| 1. |
- Geijer, Mats, 1957, et al.
(författare)
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Diagnosis and progression of sacroiliitis in repeated sacroiliac joint computed tomography.
- 2013
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Ingår i: Arthritis. - : Hindawi Limited. - 2090-1984 .- 2090-1992. ; 2013
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To assess the clinical utility of repeat sacroiliac joint computed tomography (CT) in sacroiliitis by assessing the proportion of patients changing from normal to pathologic at CT and to which degree there is progression of established sacroiliitis at repeat CT. Methods. In a retrospective analysis of 334 patients (median age 34 years) with symptoms suggestive of inflammatory back pain, CT had been performed twice, in 47 of these thrice, and in eight patients four times. The studies were scored as normal, equivocal, unilateral sacroiliitis, or bilateral sacroiliitis. Results. There was no change in 331 of 389 repeat examinations. Ten patients (3.0%) had progressed from normal or equivocal to unilateral or bilateral sacroiliitis. Of 43 cases with sacroiliitis on the first study, 36 (83.7%) progressed markedly. Two normal cases had changed to equivocal. Eight equivocal cases were classified as normal on the repeat study. In further two patients, only small changes within the scoring grade equivocal were detected. Conclusions. CT is a valuable examination for diagnosis of sacroiliitis, but a repeated examination detects only a few additional cases of sacroiliitis. Most cases with already established sacroiliitis showed progression of disease.
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| 2. |
- Geijer, Mats, 1957, et al.
(författare)
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Observer variation in computed tomography of the sacroiliac joints: a retrospective analysis of 1383 cases
- 2007
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Ingår i: Acta Radiol. - : SAGE Publications. - 0284-1851. ; 48:6, s. 665-71
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Computed tomography (CT) for evaluation of sacroiliitis has a higher diagnostic accuracy than radiography. There is a high degree of interobserver variation in evaluating sacroiliitis on radiographs. PURPOSE: To evaluate interobserver variation in CT of the sacroiliac joints for evaluation of sacroiliitis in a large number of patients. MATERIAL AND METHODS: 1383 CT examinations of the sacroiliac joints were reviewed by two observers. The outcomes as originally reported and the findings from the reviews were classified as no sacroiliitis, equivocal, unilateral sacroiliitis, or bilateral sacroiliitis. The unweighted kappa statistic was used for assessment of observer agreement. RESULTS: The interobserver agreement between the two reviewers was good (kappa = 0.6724), with excellent agreement on cases of bilateral sacroiliitis and moderate agreement on cases of unilateral sacroiliitis. Excellent agreement was also reached in normal cases. Compared to the original reports, there were moderate interobserver agreements between both reviewers' findings and the original reports (kappa = 0.4651 and kappa = 0.4481, respectively). CONCLUSION: The interobserver variation for the diagnosis of sacroiliitis on CT between two reviewers in a study setting showed good agreement, with moderate agreement between each of the observers and the original clinical reports. CT is a reliable method for evaluating the sacroiliac joints for changes of sacroiliitis.
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| 3. |
- Geijer, Mats, 1957, et al.
(författare)
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The clinical utility of computed tomography compared to conventional radiography in diagnosing sacroiliitis. A retrospective study on 910 patients and literature review
- 2007
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Ingår i: J Rheumatol. - 0315-162X. ; 34:7, s. 1561-5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Ankylosing spondylitis (AS) is a progressive, debilitating disease with complex symptoms, unclear etiology and pathogenesis, and difficult diagnosis. Current imaging methods are useful in diagnosing AS and other spondyloarthropathies, and are frequently used in investigations of sacroiliitis. The radiographic diagnosis of sacroiliitis has large interobserver variations. Computed tomography (CT) has been used for evaluation of sacroiliitis since 1979, and has been evaluated in several studies, most of them with a limited number of patients. These studies have shown a large number of false-negative results from radiography. METHODS: In a retrospective study of clinical data, we evaluated 910 patients with AS who were examined by radiography and CT within a 2-year period. The reported outcomes from radiography and CT were compared. RESULTS: The agreement between radiography and CT data was only fair, with a kappa value of 0.2418. There were 35.0% false-positive radiography reports, 22.5% false-negative radiography reports, and 86.0% false-equivocal radiography reports. In total, 41.3% of all radiological reports gave a false answer. While the number of false negatives was similar to that previously reported, the number of false positives was much higher than previously reported, and is probably similar to everyday radiology reporting. CONCLUSION: Our results indicate that the clinical utility of radiography for evaluation of sacroiliitis is limited. The high rate of inaccurate results should motivate the use of sectional imaging for its superior performance.
