[Translated article] Better results in consolidation of hallux metatarsophalangeal arthrodesis with dorsal plate and interfragmentary compression screw.

BACKGROUND AND AIMS: The first metatarsophalangeal joint arthrodesis is indicated for the treatment of various pathologies as a technique to reduce pain and improve the support of the first radius. Numerous surgical techniques and fixation methods have been described, with the combination of a dorsal plate and an interfragmentary screw being the one that has shown to be the most stable construct in biomechanical studies. Our aim is to analyze the radiological results after metatarsophalangeal arthrodesis of the hallux using a dorsal plate associated or not with an interfragmentary screw. The differences in terms of consolidation rates and complications in patients diagnosed with hallux rigidus, hallux valgus, hallux varus and failure of previous surgeries were evaluated. MATERIALS AND METHODS: A retrospective cohort study of 55 patients with a mean age of 65.10 years in whom a dorsal plate was used was performed. Patients were divided into two groups depending on whether or not an interfragmentary screw was used. The minimum follow-up was 6 months after surgery. The assessment of the pre and postoperative radiological results was based on the variation of the hallux angle, the intermetatarsal angle and the dorsal metatarsophalangeal angle of the hallux, as well as the cases of nonunion identified in each study group. RESULTS: The radiological results, statistically significant differences (p<0.05) were only found in the dorsal metatarsophalangeal angle between both study groups. No statistically significant differences were found regarding the radiological evaluation of the pre and postoperative hallux angle and intermetatarsal angle. An equal decrease of each angles was observed in both study groups. Regarding the consolidation rate, statistically significant differences (p<0.05) were found between group A, which associated an interfragmentary screw, presenting a consolidation rate of 92%, and group B, which did not associate an interfragmentary screw, and that presented a union rate of 63%. CONCLUSION: Hallux metatarsophalangeal arthrodesis of the hallux with a dorsal plate and interfragmentary screw show best results regarding consolidation rate and complications compared to those cases in which an interfragmentary screw was not used.

Better results in consolidation of hallux metatarsophalangeal arthrodesis with dorsal plate and interfragmentary compression screw. / Mejores resultados en la consolidación de la artrodesis metatarsofalángica del hallux con placa dorsal y tornillo de compresión interfragmentario.

INTRODUCTION AND AIMS: The first metatarsophalangeal joint arthrodesis is indicated for the treatment of various pathologies as a technique to reduce pain and improve the support of the first radius. Numerous surgical techniques and fixation methods have been described, with the combination of a dorsal plate and an interfragmentary screw being the one that has shown to be the most stable construct in biomechanical studies. Our aim is to analyze the radiological results after metatarsophalangeal arthrodesis of the hallux using a dorsal plate associated or not with an interfragmentary screw. The differences in terms of consolidation rates and complications in patients diagnosed with hallux rigidus, hallux valgus, hallux varus and failure of previous surgeries were evaluated. MATERIAL AND METHODS: A retrospective cohort study of 55 patients with a mean age of 65.10 years in whom a dorsal plate was used was performed. Patients were divided into 2 groups depending on whether or not an interfragmentary screw was used. The minimum follow-up was 6 months after surgery. The assessment of the pre and postoperative radiological results was based on the variation of the hallux angle, the intermetatarsal angle and the dorsal metatarsophalangeal angle of the hallux, as well as the cases of nonunion identified in each study group. RESULTS: The radiological results, statistically significant differences (p<0.05) were only found in the dorsal metatarsophalangeal angle between both study groups. No statistically significant differences were found regarding the radiological evaluation of the pre and postoperative hallux angle and intermetatarsal angle. An equal decrease of each angles was observed in both study groups. Regarding the consolidation rate, statistically significant differences (p<0.05) were found between group A, which associated an interfragmentary screw, presenting a consolidation rate of 92%, and group B, which did not associate an interfragmentary screw, and that presented a union rate of 63%. CONCLUSIONS: Hallux metatarsophalangeal arthrodesis of the hallux with a dorsal plate and interfragmentary screw show best results regarding consolidation rate and complications compared to those cases in which an interfragmentary screw was not used.

