Digital Tomosynthesis versus Conventional Radiography for Evaluating Osteonecrosis of the Femoral Head.

OBJECTIVE: The aim of this study was to compare the diagnostic performances of digital tomosynthesis (DTS) and conventional radiography in detecting osteonecrosis of the femoral head (ONFH) using computed tomography (CT), as the reference standard and evaluate the diagnostic reproducibility of DTS. MATERIALS AND METHODS: Forty-five patients (24 male and 21 female; age range, 25-77 years) with clinically suspected ONFH underwent anteroposterior radiography, DTS, and CT. Two musculoskeletal radiologists independently evaluated the presence and type of ONFH. The diagnostic performance of radiography and DTS in detecting the presence of ONFH and determining the types of ONFH were evaluated. The interobserver and intraobserver reliabilities of each imaging modality were analyzed using Cohen's kappa. RESULTS: DTS had higher sensitivity (89.4%-100% vs. 74.5%-76.6%) and specificity (97.3%-100% vs. 78.4%-83.8%) for ONFH detection than radiography. DTS showed higher performance than radiography in identifying the subtypes of ONFH with statistical significance in one reader (type 1, 100% vs. 30.8%, p = 0.004; type II, 97.1% vs. 73.5%, p = 0.008). The interobserver agreement was excellent for DTS and moderate for radiography (kappa of 0.86 vs. 0.57, respectively). The intraobserver agreement for DTS was higher than that of radiography (kappa of 0.96 vs. 0.69, respectively). CONCLUSION: DTS showed higher diagnostic performance and reproducibility than radiography in detecting ONFH. DTS may be used as a first-line diagnostic modality instead of radiography for patients suspected of having ONFH.

Quantification of the Elastic Property of Normal Thigh Muscles Using MR Elastography: Our Initial Experience.

Purpose: This study aimed to apply MR elastography (MRE) to achieve in vivo evaluation of the elastic properties of thigh muscles and validate the feasibility of quantifying the elasticity of normal thigh muscles using MRE. Materials and Methods: This prospective study included 10 volunteer subjects [mean age, 32.5 years, (range, 23-45 years)] who reported normal activities of daily living and underwent both T2-weighted axial images and MRE of thigh muscles on the same day. A sequence with a motion-encoding gradient was used in the MRE to map the propagating shear waves in the muscle. Elastic properties were quantified as the shear modulus of the following four thigh muscles at rest; the vastus medialis, vastus lateralis, adductor magnus, and biceps femoris. Results: The mean shear modulus was 0.98 ± 0.32 kPa and 1.00 ± 0.33 kPa for the vastus medialis, 1.10 ± 0.46 kPa and 1.07 ± 0.43 kPa for the vastus lateralis, 0.91 ± 0.41 kPa and 0.93 ± 0.47 kPa for the adductor magnus, and 0.99 ± 0.37 kPa and 0.94 ± 0.32 kPa for the biceps femoris, with reader 1 and 2, respectively. No significant difference was observed in the shear modulus based on sex (p < 0.05). Aging consistently showed a statistically significant negative correlation (p < 0.05) with the shear modulus of the thigh muscles, except for the vastus medialis (p = 0.194 for reader 1 and p = 0.355 for reader 2). Conclusion: MRE is a quantitative technique used to measure the elastic properties of individual muscles with excellent inter-observer agreement. Age was consistently significantly negatively correlated with the shear stiffness of muscles, except for the vastus medialis.

[Ossification of the Transverse Ligament of the Atlas on CT: Frequency and Associated Findings]. / CT를 이용한 환추횡인대 골화증의 빈도와 연관 소견.

