Radiographic Comparison Research Articles

Comparison of Radiographic and Clinical Outcomes following Treatment of Talar Osteochondral Lesions with Micronized Cartilage Extracellular Matrix Mixed with Bone Marrow Aspirate Concentrate vs Microfracture

Category:Ankle, Arthroscopy, SportsIntroduction/Purpose:Historically, microfracture has been the standard surgical treatment for talar osteochondral lesions (OLTs); however, it is associated with unsatisfactory long-term results due to the formation of biomechanically inferior reparative fibrocartilage as opposed to normal hyaline-like cartilage. Thus, the optimal treatment for OLTs remains contested. Application of micronized allogenic cartilage extracellular matrix (ECM) as an adjuvant therapy during the treatment of OLTs offers a promising option that could be administered arthroscopically to improve the quality of reparative tissue. The purpose of this study is to provide a case-control series comparing radiographic and functional outcomes following treatment of OLTs with an adjuvant mixture of micronized allogenic cartilage ECM and bone marrow aspirate concentrate (BMAC) to those achieved following standard microfracture with or without BMAC.Methods:194 patients (average age 37) with a minimum 1-year follow-up who were treated for an OLT by a fellowship-trained foot and ankle surgeon were screened for inclusion. 107 patients who received mixed micronized cartilage ECM and BMAC (Group I), 40 who were treated by microfracture augmented with BMAC (Group II), and 47 patients who were treated with traditional microfracture alone (Group III) were identified. Preoperative lesion size, lesion location, and concurrent injuries were recorded retrospectively. Foot and Ankle Outcome Scores (FAOS) were completed preoperatively and postoperatively through the prospective Registry database at the authors’ institution. Outcomes were assessed radiographically at a minimum of 6 months postoperatively by a trained radiologist using the MOCART scoring system. Linear regression modeling was used to assess differences in MOCART scores, post-operative FAOS scores, pre-to-postoperative change in FAOS, and the rate of revision surgery between groups I, II, and III.Results:The average MOCART score for Group I was 62.39, (average follow-up 16.13 months; n = 46), 58.8 (26.82 months; n =25) for Group II and, 55.36 (43.12 months; n=14) for Group III patients (p=0.57). The rate of revision surgery for OLTs treated using adjuvant micronized cartilage ECM was 5% and was significantly lower when compared to a 22.7% rate of revision surgery following microfracture with or without BMAC (p<0.001). Finally, when controlling for lesion size, changes in pre-to-postoperative FAOS Pain and Sports Activities were significantly different amongst the 3 treatment groups (p=0.05). Group I had the greatest improvement in Pain.Conclusion:Micronized allogenic cartilage extracellular matrix serves as an adjunctive therapy that may help improve patients’ radiographic and functional outcomes following treatment of OLTs when compared to outcomes following traditional microfracture. Specifically, use of adjunctive ECM appears to have better postop FAOS Pain scores when controlled for lesion size when compared to microfracture. There is a lower rate of revision surgery with the use of allogenic cartilage ECM in the short to intermediate term when compared with microfracture.

Alignment of the Incisura Fibularis with the Lateral Border of the Talus on Mortise View Radiographs in Ankle Injuries

