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BACKGROUND: The ability to estimate skeletal maturity using a knee radiograph would be useful in anterior cruciate ligament (ACL) injuries and limb-length discrepancy in immature patients. Currently, a quick, accurate, and reproducible method is lacking. METHODS: Serial knee radiographs made 3 years before to 2 years following the chronologic age associated with 90% of final height (an enhanced skeletal maturity gold standard compared with peak height velocity) were analyzed in 78 children. The Pyle and Hoerr (PH) knee method was simplified by developing discrete stages for the distal part of the femur, the proximal part of the tibia, the proximal part of the fibula, and the patella. The Roche-Wainer-Thissen (RWT) knee method was simplified from the 36 original parameters to 14 parameters by removing parameters that were poorly defined, were not relevant to the peripubertal age range, were poorly correlated with 90% final height, or were poorly reliable on a 20-radiograph pilot analysis. We also compared the recently described central peak value (CPV) of the distal part of the femur. The Greulich and Pyle (GP) left-hand bone age was included for comparison. RESULTS: In this study, 326 left knee radiographs from 41 girls (age range, 7 to 15 years) and 37 boys (age range, 9 to 17 years) were included. Stepwise linear regression showed higher correlation in predicting years from 90% final height using the modified RWT and demographic characteristics (R2 = 0.921) compared with demographic characteristics alone (R2 = 0.840), CPV and demographic characteristics (R2 = 0.866), GP and demographic characteristics (R2 = 0.899), and PH and demographic characteristics (R2 = 0.902). Seven parameters were excluded from the RWT and demographic characteristics model using stepwise linear regression and generalized estimating equations analysis, leaving 7 parameters (2 femoral, 4 tibial, and 1 fibular) in the final model. Compared with RWT and demographic characteristics (R2 = 0.921), there were minimal incremental increases by adding CPV (R2 = 0.921), GP (R2 = 0.925), or PH (R2 = 0.931). CONCLUSIONS: This large analysis of knee skeletal maturity systems isolated 7 discrete radiographic knee parameters that theoretically outperform the GP bone age in estimating skeletal maturity. CLINICAL RELEVANCE: We present a modified knee skeletal maturity system that can potentially preclude the need for additional imaging of the hand and wrist in reliably estimating skeletal maturity.
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Determinación de la Edad por el Esqueleto/métodos , Artrografía/métodos , Rodilla/diagnóstico por imagen , Adolescente , Factores de Edad , Artrografía/estadística & datos numéricos , Estatura , Niño , Femenino , Fémur/diagnóstico por imagen , Fémur/crecimiento & desarrollo , Peroné/diagnóstico por imagen , Peroné/crecimiento & desarrollo , Humanos , Rodilla/crecimiento & desarrollo , Modelos Lineales , Masculino , Rótula/diagnóstico por imagen , Rótula/crecimiento & desarrollo , Estudios Retrospectivos , Tibia/diagnóstico por imagen , Tibia/crecimiento & desarrolloRESUMEN
OBJECTIVE: The purpose of this study was to retrospectively assess the frequency and characteristics of acetabular cartilage delamination (CD) in femoroacetabular impingement (FAI) patients and to assess the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of magnetic resonance arthrography (MRA) in detecting CD based on the radiologist report. DESIGN: This is a single-center retrospective review of consecutive patients operated for symptomatic FAI. All of the patients had a 1.5-T MR-arthrogram within 12 months preoperatively. MRA reports of these patients were compared with operation notes and surgical videos of all patients by two trained assessors. RESULTS: At surgery, CD of the acetabulum was present in 169 patients out of a total of 229 patients (74%). Only 6.5% (11 patients) of CD was described on the MRA reports preoperatively. The mean age of the patients was 37.6 ± 13.3 years. The average extent of delamination was 3.12 ± 1.5 cm2 with a mean coronal × sagittal extent of 0.68 × 4.33 cm. There was a significant difference regarding age (P = 0.002), alpha angle from frog view (P = 0.002), and alpha angle from anteroposterior view (P = 0.012) between the patients with delamination and without delamination. The majority of labral tears and cartilage damage were located in the anterosuperior quadrant. MRA sensitivity was 6%, specificity 98%, NPV 27%, and PPV 91% based on the radiologist report. CONCLUSION: The CD in patients with FAI can be severely underdiagnosed with MRA. There is a need for better standard diagnostic criteria to detect CD in patients with FAI.
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Acetábulo/diagnóstico por imagen , Artrografía/estadística & datos numéricos , Enfermedades de los Cartílagos/diagnóstico por imagen , Pinzamiento Femoroacetabular/diagnóstico por imagen , Imagen por Resonancia Magnética/estadística & datos numéricos , Acetábulo/lesiones , Adulto , Artrografía/métodos , Enfermedades de los Cartílagos/complicaciones , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/lesiones , Femenino , Pinzamiento Femoroacetabular/complicaciones , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: Magnetic resonance imaging (MRI) is currently the gold standard to diagnose and monitor osteochondritis dissecans (OCD) of the knee. The purpose of this study was to evaluate for the first time if ultrasound imaging can be used to visualize osteochondritis dissecans of the distal femur. DESIGN: From May 2008 to December 2013, 44 children (26 boys and 18 girls) presenting with OCD of the knee in our department were examined and evaluated by ultrasound imaging. Mean age at diagnosis was 11.8 ± 2.2 years. Two independent experienced orthopedic surgeons analyzed the localization, stage, and the size of the OCD via ultrasound and compared the results with the MRI findings. RESULTS: Ultrasonic examination has limitations in assessing the OCD stage I and therefore is not suitable for evaluating this stage of the disease. In stages II to IV, a good correlation to MRI regarding defect localization and size can be found, when the defect is localized in a region that is accessible to ultrasonic examination. CONCLUSION: Ultrasonic scan is an appropriate tool for the screening and monitoring of OCDs stages II to IV. It provides an inexpensive and readily available alternative to MRI. In addition, the healing process of higher grade defects as well as the screening of the opposite side can also be performed by ultrasound. Detection of defects being localized close to the intercondylar notch or far posterior on the lateral condyle are limitations for the use of ultrasound.
