Reliable Imaging Modality Research Articles

Visualization of anatomical structures in the carpal region of the horse using cone beam computed tomography in comparison with conventional multidetector computed tomography.

In the diagnostics of orthopedic diseases in the horse, diagnostic imaging often plays a decisive role. Cone beam computed tomography (CBCT) imaging is used in both human and small animal medicine and becoming increasingly popular. To see whether CBCT imaging can be useful in the diagnosis of orthopedic diseases of the carpal region of the horse and to explore possible limitations we compared CBCT images with multidetector computed tomography (MDCT) images of the carpal region of equine cadaveric specimens. Twenty-eight forelimbs from fifteen horses, slaughtered for reasons unrelated to this study, were examined. Native and contrast enhanced CBCT and MDCT scans were performed. Anatomical structures were blindly evaluated by three independent experienced observers using a visual scoring system previously reported and adapted to the equine carpal region. A descriptive evaluation was carried out as well as Spearman's rank correlation and interobserver agreement was shown by percent agreement (PA). Visualization of osseous structures was excellent in both MDCT and CBCT. Articular cartilage could only be assessed in contrast enhanced scans whereby MDCT showed a slightly better visualization than CBCT. Soft tissue structures were generally difficult to assess. An exception were the medial and lateral palmar intercarpal ligament, which could not be visualized in native but were well visualized in contrast enhanced scans in both MDCT and CBCT images. For the evaluation of osseous structures and some intraarticular ligaments after contrast enhancement, CBCT serves as a reliable diagnostic imaging modality for the equine carpal region. However, soft tissue structures and cartilage are imaged more reliably using MDCT.

Accuracy and reliability of imaging modalities for studying bipolar bone loss in anterior shoulder instability: A systematic review.

Recurrent shoulder instability, a common musculoskeletal disorder, often involves glenoid bone loss and Hill-Sachs lesions. However, the optimal imaging modality for accurately and reliably quantifying bipolar bone loss remains uncertain. This systematic review aims to evaluate the accuracy and reliability of various imaging modalities in assessing bipolar bone loss in anterior shoulder instability. Major electronic databases were searched for English-language studies reporting the measurement of glenoid track width and/or determination of on/off track HSL through imaging. Studies reporting statistical measures such as area under the curve, sensitivity, specificity, positive predictive value, NPV, intraobserver reliability and interobserver reliability were included. Data extraction and risk of bias assessment were performed independently by two reviewers. The systematic review included 19 studies comprising 1567 shoulders. Overall, studies could be divided into those looking at the accuracy or reliability of determining glenoid track width, on- or off-track Hill-Sachs lesions and near-track lesions. Three-dimensional images of computed tomography (3D-CT) was the most reliable and accurate imaging modality to measure the glenoid track width. On the opposite, two-dimensional magnetic resonance imaging (2D-MRI) did not provide enough evidence of accuracy and reliability in the determination of On/Off track lesions and near-track lesions. 3D-CT demonstrated excellent reliability for measuring glenoid track width. However, the reliability of 2D-MRI for determining on/off track Hill-Sachs lesions is still controversial. Level III.

Standardized Ultrasound Protocol for Peripherally Inserted Central Catheters in Neonates: A Retrospective, X-ray Controlled Observational Study.

Objectives: Ultrasound (US) has been reported to be a reliable imaging modality for locating the tip of peripherally inserted central venous catheters (PICC) in neonates. However, its use requires a certain level of expertise, which may limit its application. Standardization of US examinations using designed protocols may improve their efficiency and ease of use. The objective of our study is to evaluate the effectiveness of introducing a standardized US protocol for PICC guidance. Methods: An expert panel was formed in order to develop a standardized US protocol for PICC assessment. Institutional review board agreement was obtained. This protocol was then used by participating clinicians to assess PICC position. Every assessment was followed by a radiographic control. The study group consisted of 262 US examinations of PICC lines in a level III neonatal intensive care unit (NICU) performed according to the designed protocol. Subsequent statistical analysis was made with the RStudio software, R version 4.3.1 (2023-06-16 ucrt). Results: Compared to the X-ray control, standardized US examinations showed 100% sensitivity, 81% specificity, an accuracy of 98% and a 98% precision for assessing catheter placement. The Cohen's Kappa value for the comparison of X-ray and US studies was 0.88, indicating good agreement between the two methods. Conclusions: Standardized US examinations have shown similar potential for evaluating the location of PICC lines when compared with radiographic studies. Implementing a standardized protocol in the NICU may facilitate the ultrasound assessment of PICC lines and reduce exposure to ionizing radiation.

