Publications by authors named "Mats Geijer"

79 Publications

Health-related quality of life in early psoriatic arthritis compared with early rheumatoid arthritis and a general population.

Semin Arthritis Rheum 2021 Feb 29;51(1):246-252. Epub 2020 Dec 29.

Department of Rheumatology, Skåne University Hospital and Lund University, Malmö, Sweden.

Objective: Both psoriatic arthritis (PsA) and rheumatoid arthritis (RA) have a significant impact on quality of life, but few reports have compared the two diseases. The current study assessed health-related quality of life (HRQoL) in PsA at diagnosis and after five years compared with early rheumatoid arthritis (RA) and a matched general population.

Methods: Patients with early PsA and early RA included in two Swedish registries with HRQoL data measured by the Medical Outcomes Study Short Form 36 (SF-36) at baseline and at five years follow-up were included. Differences in SF-36 scores compared with the general population were calculated for each patient. Physical function, disease activity, the delay before diagnosis, pain, and general wellbeing were used as explanatory variables. Statistical tests included t-tests and univariate and multivariate linear regression.

Results: PsA (n = 166) and RA (n = 133) patients of both sexes had significantly reduced HRQoL at disease onset. After five years, PsA patients still had impairments in several domains of SF-36, whereas RA patients had an almost normalized HRQoL. The time from symptom onset to diagnosis, disease activity, and disability independently contributed to the reduced improvement in PsA.

Conclusion: Both early PsA and RA are characterized by severely reduced HRQoL. Despite more severe disease at inclusion, normalization of HRQoL is seen in patients with RA but not PsA. This may be due to delay in the diagnosis of PsA or more powerful interventions in RA. Earlier detection, lifestyle intervention, and more aggressive management strategies may be needed for PsA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.semarthrit.2020.10.010DOI Listing
February 2021

Anti-CD74 IgA autoantibodies in radiographic axial spondyloarthritis; a longitudinal Swedish study.

Rheumatology (Oxford) 2020 Dec 28. Epub 2020 Dec 28.

Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden.

Objectives: Antibodies against anti-CD74 are related to axial spondyloarthritis (axSpA). The objectives were to study; 1) IgA anti-CD74 in radiographic (r)-axSpA patients in the Backbone cohort and to calculate the sensitivity and specificity of anti-CD74, 2) the fluctuation of IgA anti-CD74 levels in prospectively collected samples, 3) and to explore the relation between IgA anti-CD74 and radiographic spinal changes.

Methods: IgA anti-CD74 was analyzed by ELISA in 155 patients with r-axSpA and age- and sex-matched controls. BASDAI, ASDAS, BASFI, and BASMI were assessed and spinal radiographs were scored for r-axSpA related changes with mSASSS. Previously donated samples, before inclusion in the Backbone study, were identified in the Medical Biobank of Northern Sweden.

Results: A total of 155 patients comprising 69% men and 31% women, age (mean±SD) 55.5 ± 11.4 years, and 152 (98.1%) HLA-B27 positive, were included. The plasma level of IgA anti-CD74 was significantly higher in the patients, median (IQR), 12.9 (7.9-17.9) U/ml compared with controls 10.9 (7.2-14.6) U/ml, p= 0.003. IgA anti-CD74 was above the cut-off level of 20 U/ml in 36/155 (23.2%) patients and in 15/151 (9.9%) controls, p= 0.002. Multivariable logistic regression analyzes revealed that to have ≥1 syndesmophyte associated with IgA anti-CD74 (OR 5.64, 95% CI, 1.02-35.58, p= 0.048) adjusted for hsCRP, smoking, BMI, sex, and age. No distinct pattern of IgA anti-CD74 over time was revealed.

Conclusion: Plasma levels of IgA anti-CD74 were increased in r-axSpA and independently associated with radiographic spinal changes which suggests that IgA anti-CD74 could play a role in the pathogenies of r-axSpA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/rheumatology/keaa882DOI Listing
December 2020

Elevated serum level of hepatocyte growth factor predicts development of new syndesmophytes in men with ankylosing spondylitis.

Rheumatology (Oxford) 2020 Oct 27. Epub 2020 Oct 27.

Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg.

Objectives: To study baseline serum hepatocyte growth factor (s-HGF) as a predictor of spinal radiographic progression overall and by sex and to analyse factors correlated to changes in s-HGF in patients with AS.

Methods: At baseline and the 5-year follow-up, s-HGF was analysed with ELISA. Spinal radiographs were graded according to modified Stoke Ankylosing Spondylitis Spinal Score. Radiographic progression was defined as ≥2 modified Stoke Ankylosing Spondylitis Spinal Score units/5 years or development of ≥1 syndesmophyte. Logistic regression analyses were used.

Results: Of 204 baseline participants, 163 (80%) completed all examinations at the 5-year follow-up (54% men). Baseline s-HGF was significantly higher in men who developed ≥1 syndesmophyte compared with non-progressors, median (interquartile range) baseline s-HGF 1551 (1449-1898) vs 1436 (1200-1569) pg/ml, P = 0.003. The calculated optimal cut-off point for baseline s-HGF ≥1520 pg/ml showed a sensitivity of 70%, a specificity of 69% and univariate odds radio (95% CI) of 5.25 (1.69, 14.10) as predictor of development of ≥1 new syndesmophyte in men. Baseline s-HGF ≥1520 pg/ml remained significantly associated with development of ≥1 new syndesmophyte in men in an analysis adjusted for the baseline variables age, smoking, presence of syndesmophytes and CRP, odds radio 3.97 (1.36, 11.60). In women, no association with HGF and radiographic progression was found. Changes in s-HGF were positively correlated with changes in ESR and CRP.

Conclusion: In this prospective cohort study elevated s-HGF was shown to be associated with development of new syndesmophytes in men with AS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/rheumatology/keaa460DOI Listing
October 2020

Pre- and postoperative offset and femoral neck version measurements and validation using 3D computed tomography in total hip arthroplasty.

