Calcification Size Research Articles

New Progress in Early Diagnosis of Atherosclerosis.

Coronary atherosclerosis is a potentially chronic circulatory condition that endangers human health. The biological cause underpinning cardiovascular disease is coronary atherosclerosis, and acute cardiovascular events can develop due to thrombosis, platelet aggregation, and unstable atherosclerotic plaque rupture. Coronary atherosclerosis is progressive, and three specific changes appear, with fat spots and stripes, atherosclerosis and thin-walled fiber atherosclerosis, and then complex changes in arteries. The progression and severity of cardiovascular disease are correlated with various levels of calcium accumulation in the coronary artery. The therapy and diagnosis of coronary atherosclerosis benefit from the initial assessment of the size and degree of calcification. This article will discuss the new progress in the early diagnosis of coronary atherosclerosis in terms of three aspects: imaging, gene and protein markers, and trace elements. This study intends to present the latest methods for diagnosing patients with early atherosclerosis through a literature review.

The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Prostate-vesicular transrectal ultrasound reference ranges and associations with clinical, seminal and biochemical characteristics.

BackgroundTransrectal ultrasound (TRUS) parameters are not standardized, especially in men of reproductive age. Hence, the European Academy of Andrology (EAA) promoted a multicenter study to assess the TRUS characteristics of healthy‐fertile men (HFM) to establish normative parameters.ObjectivesTo report and discuss the prostate and seminal vesicles (SV) reference ranges and characteristics in HFM and their associations with clinical, seminal, biochemical parameters.Methods188 men (35.6 ± 6.0 years) from a cohort of 248 HFM were studied, evaluating, on the same day, clinical, biochemical, seminal, TRUS parameters following Standard Operating Procedures.ResultsTRUS reference ranges and characteristics of the prostate and SV of HFM are reported herein. The mean PV was ∼25 ml. PV lower and upper limits were 15 and 35 ml, defining prostate hypotrophy and enlargement, respectively. PV was positively associated with age, waistline, current smoking (but not with T levels), seminal volume (and negatively with seminal pH), prostate inhomogeneity, macrocalcifications, calcification size and prostate arterial parameters, SV volume before and after ejaculation, deferential and epididymal size. Prostate calcifications and inhomogeneity were frequent, while midline prostatic cysts were rare and small. Ejaculatory duct abnormalities were absent. Periprostatic venous plexus size was positively associated with prostate calcifications, SV volume and arterial peak systolic velocity. Lower and upper limits of SV anterior‐posterior diameter after ejaculation were 6 and 16 mm, defining SV hypotrophy or dilation, respectively. SV total volume before ejaculation and delta SV total volume (DSTV) positively correlated with ejaculate volume, and DSTV correlated positively with sperm progressive motility. SV total volume after ejaculation was associated negatively with SV ejection fraction and positively with distal ampullas size. SV US abnormalities were rare. No association between TRUS and time to pregnancy, number of children or history of miscarriage was observed.ConclusionsThe present findings will help in better understanding male infertility pathophysiology and the meaning of specific TRUS findings.

Clinical effects of matrix acupuncture on cervical spondylotic radiculopathy with nuchal ligament calcification

To observe the effects of matrix acupuncture on the neck disability index (NDI) score, clinical efficacy, and the calcification size of the nuchal ligament in patients of cervical spondylotic radiculopathy with nuchal ligament calcification. A total of 120 cases were randomly divided into a matrix acupuncture group and a routine acupuncture group, with 60 cases in each group. In the matrix acupuncture group, Ashi-point, bilateral Tianzhu (BL10), bilateral Fengchi (GB20), bilateral Dazhu (BL11), bilateral Jianzhongshu (SI15), and Jianjing (GB21), Tianzong (SI11), Quchi (LI11), Shousanli (LI10), Waiguan (TE5), and Hegu (LI4) at the affected side were selected. In the routine acupuncture group, C3-C7 Jiaji points at the neck and Jianjing (GB21), Tianzong (SI11), Quchi (LI11), Shousanli (LI10), Waiguan (TE5), Hegu (LI4), and Ashi-point at the affected side were selected. The patients in the two groups were treated 30 min once, six days a week, for a total of four weeks. The NDI scores, clinical efficacies, and calcification sizes of nuchal ligament were compared between the two groups every wee-kend. After four weeks of treatment, the NDI scores and calcification volumes of nuchal ligament decreased in both groups (P<0.05). Compared with the routine acupuncture group, the matrix acupuncture group showed decreased NDI scores and reduced calcification volumes of nuchal ligament at the 1st, 2nd, 3rd, and 4th weeks of treatment (P<0.05). The cure and marked effective rate in the matrix acupuncture group at the 2nd, 3rd, and 4th weeks of treatment were superior to those of the routine acupuncture group (P<0.05). The matrix acupuncture group and the routine acupuncture group are effective in reducing the NDI score and calcification size of nuchal ligament in patients of cervical spondylotic radiculopathy with nuchal ligament calcification. However, matrix acupuncture has obvious advantages over routine acupuncture.