Exploring the potential of combined B-mode features and color Doppler ultrasound in the diagnosis of ureteric stone as an alternative to ionizing radiation exposure by computed tomography.

To assess the diagnostic efficacy of integrating B-mode and color Doppler capabilities of ultrasound (US) to establish a robust standalone diagnostic tool for the diagnosis of ureteric stones as an alternative to non-contrast-enhanced computed tomography (NCCT). A total of 140 consecutive patients diagnosed with ureteric stones using NCCT were enrolled. On the same day, US in both B-mode and Color Doppler was performed by an experienced radiologist who was blinded to the NCCT scan results. The diagnostic rate of US for stone detection was recorded. Additionally, baseline patient and stone characteristics were analyzed for their association with the accuracy of stone detection using US. US exhibited a high sensitivity of 91.43%, detecting 128 out of 140 stone foci. Notably, ureteric stones in the proximal and uretero-vesical junction (UVJ) segments were readily identifiable compared to those in the pelvic region (p = 0.0003). Additionally, hydronephrosis enhanced the US's ability to detect stones (p < 0.0001). Conversely, abdominal gases and obesity adversely affected US capabilities (p < 0.0001 and p = 0.009, respectively). Stone side, size, and density showed no statistically significant impact (p > 0.05). US with its color Doppler capabilities could serve as a reliable and safe alternative imaging modality in the diagnostic work up of patients with ureterolithiasis. Factors including stone location, Hydronephrosis, weight and abdominal gases significantly influenced its accuracy.

Agreement Between Transthoracic Echocardiography and Computed Tomography Pulmonary Angiography for Detection of Right Ventricular Dysfunction in Pulmonary Embolism.

Right ventricular dysfunction (RVD) is the main determinant of mortality in patients with pulmonary embolism (PE). Thus, guidelines recommend the assessment of RVD with transthoracic echocardiography (TTE) or computed tomography pulmonary angiography (CTPA) among these patients. In this study, we investigated the agreement between TTE and CTPA for the detection of RVD. This single-center retrospective study included patients who were diagnosed with CTPA and underwent TTE within the first 24 hours following the diagnosis. Two hundred fifty-eight patients met the inclusion criteria. In 71.3% (184) of them, CTPA and TTE agreed on both the presence and absence of RVD. There was a moderate agreement between the 2 tests (Cohen's kappa = 0.404, P <.001). The agreement between right ventricle dysfunction on TTE and the increased right ventricle/left ventricle (RV/LV) on CTPA was fair (Cohen's kappa = 0.388, P <.001). Three patients died due to PE, and another 5 patients required urgent reperfusion therapy. Overall, adverse outcomes occurred in 4% (8) of patients. The sensitivity of modalities in the detection of adverse outcomes was 100%. Transthoracic echocardiography was more specific compared to CTPA (43% vs. 28%). Statistically, flattening/bulging of the interventricular septum on TTE was significantly associated with adverse outcomes. No individual CTPA parameter was related to adverse outcomes. Both CTPA and TTE are reliable imaging modalities in the detection of RVD. However, TTE is more specific, and this may help in the identification and appropriate management of patients at higher risk of decompensation. A combination of CTPA parameters rather than individual RV/LV ratios increases the sensitivity of CTPA.

Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions.

Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.

Coronary atherosclerosis among symptomatic patients with zero coronary artery calcium score in computed tomography coronary angiography

