Atlas-based knee osteophyte assessment with ultrasonography and radiography: relationship to arthroscopic degeneration of articular cartilage.

OBJECTIVES: To investigate intra- and inter-reader agreement of ultrasonography (US) and conventional radiography (CR) for the evaluation of osteophyte presence and size within the tibiofemoral joint. In addition, to correlate these findings with arthroscopic degeneration of the articular cartilage. METHOD: Forty adult patients with knee pain were enrolled in this study. Knee CR and US scanning of the medial and lateral bone margins were performed on all patients. A novel atlas for the US grading of knee osteophytes was used in the evaluation. The number and size of the osteophytes were evaluated semi-quantitatively in two rounds from both the CR images (four readers) and the US images (14 readers). The Noyes grading system was used for the evaluation of arthroscopic degeneration of the articular cartilage in 26 patients. RESULTS: On average, intra- and inter-reader US and CR agreement was substantial and comparable to each other (κ = 0.60-0.72). US detected more osteophytes than CR at both the medial (65% vs. 48%) and lateral (70% vs. 60%) compartments. A statistically significant correlation between CR- or US-based osteophyte and arthroscopy grades was observed only for US at the medial compartment (rs = 0.747, p < 0.001). CONCLUSIONS: The detection of knee osteophytes using the novel US atlas is as reproducible as reading conventional radiographs. US is more sensitive to detect knee osteophytes than CR. Furthermore, osteophytes detected with US correlate significantly with arthroscopic cartilage changes at the medial knee compartment whereas those detected by CR do not.

Inhibitory characteristics of citrullinated telopeptides of type I and II collagens for autoantibody binding in patients with rheumatoid arthritis.

OBJECTIVE: To study how soluble citrullinated telopeptides of type I and II collagens inhibit the binding of autoantibodies to the respective antigens immobilized onto solid phase, and to use modifications of previous methods to re-analyse rheumatoid arthritis (RA) and control serum samples. METHODS: Autoantibody binding was inhibited with normal or citrullinated carboxytelopeptides using enzyme-linked immunosorbent assay (ELISA) methods. Serum samples were available from 120 patients with RA and 81 controls. RESULTS: Autoantibodies that bind normal C-telopeptides were not inhibited with soluble normal or citrullinated telopeptides. However, the antibodies that bind only citrullinated telopeptides could be inhibited with corresponding citrullinated telopeptides. Thus, it is not necessary to study the binding of autoantibodies to normal collagens if the specificity of their binding is assessed by immunological inhibition. For type I telopeptide, there are two arginines, the latter of which, when citrullinated, is important for binding. For type II telopeptide, there is one arginine, which is important when citrullinated. The other amino acids, e.g. the last alanine, have only a slight effect on binding. These improved methods differentiate better between RA patients, who have specific citrullinated autoantibodies, and controls than previous ELISA methods. CONCLUSIONS: Based on inhibition assay, it is possible to measure the autoantibodies binding specifically to citrullinated telopeptides of type I and II collagens. When only one assay is involved, variance is decreased and the overall performance is easier than before.

Evaluation of innotrac aio! Second-generation cardiac troponin I assay: the main characteristics for routine clinical use.

The availability of a simple, sensitive, and rapid test using whole blood to facilitate processing and to reduce the turnaround time could improve the management of patients presenting with chest pain. The aim of this study was an evaluation of the Innotrac Aio! second-generation cardiac troponin I (cTnI) assay. The Innotrac Aio! second-generation cTnI assay was compared with the Abbott AxSYM first-generation cTnI, Beckman Access AccuTnI, and Innotrac Aio! first-generation cTnI assays. We studied serum samples from 15 patients with positive rheumatoid factor but with no indication of myocardial infarction (MI). Additionally, the stability of the sample with different matrices and the influence of hemodialysis on the cTnI concentration were evaluated. Within-assay CVs were 3.2%-10.9%, and between-assay precision ranged from 4.0% to 17.2% for cTnI. The functional sensitivity (CV = 20 %) and the concentration giving CV of 10% were approximated to be 0.02 and 0.04, respectively. The assay was found to be linear within the tested range of 0.063-111.6 mu g/L. The correlations between the second-generation Innotrac Aio!, Access, and AxSYM cTnI assays were good (r coefficients 0.947-0.966), but involved differences in the measured concentrations, and the biases were highest with cTnI at low concentrations. The second-generation Innotrac Aio! cTnI assay was found to be superior to the first-generation assay with regard to precision in the low concentration range. The stability of the cTnI level was best in the serum, lithium-heparin plasma, and lithium-heparin whole blood samples (n = 10 , decrease < 10 % in 24 hours at +20( degrees )C and at +4( degrees )C. There was no remarkable influence of hemodialysis on the cTnI release. False-positive cTnI values occurred in the presence of very high rheumatoid factor values, that is, over 3000 U/L. The 99th percentile of the apparently healthy reference group was

Wireless sensor and data transmission needs and technologies for patient monitoring in the operating room and intensive care unit.

