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Biomedical subjects

H K Genant

Publications and source records attributed to H K Genant.

At least 325 records · Page 18Linked to original sources
PubMed1991

Skeletal integrity in premenopausal and postmenopausal women receiving long-term L-thyroxine therapy.

PURPOSE: The impact of long-term L-thyroxine replacement therapy on skeletal integrity is a growing concern because of the large number of women receiving thyroid hormone therapy. The purpose of this study was to examine the hypothesis that long-term L-thyroxine therapy in which the free thyroxine index (FT4I) is maintained within a physiologic range has minimal impact on vertebral or femoral bone mineral density in both premenopausal and postmenopausal women. PATIENTS AND METHODS: We measured hip integral and spinal trabecular and integral bone densities in 28 premenopausal and 28 postmenopausal women who had been receiving L-thyroxine therapy for a median of 12 and 15 years, respectively, and in whom therapy was titrated to keep the FT4I within the normal range. The relationship between bone density parameters and thyroid hormone status was examined using univariate and multivariate statistical methods. RESULTS: Seventy-nine percent of the premenopausal women and 86% of the postmenopausal women had FT4I values in the normal range at the time of bone density determination. Moreover, throughout the study's duration, the majority of annually measured values were in the normal range for more than 80% of subjects. Premenopausal women had slightly lower bone density than would be expected for age: -6.7% (z = -0.39 +/- 0.74 [mean +/- SD], p less than 0.01), -3.1% (z = -0.22 +/- 0.78, p = 0.15), and -5.1% (z = -0.36 +/- 0.74, p less than 0.02) for spinal trabecular, spinal integral, and hip integral bone density, respectively. Postmenopausal women likewise had slightly lower bone density values that were significant only at the hip: -0.2% (z = -0.01 +/- 1.01, p = 0.95), -1.0% (z = -0.05 +/- 1.11, p = 0.80), and -6.2% (z = -0.39 +/- 0.80, p less than 0.02) for spinal trabecular, spinal integral, and hip integral bone density, respectively. When patients with previously treated Graves' disease (n = 4 in each group) were eliminated, the differences in bone density at the hip were no longer seen. Correlation analysis revealed only weak and generally nonsignificant relationships between parameters of thyroid hormone status and bone density at any site in either subgroup. Results of multiple regression analysis among the pooled data of all subjects showed that age provided a consistently significant contribution (R2 = 0.18 to 0.66) to the variability in bone density at the spine and the hip, but parameters of thyroid hormone status did not. CONCLUSION: These data provide the first supportive evidence that long-term L-thyroxine therapy that maintains the FT4I in the physiologic range is associated with a statistically significant, but clinically minimal, decrement in spinal and hip bone density in both premenopausal and postmenopausal women. The decrement at the hip was entirely due to the inclusion of patients with treated Graves' diseases. Thus, the changes in bone density in women receiving long-term L-thyroxine therapy are minimal at most and should not be a contraindication to therapy.

Adult↗
PubMed1991

The index of radiographic area (IRA): a new approach to estimating the severity of vertebral deformity.

To assess the overall severity of vertebral deformity for an individual, we developed the index of radiographic area (IRA), a computerized method for analyzing vertebral dimensions from lateral radiographs of the spine. Six coordinates for each vertebral body are recorded in a computer by means of a digitizer. A computer program identifies all abnormal vertebrae, computes the radiographic area of the remaining normal vertebrae, and then estimates the expected normal radiographic area for the abnormal vertebrae in that individual. Differences between the expected and observed radiographic area of all abnormal vertebrae are summed to produce the IRA score. The score correlated well with the quantitative score of vertebral deformity of an experienced radiologist (r = 0.85), and with the vertebral bone density by quantitative computed tomography (QCT) (r = 0.66). The IRA is a practical, standardized method for quantitating the overall severity of vertebral deformity in individuals who have vertebral fractures. Its reproducibility for longitudinal studies and clinical trials needs further study.

Aged↗
PubMed1991

MRI in the evaluation of patients with suspected instability of the shoulder joint including a comparison with CT-arthrography.

