Radiological Scoring System Research Articles

Non-Sedated Rapid Volumetric Proton Density MRI Predicts Neonatal Brachial Plexus Birth Palsy Functional Outcome

The current prognostic biomarker of functional outcome in brachial plexus birth palsy is serial clinical examination throughout the first 6 months of age. This can delay surgical treatment and prolong parental anxiety in neonates who will recover spontaneously. A potentially superior biomarker is a volumetric proton density MRI performed at clinical presentation and within the first 12 weeks of life, providing a high spatial and contrast resolution examination in 4 minutes. Nine neonates ranging in age from 4 to 9 weeks who presented with brachial plexus birth palsy were enrolled. All subjects underwent non-sedated 3 Tesla MRI with Cube Proton Density MRI sequence at the same time as their initial clinical visit. Serial clinical examinations were conducted at routine 4 week intervals and the functional performance scores were recorded. MRI findings were divided into pre-ganglionic and post-ganglionic injuries and a radiological scoring system (Shriners Radiological Score) was developed for this study. Proton Density MRI was able to differentiate between pre-ganglionic and post-ganglionic injuries. Radiological scores (Shriners Radiological Score) correlated better with functional performance at 6 months of age (P = .022) than the initial clinical examinations (Active Movement Scale P = .213 and Toronto P = .320). Rapid non-sedated volumetric Cube Proton Density MRI protocol performed at initial clinical presentation can accurately grade severity of brachial plexus birth palsy injury and predict functional performance at 6 months of age.

Lumbar disc herniation: Is there an association between histological and magnetic resonance imaging findings?

Background:Although validated radiological scoring systems and histological scoring system of surgically removed degenerated disc are used in assessment of progression of intervertebral disc degeneration, there have not been many studies that integrate these two aspects of assessments. The data available in this respect are very limited. This clinical study was designed to find the correlation between quantitative radiological score (Pfirmann grading system and Modic changes [MC]) and quantitative histological degeneration score (HDS).Materials and Methods:A cohort of 77 patients (45 males, 32 females; mean age of 38 years [range 18–58 years]) who presented with complaints of discogenic pain or radiculopathy at single level were assessed radiologically. They were graded according to the radiological pattern. The surgically excised disc specimen was graded according to HDS. The degree of radiological changes were correlated with the degree of histological changes.Results:Though the overall HDS (0–15) did not show statistically significant correlation with Pfirmann grading system, there were positive association found between mucoid degeneration, chondrocyte proliferation with the Pfirmann grading and mucoid degeneration, which were statistically significant. Female sex also had a higher association with instability pattern.Conclusion:The study shows that the Pfirmann grading system, MCs and HDS can reliably be used as scoring systems for assessing lumbar disc degeneration. The radiological assessment can be used as a noninvasive tool to assess the probable change in content rather than the microstructure of a disc undergoing degeneration.

A New Simple Radiological Scoring System for Classifying the Tegmen of the Mastoid

A New Simple Radiological Scoring System for Classifying the Tegmen of the Mastoid

A New Simple Radiological Scoring System for Classifying the Tegmen of the Mastoid

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Evaluation of interobserver variability and diagnostic performance of developed MRI‐based radiological scoring system for invasive placenta previa

