Publications by authors named "Giuseppe Guglielmi"

235 Publications

Hoffa's fat pad thickness: a measurement method with sagittal MRI sequences.

Radiol Med 2021 Mar 27. Epub 2021 Mar 27.

Department of Clinical and Experimental Medicine, School of Medicine, Foggia University, Viale L. Pinto, 1, 71121, Foggia, Italy.

Background: Hoffa's fat pad is a structure located within the fibrous joint capsule of the knee joint, but outside the synovial cavity. It plays an important biomechanical and metabolic role in knee joint, reducing the impact of forces generated by loading and producing cytokines. Changes in its size can induce modifications in the knee homeostasis. However, a great variability exists regarding its measurements. This work aims to evaluate the reliability of a measurement method of Hoffa's fat pad dimensions through MRI.

Methods: 3T sagittal IW 2D TSE fat-suppressed MRI sequences, taken from the OAI (Osteoarthritis initiative) database, of 191 male and female patients, aged between 40 and 80 years, were analysed; a manual measurement of the thickness of Hoffa's fat pad of each subject was then performed by two different readers. The interobserver reliability and intraobserver reliability of the measurements were described by coefficient of variation (CV), Pearson correlation and Bland-Altman plots.

Results: All statistical analyses have shown that not significant intra- or interobservers differences were evident (intraobserver CV % for the first observer was 2.17% for the right knee and 2.24% for the left knee, while for the second observer 2.31% for the right knee and 2.24% for the left knee; linear correlation was for the first observer r = 0.96 for the right knee and r = 0.96 for the left knee, while for the second observer r = 0.97 for the right knee and r = 0.96 for the left knee; in addition, the interobserver CV % was 1.25% for the right knee and 1.21% for the left knee and a high interobserver linear correlation was found: r = 0.97 for the right knee and r = 0.96 for the left knee). All results suggest that this manual measurement method of Hoffa's fat pad thickness can be performed with satisfactory intra- and interobserver reliability.

Conclusions: Hoffa's fat pad thickness can be measured, using sagittal MRI images, with this manual method that represents, for his high reliability, an effective means for the study of this anatomical structure.
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http://dx.doi.org/10.1007/s11547-021-01345-9DOI Listing
March 2021

Correlation of quantitative diffusion weighted MR imaging between benign, malignant chondrogenic and malignant non-chondrogenic bone tumors with histopathologic type.

Heliyon 2021 Mar 8;7(3):e06402. Epub 2021 Mar 8.

Department of Clinical and Experimental Medicine, School of Medicine, Foggia University, Foggia, Italy.

Objectives: This study aims to determine the diffusion on weighted imaging which may help in providing characterization of Apparent Diffusion Coefficient (ADC) values in benign, malignant chondrogenic and malignant non-chondrogenic bone tumors.

Material And Methods: A retrospective study with 84 samples was conducted from October 2017 to December 2019. The samples consisted of 44 males and 40 females; the age range of 10-73 years (mean age of 32.7 years old). A Diffusion-weighted Magnetic Resonance (MR) utilizes a single-shot echo-planar imaging sequence technique with the 3T MR Scanner. We classified the types of tumors into benign, malignant chondrogenic and malignant non-chondrogenic bone tumors. The mean of ADC values from the area with lowest ADC values was selected for statistical analysis. ADC values were compared between benign, malignant chondrogenic and malignant non-chondrogenic bone tumors. Therefore, Receiver Operating Curve (ROC) analysis was done to determine optimal cut-off values. The correlation of ADC values between benign, malignant chondrogenic and malignant non-chondrogenic bone tumor with histopathologic type was also evaluated.

Results: The mean of ADC values from the area of benign, malignant chondrogenic and malignant non-chondrogenic bone tumor were 1.55 × 10 mm/s, 1.84 × 10 mm/s and 1.12 × 10 mm/s respectively. As a matter of fact, there was a significant difference between benign and malignant bone tumor with cut-off value of 1.15 × 10 mm/s and had a sensitivity of 82%, and a specificity of 92.3%. Moreover, a significant correlation was also found between ADC values with the histopathology type of bone tumors.

Conclusion: The ADC values of benign and malignant (chondrogenic and non-chondrogenic groups) bone tumors are different. Thus, the measurement of ADC values improves the accuracy of the diagnosis of bone tumors.
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http://dx.doi.org/10.1016/j.heliyon.2021.e06402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969897PMC
March 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

Sternal transplant using cadaveric allograft: quantitative and qualitative assessment of bone healing by computed tomography.

Quant Imaging Med Surg 2021 Feb;11(2):502-509

Thoracic Surgery Unit, Department of Cardiothoracic Surgery and Vascular Sciences, University of Padova, Padova, Italy.

Background: Sternal transplant using cadaveric allograft (STCA) is a complex and rarely performed surgical procedure usually applied for massive bone tissue loss, sternotomy complications, or neoplastic resections. Although radiological imaging and especially computed tomography (CT) is routinely applied for the post-surgical assessment, up to now, a standardized approach evaluating the outcome of STCAs is missing. Therefore, aim of this study was to qualitatively and quantitatively evaluate, by CT, bone healing after STCA.