Associations between carotid atherosclerotic plaque characteristics determined by magnetic resonance imaging and improvement of cognition in patients undergoing carotid endarterectomy.

To determine the predictive value of carotid plaque characteristics for the improvement of cognition in patients with moderate-to-severe carotid stenosis after carotid endarterectomy (CEA), using vessel wall magnetic resonance imaging (MRI). This was a prospective cohort study. Patients with unilateral, moderate-to-severe carotid stenosis referred to the Peking University Third Hospital for CEA were prospectively recruited and underwent carotid vessel wall MRI within 1 week before CEA. We performed Montreal Cognitive Assessment (MoCA) within 1 week before and 3-4 days after CEA. The morphological and compositional characteristics of carotid plaques on MRI were evaluated. Improvement of cognition was defined as >10% increase of the total MoCA score after CEA compared with baseline. Carotid plaque characteristics were compared between patients with and without cognitive improvement. In total, 105 patients (91 males; mean age, 65.5±8.4 years) were included. The volume {48.0 [interquartile range (IQR), 21.0 to 91.6] vs. 16.3 (IQR, 8.1 to 53.1) mm3; P=0.005} and cumulative slice [4.0 (IQR, 3.0 to 7.0) vs. 3.0 (IQR, 2.0 to 5.0); P=0.019] of carotid calcification, and maximum percentage of calcification area [13.1% (IQR, 6.0% to 19.8%) vs. 6.2% (IQR, 3.7% to 10.8%); P=0.004] were significantly smaller in participants with cognitive improvement compared to those without. Univariate logistic regression analysis showed that volume [odds ratio (OR) =0.994; 95% confidence interval (CI): 0.989 to 1.000; P=0.043] and cumulative slice (OR =0.823; 95% CI: 0.698 to 0.970; P=0.020) of carotid calcification, and maximum percentage of calcification area (OR =0.949; 95% CI: 0.909 to 0.991; P=0.018) were significantly correlated with cognitive improvement. After adjusting for confounding factors, these associations remained statistically or marginally significant (volume: OR =0.994; 95% CI: 0.988 to 1.000; P=0.057; maximum percentage of calcification area: OR =0.937; 95% CI: 0.890 to 0.987; P=0.014; and cumulative slice: OR =0.791; 95% CI: 0.646 to 0.967; P=0.022). No significant associations were found between other plaque characteristics and cognitive improvement (all P>0.05). More than half of the participants with unilateral, moderate-to-severe carotid atherosclerotic stenosis had cognitive improvement. The size of calcification might be an effective indicator of cognitive improvement after CEA.

Prognostic factors determining long-term outcomes of conservative treatment for acute calcific periarthritis of the hand

Acute calcific periarthritis (ACP) of the hand is an uncommon disease that is usually self-limited. Although the conservative treatment is generally considered the primary intervention, the prognostic factors associated with long-term outcomes have yet to be identified. The purposes of this study were to investigate the long-term effects of conservative treatment and identify factors associated with long-term prognosis. We retrospectively reviewed 25 patients with a mean age of 46 years who were diagnosed with ACP of the hand and followed up over more than 2 years. Pain control with nonsteroidal anti-inflammatory drugs and activity restrictions were recommended for the initial treatment. Symptom persistence was defined as a visual analogue scale of more than 1. We compared patients with and without symptom persistence regarding potential prognostic factors such as age, gender, calcification size and type (type 1, amorphous and ill-defined; type 2, homogenous and well-defined), and joints and digits involved. Factors associated with symptom persistence were examined with multivariate analysis. At 2-year follow-up, 19 patients showed complete improvement, whereas 6 reported persistent symptoms. Symptom persistence was independently associated with the thumb involvement (odds ratio (OR), 149.77; 95% confidence interval (CI), 0.61-15.98; P=0.02) and calcification type 2 (OR, 27.68; 95% CI, 0.50-11.08; P=0.02). In our study, most patients with ACP of the hand reported symptom improvement with conservative treatment at 2 years of follow-up. Calcification of the thumb or calcification type (homogeneous with a well-defined margin) was independently associated with symptom persistence at 2 years.

