Advanced Diagnostic Imaging Research Articles

An update on gnathic pathology.

An update on gnathic pathology.

Advances in diagnostic imaging for pathologic conditions of the jaws.

Advances in dental and maxillofacial imaging are delineated along with the advantages and disadvantages of each imaging modality. The imaging modalities that are included are intraoral radiography, panoramic radiography, cone-beam computed tomography, multidetector computed tomography, magnetic resonance imaging, nuclear medicine, and ultrasound.

Multiple Extensive Complex Odontomas of the Jaws

Odontomas are odontogenic tumors occurring in the oral cavity. They are composed of dental tissues namely enamel, dentin, cementum and pulp and are mostly discovered on routine radiographic examination owing to their benign and asymptomatic nature. Not many cases of odontomas erupting into the oral cavity are reported. An extensive survey of English literature revealed ten cases of erupted compound odontomas, and the present paper reports a case of a multiple symptomatic erupted complex odontomas of unusually large size involving both the jaws and the maxillary sinus in a 13-year-old male patient. Clinical and radiological examination using conventional and advanced diagnostic imaging with CT revealed an abnormally large radio-opaque mass, the density of which resembled enamel/bone occupying both the jaws and maxillary sinuses bilaterally. Diagnosis of odontoma was made which was confirmed histopathologically. Complete excision of the lesion with lining involving whole of maxillary sinus bilaterally and from the mandibular anterior region was done. Post operative period was uneventful with no evidence of recurrence.

Quantifying synovial inflammation by imaging techniques

The past few decades have witnessed dramatic changes and advances in diagnostic imaging. In the field of arthritis, these changes have contributed to enhance the diagnostic accuracy and to conduct serial monitoring of synovial inflammation without synovial biopsy. Advanced imaging techniques employ target-specific probes to non-invasively assess molecular, cellular, and physiological abnormalities associated with the underlying pathology. Dynamic and diffusion magnetic resonance imaging (MRI) are being developed to evaluate the discrete aspects of specific inflammatory and destructive pathways of inflammatory arthritis. These newer imaging modalities provide an earlier and more reliable assessment of clinical outcome, disease activity, severity, location, and therapeutic response. These techniques will be incorporated soon in routine clinical practice, and their adoption may enable clinicians to measure the treatment response and tailor the therapeutic interventions accordingly. In this review, we have attempted to summarize the emerging non-invasive imaging techniques and their application in quantifying synovial inflammation.

Intraosseous Fifth Carpometacarpal Dislocation Associated with a Coronal Hamate Fracture: A Case Report.

Fractures of the hamate are relatively uncommon, accounting for approximately 2% to 7% of all carpal bone fractures, with injuries of the hamate body being the most rare variant1,2. These injuries typically are referred to as hamatometacarpal fracture-dislocations when associated with fracture-dislocations of the fourth and/or fifth metacarpals, as is often the case3,4. The original classification system of hamatometacarpal dislocations was developed by Cain et al. and was based on the orientation of the hamate fracture line3. Coronal fractures of the hamate body were identified as type-III injuries (Table I); however, this classification system was limited by its definition that hamatometacarpal fracture-dislocation includes a fracture of the fourth metacarpal as well as a fifth carpometacarpal (CMC) injury3. Advances in diagnostic imaging have allowed for more accurate assessment of injuries to the hamatometacarpal complex, which has resulted in the development of novel classification systems. These new classification systems have focused on more specific features of these injuries, such as the presence of metacarpal base fractures and the size of the intra-articular hamate fracture fragment (Table I)4,5. View this table: TABLE I Classification Systems for Hamatometacarpal Fracture-Dislocation* Treatment options for coronal fractures of the hamate range from conservative immobilization to operative internal fixation with Kirschner wires and/or interfragmentary screw fixation. To date, treatment guidelines have largely been based on individual case reports or small case series6. Wharton et al. suggested that any displaced coronal fractures of the hamate or coronal fractures associated with metacarpal subluxation or fracture should be treated with open reduction and internal fixation to reduce the incidence of CMC subluxation6. We describe a coronal plane cleavage fracture of the hamate with intraosseous impaction of the fifth metacarpal base proximally into the hamate, …