Purpose: To determine the frequency of ossification of the transverse ligament of the atlas (OTLA) and to investigate the associated findings on cervical spine CT and plain radiography. Materials and Methods: We reviewed 5201 CT scans of the cervical spine of 3975 consecutive patients over an 11-year period for the presence of OTLA and compared them with those of age- and sex-matched controls. The frequency and associated findings of OTLA were investigated and statistically correlated. Results: The overall frequency of OTLA was 1.1% (45 of 3975 patients) and increased with age (p < 0.005). The frequency of OTLA in patients over 80 years was 12%. The space available for the spinal cord (SAC) was smaller in patients with OTLA (p < 0.005). Mineralization of the complex of the anterior atlantooccipital membrane and Barkow ligament, ossification of the ligamentum flavum, and kyphosis of the cervical spine positively correlated to the presence of OTLA (p < 0.005). Conclusion: OTLA was associated with age, SAC narrowing, cervical kyphosis, and ossification of other cervical ligaments and may be associated with degenerative spondylosis, systemic hyperostotic status, or mechanical stress or instability.

The feasibility of shear wave elastography for diagnosing superficial benign soft tissue masses.

PURPOSE: The purpose of this study was to investigate the feasibility of shear wave ultrasound elastography for differentiating superficial benign soft tissue masses through a comparison of their shear moduli. METHODS: We retrospectively analyzed 48 masses from 46 patients from February 2014 to May 2016. Surgical excision, fine-needle aspiration, and clinical findings were used for the differential diagnosis. The ultrasonographic examinations were conducted by a single musculoskeletal radiologist, and the ultrasonographic findings were reviewed by two other radiologists who were blinded to the final diagnosis. Conventional ultrasonographic features and the median shear modulus were evaluated. We compared the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors using the Kruskal-Wallis test. Additionally, the Mann-Whitney U test was used to compare two distinct groups. RESULTS: Significant differences were found in the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors (23.7, 5.8, and 9.2 kPa, respectively; P=0.019). Epidermoid cysts showed a greater median shear modulus than ganglion cysts (P=0.014) and lipomatous tumors (P=0.049). CONCLUSION: Shear wave elastography may contribute to the differential diagnosis of superficial benign soft tissue masses through a direct quantitative analysis.

Biological function integrated prediction of severe radiographic progression in rheumatoid arthritis: a nested case control study.

BACKGROUND: Radiographic progression is reported to be highly heritable in rheumatoid arthritis (RA). However, previous study using genetic loci showed an insufficient accuracy of prediction for radiographic progression. The aim of this study is to identify a biologically relevant prediction model of radiographic progression in patients with RA using a genome-wide association study (GWAS) combined with bioinformatics analysis. METHODS: We obtained genome-wide single nucleotide polymorphism (SNP) data for 374 Korean patients with RA using Illumina HumanOmni2.5Exome-8 arrays. Radiographic progression was measured using the yearly Sharp/van der Heijde modified score rate, and categorized in no or severe progression. Significant SNPs for severe radiographic progression from GWAS were mapped on the functional genes and reprioritized by post-GWAS analysis. For robust prediction of radiographic progression, tenfold cross-validation using a support vector machine (SVM) classifier was conducted. Accuracy was used for selection of optimal SNPs set in the Hanyang Bae RA cohort. The performance of our final model was compared with that of other models based on GWAS results and SPOT (one of the post-GWAS analyses) using receiver operating characteristic (ROC) curves. The reliability of our model was confirmed using GWAS data of Caucasian patients with RA. RESULTS: A total of 36,091 significant SNPs with a p value <0.05 from GWAS were reprioritized using post-GWAS analysis and approximately 2700 were identified as SNPs related to RA biological features. The best average accuracy of ten groups was 0.6015 with 85 SNPs, and this increased to 0.7481 when combined with clinical information. In comparisons of the performance of the model, the 0.7872 area under the curve (AUC) in our model was superior to that obtained with GWAS (AUC 0.6586, p value 8.97 × 10-5) or SPOT (AUC 0.7449, p value 0.0423). Our model strategy also showed superior prediction accuracy in Caucasian patients with RA compared with GWAS (p value 0.0049) and SPOT (p value 0.0151). CONCLUSIONS: Using various biological functions of SNPs and repeated machine learning, our model could predict severe radiographic progression relevantly and robustly in patients with RA compared with models using only GWAS results or other post-GWAS tools.

Predictors of severe radiographic progression in patients with early rheumatoid arthritis: A Prospective observational cohort study.

