Virna Zampa

Predictive value of clinical findings for temporomandibular joint effusion

OBJECTIVE The aim of this work was to evaluate the predictive value of clinical symptoms for magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) effusion. STUDY DESIGN Sixty-one patients with TMJ pain were assessed by means of a standardized clinical examination and MRI. A calibrated investigator evaluated the presence of 8 clinical indicators (predictors) of TMJ effusion (outcome variable). A logistic regression analysis was performed to detect significant associations between clinical symptoms and MRI findings of TMJ effusion. The accuracy of the final logit to predict effusion was compared with that derived from univariate analysis. RESULTS A clinical examination based upon the assessment of pain in the TMJ with lateral palpation, with posterior palpation, during motion, and during maximum assisted opening, and the presence of click and crepitus sounds has an accuracy of 78.7% to predict TMJ effusion. Among the single clinical symptoms, the most reliable predictor of TMJ effusion is the presence of pain with lateral palpation (accuracy 76.2%; K =.525). CONCLUSION The use of a multiple regression approach demonstrated that an extensive clinical assessment which considers 6 main indicators consents to predict accurately the presence of MRI TMJ effusion. Based on these findings, MRI assessment should be reserved for patients in which the exact disc-condyle relationship needs to be evaluated.

Osteoid osteoma in atypical locations: The added value of dynamic gadolinium-enhanced MR imaging

PURPOSE To compare the results of dynamic gadolinium-enhanced magnetic resonance imaging (MRI), unenhanced MRI and computed tomography (CT), in terms of nidus conspicuity and diagnostic confidence of osteoid osteoma in atypical sites. MATERIALS AND METHODS CT and MR (nonenhanced T1- and T2-weighted and dynamic MRI) images of 19 patients with histologically proven osteoid osteoma located in atypical sites were retrospectively reviewed. Time-enhancement curves of the nidus and the adjacent bone marrow were generated. Images from each technique were scored for nidus conspicuity by two independent radiologists. Another blinded radiologist was asked to assess final diagnosis of the bone lesion on MR and CT images, independently. RESULTS In all cases, nidus contrast uptake started in the arterial phase and was higher compared to the surrounding bone marrow. Dynamic MRI significantly increased nidus conspicuity compared to nonenhanced MRI (P<.0001) and CT (P=.04). In 6/19 (31.6%) cases nidus conspicuity was higher at dynamic MRI compared to CT. Confident diagnosis of osteoid osteoma was achieved in all patients with MRI and in 10/19 (52.6%) patients with CT. CONCLUSION In patients with osteoid osteoma located in atypical sites, dynamic MRI increases nidus conspicuity, allowing confident diagnosis.

MRI of cerebellar white matter damage due to carbon monoxide poisoning: Case report

Extensive bilateral cerebellar white matter signal change, with sparing of the overlying cortex, consistent with demyelination was seen in a 12-year-old boy who had suffered carbon monoxide poisoning 6 years previously. His youth at the time of exposure and the long delay between exposure and examination might account for this unusual finding.

Predictive Factors of In-Stent Restenosis in Renal Artery Stenting: A Retrospective Analysis

PurposeTo retrospectively evaluate the role of clinical and procedural factors in predicting in-stent restenosis in patients with renovascular disease treated by renal artery stenting.MethodsFrom 1995 to 2002, 147 patients underwent renal artery stenting for the treatment of significant ostial atherosclerotic stenosis. Patients underwent strict clinical and color-coded duplex ultrasound follow-up. Ninety-nine patients (111 stents), with over 6 months of continuous follow-up (mean 22±12 months, range 6–60 months), were selected and classified according to the presence (group A, 30 patients, 32 lesions) or absence (group B, 69 patients, 79 lesions) of significant in-stent restenosis. A statistical analysis was performed to identify possible preprocedural and procedural predictors of restenosis considering the following data: sex, age, smoking habit, diabetes mellitus, hypertension, serum creatinine, cholesterol and triglyceride levels, renal artery stenosis grade, and stent type, length and diameter.ResultsComparing group A and B patients (χ2 test), a statistically significant relation was demonstrated between stent diameter and length and restenosis: the risk of in-stent restenosis decreased when the stent was ≥6 mm in diameter and between 15 and 20 mm in length. This finding was confirmed by multiple logistic regression analysis. Stent diameter and length were proved to be significantly related to in-stent restenosis also when evaluating only patients treated by Palmaz stent (71 stents).ConclusionAlthough it is based on a retrospective analysis, the present study confirms the importance of correct stent selection in increasing long-term patency, using stents of at least 6 mm in diameter and with a length of approximately 15–20 mm.

