定量CT和双能X线吸收评价北京地区老年人股骨近端骨结构的比较

目的 分析定量CT(QCT)和双能X线吸收(DXA)对股骨近端髋部结构分析(HSA)结果的相关性。方法 对北京地区40名男性(53~76岁)和76名女性(48~76岁)社区居民行左髋DXA和QCT扫描,分别测量股骨颈横截面积(CSA)和横截面转动惯量(CSMI),对两种方法测量结果行Spearman相关性分析。结果 QCT所测CSA和CSMI均大于DXA所测CSA和CSMI(P均<0.01),两种方法测量CSA差值的中位数为0.97 cm²,CSMI差值的中位数为0.49 cm⁴。QCT和DXA测量CSA和CSMI均显著相关(r=0.85、0.78,P均<0.01)。结论 DXA和QCT对中国老年人股骨颈CSA和CSMI测量具有较高的相关性,可用于老年人群股骨近段骨结构诊断。     

多普勒、M型及四维时空关联成像检测胎儿左心室每搏输出量的对比观察

目的 比较多普勒、M型与四维时空关联成像(STIC)测量胎儿左心每搏输出量的重复性及测量者间的一致性。方法 2名超声科医师采用双盲法分别应用多普勒、M型与四维STIC测定30胎26~30周正常单胎胎儿左心室输出量,计算组内相关系数(ICC),进行Bland-Altman图分析,评估上述测量方法的重复性和测量者间一致性。结果 ①同一测量者用3种方法测定胎儿左心室输出量的差异无统计学意义(P均>0.05);②2名观察者间3种方法测量重复性比较,其ICC值STIC法最高(多普勒法ICC:0.93,95%可信区间:0.86~0.95;M型法ICC:0.89,95%可信区间:0.82~0.91;STIC法ICC:0.95,95%可信区间:0.88~0.97);③应用Bland-Altman分析2名观察者测量的一致性,STIC法的系统偏倚及一致界限较多普勒法和M型法好(多普勒法平均差值:-0.04 ml,95%可信区间-0.22~0.14 ml;M型法平均差值:-0.06 ml,95%可信区间-0.20~0.08 ml;STIC法平均差值:-0.01 ml,95%可信区间-0.11~0.09 ml)。结论 3种方法均可用于测量胎儿左心室输出量,以STIC法测量的可重复性和一致性最高,是一种较好的选择。     

定量CT评价股骨近段骨皮质厚度及骨密度

目的 初步探讨采用定量CT(QCT)骨结构分析系统(BIT)测量股骨近段骨皮质的信度和可重复性。方法 收集30例髋部低能量骨折患者,正常侧股骨用于测量,采集髋部QCT扫描数据,于QCT分析工作站上BIT自动选定垂直于股骨颈中段长轴最狭窄处横断面,将该横断面分为4个象限,即上前象限(SA),下前象限(IA),下后象限(IP),上后象限(SP),BIT自动估算各象限骨皮质厚度(C.Th),由3名测量者分别进行测量,比较测值的差异及一致性。结果 3名测量者测得的股骨颈最狭窄处横断面平均C.Th及SA、SP、IA象限C.Th和骨密度差异均无统计学意义(P均>0.05),一致性均较好,其中平均C.Th的ICC值最高,为0.883。而3名测量者测得的IP象限C.Th和骨密度差异均有统计学意义(P均<0.05)。结论 BIT能够实现获取股骨近段骨密度结果的同时获得骨结构信息,测得的股骨颈横断面上象限及前下象限C.Th及骨密度具有很好的重复性。     

髌软骨T2-mapping成像:MRI正常与退变软骨的差异

目的 探讨1.5T MRI 0级髌软骨T2值的区域差异及其与性别、年龄间的关系,以及MRI 0级软骨与退变软骨T2值的差异。 方法 对452例患者以1.5T MR系统行常规膝关节检查后,采用6回波SE序列扫描完成髌骨轴位T2-mapping成像。对髌软骨进行MRI分级,测量并比较髌软骨最厚层面内侧、外侧、全层和病变处的T2值。 结果 MRI 0级髌骨内、外侧软骨和全层软骨的T2值差异无统计学意义(P=0.15)。髌软骨全层T2值与性别无相关性。>60岁者髌软骨T2值高于其他年龄组。当髌软骨退变时,Ⅰ~Ⅳ级T2-病变均明显高于T2-对照(P<0.001),T2-病变也明显高于MR 0级髌软骨的T2值(P<0.001)。Ⅰ~Ⅳ级髌软骨病变的T2值之间差异有统计学意义(P<0.001),且T2值随病变分级升高而增加。 结论 MRI 0级髌软骨全层T2值与性别无相关性,但随年龄增长而增加。髌软骨退变时T2值随病变严重程度而明显增加。MR T2-mapping成像对诊断和监测骨关节早期病变具有很高的临床价值。     

