Publications by authors named "Paolo Spinnato"

60 Publications

Superior mesenteric artery syndrome after scoliosis surgery.

Pediatr Int 2019 Nov;61(11):1181-1182

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

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http://dx.doi.org/10.1111/ped.13992DOI Listing
November 2019

Difficult diagnosis of Angiomatoid Fibrous Histiocytoma of the leg mimicking a benign condition.

J Radiol Case Rep 2019 Apr 30;13(4):38-45. Epub 2019 Apr 30.

Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

Angiomatoid fibrous histiocytoma is a rarely metastasizing soft-tissue tumor of low-grade malignancy. Here we report a case of angiomatoid fibrous histiocytoma located in the leg of a 15-year-old female. This case is of particular interest due to its radiological features that led to raise two questions concerning the nature of the disease (is it reactive or tumoral?) and its site of origin (within soft tissues or the tibial periosteum?). Here we describe ultrasound, magnetic resonance imaging, computed tomography scan and positron emission tomography findings that helped answer these questions, understand the real nature of the disease and its appropriate treatment. This case shows that a single type of imaging technique may not be sufficient to understand the real nature of a musculoskeletal lesion and that it is necessary to combine all information derived from various imaging techniques in order to correctly diagnose and treat the disease.
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http://dx.doi.org/10.3941/jrcr.v13i4.3414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6743639PMC
April 2019

MRI Diagnosis of Obesity-Related Spinal Epidural Lipomatosis.

Can J Neurol Sci 2020 Jan 29;47(1):124-125. Epub 2019 Oct 29.

Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.

A 61-year-old male presented to our hospital complaining of claudication: bilateral leg weakness impeding mobility. Symptoms started after 100 m of walk and recede after several minutes of rest. The patient was obese, with a body mass index (BMI) of 41 kg/m2 and reported a weight gain of about 55 pounds in the last year. Patient's comorbidities were dyslipidemia, hypertension, and antithrombin III deficiency. The patient also suffered from chronic low-back pain recently worsened and cervical pain. Pulses in the lower limbs were present. Neurological examination was also unremarkable.
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http://dx.doi.org/10.1017/cjn.2019.301DOI Listing
January 2020

Neurofibromatosis type-1-associated diffuse lung disease in children.

Pediatr Pulmonol 2019 11 13;54(11):1760-1764. Epub 2019 Aug 13.

Department of Imaging, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.

Objective: The purpose of the study was to investigate the occurrence of diffuse lung disease associated with neurofibromatosis type-1 in the pediatric population. We also aimed at evaluating computed tomography (CT) findings of the disease.

Introduction: Diffuse lung disease associated with neurofibromatosis type-1 has been described mainly in the adult population; causes and connections between lung disease and the genetic disorder are still not completely understood. The occurrence of the disease in non-smokers, the presence of blebs, bullae or cysts distinct from smoking-related emphysema on CT and the histopathological pattern characterized by lymphoplasmocytic inflammation and fibrosis, are all factors that support the association of diffuse lung disease as a distinct manifestation of neurofibromatosis.

Methods: We retrospectively reviewed, with "lung window," all the spinal CTs performed in two institutions from 2004 to 2018 for scoliosis assessment in pediatric patients affected by neurofibromatosis type-1 (group 1). Moreover, we retrospectively analyzed a control group of pediatric patients, affected by severe scoliosis without neurofibromatosis (group 2). Differences between the two groups were analyzed to ascertain whether the disease can be related to neurofibromatosis type-1 rather than to scoliosis.

Results: Six out of thirty one subjects from group 1 (19.4%) showed a condition of diffuse lung disease while none (0 of 31) in group 2. The differences between the two groups were statistically significant (P = .01). All six patients showed subpleural blebs, bullae, or cysts without basilar fibrosis.

Conclusion: Our research consolidates the hypothesis that diffuse lung disease is a direct manifestation of neurofibromatosis type-1 and that early onset is possible, even in pediatric patients.
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http://dx.doi.org/10.1002/ppul.24481DOI Listing
November 2019

Imaging the Postsurgical Upper Limb: The Radiologist Perspective.

Radiol Clin North Am 2019 Sep 12;57(5):977-1000. Epub 2019 Jun 12.

Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy.

