Research

10 pages, 4242 KiB

Open AccessArticle

Feasibility of In Vivo Metal Artifact Reduction in Contrast-Enhanced Dedicated Spiral Breast Computed Tomography

by Matthias Wetzl, Evelyn Wenkel, Chrisitan Steiding, Veikko Ruth, Julius Emons, Martin N. Wasser, Michael Uder and Sabine Ohlmeyer

Diagnostics 2023, 13(19), 3062; https://doi.org/10.3390/diagnostics13193062 - 26 Sep 2023

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Abstract

Background: Radiopaque breast markers cause artifacts in dedicated spiral breast-computed tomography (SBCT). This study investigates the extent of artifacts in different marker types and the feasibility of reducing artifacts through a metal artifact reduction (MAR) algorithm. Methods: The pilot study included 18 women [...] Read more.

Background: Radiopaque breast markers cause artifacts in dedicated spiral breast-computed tomography (SBCT). This study investigates the extent of artifacts in different marker types and the feasibility of reducing artifacts through a metal artifact reduction (MAR) algorithm. Methods: The pilot study included 18 women who underwent contrast-enhanced SBCT. In total, 20 markers of 4 different types were analyzed for artifacts. The extent of artifacts with and without MAR was measured via the consensus of two readers. Image noise was quantitatively evaluated, and the effect of MAR on the detectability of breast lesions was evaluated on a 3-point Likert scale. Results: Breast markers caused significant artifacts that impaired image quality and the detectability of lesions. MAR decreased artifact size in all analyzed cases, even in cases with multiple markers in a single slice. The median length of in-plain artifacts significantly decreased from 31 mm (range 11–51 mm) in uncorrected to 2 mm (range 1–5 mm) in corrected images (p ≤ 0.05). Artifact size was dependent on marker size. Image noise in slices affected by artifacts was significantly lower in corrected (13.6 ± 2.2 HU) than in uncorrected images (19.2 ± 6.8 HU, p ≤ 0.05). MAR improved the detectability of lesions affected by artifacts in 5 out of 11 cases. Conclusion: MAR is feasible in SBCT and improves the image quality and detectability of lesions. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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19 pages, 3832 KiB

Open AccessArticle

Quantitative Evaluation of COVID-19 Pneumonia CT Using AI Analysis—Feasibility and Differentiation from Other Common Pneumonia Forms

by Una Ebong, Susanne Martina Büttner, Stefan A. Schmidt, Franziska Flack, Patrick Korf, Lynn Peters, Beate Grüner, Steffen Stenger, Thomas Stamminger, Hans Kestler, Meinrad Beer and Christopher Kloth

Diagnostics 2023, 13(12), 2129; https://doi.org/10.3390/diagnostics13122129 - 20 Jun 2023

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Abstract

PURPOSE: To implement the technical feasibility of an AI-based software prototype optimized for the detection of COVID-19 pneumonia in CT datasets of the lung and the differentiation between other etiologies of pneumonia. METHODS: This single-center retrospective case–control-study consecutively yielded 144 patients (58 female, [...] Read more.

PURPOSE: To implement the technical feasibility of an AI-based software prototype optimized for the detection of COVID-19 pneumonia in CT datasets of the lung and the differentiation between other etiologies of pneumonia. METHODS: This single-center retrospective case–control-study consecutively yielded 144 patients (58 female, mean age 57.72 ± 18.25 y) with CT datasets of the lung. Subgroups including confirmed bacterial (n = 24, 16.6%), viral (n = 52, 36.1%), or fungal (n = 25, 16.6%) pneumonia and (n = 43, 30.7%) patients without detected pneumonia (comparison group) were evaluated using the AI-based Pneumonia Analysis prototype. Scoring (extent, etiology) was compared to reader assessment. RESULTS: The software achieved an optimal sensitivity of 80.8% with a specificity of 50% for the detection of COVID-19; however, the human radiologist achieved optimal sensitivity of 80.8% and a specificity of 97.2%. The mean postprocessing time was 7.61 ± 4.22 min. The use of a contrast agent did not influence the results of the software (p = 0.81). The mean evaluated COVID-19 probability is 0.80 ± 0.36 significantly higher in COVID-19 patients than in patients with fungal pneumonia (p < 0.05) and bacterial pneumonia (p < 0.001). The mean percentage of opacity (PO) and percentage of high opacity (PHO ≥ −200 HU) were significantly higher in COVID-19 patients than in healthy patients. However, the total mean HU in COVID-19 patients was −679.57 ± 112.72, which is significantly higher than in the healthy control group (p < 0.001). CONCLUSION: The detection and quantification of pneumonia beyond the primarily trained COVID-19 datasets is possible and shows comparable results for COVID-19 pneumonia to an experienced reader. The advantages are the fast, automated segmentation and quantification of the pneumonia foci. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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12 pages, 2327 KiB