Thirty-two patients with clinical suspicion of shoulder instability were the subject of this assessment of MRI (1.5 T G. E. Signa) and its comparison with CT-arthrography (GE8800 and GE9800) of the shoulder. Twenty-seven patients had a final diagnosis established by arthroscopy and five by arthrotomy. The imaging examinations were interpreted independently by three radiologists blinded against history, surgical diagnosis and results of the compared test. The statistical analysis included ROC-curves, sensitivity, specificity and accuracy as well as predictive values. The significance of the comparative results was assessed by the McNemar Sign test. MRI showed significantly better diagnostic results in the evaluation of labral structures (sensitivity 85%, specificity 90%, accuracy 88%) and humeral head impression fractures (75, 82, 78 %). None of the tests were of sufficient diagnostic value to identify capsular abnormalities. CT and MRI results regarding the biceps tendon and loose bodies were similar, however, statistically not significant. MRI proved to be of high diagnostic value in the assessment of the unstable shoulder and compared favorably with CT-A.

Adolescent↗
PubMed1991

Lateral tibial rim (Segond) fractures: MR imaging characteristics.

The magnetic resonance (MR) imaging characteristics of lateral tibial rim (Segond) fractures and their associated injuries were reviewed in 12 patients with radiographic evidence of this fracture. Bone marrow adjacent to the fracture emitted a focally abnormal MR signal, which indicated an injury of the lateral capsular junction. The Segond fragment, however, was seen on MR images in only four of 12 patients. Associated ligamentous and meniscal injuries identified with MR imaging and arthroscopy involved the anterior (n = 11) and medial (n = 7) cruciate ligaments and the lateral (n = 4) and medial (n = 1) menisci. Focal bone marrow edema was due to injury of the lateral capsular junction. MR imaging evidence of such edema should indicate the presence of a lateral capsular injury and fracture, if one has not already been demonstrated with conventional radiography. A high association of Segond fractures with tears of the anterior cruciate ligament was confirmed, and MR imaging signs of a Segond fracture may therefore be used as indirect evidence for tears of that ligament.

Adolescent↗
PubMed1991

Osteoarthritis of the knee: comparison of radiography, CT, and MR imaging to assess extent and severity.

Although conventional radiography is the method most frequently used for monitoring progression of osteoarthritis, it may not show osteoarthritic changes of the knee until late in the disease, and it may show involvement of only one or two compartments in patients who have tricompartmental disease. We compared radiography, CT, and MR imaging for assessing the extent and severity of osteoarthritis of the knee in 20 patients. Radiography included posteroanterior weight-bearing, true lateral, and sunrise patellar projections. Axial CT scans were reformatted in sagittal and coronal planes. MR imaging consisted of spin-echo (600-800/20; 2000/60, 120 [TR/TE]), and gradient-echo (600/30, theta = 30 degrees) sequences. The severity of osteoarthritic changes was graded from 0 to 3. MR frequently showed tricompartmental cartilage loss when radiography and CT showed only bicompartmental involvement in the medial and patellofemoral compartments. In the lateral compartment, MR showed a higher prevalence of cartilage loss (60%) than radiography (35%) and CT (25%) did. In the medial compartment, CT and MR showed osteophytes in 100% of the knees, whereas radiography showed osteophytes in only 60%. Notably, radiography often failed to show osteophytes in the posterior medial femoral condyle. On MR images, meniscal degeneration or tears were found in all 20 knees studied. Partial and complete tears of the anterior cruciate ligament were found in three and seven patients, respectively. MR is more sensitive than radiography and CT for assessing the extent and severity of osteoarthritic changes and frequently shows tricompartmental disease in patients in whom radiography and CT show only bicompartmental involvement. MR imaging is unique for evaluating meniscal and ligamentous disease related to osteoarthritis.

Adult↗
PubMed1991

Noninvasive measurements of bone mass, structure, and strength: current methods and experimental techniques.

Current methods for assessing osteoporotic fracture risk involve measuring the content and/or density of bone at a number of skeletal sites and relating the measurement to that in either age-matched or young control subjects measured at the same site with the same technique. These densitometric methods have been used to predict several types of fractures; however, engineering principles verify that the bone structure and loading conditions also affect skeletal strength. Many densitometric measurements inherently contain information about skeletal structure and bone distribution, yet this information is not clinically used. In this paper, the currently available techniques for assessing bone content and density, namely, single-photon absorptiometry, dual-photon absorptiometry, dual-energy X-ray absorptiometry, and quantitative CT, and their usefulness in assessing fracture risk and distinguishing between patients with and without osteoporosis are reviewed. Extensions of conventional densitometry that have been developed by several researchers to include information in addition to bone mass also are presented. Results from recent studies using new applications of ultrasound techniques and MR imaging are reviewed. Preliminary studies show the value of these new techniques in noninvasive measurement of bone structure in order to estimate bone strength and assess fracture risk more accurately. However, to become clinically useful, many of these methods require further investigation to increase their ease of use and decrease their cost.