AIM: To identify predictors of severe radiographic progression in patients with early rheumatoid arthritis (ERA). METHODS: A total of 374 patients with ERA were selected from a Korean prospective cohort. Based on their annual Sharp/Van der Heijde modified score changes (ΔSHS/year), patients were classified into severe and no progression groups. Predictors of severe progression were evaluated using a multivariable logistic regression. RESULTS: After a mean follow-up duration of 4.2 years, the median (interquartile range) ΔSHS/year were 6.3 (4.4-10.2) and 0 (0-0) in the severe and no progression groups, respectively. Multivariable regression model revealed that Health Assessment Questionnaire (HAQ) score (odds ratio [OR] = 2.17), anticyclic citrullinated peptide antibody (OR = 3.44), body mass index (BMI; OR = 0.88), 6-month cumulative erythrocyte sedimentation rate (OR = 1.01) and baseline SHS (OR = 1.07) were independent predictors of severe progression. A model incorporating all five predictors satisfactorily predicted severe progression, with an area under the curve of 0.80. Baseline SHS was the predictor with the highest contribution to the predictive power of the final model (38%). CONCLUSIONS: Our predictive model composed of five clinical predictors showed high discriminative ability between severe and no radiographic progression in patients with ERA. Among them, baseline SHS was the strongest predictor. Also, low BMI in Korean patients with ERA have a high risk of severe radiographic progression, as has previously been found for Caucasians.

Sonographic Differentiation Between Schwannomas and Neurofibromas in the Musculoskeletal System.

OBJECTIVES: The purpose of this study was to determine key features and define a strategy for differentiation between schwannomas and neurofibromas using sonography. METHODS: This retrospective study was approved by the Institutional Review Board at our hospital, and informed consent was waived. We reviewed sonograms of pathologically proven schwannomas and neurofibromas of the extremities and body wall. On grayscale images, tumors were evaluated on the basis of their size, maximum-to-minimum diameter ratio, shape, contour, margin, location, encapsulation, echogenicity, echo texture, cystic changes, presence of intratumoral calcifications, presence of a target sign, and presence of an entering or exiting nerve. If an entering or exiting nerve was identified, the nerve-tumor position and nerve-tumor transition were characterized. On color Doppler images, the presence and amount of vascularity were evaluated. Student t tests were used for analysis of continuous variables (size, maximum-to-minimum diameter ratio, and age); χ(2) and Fisher exact tests were used for analysis of categorical variables. RESULTS: A total of 146 pathologically proven tumors, including 115 schwannomas and 31 neurofibromas of the extremities and body wall, were included. The maximum diameter, maximum-to-minimum diameter ratio, contour, cystic portion, nerve-tumor position, nerve-tumor transition, and vascularity were significantly different in schwannomas versus neurofibromas (P < .05), and a lobulated contour, fusiform shape, and hypovascularity of neurofibromas could be helpful for differentiation when a prediction model is considered. The nerve-tumor position, nerve-tumor transition, and maximum-to-minimum diameter ratio were also significantly different between groups (P < .05) and thus could be useful for differentiation of neurogenic tumors. CONCLUSIONS: Sonographic findings are helpful in differentiating between schwannomas and neurofibromas.

Sarcopenia as a useful predictor for long-term mortality in cirrhotic patients with ascites.

This study aimed to assess and compare sarcopenia with other prognostic factors for predicting long-term mortality in cirrhotic patients with ascites. Clinical data of 65 among 89 patients with measurement of all parameters were consecutively collected. Sarcopenia was evaluated as right psoas muscle thickness measurement divided by height (PMTH) (mm/m). During a mean follow-up of 20 (range: 1-49) months, 19 (29.2%) of 65 patients died. The values of the area under the receiver operating characteristics curve (AUROC) of Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, MELD-Na, and PMTH for predicting 1-yr mortality were 0.777 (95% CI, 0.635-0.883), 0.769 (95% CI, 0.627-0.877), 0.800 (95% CI, 0.661-0.900), and 0.833 (95% CI, 0.699-0.924), whereas hepatic venous pressure gradient was not significant (AUROC, 0.695; 95% CI. 0.547-0.818, P=0.053). The differences between PMTH and other prognostic variables were not significant (all P>0.05). The best cut-off value of PMTH to predict long-term mortality was 14 mm/m. The mortality rates at 1-yr and 2-yr with PMTH>14 mm/m vs. PMTH≤14 mm/m were 2.6% and 15.2% vs. 41.6% and 66.8%, respectively (P<0.001). The mortality in cirrhotic patients with PMTH≤14 mm/m was higher than those with PMTH>14 mm/m (HR, 5.398; 95% CI, 2.111-13.800, P<0.001). In conclusion, sarcopenia, evaluated by PMTH, is an independent useful predictor for long-term mortality in cirrhotic patients with ascites.