Tratamiento quirúrgico del pie plano valgo adquirido del adulto en estadio IIB: papel de la reparación del «spring ligament» / Surgical treatment at adult acquired flatfoot stage IIB: Spring ligament repair

Antecedentes y objetivos: En el desarrollo del pie plano valgo adquirido del adulto ha cobrado gran importancia el fallo de la columna medial, y no tanto la rotura del tibial posterior, siendo principalmente la lesión del ligamento en hamaca calcaneonavicular (spring ligament) el determinante del desarrollo de esta deformidad. Nuestro objetivo es analizar los resultados clínico-radiológicos de la reparación del ligamento en hamaca y valorar la utilidad e integración de las cuñas de titanio poroso en las osteotomías a las que se asocia la reparación ligamentosa. Material y métodos: Realizamos un estudio retrospectivo de 23 casos con una edad media de 63 años, diagnosticados de pie plano valgo adquirido del adulto estadio IIB de la clasificación RAM tras fallo de tratamiento ortoprotésico, valorando los resultados clínicos mediante la escala de la American Orthopaedic Foot and Ankle Society y los resultados radiológicos pre- y postoperatorios basándose en la variación de los ángulos estudiados (cobertura talonavicular y ángulo talar - 1.° metatarsiano en la proyección dorsoplantar y línea de Meary en la proyección lateral). Resultados: Los puntuación media en escala de la American Orthopaedic Foot and Ankle Society pasó de 52±10 preoperatorio a 88±6 (p<0,05). En cuanto a los resultados radiológicos, se demostró una mejoría estadísticamente significativa (p<0,05) en la variación de los ángulos en el postoperatorio. Conclusiones: La reparación de los estabilizadores mediales, asociada a técnicas óseas ofrece excelentes resultados clínico-radiológicos en el tratamiento del pie plano valgo adquirido del adulto estadio IIB.Además, las cuñas de titanio poroso presentan una adecuada integración, evitando los problemas de pinzamiento de los peroneos asociada al uso de placas y la necesidad posterior de retirada.(AU)

Background and aims: The spring ligament has paramount role in supporting the arches and its fail causes the collapse of the medial longitudinal arc, inducing adult acquired flatfoot deformity. Our aim was to analyze the clinical and radiological outcomes of spring ligament repair and titanium wedges integration used in surgical osteotomies. Material and methods: We performed a retrospective study of 23 cases with middle ages of 63, diagnosed with adult acquired flatfoot deformity stage IIB in RAM classification after ortho-prosthetic treatment failure, assessing the functional outcomes using the American Orthopedic Foot and Ankle Society scale and the radiological outcomes studying angles variation (talonavicular uncoverage, talo-first metatarsal angle and Meary axis). Results: The mean preoperative American Orthopedic Foot and Ankle Society score of the sample was 52±10 and the postoperative 88±6 (p<0.05). The radiological outcomes showed a statistically significant improvement. Conclusion: Spring ligament repair associated to bone reconstruction offers large functional and radiological outcomes to adult acquired flatfoot deformity stage IIB treatment. Titanium wedges present an excellent bone integration.(AU)

[Translated article] Surgical treatment at adult acquired flatfoot stage IIB: Spring ligament repair / Tratamiento quirúrgico del pie plano valgo adquirido del adulto en estadio IIB: papel de la reparación del «spring ligament»

Background and aims: The spring ligament has paramount role in supporting the arches and its fail causes the collapse of the medial longitudinal arc, inducing adult acquired flatfoot deformity. Our aim was to analyze the clinical and radiological outcomes of spring ligament repair and titanium wedges integration used in surgical osteotomies. Material and methods: We performed a retrospective study of 23 cases with middle ages of 63, diagnosed with adult acquired flatfoot deformity stage IIB in RAM classification after ortho-prosthetic treatment failure, assessing the functional outcomes using the American Orthopedic Foot and Ankle Society scale and the radiological outcomes studying angles variation (talonavicular uncoverage, talo-first metatarsal angle and Meary axis). Results: The mean preoperative American Orthopedic Foot and Ankle Society score of the sample was 52±10 and the postoperative 88±6 (p<0.05). The radiological outcomes showed a statistically significant improvement. Conclusion: Spring ligament repair associated to bone reconstruction offers large functional and radiological outcomes to adult acquired flatfoot deformity stage IIB treatment. Titanium wedges present an excellent bone integration.(AU)

