An Unexpected Change in DXA Calibration not Detected by Routine Quality Control Checks

Since its commercial introduction a decade ago, the technique of dual-energy X-ray absorptiometry (DXA) has been widely recognized as a useful and sensitive method of measuring changes in bone mineral density (BMD) at selected sites in the skeleton such as the spine and proximal femur. Because of their high precision and stable calibration, DXA scanners are frequently used in clinical trials to evaluate new treatments for osteoporosis. Quality assurance procedures based on regular scanning of phantoms are widely adopted in such trials, and continuity of the phantom BMD measurements is generally believed to ensure continuity in the in-vivo calibration. We report a change in calibration of a DXA scanner that occurred during a clinical trial where the calibration shift was different for the spine and femur sites and was not predicted or explained by the standard quality control procedures using phantoms. However, we show that provided patients enrolled in studies are thoroughly randomized and the statistical analysis is confined to the differences between the treated and control groups, then the effects of such calibration shifts on conclusions regarding the efficacy of treatment are considerably smaller than the random statistical errors. Received: 12 February 1998 / Accepted: 20 May 1998     

肺炎性假瘤24例的临床X线误诊分析

目的探讨肺炎性假瘤的临床与X线误诊原因;方法依据临床与X线资料分析;结果均有不同程度的呼吸道症状,有14例痰中带血丝。肿块直径小于4cm11例,密度高而均匀,边缘光整,误诊为肺良性肿瘤。肿块直径大于4cm13例,密度不太均,边缘有分叶或有毛刺,误诊为肺癌;结论临床上多无急慢性感染症状,本病与其他占位性病变极相似,缺少特征,对本病缺乏认识是导致误诊的主要原因。肿块邻近胸膜,边缘出现尖角征,动态变化缓慢这3点对提高正确诊断率有独特的价值。     

Transient osteoporosis of the Hip: a densitometric study

Summary Three new cases of transient osteoporosis of the hip are reported. Diagnosis was achieved by plain radiographs, bone scintiscan, magnetic resonance imaging and X-ray absorptiometry of proximal femurs. The densitometry showed at the Ward's triangle a mean reduction of bone mineral density in the affected side of 36%. All subjects were treated with i.v. clodronate for ten consecutive days with a complete recovery of femoral density within 4 months. X-ray absorptiometry allows a quantification of the demineralization process and can be useful in the long term evaluation of this entity.     

Ipriflavone does not alter bone apatite crystal structure in adult male rats

We have previously found that a short-term treatment with high doses of ipriflavone increased bone density and improved the biomechanical properties of adult male rat bones, without altering their mineral composition. To determine whether this effect can be associated with alterations of bone crystal structure, we have performed X-ray diffraction analysis of bones obtained from rats treated with ipriflavone at doses that were effective in inducing favorable changes on bone density and biomechanics. Eighteen-week-old male Sprague Dawley rats were treated by oral route with either ipriflavone (200 or 400 mg/kg/day), or its vehicle for 12 weeks. The treatment was well tolerated and body weight increased to the same extent in all animals. As a measure of bone crystallinity, we examined the (310) and (002) reflections of the X-ray diffraction patterns, corresponding to the directions perpendicular and parallel to the c-axis of the crystals, respectively. No major differences were observed between ipriflavone-treated and control animals for the broadening parameter 1/2 for (310) and (002) peaks, as well as for lattice parameters. Therefore, a 12-week treatment with ipriflavone at high doses does not induce significant modifications of bone crystallinity. Thus. the positive effect of ipriflavone on bone mineral density appears to be associated with an increased apatite crystal formation rather than an increase of crystal size. These results provide further evidence for the safety and usefulness of ipriflavone in the treatment of osteoporotic syndromes.     

