Differences In Radiographic Findings Research Articles

The difference in radiographic findings in the distal limbs of working Lipizzan horses, used for dressage or driving.

Lameness originating from the distal limb is common in sport horses and can vary depending on the dynamics of movement and the surface, with differences in shoeing exacerbating this variability. Driving horses work primarily on hard surfaces (pavement), whereas dressage horses work primarily on soft surfaces (riding arenas with sand). Driving horses are traditionally shod with small fixed studs made of hard metal, which are attached to the horseshoe at 4 points, while dressage horses are shod with a simple horseshoe. We investigated the hypothesis that there is a difference in the pathological radiographic findings of the distal limbs between driving and dressage horses. The variability in the stable management and training program was minimized by including horses from the same farm. Twenty horses in a driving training program and 20 horses in a dressage program were included in the study. Radiographs of the both front feet were obtained and quantitatively evaluated for radiographic changes by three surgery/diagnostic imaging specialists. Interrater reliability was measured, and multivariate analysis was performed to compare differences in pathological radiographic findings of the distal limbs between the two groups. Kendal's concordance coefficient indicated an agreement among raters (Kw ≠ 0) for all observations. Radiographic signs of degenerative joint disease of the distal interphalangeal joint were more common in the group of driving horses compared to dressage horses. Our hypothesis was confirmed, as there were significant pathological differences between groups in distal articular margin of middle phalanx, joint space narrowing, and irregular joint surface of the middle phalanx.

Will supplemental cone beam computed tomography change the treatment plan of impacted maxillary canines based on 2D radiography? A prospective clinical study.

To evaluate the impact of cone beam computed tomography (CBCT) on treatment planning for impacted maxillary canines; secondly, to identify CBCT factors influencing a change in the treatment plan; and thirdly, to assess 2D radiographic factors that can aid in selecting appropriate candidates for CBCT. Patients with impacted maxillary canines and an overlap of a neighboring tooth in 2D radiographs and the suspicion of root resorption were referred for CBCT examination. An initial treatment plan was based on 2D radiographs, and the final treatment plan was established after the CBCT examination. Logistic regression analyses and t-tests were performed to evaluate differences in radiographic findings between the groups with and without a change in treatment plan. The study prospectively included 125 impacted canines, and 43 (34.4%) of them had a change in treatment plan after the CBCT examination. The most common change was a modification in the direction of cantilever traction (n = 28; 22.4%), while the least common was the change in decision to remove/keep the canine (n = 4; 3.2%). The size of the alpha and lateral angles had a significant impact on the decision to change the treatment plan. Other radiographic findings did not influence a change in treatment plan. One-third of the canines had a change in treatment plan after supplemental CBCT examination. Canines with large alpha and lateral angles measured in the panoramic image were found to be significantly more likely to undergo changes in the initial direction of cantilever traction or changes to the canine extraction strategy following CBCT examination.

Difference in radiographic findings and gait analysis between horses that are freshly shod and at the end of their shoeing period

Difference in radiographic findings and gait analysis between horses that are freshly shod and at the end of their shoeing period

Is there a correlation between functional results and radiographic findings in patients with distal radius fracture A0 type A3 treated with volar locking plate or external fixator?

Purpose:The aim of this study was to test the hypothesis that precise restoration of distal radius fractures is correlated to better patient-reported outcome.Methods:The correlation between radiographic results and functional outcome was explored in 156 patients with extra-articular distal radius fractures included in a multicenter, randomized controlled trial comparing 2 surgical interventions, Volar Locking Plate or External Fixator. The primary functional outcome was the Patient Rated Wrist and Hand Evaluation score (PRWHE). Radiographically we assessed volar tilt, radial inclination, radial height, ulnar variance, and the presence of ulnar styloid fracture. The Pearson correlation analysis was used to estimate correlations between parameters.Results:At 1-year follow-up the mean difference in radiographic findings compared with the uninjured side (min, max) was: reduced volar tilt 5.3° (−15°, 25°), reduced radial inclination 2.3° (−6°, 12°), radial height 1.3 mm (−4 mm, 7 mm), and ulnar variance −0.5 mm (−6 mm, 3 mm). Overall, we found no correlation between radiographic parameters and the PRWHE at 1-year follow-up within the whole group, regardless of which treatment was chosen. At the time of injury 53% (N = 80) had sustained an additional ulnar styloid fracture. After 1 year this fracture was still radiographically present in 31% (N = 43) of the patients. No correlation between PRWHE score and the presence of an ulnar styloid fracture at 1-year follow-up was found.Conclusions:We found no correlation between functional outcome (PRWHE) and radiographic findings after 1 year in patients operated on with a Volar Locking Plate or External Fixator. Patient-specific factors were more important than radiographic measurements in this study group.Level of evidence: Therapeutic Level 2Trial registration: Norway: National Committee for Medical and Health Research Ethics 213/555ClinicalTrials.gov ID: NCT01904084Randomization of first patient: 02.09.2013

Evaluation of a low-dose protocol for cone beam computed tomography of the temporomandibular joint.