Antecedentes y objetivos: En el desarrollo del pie plano valgo adquirido del adulto ha cobrado gran importancia el fallo de la columna medial, y no tanto la rotura del tibial posterior, siendo principalmente la lesión del ligamento en hamaca calcaneonavicular (spring ligament) el determinante del desarrollo de esta deformidad. Nuestro objetivo es analizar los resultados clínico-radiológicos de la reparación del ligamento en hamaca y valorar la utilidad e integración de las cuñas de titanio poroso en las osteotomías a las que se asocia la reparación ligamentosa. Material y métodos: Realizamos un estudio retrospectivo de 23 casos con una edad media de 63 años, diagnosticados de pie plano valgo adquirido del adulto estadio IIB de la clasificación RAM tras fallo de tratamiento ortoprotésico, valorando los resultados clínicos mediante la escala de la American Orthopaedic Foot and Ankle Society y los resultados radiológicos pre- y postoperatorios basándose en la variación de los ángulos estudiados (cobertura talonavicular y ángulo talar - 1.° metatarsiano en la proyección dorsoplantar y línea de Meary en la proyección lateral). Resultados: Los puntuación media en escala de la American Orthopaedic Foot and Ankle Society pasó de 52±10 preoperatorio a 88±6 (p<0,05). En cuanto a los resultados radiológicos, se demostró una mejoría estadísticamente significativa (p<0,05) en la variación de los ángulos en el postoperatorio. Conclusiones: La reparación de los estabilizadores mediales, asociada a técnicas óseas ofrece excelentes resultados clínico-radiológicos en el tratamiento del pie plano valgo adquirido del adulto estadio IIB.Además, las cuñas de titanio poroso presentan una adecuada integración, evitando los problemas de pinzamiento de los peroneos asociada al uso de placas y la necesidad posterior de retirada.(AU)

Surgical treatment at adult acquired flatfoot stage IIB: Spring ligament repair. / Tratamiento quirúrgico del pie plano valgo adquirido del adulto en estadio IIB: papel de la reparación del «spring ligament¼.

BACKGROUND AND AIMS: The spring ligament has paramount role in supporting the arches and its fail causes the collapse of the medial longitudinal arc, inducing adult acquired flatfoot deformity. Our aim was to analyze the clinical and radiological outcomes of spring ligament repair and titanium wedges integration used in surgical osteotomies. MATERIAL AND METHODS: We performed a retrospective study of 23 cases with middle ages of 63, diagnosed with adult acquired flatfoot deformity stage IIB in RAM classification after ortho-prosthetic treatment failure, assessing the functional outcomes using the American Orthopedic Foot and Ankle Society scale and the radiological outcomes studying angles variation (talonavicular uncoverage, talo-first metatarsal angle and Meary axis). RESULTS: The mean preoperative American Orthopedic Foot and Ankle Society score of the sample was 52±10 and the postoperative 88±6 (p<0.05). The radiological outcomes showed a statistically significant improvement. CONCLUSION: Spring ligament repair associated to bone reconstruction offers large functional and radiological outcomes to adult acquired flatfoot deformity stage IIB treatment. Titanium wedges present an excellent bone integration.

[Translated article] Surgical treatment at adult acquired flatfoot stage IIB: Spring ligament repair.

BACKGROUND AND AIMS: The spring ligament has paramount role in supporting the arches and its fail causes the collapse of the medial longitudinal arc, inducing adult acquired flatfoot deformity. Our aim was to analyze the clinical and radiological outcomes of spring ligament repair and titanium wedges integration used in surgical osteotomies. MATERIAL AND METHODS: We performed a retrospective study of 23 cases with middle ages of 63, diagnosed with adult acquired flatfoot deformity stage IIB in RAM classification after ortho-prosthetic treatment failure, assessing the functional outcomes using the American Orthopedic Foot and Ankle Society scale and the radiological outcomes studying angles variation (talonavicular uncoverage, talo-first metatarsal angle and Meary axis). RESULTS: The mean preoperative American Orthopedic Foot and Ankle Society score of the sample was 52±10 and the postoperative 88±6 (p<0.05). The radiological outcomes showed a statistically significant improvement. CONCLUSION: Spring ligament repair associated to bone reconstruction offers large functional and radiological outcomes to adult acquired flatfoot deformity stage IIB treatment. Titanium wedges present an excellent bone integration.

