Radiological Scoring System Research Articles

Safety and performance of a novel synthetic biomimetic scaffold for iliac crest defect reconstruction during surgical treatment of pelvic girdle pain: a first-in-human trial.

Surgical treatment of pelvic girdle pain (PGP) involves arthrodesis of sacroiliac (SI) and pubic symphysis joints. Fusion of pubic symphysis involves the implantation of an autologous iliac crest tricortical graft harvested from the iliac crest. The objective was to assess the safety of a novel synthetic graft substitute (b.Bone) for iliac crest reconstruction and to evaluate the results of PGP surgical treatment. Consecutive participants undergoing pelvic fusion and requiring iliac crest reconstruction were enrolled and followed-up for 12months in a prospective first-in-human clinical investigation. Adverse events were documented, and health-related quality of life was evaluated using EuroQol-5D-5L questionnaire. Iliac crest defect healing was evaluated by the Modified Lane and Sandhu radiological scoring system. In addition, relevant published peer-reviewed scientific articles identified from PubMed. The EQ-5D-5L scores improved steadily reaching the highest point at 365days. By 365days complete healing of the bone defect was observed. The management of PGP remains challenging with mixed results reported in the literature. While there is lack of consensus on how to manage PGP, the present study shows improved outcomes at one year following surgery. The synthetic b.Bone scaffold is a safe option with good healing outcomes for iliac crest defect reconstruction. Although b.Bone synthetic scaffold found to be safe, further studies reporting on surgical treatment of PGP are required to confirm the findings in comparative trials.

Prediction of humeral shaft fracture healing using the Radiographic Union Score for HUmeral Fractures (RUSHU).

Though most humeral shaft fractures heal nonoperatively, up to one-third may lead to nonunion with inferior outcomes. The Radiographic Union Score for HUmeral Fractures (RUSHU) was created to identify high-risk patients for nonunion. Our study evaluated the RUSHU's prognostic performance at six and 12 weeks in discriminating nonunion within a significantly larger cohort than before. Our study included 226 nonoperatively treated humeral shaft fractures. We evaluated the interobserver reliability and intraobserver reproducibility of RUSHU scoring using intraclass correlation coefficients (ICCs). Additionally, we determined the optimal cut-off thresholds for predicting nonunion using the receiver operating characteristic (ROC) method. The RUSHU demonstrated good interobserver reliability with an ICC of 0.78 (95% CI 0.72 to 0.83) at six weeks and 0.77 (95% CI 0.71 to 0.82) at 12 weeks. Intraobserver reproducibility was good or excellent for all analyses. Area under the curve in the ROC analysis was 0.83 (95% CI 0.77 to 0.88) at six weeks and 0.89 (95% CI 0.84 to 0.93) at 12 weeks, indicating excellent discrimination. The optimal cut-off values for predicting nonunion were ≤ eight points at six weeks and ≤ nine points at 12 weeks, providing the best specificity-sensitivity trade-off. The RUSHU proves to be a reliable and reproducible radiological scoring system that aids in identifying patients at risk of nonunion at both six and 12 weeks post-injury during non-surgical treatment of humeral shaft fractures. The statistically optimal cut-off values for predicting nonunion are ≤ eight at six weeks and ≤ nine points at 12 weeks post-injury.

Relationship between serum vitamin D levels and the prevalence of knee osteoarthritis: A retrospective study on 3424 subjects.

The extent of the association between vitamin D deficiency and knee osteoarthritis remains inadequately understood. This study aimed to elucidate the relationship between vitamin D levels and knee osteoarthritis through a cross-sectional analysis. This retrospective study involved an analysis of knee radiographs and serum 25-hydroxyvitamin D3 (25-(OH) vitamin D3) levels in a cohort of 3424 individuals (2901 women and 523 men). Knee osteoarthritis severity was evaluated using the Kellgren-Lawrence radiological scoring system. Of the participants, 49.2% (n= 1,683) were diagnosed with knee osteoarthritis. Among these patients, the levels of adjusted 25-(OH) vitamin D3 were significantly lower (p< 0.001). Regression analysis revealed a significant association between vitamin D deficiency and knee osteoarthritis, with an adjusted odds ratio (OR) of 1.7 (95% CI: 1.5-2.0; p< 0.001). Notably, a stronger association was observed between vitamin D deficiency and knee osteoarthritis in women under 65 compared to those aged 65 and above. The findings of this study indicate a higher prevalence of vitamin D deficiency in patients with knee osteoarthritis. Maintaining adequate serum 25-(OH) vitamin D3 levels may prevent knee osteoarthritis, especially in women below 65.

