Publications by authors named "Carmelo Messina"

111 Publications

DXA-Based Bone Strain Index: A New Tool to Evaluate Bone Quality in Primary Hyperparathyroidism.

J Clin Endocrinol Metab 2021 May 8. Epub 2021 May 8.

Unit of Endocrinology and Diabetes,Campus Bio-Medico University of Rome, Rome, Italy.

Context: Primary hyperparathyroidism (PHPT) is associated with impaired bone quality and increased fracture risk. Reliable tools for the evaluation of bone quality parameters are not yet clinically available. Bone Strain Index (BSI) is a new metric for bone strength based on Finite Element Analysis from lumbar spine and femoral neck dual X-ray absorptiometry images.

Objective: To assess the lumbar spine (LS), femoral neck (FN), and total hip (TH) BSI in PHPT compared to controls and to investigate the association of BSI with vertebral fractures (VFs) in PHPT.

Design: case-control study.

Setting: Outpatient clinic.

Patients: 50 PHPT and 100 age- and sex-matched control subjects.

Main Outcome Measures: LS-BSI, FN-BSI, TH-BSI.

Results: FN bone mineral density (BMD) and 1/3 distal radius BMD were lower in the PHPT group than in controls (FN 0.633 ± 0.112 vs 0.666 ± 0.081 p= 0.042; radius 0.566 ± 0.07 vs 0.625 ± 0.06 p<0.001). PHPT group has significant lower TBS score compared to controls (1.24 ± 0.09 vs 1.30 ± 0.10 p <0.001).BSI was significantly higher at LS (2.28±0.59 vs 2.02±0.43, p=0.009), FN (1.72±0.41 vs 1.49±0.35, p=0.001) and TH (1.51±0.33 vs 1.36±0.25, p=0.002) in PHPT. LS-BSI showed moderate accuracy for discriminating VFs (AUC 0.667; 95% CI 0.513-0.820). LS-BSI ≥ 2.2 and was a statistically significant independent predictor of VFs, with an adjusted OR ranging from 5.7 to 15.1.

Conclusion: BSI, a DXA-derived bone quality index, is impaired in PHPT and may help to identify PHPT subjects at high risk of fractures.
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http://dx.doi.org/10.1210/clinem/dgab317DOI Listing
May 2021

Plantar forefoot pain: ultrasound findings before and after treatment with custom-made foot orthoses.

Radiol Med 2021 Apr 21. Epub 2021 Apr 21.

IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.

Purpose: No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses.

Methods: Twenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton's neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes.

Results: Median VAS and FFI before treatment were 8[5-8.5] and 45.85[32.4-59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0-5] and 0 [0-2.75], respectively) and median FFI (7.9 [3.95-20] and 0 [0-3.95], respectively) showed a significant reduction in pain and disability (p < .001). Before treatment, ultrasound revealed 22 intermetatarsal bursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad oedema, 3 flexor tendinitis/tenosynovitis and 3 Morton's neuromas. After 3 months of treatment, a significant decrease of intermetatarsal bursitis (7, p < .001) was observed. No significant changes were observed in any other ultrasound parameters.

Conclusion: Ultrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.
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http://dx.doi.org/10.1007/s11547-021-01354-8DOI Listing
April 2021

MRI to Diagnose Total Hip Arthroplasty Infection: Steps toward an Accurate Diagnosis.

Radiology 2021 Apr 13:204146. Epub 2021 Apr 13.

IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

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http://dx.doi.org/10.1148/radiol.2021204146DOI Listing
April 2021

Ultrasound-Guided Periprosthetic Biopsy in Failed Total Hip Arthroplasty: A Novel Approach to Test Infection in Patients With Dry Joint.

J Arthroplasty 2021 Mar 17. Epub 2021 Mar 17.

Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

Background: To diagnose periprosthetic joint infection (PJI) preoperatively, ultrasound-guided joint aspiration (US-JA) may not be performed when effusion is minimal or absent. We aimed to report and investigate the diagnostic performance of ultrasound-guided periprosthetic biopsy (US-PB) of synovial tissue to obtain joint samples in patients without fluid around the implants.

Methods: One-hundred nine patients (55 men; mean age: 68 ± 13 years) with failed total hip arthroplasty (THA) who underwent revision surgery performed preoperative US-JA or US-PB to rule out PJI.

Results: Sixty-nine of 109 patients had joint effusion and underwent US-JA, while the remaining 40 with dry joint required US-PB. Thirty-five of 109 patients (32.1%) had PJI, while 74/109 (67.9%) had aseptic THA failure. No immediate complications were observed in both groups. Technical success of US-PB was 100%, as the procedure was carried on as planned in all cases. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US-JA were 52.2%, 97.8%, 92.3%, 80.3%, and 82.6%, while for US-PB, they were 41.7%, 100%, 100%, 80%, and 82.5%, respectively, with no significant difference (P = .779). Using the final diagnosis as reference standard, we observed a moderate agreement with both US-JA (k = 0.56) and US-PB (k = 0.50).

Conclusion: We present a novel US-guided technique to biopsy periprosthetic synovial tissue of failed THA to rule out PJI. We found similar diagnostic performance as compared with traditional US-JA. This supports future larger studies on this procedure that might be applied in patients without joint effusion.
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http://dx.doi.org/10.1016/j.arth.2021.03.029DOI Listing
March 2021

The potential of micro-CT for dating post-cranial bone fractures: a macroscopic, radiographic, and microtomography study of fractures of known post-traumatic ages.

Int J Legal Med 2021 Mar 27. Epub 2021 Mar 27.

LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi di Milano, Via L. Mangiagalli 33, 20133, Milan, Italy.

The estimation of the post-traumatic survival time (PTST) in case of bone injuries remains a tricky issue in the forensic field, especially when dealing with dry bones. Newer high-resolution imaging, and in particular microcomputed tomography (micro-CT), has the potential to significantly improve our abilities to interpret antemortem and perimortem lesions and accurately date fractures in a less destructive analysis. In this paper, nine costal fractures of known post-traumatic ages were analyzed through gross examination, conventional radiography, and microcomputed tomography, in order to test the potential of microcomputed tomography for dating fractures. As a result, microcomputed tomography provided images of high quality and definition and allowed the observation of the internal microarchitecture of the fractures and calluses. While microcomputed tomography cannot substitute histological examination for the estimation of the post-traumatic survival time, it constitutes a potent and helpful complementary tool for the analysis of bone trauma.
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http://dx.doi.org/10.1007/s00414-021-02582-3DOI Listing
March 2021

CT-derived Chest Muscle Metrics for Outcome Prediction in Patients with COVID-19.

