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BACKGROUND: Magnetic resonance (MRI) imaging of the skeletal muscles (muscle MRI for short) is increasingly being used in clinical routine for diagnosis and longitudinal assessment of muscle disorders. However, cross-centre standards for measurement protocol and radiological assessment are still lacking. OBJECTIVES: The aim of this expert recommendation is to present standards for the application and interpretation of muscle MRI in hereditary and inflammatory muscle disorders. METHODS: This work was developed in collaboration between neurologists, neuroradiologists, radiologists, neuropaediatricians, neuroscientists and MR physicists from different university hospitals in Germany. The recommendations are based on expert knowledge and a focused literature search. RESULTS: The indications for muscle MRI are explained, including the detection and monitoring of structural tissue changes and oedema in the muscle, as well as the identification of a suitable biopsy site. Recommendations for the examination procedure and selection of appropriate MRI sequences are given. Finally, steps for a structured radiological assessment are presented. CONCLUSIONS: The present work provides concrete recommendations for the indication, implementation and interpretation of muscle MRI in muscle disorders. Furthermore, it provides a possible basis for the standardisation of the measurement protocols at all clinical centres in Germany.
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BACKGROUND: Magnetic resonance (MRI) imaging of the skeletal muscles (muscle MRI for short) is increasingly being used in clinical routine for diagnosis and longitudinal assessment of muscle disorders. However, cross-centre standards for measurement protocol and radiological assessment are still lacking. OBJECTIVES: The aim of this expert recommendation is to present standards for the application and interpretation of muscle MRI in hereditary and inflammatory muscle disorders. METHODS: This work was developed in collaboration between neurologists, neuroradiologists, radiologists, neuropaediatricians, neuroscientists and MR physicists from different university hospitals in Germany. The recommendations are based on expert knowledge and a focused literature search. RESULTS: The indications for muscle MRI are explained, including the detection and monitoring of structural tissue changes and oedema in the muscle, as well as the identification of a suitable biopsy site. Recommendations for the examination procedure and selection of appropriate MRI sequences are given. Finally, steps for a structured radiological assessment are presented. CONCLUSIONS: The present work provides concrete recommendations for the indication, implementation and interpretation of muscle MRI in muscle disorders. Furthermore, it provides a possible basis for the standardisation of the measurement protocols at all clinical centres in Germany.
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Background The complex and diverse occupational disease hazards in automobile manufacturing industry pose high occupational health risks to workers. Objective To explore the methods that can accurately reflect the workplace health risk grade of automobile manufacturing enterprises, and to guide enterprises to practice risk classification management. Methods Comprehensive index method, International Commission on Mining and Metals occupational health risk assessment method (ICMM method), and risk index method were used toassess health risks of occupational disease hazards in major workstations such as welding, polishing, and painting in three automobile manufacturing enterprises in Hunan Province. Kappa consistency test was used to test the grading results of the three assessment methods. The re-examine results and detection rate of contraindications of occupational health examinations in the past three years were used to verify the assessment results. Results The results of comprehensive index method showed that the hazards of each selected workstation in enterprises A and B were evaluated as grade 2-3, among which NO2 in enterprise A was grade 3, and welding fume, NO2, and formaldehyde in enterprise B were all grade 3. The hazards of each selected workstation in enterprise C were grade 3-4, among which NO2 and benzene in were grade 4, and welding fume, manganese and its compounds, grinding wheel dust, and xylene were grade 3. The hazards evaluated by ICMM quantitative method were grade 2 and grade 5, among which manganese and its compounds in enterprise A and welding fume, grinding wheel dust, and benzene series in enterprise C were graded as grade 5. The hazards evaluated by risk index method were grade 1-4, among which manganese and its compounds in enterprises A and B were grade 3, and manganese and its compounds and benzene in enterprise