Absorptiometry, Photon↗
PubMed1991

Concomitant occurrence of subchondral cyst and ruptured anterior crucial ligament at knee joint: new findings by MRI.

The magnetic resonance imaging (MRI) in 4 cases of subchondral cyst at the knee joint region, were acquired from a 1.5 Tesla imager. We found a high incidence of concomitant occurrence of subchondral cysts with a ruptured anterior cruciate ligament (ACL) in all of these cases. The 2 men and 2 women, had an average age of 35. Clinically, they complained of dull knee pain and mild instability. Conventional radiography detected subchondral cysts in 3 of them, while MRI disclosed that all of the subchondral cysts were at the tibial plateau, close to the intercondyloid eminence. To date, MRI is the only imaging modality which can depict the concomitant occurrence of a subchondral cyst and a ruptured anterior cruciate ligament at the knee joint. Whether these subchondral cysts were the consequences of the ruptured anterior cruciate ligaments as one of the causes in addition to synovial fluid intrusion and bony contusion, need further clinical observation and investigation.

Adult↗
PubMed1991

Three-dimensional imaging of the musculoskeletal system: an overview.

The clinical applications of three-dimensional computed tomography (3-D CT) reconstruction continue to expand rapidly. Recently, the field of three-dimensional magnetic resonance (3-D MR) reconstruction has also been developing. Three dimensional imaging offers a new approach to the analysis of complex anatomic relationships. The spatial configuration of an object can be directly displayed without observers requiring mental integration of a series of two-dimensional images. The easily interpretable images of 3-D CT have proven to be useful for surgical planning. Three-dimensional CT displays have used widely in the preoperative planning of craniofacial surgery, dysplastic hips in children, and complex fractures of skeletal systems. However, 3-D MR displays are technically more difficult than those of CT scans, and 3-D MR displays of the musculaskeletal system are still in a developing stage. Recently, we explored the feasibility of 3-D MR displays. This article provides an overview of those areas of the musculoskeletal system where the use of 3-D MR has proven valuable. The current techniques and ongoing applications are also presented. We believe that this exciting development will expand our ability to visualize pathologic anatomy in the near future.

Algorithms↗
PubMed1991

The effects of estrone (Ogen) on spinal bone density of postmenopausal women.

The effects of cyclical treatment with estrone sulfate (0.3, 0.625, or 1.25 mg), plus calcium carbonate, on spinal trabecular bone density were compared with placebo in 120 postmenopausal women in this 2-year, multicenter, double-blind study. While the placebo and 0.3-mg treatment groups lost bone density (-3.6% and -5.1%), the 0.625- and 1.25-mg treatment groups experienced no significant change from baseline at 24 months (-0.8% and +0.7%). The 1.25-mg treatment group was significantly different from the placebo group at 12, 18, and 24 months. Although the 0.625-mg treatment group was significantly different from the placebo group only at 18 months, the data suggest that 0.625 and 1.25 mg of estrone sulfate had different effects than placebo and 0.3 mg of estrone sulfate and, given with supplemental calcium, are effective doses for the prevention of spinal bone loss.

Bone Density↗
PubMed1991

Osteoporosis. Current techniques and recent developments in quantitative bone densitometry.

Knowledge about the proper use and interpretation of bone densitometry studies and an understanding of appropriate medical interventions are not universal among physicians, nor are instrumentation and technical performance of bone density studies of uniformly high quality. Indeed, this deficiency of medical and technical expertise is the principal deterrent to widespread implementation of our recommended clinical applications at this time. Nonetheless, given the current impetus to disseminate information about osteoporosis, to make newer instrumentation more readily available, and to limit the cost of these techniques, we anticipate that our recommendations may soon become standard medical practice.

Absorptiometry, Photon↗
PubMed1990

Intermittent cyclical etidronate treatment of postmenopausal osteoporosis.

