Francesco Porta | Università degli Studi di Firenze (University of Florence) (original) (raw)

Papers by Francesco Porta

PubMed, Jun 1, 2012

Ultrasonography of the elbow is a very helpful and reliable diagnostic procedure for a broad spec... more Ultrasonography of the elbow is a very helpful and reliable diagnostic procedure for a broad spectrum of rheumatic and orthopedic conditions, representing a possible substitute to magnetic resonance imaging for evaluation of soft tissues of the elbow. Musculoskeletal ultrasound (US) shows many advantages over other imaging modalities, probably the most important being its capability to perform a dynamic assessment of musculoskeletal elements with patient's partnership and observation during examination. In addition, ultrasonography is cost effective, easy available, and has excellent and multiplanar capability to visualize superficial soft tissue structures. Among all imaging procedures, US is highly accepted by patients. US assessment of the elbow requires good operator experience in the assessment of normal anatomy, and suitable high-quality equipment. US of the elbow provides detailed information including joint effusions, medial and lateral epicondylitis, tears of the distal biceps and triceps tendons, radial and ulnar collateral ligament tears, ulnar nerve entrapment, cubital or olecranon bursitis and intra-articular loose bodies. The aim of this paper is to review the screening technique and the basic normal and pathological findings in elbow US.

PubMed, Jun 1, 2012

Ultrasonography (US) is a helpful imaging tool in the evaluation of the musculoskeletal system. I... more Ultrasonography (US) is a helpful imaging tool in the evaluation of the musculoskeletal system. It has some advantages over the other imaging techniques, such as plain radiography, computed tomography and magnetic resonance imaging, represented by the non-invasiveness and multiplanar imaging capability, repeatability, lack of radiation burden, good patient acceptance, and relatively limited costs. US offers an excellent resolution and a possibility for real-time dynamic examination of the joints and surrounding soft tissues, as well as enables monitoring of therapeutic response. The most common clinical indications for US examination of the shoulder are rotator cuff and biceps tendon pathology (tenosynovitis, tendinosis, complete and partial tears, and impingement) and disorders of other soft-tissue structures (joint recesses, bursae, muscles, suprascapular and axillary nerves) as well as bony cortex abnormalities. US is very useful for US-guided procedures (biopsy, joint and bursae aspirations and injections, aspiration and dissolution of calcific tendinosis). The aim of this article is to analyze the current literature about US of the shoulder and to describe both normal and pathological findings.

Rheumatology, Dec 1, 2012

Modern US equipment allows rheumatologists to directly visualize vascular, musculoskeletal, derma... more Modern US equipment allows rheumatologists to directly visualize vascular, musculoskeletal, dermal and internal organ structure. In multisystemic and challenging diseases such as vasculitides and scleroderma, where new outcome measures are required in both clinical practice and trials, US measures promise reproducible and objective scores of disease activity and extension. US reveals early pathognonomic abnormalities and may help start early treatment.

Therapeutic Advances in Musculoskeletal Disease

Introduction: Viscosupplementation with hyaluronic acid (HA) is indicated for non-responders to n... more Introduction: Viscosupplementation with hyaluronic acid (HA) is indicated for non-responders to non-pharmacological therapy, to analgesics or when non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated. The aim of this study is to compare the efficacy, safety and costs of three different HA treatments ( Sinovial® Forte, sinovial one and hyalgan). Patients and methods: Ninety patients with grade I/II Kellgren–Lawrence knee osteoarthritis were included in three groups, the first was treated with hyalgan (weekly for 5 weeks), the second with Sinovial® Forte (weekly for 3 weeks) and the third group with a single injection of sinovial one. Results: All three treatments were effective, with an average reduction in the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score of 18.9 points for hyalgan, 18.04 points for Sinovial® Forte and 17.92 points for sinovial one. The comparison of the three groups did not show any statistical difference in terms of eff...

