Ugo Albisinni

Radiofrequency thermoablation of primary non-spinal osteoid osteoma: optimization of the procedure

Osteoid osteoma is a small benign tumor that requires treatment due to the intense pain it causes. Surgical therapy has been the ablative technique of choice after a failure of medical therapy. Recently, numerous less invasive, alternative procedures have been proposed: drill trepanation with or without ethanol injections, cryoablation, and thermoablation with laser or radiofrequency. The aim of this review is to retrospectively assess the effect of radiofrequency (RF) thermoablation in the treatment of primary non-spinal osteoid osteoma. From June 2001 to July 2003, we treated 106 patients affected by osteoid osteoma with RF thermoablation. Five patients with spinal osteoid osteoma and four with a previously treated osteoma were excluded from the study. In this paper, we assess the results obtained in a selected group of 97 primary non-spinal osteoid osteoma. The lesions were predominantly in the metaphysics of the femur. Central nidus calcifications were frequent and there was no prevalence for which side they occurred. Primary success was achieved in 82 patients (85%), while we obtained secondary success in 15 patients (15%). In two patients (2%), pain persisted between the two treatments and failed to be resolved, even after the second treatment; therefore, surgical excision was performed and complete resolution was obtained. No complications were reported. In conclusion, our results confirm that the treatment of choice for non-spinal osteoid osteoma is RF thermoablation, offering several advantages over ablative techniques.

Health and ageing: A cross-sectional study of body composition

BACKGROUND & AIMSnThe aim of this work was to provide a complete profile of body composition (BC) in healthy subjects and to investigate age and gender-related differences by dual-energy X-ray absorptiometry (DXA) and its latest developments.nnnMETHODSnItalian volunteers among blood donors were enrolled in 5 different age bands (from 18 to 70 years old) to reach the threshold of 25 males and 25 females per single band (total: 250 subjects). All non-obese subjects who satisfied selective inclusion criteria were measured for weight and height and submitted to DXA, to determine fat mass (FM), non-bone lean mass (LM), bone mineral content and density, at regional and whole-body level. Moreover, the assessment of android visceral FM was performed by a new software.nnnRESULTSnA decrease in LM and increase in FM was observed with ageing, although the phenomenon was proved to be attenuated in women. The central and visceral redistribution of FM was also shown along lifetime, but women were not affected as men by this change.nnnCONCLUSIONSnThis paper is a report on the status of healthy Italian subjects in their adulthood, to be used as a reference for future investigations on physiology, pathological human conditions, and differences between countries.

Visceral Fat and Body Composition Changes in a Female Population After RYGBP: a Two-Year Follow-Up by DXA

BackgroundOur aim was to monitor the impact of Roux-en-Y gastric bypass (RYGBP) on body composition over a 24-month period by dual-energy X-ray absorptiometry (DXA).MethodsForty-one women (40.6u2009±u200910.0xa0years old; 42.6u2009±u20096.6xa0kg/m2) entering a bariatric surgery programme were submitted to whole-body DXA (Lunar iDXA) before treatment and after 3, 6, 12 and 24xa0months. Fat mass (FM), non-bone lean mass (LM), bone mineral content (BMC) and density (BMD) were measured at whole body and regionally. Android visceral adipose tissue (VAT) was estimated by a recently validated software.ResultsTwenty-nine patients (44.3u2009±u200911.8xa0years old; BMI, 45.4u2009±u20098.9xa0kg/m2) concluded the study. Following surgery, the progressive decrease of BMI was associated with reduced whole-body and regional FM. LM showed a moderate decrease at 3xa0months and stabilized thereafter. A progressive decrease of total FM/LM and android FM/LM ratios were observed in the 3- to 6-month (−19.1u2009±u20098.4xa0% and −26.5u2009±u200910.9xa0%, respectively; pu2009<u20090.0001) and 6- to 12-month periods (−23.5u2009±u200916.8xa0% and −29.4u2009±u200923.9xa0%, respectively; pu2009<u20090.0001). VAT was the parameter showing the largest decrease (−65.6u2009±u200917.5xa0% at 12xa0months; pu2009<u20090.0001). Two years after the surgery, a slight but significant decrease of total and regional LM was observed, without any significant change in BMI.ConclusionsBody composition significantly changes after RYGBP with a metabolically healthier redistribution of total and regional FM and a positive balance of FM/LM variation. DXA should be considered as a valid supplementary tool for the clinical assessment and follow-up in patients undergoing bariatric surgery.

