ABSTRACT
Opportunistic osteoporosis screening using deep learning (DL) analysis of low-dose chest CT (LDCT) scans is a potentially promising approach for the early diagnosis of this condition. We explored bone mineral density (BMD) profiles across all adult ages and prevalence of osteoporosis using LDCT with DL in a Korean population. This retrospective study included 1915 participants from two hospitals who underwent LDCT during general health checkups between 2018 and 2021. Trabecular volumetric BMD of L1-2 was automatically calculated using DL and categorized according to the American College of Radiology quantitative computed tomography diagnostic criteria. BMD decreased with age in both men and women. Women had a higher peak BMD in their twenties, but lower BMD than men after 50. Among adults aged 50 and older, the prevalence of osteoporosis and osteopenia was 26.3% and 42.0%, respectively. Osteoporosis prevalence was 18.0% in men and 34.9% in women, increasing with age. Compared to previous data obtained using dual-energy X-ray absorptiometry, the prevalence of osteoporosis, particularly in men, was more than double. The automated opportunistic BMD measurements using LDCT can effectively predict osteoporosis for opportunistic screening and identify high-risk patients. Patients undergoing lung cancer screening may especially profit from this procedure requiring no additional imaging or radiation exposure.
ABSTRACT
OBJECTIVES: To compare the diagnostic performance and image quality of dual-energy computed tomography (DECT) with electron density (ED) image reconstruction with those of DECT with standard CT (SC) and virtual non-calcium (VNCa) image reconstructions, for diagnosing lumbar disc herniation (L-HIVD). METHODS: A total of 59 patients (354 intervertebral discs from T12/L1 to L5/S1; mean age, 60 years; 30 women and 29 men) who underwent DECT with spectral reconstruction and 3-T MRI within 2 weeks were enrolled between March 2021 and February 2022. Four radiologists independently assessed three image sets of randomized ED, SC, and VNCa images to detect L-HIVD at 8-week intervals. The coefficient of variance (CV) and the Weber contrast of the ROIs in the normal and diseased disc to cerebrospinal fluid space (NCR-normal/-diseased, respectively) were calculated to compare the image qualities of the noiseless ED and other series. RESULTS: Overall, 129 L-HIVDs were noted on MRI. In the detection of L-HIVD, ED showed a higher AUC and sensitivity than SC and VNCa; 0.871 vs 0.807 vs 833 (p = 0.002) and 81% vs 70% vs 74% (p = 0.006 for SC), respectively. CV was much lower in all measurements of ED than those for SC and VNCa (p < 0.001). Furthermore, NCR-normal and NCR-diseased were the highest in ED (ED vs SC in NCR-normal and NCR-diseased, p = 0.001 and p = 0.004, respectively; ED vs VNCa in NCR-diseased, p = 0.044). CONCLUSION: Compared to SC and VNCa images, DECT with ED reconstruction can enhance the AUC and sensitivity of L-HIVD detection with a lower CV and higher NCR. CLINICAL RELEVANCE STATEMENT: To our knowledge, this is the first study to quantify the image quality of noiseless ED images. ED imaging may be helpful for detecting L-HIVD in patients who cannot undergo MRI. KEY POINTS: ED images have diagnostic potential, but relevant quantitative analyses of image quality are limited. ED images detect disc herniation, with a better coefficient of variance and normalized contrast ratio values. ED images could detect L-HIVD when MRI is not an option.
