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To develop definitions for imaging features being considered as potential classification criteria for calcium pyrophosphate deposition (CPPD) disease, additional to clinical and laboratory criteria, and to compile example images of CPPD on different imaging modalities.The American College of Rheumatology and European Alliance of Associations for Rheumatology CPPD classification criteria Imaging Advisory Group (IAG) and Steering Committee drafted definitions of imaging features that are characteristic of CPPD on conventional radiography (CR), conventional computed tomography (CT), dual-energy CT (DECT), and magnetic resonance imaging (MRI). An anonymous expert survey was undertaken by a 35-member Combined Expert Committee, including all IAG members. The IAG and 5 external musculoskeletal radiologists with expertise in CPPD convened virtually to further refine item definitions and voted on example images illustrating CR, CT, and DECT item definitions, with ≥90% agreement required to deem them acceptable.The Combined Expert Committee survey indicated consensus on all CR definitions. The IAG and external radiologists reached consensus on CT and DECT item definitions, which specify that calcium pyrophosphate deposits appear less dense than cortical bone. The group developed an MRI definition and acknowledged limitations of this modality for CPPD. Ten example images for CPPD were voted acceptable (4 CR, 4 CT, and 2 DECT), and 3 images of basic calcium phosphate deposition were voted acceptable to serve as contrast against imaging features of CPPD.An international group of rheumatologists and musculoskeletal radiologists defined imaging features characteristic of CPPD on CR, CT, and DECT and assembled a set of example images as a reference for future clinical research studies.

Purpose: To assess the role of preoperative CT-based skeletal muscle mass depletion on postoperative clinical outcomes and survival in patients who underwent total laryngectomy for cancer. Methods: Patients operated on between January 2011 and March 2020 were retrospectively included. Skeletal muscle area and intra- and inter-muscular fat accumulation were measured at the third lumbar vertebral level on preoperative CT scans. Skeletal muscle mass depletion was defined based on pre-established cut-off values. Their association with postoperative morbidity, length of stay (LOS), costs, and survival was assessed. Results: A total of 84 patients were included, of which 37 (44%) had preoperative skeletal muscle mass depletion. The rate of postoperative fistula (23% vs. 35%, p = 0.348), cutaneous cervical dehiscence (17% vs. 11%, p = 0.629), superficial incisional surgical site infections (SSI) (12% vs. 10%, p = 1.000), and unplanned reoperation (38% vs. 37%, p = 1.000) were comparable between the two patient groups. No difference in median LOS was observed (41 vs. 33 days, p = 0.295), nor in treatment costs (119,976 vs. 109,402 CHF, p = 0.585). The median overall survival was comparable between the two groups (3.43 vs. 4.95 years, p = 0.09). Conclusions: Skeletal muscle mass depletion alone had no significant impact on postoperative clinical outcomes or survival.

OBJECTIVE: Classification criteria for calcium pyrophosphate deposition disease (CPPD) will facilitate clinical research on this common crystalline arthritis. We report on the first two phases of a four-phase process for developing CPPD classification criteria. METHODS: CPPD classification criteria development is overseen by a 12-member Steering Committee. Item generation (Phase I) included a scoping literature review of five literature databases and contributions from a 35-member Combined Expert Committee and two Patient Research Partners. Item reduction and refinement (Phase II) involved a Combined Expert Committee meeting, discussions among Clinical, Imaging, and Laboratory Advisory Groups, and an item rating exercise to assess the influence of individual items toward classification. The Steering Committee reviewed the modal rating score for each item (range -3 [strongly pushes away from CPPD] to +3 [strongly pushes toward CPPD]) to determine items to retain for future phases of criteria development. RESULTS: Item generation yielded 420 items (312 from the literature, 108 from experts/patients). The Advisory Groups eliminated items they agreed were unlikely to distinguish between CPPD and other forms of arthritis, yielding 127 items for the item rating exercise. Fifty-six items, most of which had a modal rating of +/- 2 or 3, were retained for future phases. As numerous imaging items were rated +3, the Steering Committee recommended focusing on imaging of the knee, wrist, and one additional affected joint for calcification suggestive of CPP crystal deposition. CONCLUSION: A data- and expert-driven process is underway to develop CPPD classification criteria. Candidate items comprise clinical, imaging, and laboratory features.