Imaging has a paramount role in postsurgical assessment. Radiologists need to be familiar with the different surgical procedures to be able to identify expected postsurgical appearances and also detect potential complications. This article reviews the indications, normal expected postsurgical appearances, and complications of the most frequently used surgical procedures in the shoulder, elbow, and wrist. The emphasis is on points that should not be overlooked in the surgical planning.
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http://dx.doi.org/10.1016/j.rcl.2019.03.009DOI Listing
September 2019

An Unexpected Cause of Transient Tetraplegia.

Indian J Pediatr 2019 12 23;86(12):1164-1165. Epub 2019 Jul 23.

Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

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http://dx.doi.org/10.1007/s12098-019-03041-zDOI Listing
December 2019

Does pre-operative MRI predict the risk of local recurrence in primary myxofibrosarcoma of the extremities?

Asia Pac J Clin Oncol 2019 Oct 20;15(5):e181-e186. Epub 2019 May 20.

Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.

Objective: The aim of this retrospective study is to analyze and classify magnetic resonance imaging (MRI) features of primary myxofibrosarcoma (MFS) of the extremities and their correlation with patients' prognosis (local recurrence [LR] and sarcoma-specific survival [OS]).

Methods: Ninety-four patients with primary MFS of the extremities were included. All MRI were performed with 1.5 Tesla magnet using a standard protocol. The presence of a "tail pattern" was recorded. Myxoid tumor component and contrast enhancement of the tumor were evaluated and graded with semiquantitative method using a newly proposed classification.

Results: A tail-like pattern was observed in 32% MFS; most of the tumors presented with high myxoid features and high grade of gadolinium (Gd) enhancement. Type 3 myxoid characteristics (P = 0.003) were most often observed in FNCLCC grade 3 tumors. Estimated LR-free survival rate was 70.3% at 3 and 58.4% at 5 years. A higher LR-rate was observed in those tumors presenting a tail-like pattern at MRI (P = 0.039), in those with myxoid features type 2 and 3 (0.047) and in those with Gd enhancement grade 2 or 3 (P = 0.029). A worse OS was observed in Gd enhancement grade 3 (P = 0.013) and in deep tumors (P = 0.031).

Conclusions: MFS features on preoperative MRI can be useful in order to identify risk classes of LR and OS. These data may suggest that patients with a tail-like pattern, high Gd enhancement and high myxoid features should be followed up more carefully after surgery.
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http://dx.doi.org/10.1111/ajco.13161DOI Listing
October 2019

What's new in management of bone metastases?

Eur J Orthop Surg Traumatol 2019 Oct 14;29(7):1367-1375. Epub 2019 May 14.

First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece.

Metastases are the most common malignancy in bone. In patients with bone metastases, especially if a limited expected survival, the indications for surgical treatment are limited, immediate pain relief and improvement in the functional status are important, and complications of treatments are unwanted. Novel medical treatments can offer an effective palliative option in these patients. Advances in interventional radiology and surgery have led to the development of less invasive techniques with the aim to achieve the same clinical results with less surgical morbidity. These include embolization, electrochemotherapy, magnetic resonance imaging-guided high-intensity focused ultrasound, and thermal ablation. Less invasive techniques combine the advantages of less invasive procedures including decreased blood loss, earlier functional recovery and initiation of adjuvant medical therapies and seem to be both effective in pain relief and local tumor control.
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http://dx.doi.org/10.1007/s00590-019-02446-yDOI Listing
October 2019

Spontaneous bilateral medial head of gastrocnemius muscle rupture.

BMJ Case Rep 2019 Mar 31;12(3). Epub 2019 Mar 31.

Department of Diagnostic and Interventional Radiology (IRCCS), Istituto Ortopedico Rizzoli, Bologna, Italy.

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http://dx.doi.org/10.1136/bcr-2019-229252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453291PMC
March 2019

Bone marrow biopsy in the initial staging of Ewing sarcoma: Experience from a single institution.

Pediatr Blood Cancer 2019 06 5;66(6):e27653. Epub 2019 Feb 5.

Chemotherapy Section, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy.

Background: Ewing sarcoma (ES) is the second most common bone tumor in adolescents and children. Staging workup for ES includes imaging and bone marrow biopsy (BMB). The effective role of BMB is now under discussion.

Procedure: A monoinstitutional retrospective analysis reviewed clinical charts, imaging, and histology of patients with diagnosis of ES treated at the Rizzoli Institute between 1998 and 2017.

Results: The cohort included 504 cases of ES of bone; 137 (27%) had metastases at diagnosis, while the remaining 367 had localized disease. Twelve patients had a positive BMB (2.4%). Eleven had distant metastases detected at initial workup staging with imaging assessment: six patients presented with bone metastases, five with both bone and lung metastases. Only one patient with ES of the foot (second metatarsus) was found to have bone marrow involvement with negative imaging evaluation (0.3%).

