Application of imaging techniques in diagnosis and severity assessment of dermatomyositis / 中华皮肤科杂志

Dermatomyositis is an autoimmune disease involving the skin and muscles. At the onset of dermatomyositis, it is difficult to make an early diagnosis due to atypical clinical manifestations and lack of serological markers. Skin and muscle lesions are associated with disease activity and prognosis in patients with dermatomyositis or clinical amyopathic dermatomyositis. Computed tomography, magnetic resonance imaging, ultrasonography, dermoscopy and other imaging techniques may be used to assess skin and muscle involvements, which can not only improve the accuracy of early diagnosis of dermatomyositis, but also provide important reference for the assessment of disease activity and prognosis.

Biplanar imaging with tridimensional capabilities: applicability of this new examination to spinal deformities / Imagem biplanar com capacidade tridimensional: aplicabilidade do novo exame nas deformidades na coluna vertebral / Imagen biplanar con capacidad tridimensional: aplicabilidad del nuevo examen en las deformidades en la columna vertebral

ABSTRACT This study presents details about the applicability of the new image acquisition system, called the biplanar imaging system, with three-dimensional capabilities (EOS®) to the treatment of spinal deformities. This system allows radiographic acquisition of the entire body, with a great reduction in the dose of radiation absorbed by the patient and three-dimensional (3D) stereoradiographic image reconstruction of bone structures, including the spine. In the case of adolescent idiopathic scoliosis, the analysis of the spinal deformity with 3D reconstruction allows better understanding of the deformity and surgical planning. In the case of adult spinal deformity, full-body analysis allows an evaluation of the spinopelvic deformity, including loss of sagittal alignment, in addition to an evaluation of compensatory mechanisms recruited by the individual in an attempt to maintain the sagittal balance. Level of evidence III; Descriptive Review.

RESUMO O presente estudo apresenta detalhes sobre a aplicabilidade do novo sistema de aquisição de imagem, denominado sistema de imagem biplanar, com capacidade tridimensional (EOS®) no tratamento de deformidades da coluna vertebral. Tal sistema permite a aquisição radiográfica do corpo inteiro, com grande redução da dose de radiação absorvida pelo paciente e reconstrução estereoradiográfica em imagem tridimensional (3D) das estruturas ósseas, incluindo a coluna vertebral. No caso de escoliose idiopática do adolescente, a análise da deformidade da coluna vertebral com reconstrução 3D permite a melhor compreensão da deformidade e planejamento cirúrgico. No caso da deformidade da coluna vertebral do adulto, a análise do corpo inteiro permite a avaliação da deformidade espinopélvica, incluindo a perda do alinhamento sagital, além da avaliação adicional dos mecanismos compensatórios recrutados pelo indivíduo na tentativa de manter o equilíbrio sagital. Nível de evidência III; Revisão Descritiva.

RESUMEN El presente estudio presenta detalles sobre la aplicabilidad del nuevo sistema de adquisición de imagen denominado sistema de imagen biplanar, con capacidad tridimensional (EOS®) en el tratamiento de deformidades de la columna vertebral. Tal sistema permite la adquisición radiográfica del cuerpo entero, con gran reducción de la dosis de radiación absorbida por el paciente y reconstrucción estereorradiográfica en imagen tridimensional (3D) de las estructuras óseas, incluyendo la columna vertebral. En el caso de escoliosis idiopática del adolescente, el análisis de la deformidad de la columna vertebral con reconstrucción 3D permite la mejor comprensión de la deformidad y planificación quirúrgica. En el caso de la deformidad de la columna vertebral del adulto, el análisis del cuerpo entero permite la evaluación de la deformidad espinopélvica, incluyendo la pérdida de la alineación sagital, además de la evaluación adicional de los mecanismos compensatorios reclutados por el individuo en el intento de mantener el equilibrio sagital. Nivel de evidencia III; Revisión Descriptiva.

Through the keyhole: Radiological management of malignant gastric outflow obstruction beyond the pylorus

This review article presents the radiological options for management of malignant gastric outflow obstruction distal to the pylorus. We place these options in context with surgical and endoscopic alternatives and recommend their use, particularly in those institutions where endoscopic alternatives may not be readily available.

Current status of quality management of medical imaging in Korea

Imaging modalities have developed in tandem with technical developments in recent years. It is common practice worldwide to establish a medical imaging quality control system in accordance with resources and need. In2003, the Korean governmentinstituted a medical imaging quality control system for high-priced and high-end medical imaging equipment. Magnetic resonance imaging (MRI), computed tomography (CT), and mammography were included in this program. General image quality has continuously improved, but some problems remain. The medical imaging quality control program will be extended to other equipment such as positron emission tomography-CT, simulation CT for radiation treatment, and extracorporeal shockwave lithotripsy. Education programs for equipment control personnel should be improved and the quality control system should be refined.

