Laser speckle contrast analysis is a reliable measure of digital blood perfusion in Black Africans with systemic sclerosis.

OBJECTIVES: Laser speckle contrast analysis (LASCA) is evolving as a promising non-invasive tool to assess cutaneous microvascular function in systemic sclerosis (SSc). Reliability studies have mainly focused on Caucasian populations. To determine for the first time the inter-rater reliability of fingertip blood perfusion (BP) using LASCA in Black South African patients with SSc. METHODS: Consecutive Black adult patients with SSc were evaluated for peripheral BP using LASCA. Mean BP in defined regions of interest for dorsal fingertips and volar fingertips were measured in two subgroups of 20 SSc patients, each by three independent operators. Two operators were experienced in the use of the LASCA instrument and one was newly trained. Standardised protocols for conditions were followed for all measurements. Inter-rater reliability was tested using the intraclass correlation coefficient (ICC). RESULTS: The majority (87.5%) of the 40 patients included were females and 67.5% had diffuse cutaneous SSc. The mean age (standard deviation) was 48.5 (9.9) years and the median disease duration (interquartile range) was 8.5 (4, 13) years. There was good to excellent agreement, inter-rater ICC (dorsal fingertip range: 0.86-0.97 and volar fingertip range: 0.85-0.96), in both subgroups irrespective of operator skill. CONCLUSIONS: LASCA is a credible instrument in patients of Black ethnicity with SSc, and across operator experience.

A plethora of manifestations following a Mycoplasma pneumoniae infection: a case report.

Mycoplasma pneumoniae infection can present with a plethora of symptoms and result in a systemic vasculitis by activating a cascade of autoimmune reactions. In this case report, a young man without relevant past medical history was admitted to the hospital with diarrhea, abdominal pain and spiking fever. A CT-scan showed terminal ileitis. A 5-day broad spectrum antibiotic treatment (ciprofloxacin/clindamycin) did not result in any clinical improvement. On the contrary, the patient developed a cholestatic hepatitis, bilateral anterior uveitis and a dry cough. Extensive serological testing finally led to the diagnosis of a M. pneumoniae infection by paired serology (≥4-fold rise in IgG titer). In the diagnostic work-up, a PET-CT was performed and showed increased tracer uptake in the carotids and vertebral arteries, suggesting the diagnosis of vasculitis. After start of azithromycin and low-dose corticosteroids (0.5 mg/kg/day), a gradual clinical and biochemical improvement was observed. But subsequently, the patients relapsed and presented with an acute coronary syndrome. Coronary angiography revealed aneurysmatic deformation of the three coronary arteries, leading to the assumption of coronary vasculitis. Clinical improvement was achieved with high-dose corticosteroids (1 mg/kg/day). This case shows that M. pneumoniae is not merely a pulmonary infection, but that its primary symptoms can be diverse and misleading. All clinicians should be aware of its extrapulmonary manifestations.

Prospective Comparison of F-18 Choline PET/CT Scan Versus Axial MRI for Detecting Bone Metastasis in Biochemically Relapsed Prostate Cancer Patients.

We compared fluor-18 choline positron emission tomography/computed tomography (PET/CT) and axial skeleton magnetic resonance imaging (MRI) prospectively obtained for the detection of bone metastases in non-castrated patients with biochemically recurrent prostate cancer following primary treatment. PET/CT was performed 45 min post-injection of 3-4 MBq/kg F-18 methyl choline. MRI included T1- and fluid sensitive T2-weighted images of the spine and pelvis. Readers were initially blinded from other results and all scans underwent independent double reading. The best valuable comparator (BVC) defined the metastatic status. On the basis of the BVC, 15 out of 64 patients presented with 24 bone metastases. On a patient level, the sensitivity and specificity of MRI and PET were not significantly different. On a lesion level, the sensitivity of MRI was significantly better compared to PET, and the specificity did not differ significantly. In conclusion, axial MRI is an interesting screening tool for the detection of bone metastases because of its low probability of false negative results. However, F-18 choline PET is a valuable addition as it can overrule false positive MRI results and detect non-axial metastases.

Rapidly growing gastric metastasis of Merkel cell carcinoma, an unusual cause of melena.

Merkel cell carcinoma (MCC) is an uncommon, highly aggressive neuroendocrine skin carcinoma that has a tendency for local recurrence and metastatic disease. We report a rare case of recurrent melena in a 77-year-old Caucasian male. Three years earlier, the patient had undergone a radical resection of a para-umbilical MCC. A repeat esophagogastroduodenoscopy proved necessary to identify rapidly proliferating gastric metastasis of MCC as the cause of bleeding.

The Anterolateral Ligament of the Knee: What the Radiologist Needs to Know.