Correlating Reiff scores with clinical, functional, and prognostic factors: characterizing noncystic fibrosis bronchiectasis severity: validation from a nationwide multicenter study in Taiwan

BackgroundOur study aimed to confirm a simplified radiological scoring system, derived from a modified Reiff score, to evaluate its relationship with clinical symptoms and predictive outcomes in Taiwanese patients with noncystic fibrosis bronchiectasis (NCFB).MethodsThis extensive multicenter retrospective study, performed in Taiwan, concentrated on patients diagnosed with NCFB verified through high-resolution computed tomography (HRCT) scans. We not only compared the clinical features of various types of bronchiectasis (cylindrical, varicose, and cystic). Furthermore, we established relationships between the severity of clinical factors, including symptom scores, pulmonary function, pseudomonas aeruginosa colonization, exacerbation and admission rates, and HRCT parameters using modified Reiff scores.ResultsData from 2,753 patients were classified based on HRCT patterns (cylindrical, varicose, and cystic) and severity, assessed by modified Reiff scores (mild, moderate, and severe). With increasing HRCT severity, a significant correlation was found with decreased forced expiratory volume in the first second (FEV1) (p < 0.001), heightened clinical symptoms (p < 0.001), elevated pathogen colonization (pseudomonas aeruginosa) (p < 0.001), and an increased annual hospitalization rate (p < 0.001). In the following multivariate analysis, elderly age, pseudomonas aeruginosa pneumonia, and hospitalizations per year emerged as the only independent predictors of mortality.ConclusionBased on our large cohort study, the simplified CT scoring system (Reiff score) can serve as a useful adjunct to clinical factors in predicting disease severity and prognosis among Taiwanese patients with NCFB.

Quantitative T2 Mapping of Acute Pancreatitis.

Quantification of the T2 signal by means of T2 mapping in acute pancreatitis (AP) has the potential to quantify the parenchymal edema. Quantitative T2 mapping may overcome the limitations of previously reported scoring systems for reliable assessment of AP. To evaluate MR-derived pancreatic T2 mapping values in AP and correlate them with markers of disease severity. Prospective single-center study. 76 adults with AP (20-91 years, females/males: 39/37). Fat suppressed multiecho spin-echo prototype sequence to quantify T2 signal at 3T MRI. The severity of AP was assessed clinically, biologically, and by contrast-enhanced CT (CECT) performed 48-72 hours after symptom onset. MRI was then performed ≤24 hours after CT. Two readers blinded to any clinical information independently evaluated the T2 values by placing three regions of interest inside the pancreatic head, body, and tail on the T2 mapping MR sequence. Results were compared with corresponding CECT images as the standard and clinical severity parameters, using the length of hospital stay as our primary endpoint. Continuous variables were compared using the Spearman's rank correlation coefficient, analysis of variance (ANOVA) or Student's t-test. T2 values significantly correlated with the length of hospital stay (rs(74) = 0.29), CT severity index (CTSI) (rs(73) = 0.61; CTSI 0-3: 72 ± 14 msec, CTSI 4-10: 88 ± 15), intensive care unit (ICU) admission (t(2.77) = -3.41) and presence of organ failure (t(6.72) = -3.42), whereas the CTSI and Ranson score were not significantly related with ICU admission (CTSI: P = 0.24; Ranson score: P = 0.24) and organ failure (CTSI: P = 0.11; Ranson score P = 0.11). T2 mapping correlates with AP severity parameters and is useful for assessing the severity of AP with higher sensitivity than the usual clinical and radiological scoring systems. 1 TECHNICAL EFFICACY: Stage 2.

A New Radiological Scoring System as a Method of Assessing Sclerotherapy Treatment Response for Aneurysmal Bone Cysts: A Retrospective Study.

