Plain MRI Research Articles

Current progress and future trends in imaging of musculoskeletal bone tumours

Plain radiographs and MRI remains the gold standard imaging modality for bone tumour and tumour like lesions. Several imaging techniques have been developed to be used in conjunction, but doubt remains over how much additional diagnostic information they provide over and above routine MRI bone tumour sequences. Given the plethora of new modalities, this review aims to highlight some of them and how they may help in the diagnostic assessment of musculoskeletal bone tumours.

Deep learning radiomic nomogram to predict recurrence in soft tissue sarcoma: a multi-institutional study.

To evaluate the performance of a deep learning radiomic nomogram (DLRN) model at predicting tumor relapse in patients with soft tissue sarcomas (STS) who underwent surgical resection. In total, 282 patients who underwent MRI and resection for STS at three independent centers were retrospectively enrolled. In addition, 113 of the 282 patients received additional contrast-enhanced MRI scans. We separated the participants into a development cohort and an external test cohort. The development cohort consisted of patients from one center and the external test cohort consisted of patients from two other centers. Two MRI-based DLRNs for prediction of tumor relapse after resection of STS were established. We universally tested the DLRNs and compared them with other prediction models constructed by using widespread adopted predictors (i.e., staging systems and Ki67) instead of radiomics features. The DLRN1 model incorporated plain MRI-based radiomics signature into the clinical data, and the DLRN2 model integrated radiomics signature extracted from plain and contrast-enhanced MRI with the clinical predictors. Across both study sets, the two MRI-based DLRNs had relatively better prognostic capability (C index ≥ 0.721 and median AUC ≥ 0.746; p < 0.05 compared with most other models and predictors) and less opportunity for prediction error (integrated Brier score ≤ 0.159). The decision curve analysis indicates that the DLRNs have greater benefits than staging systems, Ki67, and other models. We selected appropriate cutoff values for the DLRNs to divide STS recurrence into three risk strata (low, medium, and high) and calculated those groups' cumulative risk rates. The DLRNs were shown to be a reliable and externally validated tool for predicting STS recurrence by comparing with other prediction models. • The prediction of a high recurrence rate of STS before emergence of local recurrence can help to determine whether more active treatment should be implemented. • Two MRI-based DLRNs for prediction of tumor relapse were shown to be a reliable and externally validated tool for predicting STS recurrence. • We used the DLRNs to divide STS recurrence into three risk strata (low, medium, and high) to facilitate more targeted postoperative management in the clinic.

A Radiological Study for Assessment of Cartilage Abnormalities in Patients with Osteoarthritis of Knee

Present study evaluates spectrum of abnormalities and severity of cartilage injury in patients with Osteoarthritis (OA) of knee by comparing plain radiograph and MRI. This retrospective study with 50 patients as sample that underwent MRI (on 3T scanner) and weight bearing radiograph (on 800mA &amp; 1000mA machine) of the knee at our institution. The included patient population was clinically suspected osteoarthritis of the knee. Kellgren-Lawrence grades and proposed MR grade scale was applied. The standard was based mainly on cartilage injury and additional findings. Results: Present study obtained significant result correlation while assessing the disease severity of patients on Kellgren-Lawrence score (on radiograph) and cartilage abnormality (On MRI). Distributions of associated degenerative changes were also documented. Conclusions: Plain radiographs are still important in evaluating osteoarthritis of knee. MRI plays a vital role in imaging the bony and soft tissues of knee as a whole organ. There is significant correlation between plain radiograph and MRI findings.

Analysis of 3 Cases of Refractory Urinary Tract Infection Caused by Enterococcus Faecium and Literature Review