Conclusions: On the basis of our data, we suggest reconsidering the effective role of BMB in initial staging workup for patients with ES with no signs of metastases by modern imaging techniques. In metastatic disease, the assessment of the bone marrow status may remain useful to identify a group of patients at very high risk who could benefit from different treatment strategies.
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http://dx.doi.org/10.1002/pbc.27653DOI Listing
June 2019

Vertebral Fractures of Unknown Origin: Role of Computed Tomography-Guided Biopsy.

Int J Spine Surg 2018 Dec 21;12(6):673-679. Epub 2018 Dec 21.

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

Background: We performed a retrospective evaluation of histological and imaging results of patients submitted to computed tomography (CT)-guided biopsy for vertebral fractures (VFs) of unknown etiology to evaluate the pathological causes of fractures and also to observe the diagnostic results of imaging studies available.

Methods: We retrospectively reviewed all the CT-guided vertebral biopsies performed in our institution in the last 2 years, selecting patients with VF of unknown etiology. We reviewed clinical records, imaging studies, and histological examination results. We compared diagnostic performance of the 2 most sensitive imaging modalities for detection of malignancy on the collapsed vertebral body: magnetic resonance imaging (MRI) and positron emission tomography-CT (PET-CT). Anatomopathological results have been considered the gold standard to assess the diagnostic performance of imaging studies. Age stratification has been performed to understand the distribution of different anatomopathological diagnoses in age groups.

Results: Among 282 CT-guided vertebral biopsies, 36 (12.8%) have been performed to diagnose the etiology of VF of unknown origin. In 26/32 (81.3%), the vertebral biopsy was diagnostic: 8 osteopenia, 6 multiple myelomas, 4 osteomyelitis, 2 eosinophilic granuloma, 3 metastases, 1 mastocytosis, 1 Paget's disease, and 1 dysmielopoiesis. In 6 cases, the anatomopathological diagnosis was normal bone structure, most likely excluding malignancy. There were no statistically significance differences between MRI and PET-CT results ( = 1.0000).

Conclusions: Multiple myeloma and osteopenia represent the most frequent causes of this condition in adult patients, while eosinophilic granuloma and osteomyelitis in pediatric patients. Computed tomography-guided biopsy permits one to reach diagnosis in most of cases. Both PET and MRI could be insufficient to discriminate benign from malignant causes of fractures. Computed tomography-guided biopsy is needed when the etiology of fracture remains unclear.
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http://dx.doi.org/10.14444/5084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314342PMC
December 2018

Fluid-Fluid Levels in Aneurysmal Bone Cysts.

J Pediatr 2019 Jan 27;204:317. Epub 2018 Sep 27.

Department of Radiology Auckland City Hospital Grafton, Auckland, New Zealand; Department of Radiology Hospital Nueve de Octubre Valencia, Spain.

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http://dx.doi.org/10.1016/j.jpeds.2018.08.081DOI Listing
January 2019

Spondylocarpotarsal synostosis syndrome: "Bat wings" spinal fusions and "ladybug" carpal coalitions.

Pediatr Neonatol 2019 08 5;60(4):469-470. Epub 2018 Sep 5.

Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136 Bologna, Italy.

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http://dx.doi.org/10.1016/j.pedneo.2018.08.007DOI Listing
August 2019

Potassium Citrate Supplementation Decreases the Biochemical Markers of Bone Loss in a Group of Osteopenic Women: The Results of a Randomized, Double-Blind, Placebo-Controlled Pilot Study.

Nutrients 2018 Sep 12;10(9). Epub 2018 Sep 12.

Laboratory for Orthopedic Pathophysiology and Regenerative Medicine, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy.

