PET/CT assessment in follicular lymphoma using standardized criteria: central review in the PRIMA study

Purpose

We aimed to compare the standardized central review of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scans performed after induction therapy for follicular lymphoma (FL) in the PRIMA study (Salles et al., Lancet 377:42–51, 2011; Trotman et al., J Clin Oncol 29:3194–3200, 2011) to scan review at local centres.

Methods

PET/CT scans were independently evaluated by two nuclear medicine physicians using the 2007 International Harmonization Project (IHP) criteria (Cheson et al., J Clin Oncol 25:579–586, 2007; Juweid et al., J Clin Oncol 25:571–578, 2007; Shankar et al., J Nucl Med 47:1059–1066, 2006) and Deauville 5-point scale (5PS) criteria (Meignan et al., Leuk Lymphoma 50:1257–1260, 2009; Meignan et al., Leuk Lymphoma 51:2171–2180, 2010; Barrington et al., Eur J Nucl Med Mol Imaging 37:1824–1833, 2010). PET/CT status was compared with prospectively recorded patient outcomes.

Results

Central evaluation was performed on 119 scans. At diagnosis, 58 of 59 were recorded as positive, with a mean maximum standardized uptake value (SUV_max) of 11.7 (range 4.6–35.6). There was no significant association between baseline SUV_max and progression-free survival (PFS). Sixty post-induction scans were interpreted using both the IHP criteria and 5PS. Post-induction PET-positive status failed to predict progression when applying the IHP criteria [p?=?0.14; hazard ratio (HR) 1.9; 95 % confidence interval (CI) 0.8–4.6] or 5PS with a cut-off ≥3 (p?=?0.12; HR 2.0; 95 % CI 0.8–4.7). However, when applying the 5PS with a cut-off ≥4, there was a significantly inferior 42-month PFS in PET-positive patients of 25.0 % (95 % CI 3.7–55.8 %) versus 61.4 % (95 % CI 45.4–74.1 %) in PET-negative patients (p?=?0.01; HR 3.1; 95 % CI 1.2–7.8). The positive predictive value (PPV) of post-induction PET with this liver cut-off was 75 %. The 42-month PFS for patients remaining PET-positive by local assessment was 31.1 % (95 % CI 10.2–55.0 %) vs 64.6 % (95 % CI 47.0–77.6 %) for PET-negative patients (p?=?0.002; HR 3.3; 95 % CI 1.5–7.4), with a PPV of 66.7 %.

Conclusion

We confirm that FDG PET/CT status when applying the 5PS with a cut-off ≥4 is strongly predictive of outcome after first-line immunochemotherapy for FL. Further efforts to refine the criteria for assessing minimal residual FDG uptake in FL should provide a reproducible platform for response assessment in future prospective studies of a PET-adapted approach.     

Primary ligament sutures as a treatment option of knee dislocations: a meta-analysis

Purpose

Treatment of knee dislocation is still controversial. There is no evidence to favour ligament suture or reconstruction. Until now, no meta-analyses have examined suture versus reconstruction of cruciate ligaments in knee dislocations with respect to injury pattern and rupture classification.

Methods

We searched Medline, the Cochrane Controlled Trial Database, and EMBASE for studies on surgical treatment for ‘knee dislocation’ and ‘multiple ligament injured knee’. A meta-analysis was performed using individual patient data.

Results

Nine studies including 195 patients (200 knees) with a mean age of 31.4 (±13) years fulfilled the study requirements. Thirteen cases of type II dislocations, 63 cases of type III medial, 84 cases of type III lateral, and 40 cases of type IV dislocations, according to Schenck’s classification, were found. Poor or moderate results were found in 70 % of patients without surgical treatment of ACL or PCL (n = 27). Patients (n = 40) treated by sutures of the ACL and PCL demonstrated a significantly greater proportion of excellent or good results (40 and 37.5 %, respectively) (p < 0.001). Patients who underwent reconstruction of the ACL and PCL (n = 75) showed excellent or good results (28 and 45 %, respectively). No significant difference was found when comparing suture versus reconstruction of the ACL and PCL (n.s.). The outcome depends considerably on Schenck’s injury pattern classification.

