Correlation of MRI with arthroscopy for the evaluation of the subscapularis tendon: a musculoskeletal division’s experience

Objective

To determine the accuracy of MR imaging for the evaluation of the subscapularis tendon as well as define imaging findings that will increase accuracy.

Materials and methods

Retrospective review of the MR and operative (OR) reports of 286 patients was conducted and reviewed for the presence/degree (partial (PT)/full-thickness (FT)) of tearing; only PT articular tears were included. The presence of a supraspinatus tear and time interval between surgery and MRI were also documented. All of the PT tears called on MRI were also reviewed to see if there was a statistically significant association between certain imaging characteristics and the presence of a tear in surgery. Statistical analysis included 95 % confidence intervals, Fisher’s exact, and exact Mann–Whitney tests.

Results

A total of 244 patients were included in the study with a total of 25 subscapularis tears, 16 PT and nine FT, and 219 intact tendons in arthroscopy; 20/25 tears and 200 intact tendons were diagnosed correctly on MRI, resulting in sensitivity of 80 %, specificity of 91 %, accuracy of 90 %, positive predictive value of 51 %, and negative predictive value of 98 %. There was a significant association between the presence of a PT tear during arthroscopy and fluid-like signal within the tendon on more than one imaging plane (p?<?0.001) with an accuracy of 90 %.

Conclusions

This study reflects a musculoskeletal radiology section’s experience with the diagnosis of subscapularis tendon pathology, demonstrating that MRI could be used to accurately evaluate the subscapularis tendon. An understanding of certain imaging pitfalls and the presence of fluid-like signal on multiple imaging planes should increase the diagnostic accuracy of the radiologist evaluating the subscapularis tendon for the presence of a tear.     

99mTc-EDDA/HYNIC-octreotate scintigraphy, an efficient method for the detection and staging of carcinoid tumours: results of 3 years’ experience

Purpose At all stages of the disease, serious difficulties are encountered in the imaging diagnosis of carcinoids. Somatostatin receptor scintigraphy (SRS) holds great promise for detecting primary tumours and metastases. ^99mTc-EDDA/HYNIC-octreotate should significantly improve the diagnosis of carcinoids in comparison with ¹¹¹In-Octreoscan owing to the better affinity for SSR2 and the higher count rate. The aim of this study was to assess the diagnostic efficiency of ^99mTc-EDDA/HYNIC-octreotate scintigraphy in the detection and staging of carcinoid tumours.Methods The study population comprised 75 patients (age 48.5±15.5 years): 46 with histological confirmation of carcinoid and 29 with suspected disease. ^99mTc-EDDA/HYNIC-octreotate (740 MBq) SRS and CT were performed in all patients. Fifteen patients were examined with ¹¹¹In-Octreoscan. Results High-quality ^99mTc-EDDA/HYNIC-octreotate images were obtained in all cases, with maximum tumour tracer accumulation 4 h p.i. The mean target/non-target ratios for whole body (WB) and SPECT scans were, respectively, as follows: primary lesions: 4.5 and 10.2; metastases: liver, 3.1 and 12.3; abdominal focal lesions, 2.7 and 5.8; lung, 2.7 and 8.3; mediastinum, 3.4 and 7.6; bones, 6.8 and 19.0. ^99mTc-EDDA/HYNIC-octreotate WB scans revealed more metastases than ¹¹¹In-Octreoscan, with better individual separation. ^99mTc-EDDA/HYNIC-octreotate SRS revealed new metastatic lesions in seven patients with confirmed carcinoid, and in four with dissemination the primary focus was found. Five patients qualified for radioguided surgery and 11 were referred to ⁹⁰Y-DOTA-TATE therapy. The sensitivity of SRS in comparison with CT was higher for primary lesions and liver and abdominal lymph node metastases. In the subgroup of patients with suspected neuroendocrine tumours, two duodenal carcinoids, one thymic carcinoid and one ileal carcinoid were found.Conclusion ^99mTc-EDDA/HYNIC-octreotate, with high imaging quality, is an excellent alternative to ¹¹¹In-Octreoscan for staging of carcinoids, and it seems to be the method of choice for detection of the primary focus in patients with metastases from an unknown primary tumour.     

Radiofrequency ablation for single lung tumours not suitable for surgery: seven years’ experience

Purpose

This study was done to review recurrence patterns in patients with lung cancer (primary or secondary) treated with percutaneous image-guided radiofrequency (RF) ablation.