How to evaluate appendices with borderline diameters on CT: proposal of a quick solution to overcome the limitations of the established CT criteria.

RATIONALE AND OBJECTIVES: To propose a useful computed tomography (CT) criterion, the diameter with compression (DWC), especially in appendices with borderline diameters. MATERIALS AND METHODS: We retrospectively collected 216 patients with visible appendices on CT after clinicopathologic confirmation of appendicitis. Each CT criterion of appendicitis was evaluated by an experienced abdominal radiologist: maximal outer diameter (MOD), DWC, mural thickness and enhancement, periappendiceal infiltration, and appendicolith. DWC is the expected diameter after deduction of the intraluminal compressible contents such as air and feces. All the CT criteria were compared in the appendicitis and nonappendicitis group. RESULTS: The areas under the receiver operating characteristic curve (AUC) of the MOD and the DWC were 0.967 and 0.973, respectively. The optimal cutoff value was 8.2 mm for the MOD and 6.6 mm for the DWC. Twenty-five of the 80 appendicitis patients (31.2%) and 62 of the 136 nonappendicitis patients (45.6%) had MODs between 5.7 mm and 9.8 mm in the overlap between the two groups. In this overlap, the AUC of the MODs declined sharply to 0.767, whereas the AUC of the DWCs remained 0.923. Use of the criterion of DWC >6.6 mm yielded a sensitivity of 84.0%, a specificity of 88.7%, and an accuracy of 87.4%. There were no other criteria with both sensitivity and specificity >80% in the range of overlap. CONCLUSIONS: The proposed CT criterion of the DWC is not affected by normal distension or periappendiceal inflammation but only by true appendicitis. Therefore, DWC can improve the diagnostic performance of appendicitis regardless of the MOD.

The influence of vertebral fracture on the functional disability of patients with rheumatoid arthritis.

The aim of the present study was to identify the influence of vertebral fracture (VF) on the functional disability in patients with rheumatoid arthritis (RA). This study consecutively enrolled 100 female patients aged 50 yr or older with RA. All participants underwent lateral imaging of the thoracolumbar spine by simple radiography to identify any VFs. They also completed questionnaires via interview regarding demographics, medical history, and disease outcomes including functional disability. We used univariate analysis to evaluate associations between functional disability and VF, and made multivariate logistic regression models to test independent effect of the presence of VF, the number of VFs, and the severity of VF on functional disability. Among the 100 RA patients, 47 had at least one VF, but 34 of them were asymptomatic that they had experienced a fracture. The multiple VFs ≥ 3 (OR, 8.95; 95% CI, 1.77-44.15, P = 0.01) and moderate or severe VF (OR, 3.38; 95% CI, 1.26-9.04, P = 0.02) were related to disability in univariate analysis. The multiple VFs ≥ 3 (OR, 6.13; 95% CI, 1.02-36.94, P = 0.048) was associated with functional disability of RA patients after adjusting various confounders and it was mainly in walking and arising. The VF might be an important factor which affects functional disability in RA patients.

Nondiseased liver stiffness measured by shear wave elastography: a pilot study.

