Bone Lesion

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Bone lesion absorbed dose profiles in patients with metastatic prostate cancer treated with molecular radiotherapy.

Bone lesion absorbed dose profiles in patients with metastatic prostate cancer treated with molecular radiotherapy.

To reduce the effect of partial volume and the impact of the different spatial resolutions associated with each radionuclide, lesion peak absorbed doses were obtained by averaging the maximum voxel absorbed dose with the first nearest neighbour voxel values. Absorbed dose profiles were obtained for the deliv- ered and extrapolated treatments, representing the distribution of bone lesion absorbed doses for the patient population. These were converted to cumulative dose volume histograms (cDVH) to study the spatial distribution of irradiated lesions across the patient cohort for each treatment. The patient population disease volume was defined as the sum of the metastatic tumour burdens for the 22 patients. The minimum absorbed dose to which 50% of the total volume was irradiated was calculated (D50).

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Case Report Recurrent ischemic cerebral infarction caused by Waldenström Macroglobulinemia

Case Report Recurrent ischemic cerebral infarction caused by Waldenström Macroglobulinemia

haematological diseases (es- pecially multiple myeloma) we- re strongly considered. X-ray was conducted and revealed that the patient was negative for osteolytic bone lesion, while bone marrow routine test indicated that plasma cells and lymphoplasmacytoid cells were detected. Bone marrow biopsy indicated dif- fuse hyperplasia of small lym- phocytes, plasmacytoid lym- phocytes and plasma cells, the immunophenotype was IgM(+), CD19(+), CD20(+), CD5(-), CD10(-), and CD23(-), and the plasmacytoid differ- entiated cells had the foll- owing markers: CD138(+), CD38(+), kappa(+), lambda(-) (Figure 2). According to the above results, the final diag- noses were determined to be multiple cerebral infarctions and WM. In addition to sec- ondary prevention for stroke (aspirin and atorvastatin), fur- ther treatment requiring che- motherapy was initiated at a local hospital after discharge. At follow up over one and a half years later, the patient experienced no recurrence of stroke, and his serum IgM and plasma viscosity decreased to 1860 mg/dl and 1.86 mPas, respectively.

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Osteoprotegerin inhibits bone resorption and prevents tumor
development in a xenogenic model of Ewing's sarcoma by
inhibiting RANKL

Osteoprotegerin inhibits bone resorption and prevents tumor development in a xenogenic model of Ewing's sarcoma by inhibiting RANKL

ES is characterized by extensive bone destruction due to osteolysis. Ewing ' s sarcoma cells are unable to directly degrade the bone matrix and accordingly, osteoclast activation and sub- sequent bone resorption might be responsible for the clinical features of bone destruction [10]. Indeed, as demonstrated for bone metastases [11], a vicious cycle between bone cells (osteo- clasts and osteoblasts) and tumor cells occurs during the devel- opment of tumor in bone site. Therefore, targeting the osteoclasts may represent a promising adjuvant strategy for the treatment of bone tumors. Among the factors involved in the regulation of bone remodeling, the molecular triad osteoprotegerin (OPG)/receptor activator of NF-kB (RANK)/RANK Ligand (RANKL) is strongly implicated [12,13]. Osteoclast differentiation and activation is mainly mediated by RANKL, a cytokine member of the tumor necrosis factor (TNF) superfamily (TNFSF11) that binds to its receptor RANK at the surface of osteoclasts [14]. OPG (TNFRSF11B) is a soluble protein that acts as a decoy receptor for RANKL inhibiting osteoclast formation, function and survival by prevent- ing the binding of RANKL to RANK [15]. Transgenic mice over- expressing OPG exhibit an osteopetrotic phenotype, whereas OPG- knockout mice have severe osteoporosis [16,17]. The OPG/RANKL/ RANK system is also involved in various pathologies associated with tumors in bone [18,19]. Therefore, OPG has demonstrated increased interest as a therapeutic strategy in malignant bone pathologies associated with osteolytic lesions [20,21]. Concerning primary bone tumors, the inhibition of RANKL activity by OPG induced a signi fi cant therapeutic effect on bone lesion and tumor development in two preclinical models of osteosarcoma in mice (POS-1) and in rats (OSRGa) [22]. This effect was also con fi rmed by using the soluble form of the RANKL receptor, RANK-Fc [15] or by the RNA interference strategy targeting RANKL [23]. In addition, OPG is also able to bind to the TNF Related Apoptosis Inducing Ligand (TRAIL), another member of the TNF superfamily (TNFSF10) [23], thereby limiting its ability to induce apoptosis in tumor cells. It has been even reported that OPG acts as a pro-tumoral factor in some cancer cell lines in vitro [24 – 26]. In addition, Taylor et al. previously reported that the expression of RANKL in Ewing ' s sarcoma cell lines and tissues could support osteoclast activation [10]. Therefore, targeting this cytokine with OPG may represent a promising therapeutic option.