Radiology 2021 Mar 16:204141. Epub 2021 Mar 16.

From Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (S.S., L.A.C., F.S.); Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Via del Vespro 127, 90127 Palermo, Italy (D.A.); Unit of Radiology, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milano, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy (A.C., C.M., S.G., F.S., F.S., L.M.S.); Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100 Novara, Italy (R.A., A.C., P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, 25124 Brescia, Italy (C.B., L.M.); Radiology Department, Ospedale SS. Annunziata, Via Giovanni Vicini 2, 44042 Cento, Italy (A.B., R.R.); DIMET, Università degli Studi del Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy (A.C.); Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy (S.C., E.D., C.D.B., G.D.P., I.V.); High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.E.M.); Division of Interventional Radiology, IRCCS Istituto Europeo di Oncologia - IEO, Via Ripamonti 435, 20141 Milano, Italy (G.M.); Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy (G.M., A.V.); ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162 Milano, Italy (A.V., V.T.).

Background Lower muscle mass is a known predictor of unfavorable outcome, but its prognostic impact on COVID-19 patients is unknown. Purpose To investigate the contribution of CT-derived muscle status in predicting clinical outcomes in COVID-19 patients. Materials and Methods Clinical/laboratory data and outcomes (intensive care unit [ICU] admission and death) were retrospectively retrieved for patients with reverse transcriptase polymerase chain reaction-confirmed COVID-19, who underwent chest CT on admission in four hospitals in Northern Italy from February 21 to April 30, 2020. Extent and type of pulmonary involvement, mediastinal lymphadenopathy, and pleural effusion were assessed. Cross-sectional areas and attenuation of paravertebral muscles were measured on axial CT images at T5 and T12 vertebral level. Multivariable linear and binary logistic regression, including calculation odds ratios (OR) with 95% confidence intervals (CIs), were used to build four models to predict ICU admission and death, tested and compared using receiver operating characteristic curve (ROC) analysis. Results A total 552 patients (364 men; median age 65 years, interquartile range 54-75) were included. In a CT-based model, lower-than-median T5 paravertebral muscle area showed the highest ORs for ICU admission (OR 4.8, 95% CI 2.7-8.5; <.001) and death (OR 2.3, 95% CI 1.0-2.9; =.027). When clinical variables were included in the model, lower-than-median T5 paravertebral muscle area still showed the highest ORs both for ICU admission (OR 4.3; 95% CI 2.5-7.7; <.001) and death (OR 2.3, 95% CI 1.3-3.7; =.001). At ROC analysis, the CT-based model and the model including clinical variables showed the same area under the curve (AUC) for ICU admission prediction (AUC 0.83, =.380) and were not different in predicting death (AUC 0.86 versus AUC 0.87, respectively, =.282). Conclusion In hospitalized patients with COVID-19, lower muscle mass on CT was independently associated with ICU admission and hospital mortality.
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http://dx.doi.org/10.1148/radiol.2021204141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971428PMC
March 2021

Appendicular Muscle Mass, Thigh Intermuscular Fat Infiltration, and Risk of Fall in Postmenopausal Osteoporotic Elder Women.

Gerontology 2021 Mar 5:1-10. Epub 2021 Mar 5.

IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

Background: The association between the quantity and composition of skeletal muscle and the decline in physical function in elderly is poorly understood. Therefore, the primary aim of this cross-over study was to investigate the association between thigh intermuscular adipose tissue (IMAT) infiltration, appendicular muscle mass, and risk of fall in postmenopausal osteoporotic elder women. Second, we examined the differences in muscle mass, IMAT, and risk of fall in the same sample of older subjects after being classified as sarcopenic or nonsarcopenic on the basis of the dual-energy X-ray absorptiometry (DXA)-based Appendicular Skeletal Muscle Mass Index (ASMMI).

Methods: Twenty-nine subjects (age: 72.4 ± 6.8; BMI: 23.0 ± 3.3; and T-score: -2.7 ± 0.2) completed the following clinical evaluations: (1) whole-body DXA to assess the ASMMI; (2) magnetic resonance to determine the cross-sectional muscle area (CSA) and IMAT of thigh muscles, expressed both in absolute (IMATabs) and relative (IMATrel) values; and (3) risk of fall assessment through the OAK system (Khymeia, Noventa Padovana, Italy). The existence of a correlation between the risk of fall (OAK scores, an automated version of the Brief-BESTest) and the clinical parameters (ASMMI, CSA, IMATrel, and IMATabs) was tested by the Pearson's correlation index while data homogeneity between sarcopenic and nonsarcopenic subjects was tested through unpaired Student t tests or with the Mann-Whitney rank test. Effect sizes (ES) were used to determine the magnitude of the effect for all significant outcomes.

Results: Eleven subjects were classified as sarcopenic and 18 as nonsarcopenic based on their ASMMI (cutoff value: 5.5 kg/m2). A positive correlation between OAK and CSA was observed (r2 = 0.19; p = 0.033), whereas a negative correlation between OAK and IMATrel was detected (r2 = 0.27; p = 0.009). No correlations were observed between OAK and ASMMI and between ASMMI and IMATrel. Sarcopenic subjects showed significantly lower weight (p = 0.002; ES = 1.30, large), BMI (p = 0.0003; ES = 1.82, large), CSA (p = 0.010; ES = 1.17, moderate), and IMATabs (p = 0.022; ES = 1.63, large) than nonsarcopenic individuals, whereas OAK scores and IMATrel were similar between groups.

Discussion/conclusion: Increased IMAT and lower CSA in the thigh muscles are associated with higher risk of fall while ASMMI, a value of appendicular muscle mass, was not associated with physical performance in older adults.
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http://dx.doi.org/10.1159/000513597DOI Listing
March 2021

Radiomic Machine Learning Classifiers in Spine Bone Tumors: A Multi-Software, Multi-Scanner Study.

