Spleen size: how well do linear ultrasound measurements correlate with three-dimensional CT volume assessments?

Ultrasound measurement of splenic length is standard practice, but it is not known how well this represents the true size of the spleen. Previous studies, using a combination of measurements from in vivo and resected spleens, were subject to error because of changes in splenic size. The aim of this study was to correlate the dimensions of the spleen measured by ultrasound with the splenic volume measured by helical CT. Ultrasound examination was performed on 50 adult patients at the time of their attendance for abdominal CT. Linear dimensions of the spleen were measured with the patient first in the supine and then in the right lateral decubitus (RLD) position. The splenic volume was calculated from a three-dimensional reconstruction of the CT images. There was good correlation, using Spearman's rank correlation, between ultrasound measurements and CT volumes with correlation coefficients exceeding 0.7 for all parameters except one. The linear measurement that correlated most closely with CT volume was the spleen width measured on a longitudinal section with the patient in the RLD position (correlation coefficient (r)=0.89, p<0.001). There was also good correlation between splenic length measured in the RLD position and CT volume (r=0.86, p<0.001). We conclude that a good correlation exists between in vivo ultrasound assessment of splenic size and true splenic volume. The most accurate single measurement is spleen width measured on a longitudinal section with the patient in the RLD position. However, measurement of splenic length, which is the most commonly used in clinical practice, also correlates well with splenic volume, particularly when performed with the patient in the RLD position.     

Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow?

Purpose  

Total knee arthroplasty (TKA) disturbs patellar blood flow, an unintended accompaniment to TKA that may be a cause of postoperative anterior knee pain. We examine whether disrupted patellar blood flow correlates with anterior knee pain following TKA.     

Does notch size predict ACL insertion site size?

Purpose

The primary purpose of the current study is to identify a possible correlation between the femoral intercondylar notch size and the ACL insertion site size. The secondary purpose is to determine if there is a difference between male and female notch widths and insertion site sizes.

Methods

For this study, 82 patients (41 men and 41 women) with an average age of 24.1 ± 10.0 years (range 13–58 years) undergoing anterior cruciate ligament (ACL) reconstruction were included. Arthroscopic measurements were taken at the base, middle, and top of the notch. Additionally, the notch height was measured at the highest point. The insertion sites of the ACL were identified, marked using electrocautery, and measured. The correlation between notch width and ACL insertion site size was calculated. In addition, differences between men and women with regard to the notch width and ACL insertion site size were determined.

Results

Significant positive correlations were found between the notch widths and ACL insertion site measurements and ranged from 0.222 to 0.379 (P < 0.05). There were significant differences between men and women with regard to notch and insertion site size.

Conclusion

The results of this study show that there is a significant, but weak correlation between the notch width and the ACL insertion site size. Women had a smaller notch and a smaller insertion site than men. This knowledge could influence pre-operative decision-making with regard to graft choice, single- or double-bundle surgery, and graft size.

Level of evidence

Case series, Level IV.

     

Does simple estimation of 131I-metaiodobenzylguanidine uptake in patients with neural crest tumours correlate with clinical outcome?

A retrospective study was undertaken in six patients (three male and three female) with neural crest tumours who received therapeutic doses of 131I-meta-iodobenzylguanidine (131I-MIBG) (6.7-10.5 GBq). The age range of the patients was 13-65 years (mean 36 years). Quantification of tumour uptake was obtained from images acquired with a large-field-of-view gamma camera on a single occasion between 2 and 10 days post-treatment. Tumour uptake was calculated to be 0.1% and 3.2% of the administered dose, corresponding to uptakes of 6.7-142.8 MBq. Tumour volume was assessed from computed tomography (CT) or magnetic resonance (MR) images and estimates of tumour dose made from the Medical Internal Radiation Dosimetry scheme (MIRD) tables. Estimated doses were between 7 and 113 Gy. Most significantly, our findings indicate that high tumour uptake did not always correlate with good clinical response.     

Elastography ultrasound and questionable breast lesions: Does it count?

Objective

To check possible additional value of using elastography ultrasound in the specification of questionable breast lesions.

Subjects and methods

Questionable breast lesions on gray scale ultrasound examination had been further evaluated by elastography ultrasound in 97 cases with median age of 42 years. The studied lesions were pathologically proven (58 benign and 39 malignant) using true cut tissue/surgical excision biopsy that was considered the gold standard of reference.