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Bone and Soft Tissue Tumors : General Considerations

Bone and Soft Tissue Tumors : General Considerations

In musculoskeletal lesions, age and radiography often provide important information because many tumors have a tendency to appear in certain age ranges and in certain places. The most obvious example; in an incomplete patient with a skeletal maturation, the epiphysis lesion is most likely chondroblastoma, while the completed patient is probably a giant cell tumor. Osteomyelitis, round cell tumors (ewing sarcoma, leukemia, lymphoma, myeloma) are usually located in the diaphysis and intramedullary, while other malignant tumors are often metaphyses. In all suspected bone and soft tissue lesions, a direct radiography should be performed. It is a easy, inexpensive, fast examination. Although it is not definitively diagnosed, X-rays may give serious clues in evaluating the benign / malignant distinction of bone lesion and determining its aggression. In addition, some lesions such as bone infarction and intraosseous ganglion can be diagnosed by direct radiography, and no biopsy is required. Early bone lesions with direct radiography can be demonstrated by MR, CT, TVKS.

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Osteoblastoma of the Second Metatarsal: A Case Report N. K. Sferopoulos 1*

Osteoblastoma of the Second Metatarsal: A Case Report N. K. Sferopoulos 1*

Case Presentation: A 50-year-old woman presented with localized swelling and tenderness of the right forefoot of 3 years’ duration. She reported increased swelling and intense pain, worse at night, during the last 6 months. Imaging included plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) and was indicative of a benign process. An expansile osteoblastic lesion was identified in the diaphysis of the second metatarsal on x-rays. A lytic bone lesion surrounded by an intact cortical rim with evidence of intralesional ossifications was evident on both CT scan and MRI. In the latter, there were also signs of bone marrow and soft tissue edema. The lesion was treated surgically with curettage and an osteoblastoma was diagnosed at biopsy. No further treatment was undertaken. No recurrence has occurred during a 7- year follow-up.

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Extracranial meningiomas concurrently found in the lung and vertebral bone: a case report

Extracranial meningiomas concurrently found in the lung and vertebral bone: a case report

We postulate two possibilities concerning the relation- ship between these lesions. First, it is possible that the lesions happened to coincide. Although intraosseous meningioma can occur as a primary tumor exclusively in the head and neck region [13], there have been no re- ports convincingly describing primary meningioma in the bone outside these areas. Meningioma originating from the spinal meninges can invade the vertebral bone as if it had arisen in the vertebral bone. However, in our patient, both imaging examinations and intraoperative observations by orthopedists clearly excluded the pres- ence of a spinal meningeal tumor. If each tumor had oc- curred independently, it would follow that intraosseous meningiomas could arise outside the head and neck re- gion. Second, the pulmonary meningioma may have me- tastasized to the vertebral bone, or the reverse scenario may have been present. Because no other lesions were found despite thorough examinations during the follow-up period of 41 months, it is unlikely that the un- detectable primary tumor metastasized to the lung and vertebral bone. The histopathological and immunohisto- chemical features of the vertebral bone lesion were iden- tical to those of the pulmonary lesion. Although almost all meningiomas are benign, there have been reported cases of extracranial malignant meningiomas. Both men- ingiomas in our patient corresponded to a World Health Organization grade 1 intracranial meningioma. These histopathological features generally suggest benignancy;

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Bizarre parosteal osteochondromatous proliferation (Nora’s lesion) affecting the distal end of the ulna: a case report

Bizarre parosteal osteochondromatous proliferation (Nora’s lesion) affecting the distal end of the ulna: a case report

