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.     

Diminished femoral head–neck offset and the restricted hip range of motion suggesting a possible role in ACL injuries

Purpose

Femoroacetabular impingement may be associated with anterior cruciate ligament (ACL) injuries. The purpose of this study was to determine the head–neck offset, as measured by 45° Dunn’s view alpha angles, in patients with ACL injuries compared to control subjects.

Methods

In this retrospective study, 140 consecutive non-professional athletes with primary ACL ruptures confirmed with knee arthroscopy and 100 consecutive patients with non-ACL injury were enrolled. Hip range of motion was assessed in lower extremities in all participants, and alpha angle was calculated according to 45° Dunn’s view radiographs.

Results

There is not any difference in age, gender distribution, height, weight, and BMI between groups. Internal rotation, abduction, and adduction of the hip were significantly decreased in ACL-injured patients comparing with control subjects (p < 0.001). ACL-injured patients had also a significantly higher alpha angle comparing to the control individuals (p < 0.001). The mean of alpha angle in the ACL-injured patients was 56.1 (SD 10.1) and in the non-ACL-injured group was 49.3 (SD 9.4).

Conclusions

The patients in ACL-injured group showed a significant restriction in hip range of motion and also a diminished femoral head–neck offset suggesting a possible role of these findings in the outcome assessed.

Level of evidence

III.

     

Do hip and groin muscle strength and symptoms change throughout a football season in professional male football players? A prospective cohort study with repeated measures

ObjectivesGroin injuries are common in professional male football and result in significant complaints, time-loss and cost. We aimed to study: 1. Normal values of hip muscle strength and self-reported hip and groin function (Hip And Groin Outcome Score (HAGOS)). 2. Changes in these values throughout the season. 3. If previous (groin) injuries, leg dominance or league were associated with these outcome measures.DesignProspective cohort study.Methods313 professional male football players (11 clubs) participated. Player characteristics and previous injuries were registered. Hip muscle strength (hand-held dynamometer) and HAGOS measurements were done at the start, middle and end of the season.ResultsData from 217 players were analysed. Adduction strength (mean ± standard deviation, Nm/Kg) was 3.40 ± 0.72 (start), 3.30 ± 0.65 (mid) and 3.39 ± 0.74 (end) (p = 0.186). Abduction strength was 3.45 ± 0.67, 3.14 ± 0.57 and 3.28 ± 0.61 (p < 0.001). Adduction/abduction ratio was 1.00 ± 0.21, 1.07 ± 0.22 and 1.05 ± 0.23 (p < 0.001). Statistically, the HAGOS-subscale ‘Pain’ (median [interquartile range]) deteriorated slightly during the season (p = 0.005), especially from mid-season (97.5 [90.6−100.0]) to end-of-season (95.0 [87.5−100.0]) (p = 0.003). Other subscale scores remained unchanged between time points; 85.7 (symptoms), 100.0 (daily living), 96.9 (sports and recreation) 100.0, (physical activities) and 90.0 (quality of life). Previous injuries were associated with lower HAGOS-scores. Dominant legs had higher abduction strength (p < 0.001) and lower adduction/abduction ratio (p < 0.001). No differences between leagues were found for hip muscle strength and HAGOS-scores.ConclusionsIn Dutch male professional football players, hip muscle strength and HAGOS-scores remained relatively stable throughout the season. Pain increased slightly, which while statistically significant, was not clinically relevant.     

Do tibiofemoral contact point and posterior condylar offset influence outcome and range of motion in a mobile-bearing total knee arthroplasty?

Purpose

The posterior condylar offset (PCO) and the tibiofemoral contact point (CP) have been reported as important factors that can influence range of motion and clinical outcome after total knee arthroplasty. A mobile-bearing knee implant with an anterior posterior gliding insert would in theory be more sensitive for changes in PCO and CP. For this reason, we analysed the PCO and CP and the relation with outcome and range of motion in 132 patients from a prospectively documented cohort in this type of implant.