Annals of the Rheumatic Diseases, 2021

Background:Imaging has been extensively used for the Calcium Pyrophosphate Deposition Disease (CP... more Background:Imaging has been extensively used for the Calcium Pyrophosphate Deposition Disease (CPPD) diagnosis but the prevalence of joint calcifications at imaging in CPPD patients has not been thoroughly assessed.Objectives:This systematic literature review (SLR) is aimed to estimate the prevalence of calcium crystal deposition in peripheral joints by imaging in suspected or definite CPPD patients to establish relevant joints for CPPD monitoringMethods:After defining PICOs, Pubmed and Embase were searched from inception to October 2020 for identifying studies that evaluated the use of Conventional Radiography (CR), Ultrasound (US), Computed Tomography (CT) and Dual Energy Computed Tomography (DECT) in detecting calcifications at peripheral joints in patients with defined or probable CPPD. Search strategies based on MeSH terms and free text were applied. Six reviewers independently screened titles and abstracts, eligible article full texts were evaluated for inclusion and data extr...

Scleroderma, myositis and related syndromes, 2019

Annals of the Rheumatic Diseases, 2016

to 0.925 with the PPTs (P<0.05) in differentiating between vasculitis and pneumonic infiltration ... more to 0.925 with the PPTs (P<0.05) in differentiating between vasculitis and pneumonic infiltration and increased significantly from 0.527 without the PPTs to 0.724 with the PPTs (P<0.05) in detecting thrombosis. Compared with CT angiogram and perfusion scans no differences in the involved regions were detected. Variants that were associated with enhanced peripheral vascularization on color maps in a significant manner were: rate of diffusion capacity (p=0.006), hypocomplementemia (p=0.01), hypoxemia (p=0.003), pulmonary hypertension (p=0.01). The presence of lupus anticoagulant in patients with SLE was associated with the development of pulmonary thromboembolism (p=0.001) and pulmonary vasculitis complicated with thrombosis in situ (p=0.04). Image 1. Multi-stage differential diagnosis of GGO in patients with SLE and APS using PPTs. Conclusions: PPTs are a useful addition to native MSCT scans in detecting early signs of pulmonary vasculitis, differentiating between vasculitis and pneumonic infiltration and evaluation of treatment-related changes. It equips radiologists to more easily detect areas with thrombosis especially thrombosis in situ due to pulmonary vasculitis.

Poster Presentations, 2017

0 bursae. Ultrasound abnormalities were found in 62 joints, 73 tendons, 8 bursae, 0 entheses. Ove... more 0 bursae. Ultrasound abnormalities were found in 62 joints, 73 tendons, 8 bursae, 0 entheses. Overall physical examination and MSUS showed good concordance even if MSUS was more sensitive especially in detecting extra-articular locations. Conclusions: If the extra-articular locations of synovitis are taken in consideration during the ultrasound examination, there is a good sensitivity of MSUS and a better concordance between clinical and MSUS assessment of JIA. MSUS seems more accurate than physical assessment in detecting the exact position of the inflamed synovial membrane in each anatomical location (joint, synovial sheath, synovial bursa). It could be helpful not only for better addressing the injective procedures, but also for a global quantification of the synovitis (both intra and extra-articular), even if the exact clinical meaning of these ultrasound findings is still unknown, in terms of response to treatments and prognosis.

Clinical and experimental rheumatology

To evaluate the short-term efficacy of muscle shortening manoeuvre (MSM), by inducing an increase... more To evaluate the short-term efficacy of muscle shortening manoeuvre (MSM), by inducing an increase in strength of the shoulder muscles, for the treatment of shoulder impingement syndrome (SIS). Sixty subjects (mean age: 58.6 years) with SIS were assigned to one of 3 different treatment interventions: 1) MSM: a series of fast accelerations in the upward direction was applied to the upper limb that was also submitted to forces acting in the opposite direction (added mass); 2) traditional physiotherapeutic technique: scapulothoracic gliding; 3) simple traction: the added mass was applied to the limb without the series of fast accelerations. Pain intensity, Neer's impingement sign, range of motion and muscle strength were assessed. Ultrasound (US) examination was performed before, immediately after and 30 days after each treatment to study the width of the subacromial-subdeltoid bursa, long biceps tendon sheath and acromioclavicular joint. Impingement was evaluated by dynamic examina...

Medical ultrasonography, 2012

Musculoskeletal Ultrasonography (US) is nowadays widely used for clinical grounds and for researc... more Musculoskeletal Ultrasonography (US) is nowadays widely used for clinical grounds and for research purposes in rheumatology. US of the hand and wrist has recently developed due to the technological improvement and use of new, high resolution transducers. US is currently improving clinical examination of the rheumatic hand and wrist and it is commonly used as daily practice by many rheumatologists. The number of publications addressing this area of US scanning has grown exponentially over the last few years. The aim of this paper is to review the current literature on US of the hand and wrist in rheumatology, including US scanning techniques, as well as normal and pathological findings.