双能CT评估骨密度

目的 评价利用双能CT（DECT）测量容积CT值评估骨密度（BMD）的可行性。方法 对11名志愿者采用双能X线吸收法（DXA）测量腰椎（L1~L4）及股骨（股骨颈）BMD值;并对所有研究对象进行DECT检查,获得钙值图,测量容积CT值,分析容积CT值与BMD值的相关性。结果 腰椎容积CT值与BMD值呈显著正相关（r=0.82,P<0.001;相关函数为Y=0.004X-0.879,其中Y为BMD值,X为容积CT值）;股骨容积CT值与DXA所测BMD值无明显相关性（P>0.05）。结论 DECT所测腰椎容积CT值与DXA所测BMD值密切相关,可定量反映腰椎BMD变化。     

应用AHP技术测量颈动脉内-中膜厚度

目的 探讨一种可以准确、方便地测量颈动脉内-中膜厚度(CIMT)的方法,评估其临床应用价值。 方法 应用超声动脉健康评估(AHP)软件自动测量238名健康人的颈总动脉、窦部和颈内动脉的内-中膜厚度和血管年龄(VA),同时手动测量颈总动脉的内-中膜厚度,并根据颈动脉上述三个部位和不同年龄组分别进行分析。 结果 不同部位的CIMT不同(窦部>颈总动脉>颈内动脉,P0.001)。年龄大于60岁组的CIMT明显大于其他组(P0.05)。随着CIMT的增厚,VA增大(r=0.951,P0.001)。VA随着年龄增大而增大(r=0.646,P0.001),但小于实际年龄(P0.001)。自动测量值明显小于手动测量值(P0.001)。 结论 AHP技术能方便准确地测量CIMT,具有应用于临床评估动脉粥样硬化的潜力。     

乳腺黏液癌的超声、钼靶X线表现及诊断价值

目的 探讨乳腺黏液癌(MBC)的超声及钼靶X线表现,并比较两种方法的诊断价值。方法 回顾经术后病理证实的166例MBC,对其中100例(113个病灶)影像学数据齐全者进行分析,观察其二维超声、CDFI及钼靶X线表现,比较超声和钼靶X线诊断的准确性。结果 MBC病灶超声多表现为低或混合回声, 形态规则,纵横比<1,边界清晰,内部回声不均匀、无钙化,后方回声无改变或增强,血流信号不丰富;钼靶X线多表现为形态规则、边缘部分光整的高或等密度病灶,内部多无钙化,周围无增粗血管。超声和钼靶X线诊断MBC的准确率差异无统计学意义(P>0.05),二者联合可提高诊断准确率(χ²=12.10,P<0.05)。结论 MBC的超声和钼靶X线表现有一定特异性, 联合应用二者可提高诊断准确率。     

踝关节MR三维序列成像

目的 比较MR三维稳态采集快速成像序列(3D-FIESTA)、三维扰相梯度回波序列(3D-FS-SPGR)和三维快速自旋回波脉冲序列(3D-FSE-CUBE)对踝关节的显示情况。方法 对51例(共59侧)足踝疼痛患者行3.0T MR检查,扫描序列为常规SE T1WI,FSE T2WI序列,以及三维容积采集序列、包括3D-FIESTA, 3D-FS-SPGR和3D-FSE-CUBE。扫描完成后对所有三维序列进行重建,测量并比较各序列踝关节图像上,软骨、软骨下骨、肌肉及滑膜液的SNR及CNR。结果 ①3D-FIESTA, 3D-FS-SPGR和3D-FSE-CUBE序列均可对踝关节进行任意方位重建,踝关节肌腱及韧带显示良好。②SNR:软骨SNR在3D-FS-SPGR 序列中最高,其次为3D-FIESTA,二者差异无统计学意义(P=0.719);软骨下骨SNR在3D-FIESTA序列中最高,3D-FS-SPGR和3D-FSE-CUBE序列的差异无统计学意义(P=0.424);滑膜液SNR在3D-FIESTA序列中最高,但与3D-FSE-CUBE序列的差异无统计学意义(P=0.98);肌肉两两序列分别进行比较,差异均有统计学意义(P均<0.05)。③CNR:3D-FIESTA序列中软骨/软骨下骨CNR最高,其次为3D-FS-SPGR,软骨/滑液、肌肉/滑液在3D-FIESTA和3D-FSE-CUBE序列中较高,二者差异均无统计学意义(P均>0.05)。结论 3D-FS-SPGR及3D-FIESTA具有较高的软骨SNR及与相邻组织间CNR,是评估踝关节复杂解剖结构的理想方法。     

