Significant Radiological Differences Research Articles

Potential Value of Neoadjuvant Immunochemotherapy in Patients with Driver Gene-positive Non-small Cell Lung Cancer

The proportion of patients carrying driver gene mutations is notably high among individuals with non-small cell lung cancer (NSCLC) in China. However, the current neoadjuvant treatment strategies for these patients lack evident benefits. This study aims to investigate the efficacy and adverse reactions of neoadjuvant immunochemotherapy in patients with driver gene-positive NSCLC, thereby exploring its potential therapeutic value. A total of 50 patients from two centers were retrospectively collected to compare the efficacy and adverse reactions among driver gene-positive NSCLC patients after different treatments and further explore the response to neoadjuvant immunochemotherapy among different EGFR-sensitive subtypes. A total of 50 patients from two centers were included in this study. Among the 40 patients from Peking University People's Hospital (PKUPH), 21 received neoadjuvant immunotherapy, with 57.1% showing partial response on imaging. The major pathological response (MPR) rate after neoadjuvant immunochemotherapy was 38.1%, and pathological complete response (pCR) was only observed in this group. No significant differences were noted in adverse events or their impact on surgical difficulty among different treatments. Additionally, 10 patients from Hunan Cancer Hospital (HNCA) were included to analyze the differences in efficiency among EGFR-sensitive subtypes under various neoadjuvant strategies. No significant radiological response differences were observed between neoadjuvant immunotherapy and targeted therapy. However, patients with the L858R mutation exhibited MPR and pCR only after receiving immunotherapy, surpassing targeted therapy outcomes, while no significant differences were found among 19del patients. Under the premise of not exacerbating adverse effects, neoadjuvant immunochemotherapy achieved superior rates of MPR and pCR, with long-term survival comparable to targeted therapy.

All-arthroscopic versus mini-open double row rotator cuff repair – A prospective randomised control study based on functional and radiological outcomes

PurposeIn an era where arthroscopic rotator cuff repair is dominant in the United States (77.9 % preference) compared to open surgery (53.33 %), a shift towards minimally invasive All-Arthroscopic (AA) techniques over classical Mini-Open (MO) repair is emerging. This study explores current trends in shoulder procedures in India and compares functional outcomes and radiological repair integrity between AA and MO techniques, which are understudied in the Indian context. MethodologyIn this prospective study, 60 patients (30 in the AA group and 30 in the MO group) with rotator cuff tears underwent assessment. Pre/post-operative clinical evaluations and 12-month follow-ups using UCLA and Oxford Shoulder Score, along with preoperative MRI and postoperative USG, were conducted. ResultsAt one-year follow-up, the AA group showed better functional outcomes (53.3 % excellent/good vs. 30.0 % in MO). No significant radiological differences (Sugaya grading) were found. Tear size was comparable with no association with functional/radiological outcomes. ConclusionThe AA group demonstrated favourable functional outcomes, matched to MO group findings, which is in accordance with global studies. Despite higher costs, the increasing popularity of AA in India is justified by enhanced results and reduced postoperative discomfort.

A comparison of chest radiographic findings in human immunodeficiency virus-positive and -negative children with pulmonary tuberculosis

To compare chest radiography (CXR) findings in human immunodeficiency virus (HIV)-positive and HIV-negative children who had microbiologically confirmed pulmonary tuberculosis (PTB). Retrospective analysis of CXRs from children with known HIV status and microbiologically confirmed PTB (culture or GeneXpert Xpert MTB/RIF positive), who were hospitalised or seen at a primary healthcare centre over a 5-year period. Radiological findings were compared according to HIV and nutritional status. CXRs of 130 children were analysed from 35 (27%) HIV- positive and 95 (73%) HIV-negative children with confirmed PTB, median age 45.7 months (interquartile range [IQR] 18-81.3 months). CXR changes consistent with PTB were reported in 21/35 (60%) of HIV-positive and 59/95 (62%) of HIV-negative patients, (p=0.81). Normal CXR was identified in 3/35 (8.6%) of HIV-positive and 5/95 (5.3%) of HIV-negative patients (p=0.81). Airway compression was present in 3/35 (8.6%) of HIV-positive and 7/95 (7.4%) of HIV-negative patients (p>0.99). Overall, lymphadenopathy was identified in 42/130 (32.3%) of patients, 11/35 (31.4 %) were HIV-positive compared with 31/95 (32.6%) HIV-negative patients. Airspace consolidation was present in 60% of both HIV-positive (21/35) and HIV-negative patients (57/95). Pleural effusion was present in 2/35 (5.7 %) of HIV-negative and 9/95 (9.5 %) of HIV-negative patients. There were no statistically significant radiological differences by HIV group. There were no significant differences in the CXR findings between the HIV-positive and HIV-negative children with confirmed PTB.