Association Between ‘Wind‐Test’ Findings and Resting Endoscopic Assessment of Laryngeal Function at Thoroughbred Public Auction in the UK

Reasons for performing studyDespite ongoing advances in diagnostic imaging, ‘wind‐testing’ remains the most common screening test for upper respiratory tract obstructions and is an important condition of sale at Thoroughbred public auctions in UK/Europe. Correlations between abnormal respiratory noise and resting laryngeal function have been incompletely investigated to date.ObjectivesTo determine whether associations exist between respiratory noise at lunge and subsequent diagnosis of recurrent laryngeal neuropathy (RLN).Study designRetrospective analysis of records for all post sale wind‐testing undertaken by a single veterinary practice at Tattersalls Newmarket yearling, breeze‐up and horse‐in‐training sales between 2009 and 2013.MethodsDescriptions of abnormal respiratory noise were categorised as ‘inspiratory whistle’, ‘inspiratory harsh’ or ‘pan‐respiratory harsh’, and included lunge direction during which noise was evident. Concurrent examination by 2 veterinary surgeons was a criterion for inclusion of cases. All horses making abnormal respiratory noises underwent resting endoscopy with a consensus score (Lane scale) given for laryngeal function.Results2972 horses underwent post sale wind‐testing and 418 horses (14.1%) underwent resting endoscopic examination due to abnormal respiratory noise. Likelihood of making an abnormal respiratory noise differed significantly between groups (yearlings 10.8%, ‘breeze‐up’ 2‐year‐olds 20.6%, horses‐in‐training 30.1%). Yearlings were significantly more likely (P<0.0001, Chi‐squared/Bonferroni test) to make a ‘harsh’ respiratory noise than horses‐in‐training. Type of noise (whistle) was significantly associated with resting endoscopic evidence of RLN in yearlings (P = 0.009); specificity of ‘whistle’ for RLN in this group was 38.6%. There was no association between lunge direction noise (left, right or both) and RLN.ConclusionsThese results support the widespread belief that harsh respiratory noise when lunged of presumed ‘palatal/pharyngeal’ origin is more likely in yearlings than horses‐in‐training, possibly due to upper respiratory inflammation or immaturity. Inspiratory whistle in both lunge directions is no stronger an indicator of RLN than unidirectional whistle.Ethical animal research: Ethical committee oversight not currently required by this congress: retrospective study of clinical records. Explicit owner informed consent for participation in this study was not stated. Sources of funding: None. Competing interests: None.

An appeal for safe and appropriate imaging of children.

DO YOU AGREE?○ That our nation’s children deserve safe and appropriate medical imaging.○ That when used properly, medical imaging is lifesaving.○ That there are risks to almost every aspect of health care. For medical imaging, one of the risks includes exposing children to radiation.○ That parents m

The association between advanced diagnostic imaging and ED length of stay

ObjectiveThere has been a rise in advanced diagnostic imaging (ADI) use in the emergency department (ED). Increased utilization may contribute to longer length of stay (LOS), but prior reports have not considered improved methods for modeling skewed LOS data. MethodsThe 2010 National Hospital Ambulatory Medical Care Survey data were analyzed by 5 common ED chief complaints. Generalized linear model (GLM) was compared to quantile and ordinary least squares (OLS) regression to evaluate the association between ADI and ED LOS. Receipt of computed tomography or magnetic resonance imaging was the primary exposure. Emergency department LOS was the primary outcome. ResultsOf the 33,685 ED visits analyzed, 17% involved ADI. The median LOS for patients without ADI was 138 minutes compared to 252 minutes for those who received ADI. Overall, GLM offered the most unbiased estimates, although it provided similar adjusted point estimates to OLS for the marginal change in LOS associated with ADI. The effect of imaging differed by LOS quantile, especially for patients with abdominal pain, fever, and back symptoms. ConclusionsGeneralized linear model offered an improved modeling approach compared to OLS and quantile regression. Consideration of such techniques may facilitate a more complete view of the effect of ADI on ED LOS.