ABSTRACT
Accurate structural determination of proteins is critical to understanding their biological functions and the impact of structural disruption on disease progression. Gas-phase cross-linking mass spectrometry (XL-MS) via ion/ion reactions between multiply charged protein cations and singly charged cross-linker anions has previously been developed to obtain low-resolution structural information on proteins. This method significantly shortens experimental time relative to conventional solution-phase XL-MS but has several technical limitations: (1) the singly deprotonated N-hydroxysulfosuccinimide (sulfo-NHS)-based cross-linker anions are restricted to attachment at neutral amine groups of basic amino acid residues and (2) analyzing terminal cross-linked fragment ions is insufficient to unambiguously localize sites of linker attachment. Herein, we demonstrate enhanced structural information for alcohol-denatured A-state ubiquitin obtained from an alternative gas-phase XL-MS approach. Briefly, singly sodiated ethylene glycol bis(sulfosuccinimidyl succinate) (sulfo-EGS) cross-linker anions enable covalent cross-linking at both ammonium and amine groups. Additionally, covalently modified internal fragment ions, along with terminal b-/y-type counterparts, improve the determination of linker attachment sites. Molecular dynamics simulations validate experimentally obtained gas-phase conformations of denatured ubiquitin. This method has identified four cross-linking sites across 8+ ubiquitin, including two new sites in the N-terminal region of the protein that were originally inaccessible in prior gas-phase XL approaches. The two N-terminal cross-linking sites suggest that the N-terminal half of ubiquitin is more compact in gas-phase conformations. By comparison, the two C-terminal linker sites indicate the signature transformation of this region of the protein from a native to a denatured conformation. Overall, the results suggest that the solution-phase secondary structures of the A-state ubiquitin are conserved in the gas phase. This method also provides sufficient sensitivity to differentiate between two gas-phase conformers of the same charge state with subtle structural variations.
Subject(s)
Cross-Linking Reagents , Mass Spectrometry , Ubiquitin , Cations/chemistry , Cross-Linking Reagents/chemistry , Gases/chemistry , Ions/chemistry , Sodium/chemistry , Succinimides/chemistry , Ubiquitin/chemistryABSTRACT
To evaluate diagnostic efficacy of deep learning (DL)-based automated bone mineral density (BMD) measurement for opportunistic screening of osteoporosis with routine computed tomography (CT) scans. A DL-based automated quantitative computed tomography (DL-QCT) solution was evaluated with 112 routine clinical CT scans from 84 patients who underwent either chest (N:39), lumbar spine (N:34), or abdominal CT (N:39) scan. The automated BMD measurements (DL-BMD) on L1 and L2 vertebral bodies from DL-QCT were validated with manual BMD (m-BMD) measurement from conventional asynchronous QCT using Pearson's correlation and intraclass correlation. Receiver operating characteristic curve (ROC) analysis identified the diagnostic ability of DL-BMD for low BMD and osteoporosis, determined by dual-energy X-ray absorptiometry (DXA) and m-BMD. Excellent concordance were seen between m-BMD and DL-BMD in total CT scans (r = 0.961/0.979). The ROC-derived AUC of DL-BMD compared to that of central DXA for the low-BMD and osteoporosis patients was 0.847 and 0.770 respectively. The sensitivity, specificity, and accuracy of DL-BMD compared to central DXA for low BMD were 75.0%, 75.0%, and 75.0%, respectively, and those for osteoporosis were 68.0%, 80.5%, and 77.7%. The AUC of DL-BMD compared to the m-BMD for low BMD and osteoporosis diagnosis were 0.990 and 0.943, respectively. The sensitivity, specificity, and accuracy of DL-BMD compared to m-BMD for low BMD were 95.5%, 93.5%, and 94.6%, and those for osteoporosis were 88.2%, 94.5%, and 92.9%, respectively. DL-BMD exhibited excellent agreement with m-BMD on L1 and L2 vertebrae in the various routine clinical CT scans and had comparable diagnostic performance for detecting the low-BMD and osteoporosis on conventional QCT.
