Measurement of reference value of maximum epiphyseal width lateral to Klein's line and modification of Klein's line in 2 800 hips of 1 400 normal children / 国际儿科学杂志

Objective To investigate the maximum epiphyseal width lateral to Klein' s line (MEWLKL) and modification of Klein's Line (namely difference value of bilateral MEWLKL) on hip plain radiographs of normal children, and to investigate the relationship between MEWLKL and modification of Klein's Line and gender and body side, respectively.Methods Anteroposterior (AP) view pelvic plain radiographs of fourteen thousand eight hundred and thirty-seven cases aged from zero to fourteen years old in Shengjing Hospital of China Medical University from 2005 January to 2014 December were reviewed.Seven thousand one hundred and forty-seven normal AP pelvic plain radiographs were included in the present study.Fourteen groups based on the age from one years old to fourteen years old were divided.One hundred cases in each age group, including fifty males and fifty females, were randomly selected.Fourteen hundred AP view pelvic plain radiographs including twenty eight hundred hips were measured.The reference value of MEWLKL and modification of Klein's line were measured using AutoCAD2007 software.the Normal distribution test were performed using Excel and SPSS19.0 software.The relationship curve between MEWLKL and modification of Klein's Line and age were drawed.The intra-group difference between MEWLKL and gender and body side were performed using t-test in normal children.The inter-group difference between modification of Klein's line and average MEWLKL were performed using one-way analysis of variance in normal children.Results The reference value of MEWLKL and modification of Klein's Line were both normal distribution.Average reference value of MEWLKL were (5.20 ± 1.92) mm, (5.04 ± 1.88) mm in male, and (5.36 ± 1.94) mm in female (P =0.000), (5.06 ± 1.87) mm on the left side, and (5.33 ± 1.96) mm on the right side (P =0.000).The curve of reference value of MEWLKL in fourteen general groups were similar to those of fourteen male groups and fourteen female groups, and reference value of MEWLKL increased with age.It was in the trough at the age of five [general groups: (3.77 ± 1.00) mm;male groups: (3.53 ± 1.00) mm;female groups: (4.01 ±0.94) mm], and it was at the peak at the age of thirteen [general groups: (7.49 ± 1.43)mm;female group: (7.84 ± 1.42) mm].It was at the peak at the age of fourteen in male groups, and the value was (7.24 ± 1.46) mm.The reference value of MEWLKL in fourteen groups and in female groups both fell slightly after the age of fourteen.There were second trough, (6.44 ± 1.86) mm to (6.38 ± 1.15) mm,at age eleven to twelve in female groups.The curves of reference value of MEWLKL on bilateral sides was very similar, and they increased with age.They were in the trough at the age of five [(3.54 ± 0.84) mm in left side and (4.00 ± 1.10) mm in right side], and they were at the peak at the age of thirteen [(7.25 ± 1.57)mm in left side and (7.72 ± 1.24) mm in right side].The curves both fell slightly after the age of fourteen.The general reference value of modification of Klein's line was (0.93 ±0.82) mm.The average value of each age group waved in the level of 1.0 mm.Statistical significance were found in comparison of two intergroups, age eight versus age seven (P =0.011), and age eleven versus age ten (P =0.04).The maximum value of modification of Klein's line in four of fourteen groups were greater than 2.0 mm, including 2.02 mm in age ten, 2.05 mm in age eleven, 2.3 mm in age thirteen, and 2.17 mm in age fourteen, respectively.Conclusion The value of modification of Klein's line in normal children can be more than 2.0 mm, and the average value waved in the level of 1.0 mm.It is not reliable to determine slipped capital femoral epiphysis using modification of Klein's line.

Craniosynostosis : Updates in Radiologic Diagnosis

The purpose of this article is to review imaging findings and to discuss the optimal imaging methods for craniosynostosis. The discussion of imaging findings are focused on ultrasonography, plain radiography, magnetic resonance imaging and computed tomography with 3-dimensional reconstruction. We suggest a strategy for imaging work-up for the diagnosis, treatment planning and follow-up to minimize or avoid ionized radiation exposure to children by reviewing the current literature.