Conclusion

Conservative treatment after knee dislocation yields poor clinical results. Suture repair of cruciate ligaments can still serve as an alternative option for multiligament injuries of the knee and achieve good clinical results, which are comparable to those of ligament reconstruction. The data provided by this meta-analysis should be reinforced by a prospective study, in which suture repair and ligament reconstruction are compared.

Level of evidence

IV.     

Open versus arthroscopic surgical treatment of chronic proximal patellar tendinopathy. A systematic review

Purpose

A general agreement on the best surgical treatment option of chronic proximal patellar tendinopathy is still lacking. The purpose of this systematic review was to investigate if arthroscopically assisted procedures have been reported better results compared to open surgery and to assess the methodology of studies.

Methods

Twenty-one studies were included in the review. Surgical outcomes were defined referring to the functional classification described by Kelly et al. (Am J Sports Med 12(5):375–380, [11]): return to sport was regarded as the ability of training at the original level before injury with mild or moderate pain and success as the improvement after surgery with symptom reduction. Methodological analysis was performed by two reviewers adopting the Coleman Methodology Score (CMS) (range 0–100, best score 100).

Results

Only one randomized controlled trial (RCT) met inclusion criteria; all other included studies were case series. Median sample size 24, range 11–138, mean age at surgery 26.8 ± 3.2 years, mean follow-up 32.5 ± 18.4 (median 31, range 6–60) months. Return to sport rate: global 78.5 %, open group 76.6 % and arthroscopic group 84.2 %. Success rate: global 84.6 %, open group 87.2 % and arthroscopic group 92.4 %. Differences between groups were not statistically significant. CMSs were positively correlated with the year of publication (P < 0.05).

Conclusions

Minimally invasive arthroscopically assisted procedures have not reported better statistically significant results when compared to open surgery in the treatment of chronic proximal patellar tendinopathy. The methodology of studies in this field has improved over the past 15 years, but well-designed RCTs using validated patient-based outcome measures are still lacking.

Level of evidence

Systematic Review, Level IV.     

The effect of 18F-florbetapir dose reduction on region-based classification of cortical amyloid deposition

?

There are specific dose recommendations for diagnostic amyloid PET imaging with 18F-florbetapir, but they may not apply to research studies using regional quantitative analysis. We, therefore, studied the effect of tracer dose reduction on the discriminative power of regional analysis.

Methods

Using bootstrap resampling of list-mode data from 18F-florbetapir scans, a total of 800 images were reconstructed for four different dosage levels: 100, 50, 20, and 10 %. The effect of the injected dose on the variation of measured radiotracer uptake was determined in large cortical regions defined on co-registered and segmented magnetic resonance images. The impact of the observed variation on the discrimination between normal controls and patients with AD was then assessed using data in a cohort study described by Fleisher et al. (Arch Neurol 68(11):1404–1411, 2011).

Results

The coefficient of variance for the cortex to cerebellum uptake ratio increased from 0.9 % at full dose of 300 MBq to 2.5 % at 10 % of this dose, but was still small compared to biological variation. It, therefore, had very little impact on discrimination between AD and elderly controls. The original area under the ROC curve was 0.881, decreasing to 0.878 at 10 % of full dose. Original sensitivity for discrimination between AD and controls was 82.0 %, while specificity was 77.3 %; these decreased to 81.8 and 77.1 %, respectively, at the reduced dose. However, the number of subjects within the classification border zone between proven amyloid pathology and young healthy controls increased substantially by 7 to 14 %.

Conclusion

A substantial reduction of tracer dose increases uncertainty at the classification border zone while still providing good discrimination between AD patients and controls when using activity data from cortical regions defined on co-registered and segmented MR scans.     

Detainees in police custody in the Paris,France area: medical data and high-risk situations (a prospective study over 1 year)

Background and objective

The annual number of detainees held in police custody in France is approximately 700,000. Medical data regarding arrestees are scarce across countries. We present the medical characteristics of detainees kept in police custody, including addictive behaviours and high-risk medical situations.

Methods

We conducted a prospective study over 1 year in a suburban area near Paris.

