Topic Editors

Department of Biocybernetics and Biomedical Engineering, AGH University of Science and Technology, al. Mickiewicza 30, 30-059 Cracow, Poland
Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Cracow, Poland
Prof. Dr. Andrzej Urbanik
Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Cracow, Poland
Institute of Electronics, Lodz University of Technology, Wolczanska 211/215, 90-924 Łódź, Poland

Advances in Musculoskeletal Imaging and Their Applications

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Topic Information

Dear Colleagues,

Radiographic acquisition techniques have undergone tremendous improvements since their invention. Image resolution has greatly increased and the reduction in the dose of X-ray radiation required for its creation has been achieved. The increased amount of imaging data does not necessarily mean that more medical information is accessible to the reader. Some (but often important) information is hidden from the radiologist. This is especially true for radiographic techniques.

The purpose of advanced image-analysis systems is to extract occulted data to improve the objectivity of diagnosis for a given case. The treatment of clinical problems with information obtained using advanced image analyses has increased. In musculoskeletal radiology, proven associations exist between bone scan analyses, patient health and metabolic status. Moreover, the processes of bone maturation, bone healing, bone demineralization and deformation due to overuse can be extensively analyzed with the use of CR, CT and MRI. Advanced methods significantly improve differentiation and hence the diagnostic process of medication for different lesions including neoplasms of the bone.

Papers investigating the application of both classical image processing and artificial intelligence (AI) methods in the analysis and extraction of diagnostically useful data from medical images are welcomed in this Special Issue. Such methods assist in the investigation of the shape and geometry of, for example, bone tissue or its fragments. Other AI approaches allow for the automatic detection and segmentation of tissues or organs and the assessment of their pathologies. For this purpose, the achievements of radiomics are particularly useful, including image-texture analyses. Various machine learning methods are also useful for exploring medical imaging data and are widely used in medical diagnostic support systems. Deep learning algorithms play a particularly important role in this respect. Recently, dynamic developments have been achieved in the field of deep learning algorithms, and their effectiveness has been confirmed in numerous applications of medical image analyses of various modalities.

Prof. Dr. Adam Piórkowski
Prof. Dr. Rafał Obuchowicz
Prof. Dr. Andrzej Urbanik
Prof. Dr. Michał Strzelecki
Topic Editors

Keywords

  • bone imaging
  • musculoskeletal imaging
  • image processing
  • image analysis
  • segmentation
  • textural analysis
  • machine learning

Participating Journals

Journal Name Impact Factor CiteScore Launched Year First Decision (median) APC
Diagnostics
diagnostics
3.6 3.6 2011 20.7 Days CHF 2600
Journal of Clinical Medicine
jcm
3.9 5.4 2012 17.9 Days CHF 2600
Tomography
tomography
1.9 2.3 2015 24.5 Days CHF 2400
Applied Sciences
applsci
2.7 4.5 2011 16.9 Days CHF 2400
Radiation
radiation
- - 2021 24.5 Days CHF 1000

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Published Papers (26 papers)

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10 pages, 254 KiB  
Editorial
Advances in Musculoskeletal Imaging and Their Applications
by Adam Piórkowski, Rafał Obuchowicz, Andrzej Urbanik and Michał Strzelecki
J. Clin. Med. 2023, 12(20), 6585; https://doi.org/10.3390/jcm12206585 - 18 Oct 2023
Viewed by 717
Abstract
Modern medical imaging systems provide ever-more information about the patient’s health condition [...] Full article
13 pages, 6046 KiB  
Article
Changes in Parameters after High Tibial Osteotomy: Comparison of EOS System and Computed Tomographic Analysis
by Hyun-Jin Yoo, Jae-Kyu Choi, Youn-Moo Heo, Sung-Jun Moon and Byung-Hak Oh
J. Clin. Med. 2023, 12(17), 5638; https://doi.org/10.3390/jcm12175638 - 29 Aug 2023
Cited by 1 | Viewed by 644
Abstract
Unintended rotation of the distal tibia occurs during medial open-wedge high tibial osteotomy (MOWHTO). Computed tomography (CT) is the standard method of measuring lower limb alignment; however, the new low-dose EOS system allows three-dimensional limb modeling with automated measurements of lower limb alignment. [...] Read more.
Unintended rotation of the distal tibia occurs during medial open-wedge high tibial osteotomy (MOWHTO). Computed tomography (CT) is the standard method of measuring lower limb alignment; however, the new low-dose EOS system allows three-dimensional limb modeling with automated measurements of lower limb alignment. This study investigated the differences between the changes in lower limb alignment profiles obtained using the EOS system and CT in patients who underwent MOWHTO. We investigated whether any factors contributed to the degree of deformation. Thirty patients were prospectively enrolled between October 2019 and February 2023. Changes in femoral and tibial torsion, femorotibial rotation, and posterior tibial slope were measured using pre- and post-MOWHTO CT and EOS images. We found no significant difference in pre- and postoperative tibial torsion or posterior tibial slope between CT and EOS. No variables showed a significant correlation with changes in the tibial torsion or posterior tibial slope. This study confirmed the possibility that the EOS system could replace CT in measuring changes in several parameters pre- and postoperatively. Furthermore, we confirmed that the distal tibia tended to be internally rotated after MOWHTO; however, we found no significantly related parameters related to deformation caused by MOWHTO. Full article
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10 pages, 1053 KiB  
Article
Detecting Bone Marrow Edema of the Extremities on Spectral Computed Tomography Using a Three-Material Decomposition
by Marie Schierenbeck, Martin Grözinger, Benjamin Reichardt, Olav Jansen, Hans-Ulrich Kauczor, Graeme M. Campbell and Sam Sedaghat
Diagnostics 2023, 13(17), 2745; https://doi.org/10.3390/diagnostics13172745 - 24 Aug 2023
Cited by 6 | Viewed by 893
Abstract
Background: Detecting bone marrow edema (BME) as a sign of acute fractures is challenging on conventional computed tomography (CT). This study evaluated the diagnostic performance of a three-material decomposition (TMD) approach for detecting traumatic BME of the extremities on spectral computed tomography (SCT). [...] Read more.