The relationship involving acid-base imbalance, mineral metabolism and bone health status has previously been reported but the efficacy of the alkalizing supplementation in targeting acid overload and preventing bone loss has not yet been fully elucidated. In this randomized, double-blind, placebo-controlled study, the hypothesis that potassium citrate (K citrate) modifies bone turnover in women with postmenopausal osteopenia was tested. Three hundred and ten women were screened; 40 women met the inclusion criteria and were randomly assigned to the treatment or the placebo group. They were treated with K citrate (30 mEq day) or a placebo in addition to calcium carbonate (500 mg day) and vitamin D (400 IU day). At baseline and time points of 3 and 6 months, serum indicators of renal function, electrolytes, calciotropic hormones, serum bone turnover markers (BTMs), tartrate-resistant acid phosphatase 5b (TRACP5b), carboxy-terminal telopeptide of type I collagen (CTX), bone alkaline phosphatase (BAP), procollagen type 1 N terminal propeptide (PINP)), and urine pH, electrolytes, and citrate were measured. The follow-up was completed by 17/20 patients in the "K citrate" group and 18/20 patients in the "placebo" group. At baseline, 90% of the patients exhibited low potassium excretion in 24 h urine samples, and 85% of cases had at least one urine parameter associated with low-grade acidosis (low pH, low citrate excretion). After treatment, CTX and BAP decreased significantly in both groups, but subjects with evidence of low-grade acidosis gained significant benefits from the treatment compared to the placebo. In patients with low 24h-citrate excretion at baseline, a 30% mean decrease in BAP and CTX was observed at 6 months. A significant reduction was also evident when low citrate (BAP: -25%; CTX: -35%) and a low pH (BAP: -25%; CTX: -30%) were found in fasting-morning urine. In conclusion, our results suggested that K citrate supplementation improved the beneficial effects of calcium and vitamin D in osteopenic women with a documented potassium and citrate deficit, and a metabolic profile consistent with low-grade acidosis.
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http://dx.doi.org/10.3390/nu10091293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164684PMC
September 2018

Pazopanib in relapsed osteosarcoma patients: report on 15 cases.

Acta Oncol 2019 Jan 12;58(1):124-128. Epub 2018 Sep 12.

d Department of Oncology , Oslo University Hospital, The Norwegian Radium Hospital , Oslo , Norway.

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http://dx.doi.org/10.1080/0284186X.2018.1503714DOI Listing
January 2019

Torticollis After a Somersault: A Case of Grisel's Syndrome.

Indian J Pediatr 2019 02 13;86(2):198-199. Epub 2018 Aug 13.

Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli n. 1, 40136, Bologna, BO, Italy.

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http://dx.doi.org/10.1007/s12098-018-2756-3DOI Listing
February 2019

How the absence of infrarenal inferior vena cava can mimic lymphoma.

Pediatr Neonatol 2019 02 26;60(1):110-111. Epub 2018 May 26.

Diagnostic and Interventional Radiology, "Rizzoli" Orthopaedic Institute, Italy.

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http://dx.doi.org/10.1016/j.pedneo.2018.05.006DOI Listing
February 2019

Diffuse lung disease associated with neurofibromatosis type-1 can also affect children.

World J Pediatr 2018 04 7;14(2):207. Epub 2018 Mar 7.

Diagnostic and Interventional Radiology, "Rizzoli" Orthopaedic Institute, Via G.C. Pupilli n. 1, 40136, Bologna, BO, Italy.

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http://dx.doi.org/10.1007/s12519-018-0149-3DOI Listing
April 2018

Biopsy is not necessary for the diagnosis of soft tissue hemangiomas.

Radiol Med 2018 Jul 23;123(7):538-544. Epub 2018 Feb 23.

Department of Diagnostic and Interventional Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy.

Objective: To describe the clinical and ultrasonography (US) findings of soft tissue hemangiomas, and to compare with the results of histologic diagnosis after US-guided biopsy.

Method And Materials: We retrospectively studied the files of 97 patients (48 female, 49 male; mean age, 34 years; range 4-84 years) with soft tissue hemangiomas diagnosed from 2004 to 2011. Mean follow-up was 9 years (range 7-13 years). Clinical presentation included intermittent mild pain associated with a soft tissue swelling/palpable mass in all patients, chronic pain and increased local heat in 29 patients, local swelling and decreased range of motion of the adjacent joint in 45 patients, and all the above symptoms in 23 patients. B-mode and color Doppler US evaluation included the site, location, size, shape, margins, presence of calcifications, echo structure and echogenicity. All patients had US-guided biopsy for histologic analysis.

Results: US-guided biopsy and histology confirmed the diagnosis of soft tissue hemangioma in 92 of the 97 lesions (94.8%). Histologic examination of the remaining five lesions showed nodular fasciitis (two lesions), endometriosis (one lesion), hemangioendothelioma (two lesions); US of these lesions showed variable size, irregular margins, and deep-seated location. Histologically documented soft tissue hemangiomas were most commonly superficial (74 lesions) and arteriovenous (45 lesions). Shape was most commonly oval (fusiform), margins were most commonly not well defined (irregular, hazing but circumscribed), phleboliths were more common in deep-seated lesions, echo structure was heterogeneous, and echogenicity was most commonly hyperechogen and involuting.

