A clinical prediction rule for meniscal tears in primary care: development and internal validation using a multicentre study

Background

In primary care, meniscal tears are difficult to detect. A quick and easy clinical prediction rule based on patient history and a single meniscal test may help physicians to identify high-risk patients for referral for magnetic resonance imaging (MRI).

Aim

The study objective was to develop and internally validate a clinical prediction rule (CPR) for the detection of meniscal tears in primary care.

Design and setting

In a cross-sectional multicentre study, 121 participants from primary care were included if they were aged 18–65 years with knee complaints that existed for <6 months, and who were suspected to suffer from a meniscal tear.

Method

One diagnostic physical meniscal test and 14 clinical variables were considered to be predictors of MRI outcome. Using known predictors for the presence of meniscal tears, a ‘quick and easy’ CPR was derived.

Results

The final CPR included the variables sex, age, weight-bearing during trauma, performing sports, effusion, warmth, discolouration, and Deep Squat test. The final model had an AUC of 0.76 (95% CI = 0.72 to 0.80). A cut-point of 150 points yielded an overall sensitivity of 86.1% and a specificity of 45.5%. For this cut-point, the positive predictive value was 55.0%, and the negative predictive value was 81.1%. A scoring system was provided including the corresponding predicted probabilities for a meniscal tear.

Conclusion

The CPR improved the detection of meniscal tears in primary care. Further evaluation of the CPR in new primary care patients is needed, however, to assess its usefulness.     

The hazards of lack of co-registration of ictal brain SPECT with MRI: A case report of sinusitis mimicking a brainstem seizure focus

Background

Single photon emission computed tomography (SPECT) following injection of radiotracer during a seizure is known as ictal SPECT. Comparison of an ictal SPECT study to a baseline or interictal study can aid identification of a seizure focus.

Case presentation

A young woman with encephalitis and refractory seizures underwent brain SPECT during a period of frequent seizure-like episodes, and during a seizure-free period. A focal area of increased radiotracer uptake present only when she was experiencing frequent seizure-like episodes was originally localized to the brainstem, but with later computerized co-registration of SPECT to MRI, was found to lie outside the brain, in the region of the sphenoid sinus.

Conclusion

Low-resolution SPECT images present difficulties in interpretation, which can be overcome through co-registration to higher-resolution structural images.     

Meniscal sizing before allograft: Comparison of three imaging techniques

Background

Accuracy of meniscal sizing is an important issue before allograft transplantation. To date, there is no consensus on the best imaging method. The purpose of this study was to compare plain radiographs, magnetic resonance imaging (MRI) and computed tomography (CT) arthrography in the assessment of meniscal size. We hypothesized that MRI and CT arthrography had better correlations than plain radiographs.

Diagnostic value of SPECT, PET and PET/CT in the diagnosis of coronary artery disease: A systematic review

Purpose:

The purpose of the study was to investigate the diagnostic value of SPECT, PET and PET/CT in the diagnosis of coronary artery disease, based on a systematic review.

Material and Methods:

A search of PubMed/Medline and Sciencedirect databases in the English-language literature published over the last 24 years was performed. Only studies with at least 10 patients comparing SPECT, PET or combined PET/CT with invasive coronary angiography in the diagnosis of coronary artery disease (50% stenosis) were included for analysis. Sensitivities and specificities estimates pooled across studies were analysed using a Chi-square test.

Results:

Twenty-five studies met the selection criteria and were included for the analysis. Ten studies were performed with SPECT alone; while another six studies were performed with PET alone. Five studies were carried out with both PET and SPECT modalities, and the remaining four studies were investigated with integrated PET-CT. The mean value of sensitivity, specificity and accuracy of these imaging modalities for the diagnosis of coronary artery disease was 82% (95%CI: 76 to 88), 76% (95%CI: 70 to 82) and 83% (95%CI: 77 to 89) for SPECT; 91% (95%CI: 85 to 97), 89% (95%CI: 83 to 95) and 89% (95%CI: 83 to 95) for PET; and 85% (95%CI: 79 to 90), 83% (95%CI: 77 to 89) and 88% (95%CI: 82 to 94) for PET/CT, respectively. The diagnostic accuracy of these imaging modalities was dependent on the radiotracers used in these studies, with ammonia resulting in the highest diagnostic value.