To evaluate the interobserver variability and diagnostic performance of a developed magnetic resonance imaging (MRI)-based scoring system for invasive placenta previa. Prenatal MR images of 70 women were retrospectively evaluated, 18 of whom were diagnosed with invasive placenta. The six MR features (dark band on T2 -weighted images, intraplacental abnormal vascularity, placental bulge, heterogeneous placenta, myometrial thinning, and placental protrusion sign) were scored on 5-point Likert scale separately, and the cumulative radiological score (CRS) was defined as the sum of each score. Two more experienced radiologists (readers A and B) and two less experienced residents (readers C and D) calculated the CRS. Interobserver variability was assessed by measuring the intraclass correlation coefficient. Diagnostic performance was evaluated by means of receiver operating characteristic (ROC) analysis. Interobserver variability for CRS was excellent for the more experienced radiologists (0.85), and good for all readers (0.72) and the less experienced residents (0.66). The area under the ROC curve (Az) and accuracy (Acc) for CRS were significantly higher or equivalent to those of other MR features for all readers (Az and Acc for reader A; CRS, 0.92, 91.4%; intraplacental T2 dark band, 0.83, P = 0.009, 81.4%, P = 0.03; intraplacental abnormal vascularity, 0.9, P = 0.3, 90.0%, P = 1.00; placental bulge, 0.81, P = 0.0008, 80.0%, P = 0.02; heterogeneous placenta, 0.85, P = 0.11, 74.3%, P = 0.002; myometrial thinning, 0.84, P = 0.06, 60.0%, P < 0.0001; placental protrusion sign, 0.81, P = 0.01, 81.4%, P = 0.26). This developed MRI-based scoring system demonstrated excellent or good interobserver variability, and good diagnostic performance for invasive placenta previa. J. Magn. Reson. Imaging 2016;44:573-583.

Good functional results of distal femoral opening-wedge osteotomy of knees with lateral osteoarthritis.

To evaluate the time-dependent functional outcome of patients with lateral knee osteoarthritis with increased valgus treated with lateral opening-wedge osteotomy to shift the load from the lateral to the medial compartment of the knee. Twenty-four consecutive patients with lateral knee osteoarthritis were treated with distal femoral opening-wedge varus osteotomy stabilized with the Puddu plate and bone transplantation. The mean age of the patients was 48years (CI 40.3-55.7, range 31-62). The patients were evaluated by the Knee Injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at 3 and 6months, 1, 2, 5 and 10years post-operatively. The knee osteoarthritis was graded according to the Kellgren-Lawrence radiological scoring system. The mean follow-up time was 7.9years (CI 6.8-9.0, range 4.0-10.2). The mean angular correction measured on pre- and post-operative radiographs was 9.6° (CI 7.7°-11.5°, range 4°-20°). All osteotomies healed. KOOS increased significantly during the first year by 28-122% beyond the preoperative values for all the five subscores. This improvement remained at 10-year follow-up for those with surviving osteotomy. Six knees were converted to total knee arthroplasty (TKA) mean 6.4years (CI 3.3-9.6, range 4.0-11.8) post-operatively. The osteotomy survival rate at 5years was 88% and at 10years 74%. The preoperative osteoarthritic grade did not increase significantly during the follow-up period, but was significantly correlated (r=-0.49), P=0.019 to the KOOS subscore symptoms at the 2-year follow-up. Distal femoral opening-wedge osteotomy for lateral knee osteoarthritis resulted in good functional recovery after 1year and favourable midterm results. It may be a good treatment option for middle-aged patients with valgus knees and lateral osteoarthritis in order to prevent or postpone TKA. IV.