Objective:Evaluation of cone beam CT (CBCT) examination with a low-dose scanning protocol for assessment of the temporomandibular joint (TMJ).Methods:34 adult patients referred for CBCT imaging of the TMJ underwent two examinations with two scanning protocols, a manufacturer-recommended protocol (default) and a low-dose protocol where the tube current was reduced to 20% of the default protocol. Three image stacks were reconstructed: default protocol, low-dose protocol, and processed (using a noise reduction algorithm) low-dose protocol. Four radiologists evaluated the images. The Sign test was used to evaluate visibility of TMJ anatomic structures and image quality. Receiver operating characteristic analyzes were performed to assess the diagnostic accuracy. κ values were used to evaluate intraobserver agreement.Results:With the low-dose and processed protocols, visibility of the TMJ anatomical structures and overall image quality were comparable to the default protocol. No significant differences in radiographic findings were found for the two low-dose protocols compared to the default protocol. The area under the curves (Az) averaged for the low-dose and processed protocols, according to all observers, were 0.931 and 0.941, respectively. Intraobserver agreement was good to very good.Conclusion:For the CBCT unit used in this study, the low-dose CBCT protocol for TMJ examination was diagnostically comparable to the manufacturer-recommended protocol, but delivered a five times lower radiation dose. There is an urgent need to evaluate protocols for CBCT examinations of TMJ in order to optimize them for a radiation dose as low as diagnostically acceptable (the as low as diagnostically acceptable principle recommended by NCRP).

Radiographic predictors determined with an objective assessment tool for neonatal patients with necrotizing enterocolitis

ObjectiveThe objective of this study was to develop and validate a computational tool to assist radiological decisions on necrotizing enterocolitis. MethodologyPatients that exhibited clinical signs and radiographic evidence of Bell's stage 2 or higher were included in the study, resulting in 64 exams. The tool was used to classify localized bowel wall thickening and intestinal pneumatosis using full‐width at half‐maximum measurements and texture analyses based on wavelet energy decomposition. Radiological findings of suspicious bowel wall thickening and intestinal pneumatosis loops were confirmed by both patient surgery and histopathological analysis. Two experienced radiologists selected an involved bowel and a normal bowel in the same radiography. The full‐width at half‐maximum and wavelet‐based texture feature were then calculated and compared using the Mann–Whitney U test. Specificity, sensibility, positive and negative predictive values were calculated. ResultsThe full‐width at half‐maximum results were significantly different between normal and distended loops (median of 10.30 and 15.13, respectively). Horizontal, vertical, and diagonal wavelet energy measurements were evaluated at eight levels of decomposition. Levels 7 and 8 in the horizontal direction presented significant differences. For level 7, median was 0.034 and 0.088 for normal and intestinal pneumatosis groups, respectively, and for level 8 median was 0.19 and 0.34, respectively. ConclusionsThe developed tool could detect differences in radiographic findings of bowel wall thickening and IP that are difficult to diagnose, demonstrating the its potential in clinical routine. The tool that was developed in the present study may help physicians to investigate suspicious bowel loops, thereby considerably improving diagnosis and clinical decisions.

Macrolide-Resistant Mycoplasma pneumoniae in the United States as Determined from a National Surveillance Program.

There are sparse data to indicate the extent that macrolide-resistant Mycoplasma pneumoniae (MRMp) occurs in the United States or its clinical significance. Between 2015 and 2018, hospitals in 8 states collected and stored respiratory specimens that tested positive for M. pneumoniae and sent them to the University of Alabama at Birmingham, where real-time PCR was performed for detection of 23S rRNA mutations known to confer macrolide resistance. MRMp was detected in 27 of 360 specimens (7.5%). MRMp prevalence was significantly higher in the South and East (18.3%) than in the West (2.1%). A2063G was the predominant 23S rRNA mutation detected. MICs for macrolide-susceptible M. pneumoniae (MSMp) were ≤0.008 μg/ml, whereas MICs for MRMp were 16 to 32 μg/ml. Patients with MRMp infection were more likely to have a history of immunodeficiency or malignancy. Otherwise, there were no other significant differences in the clinical features between patients infected with MRMp and those infected with MSMp, nor were there any differences in radiographic findings, hospitalization rates, viral coinfections, the mean duration of antimicrobial treatment, or clinical outcomes. There was no significant change in MRMp incidence over time or according to age, sex, race/ethnicity, or status as an inpatient or an outpatient. Patients with MRMp were more likely to have received a macrolide prior to presentation, and their treatment was more likely to have been changed to a fluoroquinolone after presentation. This is the first national surveillance program for M. pneumoniae in the United States. Additional surveillance is needed to assess the clinical significance of MRMp and to monitor changes in MRMp prevalence.

