Matias De Albert

Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Catalonia, Spain

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Publications (15)16.61 Total impact

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    ABSTRACT: OBJECTIVE: To investigate whether rheumatoid arthritis (RA) and psoriatic arthritis (PsA) can be differentiated in the early stages of the disease (duration of symptoms ≤1 year) on the basis of magnetic resonance imaging (MRI) features of the hand and wrist. MATERIAL AND METHODS: Twenty early RA and 17 early PsA patients with symptomatic involvement of the wrist and hand joints and inconclusive radiographic studies were examined prospectively with contrast-enhanced MRI. Images were evaluated in accordance with the Outcome Measures in Rheumatology Clinical Trials recommendations. RESULTS: Certain MRI features, such as the presence of enthesitis or extensive diaphyseal bone marrow edema, were observed exclusively in PsA (P = 0.0001). These distinctive findings were present in nearly 71% (12/17) of PsA patients. Diffuse and, in some cases, pronounced soft-tissue edema spreading to the subcutis was also seen more frequently in patients with PsA (P = 0.002). There were no significant differences in the frequency of synovitis, bone erosions, subchondral bone edema, or tenosynovitis between the 2 groups. However, in RA extensor tendons were involved more often than the flexor tendons, whereas in PsA the opposite was observed (P = 0.014). With respect to the discriminatory power of the different MRI findings examined, only the presence of enthesitis or diaphyseal bone edema and, to a lesser extent, the pattern of hand tendon involvement and the presence of soft-tissue edema accurately differentiated PsA from RA (all these features achieved accuracies greater than 0.70). CONCLUSIONS: We observed significant differences in the MRI findings of the hand and wrist that can help to distinguish between RA and PsA in the early stages of disease. This imaging method could help to assist in the differential diagnostic process in selected patients in whom diagnosis cannot be unequivocally established after conventional clinical, biochemical, and radiographic examinations.
    Seminars in arthritis and rheumatism 05/2012; 42(3). · 4.72 Impact Factor
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    ABSTRACT: PURPOSE/AIM 1. To review the more common imaging features of malignant soft-tissue tumors of the distal extremities. 2. To recognize the pathologic basis of these imaging features. 3. To describe the combinations of clinical and imaging features that can suggest a specific diagnosis in patients with malignant soft-tissue tumors of the distal extremities. CONTENT ORGANIZATION A. Key concepts of clinical and imaging soft-tissue masses assessment. B. Review of pathologic and imaging (radiographs, US, CT, MR imaging) findings: - Synovial sarcoma - Epithelioid sarcoma - Clear cell sarcoma - Acral myxoinflammatory fibroblastic sarcoma - Other soft-tissue sarcoma subtypes - Non-sarcomatous malignant tumors: cutaneous epidermoid carcinoma, Merkel carcinoma. C. Differential diagnosis with common benign s-t masses. D. Role of imaging in the treatment planning. SUMMARY Malignant soft-tissue tumors located in wrist-hands or ankles-feet are rare. Careful analysis of imaging features often identify those indeterminate or suspicious lesions. Some of these lesions present imaging features than can suggest a specific diagnosis: paramagnetic effect and heel location in clear cell sarcoma, cyst-like appearance and yuxtaarticular location in synovial sarcoma, and lymph node metastases in embryonal rhabdomyosarcoma, epithelioid sarcoma and Merkel carcinoma.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting; 12/2010
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    ABSTRACT: PURPOSE/AIM To review the spectrum of MD-CT and MR imaging findings of arthritis of the anterior chest wall (ACW) in patients with Spondyloarthritis. To illustrate the current role of MD-CT and MR imaging in the diagnosis of the ACW joint involvement in Spondyloarthritis. To assess potential pitfalls in the imaging diagnosis of the arthritis of the ACW. CONTENT ORGANIZATION A. Key concepts on clinical assessment of patients with suspected arthritis of the anterior chest wall (ACW). B. Anatomic considerations: - sternoclavicular joints - manubriosternal joint - sternocostal joints C. Review of imaging findings: - Synovitis, joint fluid - Erosions - Joint narrowing - Subchondral bone marrow edema - Subchondral sclerosis - Ligament ossification - Partial and complete ankylosis D. Pitfalls in MD-CT and MRI assessment of arthritis of ACW SUMMARY The imaging evaluation of arthritis of the ACW represents a problem both for the anatomic region complexity and for the low sensibility of radiographs. MD-CT and MR imaging can identify the key pathologic features of arthritis of the ACW at disease presentation. MD-CT identifies better the bone changes (erosions, subchondral sclerosis) and ligament ossification, whereas MR imagig is most sensitive in the detection of synovitis, and it is the unique modality than can detect BME changes.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting; 12/2010
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    ABSTRACT: A 9-year-old boy presented with a 3-week history of left hip pain. Four weeks prior, the patient had suffered a superficial injury to his abdomen, which required a subcutaneous suture. At admission, he had intermittent fever. He was reluctant to bear weight on his left limb and had gait disturbances. Plain-film pelvic radiographs performed in the emergency room were suspicious for a bone tumor of the left ischium. CT, bone scintigraphy, and MRI examinations were requested to rule out bone tumor.
