Radiographic versus ultrasound evaluation of the Risser Grade in adolescent idiopathic scoliosis: a prospective study of 46 patients

The determination of skeletal age is essential in the management of patients with scoliosis. One of the most frequently used techniques to determine skeletal maturity is the method described by Risser. However, repeated X-ray exposure in the follow-up examinations of scoliosis patients may increase the risk of cancer. We compared conventional radiological evaluation of the Risser grade with ultrasound evaluation. For scoliosis patients routine application of ultrasound in the follow-up examinations may significantly reduce radiation exposure. 46 adolescent idiopathic scoliosis patients (median age, 14.5 years) were investigated. Sonographic and radiographic assessment of Risser sign was carried out by two independent senior staff skeletal radiologists. Agreement of Risser Grade between the two diagnostic methods was determined by Kappa statistics. Coefficients <0.21, 0.21–0.40, 0.41–0.60, 0.61–0.80, and >0.80 were rated as poor, fair, moderate, good, and very good agreement. For Risser Grades I–III 100% agreement was found between the two methods. Disagreement between radiographic and sonographic evaluation was found in Risser Grades IV and V. In five patients, X-ray evaluation yielded Risser Grade V while ultrasound showed Risser Grade IV. In one patient, radiographic examination resulted in Risser Grade IV while Grade V was detected in ultrasound. Overall, the Kappa value showed very good agreement between the two diagnostic methods. Our findings suggest that ultrasound can be applied as an alternative method to X-ray evaluation in Risser Grade determination. It should be routinely used in clinical practice to reduce the patients exposure to radiation.     

Regional right ventricular function and timing of contraction in healthy volunteers evaluated by strain‐encoded MRI

Purpose

To prospectively determine the feasibility and accuracy of strain‐encoded (SENC) magnetic resonance imaging (MRI) for the characterization of the right ventricular free wall (RVFW) strain and timing of contraction at 3.0 Tesla (3T) MRI.

Materials and Methods

In 12 healthy volunteers the RVFW was divided into three segments (anterior, lateral, and inferior) in each of three short‐axis (SA) slices (apical, mid, and basal) and into three segments (apical, mid, and basal) in a four‐chamber view. The study was repeated on a different day and interobserver and interstudy agreements were evaluated.

Results

Maximal systolic longitudinal strain values were highest at the apex and base, with a pronounced decrease in the medial segments (apex: –19.1% ± 1.4; mid: –17.4% ± 2; base: –19.4% ± 2.4, P < 0.001), and maximal systolic circumferential strain showed the highest values at the apex (apex: –18.1% ± 1.7; mid: –17.6% ± 1.2; base: –16.6% ± 0.9, P < 0.001). Peak systolic longitudinal and circumferential shortening occurred earliest at the apex compared to the mid‐ventricle and base. Excellent interobserver and interstudy correlation and agreement were observed.

Conclusion

The use of SENC MRI for the assessment of normal RV contraction pattern is feasible and accurate in 3T MRI. J. Magn. Reson. Imaging 2008;28:1379–1385. © 2008 Wiley‐Liss, Inc.     

Phenotyping of immunocompetent cells in normal labial and palatal salivary glands and in non-autoimmune sialadenitis

Different types of inflammatory cells in healthy major and minor salivary glands (SG), including those in labial and palatal non-autoimmune sialadenitis, were quantified immunohistochemically. Plasma cells, mainly IgA type predominated in all SG types, with the smallest number seen in the palatal glands. The numbers of common leukocyte antigen (CLA) reactive lymphocytes were greater in major SGs than in minor ones and were predominantly UCHL1 positive T cell type. Macrophages and neutrophils were absent in palatal glands, rarely present in labial ones and usually present in major SGs. Increases in the number of IgG and IgM plasma cells and lymphocytes (CLA+) which include both UCHL1+ T and L26+ B cell types, were found in non-autoimmune labial and palatal sialadenitis. There was no significant correlation between the number of the inflammatory cells and the degree of glandular atrophy in both labial and palatal non-autoimmune sialadenitis. Increase in their number represents a protective response of these glands in contrast to the inflammatory cells in major autoimmune sialadenitis playing there a pathogenetic role.     

