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Objective: To compare sacroiliac joint (SIJ) lesions on MRI in women with versus without axial spondyloarthritis (ax-SpA) and establish an algorithm to determine whether such lesions are due to ax-SpA. Methods: This retrospective comparative study assessed bone marrow edema (BME), sclerosis, erosions, osteophytes, and ankylosis at the SIJ in two groups of women, one with and another without ax-SpA. Sensitivity and specificity were calculated for combinations/characteristics of lesions, using rheumatologists' assessment with assessment of spondyloarthritis international society (ASAS) criteria as the gold standard for diagnosis of ax-SpA. Results: Compared to women without ax-SpA, women with ax-SpA had more BME (61% vs 17%, p < 0.001), sclerosis (40% vs 22%, p < 0.001), erosions (35% vs 5%, p < 0.001), and ankylosis (2% vs 0%, p = 0.007), but less osteophytes (5% vs 33%, p < 0.001). The ASAS MRI criteria yielded 59% sensitivity and 88% specificity, while a new algorithm achieved 56% sensitivity and 95% specificity using the following criteria: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. Conclusions: We recommend the following pragmatic algorithm for MRI diagnosis of ax-SpA in women: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. The false positive rate when using the new algorithm (3.3%) is less than half than when using the ASAS MRI criteria (7.7%); thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA. Clinical relevance statement: The developed algorithm has a false-positive rate that is less than half than when using the ASAS MRI criteria (3.3% vs 7.7%), thus its application in clinical practice could reduce overdiagnosis and prevent overtreatment of axial spondyloarthritis. Key Points: • Compared to women without axial spondyloarthritis (ax-SpA), women with ax-SpA had a significantly higher prevalence of bone marrow edema (BME), sclerosis, erosions, and ankylosis, but a significantly lower prevalence of osteophytes. • A new algorithm for positive ax-SpA based on sacroiliac joint MRI was developed: no osteophytes at the sacroiliac joint (SIJ) and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. • We recommend this new algorithm for diagnosis of ax-SpA in women, as it has a significantly better specificity than the assessment of spondyloarthritis international society (ASAS) MRI criteria and less than half the false positive rate; thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA. [ABSTRACT FROM AUTHOR]

The article describes the case of 68-year-old woman whose quality of life was severely impaired by extensive calcinosis and myositis, and mentions topics including anti-NXP2 antibodies, topical sodium thiosulphate treatment, and adult-onset myositis.

Cameriere developed a method on orthopantomograms (OPG) to assess adult age of 18 years based on the relationship between age and the third molar maturity index I3M. The aim of this study was to evaluate whether Cameriere's method could be applied to computed-tomography scans (CT-scans) from a population of French juveniles and young adults and compare the results obtained from OPG of the same individuals. Our sample comprised 200 examinations that had been performed at the radiological department of a French University hospital between 2007 and 2020. Each patient had received an OPG and a cranial CT scan for medical purposes, and we used a similar adaptation of I3M based on OPG to determine the I3M based on CT scans. Due to exclusion criteria, our final sample comprised 71 OPGs and 63 CT scans. Based on the 71 OPGs, there was concordance between chronological age and estimated age, with a sensitivity of 78.57 %, a specificity of 89.47 %, and a misclassified rate of 18.03 % based on tooth 38, and a sensitivity of 78.79 %, a specificity of 91.67 %, and a misclassified rate of 17.78 % based on tooth 48. Our results based on CT scans presented concordance between chronological age and estimated age for tooth 38 described by a sensitivity of 77.78 %, a specificity of 94.12 %, and a misclassified rate of 16.98 %. The concordance between chronological age and estimated age based on 48 had a sensitivity of 75.00 %, a specificity of 93.75 %, and a misclassified rate of 19.23 %. The > 90 % ICC indicate an excellent similarity between measurements of teeth 38 and 48 based on OPGs and CT scans. This study has revealed the applicability of the Cameriere's method to calculate the I3M based on CT scans from a French population. The results based on CT scans are similar to results based on OPGs from the same individuals. • Cameriere's I3M method for age estimation is applicable on computed-tomography scans. • The results based on CT-scans are similar to results based on orthopantomograms. • There are a few reservations about the use of this method in clinical practice. [ABSTRACT FROM AUTHOR]