Objective: To explore the clinical features, drug resistance, treatment and prognosis of refractory urinary tract infection caused by Enterococcus faecium infection. Methods: A retrospective analysis of 3 cases of Enterococcus faecium infection admitted to the Children’s Hospital of Shaanxi Provincial People’s Hospital from January 2017 to December 2019, And the clinical manifestations of refractory urinary tract infections caused by it, routine laboratory examinations, mid-stage urine culture and drug sensitivity, urinary ultrasound, magnetic resonance (or CT) examination, treatment process and prognosis, and search and review relevant literature. Result: The three children in this group were all women, aged 5 years, 2 months, 9 years and 11 years old. One case had renal abscess, one case had acute pyelonephritis, and one case had bladder-ureteritis. Clinical features: 2 cases had fever with a temperature of 38-39.5°C, and children with renal abscess were accompanied by chills; 2 cases had frequent urination, dysuria, and urethral irritation; 1 case of 5-year-old child had only transient urinary retention, All 3 cases were treated with conventional antibiotics orally and intravenously outside the hospital. During the course of 2 cases, the leukocytes were more than 25×109/L, 3 cases had neutrophils above 70%, CRP was high, and 3 cases of mid-stage urine culture were Enterococcus faecium;2 cases were sensitive to vancomycin and linezolid, Others are resistant.3 cases had negative blood cultures, 1 case of urinary B-mode ultrasound had a thicker bladder wall, and a slightly thicker wall in the lower right ureter. Considering the inflammatory changes, 1 case had left hydronephrosis and 1 case had left kidney urinary salt crystals. MRI plain scan of both kidneys and ureters + MRU showed: 1 case had a thicker bladder wall, and the wall of the lower ureter was slightly thickened, considering the inflammatory changes. One case had a slight dilation of the upper left ureter and the renal pelvis and calyces. 1 case of CT enhanced scan + CTU showed: 1. Left nodular superior nodules and strip low-density shadow, considering the repeated deformity of the left renal pelvis and ureter with dilation of the ureter (upper renal pelvis is small, hypoplasia); [2]. Abnormal strengthening of the left kidney and a slight thickening of the fascia around the kidney; consider pyelonephritis with abscess formation or cystic lesions. 3. Mild water accumulation in the left kidney and upper middle ureter [4]. There are multiple lymph nodes in the retro peritoneum and the left side of the spine, and some are swollen. Treatment 3 cases were initially ineffective with three generations of cephalosporins, and 2 cases had obvious effect of intravenous infusion of vancomycin based on drug sensitivity. After 7-10 days of treatment, cefepime was changed for consolidation treatment and cured. One case of meropenem treatment improved. Three cases were followed up for 1 year without recurrence. 1 case relapsed 20 days after discharge, intravenous infusion of cefepime for 17 days, and nitrofurantoin was taken preventively for 2 weeks before relapse. Conclusion: Most of the urinary tract infections caused by Enterococcus faecium infections are refractory upper urinary tract infections, which have many complications, timely and mid-stage urine culture, and urinary tract B ultrasound. Magnetic resonance imaging and hydrography of both kidneys and ureters play an important role in the diagnosis of complications. High drug resistance, timely adjustment of treatment according to drug susceptibility, selection of effective drugs is very important, given a sufficient course of treatment, can improve the prognosis.

Contrast-enhanced MRI of the wrist: Intravenous application of gadolinium improves diagnosis in ulnar-sided injuries of the TFCC

PurposeAlthough lesions of the triangular fibrocartilage complex (TFCC) frequently induce ulnar-sided wrist pain and potentially distal radioulnar joint instability, diagnosis can pose a challenge due to the intricate anatomy. This study aims to evaluate the benefits of contrast-enhanced sequences for the detection of TFCC injuries in magnetic resonance imaging of the wrist. Method94 patients underwent wrist MRI with intravenous application of gadolinium-based contrast agents. For each patient, two datasets were analysed independently by two board-certified radiologists: One set comprised only plain T1- and fat-saturated proton-density-weighted sequences, while the second dataset included contrast-enhanced T1-weighted images with fat suppression. Arthroscopy or clinical reports served as reference standard with the former being used whenever available. Diagnostic confidence and TFCC component assessability were subjectively evaluated. Contrast-to-noise ratios (CNR) were calculated serve as an objective indicator of image contrast. ResultsLesions of the articular disc, the foveal and styloid ulnar attachment were present in 24 (25.5%), 61 (64.9%) and 53 (56.4%) patients. Access to contrast-enhanced T1 images improved the diagnostic accuracy for injuries of the styloid (R1/R2, 0.68/0.73 vs. 0.86/0.88) and foveal attachment (0.68/0.72 vs. 0.90/0.89) substantially compared to plain MRI (all p < 0.001), while no benefits could be identified for lesions of the central disc (0.89/0.90 vs. 0.87/0.90). Readers’ diagnostic confidence and CNR for ulnar-sided lesions improved with contrast-enhanced T1 sequences available (p < 0.001). ConclusionsWith superior CNR in lesions of the TFCC’s foveal and styloid attachment, contrast-enhanced, fat-saturated T1-weighted sequences facilitate higher diagnostic accuracy and confidence than fat-saturated PD- and plain T1-weighted MRI.