Subject(s)
Bone Diseases, Metabolic , Deep Learning , Osteoporosis , Humans , Osteoporosis/diagnostic imaging , Bone Density , Tomography, X-Ray ComputedABSTRACT
The synovium may be affected by a wide spectrum of disorders, including inflammatory, infectious, degenerative, traumatic, hemorrhagic, and tumorous conditions. Magnetic resonance imaging (MRI) is a valuable imaging modality to characterize synovial disorders. Most abnormal lesions appear as areas of nonspecific high signal intensity on T2-weighted images (T2-WI) due to high water content or increased perfusion. However, T2 hypointensity can be attributed to blood components of varying ages, calcification, inorganic crystals, fibrosis, caseous necrosis and/or amyloid deposition. Hypointense lesions on T2-WI are infrequent and additional clinical and imaging characteristics can help to limit the list of differential diagnoses, which may include tenosynovial giant cell tumor, synovial chondromatosis, rheumatoid arthritis, tuberculous arthritis, chronic tophaceous gout, amyloid arthropathy, synovial hemangioma, lipoma arborescens and hemosiderotic synovitis. Recently, susceptibility weighted imaging has been developed and may contribute to more accurate diagnosis for deoxygenated blood and calcium. We review the MRI features of hypointense synovial lesions on MRI and emphasize the characteristic findings that suggest a correct diagnosis.
Subject(s)
Joint Diseases , Synovitis , Humans , Joint Diseases/diagnosis , Joint Diseases/pathology , Synovitis/diagnostic imaging , Synovitis/pathology , Magnetic Resonance Imaging/methods , Synovial Membrane/pathology , Diagnosis, DifferentialABSTRACT
Accurate structural identification of lipids in imaging mass spectrometry is critical to properly contextualizing spatial distributions with tissue biochemistry. Gas-phase charge inversion ion/ion reactions alter the ion type prior to dissociation to allow for more structurally informative fragmentation and improve lipid identification at the isomeric level. In this work, infrared multiphoton dissociation (IRMPD) was interfaced with a commercial hybrid Qh-FT-ICR mass spectrometer to enable the rapid fragmentation of gas-phase charge inversion ion/ion reaction products at every pixel in imaging mass spectrometry experiments. An ion/ion reaction between phosphatidylcholine (PC) monocations generated from rat brain tissue via matrix-assisted laser desorption/ionization (MALDI) and 1,4-phenylenediproprionic acid reagent dianions generated via electrospray ionization (ESI) followed by IRMPD of the resulting product ion complex produces selective fatty acyl chain cleavages indicative of fatty acyl carbon compositions in the lipid. Ion/ion reaction images using this workflow allow for mapping of the relative spatial distribution of multiple PC isomers under a single sum composition lipid identification. Lipid isomers display significantly different relative spatial distributions within rat brain tissue, highlighting the importance of resolving isomers in imaging mass spectrometry experiments.
Subject(s)
Carbon , Phosphatidylcholines , Animals , Rats , Phosphatidylcholines/chemistry , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Spectrometry, Mass, Electrospray Ionization/methodsABSTRACT
Extraskeletal osteochondroma, a variant of chondroma, typically arises in the para-articular location of hands and feet. It is a rare disease and is particularly uncommon when joint components are not involved or localized away from joints. Herein, we report a case of extraskeletal osteochondroma in the posterior neck of a 66-year-old female. The characteristic radiologic finding of our case is presented, along with the typical findings of the disease and review of related literature reports.