Conclusion: Clinical presentation and typical B-mode and color Doppler US findings are adequate for the diagnosis of soft tissue hemangiomas without the need for biopsy and histologic analysis. If any clinical or US doubt, an US-guided biopsy should be performed.
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http://dx.doi.org/10.1007/s11547-018-0862-yDOI Listing
July 2018

Over-the-top ACL Reconstruction Plus Extra-articular Lateral Tenodesis With Hamstring Tendon Grafts: Prospective Evaluation With 20-Year Minimum Follow-up.

Am J Sports Med 2017 Dec 18;45(14):3233-3242. Epub 2017 Sep 18.

II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy.

Background: There are few published studies with very long-term follow-up of combined intra- and extra-articular anterior cruciate ligament (ACL) reconstruction.

Purpose: To analyze clinical and radiographic outcomes of over-the-top ACL reconstruction plus extra-articular lateral tenodesis with autologous hamstrings at minimum 20-year follow-up.

Study Design: Case series; Level of evidence, 4.

Methods: Of 60 originally eligible patients who underwent over-the-top ACL reconstruction with double-stranded hamstring tendon (leaving intact graft tibial insertions) and extra-articular lateral plasty (performed with the remnant part of tendons), 52 were prospectively evaluated at a minimum 20-year follow-up (mean follow-up, 24 years; 41 men, 11 women; mean age at time of surgery, 25.5 ± 7.6 years). Twenty-nine patients were available for prospective evaluations: clinical (Lysholm, Tegner, and objective International Knee Documentation Committee [IKDC]), instrumented (KT-2000), and radiographic (standard, long-standing, and Merchant views). Subjective KOOS (Knee injury and Osteoarthritis Outcome Score) and objective inertial sensor pivot-shift analysis (KiRA) were carried out at final follow-up. Twenty-three patients were investigated by phone interview for subjective Tegner score and documented complications, rerupture, or revision surgery.

Results: At final follow-up, mean Lysholm score was 85.7 ± 14.6; median Tegner score, 4 (range, 3-5); sport activity resumption, 86.2%; and objective IKDC score, good or excellent in 86% of patients (31%, A; 55%, B). Only 3 of 26 patients (12%) had >5-mm manual maximum KT-2000 side-to-side difference. KiRA system documented positive pivot-shift (>0.9-m/s tibial acceleration side-to-side difference) in these 3 of 26 patients (12%). Statistically significant changes were as follows: decrease in Tegner score from 7 (range, 6-8) at 5-year follow-up to 4 (range, 3-5) at 10 years ( P < .0001) and decrease in Lysholm score from 96.1 ± 7.3 at 10-year follow-up to 85.7 ± 14.6 at 20 years ( P = .0003). Radiographic evaluation demonstrated significant difference of medial joint space between injured and healthy knees in patients with concomitant medial meniscectomy (n = 8, 3.2 ± 0.6 vs 5.0 ± 1.8 mm, P = .0114). No significant differences were reported regarding lateral or patellofemoral joint space. One patient (2%) experienced rerupture, with 3 of 52 (5.8%) having a contralateral ACL injury (excluded from KT-2000 and radiographic evaluations). Overall, 4 of 29 clinical failures (objective IKDC, KT-2000) and 1 rerupture among 52 patients were registered at final follow-up.

Conclusion: Studied surgical technique demonstrated good results in laxity control at 20-year minimum follow-up. The lateral extra-articular plasty associated with ACL reconstruction did not generate lateral knee or patellofemoral osteoarthritis. The factor increasing osteoarthritis was meniscectomy.
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http://dx.doi.org/10.1177/0363546517723013DOI Listing
December 2017

Spinal osteoid osteoma: efficacy and safety of radiofrequency ablation.

Skeletal Radiol 2017 Aug 11;46(8):1087-1094. Epub 2017 May 11.

Department of Diagnostic and Interventional Radiology, "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136, Bologna, Italy.

Objective: The aim of this study was to evaluate the efficacy and complications of CT-guided radiofrequency ablation (RFA) of spinal osteoid osteoma (OO).