BACKGROUND: To determine the effects of etidronate (a bisphosphonate that inhibits osteoclast-mediated bone resorption) in the treatment of postmenopausal osteoporosis, we conducted a prospective, two-year, double-blind, placebo-controlled, multicenter study in 429 women who had one to four vertebral compression fractures plus radiographic evidence of osteopenia. METHODS: The patients were randomly assigned to treatment with phosphate (1.0 g) or placebo twice daily on days 1 through 3, etidronate (400 mg) or placebo daily on days 4 through 17, and supplemental calcium (500 mg) daily on days 18 through 91 (group 1, placebo and placebo; group 2, phosphate and placebo; group 3, placebo and etidronate; and group 4, phosphate and etidronate). The treatment cycles were repeated eight times. The bone density of the spine was measured by dual-photon absorptiometry, and the rates of new vertebral fractures were determined from sequential radiographs. RESULTS: After two years, the patients receiving etidronate (groups 3 and 4) had significant increases in their mean (+/- SE) spinal bone density (4.2 +/- 0.8 percent and 5.2 +/- 0.7 percent, respectively; P less than 0.017). The rate of new vertebral fractures was reduced by half in the etidronate-treated patients (groups 3 and 4 combined) as compared with the patients who did not receive etidronate (groups 1 and 2 combined) (29.5 vs. 62.9 fractures per 1000 patient-years; P = 0.043); the effect of treatment was most striking in the subgroup of patients with the lowest spinal bone mineral density at base line, in whom fracture rates were reduced by two thirds (42.3 vs. 132.7 fractures per 1000 patient-years; P = 0.004). The addition of phosphate provided no apparent benefit. There were no significant adverse effects of treatment. CONCLUSIONS: Intermittent cyclical therapy with etidronate for two years significantly increases spinal bone mass and reduces the incidence of new vertebral fractures in women with postmenopausal osteoporosis.

Aged↗
PubMed1990

Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis.

Progressive bone loss in osteoporosis results from bone resorption in excess of bone formation. We conducted a double-blind study in 66 women with postmenopausal osteoporosis of therapy with etidronate, a diphosphonate compound that reduces bone resorption by inhibiting osteoclastic activity. The patients were randomly assigned in equal numbers to receive oral etidronate (400 mg per day) or placebo for 2 weeks, followed by a 13-week period in which no drugs were given. This sequence was repeated 10 times, for a total of 150 weeks. Daily oral supplementation with calcium and vitamin D was given throughout the study to both groups. Vertebral bone mineral content was measured by dual-photon absorptiometry; spinal radiographs were assessed to identify new vertebral fractures. Vertebral bone mineral content increased significantly (P less than 0.01) after 150 weeks of etidronate therapy (5.3 percent; 95 percent confidence interval, 2.0 to 8.6; n = 20) but decreased with placebo (-2.7 percent; 95 percent confidence interval, -7.3 to 1.9; n = 20). The difference between groups was 8.0 percentage points (P less than 0.01; 95 percent confidence interval, 2.4 to 13.6). The rates of fracture were significantly different for the period from week 60 to week 150 between the etidronate and placebo groups (6 vs. 54 fractures per 100 patient-years; P = 0.023). No adverse clinical, biochemical, or bone histomorphometric effects of treatment were observed. We conclude that at the end of nearly three years, etidronate therapy for postmenopausal osteoporosis results in significant increases in vertebral bone mineral content and, after approximately one year of treatment, a significant decrease in the rate of new vertebral fractures.

Administration, Oral↗
PubMed1990

Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group.

To determine whether measurement of bone density predicts hip fracture in women, we prospectively studied 9703 nonblack women aged 65 years and older who had measurements of bone mineral density using single-photon absorptiometry in the calcaneus, distal radius, and proximal radius. During an average of 1.6 years of follow-up, 53 hip fractures occurred. The risk of hip fracture was inversely related to bone density at all three measurement sites. After adjusting for age, the relative risk of hip fracture was 1.66 for a decrease of 1 SD in the bone density at the calcaneus (95% confidence interval, 1.22 to 2.26), 1.55 (95% confidence interval, 1.13 to 2.11) at the distal radius, and 1.41 (95% confidence interval, 1.06 to 1.88) at the proximal radius. None of the three measurements was a significantly better predictor of hip fracture than the others. After adjusting for bone mineral density, the risk of hip fracture doubled for each 10-year increase in age (relative risk, 2.09; 95% confidence interval, 1.31 to 3.33). We conclude that decreased bone density in the appendicular skeleton is associated with an increased risk of hip fracture, but this accounts for only part of the age-related increase in risk of hip fracture among older women.

Age Factors↗
PubMed1990

Magnetic resonance imaging of the shoulder: rationale and current applications.