Eur J Radiol 2021 Apr 10;137:109586. Epub 2021 Feb 10.

IRCCS Istituto Ortopedico Galeazzi, Milano, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.

Purpose: Spinal lesion differential diagnosis remains challenging even in MRI. Radiomics and machine learning (ML) have proven useful even in absence of a standardized data mining pipeline. We aimed to assess ML diagnostic performance in spinal lesion differential diagnosis, employing radiomic data extracted by different software.

Methods: Patients undergoing MRI for a vertebral lesion were retrospectively analyzed (n = 146, 67 males, 79 females; mean age 63 ± 16 years, range 8-89 years) and constituted the train (n = 100) and internal test cohorts (n = 46). Part of the latter had additional prior exams which constituted a multi-scanner, external test cohort (n = 35). Lesions were labeled as benign or malignant (2-label classification), and benign, primary malignant or metastases (3-label classification) for classification analyses. Features extracted via 3D Slicer heterogeneityCAD module (hCAD) and PyRadiomics were independently used to compare different combinations of feature selection methods and ML classifiers (n = 19).

Results: In total, 90 and 1548 features were extracted by hCAD and PyRadiomics, respectively. The best feature selection method-ML algorithm combination was selected by 10 iterations of 10-fold cross-validation in the training data. For the 2-label classification ML obtained 94% accuracy in the internal test cohort, using hCAD data, and 86% in the external one. For the 3-label classification, PyRadiomics data allowed for 80% and 69% accuracy in the internal and external test sets, respectively.

Conclusions: MRI radiomics combined with ML may be useful in spinal lesion assessment. More robust pre-processing led to better consistency despite scanner and protocol heterogeneity.
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http://dx.doi.org/10.1016/j.ejrad.2021.109586DOI Listing
April 2021

Impact of coronavirus disease 2019 (COVID-19) outbreak on radiology research: An Italian survey.

Clin Imaging 2021 Feb 11;76:144-148. Epub 2021 Feb 11.

IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milano, Italy.

Purpose: To understand how COVID-19 pandemic has changed radiology research in Italy.

Methods: A questionnaire (n = 19 questions) was sent to all members of the Italian Society of Radiology two months after the first Italian national lockdown was lifted.

Results: A total of 327 Italian radiologists took part in the survey (mean age: 49 ± 12 years). After national lockdown, the working-flow came back to normal in the vast majority of cases (285/327, 87.2%). Participants reported that a total of 462 radiological trials were recruiting patients at their institutions prior to COVID-19 outbreak, of which 332 (71.9%) were stopped during the emergency. On the other hand, 252 radiological trials have been started during the pandemic, of which 156 were non-COVID-19 trials (61.9%) and 96 were focused on COVID-19 patients (38.2%). The majority of radiologists surveyed (61.5%) do not conduct research. Of the radiologists who carried on research activities, participants reported a significant increase of the number of hours per week spent for research purposes during national lockdown (mean 4.5 ± 8.9 h during lockdown vs. 3.3 ± 6.8 h before lockdown; p = .046), followed by a significant drop after the lockdown was lifted (3.2 ± 6.5 h per week, p = .035). During national lockdown, 15.6% of participants started new review articles and completed old papers, 14.1% completed old works, and 8.9% started new review articles. Ninety-six surveyed radiologists (29.3%) declared to have submitted at least one article during COVID-19 emergency.

Conclusion: This study shows the need to support radiology research in challenging scenarios like COVID-19 emergency.
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http://dx.doi.org/10.1016/j.clinimag.2021.02.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875708PMC
February 2021

Bone strain index as a predictor of further vertebral fracture in osteoporotic women: An artificial intelligence-based analysis.

PLoS One 2021 8;16(2):e0245967. Epub 2021 Feb 8.

Villa Santa Maria Foundation, Tavernerio (CO), Italy.

Background: Osteoporosis is an asymptomatic disease of high prevalence and incidence, leading to bone fractures burdened by high mortality and disability, mainly when several subsequent fractures occur. A fragility fracture predictive model, Artificial Intelligence-based, to identify dual X-ray absorptiometry (DXA) variables able to characterise those patients who are prone to further fractures called Bone Strain Index, was evaluated in this study.

Methods: In a prospective, longitudinal, multicentric study 172 female outpatients with at least one vertebral fracture at the first observation were enrolled. They performed a spine X-ray to calculate spine deformity index (SDI) and a lumbar and femoral DXA scan to assess bone mineral density (BMD) and bone strain index (BSI) at baseline and after a follow-up period of 3 years in average. At the end of the follow-up, 93 women developed a further vertebral fracture. The further vertebral fracture was considered as one unit increase of SDI. We assessed the predictive capacity of supervised Artificial Neural Networks (ANNs) to distinguish women who developed a further fracture from those without it, and to detect those variables providing the maximal amount of relevant information to discriminate the two groups. ANNs choose appropriate input data automatically (TWIST-system, Training With Input Selection and Testing). Moreover, we built a semantic connectivity map usingthe Auto Contractive Map to provide further insights about the convoluted connections between the osteoporotic variables under consideration and the two scenarios (further fracture vs no further fracture).

Results: TWIST system selected 5 out of 13 available variables: age, menopause age, BMI, FTot BMC, FTot BSI. With training testing procedure, ANNs reached predictive accuracy of 79.36%, with a sensitivity of 75% and a specificity of 83.72%. The semantic connectivity map highlighted the role of BSI in predicting the risk of a further fracture.

Conclusions: Artificial Intelligence is a useful method to analyse a complex system like that regarding osteoporosis, able to identify patients prone to a further fragility fracture. BSI appears to be a useful DXA index in identifying those patients who are at risk of further vertebral fractures.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245967PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870050PMC
February 2021

Home-Based Resistance Training for Older Subjects during the COVID-19 Outbreak in Italy: Preliminary Results of a Six-Months RCT.

Int J Environ Res Public Health 2020 12 19;17(24). Epub 2020 Dec 19.

IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy.

Background: The aim of this study was to evaluate the effect of a six-month home-based resistance-training program on muscle health and physical performance in healthy older subjects during the unique condition of home confinement caused by the COVID-19 pandemic.