In the intensive care unit, or during anesthesia, patients are attached to monitors by cables. These cables obstruct nursing staff and hinder the patients from moving freely in the hospital. However, rapidly developing wireless technologies are expected to solve these problems. To this end, this study revealed problem areas in current patient monitoring and established the most important medical parameters to monitor. In addition, usable wireless techniques for short-range data transmission were explored and currently employed wireless applications in the hospital environment were studied. The most important parameters measured of the patient include blood pressures, electrocardiography, respiration rate, heart rate and temperature. Currently used wireless techniques in hospitals are based on the WMTS and WLAN standards. There are no viable solutions for short-range data transmission from patient sensors to patient monitors, but potentially usable techniques in the future are based on the WPAN standards. These techniques include Bluetooth, ZigBee and UWB. Other suitable techniques might be based on capacitive or inductive coupling. The establishing of wireless techniques depends on ensuring the reliability of data transmission, eliminating disturbance by other wireless devices, ensuring patient data security and patient safety, and lowering the power consumption and price.

Reactive arthritis induced by Clostridium difficile enteritis as a complication of Helicobacter pylori eradication.

Clostridium difficile has recently been established as a cause of reactive arthritis (ReA). We present a case of Clostridium difficile-induced ReA as a complication of Helicobacter pylori eradication, which, to the best of our knowledge, is the first such case reported.

Evaluation of humeral head erosions in rheumatoid arthritis: a comparison of ultrasonography, magnetic resonance imaging, computed tomography and plain radiography.

The value of ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT) and plain radiography (PR) in detecting bone erosions on the humeral head was evaluated in a study of 26 in-patients (26 shoulders) with rheumatoid arthritis (RA). MRI depicted humeral erosions in 25 (96%), US in 24 (92%), CT in 20 (77%) and PR in 19 (73%) of the 26 shoulders. MRI and US were superior to CT in detecting small erosions. US was the most sensitive method to show surface erosions on the greater tuberosity. US, CT and MRI detected large erosions quite similarly. PR frequently missed small erosions. In the evaluation of early erosions in the rheumatoid shoulder, US and MRI are more sensitive methods than the traditionally used PR. US and MRI are suitable for the evaluation of soft-tissue involvement in the rheumatoid shoulder, but also for the detection of bone erosions of the humeral head.

Ultrasound and operative evaluation of arthritic shoulder joints.

OBJECTIVE: To assess the diagnostic value of ultrasonography (US) in the evaluation of arthritic shoulder joints. METHODS: Twenty shoulders of 20 inpatients with arthritis were evaluated by US one day before the shoulder operation. Changes in the subacromial-subdeltoid bursa, biceps tendon and tendon sheath, rotatof cuff, and glenohumeral joint were recorded and compared with findings at operation. RESULTS: In the detection of effusion/hypertrophy in the subacromial-subdeltoid bursa, US had a sensitivity of 93% and a specificity of 83%. For a biceps tendon rupture US had a sensitivity of 70% and a specificity of 100%. US missed three intraarticular biceps tendon ruptures. For effusion/hypertrophy in the biceps tendon sheath US had a sensitivity of 100% and a specificity of 83%. For a rotator cuff tear US had a sensitivity of 83% and a specificity of 57%. US missed two small longitudinal rotator cuff tears. Three thin membranous, but intact, rotator cuff tendons were classified as full thickness tears by US. Synovial effusion/hypertrophy was detected by US and at operation in all of the 12 glenohumeral joints that were evaluable at surgery. CONCLUSION: US is a reliable method in experienced hands for the evaluation of inflammatory changes of an arthritic shoulder. In advanced stages of rheumatoid shoulder joints, however, US is not useful, because destructive bone changes and tendon ruptures change the normal anatomy and restrict shoulder motions, limiting the visibility of US.

Sonography and MRI in the evaluation of painful arthritic shoulder.