Arthroscopic Treatment of Labral Tears in Patients with Borderline Developmental Dysplasia of the Hip: A Retrospective Study with Mean 5.8 Years Follow-Up.

ObjectiveTo retrospectively assess the mid‐term clinical and radiological results of hip arthroscopic treatment of labral tears in patients with borderline developmental dysplasia of the hip (BDDH).MethodsFrom January 2010 and December 2019, data were retrospectively reviewed for all patients who underwent arthroscopic surgery of the hip for the treatment of intra‐articular abnormalities. Only the Patients who had borderline developmental dysplasia (BDDH) were included. All operations were performed by two senior surgeons, the arthroscopic treatment including labral repair, labral debridement, minimal acetabuloplasty, femoroplasty and capsular closure. The evaluation consisted of pain evaluation (visual analog scale [VAS]), the modified Harris hip score (MHHS), range of motion, the radiological evaluation of plain film and MRI analysis of the hip joint. The plain film evaluation included anteroposterior views of the pelvis to assess lateral center‐edge angle (LCEA) and acetabular inclination (AI), frog‐leg lateral views of the hip to assess α angle.ResultsThere were 34 patients (36 hips) ultimately enrolled in this study. The follow‐up duration of the patients were minimal 2 years (average, 69.2 months) postoperatively. The patient group included seven men and 27 women, the mean age at the time of surgery was 30.9 years. The mean BMI was 22.3 kg/m2. From the pre‐operative status to the final follow‐up visit, mean mHHS score increased from 64.5 to 92.7, mean VAS score decreased from 6.8 to 1.3. All scores exhibited statistically significant differences (P < 0.001). The mean LCEA decreased from 22.9° to 22.7°, the mean AI decreased from 7.7° to 7.6°. Which all showed no significant differences compared with the final follow‐up to the pre‐operative status (P > 0.05). However, the mean α angle was significantly decreased from 48.3° to 40.1° (P < 0.001). We encountered no significant complications such as infection, deep venous thrombosis, fluid extravasation, or permanent nerve injury. One patient (2.94%) underwent revision periacetabular osteotomies (PAO) because of subluxation of the hip joint with permanent pain after 6 months failed conservative treatment.ConclusionArthroscopic treatment of labral tears in patients with BDDH may provide safe and durable favorable results at midterm follow‐up. The best outcome could be expected in patients with labral repair and closure of the capsule with strict patient selection criteria.

ROLE OF ULTRASOUND IMAGING IN EVALUATION OF TENDO ACHILLES LESIONS

INTRODUCTIONAchilles tendon disorders are among the more frequent maladies encountered in sports medicine. They are commonly associated with overuse injuries and can affect the quality of movement leading to thickening, vascularization, and hypoechogenicity of the diseased tendon.There are various types of overuse tendon injuries include tendinopathies, peri tendinitis, and tendon rupture. Increased tendon thickness is the most mentioned indicator of tendinopathies.The US performed has become increasingly important in the assessment of ligaments and tendons around the ankle because it is low cost, fast, readily available.AIM OF THE WORKThe aim of the work was to assess the role of ultrasound imaging in the evaluation of tendon Achilles lesionsPATIENTSThe study was conducted on 30 patients with Tendo Achilles lesions referred to Radiology Department of Alexandria University Main Hospital, during the period from January 2020 to January 2021.METHODSAll patients that fulfill the inclusion criteria were subjected to Full history taking, Clinical examination, Ultrasonographic examination, including resting axial and sagittal planed superficial high-frequency transducer probe examined series, and further Dynamic state examination, and Plain digital radio-graph and MRI examination of the Ankle joint when ever clinically indicated.