BackgroundComputed tomographic coronary angiography has been recognized as a reliable imaging modality with excellent negative predictive value and a good negative likelihood ratio to exclude coronary artery disease in stable, symptomatic patients with intermediate or high risk. 1) Coronary calcium scoring has been extensively shown to be an invaluable tool to exclude the presence of coronary artery disease in low-risk patients. 2) Our aim was to identify the presence and extent of coronary atherosclerosis in computed tomographic coronary angiography in stable symptomatic patients with a zero Coronary Calcium score. ResultsThree hundred and eighty-three (383) consecutive patients aged ≥ 18 years fulfilling the criteria were enrolled as of January 1, 2021; 165 (43.1%) were male and 218 (56.9%) were female, with a mean age of 57.8 ± 4.9 years and a zero coronary artery calcium score. Two hundred and twenty-six (226) (59.0%) were hypertensive, followed by 125 (32.6%) who were smokers, and 117 (30.5%) who were diabetic. The frequency of atherosclerotic plaque in coronary arteries was 34 (8.9%), with 16 (47.1%) being male and 18 (52.9%) being female. The mean age of patients with atherosclerosis was 54.9 ± 3.3 years; among them, 13 (38.2%) were between the ages of 45 and 54, and 10 (29.4%) were between the ages of 55 and 64. Nineteen (19) (55.9%) were hypertensive, followed by 10 (29.4%) with dyslipidemia. Twenty-three (23) (67.6%) had non-obstructive plaque, and 11 (32.3%) had obstructive plaque. In the subgroup of patients with non-obstructive plaque, 13 (56.5%) were hypertensive, 8 (34.8%) were diabetic, and 16 (69.6%) had single vessel disease, while among patients with obstructive plaque, 6 (54.5%) were hypertensive, 5 (45.5%) were smokers, and all of them had single vessel disease. The most affected artery was the left anterior descending artery. ConclusionAs the frequency of atherosclerotic plaque in patients with a zero coronary calcium score is relatively high, computed tomographic coronary angiography is indicated in stable, symptomatic patients with a lower likelihood of coronary artery disease.

INTER- AND INTRA- OBSERVER RELIABILITY OF MAGNATIC RESONANCE IMAGING FOR DIAGNOSIS OF LUMBAR FAR LATERAL DISC HERNIATION

Objective: To determine the inter- and intra- observer reliability of MRI for diagnosis of lumbar far lateral disc herniation. Method: 27 patients in whom lumbar far lateral disc herniation was definitely diagnosed by operative findings at our department between May 2018 and December 2022 were included. The magnetic resonance images consisting of T1- and T2-weighted axial and sagittal images, and these were reviewed blindly and independently by three orthopaedic spine surgeons in a random manner. The images were interpreted as positive or negative for far lateral disc herniation on 2 different occasions 3 months apart. Results were analyzed using Cohen's kappa statistic, and strengths of agreements were determined using the Landis and Koch criteria. Result: The kappa values for inter-reader agreement averaged 0.234 (0.282, 0.111, and 0.308 respectively) on the first occasion, and 0.166 (0.249, 0.111, and 0.137 respectively) on the second occasion, with an overall mean value of 0.200. Thus, the strength of agreement was only slight-to-fair according to the Landis and Koch criteria. Kappa values for intra-reader agreement averaged 0.479 (0.488, 0.491, and 0.459 respectively), indicating moderate agreement. Conclusion: The present study indicates that magnetic resonance imaging is not a reliable imaging modality for diagnosing lumbar lateral disc herniation. It is necessary to carefully evaluate the intra-foramina and extra-foramina of lumbar spine region on MRI of these patients and the spine surgeon should pay attention to the correlation between the clinical symptoms and MRI findings of these patients.

Use of Multimodality Imaging in the Evaluation of Patients With Spondyloarthropathies and Sacroiliitis.

