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Imaging Techniques and Applications in Internal Medicine and Rheumatology

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Biosciences and Bioengineering".

Deadline for manuscript submissions: closed (10 January 2022) | Viewed by 11547

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Special Issue Editor

Dr. Valentin Sebastian Schäfer

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Guest Editor

Associate Professor of Internal Medicine, Head of the Department of Rheumatology and Clinical Immunology, Head of the Ultrasound Diagnostic Centre, Speaker of the Centre for Rare Rheumatological Diseases, Department of Internal Medicine IIIOncology, Hematology, Rheumatology and Clinical ImmunologyBuilding 20 – Zentrum für Integrative Medizin, University Hospital BonnVenusberg Campus, 153127 Bonn, Germany
Interests: large vessel vasculitis; imaging in rheumatic disease; modern concepts for early diagnosis of psoriatic arthritis; pulmonary diseases in arthritides; teaching study development in ultrasound; effect of sports on the musculoskeletal system
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Special Issue Information

Dear Colleagues,

The value of using non-invasive imaging methods such as magnetic resonance imaging (MRI), ultrasound, and other imaging tools is increasingly being used in internal medicine and rheumatology.
Recently modern imaging tools like thermography, ultrasound with and without contrast media, new MRI sequences, and dual-energy computer tomography have gained importance in the field of rheumatology. These tools are increasingly used not only for diagnosis but also for follow-up of patients with rheumatic diseases. However, evidence still has to be delivered concerning values in daily clinical practice.
The use of applications (apps) is also growing among patients and physicians to assist with medical care and patient interaction.
For this Special Issue, submissions exploring Imaging “Techniques and Applications in Internal Medicine and Rheumatology” are invited.

Dr. Valentin Sebastian Schäfer
Guest Editor

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Keywords

imaging techniques
application
internal Medicine
rheumatology

Published Papers (5 papers)

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Research

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13 pages, 2462 KiB

Open AccessFeature PaperArticle

Microvascular Imaging as a Novel Tool for the Assessment of Blood Flow Velocity in Patients with Systemic Sclerosis: A Single-Center Feasibility Study

by Jan-Gerd Rademacher, Rosa Marie Buschfort, Thomas Asendorf, Viktor Korendovych, Björn Tampe and Peter Korsten

Appl. Sci. 2022, 12(5), 2306; https://0-doi-org.brum.beds.ac.uk/10.3390/app12052306 - 23 Feb 2022

Cited by 5 | Viewed by 2041

Abstract

Systemic sclerosis is an autoimmune disease characterized by organ fibrosis and vasculopathy. Almost all patients suffer from Raynaud’s phenomenon. Nailfold video capillaroscopy is the most widely imaging technique available, but flow quantification is impossible. Therefore, novel imaging techniques are of interest. We performed a single-center feasibility study using Microvascular Imaging (MVI) for flow quantification of small fingertip vessels. We compared 20 healthy controls (HCs) with 20 systemic sclerosis (SSc) patients. In HCs, measurements were, on average, statistically significantly higher when combined for all fingers (median 10.68 vs. 6 cm/s, Δ = 4.68 cm/s, p < 0.0001) and for individual fingers. An optimal cut-off value of peak systolic (PS) velocity of <6.13 cm/s and end-diastolic (ED) velocity of <2.13 cm/s discriminated HCs from SSc. Test characteristics for PS showed excellent sensitivity (0.90, 95% CI 0.70–0.98) and specificity (0.85, 95% CI 0.64–0.95; LR + 6.0). For ED velocity, sensitivity was 0.85 (95% CI 0.64–0.95) and specificity was 0.80 (95% CI 0.58–0.92, LR + 4.25). Here, we present the first study on the use of MVI to assess blood flow in the fingertips with high sensitivity and specificity in SSc. Future studies are needed to investigate correlations with the risk of organ complications, such as digital ulcers or pulmonary arterial hypertension. Full article

(This article belongs to the Special Issue Imaging Techniques and Applications in Internal Medicine and Rheumatology)