Results

Conventional ultrasound categorization before biopsy included: category 3 (probably benign) in 42.3% (n = 41), category 4a (low suspicion of malignancy) in 13.4% (n = 13), category 4b (intermediate suspicion of malignancy) in 16.5% (n = 16) and category 4c (moderate suspicion of malignancy) in 27.8% (n = 27). We had evaluated elastography ultrasound regarding elastography strain scoring and quantitative strain ratio.Sensitivity, specificity and accuracy were 89.7%, 86.2% and 87.6% for conventional ultrasound, 92.3%, 74.1% and 81.4% for elastogram 5-point scoring method and 87.1%, 89.6% and 88.6% for the calculated strain ratios respectively in the assessment of the examined breast lesions.

Conclusion

Ultrasound elastography, using both qualitative and quantitative methods can improve the performance of conventional B-mode ultrasound and enhance its specificity and accuracy in the diagnosis of questionable (BI-RADS categories 3 and 4) breast lesions.     

Intra-articular hip injection: does pain relief correlate with radiographic severity of osteoarthritis?

Objective  

Intra-articular injection is being used widely for both diagnostic and therapeutic purposes in the hip. However, its efficacy is not always predictable in patients with hip osteoarthritis (OA). The purpose of this study was to determine whether the degree of radiographic severity of OA was predictive of the response to intra-articular injection of local anesthetic with corticosteroid and to determine the relationship between immediate pain relief resulting from the anesthetic and delayed pain relief resulting from corticosteroid administration.     

White Matter Proton MR Spectroscopy in Children with Isolated Developmental Delay: Does it Mean Delayed Myelination?

RATIONALE AND OBJECTIVES: Isolated developmental delay (IDD) is a common disorder in preschool and school-age children. Conventional magnetic resonance imaging (MRI) usually does not disclose abnormalities, but a myelination delay is suspected as causative or associated factor. N-acetyl-aspartate is a surrogate marker of neuronal integrity but also of axonal integrity. The goal of our study is to determine whether magnetic resonance spectroscopy (MRS) is able to detect alterations in the white matter supporting the hypothesis of delayed myelination in children with IDD and normal MRI. MATERIALS AND METHODS: In this cross-sectional study, we enrolled 12 consecutive children meeting the criteria if IDD and aged between 3 and 12 years (mean 7.25 years) and 11 healthy children as control group (mean age 7.18, range 3-12 years) on whom we performed conventional MRI and MRS. We did not include children with abnormal MRI. Single voxel (8 cm(3)) was placed in the white matter of the left centrum semiovale. The mode of acquisition was probe-p (PRESS technique) with a TR of 2500 milliseconds and a TE of 30 milliseconds. We measured the metabolite concentration of n-acetyl-aspartate (NAA), choline (Ch), creatine (Cr) y myo-inositol (mI), and ratios of NAA, Ch, and mI to creatine. RESULTS: In children with IDD, we found a significant decrease of the following ratios: NAA/Cr (P < .016), NAA/Ch (P < .026), and NAA/mI (P < .023) in relation to controls. The mean NAA/Cr ratio in IDD children was 1.92 (SD 0.14), and in controls it was 2.09 (SD 0.14); t = 2.62, fd (freedom degrees) = 21, P < .016. No differences were seen in the remaining ratios. CONCLUSIONS: The lower NAA/Cr ratio in children with IDD in relation to controls may be a promising marker of this disorder and supports the hypothesis of delayed myelination. MRS can provide important information in children with neurodevelopmental disorders.     

Does passive hip stiffness or range of motion correlate with spinal curvature and posture during quiet standing?

