Images in Clinical Rheumatology
Usefulness of 99mTc-hydroxymethylene-diphosphonate Single Photon Emission Computed Tomography/computed Tomography Hybrid Imaging in the Study of Tarsal Tunnel Syndrome
Utilidad de la imagen híbrida tomografía por emisión de fotón único/tomografía computarizada con 99mTc-hidroximetileno-difosfonato en el estudio del síndrome del túnel tarsiano
Marta Sánchez Aguilar
, Rosario García Jiménez, Francisco Javier García Gómez, Isabel Borrego Dorado
Corresponding author
Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Read
4940
Timeswas read the article
1867
Total PDF
3073
Total HTML
Share statistics
array:24 [ "pii" => "S2173574315001082" "issn" => "21735743" "doi" => "10.1016/j.reumae.2015.11.001" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "778" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2016;12:52-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1082 "formatos" => array:3 [ "EPUB" => 47 "HTML" => 810 "PDF" => 225 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X15000583" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2015.03.011" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "778" "copyright" => "Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2016;12:52-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3408 "formatos" => array:3 [ "EPUB" => 159 "HTML" => 2237 "PDF" => 1012 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Reumatología clínica en imágenes</span>" "titulo" => "Utilidad de la imagen híbrida tomografía por emisión de fotón único/tomografía computarizada con 99mTc-hidroximetileno-difosfonato en el estudio del síndrome del túnel tarsiano" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "52" "paginaFinal" => "53" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Usefulness of 99mTc-hydroxymethylene-diphosphonate single photon emission computed tomography/computed tomography hybrid imaging in the study of tarsal tunnel syndrome" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2917 "Ancho" => 2627 "Tamanyo" => 315659 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. SPECT/TC ósea en planos axial, sagital y coronal que muestra aumento de la actividad osteoblástica en el maléolo tibial izquierdo, astrágalo y articulación calcáneo astragalina. (cruz). B. Reconstrucciones 3D de las imágenes de fusión que permiten la localización precisa del punto de atrapamiento (flecha).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Sánchez Aguilar, Rosario García Jiménez, Francisco Javier García Gómez, Isabel Borrego Dorado" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Sánchez Aguilar" ] 1 => array:2 [ "nombre" => "Rosario" "apellidos" => "García Jiménez" ] 2 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "García Gómez" ] 3 => array:2 [ "nombre" => "Isabel" "apellidos" => "Borrego Dorado" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574315001082" "doi" => "10.1016/j.reumae.2015.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315001082?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X15000583?idApp=UINPBA00004M" "url" => "/1699258X/0000001200000001/v1_201601160037/S1699258X15000583/v1_201601160037/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574315001100" "issn" => "21735743" "doi" => "10.1016/j.reumae.2015.11.003" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "769" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2016;12:54-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 898 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 679 "PDF" => 167 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Ultrasonography as a Diagnostic Tool for Skin Metastasis of a Prostate Adenocarcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "54" "paginaFinal" => "56" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ecografía en el diagnóstico de metástasis cutánea de adenocarcinoma de próstata" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1031 "Ancho" => 1750 "Tamanyo" => 266570 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Gray scale iso/hypoechoic image of a round, heterogeneous and moderately well-defined lesion. (B) Image with Doppler signal activated showing the vessel that feeds the metastatic lesion.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hèctor Corominas, Paula Estrada, Delia Reina, Dacia Cerdà-Gabaroi" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Hèctor" "apellidos" => "Corominas" ] 1 => array:2 [ "nombre" => "Paula" "apellidos" => "Estrada" ] 2 => array:2 [ "nombre" => "Delia" "apellidos" => "Reina" ] 3 => array:2 [ "nombre" => "Dacia" "apellidos" => "Cerdà-Gabaroi" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X15000339" "doi" => "10.1016/j.reuma.2015.03.