Orthostatic hypotension is a cardinal feature of multiple-system atrophy. The upright posture provokes syncopal episodes that prevent patients from standing and walking for more than brief periods. We implanted a system to restore regulation of blood pressure and enable a patient with multiple-system atrophy to stand and walk after having lost these abilities because of orthostatic hypotension. This system involved epidural electrical stimulation delivered over the thoracic spinal cord with accelerometers that detected changes in body position. (Funded by the Defitech Foundation.).

Objectives: To evaluate the image quality (IQ) of a spectral photon-counting CT (SPCCT) using filtered back projection (FBP) and hybrid iterative reconstruction (IR) algorithms (iDose4), in comparison with a dual-layer CT (DLCT) system, and to choose the best image quality according to the IR level for SPCCT. Methods: Two phantoms were scanned using a standard lung protocol (120 kVp, 40 mAs) with SPCCT and DLCT systems. Raw data were reconstructed using FBP and 9 iDose4 levels (i1/i2/i3/i4/i5/i6/i7/i9/i11) for SPCCT and 7 for DLCT (i1/i2/i3/i4/i5/i6/i7). Noise power spectrum and task-based transfer function (TTF) were computed. Detectability index (d′) was computed for detection of 4 mm ground-glass nodule (GGN) and solid nodule. Two chest radiologists performed an IQ evaluation (noise/nodule sharpness/nodule conspicuity/overall IQ) in consensus, and chose the best image for SPCCT. Results: Noise magnitude was −47% ± 2% lower on average with SPCCT than with DLCT for iDose4 range from i1 to i6. Average NPS spatial frequencies increased for SPCCT in comparison with DLCT. TTF also increased, except for the air insert with FBP, and i1/i2/i3. Higher detectability was found for SPCCT for both GGN and solid nodules. IQ for both types of nodule was rated consistently higher with SPCCT than with DLCT for the same iDose4 level. For SPCCT and both nodules, the scores for noise and conspicuity improved with increasing iDose4 level. iDose4 level 6 provided the best subjective IQ for both types of nodule. Conclusions: Higher IQ for GGN and solid nodules was demonstrated with SPCCT compared with DLCT with better detectability using iDose4. Key Points: Using spectral photon-counting CT compared with dual-layer CT, noise magnitude was reduced with improvements in spatial resolution and detectability of ground-glass nodules and solid lung nodules.As the iDose4level increased, noise magnitude was reduced and detectability of ground-glass and solid lung nodules was better for both CT systems.For spectral photon-counting CT imaging, two chest radiologists determined iDose4level 6 as the best image quality for detecting ground-glass nodules and solid lung nodules.

We investigated the role of three-dimensional (3-D) CT in the diagnosis and management of four bipartite scaphoids in three patients. We computed the volume ratio, moment of inertia ratio and direction vector from the centroid of the scaphoid to the os centrale carpi. We found that the os centrale carpi was always smaller than the scaphoid and showed an elongated shape in the scaphoid longitudinal axis. Its position was always posterior compared with the scaphoid anteroposterior axis. The main morphological feature of bipartite scaphoids was the continuity of the scaphoid from its proximal to distal aspect along the longitudinal axis. These criteria from 3-D imaging should be considered useful in the diagnosis of bipartite scaphoid as it allows differentiation from nonunion. 3-D single-photon emission computed tomography (SPECT)/CT was helpful in the surgical decision-making when the patient was symptomatic. 3-D imaging was also used for the preoperative simulation and planning of bone fusion as it simplifies surgery and makes it more accurate. Here we provide clear criteria for diagnosing bipartite scaphoids and for the planning when surgery is deemed necessary.