Annals of the Rheumatic Diseases, 2016

The t-GS score of the shoulder joint was significantly higher in the anti-CCP negative group than... more The t-GS score of the shoulder joint was significantly higher in the anti-CCP negative group than in the positive group (4.6 ± 2.0 and 2.8 ± 2.5, respectively, p<0.05). However, the remainder of the examined joints showed no significant differences. Furthermore, no significant differences were observed between the two groups in terms of the t-PD scores of all joints. In EORA patients, the t-GS and t-PD scores of the shoulder joint strongly correlated with the HAQ score (r=0.72, p<0.0001, r=0.68, p<0.0001, respectively) and, among the shoulder joint components, long head biceps tendon showed the strongest correlation both in the t-GS and t-PDS scores (r=0.64, p<0.0001, r=0.55, p<0.001). The t-PD scores of the shoulder, wrist, and MP joints correlated with DAS 28-ESR (r=0.62, p<0.0001, r=0.43, p<0.05, r=0.38, p<0.05). Conclusions: Shoulder joint involvement was a specific feature in patients with EORA and contributed to functional disability and increased disease activity. References: [1] Soubrier et al. Elderly-onset rheumatoid arthritis.

Rheumatology, 2012

The use of Doppler techniques, including power, colour and spectral Doppler, has greatly increase... more The use of Doppler techniques, including power, colour and spectral Doppler, has greatly increased in rheumatology in recent years. This is due to the ability of Doppler US (DUS) to detect pathological vascularization within joints and periarticular soft tissues, thereby demonstrating the presence of active inflammation, which has been reported to be correlated with the local neo-angiogenesis. In synovitis, DUS showed a high correlation with histological and MRI findings, thus it is considered a valid tool to detect pathological synovial vascularization. Moreover, it is more sensitive than clinical examination in detecting active joint inflammation and in the evaluation of response to treatment. In addition, DUS may be considered as a reference imaging modality in the assessment of enthesitis, MRI being not sensitive and histology not feasible. Moreover, it has been demonstrated to be able to detect changes in asymptomatic enthesis. In conclusion, DUS is a useful and sensitive tool in the evaluation and monitoring of active inflammation. Its widespread use in clinical rheumatological practice is recommended. The aim of this article is to review the current literature about the role of DUS in rheumatic diseases, analysing its validity, reliability and feasibility.

for the format and content of the report and documentation in musculoskeletal ultrasonography in ... more for the format and content of the report and documentation in musculoskeletal ultrasonography in rheumatology

Medical ultrasonography, 2012

Ultrasonography of the elbow is a very helpful and reliable diagnostic procedure for a broad spec... more Ultrasonography of the elbow is a very helpful and reliable diagnostic procedure for a broad spectrum of rheumatic and orthopedic conditions, representing a possible substitute to magnetic resonance imaging for evaluation of soft tissues of the elbow. Musculoskeletal ultrasound (US) shows many advantages over other imaging modalities, probably the most important being its capability to perform a dynamic assessment of musculoskeletal elements with patient's partnership and observation during examination. In addition, ultrasonography is cost effective, easy available, and has excellent and multiplanar capability to visualize superficial soft tissue structures. Among all imaging procedures, US is highly accepted by patients. US assessment of the elbow requires good operator experience in the assessment of normal anatomy, and suitable high-quality equipment. US of the elbow provides detailed information including joint effusions, medial and lateral epicondylitis, tears of the distal...

Background: According to guidelines, the use of steroid and/or hyaluronate (HA) intra-articular i... more Background: According to guidelines, the use of steroid and/or hyaluronate (HA) intra-articular injections for knee osteoarthritis (KOA) is controversial. Heterogeneity of studies and difference in HAs characteristics does not allow to draw safe conclusions. One of the major concerns is the accuracy of the procedure as up to 1/3 of injections could miss joint space when performed blindly (1), negatively affecting the efficacy of HA that needs to be placed correctly in the joint space Objectives: The aim of our study was to evaluate the longterm efficacy of a novel association of a Cross-Linked Sodium Hyaluronate Combined With Triamcinolone Hexacetonide (SHCTH) in patients with KOA in a real life setting. Methods: We retrospectively evaluated the clinical and ultrasonographic (US) data of patients (pts) affected by symptomatic KOA with intra-articular injections of SHCTH (1 injection every 6 months). Pts with concomitant inflammatory arthropaties were excluded. US guidance was carrie...

