ISS was percutaneously placed by two interventional radiologists in the central part of the interspinous ligament with lateral access. For each patient interspinous space, intradiscal space, intra-articular space and foraminal area (based on bone cortical on sagittal imaging) were measured on pre- and post-procedural low dose CT by two operators (OP1-OP2).
Results: Nine patients were selected with a mean age of 80,1[68-92] years. Interspinous space significantly increased (-OP1:3.3 vs 8.8mm, p<0.01 -OP2:3.4 vs 9.7mm, p<0.01) as well as foraminal area (-OP1:132 vs 155mm2, p<0.01 -OP2:132 vs 163mm2, p<0.01), according to both operators. Intradiscal space (-OP1:6.2 vs 6.8mm, p=0.069 -OP2:6.3vs6.9mm, p=0.021) and intra-articular space (OP1:2.1 vs 2.9mm, p=0.076 -OP2:2.1 vs 3.3mm, p=0.011) increased too (statistically significant according to one operator). Mean operative time was 44 minutes. Technical positioning was satisfying in 8/9 cases.
Conclusion: Interspinous spacer has immediate significant effects on lumbar morphology, significantly increasing interspinous space, foraminal area, intradiscal space and intra-articular space. The reduced invasiveness of the procedure and the possibility of percutaneous removal allows to avoid a major surgery, even if the ISS is not tolerated.
Limitations: Limits of the study are the analysis on low-dose CT and lack of a long term clinical follow-up.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 5-19
Use of DISCOGEL® to treat cervical and lumbar discal bulging: results and consideration in our monocentric experience
Purpose: Intervertebral disc bulging is a radiologic sign due to the weakness of annulus fibrosus that causes compression on the inter-vertebral foramina with a symptoms characterized by back pain with or without limbs irradiation and functional limitation
Methods: We retrospectively evaluated our monocentric experience in 78 Patients affected by cervical and lumbar disc bulging treated with DISCOGEL®. Inclusion criteria were: at least 6 weeks failure of medical therapy and disc degeneration classified as Pfirmann grade 1-3. Patients selection was based on the evaluation of a spine MRI and clinical symptoms
Results: We performed all the procedures in angiographic suite, with prone (lumbar treatment) or supine (cervical) position and in all of cases we injected 0,8 ml DISCOGEL® for every disc treated. No major adverse events have been reported. According to MacNab scale, in our experience, clinical success was achieved in the 75,7 % of cases (59/78 Patients). In the 24,3% of cases (19/78 Patients) the treatment was not efficient
Conclusion: Our study demonstrates that DISCOGEL® is safe and efficient in the treatment of cervical and lumbar disc bulging, with a good clinical success and a low adverse events rate.
Limitations: no randomization of our cohort of patients
Ethics: n/a
Funding: No funding was received for this work


P Diana Afonso (Portugal)

Iris-Melanie Noebauer-Huhmann (Austria)

European Society of Radiology

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