Efficacy and safety of radiofrequency ablation for calcified benign thyroid nodules: results of over 5\xa0years' follow-up

PurposeTo evaluate the efficacy and safety of radiofrequency ablation (RFA) for treating calcified benign thyroid nodules (CBTNs).MethodsFifty-two patients with 52 CBTNs who underwent RFA in our hospital were included in this retrospective study. According to the size of calcifications, CBTNs were divided into two groups: the punctate echogenic foci (PEF) group and macrocalcification group. Moreover, the macrocalcification group was further subdivided into two groups, the strong group and the weak group, based on their morphologic characteristics. After the RFA procedure, routine ultrasound (US) and clinical evaluation were performed at 1, 3, 6 and 12 months postoperatively and every 12 months thereafter.ResultsThe mean follow-up time was 68.98 ± 7.68 months (60–87 months), and the 5-year mean volume reduction rate (VRR) after RFA was 92.95%, with a complication rate of 0.6% (3/52). The mean initial volume of the macrocalcification group was significantly larger than that of the PEF group (9.94 ± 24.60 ml vs. 0.23 ± 0.22 ml, respectively; P = 0.011). Thus, their VRRs were not comparable between the two groups. However, baseline characteristics did not show statistically significant differences between the strong and weak macrocalcification subgroups. The VRRs of the strong subgroup were significantly lower than those of the weak subgroup at the 3-year, 4-year, and 5-year follow-ups.ConclusionRFA was effective and safe for treating CBTNs. Strong macrocalcification was related to the VRR of CBTNs after the RFA procedure.

Correction of chronic prostatitis by extracorporeal shock wave therapy

Introduction. This article presents the results of treatment of patients with chronic prostatitis (CP) type II, IIIA and IIIB by extracorporeal shock wave therapy (ESWT).The study objective was to evaluate the effectiveness of ESWT in the treatment of CP.Materials and methods. The research included 43 patients with CP. The patient’s age was 38.8 (27–65). The mean CP duration was 13.5 (3–24) months. 43 patients were assigned into 3 groups based on transrectal ultrasound (TRUS) examination. Group 1 had fibrotic changes in the prostate (n = 21). Group 2 had prostate calcifications (n = 5). Group 3 had fibrotic changes and calcifications in the prostate (n = 17). Treatment included ESWT (Dornier Aries) twice per week during 6 weeks. Each ESWT-session was comprised 2000–3500 pulses (0.05–0.062 mJ/mm2) and 8–6 Hz of frequency. All men were evaluated on 0 and 60 days of the study using NIH-CPSI (National Institutes Health Chronic Prostatitis Symptom Index), IPSS (International Prostate Symptom Score), TRUS of the prostate, the culture of seminal or prostate fluid, spermogram or prostate fluid analysis, serum prostatic specific antigen for men over 50 years of age.Results. The patients over 50 years-old had total prostatic specific antigen less than 4 ng/ml. Bacterial growth was found in the culture of seminal/prostate fluid of the 26 patients. They were additionally prescribed antibiotics according to antibiogram. All patients got the treatment well. Control study pointed at lower scores of NIH-CPSI – grade decreased from 13.39 (1–34) to 5.54 (0–24) (p &lt;0.05), IPSS decreased from 11.39 (0–34) to 4.39 (0–29) (p &lt;0.05). Prostate volume decreased from 25.18 (12.2–58.8) cm3 to 22.78 (12–56.6) cm3 according to TRUS (p &gt;0.05). In the group 1 in 3 cases local fibrosis were completely resolved, in 18 cases fibrotic changes decreased from 5.3 (0–13) mm to 3.24 (0–8.1) mm (p &lt;0.05). In the second group the number and the size of calcifications decreased from 6.92 (2–21) mm to 4 (0–20) mm (p &gt;0.05). In the group 3 calcifications were completely resolved (p &lt;0.05), the volume of fibrosis decreased from 6.8 (3.2–15) mm to 4.5 (1–17) mm (p &lt;0.05). Bacterial growth wasn’t found in 9 patients’ seminal/ prostate fluid, 16 patients had a decrease of the causative agent concentration on 60 day, WBC count normalized in all subjects with CP/chronic pelvic pain syndrome IIIA.Conclusion. ESWT is an effective and non-invasive method of treatment of CP type II, IIIA and IIIB. The proposed treatment to relieve pain syndrome, inflammation, to promote lysis of fibrosis zone and calcinates, improves the draining function of prostate, contributing to accelerated elimination of microflora.