Effect of local administration of fibroblastic growth factor with chitosan conduit on peripheral nerve regeneration: a rat sciatic nerve transection model

Technological advances in diagnostic imaging, neurosurgical instrumentation, and the use of a surgical microscope have resulted in pronounced improvements in the diagnosis and repair of transected peripheral nerves. Effect of local fibroblast growth factor (FGF) on nerve regeneration was assessed. Eighty male Wistar rats were divided into four experimental groups (n = 20), randomly: In transected group, left sciatic nerve was transected and stumps were fixed in adjacent muscle. In treatment group, defect was bridged using a chitosan conduit filled with 10 μL FGF. In chitosan conduit (CHIT) group, the conduit was filled with phosphate-buffered saline. In normal control group, sciatic nerve was exposed and manipulated. Each group was subdivided into four subgroups of five animals each and nerve fibers were studied in a 12-week period. Behavioral, functional, electrophysiological, and gastrocnemius muscle mass findings and morphometric indices confirmed faster recovery of regenerated axons in CHIT/FGF than in CHIT group (p < 0.05). Immunohistochemical reactions to S-100 in CHIT/FGF were more positive than that in CHIT group. FGF improved functional recovery and morphometric indices of sciatic nerve. It could be considered as an effective treatment for peripheral nerve repair in practice.

P11. Update on incidence of giant cell arteritis in the current era of advanced diagnostic imaging

P11. Update on incidence of giant cell arteritis in the current era of advanced diagnostic imaging

Primary Liver Tumors in Pediatric Patients: Proper Imaging Technique for Diagnosis and Staging

Liver tumors in children are rare and comprise a diverse set of both benign and malignant lesions, most of which are not clinically detected until they are large and often difficult to resect. Technological advances in diagnostic imaging have greatly influenced the surgical planning of these lesions and ultimately the clinical outcome. The intent of this article is to present an imaging algorithm for the effective and efficient workup of liver tumors in pediatric patients. This includes the appropriate timing and use of various imaging modalities, such as conventional radiographs, ultrasound, computed tomography, and magnetic resonance imaging. This article also addresses the use of sedation, intravenous contrast agents, and the benefits and limitations of specific imaging modalities. An overview of the radiologic and pathologic findings in common liver lesions in pediatric patients, as well as individual case examples demonstrating the use of the proposed workup algorithm, is provided.

Increasing use of advanced imaging: evidence that we need to do more to help our patients tolerate the uncertainty of living with cancer.

Increasing use of advanced imaging: evidence that we need to do more to help our patients tolerate the uncertainty of living with cancer.

Initial Outcomes From Federally Mandated Accreditation Site Surveys of Advanced Diagnostic Imaging Facilities Performed by the ACR