Laser therapy in bone repair in rats: analysis of bone optical density

OBJECTIVE: To investigate, by digital radiology, the bone regeneration process in rats submitted to femoral osteotomy and treated with low power laser therapy. METHODS: Forty-five Wistar rats were subjected to transverse osteotomy of the right femur and divided randomly into three experimental groups (n = 15): animals not treated with laser therapy G (C), animals that received laser therapy with λ: 660nm G (660nm) and animals that received laser therapy with λ: 830nm G (830nm). Animals were sacrificed after 7, 14 and 21 days. The bone calluses were evaluated by digital X-ray at 65 kVp, 7mA and 0.032 s exposures. RESULTS: The values obtained were submitted to variance analysis (ANOVA) followed by the Tukey-Kramer test. The significance level adopted was 5%. The groups G (C), G (660nm), and G (830nm) at the 7th day showed a significant bone development, with p <0.0116; the groups G (C), G (660nm), and G (830nm) at the 14th day showed values of p <0.0001; at the 21st day,a higher degree of bone repair were observed in group G (830nm), and G (660nm), with p <0.0169. CONCLUSION: Based on the radiographic findings, G (830nm) showed more complete bone regeneration, as shown in the gray shades of the images. Level of Evidence II, Individual Study With Experimental Design. .

A Comparison of Two Commercial Volumetry Software Programs in the Analysis of Pulmonary Ground-Glass Nodules: Segmentation Capability and Measurement Accuracy

OBJECTIVE: To compare the segmentation capability of the 2 currently available commercial volumetry software programs with specific segmentation algorithms for pulmonary ground-glass nodules (GGNs) and to assess their measurement accuracy. MATERIALS AND METHODS: In this study, 55 patients with 66 GGNs underwent unenhanced low-dose CT. GGN segmentation was performed by using 2 volumetry software programs (LungCARE, Siemens Healthcare; LungVCAR, GE Healthcare). Successful nodule segmentation was assessed visually and morphologic features of GGNs were evaluated to determine factors affecting segmentation by both types of software. In addition, the measurement accuracy of the software programs was investigated by using an anthropomorphic chest phantom containing simulated GGNs. RESULTS: The successful nodule segmentation rate was significantly higher in LungCARE (90.9%) than in LungVCAR (72.7%) (p = 0.012). Vascular attachment was a negatively influencing morphologic feature of nodule segmentation for both software programs. As for measurement accuracy, mean relative volume measurement errors in nodules > or = 10 mm were 14.89% with LungCARE and 19.96% with LungVCAR. The mean relative attenuation measurement errors in nodules > or = 10 mm were 3.03% with LungCARE and 5.12% with LungVCAR. CONCLUSION: LungCARE shows significantly higher segmentation success rates than LungVCAR. Measurement accuracy of volume and attenuation of GGNs is acceptable in GGNs > or = 10 mm by both software programs.

Preoperative N Staging of Gastric Cancer by Stomach Protocol Computed Tomography

PURPOSE: Clinical stage of gastric cancer is currently assessed by computed tomography. Accurate clinical staging is important for the tailoring of therapy. This study evaluated the accuracy of clinical N staging using stomach protocol computed tomography. MATERIALS AND METHODS: Between March 2004 and November 2012, 171 patients with gastric cancer underwent preoperative stomach protocol computed tomography (Jeju National University Hospital; Jeju, Korea). Their demographic and clinical characteristics were reviewed retrospectively. Two radiologists evaluated cN staging using axial and coronal computed tomography images, and cN stage was matched with pathologic results. The diagnostic accuracy of stomach protocol computed tomography for clinical N staging and clinical characteristics associated with diagnostic accuracy were evaluated. RESULTS: The overall accuracy of stomach protocol computed tomography for cN staging was 63.2%. Computed tomography images of slice thickness 3.0 mm had a sensitivity of 60.0%; a specificity of 89.6%; an accuracy of 78.4%; and a positive predictive value of 78.0% in detecting lymph node metastases. Underestimation of cN stage was associated with larger tumor size (P<0.001), undifferentiated type (P=0.003), diffuse type (P=0.020), more advanced pathologic stage (P<0.001), and larger numbers of harvested and metastatic lymph nodes (P<0.001 each). Tumor differentiation was an independent factor affecting underestimation by computed tomography (P=0.045). CONCLUSIONS: Computed tomography with a size criterion of 8 mm is highly specific but relatively insensitive in detecting nodal metastases. Physicians should keep in mind that computed tomography may not be an appropriate tool to detect nodal metastases for choosing appropriate treatment.