Perfectionism, mental health, and injuries in women footballers

El perfeccionismo es un rasgo de personalidad que en función de su carácter adpatativo o desaptativo podría afectar positiva o negativamente a la salud mental del deportista, y a su vulnerabilidad a la lesión deportiva. El objetivo de este trabajo es determinar la relación entre el perfeccionismo, indicadores de salud mental (depresión, ansiedad y estrés) y las lesiones deportivas en mujeres futbolistas. Participaron 74 jugadoras de fútbol con una edad media de 19.6±4.7 años. Para el análisis de los datos se utiñlizó un modelo de ecuaciones estructurales. Los resultados indicaron que la relación entre el perfeccionismo adaptativo respecto al estrés, la ansiedad y la depresión fue negativa. En contraste, la relación entre el perfeccionismo desadaptativo respecto al estrés, la ansiedad y la depresión fue positiva. Así mismo, el estrés, la ansiedad y la depresión se relacionaron positivamente con el número de lesiones en los dos últimos años. En conclusión, un mayor nivel de perfeccionismo adaptativo implica menores síntomas de ansiedad, estrés y depresión en mujeres futbolistas, pudiendo ser un factor de protección. Por el contrario, un mayor nivel de perfeccionismo desadaptativo conlleva niveles altos de estos síntomas. Finalmente, debido a que estos indicadores de salud mental están vinculados con las lesiones, determina una relación estadísticamente positiva entre el perfeccionismo desadaptativo y la probabilidad de lesionarse, y de carácter inverso, negativo, entre ésta y el perfeccionismo adaptativo.(AU)

Realistic retrospective dose assessments to members of the public around Spanish nuclear facilities.

In the frame of an epidemiological study carried out in the influence areas around the Spanish nuclear facilities (ISCIII-CSN, 2009. Epidemiological Study of The Possible Effect of Ionizing Radiations Deriving from The Operation of Spanish Nuclear Fuel Cycle Facilities on The Health of The Population Living in Their Vicinity. Final report December 2009. Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, Consejo de Seguridad Nuclear. Madrid. Available from: http://www.csn.es/images/stories/actualidad_datos/especiales/epidemiologico/epidemiological_study.pdf), annual effective doses to public have been assessed by the Spanish Nuclear Safety Council (CSN) for over 45 years using a retrospective realistic-dose methodology. These values are compared with data from natural radiation exposure. For the affected population, natural radiation effective doses are in average 2300 times higher than effective doses due to the operation of nuclear installations (nuclear power stations and fuel cycle facilities). When considering the impact on the whole Spanish population, effective doses attributable to nuclear facilities represent in average 3.5×10(-5)mSv/y, in contrast to 1.6mSv/y from natural radiation or 1.3mSv/y from medical exposures.

[A combined protocol using CT, CT perfusion and CT angiography for the evaluation of cerebral ischemia]. / Een gecombineerd protocol met CT, CT-perfusie en CT-angiografie in het acute stadium van cerebrale ischemie.

Computed tomography (CT) is a widely available, rapid and readily accessible technique for imaging of the brain by means of which other disorders, such as haemorrhage, can be excluded in patients with the signs of an acute cerebral infarction. Recently, CT perfusion and CT angiography have become available for this clinical application. These investigations can be performed in the same session as conventional CT, without significant delay. A combined CT protocol provides information on both cerebral perfusion and the patency of the extra- and intracranial arteries and can therefore yield valuable additional information in the diagnostic work-up and treatment of patients with acute cerebral ischaemia. Current and future research will have to determine the definitive value of these techniques in clinical practice.

Early posttraumatic subarachnoid hemorrhage due to dissecting aneurysms in three children.

Subarachnoid hemorrhage (SAH) due to a ruptured saccular aneurysm is uncommon in children. Pediatric traumatic aneurysms have been reported relatively frequently, tending to bleed after an interval of weeks after head injury. The authors describe three children with acute SAH after head injury caused by intracranial dissecting aneurysms. When head trauma in children is complicated by SAH in basal cisterns, dissecting aneurysms should be considered and treated, because rebleeding may occur.

Proton MRS imaging in the follow-up of patients with suspected low-grade gliomas.

We compared the value of changes in proton magnetic resonance spectroscopic imaging ((1)H-MRSI) with changes in clinical status and/or contrast-enhanced magnetic resonance imaging (MRI) in the monitoring of patients with suspected low-grade glioma (LGG). From June 1, 1999 till May 31, 2002, we included consecutive, neurologically intact adult patients suspected of having an LGG, demonstrating non-enhancing supratentorial lesions without edema or mass effect on MRI, and in whom all treatment (including a diagnostic biopsy) was deferred. Till January 1, 2003, patients were surveyed clinically and radiologically (contrast-enhanced MRI and (1)H-MRSI). Patients who showed progression on clinical examination and/or MRI were denoted as progressive disease. Other patients were denoted as stable disease. A decrease in NAA/CHO ratio of > or =20% compared to the baseline value was considered as indicative for progression on (1)H-MRSI. We included 14 patients with suspected LGG. Seven patients demonstrated progressive disease during the follow-up period, preceded or accompanied by concomitant (1)H-MRSI changes in five patients. Four of these five patients were operated on within the follow-up interval. The histological diagnosis demonstrated high-grade glioma in three and LGG in one patient. In the other two patients with progressive disease, no progression was found on (1)H-MRSI. The other seven patients demonstrated stable disease, but four of them showed progression on (1)H-MRSI. Our data do not show convincing evidence that (1)H-MRSI contributes to adequate monitoring and follow-up of patients with suspected LGG. Future research should preferably include pathological data at the time of (1)H-MRSI changes.