64排螺旋CT与MRI对军训致下肢早期应力性骨损伤的诊断价值

目的 分析军训致下肢早期应力性骨损伤的64排螺旋CT和MRI表现,探讨二者对军训致下肢早期应力性骨损伤的诊断价值。方法 回顾性分析35例经临床和影像证实的军训致下肢早期应力性骨损伤病例的影像学资料,35例均行直接数字化摄片(DR)、64排螺旋CT及MR检查。结果 35例患者中,33例为单侧,2例为双侧损伤,共37处应力性损伤,其中股骨5例、胫骨24例、跖骨6例,双侧胫骨均受累2例;X线平片检出7处病变,64排螺旋CT检出19处病变,MRI检出全部37处病变;三种方法比较,差异有统计学意义(χ²＝50.45、23.79、8.54,P均<0.01)。结论 MRI能很好地显示军训致下肢早期应力性骨损伤的各种征象,明显优于X线平片和64排螺旋CT,是诊断早期应力性骨损伤的最佳方法;64排螺旋CT可以发现早期应力性骨损伤的细微骨折线及骨皮质内的异常密度改变,二者结合对于军训致下肢早期应力性骨损伤具有很高的临床应用价值。     

产前超声评估胎儿咽、喉及气管发育

目的 探讨胎儿咽、喉及气管直径与孕周的关系,建立正常参考值范围。方法 对280胎18~38周正常单胎胎儿进行常规产前超声检查,测量咽、喉及气管直径;采用回归分析评价各测量值与孕周的关系,以组内相关系数(ICC)及Bland-Altman检验评价测量结果的重复性和一致性。结果 正常胎儿咽、喉及气管的直径均随孕周而增大,其回归方程如下:咽直径(mm)=0.230孕周-0.460(r²=0.487,P<0.01);喉直径(mm)=0.324孕周-0.851(r²=0.699,P<0.01);气管直径(mm)=0.118孕周-0.342(2=0.576,P<0.01)。测量咽、喉及气管直径的重复性和一致性均较高。结论 产前超声可用以建立胎儿咽喉及气管直径的正常参考值范围,且有助于评价胎儿发育及早期诊断胎儿气道狭窄。     

A new strategy to tackle severe knee osteoarthritis: Combination of intra-articular and intraosseous injections of Platelet Rich Plasma

ABSTRACT

Introduction: Knee osteoarthritis (KOA) is a mechanically induced, cytokine and enzyme-mediated disorder involving all the joint tissue of the knee. Rebuilding a physiological-homeostatic network at the tissue level following knee organ failure, such as in severe KOA, is a daunting task with therapeutic targets encompassing the articular cartilage, synovium and subchondral bone. Intraarticular infiltration of plasma rich in growth factors (PRP) has emerged as a promising symptomatic approach, although it is insufficient to reach the subchondral bone.

Areas covered: This review addresses current molecular and cellular data in joint homeostasis and osteoarthritis pathophysiology. In particular, it focuses on changes that subchondral bone undergoes in knee osteoarthritis and evaluates recent observations on the crosstalk among articular cartilage, subchondral bone and synovial membrane. In addition, we review some mechanistic aspects that have been proposed and provide the rationale for using PRP intraosseously in KOA.

Expert opinion: The knee joint is a paradigm of autonomy and connectedness of its anatomical structures and tissues from which it is made. We propose an innovative approach to the treatment of severe knee osteoarthritis consisting of a combination of intraarticular and intraosseous infiltrations of PRP, which might offer a new therapeutic tool in KOA therapy.     