OBJECTIVES: The purpose of this study was to investigate the value of liver stiffness in patients without liver disease using shear wave elastography and to determine the liver stiffness threshold value for identifying patients with chronic liver diseases. METHODS: A total of 150 patients who underwent liver sonography coupled with shear wave elastography were enrolled. On the basis of clinical and pathologic criteria, they were assigned to 1 of 2 groups: nondiseased liver (n = 97) and noncirrhotic chronic liver disease (n = 53). Liver stiffness was measured in the right liver, and the median value of 10 measurements was calculated. Both mean and median values in the nondiseased liver group were compared with those in the noncirrhotic chronic liver disease group. To validate this comparison, liver stiffness of the patients who underwent liver biopsy revealing either no fibrosis (fibrosis score F0; n = 5) or substantial fibrosis (F2; n = 14) was also investigated and compared. To determine the optimal threshold value for determining chronic liver disease, a receiver operating characteristic curve analysis was performed. RESULTS: The mean liver stiffness value in the nondiseased liver group was 5.4 kPa. In the noncirrhotic chronic liver disease group, the mean value was 8.1 kPa. Differences between the nondiseased liver and both noncirrhotic chronic liver disease groups were statistically significant (P < .001). The optimal liver stiffness threshold value for discriminating nondiseased liver from noncirrhotic chronic liver disease was 6.9 kPa. The sensitivity using this threshold was 94%. In the biopsy-proven patients, the mean liver stiffness values were 6.0 kPa in the F0 group and 9.9 kPa in the F2 group. CONCLUSIONS: The range of liver stiffness in patients with nondiseased liver and the optimal threshold value for discriminating these patients from those with chronic liver disease were identified.

Validity and role of vertebral fracture assessment in detecting prevalent vertebral fracture in patients with rheumatoid arthritis.

OBJECTIVES: We aimed to identify the validity and the role of vertebral fracture assessment (VFA) for the diagnosis of prevalent vertebral fracture (VF) in rheumatoid arthritis (RA) patients. METHODS: Total of 100 women with RA who were 50 years or older were enrolled. All participants underwent lateral imaging of the thoraco-lumbar spine by radiography and VFA. All radiographs were analyzed by two radiologists. Discrepancies between radiologists for spine radiography were resolved by consensus and these results were defined as the reference standard. VFA interpretation was done independently by two nuclear medicine physicians. Fracture defined by VFA measure was done only when two physicians both independently reported fracture. The inter-rater agreement for the detection of VF on VFA was evaluated by kappa statistics. We calculated percent values for the diagnostic validity of VFA in detecting VF in the 100 women as a whole and according to the presence of previous fracture or back pain. RESULTS: The prevalence of VF identified by spine radiography was 47%. Inter-rater agreement of VFA per vertebra by two VFA readers showed moderate agreement (kappa=0.60). The sensitivity, PPV, specificity and NPV of VFA compared to spine radiography were 57.3%, 30.9%, 89.1% and 96.1% for total vertebrae. All patients with history of previous VF (n=13) were visualized with VFA with 100% sensitivity but it has 64.7% sensitivity and 79.3% specificity in patients without previous VF (n=87). CONCLUSION: VFA is most useful to identify patients without VF because of its high specificity and NPV in all spine level.

Detection of prefracture hip lesions in atypical subtrochanteric fracture with dual-energy x-ray absorptiometry images.

PURPOSE: To retrospectively assess how often and how early hip dual-energy x-ray absorptiometry (DXA) images show prefracture lesions in patients with atypical subtrochanteric fracture (ASF) and determine whether DXA images with assessment of prodromal symptoms could be used for early ASF prediction. MATERIALS AND METHODS: The retrospective research protocol complied with HIPAA and was institutional review board approved, with waiver of informed consent. Among 62 women with ASF, nine without hip DXA images and seven without clear documentation of prodromal symptoms were excluded. Serial DXA images of 52 hips in 46 patients were included. Among them, 33 hips were assessed with ipsilateral DXA. For this ipsilateral group, each hip was assessed for prodromal symptoms and focal cortical changes in the lateral subtrochanteric femur cortex at DXA. Overall and cumulative detection rates for prodromal symptoms, DXA, and DXA with prodromal symptoms were measured and compared with a general linear model for overall detection rate and Cox proportional hazard models for cumulative detection rate. Thirty-three representative ipsilateral images and 199 images from subjects without fractures were reviewed in random order for prefracture lesions by three musculoskeletal radiologists independently, and the performance of DXA in ASF prediction was assessed. RESULTS: Overall detection rates for DXA, prodromal symptoms, and DXA with prodromal symptoms were 61% (20 of 33), 42% (14 of 33), and 73% (24 of 33), respectively, in the ipsilateral group. Overall detection rate comparisons showed that DXA with prodromal symptoms was superior to prodromal symptoms alone (P = .0377). The cumulative detection rate curve for DXA with prodromal symptoms was also superior to that of prodromal symptoms alone (P = .0018). Sensitivity and specificity of DXA in ASF prediction ranged from 52% (17 of 33) to 58% (19 of 33) and 99% (197 of 199) to 100% (199 of 199), respectively. CONCLUSION: Assessment of hip DXA images combined with conventional assessment of prodromal symptoms enables detection of more ASFs earlier than assessment based on prodromal symptoms alone.

The effect of zoledronic acid on the volume of the fusion-mass in lumbar spinal fusion.

BACKGROUND: Few studies have explored the effects of bisphosphonates on bony healing in patients undergoing spinal fusion surgery. Most previous studies used animal models and found that bisphosphonate shows negative effects on spinal fusion consolidation. We intended to evaluate the effect of a single-dose of zoledronic acid on the volume of the fusion-mass in lumbar spinal fusion. METHODS: A retrospective review was carried out on 44 patients with symptomatic degenerative lumbar spinal stenosis who underwent one or two-level posterolateral fusion from January 2008 and January 2011. They were divided into 4 groups: group 1, autograft and zoledronic acid; group 2, allograft and zoledronic acid; group 3, autograft alone; and group 4, allograft alone. Functional radiography and three-dimensional computed tomography scans were used to evaluate and quantify the volume of the fusion-mass. The visual analog scale (VAS), the Oswestry disability index (ODI), and the short form 36 (SF-36) were used to evaluate the clinical outcomes. RESULTS: The mean volume of the fusion-mass per level was 8,814 mm(3), 8,035 mm(3), 8,383 mm(3), and 7,550 mm(3) in groups 1, 2, 3, and 4, respectively, but there were no significant differences between the groups (p = 0.829). There were no significant decreases in the volume of the fusion-mass (p = 0.533) in the zoledronic acid groups (groups 1 and 2). The VAS, the ODI, and the SF-36 at the 6-month follow-up after surgery were not significantly different (p > 0.05) among the 4 groups. The VAS, the ODI, and the SF-36 were not correlated with the volume of the fusion-mass (p = 0.120, 0.609, 0.642). CONCLUSIONS: A single dose of zoledronic acid does not decrease the volume of the fusion-mass in patients undergoing spinal fusion with osteoporosis. Therefore, we recommend that zoledronic acid may be used after spinal fusion in osteoporotic patients.

Determination of optimal imaging mode for ultrasonographic detection of subdermal contraceptive rods: comparison of spatial compound, conventional, and tissue harmonic imaging methods.

OBJECTIVE: To determine which mode of ultrasonography (US), among the conventional, spatial compound, and tissue-harmonic methods, exhibits the best performance for the detection of Implanon® with respect to generation of posterior acoustic shadowing (PAS). MATERIALS AND METHODS: A total of 21 patients, referred for localization of impalpable Implanon®, underwent US, using the three modes with default settings (i.e., wide focal zone). Representative transverse images of the rods, according to each mode for all patients, were obtained. The resulting 63 images were reviewed by four observers. The observers provided a confidence score for the presence of PAS, using a five-point scale ranging from 1 (definitely absent) to 5 (definitely present), with scores of 4 or 5 for PAS being considered as detection. The average scores of PAS, obtained from the three different modes for each observer, were compared using one-way repeated measure ANOVA. The detection rates were compared using a weighted least square method. RESULTS: Statistically, the tissue harmonic mode was significantly superior to the other two modes, when comparing the average scores of PAS for all observers (p < 0.00-1). The detection rate was also highest for the tissue harmonic mode (p < 0.001). CONCLUSION: Tissue harmonic mode in uS appears to be the most suitable in detecting subdermal contraceptive implant rods.

