Papers by Federico Zaottini
Journal Of Ultrasonography
Plantar intrinsic muscles play a pivotal role in posture control and gait dynamics. They help mai... more Plantar intrinsic muscles play a pivotal role in posture control and gait dynamics. They help maintain the longitudinal and transverse arches of the foot, and they regulate the degree and velocity of arch deformation during walking or running. Consequently, pathologies affecting the plantar intrinsic muscles (for instance, acquired and inherited neuropathies) lead to foot deformity, gait disorders, and painful syndromes. Intrinsic muscle malfunctioning is also associated with multifactorial overuse or degenerative conditions such as pes planus, hallux valgus, and plantar fasciitis. As the clinical examination of each intrinsic muscle is challenging, ultrasound is gaining a growing interest as an imaging tool to investigate the trophism of these muscular structures and the pattern of their alterations, and potentially to follow up on the effects of dedicated rehabilitation protocols. The ten plantar intrinsic muscles can be dived into three groups (medial, central and lateral) and fo...
Journal Of Ultrasonography
Intrinsic hand muscles play a fundamental role in tuning the fine motricity of the hand and may b... more Intrinsic hand muscles play a fundamental role in tuning the fine motricity of the hand and may be affected by several pathologic conditions, including traumatic injuries, atrophic changes induced by denervation, and space-occupying masses. Modern hand surgery techniques allow to target several hand muscle pathologies and, as a direct consequence, requests for hand imaging now carry increasingly complex diagnostic questions. The progressive refinement of ultrasound technology and the current availability of high and ultra-high frequency linear transducers that allow the investigation of intrinsic hand muscles and tendons with incomparable resolution have made this modality an essential tool for the evaluation of pathological processes involving these tiny structures. Indeed, intrinsic hand muscles lie in a superficial position and are amenable to investigation by means of transducers with frequency bands superior to 20 MHz, offering clear advantages in terms of resolution and costs ...
Diagnostics
Adhesive capsulitis is an idiopathic and disabling disorder characterized by intense shoulder pai... more Adhesive capsulitis is an idiopathic and disabling disorder characterized by intense shoulder pain and progressive limitation of active and passive glenohumeral joint range of motion. Although adhesive capsulitis has been traditionally considered a diagnosis of exclusion that can be established based on a suggestive medical history and the detection of supporting findings at the physical exam, imaging studies are commonly requested to confirm the diagnostic suspicion and to exclude other causes of shoulder pain. Indeed, clinical findings may be rather unspecific, and may overlap with diseases like calcific tendinitis, rotator cuff pathology, acromioclavicular or glenohumeral arthropathy, autoimmune disorders, and subacromial/subdeltoid bursitis. Magnetic resonance imaging, magnetic resonance arthrography, and high-resolution ultrasound have shown high sensitivity and accuracy in diagnosing adhesive capsulitis through the demonstration of specific pathological findings, including thi...
European Radiology, Aug 25, 2021
Objectives Clarity regarding accuracy and effectiveness for interventional procedures around the ... more Objectives Clarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region. Methods We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around foot and ankle in order to derive their clinical indications. 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 Delphi-based consensus were used to write the paper that was shared with all panel members for final approval. Results A list of 16 evidence-based statements on clinical indications for image-guided musculoskeletal interventional procedures in the foot and ankle were drafted after a literature review. The highest level of evidence was reported for four statements, all receiving 100% agreement. Conclusion According to this consensus, image-guided interventions should not be considered a first-level approach for treating Achilles tendinopathy, while ultrasonography guidance is strongly recommended to improve the efficacy of interventional procedures for plantar fasciitis and Morton's neuroma, particularly using platelet-rich plasma and corticosteroids, respectively.
European Radiology, Jun 19, 2021
Objectives Image-guided musculoskeletal interventional procedures around the hip are widely used ... more Objectives Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications. Methods In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications. Results Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts. Conclusions This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip. Key Points • Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip. • The highest level of evidence was only reached for one statement. • Strong consensus was obtained for all statements.
Seminars in Musculoskeletal Radiology, May 26, 2023
Seminars in Musculoskeletal Radiology, May 26, 2023
The aim of this study was to rule out the diagnostic accuracy of both ultrasonography (US) and ma... more The aim of this study was to rule out the diagnostic accuracy of both ultrasonography (US) and magnetic resonance imaging (MRI) for the assessment of tendinoligamentous pain around the ankle joint. Patients and methods: This study included 35 patients (25 females and 10 males) complaining of unilateral ankle pain (acute or chronic), and they were subjected to plain X-ray (to exclude osseous pathology), US and MRI examinations. Results: The study included 35 patients where 20 patients showed tendon pathology that was diagnosed into 21 pathological entities by both US and MRI imaging modalities with no difference in interpretation between them. 21 patients had pathological ligaments which were diagnosed by both ultrasound and MRI. However, two ligamentous lesions were diagnosed as partial tear by US, while MRI diagnosed them as complete tear. Associated findings were also diagnosed as retrocalcaneal bursitis in two patients, joint effusion in four patients and joint synovitis in three patients. Conclusion: US is an excellent tool for imaging soft tissue abnormalities, as it allows rapid, inexpensive detailed examination of the structures of the ankle joint. US and MRI are two complementary tools of investigation with the former being used as primary effective tool of investigation and the latter is done to confirm the diagnosis.