Open AccessArticle

Direct Anthropometry Overestimates Cranial Asymmetry—3D Digital Photography Proves to Be a Reliable Alternative

by Felix Nieberle, Steffen Spoerl, Lisa-Marie Lottner, Gerrit Spanier, Johannes G. Schuderer, Mathias Fiedler, Michael Maurer, Nils Ludwig, Johannes K. Meier, Tobias Ettl, Torsten E. Reichert and Juergen Taxis

Diagnostics 2023, 13(10), 1707; https://doi.org/10.3390/diagnostics13101707 - 11 May 2023

Cited by 2 | Viewed by 1267

Abstract

This study compared manual and digital measurements of plagiocephaly and brachycephaly in infants and evaluated whether three-dimensional (3D) digital photography measurements can be used as a superior alternative in everyday clinical practice. A total of 111 infants (103 with plagiocephalus and 8 with [...] Read more.

This study compared manual and digital measurements of plagiocephaly and brachycephaly in infants and evaluated whether three-dimensional (3D) digital photography measurements can be used as a superior alternative in everyday clinical practice. A total of 111 infants (103 with plagiocephalus and 8 with brachycephalus) were included in this study. Head circumference, length and width, bilateral diagonal head length, and bilateral distance from the glabella to the tragus were assessed by manual assessment (tape measure and anthropometric head calipers) and 3D photographs. Subsequently, the cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Measured cranial parameters and CVAI were significantly more precise using 3D digital photography. Manually acquired cranial vault symmetry parameters were at least 5 mm lower than digital measurements. Differences in CI between the two measuring methods did not reach significance, whereas the calculated CVAI showed a 0.74-fold decrease using 3D digital photography and was highly significant (p < 0.001). Using the manual method, CVAI calculations overestimated asymmetry, and cranial vault symmetry parameters were measured too low, contributing to a misrepresentation of the actual anatomical situation. Considering consequential errors in therapy choices, we suggest implementing 3D photography as the primary tool for diagnosing deformational plagiocephaly and positional head deformations. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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17 pages, 4349 KiB

Open AccessArticle

Contrast-Enhanced Imaging Features and Clinicopathological Investigation of Steatohepatitic Hepatocellular Carcinoma

by Kailing Chen, Yadan Xu, Yi Dong, Hong Han, Feng Mao, Hantao Wang, Xuhao Song, Rongkui Luo and Wen-Ping Wang

Diagnostics 2023, 13(7), 1337; https://doi.org/10.3390/diagnostics13071337 - 03 Apr 2023

Cited by 3 | Viewed by 1384

Abstract

Steatohepatitic hepatocellular carcinoma (SH-HCC) is a distinctive histologic variant of HCC for the presence of steatohepatitis. This study intended to evaluate the contrast-enhanced imaging features and clinicopathological characteristics of 26 SH-HCCs in comparison with 26 age-and-sex-matched non-SH-HCCs. The frequency of obesity (34.6%, p [...] Read more.