Quantitative measurement in knee joint effusion: Correlation between plain radiographs and MRI

Quantitative measurement in knee joint effusion: Correlation between plain radiographs and MRI

Multimodality imaging in shoulder arthroplasties Part 1: Biomechanics, indications, preoperative imaging, and types of arthroplasties – A pictorial review

Shoulder biomechanics, shoulder arthroplasty indications and types and appropriate pre-operative imaging are discussed in part one of this two-part pictorial review. Shoulder biomechanics in severe osteoarthritis and following reverse shoulder arthroplasty are represented graphically, with discussion on the principles of reverse shoulder arthroplasty. Case examples are utilized to demonstrate the main indications for shoulder arthroplasty. The decision of whether to proceed with arthroplasty and the arthroplasty type is heavily influenced by the pre-operative imaging. Factors for type of arthroplasty include arthroplasty indication, the integrity of the deltoid and rotator cuff musculature, and the amount of glenoid and humeral head bone stock. The key findings to look for and comment on across a range of imaging modalities are reviewed, using multiple cases including plain radiography, CT, ultrasound, and MRI. Examples of arthroplasty options are provided including humeral head resurfacing arthroplasty, hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty. A good understanding of the above principles is crucial for the radiologist to interpret pre-operative imaging correctly and aid in surgical planning.

Transforaminal lumbar interbody fusion in iatrogenic lumbar instability

Background Lumbosacral instability is one of the causes of failed back surgery syndrome, and it is characterized by loss of disc height with translational and in many cases rotational instability in the sagittal plane. Transforaminal lumbar interbody fusion (TLIF) is a modification of posterior lumbar interbody fusion that requires less retraction of the thecal sac and neural element. TLIF corrects most of the pathologies in patients with iatrogenic lumbar instability as it provides rigid stabilization of the spine with high incidence of fusion, decompression of central and lateral recess with facet and disc resection, restoration of disc and foraminal heights together with sagittal plane deformity correction. Aim This study was carried out to evaluate the efficacy of TLIF in the treatment of patient with iatrogenic lumbar instability. Patients and methods A total of 16 cases were diagnosed as iatrogenic lumbar instability according to the radiological method proposed by Dupuis and colleagues. Sex distribution was nine females and seven males. Plain radiograph (static and dynamic) and MRI with gadolinium enhancement were done for all patients. Single-level transforaminal lumbar interbody fusion (TILF) was performed in 11 cases and double-level TLIF was performed in five cases. Clinical evaluation was made using Oswestry disability index. Patients were examined for occurrence of solid interbody fusion at 9- and 12-month follow-up visits. Result A total of 14 patients showed obvious clinical improvement with reduction of their Oswestry disability index from 76.75% preoperatively to 36.9% at 6 month and 22.7% after 1 year. Overall, two cases had shown no clinical improvement: one had deep wound infection and the other had pseudoarthrosis. Solid fusion occurred in 14 (87.5%) cases. One case with pseudoarthrosis was the patient who had developed deep wound infection; the other case was a patient undergoing double-level TILF with pseudoarthrosis at L5–S1. Conclusion TLIF is a safe and effective technique in the treatment of patients with postlaminectomy lumbar instability with minimal complication rate.

Whole-Exome Sequencing for Identifying Genetic Causes of Intellectual Developmental Disorders.

BackgroundIntellectual developmental disorders (IDD) generally refers to the persistent impairment of cognitive activities and mental retardation caused by physical damage to the brain or incomplete brain development. We aimed to explore its genetic causes.MethodsIn this study, 21 IDD patients were recruited. The Gesell developmental scales (GDS) and Wechsler intelligence scale for children (WISC) were used to assess the impaired level of intellectual development for all probands. A superconducting MRI scanner (Philips AcsNT 3.0 T Philips, Best, The Netherlands) was used to perform a plain MRI scan of the skull on the probands. The whole-exome sequencing was carried out using next-generation sequencing in all probands and their families.ResultsEight had seizures and four had typical characteristics of autism. Pregnancy and delivery were uneventful except for three patients. Moderate IDD (52.4%) accounted for the majority. The abnormal MRI results included ventriculomegaly, pachygyria, broadening external cerebral space, abnormal signal change and agenesis of corpus callosum. Eleven variants were identified, including the variant in CREBBP, MECP2, HCFC1, ATRX, RAB39B, CLCN4, DYRK1A and CASKgenes. The function areas result of gene-positive group were compared to that of gene-negative group. Not significant (p>0.05) items were revealed after this analysis.ConclusionEleven variants were identified, including the variant in CREBBP, MECP2, HCFC1, ATRX, RAB39B, CLCN4, DYRK1A and CASK genes. The function areas result of gene-positive group were not significantly different from the gene-negative group.