Spondyloarthropathy (SpA) is one of the most common causes of low back pain. It is caused by inflammatory arthritis in the spine, manifesting in various forms such as psoriatic arthritis (PsA), ankylosing spondylitis (AS), and sacroiliitis. A comprehensive systematic literature search was done to evaluate and compare MRI, CT, single-photon emission CT, PET, ultrasound (US) imaging, low-dose CT, and diffusion-weighted imaging (DWI) techniques in assessing SpAs. The search strategy was constructed by an analysis of key terms from relevant articles in MEDLINE ProQuest, Embase, and PubMed. The key terms used to search for these articles were "SpA," "sacroiliitis," "spondylitis," "psoriatic arthritis," "MRI," "CT scan," "x-ray," "magnetic resonance imaging," "computed tomography," "bone density," and "ultrasound." A total of 1,131 articles published in English between January 1, 2003, and October 15, 2023 were identified and screened for eligibility by members of the research team, which resulted in 69 total articles selected for the final review. US has played an important role in visualizing joint inflammation and enthesitis (inflammation of the enthesis), which are common features of PsA. Although MRI and CT are considered more reliable modalities for diagnosing active sacroiliitis, US imaging with Doppler flow can also be useful in conjunction with CT images to visualize abnormal blood flow in the sacroiliac joints, as well as other joints affected by inflammatory arthritis. MRI provides increased diagnostic confidence in the diagnosis of sacroiliitis in active AS patients when compared to CT. CT is more sensitive than plain radiographs. The PET activity score showed a good correlation in diagnosing inflammatory sacroiliitis but lacked in identifying structural lesions. CT has high diagnostic accuracy, but it exposes patients to a high radiation dose. MRI visualizes joint and tissue inflammation, bone, and bone marrow change and can identify peripheral inflammation in soft tissue and joints in patients diagnosed with PsA. MRI can also visualize bone marrow changes and subchondral edema, which can aid in the early diagnosis of ankylosing SpA and gauge disease severity. DWI and short-tau inversion recovery imaging are both MRI techniques used in detecting sacroiliitis. MRI and CT are shown to be reliable imaging modalities for the diagnosis of sacroiliitis; however, it was found that Doppler US played an accurate role in the diagnosis as well. MRI visualizes joints and tissue with the most precision, making it useful in evaluating patients with PsA, while PET CT is useful in the diagnosis of inflammatory sacroiliitis patients. There is limited literature available comparing the multiple modalities of imaging available for each SpA. The review's objective is to analyze imaging findings in patients diagnosed with sacroiliitis and SpAs. The findings in this literature review are valuable for properly assessing and diagnosing patients suffering from SpAs.

Diagnostic feasibility of middle cerebral artery stenosis or occlusion evaluated by TCCS and CEUS: Repeatability, reproducibility, and diagnostic agreement with DSA

AimThis study aimed to evaluate the feasibility of transcranial color-coded sonography (TCCS) and contrast-enhanced ultrasound (CEUS) in assessing middle cerebral artery (MCA) stem stenosis or occlusion compared to digital subtraction angiography (DSA). MethodsA total of 48 cases including 96 MCAs suspected stem stenosis or obstruction in the MCA were assessed by TCCS, CE-TCCS, and DSA. The diameters of the most severe stenosis (Ds), proximal normal artery (Dn), and diameter stenosis rate of MCA were measured using both the color doppler flow imaging (CDFI) modality of TCCS or CEUS and the CEUS imaging modality. The intraclass correlation coefficients (ICCs) and 95 % confidence intervals (CI) were evaluated, and a weighted Kappa value was used to evaluate the intra-observer agreement, inter-observer agreement, agreement between CDFI modality and DSA stenosis or occlusion, and agreement between CEUS imaging modality and DSA stenosis or occlusion. ResultsThe ICC results indicated excellent repeatability and reproducibility (all ICCs > 0.75; weighted Kappa values >0.81). Compared with DSA, the weighted Kappa values and 95 % CIs of stenosis (the first measurement was taken by two observers) of CDFI modality and CEUS imaging modality were 0.175 (0.041, 0.308) and 0.779 (0.570, 0.988) for observers A and 0.181 (0.046, 0.316) and 0.779 (0.570, 0.988) for observers B respectively. ConclusionThis study indicates that inter- and intra-observer agreements were good for the direct method of measuring percentages of MCA stenosis by TCCS and CEUS. CEUS imaging modality is a new and reliable imaging modality approach to evaluate the MCAs stenosis and occlusion.

Detection Rate of Small Pancreas Cysts and Intrareader Reliability of the Cysts Size Measurements on Transabdominal Ultrasonography.