Steatohepatitic hepatocellular carcinoma (SH-HCC) is a distinctive histologic variant of HCC for the presence of steatohepatitis. This study intended to evaluate the contrast-enhanced imaging features and clinicopathological characteristics of 26 SH-HCCs in comparison with 26 age-and-sex-matched non-SH-HCCs. The frequency of obesity (34.6%, p = 0.048) and type 2 diabetes mellitus (23.1%, p = 0.042) were significantly higher in SH-HCC patients. As seen via B-mode ultrasound (BMUS), SH-HCCs were predominantly hyperechoic (65.4%, p = 0.002) lesions, while non-SH-HCCs were mainly hypo-echoic. As seen via contrast-enhanced ultrasound (CEUS), 96.2% of SH-HCCs exhibited hyperenhancement in the arterial phase. During the portal venous and late phase, 88.5% of SH-HCCs showed late and mild washout. Consequently, most SH-HCCs and all non-SH-HCCs were categorized as LR-4 or LR-5. As seen via magnetic resonance imaging (MRI), a signal drop in the T1WI opposed-phase was observed in 84.6% of SH-HCCs (p = 0.000). Notably, diffuse fat in mass was detected in 57.7% (15/26) SH-HCCs (p < 0.001). As seen via contrast-enhanced MRI (CEMRI), most of the SH-HCCs and non-SH-HCCs exhibited heterogeneous hyperenhancement in the arterial phase (80.8% versus 69.2%, p = 0.337). During the delayed phase, 76.9% SH-HCCs and 88.5% non-SH-HCCs exhibited hypo-enhancement. Histopathologically, the rate of microvascular invasion (MVI) was significantly lower in SH-HCCs than non-SH-HCCs (42.3% versus 73.1%, p = 0.025). The frequency of hepatic steatosis >5% in non-tumoral liver parenchyma of SH-HCCs was significantly higher than in non-SH-HCCs (88.5% versus 26.9%, p = 0.000). Additionally, the fibrotic stages of S0, S1 and S2 in SH-HCCs were significantly higher than in non-SH-HCCs (p = 0.044). During follow-up, although the PFS of SH-HCC patients was significantly longer than non-SH-HCC patients (p = 0.046), for the overall survival rate of SH-HCC and non-SH-HCC patients there was no significant difference (p = 0.162). In conclusion, the frequency of metabolism-related diseases in SH-HCC patients was significantly higher than in non-SH-HCC patients. The imaging features of SH-HCCs combined the fatty change and typical enhancement performance of standard HCC as seen via CEUS/CEMRI. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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12 pages, 7744 KiB

Open AccessArticle

Low-Risk Women with Suspicious Microcalcifications in Mammography—Can an Additional Breast MRI Reduce the Biopsy Rate?

by Patrik Pöschke, Evelyn Wenkel, Carolin C. Hack, Matthias W. Beckmann, Michael Uder and Sabine Ohlmeyer

Diagnostics 2023, 13(6), 1197; https://doi.org/10.3390/diagnostics13061197 - 22 Mar 2023

Cited by 2 | Viewed by 1796

Abstract

Background: In the German Mammography Screening Program, 62% of ductal carcinoma in situ (DCIS) and 38% of invasive breast cancers are associated with microcalcifications (MCs). Vacuum-assisted stereotactic breast biopsies are necessary to distinguish precancerous lesions from benign calcifications because mammographic discrimination is not [...] Read more.

Background: In the German Mammography Screening Program, 62% of ductal carcinoma in situ (DCIS) and 38% of invasive breast cancers are associated with microcalcifications (MCs). Vacuum-assisted stereotactic breast biopsies are necessary to distinguish precancerous lesions from benign calcifications because mammographic discrimination is not possible. The aim of this study was to investigate if breast magnetic resonance imaging (MRM) could assist the evaluation of MCs and thus help reduce biopsy rates. Methods: In this IRB-approved study, 58 women (mean age 58 +/− 24 years) with 59 suspicious MC clusters in the MG were eligible for this prospective single-center trial. Additional breast magnetic resonance imaging (MRI) was conducted before biopsy. Results: The breast MRI showed a sensitivity of 86%, a specificity of 84%, a positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 91% for the differentiation between benign and malignant in these 59 MCs found with MG. Breast MRI in addition to MG could increase the PPV from 36% to 75% compared to MG alone. The MRI examination led to nine additional suspicious classified lesions in the study cohort. A total of 55% (5/9) of them turned out to be malignant. A total of 32 of 59 (54 %) women with suspicious MCs and benign histology were classified as non-suspicious by MRI. Conclusion: An additionally performed breast MRI could have increased the diagnostic reliability in the assessment of MCs. Further, in our small cohort, a considerable number of malignant lesions without mammographically visible MCs were revealed. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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13 pages, 1788 KiB

Open AccessArticle

Using A-Mode Ultrasound to Assess the Body Composition of Soccer Players: A Comparative Study of Prediction Formulas

by Paul Muntean, Monica Neagu, Elena Amaricai, Horia G. Haragus, Roxana Ramona Onofrei and Adrian Neagu

Diagnostics 2023, 13(4), 690; https://doi.org/10.3390/diagnostics13040690 - 12 Feb 2023

Cited by 2 | Viewed by 1188

Abstract

For elite athletes, monitoring body composition is important for maximizing performance without health risks. Amplitude (A)-mode ultrasound (AUS) has attracted increasing attention as an alternative to skinfold thickness measurements commonly used for assessing the amount of body fat in athletes. AUS accuracy and [...] Read more.

