The Influence of Femoral Proximal Medullary Morphology on Subtrochanteric Osteotomy in Total Hip Arthroplasty for Unilateral High Dislocated Hips.

OBJECTIVE: To evaluate the predictive values of femoral proximal medullary morphology for the use of subtrochanteric osteotomy (STO) in unilateral Crowe IV developmental dysplasia of the hip (DDH). METHODS: Ninety four patients with unilateral Crowe type IV DDH (59 hips in STO group and 35 hips in the non-STO group) between April 2008 and June 2019 were enrolled. All patients underwent THA using the Pinnacle acetabular shell, ceramic liner and femoral head, the S-ROM stem with proximal sleeve. Three parameters on the standard anteroposterior hip radiographs were measured: the widths of medullary canals at 20 mm above the center of lesser trochanter (CLT)，20 mm below the CLT and the isthmus. Canal flare index (CFI), metaphyseal canal flare index (MCFI), diaphyseal canal flare index (DCFI) were calculated. A S-ROM femoral stem was used in all patients during total hip arthroplasty (THA). RESULTS: The CFI and DCFI in the STO group were lower than those in the non-STO group. However, there was no statistical difference in MCFI between the two groups. The receiver operating characteristic (ROC) curves shown that DCFI had the highest area under the curve (AUC), at 0.885. This was followed by the CFI, which had an AUC of 0.847. The AUC of MCFI was 0.579. The optimal threshold for DCFI was 1.44, which lead to a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.771, 0.898, 0.869, and 0.818, respectively. For CFI, the optimal threshold was 3.28, resulting in a sensitivity, specificity, PPV, and NPV of 0.829, 0.729, 0.878, and 0.644, respectively. CONCLUSIONS: The DCFI and CFI may be potent indicators in predicting the use of STO in unilateral Crowe IV DDH. The optimal threshold for CFI and DCFI were 3.28 and 1.44 and had good sensitivity and specificity for predicting the use of STO during THA.

Magnetic Resonance Diffusion Kurtosis Imaging versus Diffusion-Weighted Imaging in Evaluating the Pathological Grade of Hepatocellular Carcinoma.

PURPOSE: To investigate the diagnostic efficacy of diffusion kurtosis imaging (DKI) and conventional diffusion-weighted imaging (DWI) for pathological grading. METHODS: From December 2015 to January 2017, consecutive patients suspected of having hepatocellular carcinoma (HCC) without prior treatment were prospectively enrolled in this study. MRI examinations were performed before surgical treatment. HCC patients confirmed by surgical pathology were included in the study. The mean diffusivity (MD) values, mean kurtosis (MK) values, and apparent diffusion coefficient (ADC) were calculated. The differences and correlations of these parameters among different pathological grades were analyzed. The diagnostic efficiency of DKI and DWI for predicting high-grade HCC was evaluated by receiver operating characteristic (ROC) curves. Logistic regression analyses were used to evaluate the predictive factors for pathological grade. RESULTS: A total of 128 patients (79 males and 49 females, age: 56.9±10.9 years, range, 32-80) with primary HCC were included: grade I: 22 (17.2%) patients, grade II: 37 (28.9%) patients, grade III: 43 (33.6%) patients, grade IV: 26 (20.3%) patients. The MK values of stage I, II, III, and IV were 0.86±0.13, 1.06±0.11, 1.27±0.17, and 1.57±0.13, respectively. The MK values were significantly higher in the high-grade group than in the low-grade group and were positively correlated with pathological grade (rho =0.7417, P<0.001). The MK value demonstrated a larger area under the curve (AUC), with a value of 0.93 than the MD value, which had an AUC of 0.815 (P<0.001), and ADC, which had an AUC of 0.662 (P=0.01). The MK value (>1.19), ADC (≤1.29×10-3 mm2/s), and HBV (+) were independent predictors for the pathological grade of HCCs. CONCLUSION: The MK values derived from DKI and the ADC values obtained from traditional DWI were more valuable than the MD values in predicting the histological grade of HCCs and could potentially guide clinical treatment before surgery.

Detection of Dysplastic Liver Nodules in Patients with Cirrhosis Using the Multi-Arterial CAIPIRINHA-Dixon-TWIST-Volume-Interpolated Breath-Hold Examination (MA-CDT-VIBE) Technique in Dynamic Contrast-Enhanced Magnetic Resonance Imaging.

BACKGROUND The multi-arterial CAIPIRINHA-Dixon-TWIST-volume-interpolated breath-hold examination (MA-CDT-VIBE) sequence has the advantage of detecting hypervascular lesions during the arterial phase of magnetic resonance imaging (MRI) of the liver. Liver cirrhosis may be associated with dysplastic nodules. This study aimed to compare the use of routine liver MRI sequences with the MA-CDT-VIBE sequence to identify dysplastic liver nodules in patients with liver cirrhosis. MATERIAL AND METHODS Between February 2016 and March 2017, there were 21 patients with liver cirrhosis who had 33 dysplastic liver nodules, which were detected by comprehensive multisequence MRI as the reference standard for nodule imaging. Liver MRI using edge sharpness assessment by parametric (ESAP) modeling was compared with five dynamic arterial subphases that were included in the MA-CDT-VIBE sequence with a temporal resolution of 2.8 s and an acquisition time of 20 s during one breath-hold. RESULTS In the 21 patients included in the study, the MA-CDT-VIBE technique (30/33 for the first reading and 33/33 for the second reading) showed an improved lesion detection rate compared with the ESAP technique (27/33 for the first reading and 29/33 for the second reading), and for 73% of the patients, MA-CDT-VIBE imaging showed improved arterial parenchyma contrast. There was a high degree of interobserver agreement between the two reads (kappa: 0.68-0.91; P<0.001). CONCLUSIONS The MA-CDT-VIBE sequence of MRI liver imaging improved the detection of dysplastic nodules in cirrhosis of the liver compared with routine liver MRI sequences.

Relationship between the phase value of ESWAN and fractional anisotropy of diffusion tensor imaging in patients with cerebral microbleeds: preliminary results.

AIMS: The purpose of the present study was to measure phase values (PVs) and fractional anisotropy (FA) of cerebral microbleeds (CMBs) using phase and FA map, and to investigate the potential relationship between PVs and FAs in CMBs in vivo. METHODS: We retrospectively analyzed 30 patients with CMBs using enhanced T2*-weighted angiography and diffusion tensor imaging. The PVs and FAs of CMBs were measured and documented, and the mean FAs were compared between CMBs and the corresponding normal brain tissue. The mean PVs were correlated with FAs in CMBs in seven different brain regions. RESULTS: A total of 106 CMBs were defined, and the mean FA of the CMBs in white matter, EC/IC/CR, thalamus, and cerebellum were significantly lower than that of normal brain tissue in the control group (p<0.05). Positive correlations were observed between the PV and FA of CMBs in white matter, external capsule, internal capsule and corona radiata (r=0.70, 0.38). CONCLUSION: Enhanced T2*-weighted angiography and diffusion tensor imaging sequence may be useful neuroimaging sequences that could reflect the severity of damage of white matter by measuring the FA of CMBs and provide useful reference data for the quantitative assessment of CMBs.