Inter-reader agreement of interpretation of radiological course of bile duct changes between serial follow-up magnetic resonance imaging/3D magnetic resonance cholangiopancreatography of patients with primary sclerosing cholangitis

Abstract

Objectives: Interpretation of MRI/MRCP in primary sclerosing cholangitis (PSC) at a single time point has low inter-reader agreement. Agreement of interpretation of the dynamic course of duct changes in follow-up MRI/MRCP is of clinical importance but remains unknown. Our aims are therefore to assess the inter-reader agreement of interpretation of the course of duct changes in PSC and investigate if elimination of 3?D MRCP affects inter-reader agreement.

Materials and Methods: We studied 40 consecutive PSC-patients who underwent two liver MRI/MRCPs at two time points. Two readers independently evaluated the course of duct changes between the two time points in two imaging sets, one with and one without 3?D MRCP. The intraclass correlation coefficient (ICC) was calculated for evaluation of inter-reader and intra-reader agreement between the two time points and two imaging sets accordingly.

Results: Inter-reader agreement of the interpretation of the course of duct changes between the two time points was poor (ICC up to 0.224). Elimination of 3?D MRCP neither improved inter-reader agreement which was again poor (ICC up to 0.26) nor did it change considerably the way readers interpret the course of ducts changes (ICC for intra-reader agreement between 0.809 and 0.978).

Conclusions: Inter-reader agreement of the interpretation of radiological course of duct changes is poor in serial follow-up MRI/MRCP of PSC-patients. Elimination of 3?D MRCP does not increase inter-reader agreement but maintains an excellent intra-reader agreement for the interpretation of the dynamic course of bile duct changes.

• Key points

• Inter-reader agreement of interpretation of radiological course of bile duct changes between serial follow-up MRI/MRCP examinations of patients with PSC is poor.

• Absence of 3D MRCP does not affect considerably the way readers interpret the radiological course of bile ducts changes.

• When MRCP is absent or of low quality, utilization of other sequences seems to be helpful as an alternative for bile duct evaluation.

     

Changes in masticatory mandibular movements in growing individuals: a six-year follow-up

The pattern of mandibular movement during chewing is influenced by several central and peripheral factors. The aim of the present study was to determine whether changes in masticatory function, characterized by mandibular velocity and displacement, occurred during individuals' normal growth. Forty-seven children, 9-15 years of age, were followed over a 6-year period. All had an Angle Class I occlusion with no obvious orthodontic problems. Oral motor function with respect to mandibular displacement, duration, and velocity was monitored 3-dimensionally with an opto-electronic method. The chewing cycle was divided into an opening, closing, and occlusal phase. Total body height was measured. During the follow-up period, all masticatory variables except the 3-dimensional opening distance showed significant changes. The total chewing cycle duration, the opening and occlusal time of the chewing cycle, and the 3-dimensional closing distance increased during the growth period, while the closing time of the chewing cycle, the 2-dimensional lateral and vertical distances and both the opening and closing velocity decreased. The children who grew proportionally most in height during the 6-year period, i.e. the youngest children in the group studied, showed a significantly larger decrease in the opening velocity. From this study it becomes evident that the variables of the chewing cycle undergo a continuous process of change during growth. This is possibly a reflection of anatomical changes, maturation of the central nervous system, and altered functional demands.     

Anatomical variations of the foramen transversarium in cervical vertebrae: findings,review of the literature,and clinical significance during cervical spine surgery

Purpose

To describe certain anatomical variations of the foramen transversarium, in spine cervical vertebrae in a contemporary specimen of an Indo-European population and approach their clinical importance during cervical spine surgery.

Methods

102 cervical vertebrae (C₂–C₇) from 17 different skeletons, intact without any degenerative or traumatic disorders, which belonged to the collection of the Department of Anatomy, were examined. The age of specimens at the time of their death was between 25 and 65 years. All foramina were measured with a digital caliper.

Results

The average size of the normal foramina was: 6.49 mm × 5.74 mm on the right side and 6.65 mm × 5.76 mm on the left side. Regarding the variations, we found two cervical vertebrae (1.96 %), one C₃ and one C₆, in which the right foramen transversarium is clearly smaller than the left. The exact dimensions of these foramina are: 2.3 mm × 2.5 mm on the right side and 6.54 mm × 8 mm on the left side in the first vertebra and 2.8 mm × 3.74 mm on the right side and 6 mm × 7.5 mm on the left side, in the second one. We also observed double foramina in 14 vertebrae (13.72 %). In seven vertebrae, the duplication was bilateral (6.86 %). We finally found one vertebra (0.98 %) with triplication of the foramen transversarium on the left side.

Conclusions

Summarizing, 10 out of our 17 skeletons were presented with variations (extremely narrow or multiple foramina). This finding of hypoplastic, duplicated and triplicated foramina transversaria in unexpectedly high rates raises questions about the integrity of the contained structures, the possibility of a different path for them. These variations may induce an extra-osseous position of the vertebra artery, and the ignorance of such an event may have catastrophic consequences during a surgery in the cervical spine.

     

Managing Small Ureteral Stones: A Retrospective Study on Follow-Up,Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery

Introduction

The management of ureteral calculi has evolved over the past decades with the advent of new surgical and medical treatments. The current guidelines support conservative management as a possible approach for ureteral stones sized = 10 mm.