Materials And Methods: Between 2002 and 2012, a total of 61 patients (46 male and 15 female, mean age 26.4 ± 12.7 years) were subjected to RFA for spinal OO. The diagnosis of OO was made after a period of pain and symptoms of 20.6 ± 14.4 months. RFA was performed under conscious sedation and local analgesia. Clinical symptoms were evaluated at 3, 6, and12 months, and at the end of the time of the present investigation. Mean follow-up was 41.5 ± 7.1 months.

Results: The primary efficacy of RFA, complete regression of symptoms, was obtained in 57 out of 61 patients (93.4%). Four out of 61 (6.5%) patients showed a relapse of OO (after 3 months); 2 out of 4 were subjected to a second RFA, the remaining ones were subjected to surgery. There was one complication (case of lower limb paresthesia for 30 days after the ablation) and one possible complication (a disc herniation).

Conclusion: CT-guided RFA is an excellent treatment for spinal OO. Our data suggest that this procedure should be considered for the first stage of therapy for this disease.
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http://dx.doi.org/10.1007/s00256-017-2662-1DOI Listing
August 2017

A Comparison of Different Staging Systems for Multiple Myeloma: Can the MRI Pattern Play a Prognostic Role?

AJR Am J Roentgenol 2017 Jul 18;209(1):152-158. Epub 2017 Apr 18.

2 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy.

Objective: The objective of this study is to compare the most recent systems for the staging of multiple myeloma (MM), the Durie-Salmon PLUS system and the International Staging System, according to patients' survival rates and response to therapy. Another objective is to verify whether patterns of bone marrow alteration on MRI (i.e., focal, diffuse, or variegated patterns) can provide prognostic information for patients with MM.

Materials And Methods: We retrospectively enrolled 85 patients with MM who were monitored for a minimum of 6 years and who underwent contrast-enhanced spinal and pelvic MRI at 1.5 T and whole-body FDG PET/CT at the time of diagnosis. Patients underwent MM staging performed using both staging systems and were divided into groups on the basis of their MRI patterns. These patient groups were then compared in terms of survival, response to therapy, and duration of response.

Results: Both staging systems showed great capability in differentiating patients with a worse prognosis from patients with a better outcome, with the capability of both systems found to be statistically significant, albeit less statistically significant for the Durie-Salmon PLUS system (p = 0.010 vs p = 0.046, respectively). Patients with a focal pattern on MRI had a worse survival rate than did the patients with other MRI patterns (p = 0.032).

Conclusion: These data indicate that both the International Staging System and the Durie-Salmon PLUS system have great potential for characterizing and stratifying MM to determine the survival outcome and therapy response of patients. Observation of a focal pattern on MRI seems to be associated with poorer survival.
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http://dx.doi.org/10.2214/AJR.16.17219DOI Listing
July 2017

A comprehensive review of pulsed radiofrequency in the treatment of pain associated with different spinal conditions.

Br J Radiol 2017 May 10;90(1073):20150406. Epub 2017 Feb 10.

1 Department of Radiology, Scientific Institute Rizzoli Orthopaedic Institute, Bologna, Italy.

Objective: The objective of this review was to evaluate the efficacy of pulsed radiofrequency (PRF) treatment of pain associated with different spinal conditions. The mechanisms of action and biological effects are shortly discussed to provide the scientific basis for this radiofrequency modality.

Methods: We systematically searched for clinical studies on spinal clinical conditions using PRF. We searched the MEDLINE (PubMed) database. We classified the information in one table focusing on randomized controlled trials (RCTs) and other types of studies. Date of last electronic search was October 2016.

Results: We found four RCTs that evaluated the efficacy of PRF on cervical radicular pain and five observational studies. Two trials and three observational studies were conducted in patients with facet pain. For disc-related pathology, we found one RCT with PRF applied intradiscally and three RCTs for dorsal root ganglia PRF modulation lumbosacral radicular pain. For sacroiliac joint pain, spondylolisthesis, malignancies and other minor spinal pathology, limited studies were conducted.

Conclusion: From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regard to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the absence of standardization of PRF parameters, enrolment criteria and different methods in reporting results; but, the evidence is interesting. The use of PRF in lumbar facet pain was found to be less effective than conventional RF techniques. For the other different spinal conditions, we need further studies to assess the effectiveness of PRF. Advances in knowledge: The use of PRF in lumbar facet pain was found to be less effective than conventional RF techniques. For the other different spinal conditions, we need further studies to assess the effectiveness of PRF.
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http://dx.doi.org/10.1259/bjr.20150406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605093PMC
May 2017

Abdominal pain after spine surgery.

