Incidence of greater trochanteric pain syndrome in patients suspected for femoroacetabular impingement evaluated using magnetic resonance arthrography of the hip

Objectives:

We evaluated the incidence of greater trochanter pain syndrome (GTPS) in patients who underwent magnetic resonance arthrography (MRA) of the hip for a suspected femoroacetabular impingement (FAI) syndrome.

Methods:

Hip MRA performed at our institution (3/2012–1/2014) were reviewed. The absence/presence of FAI (cam, pincer, and mixed) was noted. GTPS diagnosis was based on gluteus medius/minimus tendinopathy/tears, trochanteric bursitis, fascia lata thickening, and trochanter bone oedema/erosion. Subgroup analysis for age (under/over 40 years) and FAI type (cam, pincer, and mixed) was also performed.

Results:

N = 189 patients were included (n = 125 males; age 39 ± 12 years). FAI was diagnosed in n = 133 (70, 4%): cam type, n = 85 (63, 9%); pincer type, n = 22 (16, 6%); and mixed type, n = 26 (19, 5%). N = 72 patients (38.1%) had tendinopathy, n = 14 (7.4%) had trochanter erosion, n = 31 (16.4%) had bursitis, n = 4 had bone oedema (2.1%), and n = 3 (1.6%) had fascia lata thickening, resulting in GTPS diagnosis in n = 74 patients (39.2%). The association of normal hip morphology/GTPS was significantly higher (P = 0.023) than that of FAI/GTPS. Under 40 years, GTPS incidence was higher in patients with normal hip and pincer-type FAI (P = 0.028). Over 40 years, no difference between patients with/without FAI (P = 0.119) was seen.

Conclusions:

GTPS was more frequently observed in patients with normal hip morphology than in patients with FAI, particularly in patients under 40.

     

Nitric oxide and blood pressure responses to short-term resistance training in adults with and without type-2 diabetes: a randomized controlled trial

Background

Type-2 diabetes (T2D) is associated with endothelial dysfunction, increase in sympathetic tone and several cardiovascular disorders, such as systemic arterial hypertension and coronary artery disease.

Aims

To determine the effects of resistance training (RT) on the responses of nitric oxide (NO) and blood pressure (BP) in individuals with T2D and their controls peers.

Methods

Randomized controlled trial in which T2D patients and non-diabetic individuals (ND) performed 8 weeks of RT. Participants were 22 women and 12 men (age 62.3?±?2.5 years) that were randomly allocated into four groups: T2D training (n?=?9), ND training (n?=?10), T2D control (n?=?8), and ND control (n?=?7). NO and BP were measured before and after the whole intervention.

Results

There were no significant differences in nitrite concentrations between and within groups, with values varying between 1.22?±?0.15 and 1.45?±?0.13 Log µM. The T2D and ND experimental groups decreased systolic blood pressure (SBP) by 8.1 and 1.4 mmHg, respectively. However, the control groups showed elevation of SBP (3.6 mmHg for T2D and 4.1 mmHg for ND). Although none of these changes were significant (p?>?0.05). In addition, T2D subjects who did not undergo the training increased diastolic blood pressure (p?=?0.030) and mean arterial pressure (p?=?0.054).

Conclusions

Eight weeks of RT does not increase NO bioavailability, and in turn, does not reduce BP in T2D patients—though it prevented its increase.

Trial registration

ensaiosclinicos.gov.br (ID: RBR-4d39z9).

     

Kinematic analysis of postural control in gymnasts vs. athletes practicing different sports

Purpose

The aim of this study was to examine the postural control difference between gymnasts and other athletes practicing different sports.

Methods

Twenty-eight elite-level male athletes (7 gymnasts, 7 volleyball players, 7 windsurfers, and 7 monofin swimmers) participated in this study. Two-dimensional kinematic analysis of mediolateral and anteroposterior sway velocity of the center of mass (COM) on single plane balance board in bipedal and unipedal conditions, and on hard and foam surfaces was performed using two cameras (Sony, DCR-PC108^E, 50 Hz). Data were digitized using the video-based data analysis system SkillSpector.