C were grade 4. The Kappa value between comprehensive index method and ICMM method was 0.084 (P>0.05), that between comprehensive index method and risk index method was −0.046 (P>0.05), and that between ICMM method and risk index method was 0.014 (P>0.05), indicating poor consistency. By comparing the results of occupational health surveillance with the results of occupational health risk assessment, one worker was found to have occupational contraindication of manganese exposure and 1 worker was found to have excessive manganese in hair in enterprise A. However, the comprehensive index method graded low risk for manganese and its compounds in enterprise A and the result is conservative. The key workstations identified by ICMM method were consistent with the occupational health examination results, but the assessment grades were all extremely high risk, and the results were too strict. One worker was found to be contraindicated to welding fumes, and 2 polishers were found to have severe mixed pulmonary ventilation dysfunction in enterprise C. Mild and moderate pulmonary ventilation dysfunction was found to be common in welding and polishing workstations in each enterprise. The assessment results of welding fumes and grinding wheel dust by the risk index method were negligible risks, which were inconsistent with the occupational health examination results. Conclusion The comprehensive index method, ICMM method, and risk index method can basically identify workstations with serious occupational hazards, but they have certain limitations and applicability. In general, the evaluation results of the comprehensive index method were generates more consistent with the results with occupational health surveillance than the other two methods, is more comprehensive and objective in consideration, and is more suitable for health risk assessment of automobile manufacturing enterprises.
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Objective To explore the results, feasibility and existing problems of semi-quantitative and quantitative risk assessment models in the assessment of chemical hazard exposure in optical fiber manufacturing enterprises. Methods The chemical hazard factors of an optical fiber enterprise in Wuhan were investigated, detected and evaluated, and the semi-quantitative and quantitative risk assessment models of occupational health of chemical hazard factors in the workplace were used for risk assessment. Results In the semi-quantitative risk assessment model, the consistency between the contact index method and the comprehensive index method was good (Kappa=0.820, P2=0.539，P<0.05), and the results were grade 1, 2, 3 and 5. The non-carcinogenic risk hazard quotient of the quantitative risk assessment model was not consistent with the three semi-quantitative methods (Kappa=0), and the results were grade 1, 2, 3, 4 and 5. Conclusion The semi-quantitative risk assessment model is more suitable for the risk assessment of the optical fiber industry than the quantitative risk assessment model.
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OBJECTIVE: To compare the applicability of three risk assessment methods on occupational health risk assessment of chemical harmful factors in a resin anchorage production workshop. METHODS: A resin anchoring agent production workshop was selected as the research subject using the judgment sampling method. Contact ratio assessment method and comprehensive index method(both are semi-quantitative evaluation method) and qualitative risk assessment method were applied to estimate the occupational health risks of jobs involved with styrene, dibutyl phthalate and phthalic anhydride. The assessment was carried out, and the obtained risk level was standardized as the risk ratio. The evaluation results of these three methods were compared. RESULTS: The assessment results of exposure ratio method were 1-3, and those of comprehensive index method were 2-3. The risk ratio of the above methods after standardization is consistent with that before standardization. The result of qualitative risk assessment was 2-3, and the risk ratio after standardization was 3-4. The risk ratio after standardization was 1 level higher than that before standardization. Kappa analysis results showed that the result of contact ratio method and the comprehensive index method was in good agreement(Kappa=0.53, P<0.05). The qualitative risk assessment method was inconsistent with the contact ratio method and the comprehensive index method(Kappa values were 0.19 and 0.40, both P<0.05). CONCLUSION: Comprehensive index method is the preferred method for occupational health risk assessment of anchorage agent production workshop under the condition that detection results of occupational hazards can be obtained. Qualitative risk assessment method can be used when the test results cannot be obtained.
