Reduction of Metal Artifacts Caused by Titanium Peduncular Screws in the Spine by Means of Monoenergetic Images and the Metal Artifact Reduction Software in Dual-Energy Computed Tomography

Objectives: To evaluate the reduction of metal artifacts in patients with titanium peduncular screws in the spine using (1) conventional images (CI), (2) virtual monoenergetic reconstructions (VMRs), and (3) VMR + Metal Artifact Reduction Software (VMR + MARS), with dual-energy computed tomography (DECT). Materials and Methods: Twenty-four patients with titanium peduncular screws in the spine were studied using a 64-channel DECT. During the postprocessing phase, the CI, the VMRs from 100 to 140 keV, and the VMR at 140 keV + MARS were synthesized. All the images were considered, and a quantitative evaluation was performed measuring the attenuation values (in terms of Hounsfield Units) with region of interest, in correspondence with the most hyperdense and hypodense artifacts. All the values were then compared. A qualitative evaluation, in terms of image quality and extent of artifacts, was also performed by two radiologists. Results: In quantitative terms, the 140 keV + MARS reconstruction was able to significantly reduce both bright and dark metal artifacts, compared to CI and to VMRs. The VMR was capable of significantly reducing both dark and bright artifacts, compared to CI. In qualitative terms, the VMR at 140 keV proved to be the best, compared to CI and VMR + MARS images. Conclusions: The VMR + MARS image reduces metal artifacts from titanium peduncular screws more than VMRs alone and CI. Furthermore, the VMR can decrease metal artifacts from a quantitative and a qualitative point of view. Combining information from VMRs and VMR + MARS images could be the best way to solve the issue of metal artifacts on computed tomography images

Clinical Application of Diffusion Tensor Imaging for a Brachial Plexus Injury

Brachial plexus injuries are commonly diagnosed clinically, as conventional imaging has a low sensitivity. In recent years, diffusion tensor imaging has established a clinical role in the study of the central nervous system and, while still presenting some limitations due to the technical complexity of the acquisition method, is showing promising results when applied to peripheral nerves. Moreover, deterministic fiber tracking with the Euler's method and multishell acquisition are two novel advances in the field which contribute to enhancing the reliability of the technique reducing the respiratory and inhomogeneity artifacts in this "magnetically complex" region, and better isolating the fibers in a heterogeneous territory. Here, we report a case of brachial plexus traumatic injury, a healthy reference subject, and details on the acquisition protocol of the reconstruction algorithm

Prevalence and characteristics of diffuse idiopathic skeletal hyperostosis (DISH) in Italy

Purpose Diffuse idiopathic skeletal hyperostosis (DISH) is a benign condition characterized by ossification of the spine and prominent enthesopathies. Highly heterogeneous epidemiological figures have been reported in the literature, while in Italy the largest study has been conducted in 1992. The aim of our research is to contribute updated information about prevalence of DISH in Italy and to describe the clinical and radiographic characteristics associated with the disorder. Material and methods A retrospective review of lumbosacral spine, thoracic spine and pelvis radiographs was performed. Consecutive patients visiting the emergency department of our Institution over 3 years were enrolled. Presence of DISH was evaluated applying the Resnick and Niwayama criteria. Clinical and radiological features were also assessed. Results We included 1012 individuals (60.6% women), and DISH was present in 130 cases. The overall prevalence of DISH was 12.8% (95% CI 10.8-15.1), with higher figures in the male sample (16.8%) than in females (10.3%). In binary logistic regression adjusted for age, BMI (OR 1.50, p < 0.001) diabetes (OR 1.85, p = 0.003), hypertension (OR 2.04, p = 0.007) ischiopubic enthesopathy (OR 7.08, p < 0.001), iliac crest enthesopathy (OR 4.63, p < 0.001) and greater trochanter enthesopathy (OR 3.51, p < 0.001), were significantly associated with the condition. Conclusion The prevalence of DISH observed in our study is consistent with previous literature, and we confirm that the disorder is more frequently retrieved in men and that it is associated with the presence of metabolic disorders and pelvic enthesopathy. Knowledge about the epidemiology and characteristics of DISH is needed to properly identify the condition

Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum~disorders

Background Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD. Methods Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared. Results Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (p = 0.140) and functioning (p = 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (p = 0.016) and better QoL (p = 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care. Conclusions Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery

3D bioprinting graft scaffolds silk fibroin-based for clinical application of tissue regeneration

