The objective of this review is to evaluate the efficacy of Pulsed Radiofrequency (PRF) treatment of pain associated with different spinal conditions. The mechanisms of action and biological effects are shortly discussed to provide the scientific basis for this radiofrequency modality.

To evaluate the relationship between an incremental model including cardiovascular risk factors, carotid disease, and inflammatory biomarkers to predict the presence of obstructive coronary artery disease (CAD).

The Mediterranean diet appears to be beneficial for several medical conditions, but data regarding osteoarthritis (OA) are not available. The aim of this study was to investigate if adherence to the Mediterranean diet is associated with a lower prevalence of OA of the knee in a large cohort from North America.

Several imaging methods for the diagnosis and management of osteoporosis exist. Dual-energy X-ray absorptiometry (DXA) is the most widely available and commonly used for measuring bone mineral density (BMD). Central DXA has several advantages: It has very good reproducibility, administers a negligible radiation dose to the patient, and BMD values obtained by DXA relate to fracture risk. Nevertheless, DXA has some technical limitations that should be recognized by those physicians who interpret and report this examination. We provide recommendations for optimal DXA scan reporting in adults, including indications, skeletal sites to be measured, serial BMD measurements, and fracture risk assessment. In conclusion, DXA is the standard of reference in evaluating BMD and is effective in following up patients over time. Adequate reporting and analysis of previous DXA examinations is crucial to manage patients correctly.

Quantitative Computed Tomography (QCT) was used to investigate age-related changes in trabecular bones of the mandible. The volumetric Bone Mineral Density (vBMD) of mandibles was found to be increasing with aging in the 20-29, 30-39, 40-49 age groups, while resulted decreasing in the 50~ years age group in a Chinese population. The aim of this study was to validate QCT as a reliable method to measure the vBMD of the mandible and to assess vBMD of the mandible in a Chinese population. A total of seven hundred and eighteen volunteers (299 males, 419 females), ranging from 20 to 63 years of age, previously enrolled in another study, were included for vBMD measurements by QCT. A total of 50 subjects were enrolled for the validation of QCT measurement. Basic information (age, height and weight), and vBMD of the mandible (middle, body and angle) were recorded. Comparisons among age and sex groups were analyzed using the Mann-Whitney test. Linear correlation analysis between vBMD and age was performed. The mandibular vBMD was twice measured with QCT by one operator and resulted highly repeatable (ICC 0. 97, P 0. 05). The vBMD in the middle of the mandible was the highest, followed by that in the body and at the angle of mandible. In each age group, the mean vBMD increased with aging except for the 50~ years age group (P less than 0.05) in which it decreased. The mean mandibular vBMD was higher in females than males in each age group (P less than 0.05). Correlation between vBMD and age was statistically significant (r=0.15, P less than 0.01). QCT shows high precision for the measurement of BMD in the mandible. The present study provides normative data of the mandible in an age- and sex-stratified manner, which can be helpful in clinical practice.

Nutritional status is the results of nutrients intake, absorption and utilization, able to influence physiological and pathological conditions. Nutritional status can be measured for individuals with different techniques, such as CT Body Composition, quantitative Magnetic Resonance Imaging, Ultrasound, Dual-Energy X-Ray Absorptiometry and Bioimpendance. Because obesity is becoming a worldwide epidemic, there is an increasing interest in the study of body composition to monitor conditions and delay in development of obesity-related diseases. The emergence of these evidence demonstrates the need of standard assessment of nutritional status based on body weight changes, playing an important role in several clinical setting, such as in quantitative measurement of tissues and their fluctuations in body composition, in survival rate, in pathologic condition and illnesses. Since body mass index has been shown to be an imprecise measurement of fat-free and fat mass, body cell mass and fluids, providing no information if weight changes, consequently there is the need to find a better way to evaluate body composition, in order to assess fat-free and fat mass with weight gain and loss, and during ageing. Monitoring body composition can be very useful for nutritional and medical interventional. This review is focused on the use of Body Composition in Clinical Practice.

To evaluate (a) the performance in predicting the presence of bone fractures of trabecular bone score (TBS) and hip structural analysis (HSA) in type 2 diabetic postmenopausal women compared to a control group and (b) the fracture prediction ability of TBS versus Fracture Risk Calculator (FRAX(®)) as well as whether TBS can improve the fracture prediction ability of FRAX(®) in diabetic women.

The primary endpoint of this study was to determine the prevalence of coronary artery disease (CAD) and coronary artery calcium score (CACS) using coronary computed tomography angiography (CCTA) among patients with polyvascular atherosclerosis (PVA). Secondary endpoints were to evaluate the prevalence of cardiovascular risk factors and determine the predictors of PVA.

Osteoporosis is the most important metabolic bone disease, with a wide distribution among the elderly. It is characterized by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Identify bone weakening with an appropriate and accurate use of diagnostic imaging is of critical importance in the diagnosis and follow-up of osteoporotic patients. The aim of this review is to evaluate the detection rates of the different imaging modalities in the evaluation of bone strength, in the assessment of fracture risk and in the management of fragility fractures.