Conclusion:

Our review shows that PET has high diagnostic value for diagnosing coronary artery disease, and this indicates that it is a valuable technique for both detection and prediction of coronary artery disease.     

Indications requiring preoperative magnetic resonance imaging before knee arthroscopy

Introduction

Knee arthroscopy knee is gold standard in diagnosis and simultaneous treatment of knee disorders. But most patients undergo magnetic resonance imaging (MRI) before arthroscopy, although MRI results are not always consistent with arthroscopic findings. This raises the question in which suspected diagnoses MRI really has influence on diagnosis and consecutive surgical therapy.

Material and methods

Preoperative MRI of 330 patients with knee disorders were compared with arthroscopic findings. The MRI were performed by 23 radiologists without specialization in musculoskeletal diagnostics. Specificity, sensitivity, negative/positive predictive value and accuracy of MRI were calculated in comparison to arthroscopic findings.

Results

We found sensitivity/specificity of 58%/93% for anterior horn, 94%/46% for posterior horn of medial meniscus and 71%/81% for anterior and 62%/82% for posterior horn of lateral meniscus. Related to anterior cruciate ligament injuries we showed sensitivity/specificity of 82%/91% for grade 0 + I and 72%/96% for grade II + III. For Cartilage damage sensitivity/specificity of 98%/7% for grade I-, 89%/29% for grade II-, 96%/38% for grade III- and 96%/69% for grade IV-lesions were revealed.

Conclusions

The MRI should not be used as routine diagnostic tool for knee pain. No relevant information for meniscal lesions and anterior cruciate ligament ruptures has been gained with MRI from non-specialized outside imaging centres.The MRI should not be used as routine diagnostic tool for knee pain. No relevant information for meniscal lesions and anterior cruciate ligament ruptures has been gained with MRI from non-specialized outside imaging centres.     

The potential effect of anatomic relationship between the femur and the tibia on medial meniscus tears

Background

The anatomic and the kinematical relationships between the femur and the tibia have been previously examined in both normal and diseased knees. However, less attention has been directed to the effect of these relationships on the meniscal diseases. Therefore, we aimed to investigate the impact of femorotibial incongruence on both lateral and medial meniscal tears.

Materials and methods

A total of 100 images obtained from MRI of 100 patients (39 males and 61 females) were included in the study. Diameters of the medial and the lateral femoral condyles, thicknesses of the menisci, and diameters of the medial and the lateral tibial articular surfaces were measured.

Results

The medial meniscus tear was detected in 40 (40 %) patients. However, no lateral meniscus tear was found. Significant relationships were found between the diameters of the posterior medial femoral condyle and the medial tibial superior articular surface and between the diameters of the posterior lateral femoral condyle and the lateral tibial superior articular surface. The mean values for the diameter of the medial condyle of the femur, the lateral condyle of the femur, the medial superior articular surface of the tibia, and the lateral superior articular surface of the tibia were found to be significantly higher in cases with meniscus tear compared to cases without meniscus tear. However, no significant difference was present regarding the thicknesses of the medial and the lateral menisci. A positive relationship between the diameter of the posterior medial femoral condyle and the tibial medial superior articular surface was found in cases with (n = 40) (r ² = 0.208, p = 0.003) and without tear (n = 60) (r ² = 0.182, p = 0.001). In addition, a significant positive relationship was found between the diameter of the posterior medial femoral condyle and the medial tibial superior articular surface in cases with and without tear.

Conclusion

The impact of femorotibial incongruence on the medial meniscus tear is important for the understanding of the lesions.     

Coaptation/elevation role of the middle deltoid muscle fibers: a static biomechanical pilot study using shoulder MRI

Purpose

It is generally recognized that the middle deltoid muscle fibers (MDMF) have an elevating effect on the humeral head at small abduction angles. These forces are normally counterbalanced by the coaptation effect of the rotator cuff (RC) muscles to maintain shoulder stability. With RC tears, this balance may be jeopardized leading to shoulder dysfunction. Conversely, not all patients with RC tears develop shoulder dysfunction. The purpose of this study was to investigate the coaptation/elevation forces (CEF) ratio of the MDMF in RC tears subjects and in volunteers, using magnetic resonance imaging (MRI).