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9 pages, 999 KiB

Open AccessArticle

A New Era for the Early and Non-Invasive Diagnosis of Giant Cell Arteritis: The Use of Fast-Track Ultrasound in Clinical Practice

by Sara Monti, Paolo Delvino and Carlomaurizio Montecucco

Appl. Sci. 2022, 12(3), 1621; https://0-doi-org.brum.beds.ac.uk/10.3390/app12031621 - 03 Feb 2022

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Abstract

Background: The assessment of giant cell arteritis (GCA) in fast-track assessment clinics (FTA) including the use of ultrasound (US) is becoming the preferred practice in specialized centers. Methods: Patients with suspected GCA referred to the FTA of the Rheumatology Department, University of Pavia, Italy, between 2016 and 2021 were included to analyze the clinical and US findings. Results: A total of 553 US examinations were performed on 347 patients. A total of 246 were female (71%), and the mean age was 73 ± 12. Of these, 287 US on newly referred patients led to a confirmed diagnosis of GCA in 111 (39%). The sensitivity of US was 81.98% (95% CI 73.55–88.63%), and the specificity 99.43% (95% CI 96.88–99.99%). Only 4 patients required temporal artery biopsy. The most specific symptoms to inform the pre-test probability of GCA and differentiate from patients with other conditions were: jaw or tongue claudication, scalp tenderness, and bilateral visual loss. Headache was not reported in 33% of patients. Systemic symptoms were significantly more frequent in GCA (42.3%), together with combinations of cranial, systemic, and/or polymyalgia rheumatica symptoms. Out of 88 patients, there were 52% with a confirmed relapse. Of these, 67% had a positive US. Conclusion: The use of FTA in clinical practice ensures an early diagnosis, avoiding invasive procedures for the patient. Our data support the increasingly recognized adjunctive role of US in the monitoring of GCA. Full article

(This article belongs to the Special Issue Imaging Techniques and Applications in Internal Medicine and Rheumatology)

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11 pages, 259 KiB

Open AccessArticle

Prevalence of Findings in Routine Abdominal Ultrasound in Patients with Systemic Autoimmune Rheumatic Diseases and Their Impact on Therapeutic Decision Making

by Katharina Weiß, Wolfgang A. Schmidt, Andreas Krause and Valentin S. Schäfer

Appl. Sci. 2022, 12(2), 851; https://0-doi-org.brum.beds.ac.uk/10.3390/app12020851 - 14 Jan 2022

Viewed by 1647

Abstract

Patients with systemic autoimmune rheumatic diseases (SARD) often receive abdominal ultrasound examinations to screen for organ involvement; yet, the spectrum of findings and their clinical relevance are poorly understood. We conducted a retrospective chart review of inpatients from a rheumatological referral centre with an abdominal ultrasound between 1 January2006 and 31 December 2015, examining 1092 SARD patients with a total of 1695 inpatient stays. The mean age was 55.1 years (range: 17–90 years, SD: 15.8), and the mean disease duration was 6.4 years (range: 0.0–52.8 years, SD: 9.1). A total of 87.5% of the patients were female. The most frequent ultrasound findings were hepatic steatosis (in 26.8% of all patients), splenomegaly (15.2% of all patients), pancreatic lipomatosis (14.3% of all patients) and aortic sclerosis (13.9% of all patients). Based on glucocorticoid and disease-modifying antirheumatic drug use, we identified cases where immuno-modulatory medication was escalated; there was an association between therapy escalation and the findings of hepatomegaly and pleural effusion (as tested via Fisher’s exact test). In patients with several examinations during the defined time span (n = 318), we found ultrasound findings to change, especially findings of hepatomegaly, pleural effusion and splenomegaly. When justifying decisions regarding the further treatment of a patient in the discharge letter, abdominal ultrasound results were rarely discussed. Abdominal ultrasound rarely yielded disease-specific or treatment-changing results. Full article

(This article belongs to the Special Issue Imaging Techniques and Applications in Internal Medicine and Rheumatology)

