Sagittal spinal alignment in patients with ankylosing spondylitis by rasterstereographic back shape analysis: an observational retrospective study.
- 作者列表："Mangone M","Paoloni M","Procopio S","Venditto T","Zucchi B","Santilli V","Paolucci T","Agostini F","Bernetti A
BACKGROUND:Ankylosing spondylitis (AS) is a chronic-inflammatory disorder involving the sacroiliac-joints, spine, and spinal ligaments. A proper understanding of the sagittal plane alignment and posture is essential in managing deformities of the spine. AIM:The aim of this study was to evaluate the differences in sagittal plane alignment between patients with AS and healthy subjects by means of rasterstereography and to analyze the relationship between clinical assessments and postural features. DESIGN:Observational retrospective study. SETTING:This study took place from January 2012 to April 2014 at the rheumatologic out-patient clinic, Umberto I Hospital, Rome, Italy. POPULATION:Forty-six healthy subjects and twenty-five AS patients were enrolled in the study. METHODS:Spinal posture was measured by the rasterstereographic system Formetric 4D. Trunk inclination, kyphosis angle, lordosis angle, cervical and lumbar plumbline distance, and sagittal pelvic alignment were analyzed. Differences between the two groups in postural parameters were compared (primary outcomes). Multiple regression analysis was used to evaluate if postural parameters could be predicted by the Bath Ankylosing Spondylitis Metrology Index (BASMI) that is a composite index of spinal mobility, disease duration and body mass index (secondary outcomes). RESULTS:Patients with AS showed a significant increase in the kyphosis angle and the cervical plumbline distance and a significant reduction in the lordosis angle and the sagittal pelvic alignment when compared to healthy subjects. According to multiple regression analysis, BASMI influenced the kyphosis angle value with a standardized coefficient β of 1.93, the lordosis-angle value with a standardized coefficient β of -2.79 and sagittal pelvic alignment value with a standardized coefficient-β of -2.93. CONCLUSIONS:Rasterstereography has proved to be a valid tool in monitoring change in spinal structure in AS patients and has shown a strong correlation with clinimetric parameters of AS (BASMI). Future studies are needed, with a greater number of patients, in order to better characterize the evidently existing relationship between postural changes in AS patients and rasterstereography. CLINICAL REHABILITATION IMPACT:Rasterstereography has proved to be a valid tool in monitoring postural changes in AS patients and has shown a strong correlation with clinical evaluations. Therefore, the assessment of postural characteristics using the rasterstereographic system before and after a specific exercise program would be a reliable and valid advice without exposing subjects to high doses of radiations.
背景: 强直性脊柱炎 (AS) 是一种累及骶髂关节、脊柱和脊柱韧带的慢性炎症性疾病。正确理解矢状面排列和姿势对于管理脊柱畸形至关重要。 目的: 本研究的目的是通过立体成像评估强直性脊柱炎患者与健康受试者矢状面排列的差异，并分析临床评估与姿势特征之间的关系。 设计: 观察性回顾性研究。 背景: 本研究于2012年1月至2014年4月在意大利罗马Umberto I医院风湿病门诊进行。 人群: 46名健康受试者和25名AS患者被纳入研究。 方法: 采用三维立体成像系统Formetric 4D测量脊柱姿势。分析躯干倾斜度、后凸角、前凸角、颈、腰椎铅球距离、骨盆矢状面对线。比较两组体位参数的差异 (主要结局)。使用多元回归分析评估姿势参数是否可以通过Bath强直性脊柱炎计量指数 (BASMI) 预测，BASMI是脊柱活动性、病程和体重指数 (次要结局) 的综合指标。 结果: 与健康受试者相比，AS患者显示脊柱后凸角和颈椎铅球距离显著增加，脊柱前凸角和矢状骨盆对准显著减少。根据多元回归分析，BASMI影响后凸角值，标准化系数 β 为1.93，前凸角值，标准化系数 β 为-2.79，矢状面骨盆对线值，标准化系数 β 为-2.93。 结论: 激光立体成像已被证明是监测AS患者脊柱结构变化的有效工具，并已显示出与AS (BASMI) 临床参数的强相关性。为了更好地表征AS患者的姿势变化与立体成像之间的明显存在的关系，需要对更多的患者进行未来的研究。 临床康复影响: 已被证明是监测AS患者姿势变化的有效工具，并显示出与临床评估的强相关性。因此，在特定锻炼计划之前和之后使用栅格立体摄影系统评估姿势特征将是可靠和有效的建议，而无需将受试者暴露于高剂量的辐射。
METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.
METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.
METHODS:OBJECTIVE:The primary purpose of this study was to evaluate the effectiveness of a three-dimensional (3D) software tool (smart planes) for displaying fetal brain planes, and the secondary purpose was to evaluate its accuracy in performing automatic measurements. MATERIAL AND METHODS:This prospective study included singleton fetuses with a gestational age (GA) greater than 18 weeks. Transabdominal two-dimensional ultrasound (2DUS) and 3D smart planes images were respectively used to obtain the basic planes of the fetal brain, with five parameters measured. The images, by either two-dimensional (2D) manual or 3D automatic operation, were reviewed by two experienced sonographers. The agreements between two measurements were analyzed. RESULTS:A total of 226 cases were included. The rates of successful detection by automatic display were as high as 80%. There was substantial agreement between the measurements of the biparietal diameter, head circumference and transcerebellar diameter, but poor agreement between the measurements of cisterna magna and lateral ventricle width. CONCLUSIONS:Smart Planes might be valuable for the rapid evaluation of fetal brain, because it simplifies the evaluation process. However, the technology requires improvement. In addition, this technology cannot replace the conventional manual US scans; it can only be used as an additional approach.