Methods

Magnetic resonance imaging images in 10 subjects with RC tears and in five volunteers were used to build a three-dimensional model of the shoulder. The CEF ratio of the MDMF was estimated by representing the glenohumeral joint as a pulley.

Results

The CEF ratio increased from the posterior to the anterior fibers of the MDMF.The median and interquartile range (IQR) of the CEF ratios of the posterior-third, middle-third, anterior-third and anterior-surface segments of the deltoid were: 0.16 (IQR = 0.23), 0.61 (IQR = 0.4), 1.42 (IQR = 0.41), 1.94 (IQR = 0.56) in subjects, and 0.06 (IQR = 0.24), 0.45 (IQR = 0.28), 1.32 (IQR = 1.01), 1.49 (IQR = 0.39) in volunteers. In the subjects, the CEF ratio of the anterior-surface segment was greater than all other segments (P ≤ 0.03).

Conclusions

The CEF ratio of the MDMF increased from its posterior segment to its anterior segment, indicating a greater stabilizing effect of the anterior segment both in RC tears subjects and in volunteers. Strengthening of the anterior fibers of the MDMF could potentially improve shoulder function in subjects with RC tears.     

Evaluation of the clinical value of bone metabolic parameters for the screening of osseous metastases compared to bone scintigraphy

Background

Bone metastases are common in many types of cancer. As screening methods different imaging modalities are available. A new approach for the screening of osseous metastases represents the measurement of bone metabolic markers. Therefore aim of this study was to evaluate the usefulness of the determination of bone metabolic markers aminoterminal propeptide of type I procollagen (PINP, osteoblastic activity) and the carboxyterminal pyridinoline cross-linked telopeptide of type I collagen (ICTP, osteoclastic activity) for the detection of bone metastases associated with other malignancies.

Methods

88 patients aged 21 – 82 years with malignant tumors were prospectively studied. The serum concentrations of PINP and ICTP were measured and compared to the results of bone scintigraphy, radiological bone series, CT, MRI and clinical follow-up.

Results

Osseous metastases were found in 21 patients. 19 of them were correctly identified by bone scintigraphy (sensitivity: 90%). For bone metabolic markers results were as follows: ICTP sensitivity: 71%, specificity: 42%; PINP sensitivity: 24%, specificity: 96%.

Conclusions

As markers of bone metabolism PINP and ICTP showed low sensitivity and/or specificity for the detection of osseous metastases. The presented markers did not seem to be sufficient enough to identify patients with bone metastases or to replace established screening methods.     

Comparing Point-of-care-ultrasound (POCUS) to MRI for the Diagnosis of Medial Compartment Knee Injuries

Background

Ultrasound has become an increasingly utilized tool for the imaging of the musculoskeletal system, especially for imaging the components of the knee. Even though MRI is touted as being the golden standard for identifying knee pathologies, the use of ultrasound has gained popularity in this field given its ability for rapid diagnosis. This study aims to investigate the efficacy of point-of-care ultrasound (POCUS) to diagnose injuries to the medial knee compartment when compared to magnetic resonance imaging (MRI).

Genetics of rotator cuff tears: no association of col5a1 gene in a case-control study

Background

The incidence of RC tears increases with aging, affecting approximately 30 to 50% of individuals older than 50?years, and more than 50% of individuals older than 80?years. Intrinsic factors (age or gender), extrinsic factors (sports activity or occupation), and biological factors were identified in the onset and progression of RC tears. The attention in the study of aetiology of RC tendinopathy has shifted to the identification of gene variants. Genes encoding for proteins regulating the concentration of pyrophosphate in the extracellular matrix and genes encoding for fibroblastic growth factors, defensin beta 1 and estrogen-related receptor-beta were analyzed. However, only in one study the role of variants of collagen type V alpha 1 (col5a1) gene in RC tears was assessed. The objective of this study was to determine whether a col5a1 DNA sequence variant, rs12722 (C/T) was associated with rotator cuff (RC) tears in a case-control study.

Methods

The study included 93 Caucasian patients undergoing surgery for RC tears and 206 patients with no history and sign of RC disease as evaluated by MRI. Patients were divided into two groups. Group 1 included patients with RC tear diagnosed on clinical and imaging grounds and confirmed at the time of surgery. Group 2 (control group) included patients without history or clinical symptoms of RC disorders and with a MRI negative for RC disease. DNA was obtained from approximately 1.2?ml of venous blood using the MagCore extractor system H16 with a MagCore Genomic DNA Large Volume Whole Blood Kit (RBC Bioscience Corp., Taiwan). All study participants were genotyped for SNPs rs12722.

