Background: Multiple sclerosis is often a longitudinal disease continuum with an initial relapsing-remitting phase (RRMS) and later secondary progression (SPMS). Most currently approved therapies are not sufficiently effective in SPMS. Early detection of SPMS conversion is therefore critical for therapy selection. Important decision-making tools may include testing of partial cognitive performance and magnetic resonance imaging (MRI). Aim of the work: To demonstrate the importance of cognitive testing and MRI for the prediction and detection of SPMS conversion. Elaboration of strategies for follow-up and therapy management in practice, especially in outpatient care. Material and methods: Review based on an unsystematic literature search. Results: Standardized cognitive testing can be helpful for early SPMS diagnosis and facilitate progression assessment. Annual use of sensitive screening tests such as Symbol Digit Modalities Test (SDMT) and Brief Visual Memory Test-Revised (BVMT-R) or the Brief International Cognitive Assessment for MS (BICAMS) test battery is recommended. Persistent inflammatory activity on MRI in the first three years of disease and the presence of cortical lesions are predictive of SPMS conversion. Standardized MRI monitoring for features of progressive MS can support clinically and neurocognitively based suspicion of SPMS. Discussion: Interdisciplinary care of MS patients by clinically skilled neurologists, supported by neuropsychological testing and MRI, has a high value for SPMS prediction and diagnosis. The latter allows early conversion to appropriate therapies, as SPMS requires different interventions than RRMS. After drug switching, clinical, neuropsychological, and imaging vigilance allows stringent monitoring for neuroinflammatory and degenerative activity as well as treatment complications.
Introduction: the presence of anti-CCP is an important prognostic tool for rheumatoid arthritis (RA), but its relationship with the activity of the disease and functional capacity is still being investigated. Objectives: to study the relationship between anti-CCP and the indices of disease activity, functional capacity and structural damage, by means of conventional radiography (CR) and magnetic resonance imaging (MRI), in stabilized RA. Methods: cross-sectional study of RA patients with one to 10 years of disease. The participants were subjected to clinical evaluation with anti-CCP screening. Disease activity was assessed by means of the Clinical Disease Activity Index (CDAI) and functional capacity by means of the Health Assessment Questionnaire (HAQ). CR was analyzed by the Sharp van der Heijde index (SmvH) and MRI by the Rheumatoid Arthritis Magnetic Resonance Image Scoring System (RAMRIS). Results: 56 patients were evaluated, with median (IIq) of 55 (47.5–60.0) years, 50 (89.3%) were female among whom 37 (66.1%) were positive for anti-CCP. The median (IIq) of CDAI, HAQ, SmvH and RAMRIS were 14.75 (5.42–24.97), 1.06 (0.28–1.75), 2 (0–8) and 15 (7–35), respectively. There was no association between anti-CCP and CDAI, HAQ, SmvH and RAMRIS. Conclusion: our results did not establish the association of anti-CCP with the severity of the disease. So far, we cannot corroborate the anti-CCP as a prognostic tool in RA established.
Objective: To evaluate the imaging features of spondyloarthritis on magnetic resonance imaging (MRI) of the sacroiliac (SI) joints in terms of topography (in thirds) and affected margin, since this aspect is rarely addressed in the literature. Methods: Cross-sectional study with MRI (1.5 T) evaluation of the SI in 16 patients with diagnosis of axial spondyloarthritis regarding the presence of acute (subchondral bone edema, enthesitis, synovitis and capsulitis) and chronic changes (erosions, subchondral bone sclerosis, bone bridging and fatty replacement), performed by two radiologists, blinded to clinical data. MRI findings were correlated with clinical data including age, disease duration, medications, HLA-B27, BASDAI, ASDAS-VHS and ASDAS-PCR, BASMI, BASFI, and mSASSS. Results: Bone edema pattern and erosions showed predominance in the upper third of SI (p = 0.050, p = 0.0014, respectively). There was a correlation between the time of disease and structural changes by affected third (p = 0.028-0.037), as well as the presence of bone bridges with BASMI (p = 0.028) and mSASSS (p = 0.014). Patients with osteitis of the lower third had higher ASDAS values (ESRV: p = 0.011 and CRP: p = 0.017). Conclusion: Chronic inflammatory changes and the pattern of bone edema predominated in the upper third of the SI, but there was also concomitant involvement of the middle or lower thirds of the joint. The localization of involvement in the upper third of the SI was insufficient to differentiate between degeneration and inflammation.
With the increasing demand for sustainable energy, advanced characterization methods are becoming more and more important in the field of energy materials research. With the help of X-ray imaging technology, we can obtain the morphology, structure and stress change information of energy materials in real time from two-dimensional and three-dimensional perspectives. In addition, with the help of high penetration X-ray and high brightness synchrotron radiation source, in-situ experiments are designed to obtain the qualitative and quantitative change information of samples during the charge and discharge process. In this paper, X-ray imaging technology based on synchrotron and its related applications are reviewed. The applications of several main X-ray imaging technologies in the field of energy materials, including X-ray projection imaging, transmission X-ray microscopy, scanning transmission X-ray microscopy, X-ray fluorescence microscopy and coherent diffraction imaging, are discussed. The application prospects and development directions of X-ray imaging in the future are prospected.
Objective: To evaluate the clinical and radiographic results and complications of arthroscopic subcapital realignment osteotomy for the treatment of chronic and stable proximal femoral epiphysiolysis (PFE) in an initial series of patients. According to the literature review, the study presents the first description of an arthroscopic technique of this type of osteotomy. Methods: Between June 2012 and December 2014, seven patients underwent arthroscopic subcapital realignment osteotomy for the treatment of chronic, stable PFE. The mean age of the patients was 11 years and four months. Minimum follow-up ranged from 6 to 36 months (mean, 16.5 months). Patients were clinically evaluated according to the Harris Hip Score modified by Byrd and radiographically according to Southwick’s quantitative classification and the epiphyseal-diaphyseal angle. Postoperative complications were analyzed. Results: With regard to the evaluation of the Harris Hip Score Modified by Byrd clinical score, a preoperative mean of 35.8 points and a postoperative mean of 97.5 points were observed (p < 0.05). Radiographically, five patients were classified as Southwick grade II and two as grade III. A mean correction of the epiphyseal-diaphyseal angle of 40° was observed. There were no immediate postoperative complications. One patient developed avascular necrosis of the femoral head, without collapse or chondrolysis at the last follow-up (22 months). Conclusion: The arthroscopic technique presented by the authors for the treatment of chronic, stable PFE resulted in clinical and radiographic improvement of the patients in this initial series.
Today, diffusion-weighted MRI is an important, complementary sequence in an MRI of the abdomen, especially in oncological questions, but also in inflammatory diseases. The following paper deals with the technical basics and shows typical indications and findings as well as the value of the method in the diagnosis of parenchymatous upper abdominal organs and the gastrointestinal tract.
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