Humeral greater tuberosity osteolysis as a complication of intraosseous calcification migration: Natural history depicted by imaging

Migration of calcification within the bone leading to greater tuberosity osteolysis is a peculiar complication of the calcifying tendinitis of the rotator cuff. The case of a 38-year-old woman complaining of right shoulder pain, which had been going on for one year, is hereby described. The evolution of the infraspinatus tendon calcifying tendinitis leading to osteolysis of the greater tuberosity of the humerus is depicted by imaging and, particularly, by the MR and CT features changing over time. In this paper we focus on the importance of both MR and CT exams in the diagnostic process of the different phases of the disease. The correlation between clinical symptoms and imaging features is also helpful for imaging interpretation: the most painful phase corresponds to the migration of the calcification, whereas pain tends to decrease when the osteolysis develops. Awareness of the existence of this condition may prevent unnecessary invasive procedures. (www.actabiomedica.it)

A Case of Gout from Imperial Rome (1st-2nd Century AD)

The study of pathological alterations in ancient skeletal remains may contribute to the reconstruction of the history of diseases and health conditions of ancient populations. Therefore, in recent research palaeopathology provides an important point of view in bioarchaeology and medicine. This work describes the bone alterations observed in the skeleton of an adult woman found during archaeological excavations in the greatest necropolis of the Imperial Age in Rome. The skeletal remains showed some pathological anomalies and the most evident alterations consisted of multiple osteolytic lesions involving mainly the small bones of the feet, which presented round cavitations and scarce signs of bone repair. Differential diagnosis suggests that this individual was affected by gout, probably associated with hypothyroidism that determined her short stature

Atlas occipitalisation associated with other anomalies in a 16th century skeleton from Sardinia (Italy)

Archaeological excavations carried out in the plague cemetery of 16th century Alghero (Sardinia) brought to light the skeleton of a male aged 35–45 years, showing anomalies of the atlas. A macroscopic and radiological study has been carried out. The first cervical vertebra is fused with the skull base, resulting in an occipitalisation of the atlas. Absence of the costal element of the left foramen transversarium, resulting in an open anterior foramen transversarium, and posterior arch defect are also observed. The atlanto-occipital junction is a complex structure, susceptible to develop different patterns of congenital defects. These anatomical variations of atlas should be considered in modern clinical practice in order to formulate a correct diagnosis and to conceive an appropriate treatment. Osteoarchaeological cases are important as, beside to ascertain the presence of congenital defects in past populations, allow an in-depth study in dry bones, which can help modern medicine in interpreting anatomical variations. We present an association of congenital anomalies of the atlanto-occipital junction, a condition rarely documented in ancient and modern human skeletal remains

Noise reduction and spatial resolution in CT imaging with the ASIR iterative reconstruction algorithm at different doses and contrasts – a phantom study

Aims and objectives The aim of this study was to quantitatively assess noise reduction and spatial resolution in computed tomography (CT) imaging with the ASIR (Adaptive Statistical Iterative Reconstruction, GE Healthcare) reconstruction algorithm at different kVp, mAs and contrasts. Methods and materials Acquisitions of the Catphan-504 phantom were performed on a PET/CT scanner (Discovery-710, GE Healthcare). CT images were reconstructed using both filtered back projection (FBP) and ASIR with different percentages of reconstruction (20%, 40%, 60%, 80%, 100%). The image noise was estimated for different values of scanning parameters (i.e. tube-load, kilovoltage, pitch, slice thickness). Then, 3D/2D/1D noise power spectrum was estimated. Also, spatial resolution was assessed by obtaining the modulation transfer function (MTF) for a wide range of scanning parameters values and different contrast objects by the circular Edge Spread Function method (using CTP404 modulus) and the Point Spread Function method (using CTP528 modulus). . Results Image noise decreased (up to 50% as compared to FBP) with increasing the percentage of ASIR reconstruction (behaviour more relevant for higher spatial frequencies). Only for low tube load (<56 mAs) and low contrast objects (polistirene with respect to PMMA) acquisitions, MTF analysis showed that ASIR-reconstructed images were characterized by an appreciable reduction in spatial resolution, when compared to FBP-reconstructed images. Conclusion When compared to FBP, ASIR allows a relevant noise reduction without appreciably affecting image quality, except for very low dose and contrast acquisitions

A Case of Brachymetatarsia From Medieval Sardinia (Italy)

Archaeological excavations carried out in the Medieval village of Geridu (Sardinia) uncovered several burials dating to the late 13th or the first half of 14th century. Among these individuals, the skeleton of an adult female showing a bilateral abnormal shortness of the fourth metatarsal bone was identified. Bilaterality and absence of other skeletal anomalies allow to rule out an acquired aetiology of the disease and to support a diagnosis of congenital brachymetatarsia. Such a rare deformity has a clinical incidence of 0.02% to 0.05%, with strong predominance of the female gender. To our knowledge, no other cases of brachymetatarsia have been reported in paleopathology so far

Sclerosing bone dysplasia from 16th century Sardinia (Italy): a possible case of Camurati-Engelmann disease