11例食管平滑肌瘤临床病理X线分析

本文对11例食管平肌瘤的临床病理X线表现进行分析,本病临床症状轻微,具有典型粘膜下良性肿瘤膨胀性生长的病理特征,X线检查能充分反映其病理基础．除边线光滑的腔内充盈缺损或范围一致的腔内外肿块、“环形征”、粘膜不同程度挤压等固有X线特征外,作者认为“扇形增宽皱襞”、“肿瘤移动征”等特异征象,对诊断也很有帮助．术前诊断主要依靠食管钡餐检查．文中并讨论了鉴别诊断．     

Comparative assessment of bone mineral density of the forearm using single photon and dual X-ray absorptiometry

Summary Forearm bone mineral density (BMD) was measured at proximal and distal sites by ¹²⁵I single photon absorptiometry (SPA) and by dual energy X-ray absorptiometry (DXA) in 67 consecutive subjects, aged 18–75 years. Correlations and regression equations between these two techniques were determined. All forearm measurements were significantly correlated with each other (r=0.599–0.926; P0.0001). Although SPA and DXA correct for fat in different ways, we found similar correlation and regression equations in women with body mass index measurements above and below the mean. In addition, forearm measurements by both techniques were moderately correlated with vertebral spine and hip BMD. We conclude that overall, SPA forearm measurements in a population can be calibrated to DXA measurements if necessary, and that DXA forearm measurements are as predictive of the remainder of the skeleton as SPA measurements.     

Cat Distal Forelimb Joints and Locomotion: An X-ray Study

The complex construction of the joint apparatus of the cat distal forelimb, which allows the paw three degrees of freedom, poses special requirements on the neural signals controlling the paw position. To understand the electromyography (emg) signals of the distal forelimb muscles during locomotion, it is necessary to know the kinematics of the forelimb joints in detail. As no such information is available, we used the pulsed X-ray technique in trained cats during treadmill locomotion to analyse the angular excursions of the wrist, the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints. X-ray illuminations were done in either the parasagittal or the frontal plane. At the beginning of the stance phase the wrist (WR) and the MCP joints extended slowly, and the PIP joints flexed. Whereas the WR and the PIP joints maintained a constant angular position of approximately 200 degrees and 60 degrees, respectively, throughout the stance phase, extension continued in the MCP joints from 240 degrees at touch-down to 300 degrees at the end of the stance phase. Slightly before lift-off (100 ms) the WR and the MCP joints flexed rapidly. This flexion changed approximately 150 ms after lift-off into a slow extension. The PIP joints extended rapidly at the beginning and at the end of the swing phase, during the interposed period of the swing phase they displayed a slow flexion. Rotatory movements of the forelimb in the radioulnar joints were present during the swing and stance phases. During the swing phase the limb first supinated (starting 100 ms after lift-off); pronation occurred immediately before ground contact. During the stance phase the supination angle was kept constant until 100 ms before lift-off, when a short pronation was found. The paw was kept in an ulnar deviated position throughout the complete step cycle. Ulnar deviation decreased at the end of the swing and stance phases. The results of this study increase our understanding of how the body weight is transmitted on to the ground. They suggest four main functions for the skeletomotor apparatus and the underlying neural commands to secure the forward movement of the animal during the stance phase: (i) preparation and stabilization of a force-transmitting platform; (ii) stabilization of the wrist and the carpal/metacarpal joints; (iii) stabilization of the supination angle; (iv) antigravity control of the extension in the MCP.     

Über Melanin und Melanosomen im ZNS im Vergleich zu extracerebralen Erscheinungsformen und synthetischem Melanin aus Dopamin und Serotonin