Methods: The first and the last available postsurgical CT of patients who underwent STCA in two tertiary centers between 2009 and 2017 were collected. Standardized regions of interest were applied on the cancellous bone along the transplanted sternum, and, as reference, on the fourth thoracic vertebra, at both time points, collecting the density values. The areas nearby the fixation devices were assessed by a four-points qualitative score. To evaluate the mineralization, the analysis of the variance (ANOVA) with Bonferroni correction was applied for the quantitative measurements while the Wilcoxon test was used for the qualitative score (P<0.05). To evaluate the intra-rater reliability of the qualitative and the quantitative analyses, the same rater repeated the measurements after two months and the Cohen's kappa (k) and the intraclass correlation coefficient (ICC) were computed.

Results: Fourteen patients (11 females, 61±12.8 years) were examined. The first control CTs were performed 32±40.26 days after the STCA and the last CT were acquired after 729±745 days. The quantitative and the qualitative score significantly increased between the two intervals (P<0.05, each). The density of the transplanted sternum was lower than that of the vertebral reference at the first CT (P=0.006) while no differences occurred at the last control (P=0.361). The assessments showed high intra-rater reliability and agreement (ICC ≥0.890, k≥0.906).

Conclusions: The hereby-proposed qualitative and quantitative methods demonstrated to be good tools for assessing bone healing after STCA.
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http://dx.doi.org/10.21037/qims-20-90DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779938PMC
February 2021

First things first: A late robotic approach to anamnesis, in a patient with a thymus hematoma.

BJR Case Rep 2020 Dec 15;6(4):20200017. Epub 2020 Jun 15.

Department of Radiology, University of Foggia, Foggia, Italy.

Anterior mediastinal masses are generally asymptomatic until they grow and compress surrounding structures. Chest X-rays only suggest a mediastinal abnormality and contrast-enhanced CT scan and MRI are necessary for a better definition of the lesion. The classification of the anterior mediastinal masses is based on their etiology and it is sometimes a challenge to have an accurate differential diagnosis based only on radiological examinations: therefore, only the histopathological examination makes the correct diagnosis. Surgeons generally agree that symptomatic masses or those with progressive growth should undergo surgical resection. We report a case of an accidental finding of an organized thymic hematoma in a 46-year-old female. At first totally asymptomatic, the hematoma was misdiagnosed for a thymic cyst and resected when it increased in size and compressed surrounding mediastinal structures. A detailed anamnesis highlighted a minor thoracic trauma which turned out to be the cause. Retrosternal hematoma generally grows several months after trauma and initial stabilization; therefore, it is mandatory to include an organized hematoma in the differential diagnosis of the retrosternal neoformations.
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http://dx.doi.org/10.1259/bjrcr.20200017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709060PMC
December 2020

A Rare Case of Neglected Rupture of Right Axillary Artery Pseudoaneurysm Mimicking a Soft Tissue Tumor.

Case Rep Oncol 2020 Sep-Dec;13(3):1082-1090. Epub 2020 Sep 18.

Department of Radiology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.

Traumatic lesions of the axillary artery itself are limited to 2.9-9% of major arterial injuries. Pseudoaneurysms represent a pulsating encapsulated hematoma in communication with the lumen of a ruptured vessel. Traumatic pseudoaneurysm of the axillary artery is a rare sequela of injury to the shoulder region. We describe a case of posttraumatic pseudoaneurysm involving the axillary artery, which was initially misdiagnosed as an aggressive soft tissue tumor. The man presented 10 years after an injury from a fall from a tree with a slowly growing mass in the right upper limb region and reduced range of movement. This is a neglected case with a history of traditional massage. The patient presented a pathologic fracture of the right proximal humerus and dislocation of the glenohumeral joint. At the beginning, it was suggested to be a primary soft tissue tumor, but after several examinations, including comparable X-ray, ultrasound, and histopathology, the results did not support a soft tissue tumor. Magnetic resonance imaging and computed tomography angiography (CTA) finally confirmed the finding of a pseudoaneurysm of the right axillary artery associated with a huge hematoma with different age of the bleeding product and granulation tissue. This case demonstrates the necessity of early diagnosis of axillary artery pseudoaneurysm to prevent complications after a history of trauma. CTA is a useful modality to evaluate vascular injury and provides valuable information.
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http://dx.doi.org/10.1159/000509769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548968PMC
September 2020

Present Status of Musculoskeletal Radiology in Europe: International Survey by the European Society of Musculoskeletal Radiology.

Semin Musculoskelet Radiol 2020 Jun 28;24(3):323-330. Epub 2020 Sep 28.

Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany.