Materials and methods

From January 2003 to August 2010, 32 patients (24 with primary non-small-cell lung cancer and eight with metastases) with single lung cancer were treated with RF ablation. Post-treatment imaging results were available for each patient. Follow-up was performed using computed tomography (CT) scans at 1, 3, 6, 12, 18 and 24 months after the procedure and annually thereafter. Patterns of recurrence were classified as local, intrapulmonary, nodal, mixed and distant. We evaluated overall survival after RF ablation and the factors associated with recurrence.

Results

Seventeen (53.1%) patients showed no evidence of recurrence at follow-up imaging (range 12-72 months; mean, 32.5 months). Recurrence was seen in 15 (46.9 %) patients (range 6-36 months; mean 14.8 months). Local recurrence (40%) after RF ablation was the most frequent. Median disease-free survival was 20 months. Sex, tumour location, tumour size and tumour stage were not associated with a risk of recurrence. Patient age was related to the risk of recurrence (p<0.05).

Conslucions

Local recurrence is the most common pattern in our series. A more aggressive initial RF ablation might offer improvement in outcomes, but this hypothesis needs to be confirmed by larger studies involving a larger number of patients.     

Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in high-risk patients. We report results in the endovascular treatment of carotid artery disease with up to 8 years' follow-up. In this retrospective study, we analysed data from 853 consecutive patients (946 arteries) treated for carotid artery stenosis between April 1999 and March 2007; 491 (52%) arteries were symptomatic and 455(48%) were asymptomatic. Preprocedural evaluation of the patients was performed with echo Doppler, magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) and a neurological examination. A cerebral protection device was used in 879 (92.9%) procedures. Anti-platelet therapy was administered before and after the procedure. All patients were included in a follow-up of up to 8 years. Technical success was achieved in 943 (99.6%) lesions. At 30 days, there was a 0.21% (n = 2) death rate, a 0.42% major stroke rate, a 1.69% minor stroke/transient ischaemic attack (TIA) rate and a combined 2.32% TIA/stroke and death rate. During follow-up, echo Doppler evidenced restenosis in 39 (4.85%) cases; of these, only five, presenting restenosis >80%, were treated with an endovascular reintervention. At the long-term follow-up, two strokes (0.23%) were reported, which both occurred within the first 2 years. In our experience, carotid artery stenting seems to be a safe and effective treatment, providing satisfactory long-term clinical results.     

Sonography of the painful shoulder: role of the operator’s experience

Objective  The aim of our study was to determine the role of the operator’s experience in the sonographic evaluation of the painful shoulder and to validate assumptions about its technical performance in routine practice. Materials and methods  Two radiologists, respectively standard and expert sonographic operators, independently and prospectively scanned 65 patients with clinical suspicion of rotator cuff lesion. Magnetic resonance arthrography was the reference standard. Results  The sensitivity of the expert ultrasound operator was 95.3% for full-thickness rotator cuff tears (41/43), 70.6% for partial-thickness tears (12/17), 64.3% for intratendinous tears (9/14), 100% for abnormality of the long head of biceps tendon (seven of seven), 88.9% for supraspinatus tendinosis (16/18), 96.4% for subacromial bursa abnormalities (53/55), and 91.7% for acromioclavicular joint osteoarthritis (33/36). The two sonographic operators were in very good agreement about full-thickness rotator cuff tears (κ = 0.90), supraspinatus tendinosis (κ = 0.80), abnormalities of the long head of biceps tendon (κ = 0.84), subacromial bursa abnormalities (κ = 0.89), and acromioclavicular osteoarthritis (κ = 0.81). The agreement was only moderate for partial-thickness tears (κ = 0.63) and intratendinous tears (κ = 0.57). Conclusions  Our results show that in moderately experienced hands as in experts’ hands, sonography has a low level of interobserver variability for full-thickness rotator cuff tears. Considering partial-thickness and intratendinous rotator cuff tears, our data suggest that interobserver variability is higher.     

Fifteen years’ experience with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents: retrospective review of clinical and technical aspects

Purpose

The authors present a retrospective analysis of a large series of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement.

Materials and methods

Between March 1992 and December 2006, 658 patients were referred to our centre for TIPS placement. Indications for the procedure were digestive tract bleeding (52.8%), refractory ascites (35.3%), preservation of portal vein patency prior to liver transplantation (3.0%) and thrombosis of the suprahepatic veins (2.3%). Other indications (6.6%) included pleural ascites, portal thrombosis and hepatorenal and hepatopulmonary syndromes. All patients were evaluated with colour Doppler ultrasonography and in a few cases with computed tomography. The portal system was punctured under sonographic guidance. Wallstent, Palmaz and Nitinol thermosensitive stents were used. Embolisation of persistent varices was performed in 6.8% of cases.