DXA: Technical aspects and application.

The key role of dual-energy X-ray absorptiometry (DXA) in the management of metabolic bone diseases is well known. The role of DXA in the study of body composition and in the clinical evaluation of disorders which directly or indirectly involve the whole metabolism as they may induce changes in body mass and fat percentage is less known or less understood. DXA has a range of clinical applications in this field, from assessing associations between adipose or lean mass and the risk of disease to understanding and measuring the effects of pathophysiological processes or therapeutic interventions, in both adult and paediatric human populations as well as in pre-clinical settings. DXA analyses body composition at the molecular level that is basically translated into a clinical model made up of fat mass, non-bone lean mass, and bone mineral content. DXA allows total and regional assessment of the three above-mentioned compartments, usually by a whole-body scan. Since body composition is a hot topic today, manufacturers have steered the development of DXA technology and methodology towards this. New DXA machines have been designed to accommodate heavier and larger patients and to scan wider areas. New strategies, such as half-body assessment, permit accurate body scan and analysis of individuals exceeding scan field limits. Although DXA is a projective imaging technique, new solutions have recently allowed the differential estimate of subcutaneous and intra-abdominal visceral fat. The transition to narrow fan-beam densitometers has led to faster scan times and better resolution; however, inter- or intra-device variation exists depending on several factors. The purposes of this review are: (1) to appreciate the role of DXA in the study of body composition; (2) to understand potential limitations and pitfalls of DXA in the analysis of body composition; (3) to learn about technical elements and methods, and to become familiar with biomarkers in DXA.

A 360-degree overview of body composition in healthy people: Relationships among anthropometry, ultrasonography, and dual-energy x-ray absorptiometry

OBJECTIVEnThe aim of this study was to test the relationship between anthropometry, ultrasonography, and dual-energy x-ray absorptiometry (DXA) for the assessment of body composition in clinical practice.nnnMETHODSnThe study was carried out in Italian blood donor volunteers belonging to five different age groups (18-70 y old; 25 men and 25 women per group; N = 250 participants; n = 125 men, n = 125 women). A complete history was collected and routine blood analyses were performed to confirm healthy status. All participants were submitted to whole-body DXA (tricompartmental analysis, regional, and total body), ultrasonography (abdominal adiposity evaluation), and anthropometric measurements. DXA was used as gold standard and its biomarkers were taken as reference for fat-lean mass balance, central-peripheral fat distribution, central or visceral fat, and subcutaneous fat.nnnRESULTSnAnthropometric and ultrasound parameters were closely associated with most of DXA parameters. Composite markers representative of central and abdominal visceral fat compartments were significantly correlated with waist circumference, waist-to-hip ratio, and intra-abdominal fat thickness by ultrasound, in both men and women (P < 0.025). As expected, subcutaneous depots were significantly correlated with maximum subcutaneous fat thickness measured by ultrasonography (P < 0.025).nnnCONCLUSIONSnBoth anthropometry and ultrasonography provide a reliable estimate of visceral adipose tissue in a non-obese population compared with DXA, whereas anthropometry prediction of subcutaneous adiposity is weak. Physicians should be aware of the limits of these techniques for the assessment of body composition.

Magnetic resonance-guided focused ultrasound treatment of extra-abdominal desmoid tumors: a retrospective multicenter study

AbstractObjectivesTo assess the feasibility, safety and preliminary efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of extra-abdominal desmoid tumours.MethodsFifteen patients with desmoid fibromatosis (six males, nine females; age range, 7–66xa0years) were treated with MRgFUS, with seven patients requiring multiple treatments (25 total treatments). Changes in viable and total tumour volumes were measured after treatment. Efficacy was evaluated using an exact one-sided Wilcoxon test to determine if the median reduction in viable tumour measured immediately after initial treatment exceeded a threshold of 50xa0% of the targeted volume. Median decrease after treatment of at least two points in numerical rating scale (NRS) worst and average pain scores was tested with an exact one-sided Wilcoxon test. Adverse events were recorded.ResultsAfter initial MRgFUS treatment, median viable targeted tumour volume decreased 63xa0%, significantly beyond our efficacy threshold (Pu2009=u20090.0013). Median viable total tumour volume decreased (105xa0mL [interquartile range {IQR}, 217xa0mL] to 54xa0mL [IQR, 92xa0mL]) and pain improved (worst scores, 7.5u2009±u20091.9 vs 2.7u2009±u20092.6, Pu2009=u20090.027; average scores, 6u2009±u20092.3 vs 1.3u2009±u20092, Pu2009=u20090.021). Skin burn was the most common complication.ConclusionsMRgFUS significantly and durably reduced viable tumour volume and pain in this series of 15 patients with extra-abdominal desmoid fibromatosis.Key Points• Retrospective four-centre study shows MRgFUS safely and effectively treats extra-abdominal desmoid tumoursn • This non-invasive procedure can eradicate viable tumour in some casesn • Alternatively, MRgFUS can provide durable control of tumour growth through repeated treatmentsn • Compared to surgery or radiation, MRgFUS has relatively mild side effects