Background A widely accepted set of imaging criteria or classification has not yet been adopted to evaluate response to treatment by percutaneous sclerotherapy for aneurysmal bone cyst (ABC). In this article, we described and illustrated the Royal Orthopaedic Hospital (ROH) scoring system which is a new, reproducible, and objective tool to evaluate the radiological response. We also reported our institutional experience in the efficacy of computed tomography (CT)-guided sclerotherapy for treating such lesions. Patients and Methods A retrospective analysis was conducted for 19 patients who underwent CT-guided sclerotherapy with doxycycline and albumin to treat ABC. Follow-up magnetic resonance imaging, at a minimum of 12 months, was assessed according to the four ROH scoring system parameters: cystic component, fluid-fluid level, presence of consolidation, and cortical integrity. The cumulative score was used to grade response as either: excellent, good, equivocal, or poor. Results Out of 19 patients with a mean age of 17.8 years, 11 cases occurred in the long bones, 5 cases in the pelvis, and 1 in each of the C3 vertebral body, scapula, and talus. The mean parameter of response score for cystic component was 2, fluid-fluid level was 1.3, consolidation was 2, and cortical integrity was 2.1. Four cases showed excellent response, 12 cases showed good response, 2 cases showed equivocal response, and 1 case showed poor response. Interrater reliability was excellent (κ = 0.9). Conclusion The ROH scoring system provides the radiologist and surgeon with an objective method to score imaging parameters of response independently and achieve a grade based on the cumulative score.

Radioclinical Assessment of Posterior Tympanotomy Difficulties during Ordinary Cochlear Implantation: A Prospective Case-Series Study.

This study proposes a preoperative radiologic scoring system for predicting posterior tympanotomy (PT) and mastoidectomy-associated difficulties during cochlear implantation (CI). It was a prospective case-series study. The included CI surgeries were performed at tertiary referral institutions from October 2022 to April 2023. We included 73 CI candidates performed via the PT approach. The proposed radiologic score, composed of 13 items, was fulfilled and evaluated before each CI surgery. We correlated this score with the intraoperative difficulty and surgical duration. The operation was straightforward in 42 patients with a score of 3.87 ± 1.72 and challenging in 31 patients with a score of 10.66 ± 1.73. The radiologic score was strongly correlated with the surgical difficulty and duration (p < 0.0001). Our proposed radiologic score was a valid, reliable, and precise tool to predict intraoperative difficulty during cochlear implantation. Chorda-facial angle was the strongest predictor, significantly affecting the difficulty, surgical duration, and preoperative radiologic score. A score equal to or more than 7.5 was expected to be associated with surgical difficulty.

Comparison between different radiological scoring systems in predicting post-PCNL outcome

Background: Various scoring systems, including Guy's stone score (GSS), S.T.O.N.E. score, and Clinical Research Office of the Endourological Society (CROES) nomogram, have been assessed for predicting post-percutaneous nephrolithotomy (PCNL) success in terms of stone-free status (SFS) and complications. Our study aims to determine the optimal predictor of SFS among these systems and assess their efficacy in predicting perioperative factors and complications, using modified Clavien grade. Methods: This prospective hospital-based cohort study involved 107 patients aged ≥18 years who underwent standard PCNL (tract size &gt;24 Fr) within a year. GSS, S.T.O.N.E. score, and CROES nomogram were calculated using preoperative computed tomography (CT) scans. Comparisons between 'stone-free' and 'residual-stone' groups were statistically analyzed. Results: All parameters effectively predicted SFS. S.T.O.N.E. score exhibited excellent discriminatory power (AUC 0.844; 95% CI: 0.762-0.907), followed by GSS (AUC 0.756; 95% CI: 0.663-0.834) and CROES nomogram (AUC 0.749; 95% CI: 0.656-0.828). S.T.O.N.E. score, with an AUC of 0.844, proved the most accurate predictor at ≤7 cut-off. GUY's score correlated positively with operative time and hospital stay (correlation coefficient 0.403, 0.34). S.T.O.N.E. score also positively correlated with these factors (correlation coefficient 0.443, 0.37). CROES nomogram negatively correlated with operative time and hospital stay (correlation coefficient -0.374, -0.314). Conclusions: All scoring systems effectively predict post-PCNL SFS, with S.T.O.N.E. score being the most predictive. GSS and S.T.O.N.E. score associate significantly with operative time and hospital stay. Both GSS and S.T.O.N.E. score show significant associations with perioperative complications assessed by modified Clavien grade.