Methods: This was a randomized-controlled study that enrolled older participants that were allocated to either an experimental group performing the six-months exercise prescription (EXE) or a control group (CON). At the beginning (PRE), and after 6 months (POST), participants were assessed for muscle strength, balance, gait assessment and body composition by dual energy X-ray absorptiometry and magnetic resonance imaging. Normality distribution of data was checked with the D'Agostino and Pearson test and changes between PRE and POST were assessed by paired Student's -test while percentage and absolute changes between groups at POST were tested by unpaired -test.

Results: Nine participants were included for the final analysis: EXE, = 5 (age: 66 ± 4; BMI: 27.5 ± 3.7) and CON, = 4 (age: 71 ± 9; BMI: 24.2 ± 4.1). Significant PRE-to-POST changes were observed in the EXE group only in the chair-stand test (+19.8%, = 0.048 and ES:1.0, moderate) and in total fat mass (+5.0%, = 0.035 and ES:1.4, large) with no between-group differences. Moreover, EXE had significantly higher absolute thigh CSA values than CON at POST (14.138 ± 2977 vs. 9039 ± 1015, = 0.0178, ES = 1.7). No other within- and between-group differences were detected.

Conclusions: The home-based resistance-training program during the lockdown period, caused by the COVID-19 outbreak, determined only within-group improvement in lower limb muscle strength but not in muscle mass and composition in older subjects. Home confinement may partially explain the increase in total body fat due to a reduced daily PA regime and altered diet pattern.
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http://dx.doi.org/10.3390/ijerph17249533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767132PMC
December 2020

Reply to: In silico diagnosis for sarcopenia is not possible without anthropometric, strength, and performance assessments.

Skeletal Radiol 2021 Feb;50(2):465-466

IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.

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http://dx.doi.org/10.1007/s00256-020-03680-wDOI Listing
February 2021

Short-Term Precision Error of Bone Strain Index, a New DXA-Based Finite Element Analysis Software for Assessing Hip Strength.

J Clin Densitom 2021 Apr-Jun;24(2):330-337. Epub 2020 Nov 1.

Former: Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UO Medicina Nucleare, Milano, Italy.

Bone Strain Index (BSI) is a new finite element analysis tool applied to hip dual energy X-ray absorptiometry scans. The aim of this study was to assess the short-term precision error of BSI on the proximal femur, both on a phantom and patients. The International Society for Clinical Densitometry guidelines were followed for short-term precision error assessment. Dual energy X-ray absorptiometry measurements were performed on an anthropomorphic femur phantom that was scanned twice for 30 times, for a total of 60 scans. For the in vivo part, 30 subjects were scanned twice. BSI precision error was compared to that of bone mineral density (BMD). Both for the phantom and the in vivo study BSI reproducibility was lower compared to that of BMD, as the precision error of BSI resulted 3 times higher compared to that BMD. For phantom measurements, the highest precision value was that of total femur (TF) BMD (coefficient of variation [CoV] = 0.63%, reproducibility = 98.24%), while the lowest precision was the femoral neck (FN) BSI (CoV = 3.08%, reproducibility = 91.48%). Similarly, for the in vivo study, the highest precision was found at TF BMD (CoV = 1.36%, reproducibility = 96.22%), while the lowest value of precision was found for FN BSI (CoV = 4.17%, reproducibility = 88.46%). Reproducibility at TF was always better compared to that of the FN. BSI precision error was about 3 times higher compared to BMD, confirming previous results of lumbar spine BSI. The main source of variability of this new software is related to patient positioning.
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http://dx.doi.org/10.1016/j.jocd.2020.10.013DOI Listing
May 2021

Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls.

Radiol Med 2021 Apr 5;126(4):608-619. Epub 2020 Nov 5.

IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Via Riccardo Galeazzi 4, 20161, Milan, Italy.

Rotator cuff calcific tendinopathy (RCCT) is a very common condition, characterized by calcium deposition over fibrocartilaginous metaplasia of tenocytes, mainly occurring in the supraspinatus tendon. RCCT has a typical imaging presentation: in most cases, calcific deposits appear as a dense opacity around the humeral head on conventional radiography, as hyperechoic foci with or without acoustic shadow at ultrasound and as a signal void at magnetic resonance imaging. However, radiologists have to keep in mind the possible unusual presentations of RCCT and the key imaging features to correctly differentiate RCCT from other RC conditions, such as calcific enthesopathy or RC tears. Other presentations of RCCT to be considered are intrabursal, intraosseous, and intramuscular migration of calcific deposits that may mimic infectious processes or malignancies. While intrabursal and intraosseous migration are quite common, intramuscular migration is an unusual evolution of RCCT. It is important also to know atypical regions affected by calcific tendinopathy as biceps brachii, pectoralis major, and deltoid tendons. Unusual presentations of RCCT may lead to diagnostic challenge and mistakes. The aim of this review is to illustrate the usual and unusual imaging findings of RCCT that radiologists should know to reach the correct diagnosis and to exclude other entities with the purpose of preventing further unnecessary imaging examinations or interventional procedures.
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http://dx.doi.org/10.1007/s11547-020-01300-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007494PMC
April 2021

Quantitative Musculoskeletal Ultrasound.

Semin Musculoskelet Radiol 2020 Aug 29;24(4):367-374. Epub 2020 Sep 29.

Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.

Ultrasound (US) imaging plays a crucial role in the assessment of musculoskeletal (MSK) disorders. Several quantitative tools are offered by US systems and add information to conventional US imaging. This article reviews the quantitative US imaging tools currently available in MSK radiology, specifically focusing on the evaluation of elasticity with shear-wave elastography, perfusion with contrast-enhanced US and noncontrast superb microvascular imaging, and bone and muscle mass with quantitative US methods. Some of them are well established and already of clinical value, such as elasticity and contrast-enhanced perfusion assessment in muscles and tendons. MSK radiologists should be aware of the potential of quantitative US tools and take advantage of their use in everyday practice, both for clinical and research purposes.
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http://dx.doi.org/10.1055/s-0040-1709720DOI Listing
August 2020

T2 mapping of the sacroiliac joints in patients with axial spondyloarthritis.

