Do we really need to thank the Beatles for the financing of the development of the computed tomography scanner?

It is commonly believed that the revenues from the selling of the Beatles' records by Electric and Musical Industries (EMI) allowed the company to develop the computed tomography (CT) scanner. Some went to define this as the Beatles' gift to medicine. However, significant controversies and discrepancies arise from analysis of this statement, making its correctness doubtful. The details of financing required for the CT development and the part of EMI in financial input have never been publicly announced. This work analyzes the financial contributions to the CT development and investigates if the revenues received from the sales of the Beatles' records were used for the creation of the CT scanner. Timeline of the development of the EMI CT scanner and the financial inputs of EMI and British Department of Health and Social Security (DHSS) were assessed. Without salary expenses to Godfrey Hounsfield and his team, the development of the CT scanner cost EMI approximately ￡100,000. The British DHSS's expenses were ￡606,000. Hence, the financial contribution of DHSS into the development of the CT scanner was significantly bigger than that of EMI. Accordingly, British tax payers and officials of British DHSS are to be thanked for the CT scanner. The Beatles' input into the world's culture is valuable and does not require decoration by nonexistent connection to the development of CT. A positive aspect to this misconception is that it keeps in public memory the name of the company that developed the CT scanner.     

Quantification of synovitis in Rheumatoid Arthritis: Do we really need quantitative measurement of contrast-enhanced ultrasound?

Objective

The quantification of synovitis is of great significance for adequate therapy management and follow-up in patients with Rheumatoid Arthritis (RA). The purpose of this study was to validate a semi-quantitative Power Doppler (PD) scoring system by comparing the PD scores to the objective measurement of the synovial inflammation using dynamic contrast-enhanced Pulse-Inversion Harmonic Imaging (PIHI).

Materials and methods

In 27 patients with RA, two radiologists performed semi-quantitative scoring of a PD examination, using a four-point scale from 0 to 3, in the metacarpophalangeal joints, proximal interphalangeal joints, and the wrists. The scores were compared to the area under the time-echo intensity curves obtained by contrast-enhanced PIHI examination. The interobserver agreement for PD scoring was evaluated using the Cohen's kappa test.

Results

Preliminary results showed that the area under the curve of dynamic measurements of PIHI tended to correlate with PD scores. The interobserver agreement for PD scoring was good (κ = 0.768).

Discussion

Based on comparisons with dynamic contrast-enhanced PIHI, semi-quantitative PD scoring might meet the criteria for a reliable, reproducible, and practical scoring system. Although further studies that would include a larger study population are required, our preliminary results show that PIHI may not provide a real benefit for quantification of synovitis in day-to-day practice.     

Magnetic resonance imaging of active sacroiliitis: Do we really need gadolinium?

Introduction

Magnetic resonance imaging (MRI) of active inflammatory changes of the sacroiliac joint (SIJ) in spondyloarthritis (SpA) is performed with short tau inversion recovery (STIR) sequences and fat-saturated T1-weighted fast spin-echo (FSE) sequences after administration of gadolinium-based contrast medium (T1/Gd). The aim of the present study was to compare these two pulse sequences in terms of diagnosis, diagnostic confidence, and quantification of inflammatory changes.

Materials and methods

The study included 105 patients with suspected SpA; 72 patients developed clinical SpA over time. All patients were examined with STIR and T1/Gd and each of the two sequences was analyzed separately in conjunction with unenhanced T1 FSE images. For quantitative estimation of inflammatory changes, each sacroiliac joint (SIJ) was divided into 4 quadrants (and severity per quadrant was assigned a score of 0-4, resulting in a maximum sum score of 16 per SIJ). Diagnostic confidence was assessed on a visual analogue scale ranging from 0 to 10.