2-Hydroxyglutarate magnetic resonance spectroscopy in adult brainstem glioma.

Adult brainstem gliomas (BSGs) are rare tumors of the CNS that are poorly understood. Upregulation of the oncometabolite 2-hydroxyglutarate (2HG) in the tumor indicates the mutation of isocitrate dehydrogenase (IDH), which can be detected by magnetic resonance spectroscopy (MRS). Although histological examination is required for the definitive diagnosis of BSG, 2HG-optimized MRS (2HG-MRS) may be useful, considering the difficult nature of brainstem lesion biopsy. The aim of this study was to evaluate the utility of 2HG-MRS for diagnosing IDH-mutant adult BSG. Patients with a radiographically confirmed brainstem tumor underwent 3T MRS. A single voxel was set in the lesion with reference to the T2 or fluid-attenuated inversion recovery image and analyzed according to the 2HG-tailored MRS protocol (point-resolved spectroscopic sequence; echo time 35 msec). All patients underwent intraoperative navigation-guided or CT-guided stereotactic biopsy for histopathological diagnosis. The status of IDH and H3K27M mutations was confirmed by immunohistochemistry and direct DNA sequencing. In addition, the authors examined the relationship between patients' 2HG concentrations and survival time. Ten patients (7 men, 3 women; median age 33.5 years) underwent 2HG-MRS and biopsy. Four patients had an H3K27M mutation and 4 had an IDH1 mutation (1 R132H canonical IDH mutation, 2 R132S and 1 R132G noncanonical IDH mutations). Two had neither H3K27M nor IDH mutations. The H3K27M and IDH mutations were mutually exclusive. Most tumors were located in the pons. There was no significant radiological difference between mutant H3K27M and IDH on a conventional MRI sequence. A 2HG concentration ≥ 1.8 mM on MRS demonstrated 100% (95% CI 28%-100%) sensitivity and 100% (95% CI 42%-100%) specificity for IDH-mutant BSG (p = 0.0048). The median overall survival was 10 months in IDH-wild-type BSG patients (n = 6) and could not be estimated in IDH-mutant BSG patients (n = 4) due to the small number of deaths (p = 0.008). 2HG-MRS demonstrated high sensitivity and specificity for the prediction of IDH-mutant BSG. In addition, 2HG-MRS may be useful for predicting the prognosis of adult BSG patients.

Severe Hypoglycemic Brain Injury Associated with Diffuse Restricted Diffusion on MRI Brain Sparing Cerebellar Lobes (P10-7.006)

<h3>Objective:</h3> Report a case of severe hypoglycemia-induced brain injury in an adult with MRI brain showing extensive diffusion restriction mimicking hypoxic brain injury. <h3>Background:</h3> Hypoglycemia is commonly seen in clinical practice, with most often benign outcome when appropriately treated. However, severe hypoglycemia may be associated with transient or permanent neurologic deficits. Irreversible diffuse brain injury is more often documented in the pediatric population, in particular neonatal, though devastating injury can also happen in adults. Energy deprivation and other chemical cascades lead to neuronal necrosis. Though some overlap exists and imaging shares some similarities, neurochemistry and brain lesion distribution of hypoglycemia differs markedly from ischemia. We present a case of severe, prolonged hypoglycemia leading to diffuse hypoglycemic brain injury. <h3>Design/Methods:</h3> Case report <h3>Results:</h3> 71-year-old male with history of insulin-dependent diabetes and depression with suicidal ideations who presented to the emergency room (ER) after being found unconscious with a serum glucose of 14 mg/dl. The patient was intubated for airway protection due to GCS at 9 but without significant hypoxia, saturating 93% on room air. Despite aggressive glucose replacement, he had several hypoglycemic episodes on a 27-hour span. Laboratory testing was remarkable only for elevated creatinine kinase of 3047 mg/dl, and presence of cannabis on urine drug screen. Patient remained comatose, with only preserved corneal reflexes after weaned off sedation. Non-epileptic myoclonus was also observed, confirmed by EEG. MRI brain revealed diffuse restricted diffusion, predominantly in the cerebral cortex and deep basal ganglia but sparing cerebellar lobes. Patient did not survive. <h3>Conclusions:</h3> Severe hypoglycemia leads to energy depletion and neuronal death with some overlap with ischemic brain injury though significant radiologic differences can help differentiate both pathophysiologic processes. Cerebellar involvement is uncommon compared to ischemic injury due to highly effective glucose transporter which can help differentiate both types of injury. <b>Disclosure:</b> Dr. Ribeiro has nothing to disclose. Dr. Gatchoff has nothing to disclose. Dr. Delpirou Nouh has nothing to disclose. Dr. Moon has nothing to disclose.