Evaluation of Outcome of Proximal Tibia Fractures managed with MIPPO

Background: the concept of minimally invasive Osteosynthesis using percuatneous plate was established when it is realized that the length and alignment of proximal tibia can be restored with indirect manipulation and reduction technique. Biological fixation with percutaneous plating augments the healing process without additional risk of wound disruption and infection. Purpose: The aim of the study was to evaluate the result of proximal tibial fractures with minimal invasive percutaneous plate osteosynthesis and to assess the clinical, radiological and functional outcome of the same. Method & Material: The present study was conducted in the Department of Orthopaedics, during the period of August 2013 and August 2015, at Acharya Vinoba Bhave Rural Hospital, Wardha. The design of study was prospective cohort study. This study included 32 patients with the fracture proximal tibia of the patients and age of patient ranging from 20 to 75 years. All the patients with proximal tibia fractures were included in the study. Result: A total of 32 patients of proximal tibial fractures were treated with minimally invasive percutaneous plate osteosynthesis technique. There were 29 male and female patient, with maximum patients in the age group of 31 to 40 years. Road traffic accident evolved as most common mode of injury. Fractures were classified according to AO classification. C1 type of fracture seen in 8 (25 %) patients and A2 type in 7 (21.9%) patients. Rasmussen’s clinical and radiological scoring system was used for final evaluation of the results. The average Rasmussens clinical score was 23 .53 and average radiological score was 14.3. In present study according to Rasmussen clinical score good result were seen in 26 (81.4 %) patients and poor result seen in only 1 (3.1 %) patient. According to Rasmussen’s radiological score good results were seen in 26 (81.3 %) patients and only in 1(3.1 %) patient poor result was seen. In only 2(6.4%) patients there was implant related problem in the form of screw back out and plate prominence. The average range of knee flexion was 136.25 degree and 17 patients (53.12 %) achieved 131 -140 degrees of flexion. While 14 (43.75 %) patients achieved extension up to -2 degrees. Conclusion: Minimally invasive percutaneous plate Osteosynthesis is better technique, and should be considered as primary option for the surgical treatment of the proximal tibia fractures. Clinical outcome of MIPPO technique are favourable and comparable to world literature in terms of fracture union, early mobilization and functional outcome. MIPPO technique preserve the soft tissues around the fracture site hence healing of the fracture is early. For the same reason MIPPO can be a treatment option for the grade I compound fractures. MIPPO technique can be successfully used for the simple or grade I compound fracture of proximal tibia. Key words: Tibia, Minimal Invasive Plate Osteosynthesis, Clinical, Functional, Radiological

Tibial pilon fractures treated by interlocking intramedullary nail with distal multi-directional locking

Objective To explore the clinical efficacy of pilon fracture treated by tibial multi-directional interlocking intramedullary nail. Methods From June 2010 to January 2013, data of 23 patients with pilon fracture who were treated by tibial multi-directional interlocking intramedullary nail were retrospectively analyzed. There were 15 males and 8 females, with an average age of 36.9 years (range, 32-61 years). They were all fresh fractures, including 22 cases of closed fractures and 1 case of opened fracture (Tscherne grade 1). According to the AO/OTA classification, there were 10 fractures of type C1, 8 fractures of type C2 and 5 fractures of type C3. According to the injury mechanisms, open reduction and internal fixation' was used. Non-restrictive screws were used to convert type C to type A after pry poking reposition, then intramedullary nail was used to fixate the fracture. Burwell-Charnley radiological evaluation system was used for radiological assessment, and Teeny-Wiss ankle clinical symptoms and functional score system was used for efficacy assessment postoperative. Results The mean followup period was 20.6± 2.3 months (range, 18-24 months). All fractures were healed at an average period of 16.8±4.0 weeks (range, 14-28 weeks). According to the Burwell-Charnley radiological evaluation system, 20 cases had obtained anatomic reduction, 2 cases fair reduction and only 1 case poor reduction. The anatomic reduction rate was 87.0% (20/23). At the latest followup, the mean Teeny-Wiss score was 91.6±9.5 (range, 60-100). There were excellent in 12 cases, good in 8 cases, fair in 2 cases, and poor in 1 case, and the overall excellent and good rate was 87.0%(20/23). None of the complications such as infection, breakage of screw loosening, malunion, nonunion occurred at the time of the latest followup, but 7 cases appeared tension blisters, one case appeared skin necrosis, and 6 cases got chronic pain in the knee postoperation. Conclusion Multi-directional interlocking intramedullary nail is a safe alternative for the treatment of pilon fractures with proper patient selection and surgical indication. Key words: Tibial fractures; Fracture fixation, internal; Bone screws

Lund–Mackay and modified Lund–Mackay score for sinus surgery in children with cystic fibrosis