ABSTRACT
OBJECTIVES: To assess the diagnostic performance of dual-energy CT (DECT) with electron-density (ED) image reconstruction compared with standard CT (SC) and virtual non-calcium (VNCa) image CT reconstruction for detecting cervical disc herniation. METHODS: This cross-sectional study was approved by the IRB. We enrolled 64 patients (336 intervertebral discs from C2/3 to C7/T1; mean age, 55 years; 17 women and 47 men) who underwent DECT with spectral reconstruction and 3-T MRI within 2 weeks between January 2018 and June 2020. Four radiologists independently evaluated the first image set of randomized SC, VNCa, and ED images to detect cervical disc herniation. After 8 weeks, the readers re-evaluated the second and the last image sets with an 8-week interval. MRI evaluations performed by two other experienced served as the reference standard. Comparing diagnostic performance between each images set was evaluated by a generalized estimating equation. RESULTS: A total of 233 cervical disc herniations were noted on MRI. For detecting cervical disc herniation, electron-density images showed higher sensitivity (94% [219/233; 95% CI, 90-97] vs. 76% [177/233; 70-81] vs. 69% [160/233; 62-76]) (p < 0.001) and similar specificity (90% [93/103; 83-95] vs. 89% [92/103; 82-96] vs. 90% [93/103; 83-95]) (p > 0.05) as SC and VNCa images, respectively. Inter-reader agreement for cervical disc herniation calculated among the four readers was moderate for all image sets (κ = 0.558 for ED, κ = 0.422 for SC, and κ = 0.449 for VNCa). CONCLUSION: DECT with ED reconstruction can improve cervical disc herniation detection and diagnostic confidence compared with SC and VNCa images. KEY POINTS: ⢠Intervertebral discs with high material density are well visualized on electron-density images obtained from dual-energy CT. ⢠Electron-density images showed much higher sensitivity and diagnostic accuracy than standard CT and virtual non-calcium images for the detection of cervical disc herniation. ⢠Electron-density images can have false-negative results, especially for disc herniation with high signal intensity on T2W images and can show pseudo-disc extrusion at the lower cervical spine.
Subject(s)
Intervertebral Disc Displacement , Bone Marrow , Calcium , Cross-Sectional Studies , Edema , Electrons , Female , Humans , Intervertebral Disc Displacement/diagnostic imaging , Magnetic Resonance Imaging/methods , Male , Middle Aged , Sensitivity and Specificity , Tomography, X-Ray Computed/methodsABSTRACT
Artificial intelligence (AI) is increasingly being used in bone-age (BA) assessment due to its complicated and lengthy nature. We aimed to evaluate the clinical performance of a commercially available deep learning (DL)-based software for BA assessment using a real-world data. From Nov. 2018 to Feb. 2019, 474 children (35 boys, 439 girls, age 4-17 years) were enrolled. We compared the BA estimated by DL software (DL-BA) with that independently estimated by 3 reviewers (R1: Musculoskeletal radiologist, R2: Radiology resident, R3: Pediatric endocrinologist) using the traditional Greulich-Pyle atlas, then to his/her chronological age (CA). A paired t-test, Pearson's correlation coefficient, Bland-Altman plot, mean absolute error (MAE) and root mean square error (RMSE) were used for the statistical analysis. The intraclass correlation coefficient (ICC) was used for inter-rater variation. There were significant differences between DL-BA and each reviewer's BA (P < 0.025), but the correlation was good with one another (r = 0.983, P < 0.025). RMSE (MAE) values were 10.09 (7.21), 10.76 (7.88) and 13.06 (10.06) months between DL-BA and R1, R2, R3 BA. Compared with the CA, RMSE (MAE) values were 13.54 (11.06), 15.18 (12.11), 16.19 (12.78) and 19.53 (17.71) months for DL-BA, R1, R2, R3 BA, respectively. Bland-Altman plots revealed the software and reviewers' tendency to overestimate the BA in general. ICC values between 3 reviewers were 0.97, 0.85 and 0.86, and the overall ICC value was 0.93. The BA estimated by DL-based software showed statistically similar, or even better performance than that of reviewers' compared to the chronological age in the real world clinic.