Arthroscopic Treatment of Femoral Condyle Chondral Lesions: Microfracture Versus Liquid Bioscaffold.

This study aims to compare the microfracture (MF) technique with the bioscaffold solution application (BST-CarGel) in treating femoral chondral lesions. Thirty-eight patients ages 18-45 with isolated single femoral condyle full-thickness (ICRS grade 3-4) chondral lesions were included in the study. Patients were divided into two groups as MF applied (Group I = 21) and bioscaffold combined with MF (Group II = 17). The visual analog scale (VAS), Western-Ontario, and McMaster Osteoarthritis Index (WOMAC) were used in clinical evaluation. The location, size, and depth of lesions were evaluated with preoperative magnetic resonance imaging (MRI). Magnetic resonance observation of cartilage repair tissue (MOCART) score was used for postoperative evaluation. The mean age was 32.5 (range 19-44) years. Mean follow-up was 14.9months (range 12-24). Lesion size was 3cm2 in group I and 2.9cm2 in group II. There were no differences between groups regarding demographic characteristics but BMI (Body Mass Index) was lower in group II which was significant. The duration of surgery was longer in group II (p < 0.001). Postoperative statistical significant improvements were found in WOMAC and VAS scores in groups, but there was no statistical difference. Although there was no significant radiological difference in the group II according to the MOCART score, higher scores were obtained compared to group I. No difference was found, clinical and radiological, in terms of short-term outcomes. MF is a method to be applied as a primary treatment with its cost-effective, simple and short surgery technique, and effective clinical results up to 4cm2. Level III: retrospective comparative study.

NIMG-38. 2-HYDROXYGLUTARATE MAGNETIC RESONANCE SPECTROSCOPY IN ADULT BRAINSTEM GLIOMA PATIENTS

Abstract INTRODUCTION The onco-metabolite, 2-hydroxyglutarate (2HG), is non-invasive biomarker detected by magnetic resonance spectroscopy (MRS), indicating isocitrate dehydrogenase (IDH) mutant glioma. Especially in patients with brainstem lesions where biopsies are at high risk of causing neurological deficit, 2HG-MRS may be useful. Here, we examined the utility of 2HG-MRS for diagnosing IDH mutant adult diffuse brainstem glioma and the ability of prognosis prediction. METHODS Three tesla -MRS (3T-MRS) was performed on patients with radiographically confirmed brainstem tumor. A single-voxel was set in the lesion with reference to the T2 / FLAIR image, and analyzed according to the 2HG-tailored MRS protocol (Philips, Achieva, PRESS, TE 35 ms). All patients underwent biopsy using an intraoperative navigation system (Brain LABTM) or stereotactic biopsy system (Komai’s CT-stereotactic frame) before initial treatment. IDH and H3K27M mutation status were confirmed by immunohistochemistry and DNA sequence. We examined the relationship between 2HG values and patient survival period. RESULTS Ten patients (7 male and 3 female, median age 33.5) underwent 2HG-MRS and biopsy. Four had H3K27M mutation and 4 had IDH mutation (1 R132H, 2 R132S, and 1 R132G). Two had neither H3K27M nor IDH mutation. H3-K27 and IDH mutations were mutually exclusive. All tumor located at pons mainly. There was no significant radiological difference between H3K27M and IDH mutant in conventional MRI sequence. Pearson's chi-square test demonstrated that 2HG concentrations &amp;gt; 1.5 mM were 100% in sensitivity and 83.3% in specificity for IDH mutant glioma (p = 0.0098). The median overall survival was 130.5 months in IDH mutant glioma (n=4) and 25 months in IDH wild-type glioma (n=6), respectively. CONCLUSIONS 3T-MRS was able to detect 2HG in adult brainstem glioma. A noninvasive 2HG-MRS study may be helpful in the diagnosis and predicting prognosis of adult diffuse brainstem glioma patient.