Results

Active sacroiliitis was diagnosed in 46 patients and ruled out in 34 using STIR, whereas findings were inconclusive in 25 patients. The corresponding numbers for T1/Gd were 47, 44, and 14. Diagnostic confidence was significantly lower for STIR (7.3 ± 2.6) compared with T1/Gd (8.7 ± 1.9) (p < 0.001).The sum scores were 2.5 (±3.3) for STIR and 2.2 (±3.2) for T1/Gd for the right SIJ and 2.2 (±2.9) (STIR) and 1.9 (±3.1) (T1/Gd) for the left SIJ. Agreement was high with intraclass correlation coefficient (ICC) values of 0.86 for the right SIJ and 0.90 for the left SIJ and positive correlation (r = 0.62 right, 0.60 left).

Summary

STIR sequences alone are sufficient for establishing a reliable diagnosis and quantify the amount of inflammation in active sacroiliitis. A contrast-enhanced study is dispensable in patients with established disease or in the setting of clinical follow-up studies. However, a contrast-enhanced MR sequence is beneficial to ensure maximum diagnostic confidence when patients with early sacroiliitis are examined.     

MR arthrography of the shoulder: Do we need local anesthesia?

Purpose

To assess pain intensity with and without subcutaneous local anesthesia prior to intraarticular administration of contrast medium for magnetic resonance arthrography (MRa) of the shoulder.

Materials and methods

This single-center study was conducted after an IRB waiver of authorization, between January 2010 and December 2012. All patients provided written, informed consent for the procedure. Our prospectively populated institutional database was searched, based on our inclusion criteria. There were 249 outpatients (178 men and 71 women; mean age, 44.4 years ± 14.6; range, 15–79) who underwent MRa and were enrolled in this study. Patients were excluded if they had received surgery of the shoulder before MRa, had undergone repeated MRa of the same shoulder, and/or had undergone MRa of both shoulders on the same day. Patients were randomly assigned into one of three groups. Patients in group A (n = 61) received skin infiltration with local anesthesia. Patients in control group B (n = 92) and group C (n = 96) did not receive local anesthesia. Pain levels were immediately assessed after the injection for MRa using a horizontal visual analog scale (VAS) that ranged from 0 to 10. To compare the pain scores of the three groups for male and female patients, a two-way analysis of variance was used. A p-value equal to or less than 0.05 was considered to indicate a significant result.

Results

Patients who received local anesthesia (group A) showed a mean pain level on the VAS of 2.6 ± 2.3. In patients who did not receive local anesthetics (groups B and C), a mean pain level on the VAS of 2.6 ± 2.2 and 2.7 ± 2.4 were detected, respectively. Between the three groups, no statistically significant difference in pain intensity was detected (p = .960). There were significant differences in subjective pain perception between men and women (p = .009). Moreover, the sex difference in all three groups was equal (p = .934).

Conclusion

Local anesthesia is not required to lower a patient's pain intensity when applying intra-articular contrast media for MR arthrography of the shoulder. This could result in reduced costs and a reduced risk of adverse reactions, without an impact on patient comfort.     

Do we really need high frequency of physical activity to keep blood pressure at good levels? Results of the Brazilian national survey

Purpose

To investigate the association between frequency of physical activity (PA) and blood pressure values in the Brazilian population.

Methods

A cross-sectional study of 25,920 males and 34,282 females was analyzed. Multiple linear regression was applied to test the association of different frequencies of PA and systolic and diastolic blood pressure.

Results

In the adjusted model, subjects who reported only one weekly session of moderate-intensity PA presented systolic blood pressure on average 2.5 mm (men: β?=?? 2.48 mmhg women: β?=?? 2.48 mmhg) lower than those inactive subjects. However, diastolic blood pressure showed significant results only among those who reported practicing three sessions or more of moderate (men: β?= ? 1.97 mmhg, women: β?=?? 2.65 mmhg) or vigorous intensity PA (men: β?=?? 0.96, women: β?=?? 1.79 mmhg).

Conclusion

The results of the present study suggest that the low frequency of physical activity may have a similar protective effect, on resting systolic blood pressure, to that observed in individuals who have a weekly frequency equal to or greater than three weekly sessions.

     

Femoral torsion assessment with MRI in children: Should we use the bony or cartilaginous contours?