Comparison of the Operative Time and Post-Operative Pain with Peek Cage versus Autologous Iliac Crest Bone Graft in Anterior Cervical Discectomy and Fusion

Objective: To compare the operative time and post-operative pain with PEEK cage method versus autologous iliac crest bone graft in anterior cervical discectomy and fusion in the cervical spine.&#x0D; Material &amp; Methods: This randomized control trial study (RCT). 90 patients with cervical disc disease, cervical stenosis with or without myelopathy and cervical trauma (fractures or facet jumps with disrupted disc) were included in the study from the Department of Neurosurgery, LGH, PINS, Lahore. Patients were evaluated with plain X-rays and MRI scans of the cervical spine. All patients underwent anterior cervical decompression and fusion. In 45 patients (group A), cervical fusion was achieved with PEEK cage method and in other 45 patients (group B), autologous Iliac Crest Bone graft was used.&#x0D; Results: Mean age in group A was 57.1 years and in group B, it was 54.7 years. In group A, 31.1% patients were of cervical disc disease, 28.8% of cervical degenerative stenosis and 40% were of cervical trauma. In group B, 15 patients 33.3% were of cervical disc disease, 24.4% of cervical degenerative stenosis and 42.2% were of cervical trauma. The mean Postoperative Visual Analogue Scale (VAS) score for pain was 2.8 in group A and 5.4 in group B patients.&#x0D; Conclusion: The patients of group A (PEEK cage method) could be easily mobilized within bed and out of bed depending upon their neurological status. Decreased operative time and less post-operative pain makes PEEK cage method superior to autologous iliac crest bone graft in anterior cervical decompression and fusion.

Ischemic Stroke as a Manifestation of Cholesterol Embolization Syndrome Following Percutaneous Coronary Intervention

Cholesterol embolization syndrome (CES) is one of the major, yet underdiagnosed cause of morbidity and mortality following invasive coronary interventions. The major risk factors are elderly, male, atherosclerotic disease, anticoagulation and femoral access route. This multisystem disease affects skin, kidney, brain, eye and gastrointestinal tract. Only few cases of cholesterol embolization syndrome manifesting as an ischemic stroke are reported. We present a case of an elderly man, admitted to our ICU after percutaneous coronary intervention (PCI) who developed neurological deficits along with skin changes and renal failure. cholesterol embolization syndrome was suspected based upon the presence of cardiovascular risk factors, invasive cardiovascular intervention and clinical signs. The diagnosis of ischemic stroke made through plain MRI brain, revealed multiple areas of lacunar infarcts. He was treated with intermittent hemodialysis, statins and anti-platelet agents. On follow up, skin lesions and renal functions were improved; but slurring of speech and paresis persisted.

TO EVALUATE THE ROLE OF MAGNETIC RESONANCE IMAGING (MRI) IN PELVIC MASSES IN FEMALE PATIENTS

Background &amp; Method: Study was conducted at Mediciti Institute of Medical Sciences, Medchal, Telangana number of cases studied 30. All clinically suspected female patients with pelvic masses referred to the Department of Radio-diagnosis were evaluated. These patients were first subjected to Ultrasonography followed by MRI (plain and contrast where ever required). MRI findings were compared with that of Ultrasonography. These findings were compared with that of operative findings and histopathological findings wherever performed.&#x0D; Result: Majority of uterocervical lesions on MRI were malignant in nature. One case of endometrial polyp in usg, diagnosed as stage Ib endometrial carcinoma, and cervical fibroid was diagnosed as cervical carcinoma stage II, on MRI 2cases of cervical and 2 cases of endometrial carcinoma.&#x0D; Conclusion: In practice USG is the primary modality for diagnosing the pelvic mass. MRI is superior to ultrasound and can be used as problem solving tool in the assessment of pelvic mass. The multiplanar imaging capability allows accurate identification of origin of mass, characterization of mass(solid, haemorrhagic, fatty and fibrous contents).This may obviate surgery or significantly contribute to the preoperative planning of pelvic mass&#x0D; Keywords: Magnetic Resonance Imaging, pelvic &amp; female.&#x0D; Study Designed: Observational Study