The Journal of rheumatology, 2017

To define the ultrasonographic characteristics of calcium pyrophosphate crystal (CPP) deposits in... more To define the ultrasonographic characteristics of calcium pyrophosphate crystal (CPP) deposits in joints and periarticular tissues and to evaluate the intra- and interobserver reliability of expert ultrasonographers in the assessment of CPP deposition disease (CPPD) according to the new definitions. After a systematic literature review, a Delphi survey was circulated among a group of expert ultrasonographers, who were members of the CPPD Ultrasound (US) Outcome Measures in Rheumatology (OMERACT) subtask force, to obtain definitions of the US characteristics of CPPD at the level of fibrocartilage (FC), hyaline cartilage (HC), tendon, and synovial fluid (SF). Subsequently, the reliability of US in assessing CPPD at knee and wrist levels according to the agreed definitions was tested in static images and in patients with CPPD. Cohen's κ was used for statistical analysis. HC and FC of the knee yielded the highest interobserver κ values among all the structures examined, in both the ...

Annals of the rheumatic diseases, Jan 13, 2018

To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of ca... more To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of calcium pyrophosphate deposition disease (CPPD) at the metacarpal-phalangeal, triangular fibrocartilage of the wrist (TFC), acromioclavicular (AC) and hip joints. A web-based exercise and subsequent patient-based exercise were carried out. A panel of 30 OMERACT members, participated at the web-based exercise by evaluating twice a set of US images for the presence/absence of CPPD. Afterwards, 19 members of the panel met in Siena, Italy, for the patient-based exercise. During the exercise, all sonographers examined twice eight patients for the presence/absence of CPPD at the same joints. Intraoberserver and interobserver kappa values were calculated for both exercises. The web-based exercise yielded high kappa values both in intraobserver and interobserver evaluation for all sites, while in the patient-based exercise, inter-reader agreement was acceptable for the TFC and the AC. TFC reached ...

BMJ Open Sport & Exercise Medicine

Background Waterpolo consists of a combination of swimming and throwing with close contact betwee... more Background Waterpolo consists of a combination of swimming and throwing with close contact between players. The shoulder is the most frequently injured joint, with a combination of rotator cuff tear and tendinopathy, long head biceps tendinopathy, superior labral lesions and shoulder impingement. This unique combination is a challenge for the clinician who must determine which of these shoulder pathologies is responsible for the onset of pain and the best strategy to rehabilitate the joint and prevent recurrence. Aim The aim of this study was to estimate with ultrasound the frequency and characteristics of shoulder injuries in waterpolo players competing in different leagues. Methods Forty-two players from two clubs in the premier and second Italian league were enrolled in the study. Standard and dynamic shoulder ultrasound scans were performed on all athletes.

Medical Ultrasonography, Sep 1, 2012

A complete physical examination of the hip is often difficult due to its size and deep position. ... more A complete physical examination of the hip is often difficult due to its size and deep position. During the last two decades, ultrasonography (US) of the hip has been widely accepted as a useful diagnostic tool in patients with hip pain and /or limited range of motion. It is commonly used in both adults and children. This technique allows evaluation of different anatomical structures and their pathological changes, such as joint recess (joint effusion, synovial hypertrophy), changes within the bursae (bursitis), tendons and muscles (tendinopathy, ruptures, calcifications), as well as changes in the bony profile of the joint surfaces, ischial tuberosity, and greater trochanter (erosions, osteophytes, calcific deposits). US is very useful for guided procedures in hip joint and periarticular soft tissues under direct visualization. The needle aspiration of synovial fluid and steroid injections are commonly-applied activities in daily rheumatology practice. The relatively limited acoustic windows available to the US beam are the principal limitations to hip US. Therefore, conducting a detailed examination of some important structures together with the interpretation of Doppler signal (sometimes undetectable) is not easy, requiring good knowledge of the modality. The aim of this review is to analyze the current literature about US of the hip and to describe the most frequently-observed normal and pathological findings.

