Background: Magnetic resonance imaging (MRI) is being used extensively in the search for pathoanatomical factors contributing to low back pain (LBP) such as Modic changes (MC). However, it remains unclear whether clinical findings can identify patients with MC. The purpose of this explorative study was to assess the predictive value of six clinical tests and three questionnaires commonly used with patients with low-back pain (LBP) on the presence of Modic changes (MC).Methods: A retrospective cohort study was performed using data from Dutch military personnel in the period between April 2013 and July 2016. Questionnaires included the Roland Morris Disability Questionnaire, Numeric Pain Rating Scale, and Pain Self-Efficacy Questionnaire. The clinical examination included (i) range of motion, (ii) presence of pain during flexion and extension, (iii) Prone Instability Test, and (iv) straight leg raise. Backward stepwise regression was used to estimate predictive value for the presence of MC and the type of MC. The exploration of clinical tests was performed by univariable logistic regression models.Results: Two hundred eighty-six patients were allocated for the study, and 112 cases with medical records and MRI scans were available; 60 cases with MC and 52 without MC. Age was significantly higher in the MC group. The univariate regression analysis showed a significantly increased odds ratio for pain during flexion movement (2.57 [95% confidence interval (CI): 1.08-6.08]) in the group with MC. Multivariable logistic regression of all clinical symptoms and signs showed no significant association for any of the variables. The diagnostic value of the clinical tests expressed by sensitivity, specificity, positive predictive, and negative predictive values showed, for all the combinations, a low area under the curve (AUC) score, ranging from 0.41 to 0.53. Single-test sensitivity was the highest for pain in flexion: 60% (95% CI: 48.3-70.4).Conclusion: No model to predict the presence of MC, based on clinical tests, could be demonstrated. It is therefore not likely that LBP patients with MC are very different from other LBP patients and that they form a specific subgroup. However, the study only explored a limited number of clinical findings and it is possible that larger samples allowing for more variables would conclude differently.
Goed om te zien dat je geïnteresseerd bent in onze content. Onafhankelijke informatie is alleen niet gratis. Je mag onze artikelen uitsluitend kopiëren voor persoonlijk gebruik. Zo zal je geen inbreuk maken op onze Algemene Voorwaarden. Vragen? Stuur een e-mail naar: marketing@ntvg.nl.Voor het instellen van de optimale therapie van brandwonden – conservatief of operatief – is een vroege, accurate bepaling van de brandwonddiepte belangrijk. ‘Laser Doppler imaging’ (LDI) is een techniek waarmee een nauwkeurige inschatting van de brandwonddiepte kan worden gemaakt door het meten van de dermale perfusie. Hoewel is aangetoond dat de keuze voor het wel of niet verrichten van een operatie met LDI eerder kan worden gemaakt, heeft dit niet geleid tot een kortere tijd tot wondgenezing of kostenbesparing in de Nederlandse brandwondenzorg. LDI wordt in alle Nederlandse brandwondencentra gebruikt. Bij twijfel over de brandwonddiepte in de eerste of tweede lijn is doorverwijzing naar een brandwondencentrum raadzaam.
LINK
Incidental findings on low-dose CT images obtained during hybrid imaging are an increasing phenomenon as CT technology advances. Understanding the diagnostic value of incidental findings along with the technical limitations is important when reporting image results and recommending follow-up, which may result in an additional radiation dose from further diagnostic imaging and an increase in patient anxiety. This study assessed lesions incidentally detected on CT images acquired for attenuation correction on two SPECT/CT systems.METHODS: An anthropomorphic chest phantom containing simulated lesions of varying size and density was imaged on an Infinia Hawkeye 4 and a Symbia T6 using the low-dose CT settings applied for attenuation correction acquisitions in myocardial perfusion imaging. Twenty-two interpreters assessed 46 images from each SPECT/CT system (15 normal images and 31 abnormal images; 41 lesions). Data were evaluated using a jackknife alternative free-response receiver-operating-characteristic analysis (JAFROC).RESULTS: JAFROC analysis showed a significant difference (P < 0.0001) in lesion detection, with the figures of merit being 0.599 (95% confidence interval, 0.568, 0.631) and 0.810 (95% confidence interval, 0.781, 0.839) for the Infinia Hawkeye 4 and Symbia T6, respectively. Lesion detection on the Infinia Hawkeye 4 was generally limited to larger, higher-density lesions. The Symbia T6 allowed improved detection rates for midsized lesions and some lower-density lesions. However, interpreters struggled to detect small (5 mm) lesions on both image sets, irrespective of density.CONCLUSION: Lesion detection is more reliable on low-dose CT images from the Symbia T6 than from the Infinia Hawkeye 4. This phantom-based study gives an indication of potential lesion detection in the clinical context as shown by two commonly used SPECT/CT systems, which may assist the clinician in determining whether further diagnostic imaging is justified.
Fluorescence microscopy is an indispensable technique to resolve structure and specificity in many scientific areas such as diagnostics, health care, materials- and life sciences. With the development of multi-functional instruments now costing hundreds of thousands of Euros, the availability and access to high-tech instrumentation is increasingly limited to larger imaging facilities. Here, we will develop a cost-effective alternative by combining a commercially available solution for high-resolution confocal imaging (the RCM from confocal.nl) with an open-hardware microscopy framework, the miCube, developed in the Laboratory of Biophysics of Wageningen University & Research. In addition, by implementing a recent invention of the applicant for the spectral separation of different emitters, we will improve the multiplexing capabilities of fluorescence microscopy in general and the RCM in particular. Together, our new platform will help to translate expertise and know-how created in an academic environment into a commercially sustainable future supporting the Dutch technology landscape.
