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1.
Skeletal Radiol ; 47(2): 233-242, 2018 Feb.
Article in English | MEDLINE | ID: mdl-29110048

ABSTRACT

OBJECTIVE: To assess diagnostic accuracy and agreement among radiologists in detecting femoroplasty on pre- and post-arthroscopic comparison frog lateral and anteroposterior (AP) pelvic radiographs after treatment of femoroacetabular impingement (FAI) syndrome. MATERIALS AND METHODS: In this retrospective, cross-sectional study, 86 patients underwent hip arthroscopy (52 with and 34 without femoroplasty) for treatment of FAI syndrome. Three radiologists blinded to clinical data and chronological order of the pre- and post-arthroscopic comparison radiographs independently examined AP pelvis and frog lateral radiographs to detect femoroplasty changes. Statistical analysis outputs included diagnostic accuracy parameters and inter- and intra-observer agreement. RESULTS: Identification of femoroplasty in the frog lateral projection has mean sensitivity 70%, specificity 82%, inter-observer agreement κ 0.74-0.76 and intra-observer agreement κ 0.72-0.85. Using the AP pelvis projection to detect femoroplasty has mean sensitivity 32%, specificity 71%, inter-observer agreement κ 0.47-0.65, and intra-observer agreement κ, 0.56-0.84. CONCLUSIONS: Radiologists are only moderately sensitive, though more specific, in femoroplasty detection in the frog lateral projection. The AP pelvis projection yields lower sensitivity and specificity. Both projections have moderate inter- and intra-observer agreement.


Subject(s)
Arthroscopy , Femoracetabular Impingement/diagnostic imaging , Femoracetabular Impingement/surgery , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Treatment Outcome
2.
Br J Radiol ; 91(1089): 20170110, 2018 Sep.
Article in English | MEDLINE | ID: mdl-29144164

ABSTRACT

OBJECTIVE: Using screening mammography, this study investigated the association between obesity and axillary lymph node (LN) size and morphology. METHODS: We conducted a retrospective review of 188 females who underwent screening mammography at an academic medical centre. Length and width of the LN and hilum were measured in the largest, mammographically visible axillary node. The hilo-cortical ratio (HCR) was calculated as the hilar width divided by the cortical width. Measurements were performed by a board certified breast radiologist and a resident radiology physician. Inter-rater agreement was assessed with Pearson correlation coefficient. We performed multivariable regression analysis for associations of LN measurements with body mass index (BMI), breast density and age. RESULTS: There was a strong association between BMI and LN dimensions, hilum dimensions and HCR (p < 0.001 for all metrics). There was no significant change in cortex width with increasing BMI (p = 0.15). Increases in LN length and width were found with increasing BMI [0.6 mm increase in length per unit BMI, 95% CI (0.4-0.8), p < 0.001 and0.3 mm increase in width per unit BMI, 95% CI(0.2-0.4), p < 0.001, respectively]. Inter-rater reliability for lymph node and hilum measurements was 0.57-0.72. CONCLUSION: We found a highly significant association between increasing BMI and axillary LN dimensions independent of age and breast density with strong interobserver agreement. The increase in LN size was driven by expansion of the LN hilum secondary to fat infiltration. Advances in knowledge: This preliminary work determined a relationship between fat infiltrated axillary lymph nodes and obesity.


Subject(s)
Adipose Tissue/diagnostic imaging , Lymph Nodes/pathology , Mammography , Obesity/pathology , Adipose Tissue/pathology , Adult , Axilla , Body Mass Index , Breast/diagnostic imaging , Female , Humans , Linear Models , Lymph Nodes/diagnostic imaging , Middle Aged , Retrospective Studies
3.
J Vasc Interv Radiol ; 28(8): 1083-1089, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28549711