Minimally Invasive Radiographic Evaluation of the Dysplastic Hip Joint Configuration in Terms of Surgical Treatment with Hip Preservation by PAO.

Residual developmental dysplasia of hip (RDDH) is a factor of early osteoarthritis of the hip. The main problems are pain and instability of the hip joint due to inadequate coverage of the femoral head by the acetabulum. The purpose of this study was to radiologically evaluate RDDH after Bernese periacetabular osteotomy (PAO) and to compare RDDH to healthy hips. The radiological parameters of RDDH treated by PAO were retrospectively evaluated. Digital AP pelvic radiographs were taken, including parameters of central edge angle and femoral head coverage, medialization, distalization, and ilio-ischial angle. Clinical assessment is based on the VAS scale. The study group consisted of patients with RDDH, and the control group consisted of patients without RDDH. After PAO radiological parameters decreased: medialization by 2.68mm, distalization by 3.65mm, and ilio-ischial angle by 2.62°. However, there was an increase in the parameters: CEA by 17.61° and FHC by 16.46%. There was a mean 3 point decrease in pain on the VAS scale. There was also a statistically significant radiological difference in the structure of dysplastic hip joints before surgery and healthy hip joints of the control group. Radiological studies confirmed the effectiveness of the PAO method in the treatment of RDDH. Based on all radiological parameters, differences between healthy and dysplastic hip joints were demonstrated. We believe that a thorough understanding of the values of radiological parameters used to describe dysplastic hip joints will allow us to improve the imaging diagnosis of this condition.

NIMG-15. 2-HYDROXYGLUTARATE MAGNETIC RESONANCE SPECTROSCOPY IN ADULT BRAINSTEM GLIOMA PATIENTS

Abstract OBJECTIVE The onco-metabolite, 2-Hydroxyglutarate (2HG), is non-invasive biomarker for detecting isocitrate dehydrogenase (IDH) mutant glioma by MR-Spectroscopy. Especially 2HG-MRS may be useful in patients with brainstem lesions, where surgical biopsy presents high risk of neurological injury. Here, we examined the utility of 2HG-MRS for diagnosis of IDH mutant adult brainstem glioma. METHODS We conducted 3 tesla -MRS (3T-MRS) in 8 radiographically identified brainstem tumor (7 male and 1 female, median age 39). Single-voxel was localized from the T2-FLAIR using a 2HG-tailored MRS protocol (Philips, Achieva, PRESS, TE 35 ms). All patients underwent tumor biopsy using an intraoperative navigation system (Brain LABTM) or stereotactic biopsy system (Komai’s CT-stereotactic frame) before initial treatment. IDH and H3K27M status were diagnosed by IHC and DNA sequence. RESULTS 3 cases were H3K27M and 4 cases were IDH mutant (R132H 1 case, R132S 2 cases, and R132G 1 case). 1 case were neither H3K27M nor IDH mutant. H3-K27 and IDH1 mutations were mutually exclusive. All tumor located at pons. There were no significant radiological difference between H3K27M and IDH mutant in conventional MRI sequence. Pearson's chi-square test demonstrated that 2HG concentrations &amp;gt;1.5 mM were 100% sensitive and 75% specific for IDH mutant glioma (p = 0.0285). The median overall survival survival were 127 month in IDH mutant glioma (n=4) and 22.5 months in IDH wild-type glioma (n=4), respectively. CONCLUSIONS 2HG in adult brainstem glioma was detected by conventional 3T-MRS successfully. A noninvasive 2HG-MRS may be useful diagnostic modality for evaluating molecular status and prognosis in brainstem glioma noninvasively.

Trigeminal neurovascular contact in SUNCT and SUNA: a cross-sectional magnetic resonance study.

