Implication of bisphosphonate use in the treatment of SAPHO syndrome: Case report and discussion of current literature

AbstractEven though increasing knowledge is emerging about synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome its pathogenesis remains enigmatic. Women are preferentially affected by SAPHO syndrome. Here we present the case of a 39-year-old woman suffering from this syndrome whose bone involvement was first interpreted as diffuse sclerosing osteomyelitis of the mandible. As treatment with clindamycin did not improve the symptoms, the decision was made to administer bisphosphonates intravenously. This treatment led to a rapid improvement in symptoms, which could be explained by the apparent tendency of bisphosphonates to exert a positive effect on the jaw. With this case report we attempt to offer an explanation for the influence of this group of medications on patients suffering from SAPHO syndrome with mandibular involvement

Cone Beam CT Imaging of the Paranasal Region with a Multipurpose X-ray System—Image Quality and Radiation Exposure

Besides X-ray and fluoroscopy, a previously introduced X-ray scanner offers a 3D cone beam option (Multitom Rax, Siemens Healthcare). The aim of this study was to evaluate various scan parameters and post-processing steps to optimize image quality and radiation exposure for imaging of the parasinus region. Four human cadaver heads were examined with different tube voltages (90–121 kV), dose levels (DLs) (278–2180 nGy) and pre-filtration methods (none, Cu 0.2 mm, Cu 0.3 mm and Sn 0.4 mm). All images were reconstructed in 2 mm slice thickness with and without a metal artifact reduction algorithm in three different kernels. In total, 80 different scan protocols and 480 datasets were evaluated. Image quality was rated on a 5-point Likert scale. Radiation exposure (mean computed tomography volume index (CTDIvol) and effective dose) was calculated for each scan. The most dose-effective combination for the diagnosis of sinusitis was 121 kV/DL of 278/0.3 mm copper (CTDIvol 1.70 mGy, effective dose 77 µSv). Scan protocols with 121 kV/DL1090/0.3 mm copper were rated sufficient for preoperative sinus surgery planning (CTDIvol 4.66 mGy, effective dose 212 µSv). Therefore, sinusitis and preoperative sinus surgery planning can be performed in diagnostic image quality at low radiation dose levels with a multipurpose X-ray system

Cardiac T2 mapping: robustness and homogeneity of standardized in-line analysis

Background and purpose Interpretation of T2 values remains difficult due to limited comparability across hardware and software systems and the lack of validated measurement recommendations for the number and orientation of mandatory slices. Our aims were to provide a standardized comparison of intra- and inter-individual T2 values in the short and long axes and to investigate inter-scanner reproducibility. Method and materials Ninety cardiovascular magnetic resonance (CMR) studies in 30 healthy subjects were performed with three identical 1.5 T CMR scanners (same hardware and software) using a balanced steady-state free precession (bSSFP) gradient echo sequence in three short axis (SAx) and three long axis (LAx) views. A commercially available T2 mapping software package of the latest generation with automatic in-line motion correction was used for acquisition. Regions of interest were manually drawn in each of the 16 myocardial segments according to the American Heart Association (AHA) model in three SAx and three LAx acquisitions. Analysis of inter-scanner, inter-segmental, intra-segmental, inter-regional and inter-level differences was performed. Results Inter-scanner reproducibility was high and the mean myocardial T2 value for all evaluated segments was 45.7 ± 3.4 ms. Significant inter-segmental variations of mean T2 values were found. Mean intra-segmental T2 values were comparable between LAx and SAx acquisitions in 72%. Significantly higher T2 values were found in apical segments and a significant disparity among different regions was found for SAx and LAx orientations. Conclusion Standardized cardiac T2 mapping is highly reproducible on identical CMR systems. T2 values vary significantly between single heart segments, regions, levels, and axes in young, healthy subjects

Determining Microvascular Obstruction and Infarct Size with Steady-State Free Precession Imaging Cardiac MRI