To characterize peripheral vascular plaques color-coded as monosodium urate (MSU) deposition by dual-energy computed tomography (DECT) and assess their association with the overall soft-tissue MSU crystal burden.Patients with suspected crystal arthropathies were prospectively included in the CRYSTALILLE inception cohort to undergo baseline knees and ankles/feet DECT scans; treatment-naive gout patients initiating treat-to-target urate-lowering therapy (ULT) underwent repeated DECT scans with concomitant serum urate level measurements at 6 and 12 months. We determined the prevalence of DECT-based vascular MSU-coded plaques in knee arteries, and assessed their association with the overall DECT volumes of soft-tissue MSU crystal deposition and coexistence of arterial calcifications. DECT attenuation parameters of vascular MSU-coded plaques were compared with dense calcified plaques, control vessels, control soft tissues, and tophi.We investigated 126 gout patients and 26 controls; 17 ULT-naive gout patients were included in the follow-up study. The prevalence of DECT-based vascular MSU-coded plaques was comparable in gout patients (24.6%) and controls (23.1%; p=0.87). Vascular MSU-coded plaques were strongly associated with coexisting arterial calcifications (p0.001), but not with soft-tissue MSU deposition. Characterization of vascular MSU-coded plaques revealed specific differences in DECT parameters compared with control vessels, control soft tissues, and tophi. During follow-up, vascular MSU-coded plaques remained stable despite effective ULT (p=0.64), which decreased both serum urate levels and soft-tissue MSU volumes (p0.001).Our findings suggest that DECT-based MSU-coded plaques in peripheral arteries are strongly associated with calcifications and may not reflect genuine MSU crystal deposition. Such findings should therefore not be a primary target when managing gout patients.

Objective. Meralgia paresthetica (MP) is a mononeuropathy of the exclusively sensory lateral femoral cutaneous nerve (LFCN) that is difficult to treat with conservative treatments. Afferents from the LFCN enter the spinal cord through the dorsal root entry zones (DREZs) innervating L2 and L3 spinal segments. We previously showed that epidural electrical stimulation of the spinal cord can be configured to steer electrical currents laterally in order to target afferents within individual DREZs. Therefore, we hypothesized that this neuromodulation strategy is suitable to target the L2 and L3 DREZs that convey afferents from the painful territory, and thus alleviates MP related pain. Approach. A patient in her mid-30s presented with a four year history of dysesthesia and burning pain in the anterolateral aspect of the left thigh due to MP that was refractory to medical treatments. We combined neuroimaging and intraoperative neuromonitoring to guide the surgical placement of a paddle lead over the left DREZs innervating L2 and L3 spinal segments. Main results. Optimized electrode configurations targeting the left L2 and L3 DREZs mediated immediate and sustained alleviation of pain. The patient ceased all other medical management, reported improved quality of life, and resumed recreational physical activities. Significance. We introduced a new treatment option to alleviate pain due to MP, and demonstrated how neuromodulation strategies targeting specific DREZs is effective to reduce pain confined to specific regions of the body while avoiding disconfort.

Objectives To quantitatively evaluate the impact of virtual monochromatic images (VMI) on reduced-iodine-dose dual-energy coronary computed tomography angiography (CCTA) in terms of coronary lumen segmentation in vitro, and secondly to assess the image quality in vivo, compared with conventional CT obtained with regular iodine dose. Materials and methods A phantom simulating regular and reduced iodine injection was used to determine the accuracy and precision of lumen area segmentation for various VMI energy levels. We retrospectively included 203 patients from December 2017 to August 2018 (mean age, 51.7 ± 16.8 years) who underwent CCTA using either standard (group A, n = 103) or reduced (group B, n = 100) iodine doses. Conventional images (group A) were qualitatively and quantitatively compared with 55-keV VMI (group B). We recorded the location of venous catheters. Results In vitro, VMI outperformed conventional CT, with a segmentation accuracy of 0.998 vs. 1.684 mm2, respectively (p < 0.001), and a precision of 0.982 vs. 1.229 mm2, respectively (p < 0.001), in simulated overweight adult subjects. In vivo, the rate of diagnostic CCTA in groups A and B was 88.4% (n = 91/103) vs. 89% (n = 89/100), respectively, and noninferiority of protocol B was inferred. Contrast-to-noise ratios (CNR) of lumen versus fat and muscle were higher in group B (p < 0.001) and comparable for lumen versus calcium (p = 0.423). Venous catheters were more often placed on the forearm or hand in group B (p < 0.001). Conclusion In vitro, low-keV VMI improve vessel area segmentation. In vivo, low-keV VMI allows for a 40% iodine dose and injection rate reduction while maintaining diagnostic image quality and improves the CNR between lumen versus fat and muscle. Key Points • Dual-energy coronary CT angiography is becoming increasingly available and might help improve patient management. • Compared with regular-iodine-dose coronary CT angiography, reduced-iodine-dose dual-energy CT with low-keV monochromatic image reconstructions performed better in phantom-based vessel cross-sectional segmentation and proved to be noninferior in vivo. • Patients receiving reduced-iodine-dose dual-energy coronary CT angiography often had the venous catheter placed on the forearm or wrist without compromising image quality.