Acta Radiol Open 2020 Oct 8;9(10):2058460120964911. Epub 2020 Oct 8.

Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.

Background: Restoration of a correct biomechanical situation after total hip arthroplasty is important.

Purpose: To evaluate proximal femoral symmetry of acetabular and femoral offset and femoral neck anteversion pre- and postoperatively in hip arthroplasty by semi-automated 3D-CT and to validate the software measurements by inter- and intraobserver agreement calculations.

Material And Methods: In low-dose CT on 71 patients before and after unilateral total hip arthroplasty, two observers used a digital 3D templating software to measure acetabular offset, true and functional femoral offset, and femoral neck anteversion. Observer agreements were calculated using intraclass correlation. Hip measurements were compared in each patient and between pre- and postoperative measurements.

Results: Preoperatively, acetabular offset (2.4 mm), true (2.2 mm), and functional global offset (2.7 mm) were significantly larger on the osteoarthritic side without side-to-side differences for true and functional femoral offset or femoral neck anteversion. Postoperatively, acetabular offset was significantly smaller on the operated side (2.1 mm) with a concomitantly increased true (2.5 mm) and functional femoral offset (1.5 mm), resulting in symmetric true and functional global offsets. There were no differences in postoperative femoral neck anteversion. Inter- and intraobserver agreements were near-perfect, ranging between 0.92 and 0.98 with narrow confidence intervals (0.77-0.98 to 0.94-0.99).

Conclusion: Acetabular and concomitantly global offset are generally increased in hip osteoarthritis. Postoperative acetabular offset was reduced, and femoral offset increased to maintain global offset. 3D measurements were reproducible with near-perfect observer agreements. 3D data sets should be used for pre- and postoperative measurements in hip arthroplasty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2058460120964911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549166PMC
October 2020

Traumatic and non-traumatic bone marrow edema in ankle MRI: a pictorial essay.

Insights Imaging 2020 Aug 17;11(1):97. Epub 2020 Aug 17.

Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.

Bone marrow edema (BME) is one of the most common findings on magnetic resonance imaging (MRI) after an ankle injury but can be present even without a history of trauma. This article will provide a systematic overview of the most common disorders in the ankle and foot associated with BME.The presence of BME is an unspecific but sensitive sign of primary pathology and may act as a guide to correct and systematic interpretation of the MR examination. The distribution of BME allows for a determination of the trauma mechanism and a correct assessment of soft tissue injury. The BME pattern following an inversion injury involves the lateral malleolus, the medial part of the talar body, and the medial part of the distal tibia. In other cases, a consideration of the distribution of BME may indicate the mechanism of injury or impingement. Bone in direct contact with a tendon may lead to alterations in the bone marrow signal where BME may indicate tendinopathy or dynamic tendon dysfunction. Changed mechanical forces between bones in coalition may lead to BME. Degenerative changes or minor cartilage damage may lead to subchondral BME. Early avascular necrosis, inflammation, or stress fracture may lead to more diffuse BME; therefore, a detailed medical history is crucial for correct diagnosis.A systematic analysis of BME on MRI can help to determine the trauma mechanism and thus assess soft tissue injuries and help to differentiate between different etiologies of nontraumatic BME.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13244-020-00900-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431516PMC
August 2020

Loss of supervillin causes myopathy with myofibrillar disorganization and autophagic vacuoles.

Brain 2020 08;143(8):2406-2420

Institute of Human Genetics, Medical Faculty, RWTH Aachen University, Aachen, Germany.

The muscle specific isoform of the supervillin protein (SV2), encoded by the SVIL gene, is a large sarcolemmal myosin II- and F-actin-binding protein. Supervillin (SV2) binds and co-localizes with costameric dystrophin and binds nebulin, potentially attaching the sarcolemma to myofibrillar Z-lines. Despite its important role in muscle cell physiology suggested by various in vitro studies, there are so far no reports of any human disease caused by SVIL mutations. We here report four patients from two unrelated, consanguineous families with a childhood/adolescence onset of a myopathy associated with homozygous loss-of-function mutations in SVIL. Wide neck, anteverted shoulders and prominent trapezius muscles together with variable contractures were characteristic features. All patients showed increased levels of serum creatine kinase but no or minor muscle weakness. Mild cardiac manifestations were observed. Muscle biopsies showed complete loss of large supervillin isoforms in muscle fibres by western blot and immunohistochemical analyses. Light and electron microscopic investigations revealed a structural myopathy with numerous lobulated muscle fibres and considerable myofibrillar alterations with a coarse and irregular intermyofibrillar network. Autophagic vacuoles, as well as frequent and extensive deposits of lipoproteins, including immature lipofuscin, were observed. Several sarcolemma-associated proteins, including dystrophin and sarcoglycans, were partially mis-localized. The results demonstrate the importance of the supervillin (SV2) protein for the structural integrity of muscle fibres in humans and show that recessive loss-of-function mutations in SVIL cause a distinctive and novel myopathy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/brain/awaa206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447519PMC
August 2020

Biomechanical Properties of Common Carotid Arteries Assessed by Circumferential 2D Strain and β Stiffness Index in Patients With Ankylosing Spondylitis.

J Rheumatol 2020 Jul 1. Epub 2020 Jul 1.

This study was supported by grants from The Swedish Research Council, Västerbotten's Association Against Rheumatism, The Swedish Association Against Rheumatism, the County of Västerbotten (agreement concerning research and education of doctors), King Gustaf Vth 80-year Foundation, The Norrland's Heart Foundation, and Mats Kleberg's Foundation. 1H. Forsblad-d'Elia, MD, L. Law, BSc, J. Smeds, MD, B. Sundström, RPT, L. Ljung, MD, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå; 2K. Bengtsson, MD, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Department of Rheumatology, Gothenburg; 3M. Ketonen, MD, Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, Umeå; 4M. Geijer, MD, Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg and Faculty of Medicine, Lund University, Lund; 5S. Söderberg, MD, Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå; 6P. Lindqvist, BSc, Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, Umeå, Sweden. Address correspondence to Dr. H. Forsblad-d'Elia, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, SE-901 87 Umeå, Sweden. Email: Accepted for publication June 22, 2020.