Communicating vessels volumeter to measure upper extremity lymphedema after breast cancer: reliability and criterion validity compared to the gold standard

BackgroundThe traditional overflow method for measuring limb volume remains the gold standard, but many disadvantages still inhibit its routine use in clinical practice.ObjectiveTo assess the intra-rater and inter-rater reliability and criterion validity of the ‘communicating vessels volumeter’ (CVV) for volume measurement of lymphedematous upper extremities (LUE) by using the overflow volumeter (OV) as the reference standard.MethodsTwelve LUE of 12 women undergoing mastectomy for breast cancer were measured three times each by three raters using both methods, totaling 216 volume measurements. Criterion validity was estimated by 33 volume measurements of one cylinder of known volume by three raters using both methods, totaling 198 measurements.ResultsMeasurement time was short with both CVV and OV. The intraclass correlation coefficient_3,1 was high for both CVV and OV in intra-rater (0.99 vs 0.99) and inter-rater (0.99 vs 0.99) analyses. The bias between methods was low (7.50 mL; 0.40%) and the limits of agreement were narrow (?5.80 to 6.50%). The volumes were statistically equal with a strong correlation (R² = 0.98) between methods. CVV was more accurate than OV (0.00 vs 0.02%) in cylinder measurements.ConclusionThe high intra-rater and inter-rater reliability rates of CVV were comparable to those of OV, and the volumes resulting from LUE measurements were statistically equal in the two methods. Criterion validity rates indicated that CVV measurements were closer to the actual value of the cylinder than those obtained with the OV.     

Cross-cultural adaptation,validity and reliability of the Persian version of Fremantle Knee Awareness Questionnaire

Background& Objective: There is strong evidence regarding impaired knee self-perception in patients with chronic knee osteoarthritis (OA). Currently, the Fremantle Knee Awareness Questionnaire (FreKAQ) has been developed to evaluate knee self-perception. This study aimed to evaluate validity and reliability of the Persian version of FreKAQ in patients with chronic knee OA.Materials and methodsThe FreKAQ was translated via forward-backward translation. In total, 312 patients with chronic knee OA completed the questionnaire, and the construct validity of the instrument was evaluated using exploratory and confirmatory factor analyses (EFA and CFA). Moreover, its reliability was confirmed using internal consistency and Cronbach's alpha coefficient. In addition, intra-class correlation coefficient and standard error measurement (SEM) and minimal detectable change (MDC) were used to assess its relative and absolute consistency. Therefore 50 patients, completed the questionnaire twice at one-week intervals.ResultsIn EFA, Kaiser-Meyer-Olkin (0.705) and Bartlett's tests were significant (P < 0.001), and CFA also indicated acceptable fitting with three factors. Moreover, the indices of PNFI = 0.57, PCFI = 0.60, χ2/DF = 1.14, AGFI = 0.95, GFI = 0.97, and RMSEA = 0.027 confirmed the goodness of fit of the model. The Cronbach's alpha and repeatability were estimated at 0.817 and 0.874, respectively, and the SEM and MDC was 2.13, 4.91.ConclusionAccording to the results, the Persian version of FreKAQ had proper construct validity and reliability to evaluate the impairment of knee self-perception in patients with chronic knee OA.     

双能X射线骨密度仪不同测量方式检测大鼠骨密度的准确性

背景:双能X射线骨密度仪是诊断骨质疏松症的金标准,但采用其系统默认方式测量小动物骨密度误差很大。目的:观察双能X射线骨密度仪不同测量方式对大鼠骨密度测量准确度的影响。方法:应用双能X射线骨密度仪对六七月龄雌性SD大鼠进行全身扫描,分别采用自定义手动矩形方式、手动椭圆形方式与系统默认标准方式依次测量大鼠的全身、头部及脊柱部位的骨密度。结果与结论:手动椭圆形方式与系统默认方式测得的大鼠全身、头部和脊柱的骨密度差异无显著性意义(P>0.05),而手动矩形方式与系统默认标准方式间差异有显著性意义(P<0.01)。双能X射线骨密度仪应用手动椭圆形方式与系统默认标准方式对测量结果影响不大,但手动矩形测量方式误差较大。提示手动椭圆形方式可作为小动物骨密度测量后的分析方法之一。     