We evaluated 31 painful shoulders of 30 patients with chronic arthritis by ultrasonography (US) and compared the results with those of magnetic resonance imaging (MRI). Both US and MRI revealed effusion in the subacromial-subdeltoid (SA-SD) bursa, biceps tendon sheath (BTS) and glenohumeral (GH) joint, but MRI was more accurate in depicting joint inflammation because of its ability to visualize synovial hypertrophy. US visualized biceps tendon ruptures equally well as MRI. MRI was better able to reveal full-thickness tear of the supraspinatus tendon, whereas US showed better other changes of the supraspinatus tendon (degeneration or partial-thickness tear). Both of the imaging methods were able to depict erosions of the humeral head, but the locations occasionally differed. Inexpensive and easily available US can be recommended as the first imaging method for the detection of soft-tissue changes in the arthritic shoulder, but in rotator cuff problems both methods may be needed.

Ultrasound evaluation of the acromioclavicular joint.

OBJECTIVE: To evaluate the value of ultrasonography in assessing arthritic acromioclavicular (AC) joints. METHODS: One hundred twenty-six AC joints of 63 healthy subjects (2 groups) were prospectively examined by ultrasound to determine the-normal limits of capsular distention and the width of the joint space. Thirty-three AC joints of 32 patients with chronic arthritis were evaluated by ultrasound and, for comparison, by radiography, computed tomography (CT), and magnetic resonance imaging (MRI). RESULTS: The mean ultrasonographic distance of the joint capsule from the bone rim was 2.2 mm +/- standard deviation (SD) 0.5 mm in 21-32-year-old control subjects and 2.9 +/- 0.7 mm in 37-81-year-old control subjects. The mean width of the joint space was 4.1 +/- 0.9 mm and 3.5 +/- 0.9 mm in the same control groups, respectively. In detecting soft tissue changes in arthritic AC joints MRI was better than ultrasound. In revealing bony surface changes, CT was the best method and radiography was least sensitive but quite specific. Our most prominent finding was that ultrasound is able to exclude joint inflammation; when the ultrasonographic distance of the joint capsule from the bone rim was < 3 mm, there was no synovial hypertrophy or effusion on MRI scans. CONCLUSION: Ultrasound can detect AC joint changes reliably. It is able to exclude joint inflammation. Effusion in the AC joint may reflect inflammation, but may also be a sign of degeneration.

Ultrasound evaluation of painful rheumatoid shoulders.

OBJECTIVE: To provide more information about various types of rheumatoid involvement of the painful shoulder by ultrasonography (US). METHODS: US examinations were performed in 44 patients (88 shoulders) with rheumatoid arthritis (RA). The technique of shoulder ultrasonography was standardized in studies of 30 healthy volunteers (60 shoulders) without shoulder complaints. US findings were compared with clinical, laboratory and radiographic data to find any relationship. RESULTS: Sonography could reveal inflammatory conditions at early stages of RA when no radiographic changes were seen. The most common US finding was subacromial-subdeltoid bursitis in 61 shoulders (69%) of 35 patients. Synovitis in the glenohumeral joint was seen in 51 shoulders (58%) of 32 patients, biceps tendinitis in 50 shoulders (57%) of 29 patients and changes in the supraspinatus tendon in 29 shoulders (33%) of 20 patients. There were multiple rheumatoid symptoms in 61 shoulders (69%), one condition resulted in changes in 17 shoulders (19%) and no visible US findings in 10 shoulders (11%). Clinical findings were rather unspecific. Flexion, abduction and outward rotation were often restricted in shoulder symptoms, whereas inward rotation was rarely limited. Shoulder swelling indicated subacromial-subdeltoid bursitis. CONCLUSION: Ultrasonography is a very useful method for rheumatologists and orthopedists to see inside joints. It can provide remarkable help for local injection therapy and for planning surgery because of its suitability for evaluation of the extent of rheumatoid disease.

Ultrasound propagation speed in arthritic synovial tissue.

Ultrasonic properties of knee synovial tissues destroyed by arthritis were studied by analysing 40 tissue specimens from 21 patients using an ultrasound echo meter and an optical microscope. The idea was to compare pathological findings to ultrasound propagation speeds, and to try to find any relation between them. The fresh specimens were first measured by the echo meter to collect data for statistical calculations of the propagation speed vs. different pathological properties. Before pathological studies, the specimens were fixed in formalin solution. The connective and fat tissues were evaluated within a resolution of 5% and expressed in percentages (0-100%). Inflammatory cells, edema and villus formation were also evaluated. As results, we obtained several charts of ultrasound propagation speed and their trends in the function of different properties. It could be seen that the trend of the propagation speed increased from 1515 m/s to 1565 m/s when the percentage amount of connective tissue increased from 30% to 90%. The trend of the speed decreased from 1560 m/s to 1480 m/s when the share of fat tissue increased from 0 to 60%. The same phenomenon is already well known from some other tissues. A special new result was that the speed varied in a remarkable range of 1490-1660 m/s in samples of 0% fat and high connective tissue content. The overall average of the ultrasound propagation speed in the specimens was 1548 m/s, and the average of the standard deviations of measurements (each specimen was measured at least twice) of each tissue specimen was 8.3 m/s.