Objective: Ankylosing spondylitis (AS) is associated with an elevated risk of cardiovascular disease (CVD) related to atherosclerosis, preceded by arterial stiffness. We aimed to examine common carotid artery (CCA) biomechanical properties using ultrasound to calculate β stiffness index (indicating arterial stiffness) and, a more recently developed technique, 2-dimensional (2D) speckle tracking strain (indicating arterial motion and deformation, strain) to (1) compare with age- and sex-matched controls, and (2) analyze relationships between strain and stiffness with disease characteristics and traditional risk factors for CVD in patients with AS.

Methods: In this cross-sectional study, a cohort of 149 patients with AS, mean age 55.3 ± 11.2 years, 102 (68.5%) men, and 146 (98%) HLA-B27-positive, were examined. Bilateral CCA were examined for circumferential 2D strain and β stiffness index. A subgroup of 46 patients was compared with 46 age- and sex-matched controls, both groups without hypertensive disease, diabetes, myocardial infarction, or stroke.

Results: Mean bilateral circumferential 2D strain was lower in AS patients compared with controls (7.9 ± 2.6% vs 10.3 ± 1.9%, < 0.001), whereas mean bilateral β stiffness index was higher (13.1 ± 1.7 mmHg/mm vs 12.3 ± 1.3 mmHg/mm, = 0.02). In multivariable linear regression analyses, strain was associated with age, erythrocyte sedimentation rate, history of anterior uveitis, and treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARD) and/or biological DMARD (R 0.33), while stiffness was associated with age (R 0.19).

Conclusion: Both CCA circumferential 2D strain and β stiffness index differed between patients with AS and controls. Strain was associated with AS-related factors and age, whereas only age was associated with stiffness, suggesting that the obtained results reflect different pathogenic vascular processes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3899/jrheum.200146DOI Listing
July 2020

Effect of symmetrical restoration for the migration of uncemented total hip arthroplasty: a randomized RSA study with 75 patients and 5-year follow-up.

J Orthop Surg Res 2020 Jun 17;15(1):225. Epub 2020 Jun 17.

Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.

Background: Inferior placement of a femoral stem is predictive for early loosening and failure, but does restoration of the original hip anatomy benefit the function and survival of a total hip replacement?

Methods: Seventy-five patients with primary unilateral hip osteoarthritis operated with an uncemented anatomical stem were randomized for either standard or modular stems. We used 50 ABG II stems with modular necks and 25 standard stems (control group). We measured the symmetry in hip anatomy between healthy and operated side. The anatomical restoration variables were anteversion, global offset, and femoral offset/acetabular offset (FO/AO) quota. We performed measurements using a CT-based 3D templating and measuring software. Migratory behavior of the stems was then measured postoperatively with repeated radiostereometry (RSA) examinations over 5 years.

Results: Both stem types showed an early (within 3 months) good stabilization after an initial slight rotation into retroversion and subsidence. There were no significant differences in RSA migration between modular and standard stems. Postoperative anteversion and FO/AO quota had no impact on stem migration. The standard stem tended to result in insufficient global offset (GO), whereas the modular stem did not.

Conclusions: The modular stem gave good symmetrical anatomical restoration and, like the standard version, a benign migratory behavior. Anteversion, GO, and FO/AO quota had no significant impact on stem migration. It therefore seems to be of no importance whether we choose a modular or a standard stem with regard to postoperative stem migration for this stem type. We overestimated the effect anatomical parameters have on stem movement; hence, we believe the study to be underpowered.

Trial Registration: ClinicalTrials.gov identifier: NCT01512550. Registered 19 January 2012-retrospectively registered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13018-020-01736-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301498PMC
June 2020

Can iterative reconstruction algorithms replace tube loading compensation in low kVp hepatic CT? Subjective versus objective image quality.

Acta Radiol Open 2020 Mar 16;9(3):2058460120910575. Epub 2020 Mar 16.

Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund, Sweden.

Background: Hepatic computed tomography (CT) with decreased peak kilovoltage (kVp) may be used to reduce contrast medium doses in patients at risk of contrast-induced acute kidney injury (CI-AKI); however, it increases image noise. To preserve image quality, noise has been controlled by X-ray tube loading (mAs) compensation (TLC), i.e. increased mAs. Another option to control image noise would be to use iterative reconstructions (IR) algorithms without TLC (No-TLC). It is unclear whether this may preserve image quality or only reduce image noise.

Purpose: To evaluate image quality of 80 kVp hepatic CT with TLC and filtered back projection (FBP) compared with 80 kVp with No-TLC and IR algorithms (SAFIRE 3 and 5) in patients with eGFR <45 mL/min.

Material And Methods: Forty patients (BMI 18-32 kg/m) were examined with both protocols following injection of 300 mg I/kg. Hepatic attenuation, image noise, enhancement, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and subjective image quality were evaluated for each patient.

Results: Comparing TLC/FBP with No-TLC/IR-S5, there were no significant differences regarding hepatic attenuation, image noise, enhancement, SNR and CNR: 114 vs. 115 HU, 14 vs. 14 HU, 55 vs. 57 HU, 8.0 vs. 8.4, and 3.8 vs. 4.0 in median, respectively. No-TLC/IR-S3 resulted in higher image noise and lower SNR and CNR than TLC/FBP. Subjective image quality scoring with visual grading showed statistically significantly inferior scores for IR-S5 images.

Conclusion: CT of 80 kVp to reduce contrast medium dose in patients at risk of CI-AKI combined with IR algorithms with unchanged tube loading to control image noise does not provide sufficient diagnostic quality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2058460120910575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7076580PMC
March 2020

Irritable bowel syndrome symptoms in axial spondyloarthritis more common than among healthy controls: is it an overlooked comorbidity?

Ann Rheum Dis 2020 01 4;79(1):159-161. Epub 2019 Oct 4.

Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/annrheumdis-2019-216134DOI Listing
January 2020

80-kV hepatic CT to reduce contrast medium dose in azotemic patients: a feasibility study.

Acta Radiol 2020 Apr 3;61(4):441-449. Epub 2019 Aug 3.

Institute of Clinical Sciences, Department of Radiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0284185119866807DOI Listing
April 2020

Elevated faecal calprotectin is linked to worse disease status in axial spondyloarthritis: results from the SPARTAKUS cohort.

Rheumatology (Oxford) 2019 07;58(7):1176-1187

Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund.

Objectives: To examine faecal calprotectin (F-calprotectin) levels and presence of anti-Saccharomyces cerevisiae antibodies (ASCA) and their associations with disease subtype and current status in axial SpA (axSpA).

Methods: F-calprotectin and ASCA in serum were compared between consecutive patients with a clinical axSpA diagnosis, classified as non-radiographic axSpA (nr-axSpA; n = 40) or AS (n = 90), and with healthy controls (n = 35). Furthermore, standard axSpA outcome measures were compared between axSpA patients (nr-axSpA and AS combined) with elevated vs normal F-calprotectin, ASCA IgA and IgG, respectively.

Results: Elevated F-calprotectin (⩾50 mg/kg) was observed in 27% of nr-axSpA patients, 38% of AS patients and 6% of controls. F-calprotectin was significantly higher in AS vs nr-axSpA [AS: geometric mean 41 (95% CI 32, 54) mg/kg; nr-axSpA: 24 (95% CI 16, 38) mg/kg; P = 0.037], and in each axSpA subtype vs controls. Overall, worse disease activity and physical function scores were observed among axSpA patients with elevated vs normal F-calprotectin levels, with significant differences regarding patient's visual analogue scale for global health, ASDAS using CRP, and BASFI (adjusted for age, sex, NSAID use, anti-rheumatic treatments, and CRP). ASCA titres and seropositivity (⩾10 U/ml) were similar in nr-axSpA (IgA/IgG-seropositivity: 8%/26%) and AS (7%/28%), and clinical outcome measures did not differ between patients with elevated vs normal ASCA IgA or IgG, respectively. Compared with controls (IgA/IgG-seropositivity: 0%/17%), ASCA IgA was significantly higher in both axSpA subtypes, and IgG was significantly higher in the AS group.

Conclusion: In patients with axSpA, gut inflammation measured by elevated F-calprotectin is associated with worse disease activity and physical function, and may be a marker of more severe disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/rheumatology/key427DOI Listing
July 2019

Intermediate-Term Outcome After Distal Radius Fracture in Patients With Poor Outcome at 1 Year: A Register Study With a 2- to 12-Year Follow-Up.

J Hand Surg Am 2019 Jan 27;44(1):39-45. Epub 2018 Nov 27.

Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.

Purpose: Most patients recover well from a distal radius fracture (DRF). However, approximately one-fifth have severe disability after 1 year when evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. In the present study, we evaluated this subgroup of patients in our register with an inferior outcome. We hypothesized that the patient-reported outcome would improve with time.

Methods: Since 2001, patients 18 years and older with a DRF, at the Department of Orthopedics, Skåne University Hospital (Lund, Sweden) are prospectively registered in the Lund Wrist Fracture Register. We have previously defined a DASH score above 35 at the 1-year follow-up as the cutoff of major disability. Between 2003 and 2012, 17% of the patients (445 of 2,571) in the register exceeded this cutoff. Three hundred eighty-eight were women and 57 men and the mean age was 69 years (range, 18-95 years). One-fourth had been surgically treated. In December 2014, 2 to 12 years after the fracture, a follow-up DASH questionnaire was sent to the 346 of 445 patients still alive.

Results: Seventy-three patients (27%) had initially been treated surgically and 196 (73%) nonsurgically for their DRF. Two hundred sixty-nine of 346 patients (78%) returned the follow-up DASH questionnaire at 2 to 12 years (mean, 5.5 years) after the fracture. The overall median DASH score improved from 50 at 1 year to 36 at the 2- to 12-year follow-up, (P < .05). Forty-seven percent had improved to a score below the cutoff 35, but 53% remained at a high suboptimal level.

Conclusions: The subjective outcome after a DRF improves over time for patients with an inferior result at 1 year, but more than half of the patients continue to have major disability.

Type Of Study/level Of Evidence: Prognostic II.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2018.10.015DOI Listing
January 2019

Association between muscle strength, histopathology, and magnetic resonance imaging in sporadic inclusion body myositis.

Acta Neurol Scand 2019 Feb 8;139(2):177-182. Epub 2018 Nov 8.

Neuromuscular Centre, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.

Objectives: Inclusion body myositis is characterized by inflammatory and degenerative changes, but the temporal relation of these events is unknown.

Materials And Methods: In nineteen patients with inclusion body myositis, muscle strength was correlated with inflammatory and degenerative findings on magnetic resonance imaging (MRI) and in muscle biopsies in three different muscles (tibialis anterior, vastus lateralis, and biceps brachii). Muscle strength, measured with a handheld dynamometer, was described as percentage of muscle strength in age- and sex-matched normal individuals. The muscles were categorized as the strongest, the intermediate, and the weakest muscle in each individual. T1-weighted sequences on MRI were used to evaluate the degree of fatty infiltration and muscle atrophy and STIR sequences to evaluate edematous changes.

Results: The vastus lateralis, which in general was the weakest muscle, was significantly more atrophic compared to the other two muscles and also demonstrated most edema. The biceps brachii had in most cases an intermediate degree of weakness and atrophy but the most pronounced inflammatory cell infiltration on biopsy. Cytochrome c oxidase-negative muscle fibers were significantly more prevalent in the vastus lateralis and biceps brachii muscles than in the tibialis anterior and thus correlated with muscular atrophy, indicating that this is a secondary change. Inflammatory changes as assessed by MRI and muscle biopsy were seen in all muscles irrespective of atrophy and thus appear to be prevalent at all stages of the disease.