The skeletal remains of a male aged 45–55 years displaying several bone anomalies were unearthed from the Alghero (Sardinia) plague cemetery ‘lo Quarter’, a burial site dating back to the 1582–1583 AD outbreak. The skeleton, whose stature is about 165 cm, presents a bilateral hyperostosis with increased diameter of the diaphyses of all the long bones of the upper and lower limbs; the metaphyses appear to be involved, while the epiphyses are spared. Marked thickening of the cranial vault is also evident. Radiological study showed irregular cortical thickening and massive endoperiosteal bone apposition; sclerotic changes are observed in the diaphysis of some metacarpals. Computed tomography (CT) cross sections of the long bones displayed a thickening of the cortical portion and endoperiosteal bone apposition. The individual was affected by a sclerosing bone dysplasia, a genetic disease characterized by increased bone density. In differential diagnosis, several sclerosing bone dysplasia, such as hyperostosis corticalis generalisata, craniodiaphyseal dysplasia, craniometadiaphyseal dysplasia, pachydermoperiostosis and Camurati–Engelmann disease, as well as other disorders characterized by sclerosing manifestations, such as Erdheim–Chester disease, mehloreostosis and skeletal fluorosis, need to be considered. The anomalies observed in skeleton 2179 fit with the features of Camurati–Engelmann disease, which is the most likely candidate for final diagnosis. It is highly challenging to evaluate how such a condition may have influenced the individual’s lifestyle in terms of development, mobility and quality of life. This individual was probably symptomatic and must have experienced common clinical symptoms, such as pain in the limbs and fatigability. However, the strong development of the muscular insertions and the degenerative changes in the upper limbs suggest that the mobility problems should not have prevented him from reaching a mature age and from performing essential daily activities. The presented case is the unique paleopathological evidence of Camurati–Engelmann disease so far diagnosed

Multislice computed tomography SYNTAX score for coronary artery disease evaluation prior to transcatheter aortic valve implantation

Background: Coronary computed tomography angiography (CCTA) is a useful tool for the evaluation of coronary anatomy prior to both surgical and transcatheter aortic valve implantation (TAVI). Multislice Computed Tomography (MSCT) SYNTAX score (SXscore) strongly correlates with the traditional angiographic SXscore, and the latter has proven to predict cardiovascular events in patients with coronary artery disease (CAD) referred to TAVI. Purpose: The aim of the study is to evaluate the feasibility and accuracy of the calculation of MSCT SXscore in TAVI patients, compared to the gold standard angiographic SXscore. Materials and methods: We evaluated 65 patients eligible for TAVI who underwent both CCTA and invasive coronary angiography (ICA) prior to valve replacement. CCTA was compared to ICA in terms of sensitivity, specificity, and positive and negative predictive values. CCTA performance was evaluated at 3 levels: patient level, vessellevel and segmentlevel. MSCT SXscore was calculated, when possible (i.e. only in fullyevaluable scans), and compared to the angiographic SXscore. Results: Overall CCTA diagnostic performance was good, with high sensitivity and negative predictive values (97.2% and 96.0%, respectively) and good agreement with ICA (k=0.81). As expected, specificity and positive predictive values were lower (82.8% and 87.5%, respectively). At vessellevel, the circumflex artery (CA) was more often misdiagnosed than the other arteries. We were able to calculate MSCT SXscore in 50/65 scans (76.9%). The correlation between MSCT and angiographic SXscore was excellent (Pearson's R=0.965, P&lt;0.001). Conclusions: MSCT SXscore emerges as an interesting tool with strong agreement with angiographic SXscore, providing a noninvasive ambulatory alternative to assess CAD severity in TAVI patients

Evaluation of the Imaging Properties of a CT Scanner with the Adaptive Statistical Iterative Reconstruction Algorithm - Noise, Contrast and Spatial Resolution Properties of CT Images Reconstructed at Different Blending Levels

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Average absorbed breast dose (2ABD): an easy radiation dose index for digital breast tomosynthesis

Background: To propose a practical and simple method to individually evaluate the average absorbed dose for digital breast tomosynthesis. Methods: The method is based on the estimate of incident air kerma (ka,i) on the breast surface. An analytical model was developed to calculate the ka,i from the tube voltage, tube load, breast thickness, x-ray tube yield, and anode-filter combination. A homogeneous phantom was employed to simulate the breast in experimental measurements and to assess the dose-depth relationship. The ka,i values were employed to calculate the “average absorbed breast dose” (2ABD) index. Four mammographic units were used to develop and test our method under many conditions close to clinical settings. The average glandular dose (AGD) calculated following the method described by Dance et al., and the 2ABD computed through our method (i.e., from the exposure parameters) were compared in a number of conditions. Results: A good agreement was obtained between the ka,i computed through our model and that measured under different clinical conditions: discrepancies &lt; 6% were found in all conditions. 2ABD matches with a good accuracy the AGD for a 100% glandular-breast: the minimum, maximum, and mean differences were &lt; 0.1%, 7%, and 2.4%, respectively; the discrepancies increase with decreasing breast glandularity. Conclusions: The proposed model, based on only few exposure parameters, represents a simple way to individually calculate an index, 2ABD, which can be interpreted as the average absorbed dose in a homogeneous phantom, approximating a 100% glandular breast. The method could be easily implemented in any mammographic device performing DBT