Purpose In cardiac MRI (cMRI) injection of contrast medium may be performed prior to the acquisition of cine steady-state free precession (SSFP) imaging to speed up the protocol and avoid delay before late Gadolinium enhancement (LGE) imaging. Aim of this study was to evaluate whether a condensed clinical protocol with contrast cine SSFP imaging is able to detect early microvascular obstruction (MO) and determine the infarct size compared to the findings of LGE inversion recovery sequences. Materials and Methods The study complies with the Declaration of Helsinki and was performed following approval by the ethic committee of the University of Erlangen-Nuremberg. Written informed consent was obtained from every patient. 68 consecutive patients (14 females/54 males) with acute ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary revascularization were included in this study. CMRI was performed 6.6±2 days after symptom onset and MO and infarct size in early contrast SSFP cine imaging were compared to LGE imaging. Results MO was detected in 47/68 (69%) patients on cine SSFP and in 41/68 (60%) patients on LGE imaging. In 6 patients MO was found on cine SSFP imaging but was not detectable on LGE imaging. Infarct size on cine SSFP showed a strong agreement to LGE imaging (intraclass correlation coefficient [ICC] of 0.96 for enddiastolic, p<0.001 and 0.96 for endsystolic, p<0.001 respectively). Significant interobserver agreement was found measuring enddiastolic and endsystolic infarct size on cine SSFP imaging (p<0.01). Conclusions In patients after STEMI infarct size and presence of MO can be detected with contrast cine SSFP imaging. This could be an option in patients who are limited in their ability to comply with the demands of a cMRI protocol

Apparent Diffusion Coefficient (ADC) Histogram Analysis in Parotid Gland Tumors: Evaluating a Novel Approach for Differentiation between Benign and Malignant Parotid Lesions Based on Full Histogram Distributions

The aim of this study was to assess the diagnostic value of ADC distribution curves for differentiation between benign and malignant parotid gland tumors and to compare with mean ADC values. 73 patients with parotid gland tumors underwent head-and-neck MRI on a 1.5 Tesla scanner prior to surgery and histograms of ADC values were extracted. Histopathological results served as a reference standard for further analysis. ADC histograms were evaluated by comparing their similarity to a reference distribution using Chi2-test-statistics. The assumed reference distribution for benign and malignant parotid gland lesions was calculated after pooling the entire ADC data. In addition, mean ADC values were determined. For both methods, we calculated and compared the sensitivity and specificity between benign and malignant parotid gland tumors and three subgroups (pleomorphic adenoma, Warthin tumor, and malignant lesions), respectively. Moreover, we performed cross-validation (CV) techniques to estimate the predictive performance between ADC distributions and mean values. Histopathological results revealed 30 pleomorphic adenomas, 22 Warthin tumors, and 21 malignant tumors. ADC histogram distribution yielded a better specificity for detection of benign parotid gland lesions (ADChistogram: 75.0% vs. ADCmean: 71.2%), but mean ADC values provided a higher sensitivity (ADCmean: 71.4% vs. ADChistogram: 61.9%). The discrepancies are most pronounced in the differentiation between malignant and Warthin tumors (sensitivity ADCmean: 76.2% vs. ADChistogram: 61.9%; specificity ADChistogram: 81.8% vs. ADCmean: 68.2%). Using CV techniques, ADC distribution revealed consistently better accuracy to differentiate benign from malignant lesions (&ldquo;leave-one-out CV&rdquo; accuracy ADChistogram: 71.2% vs. ADCmean: 67.1%). ADC histogram analysis using full distribution curves is a promising new approach for differentiation between primary benign and malignant parotid gland tumors, especially with respect to the advantage in predictive performance based on CV techniques

Effect of Compression Garments on the Development of Edema and Soreness in Delayed-Onset Muscle Soreness (DOMS)