Objectives

We purport to follow the natural history of ureteral stones managed conservatively in this retrospective study, and attempt to ascribe an estimated health-care and cost-effectiveness, from presentation to time of being stone-free.

Materials and methods

192 male and female patients with a single ureteral stone sized = 10 mm were included in this study. The clinical and cost-related outcome was analyzed for different stone sizes (0-4, 4-6 and 6-10 mm). The effectiveness of selected follow-up (FU) scans was also analyzed.

Results

Stone size was found to be related to the degree of hydronephrosis and to the likelihood of need for a surgical management. Conservative management was found to be clinically effective, as 88% of the patients did not require surgery for their stone. 96.1% of the patients with a stone 0-4mm managed to expel their ureteral stone. Bigger ureteral stones were found to be more costly. The cost-effectiveness of the single FU scans was found to be related to their efficiency, while the global cost-effectiveness of conservative management vs. early surgery was higher for smaller stones (26.8 vs. 17.32% for stones 0-4 vs. 6-10 mm).

Conclusion

Conservative management is clinically effective with a significant cost-benefit, particularly for the subgroup of stones sized 0-4 mm, where a need for FU scans is in dispute.Key Words: Conservative management, Cost-effective, Tamsulosin, Ureteral calculus, Urolithiasis     

The value of transesophageal echocardiography in the investigation and management of cryptogenic cerebral ischemia: a single-center experience

The diagnostic utility of transesophageal echocardiography (TEE) has often been challenged in patients with cryptogenic stroke (CS). We estimated the prevalence of different findings on TEE examination of CS patients, their impact on secondary stroke prevention and the presence of potential age or gender disparities. We reviewed all TEE examinations that were performed in a single echocardiography laboratory during a 7-year-old period to identify CS patients that underwent investigation with TEE. Of the 518 total TEE examinations, we identified 88 CS patients. TEE revealed abnormal findings in 69.3 % of them. Patent foramen ovale (PFO) and atrial septal aneurysm (ASA) were identified in 30.6 and 22.7 % of the patients. Ascending aorta and aortic arch atheromatosis was present in 26.1 % of the patients, with complex atheromatosis diagnosed in 14.7 % of them. Cardiac myxomas were uncovered in 2.3 %. Thrombi in the left atrium and in cardiac valves were reported in 3.4 and 2.3 % of the patients, respectively. Based on TEE findings, the therapeutic management would be very likely modified in 9.1 % of the patients. Subgroup analysis revealed no gender disparities on the prevalence of TEE findings and in secondary stroke prevention, while linear regression analyses revealed significant associations of age with the prevalence of PFO, ASA, aorta atheromatosis and complex aorta atheromatosis. TEE examination should be included in the diagnostic work-up of all CS patients, irrespective of age and gender status, since it can reveal potential sources of embolism and has a significant impact for secondary stroke prevention.     

Transcranial Doppler versus transthoracic echocardiography for the detection of patent foramen ovale in patients with cryptogenic cerebral ischemia: A systematic review and diagnostic test accuracy meta‐analysis

Schwannomatosis is a genetic disorder characterized by the occurrence of multiple peripheral schwannomas. Segmental schwannomatosis is diagnosed when schwannomas are restricted to 1 extremity and is thought to be caused by genetic mosaicism. We studied 5 patients with segmental schwannomatosis through microstructural magnetic resonance neurography and mutation analysis of NF2, SMARCB1, and LZTR1. In 4 of 5 patients, subtle fascicular nerve lesions were detected in clinically unaffected extremities. Two patients exhibited LZTR1 germline mutations. This appears contrary to a simple concept of genetic mosaicism and suggests more complex and heterogeneous mechanisms underlying the phenotype of segmental schwannomatosis than previously thought. Ann Neurol 2016;80:625–628     

Relationship between vitamin D status, parathyroid hormone levels and bone mineral density in patients with chronic kidney disease stages 3 and 4

AIM: Low vitamin D status is associated with secondary hyperparathyroidism and increased bone turnover in the general population and can aggravate the hyperparathyroidism of chronic kidney disease (CKD) patients. It is also correlated to low bone mineral density (BMD), but this correlation is less clear in CKD patients. Aims of our study were to investigate these associations in CKD stages 3 and 4 patients, and to identify significant predictors of BMD in this population. METHODS: Serum 25-hydroxyvitamin D (25OHD) levels, BMD at the femur and radius, and bone mineral metabolism parameters were measured in 89 CKD stages 3 and 4 patients. Vitamin D status was defined according to the NKF/KDOQI guidelines. RESULTS: Mean 25OHD levels were 53.8+/-32.1 nmol/L and correlated to the severity of proteinuria. Thirty-five patients (39%) had vitamin D insufficiency, 29 (33%) had vitamin D deficiency and five (6%) had severe deficiency. Of the 89 patients, two had osteoporosis and 31 had osteopenia either at femur or radius. Independent predictors for the total femur BMD were the intact parathyroid hormone (iPTH) levels and the body mass index (BMI). For the total radius BMD, independent predictor was only the BMI. Serum 25OHD levels were not directly associated with BMD, but they were independent predictors of iPTH. CONCLUSION: Vitamin D insufficiency and deficiency are very common in CKD stages 3 and 4 population and may indirectly affect, via effects on iPTH, the BMD of these patients.