To examine both anterior and posterior elements of the lumbar spine in patients with low back pain using MRI T2-weighted sequences with Fat Saturation (FS) and contrast enhanced T1-weighted sequences with FS.

Colon Ischemia (CI) is the most common vascular disorder of gastrointestinal tract with a reported incidence of 6.1-44 cases/100000 person-years with confirmatory histopathology. However, the true incidence of CI poses some difficulty, and even vigilant clinicians with high-risk patients often miss the diagnosis since clinical presentation is nonspecific or could have mild transient nature. Detection of CI results crucial to plan the correct therapeutic approach and reduce the reported mortality rate (4-12%). Diagnosis of CI is based on a combination of clinical suspicion, radiological, endoscopic, and histological findings. Some AA consider colonoscopy as diagnostic test of choice, however a preparation is required and it is not without risk, above all in severely ill patients. There are two types of colonic insult: ischaemic and reperfusive. The first one occurs above all during ischaemic/non-occlusive mesenteric ischemia; in this case the colonic wall appears thinned with dilated lumen and fluid in paracolic space appears. When reperfusion occurs the large bowel wall appears thickened and stratified, because of subepithelial edema and/or hemorrhage, with consequent lumen caliber reduction. Shaggy contour of the involved intestine and misty mesentery are associated to the pericolic fluid. The pericolic fluid results a crucial finding for CI diagnosis: in fact, in case of ischemic CI, dilated thinned colonic wall could be misdiagnosed as a physiological colonic distension caused by the presence of intestinal gas, whereas, in case of reperfused CI, the thickening of large bowel wall is an unspecific condition, similar to malignant or inflammatory diseases. Moreover pericolic fluid may increase or decrease depending on the evolution of the ischemic damage suggesting the decision of a medical or surgical treatment. Radiologists should not forget the hypothesis of CI, being aware that MDCT could be sufficient to suggest the diagnosis of the IC, allowing for early identification and grading definition, and in a short term follow-up, discriminating patients who need urgent surgery from patients in which a medical treatment and follow-up and can be proposed.

Chronic inflammation and malabsorption in gastrointestinal disease can cause bone metabolism alterations and bone mineral loss in children and adults. Gastrointestinal disease is often forgotten as a cause of osteoporosis, osteopenia, or osteomalacia. The etiology of pathologic bone alterations in gastrointestinal disease is multifactorial. Bone alterations were thought to result simply from intestinal malabsorption, but a more complex interaction between cytokines and local/systemic factors influencing bone formation and resorption is envisaged. This review provides an updated discussion on bone alterations in patients with malabsorption due to celiac disease or inflammatory bowel disease.

Pediatric musculoskeletal system is particularly prone to traumatic and sports-related injuries, both acute and chronic, i.e., overuse injuries, because of inherent conditions of weakness, such as the open physis, representing the weakest aspect within the bone, the ligamentous supports and changing biomechanics. Being aware that a quick diagnosis is essential to preserve the good functionality of the limb involved, it is mandatory for the radiologist to recognize the most common patterns of these injuries, identifying those requiring a prompt surgery, as well as be confident with the technique performed, and be supported by an important background experience and knowledge skills.

Patients with primary aldosteronism (PA) have a high prevalence of osteoporosis (OP) and fractures (Fx). We evaluated the presence of PA in patients admitted to our metabolic bone disease outpatient clinic.

Chronic kidney disease (CKD) is a complex systemic disease that induces mineral metabolic dysfunction leading to bone fragility and tissue calcifications. Bone abnormalities in CKD can include increased bone turnover and resorption due to secondary hyperparathyroidism, decreased bone turnover and bone formation, defective bone mineralization, or a mixed pattern of these abnormalities. Other features of musculoskeletal involvement include synovial, tendon, and ligament thickening due to β2-microglobulin amyloidosis, soft tissue masses, or axial and peripheral arthropathies. The accurate assessment of bone involvement in early-stage CKD is crucial for the success of therapeutic interventions. We summarize the key semiologic features of bone abnormalities in CKD and review musculoskeletal complications as depicted by conventional radiography, computed tomography, magnetic resonance, and ultrasound imaging. We also discuss different experimental diagnostic approaches developed for the purpose of identifying changes in bone quality and structure in early-stage CKD.

The growing incidence of renal cell carcinoma (RCC) raises many questions about the management of these patients. The late clinical presentation, the presence of locally advanced or metastatic disease at diagnosis, the difficulty of radical surgical excision, and radioresistance make it one of the more challenging tumors to treat. The primary objective of this article is to propose an updated and critical review of the role of radiotherapy (RT) in the treatment of RCC.