The anterolateral ligament (ALL) was recently identified as a distinct component of the anterolateral capsule of the human knee joint with consistent origin and insertion sites. Biomechanical studies revealed that the current association between the pivot shift and an injured anterior cruciate ligament (ACL) should be loosened and that the rotational component of the pivot shift is significantly affected by the ALL. This may change the clinical approach toward ACL-injured patients presenting with anterolateral rotatory instability (ALRI), the most common instability pattern after ACL rupture. Radiologists should be aware of the importance of the ALL to ACL injuries. They should not overlook pathology of the anterolateral knee structures, including the ALL, when reviewing MR images of the ACL-deficient knee. In this article, the current knowledge regarding the anatomy, biomechanical function, and imaging appearance of the ALL of the knee is discussed with emphasis on the clinical implications of these findings.

Imaging of the Postoperative Anterior Cruciate Ligament: Emphasis on New Surgical and Imaging Methods.

The aim of anterior cruciate ligament (ACL) reconstruction is to restore normal function of the knee, but unfortunately abnormal kinematics and a predisposition to knee osteoarthritis occur in a significant percentage of patients. So there is an ongoing need to improve treatment options and long-term outcome of patients with a ruptured ACL. With the recent advancements in the field of ACL tissue engineering, the focus of treatment for ACL injuries is changing from resection and reconstruction toward repair and regeneration. Several new ACL repair methods were recently introduced as an alternative to traditional ACL reconstructive procedures. Radiologists must become familiar with these new surgical methods to interpret their appearance correctly on postoperative imaging studies. This article provides an overview of the latest advancements in ACL surgical methods and discusses the role of imaging to assess the postoperative ACL including both standard and advanced imaging methods.

Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries.

OBJECTIVE: To determine the frequency of anterolateral ligament (ALL) injury in patients with acute anterior cruciate ligament (ACL) rupture and to analyse its associated injury patterns. METHODS: Ninety patients with acute ACL rupture for which MRI was obtained within 8 weeks after the initial trauma were retrospectively identified. Two radiologists assessed the status of the ALL on MRI by consensus. The presence or absence of an ALL abnormality was compared with the existence of medial and lateral meniscal tears diagnosed during arthroscopy. Associated collateral ligament and osseous injuries were documented with MRI. RESULTS: Forty-one of 90 knees (46 %) demonstrated ALL abnormalities on MRI. Of 49 knees with intact ALL, 15 (31 %) had a torn lateral meniscus as compared to 25 torn lateral menisci in 41 knees (61 %) with abnormal ALL (p = 0.008). Collateral ligament (p ≤ 0.05) and osseous injuries (p = 0.0037) were more frequent and severe in ALL-injured as compared with ALL-intact knees. CONCLUSION: ALL injuries are fairly common in patients with acute ACL rupture and are statistically significantly associated with lateral meniscal, collateral ligament and osseous injuries. KEY POINTS: • ALL injuries are fairly common in patients with acute ACL rupture. • ALL injuries are highly associated with lateral meniscal and osseous injuries. • MRI assessment of ACL-injured knees should include evaluation of the ALL.

Comparison of 1.5- and 3-T MR imaging for evaluating the articular cartilage of the knee.

PURPOSE: The aim of this prospective study was to compare routine MRI scans of the knee at 1.5 and 3 T obtained in the same individuals in terms of their performance in the diagnosis of cartilage lesions. METHODS: One hundred patients underwent MRI of the knee at 1.5 and 3 T and subsequent knee arthroscopy. All MR examinations consisted of multiplanar 2D turbo spin-echo sequences. Three radiologists independently graded all articular surfaces of the knee joint seen at MRI. With arthroscopy as the reference standard, the sensitivity, specificity, and accuracy of 1.5- and 3-T MRI for detecting cartilage lesions and the proportion of correctly graded cartilage lesions within the knee joint were determined and compared using resampling statistics. RESULTS: For all readers and surfaces combined, the respective sensitivity, specificity, and accuracy for detecting all grades of cartilage lesions in the knee joint using MRI were 60, 96, and 87% at 1.5 T and 69, 96, and 90% at 3 T. There was a statistically significant improvement in sensitivity (p < 0.05), but not specificity or accuracy (n.s.) for the detection of cartilage lesions at 3 T. There was also a statistically significant (p < 0.05) improvement in the proportion of correctly graded cartilage lesions at 3 T as compared to 1.5 T. CONCLUSION: A 3-T MR protocol significantly improves diagnostic performance for the purpose of detecting cartilage lesions within the knee joint, when compared with a similar protocol performed at 1.5 T. LEVEL OF EVIDENCE: III.

Prospective comparison of 1.5 and 3.0-T MRI for evaluating the knee menisci and ACL.