Methods

The prosthesis used was a posterior cruciate retaining AP gliding mobile-bearing total knee replacement (SAL II Sulzer Medica, Switzerland). In 132 knees, the pre- and postoperative PCO and postoperative CP were evaluated. Measurements were made on X-rays of the knee taken in approximately 90° of flexion and with less than 3-mm rotation of the femur condyles. The outcome parameters, range of motion (ROM) and the knee society score (KSS), for each knee were determined preoperatively and at 5-year follow-up.

Results

The mean KSS improved from 91 to 161 at 5-year follow-up (p < 0.001) and the mean ROM from 102 to 108 (p < 0.05). The mean PCO difference (postoperative PCO–preoperative PCO) was—0.05 mm (SD 2.15). The CP was on average 53.9 % (SD 5.5 %). ROM was different between the 3 PCO groups (p = 0.05): patients with 3 or more mm decrease in PCO had the best postoperative ROM (p = 0.047). There was no statistical difference between the postoperative ROM between patients with a stable PCO and those with an increased PCO. There was no correlation between the difference in PCO and the difference in ROM; R _Pearson = ?0.056. There was no difference in postoperative ROM or postoperative total KSS between CP <60 % and CP >60 %: p = 0.22, p = 0.99, for ROM and KSS, respectively. Scatter plots showed uniform clouds of values: increase or decrease in PCO and CP had no significant influence on ROM or KSS.

Conclusion

The hypotheses that a stable PCO and a more natural CP increase postoperative ROM and improve clinical outcome could not be confirmed. On the contrary, a decreased PCO seemed to improve knee flexion. Furthermore, a relationship between PCO and CP could not be found.

Level of evidence

Prospective cohort study, Level II.     

Are physical performance and injury risk in a professional soccer team in match-play affected over a prolonged period of fixture congestion?

In this study, the effects of a prolonged period of fixture congestion (8 successive official matches in 26 days) on physical performance and injury risk and severity in a professional soccer team were investigated. Computerised motion-analysis was used to analyse the overall distance covered and that run at light- (0.0-11.0 km·h?-?1); low- (11.1-14.0 km·h?-?1); moderate- (14.1-19.7 km·h?-?1) and high-intensities (≥19.8 km·h?-?1) for the team as a whole. Distances were measured in metres per minute. Information on match injuries was recorded prospectively. The overall distance covered varied across successive matches (p<0.001) as more distance was run in games 4 and 7 compared to 2 and 3, respectively (126.6 ± 12.3 m·min?-?1 and 125.0 ± 13.2 m·min?-?1 vs. 116.0 ± 8.0 m·min?-?1 and 115.5 ± 11.0 m·min?-?1). Distance run in light-intensity exercise also varied (p<0.001) as more distance was covered in game 4 vs. 1, 2, 3, 5 and 6 (75.5 ± 3.8 m·min?-?1 vs. 70.6 ± 2.4 m·min?-?1, 71.8 ± 3.4 m·min?-?1, 69.3 ± 2.6 m·min?-?1, 71.5 ± 3.1 m·min?-?1, and 70.3 ± 2.8 m·min?-?1) and in game 8 vs. game 3 (73.1 ± 3.8 vs. 69.3 ± 2.6 m·min?-?1), respectively. When comparing match halves, there were no differences across games in overall or high-intensity distance covered and performance in these measures was similar for matches played before, during and after this period. Globally, no difference over the 8 games combined was observed between the reference team and opponents in any of the performance measures whereas the overall distance covered and that in low- (both p<0.001) and high-intensity running (p=0.040) differed in individual games. The incidence of match injury during the congested fixture period was similar to rates reported outside this period but the mean lay-off duration of injuries was substantially shorter during the former (p<0.05). In summary, while the overall distance run and that covered at lower intensities varied across games, high-intensity running performance and injury risk were generally unaffected during a prolonged period of fixture congestion. These results might be linked to squad rotation and post-match recovery strategies in place at the present club.     

Comparison of dopamine turnover, dopamine influx constant and activity ratio of striatum and occipital brain with 18F-dopa brain PET in normal controls and patients with Parkinson��s disease

Purpose

The aim of the study was to estimate normal ranges and test-retest measures for various parameters characterising dopamine metabolism from a prolonged ¹⁸F-dopa positron emission tomography (PET) measurement using a reference tissue model and compare their value for the detection of early Parkinson??s disease (PD).