For elite athletes, monitoring body composition is important for maximizing performance without health risks. Amplitude (A)-mode ultrasound (AUS) has attracted increasing attention as an alternative to skinfold thickness measurements commonly used for assessing the amount of body fat in athletes. AUS accuracy and precision, however, depend on the formula used to predict body fat percentage (%BF) from subcutaneous fat layer thicknesses. Therefore, this study evaluates the accuracy of the 1-point biceps (B1), 9-sites Parrillo, 3-sites Jackson and Pollock (JP3), and 7-sites Jackson and Pollock (JP7) formulas. Relying on the previous validation of the JP3 formula in college-aged male athletes, we took AUS measurements in 54 professional soccer players (aged 22.9 ± 3.83 y, mean ± SD) and compared the results given by different formulas. The Kruskal–Wallis test indicated significant differences (p < 10⁻⁶), and Conover’s post hoc test revealed that the JP3 and JP7 data come from the same distribution, whereas the data given by B1 and P9 differ from all the others. Lin’s concordance correlation coefficients for B1 vs. JP7, P9 vs. JP7, and JP3 vs. JP7 were 0.464, 0.341, and 0.909, respectively. The Bland–Altman analysis indicated mean differences of −0.5 %BF between JP3 and JP7, 4.7 %BF between P9 and JP7, and 3.1 %BF between B1 and JP7. This study suggests that JP7 and JP3 are equally valid, whereas P9 and B1 overestimate %BF in athletes. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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Review

Jump to: Research, Other

12 pages, 951 KiB

Open AccessReview

Dual-Energy Computed Tomography in Detecting and Predicting Lymph Node Metastasis in Malignant Tumor Patients: A Comprehensive Review

by Mengting Chen, Yundan Jiang, Xuhui Zhou, Di Wu and Qiuxia Xie

Diagnostics 2024, 14(4), 377; https://doi.org/10.3390/diagnostics14040377 - 09 Feb 2024

Viewed by 809

Abstract

The accurate and timely assessment of lymph node involvement is paramount in the management of patients with malignant tumors, owing to its direct correlation with cancer staging, therapeutic strategy formulation, and prognostication. Dual-energy computed tomography (DECT), as a burgeoning imaging modality, has shown [...] Read more.

The accurate and timely assessment of lymph node involvement is paramount in the management of patients with malignant tumors, owing to its direct correlation with cancer staging, therapeutic strategy formulation, and prognostication. Dual-energy computed tomography (DECT), as a burgeoning imaging modality, has shown promising results in the diagnosis and prediction of preoperative metastatic lymph nodes in recent years. This article aims to explore the application of DECT in identifying metastatic lymph nodes (LNs) across various cancer types, including but not limited to thyroid carcinoma (focusing on papillary thyroid carcinoma), lung cancer, and colorectal cancer. Through this narrative review, we aim to elucidate the clinical relevance and utility of DECT in the detection and predictive assessment of lymph node metastasis in malignant tumors, thereby contributing to the broader academic discourse in oncologic radiology and diagnostic precision. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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20 pages, 18157 KiB

Open AccessReview

Pictorial Review on Imaging Findings in Cerebral CTP in Patients with Acute Stroke and Its Mimics: A Primer for General Radiologists

by Benedikt Haggenmüller, Kornelia Kreiser, Nico Sollmann, Magdalena Huber, Daniel Vogele, Stefan A. Schmidt, Meinrad Beer, Bernd Schmitz, Yigit Ozpeynirci, Johannes Rosskopf and Christopher Kloth

Diagnostics 2023, 13(3), 447; https://doi.org/10.3390/diagnostics13030447 - 26 Jan 2023

Cited by 3 | Viewed by 5576

Abstract

The imaging evaluation of computed tomography (CT), CT angiography (CTA), and CT perfusion (CTP) is of crucial importance in the setting of each emergency department for suspected cerebrovascular impairment. A fast and clear assignment of characteristic imaging findings of acute stroke and its [...] Read more.