ABSTRACT

PURPOSE: To evaluate clinical outcomes following percutaneous rupture of symptomatic lumbar facet synovial cysts (LFSCs) with intra-articular steroid injection. MATERIALS AND METHODS: In this retrospective review, 44 consecutive patients with symptomatic LFSCs received primary treatment with CT-guided synovial cyst rupture with intra-articular steroid injection. Outcomes questionnaires were obtained before and 1, 4, 26, and 52 weeks after LFSC rupture. Assessment included pain medication use and numeric rating scale (NRS), Oswestry Disability Index (ODI), and 12-item short form health survey (SF-12) physical and mental composite scores (PCS and MCS). Clinical endpoint was 52-week survey response or surgery. RESULTS: LFSC rupture was technically successful in 84% (37/44) of cases. Clinical endpoint was reached in 68% (30/44) of patients with 82% overall 1-year follow-up. Lumbar spine surgery was performed in 25% (11/44) of patients within 1 year after procedure. Mean NRS, ODI, and SF-12 PCS demonstrated significant improvement at all follow-up time points (P < .001). At 52-week follow-up, NRS decreased from 8.1 to 3.7 (P < .001), ODI improved from 35 to 24 (P = .006), and SF-12 PCS improved from 31 to 42 (P < .001). Daily pain medication decreased from 71% (31/44) of patients before procedure to 29% (9/26) at 52-week follow-up (P = .012). History of prior lumbar intervention was associated with poorer LFSC rupture success (P = .025) and ODI (P = .047). CONCLUSIONS: NRS, ODI, and SF-12 PCS indices improved and pain medication use decreased significantly at all time points over 1-year follow-up after percutaneous rupture of symptomatic LFSCs with intra-articular steroid injection.


Subject(s)
Lumbar Vertebrae , Radiography, Interventional , Steroids/administration & dosage , Synovial Cyst/drug therapy , Tomography, X-Ray Computed , Zygapophyseal Joint , Adult , Aged , Aged, 80 and over , Disability Evaluation , Female , Humans , Injections, Intra-Articular , Male , Middle Aged , Pain Measurement , Punctures , Surveys and Questionnaires , Treatment Outcome
4.
AJR Am J Roentgenol ; 209(1): 205-213, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28504550

ABSTRACT

OBJECTIVE: The purpose of this study was to identify the details of percutaneous catheter drainage (PCD) of pyogenic liver abscesses, the etiologic factors, and the management techniques that contribute to successful treatment. MATERIALS AND METHODS: The records of 75 consecutively registered patients who underwent PCD of 96 abscesses at a single institution between May 2009 and May 2014 were retrospectively reviewed. Thirty-nine patients (52%) were oncology patients, and 36 (48%) had recently undergone abdominal surgery. Primary success was defined as abscess healing with the primary PCD intervention and 30-day postdrainage survival. Salvage success was defined as abscess healing with follow-up secondary PCD placement for symptomatic hepatic satellite collections or for clinical recurrence. Catheter adjustments were performed during follow-up to optimize existing drains. Univariate, multivariate, and general linear mixed model analyses were performed. The median follow-up time after catheter removal was 6 months (range, 2-62 months). RESULTS: Drains were primarily successful in 54 patients (72%), and 17 patients (23%) needed salvage PCD; thus, overall success was achieved in 71 patients (95%). The other four patients (5%) died of sepsis. The primary success rate was reduced in patients with unresectable malignancies (p = 0.01), multiple abscesses (p = 0.01), and output ≥ 15 mL/d at catheter endpoint (n = 7, p = 0.001). Only unresectable malignancies had slightly lower overall success. Large abscesses (> 150 cm3) required more catheter adjustments and longer drainage duration to reach abscess cavity closure. Successfully drained abscesses reached cavity closure a mean of 23 days (95% CI, 20-27 days) after treatment. CONCLUSION: PCD was effective first-line treatment of complicated pyogenic liver abscesses, which often require catheter adjustment and salvage drainage procedures to reliably achieve success.


