1. Elbow motion induces greater median nerve excursion and lower shear strain than wrist or finger motion in healthy volunteersTjaša Tomažin, Gregor Omejec, Nejc Umek, Suren Armeni Jengojan, Roman Kamnik, Ana Mandeljc, Žiga Snoj, 2026, original scientific article Abstract: Introduction/Aims: Previous ultrasound (US)-based assessments of median nerve (MN) displacement within the carpal tun-nel have shown inconsistent results due to methodological variability. Quantitative data on how different upper-limb movementsaffect MN displacement and shear strain at the wrist remain scarce. This study aimed to quantify MN longitudinal displacementand shear strain during finger, wrist, and elbow movements in healthy individuals to establish normative patterns of nerve glid-ing and deformation.Methods: Twenty healthy subjects (13 females; mean age: 31.9 years, range: 27–36 years) were prospectively recruited. US vid-eos captured MN motion during middle finger, wrist, and elbow movements. A custom robotic device ensured consistent wristmotion and forearm stability. Speckle-tracking software was used to analyze MN absolute longitudinal displacement, relativedisplacement to adjacent deep and superficial tissues, and normalized shear strain at both interfaces.Results: Elbow motion resulted in significantly greater MN absolute displacement (3.8 ± 1.2 mm) and displacement relative todeep tissue (3.6 ± 1.2 mm), compared to finger or wrist motion. No significant differences were observed in MN displacementrelative to superficial tissue across motions. Normalized shear strain at the deep interface was lowest during elbow motion(41.8 ± 16.6 mm−1). Significant differences were found for wrist-to-elbow and finger-to-elbow motions, but not for finger-to-wristmotions.Discussion: Presented findings highlight the importance of joint-specific contributions to MN motion and suggest that proximaljoint movements, such as at the elbow, may promote more effective nerve excursion while minimizing shear strain. This knowl-edge may help refine nerve current mobilization approaches.
Keywords: dynamic ultrasound, longitudinal displacement, median nerve, shear strain, speckle tracking
Published in DiRROS: 23.03.2026; Views: 146; Downloads: 104
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2. Injectate distribution patterns with the posterior infrazygomatic and transoral approaches to the pterygopalatine fossaAnže Jerman, Luka Pušnik, Erika Cvetko, Nejc Umek, Žiga Snoj, 2025, original scientific article Abstract: Background: Injectate distribution patterns in the pterygopalatine fossa may differ based on the drug administration approach used. This study primarily aimed to assess and compare injectate distribution following the posterior infrazygomatic and transoral approaches. The secondary aim was to evaluate the safety of both approaches. Methods: Injectate distribution patterns were evaluated in 13 cadaveric head specimens. The vessels were perfused with a gelatin-based solution containing an iodinated contrast agent. The ultrasound-guided posterior infrazygomatic approach and transoral approach were performed on contralateral sides, and needle placement was confirmed using computed tomography (CT). A methylene blue and iodinated contrast agent solution was administered following successful needle placement. Injectate distribution and injuries were assessed via CT and anatomical dissection. Results: With the posterior infrazygomatic approach, methylene blue consistently stained the maxillary artery and nerve, sphenopalatine ganglion, and lateral pterygoid muscle, whereas with the transoral approach, it most frequently surrounded the maxillary artery and structures within the greater palatine canal. The iodinated contrast agent was distributed predominantly along the needle trajectories for both approaches. Injuries to the maxillary artery and facial nerve were documented following the posterior infrazygomatic approach, whereas an injury to the lateral pterygoid plate was observed following the transoral approach. Conclusions: With the posterior infrazygomatic approach, contrast agent encompassed the entire pterygopalatine fossa, whereas the transoral approach yielded a more localized distribution, primarily within the inferior portion and greater palatine canal. These differences in distribution patterns should guide the selection of the most appropriate approach based on the specific clinical indication.