Ultrasound Features Associated With Shoulder Complaints: Calcifications Larger Than 6 mm in Young Patients and Positive Doppler Are Associated With Pain.

Objectives: To identify ultrasound (US) features associated with the presence of shoulder complaints.Methods: This observational, case-control study, compared US findings between participants with and without shoulder complaints, matched for age, sex, and dominancy. Data was collected from February 2018 to June 2020. Two-tailed Fisher's and Mann-Whitney U-tests were used, with p-values < 0.05 considered significant.Results: A total of 202 participants were enrolled (median age 56 years, range 18–70, 155 women), comprising 140 cases and 62 controls. A calcification size ≥6 mm, when age < 56 (p = 0.02), and a distance to tendon insertion ≥6 mm, when age ≥56 (p = 0.009), were only found in symptomatic shoulders. Color Doppler in rotator cuff (RC) tendons predominated in the presence of symptoms (26/140 vs. 2/62, p = 0.003). An algorithm also combining the number of calcifications, tendon echotexture and insertional thickening, osseous irregularity, cuff tears, and subacromial effusion showed a 92% (57/62) specificity for shoulder pain on this study sample.Conclusion: Calcification diameter of 6 mm or more is associated with shoulder pain in patients younger than 56 years. A distance from calcification to tendon insertion of 6 mm or more is related to pain in older patients. Doppler signal also is associated with shoulder pain. An algorithm based on a set of specific ultrasonographic criteria have a strong association with the presence of symptoms.

Carotid Artery Plaque Calcifications: Lessons From Histopathology to Diagnostic Imaging.

The role of calcium in atherosclerosis is controversial and the relationship between vascular calcification and plaque vulnerability is not fully understood. Although calcifications are present in ≈50% to 60% of carotid plaques, their association with cerebrovascular ischemic events remains unclear. In this review, we summarize current understanding of carotid plaque calcification. We outline the role of calcium in atherosclerotic carotid disease by analyzing laboratory studies and histopathologic studies, as well as imaging findings to understand clinical implications of carotid artery calcifications. Differences in mechanism of calcium deposition express themselves into a wide range of calcification phenotypes in carotid plaques. Some patterns, such as rim calcification, are suggestive of plaques with inflammatory activity with leakage of the vasa vasourm and intraplaque hemorrhage. Other patterns such as dense, nodular calcifications may confer greater mechanical stability to the plaque and reduce the risk of embolization for a given degree of plaque size and luminal stenosis. Various distributions and patterns of carotid plaque calcification, often influenced by the underlying systemic pathological condition, have a different role in affecting plaque stability. Modern imaging techniques afford multiple approaches to assess geometry, pattern of distribution, size, and composition of carotid artery calcifications. Future investigations with these novel technologies will further improve our understanding of carotid artery calcification and will play an important role in understanding and minimizing stroke risk in patients with carotid plaques.

Rapid pacing is an independent predictor for high implantation depth using self-expandable devices in TAVR

Abstract Background/Introduction Optimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated. Purpose Therefore, we aimed to 1) evaluate the impact of different pacing maneuvers on ID, and 2) identify the independent predictors of deep ID. Methods 562 TAVR patients with newer-generation self-expandable devices were retrospectively enrolled and further separated into patients undergoing TAVR under FP (n=331; 58.9%) and RP (n=231; 41.1%). The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis. Results The highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification (OR 0.56 [0.37–0.85], p=0.006*), a bicuspid valve (OR 0.34 [0.11–1.0], p=0.049*), valve size 26 mm (OR 0.47 [0.28–0.81], p=0.006*), and RP (OR 0.57 [0.37–0.87], p=0.010*) as independent and highly preventable predictors for deep valve deployment. Independent risk factors for deep ID were the use of a 34 mm device (OR 1.96 [1.22–3.15], p=0.005*) and mild aortic valve calcification (OR 1.62 [0.01–2.61], p=0.046*). In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: −5.6±2.6 mm vs. 3–5 criteria: −4.5±2.0 mm; p&amp;lt;0.0001*). Conclusion Data from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expandable devices. Funding Acknowledgement Type of funding sources: None.

Metanephric adenoma: association between the imaging features of contrast-enhanced ultrasound and clinicopathological characteristics.