Comparison of findings of radiographic and fractal dimension analyses on panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw

The aim of this study was to compare the panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw (MRONJ) for differences in radiographic findings and fractal dimension (FD). Data were collected from the medical records of 66 patients confirmed as having MRONJ. Panoramic radiographs of 66 patients (group I; without bone exposure; and group II; with bone exposure) were evaluated for the following signs; osteolysis, cortical erosion, focal and diffuse sclerosis, sequestrum, lamina dura thickening, enhancement of the inferior alveolar canal (IAC), persistent alveolar socket, pathologic fractures, and enhancement of the external oblique ridge. FD values were also compared between groups. The signs of focal and diffuse sclerosis, sequestrum, and enhancement of the IAC were observed significantly more often in group II than group I (P < .05). The mean FD values were 1.42 ± 0.11 in group I and 1.44 ± 0.18 in group II and were significantly different only in 1 region but not significantly different overall. Radiographic alterations of bone structures appeared more frequently in patients with advanced stages of MRONJ. No significant difference was detected in the FD values among the tested regions except the cancellous bone above the mandibular canal on the distal side of the mental foramen.

Radiographic predictors determined with an objective assessment tool for neonatal patients with necrotizing enterocolitis

ObjectiveThe objective of this study was to develop and validate a computational tool to assist radiological decisions on necrotizing enterocolitis. MethodologyPatients that exhibited clinical signs and radiographic evidence of Bell's stage 2 or higher were included in the study, resulting in 64 exams. The tool was used to classify localized bowel wall thickening and intestinal pneumatosis using full-width at half-maximum measurements and texture analyses based on wavelet energy decomposition. Radiological findings of suspicious bowel wall thickening and intestinal pneumatosis loops were confirmed by both patient surgery and histopathological analysis. Two experienced radiologists selected an involved bowel and a normal bowel in the same radiography. The full-width at half-maximum and wavelet-based texture feature were then calculated and compared using the Mann–Whitney U test. Specificity, sensibility, positive and negative predictive values were calculated. ResultsThe full-width at half-maximum results were significantly different between normal and distended loops (median of 10.30 and 15.13, respectively). Horizontal, vertical, and diagonal wavelet energy measurements were evaluated at eight levels of decomposition. Levels 7 and 8 in the horizontal direction presented significant differences. For level 7, median was 0.034 and 0.088 for normal and intestinal pneumatosis groups, respectively, and for level 8 median was 0.19 and 0.34, respectively. ConclusionsThe developed tool could detect differences in radiographic findings of bowel wall thickening and IP that are difficult to diagnose, demonstrating the its potential in clinical routine. The tool that was developed in the present study may help physicians to investigate suspicious bowel loops, thereby considerably improving diagnosis and clinical decisions.

Tissue Engineering of Necrotic Dental Pulp of Immature Teeth with Apical Periodontitis in Dogs: Radiographic and Histological Evaluation.

To evaluate tissue engineering technology to regenerate pulp-dentin like tissues in pulp canals of immature necrotic permanent teeth with apical periodontitis in dogs. The study was performed on 36 teeth in 12 dogs. The experiment was carried out using split mouth design. In each dog 3 teeth were selected for implementing the study procedure. Apical periodontitis was induced in Group A and B teeth. Group (A): immature upper left 2nd permanent incisors that were transplanted with a construct of autologous dental pulp stem cells with growth factors seeded in a chitosn hydrogel scaffold. Group (B): immature upper right 2nd permanent incisor that received only growth factors with scaffold. A third tooth in each dog was selected randomly for isolation of dental pulp stem cells (DPSCs). Both groups were closed with a double coronal seal of white MTA (Mineral trioxide aggregate) and glass ionomer cement. Both groups were monitored radiographically for 4 months and histologically after sacrificing the animals. There was no statistically significant difference in radiographic findings between group (A) and group (B) for healing of radiolucencies, while there was statistically significant difference between group (A) and group (B) regarding radicular thickening, root lengthening and apical closure. Histologically, group (A) teeth showed regeneration of pulp- dentin like tissue while group (B) teeth did not show any tissue regeneration. Dental pulp stem cells and growth factors incorporated in chitosan hydrogel are able to regenerate pulp- dentine like tissue and help in complete root maturation of non-vital immature permanent teeth with apical periodontitis in dogs.