Contrast-enhanced three-dimensional MR angiography of neck vessels: does dephasing effect alter diagnostic accuracy?

Abstract. The aim of this study was to evaluate diagnostic accuracy of contrast-enhanced MRA (CEMRA) compared with digital subtraction angiography (DSA) in studying neck vessels of 48 patients. In three groups of patients, we used three MRA protocols differing for voxel size to assess if intravoxel dephasing effects could modify accuracy of CEMRA. Accuracy and correlation with DSA results were calculated in all patients and separately in the three groups. A qualitative analysis of the likeness between morphology of the stenosis in CEMRA and DSA images was also assessed. In all patients accuracy and agreement with DSA were 96% and k=0.85 in subclavian arteries, 96% and k=0.84 in vertebral artery, 97% and k=0.88 in common carotid arteries, and 94% and k=0.86 in internal carotid arteries. In the three groups accuracy and agreement with DSA did not show any significant difference. Qualitative analysis of CEMRA and DSA images revealed a better agreement in depicting the morphology of stenosis using a smaller voxel size. The CEMRA represents a powerful tool for the non-invasive evaluation of neck vessels. Overestimation trend of CEMRA is confirmed and the reduction of voxel size, decreasing the dephasing intravoxel effect, allows to have a better overlapping of stenosis morphology on CEMRA compared with DSA, but it does not yield diagnostic gain in the stenosis grading.

Rippling muscle disease and facioscapulohumeral dystrophy-like phenotype in a patient carrying a heterozygous CAV3 T78M mutation and a D4Z4 partial deletion: Further evidence for “double trouble” overlapping syndromes

We report the first case of a heterozygous T78M mutation in the caveolin-3 gene (CAV3) associated with rippling muscle disease and proximal myopathy. The patient displayed also bilateral winged scapula with limited abduction of upper arms and marked asymmetric atrophy of leg muscles shown by magnetic resonance imaging. Immunohistochemistry on the patient’s muscle biopsy demonstrated a reduction of caveolin-3 staining, compatible with the diagnosis of caveolinopathy. Interestingly, consistent with the possible diagnosis of FSHD, the patient carried a 35 kb D4Z4 allele on chromosome 4q35. We discuss the hypothesis that the two genetic mutations may exert a synergistic effect in determining the phenotype observed in this patient.

Biochemical and ultrasound tests for early diagnosis of active neuro-osteoarthropathy (NOA) of the diabetic foot.

OBJECTIVES To test the effectiveness of a combined approach to an early diagnosis of neuro-osteoarthropathy (NOA) of the diabetic foot, we studied a group of outpatients with active NOA, presenting for the first time to our Diabetic Foot Clinic in 1998, by means of an integrated approach designed to assess bone turnover. PATIENTS AND METHODS Fifteen consecutive diabetic patients (five Type 1 and ten Type 2 diabetic individuals, age 61.9+/-12.2 years, diabetes duration 18.7+/-8.9 years, HbA(1c) 8.4+/-1.5%) with active NOA (Group 1) were compared to nine diabetic patients with chronic stable NOA (Group 2), 14 neuropathic diabetic patients without NOA (Group 3), 13 non-neuropathic diabetic patients (Group 4) and 15 healthy controls (Group 5). Determination of serum carboxy-terminal collagen telopeptide (ICTP), bone alkaline phosphatase isoenzyme (B-ALP), osteocalcin (BGP) concentrations, as well as urinary excretion of deoxypyridinoline (DPD) were obtained in all individuals for assessment of bone reabsorption and new bone formation. Moreover in all individuals quantitative ultrasound (QUS) of the calcaneal bone was performed and mass density of lumbar spine and femur bone was determined by dual-energy X-ray absorptiometry (DEXA). RESULTS QUS was significantly lower in the active NOA patients as compared with other groups (P<0.01), while ICTP was higher in both NOA groups (P<0.01). Urinary DPD was higher in the neuropathic non-NOA group (P<0.01) than the other groups, and osteocalcin was higher in healthy controls compared to diabetic patients without NOA. QUS and ICTP were inversely correlated (r=0.44, P=0.000). QUS in the active NOA group was significantly (P<0.01) lower in the affected compared to the unaffected foot. CONCLUSION Our results indicate a possible role for an integrated approach to the diagnosis and monitoring of NOA involving the diabetic foot. DPD may identify patients at-risk for NOA, ICTP could be tested as a marker for NOA in asymptomatic cases. Finally, QUS of the calcaneal bone may be useful in discriminating active versus quiescent phases.