This study aimed to improve the understanding of metanephric adenoma (MA) by retrospective analysis of contrast-enhanced ultrasound (CEUS) findings and clinicopathological characteristics of MAs. Gray-scale ultrasound (US) and CEUS findings of 7 adult MA patients, confirmed by postoperative pathology, were summarized via collection of clinicopathological and ultrasonographic imaging data, including tumor location, size, echo intensity, color flow, presence or absence of calcification, and liquefactive necrosis, contrast-enhanced pattern, enhancement characteristics, and contrast wash-out compared with adjacent parenchyma, and the presence or absence of a pseudocapsule. Histopathological analyses, including hematoxylin and eosin (HE) and immunohistochemical (IHC) staining, were conducted with the EnVision method. All 7 participants were female, aged 29-73 years (mean age, 54 years), with flank pain (3/7). All tumors were solid (7/7) with sizes of 2.0-5.0 cm (mean diameter, 3.07 cm), including 4 in the left kidney, 3 in the right kidney, 2 in the renal pelvis, and 5 in the renal parenchyma. On the gray-scale US, MA was shown as hypoechoic (4/7), slightly hyperechoic (2/7), isoechoic (1/7), and with a defined border. The morphology was regular and rounded (7/7), internal echogenicity was homogeneous (5/7), and no calcification was seen (7/7). The CEUS showed clear boundaries (7/7), homogeneous isodensity (5/7), with calcification (0/7), necrosis (2/11), heterogeneous hyperattenuation (2/7), pseudocapsule (2/7), and medullary phase fast wash-out (7/7). The surgical methods were radical nephrectomy (4/7) and partial nephrectomy (3/7). The duration of follow-up period for all participants was 3-74 months, and no local or distant recurrences were found. The IHC staining showed that most tumor cells were positive for WT1, cytokeratins AE1/AE3, vimentin, and CD57, and exhibited focal positivity for CK7, while negative for CD10, AMACR, and CK720. The proliferative index (Ki-67) was 2-3%. On gray-scale US, MA appears as a solid nodule with a well-defined boundary, regular morphology, and homogeneous echogenicity; CEUS shows slow progression and slightly lower homogeneous enhancement and fast wash-out in the medullary phase. These findings may provide insight into the progression of MA and aid in the development of diagnostic and therapeutic strategies.

Factors associated with a high or low implantation of self-expanding devices in TAVR

ObjectivesOptimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated. Therefore, we aimed to (1) evaluate the impact of different pacing maneuvers on ID, and (2) identify the independent predictors of deep ID.Methods473 TAVR patients with newer-generation self-expanding devices were retrospectively enrolled and one-to-one propensity-score-matching was performed, resulting in a matching of 189 FP and RP patients in each cohort. The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis.ResultsThe highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification [OR 0.50 (0.31–0.81) p = 0.005*], a “flare” aortic root [OR 0.42 (0.25–0.71), p = 0.001*], and RP (OR 0.49 [0.30–0.79], p = 0.004*) as independent highly preventable predictors of a deep ID. In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: − 5.7 mm ± 2.6 vs. 3–4 criteria − 4.3 mm ± 2.0; p < 0.0001*).ConclusionData from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expanding devices. Randomized studies should prove for validation compared to fast and non-pacing maneuvers during valve delivery and their impact on implantation depth.Trail registrationClinical Trial registration: NCT01805739.Graphic abstractStudy design: Evaluation of the impact of different pacing maneuvers (fast ventricular pacing—FP vs. rapid ventricular pacing—RP) on implantation depth (ID). After one-to-one-propensity-score-matching, independent protective and risk factors for a very deep ID beneath 6 mm toward the LVOT (< − 6 mm) were identified. Stent frame pictures as a courtesy by Medtronic®. AVC aortic valve calcification.

Analysis of Giant Intraventricular and Extraventricular Epidermoids, Defining Risk Factors for Recurrence, an Institutional Experience.

