Tumour and tumour-like lesions of the patella – a multicentre experience

Fifty-nine cases of lesions presenting in the patella were identified after review of the databases of four European bone tumour registries. Of the 59 cases, 46% were non neoplastic, 39% were benign and 15% were malignant. The commonest benign neoplasm was giant cell tumour (GCT) (11 cases). Younger patients were more likely to have a benign neoplasm. Lesions in patients less than 40 years of age included giant cell tumour, chondroblastoma, aneurysmal bone cyst (ABC), osteomyelitis, osteoid osteoma and solitary bone cyst. In patients older than 40 years, the following were common lesions: intra-osseous gout, metastasis and intra-osseous ganglion. Expansion of the patella with thinning of cortex was seen more commonly in GCT and brown tumour in hyperparathyroidism. There was associated soft tissue extension in gout and malignant lesions.     

Forensic speaker profiling: the study of supra-segmental features of Gujarati dialects for text – independent speaker identification

In forensics, personal identification and criminal profiling have proved to be one of the important tasks in which variant features have been evaluated for the information related to individuals. Speaker profiling, identification of individuals through voice, is one such aspect of profiling. A qualitative analysis of vowels in different Gujarati-speaking regions was done to study the accents of spoken Gujarati. Although Gujarati is the official language of Gujarat state, the accent, lexicon and prosody vary across geographical areas. In this paper, we have subjected four major accent regions: Standard Gujarati, Kathiawari, Carotari and Kutchi dialects, which were chosen from different parts of the Gujarat state for this study. Standard Gujarati is considered as the basic language due the close approximation to the modern Standard Gujarati. In total, 175 males and 175 females were selected from each dialectal region keeping the selection criteria in mind, giving a total of 1400 speakers. The study was conducted in the context of text independent recognition of Gujarati language speech in four dialects. Qualitative analysis of Gujarati vowels, acoustic features, intonation and tone of a speaker as compared in this study could have the potential for identification of dialect accent and to provide additional aid in forensic criminal profiling.     

Life after the game – Injury profile of past elite Australian Football players

ObjectivesTo investigate the long-term health and well-being of past elite Australian Football League (AFL) players, with particular emphasis on the effect of playing injuries on current lifestyle.DesignCross sectional survey.MethodsA health and well-being survey, completed by past AFL players (n = 592) with mean (±SD) age of 55.1 y (±15.8) and playing career of 7.7 y (±4.1) sought information on demographics, education and employment, subjective well-being, lifestyle behaviours, physical health, disease prevalence, community and social structures, and playing history.ResultsA majority of past players experienced serious injuries (76%) and concussion (73%) throughout their career, both increasing significantly with the number of games played. Of those who received injuries, 60% require on-going treatment, yet only 6% receive treatment costs covered by their club or the AFL Players’ Association. A large proportion (64%) of respondents are affected in daily life from previous AFL injuries.ConclusionsAFL careers are compounded by high injury rates, including loss of consciousness with a high incidence of multiple concussions amongst those players reporting a serious injury. Greater number of injuries received will further the likelihood of requiring on-going treatment and being affected later in life. Additional research and planning may be important in assisting other improvements in the quality of life of past AFL players.     

Heat-related deaths in Adelaide,South Australia: Review of the literature and case findings – An Australian perspective

Heat waves are not uncommon in Australia, but the event of 2009 was particularly severe and ranks third of the 21 recorded heat wave events in south-eastern Australia in terms of the resulting mortality and morbidity. This is a review of Coronial autopsy findings in South Australia (which has an area of nearly 1 million square kilometres with a population of 1.6 million that predominantly resides within the region of the capital: Adelaide) during the period of the 2009 heat wave. Fifty-four post-mortem examinations were performed on cases in which exposure to high ambient temperature was regarded as having caused or significantly contributed to the death. The findings (including results of toxicological and biochemical analyses, where available) are reviewed and compared with the post-mortem examination findings in 22 deaths over the same period not attributed to the effects of heat. There were no specific autopsy findings that distinguished heat-related from non heat-related deaths. The lack of specific post-mortem findings increases the reliance on scene investigation in order to be able to categorise a death as being heat-related. A checklist for scene investigators is proposed in order to assist with collection of relevant data to assist the Coronial investigation process.     

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.     

Gorham–Stout disease: the experience of the Rizzoli Institute and review of the literature

Gorham–Stout disease (also known as “disappearing bone disease”) was first described by Jackson in 1838, but was properly defined by Gorham and Stout in a series of 24 patients in 1954–1955. It is a rare disease of unknown etiology (about 200 cases reported in the literature) characterized by spontaneous progressive resorption of bone without malignant proliferation of vascular structures. The diagnosis is one of exclusion and it is based on combined histological, radiological, and clinical features. Benign vascular proliferation with fatty bone marrow and thinning of bony trabeculae is a typical histological feature. Standard radiographs of disappearing bone disease show progressive bony resorption with adjacent soft tissue involvement. Most cases of Gorham–Stout disease resolve spontaneously, but prognosis remains unpredictable. This study reports 13 cases of Gorham–Stout disease treated in our institution from 1968 to 2008. The aim of the work was to review our series and the literature on this rare disease, as well as to evaluate whether or not an optimal treatment can be identified and recommended.     

