Repeatability and Safety of the Functional Capacity Evaluation-One-Handed for Individuals with Upper Limb Reduction Deficiency and Amputation.

Purpose To assess repeatability and safety of the functional capacity evaluation-one-handed (FCE-OH), a FCE-OH individuals, consisting of eight items. Method The FCE-OH protocol was administered twice to 23 individuals with upper limb absence (87% male; median age 46 years; median 2 days between sessions). To examine repeatability, test-retest reliability and agreement were assessed with the intraclass correlations coefficient (ICC) and limits of agreement (LoA), respectively. Reliability was considered acceptable when ICC-values were ≥0.75. Widths of LoA of four tests were compared with those of healthy adults. Safety and pain response were assessed with a questionnaire. Results After controlling for stability of construct, ICC-values ranged between 0.23 and 0.96, and widths of LoA ranged between 16 and 79%. Intertrial (learning) effects were present in three test items. No serious adverse reactions were reported. A pain response was reported by 30% of the participants. Conclusion Good or excellent reliability was observed in five tests, while three items showed poor or moderate test-retest reliability. Interpretation of agreement was possible for four tests, of which three showed widths of LoA similar to those reported in healthy adults. Learning effects were present; therefore, interpretation at the individual level should be performed with care. As the CI of several items were wide, confirmation of results in a larger sample is warranted. Safety was confirmed.

Functional Capacity Evaluation in Upper Limb Reduction Deficiency and Amputation: Development and Pilot Testing.

Purpose To develop and pilot test a functional capacity evaluation (FCE) for individuals with upper limb absence (ULA) due to reduction deficiency or amputation, and to examine the relationship between FCE results and presence of musculoskeletal complaints (MSC). Method Five tests (overhead lifting, overhead working, repetitive reaching, fingertip dexterity, and handgrip strength) were selected and adapted if necessary. The newly developed FCE, called FCE-One-Handed (FCE-OH), was pilot tested in 20 adults individuals with ULA, and 20 matched controls. MSC were assessed via a questionnaire. Results Adaptations were considered necessary for all tests, except the handgrip strength test. The repetitive overhead lifting test of the non-affected limb was added. On the overhead lifting test, individuals with above-elbow ULA (ten males), performed similar to controls using one hand. When lifting bimanually using the prosthesis, a trend for lower lifting capacity of individuals with below-elbow ULA (seven males, three females) was observed compared to controls. On the overhead working test, individuals with above-elbow ULA performed worse compared to controls. Other tests showed no significant differences between groups. Relationships between FCE results and presence of MSC were non-significant. Conclusion The FCE-OH can be used to test functional capacity of one-handed individuals. Individuals with ULA generally showed similar functional capacity as two-handed individuals. FCE results were not related to MSC. It was discussed that a higher physical load on the non-affected limb might reflect a relative deficit of functional capacity.

Tumor diameter and volume assessed by magnetic resonance imaging in the prediction of outcome for invasive cervical cancer.

OBJECTIVE: The aim of this study was to evaluate the predictive value of pretherapeutic magnetic resonance imaging (MRI)-based measurements of tumor diameter and volume with regard to recurrent disease. METHODS: MRI on 0.5- or 1.5-T scanners was performed in 126 consecutive women with invasive carcinoma of the uterine cervix. Initial tumor diameter and volume were determined on T(2)-weighted images; volume was calculated by the standard technique of multiplying the sum of the areas by the slice thickness. Patients were treated by radical surgery, radiotherapy, or a combined approach based on clinical International Federation of Gynecology and Obstetrics (FIGO) stage and individual patient criteria. Clinical data (patient age and FIGO stage), MRI-derived tumor dimensions (diameter and volume), and histological findings (tumor invasion depth and lymph-node involvement) were associated and linked to patient outcome. RESULTS: MRI-based tumor diameter correlated strongly with histological tumor invasion depth and lymph-node status (P < 0.01 and P = 0.01) while tumor volume on MRI was significantly associated only with tumor invasion depth into adjacent tissues (P < 0.01). Univariate analysis demonstrated graphically that MRI-derived tumor diameter and volume and clinical FIGO stage are associated with progression-free survival. Correlation analysis showed a strong association between MRI-derived tumor diameter and volume on MRI (r = 68%, P < 0.01) and also demonstrated a correlation between tumor diameter on MRI and FIGO stage Ib (Ib1 versus Ib2) cervical tumors (r = 46.7%, P < 0.01). CONCLUSION: Tumor diameter and volume, determined by pretreatment MRI examinations, predict progression-free survival for patients with invasive cervical carcinoma. This study demonstrates the value of MRI as an adjunct to clinical evaluation of invasive cervical cancer, providing more complete assessment of morphological risk factors important in patient prognosis and treatment planning.