Background:Multicompartmental intraventricular epidermoids behave differently from multicompartmental extraventricular lesions and localized lesions during its management. Few studies are available which have analyzed risk factors separately in these groups of cases for recurrence of these lesions and time to recur.Materials and Methods:In this retrospective observational study, 72 cases of intracranial epidermoid were treated over a span of 7 years. Cases were categorized into three groups. Group 1 comprised 15% (11/72) of cases with intraventricular multicompartmental, Group 2 with 22% (16/72) extraventricular giant tumors with multicompartmental involvement and size >4.5 cm, and Group 3 comprised 63% (45/72) of patients with lesions <4.5 cm and localized. Data pertaining to demography, clinical and radiological features, surgery performed, postoperative complication, histology, and follow-up were obtained from medical records available in the institute.Results:The average duration to treat was 1.86 ± 0.52 (standard deviation [SD]) years, with headache as a major complaint in all the groups. Combined endoscope-assisted microsurgery was performed in 38.8% (28/72), microsurgery in 54.1% (39/72), and endoscopic excision in 6.9% (5/72) of cases. Tumor calcification was found in 23.6% (17/72) and preoperative capsular enhancement was seen in 19.4% (14/72) which persisted in 79% (11/14) of cases postoperatively on subsequent follow-up suggesting recurrence. On stepwise logistic regression analysis, preoperative capsular enhancement was a strong predictor of recurrence of tumor (P = 0.001). The average follow-up was 46 ± 14.92 (SD) months in Group 1, 52.34 ± 11.45 (SD) months in Group 2, and 63.36 ± 18.42 (SD) months in Group 3.Conclusion:Although the intracranial epidermoid is known to recur after long interval, tumor with specific characteristics can recur in short span of 5–6 years. Tumor characteristics such as preoperative capsular enhancement, multicompartmental distribution in vertebrobasilar territory, large size, and presence of calcification are strong predictors for recurrence. Performing endoscope-assisted microsurgery can decrease the postoperative morbidities but does not reduce the recurrence risk.

Ultrasound-guided needle decompression and steroid injection for calcific tendinitis of the shoulder: risk factors for repeat procedures and outcome analysis.

Background Although ultrasound-guided needle decompression (US-GND) can treat calcific tendinitis of the shoulder effectively, repeat procedures might be required for unresolved symptoms. We evaluated the overall clinical outcomes of US-GND with subacromial steroid injection and the final results and factors predisposing toward repeat procedures.Methods Ninety-eight patients who underwent US-GND for calcific tendinitis of the supraspinatus/infraspinatus were analyzed between March 2017 and December 2018. The clinical outcomes (pain visual analog scale, functional visual analog scale [FVAS], and American Shoulder and Elbow Surgeons [ASES] score) and final subjective satisfaction were compared between groups A (single US-GND) and B (repeat US-GND). The factors predisposing toward repeated US-GNDs were analyzed.Results We found that 59.3% (58/98) of patient ASES scores were ≥80, and 73.5% of patients (72/98) were satisfied with the outcome. Group B (n=14) demonstrated a significantly higher rate of dominant-arm involvement compared to group A (78.6% vs. 48.8%, p=0.046). However, initial calcification size, shape, number, density, subscapularis involvement, lavage, and procedure time did not differ significantly between the groups. Group B showed poorer final FVAS (7 [interquartile range, 6–8] vs. 8 [interquartile range, 7–9], p=0.036) and subjective satisfaction compared to group A (satisfied: 5 [35.7%] vs. 67 [79.8%], p<0.001].Conclusions US-GND with subacromial steroid injection is a viable treatment option for calcific tendinitis of the shoulder. Dominant-arm involvement was the only independent factor for repeated US-GND. Final outcome of repeated US-GND for unimproved patients was promising; however, these outcomes were poor compared to those of the patients who improved after the first procedure.

Ultrasound guided steroid injection of subacromial bursa: morphologic and clinical effects on patients with supraspinatus tendon calcifications

Objective: Subacromial injection (SAI), due to its ease of application and increased patient tolerability, is one of the preferred invasive therapies. In this study, we aimed to evaluate effectiveness of ultrasound-guided SAI in patients with supraspinatus calcific tendinitis by assessment of roentgenograms and clinical appraisal. Patients and Methods: Thirty-five patients with supraspinatus tendon calcifications as revealed by the roentgenography underwent ultrasound-guided SAI. Pre-treatment the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) scores and Gartner’s Classification of calcific tendinitis were obtained. Clinical follow-up was scheduled at 1st, 3rd and 6th months posttreatment along with a single roentgenogram planned at 6th month. Results: A total of 53 SAIs were performed on 36 shoulders, 21 female and 14 male patients. Mean size of calcifications were 12.3 and 7.1 mm, pre-treatment and at 6th month, respectively. Pre and post-injection calcification mean sizes in the group with clinical improvement were 13.6 and 5.7 mm; whereas, in group without diminished symptoms, they were 11.8 and 9.4 mm demonstrating a statistically significant intergroup difference (p&amp;lt;0.05). Pre-injection QuickDASH mean score was 52.2; this showed improvement at 1st, 3rd and 6th months post-treatment; 20.7, 22.2 and 19.5, respectively. Conclusion: Subacromial injection is a well-tolerated, easily applicable, safe and effective treatment for pain alleviation in supraspinatus calcific tendinitis.