Background: Detecting bone marrow edema (BME) as a sign of acute fractures is challenging on conventional computed tomography (CT). This study evaluated the diagnostic performance of a three-material decomposition (TMD) approach for detecting traumatic BME of the extremities on spectral computed tomography (SCT). Methods: This retrospective diagnostic study included 81 bone compartments with and 80 without BME. A TMD application to visualize BME was developed in collaboration with Philips Healthcare. The following bone compartments were included: distal radius, proximal femur, proximal tibia, distal tibia and fibula, and long bone diaphysis. Two blinded radiologists reviewed each case independently in random order for the presence or absence of BME. Results: The interrater reliability was 0.84 (p < 0.001). The different bone compartments showed sensitivities of 86.7% to 93.8%, specificities of 84.2% to 94.1%, positive predictive values of 82.4% to 94.7%, negative predictive values of 87.5% to 93.3%, and area under the curve (AUC) values of 85.7% to 93.1%. The distal radius showed the highest sensitivity and the proximal femur showed the lowest sensitivity, while the proximal femur presented the highest specificity and the distal tibia presented the lowest specificity. Conclusions: Our TMD approach provides high diagnostic performance for detecting BME of the extremities. Therefore, this approach could be used routinely in the emergency setting. Full article
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15 pages, 2015 KiB  
Article
Detection and Quantitative Assessment of Arthroscopically Proven Long Biceps Tendon Pathologies Using T2 Mapping
by Patrick Stein, Felix Wuennemann, Thomas Schneider, Felix Zeifang, Iris Burkholder, Marc-André Weber, Hans-Ulrich Kauczor and Christoph Rehnitz
Tomography 2023, 9(5), 1577-1591; https://doi.org/10.3390/tomography9050126 - 23 Aug 2023
Cited by 1 | Viewed by 1123
Abstract
This study evaluates how far T2 mapping can identify arthroscopically confirmed pathologies in the long biceps tendon (LBT) and quantify the T2 values in healthy and pathological tendon substance. This study comprised eighteen patients experiencing serious shoulder discomfort, all of whom underwent magnetic [...] Read more.
This study evaluates how far T2 mapping can identify arthroscopically confirmed pathologies in the long biceps tendon (LBT) and quantify the T2 values in healthy and pathological tendon substance. This study comprised eighteen patients experiencing serious shoulder discomfort, all of whom underwent magnetic resonance imaging, including T2 mapping sequences, followed by shoulder joint arthroscopy. Regions of interest were meticulously positioned on their respective T2 maps, capturing the sulcal portion of the LBT and allowing for the quantification of the average T2 values. Subsequent analyses included the calculation of diagnostic cut-off values, sensitivities, and specificities for the detection of tendon pathologies, and the calculation of inter-reader correlation coefficients (ICCs) involving two independent radiologists. The average T2 value for healthy subjects was measured at 23.3 ± 4.6 ms, while patients with tendinopathy displayed a markedly higher value, at 47.9 ± 7.8 ms. Of note, the maximum T2 value identified in healthy tendons (29.6 ms) proved to be lower than the minimal value measured in pathological tendons (33.8 ms), resulting in a sensitivity and specificity of 100% (95% confidence interval 63.1–100) across all cut-off values ranging from 29.6 to 33.8 ms. The ICCs were found to range from 0.93 to 0.99. In conclusion, T2 mapping is able to assess and quantify healthy LBTs and can distinguish them from tendon pathology. T2 mapping may provide information on the (ultra-)structural integrity of tendinous tissue, facilitating early diagnosis, prompt therapeutic intervention, and quantitative monitoring after conservative or surgical treatments of LBT. Full article
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15 pages, 2350 KiB  
Article
Is Corticalization in Radiographs Related to a Higher Risk of Bone Loss around Dental Implants in Smoking Patients? A 5-Year Observation of Radiograph Bone-Texture Changes
by Tomasz Wach, Piotr Hadrowicz, Grzegorz Trybek, Adam Michcik and Marcin Kozakiewicz
J. Clin. Med. 2023, 12(16), 5351; https://doi.org/10.3390/jcm12165351 - 17 Aug 2023
Cited by 2 | Viewed by 1377
Abstract
Background: Currently, the topic of dental implants is widely researched. However, still compromising are the factors that can affect implant loss as a consequence of marginal bone loss. One of the factors is smoking, which has a devastating effect on human health and [...] Read more.
Background: Currently, the topic of dental implants is widely researched. However, still compromising are the factors that can affect implant loss as a consequence of marginal bone loss. One of the factors is smoking, which has a devastating effect on human health and bone structure. Oral health and jaw condition are also negatively affected by smoking. The aim of this study was to evaluate the peri-implant jawbone corticalization phenomenon in tobacco smokers. Methods: A total of 2196 samples from 768 patients with an implant in the neck area were checked, and texture features were analyzed. The corticalization phenomenon was investigated. All analyses were performed in MaZda Software. The influence of corticalization was investigated as a factor on bone structure near the implant neck. The statistical analysis included a feature distribution evaluation, mean (t-test) or median (W-test) comparison, analysis of regression and one-way analysis of variance or Kruskal–Wallis test as no normal distribution or between-group variance was indicated for the significant differences in the investigated groups. Detected differences or relationships were assumed to be statistically significant when p < 0.05. Results: The research revealed that MBL was correlated with smoking after 5 years (0.42 mm ± 1.32 mm 0 mm ± 1.25 mm), the Corticalization Index was higher in the smoker group on the day of surgery, and it became higher after 5y of observation (185.98 ± 90.8 and 243.17 ± 155.47). The implant-loss frequency was higher in the group of smokers, too, compared to non-smokers (6.74% and 2.87%). The higher the torque value during the implant placement, the higher the Corticalization Phenomenon Index. Conclusions: The research revealed a correlation between smoking and changes in bone structure in radio textures near the implants. The corticalization phenomenon is important, may be detected immediately after implant placement and may be one of the indicators of the implant success rate. Full article
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17 pages, 7619 KiB  
Review
Hydroxyapatite Deposition Disease: A Comprehensive Review of Pathogenesis, Radiological Findings, and Treatment Strategies
by Tarek Hegazi
Diagnostics 2023, 13(16), 2678; https://doi.org/10.3390/diagnostics13162678 - 15 Aug 2023
Cited by 2 | Viewed by 1731
Abstract
Hydroxyapatite deposition disease (HADD) represents a multifaceted condition characterized by the accumulation of hydroxyapatite crystals in soft tissues, leading to subsequent inflammation and discomfort. The intricate etiology of HADD is the subject of this comprehensive review, which encompasses an in-depth analysis of the [...] Read more.
