Imaging in spinal infections: Current status and future directions.

Imaging plays an important role in the diagnosis of spinal infections. Early diagnosis is paramount in the treatment of spinal infections and leads to improved outcomes. This article reviews the imaging and relevant clinical details of infections of the spine: pyogenic spondylodiscitis, tuberculous spondylodiscitis, septic facet arthritis, epidural abscess, and subdural abscess. Though radiographs can reveal subtle changes with infections, advanced imaging modalities have increased sensitivity to aid in early diagnosis. Magnetic resonance imaging (MRI) is emphasized given it is generally the most sensitive and specific advanced imaging modality. However, nuclear medicine imaging and computer tomography (CT) play a role diagnosis in cases where MRI is not available or contra-indicated. Additionally, CT is also important for image-guided biopsy to guide antimicrobial treatment.

Role of High-Resolution CT Thorax in Diagnosing Interstitial Lung Disease and Its Association With Smoking and Connective Tissue Disorder.

Introduction Interstitial lung diseases (ILDs) primarily affect the interstitium, an alveolar wall tissue between the capillary endothelium and the alveolar epithelium. The term 'interstitial,' however, is misleading since alveolar spaces, peripheral airways, and vessels can be involved in most of these disorders.They often require a multidisciplinary diagnosis i.e., an integration of clinical, radiological, and pathological findings. A chest radiograph is relatively insensitive because of nonspecific patterns. Generally, these disorders can progress to irreversible pulmonary fibrosis and are an important cause of morbidity and mortality. It is critical to make a prompt and accurate diagnosis of the underlying causes so that patients can be managed appropriately. ILD is subdivided into idiopathic interstitial pneumonia, of which idiopathic pulmonary fibrosis (IPF) is one subset, and diffuse parenchymal lung diseases, which may be secondary to a variety of occupational or environmental exposures or others. They can complicate multiple rheumatic or connective tissue diseases (CTDs). Apart from ILD, other forms of lung damage involving the pleura, vasculature, airways, and lymphatic tissue can complicate CTDs. Aims  Aims include studying the role of high-resolution computed tomography (HRCT) in diagnosing various ILDs based on morphologic patterns, evaluating the correlation between ILD and various connective tissue disorders and the prevalence of complications in such patients, and evaluating the association of smoking with various ILDs. Methods This is a retrospective study in which HRCT thorax was performed on a 128-slice Philips CT scanner machine on 50 patients from December 2020 to February 2022 in SVP Hospital, Ahmedabad. No age or gender bias was followed. Result Out of 50 patients studied, 19 (38%) patients had the usual interstitial pneumonia (UIP) pattern and 12 (24%) had the nonspecific interstitial pneumonia (NSIP) pattern. These two were the most common among all ILD patterns. Other patterns found were hypersensitivity pneumonitis (5; 10%), respiratory bronchiolitis-related ILD (3;6%), and organizing pneumonia (2; 4%). In nine patients, the morphologic pattern was either subtle (3; 6%) or mixed (6; 12%), and the final diagnosis remained inconclusive; patients were advised clinical correlation and biopsy. Eleven (22%) patients had a history of smoking. Among smokers, the most common pattern was UIP while all patients with respiratory bronchiolitis (RB) ILD had a history of smoking. Fourteen (28%) patients showed a positive association with CTD. Among them, rheumatoid arthritis (RA) was the most common CTD and the most common pattern among RA patients was UIP. Ten (20%) of patients developed pulmonary arterial hypertension, of which two patients who had connective tissue disorder developed pulmonary arterial hypertension at a young age (24 years). The rest of the patients who developed pulmonary arterial hypertension were above 45 years of age. Among these, two were smokers. Conclusion HRCT plays an important role in the diagnosis of ILD on the basis of various morphological patterns. CTD plays a significant role in the development of ILD. UIP is the most common ILD among patients with a smoking history and RA. NSIP Is the most common in patients with CTD other than RA. Pulmonary arterial hypertension (PAH) develops early in patients with CTD. There is a significant risk of the development of PAH in patients with chronic ILD.

Association of First Metatarsal Pronation Correction With Patient-Reported Outcomes and Recurrence Rates in Hallux Valgus.