BackgroundIt has been postulated that hip muscle stiffness can be inferred from postural assessment, and that predictable relationships exist between passive stiffness of opposing muscles. Despite a lack of evidence to demonstrate such relationships, manual therapy textbooks continue to direct clinicians to treat hip muscles following postural analysis.Research QuestionDo significant correlations exist between standing posture, and hip muscle stiffness and range of motion?Methods20 participants volunteered for this observational study. Passive hip stiffness was calculated as the derivative of the moment-angle curve measured during leg raising in a variety of lying postures. Stiffness was measured during hip flexion, extension, abduction and adduction. Stiffness data was obtained during the first degree and at ROM, and at the highest common angle achieved by participants in each posture Spinal curvature and other postural components were measured using a motion tracking device. Spearman rank coefficients were determined to assess any correlations between passive stiffness, range of motion, spinal curvature and other postural components.ResultsConsistent relationships were found between maximum range of motion and hip stiffness at the common angles (P < 0.01), but not at maximum stiffness (P > 0.05). Consistent correlations were found between abductor stiffness and Q-angle (P < 0.05). Hip extensor range of motion correlated with lumbar lordosis (r = -0.472, P = 0.036). Other correlations were reported, but typically lacked consistency between left and right sides. Spinal curvature did not correlate with hip stiffness in frontal or sagittal planes (P > 0.05).SignificanceSignificant correlations were few compared with where correlations lacked statistical significance. This study demonstrates that overly simplistic assumptions about spinal posture and hip stiffness cannot be supported. Hip muscle stiffness should only be targeted in treatments where testing has demonstrated a direct need, and not assumed based upon postural assessment alone.     

Does final component alignment correlate with alignment of the bone resection surfaces in cemented total knee arthroplasty?

Purpose

To examine, with a navigation, whether the final component alignments correlate with alignment of the bone resection surfaces in cemented total knee arthroplasty (TKA), and to evaluate the factors affecting alignment deviation.

Methods

A total of 222 patients (276 knees) who underwent navigation-assisted TKA between September 2012 and January 2014 due to osteoarthritis were retrospectively reviewed. The deviation between the alignment of bone resection surfaces and the final alignment of femoral and tibial components was measured. Factors associated with alignment deviation of greater than 2° (outliers) were evaluated. These included age, sex, body mass index, bone mineral density (T score), preoperative and postoperative mechanical femorotibial angle, preoperative and postoperative flexion contractures, and the difference between medial and lateral gaps in knee extension or flexion.

Results

Outliers consisted of 24 cases (8.6%) on the femoral coronal plane, 4 cases (1.4%) on the tibial coronal plane, and 48 cases (17.4%) on the tibial sagittal plane. In the coronal plane (femur and tibia), the outliers were associated with preoperative [p < 0.001; odds ratio (OR) 0.774; 95% confidence interval (CI) 0.672–0.891] and postoperative (p < 0.001; OR 0.240; 95% CI 0.123–0.468) flexion contractures; a difference of 3 mm or more between the medial and lateral gaps in knee extension (p < 0.041; OR 5.805; 95% CI 1.075–31.343); and a T score of less than ?2.5(p < 0.024; OR 5.899; 95% CI 1.258–27.664). In the sagittal plane of the tibia, the outliers were associated with preoperative (p < 0.001; OR 0.886; 95% CI 0.829–0.946) and postoperative (p < 0.031; OR 0.803; 95% CI 0.659–0.980) flexion contractures.

Conclusion

There was a deviation between the alignments of the bone resection surfaces and the final alignments of components. With larger preoperative and postoperative flexion contractures in the coronal and sagittal planes, there were more outlier risks. The outliers in the coronal plane were associated with a difference of 3 mm or more between the medial and lateral gaps in knee extension and poor bone quality. Awareness of such alignment deviation and related factors can help diminish the outliers after TKA.

Level of evidence

IV.

     

Does a relative perfusion measure predict cerebral infarct size?

BACKGROUND AND PURPOSE: MR perfusion-weighted imaging (PWI) has been extensively used to quantify cerebral perfusion deficits after the onset of focal ischemia. The present study tested whether a relative measure of cerebral blood flow such as is obtained with PWI is sufficient to predict irreversible tissue damage following focal cerebral ischemia and reperfusion in the rat suture model. METHODS: In rats, the middle cerebral artery was occluded (MCAO) for 1 hour followed by 1-hour reperfusion. Microspheres labeled with different tracers were injected into the left ventricle to permit measurement of blood flow at different time points: before MCAO, 30 minutes post-MCAO and 30 minutes postreperfusion. Absolute cerebral blood flow (CBF) was determined and relative CBF was calculated by comparing absolute CBF at each time point to baseline values before MCAO (relative CBF(B)) or to corresponding contralateral areas in the noninfarcted hemisphere (relative CBF(C)). Infarct size was assessed by 2,3,5-triphenyltetrazolium chloride staining. RESULTS: Absolute CBF in vital tissue was 0.69 +/- 0.07 mL/g/min. In partially and completely necrotic tissue, absolute CBF was 0.39 +/- 0.05 mL/g/min and 0.30 +/- 0.09 mL/g/min, respectively. Although there was a close inverse correlation between infarct volume and absolute CBF (r = 0.79), the correlations between infarct volume and relative CBF(C) were poor (r = 0.21). CONCLUSION: The present study revealed that absolute CBF is superior to relative CBF in predicting irreversible tissue damage following ischemia and reperfusion.     