Hydroxyapatite deposition disease (HADD) represents a multifaceted condition characterized by the accumulation of hydroxyapatite crystals in soft tissues, leading to subsequent inflammation and discomfort. The intricate etiology of HADD is the subject of this comprehensive review, which encompasses an in-depth analysis of the four proposed pathogenic mechanisms and a deliberation on the predisposing factors that instigate the development of this disease. In order to provide a thorough understanding of the disease’s progression, this manuscript delineates the stages of HADD—those preceding calcification, occurring during calcification, and following calcification—in meticulous detail. This chronology forms the basis of a complete portrayal of the evolution of HADD. Moreover, this review encompasses an examination of the radiological findings associated with HADD, furnishing an extensive discourse on imaging characteristics. The potential of HADD to mimic other diseases, thereby posing diagnostic challenges, is also articulated. The discourse continues with an investigation of HADD’s differential diagnosis. This section furnishes a robust framework for distinguishing HADD from other conditions based on imaging results. To enrich the understanding of this diagnostic process, case studies illustrating real-world applications are provided. An overview of treatment modalities for HADD, including both conservative and interventional approaches, forms the concluding discussion. The pivotal role of imaging specialists in the diagnosis and management of HADD is emphasized, highlighting their vital contribution to image-guided procedures and disease monitoring. Full article
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10 pages, 2713 KiB  
Article
Ultra-High-Resolution Photon-Counting Detector CT Arthrography of the Ankle: A Feasibility Study
by Karsten Sebastian Luetkens, Jan-Peter Grunz, Andreas Steven Kunz, Henner Huflage, Manuel Weißenberger, Viktor Hartung, Theresa Sophie Patzer, Philipp Gruschwitz, Süleyman Ergün, Thorsten Alexander Bley and Philipp Feldle
Diagnostics 2023, 13(13), 2201; https://doi.org/10.3390/diagnostics13132201 - 28 Jun 2023
Cited by 3 | Viewed by 1032
Abstract
This study was designed to investigate the image quality of ultra-high-resolution ankle arthrography employing a photon-counting detector CT. Bilateral arthrograms were acquired in four cadaveric specimens with full-dose (10 mGy) and low-dose (3 mGy) scan protocols. Three convolution kernels with different spatial frequencies [...] Read more.
This study was designed to investigate the image quality of ultra-high-resolution ankle arthrography employing a photon-counting detector CT. Bilateral arthrograms were acquired in four cadaveric specimens with full-dose (10 mGy) and low-dose (3 mGy) scan protocols. Three convolution kernels with different spatial frequencies were utilized for image reconstruction (ρ50; Br98: 39.0, Br84: 22.6, Br76: 16.5 lp/cm). Seven radiologists subjectively assessed the image quality regarding the depiction of bone, hyaline cartilage, and ligaments. An additional quantitative assessment comprised the measurement of noise and the computation of contrast-to-noise ratios (CNR). While an optimal depiction of bone tissue was achieved with the ultra-sharp Br98 kernel (S ≤ 0.043), the visualization of cartilage improved with lower modulation transfer functions at each dose level (p ≤ 0.014). The interrater reliability ranged from good to excellent for all assessed tissues (intraclass correlation coefficient ≥ 0.805). The noise levels in subcutaneous fat decreased with reduced spatial frequency (p < 0.001). Notably, the low-dose Br76 matched the CNR of the full-dose Br84 (p > 0.999) and superseded Br98 (p < 0.001) in all tissues. Based on the reported results, a photon-counting detector CT arthrography of the ankle with an ultra-high-resolution collimation offers stellar image quality and tissue assessability, improving the evaluation of miniscule anatomical structures. While bone depiction was superior in combination with an ultra-sharp convolution kernel, soft tissue evaluation benefited from employing a lower spatial frequency. Full article
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13 pages, 1020 KiB  
Article
Correlation of Bone Textural Parameters with Age in the Context of Orthopedic X-ray Studies
by Paweł Kamiński, Rafał Obuchowicz, Aleksandra Stępień, Julia Lasek, Elżbieta Pociask and Adam Piórkowski
Appl. Sci. 2023, 13(11), 6618; https://doi.org/10.3390/app13116618 - 30 May 2023
Cited by 3 | Viewed by 1065
Abstract
The aim of this study was to establish a relationship between the textural parameters observed in X-ray images of bones and the age of the individual. The study utilized a meticulous visual analysis of the images to identify significant correlations between textural features [...] Read more.
The aim of this study was to establish a relationship between the textural parameters observed in X-ray images of bones and the age of the individual. The study utilized a meticulous visual analysis of the images to identify significant correlations between textural features and age. Five distinct regions of interest, namely the Wing of the Ilium, Neck of the Femur, Greater Trochanter, Ischium, and Shaft of the Femur, were identified on both sides of the body. Textural parameters were then measured for each of these regions. The left femoral neck showed the most noteworthy associations, with the textures generated from the histogram of oriented gradients and gray-level co-occurrence matrix exhibiting the strongest correlations (ρ −0.52, p-value 4.95 × 10−14). The main finding of the current study is that correlation of age-dependent bone structure differences in the femoral neck area is higher than in other structures of the femur. This proposed methodology has the potential to aid in the early detection of osteoporosis, which is crucial for devising treatment plans and identifying potential risks associated with bone fragility. Full article
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13 pages, 6089 KiB  
Article
3-Tesla T2 Mapping Magnetic Resonance Imaging for Evaluation of SLAP Lesions in Patients with Shoulder Pain: An Arthroscopy-Controlled Study
by Patrick Stein, Felix Wuennemann, Thomas Schneider, Felix Zeifang, Iris Burkholder, Marc-André Weber, Hans-Ulrich Kauczor and Christoph Rehnitz
J. Clin. Med. 2023, 12(9), 3109; https://doi.org/10.3390/jcm12093109 - 25 Apr 2023
Cited by 3 | Viewed by 3248
Abstract
This study investigated the ability of T2 mapping to assess the glenoid labrum and to differentiate between healthy labral substances and superior labral anterior posterior (SLAP) lesions using arthroscopy as the gold standard. Eighteen patients (mean age: 52.4 ± 14.72 years, 12 men) [...] Read more.
This study investigated the ability of T2 mapping to assess the glenoid labrum and to differentiate between healthy labral substances and superior labral anterior posterior (SLAP) lesions using arthroscopy as the gold standard. Eighteen patients (mean age: 52.4 ± 14.72 years, 12 men) with shoulder pain were examined using 3-Tesla T2 mapping. All the patients underwent shoulder arthroscopy. Using morphological sequences for correlation, regions of interest covering the entire labral substance were placed in the corresponding T2 maps. The diagnostic cutoff values, sensitivities, and specificities, as well as the inter-reader correlation coefficients (ICCs) determined by two independent radiologists, were calculated. The mean T2 value was 20.8 ± 2.4 ms for the healthy labral substances and 37.7 ± 10.63 ms in the patients with SLAP lesions. The maximum T2 value in normal labrum (21.2 ms) was lower than the minimum T2 value in the patients with SLAP lesions (27.8 ms), leading to sensitivities, specificities, and positive and negative predictive values of 100% (95% CI 54.1–100.0) for all the cutoff values between 21.2 and 27.8 ms. The ICCs ranged from 0.91 to 0.99. In summary, the data suggest that evaluation and quantification of the labral (ultra)structural integrity using T2 mapping may allow discrimination between arthroscopically confirmed SLAP lesions and a healthy glenoid labrum. T2 mapping may therefore be helpful in diagnosing patients with suspected labral damage. Full article
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12 pages, 1930 KiB  
Article
Effect of Anthropometric Parameters on Achilles Tendon Stiffness of Professional Athletes Measured by Shear Wave Elastography
by Claudia Römer, Enrico Zessin, Julia Czupajllo, Thomas Fischer, Bernd Wolfarth and Markus Herbert Lerchbaumer
J. Clin. Med. 2023, 12(8), 2963; https://doi.org/10.3390/jcm12082963 - 19 Apr 2023
Cited by 1 | Viewed by 1270
Abstract
Background: Shear wave elastography (SWE) is currently used to detect tissue pathologies and, in the setting of preventive medicine, may have the potential to reveal structural changes before they lead to functional impairment. Hence, it would be desirable to determine the sensitivity of [...] Read more.
