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Povzetek: Introduction/Aims Changes in body composition in patients with spinal muscular atrophy (SMA) can cause endocrine abnormalities that are insufficiently studied in adults. We aimed to assess the endocrine profile in a cohort of adults with SMA. Second, we compared body composition and endocrine profiles between nonambulatory and ambulatory patients and between different types of SMA. Methods The cross-sectional study included 29 SMA patients (18 [62.1%] males and 11 [37.9%] females) of median age 44 (IQR 30–51.5) years with type 2, 3, or 4. Body composition was measured by bioimpedance. Morning blood samples were drawn for glycated hemoglobin (HbA1c), lipid profile, testosterone, cortisol, and insulin-like growth factor-1 (IGF-1). Blood glucose, insulin, and beta-hydroxybutyrate (BHB) were measured during a 75 g oral glucose tolerance test. The homeostatic model assessment for insulin resistance index was calculated. Results In total, 75.9% of patients had increased fat mass (FM), with 51.7% having an increase despite normal body mass index. Ambulation was the most important discriminating factor of body composition. 93.1% of patients had metabolic abnormalities, including hyperglycemia, insulin resistance, and dyslipidemia. Increased BHB, a marker of ketosis, was present in more than a third of patients. Functional hypogonadism was present in half of male patients. Testosterone and IGF-1 negatively correlated with FM. Discussion Adult patients with SMA had abnormal body composition and highly prevalent metabolic disturbances that might increase cardiometabolic risk. Because treatments have modified the course of SMA, it is important to investigate whether these observations translate into clinically relevant outcomes.
Ključne besede: spinal muscular atrophy, endocrine manifestations, adults
Objavljeno v DiRROS: 15.06.2026; Ogledov: 27; Prenosov: 17
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Povzetek: Diffusion tensor imaging (DTI) enables a non-invasive assessment of tissue architecture based on water diffusion. Advancements in technology have expanded the application of DTI from the central nervous system to the peripheral nervous system. High-resolution magnetic resonance imaging (MRI) systems have further enhanced the visualization of nerve compartments. This study investigates the influence of region of interest (ROI) selection on DTI indices in ex vivoperipheral nerves. Cadaveric median nerves (n=10) were harvested and immersed in fluorinated-carbon liquid, and 9-mm segments were independently scanned with a 9.4-T MRI system (scanning time 40 h). Diffusion-weighted signals were summed, and diffusion tensors were calculated for anatomical compartments using different delineation techniques. Following the initial scan, five samples were scanned for the second time using an identical protocol. The analysis showed that the inclusion of an inert background into the ROI significantly reduces fractional anisotropy (FA). Significant differences in diffusion tensors were observed between the initial and intermediate nerve portions, with FA and mean diffusivity (MD) differing by as much as 25.2% and 25.6%, respectively. Tracing the fascicles without the interfascicular epineurium exhibited an 8.8% lower FA compared to the delineations of the epineurium. Second MRI scans showed significant changes in diffusion tensors with higher eigenvalues D1-D3 and MD. In conclusion, the intermediate portions of the nerve demonstrated greater consistency in DTI indices and are therefore recommended for analysis over the initial portions. Using an inert liquid can minimize background effects, but the inherent diffusion properties of the tissue must be carefully considered. Prolonged scanning times can alter diffusion tensors, likely due to autolytic processes, underscoring the importance of consistent pre-scanning conditions and acquisition protocols. Additionally, maintaining consistency in delineations is paramount, regardless of whether the tracing method includes or excludes the interfascicular epineurium.
Ključne besede: diffusion tensor imaging, fractional anisotropy, image analysis, perineural tissue, peripheral nerve
Objavljeno v DiRROS: 09.06.2026; Ogledov: 72; Prenosov: 55
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Povzetek: Objective: This study aimed to develop, validate and test the clinical feasibility of ultrasound (US) speckle tracking method based on gradient optical flow for quantifying small longitudinal displacements, shear and strain in peripheral nerves. Methods: The speckle tracking method was validated using seven thawed, fresh-frozen isolated cadaveric forearms. Longitudinal motion of the median nerve was captured using a high-frequency 22 MHz linear probe. An air bubble marker was inserted as a reference point for manual measurement comparison. The precision and accuracy of the method were assessed by comparing manual and automatic measurements. Clinical feasibility was tested on eight healthy subjects, measuring the longitudinal displacement of the median nerve during elbow extension and shoulder anteflexion. Results: The method demonstrated linearity, high precision and accuracy, particularly with a backtrace of five frames, reducing the displacement underestimation to 4%. In cadaveric models, the highest shear strain was observed at the nerve-tissue interfaces. In healthy subjects, the mean displacement of the median nerve was 3.3 ± 1.0 mm, with good inter-rater reliability (intraclass correlation coefficient = 0.87). Conclusion: The US speckle tracking method based on gradient optical flow effectively quantifies small longitudinal displacements and shear strain in peripheral nerves, with high precision and accuracy. However, the method could not detect longitudinal strain in nerves within the range of tested displacements. Future studies should investigate its applicability to smaller and deeper nerves and its usefulness in different pathological conditions.
Ključne besede: gradient optical flow, high-resolution ultrasound, peripheral nerve displacement, shear strain quantification, speckle tracking
Objavljeno v DiRROS: 20.04.2026; Ogledov: 160; Prenosov: 150
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Povzetek: 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.
Ključne besede: ganglion, local anesthetics, maxillary artery, maxillary nerve, pterygopalatine fossa, sphenopalatine ganglion block
Objavljeno v DiRROS: 23.03.2026; Ogledov: 228; Prenosov: 130
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Povzetek: 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.
Ključne besede: axial psoriatic arthritis, axial spondyloarthritis, imaging, magnetic resonance imaging
Objavljeno v DiRROS: 24.02.2026; Ogledov: 488; Prenosov: 227
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