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| 4. |
- Halldin, Klas, 1967, et al.
(författare)
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Three-dimensional radiological classification of lumbar disc herniation in relation to surgical outcome
- 2009
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Ingår i: International Orthopaedics. - : Springer Science and Business Media LLC. - 0341-2695 .- 1432-5195. ; 33:3, s. 725-30
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Tidskriftsartikel (refereegranskat)abstract
- Centrally located lumbar disc herniations have been reported to be of predictive value for poor post-operative clinical outcome. One hundred and fifty patients undergoing lumbar disc herniation surgery were prospectively included. Herniation-related parameters, including the grading of contours, were assessed from pre-operative computed tomography (CT) and magnetic resonance imaging (MRI) images using a new three-dimensional grading system. The radiological findings were compared with outcome parameters two years post-operatively (patient-assessed pain, function/health scores and evaluation by an independent observer). An intra- and inter-observer validation of the classification was performed in a subgroup of patients. High intra-observer and good inter-observer reliability for both CT and MRI was seen. In the study population, no relation between the distribution or size of the herniations and outcome at 2-year follow-up were found. The distribution and size of the lumbar disc herniations with the three-dimensional classification were not found to be of importance for the clinical outcome.
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| 5. |
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| 6. |
- Berry, Max, 1969, et al.
(författare)
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Endovascular training with animals versus virtual reality systems: an economic analysis
- 2008
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Ingår i: J Vasc Interv Radiol. - : Elsevier BV. - 1051-0443. ; 19:2 Pt 1, s. 233-8
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To assess the relative costs of a virtual reality (VR) laboratory and an animal laboratory for endovascular skills training. MATERIALS AND METHODS: Cost data extracted from a previous experiment was used to perform a financial analysis according to the guidelines published by the National Institutes of Health. The analysis compared the purchase or rental of a Procedicus Vascular Interventional System Trainer to the rental of an animal laboratory. RESULTS: The VR laboratory course cost $3,434 per trainee versus $4,634 in the animal laboratory according to the purchase-versus-rental analysis. The cost ratio was 0.74 in favor of the VR laboratory. Cost ratio sensitivity analysis ranged from 0.25 in favor of the VR laboratory to 2.22 in favor of the animal laboratory. The first-year potential savings were $62,410 assuming exclusive use of the VR laboratory. The 5-year training savings totaled $390,376, excluding the $60,000 residual value of the simulator. Simulator rental reduced the course price to $1,076 per trainee and lowered the cost ratio to 0.23 in favor of the VR laboratory. Findings of sensitivity analysis ranged from 0.08 to 0.70 in favor of the VR laboratory. The first-year and 5-year potential national savings increased to $185,026 and $1,013,238, respectively. CONCLUSIONS: Although evidence remains sparse that the training of interventional skills in artificial environments translates to better performance in human procedures, there are good pedagogic grounds on which to believe that such training will become increasingly important. The present comparison of the direct costs of two such models suggests that VR training is less expensive than live animal training.
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| 7. |
- Cassuto, Jean, et al.
(författare)
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Concerted actions by MMPs, ADAMTS and serine proteases during remodeling of the cartilage callus into bone during osseointegration of hip implants.
