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Objective: The purpose of this study was to assess the associations between malignancy, therapeutic regimens, and aorto-iliac aneurysm (i.e., abdominal aortic aneurysm [AAA]) growth rates., Methods: A retrospective single centre analysis identified patients with an AAA plus cancer. Patients who had two or more computed tomography angiograms over six months or more and additional malignancy were included. Clinical data and aneurysm diameters were analysed. AAA growth under cancer therapy (chemotherapy or radiation) was compared with a non-cancer AAA control cohort and to meta-analysis data. Statistics included t tests and a linear regression model with correction for initial aortic diameter and type of treatment., Results: From 2003 to 2020, 217 patients (median age 70 years; 92% male) with 246 aneurysms (58.8% AAA) and 238 malignancies were identified. Prostate (26.7%) and lung (15.7%) cancer were most frequently seen. One hundred and fifty-seven patients (72.3%) received chemotherapy, 105 patients (48.4%) radiation, and 79 (36.4%) both. Annual AAA growth (mean ± standard deviation) was not statistically significantly different for cancer and non-cancer patients (2.0 ± 2.3 vs. 2.8 ± 2.1 mm/year; p = .20). However, subgroup analyses revealed that radiation was associated with a statistically significantly reduced mean aneurysm growth rate compared with cancer patients without radiation (1.1 ± 1.3 vs. 1.6 ± 2.1 mm/year; p = .046) and to the non-cancer control cohort (1.7 ± 1.9 vs. 2.8 ± 2.1 mm/year; p = .007). Administration of antimetabolites resulted in statistically significantly increased AAA growth (+ 0.9 mm/year; p = .011), while topoisomerase inhibitors (- 0.8 mm/year; p = .17) and anti-androgens (- 0.5 mm/year; p = .27) showed a possible trend for reduced growth. Similar observations were noted for iliac aneurysms (n = 85). Additionally, the effects persisted for chemotherapy combinations (2.6 ± 1.4 substances/patient)., Conclusion: Patients with cancer and concomitant aortic aneurysms may require intensified monitoring when undergoing specific therapies, such as antimetabolite treatment, as they may experience an increased aneurysm growth rate. Radiation may be associated with reduced aneurysm growth., (Copyright © 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Objectives: The primary objective of this study was to evaluate the effects of high tibial osteotomy (HTO) on subchondral bone structure assessed with magnetic resonance (MR)-based trabecular bone imaging and the correlations of these effects with functional outcome and clinical symptoms., Methods: Patients with varus malalignment (6.2±2.2°) and without a history of knee surgery (n=22; 3 women; 48.7±10.3 years) were included into this prospective study. 1.5T MR imaging was performed before and on average 1.5 years after HTO (amount of correction 4.7±2.5°) and histomorphometric parameters of the trabecular bone were calculated for the medial/ lateral tibia and femur. Functional outcome was assessed with validated scores focusing on sports activity including the Lysholm Score, Tegner Activity Scale and the adapted Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Score., Results: Apparent trabecular number significantly decreased in all compartments of the tibiofemoral joint when comparing values before and on average 1.5 years after HTO ( P <0.05 for all). Decrease in apparent trabecular number was significantly higher within the medial tibia compared to the lateral compartment (mean difference -0.24 mm -1 (95% confidence interval (CI): -0.33, -0.14 mm -1 ); P <0.001). Apparent trabecular bone thickness significantly increased within 1.5 years after HTO in the lateral femur ( P =0.002) and tibia ( P <0.001). The Lysholm Score and Tegner Scale demonstrated an improvement of functional outcome, and the adapted WOMAC demonstrated an improvement of pain, stiffness and physical function within 1.5 years after HTO (P<0.01), with the improvement of WOMAC correlating significantly with changes in trabecular bone thickness within the medial tibia ( r = -0.48; P =0.01)., Conclusion: These findings indicate a reversal of the previous subchondral bone alterations in patients with varus malalignment after undergoing HTO, while pronounced subchondral changes were associated with a better functional outcome., Level of Evidence: 3., Competing Interests: Competing Interests: The authors declare that they have no competing interests.