ObjectiveTo assess whether the use of cartilaginous contours at the femoral condyles instead of bony contours significantly changes femoral torsion measurements in children.Materials and MethodsFemoral torsion was measured in 32 girls (mean age 10.1 years ± 2.3 standard deviation) and 42 boys (10.9 years ± 2.5) on axial magnetic resonance (MR) images by two independent readers (R1,R2). The femoral condyle angle was measured using each the cartilaginous and bony contours of the distal femur. Cartilage thickness at femoral condyles was assessed. Intraclass-correlation-coefficient (ICC) and Pearson's correlation were used for statistical analysis.ResultsMean difference between cartilaginous and bony femoral torsion in girls was −1.1° ± 1.75 (range, −5.4° to 3.1°) for R1 and −1.64° ± 1.67 (−6.3° to 2.1°) for R2, in boys −1.5° ± 1.87 (−8.4° to 1.1°) for R1 and −2.28° ± 1.48 (−4.3° to 9.7°) for R2. Weak-to-moderate correlations between difference of cartilaginous-versus-bony measurements and cartilage thickness (r = −0.15 to −0.55, P < 0.001–0.46) or age (r = −0.33 to 0.46, P < 0.001–0.006) were found for both genders. Intermethod-ICC for cartilaginous versus bony femoral torsion measurements was 0.99/0.99 for R1/R2 in girls, and 0.99/0.98 in boys.ConclusionThere is only a small difference when measuring femoral torsion through cartilaginous versus bony contours, and no major difference in this between boys and girls.     

Do anatomic variants of the acromion shape in the frontal plane influence pain and function in calcifying tendinitis of the shoulder?

Purpose  

To evaluate the relationship of a large acromion index and calcifying tendinitis of the supraspinatus tendon at the shoulder.     

Evaluation of health-related quality of life in patients with shoulder pain: are we doing the best we can?

This article provides an understanding of patient-based shoulder outcome tools and the conceptual framework of disablement models from which the patient-based outcome tools are based. To allow for the evaluation of function, disability, and health-related quality of life in patients suffering from shoulder pain and in particular those whose shoulders have high physical demands, the use of shoulder self-report patient-oriented outcome tools must become standard of practice. A wide variety of available outcome tools demonstrate acceptable levels of measurement properties and are appropriate for virtually every patient with a shoulder disorder.     

Can hip impingement be mistaken for tendon pain in the groin? A long-term follow-up of tenotomy for groin pain in athletes

Purpose

There are several reports on the association between pubalgia and intra-articular hip disorders. The purpose of this study was to evaluate the long-term outcome in athletes who underwent tenotomy due to long-standing groin pain. A secondary purpose was evaluating the frequency of femoro-acetabular impingement (FAI) and its impact on the long-term outcome.

Methods

Thirty-two high-level male athletes treated with adductor tenotomy, rectus abdominis tenotomy or both were included. At a median follow-up time of 6 years after the tenotomy, the subjects underwent standardised clinical examination, plain radiographs, completed web-based health-related patient-reported outcomes, including iHOT12, HAGOS (six subscales), EQ-5D (two subscales), HSAS for physical activity level and a VAS for overall hip function. Furthermore, patient satisfaction and return to sports were documented.

Results

Twenty-four of the 32 (75 %) athletes were satisfied with the outcome of the tenotomy, and 22 of the athletes (69 %) were able to return to their pre-injury sport. Before the long-term follow-up, two of these satisfied athletes had undergone repeat surgery (one hip arthroscopy due to FAI and one repeat tenotomy). Of the 24 satisfied athletes, eight (33 %) had a positive hip impingement test at the follow-up. Of the remaining eight athletes not satisfied with the outcome, only one returned to their pre-injury sport and three had undergone hip arthroscopy prior to follow-up. Five had positive hip impingement tests which was significantly more frequently than in the satisfied group (p = 0.008). The group with a positive hip impingement test reported significantly more pain and symptoms, more hip problems during sports and physical activity, as well as lower hip-related quality of life according to the HAGOS scores (p < 0.05), at follow-up.

