Development of a Radiographic Index for Periodontitis.

The use of radiographic indices is noticeably diminished due to the lack of simplicity and standardisation among the existing ones. The aim of this study was to introduce a radiographic index to aid clinicians in determining the extent and severity of interproximal alveolar bone loss (iABL), in relation to individual root lengths, among patients suffering from periodontitis. A retrospective analysis of 50 anonymised dental panoramic tomograms (DPTs) of patients with periodontitis was conducted. Visual interpretation of iABL was recorded by a single investigator and by 20 volunteering clinicians for the 'worst site' in each quintet. Results were compared to a gold standard quantification method. Intra-examiner and inter-examiner agreement were measured using the Kappa coefficient and the intra-class correlation coefficient, respectively. Validity was assessed using Cramér's V test. The mean intra-examiner agreement on the severity and pattern of iABL was 0.808 (K) and 0.802 (K), respectively. A stronger overall inter-examiner agreement was noted when the severity in contrast to the pattern of iABL and presence/absence of furcation involvement were analysed. The statistically significant total mean agreement values from this correlation coefficient were 0.892 and 0.739, respectively. A very strong association between all the visual interpretations carried out by all participants and the gold standard measurements was evident. Within the limitations of this study, the proposed radiographic index may serve as a simple, yet valid and reliable, adjunctive screening tool to further assist clinicians in determining the extent and severity of iABL in patients with periodontitis.

Natural progression of radiographic indices in juvenile hallux valgus deformity.

BACKGROUND: This study aimed to estimate the annual change in radiographic indices for juvenile hallux valgus (JHV) and to analyze the factors that influence deformity progression. METHODS: Patients aged <15 years who had JHV and were followed up for at least 1 year were included. Hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-first metatarsal angle, and lateral talo-first metatarsal angle were evaluated. The progression rate of HVA was adjusted by multiple factors by using a linear mixed model. RESULTS: A total of 133 feet were included. The HVA and distal metatarsal articular angle both increased by 0.8° per year (p<0.001 and p=0.003, respectively). HVA increased by 1.5° per year (p<0.001) at under the age of 10, and the HVA progression in the older patients was not statistically significant. CONCLUSIONS: JHV deformity could progress with aging. Most deformity progression could occur before the age of 10 years.

New Radiographic Index for Occipito-Cervical Instability.

STUDY DESIGN: Retrospective study. PURPOSE: To propose a new radiographic index for occipito-cervical instability. OVERVIEW OF LITERATURE: Symptomatic atlanto-occipital instability requires the fusion of the atlanto-occipital joint. However, measurements of occipito-cervical translation using the Wiesel-Rothman technique, Power's ratio, and basion-axial interval are unreliable because the radiologic landmarks in the occipito-cervical junction lack clarity in radiography. METHODS: One hundred four asymptomatic subjects were evaluated with lateral cervical radiographs in neutral, flexion and extension. They were stratified by age and included 52 young (20-29 years) and 52 middle-aged adults (50-59 years). The four radiographic reference points were posterior edge of hard palate (hard palate), posteroinferior corner of the most posterior upper molar tooth (molar), posteroinferior corner of the C1 anterior ring (posterior C1), and posteroinferior corner of the C2 vertebral body (posterior C2). The distance from posterior C1 and posterior C2 to the above anatomical landmarks was measured to calculate the range of motion (ROM) on dynamic radiographs. To determine the difference between the two age groups, unpaired t-tests were used. The statistical significance level was set at p<0.05. RESULTS: The ROM was 4.8±7.3 mm between the hard palate and the posterior C1, 9.9±10.2 mm between the hard palate and the posterior C2, 1.7±7.2 mm between the molar to the posterior C1, and 10.4±12.1 mm between the molar to the posterior C2. There was no statistically significant difference for the ROM between the young- and the middle-aged groups. The intra-observer reliability for new radiographic index was good. The inter-observer reliability for the ROM measured by the hard palate was low, but was better than that by the molar. CONCLUSIONS: ROM measured by the hard palate might be a useful new radiographic index in cases of occipito-cervical instability.