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X15000339?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315001100?idApp=UINPBA00004M" "url" => "/21735743/0000001200000001/v1_201601240019/S2173574315001100/v1_201601240019/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574315001276" "issn" => "21735743" "doi" => "10.1016/j.reumae.2015.11.008" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "780" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2016;12:50-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 907 "formatos" => array:3 [ "EPUB" => 51 "HTML" => 629 "PDF" => 227 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Haemophagocytic Syndrome in a Rheumatic Polymyalgia Patient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "50" "paginaFinal" => "51" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome hemofagocítico en paciente con polimialgia reumática" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 674 "Ancho" => 1305 "Tamanyo" => 142096 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Enlarged view of the histiocyte with vacuolated cytoplasm phagocytosing a hematopoietic cell.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Roberto Hurtado García, Paola Beneit Villena, Sonia Martín Guillén, Alicia Pérez Bernabéu" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Roberto" "apellidos" => "Hurtado García" ] 1 => array:2 [ "nombre" => "Paola" "apellidos" => "Beneit Villena" ] 2 => array:2 [ "nombre" => "Sonia" "apellidos" => "Martín Guillén" ] 3 => array:2 [ "nombre" => "Alicia" "apellidos" => "Pérez Bernabéu" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X15000601" "doi" => "10.1016/j.reuma.2015.03.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X15000601?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315001276?idApp=UINPBA00004M" "url" => "/21735743/0000001200000001/v1_201601240019/S2173574315001276/v1_201601240019/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Usefulness of 99mTc-hydroxymethylene-diphosphonate Single Photon Emission Computed Tomography/computed Tomography Hybrid Imaging in the Study of Tarsal Tunnel Syndrome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "52" "paginaFinal" => "53" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marta Sánchez Aguilar, Rosario García Jiménez, Francisco Javier García Gómez, Isabel Borrego Dorado" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Marta" "apellidos" => "Sánchez Aguilar" "email" => array:1 [ 0 => "marta231087@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Rosario" "apellidos" => "García Jiménez" ] 2 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "García Gómez" ] 3 => array:2 [ "nombre" => "Isabel" "apellidos" => "Borrego Dorado" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la imagen híbrida tomografía por emisión de fotón único/tomografía computarizada con 99mTc-hidroximetileno-difosfonato en el estudio del síndrome del túnel tarsiano" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2583 "Ancho" => 2326 "Tamanyo" => 257736 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Axial, sagittal and coronal images obtained by bone SPECT/CT showing increased osteoblastic activity in left tibial malleolus, talus and talocalcaneal joint (cross). B. 3D reconstructions of the fusion images that enabled the precise localization of the point of entrapment (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 46-year-old man with a 2-year history of left talalgia, with no past injuries, who presented with mechanical factors associated with overload, symptoms that worsened with the first steps in the morning, and nocturnal neuropathic features, without diffuse radiation, except for occasional radiation toward the plantar region. There was a transient response to analgesics and local injections.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the physical examination, localized pain was produced in response to pressure in the region of the tendon of the peroneal muscles, Achilles tendon and its insertion into the calcaneus, and medial border of the heel. Pain was also produced upon stretching of the plantar fascia. Other findings were grade 1 pes cava with rearfoot valgus of 5° in the right foot and 10° in the left, hyperkeratosis under the medial and central metatarsal heads of both feet and claudication on walking. There was no evidence of atrophy of the intrinsic musculature of the feet or trophic changes in the skin. The initial diagnosis was left plantar talalgia secondary to tendinitis and Achilles enthesitis. Ultrasound images and radiographies were inconclusive. As no response to physiotherapy or electrotherapy was observed, magnetic resonance imagining was performed to rule out tarsal tunnel syndrome (TTS). The images revealed the presence of ankle joint effusion, talofibular ligament sprain, posterior tibial tenosynovitis and signal hyperintensity on MRI of the sinus tarsi, suggestive of sinus tarsi syndrome.