The comparison between X-ray plain radiography, CT, and MR findings of gouty arthritis / 中华内分泌代谢杂志

Objective To make a comparison between the plain radiograph, CT, and MR findings of gouty arthritis and to analyse the relationship between clinical data and imaging findings. Methods Fifty-four joints of 33 patients with a confirmed diagnosis of gouty arthritis were included in this study. In the morning, the blood uric acid level of patients was tested before meal. In the afternoon, their clinical data were recorded and joints were examinated by plain radiography, CT, and MRI. The imaging findings were evaluated by tophi, bone erosion, soft tissue swelling, hydrarthrosis, synovial thickness, and bone oedema. The data was analyzed by Chi-square test, indepentdent-samples t test, and logistic regression. Results The Chi-square test was utilized to evaluate number of joints with tophi(CT>plain radiography, MR>plain radiography, PCT>plain radiography, PCT, P<0. 01). In addition, 35 joints had bone oedema and 50 joints had synovial thickness. The course of disease(tophi positive group vs tophi negative group, P<0. 01) was analyzed by indepentdent-samples t test. The tophi's causative agents including bone erosion and course of disease were analysed by logistic regression(P<0. 01). Conclusions MRI is superior to CT and plain radiography on the early diagnosis of gout. Tophi and bone erosion may not affect the blood uric acid level. With the progression of disease, the probability of tophi formation increases. The relationship between the formation of tophi and bone erosion may be interpromotied.

Emphysematous Pyelonephritis: Radiological Perspective.

Emphysematous pyelonephritis (EPN) is an acute necrotizing parenchymal and perirenal infection and is caused by gas-forming organisms. Diabetes mellitus and ureteric obstruction are the predisposing factors for EPN. Computerized tomography (CT) scan is the modality of choice in diagnosing the disease, determining the extent of infection and helps in management. We report a case of emphysematous pyelonephritis in 52 years old man with emphasis on plain radiographic and CT scan findings.

Proximal Focal Femoral Deficiency.

Proximal focal femoral deficiency (PFFD) is a developmental disorder of the proximal segment of the femur and of acetabulum resulting in shortening of the affected limb and impairment of the function. It is a spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximal femur. The diagnosis is often made by radiological evaluation which includes identification and description of PFFD and evaluation of associated limb anomalies by plain radiographs. Contrast arthrography or Magnetic Resonance Imaging is indicated when radiological features are questionable and to disclose the presence and location of the femoral head and any cartilagenous anlage. The disorder is more commonly unilateral and is apparent at birth. However, bilateral involvement is rarely seen. Therapy of the disorder is directed towards satisfactory ambulation and specific treatment depending on the severity of dysplasia.

Relationships between Posterior Ligament Complex Injury and Plain Radiograph in Thoracolumbar Spinal Fracture / 대한척추외과학회지