Results

Technical success was 98.9%. During a 1,500-day follow-up, the cumulative incidence of stent revision was 25.7% (Nitinol), 32.9% (Wallstent) and 1.8% (Palmaz). Mortality rates were 31.1%, 38.5% and 56.4%, respectively. The technical complications included six cases of heart failure, six of haematobilia, three of stent migration, two of intrahepatic haematoma and one of haemoperitoneum. Eight patients with severe portosystemic encephalopathy (PSE) were treated with a reduction stent.

Conclusions

TIPS placement is safe and effective and may act as a bridge to liver transplantation. Ultrasonography plays a fundamental role in the preliminary assessment, in portal vein puncture and during the follow-up. Stent patency is satisfactory.     

Clinical experience with the pREset stent retriever for the treatment of acute ischemic stroke—a review of 271 consecutive cases

Introduction

The purpose of this study was to evaluate the safety and efficacy of the pREset stent retriever in a real-world clinical setting.

Methods

Patients treated with pREset were selected from a prospectively maintained single-center database. A TICI score ≥2b after ≤3 passes was regarded as successful recanalization. All device-related complications and their clinical significance were reported. Parenchymal hematomas (PH) were classified according to ECASS, adding focal and diffuse subarachnoid hemorrhage (SAH) as categories. A 90-day mRS of 0–2 was defined as favorable outcome. In addition, we separately analyzed patients treated with >3 pREset passes and patients receiving other rescue maneuvers.

Results

We included 271 patients. Successful recanalization was achieved in 76.4 %. Device-related complications occurred in 9.2 % of which 2.2 % were clinically significant. PH I, PH II, focal SAH, and diffuse SAH was observed in 5.2, 4.8, 12.2, and 2.2 %, respectively. A total of 39.5 % of patients had favorable clinical outcome. Considering treatments with >3 pREset passes or other rescue procedures, an additional 8.5 and 9.3 % of target vessels were recanalized. The chance of favorable clinical outcome decreased significantly with any kind of rescue therapy. In addition, the rate of PH I was significantly higher in patients treated with >3 pREset passes, whereas all other types of hemorrhage showed no difference.

Conclusion

In terms of safety and effectiveness, pREset performed comparably to other stent retriever devices. To avoid futile recanalization and potential additional harm, escalation of therapy beyond three thrombectomy passes should only be performed after careful individual consideration of each case.     

The height of the pituitary in preterm infants during the first 2 years of life: an MRI study

Pituitary secretory activity is different in premature and full-term infants. The height of the pituitary is a marker of its secretory activity. Our purpose was to use MRI to measure height of the pituitary of premature infants and to compare it with full-term controls. The height was measured on a midline sagittal T1-weighted image in 86 premature infants (gestational age 26–36.9 weeks, mean 32.3±2.85 weeks, corrected age 0.33–2 years, mean 0.76±0.42 years) and in 70 age- and sex-matched full-term controls. The children were was divided into four age groups: A: 0.5 years; B: 0.51–1.0 year; C: 1.01–1.5 years; and D: 1.51–2.00 years. The gland was significantly ( P <0.01 ) higher in the preterm infants than in the controls (3.88±0.61 vs 3.31±0.64 mm). In the preterm group no significant difference was found between children small or appropriate for gestational age or between those with and without periventricular leukomalacia. Pituitary height by age group was: A: 3.71±0.57, B: 3.81±0.56, C: 4.09±0.68; and D:4.45±0.57 mm; statistically significant ( P <0.01) differences were found between groups A and D and B and D. The pituitary is thus higher in premature than in full-term controls and shows a trend to increase after the first year of corrected-age life.     

Cross-reactivity of the CEDIA buprenorphine assay with opiates: an Austrian phenomenon?

When testing the Microgenics CEDIA assay for immunological buprenorphine analysis, cross-reactivity between the buprenorphine reagents and opiates was observed at concentrations higher than 120 mg/l morphine, 320 mg/l methadone, 30 mg/l codeine, 60 mg/l dihydrocodeine and 520 mg/l morphine-3-glucuronide. The cross-reactivity with morphine has the greatest impact on routine screening as opiate maintenance therapy in Austria is also performed with slow-release oral morphine. The use of a second cutoff value of 30 g/l for urine samples that are (immunologically) positive for opiates is therefore suggested, compared to the cutoff value of 5 g/l proposed by the manufacturer.     

Primary closure of battle wounds of the colon: is it an option for the military surgeon?

The management of battle wounds of the colon has been safely established for many years, with primary closure of the wounds being discouraged. More recent work, involving large numbers of patients from civilian trauma centres, has challenged this. The appropriateness of these conclusions for the battle situation is discussed, including the nature of injury, the medical logistics and the combat scenario. Parameters are indicated and guide lines given, incorporating battle-proven military surgical principles and modern trauma experience. This includes damage control and possible primary closure of selected wounds. In this way the military surgeon can take an informed decision in providing optimal care for patients with battle wounds of the colon.     