Summary Melanosomes and isolated melanosomal fragments (melanin particles) originating from gangliocytes (substantia nigra), astroglia (melanosis cerebelli), and melanocytes (melanotic meningeoma; metastases of melanoblastoma; melanosis thalami of the goat) were compared with synthetic melanins prepared from dopamine and serotonin, respectively. Samples were examined by electron microscopy, X-ray diffraction analysis according to Debye-Scherrer and by infrared spectrophotometry, and the results were evaluated with regard to characteristic features as they may relate to specific cell types or chemical structures.On electron microscopy all three types of melanosomes could be differentiated unequivocally as could the two synthetic melanins. Thus, there were similarities between synthetic melanin from dopamine and the gliogenic melanins of the cerebellum; the synthetic melanin from serotonin resembled melanin of melanocytes.X-ray diffraction analysis yielded 2-4 Debye diffraction rings with all human and synthetic samples, suggesting short range orders between 3.8 to 5 Å the sample obtained from a goat with thalamic melanosis showed a specific reflex pattern. While diffraction patterns of some melanins were partially identical, in particular that of melanin from dopamine and melanin of substantia nigra and dentate nucleus, respectively, they were different for the various melanocytic melanins. Further investigations are required to determine whether these differences are due to disparities in basic chemical structures or conformations or else, to particular compositional features of the various types of melanocytes as they arise from benign or malignant tumors or a specific species.Infrared spectrophotometry at higher wave numbers revealed the well known patterns of melanins, which are not, however, very suitable, for their further differentiation. At lower wave numbers (fingerprinting) melanin of substantia nigra and the glial melanin in melanosis cerebelli yielded additional absorption bands of identical configuration. In contrast to melanin from dopamine, melanin from serotonin exhibited a closely similar absorption pattern in this spectral range, suggesting that the neuroectodermal melanins may contain a component possibly arising from serotonin.

Herrn Prof. Dr. Wilhelm Doerr zum 25. 8. 1979     

The effect of grinding of human dentine examined by X-ray diffraction, infrared spectroscopy, and electron microscopy

Analysis of human dentine by infrared spectrophotometry suggests that ball-grinding may result in damage of the apatite crystallites. The present study includes further assessments of this effect by X-ray diffraction, infrared spectroscopy, and electron microscopy. Each of three coarse-ground dentine samples (Group I) was divided into three portions of 30 mg. One of these portions was ball-ground for approximately 1 min (Group II), the second portion for 6 min (Group III), and the third portion for 23 min (Group IV). The 002 reflection showed line broadening, most marked from Group II to III. Electron microscopy showed a gradual change in crystallite appearance with increased grinding, most pronounced from Group II to III. These observations indicate that by prolonged grinding a limit is approached where no further changes in the crystallites occur. Electron microscopy also indicated that fracture of the crystallites might have occurred. This was probably accompanied by strains in the lattice. The infrared spectra indicated that no breakdown of the apatite structure had occurred during the entire grinding.     

Reference Data of Vertebral Morphometry by X-ray Absorptiometry (MXA) in Argentine Women

Anterior, middle, and posterior heights and A/P and M/P ratios were determined from T5 to L4 in 111 normal Caucasian Argentine women from 20 to 70 years of age using dual energy X-ray absorptiometry (DXA) densitometry (Expert XL). Scanning time was less than 1 minute and the semiautomatic analysis requires ∼5 minutes. The precision error for the measurements ranged from 2.2% to 4.6%. The absolute precision error for heights was 0.6 mm. The vertebral bodies tended to be significantly larger in younger women than older women, especially for anterior and middle heights and the A/P and M/P ratios of the mid-thoracic vertebrae (T6–T10). There were no significant differences between pre- and postmenopausal women in the lumbar vertebral heights. It does not appear that this was a cohort effect because stature was identical in both age groups, and there was no age difference in posterior height. The Expert-XL software normalized the vertebral height based on the average height of the L2-L4 segment in order to minimize the influence of interindividual variation of body size. The average Z-scores for vertebral heights and ratios provided by the software were close to zero indicating that the normalization procedure appropriately corrected for smaller stature in Argentine women. Consequently, the reference values for morphometry X-ray absorptiometry (MXA) were appropriate for our population. In summary, we found that (1) in ``normal' women the anterior heights of the thoracic vertebrae (and therefore the A/P ratio) were higher in premenopausal than in postmenopausal women; and (2) the normalization approach corrected for differences of vertebral height and allowed utilization of the manufacturers software in our population. Received: 28 June 1999 / Accepted: 2 November 1999