• Active discopathy is a common clinical picture of intense and continuous chronic low back pain, with few treatment options. • Evidence concerning the efficacy of corticosteroid intradiscal injection is still scarce. • The present study reports the superiority of intradiscal glucorticoids over lidocaine for pain up to 1 month and for disability up to 3 months. • No serious side effects were reported, which allows for considering intradiscal corticosteroid injection as a treatment option for active discopathy in the short term. The benefit of an intradiscal injection of corticosteroids for low back pain with active discopathy is not totally resolved. The objective of this study was to estimate the clinical efficacy of an intradiscal injection of glucocorticoids versus lidocaine in patients with low back pain and active discopathy (Modic 1 changes). A prospective, single-blind, randomized controlled study was conducted in 2 tertiary care centers with spine units. We enrolled 50 patients (mean age 50 years; 46% women) with lumbar active discopathy on MRI and failure of medical treatment for more than 6 weeks. Participants were randomly assigned to receive an intradiscal injection of glucocorticoids [50 mg prednisolone acetate (GC group), n = 24] or lidocaine [40 mg (L group), n = 26] by senior radiologists. Outcome measures were low back pain in the previous 8 days (10-point visual analog scale), Dallas Pain Questionnaire, Oswestry Disability Index, analgesic treatment and work status at 1, 3 and 6 months as well as pain at 1, 2 and 3 weeks. The primary outcome was change in pain between baseline and 1 month. Data for 39 patients (78%; 17 in the GC group, 22 in the L group) were analyzed for the primary outcome. Pain intensity was significantly reduced at 1 month in the GC versus L group [mean (SD) −2.7 (2.3) and +0.1 (2.0), P < 0.001] but not at 3 and 6 months. At 1 and 3 months, the groups significantly differed in daily activities of the Dallas Pain Questionnaire in favour of the GC group. The groups did not differ in consumption of analgesics or professional condition at any time. No serious intervention-related adverse events occurred. Study limitations included patients lost to the study because of injection-related technical issues in the L5/S1 disc and short time of follow-up. As compared with intradiscal injection of lidocaine, intradiscal injection of prednisolone acetate for low back pain with active discopathy may reduce pain intensity at 1 month but not at 3 and 6 months. [ABSTRACT FROM AUTHOR]

Purpose: To determine the margins of non-inferiority of the sensitivity of CT and the sample size needed to test the non-inferiority of CT in comparison with MRI.Materials and Methods: During a 2-year period, elderly patients with suspected radiographically occult post-traumatic bone injuries were investigated by CT and MRI in two institutions. Four radiologists analyzed separately the CT and MRI examinations to detect post-traumatic femoral injuries. Their sensitivities at CT (SeCT) and MRI (SeMRI) were calculated with the reference being a best valuable comparator (consensus reading of the MRI and clinical follow-up). ROC analysis followed by an exact test (Newcombe's approach) was performed to assess the 95% confidence interval (CI) for the difference SeCT-SeMRI for each reader. A sample size calculation was performed based on our observed results by using a one-sided McNemar's test.Results: Twenty-nine out of 102 study participants had a post-traumatic femoral injury. SeCT ranged between 83 and 93% and SeMRI ranged between 97 and 100%. The 95% CIs for (SeCT-SeMRI) were [- 5.3%, + 0.8%], (pR1 = 0.1250), [- 4.5%; + 1.2%] (pR2 = 0.2188), [- 3.4%; + 1.1%] (pR3 = 0.2500) to [- 3.8%; + 1.6%] (pR4 = 0.3750) according to readers, with a lowest limit for 95% CIs superior to a non-inferiority margin of (- 6%) for all readers. A population of 440 patients should be analyzed to test the non-inferiority of CT in comparison with MRI.Conclusion: CT and MRI are sensitive for the detection of radiographically occult femoral fractures in elderly patients after low-energy trauma. The choice between both these modalities is a compromise between the most available and the most sensitive technique.Key Points: • The sensitivity of four separate readers to detect radiographically occult post-traumatic femoral injuries in elderly patients after low-energy trauma ranged between 83 and 93% at CT and between 97 and 100% at MRI according to a best valuable comparator including MRI and clinical follow-up. • CT is a valuable alternative method to MRI for the detection of post-traumatic femoral injuries in elderlies after low-energy trauma if a 6% loss in sensitivity can be accepted in comparison with MRI. • The choice between CT and MRI is a compromise between the most available and the most sensitive technique. [ABSTRACT FROM AUTHOR]