Eur J Radiol 2020 Oct 29;131:109246. Epub 2020 Aug 29.

Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 127, 90127 Palermo, Italy.

Purpose: To test whether T2 mapping of the sacro-iliac joints (SIJs) might help identifying patients with spondyloarthritis.

Method: This study included 20 biologic-naive patients with axial spondyloarthritis (10 females; mean age: 38 ± 9years; range, 19-47) and 27 controls (16 males; mean age = 39 ± 13years; range = 28-71) who prospectively underwent SIJs MRI at 1.5 T, including a multislice multiecho spin-echo sequence. Standard MRIs were reviewed to assess the SIJs according to the Assessment of SpondyloArthritis International Society (ASAS) criteria and SPondyloArthritis Research Consortium of Canada (SPARCC) MRI index. T2 maps obtained from multiecho sequences were used to draw regions of interests in the cartilaginous part of the SIJs. Disease activity was assessed using BASDAI questionnaire. Bland-Altman method, ROC curve analysis, Chi square, Mann-Whitney U, Pearson's and Spearman's correlation coefficient were used for data analysis.

Results: According to ASAS criteria, MRI was positive for sacroiliitis in 5/20 patients (25 %). Inter-observer reproducibility of T2 values was 87 % (coefficient of repeatability = 7.0; bias = 0.49; p < .001). Mean T2 values of patients (58.5 ± 4.4 ms, range: 52.6-68.2 ms) were significantly higher (p < .001) than those of controls (44.1 ± 6.6 ms, range: 33.6-67.2 ms). A T2 value of 52.51 ms yielded 100 % sensitivity and 91.7 % specificity to differentiate patients from controls. No statistically significant association/correlation was found between T2 values and BASDAI (r=-.026, p = .827), disease duration (r = .024, p = .871), SPARCC (r=-.004, p = .981), ASAS criteria (p = .476), HLA-B27-positivity (p = .139), age (r=-.2.53, p = .891), and gender (p = .404).

Conclusions: T2 relaxation times of the SIJs were significantly higher in patients than in healthy controls, making this tool potentially helpful to early identify patients with spondyloarthritis.
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http://dx.doi.org/10.1016/j.ejrad.2020.109246DOI Listing
October 2020

Operator-Related Errors and Pitfalls in Dual Energy X-Ray Absorptiometry: How to Recognize and Avoid Them.

Acad Radiol 2020 Aug 21. Epub 2020 Aug 21.

IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano 20122, Italy. Electronic address:

Dual-energy X-ray absorptiometry (DXA) is the most common modality for quantitative measurements of bone mineral density. Nevertheless, errors related to this exam are still very common, and may significantly impact on the final diagnosis and therapy. Operator-related errors may occur during each DXA step and can be related to wrong patient positioning, error in the acquisition process or in the scan analysis. The aim of this review is to provide a practical guide on how to recognize such errors in spine and hip DXA scan and how to avoid them, also presenting some of the most common artifacts encountered in clinical practice.
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http://dx.doi.org/10.1016/j.acra.2020.07.028DOI Listing
August 2020

Failed Total Hip Arthroplasty: Diagnostic Performance of Conventional MRI Features and Locoregional Lymphadenopathy to Identify Infected Implants.

J Magn Reson Imaging 2021 01 24;53(1):201-210. Epub 2020 Aug 24.

IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Milan, Italy.

Background: Very little has been published about the diagnostic performance of MRI in total hip arthroplasty (THA) infection.

Purpose: To determine the diagnostic performance of conventional MRI features and of new lymph nodal indices to identify infection in patients with failed THA.

Study Type: Retrospective.

Population: In all, 119 patients (66 females; age 66.9 ± 12.4 years) with failed THA.

Field Strength/sequences: Metal artifact reduction sequence (MARS) protocol including short tau inversion recovery and turbo spin-echo T - and T -weighted sequences at 1.5T.

Assessment: Patients underwent pelvis MRI prior to failed THA revision. MRIs were reviewed to identify periprosthetic bone destruction, soft-tissue mass, effusion, synovitis, lamellated synovitis, extracapsular edema, fibrous periprosthetic membrane, bone edema, and extracapsular collection/sinus tract. The number and maximum diameter of inguinal, obturator and iliac lymph nodes of the affected hip were assessed and normalized to those of the unaffected hip to calculate the ratio of nodal size (RNS), ratio of node number (RNN), difference of nodal size (DNS), and difference of node number (DNN).

Statistical Tests: The Mann-Whitney U-and chi-square test were used. Diagnostic performance of indices and odds ratios (OR) were calculated.

Results: RNS, RNN, DNS, and DNN indices were significantly different (P = 0.000) between infected and noninfected THA, with accuracies ranging from 84.8% (RNS) and 93.1% (RNN). All other MRI features were significantly more prevalent in infected THA (P ≤ 0.002), except bone destruction, periarticular soft-tissue mass, and fibrous membrane (P ≥ 0.031). Sensitivities ranged from 7.9% (soft-tissue mass) to 76.3% (effusion/bone edema), specificity from 45.7% (bone destruction) to 97.5% (synovitis/lamellated synovitis), accuracy from 49.6% (bone destruction) to 81.5% (synovitis), OR from 0.261 (soft-tissue mass) to 35.550 (synovitis).

Data Conclusion: Conventional MRI features have limited accuracy to differentiate septic and aseptic THA failure. Lymph nodal indices, particularly those related to nodal number, may represent biomarkers of THA infection.

Evidence Level: 3 TECHNICAL EFFICACY STAGE: 2.
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http://dx.doi.org/10.1002/jmri.27314DOI Listing
January 2021

Pitfalls of Computed Tomography 3D Reconstruction Models in Cranial Nonmetric Analysis.

J Forensic Sci 2020 Nov 18;65(6):2098-2107. Epub 2020 Aug 18.

LABANOF, Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan, 20133, Italy.