Conclusions: Our study could not provide an answer to the question which comes first, the inflammation or the degenerative changes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ane.13040DOI Listing
February 2019

Preoperative CT of cardiac veins for planning left ventricular lead placement in cardiac resynchronization therapy.

Acta Radiol 2019 Jul 10;60(7):859-865. Epub 2018 Oct 10.

2 Department of Clinical Sciences, Arrhythmia Section, Lund University, Skane University Hospital, Lund, Sweden.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0284185118803796DOI Listing
July 2019

A five-year prospective study of spinal radiographic progression and its predictors in men and women with ankylosing spondylitis.

Arthritis Res Ther 2018 08 3;20(1):162. Epub 2018 Aug 3.

Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.

Background: Knowledge about predictors of new spinal bone formation in patients with ankylosing spondylitis (AS) is limited. AS-related spinal alterations are more common in men; however, knowledge of whether predictors differ between sexes is lacking. Our objectives were to study spinal radiographic progression in patients with AS and investigate predictors of progression overall and by sex.

Methods: Swedish patients with AS, age (mean ± SD) 50 ± 13 years, were included in a longitudinal study. At baseline and at 5-year follow up, spinal radiographs were graded according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Predictors were assessed by questionnaires, spinal mobility tests and blood samples.

Results: Of 204 patients included, 166 (81%) were re-examined and 54% were men. Men had significantly higher mean mSASSS at baseline and higher mean increase in mSASSS than women (1.9 ± 2.8 vs. 1.2 ± 3.3; p = 0.005) More men than women developed new syndesmophytes (30% vs. 12%; p = 0.007). Multivariate logistic regression analyses with progression ≥ 2 mSASSS units over 5 years or development of new syndesmophytes as the dependent variable showed that presence of baseline AS-related spinal radiographic alterations and obesity (OR 3.78, 95% CI 1.3 to 11.2) were independent predictors of spinal radiographic progression in both sexes. High C-reactive protein (CRP) was a significant predictor in men, with only a trend seen in women. Smoking predicted progression in men whereas high Bath Ankylosing Spondylitis Metrology Index (BASMI) and exposure to bisphosphonates during follow up (OR 4.78, 95% CI 1.1 to 20.1) predicted progression in women.

Conclusion: This first report on sex-specific predictors of spinal radiographic progression shows that predictors may partly differ between the sexes. New predictors identified were obesity in both sexes and exposure to bisphosphonates in women. Among previously known predictors, baseline AS-related spinal radiographic alterations predicted radiographic progression in both sexes, high CRP was a predictor in men (with a trend in women) and smoking was a predictor only in men.

Trial Registration: ClinicalTrials.gov , NCT00858819 . Registered on 9 March 2009. Last updated 28 May 2015.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13075-018-1665-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091099PMC
August 2018

Impact of donor chest radiography on clinical outcome after lung transplantation.

Acta Radiol Open 2018 Jun 14;7(6):2058460118781419. Epub 2018 Jun 14.

Centre for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.

Background: Organ donation guidelines recommend a "clear" conventional bedside chest radiograph before lung transplantation despite only moderate accuracy for cardiopulmonary abnormalities.

Purpose: To evaluate the influence of donor image interpretation on lung transplantation outcome in recipients by following early and late complications, one-year survival, and to correlate imaging findings and blood gas analysis with lung transplantation outcome in recipients.

Material And Methods: In 35 lung donors from a single institution clinical reports and study reviews of imaging findings of the mandatory bedside chest radiographs and blood gas analyses were compared with clinical outcome in 38 recipients. Hospitalization time, peri- and postoperative complications, early complications (primary graft dysfunction, infection), 30-day and one-year survival, and forced expiratory volume in 1 s percentage of predicted normal value (FEV1%) at one-year follow-up were analyzed.

Results: Findings in clinical reports and study reviews differed substantially, e.g. regarding reported decompensation, edema, infection, and atelectasis. No correlation was shown between imaging findings in clinical report or study review and blood gas analyses in the lung donors compared to postoperative outcome in recipients.

Conclusion: The interpretation of the mandatory chest radiograph in its present form does not influence one-year outcome in lung transplantation. Larger imaging studies or a change in clinical routine including computed tomography may provide evidence for future guidelines.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2058460118781419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024291PMC
June 2018

Added value of double reading in diagnostic radiology,a systematic review.

Insights Imaging 2018 Jun 28;9(3):287-301. Epub 2018 Mar 28.

Department of Radiology, Faculty of Medicine and Health, Örebro University, 701 85, Örebro, Sweden.

Objectives: Double reading in diagnostic radiology can find discrepancies in the original report, but a systematic program of double reading is resource consuming. There are conflicting opinions on the value of double reading. The purpose of the current study was to perform a systematic review on the value of double reading.

Methods: A systematic review was performed to find studies calculating the rate of misses and overcalls with the aim of establishing the added value of double reading by human observers.

Results: The literature search resulted in 1610 hits. After abstract and full-text reading, 46 articles were selected for analysis. The rate of discrepancy varied from 0.4 to 22% depending on study setting. Double reading by a sub-specialist, in general, led to high rates of changed reports.

Conclusions: The systematic review found rather low discrepancy rates. The benefit of double reading must be balanced by the considerable number of working hours a systematic double-reading scheme requires. A more profitable scheme might be to use systematic double reading for selected, high-risk examination types. A second conclusion is that there seems to be a value of sub-specialisation for increased report quality. A consequent implementation of this would have far-reaching organisational effects.

Key Points: • In double reading, two or more radiologists read the same images. • A systematic literature review was performed. • The discrepancy rates varied from 0.4 to 22% in various studies. • Double reading by sub-specialists found high discrepancy rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13244-018-0599-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990995PMC
June 2018

[Lumbar spine radiography – unreliable diagnostic accuracy and negligible value for the patients].

Lakartidningen 2017 11 14;114. Epub 2017 Nov 14.

Institutionen för translationell medicin - Divisionen för medicinsk radiologi Malmö, Sweden Institutionen för translationell medicin - Divisionen för medicinsk radiologi Malmö, Sweden.

