Use of near-infrared systems for investigations of hemodynamics in human in vivo bone tissue: a systematic review

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.A range of technologies using near infrared (NIR) light have shown promise at providing real time measurements of hemodynamic markers in bone tissue in vivo, an exciting prospect given existing difficulties in measuring hemodynamics in bone tissue. This systematic review aimed to evaluate the evidence for this potential use of NIR systems, establishing their potential as a research tool in this field. Major electronic databases including MEDLINE and EMBASE were searched using pre‐planned search strategies with broad scope for any in vivo use of NIR technologies in human bone tissue. Following identification of studies by title and abstract screening, full text inclusion was determined by double blind assessment using predefined criteria. Full text studies for inclusion were data extracted using a predesigned proforma and quality assessed. Narrative synthesis was appropriate given the wide heterogeneity of included studies. Eighty‐eight full text studies fulfilled the inclusion criteria, 57 addressing laser Doppler flowmetry (56 intra‐operatively), 21 near infrared spectroscopy, and 10 photoplethysmography. The heterogeneity of the methodologies included differing hemodynamic markers, measurement protocols, anatomical locations, and research applications, making meaningful direct comparisons impossible. Further, studies were often limited by small sample sizes with potential selection biases, detection biases, and wide variability in results between participants. Despite promising potential in the use of NIR light to interrogate bone circulation, the application of NIR systems in bone requires rigorous assessment of the reproducibility of potential hemodynamic markers and further validation of these markers against alternative physiologically relevant reference standards.This systematic review was supported by the College of Radiographers Industry Partnership Scheme (CORIPS) Doctoral Fellowship Grant (Applicant 003). The CORIPS are providing financial support but have no input into the design, performance or analysis of this systematic review. WDS, FC and CT would like to acknowledge the NIHR Exeter Clinical Research Facility and the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR Exeter Clinical Research Facility, the NHS, the NIHR or the Department of Health in England

Magnetic resonance arthrography of the hip: technique and spectrum of findings in younger patients

Magnetic resonance(MR) imaging is the reference imaging technique in the evaluation of hip abnormalities. However, in some pathological conditions—such as lesions of the labrum, cartilaginous lesions, femoroacetabular impingement, intra-articular foreign bodies, or in the pre-operative work-up of developmental dysplasia of the hip—intra-articular injection of a contrast medium is required to obtain a precise diagnosis. This article reviews the technical aspects, contraindications, normal appearance and potential pitfalls of MR arthrography, and illustrates the radiological appearance of commonly encountered conditions

Ultrasound for the evaluation of femoroacetabular impingement of the cam type. Diagnostic performance of qualitative criteria and alpha angle measurements

OBJECTIVE: To develop and assess a technique to evaluate cam type femoroacetabular impingement (FAI) using ultrasound (US). METHODS: Fifty patients (24 women, 26 men) were included (mean age: 39.1 years; age range: 16-59). US images of the anterior and anterosuperior contour of the femoral neck were obtained and analysed in 50 patients. Non-spherical shape of the head-neck junction (cam deformity), bony protuberances at the femoral neck, shape of the femoral neck (waist deficiency) and alpha angle were assessed. Magnetic resonance (MR) arthrography served as the standard of reference. Diagnostic performance and receiver operating characteristics (ROC) curves were calculated. RESULTS: Based on MR arthrography 28 patients had cam-type FAI. On US, an anterosuperior cam deformity was seen in 40/44 patients (Reader 1/Reader 2; sensitivity 93%/89%, specificity 36%/14%). A bony protuberance anterosuperiorly in 23/13 patients (sensitivity 71%/32%, specificity 86%/82%) and an anterosuperior waist deficiency in 19/35 patients (sensitivity 25%/54%, specificity 100%/54%). Sensitivity and specificity of the other criteria were lower than 70% (average of Reader 1 & 2). CONCLUSION: A technique to evaluate cam type FAI using US is presented. The detection of an anterosuperior cam deformity is sensitive, and presence of an anterosuperior bony protuberance is specific for cam FAI. Alpha angle measurements are not helpful in establishing the diagnosis