Subject(s)
Age Determination by Skeleton , Deep Learning , Adolescent , Child , Child, Preschool , Feasibility Studies , Female , Hand Bones/diagnostic imaging , Humans , Male , RadiographyABSTRACT
ABSTRACT: In the pubertal period, bone age advances rapidly in conjunction with growth spurts. Precise bone-age assessments in this period are important, but results from the hand and elbow can be different. We aimed to compare the bone age between the hand and elbow around puberty onset and to elucidate the chronological age confirming puberty onset according to elbow-based bone age.A total of 211 peripubertal subjects (127 boys and 84 girls) who underwent hand and elbow radiographs within 2 months was enrolled. Two radiologists and a pediatric orthopedic surgeon assessed bone age. Hand bone age was graded using the Greulich-Pyle (GP) method, and elbow bone age was determined using the Sauvegrain method. The correlation of 2 methods was evaluated by Demining regression analysis, and the mean absolute difference (MAD) with chronological age was compared between pre-pubertal and pubertal subjects. Receiver-operating characteristic curve analysis was performed to determine the chronological age confirming puberty onset.There was a statistically significant difference in bone age revealed by the GP and Sauvegrain methods in the pubertal group. In the pubertal group, the MAD was 1.26â±â0.90âyears with the GP method and 0.61â±â0.47âyears with the Sauvegrain method in boys (Pâ<â.001), while in girls, the MAD was 0.84â±â0.60âyears and 0.53â±â0.36âyears with the same 2 methods (Pâ=â.033). The chronological age for confirming puberty onset using the elbow was 12.2âyears in boys and 10.3âyears in girls.The bone ages of hand and elbow were different at puberty, and the elbow was a more reliable location for bone-age assessment at puberty. Puberty onset according to elbow occurred slightly earlier than expected.
Subject(s)
Age Determination by Skeleton/methods , Elbow/diagnostic imaging , Hand/diagnostic imaging , Puberty , Adolescent , Child , Elbow Joint/diagnostic imaging , Female , Humans , MaleABSTRACT
BACKGROUND: Identifying differentially abundant features between different experimental groups is a common goal for many metabolomics and proteomics studies. However, analyzing data from mass spectrometry (MS) is difficult because the data may not be normally distributed and there is often a large fraction of zero values. Although several statistical methods have been proposed, they either require the data normality assumption or are inefficient. RESULTS: We propose a new semi-parametric differential abundance analysis (SDA) method for metabolomics and proteomics data from MS. The method considers a two-part model, a logistic regression for the zero proportion and a semi-parametric log-linear model for the possibly non-normally distributed non-zero values, to characterize data from each feature. A kernel-smoothed likelihood method is developed to estimate model coefficients and a likelihood ratio test is constructed for differential abundant analysis. The method has been implemented into an R package, SDAMS, which is available at https://www.bioconductor.org/packages/release/bioc/html/SDAMS.html . CONCLUSION: By introducing the two-part semi-parametric model, SDA is able to handle both non-normally distributed data and large fraction of zero values in a MS dataset. It also allows for adjustment of covariates. Simulations and real data analyses demonstrate that SDA outperforms existing methods.
Subject(s)
Mass Spectrometry/methods , Metabolomics/methods , Proteomics/methods , Software , Models, StatisticalABSTRACT
We have implemented a linear ion trap (LIT)-based SIM-stitching method for ultra-high-resolution Fourier transform mass spectrometry (FTMS) that increases the S/N over a wide m/z range compared to non-segmented wide full-scan (WFS) spectra. Here we described an improved segmented spectral scan stitching method that was based on quadrupole mass filter (QMF)-SIM, which overcame previous limitations of ion signal loss in LIT. This allowed for accurate representation of isotopologue distributions, both at natural abundance and in stable isotope-resolved metabolomics (SIRM)-based experiments. We also introduced a new spectral binning method that provided more precise and resolution-independent bins for irreversibly noise-suppressed FTMS spectra. We demonstrated a substantial improvement in S/N and sensitivity (typicallyâ¯>â¯10-fold) for 13C labeled lipid extracts of human macrophages grown as three-dimensional (3D) cell culture, with detection of an increased number of 13C isotopologue ions. The method also enabled analysis of extracts from very limited biological samples.