Validity and Intertester Reliability of Cervical Range of Motion Using Inclinometer Measurements

Abstract

Several procedures have been developed for using inclinometers to measure cervical range of motion. The purpose of this study was to evaluate the validity and reliability of three such methods. The subjects were thirty-four practicing physical therapists. Three individuals, who served as models, had their cervical range of motion measured by the thirty-four physical therapists using a single, double, and stabilization inclinometer method. X-ray films were then taken of the models in flexion, extension, and right and left lateral flexion. A computerized axial tomography scan was used for measuring cervical spine rotation. Results indicate that the single and double methods in flexion and single and stabilization methods in flexion were valid. Inclinometer measurements of cervical flexion, extension, lateral flexion, and rotation were found to be reliable for all three methods with ICCs ranging from .89 to .94. Although inclinometry yields consistent results, there validly is questionable. Sources of error were identified and suggestions given for improving validity and reliability of cervical range of motion while using inclinometers.     

Development of a clinically applicable tool for bone density assessment

Objectives

To assess the accuracy and reliability of new software for radiodensitometric evaluations.

Methods

A densitometric tool developed by MevisLab^® was used in conjunction with intraoral radiographs of the premolar region in both in vivo and laboratory settings. An aluminum step wedge was utilized for comparison of grey values. After computer-aided segmentation, the interproximal bone between the premolars was assessed in order to determine the mean grey value intensity of this region and convert it to a thickness in aluminum. Evaluation of the tool was determined using bone mineral density (BMD) values derived from decalcified human bone specimens as a reference standard. In vivo BMD data was collected from 35 patients as determined with dual X-ray absorptiometry (DXA). The intra and interobserver reliability of this method was assessed by Bland and Altman Plots to determine the precision of this tool.

Results

In the laboratory study, the threshold value for detection of bone loss was 6.5%. The densitometric data (mm Al eq.) was highly correlated with the jaw bone BMD, as determined using dual X-ray absorptiometry (r = 0.96). For the in vivo study, the correlations between the mm Al equivalent of the average upper and lower jaw with the lumbar spine BMD, total hip BMD and femoral neck BMD were 0.489, 0.537 and 0.467, respectively (P < 0.05). For the intraobserver reliability, a Bland and Altman plot showed that the mean difference ± 1.96 SD were within ±0.15 mm Al eq. with the mean difference value small than 0.003 mm Al eq. For the interobserver reliability, the mean difference ±1.96 SD were within ±0.11 mm Al eq. with the mean difference of 0.008 mm Al eq.

Conclusions

A densitometric software tool has been developed, that is reliable for bone density assessment. It now requires further investigation to evaluate its accuracy and clinical applicability in large scale studies.     

The hypertension scale of the system of Quality of Life Instruments for Chronic Diseases, QLICD-HY: a development and validation study

AimsThis paper is aimed to develop and validate the hypertension scale of the system of Quality of Life Instruments for Chronic Diseases, QLICD-HY.MethodsThe QLICD-HY instrument was developed based on programmed decision procedures with multiple nominal and focus group discussions and pilot testing. A total of 157 inpatients with hypertension were used to provide the data measuring QOL three times before and after treatment. The psychometric properties of the scale were evaluated with respect to validity, reliability and responsiveness employing correlation and factor analyses, and t-tests.ResultsCorrelation and factor analyses confirmed good construct validity and criterion-related validity when using Short Form (36) Health Survey (SF-36) as a criterion. Test–retest reliability coefficients (Pearson r and intra-class correlation (ICC)) for the overall instrument score and all domains except for the hypertension-specific domain (SPD) (0.75) were higher than 0.80 with a range of 0.75–0.91; the internal consistency α for all domains except for the hypertension-specific domain (0.66) was higher than 0.70. The overall score and scores for most facets within each domain except for the social domain (SOD) had statistically significant changes (t-tests) after treatment with moderate effect sizes.ConclusionQLICD-HY has good validity, reliability, responsiveness and can be used as the quality-of-life instrument for patients with hypertension.     