Translating imaging traits of mass-forming intrahepatic cholangiocarcinoma into the clinic: From prognostic to therapeutic insights

Background & AimsThe progress toward clinical translation of imaging biomarkers for mass-forming intrahepatic cholangiocarcinoma (MICC) is slower than anticipated. Questions remain on the biologic behaviour underlying imaging traits. We developed and validated imaging-based prognostic systems for resected MICCs with an appraisal of the tumour immune microenvironment (TIME) underpinning patient-specific imaging traits. MethodsBetween January 2009 and December 2019, a total of 322 patients who underwent dynamic computed tomography/magnetic resonance imaging and curative-intent resection for MICC at three hepatobiliary institutions were retrospectively recruited, divided into training (n = 193) and validation (n = 129) datasets. Two radiological and clinical scoring (RACS) systems, one integrating preoperative variables and one integrating preoperative and postoperative variables, were developed using Cox regression analysis. We then prospectively analysed the TIME of tissue samples from 20 patients who met study criteria from January 2021 to December 2021 using multiplexed immunofluorescence. ResultsPreoperative and postoperative MICC-RACS systems built on carbohydrate antigen 19-9, albumin, tumour number, radiological/pathological nodal status, pathological necrosis, and three radiological traits (arterial enhancement pattern, tumour boundary, and capsular retraction) demonstrated good performance in predicting disease-specific (C-statistic >0.80) and disease-free (C-statistic >0.75) survival that outperformed rival models and staging systems across study cohorts (P <0.05 for all). Patients with MICC-RACS score of 0–2 (low risk), 3–5 (medium risk), and ≥6 (high risk) had incrementally worse prognosis after surgery. Significant differences in spatial distribution and infiltration level of immune cells were identified between arterial enhancement patterns. Enhanced infiltration of immunosuppressive regulatory T cells and M2-like macrophages at the invasive margin were noted in tumours with distinct boundary and capsular retraction, respectively. ConclusionsOur MICC-RACS systems are simple but powerful prognostic tools that may facilitate the understanding of spatially distinct TIMEs and patient-tailored immunotherapy approach. Impact and ImplicationsThe progress toward clinical translation of imaging biomarkers for mass-forming intrahepatic cholangiocarcinoma (MICC) is slower than anticipated. Questions remain on the biologic behaviour of MICC underlying imaging traits. In this study, we proposed novel and easy-to-use tools, built on radiological and clinical features, that demonstrated good performance in predicting the prognosis either before or after surgery and outperformed rival models/systems across major imaging modalities. The characteristic radiological traits integrated into prognostic systems (arterial enhancement pattern, tumour boundary, and capsular retraction) were highly correlated with heterogeneous tumour-immune microenvironments, thereby renovating treatment paradigms for this difficult-to-treat disease.

Correlation between CRP levels and RALE Score in COVID-19 patients with hypertension

Coronavirus Disease 2019 (COVID-19) is a disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. Hypertension is one of the comorbidities of COVID-19 which has a 1.442 times greater risk of worsening the body's condition than patients without hypertension. Radiographic Assessment of Lung Edema (RALE) score is a radiologic numerical scoring system in determining the severity of lung lesions based on the degree of consolidation and density of opacification on chest X-rays. Examination of CRP levels in COVID-19 patients is the initial examination of hospital admission to assess the inflammation that occurs. Therefore, the researcher aims to analyze the correlation of the CRP level examination in representing the severity of COVID-19 disease experienced by patients using the RALE score. The research method used was cross sectional analytic observational method. The subjects in the study were patients diagnosed with COVID-19 with comorbid hypertension at Dr. Moewardi Hospital, Surakarta in March 2021 - March 2022. The data obtained were then analyzed using Mann-Whitney U test and Spearman's rho bivariate correlation analysis. The results analyzed from 115 patient samples obtained the mean RALE score was 13.75. As for CRP levels, this study obtained an average of 8.0473 mg/dl. In this study, there was a significant correlation with a weak correlation level and one way correlation direction between RALE score and CRP levels (p = 0,02; r = 0.287). In conclusion, There is a significant relationship between the RALE score of thoracic photographs and CRP levels of COVID-19 patients with hypertension

Formulation of a radiological scoring system to prognosticate patients with primary intracerebral haemorrhage