Emerging data-points towards a possible aetiological and therapeutic relevance of trigeminal neurovascular contact in short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and perhaps in short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We aimed to assess the prevalence and significance of trigeminal neurovascular contact in a large cohort of consecutive SUNCT and SUNA patients and evaluate the radiological differences between them. The standard imaging protocol included high spatial and nerve-cistern contrast resolution imaging acquisitions of the cisternal segments of the trigeminal nerves and vessels. MRI studies were evaluated blindly by two expert evaluators and graded according to the presence, location and degree of neurovascular contact. The degree of contact was graded as with or without morphological changes. Neurovascular contact with morphological changes was defined as contact with distortion and/or atrophy. A total of 159 patients (SUNCT = 80; SUNA = 79) were included. A total of 165 symptomatic and 153 asymptomatic trigeminal nerves were analysed. The proportion of neurovascular contact on the symptomatic trigeminal nerves was higher (80.0%) compared to the asymptomatic trigeminal nerves (56.9%). The odds on having neurovascular contact over the symptomatic nerves was significantly higher than on the asymptomatic nerves [odds ratio (OR): 3.03, 95% confidence interval (CI) 1.84-4.99; P < 0.0001]. Neurovascular contact with morphological changes were considerably more prevalent on the symptomatic side (61.4%), compared to the asymptomatic side (31.0%) (OR 4.16, 95% CI 2.46-7.05; P < 0.0001). On symptomatic nerves, neurovascular contact with morphological changes was caused by an artery in 95.0% (n = 77/81). Moreover, the site of contact and the point of contact around the trigeminal root were respectively proximal in 82.7% (67/81) and superior in 59.3% (48/81). No significant radiological differences emerged between SUNCT and SUNA. The multivariate analysis of radiological predictors associated with the symptomatic side, indicated that the presence of neurovascular contact with morphological changes was strongly associated with the side of the pain (OR: 2.80, 95% CI 1.44-5.44; P = 0.002) even when adjusted for diagnoses. Our findings suggest that neurovascular contact with morphological changes is involved in the aetiology of SUNCT and SUNA. Along with a similar clinical phenotype, SUNCT and SUNA also display a similar structural neuroimaging profile, providing further support for the concept that the separation between them should be abandoned. Furthermore, these findings suggest that vascular compression of the trigeminal sensory root, may be a common aetiological factor between SUNCT, SUNA and trigeminal neuralgia thereby further expanding the overlap between these disorders.

Selective Fusion in Lenke 1 B/C: Before or After Menarche?

Study Design:A retrospective, comparative study.Objective:To determine the radiological behavior of the lumbar curve in selective fusions in premenarchal girls with adolescent idiopathic scoliosis (Lenke 1 B/C).Methods:A retrospective, comparative study was conducted. Selective fusion was performed in 21 patients younger than 18 years. The patients were divided into 2 groups: group A, after menarche (n = 12) and group B, before menarche (n = 9). Angles (preoperative, and at 1 and 2 years postoperatively) of the fused thoracic curves and the corresponding lumbar curves were measured and compared. For statistical analysis, the t test was used with a significance level of P < .05.Results:Mean preoperative angle value of the proximal/main thoracic curve was 61° in group A and 57° in group B (P = .44), and 21° and 20°, respectively, in the first year postoperatively (P = .61). Mean preoperative angle value of the lumbar curve was 43° in group A and 42° in group B (P = .87), while at 1 year after surgery, this curve was 19° in both groups (P = 0.91), and at 2 years postoperatively, the curve was 16° in group A and 17° in group B (P = .75).Conclusions:Over a 2-year follow-up, we did not find significant radiological differences in lumbar curves between patients who underwent surgery before and after menarche.

Traumatic Brain Injury: Comparison of Computed Tomography Findings in Pediatric and Adult Populations

Abstract Introduction Traumatic brain injury (TBI) is a global health issue, accounting for a significant number of adult and pediatric deaths and morbidity. Computed tomography (CT) is an important diagnostic modality for TBI. The primary goal of this study was to determine if there were any significant radiological differences in CT brain findings between adult and pediatric populations. Materials and Methods Data of individual patients were collected from admission to discharge/death, which included various parameters in terms of demographics, mechanism of injury, and patient outcome which were later analyzed. A total of 1,150 TBI patients were enrolled in the study. Results The most common mode of injury in adults is road traffic accident (RTA) followed by fall from height (FFH), while in pediatrics it is vice versa. Findings of basal cisterns on CT brain were found to be statistically significant in both groups; 65% adults and 71% pediatrics had only one abnormal CT finding. Most common combination CT finding in adults was acute subdural hematoma (ASDH) and basal cistern abnormality, while in pediatrics it was traumatic subarachnoid hemorrhage (SAH) and contusion. Rotterdam score (based on CT brain findings) was significantly lower for pediatric age group compared with adults. It was 2.2 ± 0.85 for adults and 1.99 ± 0.74 for pediatrics, which was statistically significant (p &lt; 0.001). Conclusions The Rotterdam score has immense predictive power for prognostication of mortality status. Pediatric age group has better prognosis in terms of survival as compared with adults, thus justifying the role of Rotterdam CT score for mortality risk stratification in providing clinical care.