Background: Bizarre parosteal osteochondromatous proliferation (BPOP), first described by Nora et al. in 1983 and therefore termed “ Nora ’ s lesion ” , is a rare lesion that occurs in the short bones of the hands and feet and eventually presents as a parosteal mass. Reports of BPOP in the long bones are very rare. A benign disease, BPOP does not become malignant, although a high rate of recurrence following surgical resection is reported. Because of its atypical imaging findings and histopathological appearance, a BPOP might be misdiagnosed as a malignant tumor such as an osteochondroma with malignant transformation, a parosteal osteosarcoma, or a periosteal osteosarcoma. Case presentation: A 58-year-old woman complained of left ulnar wrist pain at the time of her initial presentation. Plain x-rays showed ectopic calcifications in and around the distal radioulnar joint, which supported the diagnosis of subacute arthritis with hydroxyapatite crystal deposition. She was initially given a wrist brace and directed to follow-up, but her persistent pain required the administration of corticosteroid injections into the distal radioulnar joint. Increasing ulnar wrist joint pain and limited forearm pronation and wrist flexion necessitated computed tomography and contrast-enhanced magnetic resonance imaging. BPOP was diagnosed based on the preoperative imaging studies, and a resection of the lesion was performed along with the decortication of the underlying the cortical bone to reduce recurrence rates. The diagnosis of BPOP was confirmed by pathologic examination. Two years after surgery, the patient has no subsequent pain complaints and an improved range of motion.

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Acceptable outcome following resection of bilateral large popliteal space heterotopic ossification masses in a spinal cord injured patient: a case report

Acceptable outcome following resection of bilateral large popliteal space heterotopic ossification masses in a spinal cord injured patient: a case report

Recurrence of HO after surgical resection is one of the most common complications affecting the final outcome. The role of prostaglandine E2 (PGE2) in pathophysiology of HO and its increased urinary excretion in early stages of the disease has been the rational for use of non steroi- dal anti-inflammatory drugs (NSAIDs) as a preventive measure. Indomethacin has been of particular interest. Indomethacin appears to be effective in the primary pre- vention of HO after spinal cord injuries and after total hip arthroplasty and as secondary preventive measure after resection of HO lesions [25]. The major drawback of indomethacin use is the increased risk of operative bleed- ing, its gastrointestinal side effects and its negative effect in bone union. Other more selective NSAIDs have been studied for this reason and their efficacy and safety is under investigation. Radiation therapy has been used extensively for the prevention of HO. Many side effects seen with the use of indomethacin are not the concern with irradiation. With proper shielding, irradiation can be applied to only where it is needed. However, despite the low doses used for HO prophylaxis, the risk of carcino- genesis is a concern. Most articles about the effects of radiation therapy in prevention of HO focus in post-total hip arthroplasty (THA) cases. The studies about the pre- ventive effects of radiation therapy are plagued with small sample sizes and inadequate research protocol design. The optimal dose and fractionation of dosage are subjects of some researches [26].

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Comparison of Polyglycolactic - Hydroxyapatite - CHITOSAN Scaffolds with or without Mesenchymal Stem Cells in an In-vivo Study

Comparison of Polyglycolactic - Hydroxyapatite - CHITOSAN Scaffolds with or without Mesenchymal Stem Cells in an In-vivo Study

The fabrication method of PCL scaffold was previously reported [29]. Briefly, several requirements should be considered in the design of 3D scaffolds for bone tissue engineering [30-32]. First of all, an ideal bone scaffold should have sufficient porosity to accommodate osteoblasts or osteoprogenitor cells, to support cell proliferation and differentiation, and to enhance bone tissue formation. High porosity (such as ¸90%) is necessary for scaffolds for any tissue engineering applications, including bone [33, 34]. High interconnectivity between pores are also desirable for uniform cell seeding and distribution, the diffusion of nutrients to and metabolites out from the cell/scaffold constructs. A variety of processing technologies has been developed to fabricate porous 3D polymeric scaffolds for bone regeneration. These techniques mainly include solvent casting and particulate leaching, gas foaming, emulsion freeze-drying, electrospinning, rapid prototyping, and thermally induced phase separation.