No official data exist on the status of musculoskeletal (MSK) radiology in Europe. The Committee for National Societies conducted an international survey to understand the status of training, subspecialization, and local practice among the European Society of Musculoskeletal Radiology (ESSR) partner societies. This article reports the results of that survey. An online questionnaire was distributed to all 26 European national associations that act as official partner societies of the ESSR. The 24 questions were subdivided into six sections: society structure, relationship with the national radiological society, subspecialization, present radiology practice, MSK interventional procedures, and MSK ultrasound. The findings of our study show a lack of standardized training and/or accreditation methods in the field of MSK radiology at a national level. The European diploma in musculoskeletal radiology is directed to partly overcome this problem; however, this certification is still underrecognized. Using certification methods, a more homogeneous European landscape could be created in the future with a view to subspecialist training. MSK ultrasound and MSK interventional procedures should be performed by a health professional with a solid knowledge of the relevant imaging modalities and sufficient training in MSK radiology. Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology. KEY POINTS: · Standardized training and/or accreditation methods in the field of MSK radiology is lacking at a national level.. · With certification methods, such as the European diploma in musculoskeletal radiology, a more homogeneous European landscape could be created in the future with a view to subspecialist training.. · Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology..
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http://dx.doi.org/10.1055/s-0040-1713119DOI Listing
June 2020

The role of body composition assessment in obesity and eating disorders.

Eur J Radiol 2020 Oct 6;131:109227. Epub 2020 Sep 6.

School of Biomedical Engineering & Imaging Sciences, Kings College London, United Kingdom; Guy's & St Thomas' Hospitals, London, United Kingdom. Electronic address:

Lack of a balanced diet can have a significant impact on most organs of the body. Traditionally, evaluation of these conditions relied heavily upon body mass index "BMI" measurements, which are limited and open to inaccurate interpretation or omission of critical data. Advances in imaging allow better recognition of these conditions using accurate qualitative and quantitative data and correlation with any morphological changes in organs. Body composition evaluations include the assessment of the bone mineral density (BMD), visceral fat, subcutaneous fat, liver fat and iron overload and muscle fat (including the lean muscle ratio), with differential evaluation of specific muscle groups when required. Such measurements are important as a baseline and for monitoring the effect of therapies and various interventions. In addition, they may predict and help alleviate any potential complications, allowing counselling of patients in a relatable manner. This positively influences patient compliance and outcomes during early counselling, monitoring and modulation of therapy. This encourages patients suffering from obesity and eating disorders to better understand their often chronic but reversible condition. We present a review of current literature with reflection on our own practices. We discuss the importance of monitoring the reversibility of certain parameters in specific cohorts of patients. We consider the role of artificial intelligence and deep learning in developing software algorithms that can help the reading radiologist evaluate large volumes of data and present the results in a format that is easier to interpret, thereby reducing interobserver and intraobserver variabilities.
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http://dx.doi.org/10.1016/j.ejrad.2020.109227DOI Listing
October 2020

Plaque imaging volume analysis: technique and application.

Cardiovasc Diagn Ther 2020 Aug;10(4):1032-1047

Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy.

The prevention and management of atherosclerosis poses a tough challenge to public health organizations worldwide. Together with myocardial infarction, stroke represents its main manifestation, with up to 25% of all ischemic strokes being caused by thromboembolism arising from the carotid arteries. Therefore, a vast number of publications have focused on the characterization of the culprit lesion, the atherosclerotic plaque. A paradigm shift appears to be taking place at the current state of research, as the attention is gradually moving from the classically defined degree of stenosis to the identification of features of plaque vulnerability, which appear to be more reliable predictors of recurrent cerebrovascular events. The present review will offer a perspective on the present state of research in the field of carotid atherosclerotic disease, focusing on the imaging modalities currently used in the study of the carotid plaque and the impact that such diagnostic means are having in the clinical setting.
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http://dx.doi.org/10.21037/cdt.2020.03.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487381PMC
August 2020

Diagnostic and interventional management of infective spine diseases.

Acta Biomed 2020 07 13;91(8-S):125-135. Epub 2020 Jul 13.

Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.

Spondylodiscitis (SD) is one of the main causes of back pain. Although the low mortality, high morbidity is related to spondilodiscitys, leading spine instability, chronic pain or neurological deficit. Diagnostic imaging plays a primary role in diagnosing spondylodiscitis. However different accuracy is highlighted by different diagnostic tool, depending also on timing of disease which represents a cardinal element for the phenotypic manifestation of the disease, beyond spatial resolution and tissue characterization proper of specific modality imaging. Conventional Radiology (CR), Computed Tomography (CT) and MRI (Magnetic Resonance Imaging) all have proven to be of primary importance in the approach to spondylodiscitis, although magnetic resonance imaging has demonstrated the greatest advantage in identifying the disease from its earliest stages, demonstrating high sensitivity and specificity (92% and 96%, respectively). This review focus on the role of different imaging modality in the approach to the spondylodiscitis, also addressing the role of interventional radiology that is pivotal not only for a diagnosis of certainty through biopsy, but also for a minimally-invasive treatment of paravertebral abscesses spondylodiscitis-related.
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http://dx.doi.org/10.23750/abm.v91i8-S.9994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944670PMC
July 2020

Low bone mineral density in HIV-positive young Italians and migrants.

PLoS One 2020 3;15(9):e0237984. Epub 2020 Sep 3.

Department of Lab. Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.

Background: Human immunodeficiency virus (HIV) infected individuals may have osteoporosis. We aimed to evaluate the bone mineral density (BMD) in naïve antiretroviral (ARV) treated HIV positive patients comparing native Italian group (ItG) to a Migrants group (MiG) upon arrival in Italy.