Lumbar fusion involving the sacrum increases dislocation risk in primary total hip arthroplasty.

Concurrent hip and spine pathologies can alter the biomechanics of spinopelvic mobility in primary total hip arthroplasty (THA). This study examines how differences in pelvic orientation of patients with spine fusions can increase the risk of dislocation risk after THA. We identified 84 patients (97 THAs) between 1998 and 2015 who had undergone spinal fusion prior to primary THA. Patients were stratified into three groups depending on the length of lumbar fusion and whether or not the sacrum was involved. Mean age was 71 years (40 to 87) and 54 patients (56%) were female. The mean body mass index (BMI) was 30 kg/m2 (19 to 45). Mean follow-up was six years (2 to 17). Patients were 1:2 matched to patients with primary THAs without spine fusion. Hazard ratios (HR) were calculated. Dislocation in the fusion group was 5.2% at one year versus 1.7% in controls but this did not reach statistical significance (HR 1.9; p = 0.33). Compared with controls, there was no significant difference in rate of dislocation in patients without a sacral fusion. When the sacrum was involved, the rate of dislocation was significantly higher than in controls (HR 4.5; p = 0.03), with a trend to more dislocations in longer lumbosacral fusions. Patient demographics and surgical characteristics of THA (i.e. surgical approach and femoral head diameter) did not significantly impact risk of dislocation (p > 0.05). Significant radiological differences were measured in mean anterior pelvic tilt between the one-level lumbar fusion group (22°), the multiple-level fusion group (27°), and the sacral fusion group (32°; p < 0.01). Ten-year survival was 93% in the fusion group and 95% in controls (HR 1.2; p = 0.8). Lumbosacral spinal fusions prior to THA increase the risk of dislocation within the first six months. Fusions involving the sacrum with multiple levels of lumbar involvement notably increased the risk of postoperative dislocation compared with a control group and other lumbar fusions. Surgeons should take care with component positioning and may consider higher stability implants in this high-risk cohort.

Clinical outcomes of locking stand-alone cage versus anterior plate construct in two-level anterior cervical discectomy and fusion: a systematic review and meta-analysis

Two-level cervical degenerative disc disease (cDDD) can be effectively treated by anterior cervical discectomy and fusion (ACDF) similarly to single-level cDDD. Traditionally an anterior plate construct (APC) approach has been utilized, but ACDF without plate with a locking stand-alone cage (LSC) approach has emerged as an alternative option. The aim of this study was to compare the clinical outcome of LSC and APC in contiguous two-level ACDF used to treat cDDD the current literature. Searches of seven electronic databases from inception to March 2018 were conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Extracted data were analysed using meta-analysis of proportions. The nine observational studies that satisfied all criteria described a pooled cohort of 687 contiguous two-level cDDD cases managed by ACDF, with 302 (44%) and 385 (56%) managed by LSC and APC approaches, respectively. When compared with APC, LSC was associated with significantly increased subsidence likelihood (OR 2.75; p < 0.001), greater disc height (MD 0.60mm; p = 0.04) and reduced cervical lordosis (MD - 2.52°; p = 0.04) at last follow-up. Operative outcomes, fusion rates, functional scores and postoperative dysphagia rates were comparable. Although significant radiological differences were most evident, the comparability between LSC and APC in contiguous two-level ACDF with respect to all other clinical outcomes does not implicate one approach as clearly superior to the other in two-level ACDF. Larger, randomized studies with longer follow-up are required to delineate outcomes further to validate the findings of this study. These slides can be retrieved under Electronic Supplementary Material.

May baseline JCV status influence the MS clinical evolution during Natalizumab treatment? Evidence from a multicenter-2\xa0years-prospective study

BackgroundWe prospectively assessed the influence of JCV- status on disability’s accrual in RRMS patients treated with Natalizumab at two tertiary MS centres, settled in Italy.MethodsNegative binomial model was used to assess the influence of baseline JCV status (positive or negative) treatment on clinical and radiological disease activity during the 24 months’ follow-up.ResultsOne hundred eighty four patients treated with Natalizumab were enrolled (83 JCV +, whilst 101 JCV-). Over the two years of follow-up there was not significant clinical and radiological differences between the two groups.ConclusionJCV + RRMS did not showed a severe clinical course than JCV – RRMS.