PubMed, Jun 1, 2012

Ultrasonography of the elbow is a very helpful and reliable diagnostic procedure for a broad spec... more Ultrasonography of the elbow is a very helpful and reliable diagnostic procedure for a broad spectrum of rheumatic and orthopedic conditions, representing a possible substitute to magnetic resonance imaging for evaluation of soft tissues of the elbow. Musculoskeletal ultrasound (US) shows many advantages over other imaging modalities, probably the most important being its capability to perform a dynamic assessment of musculoskeletal elements with patient's partnership and observation during examination. In addition, ultrasonography is cost effective, easy available, and has excellent and multiplanar capability to visualize superficial soft tissue structures. Among all imaging procedures, US is highly accepted by patients. US assessment of the elbow requires good operator experience in the assessment of normal anatomy, and suitable high-quality equipment. US of the elbow provides detailed information including joint effusions, medial and lateral epicondylitis, tears of the distal biceps and triceps tendons, radial and ulnar collateral ligament tears, ulnar nerve entrapment, cubital or olecranon bursitis and intra-articular loose bodies. The aim of this paper is to review the screening technique and the basic normal and pathological findings in elbow US.

PubMed, Jun 1, 2012

Ultrasonography (US) is a helpful imaging tool in the evaluation of the musculoskeletal system. I... more Ultrasonography (US) is a helpful imaging tool in the evaluation of the musculoskeletal system. It has some advantages over the other imaging techniques, such as plain radiography, computed tomography and magnetic resonance imaging, represented by the non-invasiveness and multiplanar imaging capability, repeatability, lack of radiation burden, good patient acceptance, and relatively limited costs. US offers an excellent resolution and a possibility for real-time dynamic examination of the joints and surrounding soft tissues, as well as enables monitoring of therapeutic response. The most common clinical indications for US examination of the shoulder are rotator cuff and biceps tendon pathology (tenosynovitis, tendinosis, complete and partial tears, and impingement) and disorders of other soft-tissue structures (joint recesses, bursae, muscles, suprascapular and axillary nerves) as well as bony cortex abnormalities. US is very useful for US-guided procedures (biopsy, joint and bursae aspirations and injections, aspiration and dissolution of calcific tendinosis). The aim of this article is to analyze the current literature about US of the shoulder and to describe both normal and pathological findings.

Rheumatology, Dec 1, 2012

Modern US equipment allows rheumatologists to directly visualize vascular, musculoskeletal, derma... more Modern US equipment allows rheumatologists to directly visualize vascular, musculoskeletal, dermal and internal organ structure. In multisystemic and challenging diseases such as vasculitides and scleroderma, where new outcome measures are required in both clinical practice and trials, US measures promise reproducible and objective scores of disease activity and extension. US reveals early pathognonomic abnormalities and may help start early treatment.

Therapeutic Advances in Musculoskeletal Disease

Introduction: Viscosupplementation with hyaluronic acid (HA) is indicated for non-responders to n... more Introduction: Viscosupplementation with hyaluronic acid (HA) is indicated for non-responders to non-pharmacological therapy, to analgesics or when non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated. The aim of this study is to compare the efficacy, safety and costs of three different HA treatments ( Sinovial® Forte, sinovial one and hyalgan). Patients and methods: Ninety patients with grade I/II Kellgren–Lawrence knee osteoarthritis were included in three groups, the first was treated with hyalgan (weekly for 5 weeks), the second with Sinovial® Forte (weekly for 3 weeks) and the third group with a single injection of sinovial one. Results: All three treatments were effective, with an average reduction in the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score of 18.9 points for hyalgan, 18.04 points for Sinovial® Forte and 17.92 points for sinovial one. The comparison of the three groups did not show any statistical difference in terms of eff...