Clinical evaluation of stereotactic brain biopsies with an MKM-mounted instrument holder.

OBJECT: The aim of this study was to assess the clinical usefulness and accuracy of robot-assisted frameless stereotactic brain biopsies with a recently introduced MKM-mounted instrument holder. METHODS: Twenty-three patients with intracranial lesions participated in this study. Depending on the size of the intracranial lesion, fiducials for image-to-patient co-ordinate transformation consisted either of bone screws or adhesive markers. Shortly after surgery, postoperative MRI-imaging was performed to demonstrate the location of the biopsy site. These images were compared with the preoperative images to assess the biopsy localisation error. RESULTS: Postoperative biopsy sites could be demonstrated in six patients with bone screws and in 14 with adhesive markers. These two subgroups yielded average biopsy localisation errors of 3.3 mm (SD 1.7 mm) and 4.5 mm (SD 2.0 mm) respectively. This difference was not statistically significant. One biopsy was located in a liquefied haematoma. All others yielded pathological tissue. There were two postoperative haemorrhages, of which only one was temporarily symptomatic. There was no mortality in the first 30 days after surgery. CONCLUSIONS: Robot-assisted frameless point-stereotactic techniques represent an alternative to frame-based techniques for the performance of stereotactic biopsies.

[Symptomatic leiomyoma of the kidney: renal mass with difficult preoperative diagnosis]. / Leiomioma renal sintomático: una masa renal de difícil diagnóstico.

Renal leiomyoma is a benign mesenchymal tumour that, albeit very rare, has to be ruled out when a renal mass has been diagnosed. This tumour can arise from any organ of the genitourinary tract with smooth muscle cells, being the renal capsule the most frequent origin. As its behaviour is not aggressive, nephron-sparing surgery is indicated. However, as it is difficult to preoperatively differentiate the leiomyoma from the adenocarcinoma, the former is commonly diagnosed after examination of the entire organ surgically removed.

Acute headache as a presenting symptom of tacrolimus encephalopathy.

A 24 year old woman presented with a sudden excruciating headache mimicking an acute vascular event. She had undergone a lung transplantation because of cystic fibrosis and was receiving maintenance treatment with tacrolimus and prednisone. Ancillary investigation excluded vascular causes. Magnetic resonance imaging demonstrated hyperintense lesions in the infratentorial and parieto-occipital regions consistent with posterior leucencephalopathy syndrome. Both her clinical condition improved and the lesions disappeared completely after withdrawal of tacrolimus, suggesting that her condition could be explained by a tacrolimus encephalopathy.

Leiomioma renal sintomático: una masa renal de difícil diagnóstico / Symptomatic leiomyoma of the kidney: renal mass with difficult preoperative diagnosis

El leiomioma renal es un tumor mesenquimatoso benigno poco frecuente que, no obstante, se debe tener en cuenta ante el diagnóstico de una masa renal. Esta neoplasia puede originarse en cualquier órgano del aparato genitourinario que contenga músculo liso, siendo la cápsula renal la localización más frecuente. Dado el comportamiento benigno de la lesión, es subsidiario de la realización de una cirugía renal conservadora. No obstante, ante la dificultad para distinguirlo del adenocarcinoma, no será infrecuente que el diagnóstico se produzca tras el análisis histológico de una pieza de nefrectomía radical (AU)

Classification of thoracic and lumbar spine fractures: problems of reproducibility. A study of 53 patients using CT and MRI.