ObjectivePatients with cystic fibrosis (CF) frequently present with severe sinonasal disease often requiring radiologic imaging and surgical intervention. Few studies have focused on the relationship between radiologic scoring systems and the need for sinus surgery in this population. The objective of this study is to evaluate the Lund–Mackay (LM) and modified Lund–Mackay (m-LM) scoring systems in predicting the need for sinus surgery or revision surgery in patients with CF. MethodsWe performed a retrospective chart review of CF patients undergoing computed tomography (CT) sinus imaging at a tertiary care pediatric hospital from 1995 to 2008. Patient scans were scored using both the LM and m-LM systems and compared to the rate of sinus surgery or revision surgery. Receiver–operator characteristics curves (ROC) were used to analyze the radiological scoring systems. ResultsA total of 41 children with CF were included in the study. The mean LM score for patients undergoing surgery was 17.3 (±3.1) compared to 11.5 (±6.2) for those treated medically (p<0.01). For the m-LM, the mean score of patients undergoing surgery was 20.3 (±3.5) and 13.5 (±7.3) for those medically treated (p<0.01). Using a ROC curve with a threshold score of 13 for the LM, the sensitivity was 89.3% (95% CI of 72–98) and specificity of 69.2% (95% CI of 39–91). At an optimal score of 19, the m-LM system produced a sensitivity of 67.7% (95% CI of 48–84) and specificity of 84.6% (95% CI of 55–98). ConclusionThe modified Lund–Mackay score provides a high specificity while the Lund–Mackay score a high sensitivity for CF patients who required sinus surgery. The combination of both radiologic scoring systems can potentially predict the need for surgery in this population.

Diagnostic accuracy of radiologic scoring system for evaluation of suspicious hirschsprung disease in children.

Background:In 1996, Donovan and colleagues represented a scoring system for better prediction of Hirschsprung disease (HD).Objectives:Our objective was to devise another scoring system that uses a checklist of radiologic and clinical signs to determine the probability of HD in suspicious patients.Patients and Methods:In a diagnostic accuracy study, 55 children with clinical manifestations of HD that referred to a training hospital from 1998 to 2011 were assessed. A checklist was used to evaluate the items proposed by contrast enema (CE), based on six subscales, including transitional zone, rectosigmoid index (RSI), irregular contractions in aganglionic region, cobblestone appearance, filling defect due to fecaloid materials and lack of meconium defecation during the first 48 hours after birth. The patients were classified as high score and low score. Sensitivity, specificity, positive predictive value and negative predictive value of our scoring system were calculated for identifying HD, in comparison with pathologically proved or ruled out HD.Results:Of the 55 patients, 36 (65.4%) cases had HD and 19 (34.6%) cases were without HD. In the HD group, 32 patients showed high scores and four patients had low scores. The sensitivity and specificity of our diagnostic scoring system were 88.9% (95% CI: 78.6% - 99.1%) and 84.2% (95% CI: 68.7% - 100%), respectively. Moreover, positive predictive value (PPV) and negative predictive value (NPV) were 91.4% (95% CI: 82.1% - 100%) and 80% (95% CI: 62.5% - 97.5%), respectively.Conclusions:Our new scoring system of CE is a useful diagnostic method in HD. If a patient’s score is high, that patient is highly suspicious to HD and reversely, when one’s score is low, the patient presents a reduced probability to be diagnosed with HD.

Femur başı epifizinin stabil tip hafif ve orta dereceli kaymasında tek vida ile olduğu pozisyonda tespit

Objective: The aim of this study is to evaluate the results of the patients with mild and moderate stable type SCFE treated with in situ single screw fixation without reduction. Material and Method: Twelve hips of ten patients with SCFE were treated between 2000-2012. Body mass index, range of motion (R.O.M.), slipping angles on lateral X-Ray were measured and evaluated pre and postoperatively. Heyman Herndon’s clinical and Boyer’s radiologic scoring systems were evaluated at last visit. Results: The mean age was 11.4±1.5 (9-14) years. Mean following time was 62 (14-119) months. According to Southwick’s method mean slipping angle was 40° (26°-50°). Mean body mass index was 27 kg/m2. The mean preoperative flexion, internal and external rotation of the hips were 100° (50°-120°), 12° (0°-30°), 64° (20°-90°) and the mean postoperative flexion, internal and external rotation of the hips were 119° (100°-130°), 30° (10°-60°), 62° (50°-80°). Increase in R.O.M. of flexion and internal rotation was statistically significant (p

Analysis of the impact of adherent perirenal fat on peri-operative outcomes of robotic partial nephrectomy