Keywords: ganglion, local anesthetics, maxillary artery, maxillary nerve, pterygopalatine fossa, sphenopalatine ganglion block
Published in DiRROS: 23.03.2026; Views: 107; Downloads: 54
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3. Quantitative MRI Assessment of supraspinatus tendon remodeling following a single platelet-rich plasma injection using T2 mapping and relaxation time profilingKarlo Pintarić, Andrej Vovk, Vladka Salapura, Žiga Snoj, Jernej Vidmar, 2025, original scientific article Abstract: Background: Quantitative magnetic resonance imaging (MRI) techniques such as T2 mapping may detect early tendon changes following biologic therapies. This study aimed to assess the structural remodeling of the supraspinatus tendon using mean T2 values and T2 distribution profiles after an ultrasound (US)-guided single platelet-rich plasma (PRP) injection. Methods: Twenty-six patients with symptomatic supraspinatus tendinopathy were divided into tendinosis (n = 9) and partial tear (n = 13) groups. T2 mapping and clinical evaluations (shoulder pain and disability index questionnaire (SPADI), Constant-Murley score) were conducted at baseline and 6 months post-PRP. Mean T2 values were measured in three tendon segments (lateral, middle, and medial), and T2 profiles were compared to asymptomatic controls. Results: Clinical outcomes showed significant improvement in both the tendinosis and partial tear groups at the 6-month follow-up. Although no significant changes were observed in the mean T2 relaxation times across tendon segments following PRP treatment, T2 distribution profiling revealed statistically significant alterations in both groups. In the tendinosis group, post-treatment T2 profiles approached those of the asymptomatic controls, suggesting structural remodeling consistent with tendon healing. Conclusions:T2 mapping is an effective tool for detecting tendon remodeling following PRP therapy. Structural improvements indicative of tissue healing were observed in cases of tendinosis, but not in partial tendon tears. These findings support the use of T2 mapping-particularly the T2 distribution profiling-as a quantitative biomarker for assessing treatment response to PRP.
Keywords: T2 mapping, magnetic resonance imaging, supraspinatus tendon
Published in DiRROS: 27.02.2026; Views: 147; Downloads: 87
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4. Sacroiliac joint involvement in psoriatic arthritis – MRI, radiographic and clinical findings in 581 European routine care patientsNora Vladimirova, Anna Enevold Fløistrup Hadsbjerg, Simon Lyngaa Krabbe, Adrian Ciurea, Kristyna Bubova, Monika Gregová, Michael J. Nissen, Burkhard Möller, Raphael Micheroli, Susanne Pedersen, Žiga Snoj, Karlo Pintarić, Žiga Rotar, 2025, original scientific article Abstract: Background: Axial involvement in psoriatic arthritis (axPsA) is associated with more severe disease and increased pain, yet no consensus definition of axPsA exists. This study aims to describe the occurrence and characteristics of MRI and radiographic sacroiliac joint (SIJ) involvement in a European PsA cohort. Methods: Patients with a clinical diagnosis of PsA or of axial spondyloarthritis with psoriasis and available routine care SIJ MRIs were included from five European registries in the EuroSpA collaboration. SIJ MRIs and radiographs were centrally assessed for inflammatory and structural lesions, differential diagnoses, and globally evaluated for SpAindicative findings. Results: Among 581 PsA patients (mean age 45 years, 47% male), 31% exhibited SpA-indicative SIJ-MRI findings (MRI-axPsA). In MRI-axPsA patients, the most common lesions were bone marrow edema (BME) (69%), erosions (68%), and fat lesions (58%), generally present bilaterally. BME≥1 cm, inflammation in an erosion cavity, capsulitis, fat lesions≥1 cm, backfill, and ankylosis were observed almost exclusively in MRI-AxPsA patients. Differential diagnoses included osteitis condensans ilii (8%), probable strain-related BME (11%) and degenerative disease (16%). Among 259 patients with radiographs, 29% met the radiographic mNY criteria for ankylosing spondylitis and 38% had SpAindicative MRI findings. Male sex, HLA-B27 positivity, elevated CRP and history of inflammatory back pain (but not current back pain) were independently associated with MRI-detected axial involvement. Conclusion: In this large European cohort, one-third of routine care PsA patients had axial involvement, based on global SIJ MRI assessment. The study supports incorporating MRI into the future definition of axPsA to enable early identification.