Comparison of Common Methodologies for the Determination of Knee Flexor Muscle Strength

BackgroundKnee flexion strength may hold important clinical implications for the determination of injury risk and readiness to return to sport following injury and orthopedic surgery. A wide array of testing methodologies and positioning options are available that require validation prior to clinical integration. The purpose of this study was to 1) investigate the validity and test-retest reliability of isometric knee flexion strength measured by a fixed handheld dynamometer (HHD) apparatus compared to a Biodex Dynamometer (BD), 2) determine the impact of body position (seated versus supine) and foot position (plantar- vs dorsiflexed) on knee flexion peak torque and 3) establish the validity and test-retest reliability of the NordBord Hamstring Dynamometer.Study DesignValidity and reliability study, test-retest design.MethodsForty-four healthy participants (aged 27 ± 4.8 years) were assessed by two raters over two testing sessions separated by three to seven days. Maximal isometric knee flexion in the seated and supine position at 90^o knee flexion was measured with both a BD and an externally fixed HHD with the foot held in maximal dorsiflexion or in plantar flexion. The validity and test-retest reliability of eccentric knee flexor strength on the NordBord hamstring dynamometer was assessed and compared with isometric strength on the BD.ResultsLevel of agreement between HHD and BD torque demonstrated low bias (bias -0.33 Nm, SD of bias 13.5 Nm; 95% LOA 26.13 Nm, -26.79 Nm). Interrater reliability of the HHD was high, varying slightly with body position (ICC range 0.9-0.97, n=44). Isometric knee flexion torque was higher in the seated versus supine position and with the foot dorsiflexed versus plantarflexed. Eccentric knee flexion torque had a high degree of correlation with isometric knee flexion torque as measured via the BD (r=0.61-0.86). The NordBord had high test-retest reliability (0.993 (95%CI 0.983-0.997, n=19) for eccentric knee flexor strength, with an MDC₉₅ of 26.88 N and 28.76 N for the left and right limbs respectively.ConclusionCommon measures of maximal isometric knee flexion display high levels of correlation and test-retest reliability. However, values obtained by an externally fixed HHD are not interchangeable with values obtained via the BD. Foot and body position should be considered and controlled during testing.Level of Evidence2b     

A Novel Ultrasound Methodology for Estimating Spine Mineral Density

We investigated the possible clinical feasibility and accuracy of an innovative ultrasound (US) method for diagnosis of osteoporosis of the spine. A total of 342 female patients (aged 51–60 y) underwent spinal dual X-ray absorptiometry and abdominal echographic scanning of the lumbar spine. Recruited patients were subdivided into a reference database used for US spectral model construction and a study population for repeatability and accuracy evaluation. US images and radiofrequency signals were analyzed via a new fully automatic algorithm that performed a series of spectral and statistical analyses, providing a novel diagnostic parameter called the osteoporosis score (O.S.). If dual X-ray absorptiometry is assumed to be the gold standard reference, the accuracy of O.S.-based diagnoses was 91.1%, with k = 0.859 (p < 0.0001). Significant correlations were also found between O.S.-estimated bone mineral densities and corresponding dual X-ray absorptiometry values, with r² values up to 0.73 and a root mean square error of 6.3%–9.3%. The results obtained suggest that the proposed method has the potential for future routine application in US-based diagnosis of osteoporosis.     

Effects of parathyroidectomy on bone metabolism in haemodialysis patients with secondary hyperparathyroidism

Objective: To evaluate the outcome of bone metabolism and bone mineral density (BMD) in haemodialysis patients after parathyroidectomy (PTX).

Methods: A total of 31 haemodialysis patients with secondary hyperparathyroidism (SHPT) were treated with PTX. BMD of lumbar spine (LS) and femoral neck (FN) was determined by dual energy X-ray absorptiometry.

Results: Parathyroidectomy ledds to significant decrease of serum β-crosslaps (β-CTX), osteocalcin (OC) and procollagen type I amino-terminal propeptide (PINP) while serum sclerostin (SOST) increased after surgery. BMD was markedly improved in both LS and FN after PTX. Z-scores analysis further confirmed that PTX significantly benefited bone metabolism in haemodialysis patients, which well correlated with the improvement of serum iPTH and OC.

Conclusions: Parathyroidectomy leads to significant improvement of serum OC, PINP, β-CTX and SOST, which may beneficially modify calcium–phosphorus metabolism and BMD in haemodialysis patients with SHPT.