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

OBJECTIVESnOur 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.nnnMETHODSnWe 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.nnnRESULTSnIn 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.nnnCONCLUSIONSnThe 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.

Incidental vertebral compression fractures in imaging studies: Lessons not learned by radiologists

AIMnTo assess radiologists reporting rates of incidental vertebral compression fractures in imaging studies.nnnMETHODSnWe performed a review of the current literature on the prevalence and reporting rates of incidental vertebral compression fractures in radiologic examinations.nnnRESULTSnThe bibliographic search revealed 12 studies: 7 studies using conventional radiology and 5 using multidetector computed tomography (MDCT). The loss of height cut-off to define a vertebral fracture varied from 15% to 25%. Fracture prevalence was high (mean 21.1%; range 9.5%-35%) in both radiographic and MDCT studies (mean 21.6% and 20.2%, respectively). Reporting rates were low with a mean value of 27.4% (range 0%-66.3%) and were significantly lower in MDCT than in radiographic studies (mean 8.1% vs 41.1%). Notably, recent studies showed lower reporting rates than older studies.nnnCONCLUSIONnMany scientific studies have confirmed a high prevalence of vertebral compression fractures as incidental findings on imaging studies. However, the underreporting of these fractures, as determined in our study, may negatively affect patient care.

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

AbstractObjectivesIncidental 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.MethodsMR-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.ResultsA total of 780/856 female patients (91.1xa0%) undergoing MRI for oncological reasons and 76/856 (8.9xa0%) with non-oncological aims were recruited into the study (54.7u2009±u200912.2xa0years old, 21–89xa0years); 57/856 MR-loc images (6.7xa0%) were considered inadequate for diagnostic purposes and were excluded from the analysis. MR-loc detected VFs in 71/799 patients (8.9xa0%). VFs were neither reported nor previously known in the clinical history of 63/71 patients (88.7xa0%; Pu2009<u20090.001). No mention of VFs was found in any breast MR reports. In four patients MR-loc identified vertebral metastases.ConclusionsA 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.n • Localisation sequences before breast MR examinations can identify vertebral fractures.n • MR localisers should be inspected for vertebral fractures in other clinical settings.

Treatment of osteoid osteoma of the elbow by radiofrequency thermal ablation

BACKGROUNDnThis article presents the experience at the Rizzoli Orthopaedic Institute in the treatment of intracapsular osteoid osteoma (OO) of the elbow by computed tomography-guided percutaneous radiofrequency thermal ablation (RFA).nnnMATERIALS AND METHODSnOur team performed more than 800 RFA procedures to treat OO up to 2010. In 27 cases, the lesion site was the articular area of the elbow (humerus in 13 cases, ulna in 13, and radius in 1). These patients were reviewed and assessed for eradication rate, incidence of complications, and functional results measured by the Mayo Elbow Performance Score. The outcome was evaluated after a mean follow-up period of 67.4 ± 35.3 months (range, 24-128 months).nnnRESULTSnThe mean duration of symptoms at the time of diagnosis was 31.0 ± 19.8 months (range, 5-72 months). All patients complained about pain, and in 24 of 27 cases (88.8%), the joint function was significantly impaired by the presence of OO (pretreatment score, 54.8). After RFA, the Mayo Elbow Performance Score improved by a mean of 37.7 ± 14.8 points, with 25 of 27 patients (92.5%) scoring 90 to 100 points at final follow-up. OO recurred in only 1 patient (3.7%), 5 months after the procedure. However, this was successfully retreated by RFA. No adverse effects were observed, and all patients were free of disease at the final follow-up.nnnDISCUSSIONnThe RFA procedure can be technically challenging in difficult sites such as the elbow joint. The low invasiveness of RFA compared with traditional surgery allows excellent functional recovery. RFA of elbow OO is effective and safe, and it should be considered the first-choice treatment for this disease.