Methods: We conducted a cross-sectional study on 83 HIV patients less than 50 years old. We used the dual-energy X-ray absorptiometry (DXA) within six months from the HIV diagnosis. Participants were categorized as having low BMD if the femoral neck or total lumbar spine Z-score was- 2 or less.

Results: MiG showed low BMD more often than ItG (37.5% vs.13.6%), especially for the female gender (16.7% vs. 0.0%). A low CD4 rate (<200 cells/μl) was most often detected in MiG than ItG. In particular, we found most often male Italians with abnormal CD4 than male migrants (67.8% vs. 33.3%) and vice versa for females (30.5% vs. 66.7%). We found an abnormal bone mineral density at the lumbar site. Low BMD at the lumbar site was more frequently observed in female migrants than female Italians. Both male and female migrants had a Z-score value significantly lower than male and female Italians, respectively. By logistic regression low vitamin-D level was positively correlated to low BMD in ItG only. All data were verified and validated using a triple code identifier.

Conclusions: Both DXA and vitamin-D evaluation should be offered after the diagnosis of HIV infection. Lumbar site low BMD is an initial condition of bone loss in HIV young patients, especially in female migrants. Vitamin D levels and supplementation may be considered after HIV diagnosis independently of age to improve bone health.

Highlights: This study evaluates the frequency of bone mineral density in HIV positive patients naive to antiretroviral therapy. It compares the density of the native Italian population with that of HIV Migrants upon arrival in Italy. The results show that HIV positive migrants, even if younger than 50 years of age, are at risk for osteoporosis, especially if they are female.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237984PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470426PMC
October 2020

Muscle Density, but Not Size, Correlates Well With Muscle Strength and Physical Performance.

J Am Med Dir Assoc 2021 Apr 5;22(4):751-759.e2. Epub 2020 Aug 5.

Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.

Objectives: There is increasing evidence that muscle volume and mass are poor predictors of muscle strength and physical performance. Other assessments of muscle quality such as skeletal muscle density measured by computed tomography (CT) may be more important. The aim of this study was to explore associations of muscle size and density with handgrip strength (HGS) and the Timed Up and Go test (TUG). We also hypothesized that the strength of these associations would depend on the specific muscle of muscle group, namely trunk, hip, and mid-thigh muscles.

Design: Cross-sectional study.

Setting And Participants: University hospital; 316 volunteers aged 59 to 85 years.

Methods: HGS, TUG, and quantitative CT imaging of the lumber, hip, and mid-thigh were performed in volunteers. From the CT images, cross-sectional area and attenuation were determined for the gluteus muscle, trunk muscle at vertebrae L2 level, and mid-thigh muscle.

Results: In men and women, associations of muscle area with TUG were insignificant after adjustment for age, height, and weight. Associations with HGS were only significant in men for the gluteus maximus and the mid-thigh but slopes were rather low (β < 0.20). Associations between muscle density and TUG/HGS were more pronounced, in particular for HGS. After adjustment, associations with TUG were significant in women for the gluteus maximus and trunk muscle even (β -0.06, P .001 and β -0.07, P .031, respectively).

Conclusions And Implications: Muscle density is more strongly associated with muscle strength than muscle size andin women muscle density was also more strongly associated than muscle size with physical performance. Therefore, muscle density may represent a more clinically meaningful surrogate of muscle performance than muscle size. Muscle density measurements of trunk and gluteus muscles can be easily obtained from routine CT scan and, therefore, may become an important measurement to diagnose and screen for sarcopenia.
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http://dx.doi.org/10.1016/j.jamda.2020.06.052DOI Listing
April 2021

Radiation protection in non-ionizing and ionizing body composition assessment procedures.

Quant Imaging Med Surg 2020 Aug;10(8):1723-1738

Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy.

Body composition assessment (BCA) represents a valid instrument to evaluate nutritional status through the quantification of lean and fat tissue, in healthy subjects and sick patients. According to the clinical indication, body composition (BC) can be assessed by different modalities. To better analyze radiation risks for patients involved, BCA procedures can be divided into two main groups: the first based on the use of ionizing radiation (IR), involving dual energy X-ray absorptiometry (DXA) and computed tomography (CT), and others based on non-ionizing radiation (NIR) [magnetic resonance imaging (MRI)]. Ultrasound (US) techniques using mechanical waves represent a separate group. The purpose of our study was to analyze publications about IR and NIR effects in order to make physicians aware about the risks for patients undergoing medical procedures to assess BCA providing to guide them towards choosing the most suitable method. To this end we reported the biological effects of IR and NIR and their associated risks, with a special regard to the excess risk of death from radio-induced cancer. Furthermore, we reported and compared doses obtained from different IR techniques, giving practical indications on the optimization process. We also summarized current recommendations and limits for techniques employing NIR and US. The authors conclude that IR imaging procedures carry relatively small individual risks that are usually justified by the medical need of patients, especially when the optimization principle is applied. As regards NIR imaging procedures, a few studies have been conducted on interactions between electromagnetic fields involved in MR exam and biological tissue. To date, no clear link exists between MRI or associated magnetic and pulsed radio frequency (RF) fields and subsequent health risks, whereas acute effects such as tissue burns and phosphenes are well-known; as regards the DNA damage and the capability of NIR to break chemical bonds, they are not yet robustly demonstrated. MRI is thus considered to be very safe for BCA as well US procedures.
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http://dx.doi.org/10.21037/qims-19-1035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378088PMC
August 2020

Ultrasound imaging, a stethoscope for body composition assessment.