Carotid Atherosclerotic Calcification Characteristics Relate to Post-stroke Cognitive Impairment

Background: Together with cerebral small vessel disease (CSVD), large vessel atherosclerosis is considered to be an equally important risk factor in the progression of vascular cognitive impairment. This article aims to investigate whether carotid atherosclerotic calcification is associated with the increased risk of post-stroke cognitive impairment (PSCI).Methods: A total of 128 patients (mean age: 62.1 ± 12.2 years, 37 women) suffering from ischemic stroke underwent brain/neck computer tomography angiography examination. The presence and characteristic of carotid calcification (size, number and location) were analyzed on computer tomography angiography. White matter hyperintensity (WMH) was assessed using Fazekas scales. PSCI was diagnosed based on a battery of neuropsychological assessments implemented 6−12 months after stroke.Results: Among 128 patients, 26 developed post-stroke dementia and 96 had carotid calcification. Logistic regression found carotid calcification (odds ratio [OR] = 7.15, 95% confidence interval [CI]: 1.07–47.69) and carotid artery stenosis (OR = 6.42, 95% CI: 1.03–40.15) both significantly increased the risk for post-stroke dementia. Moreover, multiple, thick/mixed, and surface calcifications exhibited an increasing trend in PSCI (Ptrend = 0.004, 0.016, 0.045, respectively). The prediction model for post-stroke dementia including carotid calcification (area under curve = 0.67), WMH (area under curve = 0.67) and other covariates yielded an area under curve (AUC) of 0.90 (95% CI: 0.82–0.99).Conclusion: Our findings demonstrated that the quantity and location of carotid calcifications were independent indicators for PSCI. The significant role of large vessel atherosclerosis in PSCI should be concerned in future study.

Clinical Outcomes of Hip Arthroscopy for Hip Labrum Calcification in Young and Middle-Aged Patients.

ObjectiveTo investigate the methods and outcomes of hip arthroscopy for hip labrum calcification, and to discuss the clinical, imaging, and intraoperative findings of hip labrum calcification.MethodsThis is a therapeutic case series study. From January 2015 to June 2018, 15 patients who met the inclusion and exclusion criteria were followed up for at least 2 years for an analysis on the outcomes of arthroscopy in the treatment of hip labrum calcification and the clinical, imaging, and intraoperative findings of the patients. There were eight males and seven females, with an average age of 38.9 ± 8.8 years (range, 23–50 years). The visual analog scale (VAS), the modified Harris hip score (mHSS), and the international hip outcome tool (iHOT‐12) were used to evaluate the outcomes of surgery.ResultsA total of 15 patients were followed up for at least 2 years (28.1 ± 2.9 months). The average calcified volume was 118.0 mm3 (range, 19.4–609.2 mm3) and calcified volume was related to the preoperative hip function score. Thirteen patients had pain in the groin area (86.7%). Labrum calcifications were located (according to the clock distribution) as follows: 14 patients were anterior and superior (11:00–3:00); 12 cases of femoroacetabular impingement (FAI) were observed during operation, including five cases of pincer type, two cases of cam type, and five cases of mixed type. VAS pain score means were 7.73 ± 1.28 before surgery, decreasing to 2.0 ± 0.89 and 1.73 ± 0.79 at 1 and 2 years post‐surgery, respectively. mHSS scores were 57.40 ± 6.23 before surgery and 82.10 ± 4.76 and 83.18 ± 4.07, 1 and 2 years post‐surgery, respectively; iHOT‐12 mean score pre‐surgery was 37.67 ± 4.85, increasing to 67.64 ± 5.30 and 72.18 ± 4.49, 1 and 2 years post‐surgery, respectively. Compared with preoperative values, postoperative VAS, mHSS, and iHOT‐12 scores were significantly improved (P < 0.01); iHOT‐12 scores also significantly decreased from 1 to 2 years postoperatively (P = 0.034). No patient had complications.ConclusionHip arthroscopy is an effective method for the treatment of hip labrum calcification. The size of calcification influenced preoperative symptoms and function. Long‐term irritation from FAI may be one important cause of labrum calcification.