Background. Primary intracerebral haemorrhage is a neurological condition associated with high morbidity and mortality. Outcome prediction is necessary to allocate the available resources in such cases judicially. Our study aims to identify the radiological predictors of in-hospital mortality based on a plain CT study of the brain at admission and to develop a prognostic scoring system based on them. Material and methods. We collected the clinical and radiological data from 182 consecutive patients who presented with primary spontaneous ICH. Bivariate analysis of radiological predictors of in-hospital mortality was undertaken using unadjusted logistic regression. Those variables found to have significance were put into a multivariate logistic regression model. The Results of multivariate logistic regression were treated as a foundation for developing the scoring system. Results. The mortality rate in our series was 23.6% (N = 43). After multivariate analysis, Midline shift (MLS), presence or absence of intraventricular haemorrhage (IVH), Volume of ICH and Location of haematoma were significant predictors of mortality. Based on the identified radiological variables, a five-score prognostic scoring system (AUROC = 0.925, 95% CI 0.887–0.964)) was developed, with higher scores indicating higher mortality. Conclusions. The established scoring system, MIVL, may help physicians to do better patient counselling regarding outcomes.

Preservation versus resection of middle turbinate in endoscopic transnasal transsphenoidal pituitary surgery

BackgroundThe strategic position of the middle turbinate (MT) within the nasal cavity makes it the first kick start to resect pituitary pathology through Endoscopic Transnasal Transsphenoidal Surgery (ETTS). This research aimed to determine if the type of endonasal endoscopic approach, MT resection (MTres) versus MT preservation (MTpre), for pituitary surgery affects olfaction and sinonasal function within a subjective as well as objective manner. Patients & methodsA prospective cohort comparative study was conducted to compare the sinonasal and olfaction outcomes pre and post operatively for both groups. Sinonasal symptoms were evaluated subjectively by Sino-Nasal Outcome Test (SNOT-22), while objectively by Peri-Operative Sinus Endoscope Score (POSE) along with Lund-Mackay radiological scoring system (LMS), and a Sniffin Sticks Identification test (SIT) (Burghart, Germany) was used to measure the olfaction intensity. In both groups were used on a pre-operative period and after one, three, and six months post operatively. Results96 patients were recruited within predetermined criteria. It is found that there are no significant differences in SIT between both groups with a ρ value 0.439 post operatively. The average change in score (delta) was an increase of 0.3, with changes ranging from −3 to +4. There was no significant difference in sinonasal symptoms score among both groups, with ρ 0.07 posts operatively. There was a minor upsurge in POSE score and LMS in the preservation group but without remarkable differences with ρ value 0.1 and 0.2 subsequently. It is found that there are no significant differences in SIT between both groups with a ρ value 0.439 post operatively. ConclusionDespite these amendments to the nasal cavity, we approved that these changes do not affect the sinonasal functions.

Congruence of radiological scoring systems used in COVID-19 pneumonia and effect of comorbid diseases on radiological features

Background/Aim: Several scoring systems have been developed to standardize radiological findings in patients with COVID-19 pneumonia. The most commonly used scoring systems in the radiological examination of COVID-19 are those of the North American Radiology Association (RSNA), British Thoracic Society (BTS), and COVID-19 Reporting and Data System (CO-RADS). However, the compatibility between these radiological scoring systems has not been evaluated before. Therefore, this study evaluated the radiological features of COVID-19 pneumonia and congruence between radiological scoring systems and determined the effect of comorbidities and demographic characteristics on radiological features and thoracic computed tomography (TCT) findings in the context of COVID-19. Methods: A retrospective cohort study was performed on patients attending our unit with a suspicion of COVID-19 who also had a positive real-time transcriptase-polymerase chain reaction (RT-PCR) test. All TCT images were subjected to the RSNA, BTS, and CO-RADS scoring systems. Demographic data such as age and gender, and comorbid conditions were recorded. Results: TCT showed peripheral, posterior, and bilateral involvement in 97.7%, 97.7%, and 87.6% of the patients, respectively. The most common TCT finding was ground glass appearance, which was found in 95.5% of the patients. The Charlson Comorbidity Index (CCI) score was found to have an impact on RSNA and BTS criteria (P=0.011 and P=0.014), while age, gender, and the presence of comorbidities such as cardiovascular disease (CVD), diabetes mellitus (DM), and chronic pulmonary disease (CPD) did not have such an effect (P&gt;0.05 for all). On the other hand, CCI scores and the presence of CPD had an association with CO-RADS, but there was no effect of age, gender, DM, and CVD (P=0.915 and P=0.730). Conclusion: TCT plays an important role in early management, isolation, and follow-up of patients with COVID-19 pneumonia. The radiological scoring systems were found to exhibit good compatibility, but comorbid conditions could have an impact on the assessment. Therefore, we conclude that these radiological assessment criteria are useful in the management and monitoring of such patients.