Results

Findings showed significant between groups differences regardless of the postural stance i.e., unipedal or bipedal (d = 1.76–6.82, p < 0.01). In this regards, windsurfers presented the best postural performance in terms of sway velocity of the COM followed by gymnasts, volleyball players, and monofin swimmers. Furthermore, regardless of the postural stance, significant differences between surfaces (d = 0.61–1.03, p < 0.05) were established. In this context, COM’s sway velocity was higher for hard compared with foam surfaces for all disciplines (d = 0.75–0.66, p < 0.05) except monofin swimmers who presented higher COM’s sway velocity in foam compared to hard surfaces. Further, in the anteroposterior stance, windsurfers and gymnasts showed significantly lower floor contacts number compared with the other groups (d = 1.76–2.39, p < 0.01). However, volleyball players and monofin swimmers showed comparable postural performance in the mediolateral plane.

Conclusions

The windsurfers presented the best postural control followed by gymnasts, volleyball players, and monofin swimmers irrespective of the surface’s nature (i.e., hard or foam) and postural stance (i.e., bipedal or unipedal). Therefore, it is recommended to incorporate windsurfing practice to promote postural control of gymnastic athletes.

     

Effects of pennation angle,electrodes orientation and knee angle on surface electromyography of vastus lateralis during isometric contractions

Purpose

The effects of pennation angle (PA), electrode orientation (EO) and knee angle (KA) on the amplitude of electromyography signal (EMG) of vastus lateralis muscle (VL) were investigated.

Methods

Seventeen participants (8 men and 9 women; 26.5 ± 5.1 years; 64.4 ± 12.3 kg; 1.66 ± 0.09 m) accomplished isometric tests at four contraction intensities (COI): 25, 50, 75 and 100% of maximum voluntary contraction (MVC), with KA at 90° and 120°. PA was measured at rest and during contractions. One pair of electrodes was aligned with PA of relaxed VL fibers (pair 1) and another (pair 2) was 20° internally rotated to pair 1. The EMG root mean square (RMS) was calculated and later corrected (RMS_C) using equations including PA and 20° angle.

Results

PA increased with COI (p < 0.001), but was not influenced by KA. Both RMS and RMS_C were higher with KA at 90° than 120° (p < 0.01). RMS, but not RMS_C were higher from pair 1 in COI at 50 and 75% MVC (p < 0.05). Correlations between outcomes obtained with pair 1 and pair 2 were stronger for RMS_C (r = 0.99; p < 0.001) than RMS (r = 0.93; p < 0.01). No effect of KA or COI was detected for RMS or RMS_C expressed as %MVC (p > 0.05).

Conclusion

The PA can be used to improve RMS estimation and further expressed as %MVC maybe promisor in EMG–force related issues. Association between EMG and PA appears to be dependent on their relation to COI.

     

Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to <Emphasis Type="Italic">N</Emphasis>-Butyl Cyanoacrylate

Purpose

To identify predictive factors for embolic material conversion to N-butyl cyanoacrylate (NBCA) for the treatment of primary postpartum hemorrhage (PPH) after failed transcatheter arterial embolization (TAE) using gelatin sponge (GS).

Materials and Methods

Institutional review board approval was obtained. We retrospectively studied 62 consecutive women with primary PPH who underwent TAE between January 2006 and March 2015. Five of them were excluded for the following: cardiopulmonary arrest at arrival (n = 1), uterine inversion (n = 1), and hysterectomy after TAE (n = 3). Remaining 57 women (age range, 21–43 years; mean, 32.6 years) comprised study population. TAE was initially performed using GS in all cases and then converted to NBCA after two embolizations using GS with persistent hemodynamic instability or vaginal bleeding. The patients’ background, uterine height, vital signs, laboratory tests, disseminated intravascular coagulation score, and details of procedure were reviewed. Univariate and multivariate analyses were performed to determine factors related to embolic material conversion.

Results

Technical success rate was 100%. Fourteen patients (25%) needed embolic material conversion to NBCA. Univariate analysis showed that uterine height, systolic blood pressure (sBP), and hemoglobin level were significantly related to embolic material conversion to NBCA (P = 0.029, 0.030, and 0.042). Logistic regression analysis showed that uterine height (odds ratio, 1.37; P = 0.025) and sBP (odds ratio, 0.96; P = 0.003) were associated with embolic material conversion to NBCA.

Conclusion

Uterine height and sBP can be predictive factors for embolic material conversion to NBCA for the treatment of PPH.

Level of Evidence

Level 4, Case Control Study

     

CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension?

Objectives

To correlate hepatic and splenic CT perfusion parameters with hepatic venous pressure gradient (HVPG) measurements in patients with cirrhosis.