Results

A total of 19,098 medical examinations were performed on 13,317 individuals. The examinations mainly concerned male subjects (18,116 of 19,098, 95 %). Median age was 24 years (range 13–83). Medical examination was requested by the detainee in 6,638 of 16,801 cases (40 %). Assaults were reported in 4,052 of 17,312 cases (23 %) and occurred at the time of arrest in most cases (2,243, 13 %). A total of 2,394 of 13,317 detainees (18 %) had at least one chronic somatic disorder including asthma (603, 5 %), diabetes (263, 2 %) and arterial hypertension (205, 2 %). A history of psychiatric disorder was reported by 6 % of individuals (674 of 11,787). Regular alcohol drinking was reported by 58 % of detainees. Illicit drug use mainly involved cannabis (4,021 cases, 30 %). In 14,661 of 19,098 cases (77 %), detainees were considered to be unconditionally fit for detention in custody, and 274 detainees (1 %) were declared unfit to be detained.

Conclusion

The present study showed a high frequency of alcohol or substance use and reported assaults or traumatic lesions in arrestees. Attending physicians should pay particular attention to addictive behaviours and traumatic injuries in arrestees, both for immediate care and for prevention.     

Epidemiological profile of non-traumatic emergencies of the neck in CT imaging: our experience

Purpose

This study was undertaken to collect information on the incidence and distribution of acute, non-traumatic conditions of the neck at our emergency radiology department and to review the literature about this topic.

Materials and methods

We retrospectively reviewed 143 consecutive patients who underwent neck computed tomography (CT) for non-traumatic emergencies between 1 December 2008 and 31 December 2012. For each of the conditions identified, we defined the overall incidence, the incidence based on the site, gender, average age and age range.

Results

Computed tomography examination was positive in 125 out of 143 patients (87.4 %), 74 men and 51 women, with an average age of 51.1 years, aged between 10 and 90 years. We found 79 inflammatory/infectious conditions (63.2 % of positive cases, 55.2 % of total cases), 46 men and 33 women, with an average age of 47 years. Computed tomography revealed 26 newly found tumours (20.8/18.2 %), 19 men and 7 women, with an average age of 68.5 years, aged between 49 and 97 years. In 20 cases, 9 men and 11 women, with an average age of 57.3 years, aged between 21 and 90 years, we diagnosed other acute conditions: six cases of foreign body ingestion (4.8/4.2 %), five benign swellings (4/3.5 %), five cases of vascular disorders (4/3.5 %), and four cases of oedema of the larynx (3.2/2.8 %).

Conclusions

Our study of emergency CT of non-traumatic conditions of the neck fundamentally revealed infectious/inflammatory diseases and newly found neoplasms.     

Treatment of osteochondral defects of the talus in children

Purpose

Osteochondral talar defects are infrequent in children, and little is known about the treatment and clinical outcome of these defects. The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative and primary surgically treated osteochondral talar defects in skeletally immature children.

Methods

Thirty-six (97 %) of 37 eligible patients with a symptomatic primary osteochondral talar defect were evaluated after a median follow-up of 4 years (range 1–12 years). Clinical assessment included the Berndt and Harty outcome question, Ogilvie-Harris score, Visual Analog Scale pain score (at rest, during walking and during running), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the SF-36. Weight-bearing radiographs were compared with preoperative radiographs with the use of an ankle osteoarthritis classification system.

Results

Ninety-two per cent of the initially conservatively treated children [mean age 13 years (SD 2)] were eventually scheduled to undergo surgery. After fixation of the fragment, seven cases (78 %) reported a good Berndt and Harty outcome, and two cases (22 %) a fair outcome; the median AOFAS score was 95.0 (range 77–100). After debridement and bone marrow stimulation, 13 cases (62 %) reported a good Berndt and Harty outcome, three cases (14 %) a fair outcome, and five cases (24 %) a poor outcome; the median AOFAS score was 95.0 (range 45–100). No signs of degenerative changes were seen in both groups at follow-up.

Conclusions

Fixation and debridement and bone marrow stimulation of an osteochondral talar defect are both good surgical options after failed conservative treatment.

Level of evidence

Retrospective case series, Therapeutic, Level IV.     