Quant Imaging Med Surg 2020 Aug;10(8):1699-1722

Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

Dysregulation of the human's energy balance, mediated by non-performing endocrine organs (liver, skeletal muscle and adipose tissue, above all), can be related to human metabolic disorders characterized by an impaired body composition (BC), such as obesity and sarcopenia. While it is possible to monitor the BC and its variations at different levels, the tissue-organ composition studies have been proven to provide the most clinically applicable information. Ultrasonography (US), a fast, non-invasive, low-cost and widely available technique, holds great potential in the study of BC, as it can directly measure muscles, organs, visceral and subcutaneous fat tissue in different sections of the abdomen and body, overcoming some limits of anthropometric evaluation and other imaging techniques. Purpose of this review article is to explore the technical aspects and the applied methods of US examination to assess the potential clinical role of this technique in the context of BC characterization, investigating four pivotal topics [abdominal fat compartments, subcutaneous adipose tissue (SAT), skeletal muscle, liver].
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http://dx.doi.org/10.21037/qims-19-1048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378096PMC
August 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

Muscle mass assessment in renal disease: the role of imaging techniques.

Quant Imaging Med Surg 2020 Aug;10(8):1672-1686

Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.

Muscle wasting is a frequent finding in patients with chronic kidney disease (CKD), especially in those with end-stage kidney disease (ESKD) on chronic dialysis. Muscle wasting in CKD is a main feature of malnutrition, and results principally from a vast array of metabolic derangements typical of the syndrome, that converge in determining reduced protein synthesis and accelerated protein catabolism. In this clinical setting, muscle wasting is also frequently associated with disability, frailty, infections, depression, worsened quality of life and increased mortality. On these grounds, the evaluation of nutritional status is crucial for an adequate management of renal patients, and consists of a comprehensive assessment allowing for the identification of malnourished patients and patients at nutritional risk. It is based essentially on the assessment of the extent and trend of body weight loss, as well as of spontaneous dietary intake. Another key component of this evaluation is the determination of body composition, which, depending on the selected method among several ones available, can identify accurately patients with decreased muscle mass. The choice will depend on the availability and ease of application of a specific technique in clinical practice based on local experience, staff resources and good repeatability over time. Surrogate methods, such as anthropometry and bioimpedance analysis (BIA), represent the most readily available techniques. Other methods based on imaging modalities [dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging (MRI), and whole body computed tomography (CT)] are considered to be the "gold standard" reference methods for muscle mass evaluation, but their use is mainly confined to research purposes. New imaging modalities, such as segmental CT scan and muscle ultrasound have been proposed in recent years. Particularly, ultrasound is a promising technique in this field, as it is commonly available for bedside evaluation of renal patients in nephrology wards. However, more data are needed before a routine use of ultrasound for muscle mass evaluation can be recommended in clinical practice.
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http://dx.doi.org/10.21037/qims.2020.03.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378093PMC
August 2020

Artificial intelligence, radiomics and other horizons in body composition assessment.

Quant Imaging Med Surg 2020 Aug;10(8):1650-1660

Department of Translational Research, University of Pisa, Pisa, Italy.

This paper offers a brief overview of common non-invasive techniques for body composition assessment methods, and of the way images extracted by these methods can be processed with artificial intelligence (AI) and radiomic analysis. These new techniques are becoming more and more appealing in the field of health care, thanks to their ability to treat and process a huge amount of data, suggest new correlations between extracted imaging biomarkers and traits of several diseases as well as lead to the possibility to realise an increasingly personalized medicine. The idea is to suggest the use of AI applications and radiomic analysis to search for features that may be extracted from medical images [computed tomography (CT) and magnetic resonance imaging (MRI)], and that may turn out to be good predictors of metabolic disorder diseases and cancer. This could lead to patient-specific treatments and management of several diseases linked with excessive body fat.
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http://dx.doi.org/10.21037/qims.2020.03.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378090PMC
August 2020

MRI in the assessment of adipose tissues and muscle composition: how to use it.

Quant Imaging Med Surg 2020 Aug;10(8):1636-1649

Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.

Body composition analysis based on the characterization of different tissue compartments is currently experiencing increasing attention by a broad range of medical disciplines for both clinical and research questions. However, body composition profiling (BCP) can be performed utilizing different modalities, which all come along with several technical and diagnostic strengths and limitations, respectively. Magnetic resonance imaging (MRI) demonstrates good soft tissue resolution, high contrast between fat and water, and is free from ionizing radiation. This review article represents an overview of imaging techniques for body composition assessment, focussing on qualitative and quantitative methods of assessing adipose tissue and muscles in MRI.
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http://dx.doi.org/10.21037/qims.2020.02.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378099PMC
August 2020

Fat and bone: the multiperspective analysis of a close relationship.