J Pediatr 2015 Apr 3;166(4):1095. Epub 2015 Feb 3.

Diagnostic and Interventional Radiology, Rizzoli Orthopaedic Institute, Bologna, Italy.

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http://dx.doi.org/10.1016/j.jpeds.2014.12.055DOI Listing
April 2015

Looking beside the fracture.

J Pediatr 2013 Dec 12;163(6):1795. Epub 2013 Sep 12.

Diagnostic and Interventional Radiology, "Rizzoli" Orthopaedic Institute, Bologna, Italy.

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http://dx.doi.org/10.1016/j.jpeds.2013.07.048DOI Listing
December 2013

Occipital headache.

J Clin Neurosci 2013 Apr;20(4):582, 622

Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant’Orsola – Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy.

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http://dx.doi.org/10.1016/j.jocn.2012.09.018DOI Listing
April 2013

Detection of incidental vertebral fractures in breast imaging: the potential role of MR localisers.

Eur Radiol 2012 Dec 12;22(12):2617-23. Epub 2012 Jun 12.

Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.

Objectives: Incidental diagnosis of vertebral fractures (VFs) may represent a key point in the assessment of bone health status. Our purpose was to retrospectively evaluate localisation sequences (MR-loc) of breast MRI as a potential tool to detect osteoporotic VFs.

Methods: MR-loc sagittal images of 856 breast MRIs were reviewed by three expert musculoskeletal radiologists with a semiquantitative approach to detecting VFs. Anamnesis and data of patients were investigated. Official breast MRI and previous imaging reports were checked to understand if VFs or other relevant bone findings were known in patients' clinical history.

Results: A total of 780/856 female patients (91.1 %) undergoing MRI for oncological reasons and 76/856 (8.9 %) with non-oncological aims were recruited into the study (54.7 ± 12.2 years old, 21-89 years); 57/856 MR-loc images (6.7 %) were considered inadequate for diagnostic purposes and were excluded from the analysis. MR-loc detected VFs in 71/799 patients (8.9 %). VFs were neither reported nor previously known in the clinical history of 63/71 patients (88.7 %; P < 0.001). No mention of VFs was found in any breast MR reports. In four patients MR-loc identified vertebral metastases.

Conclusions: A systematic evaluation of MR-loc may offer additional clinical information to prevent unrecognised VFs. MR-loc may screen for VFs in other imaging settings.

Key Points: Vertebral fractures are usually a hallmark of osteoporosis. Localisation sequences before breast MR examinations can identify vertebral fractures. MR localisers should be inspected for vertebral fractures in other clinical settings.
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http://dx.doi.org/10.1007/s00330-012-2521-3DOI Listing
December 2012

Dual-energy X-ray absorptiometry in the evaluation of abdominal aortic calcifications.

J Clin Densitom 2012 Apr-Jun;15(2):198-204. Epub 2012 Feb 9.

Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Via Massarenti, Bologna, Italy.

The objective of this study was to evaluate the diagnostic performance of the new dual-energy X-ray absorptiometry equipment vs digital radiography (DR) in the detection and scoring of abdominal aortic calcifications (AACs). Seventy-five patients with indication for morphometric evaluation of the spine underwent vertebral fracture assessment (VFA) and spinal DR (gold standard). The radiographic and VFA images were analyzed to detect AAC using a previously validated 24-point scale (AAC-24) and a simplified 8-point scale (AAC-8). The evaluation was conducted by 2 expert radiologists and repeated by the more experienced of the 2 after 7d to verify the results. Patients with a score of 5 or more in AAC-24 and 3 or more in AAC-8 were considered at risk for cardiovascular diseases (CVDs). The aorta was not completely visible in 11 VFA and 1 DR images. DR detected AAC in 42 of the 63 patients (66.7%), whereas 15 patients (23.8%) were considered at risk for CVD. The VFA showed sensitivity, specificity, and accuracy in the detection of AAC with values of 78.6%, 85.7%, and 81.0%, respectively, with both AAC-24 and AAC-8; in the identification of patients at risk for CVD, VFA demonstrated sensitivity, specificity, and accuracy, respectively, with values of 86.7%, 100%, and 96.8% using AAC-24 and 86.7%, 93.8%, and 92.1% using AAC-8. In the detection of AAC, intraobserver agreement was superimposable using both the techniques (κ=1.00), whereas in the identification of patients at risk for CVD, kappa values were 0.96 and 0.95 using AAC-24 and 1.00 and 0.96 using AAC-8 for DR and VFA, respectively. Interobserver agreement in the evaluation of the presence/absence of AAC showed a kappa value of 0.76 for DR and 0.71 for VFA, whereas kappa values of 0.91 and 0.87 for DR and 0.85 and 0.83 for VFA were achieved for CVD risk using AAC-24 and AAC-8, respectively. AAC can be easily and accurately diagnosed by VFA with satisfactory accuracy, reproducibility, and repeatability. VFA may be used in the assessment and monitoring of AAC.
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http://dx.doi.org/10.1016/j.jocd.2011.11.002DOI Listing
August 2012