Effect of MRI on therapeutic decisions in invasive cervical carcinoma. Direct comparison with the pelvic examination as a preperative test.

OBJECTIVES: Our aim was to compare magnetic resonance imaging (MRI) with the current standard clinical practice (pelvic examination including general anesthesia in selected patients) with regard to treatment planning in invasive cervical carcinoma. It was of particular interest to compare the accuracy of both methods for allocating the patients to the appropriate treatment modality: surgery versus primary radiotherapy. METHODS: One hundred and three consecutive patients with primary invasive cervical carcinoma underwent both MRI at 1.5 T and pelvic examination. The gold standard for comparing treatment decisions was based on the surgico-pathologic data: tumor confined to the cervix (treatment decision for surgery) or extracervical tumor spread (treatment decision for primary radiotherapy). RESULTS: A gold standard was available in 91 patients. The pelvic examination made correct treatment decisions in 89% of patients. However, the sensitivity for extracervical spread was only 44% (8/18 patients). MRI was better at identifying extracervical tumor spread: 67 and 89% for observers 1 and 2, respectively. MRI, however, had more false positive results and correct treatment decisions were made in 69-84% of patients (observer 1, 76/91; observer 2, 63/91). CONCLUSION: Treatment decisions based on the pelvic examination were correct in 89%, with MRI not bringing improvement. MRI, however, is better in diagnosing extracervical spread, but at the cost of more false positives.

Cervical carcinoma: can dynamic contrast-enhanced MR imaging help predict tumor aggressiveness?

PURPOSE: To determine whether fast dynamic contrast agent-enhanced magnetic resonance (MR) imaging can demonstrate tumor aggressiveness of cervical carcinoma in patients who are eligible for surgical treatment. MATERIALS AND METHODS: Dynamic contrast-enhanced MR imaging of cervical carcinoma was performed in 82 consecutive patients with stage I or IIA disease who were referred for radical hysterectomy. The maximum slope and amplitude of dynamic first-pass contrast enhancement were quantified. These parameters were correlated with histologic measures of tumor aggressiveness (tumor invasion depth, pelvic lymph node status). RESULTS: The analysis was based on tumors in 62 patients: 30 aggressive and 32 relatively nonaggressive tumors. Twenty patients were excluded from analysis owing to insufficient surgical data, tumor too small for accurate assessment, or technical problems. There were no significant differences between aggressive and nonaggressive tumors in terms of the first-pass contrast-enhancement parameters of slope (2.0 vs 2.1 arbitrary signal intensity units per second, P > .5) or amplitude (24.8 vs 27.8 arbitrary units, P > .2). CONCLUSION: Dynamic contrast-enhanced MR imaging does not facilitate differentiation between aggressive and nonaggressive tumors and therefore has no clinical role in assisting in treatment decisions in patients who are candidates for radical hysterectomy.

Fast dynamic contrast-enhanced colour-coded MRI in uterine cervix carcinoma: useful for tumour staging?