    03/2010: pages 1-22;
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    ABSTRACT: Early diagnosis and treatment have been recognized as essential for improving clinical outcomes in patients with early rheumatoid arthritis. However, diagnosis is somewhat difficult in the early stages of the disease because the diagnostic criteria were developed from data obtained in patients with established rheumatoid arthritis and therefore are not readily applicable. Magnetic resonance (MR) imaging is increasingly being used in the assessment of rheumatoid arthritis due to its capacity to help identify the key pathologic features of this disease entity at presentation. MR imaging has demonstrated greater sensitivity for the detection of synovitis and erosions than either clinical examination or conventional radiography and can help establish an early diagnosis of rheumatoid arthritis. It also allows the detection of bone marrow edema, which is thought to be a precursor for the development of erosions in early rheumatoid arthritis as well as a marker of active inflammation. In addition, MR imaging can help differentiate rheumatoid arthritis from some clinical subsets of peripheral spondyloarthropathies by allowing identification of inflammation at the insertions of ligaments and tendons (enthesitis).
    Radiographics 01/2010; 30(1):143-63; discussion 163-5. · 2.73 Impact Factor
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    ABSTRACT: PURPOSE To describe and assess ultrasound (US) guided biopsy of peripheral joint synovial tissue. METHOD AND MATERIALS Between January 2008 and January 2009, 11 patients have undergone synovial biopsies performed under US guidance, as a diagnostic procedure for chronic monoarthritis of unknown etiology. There were 8 men and 3 women, mean age: 60.1 years (range 24-86 yr). Hemogram and other laboratory data were unremarkable. Radiographs and MR imaging study of the involved joint were obtained previously to the procediment in all cases. MR imaging studies identified synovitis, bone marrow edema and erosions in 10 cases, and synovial masses suggestive of Pigmented Villonodular Synovitis in 1 case. After synovial thickening was confirmed by MR and US examinations, the optimal approach to the joint was decided in accordance with maximal synovial thickening location and adjacent anatomic structures, with special emphasis on neurovascular bundles. Joint fluid aspiration was performed previously to biopsy. Trucut biopsy was performed with a 14-18 gauge biopsy gun (both 18G and 14G needle in three cases, 18G in 4 cases, 16G in 4 cases). The number of passes varied between three and seven cores (average, 4.6 cores). Biopsy specimen samples were sent for pathological and bacteriological examinations. RESULTS Synovial tissue was identified by pathologic examination of the biopsy specimen in all cases. Pathologic findings correspond to rheumatoid arthritis pannus (n=1), PVNS (n=1), and chronic synovitis without evidence of granulomas in the remaing cases (n=9). Microbiologic cultures were negative in all cases. The combination of histologic and microbiologic findings allow exclusion of joint infection in all cases. In two cases, small joint effusion was detected by US inmmediately after the procedure, and treated with US-guided arthrocentesis, which obtained serohematic effusion. No other complications occurred. CONCLUSION US guided synovial biopsy of the peripheral joints of patients with chronic monoarthritri is a safe and effective technique. It may replace open surgical biopsy because it can obtain synovial membrane samples for pathological and bacteriological examinations, in addition to synovial fluid analysis. CLINICAL RELEVANCE/APPLICATION Chronic monoarthritis often causes a diagnostic dilemma. Synovial biopsy may be the only way to exclude some infectious agents difficult to identify, including mycobacteria, brucella and fungi.