Category:Ankle, TraumaIntroduction/Purpose:Diagnoses of ankle injuries utilize plain radiographs in three views: anteroposterior (AP), lateral, and mortise. Mortise view has greater sensitivity and accuracy in assessment of the distal tibiofibular syndesmosis through visualization of the mortise clear space. Current radiologic diagnostic parameters, like medial tibiotalar clear space and tibiofibular clear space, are inconsistent and unreliable because no consensus exists to measure these parameters. However, the incisura fibularis (IF) is a consistent landmark in assessing syndesmotic stability. We believe that in ankles without fracture, dislocation, or syndesmotic disruption, the IF aligns with the lateral border of the talus when observed on mortise view radiographs. This study seeks to determine a novel, more reliable radiologic parameter in diagnosis of the ankle mortise by evaluating this alignment.Methods:We retrospectively reviewed adult patient charts from 2012-2017 and selected 100 mortise radiographs: 23 bimalleolar fractures, 14 trimalleolar fractures, 13 fibular fractures, and 50 that were negative for fracture, dislocation, and syndesmotic disruption. We analyzed preoperative radiographs (after closed reduction, if displacement occurred) and postoperative radiographs at least 3 months after open reduction/internal fixation. Mechanism of injury, laterality of radiograph, and gender of patient were not considered in this sample.We evaluated the IF and talus alignment by drawing a line from the proximal IF, through the inferior tibia, to the lateral border of the talus (IFT line in Figure 1). We considered alignments < 1 mm from our IFT line to have mortise congruence since mortise widening >/= 1 mm can decrease contact area of the tibiotalar joint and cause instability. Chi-squared analysis compared non- fracture radiographs to pre- and postoperative fracture radiographs to determine significance with p < 0.05.Results:Among radiographs without fracture, dislocation, and syndesmotic disruption, 46/50 showed alignment < 1 mm from the IFT line. 14/50 preoperative radiographs had alignment < 1 mm from the IFT line: 2 bimalleolar fractures, 4 trimalleolar fractures, and 8 fibular fractures. 43/50 postoperative radiographs had alignment < 1 mm from the IFT line: 19 bimalleolar fractures, 13 trimalleolar fractures, and 11 fibular fractures.Chi-squared analysis determined statistical significance in comparison of non-fracture radiographs with preoperative radiographs by chi-squared statistic = 42.6667 and p < 0.00001. Chi-squared test showed no significance (p > 0.05) in comparison of non- fracture radiographs with postoperative fracture radiographs by chi-squared statistic = 0.9193 and p = 0.337657. Chi-squared test did not show significance among the different types of fractures.Conclusion:We implemented a novel approach to determine a more reliable radiologic parameter in evaluation of the ankle mortise by assessment of the alignment of the IF with the lateral border of the talus on mortise view radiographs. Radiographs without fracture, dislocation, or syndesmotic disruption have alignment < 1 mm from the IFT line, which suggests mortise congruence. Alignment >/= 1 mm may indicate mortise incongruence, distal tibiofibular syndesmotic instability, and talar shift. We conclude that the IFT line can be utilized to appraise the ankle mortise in distal tibiofibular syndesmotic injuries on mortise view radiographs.

A Viable Animal Model of Neuroarthropathic Changes in Wild-Type Rodents

Category:Diabetes, Hindfoot, Midfoot/ForefootIntroduction/Purpose:Neuroarthropathy is a progressively debilitating disease commonly affecting the lower extremity, which can lead to profound bone and joint destruction, limb deformity, and even amputation. While there are several causes, long- standing neuropathy is the most common. This leads to loss of protective sensation to the foot, which combined with repetitive micro-trauma as a result of physical activity can lead to bone and joint destruction of the lower extremity as well as major deformity. Currently there are no animal models of this disease process. The purpose of this study was to develop a novel rodent model of neuroarthropathy through the induction of the underlying neuropathic state combined with a treadmill running protocol that closely resembles local micro-trauma seen in humans.Methods:Following IAUCUC approval, 8 diet-induced obesity (DIO) C57BL/6 mice were obtained along with 6 non-obese C57BL/6 control mice. DIO mice were fed a high-fat diet (60% fat by kcal) ad libitum starting at the age of 6 weeks. Control mice were administered a standard low-fat diet (10% fat by kcal) ad libitum from birth. Starting at 14 weeks-old, all mice underwent a controlled, high-intensity cardiovascular training protocol using a rodent treadmill four times per week at 30 minute intervals. This was carried out for seven weeks including a one-week acclimation period. Speed, distance and time were held constant between groups. Weekly hind-paw sensory assessments were performed including von Frey filament and hotplate testing. Anteroposterior and mediolateral X-Rays were obtained at the beginning and conclusion of the study and radiographic analysis was performed bilaterally for all specimens. Lastly, histopathologic analysis was performed to assess musculoskeletal destructive changes to the hind-paw.Results:Baseline hotplate testing revealed that obese and non-obese mice did not differ in thermal response latency (p=0.53), however following the seven-week running protocol, obese mice demonstrated increased thermal response latency compared to controls (p=0.006). Von Frey filament testing in obese mice depicted significantly reduced hind-paw withdrawal reflexes compared to controls, both prior-to and following treadmill running (p<0.001). Comparison of initial and final radiographs for obese (figures 1.A and 1.B) and non-obese mice (figures 1.D and 1.E) showed an average increase in talo-first metatarsal angle of 7.66 degrees (p=0.007) and 0.66 degrees (p=0.75) respectively. The difference in change between groups was also significant (p<0.05). Preliminary histopathological analysis revealed significant abnormal bone remodeling in obese mice following treadmill running (figure 1.C) compared to controls.Conclusion:Obese, neuropathic animals, when challenged with a controlled exercise regimen designed to induce micro-trauma develop reliable sensory, radiographic, and histopathologic parameters reminiscent of neuroarthropathy in humans. Conversely, non-obese control animals, treated with the same exercise regimen, do not develop these neurodegenerative and musculoskeletal changes. Perhaps wild-type obese mice can be further characterized as a viable model for the development of idiopathic neuroarthropathy.