Methods

Healthy volunteers (n?=?9) and patients (n?=?36) in an early stage of PD underwent an ¹⁸F-dopa PET measurement lasting 4?h. The influx rate constant k_occ and the effective distribution volume ratio (EDVR, its inverse is an indicator for dopamine turnover) were estimated by a graphical approach using dynamic data in the striatum and, as a reference region, the occipital cortex. Furthermore, ratios of activity concentrations between striatum and occipital brain taken for three time intervals completed the data analysis. All parameters were determined both in eight small volumes of interest placed in the striatum as well as averaged for caudate nucleus and putamen. For the control group, reproducibility was checked in a second study 3?months later and ranges for normal values were derived from mean?±?2 standard deviations. Receiver-operating characteristic (ROC) analyses were performed to assess the value of the parameters for diagnostic purposes.

Results

Patients with early-stage PD and healthy volunteers could be separated by the values of the putamen, not the caudate nucleus. The normal ranges of the putamen were 0.0151?C0.0216/min for the influx rate constant k_occ and 2.02?C3.00 for EDVR. For the various time intervals used the striato-occipital ratios yielded 2.24?C3.06, 2.43?C3.42 and 2.35?C3.21, respectively. Patients were characterised by significantly lower values (p?p?occ for the putamen were able to effectively differentiate between groups (sensitivity >97%, specificity 100%). In contrast, striato-occipital ratios showed a sensitivity of about only 85%.

Conclusion

For clinical applications, our data do not demonstrate any superiority of the EDVR determination compared to influx rate constant, while requiring long and tedious acquisition protocols. The normal range estimates do not represent absolute quantitative measures for dopamine metabolism but are specific for the chosen acquisition and processing procedures.     

Development of gait performance and dynamic hip and knee joint loading after containment improving surgery in patients with Legg–Calvé–Perthes disease

Current surgery outcome evaluations in patients with Legg–Calvé–Perthes disease (LCPD) are usually based on static radiological changes. The aim of the present study was to assess the development of characteristic gait parameters and passive hip range of motion (ROM) measurements during the postoperative period up to healed stage of the femoral head represented by Stulberg classification. Twelve children (10 male, 2 female) with unilateral diagnosis of LCPD and 19 healthy control subjects at the same age participated in this prospective longitudinal study. Instrumented gait analysis was performed preoperatively, 13.4 (±1.7), and 28.0 (±4.4) months postoperatively. At final follow-up, the mean leg length of the involved side was reduced by 1.10 (±0.53) cm compared to the non-involved side. In addition, a significant reduction in maximum knee flexion (−26%, p = 0.037) and knee flexion/extension ROM (−26%, p = 0.017) in stance was still present in the patient group compared to controls indicating a “stiff knee gait pattern”. In contrast, the sagittal plane hip parameters, the ipsilateral trunk lean toward the involved stance limb, and the knee and hip joint loading during gait normalized during the postoperative period. The results of the present study should motivate further exploration if patients with LCPD stiffen their knees to compensate for leg length discrepancy. Besides the standard radiological evaluation of the surgery outcome, instrumented gait analysis is a valuable method of recording functional deficits and early recognition of the need for physiotherapeutic treatment or insole supply in patients with LCPD.     

Comparison of physical activity in male and female children: does maturation matter?

PURPOSE: To investigate whether observed differences in physical activity levels in boys and girls are confounded by biological age differences particularly during the circumpubertal years. METHODS: The physical activity questionnaire for children (PAQ-C) was administered biannually or triannually to 138 (70 boys; 68 girls) Canadian children for seven consecutive years from 1991 to 1997. Participants were 9-18 yr of age. Anthropometric measurements were taken biannually and age at peak height velocity (PHV) determined. Biological age was defined as years from PHV. The data were analyzed using t-tests and random effects models. RESULTS: Level of physical activity decreased with increasing chronological age in both sexes. When aligned on chronological age bands, boys had statistically significantly higher PAQ-C summary scores than girls from 10 through 16 yr of age (P < 0.05). However, when aligned on biological age, sex differences were not apparent, except at 3 yr before PHV. Random effects models of individual growth patterns confirmed these findings. CONCLUSION: Physical activity decreased with increasing chronological age in boys and girls. There were no sex differences in the longitudinal pattern of physical activity when the confounding effects of biological age were controlled except at 3 yr before PHV.     