Lo studio ha previsto prima una scansione con TC-doppia energia (TC-DE) di pezzi anatomici da cadaveri (ossa e tessuti molli) per definire i parametri di scansione TC, necessari al successivo utilizzo sul paziente. Successivamente è stato analizzato il miglior rapporto tra dose radiante erogata e qualità̀ dell’immagine e valutati i sistemi di riduzione di dose (VEO e ASIR) e degli artefatti metallici (GSI e MAR). Il sistema VEO ha permesso una ottimale valutazione del tessuto osseo con una riduzione di dose di oltre il 50% rispetto al sistema ASIR; con il sistema GSI abbiamo individuato i livelli mono-energetici che meglio riducessero gli artefatti da protesi metallica e utilizzato il software MAR per ridurre gli artefatti post-processing. Le immagini sono state importate in formato DICOM in un software dedicato per la loro visualizzazione, segmentazione e processazione per riprodurre l'anatomia del tessuto osseo. La stampa di scaffold 3D che riproducessero il tessuto originale è stata effettuata mediante un Bioplotter. Il Bioink a base di fibroina della seta è stato utilizzato per realizzare lo scaffold e, definita l'archittettura d'interesse, sono stati ottimizzati i parametri di stampa. Sono stati utilizzati un bioink senza calcio (SFG) e uno con cloruro di calcio (SFG-CaCl2). Le cellule mesenchimali (MSCs) sono state inglobate nei bioinks e si è evidenziato che in entrambi i bioinks le cellule erano distribuite in modo omogeneo ed erano vitali a tutti i tempi sperimentali (giorno 1, 7, 14, 21) analizzati. Utilizzando specifici fattori osteogenici (FO) si è indotto in entrambi i bioinks il differenziamento cellulare in senso osteogenico. In particolare, in presenza di FO si è evidenziato un incremento della mineralizzazione nel bioink SFG-CaCl2 rispetto a quella ottenuta nel bioink SFG. Inoltre, in assenza di FO solo nel bioink SFG-CaCl2 si è notata la presenza di precipitati di calcio indicativi dell’avvenuto differenziamento osteogenico.Firstly, we performed a double-energy CT scan (CT-DE) of anatomical pieces from cadavers (bones and soft tissues) to define the radiological parameters, that were necessary to subsequent move on the patient. Subsequently, the best ratio between delivered radiant dose and image quality was analyzed and dose reduction systems (VEO and ASIR) and metal artefacts reduction systems (GSI and MAR) were evaluated. The VEO system allowed an optimal evaluation of the bone tissue with a dose reduction of over 50% compared to the ASIR system; with the GSI system we have identified the mono-energy levels that better reduced artifacts from metal prosthesis and that were used with MAR software to reduce post-processing artifacts. The images were imported in DICOM format in a dedicated software for their visualization, segmentation and processing to reproduce the anatomy of the bone tissue. The printing of 3D scaffolds that reproduced the original tissue was done using a Bioplotter. The silk fibroin Bioink was used to prepare the scaffold and, to define the architecture of interest. All the printing parameters were optimized. The Bioink were prepared both without calcium (SFG) or with calcium chloride (SFG-CaCl2). Mesenchymal cells (MSCs) were incorporated into the bioinks and we observed that in both bioinks the cells were homogeneously distributed and viable at all experimental times (day 1, 7, 14, 21) analyzed. Using specific osteogenic factors (FO), in both bioinks MSCs osteogenic differentiation was induced. In particular, in the presence of FO, we found an increase in mineralization in SFG-CaCl2 bioink compared to that obtained in SFG bioink. Moreover, in the absence of FO only in the bioink SFG-CaCl2 the presence of calcium precipitates were noted indicating that the osteogenic differentiation occured

Percutaneous CT-Guided Biopsy of the Craniovertebral Junction: Safety, Diagnostic Yield, and Technical Notes

The craniovertebral junction defined as the occiput, the atlas, and the axis is a complex bony region that contains vital neural and vascular structures. We report the experience of a single academic institution regarding CT-guided biopsy of this skeletal region. We reviewed all of the CT-guided biopsies performed in our department, completed in the craniovertebral junction. We collected data in regard to biopsy procedures, patients’ vital statistics, and histopathological diagnosis. In total, 16 patients (8M and 8F; mean age 52; range 16–86 years old) were included in this series. In eight patients, the lesions were located in the atlas vertebra (8/16—50%), in six patients in the axis (37.5%), and in two patients in the occiput (12.5%). No complications were observed during or after the procedures. All of the procedures were technically successful. The biopsy was diagnostic in 13/16 patients (81.3%): four metastatic lesions (25%—three breast and one prostate cancers), four multiple myeloma bone lesions (25%), three aneurismal bone cysts (18.8%), one aggressive hemangioma (6.3%), and one pseudogout (6.3%). Moreover, in two-thirds (66.6%) of non-diagnostic histological reports, malignancies were excluded. CT-guided percutaneous biopsy is a safe tool and allows obtaining a histological diagnosis, in most cases, even in the most delicate site of the human skeleton—the craniovertebral junction

A comprehensive review of pulsed radiofrequency in the treatment of pain associated with different spinal conditions

The objective of this review is to evaluate the efficacy of Pulsed Radiofrequency (PRF) treatment of pain associated with different spinal conditions. The mechanisms of action and biological effects are shortly discussed to provide the scientific basis for this radiofrequency modality

May polyenthesitis follow COVID-19?

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