Seminars in Musculoskeletal Radiology, May 26, 2023
There is an increasing demand for age estimations of living persons who are involved in civil and... more There is an increasing demand for age estimations of living persons who are involved in civil and criminal procedures but lack a valid birth certificate indicating their date of birth. Several studies have recommended the application of magnetic resonance imaging (MRI) and assessment of the stage of epiphyseal fusion in age estimation. This study involved retrospective MRI analysis of 335 cases (217 males and 118 females) whose ages ranged from 8 to 28 years (yrs). We assessed the degree of ossification of the proximal tibial epiphysis depending on the classifications of Schmeling and Kellinghaus used for the main stages (I, II, III, IV & V) and substages (IIa, b, c & IIIa, b, c). Significant differences between males and females at stages IIIc, IV and V (p < 0.001) were observed. Additionally, the ossification of the proximal tibial epiphyses occurred earlier in females than in males (2-4 yrs). The mean of ages in stage IV was approximately 18.6 yrs. in females and 22.5 yrs. in males, meaning that stage IV can be used as a valuable forensic marker to determine whether the person in question has reached the age of 18 yrs. We concluded that the application of MRI in the assessment of the ossification status of the proximal tibial epiphysis could be helpful in age estimation for various forensic purposes.
Seminars in Musculoskeletal Radiology, Jun 1, 2021
Seminars in Musculoskeletal Radiology, Jun 1, 2019
Seminars in Musculoskeletal Radiology, Jun 1, 2021
RMD Open, 2023
Aim This study aimed to (1) determine the intraobserver and interobserver reliability of ultrason... more Aim This study aimed to (1) determine the intraobserver and interobserver reliability of ultrasonographic measurement of muscle thickness (MT) and crosssectional area (CSA) of the rectus femoris and biceps brachii, correlating these values with manual measurements on dissected cadavers and (2) develop the first semiquantitative musculoskeletal ultrasound (MSUS) scoring system of muscle morphology in sarcopenia and assess its intraobserver and interobserver reliability. In addition, the MSUS morphology score was compared with the corresponding histological images to verify concurrent validity. Methods Ten cryopreserved limbs of 10 cadavers aged 68-91 years were evaluated. The MSUS scoring system was based on the severity of muscle degeneration on a 3-point qualitative scale: grade 1 (normal), grade 2 (moderate changes) and grade 3 (severe changes). Reliability was assessed with intraclass correlation coefficient (ICC) for the MT and CSA and with Cohen's kappa coefficients (κ) for the MSUS scoring system. Concurrent validity was analysed with ICC. Results The results showed excellent intraobserver and interobserver reliability for both the MSUS evaluation of MT and CSA (ICC ≥0.93). The MSUS scoring system showed excellent intraobserver reliability (κ=1.0) and very good interobserver reliability (κ=0.85). There was also a high intra-and inter-observer reliability for the histological scorings (ĸ ≥0.85 and mean ĸ=0.70, respectively), as well as high reliability between the histology and MSUS scoring systems (ICC=0.92). All results were statistically significant (p≤0.001). Conclusion MSUS measures of MT and CSA and the novel MSUS scoring system for degenerative muscle changes in sarcopenia was found to be reliable and strongly associated with histological findings.
Oxford University Press eBooks, Apr 1, 2019
Les affections neurologiques périphériques sont fréquentes en pratique rhumatologique et peuvent ... more Les affections neurologiques périphériques sont fréquentes en pratique rhumatologique et peuvent simuler diverses maladies de l'appareil locomoteur. Leur diagnostic repose sur l'examen clinique. Un interrogatoire soigneux et un examen clinique détaillé apportent habituellement une forte présomption. Néanmoins, il est habituel d'obtenir des examens d'imagerie, à la fois pour confirmer le diagnostic clinique et dans le cadre du bilan préopératoire. Bien que les radiographies simples et la tomodensitométrie ne puissent visualiser directement les nerfs, elles permettent d'évaluer les structures anatomiques adjacentes, notamment les os et les articulations, et elles peuvent apporter des informations utiles au choix de la stratégie thérapeutique. L'imagerie par résonance magnétique et l'échographie montrent directement les nerfs périphériques et permettent donc d'étudier leur diamètre et leur structure. Les nouvelles sondes électroniques à haute résolution et large bande de fréquence ont fait de l'échographie une technique de référence pour l'examen des nerfs périphériques normaux et pathologiques. L'échographie permet un examen dynamique, ainsi que l'examen de longs segments nerveux en peu de temps. Il s'agit d'une technique non invasive et peu onéreuse. Enfin, l'échographie est bien acceptée par les malades. Ici, nous décrirons brièvement l'anatomie normale et l'aspect échographique des nerfs périphériques avant de présenter les signes échographiques des affections les plus fréquentes (neuropathies canalaires, tumeurs et kystes).
Journal of Clinical Ultrasound, Apr 6, 2023
Seminars in Musculoskeletal Radiology, Apr 1, 2023
Uploads
Papers by Federico Zaottini