This study aimed to assess the detection rate of small (<10 mm) pancreas cyst and intrareader reliability for cyst size measurements on transabdominal ultrasonography (US). From 2020 to 2022, 194 pancreas cysts in 173 patients, incidentally detected on computed tomography or magnetic resonance imaging, were evaluated on US by 1 of 2 radiologists (readers 1 and 2). Intrareader agreements of cyst size measurements on US were assessed by intraclass correlation coefficient (ICC). Bland-Altman plot was used to visualize the differences between the first and second size measurements in each reader. In this study, readers 1 and 2 evaluated 86 cysts in 76 patients and 108 cysts in 97 patients, respectively. Most of the cysts (191 of 194) were located in the nontail portion of the pancreas. Overall detection rate of pancreas cysts by US was 92.3% (179 of 194). The mean size of measured 179 pancreas cysts was 4.7 ± 1.5 mm. The readers showed excellent intrareader agreements (ICC = 0.925 and 0.960) for cyst size measurements, except for the cysts with size ≤5 mm, where both readers showed good intrareader agreements (ICC = 0.848 and 0.873). The 95% limits of agreement of readers 1 and 2 were 13.8% and 14.9% of the mean, respectively. Therefore, transabdominal US could be a reliable follow-up imaging modality for small (<10 mm) nontail pancreas cysts incidentally detected on computed tomography or magnetic resonance imaging, especially for the cysts with size between 5 and 10 mm. Size changes of the pancreas cysts approximately less than 15% may be within the measurement error.

A Row Displacement Correction Algorithm for High-speed and Accurate Terahertz Raster Scanning Imaging

Terahertz time-domain spectroscopic imaging has become a common and useful technique for various interdisciplinary studies. Raster scan is still the most general and reliable imaging modality due to the lack of matrix detectors. In terahertz raster scanning imaging, row displacements occur due to the use of a two-way continuous scanning mode, the lack of delay line triggering, or other technical factors. The displacements result in image distortion which significantly affects the subsequent data analysis. In this article, a row displacement correction algorithm based on a genetic algorithm is proposed. The algorithm corrects images based on the principle that row displacements result in an increase of high-frequency components of the Fourier spectrum transformed along the image column direction. The algorithm performance is comprehensively verified by both numerical simulation and experimental data, showing a promising effectiveness and robustness on different sample types, shapes, orientations, and spatial distributions. The algorithm corrects the displacements numerically regardless of the causing factors, offering a wide adaptability for various THz systems to improve the scanning efficiency and image quality.

Case Report: A rare case of multicentric angiosarcomas of bone mimicking multiple myeloma on 18F-FDG PET/CT

BackgroundAngiosarcoma, a rare endothelial-origin tumor, can develop throughout the body, with the head and neck skin being the most commonly affected areas. It can also originate in other sites such as the breast, iliac artery, and visceral organs including the liver, spleen, and kidneys. Angiosarcoma of the bone is remarkably rare, presenting as either unifocal or multifocal bone lesions and often leading to a grim prognosis. Diagnosing bone angiosarcoma poses a significant challenge. 18F-FDG PET/CT serves as a reliable and indispensable imaging modality for evaluating distant metastases and clinically staging angiosarcomas.Case reportA 57-year-old woman presented with a 10-day history of dizziness and headaches. Cranial CT scan revealed bone destruction of the parietal bone, accompanied by soft tissue lesions, protruding into the epidural space. MRI examination demonstrated lesions with slightly elevated signal intensity on T2FLAIR, showing moderate enhancement. Furthermore, multiple foci were observed within the T12, L1-5, and S1-2 vertebrae, as well as in the bilateral iliac bones. For staging, 18F-FDG PET/CT was performed. The MIP PET showed multifocal FDG-avid lesions in the sternum, bilateral clavicles, bilateral scapulae, multiple ribs, and pelvic bones. Heterogeneous FDG uptake was observed in multiple bone lesions, including intracranial (SUVmax = 11.3), right transverse process of the T10 vertebra (SUVmax = 5.8), ilium (SUVmax = 3.3), and pubis (SUVmax = 4.7). The patient underwent surgical resection of the cranial lesion. The pathological diagnosis was made with a highly differentiated angiosarcoma.ConclusionAngiosarcoma of bone on FDG PET/CT scans is characterized by abnormal FDG uptake along with osteolytic destruction. This case highlights that angiosarcoma of bone can manifest as multicentric FDG uptake, resembling the pattern seen in multiple myeloma. FDG PET/CT can be a useful tool for staging this rare malignant tumor, offering the potential to guide biopsy procedures toward the most metabolically active site. And it should be considered in the differential diagnosis of multiple osteolytic lesions, including metastatic carcinoma, multiple myeloma, and lymphoma of bone.