Background: Shear wave elastography (SWE) is currently used to detect tissue pathologies and, in the setting of preventive medicine, may have the potential to reveal structural changes before they lead to functional impairment. Hence, it would be desirable to determine the sensitivity of SWE and to investigate how Achilles tendon stiffness is affected by anthropometric variables and sport-specific locomotion. Methods: To investigate the influence of anthropometric parameters on Achilles tendon stiffness using SWE and examine different types of sports to develop approaches in preventive medicine for professional athletes, standardized SWE of Achilles tendon stiffness was performed in 65 healthy professional athletes (33 female, 32 male) in the longitudinal plane and relaxed tendon position. Descriptive analysis and linear regression were performed. Furthermore, subgroup analysis was performed for different sports (soccer, handball, sprint, volleyball, hammer throw). Results: In the total study population (n = 65), Achilles tendon stiffness was significantly higher in male professional athletes (p < 0.001) than in female professional athletes (10.98 m/s (10.15–11.65) vs. 12.19 m/s (11.25–14.74)). Multiple linear regression for AT stiffness did not reveal a significant impact of age or body mass index (BMI) (p > 0.05). Subgroup analysis for type of sport showed the highest AT stiffness values in sprinters (14.02 m/s (13.50–14.63)). Conclusion: There are significant gender differences in AT stiffness across different types of professional athletes. The highest AT stiffness values were found in sprinters, which needs to be considered when diagnosing tendon pathologies. Future studies are needed to investigate the benefit of pre- and post-season musculoskeletal SWE examinations of professional athletes and a possible benefit of rehabilitation or preventive medicine. Full article
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17 pages, 3945 KiB  
Article
Strain and Strain Rate Tensor Mapping of Medial Gastrocnemius at Submaximal Isometric Contraction and Three Ankle Angles
by Ryan Hernandez, Usha Sinha, Vadim Malis, Brandon Cunnane, Edward Smitaman and Shantanu Sinha
Tomography 2023, 9(2), 840-856; https://doi.org/10.3390/tomography9020068 - 11 Apr 2023
Cited by 2 | Viewed by 1355
Abstract
Introduction: The aim of this study is to analyze the muscle kinematics of the medial gastrocnemius (MG) during submaximal isometric contractions and to explore the relationship between deformation and force generated at plantarflexed (PF), neutral (N) and dorsiflexed (DF) ankle angles. Method: Strain [...] Read more.
Introduction: The aim of this study is to analyze the muscle kinematics of the medial gastrocnemius (MG) during submaximal isometric contractions and to explore the relationship between deformation and force generated at plantarflexed (PF), neutral (N) and dorsiflexed (DF) ankle angles. Method: Strain and Strain Rate (SR) tensors were calculated from velocity-encoded magnetic resonance phase-contrast images in six young men acquired during 25% and 50% Maximum Voluntary Contraction (MVC). Strain and SR indices as well as force normalized values were statistically analyzed using two-way repeated measures ANOVA for differences with force level and ankle angle. An exploratory analysis of differences between absolute values of longitudinal compressive strain (Eλ1) and radial expansion strains (Eλ2) and maximum shear strain (Emax) based on paired t-test was also performed for each ankle angle. Results: Compressive strains/SRs were significantly lower at 25%MVC. Normalized strains/SR were significantly different between %MVC and ankle angles with lowest values for DF. Absolute values of Eλ2 and Emax were significantly higher than Eλ1 for DF suggesting higher deformation asymmetry and higher shear strain, respectively. Conclusions: In addition to the known optimum muscle fiber length, the study identified two potential new causes of increased force generation at dorsiflexion ankle angle, higher fiber cross-section deformation asymmetry and higher shear strains. Full article
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17 pages, 1920 KiB  
Article
Texture Analysis for the Bone Age Assessment from MRI Images of Adolescent Wrists in Boys
by Rafal Obuchowicz, Karolina Nurzynska, Monika Pierzchala, Adam Piorkowski and Michal Strzelecki
J. Clin. Med. 2023, 12(8), 2762; https://doi.org/10.3390/jcm12082762 - 07 Apr 2023
Cited by 6 | Viewed by 1407
Abstract
Currently, bone age is assessed by X-rays. It enables the evaluation of the child’s development and is an important diagnostic factor. However, it is not sufficient to diagnose a specific disease because the diagnoses and prognoses may arise depending on how much the [...] Read more.
Currently, bone age is assessed by X-rays. It enables the evaluation of the child’s development and is an important diagnostic factor. However, it is not sufficient to diagnose a specific disease because the diagnoses and prognoses may arise depending on how much the given case differs from the norms of bone age. Background: The use of magnetic resonance images (MRI) to assess the age of the patient would extend diagnostic possibilities. The bone age test could then become a routine screening test. Changing the method of determining the bone age would also prevent the patient from taking a dose of ionizing radiation, making the test less invasive. Methods: The regions of interest containing the wrist area and the epiphyses of the radius are marked on the magnetic resonance imaging of the non-dominant hand of boys aged 9 to 17 years. Textural features are computed for these regions, as it is assumed that the texture of the wrist image contains information about bone age. Results: The regression analysis revealed that there is a high correlation between the bone age of a patient and the MRI-derived textural features derived from MRI. For DICOM T1-weighted data, the best scores reached 0.94 R2, 0.46 RMSE, 0.21 MSE, and 0.33 MAE. Conclusions: The experiments performed have shown that using the MRI images gives reliable results in the assessment of bone age while not exposing the patient to ionizing radiation. Full article
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8 pages, 1302 KiB  
Article
The Efficacy of CT Temporal Subtraction Images for Fibrodysplasia Ossificans Progressiva
by Mami Iima, Ryo Sakamoto, Takahide Kakigi, Akira Yamamoto, Bungo Otsuki, Yuji Nakamoto, Junya Toguchida and Shuichi Matsuda
Tomography 2023, 9(2), 768-775; https://doi.org/10.3390/tomography9020062 - 03 Apr 2023
Cited by 2 | Viewed by 1364
Abstract
Purpose: To evaluate the usefulness of CT temporal subtraction (TS) images for detecting emerging or growing ectopic bone lesions in fibrodysplasia ossificans progressiva (FOP). Materials and Methods: Four patients with FOP were retrospectively included in this study. TS images were produced by subtracting [...] Read more.