Comparison of Radiographic and Echocardiographic Features between Small and Large dogs with Heartworm Disease

Comparison of Radiographic and Echocardiographic Features between Small and Large dogs with Heartworm Disease

Clinical and radiographic comparison of a hybrid cage glenoid to a cemented polyethylene glenoid in anatomic total shoulder arthroplasty

This study reports the clinical and radiographic outcomes of a hybrid cage glenoid compared with an age-matched, sex-matched, and follow-up-matched cohort of cemented all-polyethylene peg glenoids in patients undergoing anatomic total shoulder arthroplastywith 2 years' minimum follow-up. We reviewed 632 primary anatomic total shoulder arthroplasty patients from an international multi-institutional database; 316 patients received hybrid cage glenoids and were matched for age, sex, and follow-up with 316 patients with cemented all-polyethylene peg glenoids. Each cohort received the same humeral component. Scoring was performed in all patients preoperatively and at latest follow-up using 5 outcome scoring metrics and 4 active range-of-motion measurements. A Student 2-tailed unpaired t test identified differences in outcomes; P < .05 denoted a significant difference. Cage glenoid patients had significantly lower rates of radiolucent glenoid lines (9.0% vs. 37.6%, P < .0001) and radiolucent humeral lines (3.0% vs. 9.1%, P = .0088) than all-polyethylene peg glenoid patients. In the cage glenoid cohort, 4 cases of aseptic glenoid loosening (1.3%) and 4 cases of articular surface dissociation (1.3%) occurred. In the all-polyethylene peg cohort, 12 cases of aseptic loosening (3.8%) occurred. Cage glenoid patients had a significantly lower revision rate than all-polyethylene peg glenoid patients (2.5% vs. 6.9%, P = .0088). At 50 months' mean follow-up, cage glenoids demonstrated equally good clinical outcomes to all-polyethylene peg glenoids. Cage glenoids had significantly fewer radiolucent lines around both the glenoid and humeral components and a lower revision rate. Longer-term follow-up is required to confirm these promising short-term results.

Radiographic Comparison of Crestal Bone Loss Around Two Implant Systems with Different Surface Roughness: A Retrospective Study

Radiographic Comparison of Crestal Bone Loss Around Two Implant Systems with Different Surface Roughness: A Retrospective Study

Ex vivo comparison of CBCT and digital periapical radiographs for the quantitative assessment of periodontal defects.

Accurate imaging is essential for effective treatment planning in periodontology. The aim of this ex vivo study was to investigate the accuracy of cone beam computed tomography (CBCT) and digital periapical radiographs (PA) in imaging periodontal defects. Hypotheses are: 1. That CBCT is a more accurate method than PA concerning vertical measurements of periodontal bone defects2. That CBCT itself is an accurate method to describe vertical periodontal bone loss MATERIAL AND METHODS: In this study, 117 periodontal defects from 10 human cadavers were investigated radiographically by CBCT and PA by one calibrated observer. Afterwards the vertical bone loss was measured with a periodontal probe by the same calibrated observer. Differences between radiographic and clinical measurements were calculated and analyzed. Bland-Altmann plots including 95% limits of agreement were calculated. The 95% limits of agreement ranged from 3.29 to -3.27mm between clinical measurements and measurements in PAs, and from 2.13 to -1.97mm in CBCTs. The mean difference between clinical and radiographic measurements was 0.0009mm for PA and 0.0835mm for CBCT. When comparing the clinical measurements, CBCT had a higher agreement and less deviations than PAs, and CBCT seems to be an accurate method to describe vertical periodontal bone loss. Accurate description of defects is helpful for accurate treatment planning.