Methods

Twenty-one patients with cirrhosis (males, 17; females, 4; mean ± SD age, 57?±?7 years) underwent hepatic and splenic perfusion CT on a 320-detector row volume scanner as well as invasive measurement of HVPG. Different CT perfusion algorithms (maximum slope analysis and Patlak plot) were used to measure hepatic arterial flow (HAF), portal venous flow (PVF), hepatic perfusion index (HPI), splenic arterial flow (SAF), splenic blood volume (SBV) and splenic clearance (SCL). Hepatic and splenic perfusion parameters were correlated with HVPG, and sensitivity and specificity for detection of severe portal hypertension (≥12 mmHg) were calculated.

Results

The Spearman correlation coefficient was ?0.53 (p?<?0.05) between SAF and HVPG, and ?0.68 (p?<?0.01) between HVPG and SCL. Using a cut-off value of 125 ml/min/100 ml for SCL, sensitivity for detection of a HVPG of ≥12 mmHg was 94%, and specificity 100%. There was no significant correlation between hepatic perfusion parameters and HVPG.

Conclusion

CT perfusion in patients with cirrhosis showed a strong correlation between SCL and HVPG and may be used for detection of severe portal hypertension.

Key points

? SAF and SCL are statistically significantly correlated with HVPG ? SCL showed stronger correlation with HVPG than SAF ? 125 ml/min/100 ml SCL-cut-off yielded 94?% sensitivity, 100?% specificity for severe PH ? HAF, PVF and HPI showed no statistically significant correlation with HVPG

     

Comparison of the efficiency of an extra-articular absorber system and high tibial osteotomy for unloading the medial knee compartment: an in vitro study

Purpose

The unloading effect of an extra-articular absorber system on the knee joint medial compartment was compared with high tibial osteotomy (HTO) under physiological conditions in vitro.

Methods

Seven fresh-frozen cadaveric knees were used to test isokinetic flexion–extension motions under physiological loading using a biomechanical knee simulator. Tibiofemoral area contact and peak contact pressures were measured using pressure-sensitive film in the untreated medial compartment. Pressures were measured after KineSpring System implantation and HTO (5° and 10° correction angles) performed with an angular-stable internal fixator (Tomofix).

Results

Implantation of the unloading device resulted in significantly decreased medial compartment area contact pressure (Δ0.02 ± 0.01 MPa, p = 0.001) and peak contact pressure (Δ0.3 ± 0.1 MPa, p = 0.001) compared with the first test cycle results in the untreated knee. HTO significantly decreased the pressure (p = 0.001). Compared with the first test cycle, HTO (5° correction angle) decreased the mean contact pressure by Δ0.03 ± 0.01 MPa and peak contact pressure by Δ0.3 ± 0.01 MPa. With a 10° correction angle, HTO decreased contact pressure by Δ0.04 ± 0.02 MPa and peak contact pressure by Δ0.4 ± 0.1 MPa compared with that at the 5° correction angle.

Conclusion

Implantation of an extra-capsular unloading device resulted in a significant unloading effect on the medial compartment comparable to that achieved with HTO at 5° and 10° correction angles. Thus, implantation of an extra-articular, extra-capsular absorber could become the method of choice when treating patients with unicompartmental osteoarthritis that cannot be adequately treated by HTO because of their straight-leg axis.

     

Postprandial changes in secretory flow of pancreatic juice in the main pancreatic duct: evaluation with cine-dynamic MRCP with a spatially selective inversion-recovery (IR) pulse

Purpose

To evaluate the influence of oral ingestion on the secretory flow dynamics of physiological pancreatic juice within the main pancreatic duct in healthy subjects by using cine-dynamic MRCP with spatially-selective inversion-recovery (IR) pulse non-invasively.

Materials and methods

Thirty-eight healthy subjects were investigated. MRCP with spatially-selective IR pulse was repeated every 15 s for 5 min to acquire a total of 20 images (cine-dynamic MRCP). A set of 20 MRCP images was repeatedly obtained before and after liquid oral ingestion every 7 min (including 2-min interval) for 40 min (a total of seven sets). Secretion grade of pancreatic juice on cine-dynamic MRCP was compared before and after oral ingestion using the nonparametric Wilcoxon signed-rank test.