Adherent perirenal fat (APF) can be defined as inflammatory fat sticking to renal parenchyma, whose dissection is difficult and makes it troublesome to expose the tumour. Our objective was to evaluate the impact of APF on the technical difficulty of robot-assisted partial nephrectomy (RPN). We analysed data of 202 patients who underwent RPN for a small renal tumour. Patients were divided into two groups according to the presence of APF. Peri-operative data were compared between the two groups. Predictors of APF were evaluated by univariate and multivariate analysis. The validity of the MAP score (radiological scoring system) was also assessed. APF was observed in 80 patients (39.6 %). Tumour complexity and surgeon's experience were similar between both groups. Operative time was 40 min longer in the APF group (188.5 vs. 147.9 min, p < 0.0001). Blood loss was twice higher, and transfusions were more common in the APF group (694 vs. 330 ml, p < 0.0001 and 19 vs. 5.8 %, p = 0.003, respectively). APF was associated with an increased risk of conversion to open surgery (11.2 vs. 0 %, p = 0.0002) or radical nephrectomy (6.2 vs. 0.8 %, p = 0.03). In multivariate analysis, male gender (OR 13.2, p < 0.0001), obesity (OR 1.2, p = 0.007), hypertension (OR 3.7, p = 0.02), and MAP score (OR 3.3; p < 0.0001) were significant predictors of APF. During RPN, APF is associated with increased bleeding and a higher risk of conversion to open surgery and to radical nephrectomy. Male gender, hypertension, obesity, and MAP score are predictors of APF.

Primary bone grafting with locked plating for comminuted distal femoral fractures: can it improve the results?

Background Distal femoral fractures are challenging injuries. The thin cortex, wide medulla, extensive comminution, and articular extension make fixation difficult, with high rates of nonunion and implant failure. Fixation of such fractures with bridging plates relies on secondary healing with callus formation. Although locked plating has improved the fixation strength, recent studies substantiate the concern that the high stiffness of these constructs suppresses callus formation, contributing to a nonunion rate of up to 19% seen with periarticular fractures. The absence or delay of osseous union maintains the construct loaded with the possibility of implant failure or loss of fixation. Aim of the work To highlight the importance of primary bone grafting with distal femoral locked plates in fixation of comminuted distal femoral fractures in adults as a biological enhancer of early callus formation; adding a protective mechanical support - once integrated - to the construct against stresses that can cause non-union and/or implant failure due to the reported callus suppression with such constructs with high stiffness. Patients and methods This prospective study included 11 patients with closed, comminuted distal femoral fractures. Clinical and radiological evaluation was performed. Fractures were classified according to the AO-OTA system. Radiological results were evaluated according to the ASAMI radiological scoring system, whereas functional results were assessed according to Schatzker and Lambert criteria and the ASAMI functional scoring system. All fractures were fixed through the open lateral approach using locked plates with primary autogenous bone grafting in the comminuted area all around. Results All fractures united with a mean union time of 16.2 weeks. The functional outcome according to the used scoring systems was excellent in nine patients (81.8%) and good in two patients (18.2%). Thus, satisfactory results (excellent and good) were obtained in all cases of the studied group, with no cases developing nonunion or implant failure. Conclusion Adding primary autogenous bone grafting to the locked bridging construct can overcome the problem of deficient callus formation. It does not only induce rapid callus formation biologically, but also mechanically protects the construct - once integrated - against repetitive stresses that can cause varus collapse, nonunion, and implant failure.

MRI-based radiologic scoring system for extent of brain injury in children with hemiplegia.