Annals of the Rheumatic Diseases, 2021

Background:Imaging has been extensively used for the Calcium Pyrophosphate Deposition Disease (CP... more Background:Imaging has been extensively used for the Calcium Pyrophosphate Deposition Disease (CPPD) diagnosis but the prevalence of joint calcifications at imaging in CPPD patients has not been thoroughly assessed.Objectives:This systematic literature review (SLR) is aimed to estimate the prevalence of calcium crystal deposition in peripheral joints by imaging in suspected or definite CPPD patients to establish relevant joints for CPPD monitoringMethods:After defining PICOs, Pubmed and Embase were searched from inception to October 2020 for identifying studies that evaluated the use of Conventional Radiography (CR), Ultrasound (US), Computed Tomography (CT) and Dual Energy Computed Tomography (DECT) in detecting calcifications at peripheral joints in patients with defined or probable CPPD. Search strategies based on MeSH terms and free text were applied. Six reviewers independently screened titles and abstracts, eligible article full texts were evaluated for inclusion and data extr...

Scleroderma, myositis and related syndromes, 2019

Annals of the Rheumatic Diseases, 2016

to 0.925 with the PPTs (P<0.05) in differentiating between vasculitis and pneumonic infiltration ... more to 0.925 with the PPTs (P<0.05) in differentiating between vasculitis and pneumonic infiltration and increased significantly from 0.527 without the PPTs to 0.724 with the PPTs (P<0.05) in detecting thrombosis. Compared with CT angiogram and perfusion scans no differences in the involved regions were detected. Variants that were associated with enhanced peripheral vascularization on color maps in a significant manner were: rate of diffusion capacity (p=0.006), hypocomplementemia (p=0.01), hypoxemia (p=0.003), pulmonary hypertension (p=0.01). The presence of lupus anticoagulant in patients with SLE was associated with the development of pulmonary thromboembolism (p=0.001) and pulmonary vasculitis complicated with thrombosis in situ (p=0.04). Image 1. Multi-stage differential diagnosis of GGO in patients with SLE and APS using PPTs. Conclusions: PPTs are a useful addition to native MSCT scans in detecting early signs of pulmonary vasculitis, differentiating between vasculitis and pneumonic infiltration and evaluation of treatment-related changes. It equips radiologists to more easily detect areas with thrombosis especially thrombosis in situ due to pulmonary vasculitis.

Poster Presentations, 2017

0 bursae. Ultrasound abnormalities were found in 62 joints, 73 tendons, 8 bursae, 0 entheses. Ove... more 0 bursae. Ultrasound abnormalities were found in 62 joints, 73 tendons, 8 bursae, 0 entheses. Overall physical examination and MSUS showed good concordance even if MSUS was more sensitive especially in detecting extra-articular locations. Conclusions: If the extra-articular locations of synovitis are taken in consideration during the ultrasound examination, there is a good sensitivity of MSUS and a better concordance between clinical and MSUS assessment of JIA. MSUS seems more accurate than physical assessment in detecting the exact position of the inflamed synovial membrane in each anatomical location (joint, synovial sheath, synovial bursa). It could be helpful not only for better addressing the injective procedures, but also for a global quantification of the synovitis (both intra and extra-articular), even if the exact clinical meaning of these ultrasound findings is still unknown, in terms of response to treatments and prognosis.

Clinical and experimental rheumatology

To evaluate the short-term efficacy of muscle shortening manoeuvre (MSM), by inducing an increase... more To evaluate the short-term efficacy of muscle shortening manoeuvre (MSM), by inducing an increase in strength of the shoulder muscles, for the treatment of shoulder impingement syndrome (SIS). Sixty subjects (mean age: 58.6 years) with SIS were assigned to one of 3 different treatment interventions: 1) MSM: a series of fast accelerations in the upward direction was applied to the upper limb that was also submitted to forces acting in the opposite direction (added mass); 2) traditional physiotherapeutic technique: scapulothoracic gliding; 3) simple traction: the added mass was applied to the limb without the series of fast accelerations. Pain intensity, Neer's impingement sign, range of motion and muscle strength were assessed. Ultrasound (US) examination was performed before, immediately after and 30 days after each treatment to study the width of the subacromial-subdeltoid bursa, long biceps tendon sheath and acromioclavicular joint. Impingement was evaluated by dynamic examina...

Medical ultrasonography, 2012

Musculoskeletal Ultrasonography (US) is nowadays widely used for clinical grounds and for researc... more Musculoskeletal Ultrasonography (US) is nowadays widely used for clinical grounds and for research purposes in rheumatology. US of the hand and wrist has recently developed due to the technological improvement and use of new, high resolution transducers. US is currently improving clinical examination of the rheumatic hand and wrist and it is commonly used as daily practice by many rheumatologists. The number of publications addressing this area of US scanning has grown exponentially over the last few years. The aim of this paper is to review the current literature on US of the hand and wrist in rheumatology, including US scanning techniques, as well as normal and pathological findings.