Supplementary Posteromedial Plating for the Fixation of Complex Tibial Plateau Fractures: A Prospective Study.

Introduction The management of complex tibial plateau fractures (CTPF) involving the posterior tibial plateau remains challenging and achieving maintenance of an axially stable construct with a single lateral locked plate is uncertain. Dual plating for such fractures via separate incisions can provide better fixation with superior clinical and radiological outcomes. This prospective study aimed to evaluate the results of the management of Schatzker type V and VI complex tibial plateau fractures using a conventional anterolateral plate along with a posteromedial buttress plate via two separate approaches and the potential complications associated with it. Methods Fifty-six patients presenting with tibial plateau fractures to the Department of Orthopaedics at a tertiary care center in the northern part of the state of Uttar Pradesh, India, between January 2018 and July 2022 were screened. Subsequently, 28 patients with CTPFs (AO/OTA types 41C1, 41C2, AND 41C3) were included in the study, managed with dual plating, and followed up for a duration of 12 months. The clinico-radiological outcome was assessed using Rasmussen's Functional Grading System (RFS), Oxford Knee Score (OKS), knee range of motion achieved, and Rasmussen's Radiological Scoring System (RRS), and statistical analysis of the data was performed. Results A total of 24 (85.71%) patients had excellent OKS and good to excellent RFS at the final follow-up. The average knee range of motion was 3.21° to 122°, with only two patients reporting an extensor lag of more than 10°. The final follow-up radiographs showed a mean medial proximal tibial angle (MPTA) of 83.98° ± 6.89 (75.44-89.21) and a mean posterior tibial plateau angle (PTPA) of 12.31 ± 4.69 (5.12 to 16.49) with the RRS showing excellent or good radiographic results with a mean score of 14.1 ± 1.7 (range 8-16). None of the patients showed signs of deep infection, whereas superficial infection was reported in two patients. A single case of secondary loss of particular reduction was seen. Conclusion Supplementary posterior buttress plating, along with the conventional anterolateral plate for the management of CTPF, achieves rigid fixation with superior articular reduction, a high knee score, a good range of motion, lower complication rates, and limited deformities with a good radiological outcome, with a few demerits of prolonged operative time, technically demanding procedure, increased blood loss, and a protracted hospital stay which can be minimized in most instances using minimally open reduction techniques and careful soft-tissue handling.

Open-aqueduct LOVA, LIAS, iNPH: a comparative clinical-radiological study exploring the “grey zone” between different forms of chronic adulthood hydrocephalus

PurposeThe definition of chronic adult hydrocephalus encompasses different pathological entities with overlapping characteristics, including long-standing overt ventriculomegaly in adults (LOVA), late-onset idiopathic aqueductal stenosis (LIAS) and idiopathic normal pressure hydrocephalus (iNPH). The aim of our study was to identify preoperative clinical and radiological features peculiar of these diseases providing some pathophysiology inferences on these forms of hydrocephalus.MethodsClinical and radiological preoperative records, type of surgical treatment and clinical outcome of patients with chronic adult hydrocephalus who were surgically treated between 2013 and 2019 were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the contribution of each variable to the differential diagnosis.ResultsIn total, 105 patients were included: 18 with LOVA, 23 with LIAS and 64 with iNPH. On multivariate analysis, an enlarged cisterna magna and a more severe ventriculomegaly were associated with the diagnosis of LOVA, while an older age and DESH with iNPH. LIAS patients tend to have an higher prevalence of raised ICP symptoms. Based on that, a clinical and radiological scoring system was developed to distinguish between iNPH and no iNPH cases. A precise cut-off value with a sensitivity of 95.1% and a specificity of 90.6% was identified.ConclusionsLOVA, LIAS and iNPH are different forms of chronic adulthood hydrocephalus and present different and peculiar clinical and radiological features, with an impact on the treatment and outcome prediction. The implementation of a clinical-radiological score for differential diagnosis may help the differentiation. Further studies are warranted.