Purpose: To evaluate the usefulness of CT temporal subtraction (TS) images for detecting emerging or growing ectopic bone lesions in fibrodysplasia ossificans progressiva (FOP). Materials and Methods: Four patients with FOP were retrospectively included in this study. TS images were produced by subtracting previously registered CT images from the current images. Two residents and two board-certified radiologists independently interpreted a pair of current and previous CT images for each subject with or without TS images. Changes in the visibility of the lesion, the usefulness of TS images for lesions with TS images, and the interpreter’s confidence level in their interpretation of each scan were assessed on a semiquantitative 5-point scale (0–4). The Wilcoxon signed-rank test was used to compare the evaluated scores between datasets with and without TS images. Results: The number of growing lesions tended to be larger than that of the emerging lesions in all cases. A higher sensitivity was found in residents and radiologists using TS compared to those not using TS. For all residents and radiologists, the dataset with TS tended to have more false-positive scans than the dataset without TS. All the interpreters recognized TS as useful, and confidence levels when using TS tended to be lower or the same as when not using TS for two residents and one radiologist. Conclusions: TS improved the sensitivity of all interpreters in detecting emerging or growing ectopic bone lesions in patients with FOP. TS could be applied further, including the areas of systematic bone disease. Full article
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17 pages, 1864 KiB  
Article
Comfort and Support Values Provided by Different Pillow Materials for Individuals with Forward Head Posture
by Ceyhun Türkmen, Serdar Yılmaz Esen, Zafer Erden and Tülin Düger
Appl. Sci. 2023, 13(6), 3865; https://doi.org/10.3390/app13063865 - 17 Mar 2023
Cited by 1 | Viewed by 3377
Abstract
Based on the pressure distributions in the head, neck, and upper body and the spine support values, this study aims to recommend the most suitable pillow for those with forward head posture (FHP) according to different sleeping positions. This descriptive cross-sectional study recruited [...] Read more.
Based on the pressure distributions in the head, neck, and upper body and the spine support values, this study aims to recommend the most suitable pillow for those with forward head posture (FHP) according to different sleeping positions. This descriptive cross-sectional study recruited thirty healthy 18- to 55-year-old men and women with body mass indexes of less than 30 kg/m2. Participants tried five different pillows (viscose, fiber, cotton, goose feather, and wool) on a medium-firm hybrid mattress at room temperature with a humidity of 45–55%. Participants tried the pillows first in the supine position, then side-lying, and finally in the prone position. A pressure-mapping system was utilized to measure the pressure distributions of the head and shoulder areas in millimeters of mercury (mmHg) and the amount of support provided by the pillow to these regions in square centimeters (cm2). When the comfort and support parameters of different pillow materials were compared among all participants, for the supine position, Pillow B and Pillow E provided higher head comfort (p < 0.001), while Pillow A and Pillow E provided higher shoulder support (p = 0.044). In the side-lying position, Pillow B provided higher head comfort (p < 0.001) and Pillow C (p = 0.003) higher shoulder comfort. In the prone position, Pillow B and Pillow E provided higher head comfort (p < 0.001), while Pillow E also provided higher shoulder support (p = 0.002). This study showed pillow materials affect the spine comfort and support of the participants, and these values may vary according to different spinal alignments, such as FHP. According to the preferred sleeping position, the pillow material that supports the spine and its comfort and support values may also change. Full article
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12 pages, 1012 KiB  
Article
Diagnostics Using the Change-of-Direction and Acceleration Test (CODAT) of the Biomechanical Patterns Associated with Knee Injury in Female Futsal Players: A Cross-Sectional Analytical Study
by Loreto Ferrández-Laliena, Lucía Vicente-Pina, Rocío Sánchez-Rodríguez, Eva Orantes-González, José Heredia-Jimenez, María Orosia Lucha-López, César Hidalgo-García and José Miguel Tricás-Moreno
Diagnostics 2023, 13(5), 928; https://doi.org/10.3390/diagnostics13050928 - 01 Mar 2023
Cited by 2 | Viewed by 1961
Abstract
The primary aim of this study was to identify kinematic differences at initial contact between female futsal players with and without previous knee injury, using a functional motor pattern test. The secondary aim was to determine kinematic differences between the dominant and non-dominant [...] Read more.
The primary aim of this study was to identify kinematic differences at initial contact between female futsal players with and without previous knee injury, using a functional motor pattern test. The secondary aim was to determine kinematic differences between the dominant and non-dominant limb in the whole group, using the same test. A cross-sectional study was performed in 16 female futsal players allocated into two groups: eight females with a previous knee injury, i.e., affected by the valgus collapse mechanism without surgical intervention, and eight with no previous injury. The evaluation protocol included the change-of-direction and acceleration test (CODAT). One registration was made for each lower limb, i.e., the dominant (the preferred kicking limb) and non-dominant limb. A 3D motion capture system (Qualisys AB, Göteborg, Sweden) was used to analyze the kinematics. The Cohen’s d effect sizes between the groups demonstrated a strong effect size towards more physiological positions in the non-injured group in the following kinematics in the dominant limb: hip adduction (Cohen’s d = 0.82), hip internal rotation (Cohen’s d = 0.88), and ipsilateral pelvis rotation (Cohen’s d = 1.06). The t-test for the dominant and non-dominant limb in the whole group showed the following differences in knee valgus: dominant limb (9.02 ± 7.31 degrees) and non-dominant limb (1.27 ± 9.05 degrees) (p = 0.049). Conclusions: The players with no previous history of knee injury had a more physiological position for avoiding the valgus collapse mechanism in the hip adduction and internal rotation, and in the pelvis rotation in the dominant limb. All the players showed more knee valgus in the dominant limb, which is the limb at greater risk of injury. Full article
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20 pages, 2642 KiB  
Article
Exploring the Importance of Corticalization Occurring in Alveolar Bone Surrounding a Dental Implant
by Marcin Kozakiewicz and Tomasz Wach
J. Clin. Med. 2022, 11(23), 7189; https://doi.org/10.3390/jcm11237189 - 02 Dec 2022
Cited by 4 | Viewed by 3393
Abstract
Several measures describing the transformation of trabecular bone to cortical bone on the basis of analysis of intraoral radiographs are known (including bone index or corticalization index, CI). At the same time, it has been noted that after functional loading of dental implants [...] Read more.