Subject(s)
Lipids/analysis , Macrophages/chemistry , Carbon Isotopes/chemistry , Fourier Analysis , Glucose/chemistry , Glucose/metabolism , Humans , Isotope Labeling , Macrophages/metabolism , Mass Spectrometry/methods , Metabolomics/methods , Spheroids, Cellular/chemistry , Spheroids, Cellular/metabolismABSTRACT
BACKGROUND: Epidural steroid injections (ESIs) have been widely used in managing spinal pain. Dexamethasone has recently emerged as a useful drug in this setting, relative to particulate steroids, although the associated systemic effects have not been fully elucidated. This study aimed to investigate the incidences and types of systemic effects after fluoroscopically guided ESI with dexamethasone. METHODS: This retrospective study included 888 ESIs with dexamethasone (fluoroscopically guided at the cervical and lumbosacral levels) performed on 825 patients during January to June 2017. Data regarding systemic effects were collected via telephone interviews using a standardized questionnaire at 2 weeks after the procedure. Data on patient demographic, clinical, and procedural characteristics were collected and analyzed to identify factors that were associated with systemic effects. All statistical analyses were performed using the chi-squared test. RESULTS: Among the 825 patients, 40 patients (4.8%) experienced systemic effects during the 2-week follow-up period. The most common systemic effect was facial flushing (12 patients, 1.5%), which was followed by urticaria (7 patients, 0.8%) and insomnia (7 patients, 0.8%). A history of spine surgery was significantly associated with the occurrence of systemic effects (P = 0.036). Systemic effects were significantly more common for injections at the cervical level than at the lumbar level (P = 0.019). CONCLUSIONS: Approximately 4.8% of the patients who underwent ESI with dexamethasone experienced minor and transient systemic effects. These effects were more common in patients who had undergone a previous spine surgery or received a cervical ESI.
Subject(s)
Clinical Competence/statistics & numerical data , Magnetic Resonance Imaging/methods , Radiologists/statistics & numerical data , Spondylosis/diagnostic imaging , Adult , Aged , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/pathology , Female , Humans , Male , Middle Aged , Observer Variation , Reproducibility of Results , Retrospective StudiesABSTRACT
Lung cancer is the leading cause of cancer deaths in the United States. Patients with early stage lung cancer have the best prognosis with surgical removal of the tumor, but the disease is often asymptomatic until advanced disease develops, and there are no effective blood-based screening methods for early detection of lung cancer in at-risk populations. We have explored the lipid profiles of blood plasma exosomes using ultra high-resolution Fourier transform mass spectrometry (UHR-FTMS) for early detection of the prevalent non-small cell lung cancers (NSCLC). Exosomes are nanovehicles released by various cells and tumor tissues to elicit important biofunctions such as immune modulation and tumor development. Plasma exosomal lipid profiles were acquired from 39 normal and 91 NSCLC subjects (44 early stage and 47 late stage). We have applied two multivariate statistical methods, Random Forest (RF) and Least Absolute Shrinkage and Selection Operator (LASSO) to classify the data. For the RF method, the Gini importance of the assigned lipids was calculated to select 16 lipids with top importance. Using the LASSO method, 7 features were selected based on a grouped LASSO penalty. The Area Under the Receiver Operating Characteristic curve for early and late stage cancer versus normal subjects using the selected lipid features was 0.85 and 0.88 for RF and 0.79 and 0.77 for LASSO, respectively. These results show the value of RF and LASSO for metabolomics data-based biomarker development, which provide robust an independent classifiers with sparse data sets. Application of LASSO and Random Forests identifies lipid features that successfully distinguish early stage lung cancer patient from healthy individuals.