Lumbar spine radiography - unreliable diagnostic accuracy and negligible value for the patients In 2016 140 000 lumbar spine radiographies were performed in Sweden (14 000 per million inhabitants) to a cost of about 85 million SEK (≈8.5 million Euro) and a negligible value for the patients with low back pain. In the work-up of low back pain, when imaging is indicated, lumbar spine radiography should be replaced by limited magnetic resonance imaging including a whole lower body coronal STIR sequence or computed tomography with radiation dose adapted to indication and patient age. Indication for imaging should be restricted to 1) low back pain with more than 3-4 weeks duration in combination with at least one »red flag«, 2) radicular pain without improvement on conservative treatment, or 3) low back pain with more than 8 weeks duration in combination with »yellow flags«.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2017

Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study.

Arthritis Res Ther 2017 Dec 8;19(1):273. Epub 2017 Dec 8.

Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.

Background: Studies have shown increased prevalence of osteoporosis and increased risk for vertebral fractures in patients with ankylosing spondylitis (AS). Measurements of bone mineral density (BMD) in the lumbar spine anterior-posterior (AP) projection may be difficult to interpret due to the ligamentous calcifications, and the lateral projection might be a better measuring site. Our objectives were to investigate BMD changes after 5 years at different measuring sites in patients with AS and to evaluate disease-related variables and medications as predictors for BMD changes.

Methods: In a longitudinal study, BMD in Swedish AS patients, 50 ± 13 years old, was measured with dual-energy x-ray absorptiometry (DXA) at the hip, the lumbar spine AP and lateral projections, and the total radius at baseline and after 5 years. Patients were assessed with questionnaires, blood samples, and spinal radiographs for grading of AS-related alterations in the spine with the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and assessment of vertebral fractures by the Genant score. Multiple linear regression analyses were used to investigate predictors for BMD changes.

Results: Of 204 patients included at baseline, 168 (82%) were re-examined after 5 years (92 men and 76 women). BMD decreased significantly at the femoral neck and radius and increased significantly at the lumbar spine, both for AP and lateral projections. Mean C-reactive protein during follow-up predicted a decrease in the femoral neck BMD (change in %, β = -0.15, p = 0.046). Use of bisphosphonates predicted an increase in BMD at all measuring sites (p < 0.001 to 0.013), except for the total radius. Use of tumor necrosis factor inhibitors (TNFi) predicted an increase in AP spinal BMD (β = 3.15, p = 0.012).

Conclusion: The current study (which has a long follow-up, many measuring sites, and is the first to longitudinally assess the lateral projection of the spine in AS patients) surprisingly showed that lateral projection spinal BMD increased. This study suggests that the best site to assess bone loss in AS patients is the femoral neck and that inflammation has an adverse effect, and the use of bisphosphonates and TNFi has a positive effect, on BMD in AS patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13075-017-1480-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721362PMC
December 2017

No long-term risk of wrist osteoarthritis due to subchondral haematomas in distal radial fractures.

J Plast Surg Hand Surg 2018 Jun 8;52(3):163-165. Epub 2017 Sep 8.

a Department of Hand Surgery , Skåne University Hospital Malmö , Malmö , Sweden.

Objective: The objective of this study of distal radius fractures was to determine if a subchondral haematoma in an unfractured compartment predicts secondary osteoarthritis.

Methods: In 1995-1997, 41 patients, 22 women, a median age of 41 years (20-57 years) with a displaced distal radius fracture underwent diagnostic wrist arthroscopy in addition to the fracture treatment. In 12 patients (7/12 women), subchondral haematomas were identified in a joint compartment not involved in the fracture.

Results: At 13-15 years, 37 patients were still alive. Twenty-eight patients attended the follow-up and 8/28 had had a subchondral haematoma within an uninjured compartment at the time of arthroscopy. The range of motion at 13-15 years was impaired in the injured wrist, but unrelated to the presence of a subchondral haematoma. The mean grip strength in patients with subchondral haematoma was 80% of the contralateral, compared to 78% in patients without. No correlation was found between the presence of a subchondral haematoma at arthroscopy and the development of radiographic osteoarthritis in the long term.

Conclusion: The presence of a subchondral hematoma in an uninjured compartment at the time of fracture did not alter the long-term clinical or radiographic outcome after a distal radius fracture.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/2000656X.2017.1372290DOI Listing
June 2018

DAPSA, DAS28 and MDA predict long-term treatment regime in psoriatic arthritis. The Swedish Early Psoriatic Arthritis Cohort.

Clin Exp Rheumatol 2017 Nov-Dec;35(6):936-942. Epub 2017 Jun 16.

Department of Public Health and Clinical, Medicine/Rheumatology, Umeå University, Sweden.

Objectives: To describe treatment patterns in the Swedish early psoriatic arthritis cohort (SwePsA) of the mono-/oligo-arthritic (M/O) and polyarthritis (P) and identify early predictive factors for treatment with disease-modifying anti-rheumatic (DMARD), non-steroidal anti-inflammatory drugs (NSAID), and tumour necrosis factor inhibition (TNFi) after 5 years.

Methods: Data for 198 M/O and P PsA were obtained within the programme for SwePsA. Multinomial and binary logistic regression analyses were used to assess the association between early predictive factors and treatment after 5 years adjusted for age at inclusion. The analysis of DMARD/NSAID was adjusted for medication at inclusion.

Results: After inclusion visit, DMARD was prescribed in 30% of M/O and 56% of P PsA; mainly methotrexate. TNFi was not prescribed at inclusion, but 23 patients were treated at 5-year follow-up. The adjusted OR (95% CI) for treatment with both DMARD and NSAID after 5 years was 3.65 (1.34 - 9.89) (p=0.010) for Disease Activity Score 28 (DAS28) >3.2 and 2.90 (1.20-6.99) (p=0.038) for Disease Activity Index in Psoriatic Arthritis (DAPSA) >14 at inclusion. TNFi treatment was, after adjusting for age, associated with high erythrocyte sedimentation rate (p=0.0043), high C-reactive protein (p=0.013), DAPSA (p<0.001), not reaching minimal disease activity (p=0.001) high health assessment questionnaire (p=0.001), patient's overall assessment on the visual analogue scale (VAS) (p=0.009), high pain VAS (p=0.007), and high number of tender and swollen joints (p=0.031) at inclusion.