Delayed-onset muscle soreness (DOMS), an ultrastructural muscle injury, is one of the most common reasons for impaired muscle performance. The purpose of this study was to investigate the influence of sport compression garments on the development of exercise-induced intramuscular edema in the context of DOMS. DOMS was induced in 15 healthy participants. The participants performed a standardized eccentric exercise of the calf muscles. Magnetic resonance imaging (MRI) was performed at baseline and 60h after exercise (T2-weighted signal intensity and T2 relaxation time was evaluated in each compartment and the intramuscular edema in the medial head of the gastrocnemius muscle was segmented). After the exercise, a conventional compression garment (18-21 mmHg) was placed on one randomized calf for 60h. The level of muscle soreness was evaluated using a visual analogue pain scale. T2-weighted signal intensity, T2 relaxation time and intramuscular edema showed a significant interaction for time with increased signal intensities/intramuscular edema in the medial head of the gastrocnemius muscle at follow-up compared to baseline. No significant main effect for compression or interaction between time and limb occurred. Further, no significant differences in the soleus muscle and the lateral head of the gastrocnemius muscle were noted between limbs or over time. After exercise, there was significantly increased muscle soreness in both lower legs in resting condition and when going downstairs and a decreased range of motion in the ankle joint. No significant difference was observed between the compressed and the non-compressed calf. Our results indicate that wearing conventional compression garments after DOMS has been induced has no significant effect on the development of muscle edema, muscle soreness, range of motion and calf circumference

Achieving high spatial and temporal resolution with perfusion MRI in the head and neck region using golden-angle radial sampling

Objectives!#!Conventional perfusion-weighted MRI sequences often provide poor spatial or temporal resolution. We aimed to overcome this problem in head and neck protocols using a golden-angle radial sparse parallel (GRASP) sequence.!##!Methods!#!We prospectively included 58 patients for examination on a 3.0-T MRI using a study protocol. GRASP (A) was applied to a volumetric interpolated breath-hold examination (VIBE) with 135 reconstructed pictures and high temporal (2.5 s) and spatial resolution (0.94 × 0.94 × 3.00 mm). Additional sequences of matching temporal resolution (B: 2.5 s, 1.88 × 1.88 × 3.00 mm), with a compromise between temporal and spatial resolution (C: 7.0 s, 1.30 × 1.30 × 3.00 mm) and with matching spatial resolution (D: 145 s, 0.94 × 0.94 × 3.00 mm), were subsequently without GRASP. Instant inline-image reconstructions (E) provided one additional series of averaged contrast information throughout the entire acquisition duration of A. Overall diagnostic image quality, edge sharpness and contrast of soft tissues, vessels and lesions were subjectively rated using 5-point Likert scales. Objective image quality was measured as contrast-to-noise ratio in D and E.!##!Results!#!Overall, the anatomic and pathologic image quality was substantially better with the GRASP sequence for the temporally (A/B/C, all p &amp;lt; 0.001) and spatially resolved comparisons (D/E, all p &amp;lt; 0.002 except lesion edge sharpness with p = 0.291). Image artefacts were also less likely to occur with GRASP. Differences in motion, aliasing and truncation were mainly significant, but pulsation and fat suppression were comparable. In addition, the contrast-to-noise ratio of E was significantly better than that of D (p!##!Conclusions!#!High temporal and spatial resolution can be obtained synchronously using a GRASP-VIBE technique for perfusion evaluation in head and neck MRI.!##!Key points!#!• Golden-angle radial sparse parallel (GRASP) sampling allows for temporally resolved dynamic acquisitions with a very high image quality. • Very low-contrast structures in the head and neck region can benefit from using the GRASP sequence. • Inline-image reconstruction of dynamic and static series from one single acquisition can replace the conventional combination of two acquisitions, thereby saving examination time

Comparison of Diagnostic Performance and Image Quality between Topup-Corrected and Standard Readout-Segmented Echo-Planar Diffusion-Weighted Imaging for Cholesteatoma Diagnostics

This study compares the diagnostic performance and image quality of single-shot turbo spin-echo DWI (tseDWI), standard readout-segmented DWI (rsDWI), and a modified rsDWI version (topupDWI) for cholesteatoma diagnostics. Thirty-four patients with newly suspected unilateral cholesteatoma were examined on a 1.5 Tesla MRI scanner. Diagnostic performance was evaluated by calculating and comparing the sensitivity and specificity using histopathological results as the standard of reference. Image quality was independently reviewed by two readers using a 5-point Likert scale evaluating image distortions, susceptibility artifacts, image resolution, lesion conspicuity, and diagnostic confidence. Twenty-five cholesteatomas were histologically confirmed after surgery and originated in the study group. TseDWI showed the highest sensitivity with 96% (95% confidence interval (CI): 88–100%), followed by topupDWI with 92% (95% CI: 81–100%) for both readers. The sensitivity for rsDWI was 76% (95% CI: 59–93%) for reader 1 and 84% (95% CI: 70–98%) for reader 2, respectively. Both tseDWI and topupDWI revealed a specificity of 100% (95% CI: 66–100%) and rsDWI of 89% (95% CI: 52–100%). Both tseDWI and topupDWI showed fewer image distortions and susceptibility artifacts compared to rsDWI. Image resolution was consistently rated best for topupDWI, followed by rsDWI, which both outperformed tseDWI. TopupDWI and tseDWI showed comparable results for lesions’ conspicuity and diagnostic confidence, both outperforming rsDWI. Modified readout-segmented DWI using the topup-correction method is preferable to standard rsDWI and may be regarded as an accurate alternative to single-shot turbo spin-echo DWI in cholesteatoma diagnostics