Arthroscopic Stabilization of Chronic Acromioclavicular Joint Dislocations

Background: Arthroscopically assisted single-bundle (SB) or double-bundle coracoclavicular (CC) ligament reconstruction using autologous tendon grafts has been reported to provide acromioclavicular (AC) joint (ACJ) stability in chronic instability cases. Recently, additional AC ligament reconstruction to provide triple-bundle (TB) stabilization has been introduced but lacks a comparison of clinical and radiological outcomes. Hypothesis: Arthroscopically assisted anatomic TB CC and AC reconstruction yields superior clinical and radiological results when compared with nonanatomic SB CC reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Twenty-six patients (mean [±SD] age, 46.9 ± 12.8 years) suffering from chronic high-grade ACJ instability underwent ACJ stabilization using autologous hamstring grafts. Twelve patients underwent combined anatomic TB CC and AC reconstruction using a semitendinosus tendon with clavicular interference screw fixation (TB group), and 14 underwent isolated SB CC reconstruction using the AC GraftRope system with a gracilis tendon (SB group). After a minimum follow-up of 2 years (mean, 29.0 ± 7.4 months), patients were evaluated radiologically and clinically using the Constant, American Shoulder and Elbow Surgeons (ASES), Taft, and Acromioclavicular Joint Instability Score (ACJI) outcome measures. Results: The mean Constant score increased significantly in both groups, from 71.6 preoperatively to 88.8 postoperatively in the TB group and from 67.8 to 82.6 in the SB group (P ≤ .009). No intergroup difference was found regarding the final Constant or ASES scores. Regarding the ACJ-specific scores, the final outcomes were significantly different: 10.9 (TB group) versus 9.0 (SB group) for the mean Taft score (P = .018) and 84.7 versus 58.4, respectively, for the mean ACJI score (P = .0001). No significant radiological difference was found regarding the mean CC distance (10.7 mm [TB group] vs 13.1 mm [SB group]). The TB group showed superior horizontal ACJ stability (P = .011), which was associated with a better clinical outcome according to the ACJI and Taft scores. In the SB group, the rate of ACJ instability recurrence was higher (21% vs 8% [TB group]). Conclusion: Combined arthroscopically assisted anatomic TB CC and AC ligament reconstruction using an autologous semitendinosus tendon graft provides superior clinical and radiological results compared with isolated nonanatomic SB CC ligament reconstruction using the AC GraftRope system. In particular, the TB technique can better restore horizontal ACJ stability, which is associated with superior ACJ-specific outcome scores.

The Relationship Between Accessory Navicular and Flat Foot: A Radiologic Study.

The aim of this study was to investigate the relationship between accessory navicular (AN) and flat foot and to evaluate the association between flat foot and the symptoms of patients with AN. We enrolled 196 patients with painful or asymptomatic AN in this study. Patients who were older than 18 years or who had no weight-bearing radiographs of the feet were not included. Another 46 normal participants were used as a control group. The AN group was divided into 3 subgroups: a group with asymptomatic AN; a symptomatic group that had not undergone excision; and a symptomatic group that had undergone surgery. Seven radiographic indices were measured including calcaneal pitch angle, tibiocalcaneal angle, talocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, lateral talo-first metatarsal angle, and AP talo-first metatarsal angle. Groups were compared regarding age, sex, presence of pain at the time of surgery, and radiographic parameters. The calcaneal pitch angle in the AN group was significantly smaller than that of controls (P=0.004). Naviculocuboid overlap (P=0.001), talonavicular coverage angle (P<0.001), lateral talo-first metatarsal angle (P=0.014), and AP talo-first metatarsal angle (P<0.001) were significantly larger in the AN group than in controls. No significant radiologic differences were seen between patients with symptomatic and asymptomatic AN. No significant radiographic differences were found between the groups of patients who had and who had not had bone excised. AN associated with radiographic parameters felt to be representative of a flat foot; however, the degree of flat foot was not associated with the development and severity of symptoms in patients with AN.