Subject(s)
Carcinoma, Non-Small-Cell Lung/blood , Carcinoma, Non-Small-Cell Lung/diagnosis , Lipids/blood , Lung Neoplasms/blood , Lung Neoplasms/diagnosis , Adult , Aged , Aged, 80 and over , Exosomes/chemistry , Female , Humans , Male , Mass Spectrometry , Middle Aged , Multivariate Analysis , Neoplasm StagingABSTRACT
OBJECTIVE: To assess the efficacy of fluoroscopy-guided facet joint injection for symptomatic spondylolysis and to analyze the outcome predictors. MATERIALS AND METHODS: This study included 108 patients who underwent fluoroscopy-guided facet joint steroid injection for symptomatic spondylolysis with follow-up medical records from January 2013 to December 2016. Among them, 47 patients underwent concomitant epidural steroid injection. Response to injection was assessed at the initial follow-up. The symptom-free interval was analyzed using the Kaplan-Meier method. Outcome predictors were statistically analyzed using independent t test and Chi-square test. RESULTS: The facet joint injection was effective in 52 of 108 (48.1%) patients at initial follow-up. Recurrence was reported in 21 of these 52 (40.4%) patients. For the 52 patients in whom facet joint injection was effective, the median symptom-free interval was 298 days (95% confidence interval, 29-567 days). No significant difference was found in the response between the group with facet joint injection only (n = 61) and the group with facet joint injection and additional ESI (n = 47). Additionally, no significant outcome predictors were detected. CONCLUSIONS: Fluoroscopy-guided facet joint injection may potentially be an effective therapy for providing prolonged pain relief and avoiding unnecessary surgery for symptomatic spondylolysis without significant outcome predictors.
Subject(s)
Fluoroscopy/methods , Radiography, Interventional/methods , Spondylolysis/diagnostic imaging , Spondylolysis/drug therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Injections, Intra-Articular/methods , Lumbar Vertebrae , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young Adult , Zygapophyseal JointABSTRACT
The aim of this study was to assess the concordance between magnetic resonance imaging (MRI) grading for cervical neural foraminal stenosis (CNFS) based on axial and oblique sagittal images and evaluate the reliability of each grading plane. CNFS was graded at C2-3 to C7-T1 levels based on axial and oblique sagittal images separately by three radiologists. The concordance between CNFS grading based on axial and oblique sagittal images was strong for all three observers (Kendall's W=0.80, 0.79, and 0.82), despite the tendency of higher grading with oblique sagittal images. Both imaging planes supported strong interobserver reliability.
Subject(s)
Cervical Vertebrae/diagnostic imaging , Magnetic Resonance Imaging/methods , Spinal Stenosis/diagnosis , Adult , Aged , Aged, 80 and over , Cervical Vertebrae/pathology , Constriction, Pathologic/diagnosis , Constriction, Pathologic/diagnostic imaging , Female , Humans , Male , Middle Aged , Observer Variation , Radiologists , Reproducibility of Results , Spinal Stenosis/diagnostic imaging , Young AdultABSTRACT
Background Both multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are used for assessment of lumbar foraminal stenosis (LFS). Therefore, it is relevant to assess agreement between these imaging modalities. Purpose To determine intermodality, inter-, and intra-observer agreement for assessment of LFS on MDCT and MRI. Material and Methods A total of 120 foramina in 20 patients who visited our institution in January and February 2014 were evaluated by six radiologists with different levels of experience. Radiologists evaluated presence and severity of LFS on sagittal CT and MR images according to a previously published LFS grading system. Intermodality agreement was analyzed by using weighted kappa statistics, while inter- and intra-observer agreement were analyzed by using intraclass correlation coefficients (ICCs) and kappa statistics. Results Overall intermodality agreement was moderate to good (kappa, 0.478-0.765). In particular, two professors and one fellow tended to overestimate the degree of LFS on CT compared with MRI. For inter-observer agreement of all six observers, ICCs indicated excellent agreement for both CT (0.774) and MRI (0.771), while Fleiss' kappa values showed moderate agreement for CT (0.482) and MRI (0.575). There was better agreement between professors and fellows compared with residents. For intra-observer agreement, ICCs indicated excellent agreement, while kappa values showed good to excellent agreement for both CT and MRI. Conclusion MDCT was comparable to MRI for diagnosis and assessment of LFS, especially for experienced observers. However, there was a tendency to overestimate the degree of LFS on MDCT compared with MRI.