Is the novel suspension exercises superior to core stability exercises on some EMG coordinates,pain and range of motion of patients with disk herniation?

Information about comparing the effectiveness of exercise methods on management of disk herniation is limited. The aim of this study was to compare the effect of two programs of suspension and core stability exercises on some electromyography (EMG) coordinates, pain and range of motion of patients with disk herniation. Thirty-two men with disk herniation participated in this clinical trial study which was randomly divided into three groups of suspension exercises (n: 12, age: 34.25?±?8.81, BMI: 24.01?±?2.7), core stability exercises (n: 10, age: 35?±?10.3, BMI: 25?±?2.27) and control (n: 10, age: 34.4?±?6.67, BMI: 23.76?±?1.45). Electrical activity of rectus abdominis, internal and external oblique and erector spinae muscles was masured by superficial EMG, back pain by McGill Pain Questionnaire and range of motion by Modified Schober test, one day before and immediately after of intervention period. The experimental groups performed an 8-week training period while the control group was only followed up. Data were analyzed using paired sample t test and analysis of covariance test and statistical significance was set at 0.05. Suspension group showed significant improvement in EMG of rectus abdominis, internal and external oblique muscles (respectively, p?=?0.030, p?=?0.017, p?=?0.022) and pain (p?=?0.001) compared to core stability group; but there was no significant difference between two groups in EMG of erector spinae muscle and range of motion. Changes in both training groups were significant in all variables compared to control groups (p ? 0.05). Our findings showed that although both exercises were effective in patients with lumbar disk herniation, but the effectiveness of suspension exercises in increasing muscle activation and reducing pain was more pronounced than core stability exercises.

Iranian Registry of Clinical Trials (IRCT): IRCT20191016045136N1.

     

Comparison of manual and semi-automatic measuring techniques in MSCT scans of patients with lymphoma: a multicentre study

Objectives

Multicentre evaluation of the precision of semi-automatic 2D/3D measurements in comparison to manual, linear measurements of lymph nodes regarding their inter-observer variability in multi-slice CT (MSCT) of patients with lymphoma.

Methods

MSCT data of 63 patients were interpreted before and after chemotherapy by one/tworadiologists in five university hospitals. In 307 lymph nodes, short (SAD)/long (LAD) axis diameter and WHO area were determined manually and semi-automatically. Volume was solely calculated semi-automatically. To determine the precision of the individual parameters, a mean was calculated for every lymph node/parameter. Deviation of the measured parameters from this mean was evaluated separately. Statistical analysis entailed intraclass correlation coefficients (ICC) and Kruskal–Wallis tests.

Results

Median relative deviations of semi-automatic parameters were smaller than deviations of manually assessed parameters, e.g. semi-automatic SAD 5.3 vs. manual 6.5 %. Median variations among different study sites were smaller if the measurement was conducted semi-automatically, e. g. manual LAD 5.7/4.2 % vs. semi-automatic 3.4/3.4 %. Semi-automatic volumetry was superior to the other parameters (2.8 %).

Conclusions

Semi-automatic determination of different lymph node parameters is (compared to manually assessed parameters) associated with a slightly greater precision and a marginally lower inter-observer variability. These results are with regard to the increasing mobility of patients among different medical centres and in relation to the quality management of multicentre trials of importance.

Key Points

? In a multicentre setting, semi-automatic measurements are more accurate than manual assessments. ? Lymph node volumetry outperforms all other semi-automaticallyand manually performed measurements. ? Use of semi-automatic lymph node analyses can reduce the inter-observer variability.     

Do the hamstrings and adductors contribute to excessive internal rotation of the hip in persons with cerebral palsy?