Early evidence kits in sexual assault: an observational study of spermatozoa detection in urine and other forensic specimens

Purpose

To determine the detection frequency of spermatozoa in early evidence kit specimens and in subsequent full forensic specimens in alleged sexual assault.

Methods

Observational cohort study of 100 consecutive alleged sexual assault cases, presenting in Western Australia between 19th July 2008 and 6th February 2012, with both early evidence kit and full forensic evidence specimen collections. Eighty-eight cases were included in the study. Smears from all forensic specimens were analyzed by light microscopy to determine the detection frequency and structural characteristics of spermatozoa. Patient demographic features, characteristics of the alleged assault and details and timing of forensic collections were also recorded.

Results

Spermatozoa were detected in early evidence kit specimens in 35 % (31/88) and in full forensic specimens in 42 % (37/88) of all cases (irrespective of type of alleged penetration). In alleged penile-vaginal penetration, spermatozoa were detected in early evidence kit specimens in 40 % (21/53) of cases when both first void urine and vulval gauze wipe were collected. Spermatozoa were detected in full forensic specimens in 45 % (31/69) of cases. Spermatozoa were detected in early evidence kit oral rinse specimens in 6 % (1/18) of cases of alleged penile-oral penetration and in early evidence perianal gauze wipe specimens in 33 % (2/6) cases of alleged penile-anal penetration. Spermatozoa were detected in the early evidence kit first void urine specimen in a single case, 11 % (1/9), in which the nature of the alleged assault was unknown. Spermatozoa were detected in early evidence kit specimens and not in full forensic specimens in 3 % (3/88) of cases.

Conclusions

Early evidence kit specimens are effective in recovery of spermatozoa, and in particular urine and vulval gauze wipe are worthwhile early forensic specimens for the detection of spermatozoa. Collection of early evidence specimens led to detection of spermatozoa-positive cases, which were not detected by subsequent full forensic specimen collection.     

MRI findings in the lumbar spines of asymptomatic elite junior tennis players

Objective

To evaluate the MRI findings in the lumbar spines of asymptomatic elite junior tennis players.

Materials and Methods

The lumbar spine MRI studies of 98 asymptomatic junior elite tennis players (51 male, 47 female) with a mean age of 18 years (age range 11.2–26.3 years; standard deviation 3.1) was reviewed by two consultant musculoskeletal radiologists using consensus opinion. Images were assessed using accepted classification systems.

Results

Four players (4 %) had no abnormality. Facet joint arthropathy occurred in 89.7 % of the players, being mild in 84.5 % of cases. There were 41 synovial cysts in 22.4 % of the cohort all occurring in the presence of facet arthropathy. Disc degeneration was noted in 62.2 % of players, being mild in 76.2 % of those affected. Disc herniation was noted in 30.6 % of players, with 86.1 % of these being broad based and 13.9 % being focal. There was nerve root compression in 2 %. There were 41 pars interarticularis abnormalities in 29.6 % of patients, 63.4 % of these being grades 1–3. There was grade 1 spondylolisthesis in 5.1 % of players. The prevalence of facet joint arthropathy, disc degeneration, disc herniation and pars interarticularis fracture was lower in female players than in male and lower in the under 16-year-olds compared with the over 20-year-olds.

Conclusion

There is a significant amount of underlying pathology that would normally go undetected in this group of asymptomatic elite athletes. Whilst these findings cannot be detected clinically, their relevance is in facilitating appropriate prehabilitation to prevent loss of playing time and potentially career-ending injuries.     

Intermediate ray deficiency—a new type of lower limb hypoplasia

Objective

Diagnosis of fibular hemimelia is based on the identification of absence or shortening of the fibula in relation to the tibia. Despite the existence of different classifications of this congenital deficiency, certain morphological forms defy proper classification. One such form is absence of foot rays with leg shortening in the presence of an entire fibula. In these cases, foot morphology suggests that central foot rays, not lateral ones, are affected by the deficiency; thus justifying the hypothesis concerning the existence of a separate type of hypoplasia, which may be named “intermediate ray deficiency” (IRD).