Quant Imaging Med Surg 2020 Aug;10(8):1614-1635

Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

The study of bone has for many years been focused on the study of its mineralized component, and one of the main objects of study as radiology developed as a medical specialty. The assessment has until recently been almost limited to its role as principal component of the scaffolding of the human body. Bone is a very active tissue, in continuous cross-talk with other organs and systems, with functions that are endocrine and paracrine and that have an important involvement in metabolism, ageing and health in general. Bone is also the continent for the bone marrow, in the form of "yellow marrow" (mainly adipocytes) or "red marrow" (hematopoietic cells and adipocytes). Recently, numerous studies have focused on these adipocytes contained in the bone marrow, often referred to as marrow adipose tissue (MAT). Bone marrow adipocytes do not only work as storage tissue, but are also endocrine and paracrine cells, with the potential to contribute to local bone homeostasis and systemic metabolism. Many metabolic disorders (osteoporosis, obesity, diabetes) have a complex and still not well-established relationship with MAT. The development of imaging methods, in particular the development of cross-sectional imaging has helped us to understand how much more laid beyond our classical way to look at bone. The impact on the mineralized component of bone in some cases (e.g., osteoporosis) is well-established, and has been extensively analyzed and quantified through different radiological methods. The application of advanced magnetic resonance techniques has unlocked the possibility to access the detailed study, characterization and quantification of the bone marrow components in a non-invasive way. In this review, we will address what is the evidence on the physiological role of MAT in normal skeletal health (interaction with the other bone components), during the process of normal aging and in the context of some metabolic disorders, highlighting the role that imaging methods play in helping with quantification and diagnosis.
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http://dx.doi.org/10.21037/qims.2020.01.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378091PMC
August 2020

Established paths and new avenues: a review of the main radiological techniques for investigating sarcopenia.

Quant Imaging Med Surg 2020 Aug;10(8):1602-1613

Radiology Institute, Department of Medicine-DIMED, University of Padova, Padova, Italy.

Sarcopenia is a clinical condition mainly affecting the elderly that can be associated in a long run with severe consequences like malnutrition and frailty. Considering the progressive ageing of the world population and the socio-economic impact of this disease, much effort is devoted and has to be further focused on an early and accurate diagnostic assessment of muscle loss. Currently, several radiological techniques can be applied for evaluating sarcopenia. If dual-energy X-ray absorptiometry (DXA) is still considered the main tool and it is even recommended as reference by the most current guidelines of the European working group on sarcopenia in older people (EWGSOP), the role of ultrasound (US), computed tomography (CT), peripheral quantitative CT (pQCT), and magnetic resonance imaging (MRI) should not be overlooked. Indeed, such techniques can provide robust qualitative and quantitative information. In particular, regarding MRI, the use of sequences like diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS) and mapping that could provide further insights into the physiopathological features of sarcopenia, should be fostered. In an era pointing to the quantification and automatic evaluation of diseases, we call for future research extending the application of organ tailored protocols, taking advantage of the most recent technical developments.
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http://dx.doi.org/10.21037/qims.2019.12.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378089PMC
August 2020

Body composition imaging.

Quant Imaging Med Surg 2020 Aug;10(8):1576-1579

Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

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http://dx.doi.org/10.21037/qims-2019-bc-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378092PMC
August 2020

The value of DTI: achieving high diagnostic performance for brain metastasis.

Radiol Med 2021 Feb 20;126(2):291-298. Epub 2020 Jun 20.

Department of Clinical and Experimental Medicine, University School of Medicine, Viale L. Pinto, 1, 71121, Foggia, Italy.

Background: The evaluation of brain metastases generally requires post-contrast MRI exam, but some patients have contraindication to contrast medium administration.

Purpose: To investigate the value of the MRI diffusion tensor imaging (DTI) for detection of metastatic brain tumor.

Materials And Methods: We retrospectively analyzed the MRI data from 23 patients (13 males and 10 females) with brain metastases. The MRI protocol consisted in T1WI, T2WI, post-contrast 3DT1WI and DTI images (b = 1000) sequences. The brain metastatic lesions were counted in each of these sequences. We compared the advantages and limitations of different sequences in the brain metastases detection. The number of metastatic lesions identified on the contrast-enhanced 3DT1WI image is used as the reference. FA values were measured in the intratumoral, adjacent peritumoral and distant peritumoral edema area (PTEA) of brain metastasis, and the differences were statistically analyzed.

Results: DTI can detect more brain metastatic lesions rather than T1WI and T2WI. The number of brain metastases on DTI is similar to post-contrast 3D T1WI. There is no statistical difference in the FA value change between the adjacent and distant PTEA.

Conclusion: The DTI original image can be used as an alternative examination for patients with contraindications to contrast-enhanced MRI. It has high sensitivity to intratumoral hemorrhage, which has advantage to detect brain metastatic lesions as compared with T1WI or T2WI images.
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http://dx.doi.org/10.1007/s11547-020-01243-6DOI Listing
February 2021

Semi-quantitative grading and extended semi-quantitative grading for osteoporotic vertebral deformity: a radiographic image database for education and calibration.

Ann Transl Med 2020 Mar;8(6):398

Department of Radiology, Hospital of Traumatology, Carretera de Jaen SN, Granada, Spain.