Comparison of Predicting the Severity of Disease by Clinical and Radiological Scoring Systems in Acute Pancreatitis

Aim: Acute pancreatitis (AP) is a frequent reason for patient presentation in emergency department. It is hard to assess objectively the grade of the disease due to a wide range of clinical signs in terms of determination the need for intensive care or surgical intervention. At this stage there is not a unique, unified scoring system that determines the severity of the disease. In this study we aimed to compare clinically used AP scoring systems; Ranson, BISAP and Balthazar (CTSI), SIRS to predict disease severity. Material and Methods: In this study, AP patients that were diagnosed by Atlanta criteria were analyzed retrospectively. The clinical, laboratory and radiological images and results of the patients were analyzed by using the "first 24 hours Ranson", "BISAP" and SIRS scores. The Balthazar scores were calculated from the CT reports retrospectively. Results: Age, respiratory rate and BUN values of the patients with mortality were significantly higher than the patients who survived, whereas diastolic blood pressure, systolic blood pressure, SO2 and amylase values of the patients with mortality were found to be significantly lower than the patients who survived. When the 6 month mortality prediction of prognostic scoring systems was examined, it was found that the BISAP score could catch 94% of mortality (95% CI: 0.88-0.97), and the SIRS score could predict mortality by 74.7% (95% CI: 0,66-0,82). Conclusion: Regarding the APs severity prediction, BISAP and SIRS scores were more sensitive and specific in terms of monthly and overall mortality in patients.

Clinical and radiological outcome measures in patients after reconstruction of displaced acetabular fractures.

Objective: To determine the clinical and radiological outcome parameters of surgical treatment of acetabular fractures in patients after reconstruction of displaced acetabular fractures. Study Design: Prospective study. Setting: Department of Orthopedics, Lahore General Hospital, Lahore. Period: January 2014 to December 2019. Material &amp; Methods: A total of 27 cases of acetabular fractures operated with open reduction and internal fixation were included. Seven patients were lost to follow-up. The outcome measures were noted in 20 patients after three years follow-up. Modified Merle D'Aubigné and Postal score and Matta radiological scoring systems were utilized to note the outcomes. Results: There were 14 (70.0%) male and 6 (30.0%) female. Overall mean age was 35.5+8.4 years ranging between 25 to 65 years. Road traffic accidents were the most frequent mechanism of injury noted in 16 (80.0%) patients. The Kocher-Langenback approach was the most commonly adopted surgical approach done in 14 (70.0%) patients. The functional outcome according to Modified Merle D’Aubigné and Postal score was excellent in 9 (45%) patients and poor in 4 (20%). The radiological conclusion according to Matta’s radiological score was excellent in 8 (40%) patients and poor in 4 (20%). Four patients developed avascular necrosis of head of femur for which total hip replacement was done later. Conclusion: Complications were common and outcome was variable after reconstructing of displaced acetabular fractures.

Change in calcinosis over 1 year using the scleroderma clinical trials consortium radiologic scoring system for calcinosis of the hands in patients with systemic sclerosis

IntroductionCalcinosis cutis is a debilitating complication of systemic sclerosis (SSc). We previously developed a radiographic scoring system to assess severity of calcinosis affecting the hands in patients with SSc. We sought to further validate our radiographic scoring system to assess for change over 1 year and to identify factors associated with improvement or progression. Materials and methodsBaseline and 1-year antero-posterior hand radiographs were obtained in 39 SSc patients with calcinosis prospectively enrolled at 6 centers within the US, Canada, Mexico and Australia. Two readers (one radiologist and one rheumatologist) scored all radiographs using the calcinosis scoring system and a 5-point Likert scale (1 = A lot better, 2 = A little better, 3=No change, 4 = A little worse, 5 = A lot worse) on follow-up. By maximizing the Kappa coefficient of agreement between grouped Likert scale (better/no change/worse) and the percentage of change of calcinosis in the radiographic scoring system, we defined progressive calcinosis as >25% increase in score from baseline at 1-year, stable calcinosis as change in score between -25% to 25%, and improvement of calcinosis as decrease in score by >25%. Nineteen SSc patients from an independent cohort were used for validation. ResultsInter-rater reliability of the calcinosis scoring system was high with intra-class correlation coefficient of 0.93 (0.89–0.95). The median percentage of change from baseline to 1 year was 12.8% (range -89.3 to 290.2%). Sixteen patients (41%) experienced progression of calcinosis over 1 year; 18 (46%) remained stable; and 5 (13%) had improvement. Patients with progressive calcinosis had lower T-score on bone densitometry (-3.3 vs -1.7, p = 0.044) and higher prevalence of loss of digital pulp on physical exam (56% vs 22%, p = 0.027), with a trend towards lower baseline modified Rodnan skin score (mRSS) (3.8 vs. 5.9, p = 0.057), than patients who did not progress. Patients who experienced improvement in calcinosis had lower prevalence of digital pitting scars (20% vs 71%, p = 0.047) than patients whose calcinosis did not improve. In multivariable analysis, loss of digital pulp remained a predictor of calcinosis progression (OR 5.8, p = 0.023, CI 1.27 - 26.36). In the validation cohort, 2 (11%) patients improved, 10 (53%) remained stable, and 7 (37%) progressed. ConclusionsWe confirmed the excellent inter-rater reliability of our radiographic calcinosis scoring system and demonstrated its usefulness to detect change over time. Approximately 40% of patients experienced progression of calcinosis over 1 year. Loss of digital pulp was predictive of progressive calcinosis providing further evidence that digital ischemia contributes to the progression of calcinosis.