Many studies in the literature have highlighted the utility of virtual 3D databanks as a substitute for real skeletal collections and the important application of radiological records in personal identification. However, none have investigated the accuracy of virtual material compared to skeletal remains in nonmetric variant analysis using 3D models. The present study investigates the accuracy of 20 computed tomography (CT) 3D reconstruction models compared to the real crania, focusing on the quality of the reproduction of the real crania and the possibility to detect 29 dental/cranial morphological variations in 3D images. An interobserver analysis was performed to evaluate trait identification, number, position, and shape. Results demonstrate a false bone loss in 3D models in some cranial regions, specifically the maxillary and occipital bones in 85% and 20% of the samples. Additional analyses revealed several difficulties in the detection of cranial nonmetric traits in 3D models, resulting in incorrect identification in circa 70% of the traits. In particular, pitfalls included the detection of erroneous position, error in presence/absence rates, in number, and in shape. The lowest percentages of correct evaluations were found in traits localized in the lateral side of the cranium and for the infraorbital suture, mastoid foramen, and crenulation. The present study highlights important pitfalls in CT scan when compared with the real crania for nonmetric analysis. This may have crucial consequences in cases where 3D databanks are used as a source of reference population data for nonmetric traits and pathologies and during bone-CT comparisons for identification purposes.
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http://dx.doi.org/10.1111/1556-4029.14535DOI Listing
November 2020

Image-based biomechanical models of the musculoskeletal system.

Eur Radiol Exp 2020 08 13;4(1):49. Epub 2020 Aug 13.

IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

Finite element modeling is a precious tool for the investigation of the biomechanics of the musculoskeletal system. A key element for the development of anatomically accurate, state-of-the art finite element models is medical imaging. Indeed, the workflow for the generation of a finite element model includes steps which require the availability of medical images of the subject of interest: segmentation, which is the assignment of each voxel of the images to a specific material such as bone and cartilage, allowing for a three-dimensional reconstruction of the anatomy; meshing, which is the creation of the computational mesh necessary for the approximation of the equations describing the physics of the problem; assignment of the material properties to the various parts of the model, which can be estimated for example from quantitative computed tomography for the bone tissue and with other techniques (elastography, T1rho, and T2 mapping from magnetic resonance imaging) for soft tissues. This paper presents a brief overview of the techniques used for image segmentation, meshing, and assessing the mechanical properties of biological tissues, with focus on finite element models of the musculoskeletal system. Both consolidated methods and recent advances such as those based on artificial intelligence are described.
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http://dx.doi.org/10.1186/s41747-020-00172-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423821PMC
August 2020

Technical Feasibility of Electromagnetic US/CT Fusion Imaging and Virtual Navigation in the Guidance of Spine Biopsies.

Ultraschall Med 2020 Aug 12. Epub 2020 Aug 12.

Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy.

Purpose:  To test the technical feasibility of electromagnetic computed tomography (CT) + ultrasound fusion (US)-guided bone biopsy of spinal lesions.

Materials And Methods:  This retrospective study included 14 patients referred for biopsy of spinal bone lesions without cortical disruption or intervertebral disc infection. Lesions were located in the sacrum (n = 4), lumbar vertebral body (n = 7) or intervertebral disc (n = 3). Fusion technology matched a pre-procedure CT scan with real-time ultrasound. The first six procedures were performed under both standard CT and CT + US fusion guidance (group 1). In the last eight procedures, the needle was positioned under fusion imaging guidance alone, and CT was only used at the end of needle placement to confirm correct positioning (group 2). Additionally, we retrieved 8 patients (controls) with location-matched lesions as group 2, which were biopsied in the past with the standard CT-guided technique. The procedure duration and number of CT passes were recorded.

Results:  Mean procedure duration and median CT pass number were significantly higher in group 1 vs. group 2 (45 ± 5 vs. 26 ± 3 minutes, p = 0.002 and 7; 5.25-8.75 vs. 3; 3-3.25, p = 0.001). In controls, the mean procedure duration was 47 ± 4 minutes (p = 0.001 vs. group 2; p = 0.696 vs. group 1) and the number of CT passes was 6.5 (5-8) (p = 0.001 vs. group 2; p = 0.427 vs. group 1). No complications occurred and all specimens were adequate overall. In one case in group 2, the needle position was modified according to CT assessment before specimen withdrawal.

Conclusion:  Electromagnetic CT+US fusion-guided bone biopsy of spinal lesions is feasible and safe. Compared to conventional CT guidance, it may reduce procedural time and the number of CT passes.
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http://dx.doi.org/10.1055/a-1194-4225DOI Listing
August 2020

Segmented lordotic angles to assess lumbosacral transitional vertebra on EOS.

Eur Spine J 2020 10 11;29(10):2470-2476. Epub 2020 Aug 11.

IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.

Purpose: To test the vertical posterior vertebral angles (VPVA) of the most caudal lumbar segments measured on EOS to identify and classify the lumbosacral transitional vertebra (LSTV).

Methods: We reviewed the EOS examinations of 906 patients to measure the VPVA at the most caudal lumbar segment (cVPVA) and at the immediately proximal segment (pVPVA), with dVPVA being the result of their difference. Mann-Whitney, Chi-square, and ROC curve statistics were used.

Results: 172/906 patients (19%) had LSTV (112 females, mean age: 43 ± 21 years), and 89/172 had type I LSTV (52%), 42/172 type II (24%), 33/172 type III (19%), and 8/172 type IV (5%). The cVPVA and dVPVA in non-articulated patients were significantly higher than those of patients with LSTV, patients with only accessory articulations, and patients with only bony fusion (all p < .001). The cVPVA and dVPVA in L5 sacralization were significantly higher than in S1 lumbarization (p < .001). The following optimal cutoff was found: cVPVA of 28.2° (AUC = 0.797) and dVPVA of 11.1° (AUC = 0.782) to identify LSTV; cVPVA of 28.2° (AUC = 0.665) and dVPVA of 8° (AUC = 0.718) to identify type II LSTV; cVPVA of 25.5° (AUC = 0.797) and dVPVA of - 7.5° (AUC = 0.831) to identify type III-IV LSTV; cVPVA of 20.4° (AUC = 0.693) and dVPVA of - 1.8° (AUC = 0.665) to differentiate type II from III-IV LSTV; cVPVA of 17.9° (AUC = 0.741) and dVPVA of - 4.5° (AUC = 0.774) to differentiate L5 sacralization from S1 lumbarization.