Objective To assess the ability of dual-energy computed tomography (DECT) in identifying early calcium crystal deposition in menisci and articular cartilage of the knee, depending on the presence/absence of chondrocalcinosis seen on conventional CT. Methods One hundred thirty-two knee DECT scans from patients with suspected crystal-associated arthropathy were reviewed and assigned to a calcium pyrophosphate deposition (CPPD) group (n = 50) or a control group (n = 82). Five DECT attenuation parameters were measured in preset regions of interest (ROIs) in menisci and articular cartilage and compared between groups using linear mixed models with adjustment for confounders. Subgroup analysis, excluding ROIs with chondrocalcinosis seen on conventional CT, was performed. Results In both menisci and articular cartilage, and for all 5 DECT attenuation parameters, calcified ROIs in CPPD patients showed significantly higher values than ROIs in controls (P ≤ 0.036). Conversely, noncalcified ROIs in CPPD patients were comparable with those in controls (P ≥ 0.09). While specific DECT parameters yielded good accuracy (area under the curve [AUC] 0.87-0.88) in differentiating calcified ROIs in CPPD patients from ROIs in controls, DECT failed to distinguish between noncalcified ROIs in CPPD patients and controls (AUC 0.58-0.59). Conclusion While DECT has the potential to characterize knee intraarticular mineralization, this technique cannot yet accurately identify early calcium crystal deposition that is not visible as chondrocalcinosis on conventional CT.

Objective To examine the accuracy of dual-energy CT (DECT) vs ultrasound or their combination for the diagnosis of gout. Methods Using prospectively collected data from an outpatient rheumatology clinic at a tertiary-care hospital, we examined the diagnostic accuracy of either modality alone or their combination, by anatomical site (feet/ankles and/or knees), for the diagnosis of gout. We used two standards: (i) demonstration of monosodium urate crystals in synovial fluid (gold), and (ii) modified (excluding DECT and ultrasound) 2015 ACR–EULAR gout classification criteria (silver). Results Of the 147 patients who provided data, 48 (33%) had synovial fluid analysis performed (38 were monosodium urate-crystal positive) and mean symptom duration was 9.2 years. One hundred (68%) patients met the silver standard. Compared with the gold standard, diagnostic accuracy statistics for feet/ankles DECT, feet/ankles ultrasound, knees DECT and knees ultrasound were, respectively: sensitivity: 87%, 84%, 91% and 58%; specificity: 100%, 60%, 87% and 80%; positive predictive value: 100%, 89%, 97% and 92%; negative predictive value: 67%, 50%, 70% and 33%; area under the receiver operating characteristic curve: 0.93, 0.72, 0.89 and 0.66. Combining feet/ankles DECT with ultrasound or knees DECT with ultrasound led to a numerically higher sensitivity compared with DECT alone, but overall accuracy was lower. Similarly, combining imaging knees to feet/ankles also yielded a numerically higher sensitivity and negative predictive values compared with feet/ankles DECT alone, without differences in overall accuracy. Findings were replicated compared with the silver standard, but with lower numbers. Conclusions Feet/ankles or knees DECT alone had the best overall accuracy for gout diagnosis. The DECT–US combination or multiple joint imaging offered no additional increase in overall diagnostic accuracy.