Reproducibility of fracture classification systems in general has been a matter of controversy. The reproducibility of spinal fracture classifications has not been sufficiently studied. We studied the inter-observer and intra-observer reproducibility of the Magerl (AO) classification using radiograms, CTs and MRIs of 53 patients. We compared this classification with the older and simpler Denis classification. Five observers classified the fractures, first using the radiograms and CTs and, 6 weeks later, with radiograms and MRIs. Three of the observers repeated the readings after 3 months. Three observers also classified the fractures according to Denis. Agreement was measured using Cohen's kappa test. The type (A, B, C) classification of the AO system was fairly reproducible with CTs. With MRI this was only moderate. Group subclassification of the types yielded higher kappa values, corresponding to substantial agreement. The agreement was, in general, better with the Denis classification, but the variance was higher due to the difficulty of finding proper categories for some injury patterns. Although the AO classification allows proper registration of all kinds of injury, the reproducibility, especially at the type level, is problematic. Use of MRI and better definition of the distinctive properties of the three different types may enhance the reproducibility of the scheme.

MRI of the brachial plexus in polyneuropathy associated with monoclonal gammopathy.

On magnetic resonance (MR) imaging of the brachial plexus increased signal intensity and swelling of the brachial plexus has been found in chronic inflammatory demyelinating polyneuropathy (CIDP). Whether these proximal abnormalities are also present in the distal polyneuropathy associated with monoclonal gammopathy is unknown. Therefore, we performed MR imaging of the brachial plexus in 21 patients with polyneuropathy associated with IgM monoclonal gammopathy (11 IgM with anti-MAG antibodies, 10 IgM without anti-MAG antibodies). For comparison we studied 9 patients with polyneuropathy associated with IgG monoclonal gammopathy and 8 patients with CIDP. Among the 30 patients with monoclonal gammopathy, 24 patients had demyelinating polyneuropathy. Among these 24 patients, there was increased signal intensity of the brachial plexus on the T2-weighted images regardless of whether clinical deficits were generalized or purely distal in location. No association was found with the isotype of the monoclonal gammopathy. Of the 8 patients with CIDP, 5 had brachial plexus abnormalities. None of the 6 patients with axonal polyneuropathy associated with monoclonal gammopathy had such abnormalities. Thus, MR imaging of the brachial plexus shows that the distal demyelinating polyneuropathy associated with monoclonal gammopathy is more generalized than presumed.

[Reabsorption syndrome after transurethral resection (TUR) of the prostate: review of physiologic, diagnostic, and therapeutic features]. / Síndrome de reabsorción post-resección transuretral (R.T.U.) de próstata: revisión de aspectos fisiopatológicos, diagnósticos y terapéuticos.

In spite of the development of non-invasive strategies, surgical treatment of the prostate (TURP) and, mostly transurethral resection, is the most effective choice for patients suffering from benign prostatic hyperplasia who do not respond properly to pharmacological treatment. Absorption of hypotonic fluids used during TURP may cause hemodynamic and central nervous system disturbances. These symptoms, both taken separately or as a whole, are best known as "Transurethral prostatic resection syndrome" or "TURP syndrome". The original description of this syndrome dates from half a century ago; however, a number of items regarding its physiopathology and treatment remain unclear. We present a review of this pathological entity, compiling diagnostic and therapeutical approaches.

Reproducibility of measurements of cerebral infarct volume on CT scans.

BACKGROUND AND PURPOSE: Infarct volume is increasingly used as an outcome measure in clinical trials of therapies for acute ischemic stroke. We tested which of 5 different methods to measure infarct size or volume on CT scans has the highest reproducibility. METHODS: Infarct volume and total intracranial volume were measured with Leica Q500 MCP image analysis software, or with a caliper, on 38 CT scans of patients who participated in the Tirilazad Efficacy Stroke Study II (TESS II). The scans were performed 8 days (+/-2 days) after the onset of symptoms. The 5 methods tested were based on (1) semiautomated pixel thresholding, (2) manual tracing of the perimeter, (3) a stereological counting grid, (4) measurement of the 3 largest diameters, and (5) the single largest diameter. The measurements were performed independently by 2 observers; the first observer performed all measurements twice. RESULTS: The single largest diameter did not correlate well with infarct volume. Of the other methods, manual tracing of the perimeter of the infarct had the lowest intraobserver and interobserver variability: coefficients of variation were 8.6% and 14.1%, respectively. For total intracranial volume, manual tracing also provided the highest reproducibility: intraobserver and interobserver coefficients of variation were 3.3% and 4.9%, respectively. CONCLUSIONS: Manual tracing of the perimeter is the most reproducible method for measuring the volumes of the infarct and the total intracranial space in multicenter trials of therapies for acute ischemic stroke.