Conclusions: Disease activity in early M/O and P PsA is to be considered in deciding the level of health care assessment and future pharmacological treatment. DAS28 >3.2 and DAPSA>14 early in the disease predict subsequent treatment with DMARD. For prediction of biological treatment, not reaching MDA at onset of disease, would be the composite index of choice.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2018

Effective dose in low-dose CT compared with radiography for templating of total hip arthroplasty.

Acta Radiol 2017 Oct 27;58(10):1276-1282. Epub 2017 Mar 27.

2 Department of Clinical Sciences, Lund University, Lund, Sweden.

Background Recently, total hip arthroplasty (THA) has come to focus on restoration of individual anatomy including femoral neck anteversion and global offset (femoral and acetabular offset). Three-dimensional (3D) computed tomography (CT) data could provide a better basis for preoperative templating. The use of CT has been hampered by high radiation dose. Purpose To evaluate the effective dose used in pelvis and hip CT for THA templating. Material and Methods CT data from two clinical trials of THA were evaluated for CT scan length and volume CT dose index (CTDI). The effective doses from hip-knee-ankle CT and pelvis and hip radiography were compared. Conversion factors for effective dose for radiography were calculated using the PCXMC software. Results A reduced dose CT protocol for pelvis imaging gave a substantial dose reduction compared with standard CT, while maintaining sufficient image quality. Between the two clinical trials there was a significant reduction in effective CT dose corresponding to changes in the CT protocol ( P < 0.01). The CT dose for the latter group was similar to, but nevertheless significantly higher than for, radiography ( P < 0.01). However, in the latter group the theoretical minimum dose for CT, using the minimum scan length required by the templating software, was equal to the dose from radiography. Conclusion Although the CT dose remained higher than for radiography, potential reductions in scan length could reduce the dose further so that CT would have a comparable level of risk to radiography with the added benefit of 3D templating.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0284185117693462DOI Listing
October 2017

Similar 1-year subjective outcome after a distal radius fracture during the 10-year-period 2003-2012.

Acta Orthop 2017 Aug 14;88(4):451-456. Epub 2017 Mar 14.

a Department of Orthopedics , Clinical Sciences, Lund University and Skåne University Hospital , Lund.

Background and purpose - During the last decades, treatment of distal radius fractures (DRFs) has changed, with surgical intervention being more common and with new techniques. We investigated whether this change has influenced the subjective outcome. Here we report, year by year, the 1-year score after a DRF over a 10-year-period, using a patient-reported outcome measure. Patients and methods - Patients aged 18 years or more with a DRF between 2003 and 2012 were prospectively and consecutively registered in a longitudinal outcome database. 1 year after the fracture, all the patients were sent a validated subjective outcome questionnaire, the Disabilities of the Arm, Shoulder, and Hand (DASH). The lower the score (0-100), the better the outcome. Results - Between 2003 and 2012, 3,666 patients (2,833 of them women; mean age 62 (18-98) years) were included. 22% were operated and the rate remained constant over the years. The surgical methods shifted from external fixators (42%) and fragment-specific plates (45%) in 2003, to mainly volar locking plates (65%) in 2012. 70% of the patients responded to the 1-year DASH questionnaire. The median DASH score was 9 (IQR: 2-25) for the cohort, both in surgically treated patients (9 (IQR: 3-25)) and in non-surgically treated patients (9 (IQR 2-27)). Subgroup analysis showed a higher median DASH score for women than for men; for patients with AO type C fractures rather than type B or type A fractures; for patients with external fixation or fragment-specific fixation than for those who underwent surgery using volar locking plates; and for patients who were operated by a general orthopedic surgeon rather than a hand surgeon. Interpretation - The shift in surgical treatment had no influence on the subjective outcome for the cohort.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/17453674.2017.1303601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499340PMC
August 2017

MR appearance of the temporal evolution and resolution of spontaneous osteonecrosis of the knee: a case report.

Acta Radiol Open 2017 Feb 1;6(2):2058460116688719. Epub 2017 Jan 1.

Department of Radiology, Akademiska Hospital, Uppsala, Sweden.

Spontaneous osteonecrosis of the knee (SONK) is a feared condition of unknown cause, in its classic form appearing in the medial femoral condyle in middle-aged or elderly subjects. Diagnosis with radiography is notoriously difficult with a long latency before typical changes appear. Magnetic resonance imaging (MRI) is regarded as a diagnostic tool with the possibility to give an earlier diagnosis with improved chances for treatment. However, also with MRI there may be an initial diagnostic blind spot before typical changes appear. Little is known about the temporal evolution of the MRI changes. In the current case report, a case of SONK is reported where serial imaging with MRI was performed, from initial symptoms to eventual resolution after almost three years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2058460116688719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298408PMC
February 2017

Impact of iterative reconstruction on image quality of low-dose CT of the lumbar spine.

Acta Radiol 2017 Jun 14;58(6):702-709. Epub 2016 Nov 14.