Anterior Compression Index for Evaluating Atlantoaxial Dislocation and Restoration / 中国神经精神疾病杂志

Objective The study was to investigate the value of deduction and application of anterior compression index in evaluation of atlantoaxial dislocation and restoration. Method Twenty-eight cases of the control group and 28 cases of atlantoaxial dislocation treated with posterior restoration and screw-rod internal fixation technique before and af?ter surgery were recruited in this study and their data was retrospectively analyzed. All of the people underwent sagittal computerized tomography scan films. The anterior compression index was measured in all cases. Results The mean value of anterior compression index of the control group was 87.86±24.98. The mean value of anterior compression index of the preoperative patients was 230.44 ± 97.60 and the mean value of the postoperative patients was 106.27 ± 73.53. There was significant difference in those two parameters between the preoperative patients and the controls(t=-7.50,P<0.0001). There was no significant difference between the postoperative patients and the control group (t=-1.26, P=0.2171). Anteri?or compression index were significantly lower after surgical operation (t=10.35, compared with before, P<0.0001). Con?clusion Anterior compression index can be an excellent measurement tool for the assessment of relationship of atlas and axis in atlantoaxial dislocation patients before and after posterior restoration operation.

New Radiographic Index for Occipito-Cervical Instability

STUDY DESIGN: Retrospective study. PURPOSE: To propose a new radiographic index for occipito-cervical instability. OVERVIEW OF LITERATURE: Symptomatic atlanto-occipital instability requires the fusion of the atlanto-occipital joint. However, measurements of occipito-cervical translation using the Wiesel-Rothman technique, Power's ratio, and basion-axial interval are unreliable because the radiologic landmarks in the occipito-cervical junction lack clarity in radiography. METHODS: One hundred four asymptomatic subjects were evaluated with lateral cervical radiographs in neutral, flexion and extension. They were stratified by age and included 52 young (20-29 years) and 52 middle-aged adults (50-59 years). The four radiographic reference points were posterior edge of hard palate (hard palate), posteroinferior corner of the most posterior upper molar tooth (molar), posteroinferior corner of the C1 anterior ring (posterior C1), and posteroinferior corner of the C2 vertebral body (posterior C2). The distance from posterior C1 and posterior C2 to the above anatomical landmarks was measured to calculate the range of motion (ROM) on dynamic radiographs. To determine the difference between the two age groups, unpaired t-tests were used. The statistical significance level was set at p<0.05. RESULTS: The ROM was 4.8+/-7.3 mm between the hard palate and the posterior C1, 9.9+/-10.2 mm between the hard palate and the posterior C2, 1.7+/-7.2 mm between the molar to the posterior C1, and 10.4+/-12.1 mm between the molar to the posterior C2. There was no statistically significant difference for the ROM between the young- and the middle-aged groups. The intra-observer reliability for new radiographic index was good. The inter-observer reliability for the ROM measured by the hard palate was low, but was better than that by the molar. CONCLUSIONS: ROM measured by the hard palate might be a useful new radiographic index in cases of occipito-cervical instability.

Correlation of clinical disease severity to radiographic thumb osteoarthritis index.