Magnetic resonance imaging follow-up can screen for soft tissue changes and evaluate the short-term prognosis of patients with developmental dysplasia of the hip after closed reduction

BackgroundMagnetic resonance imaging (MRI) can show the architecture of the hip joint clearly and has been increasingly used in developmental dysplasia of the hip (DDH) confirmation and follow-up. In this study, MRI was used to observe changes in the hip joints before and after closed reduction (CR) and to explore risk factors of residual acetabular dysplasia (RAD).MethodsThis is a prospective analysis of unilateral DDH patients with CR and spica cast in our hospital from October 2012 to July 2018. MRI and pelvic plain radiography were performed before and after CR. The labro-chondral complex (LCC) of the hip was divided into four types on MRI images. The variation in the thickening rate of the ligamentum teres, transverse ligaments, and pulvinar during MRI follow-up was analyzed, and the difference in cartilaginous acetabular head index was evaluated. The “complete relocation” rate of the femoral head was analyzed when the cast was changed for the last time, and the necrotic rate of the femoral head was evaluated after 18 months or more after CR. Lastly, the risk factors of RAD were analyzed.ResultsA total of 63 patients with DDH and CR were included. The LCC was everted before CR and inverted after CR, and the ligamentum teres, transverse ligaments, and pulvinar were hypertrophic before and after CR, and then gradually returned to normal shape. The cartilaginous acetabular head index gradually increased to normal values. Complete relocation was observed in 58.7% of femoral heads, while 8.6% had necrosis. The abnormalities in LCC was related to RAD (OR: 4.35, P = 0.03), and the rate of type 3 LCC in the RAD group was higher. However, the IHDI classification (P = 0.09); the “complete relocation” of femoral heads (P = 0.61); and hypertrophy of the ligamentum teres (P = 1.00), transverse ligaments (P = 1.00), and pulvinar (P = 1.00) were not related to RAD.ConclusionsIn this study, MRI can observe the variations of the abnormal soft tissue structures of the diseased hips after CR and spica casting, and can evaluate which hips will have RAD after CR. Therefore, we can utilize MRI in DDH patients appropriately.

Abstract PS14-02: A randomised phase IB/IIA study of CApecitabine plus Radium-223 in breast cancer patients with BONe metastases (CARBON) - Safety and preliminary efficacy findings