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OBJECTIVE: To compare the applicability of three semi-quantitative methods for risk assessment for occupational health in a mechanic processing enterprise. METHODS: The judgment sampling method was used to select a mechanic processing enterprise as the study subject. The occupational health risk was evaluated using contact ratio, exponential and comprehensive exponential analyzing method, and the results of different methods were compared. RESULTS: The occupational health risk level of all the posts in sandblasting, sawing, welding, grinding and painting in the mechanic processing enterprises were of moderate risk or above. The consistency of evaluation results of the contact ratio, exponential and comprehensive exponential methods was poor(weighted Kappa=0.30, P>0.05). The consistency of exponential and comprehensive exponential methods was excellent(weighted Kappa=1.00, P<0.01). When the contact concentration(E)/occupational exposure limits(OEL) is <0.50, the contact ratio method is less than or equal to the exponential method and the comprehensive exponential method. When 0.50 ≤E/OEL<2.00, the results of these three methods are consistent. When the E/OEL ≥2.00, the evaluation result of the contact ratio method is equal to or higher than the exponential method and the comprehensive exponential method.CONCLUSION: The contact ratio method is easy to obtain, simple and convenient. The exponential method is suitable for occupational disease risk factors in the workplace without OELs or unable to obtain test data, and it is more practical. The comprehensive exponential method is considered comprehensive and suitable for occupational health risk assessment in the workplace.
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PURPOSE: To review literature until November 2015 and reach a consensus on whether automatic semi-quantification of brain FDG-PET is useful in the clinical setting for neurodegenerative disorders. METHODS: A literature search was conducted in Medline, Embase, and Google Scholar. Papers were selected with a lower limit of 30 patients (no limits with autopsy confirmation). Consensus recommendations were developed through a Delphi procedure, based on the expertise of panelists, who were also informed about the availability and quality of evidence, assessed by an independent methodology team. RESULTS: Critical outcomes were available in nine among the 17 papers initially selected. Only three papers performed a direct comparison between visual and automated assessment and quantified the incremental value provided by the latter. Sensitivity between visual and automatic analysis is similar but automatic assessment generally improves specificity and marginally accuracy. Also, automated assessment increases diagnostic confidence. As expected, performance of visual analysis is reported to depend on the expertise of readers. CONCLUSIONS: Tools for semi-quantitative evaluation are recommended to assist the nuclear medicine physician in reporting brain FDG-PET pattern in neurodegenerative conditions. However, heterogeneity, complexity, and drawbacks of these tools should be known by users to avoid misinterpretation. Head-to-head comparisons and an effort to harmonize procedures are encouraged.
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Neurodegenerative Diseases/diagnostic imaging , Positron-Emission Tomography , Dementia/diagnostic imaging , Diagnosis, Differential , Fluorodeoxyglucose F18 , Humans , Sensitivity and SpecificityABSTRACT
Visual and semi-quantitative assessments of 123I-FP-CIT single-photon emission computed tomography (SPECT) are useful for the diagnosis of dopaminergic neurodegenerative diseases (dNDD), including Parkinson's disease, dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration. However, the diagnostic value of combined visual and semi-quantitative assessment in dNDD remains unclear. Among 239 consecutive patients with a newly diagnosed possible parkinsonian syndrome who underwent 123I-FP-CIT SPECT in our medical center, 114 patients with a disease duration less than 7 years were diagnosed as dNDD with the established criteria or as non-dNDD according to clinical judgment. We retrospectively examined their clinical characteristics and visual and semi-quantitative assessments of 123I-FP-CIT SPECT. The striatal binding ratio (SBR) was used as a semi-quantitative measure of 123I-FP-CIT SPECT. We calculated the sensitivity and specificity of visual assessment alone, semi-quantitative assessment alone, and combined visual and semi-quantitative assessment for the diagnosis of dNDD. SBR was correlated with visual assessment. Some dNDD patients with a normal visual assessment had an abnormal SBR, and vice versa. There was no statistically significant difference between sensitivity of the diagnosis with visual assessment alone and semi-quantitative assessment alone (91.2 vs. 86.8%, respectively, p = 0.29). Combined visual and semi-quantitative assessment demonstrated superior sensitivity (96.7%) to visual assessment (p = 0.03) or semi-quantitative assessment (p = 0.003) alone with equal specificity. Visual and semi-quantitative assessments of 123I-FP-CIT SPECT are helpful for the diagnosis of dNDD, and combined visual and semi-quantitative assessment shows superior sensitivity with equal specificity.