Results

We first estimated that our study had 92% power at p?<?0.05 to detect a genetic effect size of 2.05 in the RT tears (93 individuals) and healthy population (206 individuals) cohorts, assuming a minor allele frequency for col5a1 variant rs12722 of 0.5707 in the Italian population (gnomAD frequency). No significant difference in allele and genotype frequencies was observed between RT tears patients and healthy controls. Similarly, no significant association was seen between the RT tears and healthy controls participants in the combined genotype distributions.

Conclusion

In conclusion, no correlations between the SNP rs12722 of col5a1 gene and RC tears susceptibility was found.

     

Pinpointing Moments of High Anxiety During an MRI Examination

Background

Magnetic Resonance Imaging (MRI) is associated with high levels of anxiety in many patients which may interfere with image quality and increase examination time. In order to develop effective intervention strategies that decrease anxiety, more insights into moments of high anxiety during a MRI examination are necessary.

Purpose

The present study aimed at obtaining insights into anxiety levels and moments of high anxiety during a Magnetic Resonance Imaging examination.

Method

The study included 67 patients, of whom 52 (77.6 %) were categorized as highly anxious. Stress and anxiety were measured continuously throughout the entire duration of the MRI examination by monitoring the heart rate. An increase in heart rate during the scan was taken as an indication for higher stress and anxiety. In addition to measuring stress and anxiety objectively, anxiety was assessed subjectively before and after the procedure by means of self-report questionnaires.

Results

The self-report data indicate that patients were highly anxious before the MRI examination. Moreover, the electrophysiological data clearly show that anxiety levels were highest at the beginning of the procedure, i.e., when the MRI table moved into the scanner, and then decreased over the course of the examination. Furthermore, the findings show that while subjectively measured anxiety was higher in patients who had taken anxiolytics prior to the MRI examination than in patients who had not taken any anxiolytics, objectively measured anxiety during the scan was equally high in both groups.

Conclusion

The present study provides detailed insights into the anxiety levels during an MRI examination, which may aid in developing effective anxiety-reduction strategies. Additionally, the findings show that measuring anxiety continuously throughout the entire examination using electrophysiology in combination with measuring anxiety subjectively prior to and after the scan provides a more complete assessment of MRI-related anxiety.     

National consensus on the definition,investigation, and classification of meniscal lesions of the knee

Background

The aim of this study was to deliver standardised terminology for the identification and stratification of patients with meniscal lesions of the knee.

The validity of the Moxus Modular metabolic system during incremental exercise tests: impacts on detection of small changes in oxygen consumption

Purpose

We investigated the accuracy of the Moxus Modular Metabolic System (MOXUS) against the Douglas Bag Method (DBM) during high-intensity exercise, and whether the two methods agreed when detecting small changes in $\dot{V}{\text{O}}_{2}$ between two consecutive workloads ( $\Delta {\dot{{V}}\text{O}}_{ 2}$ ).

Methods

Twelve trained male runners performed two maximal incremental running tests while gas exchange was analyzed simultaneously by the two systems using a serial setup for four consecutive intervals of 30 s on each test. Comparisons between methods were performed for $\dot{V}{\text{O}}_{2}$ , ${\dot{{V}}}_{\text{E}}$ , fractions of expired O₂ (FeO₂) and CO₂ (FeCO₂) and $\Delta {\dot{{V}}\text{O}}_{ 2}$ .

Results

The MOXUS produced significant higher (mean ± SD, n = 54) readings for $\dot{V}{\text{O}}_{2}$ (80 ± 200 mL min^?1, p = 0.005) and ${\dot{{V}}}_{\text{E}}$ (2.9 ± 4.2 L min^?1, p < 0.0001), but not FeO₂ (?0.01 ± 0.09). Log-transformed 95 % limits of agreement for readings between methods were 94–110 % for $\dot{V}{\text{O}}_{2}$ , 97–108 % for $\dot{V}_{\text{E}}$ and 99–101 % for FeO₂. $\Delta \dot{V}{\text{O}}_{2}$ for two consecutive measurements was not different between systems (120 ± 110 vs. 90 ± 190 mL min^?1 for MOXUS and DBM, respectively, p = 0.26), but agreement between methods was very low (r = 0.25, p = 0.12).