Materials and methods

Nine patients with IRD, with an average age of 9.4 years at diagnosis (2.9–15), were analyzed. Clinical and radiographic parameters of the leg and foot were recorded according to the Stanitski classification of fibular hemimelia. The position of the lateral and medial malleoli was assessed. Axial alignment was analyzed according to the Paley method.

Results

The number of foot rays in eight cases was 4, while in one case, it was 3. Talocalcaneal synostosis was observed in seven cases. The shape of the ankle joint was spherical in six cases, horizontal in two cases and valgus in one case. The position of the lateral malleolus was slightly higher compared to normal. An average functional leg length discrepancy was 4.4 cm. The average percentage of fibular shortening was 9.5 %, tibial shortening 8.7 % and femoral shortening 3.3 %. In all of the cases, slight knee valgus was observed on the femoral level (average 3.3°) and tibial level (average 2.0°). As a result, criteria for IRD diagnosis were proposed.

Conclusion

“Intermediate ray deficiency” might be defined as a separate type of lower limb hypoplasia.     

Percutaneous Cryoablation of Symptomatic Abdominal Scar Endometrioma: Initial Reports

Purpose

The purpose of this preliminary study was to report the short-term local control of percutaneous image-guided cryoablation of localized symptomatic abdominal scar endometrioma.

Methods

Four consecutive patients (mean age 34.5 years) with a total of ten lesions were included, with mean preoperative pain of 7 (range 5–9) on the visual analog scale. Cryoablation was performed in a single session under general anesthesia.

Results

Postoperative superficial edema disappeared within 2 weeks for all patients. No severe complications (>grade 2 according to the CTCAE classification) were reported. Mean postoperative pain was 1.7 at 6 months (range 0–5) and magnetic resonance imaging demonstrated a significant volume decrease for all patients (range 72.2–100 %; p = 0.028).

Conclusions

Percutaneous cryoablation shows promising local control in patients with symptomatic abdominal wall endometriosis.     

Increased medial foot loading during drop jump in subjects with patellofemoral pain

Purpose

To compare medial-to-lateral plantar forces during drop jump and single leg squat in individuals with and without patellofemoral pain.

Methods

This cross-sectional study compared 23 young adults with patellofemoral pain to 20 age- and sex-matched controls without knee pain. The plantar pressure distribution was collected during drop jump and single leg squat using pressure-sensitive Pedar insoles, inserted into a standard flat shoe. The primary outcome was the medial-to-lateral force, quantified as the peak force under the medial forefoot as the percentage of force under the total forefoot during drop jump. Secondary outcomes included peak medial-to-lateral force during single leg squat and mean forces during drop jump and single leg squat.

Results

The primary outcome showed that individuals with patellofemoral pain had a 22 % higher medial-to-lateral peak force during drop jump, (p = 0.03). Secondary outcomes showed 32 % higher medial-to-lateral peak force during single leg squat (p = 0.01) and 19–23 % higher medial-to-lateral mean force during drop jump and single leg squat (p = 0.02–0.04).

Conclusion

These findings indicate that individuals with patellofemoral pain display a more medially oriented loading pattern of the forefoot compared to individuals without knee pain. This loading pattern may be associated with the distribution of forces acting on the patellofemoral joint and suggest treatment of PFP should consider interventions that target normalisation of foot loading.

Level of evidence

III.     

Epidemiology of acute knee injuries seen at the Emergency Department at Umeå University Hospital,Sweden, during 15 years

Purpose

To describe the incidence and injury distribution of knee injuries in the general population of a European setting.

Methods

Retrospective study of all knee injuries registered at the Emergency Department at Umeå University Hospital, Sweden, during 1995–2009 in relation to age, sex, diagnosis, location and activity at the time of injury, mechanism of injury, and treatment and/or follow-up plan.

Results

During 1995–2009, 12,663 knee injuries were registered, 8 % of all injuries. The incidence of knee injuries resulting in a visit to the Emergency Department was six cases per 1,000 person years. One-third of all injuries occurred during sports. And 30 % were 15–24 years. More men than women were injured during sporting activities and women were mostly injured during transportation.

Conclusion

Knee injuries in a general population are common and the injury distribution varies with age and sex. Sports activities and young age were prominent features of the injured population.