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 12/2009
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    ABSTRACT: To evaluate the correlation between neurological deficits indicative of compressive myelopathy and MRI findings in a series of patients with RA and symptomatic involvement of the cervical spine. Forty-one consecutive patients with RA were studied using cervical spine MRI. Unconditional logistic regression analysis was used to identify MRI parameters of cervical spine involvement associated with the development of neurological dysfunction. The mean age of the 41 patients (33 women and 8 men) was 59 yrs (range 23-82 yrs), while the median disease duration was 18 +/- 9 yrs (range 4-40 yrs). According to Ranawat's classification, 17 (42%) patients were in Class I, 21 (51%) in Class II and 3 (7%) in Class III. Thus, patients with clinical manifestations of compressive myelopathy (Ranawat's Class II + III) represented 58% (24/41) of all cases. Among the different MRI parameters of cervical spine involvement analysed, only the presence of atlantoaxial spinal canal stenosis [odds ratio (OR) 4.55; 95% CI 1.14-18.15], atlantoaxial cervical cord compression (OR 9.6; 95% CI 1.08-85.16) and subaxial myelopathy changes (OR 11.43; 95% CI 1.3-100.81) were associated with a significantly increased risk for neurological dysfunction (Ranawat's Class II or III). In RA patients with symptomatic cervical spine involvement, there is a strong correlation between the development of neurological dysfunction and MRI identification of atlantoaxial spinal canal stenosis, especially in those cases with evidence of upper cervical cord or brainstem compression and subaxial myelopathy changes.
    Rheumatology (Oxford, England) 11/2008; 47(12):1814-9. · 4.44 Impact Factor
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    ABSTRACT: To investigate the frequency and clinical significance of bone marrow edema (BME) in a series of patients with rheumatoid arthritis (RA) and symptomatic involvement of the cervical spine. We studied 19 consecutive RA patients with cervical spine magnetic resonance imaging (MRI) according to a specifically designed protocol that included short inversion time inversion recovery sequences. All cases had neck pain unresponsive to conventional treatment, neurological symptoms, or signs suggestive of cervical myelopathy, or cervical pain with evidence of atlantoaxial subluxation on radiographs. The mean age of the 19 patients (15 women and 4 men) at time of the study was 59 +/- 12 years (range, 23-82) and the median disease duration was 14 +/- 7.4 years (range, 4-30). BME was observed in 74% (14/19) of the patients: at the atlantoaxial level alone in 16% of the patients; subaxially alone in 16%; and at both levels in 42% of the patients. At the atlantoaxial level, BME was usually observed involving the odontoid process, whereas subaxially BME was limited to the vertebral plates and the interapophyseal joints. Patients with BME had higher erythrocyte sedimentation rate (ESR) values at the time of MRI examination (P = 0.014) and more severe atlantoaxial joint MRI synovitis scores (P = 0.05) compared with the remaining patients; the frequency of odontoid erosions was also greater in this group, but the difference did not reach statistical significance. Altogether, these data suggest a more severe inflammatory response in these patients. In this group a significant correlation was found between BME scores at atlantoaxial level and (1) ESR values (r = 0.854; P = 0.001) and (2) atlantoaxial joint MRI synovitis scores (r = 0.691; P = 0.001). BME is frequently observed in patients with established RA and symptomatic cervical spine involvement. Both atlantoaxial and subaxial levels are equally affected. The presence of BME seems related to the intensity of the inflammatory response and to the severity of the atlantoaxial joint synovitis.