Subject(s)
Drainage/methods , Liver Abscess/diagnostic imaging , Liver Abscess/surgery , Radiography, Interventional , Ultrasonography, Interventional , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Female , Humans , Liver Abscess/etiology , Male , Middle Aged , Retrospective Studies , Salvage Therapy , Survival Rate , Treatment Outcome
5.
J Ultrasound Med ; 36(7): 1453-1460, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28339133

ABSTRACT

OBJECTIVES: To compare the diagnostic accuracy of hand-held point-of-care (POC) versus conventional sonography in a general diagnostic setting with the intention to inform medical providers or clinicians on the rational use of POC ultrasound in resource limited settings. METHODS: Over 3 months in 2010, 47 patients were prospectively enrolled at a single academic center to obtain 54 clinical conventional ultrasound examinations and 54 study-only POC ultrasound examinations. Indications were 48% abdominal, 26% retroperitoneal, and 24% obstetrical. Nine blinded readers (sonographers, residents, and attending radiologists) sequentially assigned diagnoses to POC and then conventional studies, yielding 476 interpreted study pairs. Diagnostic accuracy was obtained by comparing POC and conventional diagnoses to a reference diagnosis established by the unblinded, senior author. Analysis was stratified by study type, body mass index (BMI), diagnostic confidence, and image quality. RESULTS: The mean diagnostic accuracy of conventional sonography was 84% compared with 74% for POC (P < .001). This difference was constant regardless of reader, exam type, or BMI. The sensitivity and specificity to detect abnormalities with conventional was 85 and 83%, compared with 75 and 68% for POC. The POC sonography demonstrated greater variability in image quality and diagnostic confidence, and this accounted for lower diagnostic accuracy. When image quality and diagnostic confidence were similar between POC and conventional examinations, there was no difference in accuracy. CONCLUSIONS: Point-of-care was nearly as accurate as conventional sonography for basic, focused examinations. Observed differences in accuracy were attributed to greater variation in POC image quality.


Subject(s)
Point-of-Care Testing/statistics & numerical data , Radiology Department, Hospital/statistics & numerical data , Ultrasonography/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Health Care Rationing/methods , Health Care Rationing/statistics & numerical data , Humans , Male , Middle Aged , New Hampshire/epidemiology , Observer Variation , Prospective Studies , Quality Assurance, Health Care , Reproducibility of Results , Sensitivity and Specificity , Single-Blind Method , Ultrasonography/methods , Young Adult
6.
Biomed Opt Express ; 7(6): 2186-201, 2016 Jun 01.
Article in English | MEDLINE | ID: mdl-27375937

ABSTRACT

A portable near-infrared spectral tomography (NIRST) system was developed with simultaneous frequency domain (FD) and continuous-wave (CW) optical measurements for efficient characterization of breast cancer in a clinical oncology setting. Simultaneous FD and CW recordings were implemented to speed up acquisition to 3 minutes for all 9 wavelengths, spanning a range from 661nm to 1064nm. An adjustable interface was designed to fit various breast sizes and shapes. Spatial images of oxy- and deoxy-hemoglobin, water, lipid, and scattering components were reconstructed using a 2D FEM approach. The system was tested on a group of 10 normal subjects, who were examined bilaterally and the recovered optical images were compared to radiographic breast density. Significantly higher total hemoglobin and water were estimated in the high density relative to low density groups. One patient with invasive ductal carcinoma was also examined and the cancer region was characterized as having a contrast ratio of 1.4 in total hemoglobin and 1.2 in water.