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Implantosuported Rehabilitation after Marginal Recession of Mandibular Calcifying Epithelial Odontogenic Tumor: Case Report

Implantosuported Rehabilitation after Marginal Recession of Mandibular Calcifying Epithelial Odontogenic Tumor: Case Report

The Calcifying Epithelial Odontogenic Tumor (CEOT) also called the Pind- borg’s Tumor represents a rare benign epithelial odontogenic neoplasm with locally aggressive behavior. Surgical excision with a safety margin is one of the treatment options, requiring bone and soft tissue reconstruction for im- plant-supported rehabilitation, providing the individual with a return to adequate oral functions. The objective of the present study is to report on the case of the treatment stages and the factors involved in the rehabilitation of a 23-year-old man with a history of mandibular lesion diagnosed as CEOT. A marginal resection of the mandible lesion was performed, with posterior re- construction with iliac crest bone graft and soft tissue graft to allow the im- plant-supported rehabilitation. Currently, in the postoperative control, the individual shows no signs of tumor recurrence and is rehabilitated without functional and/or aesthetic complaints. Surgical excision should be framed as a form of treatment, aiming for better resolution in the more complex cases of these invasive tumors.

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Osteoclastoma of Proximal Ulna―Atypical Location in a 13 Year Old Child

Osteoclastoma of Proximal Ulna―Atypical Location in a 13 Year Old Child

The treatment options should always consider oncological radicality of the tumour and the restoration of functionality [15]-[17]. In the present case scenario intralesional curettage was possible as the tumour was a grade II lesion and the reconstruction was carried out with augmentation of bone cement with autologous cor- tico-cancellous bone graft from maternal iliac crest as the child is young.

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Patient-reported health-related quality of life after a displaced intra-articular calcaneal fracture: a systematic review

Patient-reported health-related quality of life after a displaced intra-articular calcaneal fracture: a systematic review

(calcaneus[tiab] OR calcaneum[tiab] OR calcaneal[tiab] OR calcis[tiab] OR kalkaneus[tiab] OR (heel[tiab] AND bone[tiab]) OR fersenbein[tiab] OR hielbeen[tiab] OR hielbot[tiab] OR calcanean[tiab] OR calcanea[tiab]) AND (fracture[tiab] OR fractures[tiab] OR lesion[tiab] OR lesions[tiab] OR broken[tiab] OR fractured[tiab] OR splintered[tiab] OR displaced[tiab] OR displacement[tiab] OR discontinuity[tiab] OR discontinuities[tiab] OR gebroken[tiab] OR fracture[tiab] OR frakturen[tiab] OR fractuur[tiab] OR fracturen[tiab] OR fragmentation[tiab] OR fragmented[tiab] OR fragment[tiab] OR cleavage[tiab] OR cleavages[tiab]) AND (sf36[tiab] OR sf-36[tiab] OR (sf[tiab] AND 36[tiab]) OR (health[tiab] AND (survey[tiab] OR surveys[tiab] OR review[tiab] OR reviews[tiab] OR questionnaire[tiab] OR questionnaires[tiab])) OR (short[tiab] AND (form[tiab] OR form-36[tiab])) OR short-form[tiab] OR euroqol[tiab] OR euroqol-5[tiab] OR euroqol-6[tiab] OR eq-5d[tiab] OR eq-6d[tiab] OR (quality[tiab] AND life[tiab]) OR ((clinical[tiab] OR functional[tiab]) AND (assessment[tiab] OR score[tiab] OR scores[tiab] OR outcome[tiab] OR outcomes[tiab])))

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The clinical significance, natural history and predictors of bone marrow lesion change over eight years

The clinical significance, natural history and predictors of bone marrow lesion change over eight years

Visit one only involved T1 MRI scans, which were not suitable for comparison of BMLs over time. Subchondral BMLs were assessed using Osirix software (University of Geneva, Geneva, Switzerland) and were defined as areas of increased signal adjacent to the subcortical bone at the medial tibial, medial femoral, lateral tibial, lateral femoral, superior patella, and inferior patella sites as de- scribed previously [3]. One trained observer scored the BMLs by measuring the maximum area (cm 2 ) of the le- sion at both time points. The observer manually selected the MRI slice with the greatest BML size. The BML with the largest size was recorded if more than one le- sion was present at the same site. MRIs at both time points were read paired with the chronological order known to the observer but blinded to clinical status. Participants were given a BML score (cm 2 ) for each of the six sites (medial tibial, medial femoral, lateral tibial, lateral femoral, superior patella, and inferior patella sites) as well as a total BML score, which was the sum