The Genant's semi-quantitative (GSQ) criteria is currently the most used approach in epidemiology studies and clinical trials for osteoporotic vertebral deformity (OVD) evaluation with radiograph. The qualitative diagnosis with radiological knowledge helps to minimize false positive readings. However, unless there is a face-to-face training with experienced readers, it can be difficult to apply GSQ criteria by only reading the text description of Genant (in 1993), even for a musculoskeletal radiologist. We propose an expanded semi-quantitative (eSQ) OVD classification with the following features: (I) GSQ grade-0.5 is noted as minimal grade (eSQ grade-1) for OVDs with height loss <20%; (II) GSQ mild grade (grade-1) is the same as eSQ mild grade (grade-2); (III) GSQ moderate grade (grade-2) is subdivided into eSQ grade-3 (moderate, >25%-1/3 height loss) and eSQ grade-4 (moderately-severe, >1/3-40% height loss); (IV) GSQ severe grade is subdivided into eSQ grade-5 (severe, >40%-2/3 height loss) and eSQ grade-6 (collapsed, with >2/3 height loss). We advocate to estimate vertebral height loss with adjacent vertebral heights as the reference (rather than using individual vertebra's posterior height as the reference). This article presents radiographs of 36 cases with OVD, together with gradings using GSQ criteria and eSQ criteria. The examples in this article can serve as teaching material or calibration database for readers who will use GSQ criteria or eSQ criteria. Our approach for quantitative measurement is explained graphically.
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http://dx.doi.org/10.21037/atm.2020.02.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186643PMC
March 2020

Transthoracic ultrasound sign in severe asthmatic patients: a lack of "gliding sign" mimic pneumothorax.

BJR Case Rep 2019 Dec 15;5(4):20190030. Epub 2019 Nov 15.

Unit of Interventional and Diagnostic Ultrasound of Internal Medicine IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.

Transthoracic ultrasound (TUS) is a validate complementary technique widely used in everyday medical practice. TUS is the gold-standard for studying pleural effusion and for echo-guided thoracentesis, moreover, it is employed in detection of pleural and pulmonary lesions adherent to pleural surface and their ccho-guided percutaneous needle biopsy (PTNB). We used TUS technique to study severe asthma patients. We found that several patterns are constant in these patients. One of these patterns, . lack of gliding sign, mimic pneumothorax (PNX). In this study, we attempted an echographic approach to asthma, trying to lay the first stone for the individuation of common ultrasound patterns in this disease.
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http://dx.doi.org/10.1259/bjrcr.20190030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945254PMC
December 2019

Changes in Adipose Tissue Distribution and Association between Uric Acid and Bone Health during Menopause Transition.

Int J Mol Sci 2019 Dec 14;20(24). Epub 2019 Dec 14.

Menopause and Osteoporosis Centre, University of Ferrara, 44124 Ferrara, Italy.

Despite convincing experimental evidence, epidemiological studies on the effects of serum uric acid (SUA) on bone health are still conflicting since factors influencing SUA bioavailability have not been adequately considered. To shed some light on this issue, we investigated the impact of adiposity and menopause status on the relationship between SUA and bone health. We examined SUA in relation to bone mineral density (BMD) at different skeletal sites and with markers of bone metabolism in 124 pre-menopausal and 234 post-menopausal women and assessed whether adiposity, evaluated by anthropometry and dual x-ray absorptiometry (DXA), might have a discriminant role. After conservative adjustment (covariates: age, hormones treatment, smoking and time since menopause), SUA showed a significant and positive association with total hip BMD ( = 0.220, < 0.01) among postmenopausal women, maintained also after adjustment for legs adiposity. Notably, stratification for waist circumference quartiles revealed that the correlation between SUA and total hip BMD was significant ( = 0.444, = 0.001) in the highest quartile (91-100 cm). Our results suggest that SUA might be beneficial for bone health in postmenopausal women being characterized by a more android fat distribution, ascribing to SUA a discriminant role during menopause transition, potentially relevant also for men.
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http://dx.doi.org/10.3390/ijms20246321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941025PMC
December 2019

The role of radiological and hybrid imaging for muscle metastases: a systematic review.

Eur Radiol 2020 Apr 13;30(4):2209-2219. Epub 2019 Dec 13.

Radiology Institute, Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35100, Padova, Italy.

Aim Of The Study: Skeletal muscle metastases (SMM) are a rare entity, mainly detected at autopsy. Nevertheless, radiological and nuclear medicine imaging can contribute to the diagnosis with a significant impact on the treatment and prognosis of neoplastic patients. This study aimed to systematically review the features of SMM at imaging considering the primary tumors and the sites of occurrence.

Materials And Methods: We conducted a systematic search of three electronic database (i.e., PubMed, Science Direct, and Web of Science) up to May 2019, without any language or time interval restriction. Two reviewers performed the search and selection process, data extraction, and synthesis. We resolved disagreements by consensus and/or involving a third reviewer. The included studies have been classified according to the Oxford Centre for Evidence Based Medicine (CEBM) grading system.

Results: Out of 8598 and 1077 articles respectively for radiological and hybrid imaging, 29 papers were included. According to CEBM, twelve were level 4. Computed tomography (CT) is mainly applied and, despite the existence of CT and magnetic resonance-based classifications, these are rarely used. Positron emission tomography/CT allowed the detection of small and subtle lesion also in the extremities. Muscles of the trunk were mostly affected and mainly respiratory tumors are associated with this type of metastatic spread.