Because it can demonstrate a wide range of tissue contrast with excellent resolution, magnetic resonance (MR) imaging has revolutionized imaging in many areas of the musculoskeletal system and has generated excitement among those interested in the painful shoulder. Shoulder impingement syndrome and glenohumeral instability constitute the two major categories of shoulder derangements. Correct diagnosis requires the use of appropriate pulse sequences and imaging planes, proper patient positioning, and a satisfactory surface coil. In addition the imager must have a thorough understanding of shoulder anatomy and pathology. We present a summary of the current status of MR imaging of the shoulder including technical, anatomic, and pathologic considerations and a review of the pertinent literature.

Humans↗
PubMed1990

Lumbar spinal fusion. Assessment of functional stability with magnetic resonance imaging.

Segmental spinal instability was evaluated with magnetic resonance (MR) imaging, computed tomography (CT), and conventional radiography in 33 patients who had undergone surgical spinal fusion. In 16 of the 19 patients who had a diagnosis of solid fusion, the immobilized vertebral bodies demonstrated areas of high signal intensity on images with short repetition time (TR) and echo time (TE). The signal intensity of these areas was either less intense or normal on images with long TR and TE. In 10 of the 14 patients with segmental instability at the fusion site, subchondral vertebral bands of low signal intensity were shown on short TR/TE images, which demonstrated high signal intensity on long TR/TE images. All but two of the patients showed vertebral signal changes 12 or more months past fusion or onset of clinical symptoms. The vertebral MR signal intensity in solid lumbar fusions might be related to marrow composition changes resulting from decreased biomechanical stress, while the vertebral signal intensities in patients with unstable fusions might be related to reparative granulation tissue, inflammation, edema, and hyperemic changes. Magnetic resonance imaging appears to be unique in its assessment of functional fusion stability. Magnetic resonance may be most useful in patients symptomatic of fusion pseudarthrosis in whom conventional radiography and CT fail to demonstrate anatomic disruption.

Female↗
PubMed1990

Comparative assessment of dual-photon absorptiometry and dual-energy radiography.

Dual-energy bone densitometry can be performed with two types of scanners. The traditional dual-photon absorptiometry (DPA) machines use an isotope source, whereas the newly introduced dual-energy radiography (DER) devices use an incorporated x-ray tube. The authors evaluated the performance of DPA and DER devices at their institution. The short-term precision error in vivo was 1.2% for femoral neck measurements with DER. Long-term precision error in vitro was reduced from 1.30% (DPA) to 0.44% (DER). The scanning time for both spine and hip measurements was reduced from 20-40 minutes to 6-7 minutes. Intraosseous fat sensitivity remained the same, at a level of 12 mg/cm2 apparent decrease of bone mineral density (BMD) per 10% fat by volume change, and for both devices there was no shift in BMD when phantom thickness was increased by 1.5 inches. The correlation of DPA and DER was high: r = .98 for the spine and r = .95 for the femoral neck. Correlation of DPA versus quantitative computed tomography (CT) (r = .83) and DER versus quantitative CT (r = .85) was good. The advent of DER represents a significant advance for the field of bone densitometry.

Absorptiometry, Photon↗
PubMed1990

Spinal bone mineral density measured with quantitative CT: effect of region of interest, vertebral level, and technique.

This study documents the relationship between different vertebral bone compartments with quantitative computed tomography (CT). Four distinct patient groups were investigated: healthy pre- and early postmenopausal women as well as healthy and osteoporotic late postmenopausal women. Three different regions of interest (ROIs) were employed: the elliptical ROI located in the anterior trabecular portion of the vertebral body, the peeled ROI of irregular shape that circumscribes most of the trabecular bone, and the integral ROI including all bone except for the transverse processes. Both single- and dual-energy quantitative CT techniques were employed at T-12 through L-3. Correlation between measurements in the elliptical and peeled ROIs was high (r = .985). The authors concluded that either ROI is acceptable for clinical use. The decrements in bone mineral density (BMD) for the integral ROI were smaller than those for the elliptical ROI. Dual-energy measurements were consistently higher than single-energy measurements. BMD as a function of vertebral level decreased systematically from T-12 to L-3. However, the average density of T-12 through L-3 can be accurately predicted by the average density of L-1 and L-2 (r = .997). Precision did not deteriorate significantly when BMD was expressed as the average of L-1 and L-2 (1.5%) instead of T-12 through L-3 (1.4%). In this study the data suggest a modified quantitative CT protocol for clinical applications in which BMD of only L-1 and L-2 are measured at a fixed gantry tilt.

Adult↗