Conclusion

Tenotomy for pubalgia yielded a satisfactory long-term outcome, with three of four athletes being able to return to their pre-injury sport. The athletes that did not return to their pre-injury sport had higher frequency of positive hip impingement test and inferior functional outcome compared with the athletes that did return to their pre-injury sport. It is therefore recommended that the hip should be carefully evaluated for hip impingement before tenotomy is considered as treatment for athletes with pubalgia.

Level of evidence

Retrospective case series, Level IV.     

MRI of non-specific low back pain and/or lumbar radiculopathy: do we need T1 when using a sagittal T2-weighted Dixon sequence?

To show that for the MRI workup of non-specific low back pain and/or lumbar radiculopathy, the acquisition of T1-weighted sequences in the sagittal plane could be waived when using an FSE T2-weighted Dixon sequence. Three musculoskeletal radiologists retrospectively reviewed fifty lumbar spine MRI examinations performed for non-specific low back pain and/or lumbar radiculopathy. Two protocols were separately analyzed in the sagittal plane: a standard protocol (T1-weighted, in-phase, and water-only images of an FSE T2-weighted Dixon sequence) and a simplified protocol (fat-only, in-phase, and water-only images of an FSE T2-weighted Dixon sequence). Eight items usually assessed on T1-weighted sequences were analyzed for each of the vertebrae (n = 250), vertebral endplates (n = 500), vertebral corners (n = 1000), foramina (n = 500), lamina (n = 500), and facet joints (n = 500). Interchangeability of these protocols was tested using the individual equivalence index. A decrease in interobserver agreement of ≥ 5% when one reader used the simplified protocol compared with when both readers used the standard protocol was considered clinically significant. Interreader and intrareader agreement were assessed using kappa statistics. Rates of findings with each protocol were compared using odd ratios. The standard and simplified protocols were interchangeable (range of upper bound of the 95%CI of individual equivalence index = 0.25 to 1.38%). Intraprotocol and interprotocol interreader kappa values were similar (0.253–0.671 vs. 0.236–0.723, respectively). Rates of findings were not statistically significantly different (p ≥ 0.074), or were higher with the simplified protocol (p ≤ 0.036). In our target population, a single sagittal T2-weighted Dixon sequence may replace the recommended combination of T1-, T2-, and fat-suppressed T2-weighted sequences. • In patients with non-specific low back pain or lumbar radiculopathy, spine MRI in the sagittal plane could be limited to a single FSE T2-weighted Dixon sequence, hereby reducing the acquisition time. • A simplified protocol of spine MRI in the sagittal plane combining FSE T2-weighted Dixon sequence provides the same information as a standard protocol including T1-, T2-, and fat-suppressed T2-weighted sequences for the workup of degenerative lumbar spine lesions. • For some findings shown on the simplified protocol, such as focal bone marrow replacement lesions or signs of infection, additional sequences including pre- and post-contrast T1-weighted sequences may be required, as is currently the case when using the standard protocol.     

Metric approach for age assessment of children: an alternative to radiographs?

The objective of this study was to examine the use of metric assessment of the face and body height for age estimation of young children for legal proceedings. The sample consisted of 591 healthy children (317 boys and 274 girls) aged between 3 and 6 years from Germany, Italy and Lithuania. Multiple regression models for age estimation were developed using body height and selected craniofacial measurements and proportions. The accuracy of the models was assessed by the mean absolute error on a sample of 60 children. Sex-specific regression equations were established using five craniofacial indices (sestozyzy, zyzyeueu, tsetgn, seprnsegn, seprnsesto), associated absolute measurements, and body height. The standard deviations for a mean age estimate in a child of a given sex, body height and face dimensions ranged from 6 to 10 months. Mean absolute errors between real and estimated ages ranged from 4 to 9 months. It is concluded that facial measurements and body height may be used for age estimation in young children either as a complementary method to dental and skeletal assessment or as an alternative method for radiological evaluation when this cannot be applied due to lack of access or legislative restrictions for unaccompanied minors or adopted children