Children with cerebral palsy frequently walk with excessive internal rotation of the hip. Spastic medial hamstrings or adductors are presumed to contribute to the excessive internal rotation in some patients; however, the capacity of these muscles to produce internal rotation during walking in individuals with cerebral palsy has not been adequately investigated. The purpose of this study was to determine the hip rotation moment arms of the medial hamstrings and adductors in persons who walk with a crouched, internally-rotated gait. Highly accurate computer models of three subjects with cerebral palsy were created from magnetic resonance images. These subject-specific models were used in conjunction with joint kinematics obtained from gait analysis to calculate the rotational moment arms of the muscles at body positions corresponding to each subject’s internally-rotated gait. Analysis of the models revealed that the medial hamstrings, adductor brevis, and gracilis had negligible or external rotation moment arms throughout the gait cycle in all three subjects. The adductor longus had an internal rotation moment arm in two of the subjects, but the moment arm was small (<4 mm) in each case. These findings indicate that neither the medial hamstrings nor the adductor brevis, adductor longus, or gracilis are likely to be important contributors to excessive internal rotation of the hip. This suggests that these muscles should not be lengthened to treat excessive internal rotation of the hip and that other factors are more likely to cause internally-rotated gait in these patients.     

Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury?

Objective (1) To determine the accuracy of computed tomography (CT) in the evaluation of ligament tear and avulsion in patients with tibial plateau fracture. (2) To evaluate whether the presence or severity of fracture gap and articular depression can predict meniscal injury. Design and patients A fellowship-trained musculoskeletal radiologist retrospectively reviewed knee CT and MRI examinations of 41 consecutive patients presenting to a level 1 trauma center with tibial plateau fractures. Fracture gap, articular depression, ligament tear and footprint avulsions were assessed on CT examinations. The MRI studies were examined for osseous and soft tissue injuries, including meniscal tear, meniscal displacement, ligament tear, and ligament avulsion. Results CT demonstrated torn ligaments with 80% sensitivity and 98% specificity. Only 2% of ligaments deemed intact on careful CT evaluation had partial or complete tears on MRI. Although the degree of fracture gap and articular depression was significantly greater in patients with meniscal injury compared with those without meniscal injury, ROC analysis demonstrated no clear threshold for gap or depression that yielded a combination of high sensitivity and specificity. Conclusions In the acute setting, CT offers high sensitivity and specificity for depicting osseous avulsions, as well as high negative predictive value for excluding ligament injury. However, MRI remains necessary for the preoperative detection of meniscal injury.     

Evaluation of intrasyrinx fluid motion by spatial modulation of magnetization-magnetic resonance imaging in syringomyelia with long-term follow-up: a predictor of postoperative prognosis?

OBJECTIVE: To evaluate the use of measuring intrasyrinx fluid motion in syringomyelia by spatial modulation of magnetization (SPAMM)-magnetic resonance imaging (MRI) for predicting postoperative results. MATERIALS AND METHODS: Fourteen patients with syringomyelia, who underwent surgery between 1995 and 2004 and took both preoperative SPAMM-MRI and postoperative MRI, were reviewed retrospectively. The SPAMM-MRI was obtained on a 1.5-T system using the electrocardiogram-triggered multiphase image technique with repetition time/time to echo/diffusion time/flip angle = 42 milliseconds/7.2 milliseconds/0 to 600 milliseconds/20 degrees. Three radiologists analyzed the tagging band shifting of the intrasyrinx fluid motions on the preoperative SPAMM-MRI. If the tagging band shifting during the systolic phase was more than half of the band space, it was regarded as good fluid motion. The correlation between the preoperative intrasyrinx fluid motion and the postoperative shrinkage of the syrinx was statistically analyzed. RESULTS: The underlying causes of the syringomyelia were Arnold-Chiari malformation (7 patients), trauma (4 patients), and infectious disease (3 patients). Eight of 9 patients who had good fluid motion in the syrinx showed postoperative shrinkage of the syrinx. However, the 5 patients who had poor fluid motion showed no shrinkage of the syrinx. The fluid motion of the syrinx was highly correlated with the postoperative shrinkage of the syrinx (P < 0.01). CONCLUSIONS: Evaluation of the intrasyrinx fluid motion in syringomyelia using the SPAMM-MRI can be a useful predictor of postoperative results and may indicate how well the pulse wave is transmitted from the heart to the syrinx.     