L'arrêté du 8/4/2013 demande aux Facultés de Médecine de certifier les compétences cliniques des étudiants en fin de 2e cycle, sous la forme d'une épreuve de mise en situation clinique. À l'heure de la nouvelle réforme du 2e cycle des études médicales, le certificat de compétences cliniques (C3) devient une priorité pédagogique pour les facultés. L'objectif de cet examen est de « vérifier les compétences acquises par les étudiants et leur capacité à synthétiser les connaissances ». A la faculté de Montpellier-Nîmes (Occitanie Est), par souci d'homogénéité avec ce qui est en place en Occitanie Ouest (Toulouse Purpan), a été fait le choix d'un parcours « ECOS » (examen clinique objectif structuré), s'appuyant sur la simulation. Nous rapportons ici les modalités et les principaux résultats obtenus lors d'une 1ère édition « blanche » du C3 sur le site de Montpellier. À l'instar de l'épreuve toulousaine, notre C3 propose un parcours ECOS, adapté aux spécificités de notre faculté (laboratoire de simulation haute fidélité « Hi-Fi » mais aussi contraintes liées au bâtiments). Ce parcours est basé sur 7 stations distinctes de 7 minutes chacune :. – iconographie (radiologie, dermatologie, ECG) ; – vignettes cliniques (mini-dossiers type internat traditionnel sans QRM) ; – thérapeutique et pharmacologie (analyse de traitement) ; – mise en situation clinique (simulation Hi-Fi filmée avec 2 postes en médecine d'adultes, 1 en obstétrique, 1 en pédiatrie) ; – débriefing/reformulation (filmé) ; – annonce diagnostique (maladie grave) ; – gestes techniques (ponction lombaire, sondes nasogastrique et urinaire). Les étudiants étaient convoqués sur 4 demi-journées du 22 au 25 juin 2018, avec des sujets distincts, et répartis en 2 flux. Le même type de parcours a été organisé sur les 2 sites (Montpellier et Nîmes) de notre faculté. Nous présentons ici les résultats bruts obtenus sur le site de Montpellier. Les effectifs facultaires (examinateurs, surveillants, techniciens et formateurs en simulation) étaient de 40 personnes par demi-journée, soit près de 80 mobilisées au total dont une cinquantaine d'enseignants. Sur les 204 étudiants de DFASM2 convoqués à titre « d'entraînement » non sanctionnant, 143 (70 %) étaient présents. Tous ont achevé le parcours. La note moyenne de l'épreuve était de 92/140 (± 14), soit 13/20. 7 étudiants n'avaient pas la moyenne. Les notes moyennes par station étaient respectivement (/20) de : 13,5 ± 4 ; 12,7 ± 4,7 ;11,7 ± 4 ;13,3 ± 2,9 (stations 4 + 5) ; 13,8 ± 2,8 et 14,4 ± 3,3. On notait une dispersion des notes variable pour chaque station, indiquant une hétérogénéité des performances au niveau individuel, mais n'impactant que peu la note finale. On notait une corrélation des notes du C3 aux notes obtenues aux examens facultaires de type ECNi uniquement pour les stations 1 à 3, basées sur les connaissances et le raisonnement (r = 0,28, p < 0,05). La mise en place sur notre faculté bi-site du C3, sur le modèle de la Faculté de Toulouse Purpan, démontre la faisabilité de ce parcours ECOS, et son caractère « exportable » et reproductible, mais au prix de la mobilisation de ressources facultaires importantes. Ce parcours multimodal avec simulation permet d'évaluer les compétences cliniques des étudiants de manière transversale, pluridisciplinaire et en intégrant les 3 domaines taxonomiques que sont le savoir, le savoir-faire et le savoir-être. L'hétérogénéité des performances par station témoigne de la mobilisation de capacités différentes. L'analyse plus fine de ces résultats pourrait permettre d'identifier des clusters d'étudiants avec des besoins spécifiques, et conduire à la mise en œuvre d'interventions pédagogiques ciblées tout au long du second cycle. [ABSTRACT FROM AUTHOR]