Abstract Background: Bone metastases (BMs) occur in approximately 70% of patients (pts) with metastatic breast cancer (MBC). Despite significant advances in the management of BMs with bone-targeted agents and the associated reduction in skeletal-related events, there remains an unmet need for further treatment options to improve median overall survival beyond 2-3 years. Radium-223 [R] dichloride is an alpha-emitting radiopharmaceutical that is avidly taken up, like calcium, into the bone where it emits high-energy, short-range alpha-particles resulting in a targeted anti-tumour effect on BMs. Combining R with current systemic therapy could potentially enhance efficacy in MBC with BMs. Methods: CARBON is a UK, open-label, multi-centre phase IB/IIA study evaluating the combination of capecitabine [C] (1000mg/m2 bd days 4-17, 12x21 day cycles) with R 55kBq/kg day 1 given on a 6-weekly schedule in pts with BMs from MBC (+/- other sites of disease) with ≥2 bone lesions on radionuclide bone scan and/or ≥1 lesion confirmed on plain radiographs, CT or MRI. Other eligibility criteria included ECOG PS 0-2, ≤ 2 lines of chemotherapy for MBC and current use of a bisphosphonate / denosumab for ≥6 weeks. To establish the feasibility and safety of C+R the phase IB opened in August 2016 registering 6 pts; the primary endpoint was dose-limiting toxicities (DLTs), defined as ≥grade 3 gastrointestinal toxicity lasting &amp;gt;48 hours or ≥grade 4 haematological toxicity lasting &amp;gt;7 days. Subsequently, between April 2017 and March 2019 28 pts were randomised (2:1) to C+R vs C in phase IIa to further characterise the safety profile, with frequency of CTC grade 3-4 toxicities and diarrhoea as primary endpoints. Preliminary evaluation of efficacy through assessment of bone turnover marker changes from baseline to end of cycle 5 and time to progression in bone and overall was made. Results: Baseline clinico-pathologic characteristics and prior treatments were well balanced between the arms; 13 C+R and 9 C pts had visceral metastases. There were 0 DLTs in the 6 phase IB pts, therefore the same C+R dose and schedule was studied in phase IIA. 2 pts randomised to C+R received C alone and are included in the C arm. The safety population consists of 34 pts (23 C+R, 11 C). Median number of cycles received was 8.5 (range 3-12) in C+R arm and 12 (range 1-12) in C arm. 38/307 (12%) treatment cycles were delayed (25 [13%] C+R arm, 13 [12%] C arm). 11 (48%) C+R and 6 (55%) C pts had a permanent C dose reduction. 94/95 (99%) prescribed R cycles were administered. 9 (39%) C+R and 9 (82%) C pts completed all 12 cycles. Other reasons for discontinuation were: progressive disease in 12 (52%) C+R and 0 in C pts; toxicity in 1 (4%) C+R and 1 (9%) C pt; clinician decision in 1 (9%) C pt; progressive disease and toxicity in 1 (4%) C+R pt. Only 25/575 (4%) reported AEs were grade 3-4 (n=21 in 11 [48%] C+R pts, n=4 in 4 [36%] C pts) with 0 episodes of grade 3-4 diarrhoea. Table 1 shows maximum grades of diarrhoea and haematological AEs experienced by arm. 18 SAEs occurred (n=11 in 8 C+R pts, n=7 in 2 C pts). 8 (44%) SAEs were grade 3 (C+R: 6, C: 2); none were related to diarrhoea. There were 0 SUSARs. Conclusion: In the first completed trial evaluating R with chemotherapy in MBC pts, the combination of C+R is safe and well-tolerated. Preliminary efficacy analyses including bone markers are ongoing and will be presented at the meeting. The creation of the data was supported in part by Bayer Plc and Yorkshire Cancer Research. Table 1: Maximum CTCAE grade (G) experienced - diarrhoea and haematological AEs.C+R (n=23)C (n=11)Not experiencedG1G2G3G4Not experiencedG1G2G3G4Diarrhoea7 (30%)14 (61%)2 (9%)006 (55%)4 (36%)1 (9%)00Neutropenia18 (78%)02 (9%)3 (13%)010 (91%)01 (9%)00Thrombocytopenia21 (91%)1 (4%)1 (4%)009 (82%)1 (9%)1 (9%)00Anaemia21 (91%)2 (9%)0008 (73%)1 (9%)2 (18%)00 Citation Format: Matthew Winter, Jessica Kendall, Sarah Brown, Emma Rathbone, Caroline Wilson, Sacha Howell, Chris Twelves, Carlo Palmieri, Anjana Anand, Iain MacPherson, Rob Coleman, Janet Brown. A randomised phase IB/IIA study of CApecitabine plus Radium-223 in breast cancer patients with BONe metastases (CARBON) - Safety and preliminary efficacy findings [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS14-02.

The prevalence of Vickers' ligament in Madelung's deformity: a retrospective multicentre study of 75 surgical cases.

In a retrospective multicentre study, we aimed to correlate clinical factors and findings on plain radiographs and MRI with the intraoperative presence of Vickers’ ligament in Madelung’s deformity. We screened the records, in which the absence or presence of Vickers’ ligament was affirmatively indicated, of 75 consecutive operated extremities in 58 patients. In 83% a Vickers’ ligament was observed intraoperatively. The whole bone Madelung type (as opposed to the distal type) and a distal radial notch were independent, significant predictors for the presence of the ligament. The correct Vickers detection rate using MRI was 85% of the 27 cases for which MRI was available. Thus, the MRI was a good but not perfectly reliable modality. We conclude that Vickers’ ligament is present in the majority but not all cases with Madelung deformity. We advise that patients with a more severe type of Madelung’s deformity and a distal radial notch should be monitored closely.Level of evidence: IV