PURPOSE: To determine if a slight modification of the 1987 Eaton-Glickel staging and interpreting 4 standardized radiographs for trapeziometacarpal (TMC) osteoarthritis (OA) improved analysis, to determine if a quantifiable index measurement from a single Robert (pronated anteroposterior) view enhanced reproducibility, and to examine whether improved radiographic staging correlated to clinically relevant disease and thus support validity. METHODS: We analyzed 4 thumb radiographs (posteroanterior, lateral, Robert, and stress views) in 60 consecutive subjects representing an adult population spectrum of asymptomatic to advanced disease. Two experienced hand surgeons (A.L.L. and A.P.C.W.), 1 chief resident (A.J.B.), and 1 medical student (J.M.M.) performed the analysis on each subject's radiographs. We analyzed all 4 radiographs for Eaton and modified Eaton staging and then later analyzed only the Robert view for the thumb osteoarthritis (ThOA) index measurement. The radiographs were randomized and reread a week later for each classification at separate times. Surgically excised trapeziums from 20/60 subjects were inspected for first metacarpal surface disease and correlated to the 3 classifications. RESULTS: All 3 staging classifications demonstrated high reproducibility, with the intraclass correlation coefficient averaging 0.73 for the Eaton, 0.83 for the modified Eaton, and 0.95 for the ThOA index. Articular wear and metacarpal surface eburnation correlated highest to the ThOA index, with advanced disease 1.55 or greater correlating to Eaton III/IV and modified Eaton stage 3/4 in a linear relationship. CONCLUSIONS: The ThOA index based on a Robert view provided a measurable alternative to Eaton staging and correlated to severity of surgically relevant thumb TMC OA. CLINICAL RELEVANCE: A simple reproducible radiographic measurement may enhance TMC OA classification and provide a reliable means to predict clinical disease. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

A novel radiographic index for the diagnosis of posterior acromioclavicular joint dislocations.

BACKGROUND: Posterior acromioclavicular (AC) joint dislocations are frequently misclassified because posterior translation of the clavicle is difficult to evaluate in Zanca radiograph views. A novel radiographic index was used in this study to accurately diagnose posterior dislocations of the AC joint. HYPOTHESIS: This novel index has a high degree of accuracy for the diagnosis of posterior AC joint dislocations. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: This was an analytic, descriptive study of 150 patients with different grades of AC injuries according to the Rockwood classification (30 patients for each grade of injury: I, II, III, IV, and V). The diagnosis of an AC injury was made both clinically and radiographically by using comparative Zanca and axillary views. Two measurements were performed in Zanca views: the coracoclavicular distance and the AC width distance. A width index was calculated for each patient. The Student t test, Bonferroni test, logistic regression, linear regression, and receiver operating characteristic (ROC) curves were used for statistical analysis. Forty cases were impartially selected to obtain a κ concordance value. RESULTS: The average value of the AC width index per group (according to the Rockwood classification) was as follows: type I, 2.1% (range, -12% to 25%); type II, 4.2% (range, -19% to 29%); type III, 19.1% (range, -59% to 91%); type IV, 110.3% (range, 47% to 181%); and type V, -3.8% (range, -71% to 62%). There was a significant difference between the average width index in the patients with type IV injuries and those in the remaining groups (P < .05). The ROC curve showed that a width index of 60% has a sensitivity of 95.7% and specificity of 97.5%, with a positive predictive value of 96.7% and negative predictive value of 95.6% to predict a type IV injury. Intraobserver reliability was rated as substantial agreement for each of 3 observers; the interobserver reliability of the 3 independent raters was almost perfect. CONCLUSION: An AC width index of ≥60% is highly accurate for the diagnosis of a posterior AC joint dislocation, with high intraobserver and interobserver concordance.

Different clinical expression of patients with ankylosing spondylitis according to gender in relation to time since onset of disease. Data from REGISPONSER.