Subject(s)
Lumbar Vertebrae/diagnostic imaging , Magnetic Resonance Imaging/methods , Multidetector Computed Tomography/methods , Spinal Stenosis/diagnostic imaging , Aged , Constriction, Pathologic , Female , Humans , Male , Middle Aged , Observer Variation , Reproducibility of ResultsABSTRACT
Frailty has been previously studied in Western countries and the urban Korean population; however, the burden of frailty and geriatric conditions in the aging populations of rural Korean communities had not yet been determined. Thus, we established a population-based prospective study of adults aged ≥ 65 years residing in rural communities of Korea between October 2014 and December 2014. All participants underwent comprehensive geriatric assessment that encompassed the assessment of cognitive and physical function, depression, nutrition, and body composition using bioimpedance analysis. We determined the prevalence of frailty based on the Cardiovascular Health Study (CHS) and Korean version of FRAIL (K-FRAIL) criteria, as well as geriatric conditions. We recruited 382 adults (98% of eligible adults; mean age: 74 years; 56% women). Generally, sociodemographic characteristics were similar to those of the general rural Korean population. Common geriatric conditions included instrumental activity of daily living disability (39%), malnutrition risk (38%), cognitive dysfunction (33%), multimorbidity (32%), and sarcopenia (28%), while dismobility (8%), incontinence (8%), and polypharmacy (3%) were less common conditions. While more individuals were classified as frail according to the K-FRAIL criteria (27%) than the CHS criteria (17%), the CHS criteria were more strongly associated with prevalent geriatric conditions. Older Koreans living in rural communities have a significant burden of frailty and geriatric conditions that increase the risk of functional decline, poor quality of life, and mortality. The current study provides a basis to guide public health professionals and policy-makers in prioritizing certain areas of care and designing effective public health interventions to promote healthy aging of this vulnerable population.
Subject(s)
Aging , Geriatric Assessment/statistics & numerical data , Health Status , Activities of Daily Living , Aged , Aged, 80 and over , Body Composition , Cognition Disorders/epidemiology , Cross-Sectional Studies , Demography , Disabled Persons , Female , Humans , Interviews as Topic , Male , Prevalence , Quality of Life , Republic of Korea/epidemiology , Rural Population , Sarcopenia/epidemiologyABSTRACT
PURPOSE: To retrospectively evaluate the diagnostic role of the contrast-enhanced MRI (CE-MRI) for differentiation between benign VCFs and malignant VCFs focusing on the internal transparent trabecular bone on CE-MRI (the "see-through sign"). MATERIALS AND METHODS: The institutional review board approved this study and informed consent was waived due to the retrospective nature of the study. From January 2012 to December 2013, all 149 consecutive benign or malignant VCF patients were enrolled for consideration in this study from a CE-MRI database. In the first analysis, four radiologists independently evaluated the presence or absence of the see-through sign. The see-through sign was defined as internal transparent trabecular bone morphology on CE-MRI. The intraclass correlation coefficient (ICC), percentage agreement, and Fleiss's kappa statistics were obtained. RESULTS: Fifty-seven patients (M:F = 27:30; mean age, 63 years; age range, 20-88 years) who diagnosed as acute benign (n = 24) and malignant (n = 33) VCFs were finally included for the analysis. The results of all readers showed that the see-through sign was associated with acute benign VCFs (p < 0.05). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the see-through sign ranged from 75-96, 70-88, 66-85, 81-97 %, respectively. The inter-observer reliability of the see-through sign was sufficient with ICC = 0.847, percentage agreement = 78.9, and κ = 0.578. CONCLUSION: The see-through sign on CE-MRI is featured in acute benign VCFs, and it can be a useful finding to differentiate between benign and malignant VCFs.