Results

Median secretion grades of pancreatic juice at 5 min (score?=?2.15), 12 min (score?=?1.95) and 19 min (score?=?2.05) after ingestion were significantly higher than that before ingestion (score?=?1.40) (P?=?0.004, P?=?0.032, P?=?0.045, respectively). Secretion grade of pancreatic juice showed a maximum peak of 2.15 at 5 min after ingestion. Thereafter, the secretion grade of pancreatic juice tended to gradually decline.

Conclusion

Non-invasive cine-dynamic MRCP using spatially-selective IR pulse showed potential for evaluating postprandial changes in the secretory flow dynamics of pancreatic juice as a physiological reaction.

Key Points

? Secretion grade of pancreatic juice at cine-dynamic MRCP after ingestion was evaluated. ? Secretion grade was significantly increased within 19 min after liquid meal ingestion. ? Secretion grade showed maximum peak of 2.15 at 5 min after ingestion. ? Postprandial changes in pancreatic juice flow can be assessed by cine-dynamic MRCP.

     

Effect of microbubble-enhanced ultrasound on percutaneous ethanol ablation of rat walker-256 tumour

Objectives

Percutaneous ethanol ablation (PEA) is an effective method for treating small liver cancer. Microbubble-enhanced ultrasound (MEUS) can potentially promote PEA by disrupting the tumour’s circulation. In this study, treatment combining MEUS and PEA was performed to find any synergistic effects in tumour ablation.

Methods

Ten rats bearing subcutaneous Walker-256 tumours were treated by MEUS combined with PEA. The other 18 tumour-bearing rats that were treated by MEUS or PEA served as the controls. MEUS was conducted by therapeutic ultrasound (TUS) and microbubble injection. TUS was operated at a frequency of 831 KHz with a pressure amplitude of 4.3 MPa. Tumour blood perfusion was assessed by contrast-enhanced ultrasound (CEUS), and the tumour necrosis rate was determined by histological examination.

Results

CEUS showed that the tumour blood perfusion almost vanished in all of the MEUS-treated tumours. The contrast peak intensity dropped 84.8 % in the MEUS?+?PEA-treated tumours when compared to 46.3 % (p?<?0.05) in the PEA-treated tumours 24 h after treatment. The tumour necrosis rate of the combination therapy was 97.50 %, which is much higher than that of the MEUS- (66.2 %) and PEA-treated (81.0 %) tumours.

Conclusion

PEA combined with MEUS can induce a much more complete tumour necrosis.

Key Points

? This experiment demonstrated a novel method for enhancing percutaneous ethanol ablation. ? Microbubble-enhanced therapeutic ultrasound is capable of disrupting tumour circulation. ? Combined therapy of MEUS and PEA can induce more complete necrosis of tumours.

     

Can we predict the size of frequently used autografts in ACL reconstruction?

Purpose

This study presents a method to measure the size of quadriceps, patellar tendon and hamstring autografts using preoperative magnetic resonance imaging (MRI).

Methods

Sixty-two subjects with a mean age of 25 ± 10 years who underwent ACL surgery between 2011 and 2014 were included. Patient anthropometric data were recorded for all subjects. During surgery, the respective autograft was harvested and measured using commercially available graft sizers. MRI measurements were performed by two raters, who were blinded to the intra-operative measurements.

Results

The inter- and intra-rater reliability was ≥0.8 for all MRI measurements. The intra-class correlation coefficient between the MRI measurement of the graft and the actual size of the harvested graft was 0.639. There were significant correlations between quadriceps tendon thickness and height (r = 0.3, p < 0.03), weight (r = 0.3, p < 0.01), BMI (r = 0.3, p < 0.04) and gender (r = ?0.4, p < 0.002) and patellar tendon thickness and height (r = 0.4, p < 0.01), weight (r = 0.3, p < 0.01) and gender (r = ?0.4, p < 0.012).

Conclusion

Preoperative MRI measurements of quadriceps, patellar tendon and hamstring graft size are highly reliable with moderate-to-good accuracy. Significant correlations between patient anthropometric data and the thicknesses of the quadriceps and patellar tendons were observed. Obtaining this information can be useful for preoperative planning and to help counsel patients on appropriate graft choices prior to surgery.

Level of evidence

III.

     

Prediction of semitendinosus–gracilis graft diameter in children and adolescents using anthropometric measures

Purpose

The aim of this study was to evaluate whether the anthropometric and demographic measures of patients under 18 years can be used to predict the diameter of STG autograft in ACL reconstruction surgery.