BACKGROUND: MRI (magnetic resonance imaging) is widely used to diagnose meniscal pathology and ACL (anterior cruciate ligament) tears. Because of the enhanced signal-to-noise ratio and improved image quality at higher field strength, knee MRI equipment is shifting from 1.5 to 3.0 T. To date, objective evidence of improved diagnostic ability at 3.0 T is lacking. The purpose of this prospective study was to assess the accuracy of 1.5 and 3.0-T MRI of the knee, in the same individuals, for diagnosing meniscal pathology and ACL tears, utilizing arthroscopy as the reference standard. METHODS: Two hundred patients underwent MRI of the knee at 1.5 and 3.0 T. All MRI examinations consisted of multiplanar turbo spin-echo sequences. One hundred patients underwent subsequent knee arthroscopy. Two blinded independent radiologists assessed all MRI studies to identify meniscal pathology and ACL tears. In patients with MRI results indicating the need for surgical treatment, the sensitivity and specificity of the 1.5 and 3.0-T protocols for detecting these lesions were determined, utilizing arthroscopy as the reference standard, and compared with use of the McNemar test. The kappa statistic for inter-reader agreement in the 200 patients was calculated. RESULTS: For medial meniscal tears, the mean sensitivity and specificity for the two readers were 93% and 90%, respectively, at 1.5 T and 96% and 88%, respectively, at 3.0 T. For lateral meniscal tears, the mean sensitivity and specificity were 77% and 99%, respectively, at 1.5 T and 82% and 98%, respectively, at 3.0 T. For ACL tears, the mean sensitivity and specificity were 78% and 100%, respectively, at 1.5 T and 80% and 100%, respectively, at 3.0 T. None of the values for either reader differed significantly between the 1.5 and 3.0-T MRI protocols. Inter-reader agreement was almost perfect to perfect (kappa = 0.82 to 1.00). CONCLUSIONS: Routine use of a 3.0-T MRI protocol did not significantly improve accuracy for evaluating the knee menisci and ACL compared with a similar 1.5-T protocol.

Partial tear of the anterior cruciate ligament of the knee: injury patterns on MR imaging.

PURPOSE: To describe rupture patterns of partial anterior cruciate ligament (ACL) tears on magnetic resonance (MR) imaging. METHODS: MR images of 51 patients with a surgically confirmed partial ACL tear were retrospectively and independently interpreted by 2 experienced, blinded radiologists. Using previously described MR criteria, ACLs were categorized as follows: complete tear, partial tear, isolated anteromedial or posterolateral bundle tear, mucoid degeneration or normal ACL. MR interpretations were compared with the arthroscopic results as the standard of reference. Inter- and intraobserver agreements were determined using kappa (к) coefficients. RESULTS: On MR imaging, ACL injuries were categorized as complete tears (16-23%), partial tears (20-47%), mucoid degeneration (12-27%) or normal ACLs (18-23%). Isolated ACL bundle tears were diagnosed on MR in 6% of our patients. Accuracy of MR for the diagnosis of partial ACL tears was 25-53%. Interobserver agreement was moderate (к = 0.48-0.56). Intraobserver agreement was good (к = 0.72-0.76). CONCLUSION: MR diagnosis of a partial ACL tear is difficult because various tear patterns may be seen. Many partial tears demonstrate MR features that are indistinguishable from complete ACL tear, mucoid ACL degeneration or normal ACL. An isolated ACL bundle tear is infrequently detected on MR images.

Reliability and construct validity of ultrasonography of soft tissue and destructive changes in erosive osteoarthritis of the interphalangeal finger joints: a comparison with MRI.

OBJECTIVES: To study the reliability and construct validity of ultrasound in interphalangeal finger joints affected by erosive osteoarthritis (EOA) and non-EOA with MRI as the reference method. METHODS: 252 joints were examined by ultrasound, conventional radiography and clinical examination. Ultrasound was performed using a high-frequency linear transducer (12 × 18 MHz). On the same day, magnetic resonance images of 112 joints were obtained on a 3.0 T magnetic resonance unit. The ultrasound and MRI images were re-read independently by other readers unaware of the diagnosis, clinical and other imaging findings. Interobserver reliability was calculated by the percentage of exact agreement obtained and κ statistics. With MRI as the reference method, the sensitivity and specificity of ultrasound in detecting structural (bone erosions and osteophytes) and soft tissue (effusion and grey-scale synovitis) changes in EOA were calculated. RESULTS: Ultrasound and MRI were found to be more sensitive in detecting erosions than conventional radiography in EOA. A high agreement between ultrasound and MRI in the assessment of bone erosions (77.7%), osteophytes (75.9%) and synovitis (86.5%) was present. A high percentage of inflammatory changes was found in EOA, and in smaller amount in non-EOA, both confirmed by MRI. Good interobserver reliability of ultrasound was obtained for all variables (all median κ > 0.8). CONCLUSION: Grey-scale ultrasound proved to be a reliable and valid imaging technique to assess erosions and soft tissue changes, compared with MRI as a reference method in EOA.