Eficácia da irrigação ultrassônica passiva na limpeza e eliminação de Enterococcus faecalis dos canais radiculares / Efficacy of passive ultrasonic irrigation in cleaning and elimination of Enterococcus faecalis from root canals

O objetivo deste estudo foi avaliar a eficácia da Irrigação Ultrassônica Passiva (IUP) na limpeza e eliminação Enterococcus faecalis de canais radiculares, em comparação à Irrigação Manual Convencional (IMC). O estudo foi dividido em dois capítulos. No capítulo I, foram utilizadas raízes de 75 dentes unirradiculados humanos extraídos. Após o preparo biomecânico, os espécimes foram divididos em cinco microplacas de cultura e esterilizados em óxido de etileno. Os canais radiculares foram contaminados com Enterococcus faecalis (ATCC 29212) e incubados a 37ºC durante 21 dias. As microplacas com os espécimes foram divididas em cinco grupos de acordo com o protocolo de irrigação utilizado (n=15): G1- IUP com solução salina; G2- IUP com NaOCl 1%; G3- IMC com solução salina; G4- IMC com NaOCl 1%; G5- controle (sem irrigação). Foram realizadas três coletas microbiológicas: inicial (após 21 dias de contaminação do canal), imediatamente após irrigação e final (após 7 dias dos tratamentos realizados). Após diluições decimais seriadas e semeadura, foi determinado o número de unidades formadoras de colônia por mililitro de solução (UFC/mL). No capítulo II, foram utilizadas raízes de dentes artificiais unirradiculados. Após o preparo dos canais radiculares, foram realizados quatro canais laterais nos terços apical e médio da raiz, nas superfícies vestibular e lingual. Posteriormente, os canais foram preenchidos com uma solução de contraste radiológico. Os espécimes foram divididos aleatoriamente em três grupos de acordo com o protocolo de irrigação (n=08): GI- IMC com agulha 30G, GII- IUP1 com fluxo intermitente, GIII- IUP2 com fluxo contínuo. Antes e após irrigação, os dentes foram radiografados no sentido proximal utilizando um sistema radiográfico digital. As áreas do canal radicular e canais laterais simulados antes (preenchido pelo contraste) e após irrigação (remanescente do contraste) foram mensuradas por meio do programa Image Tool 3.0. Os dados obtidos nos dois experimentos foram analisados por meio dos testes ANOVA e Tukey, com nível de significância de 5%. Na avaliação antimicrobiana, a coleta pós-irrigação não mostrou diferença estatisticamente significante entre G1 e G3 nem entre G2 e G4 (p>0,05), mas G2 e G4 mostraram uma contagem inferior de UFC/mL comparado aos demais grupos (p<0,05). Houve diferença estatisticamente significante entre a coleta inicial e pós-preparo e entre pós-preparo e a final (p<0,05) em todos os grupos, exceto no grupo controle. Na coleta final, todos os grupos apresentaram valores similares aos da coleta final. No teste avaliando a capacidade de limpeza, não houve diferença significante entre os grupos na remoção da solução de contraste do canal radicular principal mostrando porcentagem de limpeza similar (p>0,05). Nos canais laterais simulados, os resultados não mostraram diferenças significativas entre os grupos no terço médio (p>0,05). No terço apical, o grupo IUP1 mostrou-se superior, obtendo maior porcentagem de limpeza quando comparado ao grupo de IMC com diferença significante (p<0,05). Conforme as metodologias empregadas, pode-se concluir que a IUP e IMC associada à NaOCl a 1% contribui para diminuição da contaminação sem eliminar completamente de E. faecalis do sistema de canais radiculares. Quanto à remoção da solução de contraste dos canais radiculares e canais laterais simulados, a IUP com fluxo intermitente promoveu maior limpeza de canais laterais simulados no terço apical comparada à IMC