Non‐infectious inflammatory disorders of the nail apparatus

Inflammatory non‐infectious diseases of the nails are not uncommon. The nail changes may look different in the same diseases, but also very much alike in various different nail disorders depending on which particular structure of the nail apparatus is involved. Of all skin diseases, psoriasis is the one with the most frequent nail involvement. The presence of many pits allows the diagnosis to be made, but salmon spots and onycholysis are also characteristic features. Lichen planus may occur isolated on the nails or in association with lesions of the skin and adjacent mucosal membranes. Longitudinal striations and loss of the nail plate shine are the most frequent features of nail lichen planus. The more severe the alopecia areata is and the younger the patient is, the more often it affects the nail, usually with a rough surface and loss of shine. Eczemas and various autoimmune dermatoses may also affect the nails but the changes are not clinically specific.     

Sp?tmetastase eines Granulosazelltumors bei einer 74-j?hrigen Patientin

Ohne Zusammenfassung     

Radiation-induced cataract in astronauts and cosmonauts

BACKGROUND: Opacification of the ocular lens is an important effect of exposure to ionizing radiation. Astronauts and cosmonauts are exposed to relatively high doses of all types of radiation in space, including high-energy particle radiation. A study was initiated to examine the lenses of the eyes of astronauts/cosmonauts to detect signs of radiation-induced cataracts. The aim of this study was to take a first step towards gaining improved, quantitative insight into the risk of radiation-induced cataract associated with long space missions. METHODS: The lenses of 21 former astronauts and cosmonauts were examined, using an upgraded Topcon SL-45 B Scheimpflug camera system. The degrees of opacification in this group of astronauts and cosmonauts were compared with the measurements in a reference group. This reference group was established by examining a cohort of 395 persons using the same Scheimpflug system. RESULTS: Initial results indicated that opacity values in most of the astronauts and cosmonauts were slightly to strongly increased in regions IV (posterior cortex) and V (posterior capsule), compared with the average opacity values for the respective age-group of the reference cohort. CONCLUSION: The aim of this study - to conduct first examinations of astronauts' and cosmonauts' ocular lenses with regard to signs of radiation-induced cataract - was successfully achieved in a total of 21 astronauts and cosmonauts using a Scheimpflug camera system. It is planned to examine a larger group of astronauts and cosmonauts in the future.     

Indikationen für kardiovaskul?re Magnetresonanztomographie

Zusammenfassung   Die kardiovaskuläre Magnetresonanztomographie (CMR) hat sich von einem Nischenverfahren zur Darstellung angeborener Herzfehler, zur Diagnostik großer Gefäße sowie zur Untersuchung von Perikard und Tumoren zu einem breit nutzbaren, hochgradig genauen und schnellen Untersuchungsverfahren entwickelt. Neue Indikationen finden sich insbesondere im Bereich der ischämischen Herzerkrankungen, für deren Erkennung Dobutamin-Stress, Adenosin-Perfusion, Narben- und Vitalitätsdarstellung und zunehmend auch die Koronararteriendarstellung durchgeführt werden können.     

Evaluation of New Software for Angiographic Determination of Right Ventricular Volumes

Objectives: The scope of the study was to evaluate a recent software for angiographic volume determination as compared to cardiovascular magnetic resonance imaging. Background: A new right ventricular analysis software closes a diagnostic gap in quantitative angiography. Cardiovascular magnetic resonance imaging short axis multi slice summation is a validated reference standard. Methods: Right ventricular angiograms were acquired in frontal and lateral projection in 15 pediatric and 17 adult patients. Additional angiograms were acquired in RAO30°/LAO60° projections in 10 adult patients. The tested models comprised area length with different regressions, multi-slice with different regressions, Boak, and pyramid method. Original regressions were used to calculate angiographic right ventricular volume. Right ventricular reference volumes were determined by multi-slice summation from cardiac magnetic resonance short-axis images. Results: Mean inter-observer difference was −1 ml (95% confidence: −35–34 ml) and mean intra-observer difference was 0 ml (95% confidence: −22–22 ml). There was no significant difference (4 ml, 95% confidence: −22–30 ml) between geometric calibration and calibration by a sphere. The area length and multi-slice models demonstrated the best agreement with the cardiac magnetic resonance reference. Performance was best for the Onnasch Lange models. Conclusion: The evaluated software provides acceptably accurate volume estimates for the majority of ventricles. In a few cases larger errors may occur, however. The area length and multi-slice models preferably with Onnasch Lange regressions may be recommended. Inter- and intra-observer agreement were excellent. Geometric calibration using data from DICOM header files may be used.