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Magnetotherapy and local injections produced no improvement, and <span class="elsevierStyleSup">99m</span>Tc-hydroxymethylene diphosphonate bone scintigraphy and SPECT/CT fusion imaging (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) with 3D reconstruction (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) were carried out. The images showed the precise location of increased osteoblastic activity in left tibial malleolus, talus and talocalcaneal joint, and a diagnosis of TTS was established. The results of the electrophysiological study revealed no evidence of motor or sensory anomalies. Given the persistence of the neuropathy, which the patient described as an electrical pain that ran along the nerve to the tarsal tunnel, delivering a shock in the arch and sole of the foot, he was referred to surgery to undergo nerve release.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Osteoarticular disorders of the foot are difficult to diagnose because of the complex anatomy and function of that structure. This circumstance confers a fundamental role on the imaging techniques employed in the assessment, treatment and follow-up of these conditions.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Tarsal tunnel syndrome is caused by a neuropathy due to the entrapment of posterior tibial nerve within its fibro-osseous tunnel beneath the flexor retinaculum on the medial side of the ankle<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> It is an uncommon condition, with important clinical implications. The combination of morphological imaging and functional imaging with 3D reconstruction significantly increases the sensitivity of scintigraphy,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> substantially improving the accuracy of the anatomical localization of the lesion, aiding in the evaluation of its grade and extension and facilitating surgical planning.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Instructive Message</span><p id="par0030" class="elsevierStylePara elsevierViewall">Hybrid morphological and functional imaging with 3D reconstruction results in a substantial improvement in the quality of life of patients with TTS, enabling an early and accurate diagnosis, which leads to effective treatment, avoiding fruitless diagnostic and therapeutic measures.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Ethical Disclosures</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Protection of human and animal subjects</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Confidentiality of data</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Instructive Message" ] 1 => array:3 [ "identificador" => "sec0010" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Right to privacy and informed consent" ] ] ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-01-15" "fechaAceptado" => "2015-03-27" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sánchez Aguilar, García Jiménez R, García Gómez FJ, Borrego Dorado I. Utilidad de la imagen híbrida tomografía por emisión de fotón único/tomografía computarizada con 99mTc-hidroximetileno-difosfonato en el estudio del síndrome del túnel tarsiano. Reumatol Clin. 2016;12:52–53.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2583 "Ancho" => 2326 "Tamanyo" => 257736 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Axial, sagittal and coronal images obtained by bone SPECT/CT showing increased osteoblastic activity in left tibial malleolus, talus and talocalcaneal joint (cross). B. 3D reconstructions of the fusion images that enabled the precise localization of the point of entrapment (arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SPECT/CT in imaging foot and ankle pathology-The demise of other coregistration techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.K. Mohan" 1 => "G. Gnanasegaran" 2 => "S. Vijayanathan" 3 => "I. Fogelman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.semnuclmed.2009.08.004" "Revista" => array:6 [ "tituloSerie" => "Semin Nucl Med" "fecha" => "2010" "volumen" => "40" "paginaInicial" => "41" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19958849" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Forefoot: a basic integrated imaging perspective for