Vertebral fracture assessment by new dual-energy X-ray absorptiometry.

Bone 2012 Apr 31;50(4):836-41. Epub 2012 Jan 31.

Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant'Orsola, Malpighi Hospital, Via G. Massarenti 9, 40138 Bologna, Italy.

The aim of this study was to investigate the diagnostic performance of new dual-energy X-ray absorptiometry (DXA) technologies in the detection of vertebral fractures (VFs). Sixty-eight patients were submitted to DXA and conventional radiography (XR) on the same day. Lateral images of the spine were independently evaluated by three radiologists with different experience in skeletal imaging, in two sessions with 7 days between evaluations of the same anonymous images. The most expert physician repeated the analysis in a subsequent reading session after further 7 days. Results from expert XR evaluation were considered as gold standard. A semiquantitative approach was used to interpret images and morphometric analysis was performed when a VF was suspected. Seventy vertebrae (70/884, 7.9%) were excluded from the lesion-based analysis, as not evaluable: 11/70 (15.7%) missed by XR only, 56/70 (80.0%) missed by DXA only, 3/70 (4.3%) missed by both techniques (upper thoracic spine). Forty "true" fractures were detected (4.9% out of 814 vertebrae) in 26 patients (38.2% of the 68 studied patients). Twenty-five (62.5%) were mild fractures. DXA sensitivity and specificity were 70.0% and 98.3% on a lesion-based analysis, 73.1% and 90.5% on a patient-based analysis. Intra-observer agreement was excellent with no significant difference between the two techniques. Inter-observer agreement among the 3 observers was higher for XR (k=0.824 versus 0.720 in the detection of VFs, p=0.011). DXA accuracy was not influenced by radiologist experience; T4-L4 assessability as well as reproducibility and repeatability of the two techniques and accuracy of DXA were independent from sex, age, body mass index, grade of arthrosis. However DXA sensitivity was affected by mild VFs. Vertebral level did not affect the diagnostic performance with exception of vertebral body assessability. Latest improvements make VFs assessment by DXA competitive with traditional radiographic gold standard, providing consistent advantages and attractions. Few limitations still affect DXA performance and need to be overcome.
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http://dx.doi.org/10.1016/j.bone.2012.01.018DOI Listing
April 2012

A careful evaluation of scout CT lateral radiograph may prevent unreported vertebral fractures.

Eur J Radiol 2012 Sep 25;81(9):2353-7. Epub 2011 Sep 25.

Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy.

Objectives: Our purpose was to review scout CT lateral radiographs to reveal osteoporotic vertebral fractures unreported by radiologists and to explore scout CT as a potential diagnostic tool in the detection of vertebral fractures.

Methods: We considered 500 patients (303 males, 197 females, age 64.6±13.5 year-old). Our investigation was firstly focused on scout CT lateral images to detect vertebral fractures with a combined semiquantitative and quantitative diagnostic approach. Findings addressed to vertebral fracture were subsequently confirmed by multiplanar sagittal CT reconstructions. Whenever a vertebral fracture was discovered the radiologist report was read and a collection of patient anamnesis followed to understand whether fractures were already known.

Results: In 44/500 patients (8.8%) the evaluation on scout CT was incomplete or limited for patient/technical-based conditions, and 15 were excluded from the analysis. In 67/485 patients (13.8%) 99 vertebral fractures were detected. Among 67 fractured patients only 18 (26.9%) were previously diagnosed by radiologists. However, in the clinical history of 32 patients vertebral fractures were already known.

Conclusions: The perception and sensibility to vertebral fractures among radiologists are still poor when the assessment of the spine is not the aim of the examination. Short time spent for the evaluation of scout CT lateral radiographs could improve our accuracy.
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http://dx.doi.org/10.1016/j.ejrad.2011.08.015DOI Listing
September 2012
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