STUDY DESIGN: A prospective study of 100 patients with thoracolumbar spinal fractures. OBJECTIVES: To assess the relationships between a posterior ligament complex injury and plain radiograph in thoracolumbar spinal fractures. SUMMERY OF LITERATURE REVIEW: Some studies have reported the value of MRI for the evaluation of a posterior ligament complex injury. However, most of these did not evaluate the relationships between the posterior ligament complex and plain radiograph of the thoracolumbar spine fractures. MATERIALS AND METHODS: 100 patients with either a thoracolumbar compression or burst spinal fracture, from T11 to L2 levels, were evaluated by plain radiographs, taken in the supine position, and MRI taken within a week of the trauma. The wedge angle, Cobb's angle and anterior body height were measured on the plain radiographs, and the presence of posterior ligament complex injury on MRI was evaluated and analyzed. RESULTS: In the compression fracture group, the wedge angle, Cobb's angle and anterior body height loss were 19.9+/-1.4 degrees, 14.3+/-2.2 degrees and 35.6+/-3.6%, respectively, in the posterior ligament complex injury subgroup, but only the anterior vertebral body height loss was statistically significant (p=0.04). In the burst fracture group, the wedge angle, Cobb's angle and anterior body height loss were 26.4+/-2.0 degrees, 23.3+/-1.7 degrees and 57.4+/-5.2%, respectively, in the posterior ligament complex injury subgroup, which were all statistically significant (p=0.00, 0.02, 0.00). With a sensitivity of 75% or greater, the wedge angle, Cobb's angle and anterior body height loss in compression and burst fractures were more than 15 degrees, 10 degrees and 30% and 20 degrees, 20 degrees and 40%, respectively. CONCLUSIONS: When the values of wedge angle, Cobb's angle and anterior body height loss in the compression and burst fractures were more than 15 degrees, 10 degrees and 30% and 20 degrees, 20 degrees and 40%, respectively, and the sensitivity for the presence of a posterior ligament complex injury was more than 75%. Therefore, these values in the screening test are indicators for the presence of a posterior ligament complex injury. Further careful evaluations, such as MRI, are still required in deciding the appropriate treatment method.

Analysis of the Orientation of Lumbar Isthmic Defect / 대한정형외과학회잡지

PURPOSE: We analyzed angles of defect planes of spondylolysis from coronal plane using axial computed tomography to identify the problem of 45degrees oblique plain radiograph by which we routinely has used and to suggest an appropriate radiological diagnostic tool for spondylolysis. MATERIALS AND METHODS: From January 2001 to July 2002, 84 cases of spondylolysis from 44 patients were studied. The diagnosis of spondylolysis was confirmed with axial computed tomography in all cases and angles of isthmic defect from coronal plane were measured. We intended to assess the distribution of angles of isthmic defect and analyzed the result of plain radiographs which were obtained in the direction parallel to the angle of the mean value. RESULTS: Although angles of lumbar isthmic defects have a wide distribution, the mean value was 20.9+/- 9.5degrees which was nearer to coronal plane than 45degrees oblique plane. Fifty eight cases were distributed within 23degrees from coronal plane. A diagnostic sensitivities were 88.1% in lateral view, 78.6% in 45degrees oblique view and 100% in 20degrees oblique view, so a 20degrees oblique view seemed to be more sensitive in diagnosis of lumbar isthmic defect. CONCLUSION: Because the mean angle of lumbar isthmic defects from coronal plane was about 21degrees, obliqueview with 20degrees was more appropriate and sensitive diagnostic tool for spondylolysis than oblique view with 45degrees which have been used routinely.

Morphometry of Wrist in Korean Adults Using Plain Radiograph / 대한정형외과학회잡지

Currently, many techniques for the diagnosis of carpal disorders have been developed. Plain radiograph is the most simple and low-cost procedure that offers various information on the normal wrist. Nonetheless, a sufficient amount of morphometric database for Koreans has not been studied. In this study, the authors reviewed 100 cases of plain posteroanterior radiograph of the wrist in normal Korean adults for both sexes in order to establish normal databases. Various parameters were measured, and comparisons between the sexes, age groups, foreign databases and other domestic databases were made. The results were as follows. 1. In all measurements of the length and ratio except ulnar variance, there were significant differences between the sexes. But there was no significant difference between the sexes in angular measurements. No significant difference in measurements were found among the groups based on their age. 2. The average ulnar variance was 0.6 mm, and it was higher than Europeans and Americans. 3. The average carpal height ratio was 53.5% and significantly lower in females, but the revised carpal height ratio was higher. This means that the length of the capitate is shorter and the length of the third metacarpal bone is relatively longer in females, if the carpal height is constant. 4. The carpal-radial distance ratio, the carpal-ulnar distance ratio, and the carpal width-carpal height ratio were significantly lower in females. This means that the carpal width is relatively narrower in females. The authors hope that information concerning normal roentgenographic measurements of the wrist can help to diagnose the carpal disorders including the diseases appearing carpal collapse or carpal translation and to design wrist implants.