A randomized controlled trial demonstrating sustained benefit of autologous matrix-induced chondrogenesis (AMIC®) over microfracture: 10-year follow-up.

PURPOSE: Autologous matrix-induced chondrogenesis (AMIC®) and microfracture are established treatments for focal chondral defects in the knee, but there are little clinical data concerning these procedures over the long term. This study evaluates the outcomes of AMIC® compared to microfracture over 10-year follow-up. METHODS: Forty-seven patients were randomized and treated either with MFx (n = 13), sutured AMIC® (n = 17) or glued AMIC® (n = 17) in a prospective, randomized, controlled multicentre trial. The Modified Cincinnati Knee Score, a visual analogue scale for pain and MOCART score were used to assess outcomes over 10 years post-operatively. RESULTS: All treatment arms improved in the first 2 years, but a progressive and significant deterioration in scores was observed in the MFx group, while both AMIC® groups remained stable. MOCART scores were comparable between groups. CONCLUSION: The AMIC® procedure results in improved patient outcomes in comparison with microfracture up to 10 years following surgery for the repair of focal chondral defects in the knee. CLINICALTRIALS: gov Identifier: NCT02993510.

A Randomized, Controlled Trial Comparing Autologous Matrix-Induced Chondrogenesis (AMIC®) to Microfracture: Analysis of 1- and 2-Year Follow-Up Data of 2 Centers.

Microfracture (MFx) is currently the recommended option for the treatment of small cartilage defects but is not regarded as suitable for the treatment of defects larger than 2.5 cm(2). To extent its applicability to medium-sized defects MFx has been combined with a collagen type I/III matrix (Chondro-Gide(®)). This technique is called Autologous Matrix-Induced Chondrogenesis (AMIC(®)) and meanwhile a clinically established treatment option for localized full-thickness small- to medium-sized cartilage defects. Despite its more spreading clinical use, clinical data published so far are limited to mainly case report series. In this study, we report the first results of a randomized, controlled trial assessing the efficacy and safety of AMIC(®) versus MFx. Patients enrolled in 2 centers were included in this analysis. 38 patients (aged 21-50 years, mean defect size 3.4 cm(2)) were randomized and treated either with MFx, with sutured AMIC(®) or glued AMIC(®). Clinical outcomes (modified Cincinnati and ICRS score) could be assessed in 30 patients at 1-year and 27 patients at 2-years post-operation. Improvements in both scores were seen at 1-and 2-years post-operation, irrespective of the technique used. MRI assessment revealed a satisfactory and homogenous defect filling in the majority of patients. No treatment-related adverse events were reported. This interim analysis confirms the mid-term results for AMIC(®) reported in literature. It demonstrates clearly that clinical outcomes at 1-year post-operation are maintained at 2-years. Therefore we consider enhancing MFx with Chondro-Gide (®) is a valid and safe cartilage repair option for small- to medium-sized cartilage defects of the knee.

Aporte de la resonancia magnética al diagnóstico de las neoplasias hepáticas / Contribution of magnetic resonance imaging to the diagnosis of hepatic neoplasm

Presence and characterization of focal liver lesions is of fundamental importance in abdominal MR imaging. An abundance of benign and malignant lesions with various appearances can be found in MR imaging. Since both malignant and benign lesions may occur concomitantly in the same patient, it is of decisive importance not only to detect but to characterize a lesion. This is particularly mandatory if a surgical procedure or multimodal therapy concepts are planned. Intravenously administered, non-specific contrast agents have been used in abdominal MR imaging for more than fifteen years. This category of contrast agents -typically Gadolinium (Gd)- chelated compounds - has properties similar to those of extracellular space (ECS) contrast agents used in iodineenhanced CT. Various efforts have been made over the last decade to develop contrast agents that combine the excellent tissue specificity. These contrast media have been divided into two categories according to their target cell population: substances tailored to the reticuloendothelial system (RES) of the liver and compounds targeted to hepatocytes. In the following article, we will discuss the different classes of contrast agents regarding their biodistribution, pharmacokinetic properties, typical imaging features, and clinical impact

La presencia y caracterización de las lesiones hepáticas focales es de importancia fundamental en las imágenes abdominales obtenidas por resonancia magnética (RM). Es posible encontrar gran cantidad de lesiones benignas y malignas con diversa apariencia en la RM. Dado que en un mismo paciente pueden hallarse lesiones benignas y malignas concomitantemente, es de importancia decisiva no sólo la detección sino la caracterización de una lesión. Esto es especialmente imperativo cuando se planea realizar un procedimiento quirúrgico o una terapia multimodal. Los agentes de contraste no específicos, administrados por vía intravenosa, se utilizan en las imágenes abdominales obtenidas por RM desde hace más de quince años. Esta categoría de medios de contraste (típicamente, quelatos de gadolinio) tiene propiedades similares a aquellos agentes de contraste del espacio extracelular (EEC) utilizados en las tomografías computarizadas con refuerzo de contraste yodado. En la última década se realizaron varios esfuerzos para elaborar agentes de contraste que combinen una excelente resolución de contraste de las imágenes por RM con una mejoría en la especificidad tisular. Estos medios de contraste se dividieron en dos categorías de acuerdo con su población celular blanco: las sustancias dirigidas al sistema reticuloendotelial (SER) del hígado y los compuestos dirigidos a los hepatocitos. En el siguiente artículo analizamos las diferentes clases de medios de contraste con respecto a su biodistribución, propiedades farmacocinéticas, características típicas de las imágenes y consecuencias clínicas

[Procedures, spectrum and radiation exposure in CT-fluoroscopy]. / Verfahren, Spektrum und Strahlenexposition der CT-Fluoroskopie.

PURPOSE: To assess the techniques, indications and radiation exposures incurred with CT fluoroscopy. MATERIAL AND METHODS: A 1-year period of use of CT fluoroscopy to guide diagnostic and therapeutic interventional procedures was analyzed. The spectrum of indications, different CT fluoroscopic methods and radiation exposures for the radiologist were assessed. Scatter exposures were measured with and without placement of a lead drape on the patient, with and without use of thin rubber radiation protection gloves. In addition, scattered radiation was determined for a combination of lead drape and radiation protection gloves. RESULTS: There is a wide variety for the use of CT fluoroscopy ranging from diagnostic biopsy procedures to therapeutic interventions such as radiofrequency ablation of liver metastases and CT fluoroscopy-guided osteosynthesis of fractures. Scatter exposure rates to the radiologists hand ranged from 1-320 microSv/case without use of a lead drape and without radiation protection gloves. The lead drape reduced the scattered exposure for the radiologists hand by 72%. Radiation protection gloves reduced scatter radiation by 49%. The combination of both radiation protection devices was most effective in decreasing the dose by 97%. CONCLUSIONS: CT fluoroscopy is a useful targeting method with a wide variety for interventional procedures. However, significant radiation exposures may occur. Therefore, the radiologists should be aware of different techniques of CT fluoroscopy guidance and the methods to reduce scatter radiation.