X-Ray Induced Formation of γ-H2AX Foci after Full-Field Digital Mammography and Digital Breast-Tomosynthesis

Purpose: To determine in-vivo formation of x-ray induced c-H2AX foci in systemic blood lymphocytes of patients undergoing full-field digital mammography (FFDM) and to estimate foci after FFDM and digital breast-tomosynthesis (DBT) using a biological phantom model. Materials and Methods: The study complies with the Declaration of Helsinki and was performed following approval by the ethic committee of the University of Erlangen-Nuremberg. Written informed consent was obtained from every patient. For in-vivo tests, systemic blood lymphocytes were obtained from 20 patients before and after FFDM. In order to compare invivo post-exposure with pre-exposure foci levels, the Wilcoxon matched pairs test was used. For in-vitro experiments, isolated blood lymphocytes from healthy volunteers were irradiated at skin and glandular level of a porcine breast using FFDM and DBT. Cells were stained against the phosphorylated histone variant c-H2AX, and foci representing distinct DNA damages were quantified. Results: Median in-vivo foci level/cell was 0.086 (range 0.067–0.116) before and 0.094 (0.076–0.126) after FFDM (p = 0.0004). In the in-vitro model, the median x-ray induced foci level/cell after FFDM was 0.120 (range 0.086–0.140) at skin level and 0.035 (range 0.030–0.050) at glandular level. After DBT, the median x-ray induced foci level/cell was 0.061 (range 0.040– 0.081) at skin level and 0.015 (range 0.006–0.020) at glandular level. Conclusion: In patients, mammography induces a slight but significant increase of c-H2AX foci in systemic blood lymphocytes. The introduced biological phantom model is suitable for the estimation of x-ray induced DNA damages in breast tissue in different breast imaging techniques

Influence of Different Antioxidants on X-Ray Induced DNA Double-Strand Breaks (DSBs) Using γ-H2AX Immunofluorescence Microscopy in a Preliminary Study

Background Radiation exposure occurs in X-ray guided interventional procedures or computed tomography (CT) and γ-H2AX-foci are recognized to represent DNA double-strand breaks (DSBs) as a biomarker for radiation induced damage. Antioxidants may reduce the induction of γ-H2AX-foci by binding free radicals. The aim of this study was to establish a dose-effect relationship and a time-effect relationship for the individual antioxidants on DSBs in human blood lymphocytes. Materials and Methods Blood samples from volunteers were irradiated with 10 mGy before and after pre-incubation with different antioxidants (zinc, trolox, lipoic acid, ß-carotene, selenium, vitamin E, vitamin C, N-acetyl-L-cysteine (NAC) and Q 10). Thereby, different pre-incubation times, concentrations and combinations of drugs were evaluated. For assessment of DSBs, lymphocytes were stained against the phosphorylated histone variant γ-H2AX. Results For zinc, trolox and lipoic acid regardless of concentration or pre-incubation time, no significant decrease of γ-H2AX-foci was found. However, ß-carotene (15%), selenium (14%), vitamin E (12%), vitamin C (25%), NAC (43%) and Q 10 (18%) led to a significant reduction of γ-H2AX-foci at a pre-incubation time of 1 hour. The combination of different antioxidants did not have an additive effect. Conclusion Antioxidants administered prior to irradiation demonstrated the potential to reduce γ-H2AXfoci in blood lymphocytes