Efficacy of nasal irrigation in the treatment of acute sinusitis in atopic children

Nasal irrigation has been used as adjunctive therapy for sinonasal disease but is under-researched in children. The study aim was to evaluate the effectiveness of nasal irrigation with normal saline in the management of acute sinusitis in atopic children. We enrolled 60 atopic children with acute sinusitis, of whom 29 received nasal irrigation with normal saline and 31 did not receive nasal irrigation. All participants underwent a nasal peak expiratory flow rate (nPEFR) test, a nasal smear examination, and radiography (Water's projection) and were requested to complete a Pediatric Rhinoconjunctivitis Quality-of-Life Questionnaire (PRQLQ) during the baseline visit. All participants were requested to record symptoms in a daily diary and were followed up at 1-week intervals. A physical examination, nasal smear, and nPEFR were performed at each visit, and all daily diaries were collected. At the final visit (after 3 weeks), the symptom diaries were reviewed and participants were requested to complete the PRQLQ again. nPEFR, radiography, and a nasal smear were also repeated. There were significant improvements in mean PRQLQ and nPEFR values (p < 0.05) for the irrigation compared to the non-irrigation group. There was no significant difference in radiographic findings between the groups (p > 0.05). The irrigation group recorded significant improvements in eye congestion, rhinorrhea, nasal itching, sneezing, and cough symptoms compared with the non-irrigation group. Nasal irrigation is an effective adjunctive treatment for acute sinusitis in atopic children.

Pulmonary Disease Caused by Rapidly Growing Mycobacteria: A Retrospective Study of 44 Cases in Japan

Background: The features of pulmonary disease caused by rapidly growing mycobacteria (RGM) have not been sufficiently documented. Objectives: To establish these features, we retrospectively evaluated 44 patients. Methods: We screened respiratory isolates at the National Toneyama Hospital (Osaka, Japan) between 2003 and 2007. Diagnosis was based on the latest guidelines of the American Thoracic Society. The patients were classified into 3 types according to their radiographic findings: fibrocavitary, nodular bronchiectatic and unclassified variant. Results: We obtained 1,348 nontuberculous mycobacteria respiratory isolates from 1,187 patients, including 119 RGM isolates from 100 patients. Forty-four of these 100 patients were definitively diagnosed with respiratory disease due to RGM. The most common pathogen was Mycobacteriumabscessus, which accounted for 65.9% of cases, followed by Mycobacterium fortuitum at 20.5%. There was a statistically significant difference in smoking history between patients infected with these 4 RGM species (excluding those with an unknown smoking history; p = 0.039). The overall evaluation of radiographic findings revealed 18.2% as fibrocavitary, 43.2% as nodular bronchiectatic and 38.6% as unclassified variants in these 44 patients. There was a significant difference in radiographic findings between the 4 RGM species (p = 0.002). There was also a significant difference in radiographic findings between M. abscessus and M. fortuitum infected patients (p = 0.022). Conclusions: Patients with M. abscessus seem to have less of a smoking history and more frequent nodular bronchiectatic radiographic patterns than patients with M. fortuitum. In contrast, fibrocavitary patterns might be more frequent with M. fortuitum infection.

The effect of diabetic control status on the clinical features of pulmonary tuberculosis

The aim of this study was to determine whether control status of diabetes mellitus influences clinical and radiographic manifestations and treatment responses in patients with tuberculosis (TB). The medical records of 492 patients who started anti-TB medication between January 2005 and December 2009 were retrospectively reviewed. Diabetes was diagnosed in 124 patients (25.2%). Of these, 74 (59.7%) were uncontrolled (HbA1C≥7.0), 25 (20.2%) were controlled (HbA1C<7.0), and HbA1C levels were not assessed in the remaining 25 (20.2%). There were no differences in clinical symptoms between diabetics and non-diabetics, regardless of diabetes control status. There were also no differences in radiographic findings or AFB results between controlled diabetics and non-diabetics. However, uncontrolled diabetics had more cavitary lesions (p=0.008) and higher positive smear rates (p<0.001) compared with non-diabetics. After adjustment for age, cavities and positive smears before initiation of treatment, uncontrolled diabetes was a significant risk factor for a positive sputum culture at 2 months (odds ratio, 4.316; 95% CI, 1.306-14.267; p=0.017). Uncontrolled diabetics seem to have more cavities, higher positive smear rates and lack of culture conversion after two months of therapy. Therefore, TB patients with uncontrolled diabetes should be carefully managed and treated.