Conclusion: The cVPVA and dVPVA measured on EOS showed good diagnostic performance to identify LSTV, to correctly classify it, and to differentiate L5 sacralization from S1 lumbarization.
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http://dx.doi.org/10.1007/s00586-020-06565-7DOI Listing
October 2020

Muscle MRI in two SMA patients on nusinersen treatment: A two years follow-up.

J Neurol Sci 2020 Oct 29;417:117067. Epub 2020 Jul 29.

Neurorehabilitation Unit, NEMO Clinical Center, University of Milano, Milano, Italy.

Introduction: The effects of nusinersen in adults with SMA rely on neuromotor function scales and qualitative assessments. There are limited clinical or imaging data on muscle changes over time.

Methods: Two adult SMA patients underwent clinical assessments including measures of upper and lower limb function with Revised Upper Limb Module (RULM) and Hammersmith Function Motor Scale Expanded (HFMSE); both patients were also studied with whole-body muscle MRI (T1-weighted and Diffusion Tensor Imaging/DTI sequences), at baseline and after 10 and 24 months from the beginning of treatment with nusinersen.

Results: After two years of treatment, HFMSE and RULM scores were stable in both patients. DTI sequences revealed an increased number, length and organization of muscle fiber tracks, and Fractional Anisotropy (FA) values showed a significant reduction after 10 and 24 months from baseline, in their corresponding maps.

Discussion: Muscle DTI imaging seems to play an interesting role to monitor treatment effects over time in adult SMA patients.
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http://dx.doi.org/10.1016/j.jns.2020.117067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388822PMC
October 2020

Body composition with dual energy X-ray absorptiometry: from basics to new tools.

Quant Imaging Med Surg 2020 Aug;10(8):1687-1698

IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy.

Dual-energy X-ray absorptiometry (DXA) in nowadays considered one of the most versatile imaging techniques for the evaluation of metabolic bone disorders such as osteoporosis, sarcopenia and obesity. The advantages of DXA over other imaging techniques are the very low radiation dose, its accuracy and simplicity of use. In addition, fat mass (FM) and lean mass (LM) values by DXA shows very good accuracy compared to that of computed tomography and magnetic resonance imaging. In this review we will explain the technical working principles of body composition with DXA, together with the possible limitations and pitfalls that should be avoided in daily routine to produce high-quality DXA examinations. We will also cover the current clinical practical application of whole body DXA values, with particular emphasis on the use of LM indices in the diagnostic workup of reduced muscle mass, sarcopenia and osteosarcopenic obesity according to the most recent guidelines. The possible use of adipose indices will be considered, such as the fat mass index (FMI) or the android/gynoid ratio, as well as lipodystrophy indices and the evaluation of visceral adipose tissue (VAT). Whenever available, we will provide possible cut-off diagnostic values for each of these LM and FM indices, according to current literature and guidelines.
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http://dx.doi.org/10.21037/qims.2020.03.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378094PMC
August 2020

Impact of coronavirus disease 2019 (COVID-19) emergency on Italian radiologists: a national survey.

Eur Radiol 2020 Dec 14;30(12):6635-6644. Epub 2020 Jul 14.

IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.

Objectives: To perform an online survey aimed at evaluating the impact of COVID-19 on Italian radiology departments.

Methods: We launched a survey composed of 25 questions about how COVID-19 has changed the safety and organization of daily activity in Italian radiology units.

Results: A total of 2136/10,564 (20.2%) radiologists of the Italian Society of Medical and Interventional Radiology participated. Two-thirds performed at least one diagnostic/interventional procedure on COVID-19 patients. The 88.1% reported a reduction in the elective imaging volumes, with US, mammography, and MRI having shown the greater decrease (41.1%, 23.9%, and 21.1%, respectively). In 69.6% of cases, institutions had trouble getting personal protective equipment (PPE), especially public hospitals and southern institutions. Less than 30% of participants were subjected to RT-PCR swab test, although 81.5% believed that it should be done on all health workers and 70% suggested it as the most important measure to improve safety at work. Slightly more than half of participants declared to work safely and felt to be adequately protected by their institutions. Up to 20% of northern participants were redeployed to clinical services. The first imaging examination performed by admitted COVID-19 patients was chest radiography in 76.3% of cases. Almost half of participants reported that less than 30% of health workers were infected in their radiology department, with higher rates in northern regions and public institutions.

Conclusions: This snapshot of the current situation in Italian radiology departments could be used to harmonize the organization of working activity in order to safely and effectively face this pandemic.

Key Points: • More than two-thirds of institutions had trouble getting PPE for health workers, with public hospitals and southern institutions that presented more procurement problems • A substantial drop of imaging volumes was observed in the vast majority of Italian radiology departments, mostly due to the decrease of ultrasound, mammography, and MRI, especially in private practice were working activity was stopped in 13.3% of institutions • RT-PCR swab to health workers was reported as the most suggested measure by Italian radiologists to improve safety at work, as more than 80% of them believed that it should be performed to all health workers, although less than 30% were subjected to this test.
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http://dx.doi.org/10.1007/s00330-020-07046-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358329PMC
December 2020

Ultrasound-Guided Percutaneous Tenotomy of the Long Head of Biceps Tendon in Patients with Symptomatic Complete Rotator Cuff Tear: In Vivo Non-contRolled Prospective Study.

J Clin Med 2020 Jul 4;9(7). Epub 2020 Jul 4.

Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milano, Italy.

Background: We prospectively tested technical feasibility and clinical outcome of percutaneous ultrasound-guided tenotomy of long head of biceps tendon (LHBT).

Methods: We included 11 patients (6 women; age: 73 ± 8.6 years) with symptomatic full-thickness rotator cuff tear and intact LHBT, in whom surgical repair was not possible/refused. After ultrasound-guided injection of local anesthetic, the LHBT was cut with a scalpel under continuous ultrasound monitoring until it became no longer visible. Pain was recorded before and at least six months after procedure. An eight-item questionnaire was administered to patients at follow-up.