High-Resolution Magnetic Resonance and volume rendering of the labyrinth

Abstract. Our aim was to verify the feasibility of volume rendering (VR) of high-resolution magnetic resonance (HR-MR) data sets of the labyrinth. We retrospectively reviewed the HR-MR data sets of 16 consecutive patients with no MR evidence of labyrinthine pathology. High-resolution MR data sets were obtained by means of a 3D T2-weighted FSE sequence with the use of a 3-in. circular surface coil for signal reception, and processed with a high-end workstation. Two reviewers performed separately VR of the labyrinth by selecting the signal intensity interval for attribution of opacity and transparency. Concerning the time taken for definition of the volume of interest, the two observers needed, respectively, 28.9 and 33.1 min (SD ± 8.7–9.5 min), whereas the time taken for VR was respectively, 26 and 33.2 min (SD ± 8.8–8.9 min). Concerning the selection of the signal intensity interval, the two observers had, respectively, 86.4 and 88.7 mean lower threshold (SD ± 34.5–33.5), 488.9 and 495.4 mean upper threshold (SD ± 56.3–53.8). In our experience, we have found VR of HR-MR to offer a reliable and reproducible technique for producing 3D representations of the labyrinth. The VR algorithms use all data within the imaging volume and optimize the dynamic range ascribed to the object being visualized.

Contrast-enhanced three-dimensional MR angiography in the assessment of subclavian artery diseases

Abstract. The purpose of this prospective study was to determine the potential diagnostic value of 3D breath-hold contrast-enhanced MRA (CEMRA) in the evaluation of subclavian artery pathology, and to compare CEMRA and digital subtraction angiography (DSA) findings. The study group included 50 patients with suspicion of subclavian artery pathology: 40 suspected steno-occlusive disease and 10 different vascular anomalies. The MRA examinations were performed on a 1.5-T system using fast 3D sequences. A fixed dose of 40 ml Gd-DTPA was administered at 2 ml/s after previous bolus tracking. Images were analyzed to assess: subclavian depiction; luminal changes; collateral branches; and feeders of arterial venous malformations (AVM). A multireader blinded fashion was used. The CEMRA revealed an optimal agreement with DSA findings in the different types of diseases. Sensitivity and specificity were 90 and 95 %, respectively, in detecting steno-occlusive disease (including functional and arteritic stenoses), and 100 and 100 %, respectively, in cases of vascular anomalies (dilation, kinking, anomalous origin and AVM). Contrast-enhanced MRA can be proposed as a non-invasive, robust technique for imaging subclavian pathologies with high diagnostic performance.

Thigh magnetic resonance imaging for the evaluation of disease activity in patients with idiopathic inflammatory myopathies followed in a single center.

Introduction: In patients with idiopathic inflammatory myopathies (IIM), magnetic resonance imaging (MRI) has been proposed as a useful tool for diagnosis and follow‐up. It may identify muscle inflammation (edema) and fatty infiltration for evaluation of disease activity and damage. Little information is available on the role of MRI in assessment of large cohorts of adult patients with IIM. Methods: Fifty‐one patients underwent MRI of the thigh muscles, laboratory tests, and clinical evaluation, including Physician Global Assessment (PGA) of myositis activity and the Manual Muscle Test 8 (MMT8). Results: Muscle edema correlated significantly with creatine kinase values (P = 0.017) and PGA (P < 0.001). A significant correlation between edema and MMT8 values (P = 0.025) was observed when patients with muscle fatty infiltration were excluded. With respect to clinical diagnosis, the sensitivity of MRI was 92.3%, and specificity was 83.3%. Conclusions: MRI appears to provide additional information that complements clinical and biochemical examinations. Muscle Nerve 54: 666–672, 2016