    Seminars in arthritis and rheumatism 04/2008; 38(4):281-8. · 4.72 Impact Factor
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    ABSTRACT: PURPOSE/AIM To review the Multidetector CT (MD-CT) and MR imaging patterns of tarsal coalition. To illustrated the associated bone and soft-tissue lesions in patients with tarsal coalition. CONTENT ORGANIZATION A) Key clinical concepts in clinical diagnosis and management of tarsal coalition B) Hindfoot anatomy review C) Technical considerations D) MD-CT and MR imaging features of the different types of tarsal coalition E) Associated lesions: 1- Secondary articular degenerative changes 2 - BME - Joint effusion, synovitis 3- Tendinous lesions ( tenosynovitis, longitudinal tears) 4- Sinus tarsal syndrome 5- Plantar fasciitis F) Role of advanced imaging techniques in treatment planning SUMMARY MD- CT and MR imaging are invaluable for assessment of tarsal coalitions because they allow differentiation of osseous from nonosseous coalitions and because they depict the full extent of joint involvement. Identification of common associated lesions (Joint effusion, secondary degenerative changes, tendinous lesions, BME, plantar fasciitis and sinus tarsal syndrome) have crucial importance in treatment planning, mainly when surgery is indicated.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM To the review the different patterns of displaced proximal humeral fractures on MD-CT based on Neer classification. To recognize the significance of displacement and/or angulation of the different fracture fragments in surgery planification. CONTENT ORGANIZATION A) Key points in clinical management of proximal humeral fractures B) MD-CT technical considerations (MPR,VR) C) Proximal humeral anatomy on MD-CT D) Review of the Neer classification system, emphasizing the definition of separate part E) Main indications of MD-CT in proximal humeral fractures F) Rol of post-processing MD-CT (MPR, VR) in Neer classification of proximal humeral fractures G) Key points of surgical treatment of displaced proximal humeral fractures SUMMARY Proximal humerus fractures are complex injuries which are difficult to diagnose precisely on radiographs. MD-CT can diagnose accurately the different pattern of Neer classification and the displacement and/or angulation of fragments, to decide a proper surgically treatment.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM To: 1. Present a comprehensive review of the pathogenesis, classification and imaging findings of SNAC wrist. 2. Describe the imaging key points required for an optimal management expressed in the language used by hand surgeons to improve radiological reports. 3. Illustrate the most common surgical procedures and their radiological appearance. CONTENT ORGANIZATION 1.Scaphoid region anatomy/ fracture patterns. 2.MDCT findings Scaphoid non-union.Scaphoid necrosis. SNAC classification. 3.Key points Proximal pole necrosis. Scaphoid humpback deformity and scaphoid length. Dorsal Intercalated Segment Instability (DISI).Capitate head status. Radio-scaphoid, luno-capitate or scapho-capitate impingement 4.Surgical procedures Screw Fixation. Styloidectomy. Scaphoidectomy and four corner fusion. Capitolunate arthrodesis. Proximal row carpectomy Wrist fusion. SUMMARY The imaging of SNAC wrist and its classification is focused on periscaphoid osteoarthritic changes, which can better assessed using MDCT. It is important to recognize and to reflect appropriately in the radiological reports a) some associated entities such as DISI and proximal scaphoid necrosis and b) other MDCT findings (humpback deformity, scaphoid length, etc.) since they have an important prognosis significance and help to design which should be surgical approach.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM 1. To review the imaging features of cervical spine involvement in Rheumatoid Arthritis patients. 2. To discuss the role of the different imaging modalities and their impact on the clinical management of cervical spine involvement in Rheumatoid Arthritis patients. CONTENT ORGANIZATION A. General statements of cervical spine involvement in RA. B. Technical considerations: - Radiographs (standard and functional views) - MD-CT - MR imaging (standard, neck flexed sequences) C. Imaging features: - Erosions - Synovitis - Subchondral bone marrow edema - Ligamentous changes D. Patterns of Cervical Spine Instability: - Atlantoaxial (all types) - Subaxial E. Role of imaging in the treatment planning of these patients, with emphasis on managment of cervical subluxations SUMMARY Radiographs are the first imaging test in RA patients with suspected cervical spine involvement because can identify atlantoaxial joint instability, but are insensitive to early changes. MR imaging is the modality of choice to detect synovitis, erosions and bone edema in the atlantoaxial joint, as well as to assess the spinal canal and medullay cord, mainly in symptomatic cases. MD CT is helpful when MR imaging is contraindicated and to assess surgically treated patients.