OBJECTIVE: To quantify first-pass enhancement of cervix carcinoma using fast dynamic MRI. To assess the accuracy of dynamic contrast-enhanced colour-coded MRI for determining tumour invasion into surrounding pelvic tissues. METHODS: Gadolinium enhanced dynamic MRI at one image every 2 s was performed in 47 patients with cervical carcinoma and five controls. First-pass contrast enhancement of cervix carcinoma and surrounding pelvic tissues was quantified. Automated colour-coded images were constructed using the dynamic parameters slope, amplitude and timing of enhancement. Of 47 patients, 28 underwent surgery and colour coded images were correlated with histological findings. RESULTS: First-pass contrast enhancement imaging of cervix carcinoma required a temporal resolution of dynamic MRI of one image every 3-4 s. Cervix carcinoma first-pass was more rapid and intense than that of other pelvic tissues (P<0.001) with the exception of normal myometrium (P>0.05). Binary colour coding, however, was not reliable for tumour delineation or for accurate assessment of tumour invasion into the parametria or the bladder wall. Overestimation of the extent of tumour invasion occurred in 15, 16 and nine out of 28 patients, respectively, using amplitude, slope and timing of enhancement as parameters. CONCLUSION: Dynamic contrast-enhanced colour-coded MRI of cervix carcinoma has limited value for assessing the extent of tumour spread and tumour staging.

MR imaging of uterine cervical carcinoma: comparison between fast spin-echo MRI and GRASE.

The aim of our study was to compare the image quality of T2-weighted gradient-echo-and-spin-echo (GRASE) MRI and fast spin-echo (FSE) MRI for imaging of cervical carcinoma. In 40 patients FSE8 (TR/TE = 3400/90 ms) MRI with echo train length (ETL) of 8, GRASE (3400/90) MRI with ETL of 18, turbo factor of 6 and 3 gradient reversals, and FSE18 (2500/120) MRI with ETL of 18 were performed. Tissue contrast, subjectively rated image quality, and accuracy of tumor delineation were compared. Surgical correlation was obtained in 27 subjects. Contrast-to-noise ratios of the tumor-cervix stroma, tumor-parametrium and tumor-rectum wall interfaces were better in FSE18 than in FSE8 and GRASE (P < 0.001) but not different between FSE8 and GRASE. Subjective image quality was better in FSE18 and FSE8 than in GRASE (P < 0.02). The accuracy of tumor delineation was similar for the three different sequences. The accuracy of FSE and GRASE MRI for the delineation of cervical carcinoma is similar. Based on measurement of image quality and CNRs, however, high turbo factor FSE provides better image quality in MRI of cervical carcinoma. Whether the superior characteristics may result in better staging has to be explored in larger clinical trials.

Cervical carcinoma: do fast SE and fat suppression techniques improve MR tumor staging at 0.5 T?

PURPOSE: Our goal was to compare fast SE (FSE) with T2-weighted conventional SE (CSE) MRI of cervical carcinoma and to evaluate the potential advantage of fat suppression technique. METHODS: We compared the tissue contrasts between cervical carcinoma and the surrounding tissues in 24 patients. The following MR sequences were obtained at 0.5 T: T1-weighted CSE (450/20 ms), T2-weighted CSE (2,500/45, 90), and T2-weighted FSE (4,800/120), the latter with and without fat suppression using fat-selective prepulses. RESULTS: T2-weighted FSE MRI provided significantly better contrasts between tumor and normal cervical stroma (p < 0.001) and between tumor and rectum wall (p < 0.05) than T2-weighted CSE MRI. T1-weighted SE MRI gave the highest tissue contrast between tumor and parametrial tissue (p < 0.001). Fat suppression did not further improve tissue contrasts. CONCLUSION: MR staging of cervical carcinoma is best done with the combination of T1-weighted SE and T2-weighted FSE images, without additional fat suppression.

Reperfused and nonreperfused myocardial infarction: diagnostic potential of Gd-DTPA--enhanced MR imaging.

Forty-five patients with suspected acute myocardial infarction were examined with magnetic resonance (MR) imaging before and serially up to 30 minutes after intravenous injection of gadolinium diethylenetriaminepentaacetic acid (DTPA), 0.1 mmol/kg of body weight. Coronary angiography after thrombolytic therapy was performed in all patients to assess reperfusion. Intensity ratios between both reperfused and nonreperfused infarcted areas and normal myocardium increased significantly up to 15-20 minutes after administration of Gd-DTPA and were still elevated 30 minutes after injection (P less than .0001). In accordance with the findings in experimental studies, four distribution patterns of infarct enhancement were observed. The overlap in enhancement patterns and similar maximal intensity ratios after Gd-DTPA administration for both reperfused and nonreperfused infarcts preclude a reliable differentiation on the basis of these factors alone. Significant enhancement of both reperfused and nonreperfused infarcts allows adequate infarct imaging up to at least 30 minutes after administration of Gd-DTPA.

Value of magnetic resonance imaging in patients with a recent myocardial infarction: comparison with planar thallium-201 scintigraphy.

The diagnostic accuracy of spin-echo Magnetic Resonance (MR) imaging in the detection and localization of a recent myocardial infarction (mean 4 days old) was compared to planar thallium-201 scintigraphy in 20 patients with a documented myocardial infarction. A control group of 10 subjects underwent a similar MR imaging procedure without thallium-201 scintigraphy. T1-weighted MR images (TE 30 msec) showed abnormal thinning of the infarcted left ventricular wall during systole (less than 50% of the opposite wall) in 11 patients (55%). On T2-weighted multi-echo MR images, (TE 30-60-90-120 msec) abnormally increased signal intensity was found in 17 patients and coincided with the location of the infarction. Thallium-201 scintigraphy detected the infarction in 18 patients. Comparison of T2-MR imaging and thallium-201 scintigraphy showed concordant findings in 82% of the left ventricular segments. In 9% of segments, thallium uptake was reduced with normal T2-MR and in 9% we found a normal thallium uptake with abnormal T2-MR findings. In all subjects of the control group, T1-MR images were normal, and only one subject showed increased signal intensity on T2-MR images. We conclude that the diagnostic accuracy of MR imaging in detecting a myocardial infarction is similar to that of T1-201 scintigraphy.

Improved detection of acute myocardial infarction by magnetic resonance imaging using gadolinium-DTPA.

To assess the value of the paramagnetic contrast agent Gadolinium (Gd)-DTPA in Magnetic Resonance Imaging (MRI) of acute myocardial infarction (AMI), we studied 20 patients with a first AMI by ECG-gated MRI before and after intravenous administration of 0.15 mmol/kg Gd-DTPA. The MRI studies were performed after a mean of 98 hours (range 15-241) after the acute onset of AMI. Spin-echo measurements (TE 30 msec) were made using a Philips Gyroscan (0.5 Tesla). After performing the baseline MRI scans, the MRI procedure was repeated every 10 minutes for up to 40 minutes following injection of Gd-DTPA. In 18 (90%) patients contrast enhancement in the infarcted myocardial areas was observed after Gd-DTPA. In these patients intensity versus region curves, derived from 9 to 11 adjacent myocardial regions of interest, showed increased signal intensities in the infarcted areas after administration of Gd-DTPA. The precontrast signal intensity ratio between infarcted and normal myocardium was 1.14 +/- 0.15 (mean +/- SD); the postcontrast ratios at 10 minutes were 1.41 +/- 0.21 (P less than 0.05), at 20 minutes 1.61 +/- 0.19 (P less than 0.01), at 30 minutes 1.43 +/- 0.20 (P less than 0.05), and at 40 minutes 1.33 +/- 0.20 (P = NS). It is concluded that MRI using the contrast agent Gd-DTPA significantly improves the visualization and detection of infarcted myocardial areas in patients with AMI and that optimal contrast enhancement is obtained 20 minutes after administration of Gd-DTPA.