Methods

Retrospective series of 169 patients under 18 years (112 men, 57 women, average age 15.8 years) underwent ACL reconstruction surgery with STG autograft. We recorded anthropometric measures (weight, height and BMI), demographics (age and gender) and autograft diameter used. Correlation coefficients, linear regression and unpaired t test were used to determine the relationship between anthropometric/demographic variables and the diameter of the graft. p values <0.05 were considered statistically significant.

Results

Correlation analysis showed a significant positive relation between height and graft diameter (r = 0.483, p < 0.0001) as well as between weight and graft diameter (r = 0.248, p = 0.001). However, age and BMI did not correlate with graft thickness (r = 0.098 and p = 0.203, r = 0.009 and p = 0.905, respectively). The mean graft diameter in men was 8.2 (range 6–10) and 7.5 in women (range 6–9), a difference that was statistically significant (p < 0.001).

Conclusions

Prediction of the STG graft diameter according to the height of the patient is an easy and reliable method in children and adolescents. These data may provide relevant preoperative information about the need of an alternative graft source and can be useful when counselling patients.

Level of evidence

IV.

     

Can positron emission mammography help to identify clinically significant breast cancer in women with suspicious calcifications on mammography?

Objective

To evaluate the diagnostic accuracy of positron emission mammography (PEM) for identifying malignant lesions in patients with suspicious microcalcifications detected on mammography.

Methods

A prospective, single-centre study that evaluated 40 patients with suspicious calcifications at mammography and indication for percutaneous or surgical biopsy, with mean age of 56.4 years (range: 28-81 years). Patients who agreed to participate in the study underwent PEM with 18F-fluorodeoxyglucose before the final histological evaluation. PEM findings were compared with mammography and histological findings.

Results

Most calcifications (n?=?34; 85.0 %) were classified as BIRADS 4. On histology, there were 25 (62.5 %) benign and 15 (37.5 %) malignant lesions, including 11 (27.5 %) ductal carcinoma in situ (DCIS) and 4 (10 %) invasive carcinomas. On subjective analysis, PEM was positive in 15 cases (37.5 %) and most of these cases (n?=?14; 93.3 %) were confirmed as malignant on histology. There was one false-positive result, which corresponded to a fibroadenoma, and one false negative, which corresponded to an intermediate-grade DCIS. PEM had a sensitivity of 93.3 %, specificity of 96.0 % and accuracy of 95 %.

Conclusion

PEM was able to identify all invasive carcinomas and high-grade DCIS (nuclear grade 3) in the presented sample, suggesting that this method may be useful for further evaluation of patients with suspected microcalcifications.

Key Points

? Many patients with suspicious microcalcifications at mammography have benign results at biopsy. ? PEM may help to identify invasive carcinomas and high-grade DCIS. ? Management of patients with suspicious calcifications can be improved.

     

Role of curative treatment in patients with intermediate-stage hepatocellular carcinoma

Purpose

To retrospectively evaluate the role of curative treatment in patients with intermediate-stage hepatocellular carcinomas (HCCs), and to identify the subgroup having benefit from curative treatment.

Methods

From April 2000 to December 2014, 100 patients with intermediate-stage HCCs underwent either curative treatment (hepatectomy: n = 23, radiofrequency ablation (RFA); n = 29, both: n = 4) or transarterial chemoembolization (TACE): n = 44) as initial treatments for HCCs. Overall survival, influence of treatment allocation on prognosis, and factors affecting treatment allocation were evaluated.

Results

The 5-year survival rate was 59.2% [95% confidence interval (CI) 51.6–66.8%] in the curative group, and 25.1% (95% CI 11.5–38.7%) in the TACE group. Treatment allocation was the only significant prognostic factor (p = 0.014, hazard ratio: 0.382, 95% CI 0.177–0.821). The curative group consisted of more patients with Child-Pugh A (p = 0.0016) than the TACE group, a tumor number of 3 or fewer (p < 0.0001), a unilobar tumor location (p = 0.02), within 4 of 7 cm criterion (p = 0.001), and within up-to-7 criterion (p = 0.04). Child-Pugh A, within the 4 of 7 cm criterion, and a unilobar tumor location were significantly linked with treatment allocation in multivariate analysis.

Conclusions

Curative treatment can prolong survival in selected patients with intermediate-stage HCCs.

     

Late recanalisation beyond 24 hours is associated with worse outcome: an observational study

Objectives

We evaluated the rate of late recanalisation beyond 24 h after intravenous thrombolysis (IVT) and its relationship with haemorrhagic transformation and outcome.