Level of evidence

IV.     

Postmortem CT compared to autopsy in children; concordance in a forensic setting

Objectives

The aim of this study is to assess the accuracy of postmortem CT (PMCT) in determining the cause of death in children who underwent a forensic autopsy because of a suspected nonnatural death.

Methods

We selected forensic pediatric autopsies at the Netherlands Forensic Institute, whereby the subject underwent PMCT between 1-1-2008 and 31-12-2012. Cause of death was independently scored by a radiologist and a pathologist. Cause of death was classified (1) in categories being natural, unnatural, and unknown; (2) according to the ICD-10; and (3) according to institutional classification.

Results

In the study period, 189 pediatric forensic autopsies were performed. Fifteen were excluded because of putrefaction. Of the remaining 174 autopsies, 98 (56 %) underwent PMCT. PMCT and autopsy identified the same category in 69/98 cases (70 %, kappa 0.49). They identified the same cause of death in 66/98 cases (67 %, kappa 0.5) using ICD-10; in 71/98 (72 %, kappa 0.62) using a forensic classification. PMCT performed better in unnatural deaths (59–67 % agreement) than in natural deaths (0 % agreement). If no cause of death was detected with autopsy, PMCT failed to identify a cause of death in 98 % (39/40).

Conclusions

Pediatric PMCT does identify the majority of unnatural causes of death, but does not identify new diagnoses (true positives) if no cause of death is found during autopsy. Diagnostic accuracy in natural deaths is low.

Key points

? The case mix is an important predictor for the concordance between PMCT and autopsy. ? In case of an unnatural death, 72–-81 % of PMCT results matches autopsy results. ? In case of a natural death, 0 % of PMCT results matches autopsy results. ? If no cause of death is identified with autopsy, 98 % of PMCT results concurs.     

Immersion-related deaths in infants and children: autopsy experience from a specialist center

Purpose

To investigate the demographics, circumstances and autopsy findings in infants and children dying following immersion.

Methods

A retrospective review of a pediatric autopsy database at a specialist center over a 16-year period (1995–2010) was undertaken to identify deaths between 7 days and 16 years of age in whom death occurred following immersion.

Results

28 infants and children died following immersion during the study period. 82 % were aged <4 years, with peak age of death between 1 and 2 years. Immersion occurred at home in a bath or private pool in 70 % of cases. There was a lack of direct supervision in all but two cases where the information was recorded (91 %); one of these cases occurred in a public swimming lesson, and in the other the carer was incapacitated. Autopsy findings were non-specific. Facial or subconjunctival petechial hemorrhages were a feature of 18 % of cases. There was increased lung weight, or histological pulmonary edema/intra-alveolar hemorrhage in all but one case.

Conclusions

The data suggest that the majority of pediatric immersion-related deaths were potentially preventable with appropriate supervision. The findings strongly support the role of education regarding adequate carer supervision of infants and children while bathing, particularly in children with underlying conditions such as epilepsy. As private pools and “hot tubs” become more common in the UK and other jurisdictions, specific recommendations such as fencing pools will need to be included in advice to carers. So-called ‘dry drowning” appears to be an uncommon mechanism of death in this age group.     

Return to judo after joint replacement

Purpose

The main purpose of this study was to investigate whether judo could be practised after joint replacement.

Methods

Two hundred and twelve questionnaires were sent to Judokas licensed at the French Judo Federation, over the age of 60, with at least a black belt 6th Dan. Out of 83 responses, 38 individuals, mean age 72.8 ± 7.9 years old, had at least one implant. The survey identified 36 total hip arthroplasties (THA) in 27 patients, 10 total knee arthroplasties (TKA) in 8 patients and 3 total shoulder arthroplasties (TSA) in 3 patients. The main evaluation criterion was the return to judo after joint replacement. Secondary criteria were the level of judo after surgery, rate of surgical revision at the final follow-up and the level of patient satisfaction.