Gorham-Stout disease and generalized lymphatic anomaly—clinical, radiologic, and histologic differentiation

Gorham-Stout disease (GSD) is a rare vascular disorder of lymphatic origin characterized by progressive osteolysis. Generalized lymphatic anomaly (GLA) is a multisystem disorder that also commonly affects bone. We hypothesized that Gorham-Stout disease is different from other osseous lymphatic anomalies. We proposed to discriminate these entities by analyzing findings on skeletal imaging. Clinical data, imaging studies, and histopathologic findings were retrospectively reviewed in patients presenting to our Vascular Anomalies Center with lymphatic anomalies of bone. Within a cohort of 51 patients with lymphatic disorder and radiological evidence of bony involvement, two distinct categories emerged. Nineteen patients met the imaging criteria for GSD: progressive osteolysis with resorption and cortical loss. Thirty-two were categorized as GLA: Discrete radiolucencies and increasing numbers of bone affected over time, but without evidence of progressive osteolysis. The ribs were the most common site in both groups, followed by the cranium, clavicle, and cervical spine in GSD, and thoracic spine, humerus, and femur in GLA. Fewer bones were involved in GSD, with relative sparing of the appendicular skeleton. Associated infiltrative soft tissue abnormality was seen in 18 in GSD, but only six with GLA. Macrocystic lymphatic malformations were identified in 14 with GLA, but none with GSD. There are significant radiological differences between GSD and GLA, although there are some overlapping features. The major distinguishing characteristic is the progressive osteolysis seen in GSD. Findings suggestive of GLA are more extensive involvement, particularly of the appendicular skeleton, presence of discretemacrocystic lymphatic malformations and visceral organ lesions.

Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head.

Osteonecrosis of the femoral head, a disease primarily affecting young adults, is often associated with the collapse of the articular surface and subsequent arthrosis. Some authors have reported good results with the use of vascularized and non-vascularized fibular grafts to treat osteonecrotic lesions of the femoral head. The aim of this study was to compare the results of vascularized fibular grafting with that of non-vascularized fibular grafting in the treatment of femoral head osteonecrosis. Between January 1999 and June 2008, 11 osteonecrotic hips of 8 patients who underwent vascularized fibular grafting and 15 osteonecrotic hips of 13 patients who underwent nonvascularized fibular grafting were compared according to etiology, stage, age, sex, preoperative and postoperative first year Harris hip and VAS scores. Steroid use was the most common etiologic factor, found in 26 hips of 21 patients in the entire patient population. There was no significant difference between the two groups according to their age, sex and preoperative Harris hip scores (p>0.05). According to the Ficat staging system for radiological evaluation, 4 hips were Grade 2A, 4 hips were Grade 2B, and 3 hips were Grade 3 in the vascularized group and 8 hips were Grade 2A, 3 hips Grade 2B, 3 hips Grade 3 and one hip was identified as Grade 4 in the non-vascularized group. When the Harris hip and VAS scores of both groups were evaluated, the group treated by vascularized fibular grafting had significantly higher scores than the ones treated by non-vascularized fibular grafting in the other group (p<0.05). Furthermore, when the Harris hip and VAS scores of preoperative and postoperative first year of vascularized fibular grafting patients were compared, there were significantly higher scores after the surgery. Although there was no significant radiological difference in the early results of both surgical techniques, the clinical results of vascularized fibular grafting treatment were significantly better than the results of non-vascularized fibular grafting treatment in the osteonecrosis of the femoral head. Vascularized fibular grafting improves the clinical status at an early period and prevents subchondral collapse.

Comparison of novel xenograft (bovine fetal growth plate) and allograft effects on experimental bone defect healing in rabbit

Large bone defects resulting from trauma, tumors, osteitis, implant loosening, or corrective osteotomies require surgical therapy because spontaneous regeneration is limited to relatively small defects. Currently, transplantation of autografts or allografts, mineral bone substitutes, and callus distraction are the most commonly used techniques for skeletal reconstruction. Each method has significant limitations, e.g., availability and biological or biomechanical reasons. This study was designed to evaluate allograft and new xenograft (bovine fetal growth plate) effects on the bone healing process. Twenty male New Zealand White rabbits were used in this study. In the allograft group, the defect was filled by fresh allogeneic cortical graft; in the xenograft group, the defect was filled by a segment of bovine fetal growth plate and was fixed by cerclage wire. Radiological, histopathological, and biomechanical evaluations were performed and results were scored and analyzed statistically. Statistical tests did not support significant differences between the two groups radiographically at the 14th postoperative day (P > 0.05). There was a significant difference in bone formation at the 28th, 42nd, and 56th postoperative days. There were significant radiological differences for bone union and remodeling by the 42nd day postoperatively (P < 0.05). The xenograft was superior to the allograft by the 56th postoperative day for radiological bone formation (P < 0.03); histopathological and biomechanical evaluation revealed no significant differences between the two groups. It can be concluded that the superior bone healing process in the xenograft group was due to the presence of some osteoinduction proteins in bovine fetal growth plate.