Methods

We reviewed prospectively collected clinical and imaging data from acute ischaemic stroke patients with distal internal carotid artery or proximal middle cerebral artery occlusion who underwent angiography on admission, 24 h and 1 week after IVT. Patients were trichotomised according to vascular status: timely recanalisation (<24 h), late recanalisation (24 h-7 days), and no recanalisation.

Results

Non-invasive angiography revealed timely recanalisation in 52 (50.0 %) patients, late recanalisation in 25 (24.0 %) patients, and no recanalisation in 27 (26.0 %) patients. Pre-existing atrial fibrillation was associated with the occurrence of late recanalisation (odds ratio 6.674; 95 % CI: 1.197 to 37.209; p?=?0.030). In patients without timely recanalisation, shift analysis indicated that late recanalisation led to a worse modified Rankin Scale score (odds ratio 6.787; 95 % CI: 2.094 to 21.978; p?=?0.001).

Conclusions

About half of all patients without recanalisation by 24 h after IVT may develop late recanalisation within 1 week, along with higher mRS scores by 3 months. Pre-existing atrial fibrillation is an independent predictor for late recanalisation.

Key Points

? About half of patients may develop late recanalisation within 1 week. ? Pre-existing atrial fibrillation was associated with the occurrence of late recanalisation. ? Late recanalisation led to a higher mRS score than no recanalisation.

     

The effects of water-based strength exercise on quality of life in young women

Background

Exercise improves quality of life (QoL). However, little is known concerning the effects of different volumes of strength exercise on QoL. The aims of this study are to: (1) evaluate the effects of water-based strength exercise on QoL of healthy young women and (2) compare the effects of different volumes of water-based strength exercises on QoL of healthy young women.

Methods

Sixty-six participants were randomly allocated into four groups with different volumes of exercise. The participants performed water-based strength exercises for 20 weeks, two times a week, supervised by trained physiologists.

Results

A significant improvement was found in overall QoL (F = 5.96; p = 0.018) and in physical (F = 22.01; p < 0.001), psychological (F = 8.408; p = 0.006) and environment domains (F = 8.34; p = 0.006). In addition, a significant decrease of depressive symptoms was found (F = 22.32; p < 0.001). No difference was found between groups in any domain of QoL or depressive symptoms.

Conclusion

Water-based strength exercise improves specific domains of QoL and decreases depressive symptoms of young healthy women. Different volumes of exercise promote similar effects on QoL and depressive symptoms.

     

Assessment of deep myometrial invasion of endometrial cancer on MRI: added value of second-opinion interpretations by radiologists subspecialized in gynaecologic oncology

Objective

To investigate the added value of secondary reports issued by radiologists subspecializing in gynaecologic imaging for determining deep myometrial invasion of endometrial cancer on MRI.

Methods

Initial (from referring institutions) and secondary (by subspecialized radiologists) interpretations of MRI of 55 patients with endometrial cancer were retrospectively reviewed. A radiologist blinded to clinicopathological information assessed both reports for the presence of deep myometrial invasion. Reference standard was based on hysterectomy specimens. Kappa coefficients (k) were used to measure their concordance. McNemar testing and receiver operating characteristic (ROC) analysis was used to compare sensitivities, specificities and areas under the curves (AUCs).

Results

Deep myometrial invasion was present in 25 (45.5 %) patients. Among 27.3 % (15/55; k?=?0.458) patients with discrepant results, secondary interpretations were correct in 10 (66.7 %) cases. Sensitivity was higher in secondary than in initial reports (76.0 % vs. 48.0 %, p?=?0.039) while no significant difference was seen in specificity (70.0 % vs. 76.7 %, p?=?0.668). At ROC analysis, there was a tendency for higher AUCs in secondary reports (0.785 vs 0.669, p?=?0.096).

Conclusion

Secondary readings of MRI by subspecialized gynaecologic oncologic radiologists may provide incremental value in determining deep myometrial invasion of endometrial cancer.

Key Points

? Deep myometrial invasion is an important prognostic factor in endometrial cancer.? Assessment of deep myometrial invasion is often discrepant between initial and secondary reports.? Secondary reports showed higher sensitivity and accuracy.? Secondary review of MRI may provide incremental value in endometrial cancer patients.