Abstract 18876: Safety and Efficacy of Coronary CT Angiography in Acute Chest Pain. A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Background: Coronary computed tomography angiography (CCTA) allows direct visualization of coronary arteries. As a result of the high accuracy, CCTA has been proposed as an initial step in patients presenting to the emergency department (ED) with acute chest pain to rule out obstructive coronary artery disease (CAD). The effect of the initial CCTA strategy on downstream testing with coronary angiogram and coronary revascularization is yet to be delineated. Objective: To investigate the safety and efficacy of CCTA in patients presenting to the ED with acute chest pain compared to standard of care (SoC). Method: We searched PubMed, Cochrane CENTRAL Register, and ClinicalTrials.gov (inception through July 1st, 2023) for randomized clinical trials evaluating the outcomes of CCTA in acute chest pain. We used a random-effect model to calculate risk ratio (RR) with a 95% confidence interval (CI). The endpoints were all-cause mortality, major adverse cardiac events (MACE), rates of coronary angiography, and length of stay (LOS). Results: A total of 17 studies comprising 9237 patients were included in the analysis. Compared to SoC, the CCTA group had a shorter length of hospitalization (RR -0.3; 95%CI -0.64- -0.13; P = 0.0005). There was no significant difference in all-cause mortality or MACE (RR 0.8; 95%CI 0.45- 1.5; P = 0.52) and (RR -1.00; 95%CI 0.76- 1.3; P = 0.98), respectively. Rates of coronary angiography did not differ between the two groups (RR 0.93; 95%CI 0.61- 1.41; P = 0.96). Conclusion: CCTA is a reliable non-invasive imaging modality that can play a significant role in evaluating acute chest pain in the emergency department and is associated with a decrease in the length of stay without an increase in MACE. There was no increase in downstream coronary angiogram or coronary revascularization in the CCTA group.

Abstract 18938: Identification and Diagnosis of Culprit Lesions by Optical Coherence Tomography (OCT) in Patients With Non-ST Elevated Acute Coronary Syndromes

Introduction and Hypothesis: Optical coherence tomography (OCT) is a reliable imaging modality for plaque characterization in patients with acute coronary syndromes (ACS). While numerous studies have provided insight into the utility of OCT in ST-elevated ACS patients, our study sought to evaluate the frequency and morphological characters of lesions in patients with non-ST elevated acute coronary syndromes (Unstable angina (UA) and Non-ST elevated myocardial infarction (NSTEMI)). Methods: This multi-center, observational study included 170 patients admitted with a working diagnosis of NST-elevated ACS from October 2021 to January 2023. OCT imaging was obtained during coronary angioplasty for lesion characterization and morphology. Frequencies were compared between UA and NSTEMI sub-groups. Results: OCT imaging in patients with non-ST elevated acute coronary syndromes showed plaque erosion in 46% (n= 78), plaque rupture in 35% (n= 60), tight stenosis in 13% (n= 22), and calcified nodules in 6% (n= 10). Sub-group comparative analysis showed a statistically significant increase in plaque erosion in NSTEMI compared to UA (p&lt;0.005), while tight stenosis was significantly more common in UA (p=0.017). Morphological analysis showed a high presence of calcified nodules and red thrombus in NSTEMI patients compared to UA patients (p&lt;0.005). Conclusions: Our study concluded that optical coherence tomography is reliable in identifying and characterizing lesions in patients with non-ST elevated ACS. NSTEMI patients have a higher occurrence of plaque erosion, plaque rupture, calcified nodules, and red thrombus than patients with unstable angina.

Comparative Assessment of Echocardiography and Magnetic Resonance Imaging in the Evaluation of Structural Cardiopathies in Adults: A Comprehensive Analysis

Cardiovascular diseases, specifically structural cardiopathies, continue to pose a significant burden on global healthcare systems. The accurate assessment of these conditions in adults demands precise and reliable imaging modalities. This article presents a comprehensive exploration of the role of two prominent diagnostic tools, echocardiography and magnetic resonance imaging (MRI), in the evaluation of structural cardiopathies in the adult population. We scrutinize the clinical utility, advantages, limitations, and diagnostic accuracy of both imaging techniques, shedding light on their respective roles in the clinical decision-making process. Furthermore, we delve into recent advancements and emerging trends in echocardiography and MRI, highlighting the potential synergistic use of these modalities to optimize the diagnostic and therapeutic approach to structural cardiopathies in adults. The findings from this review will contribute to enhancing clinical practice and patient outcomes in the management of these intricate cardiovascular conditions.