Results: A median of 4 tendon cuts were needed to ensure complete tenotomy. Mean procedure duration was 65 ± 5.7 s. Mean length of skin incision was 5.8 ± 0.6 mm. Pre-tenotomy VAS score was 8.2 ± 0.7, post-tenotomy VAS was 2.8 ± 0.6 ( < 0.001). At follow-up, 5/11 patients were very satisfied, 5/11 satisfied and 1/11 neutral. One patient experienced cramping and very minimal pain in the biceps. Six patients had still moderate shoulder pain, 1/11 minimal pain, 2/11 very minimal pain, while 2/11 had no pain. No patients had weakness in elbow flexion nor limits of daily activities due to LHBT. One patient showed Popeye deformity. All patients would undergo ultrasound-guided tenotomy again.

Conclusion: ultrasound-guided percutaneous LHBT tenotomy is technically feasible and effective.
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http://dx.doi.org/10.3390/jcm9072114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408901PMC
July 2020

Ultrasound-Guided Percutaneous Irrigation of Rotator Cuff Calcific Tendinopathy (US-PICT): Patient Experience.

Biomed Res Int 2020 10;2020:3086395. Epub 2020 Jun 10.

IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy.

Purpose: To assess patients' experience of ultrasound-guided percutaneous irrigation of rotator cuff calcific tendinopathy (US-PICT).

Methods: Ninety-one patients (58 females; mean age: 50.5 ± 8.3 years) treated by US-PICT (local anesthesia, single-needle lavage, and intrabursal steroid injection) answered to a list of questions regarding their experience of the procedure before treatment, immediately after treatment, and three months later. The Borg CR10 scale was used to evaluate perceived pain, discomfort during anesthetic injection, and anxiety. The Wilcoxon, Spearman's rho, linear regression, and chi-square statistics were used.

Results: 81/91 patients complained mild discomfort during the injection of anesthetics (2, 1-2). Pain scores during US-PICT were very low (0, 0-1), with 70% patients having not experienced pain. After treatment, we found a significant reduction of pain (before: 8, 7-8; 3-month: 3, 1-6; < .001) and anxiety (before: 5, 2-7; during treatment: 2, 1-7; = 0.010), with high overall satisfaction (immediately after: 10, 9-10; 3-month: 9, 7-10) and confidence in the possibility of recovery (immediately after: 9, 8-10; 3-month: 10, 8-10), respectively. Treatments performed before US-PICT were not statistically associated with pain relief ( = 0.389) and clinical improvement ( = 0.937). We found a correlation between satisfaction immediately postprocedure and confidence in the possibility of recovery ( = 0.002) and between satisfaction three months after treatment and clinical improvement ( < 0.001) and patients' reminds about the description of the procedure ( = 0.005) and of the potential complications ( = 0.035).

Conclusions: US-PICT is a mildly painful, comfortable, and well-tolerated procedure, regardless of any previous treatments. Patients' satisfaction is correlated with clinical benefit and full explanation of the procedure and its complications.
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http://dx.doi.org/10.1155/2020/3086395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303755PMC
March 2021

Diffusion-Weighted Imaging in Oncology: An Update.

Cancers (Basel) 2020 Jun 8;12(6). Epub 2020 Jun 8.

IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy.

To date, diffusion weighted imaging (DWI) is included in routine magnetic resonance imaging (MRI) protocols for several cancers. The real additive role of DWI lies in the "functional" information obtained by probing the free diffusivity of water molecules into intra and inter-cellular spaces that in tumors mainly depend on cellularity. Although DWI has not gained much space in some oncologic scenarios, this non-invasive tool is routinely used in clinical practice and still remains a hot research topic: it has been tested in almost all cancers to differentiate malignant from benign lesions, to distinguish different malignant histotypes or tumor grades, to predict and/or assess treatment responses, and to identify residual or recurrent tumors in follow-up examinations. In this review, we provide an up-to-date overview on the application of DWI in oncology.
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http://dx.doi.org/10.3390/cancers12061493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352852PMC
June 2020

Correlation between muscle mass and quality around the hip and of psoas muscles at L3 level using unenhanced CT scans.

Skeletal Radiol 2020 Oct 31;49(10):1649-1655. Epub 2020 May 31.

IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.

Objective: CT segmentation of psoas muscles at L3 level is used to measure sarcopenia status, but it is not feasible when L3 is not included in the examination. We tested the correlation of psoas muscle mass and quality estimation at L3 with that of hip muscles, which could be opportunistically used in patients undergoing hip surgery.

Materials And Methods: Unenhanced abdominal CT performed in 50 patients (29 males, mean/median age 69/72 years) were reviewed. Regions of interest were drawn to assess cross-sectional area (CSA) and attenuation of psoas muscles at L3. These values were correlated with CSA and attenuation of iliopsoas, rectus femoris, sartorius, and tensor fascia latae at the level of the hip, separately on each side. After applying Bonferroni correction for multiple comparisons, statistical significance was set as P < .002.

Results: Attenuation of each psoas at L3 and ipsilateral hip muscles was significantly correlated (P ≤ .001, r = .491-.754). A significant correlation was observed between CSA of right psoas and ipsilateral muscles (P ≤ .00, r = .432-.525). We observed a significant correlation between CSA of left psoas and ipsilateral rectus femoris, iliopsoas, tensor fascia latae at the apex of the femoral head, and sartorius at the level of the lesser trochanter (P ≤ .001, r = .431-.502). Average time to measure CSA and attenuation of psoas muscles at L3 was 41 s, that of hip muscles was 2 min 12 s.

Conclusion: Measurements of mass and quality of hip muscles are feasible and correlate to those of psoas muscles at L3, being potentially used in future works on the association of sarcopenia and outcomes after hip surgery.
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http://dx.doi.org/10.1007/s00256-020-03475-zDOI Listing
October 2020

Musculoskeletal Ultrasound in the Emergency Department.

Semin Musculoskelet Radiol 2020 Apr 21;24(2):167-174. Epub 2020 May 21.

IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.

The skin, nerves, and tendons are superficial anatomical structures that can easily be investigated with an ultrasound (US) examination in the emergency department (ED). US evaluation is relatively underused in musculoskeletal evaluation when compared with other emergency applications, such as abdominal trauma, possible aortic aneurysm, and in the cardiovascular system. The aim of this article is to revise the main bone and soft tissue conditions that can be assessed using US in the ED.
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http://dx.doi.org/10.1055/s-0039-3402050DOI Listing
April 2020