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM Describe the clinically relevant anatomic features of the tibial plateau Discuss the pathophysiology of tibial plateau fractures. Identify the Multidetector CT appearances of tibial plateau fractures in the Schatzker clasification and their treatment implications. CONTENT ORGANIZATION A. Anatomic features of the tibial plateau. B. Pathophysiology of tibial plateau fractures. C. General technical considerations in Multidector CT evaluation of tibial plateau fractures. D. Tibial plateau fractures patterns on Multidetector CT: Schatzker classification. E. Usefulness of multidetector CT assessment of associated ligamentous injuries. F. Pitfalls on Multidetector CT assessment of tibial plateau fractures. G. Treatment planning: operative or non operative management. SUMMARY Multidetector CT has become the modality of choice in identifying and characterizing tibial plateau fractures. Familiarity with the pathophysiology of tibial plateau fractures is essential to understand their imaging patterns as well as the associated ligamentous injuries. Knowledge of multidetector CT patterns of tibial plateau fracture and their classification accordingly to the Schatzker description is essential for radiologist to guide the treating physicians.
    Radiological Society of North America 2008 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM To illustrate the normal anatomy of cervical spine on Multi-Detector Computed Tomography (MDCT). To review the pathophysiology of cervical spine fractures and imaging features of stability/instability on MDCT. To describe the clinical and management significance of each type of lesion. CONTENT ORGANIZATION 1. Technical considerations of MD-CT of the cervical spine in trauma 2. MDCT features of fractures according to the lesional mechanism : - Flexion injuries - Flexion-rotation injuries - Extension injuries - Hyperextension-lateral rotation injuries - Vertical compression injuries - Craniocervical injuries 3. MDCT findings indicating biomechanical instability or compromise of the spinal canal 4. Associated lesions 5. Role of imaging in treatment planning SUMMARY MDCT is replacing radiographs to rule out cervical spine fractures mainly in high-energy traumatisms. As it is becoming the standard imaging technique in evaluating politraumatic patients, it is important to familiarize with the technical issues and MDCT imaging features of cervical spine fractures. After completing this exhibit the radiologist should be able to recognize different types of cervical spine fractures on MDCT and to provide clinicals information to guide treatment planning.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM To review the spectrum of MR imaging findings of early and late-stage sacroiliitis in patients with Spondyloarthritis. To illustrate the usefulness of MR imaging in establishing an early diagnosis of Spondyloarthritis, when radiographs and CT are normal or show inconclusive changes. CONTENT ORGANIZATION A. Key concepts on clinical assessment of patients with suspected Spondyloarthritis. B. MR technical considerations in assessment of sacroiliitis. C. Review of MR findings: - Synovitis - Subchondral bone marrow edema (BME) - Enthesitis - Erosions - Subchondral fatty marrow infiltration and sclerosis - Partial and complete ankylosis D. Pitfalls in MR assessement of sacroiliitis. E. Current role of MR imaging of sacroiliac joints in the diagnosis of Spondyloarthritis. SUMMARY MR imaging can identify the key pathologic features of sacroiliitis at disease presentation. Synovitis and subchondral BME, which are though to be markers of active inflammation, predominate in the dorsocaudal region of the synovial joint in early disease. MR imaging detection of sacroiliac enthesitis can help to confirm the diagnosis in difficult or equivocal cases. Erosions, subchondral fatty marrow infiltration and sclerosis, and ankylosis are late, irreversible changes.
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting;