A retrospective, semi-quantitative image quality analysis of cone beam computed tomography (CBCT) and MSCT in the diagnosis of distal radius fractures.

OBJECTIVE: To compare image quality and diagnostic validity of CBCT and MSCT for distal radius fractures. METHODS: 35 CBCT and 33 MSCT scans were retrospectively reviewed with a visual grading scale regarding the depiction of cortical bone, trabecular bone, articular surfaces, and soft tissue. The extent and type of artefacts was analyzed. Agreement on AO classification and measurement of cortical disruption and length of the fracture gap was determined. Fracture reduction was evaluated in post-treatment x-rays. Statistical analysis was performed with visual grading characteristics (VGC), chi square tests, and Kendall's coefficient of concordance. RESULTS: CBCT performed significantly worse for cortical bone, articular surfaces, and especially soft tissue. Trabecular bone showed no significant difference. Significantly more CBCT images showed artefacts. Physics-based artefacts were the most common. CBCT scans also showed motion artefacts. There was no significant difference in agreement on AO classification. The agreement on measurements was substantial for both modalities. Slightly more fractures that had undergone MSCT imaging showed adequate reduction. CONCLUSION: This initial study of an orthopaedic extremity CBCT scanner showed that the image quality of a CBCT scanner remains inferior for most structures at standard settings. Diagnostic validity of both modalities for distal radius fractures seems similar. KEY POINTS: • Subjectively, CBCT remains inferior to MSCT in depicting most structures. • Similar diagnostic validity for CBCT and MSCT imaging of distal radius fractures. • CBCT is a possible alternative to MSCT in musculoskeletal imaging. • Visual grading characteristics (VGC) analysis proves useful in analyzing visual grading scales.

Sonographic long-term study: paediatric growth charts for single kidneys.

AIMS: To explore the clinical course of children with "single kidney" (defined as either a solitary or single functioning kidney) with reference to renal function (glomerular filtration rate (GFR) and proteinuria), body height and particularly sonomorphological features. PATIENTS AND METHODS: This retrospective monocentric study evaluated 119 children with a solitary or single functioning kidney (>90% unilateral function on isotope scan) between 1997 and 2007. Patients were followed for 6.3 years (median, range 1-17) and had at least three renal ultrasound examinations (median 8). During recruitment six children were identified with chronic kidney disease (CKD) stage III or worse. These patients were analysed separately. RESULTS: The aetiology of "single kidney" was attributed to contralateral multicystic dysplastic kidney (26%), tumournephrectomy (24%), renal agenesis (18%), hypo/dysplasia (11%) and obstructive or refluxive uropathy (18%). Irrespective of aetiology, the sonographic dimensions of "single kidneys" were in the upper range of normal paired kidneys and showed adequate growth. Compensatory renal hypertrophy (defined as >95% CI on two or more recent measurements) occurred in a third of patients. All six patients with CKD and GFR less than 60 ml/minute per 1.73 m(2) had pathological sonomorphology of their "single kidney" with inadequate renal growth (6/6), abnormal echogenicity (5/6), hypo/dysplasia (5/6). In addition, proteinuria (5/6) and short stature (3/6) were found. CONCLUSIONS: New reference centiles were generated to assess renal size of "single kidneys" in paediatric patients. These charts will facilitate counselling of patients and parents. Further evidence for a benign clinical course of children with "single kidney" and absent additional pathology of the remnant kidney is presented.

Ceruloplasmin as a marker of neoplastic activity in rabbits bearing the VX-2 carcinoma.

The establishment of an experimental model with rabbits in which VX-2 carcinoma was implanted in the gastrocnemius muscle and subsequently successfully cured by a second tumor cell inoculation has been reported previously. Tumor growth and regression could be followed by manula palpation. The changes in serum ceruloplasmin (CP, EC 1.10.3.2) levels of individual rabbits during tumor development and regression were followed. CP levels increased 4- to 8-fold of normal during the progression of the malignant process, often before tumors could be detected by palpation. With tumor regression CP levels returned to normal. When metastasis developed, the CP levels remained high. This phenomenon seems to be related to the VX-2 carcinoma, since CP levels in rabbits challenged with various antigens and suffering from induced multiple s.c. abscesses did not change significantly, while in pregnant rabbits CP levels increased up to at most 3-fold. It is concluded that serum CP level can serve as a reliable biochemical marker of the activity of this malignant process. The practical application of this finding lies in the follow-up of malignant processes in humans and is now under investigation.

Detection of the disabled in a rural area.

A rural Jewish and Arab population of about 24,000 was selected for a rehabilitation study on the disabled. The detection consisted of the collection of existing data from local sources and a door-to-door screening based on an interview schedule. About 22,000 (93%) individuals responded to the interview. In subjects under the age of 65, the degree of agreement between the findings of the door-to-door screening and the information obtained from official local sources was 45.4% among disabled Jewish villagers, and 24% for disabled Arab villagers. On the other hand, in the same age group, the door-to-door interview failed to reveal between 12 to 18% of the subjects reported as disabled by the various local authorities. The reason for this low percentage of agreement is discussed. The disablement rate in the 0- to 13-year age group was 9% for Arab and 12.5% for Jewish children. In the working age group (14 to 64 years) the disablement rate was 5.3% for Arabs and 7.9% for Jews. More than 30% of both Arabs and Jews in this age group had impairments and chronic conditions that did not interfere with their functioning in normal life. In the pensionable age group (65+ years), 8.3% of Arab villagers and 2.3% of Jewish villagers were totally dependent. Special efforts were made to detect the functional limitations of housewives and of the homebound. The interview schedule had a marked educational effect on the professionals and on the villagers. This facilitated the establishment of a rural rehabilitation service in an Arab village, the first service of its kind in Israel.