The Tarawa Project Part II: Resolved Commingling and Identification of Casualties from the Battle of Tarawa

The Battle of Tarawa during World War II resulted in over 7,000 casualties on an approximately three-square-mile Pacific island that necessitated hasty burials, often with poor associated documentation. The loss of original burial information combined with postwar cemetery consolidation efforts resulted in the commingling, disassociation, and loss of identity of casualty remains. This report discusses two cases that are the product of ongoing efforts to recover remains still buried on the Tarawa Atoll and to identify Tarawa unknowns disinterred from the National Memorial Cemetery of the Pacific. Both cases involve the reassociation of disinterred elements to elements recently excavated from their original wartime burial locations on Betio Island. These cases illustrate the steps taken to reassociate elements, the multiple lines of evidence necessary to do so, and the eventual outcome of Tarawa Project identification efforts. Dental and chest radiograph comparisons of the disinterred remains were used to create and narrow short lists of unaccounted-for service members. These comparisons were combined with historical documentation and DNA analysis of remains recovered from the Tarawa Atoll to suggest association of additional elements. Articulation, refitting of fragments, pair-matching, and osteometric sorting supported the association of the disparate elements to single individuals. Ultimately, the dental and chest radiograph comparisons, biological profile, DNA testing, and historical data led to the positive identification of both individuals. The complicated nature of the Tarawa commingled assemblage emphasizes the importance of a multidisciplinary approach to the resolution and identification of commingled human remains.

Radiographic comparison of density and height of posterior maxillary bone after open sinus lift surgery with and without PRF.

Background Expansion of maxillary sinus towards the alveolar crest due to tooth loss or horizontal‒vertical resorption of the alveolar bone decreases the available bone for the placement of dental implants in the posterior maxilla. The method suggested for placing implants with a standard length is the use of sinus lift surgery with autogenous bone graft or bone substitute materials. The aim of the present research, with split-mouth design, was radiographic comparison of the density and height of the posterior of maxillary bone after open sinus lift procedure with and without PRF. Materials and Methods. In this split-mouth clinical trial, 14 patients were evaluated, with complete or partial bilateral edentulism of the upper jaw. In each case, for the sinus lift surgery of the test side, PRF was used, while in the sinus lift surgery of the other side of the same patient no graft materials were used. After six months and before the second surgery, CBCT was used to evaluate bone density and height. Results All the 41 implants were osseointegrated and were clinically stable. The bone height was 1.42 mm higher in the PRF group than the group without PRF, which was statistically significant. The mean density of the bone formed around the dental implants in the PRF group was 52.85 units higher than that of the group without PRF, which was statistically significant. Conclusion Using PRF in sinus lift surgery might enhance the quantity and quality of bone formation.

Radiographic comparison between the portals in the positioning of glenoid anchors in the surgical treatment of shoulder instability

Radiographic comparison between the portals in the positioning of glenoid anchors in the surgical treatment of shoulder instability

Comparison of Plain Radiograph and MRI in Avascular Necrosis of Femoral Head

Comparison of Plain Radiograph and MRI in Avascular Necrosis of Femoral Head

Assessment of linear measurements with intra oral grid on intra oral periapical image – A comparison of digital and conventional film images using bisecting angle and paralleling techniques