     

Metformin discontinuation less than 72 h is suboptimal for F-18 FDG PET/CT interpretation of the bowel

Objective

Metformin-induced [F-18] fluorodeoxyglucose (FDG) bowel uptake can hinder positron emission tomography/computed tomography (PET/CT) evaluation of the bowel. This study aimed to investigate the segmental bowel uptake of FDG according to metformin discontinuation times up to 72 h.

Methods

We retrospectively divided 240 diabetic patients into four groups: metformin discontinuation <24 h (group A; n = 86), 24–48 h (group B; n = 40), 48–72 h (group C; n = 12), and no metformin (control group; n = 102). Segmental FDG bowel uptakes were measured visually (four-point scale) and semi-quantitatively (maximum standardized uptake value).

Results

Compared with the control group, FDG uptake increased significantly from the ileum to the rectosigmoid colon in group A, from the transverse to the rectosigmoid colon in group B, and from the descending colon to the rectosigmoid colon in group C in both visual and semi-quantitative analyses.

Conclusions

Metformin discontinuation for <72 h is likely suboptimal for PET/CT image interpretation, especially with respect to the distal segments of the colon.

     

Optimal load for the muscle power profile of prone bench pull in Brazilian Jiu-Jitsu athletes

Background

No studies were observed optimal intensity loads for the muscle power performance during prone bench pull exercise in Brazilian Jiu-Jitsu athletes (BJJ) and this exercise is more similar with grip technics.

Purpose

To identify the optimal intensity for the muscle power performance variables during PBP exercise in BJJ athletes.

Methods

Fifteen athletes (25.5 ± 4.9 years; 65.6 ± 12.2 kg; 177.5 ± 4.7 cm) performed PBP at 30, 40, 50 and 60% of one repetition maximum (1RM) in a random order. The mean power (MP), mean velocity (MV), mean propulsive power (MPP) and mean propulsive velocity (MPV) were determined by measuring the barbell displacement by a linear encoder.

Results

In all power performance variables, higher power output was observed at 40 and 50% 1RM when compared to 30 and 60% 1RM (MP: F = 29.07; p < 0.001; MV: F = 40.80; p < 0.001; MPP: F = 53.69; p = 0.003; MPV: F = 166.2; p > 0.001). Additionally, it was observed higher MPP at 50% 1RM when compared to 40% 1RM (F = 55.23; p < 0.001). The polynomial adjustment indicated that the optimal intensity load for producing highest power performance ranged from 45 to 50% 1RM (R ² = 0.938–0.989) across all variables.

Conclusion

The loads between 45 and 50% 1RM produced the optimal muscle power performance during PBP exercise in BJJ athletes.

     

Diffusion-Weighted Imaging-guided MR Spectroscopy in Breast Lesions using Readout-Segmented Echo-Planar Imaging

Purpose

To investigate the feasibility and effectiveness of diffusion-weighted imaging (DWI)-guided magnetic resonance spectroscopy (MRS) using readout-segmented echo-planar imaging (RS-EPI) to characterise breast lesions.

Materials and methods

A total of 258 patients with 258 suspicious breast lesions larger than 1 cm in diameter were examined using DWI-guided, single-voxel MRS with RS-EPI. The mean total choline-containing compound (tCho) signal-to-noise ratio (SNR) and concentration were used for the interpretation of MRS data. T-tests, χ²-tests, receiver operating characteristic (ROC) curve analyses and Pearson correlations were conducted for statistical analysis.

Results

Histologically, 183 lesions were malignant, and 75 lesions were benign. Both the mean tCho SNR and concentration of malignant lesions were higher than those of benign lesions (6.23?±?3.30 AU/mL vs. 1.26?±?1.75 AU/mL and 3.17?±?2.03 mmol/kg vs. 0.86?±?0.83 mmol/kg, respectively; P?<?0.0001). For a tCho SNR of 2.0 AU/mL and a concentration of 1.76 mmol/kg, the corresponding areas under the ROC curves were 0.93 and 0.90, respectively. The mean tCho SNR and concentration negatively correlated with apparent diffusion coefficients calculated from RS-EPI, with correlation coefficients of ?0.54 and ?0.48, respectively.

Conclusion

DWI-guided MRS using RS-EPI is feasible and accurate for characterising breast lesions.

Key Points

? The mean tCho SNR and concentration negatively correlated with ADCs.? DWI-guided MRS using RS-EPI is feasible.? DWI-guided MRS using RS-EPI accurately characterises breast lesions.