Association of adipokines with severity of knee osteoarthritis assessed clinically and on magnetic resonance imaging.

Objectives: We aimed to evaluate the association between the adipokines: Leptin, Adiponectin, Resistin, and high sensitive-C-reactive protein (hs-CRP) with clinical, radiographical and magnetic resonance imaging (MRI) assessment of knee osteoarthritis (OA) severity. Design: We performed a cross-sectional study in participants with earlier knee OA. Demographics, clinical (WOMAC), radiographical and MRI (BLOKS scoring) severity of knee OA were assessed. Serum leptin, adiponectin, resistin and hs-CRP were measured. Association of adipokines and hs-CRP with clinical, radiographic and MRI severity outcomes were evaluated using regression models with adjustment with age, sex, and body mass index (BMI). Results: 137 participants with earlier knee OA (82% women, mean â€‹± â€‹SD age: 55.5 â€‹± â€‹7.8 years) were included. Participants had moderate knee OA symptoms, mean WOMAC pain and function were 30.6 â€‹± â€‹18.0, and 31.7 â€‹± â€‹19.8 respectively. Mean BMI was 27.0 â€‹± â€‹5.9 â€‹kg/m2. After adjustment with age, sex and BMI, serum leptin was positively associated with osteophyte size, cartilage integrity, infrapatellar synovitis and effusion. While hs-CRP was associated with meniscus extrusion and adiponectin was associated with WOMAC pain and function. Conclusion: Serum adipokines, particularly leptin was associated with severity of various structural defects of the knee joint on MRI beyond age, sex and BMI in earlier knee OA.

Spectrum of lung perfusion changes on dual-energy CT in COVID-19: incremental benefit to conventional CT.

The purpose of this case report is to demonstrate lung perfusion changes on dual-energy CT (DECT) in patients with Coronavirus disease 2019 (COVID-19). Since the first case of COVID-19 was reported in Wuhan, Hubei province in China, the spectrum of lung parenchymal findings has been well described but the underlying pathophysiology is less well understood. DECT imaging contributes to the growing evidence that vascular dysregulation has an important role in the underlying pathophysiology of the disease. Three patients with reverse transcriptase polymerase chain reaction (RT-PCR)-confirmed COVID-19 underwent DECT scans. One patient had a DECT for persistent spikes in temperature while the other two patients underwent dual-energy CT pulmonary angiograms (CTPA) for worsening shortness of breath, elevated D dimers and suspected pulmonary embolism. The perfusion abnormalities include focal areas of both hyperperfusion, hypoperfusion, and areas of hypoperfusion surrounded by hyperemia. In addition, dilatation of segmental and subsegmental pulmonary arteries was seen in relation to the lung parenchymal change. DECT has proven useful in supporting the hypothesis that vascular dysregulation plays a significant role in the pulmonary pathophysiology of COVID-19. Early identification and a high index of suspicion  is required in the emergency department setting to identify and isolate cases even prior to the results of RT-PCR test being available. Vascular changes on DECT may be an additional radiological feature in detecting the presence of and predicting the severity of disease in the emergency department or acute care setting.

Radiographic features of COVID-19 based on an initial cohort of 96 patients in Singapore.

INTRODUCTION: Chest radiographs (CXRs) are widely used for the screening and management of COVID-19. This article describes the radiographic features of COVID-19 based on an initial national cohort of patients. METHODS: This is a retrospective review of swab-positive patients with COVID-19 who were admitted to four different hospitals in Singapore between 22 January and 9 March 2020. Initial and follow-up CXRs were reviewed by three experienced radiologists to identify the predominant pattern and distribution of lung parenchymal abnormalities. RESULTS: In total, 347 CXRs of 96 patients were reviewed. Initial CXRs were abnormal in 41 (42.7%) out of 96 patients. The mean time from onset of symptoms to CXR abnormality was 5.3 ± 4.7 days. The predominant pattern of lung abnormality was ground-glass opacity on initial CXRs (51.2%) and consolidation on follow-up CXRs (51.0%). Multifocal bilateral abnormalities in mixed central and peripheral distribution were observed in 63.4% and 59.2% of abnormal initial and follow-up CXRs, respectively. The lower zones were involved in 90.2% of initial CXRs and 93.9% of follow-up CXRs. CONCLUSION: In a cohort of swab-positive patients, including those identified from contact tracing, we found a lower incidence of CXR abnormalities than was previously reported. The most common pattern was ground-glass opacity or consolidation, but mixed central and peripheral involvement was more common than peripheral involvement alone.