BACKGROUND: The purpose of this study was to determine if a postoperative decrease in first metatarsal pronation on 3-dimensional imaging was associated with changes in patient-reported outcomes as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function, pain interference, and pain intensity domains or recurrence rates in patients with hallux valgus (HV) who undergo a first tarsometatarsal fusion (modified Lapidus procedure). METHODS: Thirty-nine consecutive HV patients who met the inclusion criteria and underwent a modified Lapidus procedure had preoperative and ≥2-year postoperative PROMIS scores and had first metatarsal pronation measured on preoperative and at least 5-month postoperative weightbearing CT scans were included. Multivariable regression analyses were used to investigate differences in the change in PROMIS domains preoperatively and 2 years postoperatively between patients with "no change/increased first metatarsal pronation" and "decreased first metatarsal pronation." A log-binomial regression analysis was performed to identify if a decrease in first metatarsal pronation was associated with recurrence of the HV deformity. RESULTS: The decreased first metatarsal pronation group had a significantly greater improvement in the PROMIS physical function scale by 7.2 points (P = .007) compared with the no change/increased first metatarsal pronation group. Recurrence rates were significantly lower in the decreased first metatarsal pronation group when compared to the no change/increased first metatarsal pronation group (risk ratio 0.25, P = .025). CONCLUSION: Detailed review of this limited cohort of patients who underwent a modified Lapidus procedure suggests that the rotational component of the HV deformity may play an important role in outcomes and recurrence rates following the modified Lapidus procedure. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Pronation on weightbearing radiographs does not correlate with pronation from weightbearing CT scans.

INTRODUCTION: In hallux valgus (HV), first metatarsal pronation is increasingly recognized as an important aspect of the deformity. The purpose of this study was to compare pronation in HV patients determined from the shape of the lateral head of the first metatarsal on AP weightbearing radiographs with pronation calculated from weightbearing CT (WBCT) scans. METHODS: Patients were included in this study if they had preoperative and 5-month postoperative WBCT scans and corresponding weightbearing AP radiographs of the affected foot. Pronation of the first metatarsal on WBCT scans was measured using a 3D CAD model and the alpha angle and categorized into four groups on radiographs. Association between pronation groups on radiographs and WBCT scans was determined using Spearman correlation coefficients (rs) and by comparing mean WBCT pronation of the first metatarsal between plain radiograph pronation groups. RESULTS: Agreement between the two observers' pronation on radiographs was good (k = 0.634) and moderate (k = 0.501), respectively. There was no correlation between radiographic pronation and the 3D CAD model (rs < 0.15). Preoperatively, there was weak correlation between the alpha angle and the radiographic pronation groups (rs = 0.371, P = 0.048) although this relationship did not hold postoperatively (rs = 0.330, P = 0.081). There was no difference in mean pronation calculated on WBCT scans between the plain radiographic groups. CONCLUSION: Pronation of the first metatarsal measured on weightbearing AP radiographs had moderate interobserver agreement and was only weakly associated with pronation measured from WBCT scans. These results suggest that first metatarsal pronation measured on weightbearing radiographs is not a substitute for pronation measured on WBCT scans. LEVEL OF EVIDENCE: III, retrospective cohort study.

Correlation of Different Methods of Measuring Pronation of the First Metatarsal on Weightbearing CT Scans.

BACKGROUND: There is no consensus in the foot and ankle literature regarding how to measure pronation of the first metatarsal in patients with hallux valgus. The primary purpose of this study was to compare 2 previously published methods for measuring pronation of the first metatarsal and a novel 3-dimensional measurement of pronation to determine if different measurements of pronation are associated with each other. METHODS: Thirty patients who underwent a modified Lapidus procedure for their hallux valgus deformity were included in this study. Pronation of the first metatarsal was measured on weightbearing computed tomography (WBCT) scans using the α angle with reference to the floor, a 3-dimensional computer-aided design (3D CAD) calculation with reference to the second metatarsal, and a novel method, called the triplanar angle of pronation (TAP), that included references to both the floor (floor TAP) and base of the second metatarsal (second TAP). Pearson's correlation coefficients were used to determine if the 3 calculated angles of pronation correlated to each other. RESULTS: Preoperative and postoperative α angle and 3D CAD had no correlation with each other (r = 0.094, P = .626 and r = 0.076, P = .694, respectively). Preoperative and postoperative second TAP and 3D CAD also had no correlation (r = 0.095, P = .624 and r = 0.320, P = .09, respectively). However, preoperative and postoperative floor TAP and α angle were found to have moderate correlations (r = 0.595, P = .001 and r = 0.501, P = .005, respectively). CONCLUSION: The calculation of first metatarsal pronation is affected by the reference and technique used, and further work is needed to establish a consistent measurement for the foot and ankle community. LEVEL OF EVIDENCE: Level III, retrospective cohort study.