Bone SPECT/CT in the Evaluation of Painful Total Ankle Replacement: Validation of Localization Scheme and Preliminary Evaluation of Diagnostic Patterns.

PURPOSE: Third-generation total ankle replacement (TAR) is an increasingly popular and effective treatment for end-stage osteoarthritis, yet identifying causes of failure remains challenging. We evaluated integrated bone SPECT/CT in recurrent pain after TAR by validating a standardized reporting scheme, identifying uptake patterns, and assessing diagnostic performance and impact on clinical management. PATIENTS AND METHODS: A total of 24 TARs in 16 patients with persistent or recurrent pain received integrated bone SPECT/CT using diagnostic CT settings. Images were retrospectively reviewed, and a novel localization scheme was validated by assessing interrater agreement. Distinct uptake patterns were identified, and diagnostic test characteristics were estimated. Reference standard consisted of clinical follow-up, laboratory findings, and subsequent procedures, including revision surgery. RESULTS: Standardized scoring of bone SPECT/CT uptake was highly reproducible (intraclass correlation coefficient, 0.79; 95% confidence interval [CI], 0.75-0.82). The final diagnoses were gutter impingement (n = 12), periprosthetic (stress) fracture (n = 5), loosening (n = 5), tarsal arthritis (n = 1), and erysipelas (n = 1). Overall, the diagnostic test characteristics of bone SPECT/CT were as follows: sensitivity of 100% (95% CI, 82%-100%), specificity of 80% (95% CI, 28%-99%), and accuracy of 96% (95% CI, 79%-100%). Gutter impingement, periprosthetic fracture, and loosening were correctly identified in all cases revealing distinct uptake patterns. Importantly, persistent diffuse uptake was frequently observed, warranting cautious interpretation. Bone SPECT/CT impacted clinical management in 86%, with symptomatic improvement in 83% of patients. CONCLUSIONS: Integrated bone SPECT/CT of painful TARs may benefit from standardized localization to reveal distinct uptake patterns representing common complications after TAR. Initial results show highly promising diagnostic value with potentially important impact on clinical management.

Vocal Tract Morphology in Inhaling Singing: Characteristics During Vowel Production-A Case Study in a Professional Singer.

BACKGROUND: A professional singer produced various vowels on a comfortable loudness and pitch in an inspiratory and expiratory phonation manner. The present study investigates the morphological differences and tries to find a link with the acoustical characteristics. OBJECTIVES/HYPOTHESIS: We hypothesize that features, constantly present over all vowels, characterize inhaling phonation and that the formant frequencies reflect the morphological findings. STUDY DESIGN: A prospective case study was carried out. METHODS: A female singer uttered the vowels /a/, /e/, /i/, /o/, and /u/ in a supine position under magnetic resonance imaging, on a comfortable loudness and pitch, in both inhaling and exhaling manner. The exact same parameters as in previous reports were measured (1-3). Acoustical analysis was performed with Praat. RESULTS: Wilcoxon directional testing demonstrates a statistically significant difference in (1) the distance between the lips, (2) the antero-posterior tongue diameter, (3) the distance between the lips and the tip of the tongue, (4) the distance between the epiglottis and the posterior pharyngeal wall, (5) the narrowing of the subglottic space, and (6) the oropharyngeal and the hypopharyngeal areas. Acoustical analysis reveals slightly more noise and irregularity during reverse phonation. The central frequency of F0 and F1 is identical, whereas that of F2 and F3 increases, and that of F4 varies. CONCLUSIONS: A smaller mouth opening, a narrowing of the subglottic space, a larger supralaryngeal inlet, and a smaller antero-posterior tongue diameter can be considered as morphological characteristics for reverse phonation. Acoustically, reverse phonation discretely contains more noise and perturbation. The formant frequency distribution concurs with a mouth narrowing and pharyngeal widening during inhaling.

Vocal Tract Morphology in Inhaling Singing: An MRI-Based Study.

OBJECTIVES/HYPOTHESIS: Inhaling singing is a recently developed singing technique explored by the soprano singer Françoise Vanhecke. It is based on an inspiratory airflow instead of an expiratory airflow. This article describes the anatomical structural differences of the vocal tract between inhaling and exhaling singing. We hypothesize that the vocal tract alters significantly in inhaling singing, especially concerning the configuration of the anatomical structures in the oral cavity and the subglottal region. STUDY DESIGN: This is a prospective study. METHODS: A professional singer (F.V.) performed sustained tones from F5 chromatically rising up to Bb5 on the vowel /a/. Vocal tract anatomy is assessed by magnetic resonance imaging. RESULTS: Wilcoxon directional testing demonstrates (1) that the vocal tract volume above the glottal region does not differ statistically in contrast to the subglottal region and (2) significant changes in the configuration of the tongue, the upright position of the epiglottis, the length of the floor of mouth, and the distance between the teeth. CONCLUSIONS: The narrowing of the subglottis is considered to be secondary to suction forces used in the inhaling singing technique. The changes in the anatomical structures above the vocal folds possibly suggest a valve-like function controlling the air inlet together with the regulator function of the resonator capacities of the vocal tract.