The aim of this study was to evaluate the findings of the first year of validation site surveys performed by the ACR pursuant to new federal accreditation requirements for nonhospital advanced diagnostic imaging (ADI) facilities. In the first year of validation site surveys (November 2012 to November 2013), the ACR surveyed 943 ADI facilities across 21 states. Data were extracted from these site survey reports and analyzed on the basis of the survey outcomes and the frequency and type of deficiencies and recommendations. Follow-up data were obtained from the ACR for facilities deemed noncompliant on the site survey to determine if these facilities adequately took the corrective actions necessary to maintain accreditation. Of the 943 ADI facilities surveyed, 45% (n = 421) were deemed compliant with the ACR accreditation standards, and 55% (n = 522) had one or more deficiencies. Failure to produce the required personnel documentation and absence of mandatory written policies were the two most common causes of deficiencies. Facilities accredited in more modalities tended to fare better in the site surveys, with the number of accredited modalities at a facility negatively associated with the likelihood of a deficiency (P = .007). Of the facilities with deficiencies, 73% (n = 382) took the necessary corrective actions to maintain accreditation, 27% (n = 140) were in the process of taking corrective actions, and no facility has lost accreditation because of an inability to adequately address the deficiencies. Nonbinding recommendations were made to 37% (n = 346) of facilities, and facilities with deficiencies were statistically more likely to receive recommendations (P < .001). Initial site surveys of ADI facilities demonstrated a high proportion of deficient facilities, but no facility has lost accreditation because of an inability to correct these deficiencies. Knowledge of the most common sources of deficiencies and recommendations can assist ACR-accredited ADI facilities in better preparing for validation site surveys, reducing the likelihood of facility noncompliance.

Advanced Diagnostic Imaging in Privately Insured Patients: Recent Trends in Utilization and Payments

Recent studies have reported that the rate of growth in utilization of noninvasive diagnostic imaging has slowed, with a concomitant reduction in total payments to providers in the Medicare Part B fee-for-service population. Utilization and payment growth trends in commercially insured populations, however, are not as well understood. We used the Truven Health Analytics MarketScan® Commercial Claims and Encounters database containing more than 29 million individuals to investigate commercially insured population trends in utilization of and payments for CT, MRI, PET, and ultrasound procedures in the years 2007-2011. We found that imaging use--after a brief downturn in 2010--rose again in 2011, coupled with substantial increases in adjusted payments for all four imaging modalities, raising concerns about future efforts to stem growth in imaging use and associated spending.

Recent developments and current management of penile cancer

Penile carcinoma is a rare disease, with over 95% of tumors being squamous cell carcinomas. Due to the low case numbers there has been a paucity of good-quality prospective studies available on which to base best clinical practice. The development of specialist high-volume centers in both the UK and Europe has started to permit multicenter collaboration and analysis of larger cohorts, with a knock-on improvement in patient care. Advances in diagnostic imaging, surgical techniques for both the penis and inguinal regions, and improved delivery of radiotherapy have helped to improve outcomes and quality of life. Molecular biology has started to shed light on the pathogenesis of the disease and the role that human papillomavirus may play. The aim of this article is to give an up-to-date review of the management of penile cancer encompassing the above.

COMPUTED TOMOGRAPHIC AND CROSS-SECTIONAL ANATOMY OF THE NORMAL PACU (COLOSSOMA MACROPONUM)

The purpose of this study was to compare and define the normal cross-sectional gross and computed tomographic (CT) anatomy for a species of boney fish to better gain insight into the use of advanced diagnostic imaging for future clinical cases. The pacu (Colossoma macropomum) was used because of its widespread presence in the aquarium trade, its relatively large body size, and its importance in the research and aquaculture settings. Transverse 0.6-mm CT images of three cadaver fish were obtained and compared to corresponding frozen cross sections of the fish. Relevant anatomic structures were identified and labeled at each level; the Hounsfield unit density of major organs was established. The images presented good anatomic detail and provide a reference for future research and clinical investigation.

Interventional treatment of brain ischemia related to intracranial cerebrovascular occlusive lesions

This review discusses the present use of interventional transcatheter strategies to treat patients with acute brain ischemia and severe stenosis of intracranial large arteries. The benefits and risks of opening freshly occluded intracranial large arteries in patients with brain ischemia depend on the extent of infarction, the location, the mechanism of thromboembolism, and the clot burden present, as well as time. Mechanical removal of thromboemboli with stent retrievers can quickly and effectively open occluded arteries. Aggressive medical treatment is highly effective in stabilizing intracranial large artery atherostenotic lesions. Interventional treatment of acute and threatened brain ischemia is a rapidly changing field. New devices, new thrombolytic agents, and new antithrombotic agents are continuously being introduced and tested. Diagnostic imaging advances are improving the ability of clinicians to identify the important features needed to select patients optimally. Interventionalists are gaining experience with their new tools. Key questions remain including patient selection criteria, use of optimal brain and vascular imaging, appropriate devices for recanalization, and the concomitant use of intravenous thrombolytics, among others.

Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis

To report a rare case of pituitary metastasis (PM) from hepatocellular carcinoma (HCC) and help better understand the incidence of PM and its most common presenting symptoms through a pooled individual patient data analysis. Literature regarding PM was systematically reviewed with a pooled individual patient data analysis conducted. Pooled individual data analysis result is also compared with the result in a most recent systematic review. Our results demonstrate that the incidence of PM among all intracranial metastases is 0.87% (95% CI 0.56, 1.18); it is 1.9% (95% CI 1.46, 2.34) among all autopsied cancer cases; it is 11.56% (95% CI 7.08, 16.04) among all breast cancer patients who had hypophysectomies and 12.83% (95% CI 10.5, 15.16) among all autopsied breast cancer patients. The fixed effect model showed that the incidence of PM in breast cancer patients group is significantly higher (p < 0.001) with an odds ratio of 6.71 (95% CI 4.24, 10.61). Breast and lung cancer are the most common primary cancer of PM with a percentage of 37.2 and 24.2 respectively. The next most common primary sites are prostate and kidney respectively, although the percentages for each are only about 5. Diabetes insipidus (DI) remains the most common symptom among all reported PM cases with a pooled incidence of 42.34% (95% CI 36.15, 48.53). Although not significant (χ(2) = 2.846, df = 1, p = 0.061), it is less common in the most recent reported cases which has a pooled incidence of 32.76% (95% CI 20.31, 45.21). DI is extremely rare in the reported PM cases from HCC (none of the eight cases presented with DI). The symptoms of anterior hypopituitarism (23.68 vs 39.66%, p = 0.015), visual deterioration (27.89 vs 41.38%, p = 0.039), cranial nerve palsies (21.58 vs 41.38%, p = 0.003) and headaches (15.79 vs 32.76%, p = 0.005) were reported significantly higher than previously described in the literature. Pituitary metastasis is rare in patients with cancer, and the pituitary gland is an uncommonly involved location in patients with intracranial metastases. With advanced diagnostic imaging techniques and increased awareness about the manifestation of sellar lesions, the incidence of cranial nerve palsies and anterior pituitarism are higher than reported. This information may allow earlier diagnosis of PM.

Comparative Evaluation of Different Radiographic Techniques in Pediatric Dentistry – An in vivo study

Radiographic imaging is an important diagnostic adjunct for clinical assessment of dental patients. Rapid advances in diagnostic imaging have major impact on dental radiology. Obtaining diagnostic radiographs in the paediatric dental patient is probably the most difficult to accomplish, because of fear and anxiety in children which is usually present during the first dental visit. So keeping this in mind few innovative radiographic techniques are used in this study, which can be used in paediatric dentistry to decrease the anxiety of children as well as parents. Intraoral periapical radiographs were taken in mandibular and maxillary arch with different techniques like using lollipop, snap-a-ray, bubblegum, desensitization and vertical holding of the film in pediatric patients. The efficacy of each technique was evaluated by Faces Pain Scale. The results revealed that the most accepted technique by paediatric patients was the lollipop technique.

Advances in targeting strategies for nanoparticles in cancer imaging and therapy.

In the last decade, nanoparticles have offered great advances in diagnostic imaging and targeted drug delivery. In particular, nanoparticles have provided remarkable progress in cancer imaging and therapy based on materials science and biochemical engineering technology. Researchers constantly attempted to develop the nanoparticles which can deliver drugs more specifically to cancer cells, and these efforts brought the advances in the targeting strategy of nanoparticles. This minireview will discuss the progress in targeting strategies for nanoparticles focused on the recent innovative work for nanomedicine.