Isolated complete ulnar collateral ligament tear of the elbow in a gymnast: does it need surgery?

Ulnar collateral ligament (UCL) tears can occur from trauma or chronic overuse, and the treatment depends on the type of sport the patient plays and the severity of symptoms. Overuse UCL injuries are most commonly due to micro-trauma in overhead athletes such as baseball players, softball players, and tennis players. Acute complete UCL tears in athletes due to trauma are less common but generally operative treatment is recommended. In gymnastics, elbow dislocations are more common than isolated UCL injuries, and there is sparse literature on the success of non-operative treatment of isolated UCL injuries in this group of athletes. In this case report, we report a high-level competitive gymnast with an UCL tear and a partial tear of the forearm flexor mass, which was confirmed by a thorough careful physical examination and magnetic resonance imaging. The patient was treated non-operatively and successfully returned to gymnastics without symptoms. This case supports the suggestion that UCL tears of the elbow can be treated successfully in some gymnasts without surgery, and that treatment should be individualized in this group of athletes.     

MR assessment of Müllerian duct anomalies: Does it help?

Purpose

To evaluate the role of magnetic resonance imaging in diagnosis of Müllerian duct anomalies.

Patients and methods

A prospective study included 48 female patients suspected to have Müllerian duct anomalies. All patients underwent trans-abdominal and/or trans-vaginal real time ultrasonography. MRI was performed for all patients. Cases were classified according to American Society of Infertility classification. Outcome information reviewed in comparison with final hystroscopic and labaroscopic data.

Results

This study included 48 patients suspected to have Müllerian duct anomalies according to ultrasonography. MRI final diagnosis was classified according to American Fertility Society as follows: Class I, 15 patients representing 31%, class II, 7 patients representing 15%, class III, 2 patients representing 4%, class IV, 6 patients representing 13%, class V, 15 patients representing 31% and class VI, 3 patients representing 6%.

Conclusion

MRI of the pelvis proved to be highly efficient in the diagnosis of Müllerian duct anomalies and can be considered a corner stone for diagnosis. It proved to be a non invasive, accurate, method for diagnosis and can predict outcome of the condition.     

Does one size fit all? Adaptive radiotherapy for bladder cancer: A feasibility study

IntroductionAdaptive techniques to deliver radiotherapy to the bladder may ensure treatment accuracy whilst sparing organs at risk. This study assesses the frequency of when an alternative plan to the current standard may be beneficial and establish the treatment resource implications of adaptive techniques. Assess the variation in accuracy of skeletal surrogate compared to the target. Additionally describes a training package for therapeutic radiographers evaluating CBCT datasets for adaptive techniques.MethodsA library of three plans was created for each patient, small, standard and large. Weekly CBCT and planar imaging data were acquired from 10 bladder cancer patients receiving radical radiotherapy. Bladder volumes from weekly CBCT were compared to the planning scan. Image registration was performed using bone and soft tissue structures on the CBCT images. A database of images was created to develop competency assessment and a training package.ResultsMatching to a skeletal surrogate may under estimate movement of the target. Bladder volume can vary significantly during the course of treatment, even in the presence of bladder preparation protocols. The additional time required to implement this technique is 4 min per fraction compared to standard treatment with planar imaging.ConclusionsThis feasibility study is a useful process to facilitate the implementation of adaptive techniques. However a limitation of this study is the low number of CBCT datasets evaluated. The advent of IGRT and adaptive techniques gives increased confidence to reduce margins, consequently facilitating hypo-fractionation, and may provide a gain in linear accelerator efficiency and reduce the number of hospital visits for the patient. CBCT paired with a development programme for therapeutic radiographers is an effective and efficient means of implementing adaptive radiotherapy.