Overall mortality in combined pulmonary fibrosis and emphysema related to systemic sclerosis

OBJECTIVES: This multicentre study aimed to investigate the overall mortality of combined pulmonary fibrosis and emphysema (CPFE) in systemic sclerosis (SSc) and to compare CPFE-SSc characteristics with those of other SSc subtypes (with interstitial lung disease-ILD, emphysema or neither). METHODS: Chest CTs, anamnestic data, immunological profile and pulmonary function tests of patients with SSc were retrospectively collected. Each chest CT underwent a semiquantitative assessment blindly performed by three radiologists. Patients were clustered in four groups: SSc-CPFE, SSc-ILD, SSc-emphysema and other-SSc (without ILD nor emphysema). The overall mortality of these groups was calculated by Kaplan-Meier method and compared with the stratified log-rank test; Kruskal-Wallis test, t-Student test and χ² test assessed the differences between groups. P<0.05 was considered statistically significant. RESULTS: We enrolled 470 patients (1959 patient-year); 15.5 % (73/470) died during the follow-up. Compared with the SSc-ILD and other-SSc, in SSc-CPFE there was a higher prevalence of males, lower anticentromere antibodies prevalence and a more reduced pulmonary function (p<0.05). The Kaplan-Meier survival analysis demonstrates a significantly worse survival in patients with SSc-CPFE (HR vs SSc-ILD, vs SSc-emphysema and vs other-SSc, respectively 1.6 (CI 0.5 to 5.2), 1.6 (CI 0.7 to 3.8) and 2.8 (CI 1.2 to 6.6). CONCLUSIONS: CPFE increases the mortality risk in SSc along with a highly impaired lung function. These findings strengthen the importance to take into account emphysema in patients with SSc with ILD

Extension of Pulmonary Fibrosing Diseases: a Comparison of Quantification Scoring Systems

OBJECTIVES To compare interobserver variability of main visual scoring systems for the quanti cation of global extension of pulmonary interstitial disease among new method of scoring based on HRCT coronal images; de ne which of these scores better correlates with functional de cit. MATERIAlS AND METHDS Study population was constituted by 39 patient affected by ILD (20 UIP, 14 NSIP, 4 CPFE and 1 CHP) who underwent both HRCT and PFT. HRCT images were assessed regardless of two trainee radiologists using three different methods of visual scoring: 1) on ve HRCT images at pre-established levels; 2) on three lung zones through “scrolling” of HRCT images; 3) on six HRCT images reformatted for coronal reconstructions. We compared the levels of interobserver variation for each visual scoring method through Bland-Altman test. In addition, we compared correlation between DLco and visual scores obtained with these three different methods. RESULTS The 95% LoA of ILD extent between observer 1 and 2 for visual scoring method 1, 2 and 3 were respec- tively -35.2% to 20%, -38.8% to 17.4%, -41.3% to 24.9%. Method 1 had a fair correlation (r = -0.3, p = 0.05) between averaged observers’ scores and DLco. Method 2 reported the lowest correlation (r = -0.2, p = 0.2), while the greatest one was observed for method 3 (r = -0.4, p = 0.03). CONCLUSIONS Despite the visual scoring method based on HRCT coronal images showed the greatest interobserver vari- ability, its use improved correlations between ILD extent on HRCT and DLco

Imaging of osteonecrosis of the femoral head

Osteonecrosis of the femoral head is a common disease affecting both children and adults causing acute hip pain and functional impairment. Among the various techniques allowing a correct diagnosis, MRI represents the gold standard for an early detection, the latter being useful for a positive outcome. The purpose of this review is to describe the imaging findings of the osteonecrosis of the femoral head

Effect of First Ray Insufficiency and Metatarsal Index on Metatarsalgia in Hallux Valgus