Diffusion tensor imaging of periventricular leukomalacia – Initial experience

Aim of the study

To investigate the role of MR diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) in the assessment of altered major white matter fibers in preterm infants and children with PVL.

Patients and methods

We used diffusion tensor imaging to evaluate the major white matter tract fibers in 15 children with periventricular leukomalacia in correlation with cognitive and motor disability. Mean age of the patients was 28.5 months (range: 9–84 months). 5 normal control children were recruited (mean age: 21.4, range: 11–60 months). MR imaging was obtained by using a 1.5-T, whole-body scanner. DTI was acquired after the routine sequences. Then, data post-processing and fiber-tracking method was applied.

Results

This study demonstrated the existence of the WM tract injury in PVL patients using the DTI tractography approach in correlation with neurodevelopmental delay in patients with various degrees of cognitive and motor impairment. Compared with the normal control group, the following abnormalities were detected on qualitative analysis of the white matter tracts.

Corticospinal tracts

Decreased volume and cross-sectional area on the affected side.

Ascending sensorimotor tracts

Thinning of sensory fiber tracts and posterior thalamic radiations.

Commissural and association tracts

Significant damage of the callosal fibers was reported in cases with partial agenesis of the corpus callosum.

Conclusion

DTI proved to be a promising noninvasive method for assessing the severity of white matter tract injury in patients with PVL. This is owing to the capability of fiber-tracking techniques to provide more information for understanding the pathophysiologic features of sensorimotor and cognitive disability associated with PVL. This will allow for the early intervention and initiation of rehabilitation programs aiming for minimizing the associated neurological deficit.     

Assessment of the willingness of Australian radiographers in mammography to accept new responsibilities in role extension: Part two – qualitative analysis

Advanced practice in screening mammography has become widespread in the United Kingdom over the last 20 years, and Australian radiographers working in BreastScreen programs have shown interest in similar developments. Radiographers working in BreastScreen Australia were surveyed in order to capture their thoughts and perceptions on role extension.Questionnaires were circulated to radiographers working in BreastScreen Australia programs. Thematic analysis was used to analyze the open response questions to explore the advantages and disadvantages identified by the participants with respect to role expansion in screening mammography as well as any changes to their duties over the last decade.There were 253 responses to the survey and of those responses, 70% of radiographers shared their thoughts on role extension and 49% provided comments on changes in the workplace. The majority (61%) radiographers responding to the role extension question were concerned about potential problems associated with role extension; the biggest issues were that role extension should not be mandatory and that selection criteria for advanced practitioners should be stringent, with adequate time made available for training and study. The major change in the role of the radiographer has been the increased time dedicated to quality assurance tasks and administrative duties as well as more training required due to technological changes from film-screen to digital mammography.There is high interest in role extension by radiographers working in BreastScreen programs, provided that it is voluntary. The role of the radiographer within breast imaging in Australia is still evolving.     

Quantitative chemical-shift MR imaging cutoff value: Benign versus malignant vertebral compression – Initial experience

Purpose

To evaluate the diagnostic accuracy of in-phase/opposed-phase quantitative chemical shift magnetic resonance (MR) imaging of the spine and to determine the cutoff value that enables differentiation of malignant from benign compression fractures, in patients with known primary malignancy.

Patients and methods

Prospective assessment of thirty-two patients with known primary malignancy who presented with vertebral compression fractures, MR imaging of the spine at 1.5 Tesla with standard conventional MR sequences and additional chemical shift (in-phase/opposed-phase) imaging was done. Quantitative image analysis by drawing regions of interest (ROI) on the abnormal marrow of compressed (study group) and adjacent normal vertebra (control group) was also performed in each patient. The signal intensity ratio (SIR) of the marrow was determined by dividing the mean signal intensity on the opposed-phase to the mean signal intensity on the in-phase images and statistical analysis was performed.

Results

Mean SIR of benign vertebral compression [0.73 ± 0.07 (range 0.12–1.2)] was significantly lower than malignant SIR values [1.72 ± 0.14 (range 0.8–2.96)] (p < 0.0001; area under the ROC curve, 0.97). The optimal SIR cutoff value for separating benign and malignant vertebral compression was found to be 0.91 with a calculated sensitivity of 93%, specificity of 82% and accuracy of 88%.

Conclusion

Quantitative chemical shift MR imaging could be a valuable addition to standard MR imaging techniques and represent a rapid problem solving tool in differentiating benign from malignant vertebral compression, especially in patients with known primary malignancies.     