Discussion

Although it was tested during high-intensity exercise and short sampling intervals, the MOXUS performed within the acceptable range of accuracy reported for automated analyzers. Most of the differences between equipments were due to differences in $\dot{V}_{\text{E}}$ . Detecting small changes in $\dot{V}{\text{O}}_{2}$ during an incremental test with small changes in workload, however, might be beyond the equipment’s accuracy.     

The meniscal insertion of the knee anterolateral ligament

Purpose

The aim of this study is to characterize in detail the meniscal insertion of the anterolateral ligament (ALL) of the knee, establishing parameters regarding the circumference of the lateral meniscus and the popliteal muscle tendon (PMT) groove in addition to its histological analysis.

Methods

A total of 33 knees of cadavers were dissected. The ALL and the lateral meniscus were removed en bloc. After removal of the anatomical specimen, the meniscus circumference, the ALL insertion points on the external surface of the lateral meniscus, and the PMT groove were measured. Eight menisci were subjected to histological analysis.

Results

The ALL was found in all dissections performed. The ALL insertion occurred macroscopically in the transition between the anterior horn and the lateral meniscus body, specifically beginning at 36.0 % and ending at 41.9 % of the meniscal circumference, occupying a mean area of 5.6 mm. The distance between the end of the ALL meniscal insertion and the beginning of the PMT groove averaged 12.9 mm. In the histological evaluation, in longitudinal sections, we observed dense collagen fibers of the ligament inserting on the external surface of the meniscus. It is possible to observe a spreading of collagen fibers at the moment of meniscal insertion.

Conclusions

The ALL meniscal insertion was found in all dissected specimens, beginning with approximately 36 % of the meniscal outer diameter, 12.9 mm anterior to the beginning of the PMT groove. The histological analysis confirmed the presence of true ligamentous tissue in the dissected specimens.

     

A new interpolation-free procedure for breath-by-breath analysis of oxygen uptake in exercise transients

Introduction

Interpolation methods circumvent poor time resolution of breath-by-breath oxygen uptake ( \(\dot{V}{\text{O}}_{2}\) ) kinetics at exercise onset. We report an interpolation-free approach to the improvement of poor time resolution in the analysis of \(\dot{V}{\text{O}}_{2}\) kinetics.

Methods

Noiseless and noisy (10 % Gaussian noise) synthetic data were generated by Monte Carlo method from pre-selected parameters (Exact Parameters). Each data set comprised 10 ( \(\dot{V}{\text{O}}_{2}\) )-on transitions with noisy breath distribution within a physiological range. Transitions were superposed (no interpolation, None), then analysed by bi-exponential model. Fitted model parameters were compared with those from interpolation methods (average transition after Linear or Step 1-s interpolations), applied on the same data. Experimental data during cycling were also analysed. The 95 % confidence interval around a line of parameters’ equality was computed to analyse agreement between exact parameters and corresponding parameters of fitted functions.

Results

The line of parameters’ equality stayed within confidence intervals for noiseless synthetic parameters with None, unlike Step and Linear, indicating that None reproduced Exact Parameters. Noise addition reduced differences among pre-treatment procedures. Experimental data provided lower phase I time constants with None than with Step.

Conclusion

In conclusion, None revealed better precision and accuracy than Step and Linear, especially when phenomena characterized by time constants of <30 s are to be analysed. Therefore, we endorse the utilization of None to improve the quality of breath-by-breath \(\dot{V}{\text{O}}_{2}\) data during exercise transients, especially when a double exponential model is applied and phase I is accounted for.     

The Genovese grading scale is not reliable for MR assessment of collagen meniscus implants

Background

The purpose of the study was to evaluate the intra- and inter-observer reliabilities of the Genovese grading on MRI in patients after collagen meniscus substitution.