Exploring the Association of Innate Immunity Biomarkers With MRI Features in Both Early and Late Stages Osteoarthritis.

Objective: To evaluate the association between biomarkers of innate immunity and the magnetic resonance imaging (MRI) features of earlier and later stages of knee osteoarthritis (KOA). Methods: From 139 and 20 participants with earlier and later stages of KOA, respectively, we analyzed knee MRIs scored using the Boston Leeds Osteoarthritis Knee Score (BLOKS) at recruitment with biomarkers. In paired serum (s) and synovial fluid (sf), we quantified three biomarkers related to innate immunity: lipopolysaccharide binding protein (LBP), CD14 and Toll-like receptor 4 (TLR4), and three proinflammatory biomarkers [interleukin-6 (IL6), IL8, and tumor necrosis factor alpha (TNFα)]. Results: In participants with earlier KOA, (s) LBP was statistically significantly associated with meniscal extrusion, and (sf) CD14 was associated with effusion after adjustment with age, sex, and body mass index. In participants with later stage of KOA, (sf) LBP was associated with effusion. (sf) CD14 was associated with cartilage loss and BML. In earlier stage of KOA, the proinflammatory biomarkers IL6, IL8, and TNFα were associated with most MRI features. Conclusion: Innate immunity biomarkers (s) LBP was associated with MRI meniscal extrusion; (sf) CD14 was associated with MRI synovial inflammation in earlier stage and BMLs in later stage of KOA. Associations between proinflammatory biomarkers and various MRI features in earlier stage of KOA were observed.

The association of plasma IL-1Ra and related cytokines with radiographic severity of early knee osteoarthritis.

Objective: We aimed to evaluate the association between inflammatory biomarkers in peripheral blood and severity of knee osteoarthritis (OA). Methods: We performed a cross-sectional study in participants with frequent knee pain, evaluated radiographic and clinical severity. We measured inflammatory biomarkers: plasma (p) IL-1Ra, IL-1ß, IL-18, serum (s) CD14, hsCRP and bone and cartilage biomarkers: urine (u) CTX-II, (s) HA, COMP, CTX-I, PIIANP. We assessed radiographic severity by Kellgren-Lawrence (KL) grading and Osteoarthritis Research Society International (OARSI) standardized scoring atlas; and clinical severity by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: 139 participants (82% women, mean ± SD age: 55.5 ± 7.8 years) were included. (p) IL-1Ra was negatively associated with radiographic severity by KL grading (Spearman rho = -0.197, P = 0.021), osteophytes (Spearman rho = -0.217, P = 0.011), and joint space narrowing of index knee (Spearman rho = -0.172, P = 0.045); and KL sum score of both knees (Spearman rho = -0.180, P = 0.035), after adjustment for age, gender and body mass index (BMI). Other inflammatory markers were not associated with radiographic severity. Cartilage degradation markers (u) CTXII and (s) COMP were modestly associated with radiographic severity after adjustment. In multivariate models, (s) hsCRP and the bone and cartilage biomarkers, but not the inflammatory biomarkers, were associated with radiographic severity. Conclusion: Among the inflammatory biomarkers in peripheral blood, IL-1Ra was negatively associated with radiographic severity in this early knee OA cohort.

Clear cell chondrosarcoma with secondary aneurysmal bone cyst changes.

Clear cell chondrosarcoma is a rare cartilaginous tumour of low-grade malignancy. Although it has a characteristic histological appearance, its radiological features and clinical presentation often mimic a benign lesion. Herein, we describe the case of a patient with a clear cell chondrosarcoma of the right proximal femur that had an atypical appearance of chronic avascular necrosis on initial plain radiographs, which made preoperative diagnosis a challenge. In addition, the tumour also had extensive areas of aneurysmal bone cyst-like changes, which is not only a rare histologic phenomenon in clear cell chondrosarcoma, but also a confounding factor in the interpretation of the radiologic findings.

Clinics in diagnostic imaging (151). Acromioclavicular joint geyser sign with chronic full-thickness supraspinatus tendon (SST) tear.

An 82-year-old man presented with neck pain, right upper limb radiculopathy and right shoulder pain. Physical examination revealed a soft lump over the right shoulder joint, as well as reduced range of shoulder movements. On magnetic resonance imaging, the soft lump was shown to be a cystic mass over the acromioclavicular joint and was related to a full-thickness supraspinatus tendon tear. This is the classic geyser sign. The pathophysiology and clinical features of the geyser sign, and its imaging features with various imaging modalities, are discussed.