Brain MR imaging is recommended in children with cerebral palsy. Descriptions of MR imaging findings lack uniformity, due to the absence of a validated quantitative approach. We developed a quantitative scoring method for brain injury based on anatomic MR imaging and examined the reliability and validity in correlation to motor function in children with hemiplegia. Twenty-seven children with hemiplegia underwent MR imaging (T1, T2-weighted sequences, DTI) and motor assessment (Manual Ability Classification System, Gross Motor Functional Classification System, Assisting Hand Assessment, Jebsen Taylor Test of Hand Function, and Children's Hand Experience Questionnaire). A scoring system devised in our center was applied to all scans. Radiologic score covered 4 domains: number of affected lobes, volume and type of white matter injury, extent of gray matter damage, and major white matter tract injury. Inter- and intrarater reliability was evaluated and the relationship between radiologic score and motor assessments determined. Mean total radiologic score was 11.3 ± 4.5 (range 4-18). Good inter- (ρ = 0.909, P < .001) and intrarater (ρ = 0.926, P = < .001) reliability was demonstrated. Radiologic score correlated significantly with manual ability classification systems (ρ = 0.708, P < .001), and with motor assessments (assisting hand assessment [ρ = -0.753, P < .001]; Jebsen Taylor test of hand function [ρ = 0. 766, P < .001]; children's hand experience questionnaire [ρ = -0. 716, P < .001]), as well as with DTI parameters. We present a novel MR imaging-based scoring system that demonstrated high inter- and intrarater reliability and significant associations with manual ability classification systems and motor evaluations. This score provides a standardized radiologic assessment of brain injury extent in hemiplegic patients with predominantly unilateral injury, allowing comparison between groups, and providing an additional tool for counseling families.

Mo1324 Idiopathic Recurrent Acute Pancreatitis (IRAP) and Diminished Parenchymal Radiodensity on Interval Non-Contrast CT Scan (NCT). Is Increased Intraparenchymal Pancreatic Fat (IPF) Content Associated With iRAP?

Introduction: A number of scoring systems have been developed to predict the prognosis of acute pancreatitis (AP). Extra pancreatic inflammation as evident by pleural effusion, ascites, and retroperitoneal fluid collections has been shown to be an important marker of severity. Aim: To compare EPIC scoring system with BISAP, SIRS, CTSI and MCTSI and Renal rim grade scoring systems in predicting persistent organ failure (POF), intervention and mortality in AP. Patients and Methods: The demographic, radiographic, and laboratory data from consecutive patients with AP admitted in our unit over last 14 months were retrospectively evaluated. The SIRS, BISAP, CTSI, MCTSI, Renal rim grade and the EPIC score (based on the presence of pleural effusion, ascites, and retroperitoneal and mesenteric inflammation) were calculated for all the patients. The scores were evaluated by calculating receiver operator characteristic (ROC) curves and the area under the ROC curve. Results: One hundred and five patients (65 males; mean age 40.6± 12.9 years) with AP were included in the study. Eight patients died and 71 patients developed POF whereas radiological/ endoscopic intervention were needed in 16 patients. The mean CTSI, MCTSI and EPIC score were 5.8 ± 3.0, 7.1 ± 2.6 and 4.0 ± 1.9 respectively. The area under curves (AUC) for SIRS, BISAP, CTSI, MCTSI, Renal Rim Score and EPIC score in predicting POF were 0.65 (CI: 0.53-0.78), 0.75 (CI: 0.65-0.86), 0.66 (CI: 0.54-0.78), 0.70 (CI: 0.58-0.81), 0.64 (0.52-0.76), 0.71 (CI: 0.60-0.83) respectively, for radiological/endoscopic intervention were 0.50 (CI: 0.35-0.65), 0.64 (CI: 0.49-0.78), 0.51 (CI: 0.36-0.66), 0.55 (CI: 0.41-0.70),0 .51 (0.36-0.67), 0.66 (CI: 0.52-0.81) respectively, and for mortality 0.57 (CI: 0.38-0.75), 0.90 (CI: 0.83-0.97), 0.67 (CI: 0.50-0.83), 0.68 (CI: 0.51-0.85), 0.73 (CI: 0.57-0.89) and 0.77 (CI: 0.64-0.90) respectively. Conclusion: The predictive assessment of radiological scoring systems for POF, need for intervention and mortality is similar to clinical scoring systems. EPIC score is superior to other radiological scoring systems in predicting endoscopic/radiological intervention.