Tiludronate infusion in the treatment of bone spavin: A double blind placebo‐controlled trial

Tiludronate regulates bone remodelling through a decrease of the resorptive process and should therefore ameliorate the remodelling processes active in osteoarthritis of the distal tarsal joints ('bone spavin') and alleviate pain associated with abnormal bone lysis. To confirm the efficacy of tiludronate, administered as a single infusion at a dose of 1 mg/kg bwt, in the treatment of bone spavin in the horse. A double blind placebo controlled trial on 108 clinical cases of bone spavin was undertaken. The lameness score of the lamest limb was assessed following distal tarsal analgesia of the contralateral limb and followed-up using the same procedure throughout the study. Bone spavin in the lamest limb was confirmed by distal tarsal analgesia and radiography. Horses were treated at Day 0 and reassessed 60 days later after controlled exercise. A second nonblinded treatment was given to unresponsive horses and all horses were re-examined at Day 120. Exercise levels were recorded at each examination. Eighty-seven horses completed the trial as per the protocol. The tiludronate horses were significantly less lame than the placebo horses (P = 0.0318). Horses treated at Day 60 with tiludronate showed further improvement in lameness at Day 120 (P = 0.0096 and P = 0.0034 for horses treated with tiludronate and placebo at Day 0, respectively). The only significant difference in radiographic findings between tiludronate and placebo was for presence of periarticular osteophytes (P = 0.006). Tiludronate treatment is proven to be effective in bone spavin in horses in association with a controlled exercise programme. Tiludronate in combination with controlled exercise offers an alternate medical treatment for bone spavin.

Radiographic and balance characteristics for patient with osteoporotic vertebral fracture

Osteoporosis is a common health issue and leads to many fractures as well as balance problems. The radiographic and balance characteristics for different types of spinal deformity caused by osteoporosis are still unknown. The purposes of this study were to investigate the differences in radiographic and balance characteristics among different types of spinal deformities (lower kyphosis and whole kyphosis) and normal spines. Sagittal anterior‐posterior and medial‐lateral radiographic views were taken for radiographic analysis, while forceplate data at zero, three, six, and nine minutes of standing were employed for balance testing. There were significant differences in radiographic findings and balance performances between osteoporotic subjects and normal individuals. The lower kyphotic group revealed significantly greater spinal curvatures such as T‐Cobb's (50.9±18.3 degrees), L‐Cobb's (33.4±22.0 degrees), and SI angles (33.4±22.0 degrees) than those of the whole kyphotic group. However, significantly greater C7‐S1 distance (6.9±3.5.0 cm) and C7‐Lapex distance (6.2±3.9 cm) were found in the whole kyphotic group. For balance performance, the sway area of normal, lower kyphotic and whole kyphotic groups are 37.4±19.1 mm2, 71.9±71.2 mm2 and 119.1±114.8 mm2, respectively. The study suggested balance performance could be predicted by spinal lateral radiographies for patients with osteoporotic vertebral fractures.

Revision total knee arthroplasty: should tibial stems be cemented or uncemented?

Thirty-two consecutive coordinate revision total knee replacements (17 cemented, 15 cementless) with longer than 2-year follow-up were radiographically reviewed for assessment of radiosclerotic and radiolucent lines, fit and fill of the stem, constraint of the prosthesis (posterior stabilized vs. varus–valgus constraint) and whether the stems were cemented or uncemented. Radiosclerosis was noted around uncemented stems and radiolucency was identified at the cement prosthesis interface on anteroposterior and lateral X-rays. Radiolucent or sclerotic lines were rated according to the number of zones involved on most recent follow-up radiographs and were recorded if progressive from initial post-operative radiographs. There were 17 cemented and 15 uncemented tibial stems. Twenty-two posterior stabilized and 10 varus–valgus constrained implants, 17 cemented and 15 uncemented stems and 16–32 stems rated as having poor fit and fill. The cemented stems had fewer zones involving radiolucent–sclerotic lines than the uncemented tibial stems ( P=0.006). Prosthesis constraint and stem fit and fill did not statistically influence radiographic signs of loosening. This short-term follow-up study suggests that cement may afford better early stability to the tibial component. The difference in constraint between a posterior stabilized implant and a varus–valgus constrained implant may not be great enough to influence radiographic appearance in the short-term. Similarly, stem fit and fill differences may not have been large enough to demonstrate a difference in radiographic findings.