Conclusion: Radiological and hybrid imaging allow a precise characterization of SMM. However, a more systematic approach, including also the application of available classification systems, may increase the diagnostic accuracy for this rare type of metastases.

Key Points: • Skeletal muscle metastases have heterogeneous characteristics at imaging but mostly abscess-like features and high metabolic activity are described. • Skeletal muscle metastases mainly affect the muscles of the trunk. • Pulmonary, urological, and gastrointestinal cancers are the most frequent cause of skeletal muscle metastases.
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http://dx.doi.org/10.1007/s00330-019-06555-4DOI Listing
April 2020

Assessment of lumbar disc herniaton using fractional anisotropy in diffusion tensor imaging along with conventional T2-weighted imaging.

Neuroradiol J 2020 Feb 27;33(1):24-31. Epub 2019 Nov 27.

Radiology Department, IRCCS Ospedale Casa Sollievo della Sofferenza, Italy.

Objective: To assess the usefulness of diffusion tensor imaging and its fractional anisotropy map along with conventional T2-weighted imaging in evaluating the anisotropic water diffusion variations of annulus fibres involved in herniation disc pathology.

Materials And Methods: Seventy-five patients with previous medical ethics committee approval and informed consent experiencing low back pain were selected for this prospective randomised blinded trial. Lumbar disc fractional anisotropy maps were obtained acquiring diffusion tensor sequences on a 3T machine. The matrix of nucleus pulposus and structures of annulus fibres were analysed using fractional anisotropy textural features to highlight any presence of lumbar disc herniation. Observer variability and reliability between two neuroradiologists were evaluated. The χ test, two-tailed test and linear regression analysis were used to focus differences in patients' demographic data and magnetic resonance imaging findings.

Results: Annular fissures with extrusions were identified using diffusion tensor imaging in 10 out of 17 discs (study group) previously assessed as bulging discs using conventional magnetic resonance imaging. Eighteen extrusions out of 39 (study group) disc levels were identified on diffusion tensor imaging compared to eight extrusions highlighted on T2-weighted imaging ( < 0.01). All eight (study group) disc extrusions evaluated on T2-weighted imaging showed annular fissures on diffusion tensor imaging. Seven out of 14 (study group) protrusions highlighted on T2-weighted imaging had no annular fissures on diffusion tensor imaging; thirty-six disc levels in the control group had no evidence of annular fissures on diffusion tensor imaging ( > 0.01).

Conclusions: The addition of diffusion tensor imaging sequences and fractional anisotropy mapping to a conventional magnetic resonance imaging protocol could be useful in detecting annular fissures and lumbar disc herniation.
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http://dx.doi.org/10.1177/1971400919891288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005986PMC
February 2020

Weight-bearing CT Technology in Musculoskeletal Pathologies of the Lower Limbs: Techniques, Initial Applications, and Preliminary Combinations with Gait-Analysis Measurements at the Istituto Ortopedico Rizzoli.

Semin Musculoskelet Radiol 2019 Dec 19;23(6):643-656. Epub 2019 Nov 19.

Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

Musculoskeletal radiology has been mostly limited by the option between imaging under load but in two dimensions (i.e., radiographs) and three-dimensional (3D) scans but in unloaded conditions (i.e., computed tomography [CT] and magnetic resonance imaging in a supine position). Cone-beam technology is now also a way to image the extremities with 3D and weight-bearing CT. This article discusses the initial experience over a few studies in progress at an orthopaedic center. The custom design of total ankle replacements, the patellofemoral alignment after medial ligament reconstruction, the overall architecture of the foot bones in the diabetic foot, and the radiographic assessment of the rearfoot after subtalar fusion for correction of severe flat foot have all taken advantage of the 3D and weight-bearing feature of relevant CT scans. To further support these novel assessments, techniques have been developed to obtain 3D models of the bones from the scans and to merge these with state-of-the-art gait analyses.
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http://dx.doi.org/10.1055/s-0039-1697939DOI Listing
December 2019

Dynamic Weight-bearing Magnetic Resonance in the Clinical Diagnosis of Internal Temporomandibular Joint Disorders.

Semin Musculoskelet Radiol 2019 Dec 19;23(6):634-642. Epub 2019 Nov 19.

Department of Clinical and Experimental Medicine, University School of Medicine, Foggia, Italy.

Temporomandibular joint (TMJ) disorders can be painful and cause functional limitations and bone changes. Deeper clinical knowledge of the pathologies related to the TMJ has always been hindered by the difficult identification of the causes that limit its movement. Weight-bearing magnetic resonance imaging (WBMRI) can reproduce the articular movement in orthostasis and allows the evaluation of joint movement. WBMRI, compared with other procedures such as double-type condylography and real-time dynamic ultrasound, helps to better identify tissue characteristics of the articular glenoid-condylar surfaces, articular space, disk position on both the open and closed mouth, and the locoregional musculotendinous area. WBMRI also identifies the true position of the articular disk in orthostasis, emphasizing the different joint positions compared with the study carried out in a clinostatic (supine) position.
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http://dx.doi.org/10.1055/s-0039-1697938DOI Listing
December 2019