The imaging evaluation of computed tomography (CT), CT angiography (CTA), and CT perfusion (CTP) is of crucial importance in the setting of each emergency department for suspected cerebrovascular impairment. A fast and clear assignment of characteristic imaging findings of acute stroke and its differential diagnoses is essential for every radiologist. Different entities can mimic clinical signs of an acute stroke, thus the knowledge and fast identification of stroke mimics is important. A fast and clear assignment is necessary for a correct diagnosis and a rapid initiation of appropriate therapy. This pictorial review describes the most common imaging findings in CTP with clinical signs for acute stroke or other acute neurological disorders. The knowledge of these pictograms is therefore essential and should also be addressed in training and further education of radiologists. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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Other

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3 pages, 1870 KiB

Open AccessInteresting Images

Amniotic Band Syndrome—Prenatal Diagnosis

by Nicolae Gică, Livia Mihaela Apostol, Corina Gică, Iulia Huluță, Ana Maria Vayna, Anca Maria Panaitescu and Nicoleta Gana

Diagnostics 2024, 14(1), 34; https://doi.org/10.3390/diagnostics14010034 - 23 Dec 2023

Viewed by 774

Abstract

This is a case of a fetus affected by an amniotic band detected at 20 weeks of gestation. A presumptive diagnosis was made based on the ultrasound features. The ultrasound showed an abnormally developed right lower limb and no other associated fetal abnormalities. [...] Read more.

This is a case of a fetus affected by an amniotic band detected at 20 weeks of gestation. A presumptive diagnosis was made based on the ultrasound features. The ultrasound showed an abnormally developed right lower limb and no other associated fetal abnormalities. The unilaterality of the defect decreases the chances of genetic abnormality or an early vascular insult. The postnatal examination of the newborn concluded that the prenatal diagnosis was right. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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8 pages, 2577 KiB

Open AccessInteresting Images

No Critical Ultrasound, No Life: The Value of Point-of Care Critical Ultrasound in the Rescue of Critically Ill Infants

by Jing Liu, Ya-Li Guo and Xiao-Ling Ren

Diagnostics 2023, 13(24), 3624; https://doi.org/10.3390/diagnostics13243624 - 08 Dec 2023

Viewed by 1129

Abstract

Point-of-care critical ultrasound (POC-CUS) screening plays an increasingly important role in the treatment of critically ill infants. Without POC-CUS, the lives of many infants would not be saved in time and correctly. A premature infant with systemic multiple organ system dysfunction caused by [...] Read more.

Point-of-care critical ultrasound (POC-CUS) screening plays an increasingly important role in the treatment of critically ill infants. Without POC-CUS, the lives of many infants would not be saved in time and correctly. A premature infant with systemic multiple organ system dysfunction caused by fungal sepsis was treated and nursed under the guidance of POC-CUS monitoring, and the infant was ultimately cured. This premature infant had systemic multiple organ system dysfunction and disseminated intravascular coagulation (DIC) caused by fungal sepsis. In the hypercoagulable state of early-stage DIC, cardiac thrombosis could be found using ultrasound screening. For this case, right renal artery thrombosis was found via renal artery Doppler ultrasound examination. Due to the severity of this disease, ultrasound-guided peripherally inserted central catheter (PICC) insertion and ultrasound checks of the PICC tip’s position were performed, which ensured the success of this one-time catheterization and shortened the catheterization time. Lung ultrasound is used for the diagnosis and differential diagnosis of pulmonary diseases, and to guide the application of mechanical ventilation. Because the abdominal circumference of the patient’s markedly enlarged abdominal circumference, bloody stool, and absence of bowel sounds, abdominal ultrasonography was performed, which revealed a markedly enlarged liver, significant peritoneal effusion, and necrotizing enterocolitis. Guided by POC-CUS monitoring, we had the opportunity to implement timely and effective treatment that ultimately saved this critically ill patient’s life. The successful treatment of this newborn infant fully reflects the importance of carrying out POC-CUS screening. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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5 pages, 1349 KiB

Open AccessInteresting Images

Myocardial Edema: A Rare but Specific Manifestation of Neonatal Capillary Leak Syndrome

by Jing Liu and Yue-Qiao Gao

Diagnostics 2023, 13(23), 3597; https://doi.org/10.3390/diagnostics13233597 - 04 Dec 2023

Cited by 1 | Viewed by 822

Abstract

Capillary leak syndrome (CLS) is a rare, potentially life-threatening systemic disease with a mortality rate of more than 30%. Its major clinical manifestation and diagnostic basis are systemic hyperedema. However, we lack knowledge about the presence of severe myocardial edema in patients with [...] Read more.