7.
J Knee Surg ; 29(5): 414-22, 2016 Jul.
Article in English | MEDLINE | ID: mdl-26442445

ABSTRACT

Isolated medial tibial plateau injuries are uncommon and underdescribed in the literature. As such, the range of fracture severity and outcomes in comparison to more frequently described tibial plateau fractures are lacking. To assess outcomes of this rare injury, we compared two cohorts of patients. Overall, 27 patients who sustained 27 isolated medial plateau (Schatzker type IV) fractures and 81 patients with 81 split depression lateral plateau (Schatzker type II) fractures were compared. The outcomes were stratified by injury mechanism energy and assessed with radiographs, clinical and arthroscopic examinations, and functional status with the short musculoskeletal function assessment questionnaire (SMFA). Overall, 52% of Schatzker type IV fractures versus 71% of Schatzker type II were associated with high-energy injuries. Schatzker type IV fractures were more often nondisplaced and amenable to being managed, nonoperatively, 22 versus 6%, with excellent results. Schatzker type II fractures had a corresponding higher proportion of postoperative articular step off greater than 12 mm and poorer 12-month SMFA scores. Schatzker type IV fractures were more often treated with an external fixator than Schatzker type II fractures (22 vs. 1%). Within Schatzker type IV fractures, high- versus low-energy injuries did not differ significantly with regards to initial articular step off (4.2 vs. 5.1 mm), ligamentous and meniscal injury, or SMFA outcomes. Isolated medial plateau fractures had low- and high-energy patterns with differing management and outcomes. Schatzker type IV fractures overall were associated with lower energy mechanisms, less initial articular step off, and better functional outcomes than Schatzker II comparisons in this cohort. The level of evidence is 4.


Subject(s)
Fracture Fixation , Knee Injuries/surgery , Tibial Fractures/surgery , Adult , Aged , Cohort Studies , External Fixators , Female , Humans , Knee Injuries/diagnostic imaging , Knee Injuries/etiology , Male , Middle Aged , Radiography , Range of Motion, Articular , Recovery of Function , Retrospective Studies , Tibial Fractures/diagnostic imaging , Tibial Fractures/etiology , Treatment Outcome
8.
RNA ; 17(6): 1100-10, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21518804

ABSTRACT

The 3-methylcytidine (m³C) modification is widely found in eukaryotic species of tRNA(Ser), tRNA(Thr), and tRNA(Arg); at residue 32 in the anti-codon loop; and at residue e2 in the variable stem of tRNA(Ser). Little is known about the function of this modification or about the specificity of the corresponding methyltransferase, since the gene has not been identified. We have used a primer extension assay to screen a battery of methyltransferase candidate knockout strains in the yeast Saccharomyces cerevisiae, and find that tRNA(Thr(IGU)) from abp140-Δ strains lacks m³C. Curiously, Abp140p is composed of a poorly conserved N-terminal ORF fused by a programed +1 frameshift in budding yeasts to a C-terminal ORF containing an S-adenosylmethionine (SAM) domain that is highly conserved among eukaryotes. We show that ABP140 is required for m³C modification of substrate tRNAs, since primer extension is similarly affected for all tRNA species expected to have m³C and since quantitative analysis shows explicitly that tRNA(Thr(IGU)) from an abp140-Δ strain lacks m³C. We also show that Abp140p (now named Trm140p) purified after expression in yeast or Escherichia coli has m³C methyltransferase activity, which is specific for tRNA(Thr(IGU)) and not tRNA(Phe) and occurs specifically at C32. We suggest that the C-terminal ORF of Trm140p is necessary and sufficient for activity in vivo and in vitro, based on analysis of constructs deleted for most or all of the N-terminal ORF. We also suggest that m³C has a role in translation, since trm140-Δ trm1-Δ strains (also lacking m²,²G26) are sensitive to low concentrations of cycloheximide.


Subject(s)
Anticodon/metabolism , Cytidine/analogs & derivatives , Microfilament Proteins/genetics , RNA, Transfer/chemistry , Saccharomyces cerevisiae Proteins/genetics , Saccharomyces cerevisiae/enzymology , Saccharomyces cerevisiae/genetics , tRNA Methyltransferases/genetics , Anticodon/chemistry , Cytidine/chemistry , Cytidine/metabolism , Microfilament Proteins/chemistry , Microfilament Proteins/metabolism , Nucleic Acid Conformation , Protein Structure, Tertiary , RNA, Transfer/genetics , RNA, Transfer/metabolism , S-Adenosylmethionine/genetics , S-Adenosylmethionine/metabolism , Saccharomyces cerevisiae/metabolism , Saccharomyces cerevisiae Proteins/chemistry , Saccharomyces cerevisiae Proteins/metabolism , tRNA Methyltransferases/chemistry , tRNA Methyltransferases/metabolism
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