Correction to: Endovascular stroke treatment’s impact on malignant type of edema (ESTIMATE)

Journal of Neurology - The original keywords were not sufficiently precise in describing the article content. Therefore, the key words were amended to include hemicraniectomy and malignant edema.     

The Utility of Shear-Wave Elastography in the Evaluation of Myositis

Changes in muscle elasticity are expected in patients with untreated myositis. The purpose of this study was to define the accuracy of shear-wave elastography (SWE) in diagnosing myositis. This case control study included 21 patients (mean age, 49.4 y; 12 women) with myositis who underwent SWE, magnetic resonance imaging (MRI) and biopsy of the involved muscle group. SWE was performed accordingly in a control group (n = 24; mean age, 51.2 y; 8 women). Blood tests consisted of creatine kinase (CK) and aldolase. Two operators performed SWE in longitudinal and transverse planes of muscular fibers, quantifying the mean shear-wave velocity (SWV) and the pattern of stiffness. On MRI, short-TI inversion recovery (STIR) signal hyperintensity and T1 contrast enhancement of muscle was considered diagnostic for myositis. The patient group suffered from different types of myositis (nine patients with polymyositis, eight with dermatomyositis and four with other types of myositis). Blood tests showed significantly increased CK and aldolase values in patients with myositis (p < 0.001 and p < 0.0001). MRI showed a sensitivity of 0.95. In the patient group, the mean SWVs of longitudinal and transverse measurements were 2.8 ± 1.4 m/s and 3.1 ± 1.2 m/s, respectively. In the control group, SWVs were 2.3 ± 0.5 m/s and 2.4 ± 0.5 m/s, respectively. The difference between transverse measurements was significant (p = 0.02). Increased heterogeneity as a marker for myositis in transverse SWE showed a sensitivity of 0.8, specificity of 0.79, positive predictive value (PPV) of 0.76 and negative predictive value (NPV) of 0.82. Inter-observer difference was very low (κ = 0.92). Increased heterogeneity in both planes compared with histologic results showed a sensitivity of 0.56, specificity of 0.93, PPV of 0.91 and NPV of 0.62. Spearman correlation between CK <1000 U/L and SWE was 0.54. In conclusion, transverse orientation SWE may serve as an imaging biomarker for the diagnosis of myositis through the display of a heterogeneous pattern and increased absolute SWV values of inflamed muscles.     

Guidelines for anti-scatter grid use in pediatric digital radiography

Background

Pediatric radiography presents unique challenges in balancing image quality and patient dose. Removing the anti-scatter grid reduces patient dose but also reduces image contrast. The benefit of using an anti-scatter grid decreases with decreasing patient size.

Objective

To determine patient thickness thresholds for anti-scatter grid use by comparing scatter-to-primary ratio for progressively thinner patients without a grid to the scatter-to-primary ratio for a standard adult patient with a grid.

Materials and methods

We used Solid Water? phantoms ranging in thickness from 7 cm to 16 cm to simulate pediatric abdomens. The scatter-to-primary ratio without a grid was measured for each thickness at 60 kVp, 70 kVp and 80 kVp for X-ray fields of view (FOV) of 378 cm², 690 cm² and 1,175 cm² using indirect digital radiography (iDR) and computed radiography (CR). We determined thresholds for anti-scatter grid use by comparing the intersection of a fit of scatter-to-primary ratio versus patient thickness with a standard adult scatter-to-primary ratio measured for a 23-cm phantom thickness at 80 kVp with an anti-scatter grid. Dose area product (DAP) was also calculated.

Results

The scatter-to-primary ratio depended strongly on FOV and weakly on kVp; however DAP increased with decreasing kVp. Threshold thicknesses for grid use varied from 5 cm for a 14?×?17-cm FOV using iDR to 12 cm for an 8?×?10-cm FOV using computed radiography.

Conclusions

Removing the anti-scatter grid for small patients reduces patient dose without a substantial increase in scatter-to-primary ratio when the FOV is restricted appropriately. Radiologic technologists should base anti-scatter grid use on patient thickness and FOV rather than age.