Mo1323 Extra Pancreatic Inflammation on Computed Tomography and Severity of Acute Pancreatitis: Comparison of Extra Pancreatic Inflammation on CT (EPIC) Score With BISAP, SIRS, Renal Rim, CTSI, and MCTSI Scoring Systems

Introduction: A number of scoring systems have been developed to predict the prognosis of acute pancreatitis (AP). Extra pancreatic inflammation as evident by pleural effusion, ascites, and retroperitoneal fluid collections has been shown to be an important marker of severity. Aim: To compare EPIC scoring system with BISAP, SIRS, CTSI and MCTSI and Renal rim grade scoring systems in predicting persistent organ failure (POF), intervention and mortality in AP. Patients and Methods: The demographic, radiographic, and laboratory data from consecutive patients with AP admitted in our unit over last 14 months were retrospectively evaluated. The SIRS, BISAP, CTSI, MCTSI, Renal rim grade and the EPIC score (based on the presence of pleural effusion, ascites, and retroperitoneal and mesenteric inflammation) were calculated for all the patients. The scores were evaluated by calculating receiver operator characteristic (ROC) curves and the area under the ROC curve. Results: One hundred and five patients (65 males; mean age 40.6± 12.9 years) with AP were included in the study. Eight patients died and 71 patients developed POF whereas radiological/ endoscopic intervention were needed in 16 patients. The mean CTSI, MCTSI and EPIC score were 5.8 ± 3.0, 7.1 ± 2.6 and 4.0 ± 1.9 respectively. The area under curves (AUC) for SIRS, BISAP, CTSI, MCTSI, Renal Rim Score and EPIC score in predicting POF were 0.65 (CI: 0.53-0.78), 0.75 (CI: 0.65-0.86), 0.66 (CI: 0.54-0.78), 0.70 (CI: 0.58-0.81), 0.64 (0.52-0.76), 0.71 (CI: 0.60-0.83) respectively, for radiological/endoscopic intervention were 0.50 (CI: 0.35-0.65), 0.64 (CI: 0.49-0.78), 0.51 (CI: 0.36-0.66), 0.55 (CI: 0.41-0.70),0 .51 (0.36-0.67), 0.66 (CI: 0.52-0.81) respectively, and for mortality 0.57 (CI: 0.38-0.75), 0.90 (CI: 0.83-0.97), 0.67 (CI: 0.50-0.83), 0.68 (CI: 0.51-0.85), 0.73 (CI: 0.57-0.89) and 0.77 (CI: 0.64-0.90) respectively. Conclusion: The predictive assessment of radiological scoring systems for POF, need for intervention and mortality is similar to clinical scoring systems. EPIC score is superior to other radiological scoring systems in predicting endoscopic/radiological intervention.

Mo1325 Patterns of Alcohol and Tobacco Use in a Prospective Cohort: Alcohol Is Associated With Organ Failure and Necrosis in Sentinel Acute Pancreatitis

Introduction: A number of scoring systems have been developed to predict the prognosis of acute pancreatitis (AP). Extra pancreatic inflammation as evident by pleural effusion, ascites, and retroperitoneal fluid collections has been shown to be an important marker of severity. Aim: To compare EPIC scoring system with BISAP, SIRS, CTSI and MCTSI and Renal rim grade scoring systems in predicting persistent organ failure (POF), intervention and mortality in AP. Patients and Methods: The demographic, radiographic, and laboratory data from consecutive patients with AP admitted in our unit over last 14 months were retrospectively evaluated. The SIRS, BISAP, CTSI, MCTSI, Renal rim grade and the EPIC score (based on the presence of pleural effusion, ascites, and retroperitoneal and mesenteric inflammation) were calculated for all the patients. The scores were evaluated by calculating receiver operator characteristic (ROC) curves and the area under the ROC curve. Results: One hundred and five patients (65 males; mean age 40.6± 12.9 years) with AP were included in the study. Eight patients died and 71 patients developed POF whereas radiological/ endoscopic intervention were needed in 16 patients. The mean CTSI, MCTSI and EPIC score were 5.8 ± 3.0, 7.1 ± 2.6 and 4.0 ± 1.9 respectively. The area under curves (AUC) for SIRS, BISAP, CTSI, MCTSI, Renal Rim Score and EPIC score in predicting POF were 0.65 (CI: 0.53-0.78), 0.75 (CI: 0.65-0.86), 0.66 (CI: 0.54-0.78), 0.70 (CI: 0.58-0.81), 0.64 (0.52-0.76), 0.71 (CI: 0.60-0.83) respectively, for radiological/endoscopic intervention were 0.50 (CI: 0.35-0.65), 0.64 (CI: 0.49-0.78), 0.51 (CI: 0.36-0.66), 0.55 (CI: 0.41-0.70),0 .51 (0.36-0.67), 0.66 (CI: 0.52-0.81) respectively, and for mortality 0.57 (CI: 0.38-0.75), 0.90 (CI: 0.83-0.97), 0.67 (CI: 0.50-0.83), 0.68 (CI: 0.51-0.85), 0.73 (CI: 0.57-0.89) and 0.77 (CI: 0.64-0.90) respectively. Conclusion: The predictive assessment of radiological scoring systems for POF, need for intervention and mortality is similar to clinical scoring systems. EPIC score is superior to other radiological scoring systems in predicting endoscopic/radiological intervention.