Femoral morphology and epiphyseal growth plate changes of the hip during maturation: MR assessments in a 1-year follow-up on a cross-sectional asymptomatic cohort in the age range of 9–17?years

Objectives

The goal of this prospective study was to characterize the morphology and physeal changes of the femoral head during maturation using MRI in a population-based group of asymptomatic volunteers.

Materials and methods

Sixty-four pupils (127 hips) of 331 pupils from a primary and high school were asked to take part in this study and were willing to participate. 3T MRI of the hip was obtained at baseline and 1-year follow-up. With these images, we analyzed the femoral morphology and epiphyseal changes related to age, status of the physis, and location on the femur.

Results

The radius of the femoral head and neck increased with age, as expected, (p?p?p?>?0.05). Building groups by using the epiphyseal status, we found that the epiphyseal extension had the highest changes in the "open" group and almost stopped in the "closed" group. The tilt angle did not change significantly (p?>?0.05). Significant smaller alpha-angles were found in the "closed" group, however, these were in a normal range in all of them. Correlated to the position, the highest alpha-angle values were located in anterior-superior and superior-anterior position.

Conclusions

Our data can be used as normative values, which can be compared to patients or cohorts with certain risk factors (e.g., professional athletes), this will offer the chance to detect and understand pathological changes.     

Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?

The knee joint kinematics of a group (n=20) of elderly normal subjects (mean age=67 years) were investigated using flexible electrogoniometry. The flexion-extension angle of the knee was recorded during a range of functional activities performed as part of a circuit in and around the hospital. The functions analysed including gait, walking on slopes, stair negotiation, the use of standard and low chairs and a bath. The data were used to produce the pattern of joint angulation against the percentage of the cycle for each individual conducting each activity. Further the maximum and minimum knee joint angles and the excursion of the joint during the cycle were identified. The results indicate gait and slopes require less than 90 degrees of knee flexion, stairs and chairs 90-120 degrees of flexion and a bath approximately 135 degrees of flexion. The data suggests that 110 degrees of flexion would seem a suitable goal for the rehabilitation of motion in the knee. It is concluded that flexible electrogoniometry is a suitable and practical method for evaluating knee motion during a range of functional activities.     

Comparison of muscle-to-nodule and parenchyma-to-nodule strain ratios in the differentiation of benign and malignant thyroid nodules: Which one should we use?

Objective

The aim of this study is to investigate the diagnostic accuracy of muscle-to-nodule strain ratio (MNSR) in the differentiation of benign and malignant thyroid nodules and to see if there was a difference between MNSR and parenchyma-to-nodule strain ratios (PNSR) in diagnosis.

Methods

A total of 106 consecutive patients (88 women and 18 men; age range 19–79 years) with thyroid nodules were prospectively examined using ultrasound and sonoelastography before the fine-needle aspiration biopsy. The mean MNSR and PNSR were calculated for each nodule and the elasticity score was determined according to four-point scoring system.

Results

According to the four-point scoring system, 44 of the 83 benign nodules had a score of one or two while 22 of the 23 malignant nodules had a score of three or four (p < 0.001). Using ROC analysis, the best cutoff point for MNSR 1.85 and for PNSR 3.14 was calculated. The sensitivity and specificity for the MNSR were 95.6%, 92.8%, respectively; for the PNSR were 95.6%, 93.4%, respectively, when the best cutoff points were used (p < 0.001). The κ value for the PNSR and MNSR methods was 0.87, which indicated an almost perfect agreement (p < 0.001).

Conclusions

Sonoelastography has a high diagnostic accuracy in the differentiation of benign and malignant thyroid nodules. There was no significant difference between MNSR and PNSR in the differentiation of benign and malignant thyroid nodules. Therefore, we think that MNSR could safely be used in situations where PNSR could not be used.