A Study to Evaluate the Efficacy of Ultrasonography as a Diagnostic Screening Tool in Maxillofacial Fractures: A Prospective Study.

The aim of the study was to estimate the diagnostic efficacy of high-resolution ultrasonography (USG) in the diagnosis of maxillofacial fractures. A descriptive diagnostic evaluation study was carried out on 30 patients with suspected maxillofacial fractures, out of which 26 were male (86.7%) and 4 were female (13.3%). After initial management, detailed clinical examinations were carried out and significant findings were noted. Computed tomography (CT) scans were performed in fracture-suspecting patients followed by USG examination which was done in a standardized pattern on both sides of the face. The result of USG was compared with the CT scan report. Based on CT findings, 65 sites were found to be fractured, and this was considered the gold standard. Ultrasonography detected 58 fractures at these 780 sites, of which 54 were true fractures, while 4 were false-positive results. However, USG was not able to detect eleven fractures. The overall sensitivity and specificity of USG were 83.1% and 99%, respectively. The positive and negative predictive values were 93% and 98%, respectively. According to our study, it may be concluded that USG may be recommended as a diagnostic screening tool to detect superficial maxillofacial fractures. Ultrasonography provides a safe, cost-effective, reliable, non-invasive, easily available, and portable imaging modality to screen for maxillofacial fractures.

A systematic review and meta-analysis on the diagnostic utility of ultrasound for clavicle fractures.

Ultrasound's real-time, high-resolution imaging, and accessibility at the point of care make it a valuable tool for diagnosing clavicle fractures, with growing evidence supporting its diagnostic accuracy compared to other imaging modalities. To assess the diagnostic utility of ultrasound in detecting clavicle fractures. A systematic review and meta-analysis were conducted by performing a comprehensive literature search in PubMed, Scopus, Web of Science, and Embase databases up to March 10, 2023, following established guidelines. Eligible studies that reported outcomes of interest were included, relevant data elements were extracted, and data analysis was performed using STATA software version 17.0. Meta-analysis of seven included studies showed high-pooled sensitivity (0.94) and specificity (0.98) values for ultrasonography in diagnosing clavicle fractures, with low to moderate heterogeneity for sensitivity and high heterogeneity for specificity. Meta-regression and subgroup analyses revealed that pediatric studies had higher sensitivity but significantly lower specificity (P=0.01) compared to mixed or adult studies. Additional subgroup analysis in the pediatric group indicated decreased heterogeneity for specificity. Fagan plot analysis demonstrated favorable post-test probabilities for both positive and negative results across varying pre-test probabilities. Additionally, the likelihood ratio scatter matrix showed moderate to high test performance for both exclusion and confirmation purposes. The current literature supports ultrasound as a reliable imaging modality for detecting clavicle fractures. It offers accurate diagnosis without exposing patients, especially children, to radiation.