Evaluation of image quality of ultrasound scanners in medical diagnostics.

The evaluation of the properties of ultrasound diagnostic scanners has not yet been standardized. Because the image itself is the basis of diagnostic decisions, it should also be the basis of evaluation of the capabilities of scanners. This study is aimed to help the standardization work by suggesting a procedure for testing the image quality of the scanners. The image quality depends on the tissue resolution, which is difficult to determine without real tissue studies. Therefore, the presented testing procedure consists of two parts: first, lateral and longitudinal resolution, image uniformity, sensitivity, and cyst and tumor imaging are determined by phantom tests; second, imaging experiments of formalin-fixed tissue samples are used to give information on the imaging capability of selected tissue details and boundaries. The procedure has been carried out by an experimental comparative test of 30 scanner and transducer combinations. The role of real tissue tests is important. A reliable whole-body phantom, including liquids flowing in veins, would be a breakthrough in testing real-time image quality.

Completely computer-focused ultrasound imaging. First clinical imaging results.

Completely computer-focused ultrasound imaging has been achieved using the UHB (ultrasound holographic B) method. This is a synthetic aperture method that combines ultrasonic holography and the conventional B-scan method. A wide-angle ultrasound burst (4 MHz) is transmitted into the object and the reflected echoes are measured as a function of the propagation time, but both the amplitude and phase angle are recorded, giving multiple one-dimensional holograms in a cross-sectional plane. This UHB data is rearranged to obtain one-dimensional wave fields, which represent the wave fronts reflected from each depth. The image is then reconstructed by propagating these wave fields backward to their original positions on the image using Fourier transform, a spectrum shift theorem, and inverse Fourier transform. The whole UHB image is obtained by calculating the intensity lines from these wave fields and by scanning these lines one by on the cathode ray tube (CRT) monitor. Following extensive laboratory testing with single and multielement transducers, special 32- and 64-element linear array transducers were fabricated, as was computer software capable of producing a UHB image in 40 seconds. Tissue imaging tests followed by clinical imaging of 30 patients showed that images obtained with this prototype compared favorably with those obtained by state-of-the-art conventional ultrasound scanners. The potential advantages of the new method are enhanced lateral resolution and the incorporation of phase information in tissue characterization. This would be important in diagnostic and intraoperative, especially neurosurgical, imaging.

Frequency domain compensation for inhomogeneous layers in ultrasound holography.

A frequency-domain compensation method is presented that is based on the ultrasound holography B-scan (UHB) imaging principle. In an acoustic imaging system, the wavefront-angle-dependent distortions caused by any kind of known inhomogeneous reason can be compensated by this method. It is applied here in the frequency domain using the so-called rear-ranging operation for the longitudinal distortion and the multiplication of phase factors for the lateral distortion. The method is especially suitable for compensating different velocity layers in acoustic imaging systems. The results of both computer simulations and water-tank experiments are promising.

Ultrasound holographic B-scan imaging.

An ultrasound holographic B-scan (UHB) imaging apparatus comprising a minicomputer system, a data acquisition unit, and a special 64-element UHB transducer has been developed. Simulation studies and real experiments with a tissue-equivalent phantom show that lateral and longitudinal resolution (-6 dB) of about 1 mm was achieved in the entire image. Furthermore, results from clinical evaluation, including diagnostic and neurosurgical imaging, suggest that the UHB imaging method is operational and has some special advantages in patient diagnosis. Theoretically, the addition of phase information to the ultrasound images can result in enhanced tissue characterization, which is extremely important in tumor diagnosis and treatment.

Three-dimensional ultrasound imaging of brain for neurosurgery.

The ultrasound study group at the Departments of Neurosurgery and Electrical Engineering, University of Oulu, has worked since 1980 on the development of ultrasound holographic B (UHB) imaging for clinical use. It has produced images of human brain based on synthetic focusing of data obtained by wide-angle nonfocused transducers. At the same time, clinical ultrasound B-imaging has been applied to brain and spinal cord surgery. On the basis of laboratory and clinical investigations, some of the possibilities of three dimensional ultrasound imaging in neurosurgery are presented. Particularly the role of supplementary three-dimensional ultrasound imaging data in computer-controlled brain surgery is stressed.