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Empirical evaluation of the inter relationship of articular elements involved in the pathoanatomy of knee osteoarthritis using Magnetic Resonance Imaging

Empirical evaluation of the inter relationship of articular elements involved in the pathoanatomy of knee osteoarthritis using Magnetic Resonance Imaging

Diagnostic imaging has played an important role in the study of OA pathogenesis. Radiographs have long served as the standard imaging study for assessing OA [8]. Sys- tems for evaluating radiographic OA such as that of Kell- gren and Lawrence focus on osteophytosis and joint space narrowing [9]. Joint space narrowing is an indirect meas- ure of articular cartilage loss [10-12]. Cartilage loss is asso- ciated with subchondral sclerosis, a process of subchondral bony remodeling that alters relative bone density. Cartilage loss has also been associated with oste- ophytosis, the growth of endochondral bone that is thought to be an attempt to stabilize the diseased joint [13]. The use of magnetic resonance imaging (MRI) to vis- ualize structures such as the synovium, meniscus and bone marrow that cannot be visualized with plain radio- graphs has demonstrated that these structures are also affected in the context of OA [14-33].

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Evaluation of bone marrow lesion volume as a knee osteoarthritis biomarker   longitudinal relationships with pain and structural changes: data from the Osteoarthritis Initiative

Evaluation of bone marrow lesion volume as a knee osteoarthritis biomarker longitudinal relationships with pain and structural changes: data from the Osteoarthritis Initiative

baseline BMLs [11]. Additionally, we found that in the association between JSN progression and BMLs it may be that baseline BML size is more important than BML volume change. These findings may be related to the underlying structural changes associated with BMLs. BMLs are characterized by altered subchondral bone structure (for example, decreased mineral content, fibrosis, edema, and altered trabecular morphometry) [32-38]. Per- haps progression from no or small baseline BML coincides with these changes leading to an increase in symptoms and JSN progression. Therefore, large BMLs are associated with abnormal bone structures. Once the bone has been compromised with a large BML, a reduction in BML size may reflect changes in the bone that can adapt quickly and may be related to knee symptoms (for example, fibro- sis, edema) but not reflect changes in structural integrity (for example, mineral content, altered trabecular morpho- metry), which may relate to risk of JSN progression and take longer to recover.

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CDC73 gene mutations in sporadic ossifying fibroma of the jaws

CDC73 gene mutations in sporadic ossifying fibroma of the jaws

The clinical characteristics of the 40 cases enrolled in this study are summarized in Table 1. The patient age at first presentation ranged from 1 to 47 years (median age: 19.5 years). The male to female ratio was 19:21. Seven- teen (44.7 %, 17/38) tumors occurred in the maxilla, while 21 (55.3 %, 21/38) occurred in the mandible. Two cases, which have been reported previously [8], showed multiple lesions affecting both the maxilla and the man- dible. Bone or facial swelling (90 %, 36/40) was the most common clinical presentation, and other presentations included pain (10 %, 4/40), bite pain (2.5 %, 1/40), nasal obstruction (5 %, 2/40), sense of numbness (7.5 %, 3/40), sense of discomfort (5 %, 2/40), looseness of teeth (2.5 %, 1/40), tinnitus (2.5 %, 1/40), and surface fester (2.5 %, 1/40). In 38 of 40 patients with available ra- diographs, radiographic features included radiolucent (eight cases, 21 %), mixed (25 cases, 66 %;), and radioopaque lesions (5 cases, 13 %). Lesions of 29 cases were well-defined, and those of 9 cases were ill-defined.

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Aneurysmal bone cyst in central ossifying fibroma:  “lesion in a lesion”, mandible