Category: Midfoot/Forefoot Introduction/Purpose: There are two concepts that tried to explain the etiology of metatarsalgia in hallux valgus patients: First, the one that states that as the magnitude of hallux valgus increases, there is a mechanical overload of the lesser metatarsals. Second, that an increased relative lesser metatarsal length is a factor in the development of metatarsalgia. However there is no current evidence that these facts predisposes for primary metatarsalgia. The purpose of the study was to evaluate the factors associated with metatarsalgia in hallux valgus patients. Methods: A cross-sectional study of 121 consecutive adult patients with non-arthritic hallux valgus was carried out. Binary logistic regression was performed to identify the effect of the clinical and demographic factors on the occurrence of metatarsalgia. Results: One hundred twenty one patients (184 feet) with hallux valgus were analyzed. The median weight was 65 Kg (IQR 58 – 72). Metatarsalgia was present in 84 (45.6%) feet. The binary logistic regression showed that lesser toe deformity (OR 2.6 IC95% 0.2-0.5), gastrocnemius shortening (OR 5.8 IC95% 2.8-12.3), metatarsal index (OR 0.3 IC95% 0.2-0.5) and weight (OR 2.5 IC95% 1.2-5.3) were significantly associated. Conclusion: Metatarsalgia occurs in almost a half of hallux valgus patients. It has a multifactorial etiology. Our finding questions the common theory that both the magnitude of hallux valgus deformity and an increased length of a lesser metatarsal by themselves, predisposes for primary metatarsalgia. Metatarsalgia was associated with Achilles shortening, excessive weight and associated lesser toe deformity. These factors should be addressed in order to treat this disorder adequately

Semiautomatic analysis on computed tomography in locally advanced or metastatic non-small cell lung cancer: Reproducibility and Prognostic Significance of Unidimensional and 3-dimensional Measurements.

Purpose: The aim of the study was to compare both reproducibility and prognostic value of lesion size measurements obtained manually and semiautomatically on computed tomography in advanced non-small cell lung cancer (NSCLC). Materials and Methods: Manual axial longest diameter, semiautomatic axial longest diameter, and volume of NSCLC lesions were independently analyzed by 4 readers at baseline and after at least 1 cycle of platinum-based chemotherapy. The prognostic value of the proportional change in lesion size between baseline and follow-up CT was evaluated using either RECIST or experimental thresholds derived from the quartiles of the changes as assessed manually or semiautomatically. Results: Semiautomatic axial longest diameter (concordance correlation coefficient [CCC]: 0.980 to 0.987; variation coefficient [VC%]: 6% to 7.3%) and volume (CCC: 0.974 to 0.991; VC%: 5.6% to 9.5%) were more reproducible than manual axial longest diameter (CCC: 0.950 to 0.984; VC%: 6.4% to 11.7%). RECIST categories did not stratify patients with different survival durations. For 3/4 readers, a decrease of ≤70% in lesion volume was associated with shorter survival (median survival: 11 mo, P<0.05; hazard ratio: 5 to 22.2, P<0.05). Conclusions: In advanced NSCLC, semiautomatic measures were more reproducible than manual diameter, and volumetric measurement may better predict patient survival

Texture analysis in a rare case of tibial intraosseous lipoma

Intraosseous lipoma is a very rare lesion, accounting for only 0.1% of all primary osseous tumors (1), first described in 1980 (2). This lesion is considered the rarest of benign bone tumors (3); probably it is not the actual incidence because these lesions are frequently asymptomatic and the introduction of cross-sectional imaging, especially MRI, seems to have increased the detection (4). The majority of intraosseus lipomas are in the lower limbs (70%) and the os calcis being the most frequently involved (32%). Most cases reported in literature have an age of 40 years (5). Tumor texture could be measured from medical images that provide a non-invasive method of capturing intratumoral heterogeneity and could potentially enable a prior assessment of a patient. Some Authors recently proposed Texture analysis to characterize musculoskeletal lesions (6). For the first time we measured the tumoral texture from Magnetic Resonance images in tibial intraosseous lipoma in a 29-years-old female