Theobjective of this study was todetermine the normativebone mineral density (BMD) of cortical and trabecular bone regions in the adult glenoid and itsdependence on the subject's age andsex.We analyzed computed tomography (CT) scans of 450 shoulders (317 males, 18-69 years)withoutany signs of glenohumeral joint pathology. Glenoid BMD was automaticallyquantified in six volumes of interest (VOIs): cortical bone (CO), subchondral cortical plate (SC), subchondral trabecular bone (ST), and three adjacent layers of trabecular bone (T1, T2, T3).BMD was measuredin Hounsfield unit (HU).We evaluated the association between glenoid BMD and sex and age with the Student'st-test andPearson'scorrelation coefficient (r), respectively.The lambda-mu-sigma method was used to determineage- and sex-specific normative values ofglenoid BMDin cortical (CO, SC) and trabecular (ST, T1, T2,T3)bone.Glenoid BMD was higher in males than females, in most age groups and most VOIs. Before 40 years old, the effect of age on BMD was very weak inboth males and females.After40 years old, BMD declined over time in all VOIs.ThisBMD decline with age was greater in females (cortical: r = - 0.45, trabecular:r = - 0.41) than in males (cortical:r = - 0.30;trabecular: r = - 0.32). Thesenormativeglenoid BMD values couldproveclinically relevantin the diagnosis and management of patients with various shoulderdisorders,in particular glenohumeral osteoarthritis and shoulder arthroplasty or shoulder instability, as well as in related research. Keywords This article is protected by copyright. All rights reserved.

Purpose We aimed to thoroughly characterize image quality of a novel deep learning image reconstruction (DLIR), and investigate its potential for dose reduction in abdominal CT in comparison with filtered back-projection (FBP) and a partial model-based iterative reconstruction (ASiR-V). Methods We scanned a phantom at three dose levels: regular (7 mGy), low (3 mGy) and ultra-low (1 mGy). Images were reconstructed using DLIR (low, medium and high levels) and ASiR-V (0% = FBP, 50% and 100%). Noise and contrast-dependent spatial resolution were characterized by computing noise power spectra and target transfer functions, respectively. Detectability indexes of simulated acute appendicitis or colonic diverticulitis (low contrast), and calcium-containing urinary stones (high contrast) (|ΔHU| = 50 and 500, respectively) were calculated using the nonprewhitening with eye filter model observer. Results At all dose levels, increasing DLIR and ASiR-V levels both markedly decreased noise magnitude compared with FBP, with DLIR low and medium maintaining noise texture overall. For both low- and high-contrast spatial resolution, DLIR not only maintained, but even slightly enhanced spatial resolution in comparison with FBP across all dose levels. Conversely, increasing ASiR-V impaired low-contrast spatial resolution compared with FBP. Overall, DLIR outperformed ASiR-V in all simulated clinical scenarios. For both low- and high-contrast diagnostic tasks, increasing DLIR substantially enhanced detectability at any dose and contrast levels for any simulated lesion size. Conclusions Unlike ASiR-V, DLIR substantially reduces noise while maintaining noise texture and slightly enhancing spatial resolution overall. DLIR outperforms ASiR-V by enabling higher detectability of both low- and high-contrast simulated abdominal lesions across all investigated dose levels.

Introduction: The olecranon Chevron osteotomy (OCO) is commonly used to approach complex intraarticular fractures of the distal humerus. Predrilled tension band wiring (TBW) has historically been used to fix OCO. However, clinical outcomes are burdened by secondary loss of reduction and up to 21.3% non-union rates. The biomechanical stability of anatomic locking compression plate (LCP) was reported to be superior to TBW in olecranon fracture fixation. We hypothesised that this implant may also be superior to TBW in the anatomic reconstruction of the articular surfaces of the ulnar greater sigmoid notch after OCO by predrilling the holes of the angular stable plate with the threaded drill guide prior to osteotomy., Materials and methods: Lateral standardised and calibrated radiographs of twenty synthetic ulnar bones were obtained using a custom-made holder prior to preparation by a senior orthopaedic trauma surgeon. Ten specimens were then predrilled using the threaded drill bit guide of an olecranon LCP, while the other ten samples were predrilled with two 1.6 mm Kirschner wires. A distal "V" OCO was performed using a 0.6 mm oscillating saw. After repositioning and fixation with the corresponding device, lateral radiographs were repeated. Two independent observers used the TraumaCad planning software to document the articular geometry of the ulnar greater sigmoid notch pre- and postoperatively. The diameter of the best-fitting circle (diameter), the distance between the tip of the coronoid and the olecranon processes (distance) and the maximum articular depth were measured., Results: With the TBW technique, after OCO and fixation, all three postoperative measurements were significantly (p = 0.13). Inter and intra-observer measurement reliability was strong to very strong (intraclass correlation coefficients >= 0.793) for all three variables., Conclusion: Our study reveals that the predrilled LCP technique is more accurate than the predrilled TBW in restoring the anatomic articular geometry of the ulnar greater sigmoid notch after OCO. (C) 2020 Elsevier Ltd. All rights reserved.