Background: The success of various treatments protocols depends on pre-operative diagnostic aids such as radiographic assessment with linear measurements, in such scenario radiographic grid with its unique design aids like a scale for image analysis on intraoral periapical radiograph. Hence, the intra oral grid is a simple and accurate way of measuring objects, and another advantage is to overcome various magnification errors associated with measurements. So, the present study was designed to know its accuracy in assessing the linear measurements. Materials and Method: The study sample comprised a total of 40 subjects, which were categorized into four groups. A total of 240 exposures were taken, where each patient was subjected to six radiographs, of which two are conventional intraoral periapical radiographs without grid, and two are conventional intraoral periapical radiographs with grid by bisecting and paralleling technique and another two radiographs are taken by digital CMOS sensor with intraoral periapical grid in all four groups. The measurements were performed on the radiographs using scale and divider and in case of radiograph with the grid by counting the grid lines from specific points. Results: The results of the study revealed on comparison of conventional and digital radiographs with and without a grid in both bisecting and paralleling technique in all the four groups, there was a statistically significant difference noticed with digital radiography compared to the conventional method in assessing the measurements with the grid with P value

A Radiographic Comparison of Crestal Bone Loss Around One-Staged and Two-Staged Implants: An Invivo Study

Abstract Purpose: To compare the crestal bone loss (CBL) around implants placed in a submerged or non submerged procedure using radiovisiography. Materials and Method: Implants were placed in the posterior mandible in a split mouth study design. In each edentulous area one implant was inserted using a nonsubmerged procedure (Group 1) where healing abutments were placed after implant installation and in the other implant was placed using a conventional surgical approach (Group 2) .A total of 10 implants were placed in 5 patients . Standardized radiovisiographs were taken immediately after implant insertion, 3 months after implant placement, and 6 months after implant placement. The data were analyzed using ImageJ software and subjected to paired t-test. Results. Three and 6 months after implant placement, the one-stage implants showed significantly more CBL (0.43±.04mm), (0.3±.06mm) than two-stage implants (0.35±07mm), (0.2±.02mm) respectively. Significant differences were found in terms of CBL in the treatment groups being investigated. Conclusion: One-stage implants showed significantly more CBL than two-stage implants

Radiographic Comparison of Carpal Morphometry in Thoroughbred and Standardbred Race horses

Carpal conformation is thought to contribute to the frequency of carpal pathology so non-invasive measurement of carpal morphometry would be useful to identify joints at risk. However, there are scant radiographic morphometrical details for the carpals of Thoroughbred (TB) and Standardbred (SB) racehorses even though these breeds differ in the incidence of carpal damage. This study aimed to identify morphometrical similarities and differences in carpal conformation in TB and SB. Thirty carpal dorsopalmar radiographs (DP) were collected from 15 TB and 15 SB. All DP radiographs were at zero degrees or within the acceptable range of rotation. Twelve carpal radiographic parameters were selected and measured on each radiograph. Statistical analysis found significant differences in four carpal parameters. These parameters revealed that the middle carpal joint in SB was significantly more angled distomedially whereas the radial distal metaphysis showed a greater distolateral inclination in TB. The radiocarpal and the carpometacarpal articulations exhibited common features in the two groups of horses. These carpal traits in TB and SB highlight their potential association with loading distribution and pathology. Measuring carpi from untrained and injured horses is necessary to establish breed specific features for the ideal carpal conformation in each of these breeds.

Fibroma ossificante central: relato de caso

Introdução: O Fibroma Ossificante Central é um tumor verdadeiro benigno, raro, que necessita da combinação dos exames clínicos, radiográficos e histopatológico para ser diagnosticado. Essa lesão é assintomática, mas pode apresentar um grande volume causando assimetria facial. Pode ter comportamento agressivo e surge da membrana periodontal onde contém células multipotentes capazes de formar cemento, osso lamear e tecido fibroso. Nos maxilares, envolve com mais frequência a mandíbula e pode haver deslocamento dentário. O tratamento é feito por enucleação cirúrgica. Detalhamento do caso: O presente trabalho relata um caso clínico de um Fibroma Ossificante Central na mandíbula, focando nas suas características clínicas, imaginológicas e histopatológicas e no tratamento, assim como revisar a literatura sobre o tema. A paciente procurou atendimento se queixando do aparecimento da lesão após a exodontia de um dente. A lesão teve como diagnóstico Fibroma Ossificante Central, o tratamento foi a cirurgia por enucleação e a reconstrução da mandíbula foi feita com placa e parafusos de titânio. A paciente teve um bom prognóstico e não houve recidiva até o presente momento. Discussão: Na comparação radiográfica, apresenta-se, dependendo do estágio de desenvolvimento, bem delimitada com limites bem definidos. Neste caso, constatou-se uma lesão de limites difusos, o que é contraditório com a literatura.