Ultrasound tomography reconstruction algorithm using two opposite rotatable linear arrays for breast cancer diagnosis

This article presents a new ultrasound transmission tomography reconstruction algorithm based on a isometric fan-shaped beam along the straight trajectory for an original breast ultrasound imaging system with the cylindrical motion of opposite linear arrays. The ultrasound computed tomography system and measurement scheme are described in detail. The reconstruction algorithm is derived. The numerical breast phantom model is built, including eight structures representing the adipose tissue, glandular tissue, cysts, fibroadenomas, cancer, and calcifications. Using one array as a transmitter and the other one as a receiver, the attenuation distribution in a medium interposed between them is reconstructed. However, limited angle tomography is usually plagued by artifacts along the depth of the image that cause shape distortion to be ellipses, which had an impact on the accurate judgment of the size and shape. B-mode ultrasound images are used as prior information to aid in improving the image quality of limited aperture reconstructions. Simulation results show that the number, location, size, and shape of cancer, cyst, fibroadenoma, and calcification in the numerical breast phantom are reconstructed. Moreover, the quantitative analysis of reconstructed images demonstrates that the reconstruction performance of the region of interest has been greatly improved, which verifies the feasibility of the algorithm using two opposite linear arrays. The reconstruction images are produced by the designed ultrasound tomography reconstruction algorithm, allowing the assessment of the morphology, orientation, internal structure, and margins of lesions in the breast tissue. The ability to create good attenuation images using the cylindrical motion of opposite linear arrays allows reconstructing the three-dimensional image for breast cancer detection and characterization studies.

Algorithm of management based on treatment goals for calcifying tendonitis of the shoulder: rigidity, pain and size of calcification

Purpose: The objective of the present manuscript is to propose a step-by-step algorithm for the management of calcifying tendonitis (CT) of the shoulder based on treatment goals, from conservative to surgical approaches. Method: A clinical note to present the main treatments for the management of calcifying tendonitis of the shoulder based on pain, rigidity and size of calcification based on the clinical experience and previous publications of the authors has been performed. Arguments: Treatment is conservative and surgical although there is controversy on the most adequate treatment. Kinesiotherapy is the recommended therapy for shoulder rigidity. For pain management after NSAIDs; microwaves, short waves, TENS, ultrasounds and Interferentials are effective. For the management of size of calcification, Iontophoresis, Electroshock wave therapy, Ultrasound needle guided aspiration and arthroscopic surgeries are the recommended alternatives, in that order. Conclusions: CT of the shoulder must be treated based on specific goals, mainly pain, rigidity or size of calcification. The proposed step-by-step algorithm of treatment is suggested based on the effectiveness of available techniques. If rigidity is present, kinesiotherapy is the recommended technique. For pain management, physical therapy such as microwaves, short waves, TENS, Ultrasound and Interferentials are effective techniques. For the treatment of calcification, iontophoresis is the most common, safe and inexpensive technique. If all previous conservative techniques failed, advanced techniques such as ESWT, US guided aspiration and arthroscopy are recommended, although they are not exempt of risk factors and complications.

Nomogram prediction for the involution of the ablation zone after radiofrequency ablation treatment in patients with low-risk papillary thyroid carcinoma

Objectives To construct a prognostic nomogram to predict the involution of the ablation zone for patients with low-risk papillary thyroid carcinoma (PTC) who underwent radiofrequency ablation (RFA) treatment. Methods Data from 204 patients with low-risk PTC without extrathyroidal extension or cervical lymph node or distant metastasis who underwent RFA treatment were collected from January 2018 to January 2019. Clinicopathological and imaging characteristics were analyzed. The prognostic factors associated with the involution of the ablation zone within 12 months after RFA were identified by logistic analysis, and the nomogram was established. Calibration curve and decision curve analysis were used to evaluate the nomogram performance. Results Of the 204 patients included in this study, the ablation zone in 78 (38%) patients did not completely disappear in the 12 months after RFA. Four variables, including sex (odds ratio [OR], 3.303; 95% confidence interval [CI], 1.418–8.418; p = 0.008), age (OR, 1.045; 95% CI, 1.012–1.081; p = 0.009), calcification size (OR, 1.666; 95% CI, 1.041–2.701; p = 0.035), and RFA energy (OR, 2.902; 95% CI, 1.333–6.683; p = 0.009), were found to be closely associated with ablation zone non-disappearance at 12 months after RFA by multivariate analysis. A nomogram model was constructed, and its accuracy was well validated (C-index = 0.787). Conclusions This study constructed and validated a risk model that could accurately predict the involution of the ablation zone after RFA for patients with PTC. This could provide clinicians with useful resource to guide patient counseling regarding tumor prognosis after RFA.