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Chapel Allerton, United Kingdom

Rankine J.J.,Leeds Musculoskeletal Biomedical Research Unit | Nicholas C.M.,Leeds General Infirmary | Wells G.,Leeds General Infirmary | Barron D.A.,Leeds General Infirmary
American Journal of Roentgenology | Year: 2012

OBJECTIVE. The purpose of this study is to determine the diagnostic accuracy of radiographs in the diagnosis of Lisfranc injury. In addition, a foot phantom was investigated to determine the optimum degree of craniocaudal angulation on the anteroposterior radiograph to best show the joint. The angle of the joint in patients with midfoot injury was investigated to determine the optimum degree of craniocaudal angulation. MATERIALS AND METHODS. Sixty patients examined by CT had their radiographs evaluated independently and by consensus opinion by two observers, and the diagnostic performance was calculated using CT as the reference standard. A foot phantom was radiographed with varying degrees of craniocaudal angulation, and the radiograph that best revealed the joint was determined. This was compared with the angle of the joint as measured on CT. The angle of the joint in all 60 patients was measured on CT. RESULTS. The radiographs correctly identified 31 of the 45 cases (68.9%) of Lisfranc injury, with a positive predictive value of 84.4%, a negative predictive value of 53.3%, a sensitivity of 84.4%, and a specificity of 53.3%. Twenty degrees of craniocaudal angulation best showed the second tarsal-metatarsal joint of the phantom, and this correlated with a 20° angle measured by CT. The mean (± SD) angle of the joint in the patients was 28.9° ± 5.7°. CONCLUSION. Conventional radiographs miss a significant number of cases of Lisfranc injury. Craniocaudal angulation can better show the joint, and an angle of 28.9° is likely to optimally visualize the joint in the majority of patients. © American Roentgen Ray Society.

Hodgson R.J.,Leeds Musculoskeletal Biomedical Research Unit
Orthopaedics and Trauma | Year: 2011

Magnetic resonance imaging is widely used in the investigation of disorders of the musculoskeletal system.When a patient is placed in a strong magnetic field a signal can be obtained, the frequency of which is related to the strength of the magnetic field. By changing the field strength so it depends on location, it is possible to create an image of the patient. The image intensity depends on several inherent properties of the tissues including hydrogen content, and T1 and T2 relaxation times. MRI is uniquely able to control the sensitivity of the image to these properties to generate different types of image contrast, including T1, T2 and proton density weighting, with and without fat suppression. The most appropriate image for a particular application is a compromise between the conflicting requirements of image resolution, time and image quality.A number of artefacts including chemical shift, metal and magic angle artefacts may degrade images of the musculoskeletal system; however these can be minimized by appropriate choice of imaging parameters.Newer techniques such as delayed gadolinium enhanced MRI of cartilage, dynamic contrast enhanced MRI and ultrashort echo time imaging are now becoming available and these further extend the capabilities of MRI. © 2010 Elsevier Ltd.

Grainger A.,Leeds Teaching Hospitals | Grainger A.,Leeds Musculoskeletal Biomedical Research Unit | Rowbotham E.,Royal United Hospital
Seminars in Musculoskeletal Radiology | Year: 2013

Since the advent of disease-modifying antirheumatic drugs for the treatment of rheumatoid arthritis, there has been an increasing emphasis on the early diagnosis and monitoring of this condition. This has led to the greater involvement of advanced imaging techniques such as ultrasound and MRI. Ultrasound appearances of common findings in rheumatoid arthritis are discussed in this review. Comparison of ultrasound in terms of sensitivity and specificity with other imaging modalities and with clinical examination is also made. Quantification is also discussed as a tool to allow assessment of response to drug therapy, an area that is likely to progress further as techniques become increasingly reproducible. Finally, as ultrasound techniques continue to develop, its involvement in the management of patients with rheumatoid arthritis is increasing. New techniques such as fusion imaging and sonoelastography, while at present still largely research-based entities, may offer increasingly improved diagnostic benefits in the field of inflammatory arthropathy. Copyright © 2013 by Thieme Medical Publishers, Inc.