Aneurysmal bone cyst in central ossifying fibroma: “lesion in a lesion”, mandible

method. The radiographic features of JABC’s are variable. (KalantarMotamedi, 1998; Medeiros et al., 1993) Almost in many instances the lesion frequently appears as a well- circumscribed multilocular or unilocular radiolucency with a bloated appearance. Thin septa present might result in a soap bubble appearance. The teeth will be vital, with displacement and resorption of roots. (Lopez-ArcasCalleja et al., 2007) Histologically, other pre-existing entities decide the incidence of primary and secondary categories of ABC’s. (Levy et al., 1975; Nadimi et al., 1987) Previously reported few cases reveal a very close association of Ossifying fibroma with JABC’s as observed in this case report. (Arden et al., 1997; Citardi et al., 1996) The pathogenesis of ABC’s remain controversial, with theories ranging from a post traumatic, reactive vascular malformation to genetically predisposed bone tumours. Most widely accepted theories to date has been that local circulatory abnormalities led to increased venous pressure resulting in dilation of local vascular network. Treatment concerns many methods like surgery, embolization, cryotherapy and a wait & see strategy. To date surgical therapy is still the most frequently applied treatment of ABC’s secondary to Ossifying fibroma. The extent of surgery is related to the size and position of lesion, ranging from sample curettage to extended resection. (Cottalorda and Bourelle, 2007; Bernier and Bhaskar, 1958) Struthers and shears have proposed high recurrence rates of ABC’s, usually recurring within the first year after the initial treatment.

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Bone marrow lesion volume reduction is not associated with improvement of other periarticular bone measures: data from the Osteoarthritis Initiative

Bone marrow lesion volume reduction is not associated with improvement of other periarticular bone measures: data from the Osteoarthritis Initiative

The Role of Bone in Knee Osteoarthritis Progression is supported by NIH/ NIAMS (grant 1R01AR054938). The OAI is a public-private partnership comprising five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Pfizer, Inc.; Novartis Pharmaceuticals Corporation; Merck Research Laboratories; and GlaxoSmithKline. Private-sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript has received the approval of the OAI Publications Committee based on a review of its scientific content and data interpretation. This work was supported in part by the Houston VA HSR&D Center of Excellence (HFP90-020). The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs.

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Canada Denmark MRI scoring system of the spine in patients with axial spondyloarthritis: updated definitions, scoring rules and inter reader reliability in a multiple reader setting

Canada Denmark MRI scoring system of the spine in patients with axial spondyloarthritis: updated definitions, scoring rules and inter reader reliability in a multiple reader setting

able to identify a slight progression of new bone forma- tion at the group level. When comparing the reliability for assessing spinal structural lesions across various studies, the proportion of patients who reached different stages in the evolution of disease should be taken into account. Higher reliability may be reached if patients were to be selected based on spinal involvement above a certain threshold at baseline, or in studies with longer follow-up since disease progression is slow. Another contributor to the slight to moderate reliability for bone erosion and new bone formation status scores is that structural lesions are often small and hard to detect on MRI T1-weighted images, where cortical bone provides no MRI signal and contrast and spatial resolution is limited compared with radiography. We have previously shown that the CANDEN MRI spine new bone formation score correlates with clin- ical examination (Bath Ankylosing Spondylitis Metrology Index) as well as with a radiographic score (modified Stoke Ankylosing Spondylitis Spine Score, mSASSS). 7

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Chronic nonbacterial osteomyelitis in childhood: prospective follow up during the first year of anti inflammatory treatment

Chronic nonbacterial osteomyelitis in childhood: prospective follow up during the first year of anti inflammatory treatment

There was a mean delay of 5 months in making the diagnosis after the first symptoms had appeared. In all patients the disease onset was before 18 years of life, ranging from 25 months to 16 years of age with a mean age of 11.0 years. Eight patients showed a unifocal lesion, and 29 had multifocal lesions - 27 at the time of diagnosis, and two initially presented as a unifocal lesion but developed additional bone lesions during the first year of the disease. All together, 184 clinical foci (pain, functional impairment or swelling) were detected over 1 year (initial, 79 foci; after 1 month, 38 foci; after 3 months, 27 foci; after 6 months, 21 foci; and after 12 months, 19 foci) - resulting in a mean of 1.0 (2.1 at time of diagnosis, 1.1 after 1 month, 0.8 after 3 months, 0.6 after 6 months, and 0.5 after 1 year of treatment) per patient, showing a significantly lower number in fol- low-ups (analysis of variance (ANOVA), P < 0.05). The number of clinical lesions in the thorax, spine, pelvis and extremities were significantly less in the follow-ups of months 3, 6, and 12, whereas the head involvement remained unchanged (n = 1) on a low level (ANOVA, P < 0.05). The head was clinically involved in 2.7%, the extremities in 53.3%, the thorax in 19.6%, the spine in 6.5% and the pelvis in 17.9% of patients (Table 1).

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