Subject(s)
Corpus Striatum/metabolism , Neurodegenerative Diseases/diagnosis , Supranuclear Palsy, Progressive/diagnosis , Tropanes/metabolism , Aged , Aged, 80 and over , Brain/metabolism , Brain/pathology , Diagnosis, Differential , Female , Humans , Lewy Body Disease/diagnosis , Male , Retrospective Studies , Sensitivity and Specificity , Tomography, Emission-Computed, Single-Photon/methodsABSTRACT
Systemic sclerosis is a complex disease that involves "autoimmunity," "inflammation," "fibrosis," and "vasculopathy." Microvascular damage and dysfunction particularly represent the earliest morphological and functional markers of systemic sclerosis. These morphological changes and progressions can be detected by nailfold videocapillaroscopy (NVC). In 2013, the American College of Rheumatology and European League Against Rheumatism (ACR/EULAR) proposed a new set of criteria for systemic sclerosis for the first time in 30 years. Items are given a weighted score, and a score more than 9 indicates systemic sclerosis. These classification criteria encompass a broader spectrum of systemic sclerosis patients including those with early stage and with excellent sensitivity and specificity. Notably, nailfold capillary abnormalities were one of the new items in the criteria. Moreover, these abnormalities are also markers of systemic sclerosis severity and progression, as reduced capillary density has been associated with a high risk of developing digital skin ulcers and pulmonary arterial hypertension. Since microvascular damage and dysfunction represent early markers of systemic sclerosis, qualitative and semi-quantitative assessment of videocapillaroscopy images is expected in clinical application and treatment outcome assessment. Despite the potential for targeted therapies in systemic sclerosis, there is no established therapy as yet. This may be due to several reasons. First, no fully validated outcome measures exist. Second, diagnosis of systemic sclerosis is often delayed and early intervention is difficult. Moreover, systemic sclerosis has clinical heterogeneity. Appropriate use of NVC helps to overcome these issues. Moreover, NVC may be useful in evaluating the pathogenesis of systemic sclerosis.
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OBJECTIVE: Longitudinal shortening is traditionally considered the predominant part of global right ventricular (RV) systolic function. Less attention has been paid to transverse contraction. The aim of this study was to evaluate RV transverse motion by cardiovascular magnetic resonance (CMR) in a large cohort of patients and to assess its relationship with RV ejection fraction (RVEF). STUDY DESIGN: We retrospectively analyzed the CMR scans of 300 patients referred to our center in 2010. RVEF was determined from short axis sequences using the volumetric method. Transverse parameters called RV fractional diameter changes were calculated after measuring RV diastolic and systolic diameters at basal and mid-level in short axis view (respectively FBDC and FMDC). We also measured the tricuspid annular plane systolic excursion (TAPSE) as a longitudinal reference. RESULTS: Our population was divided into 2 groups according to RVEF. 250 patients had a preserved RVEF (>40%) and 50 had a RV dysfunction (RVEF ≤ 40%). Transverse and longitudinal motions were significantly reduced in the group with RV dysfunction (p<.0001). After ROC analysis, areas under the curve for FBDC, FMDC and TAPSE, were respectively 0.79, 0.82 and 0.72, with the highest specificity and sensitivity respectively of 88% and 68% for FMDC (threshold at 20%) for predicting RV dysfunction. FMDC had an excellent negative predictive value of 93%. CONCLUSION: RV fractional diameter changes, especially at the mid-level, appear to be accurate for semi-quantitative assessment of RV function by CMR. A cut-off of 20% for FMDC differentiates patients with a low (EF≤40%) or a preserved RVEF.