radiologists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.R. Nouh" 1 => "A.A. Khalil" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clinimag.2014.02.011" "Revista" => array:6 [ "tituloSerie" => "Clin Imaging" "fecha" => "2014" "volumen" => "38" "paginaInicial" => "397" "paginaFinal" => "409" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24746447" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tarsal tunnel syndrome: a literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Ahmad" 1 => "K. Tsang" 2 => "P.J. Mackenney" 3 => "A.O. Adedapo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.fas.2011.10.007" "Revista" => array:6 [ "tituloSerie" => "Foot Ankle Surg" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "149" "paginaFinal" => "152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22857954" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alteraciones gammagráficas en las enfermedades metabólicas óseas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.C. Alonso Farto" 1 => "J. Orcajo Rincón" 2 => "D. Zamudio Rodríguez" 3 => "R. Hernández Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "REEMO" "fecha" => "2009" "volumen" => "18" "paginaInicial" => "25" "paginaFinal" => "33" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical applications of SPECT/CT in imaging the extremities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.W. Huellner" 1 => "K. Strobel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00259-013-2533-5" "Revista" => array:7 [ "tituloSerie" => "Eur J Nucl Med Mol Imaging" "fecha" => "2014" "volumen" => "41" "numero" => "Suppl 1" "paginaInicial" => "S50" "paginaFinal" => "S58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23963296" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001200000001/v1_201601240019/S2173574315001082/v1_201601240019/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001200000001/v1_201601240019/S2173574315001082/v1_201601240019/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315001082?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 5 | 12 |
| 2024 October | 40 | 34 | 74 |
| 2024 September | 38 | 13 | 51 |
| 2024 August | 48 | 26 | 74 |
| 2024 July | 45 | 25 | 70 |
| 2024 June | 51 | 34 | 85 |
| 2024 May | 54 | 26 | 80 |
| 2024 April | 46 | 20 | 66 |
| 2024 March | 42 | 29 | 71 |
| 2024 February | 45 | 29 | 74 |
| 2024 January | 28 | 22 | 50 |
| 2023 December | 30 | 26 | 56 |
| 2023 November | 34 | 22 | 56 |
| 2023 October | 34 | 34 | 68 |
| 2023 September | 60 | 35 | 95 |
| 2023 August | 32 | 14 | 46 |
| 2023 July | 37 | 33 | 70 |
| 2023 June | 35 | 26 | 61 |
| 2023 May | 49 | 21 | 70 |
| 2023 April | 26 | 15 | 41 |
| 2023 March | 44 | 29 | 73 |
| 2023 February | 45 | 35 | 80 |
| 2023 January | 44 | 10 | 54 |
| 2022 December | 61 | 44 | 105 |
| 2022 November | 43 | 31 | 74 |
| 2022 October | 47 | 29 | 76 |
| 2022 September | 48 | 36 | 84 |
| 2022 August | 39 | 32 | 71 |
| 2022 July | 41 | 35 | 76 |
| 2022 June | 32 | 35 | 67 |
| 2022 May | 45 | 38 | 83 |
| 2022 April | 35 | 57 | 92 |
| 2022 March | 40 | 40 | 80 |
| 2022 February | 45 | 22 | 67 |
| 2022 January | 50 | 39 | 89 |
| 2021 December | 48 | 49 | 97 |
| 2021 November | 57 | 45 | 102 |
| 2021 October | 56 | 46 | 102 |
| 2021 September | 34 | 33 | 67 |
| 2021 August | 32 | 38 | 70 |
| 2021 July | 32 | 24 | 56 |
| 2021 June | 31 | 32 | 63 |
| 2021 May | 41 | 53 | 94 |
| 2021 April | 66 | 83 | 149 |
| 2021 March | 58 | 20 | 78 |
| 2021 February | 32 | 25 | 57 |
| 2021 January | 37 | 29 | 66 |
| 2020 December | 31 | 21 | 52 |
| 2020 November | 31 | 24 | 55 |
| 2020 October | 34 | 12 | 46 |
| 2020 September | 44 | 21 | 65 |
| 2020 August | 31 | 20 | 51 |
| 2020 July | 25 | 14 | 39 |
| 2020 June | 36 | 20 | 56 |
| 2020 May | 30 | 18 | 48 |
| 2020 April | 21 | 9 | 30 |
| 2020 March | 16 | 5 | 21 |
| 2020 February | 1 | 0 | 1 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 3 | 1 | 4 |
| 2018 April | 48 | 12 | 60 |
| 2018 March | 68 | 6 | 74 |
| 2018 February | 46 | 4 | 50 |
| 2018 January | 20 | 2 | 22 |
| 2017 December | 39 | 3 | 42 |
| 2017 November | 22 | 6 | 28 |
| 2017 October | 16 | 6 | 22 |
| 2017 September | 21 | 4 | 25 |
| 2017 August | 21 | 4 | 25 |
| 2017 July | 22 | 13 | 35 |
| 2017 June | 31 | 7 | 38 |
| 2017 May | 38 | 8 | 46 |
| 2017 April | 32 | 6 | 38 |
| 2017 March | 20 | 3 | 23 |
| 2017 February | 12 | 9 | 21 |
| 2017 January | 19 | 6 | 25 |
| 2016 December | 61 | 13 | 74 |
| 2016 November | 52 | 17 | 69 |
| 2016 October | 49 | 13 | 62 |
| 2016 September | 70 | 11 | 81 |
| 2016 August | 53 | 10 | 63 |
| 2016 July | 39 | 9 | 48 |
| 2016 April | 1 | 0 | 1 |
| 2016 February | 2 | 28 | 30 |
| 2016 January | 2 | 24 | 26 |
Show all