Role of imaging in progressive-fibrosing interstitial lung diseases.

Imaging techniques are an essential component of the diagnostic process for interstitial lung diseases (ILDs). Chest radiography is frequently the initial indicator of an ILD, and comparison of radiographs taken at different time points can show the rate of disease progression. However, radiography provides only limited specificity and sensitivity and is primarily used to rule out other diseases, such as left heart failure. High-resolution computed tomography (HRCT) is a more sensitive method and is considered central in the diagnosis of ILDs. Abnormalities observed on HRCT can help identify specific ILDs. HRCT also can be used to evaluate the patient's prognosis, while disease progression can be assessed through serial imaging. Other imaging techniques such as positron emission tomography-computed tomography and magnetic resonance imaging have been investigated, but they are not commonly used to assess patients with ILDs. Disease severity may potentially be estimated using quantitative methods, as well as visual analysis of images. For example, comprehensive assessment of disease staging and progression in patients with ILDs requires visual analysis of pulmonary features that can be performed in parallel with quantitative analysis of the extent of fibrosis. New approaches to image analysis, including the application of machine learning, are being developed.

Prevention of Proximal Junctional Kyphosis & Failure Using Sublaminar Bands in a Hybrid Construct in Pediatric Kyphosis Deformity.

The purpose of this study was to evaluate short term proximal junctional kyphosis and failure (PJK/PJF) rates and clinical outcomes in patients who underwent posterior spinal fusion (PSF) and deformity correction using sublaminar bands in a hybrid construct. This is a retrospective review of pediatric spinal deformity cases performed by a single surgeon from January 2008 to December 2012. One hundred thirty-six pediatric deformity patient charts were reviewed for inclusion into the study. All 136 patients reviewed had been operatively managed for a spinal deformity and were younger than 18 years of age. Our study's inclusion criteria comprised patients with a kyphosis greater than 60°, the use of sublaminar polyester bands in a hybrid surgical construct, and a minimum of 2 years of follow-up. Of the 136 spinal deformity cases reviewed, 17 cases met our inclusion criteria. No cases were excluded because of technical difficulty of band placement or for not using a hybrid construct with sublaminar bands (as it was the primary surgeon's principal construct of choice). PJK was defined as proximal junction sagittal Cobb angle (PJA) of at least 10° greater than the preoperative measurement. This was assessed by comparison of preoperative and postoperative radiographs. Our hypothesis was that PSF performed with our technique would have a lower rate of PJK than previously reported with other methods of fixation. The range of the preoperative kyphosis was 62°-111°, and postoperative kyphosis was 12°-55°. There was one case of PJK (5.8%) and no cases of PJF. This study on short term outcomes of PSF using sublaminar bands in a hybrid technique for treatment of kyphosis demonstrated a lower rate of PJK than has been reported in prior studies. This technique protects the fixation within the upper instrumented vertebrae of long segment PSFs.

A Comparison of Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion in Patients with Two-Level Cervical Degenerative Disc Disease: 5-Year Follow-Up Results