Interobserver variability of magnetic resonance angiography in the diagnosis of carotid stenosis – effect of observer experience

Magnetic resonance angiography (MRA) for determining the degree of carotid stenosis prior to carotid endarterectomy is attractive because it does not have the high morbidity associated with conventional intra-arterial angiography. We assessed the interobserver variability in the estimation of the degree of stenosis amongst observers of different experience. In a prospective study, consecutive patients with transient ischaemic attacks and symptomatic tight carotid stenosis shown by Doppler ultrasound underwent conventional intra-arterial angiography and 2-D and 3-D time-of-flight MRA of the carotid bifurcations. The films of the processed MRA images were reviewed blind to other clinical and imaging data by eight observers of different levels of experience and coded for the presence and degree of stenosis. The stenosis on intra-arterial angiography was used as the reference standard. There was considerable variability between observers for estimation of the degree of stenosis on MRA. The observers' accuracy ranged from 41% (student) to 79% (experienced). From these estimations, excluding those of the student, it could be seen that up to 23% of patients who would have had an endarterectomy based on MRA should not have done so according to angiography, and up to 33% of patients who should have had an endarterectomy according to angiography would have inappropriately missed having an endarterectomy based on MRA results. Observer reliability of MRA processed images is not good, even in experienced hands. Using the source images and views of the circle of Willis might improve the accuracy, but a further study is required to assess this.     

Criminal profiling through MALDI MS based technologies – breaking barriers towards border-free forensic science

The theme of the 2018 ANZFSS symposium, ‘Forensic Science without borders’ is probably the key to Forensic Science progress. Advocating the need for ‘no borders’ acknowledges the existence of barriers to break and this can only be achieved through the delivery of research that is impactful. Certainly, every researcher values their research but not every research generates impact; the first border to cross for research implementation is that of the laboratory in which the research takes place. This transition requires strategic planning through the design of the pathways to impact the beneficiaries of the research. The 2018 ANZFSS symposium theme offered a good opportunity for reflection on the several meanings of ‘forensic science without borders’ and the barriers to break. This article will be a reflection from a personal perspective in developing, alongside other researchers, a new discipline which the author has named ‘chemical criminal profiling’ through fingermark analysis. Here, glimpses into the journey of developing this research area will be provided, highlighting the barriers that need to be broken in order to make the technology operational and available with no borders.     

Twins in spirit part II: DOTATATE and high-affinity DOTATATE—the clinical experience

Purpose

Over recent decades interest in diagnosis and treatment of neuroendocrine tumours (NET) has steadily grown. The basis for diagnosis and therapy of NET with radiolabelled somatostatin (hsst) analogues is the variable overexpression of hsst receptors (hsst1–5 receptors). We hypothesized that radiometal derivatives of DOTA-iodo-Tyr³-octreotide analogues might be excellent candidates for somatostatin receptor imaging. We therefore explored the diagnostic potential of ⁶⁸Ga-DOTA-iodo-Tyr³-octreotate [⁶⁸Ga-DOTA,3-iodo-Tyr³,Thr⁸]octreotide (⁶⁸Ga-HA-DOTATATE; HA, high-affinity) compared to the established ⁶⁸Ga-DOTA-Tyr³-octreotate (⁶⁸Ga-DOTATATE) in vivo.

Methods

The study included 23 patients with known somatostatin receptor-positive metastases from NETs, thyroid cancer or glomus tumours who were investigated with both ⁶⁸Ga-HA-DOTATATE and ⁶⁸Ga-DOTATATE. A patient-based and a lesion-based comparative analysis was carried out of normal tissue distribution and lesion detectability in a qualitative and a semiquantitative manner.

Results

⁶⁸Ga-HA-DOTATATE and ⁶⁸Ga-DOTATATE showed comparable uptake in the liver (SUV_mean 8.9?±?2.2 vs. 9.3?±?2.5, n.s.), renal cortex (SUV_mean 13.3?±?3.9 vs. 14.5?±?3.7, n.s.) and spleen (SUV_mean 24.0?±?6.7 vs. 22.9?±?7.3, n.s.). A somewhat higher pituitary uptake was found with ⁶⁸Ga-HA-DOTATATE (SUV_mean 6.3?±?1.8 vs. 5.4?±?2.1, p?<?0.05). On a lesion-by-lesion basis a total of 344 lesions were detected. ⁶⁸Ga-HA-DOTATATE demonstrated 328 lesions (95.3 % of total lesions seen), and ⁶⁸Ga-DOTATATE demonstrated 332 lesions (96.4 %). The mean SUV_max of all lesions was not significantly different between ⁶⁸Ga-HA-DOTATATE and ⁶⁸Ga-DOTATATE (17.8?±?11.4 vs. 16.7?±?10.7, n.s.).

Conclusion

Our analysis demonstrated very good concordance between ⁶⁸Ga-HA-DOTATATE and ⁶⁸Ga-DOTATATE PET data. As the availability and use of ⁶⁸Ga-HA-DOTATATE is not governed by patent restrictions it may be an attractive alternative to other ⁶⁸Ga-labelled hsst analogues.