POSSIBILITIES OF FUNCTIONAL MULTISPIRAL COMPUTED TOMOGRAPHY OF THE KNEE JOINT IN THE DIAGNOSIS OF PATELLOPHEMORAL
ARTICULATION PATHOLOGY
Ternovoy S.K.¹,² , Serova N.S.¹, Bakhvalova A.V.¹, Lychagin A.V.¹, Lipina M.M.¹
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Purpose. To evaluate the possibilities of a new technique of functional multispiral computed tomography (fMSCT) of the knee joint in the diagnosis of pathology of patellofemoral articulation (PFA). Materials and methods. A total of 45 patients from 18 to 57 years old with suspected PFA pathology were examined according to the analysis of complaints and clinical examination. The subjects examined the knee joints using standard multispiral computed tomography (MSCT) and the new fMSCT technique on a Toshiba Aquilion ONE 640 tomograph. Initially, fMSCT was tested on five volunteers, after which the optimal protocol was adopted, according to it all patients were examined. Thus an assessment and comparison of the parameters of the patella displacement, the ratio and condition of the facets according to MSCT and fMSCT were carried out. Results. According to the fMSCT data, 64.4% of patients (n=29) had a lateral position of the patella, and 71.1% (n=32) had a lateral facet hyperpression, whereas according to MSCT these signs were detected in 24.4% (n=11) and 8.9% (n=4) of patients, respectively. The results of fMSCT allowed us to identify the degree of lateral instability and hyperpression of the lateral facet of the patella. In 13.3% of patients (n=6) with fMSCT, medialization of the patella was noted, although with MSCT in these same patients normal TT-TG indices were observed. According to MSCT, narrowing of the gap in the medial sections was not observed in any patient (n=0), whereas according to the fMSCT, 3 out of 45 patients showed signs of hyperpression of the medial facet. After analysis of the results of fMSCT, the treatment tactics were changed to surgical (arthroscopic lateral release of the patella) in 35.6% of cases (n=16). Conclusions. FMSCT of the knee joint is a promising non-invasive method that has good diagnostic capabilities in identifying of PFA pathology, including with minor violations of articulation stability. FMSCT is more informative than standard MSCT in verification of facet hyperpression (8.9% (n=4) and 77.8% (n=35) according to MSCT and FMSCT, respectively), lateral position (24.4% (n=11) and 64, 4% (n=29) according to MSCT and fMSCT, respectively) and medialization of the patella (0% (n=0) and 13.3% (n=6) according to MSCT and FMSC, respectively).
The technique allows to detect changes at an early stage and optimize the diagnostic algorithm for this group of diseases. FMSCT makes it possible to correctly determine the tactics of patient treatment (the data of FMSCT allowed to change the tactics to surgical (arthroscopic lateral release of the patella) and calculate the volume of intervention in 35.6% of patients (n=16)), which helps to significantly improve treatment outcomes and prevent the development of degenerative dystrophic changes of the anterior region of knee joint. |
1 - I.M. Sechenov First Moscow State Medical University. 2 - National Cardiology Research Center.
Moscow, Russia. |
Keywords: fMSCT, instability of the patellofemoral joint, hyperpression of the facet of the patella, lateral position of the patella.
Corresponding author: Bakhvalova V.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Ternovoy S.K., Serova N.S., Bakhvalova A.V., Lychagin A.V., Lipina M.M. Possibilities of functional multispiral computed tomography of the knee joint in the diagnosis of patellophemoral articulation pathology. REJR 2020; 10(2):129-139. DOI:10.21569/2222-7415-2020-10-2-129-139.
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Received: 06.05.20 Accepted: 07.07.20
Exploring the possibilities of Ultrasonic Shear Wave Elastography (SWE) in controlling the formation of bone calluses at different stages of its development.
Material and methods. A study of 51 patients (29 men, 22 women from 17 to 65 years) with fractures of long tubular bones of the upper and lower limbs was conducted. Ultrasound tests were performed on the SuperSonic Aixplorer (France) device with an assessment of tissue stiffness in the kPa and the use of multifrequency probes 2-15 MHz. In the area of the fracture scanned bone corn, surrounding soft tissues and vessels, excluded interposition. The formation of bone calluses was studied at different stages of its development, from 0-7 days to 6 months.
Results. According to the SWE, the most intensive increase in bone calluses is in the first 1.5 months after the fracture, followed by the build-up of bone calluses. For each stage of bone callos formation determined sensitivity, specificity of the method of SWE.
Discussion. The use of the SWE method to control the formation of bone calluses is possible from the first days after bone fracture. The stiffness of bone calluses at SWE is determined in the kPa. Ultrasound also allows you to study the condition of bone fragments, surrounding tissues and vessels. Conducting ultrasound with the use of SWE, dopplerography allows in dynamics to trace the formation of bone calluses in all three stages of its development.
Conclusion. SWE wave allows to determine the stiffness of the bone calluses in the dynamics, starting from the first days after the fracture and to its complete formation. SWE implements a new approach to assess the stiffness of bone calluses, which allows to get accurate quantitative results in real time. The sensitivity and specificity of the SWE in determining the stiffness of bone calluses is highest in the first – connective tissue stage of its formation (94% and 90% respectively).