Annals of the Rheumatic Diseases, 2016

The t-GS score of the shoulder joint was significantly higher in the anti-CCP negative group than... more The t-GS score of the shoulder joint was significantly higher in the anti-CCP negative group than in the positive group (4.6 ± 2.0 and 2.8 ± 2.5, respectively, p<0.05). However, the remainder of the examined joints showed no significant differences. Furthermore, no significant differences were observed between the two groups in terms of the t-PD scores of all joints. In EORA patients, the t-GS and t-PD scores of the shoulder joint strongly correlated with the HAQ score (r=0.72, p<0.0001, r=0.68, p<0.0001, respectively) and, among the shoulder joint components, long head biceps tendon showed the strongest correlation both in the t-GS and t-PDS scores (r=0.64, p<0.0001, r=0.55, p<0.001). The t-PD scores of the shoulder, wrist, and MP joints correlated with DAS 28-ESR (r=0.62, p<0.0001, r=0.43, p<0.05, r=0.38, p<0.05). Conclusions: Shoulder joint involvement was a specific feature in patients with EORA and contributed to functional disability and increased disease activity. References: [1] Soubrier et al. Elderly-onset rheumatoid arthritis.

Rheumatology, 2012

The use of Doppler techniques, including power, colour and spectral Doppler, has greatly increase... more The use of Doppler techniques, including power, colour and spectral Doppler, has greatly increased in rheumatology in recent years. This is due to the ability of Doppler US (DUS) to detect pathological vascularization within joints and periarticular soft tissues, thereby demonstrating the presence of active inflammation, which has been reported to be correlated with the local neo-angiogenesis. In synovitis, DUS showed a high correlation with histological and MRI findings, thus it is considered a valid tool to detect pathological synovial vascularization. Moreover, it is more sensitive than clinical examination in detecting active joint inflammation and in the evaluation of response to treatment. In addition, DUS may be considered as a reference imaging modality in the assessment of enthesitis, MRI being not sensitive and histology not feasible. Moreover, it has been demonstrated to be able to detect changes in asymptomatic enthesis. In conclusion, DUS is a useful and sensitive tool in the evaluation and monitoring of active inflammation. Its widespread use in clinical rheumatological practice is recommended. The aim of this article is to review the current literature about the role of DUS in rheumatic diseases, analysing its validity, reliability and feasibility.

for the format and content of the report and documentation in musculoskeletal ultrasonography in ... more for the format and content of the report and documentation in musculoskeletal ultrasonography in rheumatology

Medical ultrasonography, 2012

Ultrasonography of the elbow is a very helpful and reliable diagnostic procedure for a broad spec... more Ultrasonography of the elbow is a very helpful and reliable diagnostic procedure for a broad spectrum of rheumatic and orthopedic conditions, representing a possible substitute to magnetic resonance imaging for evaluation of soft tissues of the elbow. Musculoskeletal ultrasound (US) shows many advantages over other imaging modalities, probably the most important being its capability to perform a dynamic assessment of musculoskeletal elements with patient's partnership and observation during examination. In addition, ultrasonography is cost effective, easy available, and has excellent and multiplanar capability to visualize superficial soft tissue structures. Among all imaging procedures, US is highly accepted by patients. US assessment of the elbow requires good operator experience in the assessment of normal anatomy, and suitable high-quality equipment. US of the elbow provides detailed information including joint effusions, medial and lateral epicondylitis, tears of the distal...

Background: According to guidelines, the use of steroid and/or hyaluronate (HA) intra-articular i... more Background: According to guidelines, the use of steroid and/or hyaluronate (HA) intra-articular injections for knee osteoarthritis (KOA) is controversial. Heterogeneity of studies and difference in HAs characteristics does not allow to draw safe conclusions. One of the major concerns is the accuracy of the procedure as up to 1/3 of injections could miss joint space when performed blindly (1), negatively affecting the efficacy of HA that needs to be placed correctly in the joint space Objectives: The aim of our study was to evaluate the longterm efficacy of a novel association of a Cross-Linked Sodium Hyaluronate Combined With Triamcinolone Hexacetonide (SHCTH) in patients with KOA in a real life setting. Methods: We retrospectively evaluated the clinical and ultrasonographic (US) data of patients (pts) affected by symptomatic KOA with intra-articular injections of SHCTH (1 injection every 6 months). Pts with concomitant inflammatory arthropaties were excluded. US guidance was carrie...