The Mediterranean diet appears to be beneficial for osteoarthritis (OA), but the few data available regarding the association between the diet and the condition are limited to X-ray and clinical findings. The current study aimed to investigate the association between adherence to the Mediterranean diet and knee cartilage morphology, assessed using magnetic resonance (MRI) in a cohort of North American participants. Seven hundred eighty-three participants in the Osteoarthritis Initiative (59.8% females; mean age 62.3 years) in possession of a MRI assessment (a coronal 3D FLASH with Water Excitation MR sequence of the right knee) were enrolled in our cross-sectional study. Adherence to the Mediterranean diet was evaluated using a validated Mediterranean diet score (aMED). The strength of the association between aMED and knee MRI parameters was gauged using an adjusted linear regression analysis, expressed as standardized betas with 95% confidence intervals (CIs). Using an adjusted linear regression analysis, each increase of one standard deviation (SD) in the aMED corresponded to a significant increase in the central medial femoral cartilage volume (beta = 0.12; 95%CI 0.09 to 0.15), in the mean central medial femoral cartilage thickness (beta = 0.13; 95%CI 0.01 to 0.17), in the cartilage thickness of the mean central medial tibiofemoral compartment (beta = 0.12; 95%CI 0.09 to 0.15), and in the cartilage volume of the medial tibiofemoral compartment (beta = 0.09; 95%CI 0.06 to 0.12). Higher adherence to a Mediterranean diet was found to be associated with a significant improvement in knee cartilage as assessed by MRI, even after adjusting for potential confounding factors.

Sarcopenia is a condition characterized by progressive and generalized reduction in skeletal muscle mass and muscle strength, associated with an increased risk of adverse outcomes (disability, hospitalization, death). The growing attention in the last years, aiming to establish a consensus definition and treatment, reflects the interest of the scientific community toward this complex condition, which has many implications in clinical practice and public health. Dual-energy X-ray absorptiometry (DXA) is the gold-standard technique in the analysis of body composition at molecular level, providing assessment and quantification of fat mass, lean mass and bone mineral content, both in a single body region of interest and at whole-body level. In particular, through the assessment of non-bone lean mass parameters, such as appendicular lean mass adjusted for BMI or height (ALM/BMI and ALM/ht(2), respectively), it is possible to discriminate subjects with "physiological" loss of muscle mass from those with "pathological" impoverishment of this compartment, referring to specific cutoff values validated in the literature, but keeping in mind the lack of standardization of DXA measures. In addition, it is useful in treatment planning, estimating resting energy expenditure, and in follow-up, because it allows quantifying with high reproducibility the modifications in BC, distinguishing when the change is biological (deterioration due to a progression of the disease or improvement due to treatment). Due to DXA favorability in terms of accuracy, simplicity, availability, low cost and low radiation exposure, its role in sarcopenia diagnosis is becoming increasingly important, emerging as reference assessment technique in muscle mass evaluation.

Ultrasound is a non-invasive, fast, relatively inexpensive and available tool for estimating adiposity in clinical practice, and in several research settings. It does not expose patients to ionizing radiation risks, making the method ideal for the evaluation, and for follow-up studies. Several parameters and indexes based on adipose tissue thickness have been introduced and tested, and these have been correlated with clinical and laboratoristic parameters. Moreover, ultrasound can also be directed to the estimation of adipose tissue and intracellular fat indirectly, at cellular-molecular level: an opportunity for many radiologists who already and sometimes unconsciously perform "body composition" assessment when looking at the liver, at muscle as well as at other organs. However, standardized procedure and parameters are needing to improve accuracy and reproducibility. The purposes of this review are: 1) to provide a complete overview of the most used and shared measurements of adiposity; 2) to analyze technical conditions, accuracy, and clinical meaning of ultrasound in the study of body composition; 3) to provide some elements for the use of ultrasound in the evaluation of intra-cellular lipids accumulation, in two hot spots: liver and skeletal muscle.

When bone becomes frail due to metabolic disorders, one or more vertebral fractures (VFs) may occur. A vertebral body fracture after minor trauma is a hallmark of osteoporosis. VFs represent a target in clinical practice and are often an endpoint in clinical trials. The health care and economic burden of VFs is huge, and they also significantly increase mortality and morbidity, as well as impairing function and quality of life. VFs are frequently clinically silent, thus imaging plays a role not only after symptoms appear but also in screening. A VF can be detected incidentally during imaging examinations performed for different clinical indications. A rapid look at the spine included in the scanned field may lead to the discovery of a VF, which must be reported because the event may change the management of the patient and prevent further problems, defusing the so-called vertebral fracture cascade. This review article focuses on VF awareness and identification to answer these questions: What is a VF? What is the impact of VFs? How can we detect VF?

The main purpose of this paper is to analyze the digital radiographic methodologies used in diagnostic investigation, in order to reduce radiation doses to the patients by assuring a good quality of the images. To this end, the main parameters influencing the absorbed dose during radiographic exams and the effect of the human body on X-ray attenuation were investigated. It is generally understood that radiographic techniques need an appropriate choice of the operative parameters as functions of patients' characteristics, with the aim of providing the minimum dose that is compatible with an image that satisfies the goal of the examination and has a good signal-to-noise ratio. In an effort to identify an optimized radiographic protocol, the correlation between body size and radiation dose was investigated.