Resume Contexte Le taux d’echec apres arthroplastie totale anatomique de l’epaule (ATEa) est plus eleve en cas de perte osseuse asymetrique de la glene secondaire a une usure posterieure, ainsi qu’en cas de subluxation posterieure statique persistante de la tete humerale (SPH). Hypothese Nous avons teste l’hypothese selon laquelle l’utilisation combinee d’un implant glenoidien augmente posterieurement (GAP) avec une planification chirurgicale en 3D et des guides d’instrumentation specifiques au patient (ISP) permet de reduire a court terme la SPH apres une ATEa chez les patients avec des glenes de type B2 ou B3. Materiel et methodes Nous avons inclus neuf patients consecutifs atteints d’omarthrose primaire et presentant des glenes de type B2 ou B3, qui ont beneficie d’une ATEa avec implants GAP a quille cimentee (augmentation posterieure de 15, 25 ou 35 degres). Tous les patients ont eu une tomodensitometrie (TDM) de l’epaule preoperatoire combinee a une planification chirurgicale 3D couplee a un ISP. Des TDMs postoperatoires ont ete effectuees apres 14 semaines en moyenne (de 10 a 21 semaines). La subluxation scapulo-humerale ainsi que la version et l’inclinaison de la glene ont ete mesurees en 3D, a la fois sur des TDMs pre- et postoperatoires, avec la meme methode quantitative et fiable. Resultats Nous avons observe une diminution significative de la subluxation scapulo-humerale de 49 ± 12 % en preoperatoire, a 22 ± 17 % en postoperatoire (p = 0,0039), avec une taille d’effet importante (Cohen's d = 1,89). La version preoperatoire de la glene a ete corrigee de −17,3 ± 9,4 degres a −5,2 ± 7,5 degres en postoperatoire. La difference absolue entre la version et l’inclinaison postoperatoire et les mesures correspondantes planifiees chirurgicalement etait respectivement de 5,4 ± 3,6 degres et 3,3 ± 2,0 degres. Conclusion L’utilisation combinee d’implants GAP avec la planification preoperatoire 3D et une ISP entraine une diminution significative a court terme de la SPH et de la version glenoidienne chez les patients presentant une usure asymetrique posterieure de la glene. Nous suggerons que ces implants asymetriques ne devraient pas se limiter a l’augmentation posterieure, car les usures osseuses sont egalement observees dans d’autres secteurs de la glene. Niveau d’evidence scientifique IV, science de base.

Treatment of soft tissue sarcomas (STS) should only be initiated once the diagnosis is fully established. Resection of tumors of unknown nature should be avoided. Nevertheless, specialized centers continue to face numbers of unplanned excisions (UPE) in STS.To compare oncologic and functional outcomes, number of surgeries, length of hospital stay and treatment costs of UPE versus planned excision (PE) in STS.A retrospective single tertiary center study was performed on 201 patients. Survival, local and distant recurrence rates were compared between PE (n = 137) and UPE (n = 64). In a subgroup analysis of 60 patients, functional outcome (MSTS and TESS scores), and socio-economic impact (number of surgeries, length of hospital stay and treatment costs) in "functional planned excision" (fPE) group (n = 30) and "functional unplanned excision" (fUPE) group (n = 29) were compared.There was no significant difference in oncological outcome between PE and UPE. In the subgroup analysis, we found a non-significant difference in functional outcome. Patients in the fUPE had significantly more surgeries (3.5 vs. 1.4; p 0.00001) and costs of their management was 64% higher than fPE (p = 0.048). Hospital stay was longer after fUPE but not statistically significant (18.3 days vs. 11.8 days; p = 0.13).Even though oncological and functional outcomes are comparable after PE and UPE of STS, the number of surgeries, length of hospital stay and treatment costs were higher in patients with UPE. Our data underscore the importance of specialized STS treatment centers including multidisciplinary management.