OBJECTIVE: To describe the differential characteristics by gender and time since disease onset in patients diagnosed with ankylosing spondylitis (AS) attending the Spanish rheumatology clinics, including those on the "Spanish Registry of spondyloarthritis" (REGISPONSER), as well as the diagnostic and therapeutic implications that this entails. PATIENTS AND METHODS: This is a transversal and observational study of 1514 patients with AS selected from 2367 spondyloarthritis cases included in REGISPONSER. For each patient, the demographics, epidemiology, geriatric, clinical, laboratory, radiological, and therapeutic aspects were were evaluated and comprehensively recorded under the aegis of REGISPONSER, constituting the Minimum Basic identifying data for the disease. Physical function was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI). Clinical activity was evaluated using erythrocyte sedimentation rate, C reactive protein and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Each patient underwent pelvic anteroposterior, anteroposterior and lateral lumbar spine as well as lateral cervical spine x rays; they were scored according to the Bath Ankylosing Spondylitis Spine Radiographic Index, which measures structural damage. RESULTS: Of the 1514 patients screened, 1131 (74.7%) were men. We found significant differences in age at onset of symptoms as well as in the day of inclusion, between the two groups, being lower in men. We also obtained differences in the duration of the disease, which was lower in women. As for the existence of a history of AS among first-degree relatives, family forms were more common among women. The mean BASDAI score was also higher in women, regardless of time since onset of disease. In contrast, the improvement of pain with the use of NSAID's and radiological severity were higher in men, both reaching statistical significance. CONCLUSIONS: Among the Spanish AS patients, there are some differences in the clinical manifestations, even when the time since onset of disease was controlled; we also found radiological differences by gender; men showing more structural damage, while women were more active. These data suggest that the phenotype of AS differs between genders. This can influence the subsequent diagnostic approach and therapeutic decisions.

A Radiographic Analysis of the Feet in Heel Pain / 대한족부족관절학회지

PURPOSE: This study is to compare the medial longitudinal arch between heel pain group and normal painless group. MATERIALS AND METHODS: Heel pain group 242 feet and normal group 140 feet were evaluated through the radiographic images of standing foot-ankle lateral view. Four radiographic indices, talo-1stmetatarsal angle (TMA), calcaneal-1st metatarsal angle (CMA), calcaneal pitch angle (CPA), and arch ratio (AR), were used as well as BMI. RESULTS: There was no difference between heel pain group and normal group in the TMA, CMA, CPA, and AR. But in the BMI, heel pain group showed 1.7 kg/m2 (p=0.0002) higher than normal group. To eliminate the sexual error, male and female were evaluated separately. Male heel pain group showed 2.9 degrees more dorsiflexion (p=0.001) in the TMA, 3.1 degrees greater (p=0.007) in the CMA, 0.01 lower (p=0.028) in the AR, and 1.0 kg/m2 greater (p=0.033) in the BMI than normal male group. There were no difference in the CPA. Female heel pain group showed 3.6 degree greater (p=0.035) in the CMA, and 1.9 kg/m2 greater (p=0.002) in the BMI than normal female group. But other indices demonstrated no differences. CONCLUSION: talo-1stmetatarsal angle, calcaneal-1st metatarsal angle and arch ratio were radiographic indices related with heel pain.

A Radiographic Analysis of the Feet in Heel Pain / 대한족부족관절학회지

PURPOSE: This study is to compare the medial longitudinal arch between heel pain group and normal painless group. MATERIALS AND METHODS: Heel pain group 242 feet and normal group 140 feet were evaluated through the radiographic images of standing foot-ankle lateral view. Four radiographic indices, talo-1stmetatarsal angle (TMA), calcaneal-1st metatarsal angle (CMA), calcaneal pitch angle (CPA), and arch ratio (AR), were used as well as BMI. RESULTS: There was no difference between heel pain group and normal group in the TMA, CMA, CPA, and AR. But in the BMI, heel pain group showed 1.7 kg/m2 (p=0.0002) higher than normal group. To eliminate the sexual error, male and female were evaluated separately. Male heel pain group showed 2.9 degrees more dorsiflexion (p=0.001) in the TMA, 3.1 degrees greater (p=0.007) in the CMA, 0.01 lower (p=0.028) in the AR, and 1.0 kg/m2 greater (p=0.033) in the BMI than normal male group. There were no difference in the CPA. Female heel pain group showed 3.6 degree greater (p=0.035) in the CMA, and 1.9 kg/m2 greater (p=0.002) in the BMI than normal female group. But other indices demonstrated no differences. CONCLUSION: talo-1stmetatarsal angle, calcaneal-1st metatarsal angle and arch ratio were radiographic indices related with heel pain.