The aim of this study was to evaluate the cleaning efficacy and elimination of Enterococcus faecalis from the root canal provided by passive ultrasonic irrigation (PUI) compared with conventional needle irrigation (CNI). The study was divided into two chapters. In chapter I, seventy-five extracted human singlerooted teeth were used. After root canal instrumentation, specimens were randomly divided into cell culture microplates. The microplates containing the specimens were wrapped and sterilized by ethylene oxide. Root canals were inoculated with Enterococcus faecalis (ATCC 29212) and incubated at 37ºC for 21 days. The microplates containing the roots were randomly divided in five groups, according to the irrigation method: G1- PUI with saline solution, G2- PUI with 1% NaOCl, G3- CNI with saline solution, G4- CNI with 1% NaOCl, G5- control (no irrigation). Microbiological samples were collected at three time points: initial (21 days after inoculation), post-irrigation (immediately after irrigation), and final (7 days after irrigation). After serial decimal dilutions, the inocula were seeded and was determined the number of CFU/mL. In chapter II, single-rooted artificial teeth were used. After root canal instrumentation, four lateral canals were performed in the middle and apical thirds. After, the root canals were filled with a contrast solution. The roots were randomly divided into three groups, according to the irrigation technique (n=8): GI- IMC with 30-gauge needle, GII- IUP1 with intermittent flow and GIII- IUP2 with continuous flow. Before and after irrigation, the roots were radiographed using a digital radiographic system. The areas of the root canal and lateral canals simulated before (filled by contrast) and after irrigation (remainder of contrast) were measured using Image Tool 3.0 software. Data obtained from the two experiments were subjected to ANOVA and Tukey tests (5%). In antimicrobial test, the post-irrigation samples did not demonstrate statistically significant difference between G1 and G3 nor between G2 and G4 (p>0,05), but G2 and G4 showed a lower CFU/mL than the other groups (p<0,05). Statistically significant difference was observed between the initial and post-irrigation samples and between the post-irrigation and final samples (p<0,05) in all groups, except in the control. The final samples of all groups presented bacterial counts similar to the initial samples. In the ability cleaning test, there was no statistically significant difference between all groups in the removal of contrast solution of the root canal. In lateral canal simulated, the results showed no significant differences between all groups in the middle third. In the apical third, PUI1 (intermittent flow) was better, resulting greater percentage of cleaning when compared to group I (CNI) with significant differences. According with the methodologies employed, it can be concluded that PUI or CNI with 1% NaOCl contribute to the reduction of contamination without complete removal of E. faecalis from the RCS. Concerning the removal of the contrast solution of root canals and lateral canals simulated, PUI with intermittent flow was significantly effective in cleaning the lateral canals in the apical third in comparison with NCI

Diagnostic Value of Clinical T Staging Assessed by Endoscopy and Stomach Protocol Computed Tomography in Gastric Cancer: The Experience of a Low-Volume Institute

PURPOSE: Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute. MATERIALS AND METHODS: We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging. RESULTS: The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm. CONCLUSIONS: Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.

Diagnostic Value of Clinical T Staging Assessed by Endoscopy and Stomach Protocol Computed Tomography in Gastric Cancer: The Experience of a Low-Volume Institute

PURPOSE: Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute. MATERIALS AND METHODS: We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging. RESULTS: The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm. CONCLUSIONS: Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.

Extraoral periapical radiography: an alternative approach to intraoral periapical radiography

It is difficult to take intraoral radiographs in some patients who are intolerable to place the film in their mouth. For these patients, Newman and Friedman recommended a new technique of extraoral film placement. Here we report various cases that diagnostic imaging was performed in patients using the extraoral periapical technique. This technique was used to obtain the radiographs for the patients with severe gag reflex, pediatric dental patients, and patients with restricted mouth opening. This technique can be recommended as an alternative to conventional intraoral periapical technique in cases where intraoral film placement is difficult to achieve.

Comparative analysis of partial imaging performance parameters of home and imported X-ray machines / 中华放射学杂志

Objective To compare and analyze the performance indexes and the imaging quality of the home and imported X-ray machines through testing their partial imaging performance parameters. Methods By separate sampling from 10 home and 10 imported X-ray machines, the parameters including tube current, time of exposure, machine total exposure, and repeatability were tested, and the imaging performance was evaluated according to the national standard. Results All the performance indexes met the standard of GB4505-84. The first sampling tests showed the maximum changing coefficient of imaging performance repeatability of the home X-ray machines was ?max1=0.025,while that of the imported X-ray machine was ?max1=0.016. In the second sampling tests, the maximum changing coefficients of the two were ?max2=0.048 and ?max2=0.022, respectively. Conclusion The 2 years′ follow-up tests indicate that there is no significant difference between the above-mentioned parameters of the elaborately adjusted home X-ray machines and imported ones, but the home X-ray machines are no better than the imported X-ray machines in stability and consistency.