Poster 193: Glenoid Bone Loss Evaluation: Utilization of Current Methods

Objectives: Preoperative evaluation of glenoid bone loss is essential in surgical planning and for patients’ expectations of their surgical outcome. The four literature backed methods for measuring glenoid bone loss include the chord method, percent diameter method, the intraoperative probe method, and Pico method. Using the intraoperative probe method, it has been suggested that 25% bone loss of the inferior glenoid may be the threshold of significant bone loss. In contrast, other studies show bone loss using percent diameter above 13.5-17.3% has been associated with significantly worse clinical outcomes. Differences in bone loss measurements method utilization can lead orthopedic surgeons to proceeding with soft-tissue stabilization in a high-risk patient or alternatively to an unnecessary osseous augmentation procedure. Therefore, it is important to understand how orthopedic surgeons measure bone loss. While 3D CT and the Pico method have been previously described as the gold standard in bone loss evaluation for their highest accuracy and interobserver reliability, it is unclear how most orthopedic surgeons evaluate for bone loss in their practice. The purpose of this study is to investigate how orthopedic surgeons measure glenoid bone loss. Methods: Based on existing literature, a 16-question survey was created by the senior author. This survey included questions investigating participants’ demographic information, typical surgical practice and volume, and glenoid bone loss identification method. The survey was sent out to members of the American Orthopedic Society for Sports Medicine (AOSSM) and Arthroscopy Association of North America (AANA). Results: One-hundred-seventy-two orthopedic surgeons responded to the survey with an average of 13.4 years in practice and average number of instability surgeries performed each year of 31.2 +/- 35. In regard to subspecialty, 137 participants completed a sports medicine fellowship, 18 completed a shoulder and elbow fellowship, 10 completed both a sports medicine and shoulder and elbow fellowship, 1 completed a sports medicine and pediatric sports medicine fellowship, and 1 completed a sports medicine and trauma fellowship (97% response rate). Responders were from a variety of geographic locations: 26% were from the Northeast, 30% were from the Midwest, 21% were from the South, 10% were from Mountain States, 10% were from the West Coast, 1 was from Hawaii, 1 was from Alaska, 1 was from Columbia, and 1 practiced in Italy (98% response rate). 46% of responders belong to a private practice, while 34% practice at an academic institution. An additional 16% reported a hospital- based practice, 2% reported military affiliation, and 2% work in a private practice with academic affiliations (99% response rate). 91.3% of responders said that they routinely measure glenoid bone loss. 3D CT was the imaging modality most commonly used for bone loss evaluation (125), followed by 2D MRI (86), X-rays (68), 2D CT (60), and 3D MRI (11) (Figure 1). The frequency of four common bone loss evaluation methods were analyzed: percent diameter loss was the most commonly used and was used routinely, the intraoperative probe length method was used occasionally, Pico method was used rarely, and the chord length method was used never (Figure 2). There was no significant effect of time in practice, practice location, and fellowship training on bone loss methods. Those in private practice or a medical group setting had a higher frequency of using the intraoperative probe length method. Conclusions: The result of this study suggests that there is significant inconsistency in how orthopedic surgeons evaluate and measure glenoid bone loss in the setting of shoulder instability. While physicians commonly use the most reliable imaging modality (3D CT), the most accurate literature backed method for evaluating bone loss (Pico method) is seldom used. Future research is necessary to understand the limiting factor for orthopedic surgeons to incorporate validated glenoid bone loss measurements into their practice and develop new automated methods to improve overall utilization.

Reliable Visualization of the Treatment Effect of Transperineal Focal Laser Ablation in Prostate Cancer Patients by Magnetic Resonance Imaging and Contrast-enhanced Ultrasound Imaging

BackgroundTransperineal focal laser ablation (TPLA) treatment for prostate cancer (PCa) is an experimental focal ablative therapy modality with low morbidity. However, a dosimetry model for TPLA is lacking. ObjectiveTo determine (1) the three-dimensional (3D) histologically defined ablation zone of single- and multifiber TPLA treatment for PCa correlated with magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) and (2) a reliable imaging modality of ablation zone volumetry. Design, setting, and participantsThis was a prospective, multicenter, and interventional phase I/II pilot study with an ablate-and-resect design. TPLA was performed in 12 patients with localized prostate cancer divided over four treatment regimens to evaluate potential variation in outcomes. InterventionTPLA was performed approximately 4 wk prior to robot-assisted radical prostatectomy (RARP) in a daycare setting using local anesthesia. Outcome measurements and statistical analysisFour weeks after TPLA, ablation zone volumetry was determined on prostate MRI and CEUS by delineation and segmentation into 3D models and correlated with whole-mount RARP histology using the Pearson correlation index. Results and limitationsTwelve office-based TPLA procedures were performed successfully under continuous transrectal ultrasound guidance using local perineal anesthesia. No serious adverse events occurred. A qualitative analysis showed a clear demarcation of the ablation zone on T2-weighted MRI, dynamic contrast-enhanced MRI, and CEUS. On pathological evaluation, no remnant cancer was observed within the ablation zone. Ablation zone volumetry on CEUS and T2-weighted MRI compared with histology had a Pearson correlation index of r = 0.94 (95% confidence interval [CI] 0.74–0.99, p < 0.001) and r = 0.93 (95% CI 0.73–0.98, p < 0.001), respectively. ConclusionsCEUS and prostate MRI could reliably visualize TPLA ablative effects after minimally invasive PCa treatment with a high concordance with histopathological findings and showed no remnant cancer. Patient summaryThe treatment effects of a novel minimally invasive ablation therapy device can reliably be visualized with radiological examinations. These results will improve planning and performance of future procedures.