Kotyla P.J.,University of Silesia | Owczarek A.,University of Silesia | Rakoczy J.,Teaching University Hospital No. 7 | Lewicki M.,University of Silesia | And 3 more authors.
Journal of Rheumatology | Year: 2012

Objective. To study the influence of anti-tumor necrosis factor-α (TNF-α) treatment on echocardiographic measures and concentrations of endothelin 1 (ET-1), interleukin 6 (IL-6), and amino-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in a cohort of 23 female patients with rheumatoid arthritis (RA). Methods. We recruited 23 patients (mean age 51.3 ± 1.55 yrs) with RA resistant to treatment with disease-modifying antirheumatic drugs and average disease duration of 7.1 ± 1.0 years who had been selected to start treatment with the anti-TNF-α antagonist infliximab. Transthoracic echocardiographic examinations were performed before the first infusion and repeated after 1 year of treatment. Data for age, sex, RA disease activity by Disease Activity Score (DAS28) and echocardiographic data, NT-proBNP, IL-6, ET-1, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and other routine laboratory data were collected before treatment and after 1 year. Results. Twelve months of treatment with infliximab resulted in reduction of RA activity (i.e., reduction of DAS and acute-phase reactants). There was increased left ventricle ejection fraction, from 58.5% before treatment to 63% after. Treatment with infliximab also resulted in significant reduction of ET-1 (1.26 fmol/ml before treatment vs 0.43 fmol/ml after), IL-6 (58.46 pg/ml vs 3.46 pg/ml), and NT-proBNP (43.06 fmol/ml vs 14.78 fmol/ml). These reductions were observed after just 4 months of treatment and remained significant until the termination of the study. Conclusion. In patients with RA, treatment with infliximab contributed significantly to increase in left ventricular ejection fraction. Improvement of cardiac function was shown by conventional echocardiography; there was reduction of biochemical markers of heart failure. The Journal of Rheumatology Copyright © 2012. All rights reserved.

Rankine J.J.,Leeds General Infirmary | Rankine J.J.,Leeds Musculoskeletal Biomedical Research Unit | Dickson R.A.,Orthopaedic Surgery
Spine | Year: 2010

Study Design. Retrospective review of the CT scans performed in a group of patients examined for a possible spondylolysis. Objective. To investigate whether there is an association between unilateral spondylolysis and facet joint tropism. Summary of Backgrounf Data. Spondylolysis is a fatigue fracture of the pars interarticularis of great importance in sports injury. The demonstration of a unilateral spondylolysis is important because there is a potential for full healing if the athletic activity is modified, whereas bilateral spondylolysis frequently leads to established nonunion. Coronally orientated facet joints are known to predispose to spondylolysis by increasing the point loading of the pars interarticularis. The importance of this finding has not been investigated in unilateral spondylolysis. Methods. A review of patients with low back pain and a possible diagnosis of spondylolysis who were investigated with multislice CT was performed. The coronal orientation of the facet joints at L4/5 and L5/S1 was measured and comparison was done between those with and without a spondylolysis. Results. The coronal angle of 140 facet joints in 35 patients was recorded. Of 35 patients, 23 had a spondylolysis which was unilateral in 12 patients. The facet joint angle was significantly more coronally orientated in the presence of a spondylolysis when compared with an intact pars (means, 53° and 43°, respectively; P < 0.01). In the presence of a unilateral spondylolysis, the facet joint was significantly more coronally orientated on the side of the spondylolysis (means, 52° and 45°, respectively; P < 0.01). Conclusion. This study is the first investigation of facet joint anatomy in unilateral spondylolysis. Asymmetric facet joints do increase the force through one side of the spine, with a unilateral spondylolysis occurring on the side of the more coronally orientated facet joint. © 2010, Lippincott Williams & Wilkins.

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