Capillary leak syndrome (CLS) is a rare, potentially life-threatening systemic disease with a mortality rate of more than 30%. Its major clinical manifestation and diagnostic basis are systemic hyperedema. However, we lack knowledge about the presence of severe myocardial edema in patients with CLS. If myocardial edema cannot be detected, it will become a dangerous hidden condition that threatens the safety of patient lives. With the routine application of point-of-care critical ultrasound (POC-CUS) in clinical practice, we found that 2 of 37 (5.41%) CLS patients had severe myocardial edema as the main manifestation. It is also necessary to distinguish it from myocardial noncompaction in newborn infants with severe myocardial edema. This paper will help us to have a deeper understanding and correct management of CLS and, thus, help us to improve the prognosis of patients. This article also suggests the necessity of routine implementation of POC-CUS in the neonatal intensive care unit. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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9 pages, 2102 KiB

Open AccessInteresting Images

Thyroglossal Duct Lipoma: A Case Report and a Systematic Review of the Literature for Its Management

by Luca Giovanni Locatello, Marilena Graziadio, Elena D’Orlando, Alfredo Vallone, Cesare Miani, Enrico Pegolo and Maria Gabriella Rugiu

Diagnostics 2023, 13(5), 932; https://doi.org/10.3390/diagnostics13050932 - 01 Mar 2023

Viewed by 1236

Abstract

Thyroglossal duct (TGD) remnants in the form of cysts or fistulas usually present as midline neck masses and they are removed along with the central body of the hyoid bone (Sistrunk’s procedure). For other pathologies associated with the TGD tract, the latter operation [...] Read more.

Thyroglossal duct (TGD) remnants in the form of cysts or fistulas usually present as midline neck masses and they are removed along with the central body of the hyoid bone (Sistrunk’s procedure). For other pathologies associated with the TGD tract, the latter operation might be not necessary. In the present report, a case of a TGD lipoma is presented and a systematic review of the pertinent literature was performed. We present the case of a 57-year-old woman with a pathologically confirmed TGD lipoma who underwent transcervical excision without resecting the hyoid bone. Recurrence was not observed after six months of follow-up. The literature search revealed only one other case of TGD lipoma and controversies are addressed. TGD lipoma is an exceedingly rare entity whose management might avoid hyoid bone excision. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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24 pages, 3351 KiB

Open AccessCase Report

Patellar Resurfacing in Total Knee Arthroplasty, a Never-Ending Controversy; Case Report and Literature Review

by Răzvan Adam, Cosmin Moldovan, Sorin Tudorache, Tudor Hârșovescu, Carmen Orban, Mark Pogărășteanu and Elena Rusu

Diagnostics 2023, 13(3), 383; https://doi.org/10.3390/diagnostics13030383 - 19 Jan 2023

Viewed by 3131

Abstract

Total knee arthroplasty (TKA) remains a lifesaving procedure for advanced gonarthrosis. However, patella resurfacing (PR) in TKA remains a controversial procedure, leading to extensive discussions amongst orthopedic surgeons, regarding its indications and results. Based on these premises, we present a clinical case of [...] Read more.

Total knee arthroplasty (TKA) remains a lifesaving procedure for advanced gonarthrosis. However, patella resurfacing (PR) in TKA remains a controversial procedure, leading to extensive discussions amongst orthopedic surgeons, regarding its indications and results. Based on these premises, we present a clinical case of a 70-year-old Caucasian woman admitted for pain, swelling and limitation of left knee joint mobility. Her medical history records an Ahlback stage IV gonarthrosis with simultaneous bilateral TKA surgery performed in different hospital, when two NexGen cemented total prostheses were implanted with patellar resurfacing being performed only on the right side. Our clinical (American Knee Society Score, Lonner and Feller scales) and radiological evaluations (CT scan and Xray) revealed left patellar arthrosis and a slight lateral subluxation of the patella. The chosen treatment plan was revision surgery for PR and patellar prosthesis with a cemented patellar component, cross-linked polyethylene, no 32 NexGen model with 8.5 mm thickness. The immediate and distant postoperative evolution was favorable. Extensive literature review shows that, at present, PR remains at surgeon’s discretion mainly based on his previous results. Therefore, we believe there is an imperative need to develop high quality studies based on accurate scientific evidence to universally establish valid guidelines for PR in TKA. Full article

(This article belongs to the Special Issue Advances in Diagnostic Medical Imaging in 2023)

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