Several measures describing the transformation of trabecular bone to cortical bone on the basis of analysis of intraoral radiographs are known (including bone index or corticalization index, CI). At the same time, it has been noted that after functional loading of dental implants such transformations occur in the bone directly adjacent to the fixture. Intuitively, it seems that this is a process conducive to the long-term maintenance of dental implants and certainly necessary when immediate loading is applied. The authors examined the relationship of implant design features to marginal bone loss (MBL) and the intensity of corticalization over a 10-year period of functional loading. This study is a general description of the phenomenon of peri-implant bone corticalization and an attempt to interpret this phenomenon to achieve success of implant treatment in the long term. Corticalization significantly increased over the first 5-year functional loading (CI from 200 ± 146 initially to 282 ± 182, p < 0.001) and maintained a high level (CI = 261 ± 168) in the 10-year study relative to the reference bone (149 ± 178). MBL significantly increased throughout the follow-up period—5 years: 0.83 ± 1.26 mm (p < 0.001), 10 years: 1.48 ± 2.01 mm (p < 0.001). MBL and radiographic bone structure (CI) were evaluated in relation to intraosseous implant design features and prosthetic work performed. In the scope of the study, it can be concluded that the phenomenon of peri-implant jawbone corticalization seems an unfavorable condition for the future fate of bone-anchored implants, but it requires further research to fully explain the significance of this phenomenon. Full article
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9 pages, 594 KiB  
Article
A New Role for Epidurography: A Simple Method for Assessing the Adequacy of Decompression during Percutaneous Plasma Disc Decompression
by Ho Young Gil, Wonseok Seo, Gyu Bin Choi, Eunji Ha, Taekwang Kim, Jungyul Ryu, Jae Hyung Kim and Jong Bum Choi
J. Clin. Med. 2022, 11(23), 7144; https://doi.org/10.3390/jcm11237144 - 01 Dec 2022
Cited by 1 | Viewed by 1396
Abstract
Percutaneous plasma disc decompression (PPDD) is a minimally invasive treatment for discogenic low back pain and herniated disc-related symptoms. However, there are no known outcome predictive variables during the procedure. The purpose of this study was to evaluate and validate epidurography as an [...] Read more.
Percutaneous plasma disc decompression (PPDD) is a minimally invasive treatment for discogenic low back pain and herniated disc-related symptoms. However, there are no known outcome predictive variables during the procedure. The purpose of this study was to evaluate and validate epidurography as an intra-procedure outcome predictor. We retrospectively enrolled 60 consecutive patients who did not respond to conventional treatments. In the next stage of treatment, PPDD was performed, and the epidurography was conducted before and after the PPDD. We analyzed the relationship between epidurographic improvement and the success rate. The Numerical Rating Scale and the Oswestry Disability Index were used to assess pain and functional capacity, respectively, before the procedure and 1 month after the procedure. The pain reduction and the success rate in the epidurographic improvement group were significantly higher than in the epidurographic non-improvement group. Both the Numerical Rating Scale and the Oswestry Disability Index scores were significantly reduced in both groups, but there was no significant difference in Oswestry Disability Index scores. This study’s results showed that PPDD is an effective treatment method. We also suggested that epidurography may be a potential outcome predictor for ensuring successful outcomes and determining the endpoint of the procedure. Full article
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9 pages, 1511 KiB  
Article
Significance of Temporal Muscle Thickness in Chronic Subdural Hematoma
by Daniel Dubinski, Sae-Yeon Won, Bedjan Behmanesh, Daniel Cantré, Isabell Mattes, Svorad Trnovec, Peter Baumgarten, Patrick Schuss, Thomas M. Freiman and Florian Gessler
J. Clin. Med. 2022, 11(21), 6456; https://doi.org/10.3390/jcm11216456 - 31 Oct 2022
Cited by 4 | Viewed by 1578
Abstract
Background: Reduced temporal muscle thickness (TMT) was verified as an independent negative prognostic parameter for outcome in brain tumor patients. Independent thereof, chronic subdural hematoma (CSDH) is a neurosurgical condition with high recurrence rates and unreliable risk models for poor outcome. Since sarcopenia [...] Read more.
Background: Reduced temporal muscle thickness (TMT) was verified as an independent negative prognostic parameter for outcome in brain tumor patients. Independent thereof, chronic subdural hematoma (CSDH) is a neurosurgical condition with high recurrence rates and unreliable risk models for poor outcome. Since sarcopenia was associated with poor outcome, we investigated the possible role of TMT and the clinical course of CSDH patients. Methods: This investigation is a single-center retrospective study on patients with CSDH. We analyzed the radiological and clinical data sets of 171 patients with surgically treated CSDH at a University Hospital from 2017 to 2020. Results: Our analysis showed a significant association between low-volume TMT and increased hematoma volume (p < 0.001), poor outcome at discharge (p < 0.001), and reduced performance status at 3 months (p < 0.002). Conclusion: TMT may represent an objective prognostic parameter and assist the identification of vulnerable CSDH patients. Full article
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11 pages, 1890 KiB  
Article
Ultrasound Can Be Usefully Integrated with the Clinical Assessment of Nail and Enthesis Involvement in Psoriasis and Psoriatic Arthritis
by Yu-Shin Huang, Yu-Huei Huang, Chiung-Hung Lin, Chang-Fu Kuo and Yun-Ju Huang
J. Clin. Med. 2022, 11(21), 6296; https://doi.org/10.3390/jcm11216296 - 26 Oct 2022
Cited by 4 | Viewed by 2212
Abstract
Objectives: This study aimed to examine and compare the findings of nail and enthesis ultrasonography in patients with psoriasis and psoriatic arthritis. Methods: We identified 154 patients with psoriatic arthritis and 35 patients with psoriasis who were treated at Chang Gung Memorial Hospital, [...] Read more.
Objectives: This study aimed to examine and compare the findings of nail and enthesis ultrasonography in patients with psoriasis and psoriatic arthritis. Methods: We identified 154 patients with psoriatic arthritis and 35 patients with psoriasis who were treated at Chang Gung Memorial Hospital, Taiwan, between September 2018 and January 2019. Results: There were significant differences in the Nail Psoriasis Severity Index scores and Glasgow Ultrasound Enthesitis Scoring System scores between patients with psoriasis and those with psoriatic arthritis. B-mode ultrasonography revealed that onychopathic changes were more common in the psoriasis group. The psoriatic arthritis group showed a higher proportion of lower-limb enthesopathy, with significant differences in distal patellar ligament thickness and Achilles tendon thickness. Conclusion: The findings of nail ultrasonography were more severe in psoriasis cases, and the ultrasonographic findings of enthesopathy of the lower limb were more severe in cases of psoriatic arthritis. Full article
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15 pages, 2090 KiB  
Article
Are Torque-Induced Bone Texture Alterations Related to Early Marginal Jawbone Loss?
by Tomasz Wach, Małgorzata Skorupska and Grzegorz Trybek
J. Clin. Med. 2022, 11(20), 6158; https://doi.org/10.3390/jcm11206158 - 19 Oct 2022
Cited by 3 | Viewed by 1430
Abstract
The reason why marginal bone loss (MBL) occurs after dental implant insertion without loading has not yet been clearly investigated. There are publications that confirm or reject the notion that there are factors that induce marginal bone loss, but no research investigates what [...] Read more.