RADIOLOGICAL VALUATION OF STRESS FRACTURES OF THE LOWER LIMB

The purpose of this study is to diagnose stress fractures early to prevent bone remodelling, non-union injuries and loss of function by using various modalities. Plain Radiograph, CT scan and MRI of 50 patients imaged with history of of localized pain related to change in their physical activity or followed by an effort/activity to which they were not accustomed were retrospectively reviewed for stress fractures. Lesions with both bone injuries and pathological findings on the adjacent soft tissues were taken into consideration and evaluated further. The age of the study population ranged from 16 to 75 years. Of the 50 patients studied, 25 were men and 25were women. We found 5 mild stress reaction, 10 insufficiency fractures and 35 stress fractures. The use of CT and MRI is of a great importance for early diagnosis and thus was essential to exclude other causes of bone lesions that may create confusion in the differential diagnosis of a patient with pain and non-specific abnormalities on plain radiography. In the absence of a clear co-relation between repeated stress and pain in an active individual the clinical diagnosis of a stress related bone injury may be troublesome and a possible delay may cause worsening of this condition and further impairment to a professional athlete.

Role of plain radiograph versus MRI in avascular necrosis of femoral head

Background: Avascular necrosis of the femoral head (AVN) is an increasingly common cause of musculoskeletal disability, and it poses a major diagnostic and therapeutic challenge. Although patients are initially asymptomatic, AVN usually progresses to joint destruction, usually before the fifth decade. Aims and Objectives: To study role of plain radiograph versus MRI in Avascular Necrosis of Femoral head. Methodology: This was a cross-sectional study carried out in the patients clinically suspected of avascular necrosis of femur at tertiary health care centre during the one year period i.e. January 2018 to January 2019 during the one year period there were 37 patients suspected of avascular necrosis of Femur The sensitivity and specificity was calculated by ROC curves from the medcal software.Result: In our study we have seen that the sensitivity (Sn)and Specificity (Sp) for X-ray and MRI respectively for various stages was For STAGE Iwas34.29, 29.12and98.45,95.12 ;forSTAGE IIwas 75.12,68.23 and 99.17,98.27;forSTAGE III98.56,93.12and99.69,98.36;forSTAGE IV99.34,92.19and100,99.19 . Conclusion: It can be concluded from our study that in the early stages of disease MRI was highly sensitive and specific as compared to plain X-ray hence MRI should be preferred over the plain X-ray in the confirmation and early surgical intervention if any.

Diagnosis and analysis of primary central nervous system lymphoma based on MRI segmentation algorithm.

Objective:This paper summarizes the MRI imaging findings of primary central nervous system lymphoma (PCNSL) in the posterior cranial fossa to improve the accuracy of PCNSL diagnosis in the posterior cranial fossa.Methods:This study retrospectively analyzed the MRI imaging manifestations of 15 PCNSL posterior cranial fossa cases confirmed by puncture or surgical pathology from June 2017 to May 2018, including their occurrence sites, the number of lesions, MRI plain and enhanced manifestations, and diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy. Imaging (MRS) performance.Results:A total of 15 cases were enrolled, including 10 cases of single lesion and five cases of multiple lesions. The total number of lesions was 25, which were in the cerebellar hemisphere and cerebellar vermis, midbrain, fourth ventricle, and pontine cerebellum. The lesions were round, irregular, nodular, patchy, with low or medium signals on T1WI, equal or slightly higher signals on T2WI, and enhanced with 25 meningiomas-like gray matter signals. All of them were significantly strengthened. “Acupoint sign” and “umbilical depression sign” were seen in eight lesions. There were 17 massive and nodular enhancements, four striped enhancements, three patchy enhancements, and one circular enhancement. five cases of DWI showed homogeneous high signal, two cases showed uneven high signal, and 3 cases showed medium signal. The ADC value of tumor parenchyma in 10 patients was (0.62±0.095)×10-3mm2/s. MRS examination showed obvious Lip peak in two cases.Conclusion:PCNSL in posterior cranial fossa has certain characteristics. DWI, ADC value and MRS are helpful to improve the correct diagnosis rate of PCNSL.