11 pages, 589 KiB

Open AccessFeature PaperArticle

Preliminary Report for the Development of a Multiparameter Protocol for the Identification of Sinusoidal Obstruction Syndrome including Abdominal Ultrasound before and after Allogeneic Stem Cell Transplantation

by Sebastian Schlaweck, Claus Juergen Bauer, Friederike Schmitz, Peter Brossart, Tobias A. W. Holderried and Valentin Sebastian Schäfer

Appl. Sci. 2022, 12(2), 829; https://0-doi-org.brum.beds.ac.uk/10.3390/app12020829 - 14 Jan 2022

Cited by 1 | Viewed by 1203

Abstract

Sinusoidal obstruction syndrome (SOS) is a rare complication after allogeneic hematopoietic stem cell transplantation (alloHSCT) caused by endothelial dysfunction. Previous definitions and diagnostic criteria for the presence of SOS include bilirubinemia, hepatomegaly and weight gain, but histological evaluation is still the only way to prove the diagnosis of SOS. However, biopsy remains an invasive technique and is therefore undesirable in the alloHSCT scenario. Hence, a non-invasive diagnostic strategy is critical. Besides thorough clinical assessment and laboratory values, ultrasound examination remains part of the diagnostic workflow in clinical routine. Previous studies defined sonographic abnormalities, which are associated with the occurrence of SOS, but a standardized protocol to perform reliable abdominal ultrasound has not been finally defined. In this study, we evaluated a multi-parameter protocol including laboratory values as well as ultrasound examination pre- and post-alloHSCT. The application of this protocol was feasible in clinical practice and achieved a high inter- and intra-rater reliability. In our population, no case of SOS was identifiable and, in line with previous studies, no changes known to be associated with SOS were detected by ultrasound examination in our cohort. Additionally, we investigated subgroups of patients partly fulfilling SOS diagnostic criteria analyzing correlations between the fulfilled criteria and aberrances in ultrasound measurements pre- and post-alloHSCT. Although statistical examination may be limited by a small sample size and missing SOS cases, hyperbilirubinemia, thrombocytopenia and weight gain showed only a coincidence with selected, enlarged liver dimensions in few patients. This may underline the fact that hepatomegaly occurs as an unspecific finding after alloHSCT. Our protocol, including the ultrasound examination pre- and post-alloHSCT and laboratory parameters, may help to rule out SOS early, but validation in a greater population and different transplantation centers is required to warrant broader appliance. Nevertheless, we aim to contribute to an elaborate and standardized work-flow in peri-alloHSCT patient care. Full article

(This article belongs to the Special Issue Imaging Techniques and Applications in Internal Medicine and Rheumatology)

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Review

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11 pages, 1446 KiB

Open AccessReview

Ultrasound in Telemedicine: A Brief Overview

by Florian Recker, Elena Höhne, Domagoj Damjanovic and Valentin S. Schäfer

Appl. Sci. 2022, 12(3), 958; https://0-doi-org.brum.beds.ac.uk/10.3390/app12030958 - 18 Jan 2022

Cited by 12 | Viewed by 4848

Abstract

The delivery of healthcare from a distance, also known as telemedicine, has evolved over the past 50 years, changing the way healthcare is delivered globally. Its integration into numerous domains has permitted high-quality care that transcends the obstacles of geographic distance, lack of access to health care providers, and cost. Ultrasound is an effective diagnostic tool and its application within telemedicine has advanced substantially in recent years, particularly in high-income settings and low-resource areas. The literature in Pubmed from 1960–2020 was assessed with the keywords “ultrasound”, “telemedicine”, “ultrasound remote”, and “tele-ultrasound” to conduct a SWOT analysis (strengths, weaknesses, opportunities, and threats). In addressing strengths and opportunities, we emphasized practical aspects, such as the usefulness of tele-ultrasound and the cost efficiency of it. Furthermore, aspects of medical education in tele-ultrasound were considered. When it came to weaknesses and threats, we focused on issues that may not be solved immediately, and that require careful consideration or further development, such as new software that is not yet available commercially. Full article

(This article belongs to the Special Issue Imaging Techniques and Applications in Internal Medicine and Rheumatology)

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