The reason why marginal bone loss (MBL) occurs after dental implant insertion without loading has not yet been clearly investigated. There are publications that confirm or reject the notion that there are factors that induce marginal bone loss, but no research investigates what exactly occurs in the bone surrounding the implant neck. In this study, 2196 samples of dental implant neck bone radiographs were analyzed. The follow-up period was 3 months without functional loading of the implant. Marginal bone loss was evaluated in relation to the torque used during the final phase of implant insertion. Radiographic texture features were also analyzed and evaluated. The analyses were performed individually for the anterior and posterior part of the alveolar crest in both the mandible and maxilla. After 3 months, an MBL relation with higher torque (higher than 40 Ncm; p < 0.05) was observed, but only in the lower jaw. The texture features Sum Average (SumAverg), Entropy, Difference Entropy (DifEntr), Long-Run Emphasis (LngREmph), Short-Run Emphasis (ShrtREmph), and discrete wavelet decomposition transform features were changed over time. This study presents that MBL is related to the torque value during dental implant insertion and the location of the procedure. The increasing values of SumAverg and LngREmph correlated with MBL, which were 64.21 to 64.35 and 1.71 to 2.01, respectively. The decreasing values of Entr, DifEntr, and ShrtREmph also correlated with MBL, which were 2.58 to 2.47, 1.11 to 1.01, and 0.88 to 0.84, respectively. The analyzed texture features may become good indicators of MBL in digital dental surgery. Full article
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9 pages, 1168 KiB  
Article
High Accuracy and Safety of Intraoperative CT-Guided Navigation for Transpedicular Screw Placement in Revision Spinal Surgery
by Yen-Yao Li, Shih-Hao Chen, Kuo-Chin Huang, Chien-Yin Lee, Chin-Chang Cheng, Ching-Yu Lee, Meng-Huang Wu and Tsung-Jen Huang
J. Clin. Med. 2022, 11(19), 5853; https://doi.org/10.3390/jcm11195853 - 02 Oct 2022
Cited by 1 | Viewed by 1721
Abstract
Background: Intraoperative CT-guided navigation (iCT-navigation) has been reported to improve the accuracy and safety of transpedicular screw placement in primary spinal surgery. However, due to a disrupted bony anatomy and scarring tissue, revision spinal surgery can be challenging. The purpose of this study [...] Read more.
Background: Intraoperative CT-guided navigation (iCT-navigation) has been reported to improve the accuracy and safety of transpedicular screw placement in primary spinal surgery. However, due to a disrupted bony anatomy and scarring tissue, revision spinal surgery can be challenging. The purpose of this study was to evaluate the accuracy and safety of iCT-navigation for screw placement at the virgin site versus the revision site in revision thoracolumbar spinal surgery. Method: In total, 254 screws were inserted in 27 revision surgeries, in which 114 (44.9%) screws were inserted at the site with previous laminectomy or posterolateral fusion (the revision site), 64 (25.2%) were inserted at the virgin site, and 76 (29.9%) were inserted to replace the pre-existing screws. CT scans were conducted for each patient after all screws were inserted to intraoperatively confirm the screw accuracy. Results: In total, 248 (97.6%) screws were considered accepted. The rate of accepted screws at the virgin site was 98.4% (63/64) versus 95.6% (109/114) at the revision site (p: 0.422). There were six (2.4%) unaccepted screws, which were immediately revised during the same operation. There was no neurological injury noted in our patients. Conclusion: With the use of iCT-navigation, the rate of accepted screws at the revision site was found to be comparable to that at the virgin site. We concluded that iCT-navigation could achieve high accuracy and safety for transpedicular screw placement in revision spinal surgery and allow for the immediate revision of unaccepted screws. Full article
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12 pages, 2434 KiB  
Study Protocol
The Efficacy of Trabecular Titanium Cages to Induce Reparative Bone Activity after Lumbar Arthrodesis Studied through the 18f-Naf PET/CT Scan: Observational Clinical In-Vivo Study
by Fabio Cofano, Daniele Armocida, Livia Ruffini, Maura Scarlattei, Giorgio Baldari, Giuseppe Di Perna, Giulia Pilloni, Francesco Zenga, Elena Ballante, Diego Garbossa and Fulvio Tartara
Diagnostics 2022, 12(10), 2296; https://doi.org/10.3390/diagnostics12102296 - 23 Sep 2022
Cited by 3 | Viewed by 1370
Abstract
Background: Titanium trabecular cages (TTCs) are emerging implants designed to achieve immediate and long-term spinal fixation with early osseointegration. However, a clear radiological and clinical demonstration of their efficacy has not yet been obtained. The purpose of this study was to evaluate the [...] Read more.
Background: Titanium trabecular cages (TTCs) are emerging implants designed to achieve immediate and long-term spinal fixation with early osseointegration. However, a clear radiological and clinical demonstration of their efficacy has not yet been obtained. The purpose of this study was to evaluate the reactive bone activity of adjacent plates after insertion of custom-made titanium trabecular cages for the lumbar interbody with positron emission tomography (PET)/computed tomography (CT) 18F sodium fluoride (18F-NaF). Methods: This was an observational clinical study that included patients who underwent surgery for degenerative disease with lumbar interbody fusion performed with custom-made TTCs. Data related to the metabolic-reparative reaction following the surgery and its relationship with clinical follow-up from PET/CT performed at different weeks were evaluated. PET/CTs provided reliable data, such as areas showing abnormally high increases in uptake using a volumetric region of interest (VOI) comprising the upper (UP) and lower (DOWN) limits of the cage. Results: A total of 15 patients was selected for PET examination. Timing of PET/CTs ranged from one week to a maximum of 100 weeks after surgery. The analysis showed a negative correlation between the variables SUVmaxDOWN/time (r = −0.48, p = 0.04), ratio-DOWN/time (r = −0.53, p = 0.02), and ratio-MEAN/time (r = −0.5, p = 0.03). Shapiro−Wilk normality tests showed significant results for the variables ratio-DOWN (p = 0.002), ratio-UP (0.013), and ratio-MEAN (0.002). Conclusions: 18F-NaF PET/CT has proven to be a reliable tool for investigating the metabolic-reparative reaction following implantation of TTCs, demonstrating radiologically how this type of cage can induce reparative osteoblastic activity at the level of the vertebral endplate surface. This study further confirms how electron-beam melting (EBM)-molded titanium trabecular cages represent a promising material for reducing hardware complication rates and promoting fusion. Full article
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10 pages, 3688 KiB  
Article
A Novel Lightweight Approach to COVID-19 Diagnostics Based on Chest X-ray Images
by Agata Giełczyk, Anna Marciniak, Martyna Tarczewska, Sylwester Michal Kloska, Alicja Harmoza, Zbigniew Serafin and Marcin Woźniak
J. Clin. Med. 2022, 11(19), 5501; https://doi.org/10.3390/jcm11195501 - 20 Sep 2022
Cited by 5 | Viewed by 1414
Abstract
Background: This paper presents a novel lightweight approach based on machine learning methods supporting COVID-19 diagnostics based on X-ray images. The presented schema offers effective and quick diagnosis of COVID-19. Methods: Real data (X-ray images) from hospital patients were used in this study. [...] Read more.