Keywords: axial psoriatic arthritis, axial spondyloarthritis, imaging, magnetic resonance imaging
Published in DiRROS: 24.02.2026; Views: 280; Downloads: 109
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5. Image-guided injections for facet joint pain : evidence-based Delphi conjoined consensus paper from the European Society of Musculoskeletal Radiology and European Society of NeuroradiologyLuca Maria Sconfienza, Danoob Dalili, Miraude Adriaensen, Domenico Albano, Georgina Allen, Maria Pilar Aparisi Gomez, Žiga Snoj, 2025, original scientific article Abstract: Objectives: To perform a Delphi-based consensus on published evidence on image-guided injections for facet joint pain (FJP) and provide clinical indications. Methods: We report the results of an evidence-based Delphi consensus of 38 experts from the European Society of Musculoskeletal Radiology and the European Society of Neuroradiology, who reviewed the published literature for evidence on image-guided injections for FJP. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when ≥ 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the consensus were used to write the paper. Results: Twenty statements on image-guided FJP treatment have been drafted. Eighteen statements received strong consensus, while two received broad consensus. Three statements reached the highest level of evidence, all of them regarding the lumbar spine. All radiological methods are used for image-guided injections for FJP, and regardless of the radiological method used, all show good safety and efficacy. Facet joint injections and medial branch blocks are used in all spinal regions to treat FJP, and both show similar clinical outcomes. Advanced technological solutions have been studied in the field of lumbar FJP; however, the level of evidence for these is low. Conclusion: Despite promising results reported by published papers on image-guided injections for FJP, there is still a lack of evidence on injection efficacy, appropriateness of imaging methods, and optimal medication.
Keywords: spine, facet joints, interventional radiology, injection, Delphi process
Published in DiRROS: 12.12.2025; Views: 537; Downloads: 219
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6. Effect of tirzepatide-induced weight loss on adipose tissue in obesity : rationale and design of the randomized placebo-controlled Tirzepatide Brown and Beige Adipose Tissue Activation (TABFAT) trialRok Herman, Mojca Jensterle Sever, Simon Horvat, Luka Ležaič, Žiga Snoj, Igor Pušnik, Katja Goričar, Andrej Cör, Luka Pušnik, Vid Mlačnik, Lara Hanželič, Andrej Janež, 2025, original scientific article Abstract: Background Obesity is a complex disease marked by excessive, dysfunctional adipose tissue accumulation. Recent research underscores the pivotal role of brown adipose tissue (BAT) in metabolic health and its potential as a thera- peutic target for obesity management. Emerging preclinical and clinical evidence suggests that second-generation anti-obesity drugs, especially dual agonists such as tirzepatide, may enhance BAT activity. Additionally, beige adipose tissue, derived from white adipose tissue (WAT), may contribute significantly to whole-body thermogenesis, yet its role remains underexplored. Methods This investigator-initiated, randomized, placebo-controlled clinical trial aims to evaluate the effects of tirzepatide on BAT activity and WAT browning in premenopausal women with obesity. Thirty-four participants will be randomized 1:1 to receive either tirzepatide or a placebo for 24 weeks. Primary outcomes include changes in BAT volume and activity, assessed using 18F-FDG-PET/CT, MRI, and infrared thermography, as well as the induction of WAT browning, evaluated through changes in mRNA expression patterns and histomorphometric alterations in subcuta- neous adipose tissue samples. Secondary outcomes will involve the assessment of whole-body composition, resting energy expenditure, and various metabolic health markers, correlated with thermogenic adipose tissue changes. Comparative analysis of BAT assessment methods will refine protocols for research and clinical use. Discussion This study is the first to systematically explore the potential of pharmacological obesity management to enhance BAT activity and induce WAT browning. Results may establish thermogenic adipose tissue augmentation as a novel mechanism of action for second-generation anti-obesity medications.
Keywords: brown adipose tissue, beige adipose tissue, pancreas resection, tirzepatide, obesity
Published in DiRROS: 26.11.2025; Views: 350; Downloads: 208
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7. Assessment of short-term effect of platelet-rich plasma treatment of tendinosis using texture analysis of ultrasound imagesKarlo Pintarić, Vladka Salapura, Žiga Snoj, Andrej Vovk, Mojca Božič Mijovski, Jernej Vidmar, 2023, original scientific article Keywords: texture analysis, ultrasonography, tendinosis
Published in DiRROS: 25.07.2024; Views: 1123; Downloads: 377
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