Comparison of the Efficacy of Balthazar Score and C-Reactive Protein-Albumin Ratio for Determination of Acute Pancreatitis Severity.

Acute pancreatitis (AP) clinic has a wide spectrum ranging from asymptomatic cases to mortality. Early diagnosis and prediction are of great importance to prevent mortality in AP patients. Many prognostic scoring systems have been developed for AP to date. At the time of the initial assessment of attendance to the emergency department (ED), it is impractical to use existing prognostic scoring systems for patients with a diagnosis of AP in most patients. The prognostic performances of radiological and clinical scoring systems of 329 patients diagnosed with acute pancreatitis were compared in terms of C-reactive protein-albumin ratio (CAR) levels, mortality and severity according to Balthazar score. It was observed that the CAR value increased as the AP severity increased. For mortality estimation, the ROC curve was used for sensitivity, specificity, and cut-off values for each scoring system for CAR. When mild pancreatitis and severe pancreatitis were compared according to Balthazar score, the differences between CAR were statistically significant and positive correlations were present. The CAR value has been shown to be a useful clinical tool that can be used with its high predictive value. CAR has the advantages of being easily accessible, inexpensive, and having moderately high diagnostic power to predict AP severity.

Anterior intrapelvic approach and suprapectineal quadrilateral surface plate for acetabular fractures with anterior involvement: a retrospective study of 34 patients

BackgroundThe purpose of the study is to evaluate the use of the suprapectineal quadrilateral surface (QLS) plates associated with the anterior intrapelvic approach (AIP) to the acetabulum in the surgical treatment of acetabular fractures with anterior involvement.MethodsWe did a retrospective study of patients surgically treated with QLS plates and AIP for acetabular fractures with the involvement of the anterior column, between February 2018 and February 2020, in our Hospital. The following data were recorded: mechanism of injury, the pattern of fracture, presence of other associated injuries, the time before performing the surgery, surgical approach, position on operating table, time of surgery, intraoperative bleeding, hospitalization time, intraoperative and postoperative complications. Follow-ups were performed at 1, 3, 6, 12 months, then annually. The clinical-functional outcome was assessed with the Merle d’Aubigne Postel score (MAP) modified by Matta; while the radiological outcome with the Matta Radiological Scoring System (MRSS). A Chi-square test was utilized to examine associations between parametric variables.ResultsWe included 34 patients, mean age 62.1, with an average follow-up of 20.7 months. The most frequent traumatic mechanism was road trauma. There were 15 isolated anterior columns and 19 associated patterns. There were 5 cases of associated visceral injuries, and 10 cases of other associated skeletal fractures. All patients were in the supine position. The surgical approach used was the AIP in all cases, with the addition of the first window of the ilioinguinal approach in 16 cases and of the Kocher-Langenbeck approach in 2 cases. The average time before performing the surgery was 8.5 days. The mean time of the surgery and the mean length of stay after surgery were 227.9 min and 8.2 days, respectively. There weren’t cases of intra-operative complications, while there were postoperative complications in 5 patients. The MRSS was judged anatomical in 26 cases, imperfect in 7 cases and poor in 1 case. The average MAP value was 15.2. We observed a significant relationship between the radiological outcome and the clinical outcome (p < 0.05).ConclusionsThe QLS plates in association with the AIP approach represent an effective treatment strategy for the treatment of acetabular fractures with anterior involvement.