- 2020
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Ingår i: Bone reports. - : Elsevier BV. - 2352-1872. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Although the number of patients undergoing total hip arthroplasty is constantly on the rise, we only have limited knowledge of the molecular mechanisms necessary for successful osseointegration of implants or the reasons why some fail. Understanding the spatiotemporal characteristics of signaling pathways involved in bone healing of implants is therefore of particular importance for our ability to identify factors causing implants to fail. The current study investigated the role of three families of proteases, i.e. MMPs (matrix metalloproteinases), ADAMTS (a disintegrin and metalloproteinase with thrombospondin motifs) and serine proteases, as well as their endogenous inhibitors during osseointegration of hip implants that have endured two decades of use without clinical or radiological signs of loosening.Twenty-four patients that had undergone primary THA due to one-sided osteoarthritis (OA) were monitored during 18 years (Y) with repeated measurements of plasma biomarkers, clinical variables and radiographs. All implants were clinically and radiographically well-fixed throughout the follow-up. Eighty-one healthy donors divided in three gender and age-matched groups and twenty OA patients awaiting THA, served as controls. Plasma was analyzed for MMP-1, -2, -3, -8, -9, -10, -13, -14, tissue inhibitor of metalloproteinase (TIMP)-1, -2, -3, ADAMTS4, ADAMTS5, the serine proteases neutrophil elastase (NE), proteinase 3 (PR3) and their endogenous inhibitors, secretory leucocyte proteinase inhibitor (SLPI), trappin-2/elafin and serpina1 (α-1 antitrypsin). Cartilage turnover was monitored using two markers of cartilage synthesis, type II procollagen and PIICP (procollagen II C-terminal propeptide), and two markers of cartilage degradation, CTX-II (C-terminal telopeptide fragments of type II collagen) and split products of aggrecan (G1-IGD-G2).MMP-1, MMP-9, ADAMTS4, NE and PR3 were above healthy in presurgery OA patients but returned to the level of healthy within 6 weeks (W) after surgery. MMPs and serine proteases were counter-regulated during this phase by TIMP-1, SLPI and trappin-2/elafin. Type II procollagen, PIICP and CTX-II increased to a peak 6 W after surgery with a gradual return to the level of controls within weeks. Significant increases by MMP-8, MMP-9, ADAMTS4, ADAMTS5, NE, PR3 and the protease inhibitors, TIMP-3 and serpina1, were seen 5 Y after hip arthroplasty paralleled by a sharp increase in the levels of the cartilage degradation markers, CTX-II and G1-IGD-G2. All the above mediators were normalized before 18 Y, except MMP-1 and MMP-9 that remained above healthy at 18 Y. MMP-14 increased immediately after surgery and remained elevated until 5 Y postsurgery before returning to the level of controls at 7 Y.Notwithstanding temporal differences, the molecular processes of bone repair in arthroplasty patients show great spatial similarities with the classical phases of fracture repair as previously shown in animal models. Cartilagenous callus, produced and remodeled early after hip arthroplasty, is replaced with bone 5 Y to7 Y after surgery by the concerted actions of MMP-8, MMP-9, ADAMTS4, ADAMTS5, NE and PR3, thus suggesting that a complex regulatory cross-talk may exist between different families of proteases during this transitional phase of cartilage degradation. Regulation and fine-tuning of cartilage remodeling by MMPs and ADAMTS is controlled by TIMP-3 whereas serine proteases are regulated by serpina1. Increased MMP-1 and MMP-9 beyond 10Y post-THA support a role during coupled bone remodeling.
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| 8. |
- Cassuto, Jean, et al.