Posterior eccentric glenoid wear is associated with higher complication rates after shoulder arthroplasty. The recently reported association between the acromion shape and glenoid retroversion in both normal and osteoarthritic shoulders remains controversial. The three-dimensional coordinates of the angulus acromialis (AA) and acromioclavicular joint were examined in the scapular coordinate system. Four acromion angles were defined from these two acromion landmarks: the acromion posterior angle (APA), acromion tilt angle (ATA), acromion length angle (ALA), and acromion axial tilt angle (AXA). Shoulder computed tomography scans of 112 normal scapulae and 125 patients with primary glenohumeral osteoarthritis were analyzed with simple and stepwise multiple linear regressions between all morphological acromion parameters and glenoid retroversion. In normal scapulae, the glenoid retroversion angle was most strongly correlated with the posterior extension of the AA (R2 = 0.48, p < 0.0001), which can be conveniently characterized by the APA. Combining the APA with the ALA and ATA helped slightly improve the correlation (R2 = 0.55, p < 0.0001), but adding the AXA did not. In osteoarthritic scapulae, a critical APA > 15 degrees was found to best identify glenoids with a critical retroversion angle > 8 degrees. The APA is more strongly associated with the glenoid retroversion angle in normal than primary osteoarthritic scapulae.

This retrospective observational study aimed to evaluate whether preoperative sarcopenia, assessed by CT imaging, was associated with postoperative clinical outcomes and overall survival in patients that underwent liver resections. Patients operated on between January 2014 and February 2020 were included. The skeletal muscle index (SMI) was measured at the level of the third lumbar vertebra on preoperative CT scans. Preoperative sarcopenia was defined based on pre-established SMI cut-off values. The outcomes were postoperative morbidity, length of hospital stay (LOS), and overall survival. Among 355 patients, 212 (59.7%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (63.5 years) and had significantly lower BMIs (23.9 kg/m2) than patients without sarcopenia (59.3 years, p < 0.01, and 27.7 kg/m2, p < 0.01, respectively). There was no difference in LOS (8 vs. 8 days, p = 0.75), and the major complication rates were comparable between the two groups (11.2% vs. 11.3%, p = 1.00). The median overall survival times were comparable between patients with sarcopenia and those without sarcopenia (15 vs. 16 months, p = 0.87). Based on CT assessment alone, preoperative sarcopenia appeared to have no impact on postoperative clinical outcomes or overall survival in patients that underwent liver resections. Future efforts should also consider muscle strength and physical performance, in addition to imaging, for preoperative risk stratification.

Simple Summary Cancer cachexia often includes sarcopenia, which is characterized by a progressive, generalized loss of skeletal muscle mass and strength, combined with fatty infiltration into the muscle. Sarcopenia has been considered a patient-specific imaging biomarker for predicting outcomes after cancer surgery. The present study aimed to evaluate whether preoperative sarcopenia was associated with postoperative outcomes and survival in patients that underwent liver resections. Sarcopenia, assessed by preoperative CT imaging, was present in two-thirds of patients. Independent risk factors for sarcopenia were age, male sex, ASA score ≥ 3, and malignancies. Based on CT assessment alone, sarcopenia had no impact on clinical outcomes or overall survival after hepatectomy. Abstract This retrospective observational study aimed to evaluate whether preoperative sarcopenia, assessed by CT imaging, was associated with postoperative clinical outcomes and overall survival in patients that underwent liver resections. Patients operated on between January 2014 and February 2020 were included. The skeletal muscle index (SMI) was measured at the level of the third lumbar vertebra on preoperative CT scans. Preoperative sarcopenia was defined based on pre-established SMI cut-off values. The outcomes were postoperative morbidity, length of hospital stay (LOS), and overall survival. Among 355 patients, 212 (59.7%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (63.5 years) and had significantly lower BMIs (23.9 kg/m2) than patients without sarcopenia (59.3 years, p < 0.01, and 27.7 kg/m2, p < 0.01, respectively). There was no difference in LOS (8 vs. 8 days, p = 0.75), and the major complication rates were comparable between the two groups (11.2% vs. 11.3%, p = 1.00). The median overall survival times were comparable between patients with sarcopenia and those without sarcopenia (15 vs. 16 months, p = 0.87). Based on CT assessment alone, preoperative sarcopenia appeared to have no impact on postoperative clinical outcomes or overall survival in patients that underwent liver resections. Future efforts should also consider muscle strength and physical performance, in addition to imaging, for preoperative risk stratification.