1 Department of Radiology, School of Medical Sciences, Örebro University, Örebro, Sweden.

Background Iterative reconstruction (IR) is a recent reconstruction algorithm for computed tomography (CT) that can be used instead of the standard algorithm, filtered back projection (FBP), to reduce radiation dose and/or improve image quality. Purpose To evaluate and compare the image quality of low-dose CT of the lumbar spine reconstructed with IR to conventional FBP, without further reduction of radiation dose. Material and Methods Low-dose CT on 55 patients was performed on a Siemens scanner using 120 kV tube voltage, 30 reference mAs, and automatic dose modulation. From raw CT data, lumbar spine CT images were reconstructed with a medium filter (B41f) using FBP and four levels of IR (levels 2-5). Five reviewers scored all images on seven image quality criteria according to the European guidelines on quality criteria for CT, using a five-grade scale. A side-by-side comparison was also performed. Results There was significant improvement in image quality for IR (levels 2-4) compared to FBP. According to visual grading regression, odds ratios of all criteria with 95% confidence intervals for IR2, IR3, IR4, and IR5 were: 1.59 (1.39-1.83), 1.74 (1.51-1.99), 1.68 (1.46-1.93), and 1.08 (0.94-1.23), respectively. In the side-by-side comparison of all reconstructions, images with IR (levels 2-4) received the highest scores. The mean overall CTDI was 1.70 mGy (SD 0.46; range, 1.01-3.83 mGy). Image noise decreased in a linear fashion with increased strength of IR. Conclusion Iterative reconstruction at levels 2, 3, and 4 improves image quality of low-dose CT of the lumbar spine compared to FPB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0284185116669870DOI Listing
June 2017

Fragment-Specific Fixation Versus Volar Locking Plates in Primarily Nonreducible or Secondarily Redisplaced Distal Radius Fractures: A Randomized Controlled Study.

J Hand Surg Am 2017 Mar 11;42(3):156-165.e1. Epub 2017 Jan 11.

Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.

Purpose: To compare the patient-reported, clinical, and radiographic outcome of 2 methods of internal fixation in distal radius fractures.

Methods: Fifty patients, mean age 56 years (range, 21-69 years) with primarily nonreducible or secondarily redisplaced distal radius fractures were randomized to open reduction internal fixation using volar locking plates (n = 25) or fragment-specific fixation (n = 25). The patients were assessed on grip strength, range of motion, patient-reported outcome (Quick Disabilities of the Arm, Shoulder, and Hand), pain (visual analog scale), health-related quality of life (Short Form-12 [SF-12]), and radiographic evaluation. Grip strength at 12 months was the primary outcome measure.

Results: At 12 months, no difference was found in grip strength, which was 90% of the uninjured side in the volar plate group and 87% in the fragment-specific fixation group. No differences were found in range of motion and the median Quick Disabilities of the Arm, Shoulder, and Hand score was 5 in both groups. The overall complication rate was significant, 21% in the volar locking plate group, compared with 52% in the fragment-specific group.

Conclusions: In treatment of primarily nonreducible or secondarily redisplaced distal radius fractures, volar locking plates and fragment-specific fixation both achieve good and similar patient-reported outcomes, although more complications were recorded in the fragment-specific group.

Type Of Study/level Of Evidence: Therapeutic II.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2016.12.001DOI Listing
March 2017

Imaging of the Lungs in Organ Donors and its Clinical Relevance: A Retrospective Analysis.

J Thorac Imaging 2017 Mar;32(2):107-114

Departments of *Radiology ∥Neurosurgery ¶Cardiothoracic Surgery, Skåne University Hospital †Department of Laboratory Medicine ‡Divison of Clinical Chemistry and Pharmacology §Lund University Bioimaging Centre **Department of Clinical Sciences, Lund University, Lund ††Department of Radiology, Örebro University, Örebro, Sweden #Meander Medical Centre, Amersfoort, The Netherlands.

Purpose: The aim of the study was to retrospectively evaluate the diagnostic imaging that potential lung donors undergo, the reader variability of image interpretation and its relevance for donation, and the potential information gained from imaging studies not primarily intended for lung evaluation but partially including them.

Materials And Methods: Bedside chest radiography and computed tomography (CT), completely or incompletely including the lungs, of 110 brain-dead potential organ donors in a single institution during 2007 to 2014 were reviewed from a donation perspective. Two chest radiologists in consensus analyzed catheters and cardiovascular, parenchymal, and pleural findings. Clinical reports and study review were compared for substantial differences in findings that could have led to a treatment change, triggered additional examinations such as bronchoscopy, or were considered important for donation.

Results: Among 136 bedside chest radiographs, no differences between clinical reports and study reviews were found in 37 (27%), minor differences were found in 28 (21%), and substantial differences were found in 71 (52%) examinations (P<0.0001). In 31 of 42 (74%) complete or incomplete CT examinations, 50 of 74 findings with relevance for lung donation were not primarily reported (P<0.0001).

Conclusions: The majority of donor patients undergo only chest radiography. A targeted imaging review of abnormalities affecting the decision to use donor lungs may be useful in the preoperative stage. With a targeted list, substantial changes were made from initial clinical interpretations. CT can provide valuable information on donor lung pathology, even if the lungs are only partially imaged.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RTI.0000000000000255DOI Listing
March 2017

A computer-assisted systematic quality monitoring method for cervical hip fracture radiography.

Acta Radiol Open 2016 Dec 5;5(12):2058460116674749. Epub 2016 Dec 5.

Department of Medical Imaging and Physiology, Skåne University Hospital and Lund University, Lund, Sweden.

Background: A thorough quality analysis of radiologic performance is cumbersome. Instead, the prevalence of missed cervical hip fractures might be used as a quality indicator.

Purpose: To validate a computer-based quality study of cervical hip fracture radiography.

Material And Methods: True and false negative and positive hip trauma radiography during 6 years was assessed manually. Patients with two or more radiologic hip examinations before surgery were selected by computer analysis of the databases. The first of two preoperative examinations might constitute a missed fracture. These cases were reviewed.

Results: Out of 1621 cervical hip fractures, manual perusal found 51 (3.1%) false negative radiographic diagnoses. Among approximately 14,000 radiographic hip examinations, there were 27 (0.2%) false positive diagnoses. Fifty-seven percent of false negative reports were occult fractures, the other diagnostic mistakes. There were no significant differences over the years. Diagnostic sensitivity was 96.9% and specificity 99.8%. Computer-assisted analysis with a time interval of at least 120 days between the first and the second radiographic examination discovered 39 of the 51 false negative reports.

Conclusion: Cervical hip trauma radiography has high sensitivity and specificity. With computer-assisted analysis, 76% of false negative reports were found.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2058460116674749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152935PMC
December 2016