Can a radiological scoring system for assessing the malignant potential of thyroid nodules be safely applied in clinical practice?

Can a radiological scoring system for assessing the malignant potential of thyroid nodules be safely applied in clinical practice?

The Centricity Score: A Novel Measurement to Aid in Conservative Breast Cancer Surgery

Introduction: This study describes an intra-operative scoring system to advise the surgeon of the centricity of the tumour in the excised specimen. Methods: Spatial estimations were prospectively made in 10 consecutive patients undergoing wide local excision (WLE) using Bioptics intra-operative digital specimen imaging. The centricity score was defined as 100 – (ICD/SD × 100), where ICD is the inter-centre distance between the specimen’s centre and the tumour’s centre. Results: 10 patients with invasive breast cancer (T1b to T4a), mean age 56 years (range 44 - 71) were studied. The mean tumour and specimen diameter was 24 mm ± 10 (range 12 - 48) and 101 mm ± 22 (range 64 - 140). The mean centricity score was 86 ± 9 (range 65 - 95). Conclusion: This study successfully describes an intraoperative radiological spatial scoring system for patients undergoing WLE. Tumours were well centered in specimens with an overall score of 86/100. The centricity score could be used to guide excision and potentially set benchmarks for conservative breast surgery.

Structural evaluation and animal implantation of porous eggshell wastederived hydroxyapatite graft as bone substitution

The development of hydroxyapatite graft with high economically value is needed for orthopedic practice in developing countries. Eggsell waste is well known as natural substance for calcium resource. It has been used as raw material in producing hydroxyapatite. This study was conducted to synthesize porous hydroxyapatite from eggshell waste and evaluate its activity as bone substitution. The porous hydroxyapatite graft was manufactured from eggshell and sugar as a raw material using hydrothermal process. The porous eggshell waste-derived hydroxyapatite (EW-HAP) graft was characterized using X ray difractometer (XRD) and analytical scanning electron microscope (SEM) and compared with commercial hydroxyapatite (HAP) JCPDS 09-432 graft (Bangros®) as standard. The porous EW-HAP graft obtained was then implanted on critically sized femoral defects surgically created in the right thigh of male Wistar rats (Rattus norvegicus) with Bangros® as control. Radiological examination using XRD and histological examination using hematoxyline-and-eosin staining of the bone femour were performed at 28 days after implantation. The results showed that the XRD pattern for EW-HAP was likely similar with the HAP standard. However, the SEM examination showed that the pasticle size of EW-HAP graft (2.5-3 μm) was higher than those HAP standard graft (1.5-2 μm). Radiographs according to the International of Limb Salvage (ISOLS) radiological evaluation system between EW-HAP graft (6.1 ± 1.45) and HAP control graft (6.9 ± 2.10) was not significantly different (p>0.05). Moreover, histological examination according to Lane and Shandu scoring system between the both graft (4.0 ± 0.94 versus 4.4 ± 0.92) was also not significantly different (p>0.05). It can be concluded that the structure EW-HAP graft is similar with HAP graft standard. The both grafts have also equal outcome as bone substitution.