A solitary lesion of talus with mixed sclerotic and lytic changes: Rosai-Dorfman disease of 25 years’ duration

Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is an unusual form of histiocytic disorder predominantly affecting children and young adults. Bone lesions are infrequent. We describe a 63-year-old woman with a solitary lesion of the talus which was misdiagnosed for 25 years. The patient never had adenopathy or other organ involvement. The radiographic findings were a mixture of sclerotic and lytic changes, an extremely rare and unusual presentation of the disease.     

Intra-arterial treatment with <Superscript>90</Superscript>Y microspheres for hepatocellular carcinoma: 4 years experience at the Ghent University Hospital

Purpose  

We report on our experience in terms of eligibility, safety, response and survival for treatment of hepatocellular carcinoma (HCC) with ⁹⁰Y microspheres. Secondly, we investigated the urinary excretion of ⁹⁰Y following treatment.     

177Lu-DOTATATE therapy in patients with neuroendocrine tumours: 5 years’ experience from a tertiary cancer care centre in India

Purpose

The choice of an appropriate treatment option in patients with inoperable or metastatic neuroendocrine tumours (NETs) is limited, and approximately 50 % of patients have advanced NET at diagnosis, and 65 % die within 5 years. Treatment with ¹⁷⁷Lu-DOTATATE (¹⁷⁷Lu-[DOTA⁰,Tyr³] octreotate) is a promising new option in the treatment of metastatic NETs.

Methods

Patients with metastatic NET who underwent ¹⁷⁷Lu-DOTATATE during the period 2009 to 2013 were included in this retrospective study. Follow-up imaging studies including a ⁶⁸Ga-DOTANOC PET/CT scan and a posttherapy ¹⁷⁷Lu-DOTATATE scan were compared with baseline imaging to determine response to treatment. Progression-free survival (PFS) was calculated using the Kaplan-Meier method and Cox regression analysis was also done.

Results

Ten patients (25 %) had a minimal response, 13 (32.5 %) had a partial response and 9 (22.5 %) had stable disease. Progressive disease was seen in 8 patients (20 %), including 6 patients who died during or after the treatment period. The estimated mean PFS in those who received one or two cycles of ¹⁷⁷Lu-DOTATATE was 8.3 months (95 % CI 6.2 to 10.3 months) compared to an estimated mean PFS of 45.6 months (95 % CI 40.9 to 50.2 months) in those who received more than two cycles of ¹⁷⁷Lu-DOTATATE (log-rank Mantel-Cox Χ ²?=?8.01, p?=?0.005).

Conclusion

Our study showed that treatment with ¹⁷⁷Lu-DOTATATE should be considered in the management of NETs, considering the limited success of alternative treatment modalities. Treatment response and PFS is determined primarily by the dose delivered and best results are obtained when more than two cycles of ¹⁷⁷Lu-DOTATATE are given, with careful monitoring for possible side effects.     

Influence of light conditions (colour temperature and illuminance) on the evaluation of root translucency for the application of Lamendin’s age-at-death estimation technique

International Journal of Legal Medicine - Estimation of age-at-death represents a central focus in forensic human identification, as it is a key parameter used in the identification of unidentified...     

Electrochemiluminescence and voltammetry of tris(2,2′-bipyridine)ruthenium (II) with amphetamine-type stimulants as coreactants: an application to the discrimination of methamphetamine

Purpose

We have tried to establish an electrochemical detection method for screening of the stimulants in the forensic samples using electrochemiluminescence (ECL) and voltammetric techniques.

Methods

Amphetamine-type stimulants (ATSs), such as methamphetamine (MA), amphetamine (AM), dimethylamphetamine (DMA), and methoxyphenamine (MP) have been studied as coreactants in the [Ru(bpy)₃]²⁺ (bpy = 2,2′-bipyridine) ECL system.

Results

There were two specific ECL peaks located at + 1.1 and + 1.4 V for MP, whereas there was only one ECL peak at + 1.1 V for MA and DMA, and no ECL response for AM. Different reaction mechanisms were proposed to understand the generation of ECL by the [Ru(bpy)₃]²⁺/ATS system. Because the voltammetric responses of these ATSs at a glassy carbon electrode were also different, it was possible to detect MA without a separation process based on the characteristic ECL and cyclic voltammetric signals. By a combination of ECL and voltammetric measurements, a simple and rapid screening method for MA could be proposed, and was applied in the determination of MA in human urine samples with sufficient sensitivity.

Conclusions

The present electrochemical approach seems to provide a new way for primary screening of MA in forensic application.