(författare)
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The importance of BMPs and TGF-βs for endochondral bone repair – A longitudinal study in hip arthroplasty patients
- 2023
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Ingår i: Bone Reports. - 2352-1872. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Osseointegration of hip implants, although a decade-long process, shows striking similarities with the four major phases of endochondral bone repair. In the current study we investigated the spatiotemporal involvement of bone morphogenic proteins (BMPs) and transforming growth factor betas (TGF-βs) throughout the process of bone repair leading to successfully osseointegrated hip implants. Materials and methods: Twenty-four patients that had undergone primary total hip arthroplasty (THA) due to one-sided osteoarthritis (OA) were investigated during a period of 18 years (Y) with repeated measurements of plasma biomarkers as well as clinical and radiological variables. All implants were clinically and radiographically well anchored throughout the follow-up. Eighty-one healthy donors divided in three gender- and age-matched groups and twenty OA patients awaiting THA, served as controls. Plasma was analyzed for BMP-1, -2, -3, -4, -6, -7 -9 and TGF-β1, -β2, -β3 by use of a high-sensitivity and wide dynamic range electrochemiluminescence technique allowing for detection of minor changes. Results: Spatiotemporal changes during the follow-up are presented in the context of the four phases of endochondral bone repair shown in earlier studies and transposed to the current study based on similarities in biomarker responses. Phase 1: Primary proinflammatory phase lasting from surgery until day 7, Phase 2: Chondrogenic phase from day 7 until 18 months postsurgery, Phase 3: Secondary proinflammatory and cartilage remodeling phase lasting from 18 months until 7Y, Phase 4: coupled bone remodeling from 7Y until 18Y postsurgery. BMP-1 increased sharply shortly after surgery and remained significantly above healthy during the chondrocyte recruitment, proliferation, and hypertrophy phases with a subsequent return to control level at 5Y postsurgery. BMP-2 was above healthy controls before surgery and 1 day after surgery before decreasing to control level and remaining there throughout the follow-up. BMP-3 was at control level from presurgery until 6M after surgery when it increased to a peak at 2Y during the cartilage hypertrophy phase followed by a gradual decrease to control level at 10Y during the phase of bone formation. In the following, BMP-3 decreased below controls to a nadir 15Y postsurgery during coupled bone remodeling. BMP-4 was at control level from presurgery until 10Y postsurgery when it increased to a sharp peak at 15Y after surgery followed by a return to the level of healthy at 18Y. BMP-6 did not differ from healthy during the follow-up. BMP-7 was at control level from presurgery until 1Y postsurgery before gradually increasing to a peak at 10Y during the early phase of osteogenesis with a gradual return to control level at 18Y during the phase of coupled bone remodeling. BMP-9 was above OA before surgery followed by a decrease to basal level on day 1 after surgery and a renewed increase to a plateau above controls lasting from 6 W until returning to the level of healthy at 18Y postsurgery, i.e., throughout the phases of cartilage formation, cartilage hypertrophy and remodeling, bone formation and coupled bone remodeling. TGF-β1 was above controls presurgery before decreasing to baseline shortly after surgery followed by a renewed increase at 6 M to a peak at 2Y during cartilage hypertrophy/remodeling followed by a gradual return to baseline at 10Y during early osteoblastogenesis. TGF-β2 was at control level from presurgery until the phase of cartilage remodeling at 5Y when it increased sharply to a peak at 7Y with a gradual return to baseline at 18Y postsurgery. TGF-β3 remained at control level throughout the study. Conclusion: This study shows that the involvement of BMPs and TGF-βs in endochondral bone repair is a process of stepwise recruitment of individual biomarkers characterized by distinct, yet overlaping, spatiotemporal patterns that extend from the early phase of pre-chondrocyte recruitment until the late phase of coupled bone remodeling.
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| 9. |
- Collin, David, et al.
(författare)
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Added value of interpreter experience in occult and suspect hip fractures: a retrospective analysis of 254 patients.
- 2016
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Ingår i: Emergency Radiology. - : Springer Science and Business Media LLC. - 1438-1435 .- 1070-3004. ; 23:3, s. 229-234
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Tidskriftsartikel (refereegranskat)abstract
- The influence of experience in categorizing suspect and occult fractures on radiography compared to MRI and clinical outcome has not been studied. The aim of this study is to evaluate the importance of experience in diagnosing normal or suspect hip radiographs compared to MRI. Primarily reported normal or suspect radiography in 254 patients with low-energy hip trauma and subsequent MRI was re-evaluated by two experienced reviewers. Primary readings and review were compared. The prevalence of fractures among normal and suspect radiographic studies was assessed. Clinical outcome was used as reference. At review of radiography, 44 fractures (17 %) were found. Significantly more fractures were found among suspect cases than among normal cases. At MRI, all 44 fractures were confirmed, and further 64 fractures were detected (25 %). MRI detected all fractures with no missed fractures revealed at follow-up. There were a significantly higher proportion of fractures at MRI among the suspect radiographic diagnoses for both the primary report and at review than among occult cases. The more experienced reviewers classified radiography examinations with higher accuracy than primary reporting general radiologists. There was almost complete agreement on MRI diagnoses.
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| 10. |
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