Background: This paper presents a novel lightweight approach based on machine learning methods supporting COVID-19 diagnostics based on X-ray images. The presented schema offers effective and quick diagnosis of COVID-19. Methods: Real data (X-ray images) from hospital patients were used in this study. All labels, namely those that were COVID-19 positive and negative, were confirmed by a PCR test. Feature extraction was performed using a convolutional neural network, and the subsequent classification of samples used Random Forest, XGBoost, LightGBM and CatBoost. Results: The LightGBM model was the most effective in classifying patients on the basis of features extracted from X-ray images, with an accuracy of 1.00, a precision of 1.00, a recall of 1.00 and an F1-score of 1.00. Conclusion: The proposed schema can potentially be used as a support for radiologists to improve the diagnostic process. The presented approach is efficient and fast. Moreover, it is not excessively complex computationally. Full article
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15 pages, 3918 KiB  
Article
Measures of Corticalization
by Marcin Kozakiewicz
J. Clin. Med. 2022, 11(18), 5463; https://doi.org/10.3390/jcm11185463 - 16 Sep 2022
Cited by 7 | Viewed by 1549
Abstract
After the insertion of dental implants into living bone, the condition of the peri-implant bone changes with time. Implant-loading phenomena can induce bone remodeling in the form of the corticalization of the trabecular bone. The aim of this study was to see how [...] Read more.
After the insertion of dental implants into living bone, the condition of the peri-implant bone changes with time. Implant-loading phenomena can induce bone remodeling in the form of the corticalization of the trabecular bone. The aim of this study was to see how bone index (BI) values behave in areas of bone loss (radiographically translucent non-trabecular areas) and to propose other indices specifically dedicated to detecting corticalization in living bone. Eight measures of corticalization in clinical standardized intraoral radiographs were studied: mean optical density, entropy, differential entropy, long-run emphasis moment, BI, corticalization index ver. 1 and ver. 2 (CI v.1, CI v.2) and corticalization factor (CF). The analysis was conducted on 40 cortical bone image samples, 40 cancellous bone samples and 40 soft tissue samples. It was found that each measure distinguishes corticalization significantly (p < 0.001), but only CI v.1 and CI v.2 do so selectively. CF or the inverse of BI can serve as a measure of peri-implant bone corticalization. However, better measures are CIs as they are dedicated to detecting this phenomenon and allowing clear clinical deduction. Full article
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12 pages, 2677 KiB  
Case Report
Direct Visualization of Cervical Interlaminar Epidural Injections Using Sonography
by Nana Maeda, Manabu Maeda and Yasuhito Tanaka
Tomography 2022, 8(4), 1869-1880; https://doi.org/10.3390/tomography8040157 - 22 Jul 2022
Cited by 4 | Viewed by 2549
Abstract
In this case series, we describe a novel ultrasound (US)-guided cervical interlaminar epidural steroid injections (CILESIs) procedure that does not depend on the loss-of-resistance method for epidural space identification. A needle is introduced into three US-identified structures (triple bar sign), the interspinal ligament, [...] Read more.
In this case series, we describe a novel ultrasound (US)-guided cervical interlaminar epidural steroid injections (CILESIs) procedure that does not depend on the loss-of-resistance method for epidural space identification. A needle is introduced into three US-identified structures (triple bar sign), the interspinal ligament, ligamentum flavum, and dura mater. The injectants are monitored using superb microvascular imaging during injection. Here, we demonstrate the use of US-guided CILESIs in nine cases and propose the use of sonography, rather than conventional methods, for easier and safer cervical epidural injections. Sonography for direct visualization of cervical epidural injection may allow for outpatient injections. Full article
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9 pages, 1426 KiB  
Article
Perioperative Radiographic Predictors of Non-Union in Infra-Isthmal Femoral Shaft Fractures after Antegrade Intramedullary Nailing: A Case–Control Study
by Wei-Cheng Hung, Chin-Jung Hsu, Abhishek Kumar, Chun-Hao Tsai, Hao-Wei Chang and Tsung-Li Lin
J. Clin. Med. 2022, 11(13), 3664; https://doi.org/10.3390/jcm11133664 - 24 Jun 2022
Cited by 2 | Viewed by 4535
Abstract
Antegrade intramedullary (IM) nailing is the gold standard treatment for femoral shaft fractures; however, the non-union rate of infra-isthmal femoral shaft fractures is still high after antegrade IM nailing. This retrospective case–control study aimed to determine the association between perioperative radiographic factors and [...] Read more.
Antegrade intramedullary (IM) nailing is the gold standard treatment for femoral shaft fractures; however, the non-union rate of infra-isthmal femoral shaft fractures is still high after antegrade IM nailing. This retrospective case–control study aimed to determine the association between perioperative radiographic factors and the non-union of infra-isthmal femoral shaft fractures after antegrade IM nailing. Univariate and multivariate analyses were used to evaluate the radiographic risk factors of non-union. Ninety-three patients were included, with thirty-one non-unions and sixty-two matched controls between 2007 and 2017. All were regularly followed up for 2 years. Receiver operating characteristic analysis revealed that a ratio of the unfixed distal segment > 32.5% was strongly predictive of postoperative non-union. The risk factors for non-union were AO/OTA type B and C (odds ratio [OR]: 2.20), a smaller ratio of the distal fragment (OR: 4.05), a greater ratio of the unfixed distal segment (OR: 7.16), a higher ratio of IM canal diameter to nail size at the level of fracture (OR: 6.23), and fewer distal locking screws (OR: 2.31). The radiographic risk factors for non-union after antegrade IM nailing for infra-isthmal femoral shaft fractures were unstable fractures, shorter distal fragments, longer unfixed distal fragments, wider IM canal, and fewer distal locking screws. Surgeons must strive to avoid non-union with longer and larger nails and apply more distal locking screws, especially for unstable, wider IM canal, and shorter distal fragment fractures. Full article
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