To present a long-term clinical and radiographic comparison between the Prestige LP cervical disc replacement and the Zero-P spacer cervical disc fusion in the treatment of patients with symptomatic 2-level cervical degenerative disease. In total, 36 patients in the anterior cervical discectomy and fusion (ACDF) group and 24 patients in the cervical disc arthroplasty (CDA) group were analyzed before surgery and at 1 week and 3, 6, 12, 24, and 60 months after surgery. Clinical assessments included the Japanese Orthopaedic Association score, visual analog scale, and Neck Disability Index scores. Radiographic assessments included cervical lordosis, range of motion (ROM) of the total cervical spine, functional spinal unit (FSU), and superior and inferior adjacent segments. Complications including heterotopic ossification and adjacent-segment degeneration (ASD) at 5-year follow-up were collected as well. Mean follow-up period was 65.6 months. Both the ACDF and CDA groups showed significant clinical improvements in terms of Japanese Orthopaedic Association score, visual analog scale, and Neck Disability Index (P<0.05), but there was no significant difference between groups at the last follow-up period. A significant increase of cervical lordosis was observed in the CDA group after surgery whereas a significant difference was not observed between groups. ROM of the total cervical spine and FSU were maintained during the follow-up, and a significant decrease was observed in the ACDF group after surgery (P< 0.05). The ROM of the superior adjacent segment did not show any difference whereas the ROM of the inferior adjacent segment in the ACDF group presented a significant increase at 6 months and 1 year after surgery and a significant decrease at the last follow-up period. A total of 8 (33.3%) patients in the CDA group had an occurrence of heterotopic ossification. ASD was observed in 2 (8.3%) patients who underwent CDA surgery and 8 (22.2%) patients who underwent ACDF surgery. The use of the Prestige-LP and ZERO-P Spacer implantations is safe and effective. At 5 years after surgery, CDA with Prestige-LP is superior in terms of ROM of the total cervical spine, FSU, and inferior adjacent segment. It also has a relatively low occurrence rate of ASD. This procedure may be a suitable choice for the treatment of contiguous 2-level CDDD.

Comparison of CBCT and Panoramic Radiographs to Determine Anatomic Limitations for Implant Placement in the Posterior Mandible

Cone-Beam Computed Tomography (CBCT) and/or panoramic radiography are critical in planning implant surgery to avoid complications, but the literature lacks consensus on the absolute indications for CBCT. Some studies suggest panoramic images alone may suffice for routine cases, while the American Academy of Oral and Maxillofacial Radiology recommends CBCT for all implant surgeries. Indications for CBCT are perhaps most unclear in the posterior mandible where the surgeon must contend with both the inferior alveolar canal (IAC) and lingual concavities (LC). Comparison studies show selected implants being shorter, longer, or no different between the two imaging modalities, but do not explain how the LC and buccolingual implant orientation (BIO) based on CBCT account for discrepancies. Other studies analyzed the LC on CBCT, but did not explain if it impacted assessment of space available for implants. Our study aims to determine if CBCT demonstrates differences in available bone for implant placement compared to panoramic in the mandibular first molar region, and if differences are due primarily to LC/BIO rather than magnification and distortions on panoramic.

Comparison of radiographs, tomosynthesis and CT with metal artifact reduction for the detection of hip prosthetic loosening.

To evaluate the diagnostic performance of digital tomosynthesis (DTS) for the diagnosis of hip prosthesis loosening (PL) compared with conventional radiographs and CT with metal artifact reduction (CT-MAR). Forty-nine patients with painful hip prosthesis were prospectively included and underwent anteroposterior and lateral radiographs, anteroposterior DTS and CT-MAR of the hip. This study was approved by the local ethics committee, and all patients signed an informed consent form. Images were evaluated independently by two radiologists. Periprosthetic radiolucent lines wider than 2 mm found in two or more Gruen or De Lee and Charnley zones were considered diagnostic of PL. All cases of PL were confirmed surgically. Patients with a stable radiological follow-up for at least 1 year with an alternative cause for the symptoms or with no surgical evidence of PL were considered PL negative. There were 21 cases of PL, 9 unilateral and 12 bilateral. For both the acetabular and femoral sides, DTS had a specificity for PL detection similar to that of conventional radiographs and CT-MAR (98.5-100%, 96.9%-100% and 96.9-95.4% respectively for both readers) and a sensitivity similar to conventional radiographs (39.9-45.4% versus 33.3-51.5% for both readers) but lower than CT-MAR (84.85% for both readers). The interobserver agreement was 0.84 for CT-MAR, 0.53 for DTS and 0.39 for conventional radiographs. DTS has a similar diagnostic performance to radiographs for the diagnosis of PL with a better interobserver agreement. The sensitivity however remains lower than that of CT-MAR. • Plain radiograph is still the first imaging step when hip prosthesis loosening is suspected. • Interobserver agreement is better with digital tomosynthesis than radiographs. • Sensitivity of CT with state-of-the-art metal artifact reduction is superior to that of digital tomosynthesis.