Purpose: To compare the diagnostic accuracy of whole-body T1, short tau inversion recovery (STIR), high b-value diffusion-weighted imaging (DWI), and sequence combinations to detect bone involvement in prostate cancer (PCa) and multiple myeloma (MM) patients.Materials and Methods: We included 50 consecutive patients with PCa at high risk for metastasis and 47 consecutive patients with a histologically confirmed diagnosis of MM who received whole-body MRI at two institutions from January to December 2015. Coronal T1, STIR, and reconstructed coronal high b-values DWI were obtained for all patients. Two musculoskeletal radiologists read individual sequences, pairs of sequences (T1-DWI, T1-STIR, and STIR-DWI), and all combined (T1-STIR-DWI) to detect bone involvement. Receiver operating characteristic curve analysis was used to assess diagnostic performance according to a "best valuable comparator" combining baseline and 6-month imaging and clinical and biological data. Interobserver agreement was calculated.Results: Interobserver agreement for individual and combined MRI sequences was very good in the PCa group and ranged from good to very good in the MM group (0.76-1.00). In PCa patients, T1-DWI, T1-STIR, and T1-STIR-DWI showed the highest performance (sensitivity = 100% [95% CI = 90.5-100%], specificity = 100% [75.3-100%]). In MM patients, the highest performance was achieved by T1-STIR-DWI (sensitivity = 100% [88.4-100%], specificity = 94.1% [71.3-100%]). T1-STIR-DWI significantly outperformed all sequences (p < 0.05) except T1-DWI (p = 0.49).Conclusion: In PCa patients, a combination of either T1-DWI or T1-STIR sequences is not inferior to a combination of three sequences to detect bone metastases. In MM, T1-STIR-DWI and T1-DWI had the highest diagnostic performance for detecting bone involvement.Key Points: • The sequences used in Whole Body MRI studies to detect bone involvement in prostate cancer and myeloma were evaluated. • In prostate cancer, any pairwise combinations of T1, STIR, and DWI have high diagnostic value. • In myeloma, the combinations T1-STIR-DWI or T1-DWI sequences should be used. [ABSTRACT FROM AUTHOR]

Malgré les résultats récents de méta-analyses d'essais randomisés contrôlés, la place du PRP et de l'acide hyaluronique dans le traitement symptomatique de la gonarthrose reste incertaine. Très peu d'études sont disponibles sur le potentiel effet synergique de leur association dans des formes légères à modérées de gonarthrose symptomatiques [1]. Cet essai randomisé contrôlé multicentrique de non-infériorité (clinical trial NCT03328728) en simple aveugle (investigateur) visait à comparer l'efficacité et la tolérance de la combinaison PRP et acide hyaluronique non réticulé (PRP-HA, CellularMatrix A-CP-HA ®) en mono-injection par rapport à Hylan G-F20 (HA), avec suivi à 1, 3 et 6 mois, en intention de traiter (ITT). Les patients âgés de 40 à 80 ans avec une gonarthrose fémoro-tibiale symptomatique (WOMAC A1 (douleur à la marche) ou WOMAC Fonction > 50/100) et un stade radiographique II ou III de Kellgren et Lawrence (KL) ont été randomisés en deux groupes : PRP-HA vs. HA, en mono-injection radio ou échoguidée à M0. Un suivi du retentissement de la gonarthrose sur six mois a été réalisé à M1, M3 et M6. Le critère principal était la différence du score WOMAC douleur à la marche entre M0 et M6 entre les 2 groupes. Les critères secondaires ont été recueillis et comparés à M1, M3 et M6 (WOMAC Douleur, Fonction et Total, le SF-36) ainsi le pourcentage de patients répondeurs à M6 selon les critères OMERACT-OARSI, selon le Patient Acceptable Symptomatic State (PASS) et le Minimal Clinical Important Improvement (MCII) du WOMAC douleur. Les facteurs de bonne réponse (répondeurs PASS et MCII) à M6 ont été recherchés en analyse univariée et multivariée. La tolérance a été évaluée en comparant les effets indésirables sur 6 mois dans les deux groupes. Au total, 156 patients ont été inclus entre 2018 et 2021 : âge 59,6 ± 9,2 ans, IMC 28,1 ± 5,8 kg/m2, 37,8 % grade II KL et 62,2 % grade III KL. L'amélioration symptomatique (WOMAC douleur, fonction et WOMAC total) était significative dans les 2 groupes à M1, M3 et M6. La différence concernant le WOMAC douleur à la marche à M6 était significative pour le test de non-infériorité (−6,34 [−12,51 ; −0,18], p = 0,044) et pour le test de supériorité (−6,34 [−12,45 ; −0,22], p = 0,042) en faveur du PRP-HA Les résultats ne mettaient pas en évidence de différence significative sur le WOMAC douleur, fonction et total et le SF-36. À M6, il existait une différence non significative en répondeurs OMERACT-OARSI en faveur du PRP-HA (58 % vs 48 %, p = 0,26) mais significative en MCII (78,8 % vs 61,3 %, p = 0,036) et PASS (50,6 % vs 33,3 %, p = 0,03). En analyse multivariée, seul le traitement alloué était associé à une bonne réponse PASS à M6 (PRP + HA, OR = 2,05 [1,02–3,92] ; p = 0,05) et MCII (PRP + HA, OR = 2,21 [1,09–4,44] ; p = 0,02). Il n'y avait pas de différence en termes de satisfaction à M1, M3 et M6, ni en termes de survenue d'effets indésirables. Dans cet ERC multicentrique chez des patients souffrant de gonarthrose fémoro-tibiale symptomatique, la combinaison du PRP-AH non réticulé en mono-injection était au moins équivalent à Hylan G-F20 pour le bénéfice symptomatique (WOMAC) à 6 mois, avec un bon profil de tolérance. La proportion de patients atteignant le PASS et le MCII du WOMAC douleur est significativement supérieure dans le groupe PRP-AH. [ABSTRACT FROM AUTHOR]