Background: Prognostic factors for the disease course of patients with spondylodiscitis have not been well studied., Methods: The prognostic value of initial magnetic resonance imaging (MRI) and computed tomography imaging parameters was analyzed in 62 patients (47% women; mean age ± SD, 71.6 ± 9.6 years) with a confirmed diagnosis of spondylodiscitis. The disease course was separately evaluated during initial treatment response during hospitalization, relapse, and clinical short-term follow-up at 3 months., Results: Overall CT findings graded as definitely inflammatory (P = 0.006), reduced disc height on MRI (P = 0.044) and fluid-equivalent hyperintensity of discs on T2 short tau inversion recovery-weighted sequences (P = 0.047) were associated with poor initial treatment response. High initial C-reactive protein value (>10.1 mg/dL) was associated with a higher relapse rate (P = 0.038). Risk factors for poor outcome were infection with low-virulence bacteria (P = 0.040) and overall MRI findings atypical for infection (P = 0.027)., Conclusions: Compared with MRI, CT imaging parameters have a higher prognostic value regarding the disease course. Patients infected with low-virulence bacteria and atypical MRI findings are at higher risk for poor clinical outcome and thus warrant closer monitoring., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The diagnostic value of computed tomography (CT)-guided spinal biopsy in patients with suspected spondylodiscitis is reported inconsistently in the literature. Our aim was to evaluate associations between procedural, clinical, and imaging parameters and the diagnostic yield of CT-guided spinal biopsy., Methods: One hundred and two procedures performed in 87 patients with clinically suggested spondylodiscitis were analyzed retrospectively. Preprocedural magnetic resonance (MR) and CT images were evaluated regarding signal alterations, vertebral destruction, and soft-tissue involvement. The position of the biopsy needle in correlation with MR imaging findings was assessed. Patient characteristics and clinical details were noted. Parameters were compared in patients with positive and negative microbiological and histologic results., Results: Following microbiologic and histologic analysis, infectious spondylodiscitis was diagnosed in 29 and 23 biopsies, respectively. Microbiology results were significantly higher in biopsy specimens with central needle positioning within contrast enhancing tissue in correlation with the MR images (36% vs. 7%; P = 0.005). Biopsy specimens positioned in fluid-equivalent hyperintense discs in T2-weighted sequences yielded significantly lower microbiology results (6% vs. 33%; P = 0.036). Purely lytic endplate destruction and mixed vertebral density as shown by CT increased microbiology results (60% vs. 24%; P = 0.028). Previous antibiotic treatment for any cause did not influence microbiology yields significantly (P = 0.232)., Conclusions: MR imaging is mandatory to determine the optimal biopsy position. No clinical or imaging parameter could rule out a positive biopsy result and thus omit an unnecessary procedure. Biopsy should not be avoided if antibiotic treatment has previously been administered., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To evaluate whether preoperative multirow detector computed tomography (MDCT) findings were associated with clinical outcome 24 months after dynamic stabilization for painful degenerative lumbar spine disease., Methods: Preoperative MDCT examinations of 63 patients (66 ± 11.7 years; 60% women) treated with a dynamic screw rod system for painful degenerative segmental instability with/without spinal stenosis were assessed for quantitative and qualitative parameters defining degenerative changes of the thoracolumbar spine, including grades of disc herniation, degenerative spondylolisthesis, vertebral body sclerosis, cross-sectional area of the spinal canal at disc level, intervertebral disc height, ancillary bone mineral density, and anteroposterior diameter of intervertebral foramina. Clinical performance was assessed at baseline and 24 months with quantitative scales, including the Oswestry Disability Index and Short-Form 36 physical component summary. For statistical analysis classification and regression trees, linear regression and nonparametric tests were used., Results: Clinical scores improved substantially over 24 months compared with preoperative values (delta Oswestry Disability Index -32.1 ± 17.2, delta Short-Form 36 physical component summary 4.9 ± 2.3). Physical component summary improvement was significantly better in patients with lower grades of disc herniation (P < 0.001) and/or spondylolisthesis (P = 0.011), lower cross-sectional area of the spinal canal (P = 0.043), high intervertebral disc height (P = 0.006), and high grades of vertebral body sclerosis (P = 0.002). Patients with high bone mineral density and initially low diameter of intervertebral foramina showed a significantly better improvement of Oswestry Disability Index (P < 0.05)., Conclusions: Clinical improvement after dynamic stabilization was significantly associated with 7 independent baseline imaging findings. Preoperative evaluation of these MDCT parameters may improve therapy selection for patients with degenerative lumbar spine disease., (Copyright © 2016 Elsevier Inc. All rights reserved.)