Evaluation of the chondromalacia patella using a microscopy coil: comparison of the two-dimensional fast spin echo techniques and the three-dimensional fast field echo techniques.

OBJECTIVE: We wanted to compare the two-dimensional (2D) fast spin echo (FSE) techniques and the three-dimensional (3D) fast field echo techniques for the evaluation of the chondromalacia patella using a microscopy coil. MATERIALS AND METHODS: Twenty five patients who underwent total knee arthroplasty were included in this study. Preoperative MRI evaluation of the patella was performed using a microscopy coil (47 mm). The proton density-weighted fast spin echo images (PD), the fat-suppressed PD images (FS-PD), the intermediate weighted-fat suppressed fast spin echo images (iw-FS-FSE), the 3D balanced-fast field echo images (B-FFE), the 3D water selective cartilage scan (WATS-c) and the 3D water selective fluid scan (WATS-f) were obtained on a 1.5T MRI scanner. The patellar cartilage was evaluated in nine areas: the superior, middle and the inferior portions that were subdivided into the medial, central and lateral facets in a total of 215 areas. Employing the Noyes grading system, the MRI grade 0-I, II and III lesions were compared using the gross and microscopic findings. The sensitivity, specificity and accuracy were evaluated for each sequence. The significance of the differences for the individual sequences was calculated using the McNemar test. RESULTS: The gross and microscopic findings demonstrated 167 grade 0-I lesions, 40 grade II lesions and eight grade III lesions. Iw-FS-FSE had the highest accuracy (sensitivity/specificity/accuracy = 88%/98%/96%), followed by FS-PD (78%/98%/93%, respectively), PD (76%/98%/93%, respectively), B-FFE (71%/100%/93%, respectively), WATS-c (67%/100%/92%, respectively) and WATS-f (58%/99%/89%, respectively). There were statistically significant differences for the iw-FS-FSE and WATS-f and for the PD-FS and WATS-f (p < 0.01). CONCLUSION: The iw-FS-FSE images obtained with a microscopy coil show best diagnostic performance among the 2D and 3D GRE images for evaluating the chondromalacia patella.

A comparison of the diagnostic performances of visceral organ-targeted versus spine-targeted protocols for the evaluation of spinal fractures using sixteen-channel multidetector row computed tomography: is additional spine-targeted computed tomography necessary to evaluate thoracolumbar spinal fractures in blunt trauma victims?

BACKGROUND: It remains to be determined whether spine-targeted computed tomography (thoracolumbar spine computed tomography [TLS-CT]) images and visceral organ-targeted CT (abdominopelvic [AP]-CT) images are comparable for the evaluation of thoracolumbar spinal fractures using 16-channel multidetector row CT. The elimination of an additional spine-targeted CT protocol would substantially reduce time, the storage burden, and potential patient radiation exposure. METHODS: A total of 420 vertebrae in 72 consecutive patients who underwent AP-CT to assess blunt traumatic injury and an additional CT examination using a TLS-CT protocol to evaluate spinal fractures were retrospectively evaluated. The AP-CT set (set A, reconstructed with using a wide display field of view [FOV] and a soft algorithm) and the TLS-CT set (set S, reconstructed using a narrow display FOV and a hard algorithm) were composed of axial plus reformatted sagittal or coronal images or both. Three radiologists independently reviewed all CT data retrospectively. Performances for detecting and typing fractures were compared by using areas under receiver operating characteristic curves and by determining concordance rates. RESULTS: The overall areas under the curves for sets S and A for fracture detection were 0.996 and 0.995, respectively; no significant difference was found between the two sets. Concordance rates for typing performance also showed no statistical significance between the two sets for any of the three observers. CONCLUSION: Sixteen-channel multidetector row CT images reconstructed using a soft algorithm and a wide display FOV that cover the entire abdomen using a visceral organ-targeted protocol with 1.5-mm collimation are sufficient for the evaluation of spine fractures in trauma patients, given that multiplanar-reformatted images are provided.