We aimed to evaluate whether computed tomography (CT)-derived preoperative sarcopenia measures were associated with postoperative outcomes and survival after video-assisted thoracoscopic (VATS) anatomical pulmonary resection in patients with early-stage non-small cell lung cancer (NSCLC). We retrospectively reviewed all consecutive patients that underwent VATS anatomical pulmonary resection for NSCLC between 2012 and 2019. Skeletal muscle mass was measured at L3 vertebral level on preoperative CT or PET/CT scans to identify sarcopenic patients according to established threshold values. We compared postoperative outcomes and survival of sarcopenic vs. non-sarcopenic patients. A total of 401 patients underwent VATS anatomical pulmonary resection for NSCLC. Sarcopenia was identified in 92 patients (23%). Sarcopenic patients were predominantly males (75% vs. 25%; p < 0.001) and had a lower BMI (21.4 vs. 26.5 kg/m2; p < 0.001). The overall postoperative complication rate was significantly higher (53.2% vs. 39.2%; p = 0.017) in sarcopenic patients and the length of hospital stay was prolonged (8 vs. 6 days; p = 0.032). Two factors were associated with postoperative morbidity in multivariate analysis: BMI and American Society of Anesthesiologists score >2. Median overall survival was comparable between groups (41 vs. 46 months; p = 0.240). CT-derived sarcopenia appeared to have a small impact on early postoperative clinical outcomes, but no effect on overall survival after VATS anatomical lung resection for NSCLC.

Chronic osteomyelitis is an inflammatory process of the bone caused by an infectious agent. This condition leads to altered bone vascularization and thus to bone destruction and formation of necrotic bone fragments (sequestrum). The treatment of chronic osteomyelitis is primarily based on surgical management, which includes debridement of the sequestrum and sampling of bone tissue for microbiological analysis in order to initiate a targeted antibiotic therapy. A multidisciplinary approach is essential, involving expertise in orthopedic surgery, musculoskeletal imaging and nuclear medicine, infectious diseases, as well as plastic or vascular surgery for complex cases with soft tissue and/or vascular defects.L’ostéomyélite chronique est un processus inflammatoire osseux causé par un agent infectieux. Cette pathologie provoque une altération de la vascularisation intraosseuse et périostée donnant lieu à des fragments d’os nécrotiques (séquestres). Le traitement de l’ostéomyélite chronique repose sur une prise en charge chirurgicale permettant de débrider les séquestres et de réaliser des prélèvements osseux pour des analyses microbiologiques afin d’instaurer une antibiothérapie ciblée sur l’agent pathogène. Une approche multidisciplinaire doit impliquer une expertise en chirurgie orthopédique, en imagerie musculosquelettique et médecine nucléaire, en maladies infectieuses, ainsi qu’en chirurgie plastique ou vasculaire pour les cas avec perte des tissus mous ou défaut de vascularisation.

Shoulder pain in the context of rotator cuff disorders is a frequent source of medical consultation. A wide range of therapeutic options is reported in the literature. Non- or minimally invasive treatments include physiotherapy, anti-inflammatory medication, and infiltration of corticosteroids or platelet-rich plasma. Surgical treatments include subacromial debridement, long head of the biceps tenotomy/tenodesis, rotator cuff repair, superior capsular reconstruction, and tendon transfers. Reverse shoulder arthroplasty completes the therapeutic arsenal. Guiding and advising the patient in the face of all these options can therefore be challenging. This article aims to summarize the clinical, demographic, and imaging characteristics useful in guiding and choosing the most appropriate treatment option for each patient.La pathologie de la coiffe des rotateurs est une source fréquente de consultation. Les options thérapeutiques proposées dans la littérature sont vastes. Les traitements conservateurs comprennent la physiothérapie, les anti-inflammatoires ainsi que l’infiltration de corticostéroïdes ou de plasma riche en plaquettes. Les traitements chirurgicaux incluent le débridement sous-acromial, les gestes sur le tendon du long chef du biceps, la réinsertion des tendons de la coiffe des rotateurs, la reconstruction capsulaire supérieure et les transferts tendineux. La prothèse d’épaule inversée vient compléter l’arsenal thérapeutique. Conseiller le patient face à toutes ces options peut donc s’avérer complexe. Cet article vise à résumer les caractéristiques cliniques, démographiques et radiologiques permettant d’orienter au mieux chaque patient.