Bilateral fused os intermetatarseum presenting as dorsal foot pain: a case report

Purpose

Os intermetatarseum is a rare accessory bone of the forefoot and usually situated between the base of the first and second metatarsals. Most of the cases are asymptomatic and diagnosed incidentally. Here, we report a rare form of os intermetatarseum presented with bilateral dorsal foot pain and to the authors’ knowledge, it is the first case which includes computerized tomography (CT) and magnetic resonance imaging (MRI) findings.

Methods

A 23-year-old male complained of localized bump at the dorsum of the both feet underwent bilateral anteroposterior foot radiograms which was unremarkable and then CT and MRI were performed.

Results

MRI of both feet demonstrated osseous structures in relation with medial os cuneiforme. Computerized tomography demonstrated bilateral os intermetatarsea fused with medial os cuneiforme.

Conclusions

It is important for radiologist to know that os intermetatarseum can be presented as dorsal foot pain. Due to its position, it is difficult to demonstrate os intermetatarseum in plain radiographs, CT and MRI should be performed in clinically suggestive cases.     

Small bowel enteroclysis with magnetic resonance imaging and computed tomography in patients with failed and uncertain passage of a patency capsule

Background

Leading-edge technology such as magnetic resonance imaging (MRI) or computed tomography (CT) often reveals mammographically and ultrasonographically occult lesions. MRI is a well-documented, effective tool to evaluate these lesions; however, the detection rate of targeted sonography varies for MRI detected lesions, and its significance is not well established in diagnostic strategy of MRI detected lesions. We assessed the utility of targeted sonography for multidetector-row CT (MDCT)- or MRI-detected lesions in practice.

Methods

We retrospectively reviewed 695 patients with newly diagnosed breast cancer who were candidates for breast conserving surgery and underwent MDCT or MRI in our hospital between January 2004 and March 2011. Targeted sonography was performed in all MDCT- or MRI-detected lesions followed by imaging-guided biopsy. Patient background, histopathology features and the sizes of the lesions were compared among benign, malignant and follow-up groups.

Results

Of the 695 patients, 61 lesions in 56 patients were detected by MDCT or MRI. The MDCT- or MRI-detected lesions were identified by targeted sonography in 58 out of 61 lesions (95.1%). Patients with pathological diagnoses were significantly older and more likely to be postmenopausal than the follow-up patients. Pathological diagnosis proved to be benign in 20 cases and malignant in 25. The remaining 16 lesions have been followed up. Lesion size and shape were not significantly different among the benign, malignant and follow-up groups.

Conclusions

Approximately 95% of MDCT- or MRI-detected lesions were identified by targeted sonography, and nearly half of these lesions were pathologically proven malignancies in this study. Targeted sonography is a useful modality for MDCT- or MRI-detected breast lesions.     

Non Invasive Assessment of Lung Disease in Ataxia Telangiectasia by High-Field Magnetic Resonance Imaging

Purpose

A sensitive imaging technique that assesses ataxia telangiectasia (AT) lung disease without ionizing radiation is highly desirable. We designed a study to evaluate lung changes using magnetic resonance imaging (MRI), and to investigate the relationships among severity and extent of pulmonary abnormalities and clinical, microbiological and functional data in children and young adults with AT.

Methods

Fifteen AT patients (age, 11.3 years; range, 6–31) underwent 3.0-T MRI, spirometry, and deep throat or sputum culture. Images were scored using a modified Helbich score.

Results

Although only 8 patients (53 %) had recurrent/chronic respiratory symptoms, MRI identified lung abnormalities in all. Bronchiectasis, peribronchial thickening, mucous plugging, and collapse/consolidation were present in 60 %, 87 %, 67 %, and 13 % of cases, respectively, with no difference between subjects with or without respiratory symptoms. No difference in changes of specific scores was found between the two groups, but the total MRI score was higher in patients with respiratory symptoms (6.5 versus 5, respectively; p?=?0.02). Total or specific MRI scores were not associated with patients’ age. Of all scores, only mucous plugging subscore appeared significantly related to FEV₁ (r?=?0.7, p?=?0.04) and FEF_25–75% (r?=?0.9, p?=?0.001). MRI scores from patients with positive (n?=?5) or negative (n?=?10) sputum culture were not significantly different.

Conclusions

MRI is valuable in the assessment of extent and severity of pulmonary changes in children and adults with AT. It represents an helpful tool for the longitudinal evaluation of patients and may be also used as an outcome surrogate to track the effects of medications.