The Journal of rheumatology, 2017

To define the ultrasonographic characteristics of calcium pyrophosphate crystal (CPP) deposits in... more To define the ultrasonographic characteristics of calcium pyrophosphate crystal (CPP) deposits in joints and periarticular tissues and to evaluate the intra- and interobserver reliability of expert ultrasonographers in the assessment of CPP deposition disease (CPPD) according to the new definitions. After a systematic literature review, a Delphi survey was circulated among a group of expert ultrasonographers, who were members of the CPPD Ultrasound (US) Outcome Measures in Rheumatology (OMERACT) subtask force, to obtain definitions of the US characteristics of CPPD at the level of fibrocartilage (FC), hyaline cartilage (HC), tendon, and synovial fluid (SF). Subsequently, the reliability of US in assessing CPPD at knee and wrist levels according to the agreed definitions was tested in static images and in patients with CPPD. Cohen's κ was used for statistical analysis. HC and FC of the knee yielded the highest interobserver κ values among all the structures examined, in both the ...

Annals of the rheumatic diseases, Jan 13, 2018

To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of ca... more To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of calcium pyrophosphate deposition disease (CPPD) at the metacarpal-phalangeal, triangular fibrocartilage of the wrist (TFC), acromioclavicular (AC) and hip joints. A web-based exercise and subsequent patient-based exercise were carried out. A panel of 30 OMERACT members, participated at the web-based exercise by evaluating twice a set of US images for the presence/absence of CPPD. Afterwards, 19 members of the panel met in Siena, Italy, for the patient-based exercise. During the exercise, all sonographers examined twice eight patients for the presence/absence of CPPD at the same joints. Intraoberserver and interobserver kappa values were calculated for both exercises. The web-based exercise yielded high kappa values both in intraobserver and interobserver evaluation for all sites, while in the patient-based exercise, inter-reader agreement was acceptable for the TFC and the AC. TFC reached ...

BMJ Open Sport & Exercise Medicine

Background Waterpolo consists of a combination of swimming and throwing with close contact betwee... more Background Waterpolo consists of a combination of swimming and throwing with close contact between players. The shoulder is the most frequently injured joint, with a combination of rotator cuff tear and tendinopathy, long head biceps tendinopathy, superior labral lesions and shoulder impingement. This unique combination is a challenge for the clinician who must determine which of these shoulder pathologies is responsible for the onset of pain and the best strategy to rehabilitate the joint and prevent recurrence. Aim The aim of this study was to estimate with ultrasound the frequency and characteristics of shoulder injuries in waterpolo players competing in different leagues. Methods Forty-two players from two clubs in the premier and second Italian league were enrolled in the study. Standard and dynamic shoulder ultrasound scans were performed on all athletes.

Medical Ultrasonography, Sep 1, 2012

A complete physical examination of the hip is often difficult due to its size and deep position. ... more A complete physical examination of the hip is often difficult due to its size and deep position. During the last two decades, ultrasonography (US) of the hip has been widely accepted as a useful diagnostic tool in patients with hip pain and /or limited range of motion. It is commonly used in both adults and children. This technique allows evaluation of different anatomical structures and their pathological changes, such as joint recess (joint effusion, synovial hypertrophy), changes within the bursae (bursitis), tendons and muscles (tendinopathy, ruptures, calcifications), as well as changes in the bony profile of the joint surfaces, ischial tuberosity, and greater trochanter (erosions, osteophytes, calcific deposits). US is very useful for guided procedures in hip joint and periarticular soft tissues under direct visualization. The needle aspiration of synovial fluid and steroid injections are commonly-applied activities in daily rheumatology practice. The relatively limited acoustic windows available to the US beam are the principal limitations to hip US. Therefore, conducting a detailed examination of some important structures together with the interpretation of Doppler signal (sometimes undetectable) is not easy, requiring good knowledge of the modality. The aim of this review is to analyze the current literature about US of the hip and to describe the most frequently-observed normal and pathological findings.