Results

Twenty-nine out of 38 patients who underwent joint replacement returned to judo practice (76.3 %) a mean 4.1 ± 2.9 months after surgery. On the other hand, all patients stopped competitive judo. The surgeon recommended 65.8 % of these patients to stop practising judo. There were 2 surgical revisions in the THA group (5.5 %) for loosening at 6 and 9 years of follow-up. No dislocations or fractures were reported at the final follow-up. Thirty-two patients (84.2 %) were satisfied with their implant.

Conclusion

The practice of judo does not seem to be limited by joint replacement. A clinical and radiological study should be performed to confirm these results.

Level of evidence

Case series with no comparison group, Level IV.     

Grading of Cerebral Glioma with Multiparametric MR Imaging and 18F-FDG-PET: Concordance and Accuracy

Objectives

To retrospectively evaluate concordance rates and predictive values in concordant cases among multiparametric MR techniques and FDG-PET to grade cerebral gliomas.

Methods

Multiparametric MR imaging and FDG-PET were performed in 60 consecutive patients with cerebral gliomas (12 low-grade and 48 high-grade gliomas). As the dichotomic variables, conventional MRI, minimum apparent diffusion coefficient in diffusion-weighted imaging, maximum relative cerebral blood volume ratio in perfusion-weighted imaging, choline/creatine ratio and (lipid and lactate)/creatine ratio in MR spectroscopy, and maximum standardised uptake value ratio in FDG-PET in low- and high-grade gliomas were compared. Their concordance rates and positive/negative predictive values (PPV/NPV) in concordant cases were obtained for the various combinations of multiparametric MR techniques and FDG-PET.

Results

There were significant differences between low- and high-grade gliomas in all techniques. Combinations of two, three, four, and five out of the five techniques showed concordance rates of 77.0?±?4.8 %, 65.5?±?4.0 %, 58.3?±?2.6 % and 53.3 %, PPV in high-grade concordant cases of 97.3?±?1.7 %, 99.1?±?1.4 %, 100.0?±?0 % and 100.0 % and NPV in low-grade concordant cases of 70.2?±?7.5 %, 78.0?±?6.0 %, 80.3?±?3.4 % and 80.0 %, respectively.

Conclusion

Multiparametric MR techniques and FDG-PET have a concordant tendency in a two-tiered classification for the grading of cerebral glioma. If at least two examinations concordantly indicated high-grade gliomas, the PPV was about 95 %.

Key Points

? Modern imaging techniques can help predict the aggressiveness of cerebral gliomas. ? Multiparametric MRI and FDG-PET have a concordant tendency to grade cerebral gliomas. ? Their high-grade concordant cases revealed at least 95 % positive predictive values. ? Their low-grade concordant cases revealed about 70–80 % negative predictive values.     

Multiple hereditary exostoses and ischiofemoral impingement: a case–control study

Objective

To assess whether there is a significant difference in the ischiofemoral space in patients with multiple hereditary exostoses affecting the proximal femora compared to normal patients.

Introduction

Ischiofemoral impingement is an increasingly recognized cause of hip and buttock pain. This causes narrowing of the ischiofemoral space resulting in an abnormal quadratus femoris muscle.

Materials and methods

We performed a retrospective search for individuals with MHE with proximal femoral involvement on pelvic MRI over a 7-year period (2006–2013). Suitable patients were age- and sex-matched with a control group. The minimum ischiofemoral space (MIFS) was recorded in each hip, as was the presence of edema and atrophy of quadratus femoris and concomitant hip osteoarthrosis. MRI features suggestive of ischiofemoral impingement were defined as MIFS less than 10 mm or an abnormal quadratus femoris muscle.

Results

Twenty-one hips in 11 individuals with MHE were included in the study. A total of 42 hips were analyzed. The mean age was 37 years (range, 13–72 years) and 55 % were male. There was a significant difference (p?<?0.05) in the MIHS in individuals with MHE (mean, 10.7 mm, range, 0–21 mm) compared to a control group (mean, 18.1 mm, range, 10.5–26.5 mm). MRI features suggestive of ischiofemoral impingement were seen in 13/21 (62 %) hips in the MHE group and 0/21 (0 %) in the control group.

Conclusions

The reduced ischiofemoral space and associated quadratus femoris abnormalities in patients with MHE involving the proximal femora may account for hip/buttock symptoms in the absence of significant degenerative change.