Introduction/Background The profit of an intradiscal injection of corticoids in low back pain with Modic 1 changes is not totally resolved. The objectives of this work is to estimate the clinical profit at 1, 3 and 6 months after an intradiscal injection of prednisolone acetate versus a lidocain one in low back pain with Modic. Material and method Fifty patients with low back pain in failure of the medical treatment for more than 6 weeks where included in this prospective, double blind, randomized study. Results Pain intensity was significantly improved a 1 month in the prednisolone acetate group compared to the lidocain group. A significant diffrence is also observed at 1 and 3 months in the activities of the everiday life of DALLAS questionnaire in favour of the glucocorticoid group. There was no significant difference, throughout the follow up on Oswestry evolution, comsuption of analgesic or in professional condition. Conclusion Intradiscal injection of prednisolone acetate in low back pain with modic 1 changes reduces pain intensity at 1 month but not at 3 and 6 months versus lidocain. [ABSTRACT FROM AUTHOR]

Study Design: This was a single center, retrospective observational study.Objective: to investigate-in a cancer population-the prevalence and hallmarks of intravertebral enhancement (IVE) detected on contrast-enhanced CT.Summary Of Background Data: Intravertebral enhancements secondary to iodinated contrast stagnation have been described. Cancer patients have an increased risk of perivertebral venous thrombosis or stenosis secondary to several risk factors (cancer or drug induced hypercoagulability, deterioration of venous flow linked to catheter insertion, prolonged immobilization). In case of a high density lesion identified on CT, the diagnostic choice between metastasis and contrast media within bone marrow vessels may be an issue, especially as oncologic follow-up CT scans are usually performed with contrast medium injection.Methods: 2572 contrast-enhanced body CT scans performed in cancer patients over 3 months in the medical imaging department of a university hospital were retrospectively reviewed. IVE was sought when paravertebral venous collateral circulation was detected and bone metastasis ruled out and classified as linear or nodular. Their locations within vertebra, their relation to the injection side and the predominant collateral venous network side were evaluated.Results: Sixty-seven (2.8%) patients had a collateral paravertebral venous system and among them 21 had IVE (37%). There were 208 IVE locations involving 75 vertebrae. 199 IVE were linear-shaped (95.7%) and 9 nodular-shaped (4.3%). 80.8% were located between C6 and T4. 88.9% were localized in the vertebral body. 73.1% were located medially or ipsilateral to the injection side.Conclusion: Intravertebral enhancement is found in 37% of the patients with paraspinal collateral venous circulation when a CT scan is performed for cancer. The ipsilateral or medial position of the IVE relative to the injection side and the side of the dominant perivertebral venous system, and the possibility of connecting the IVE to a paravertebral vein may be in favor of vascular opacification. [ABSTRACT FROM AUTHOR]

The 4 cases reported here are meant to illustrate the value of colour doppler-echocardiography in the diagnosis of ventricular septal rupture consecutive to an anterior myocardial infarction. With this method, the examination begins with colour doppler ultrasound superimposed on two-dimensional echocardiographic images and is completed by pulsed and continuous wave doppler velocimetry. In all 4 patients an abnormal colour doppler flow was visualized from the outset; it started in the left ventricule and crossed the ventricular septum to enter the right ventricule, thus confirming the diagnosis and locating the septal defect. This abnormal flow was easy to recognize. On the apical "4 cavity" projection it followed a semi-circular anti-clockwise course which occurred at each cardiac cycle. The flow was red at first in presystole at the apex of the left ventricule; it became blue in pre- and middle-systole while traversing the septum, then mosaic-like in middle- or end-systole around the septal defect on the right ventricular side, and finally blue again in pre-diastole within the right ventricle. The blue trans-septal flow persisted at least up to pre-diastole. The diagnosis of septal rupture was confirmed at surgery in 3 cases and at right heart catheterization in 1 case. Colour doppler-echocardiography is a simple, efficient and rapid method, superior to contrast echocardiography or pulsed doppler alone, for direct real-time visualization of the shunt. It makes the septal defect easy to locate, and it avoids invasive exploratory manoeuvres in cases where surgery is contra-indicated and/or when coronary angiography is not mandatory.