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Artrografía/estadística & datos numéricos , Fémur/diagnóstico por imagen , Imagen por Resonancia Magnética/estadística & datos numéricos , Osteocondritis Disecante/diagnóstico por imagen , Ultrasonografía/estadística & datos numéricos , Artrografía/métodos , Niño , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Reproducibilidad de los Resultados , Ultrasonografía/métodosRESUMEN
BACKGROUND: Numerous quantitatively based studies measuring the accuracy of MRI and MRA for the diagnosis of rotator cuff tears remain inconclusive. In order to compare the accuracy of MRI with MRA in detection of rotator cuff tears a meta-analysis was performed systematically. METHODS: PubMed/Medline and Embase were utilized to retrieve articles comparing the diagnostic performance of MRI and MRA for use in detecting rotator cuff tears. After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis the pooled evaluation indexes including sensitivity and specificity as well as hierarchical summary receiver operating characteristic (HSROC) curves with 95% confidence interval (CI) were calculated. RESULTS: Screening determined that 12 studies involving a total of 1030 patients and 1032 shoulders were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that MRA has a higher sensitivity and specificity than MRI for the detection of any tear; similar results were observed in the detection of full-thickness tears. However, for the detection of partial-thickness tear, MRI has similar performance with MRA. CONCLUSION: MRI is recommended to be a first-choice imaging modality for the detection of rotator cuff tears. Although MRA have a higher sensitivity and specificity, it cannot replace MRI after the comprehensive consideration of accuracy and practicality.
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Artrografía/métodos , Imagen por Resonancia Magnética/métodos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artrografía/estadística & datos numéricos , Femenino , Humanos , Laceraciones/diagnóstico por imagen , Laceraciones/patología , Imagen por Resonancia Magnética/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Manguito de los Rotadores/patología , Rotura/diagnóstico por imagen , Rotura/patología , Sensibilidad y Especificidad , Adulto JovenRESUMEN
OBJECTIVES: To perform an online survey about the use of magnetic resonance arthrography (MRA) in clinical practice. METHODS: We administered an online survey to all 1,550 members of the European Society of Musculoskeletal Radiology (ESSR) about MRA asking ten different questions. Subgroup analysis was performed between general and orthopaedic hospitals using χ2 and Mann-Whitney U statistics. RESULTS: One-hundred forty-eight answers were included (148/1,550, 9.5% of ESSR members). A median of 3,000 (interquartile range: 1,567.5-5,324.5) musculoskeletal MR examinations and a median of 125.5 MRAs (50.75-249) per institution were performed in 2016. Ratio between MRA and musculoskeletal MR was 4.7% (1.6%-9.0%). Using MRA, the most investigated joint was the shoulder followed by the hip (96.6%). The most common indications were the evaluation of instability, labrum, and rotator cuff (85.1%). Fluoroscopy represented the preferred injection guidance. A self-prepared mixture of Gadolinium/saline is preferred in general hospitals, while pre-diluted Gadolinium-based syringes are mainly used in orthopaedic hospitals (P=.010). The number of MRA performed at orthopaedic hospitals (284;83.75-449.50) was higher (P=.006) than that performed at general hospitals (115.50;44.75-234.25). CONCLUSIONS: One out of twenty MR examinations is a MRA, with higher prevalence in orthopaedic hospitals. The shoulder and the hip are the most investigated joints. Instability, labrum, and cuff are the most common indications. KEY POINTS: ⢠The most common MRAs are shoulder and hip (96.6% of answers). ⢠Most common clinical indications for MRA are instability, labrum, and rotator cuff (85.1% of answers). ⢠Fluoroscopy represents the preferred guidance to inject joints (61.0% of answers). ⢠The median number of MRA performed at orthopaedic hospitals (n=284) was significantly higher (P=.006) than that performed at general hospitals (n=115.50). ⢠A self-prepared mixture of Gadolinium/saline solution is preferred in general hospitals (64.8%) compared to orthopaedic hospitals (36.0%; P=0.010).
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Artrografía/estadística & datos numéricos , Articulaciones/diagnóstico por imagen , Imagen por Resonancia Magnética/estadística & datos numéricos , Enfermedades Musculoesqueléticas/diagnóstico , Sistema Musculoesquelético/diagnóstico por imagen , Radiología , Sociedades Médicas , Adulto , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
Purpose To evaluate the diagnostic accuracies of nonenhanced magnetic resonance (MR) imaging and MR arthrography for diagnosis of superior labrum anterior-to-posterior (SLAP) tears by using a systematic review and meta-analysis. Materials and Methods A comprehensive literature search was performed on the two main concepts of MR imaging (MR imaging, and direct and indirect MR arthrography) and SLAP tears. Inclusion criteria consisted of original studies that assessed the diagnostic accuracy of MR imaging, direct MR arthrography, and/or indirect MR arthrography for the detection of SLAP tears, by using surgical findings as the reference standard. The Quality Assessment of Diagnostic Accuracy Studies 2, or QUADAS-2 Quality Assessment of Diagnostic Accuracy Studies 2 Quality Assessment of Diagnostic Accuracy Studies 2 , tool was used to assess methodologic quality. Meta-analyses were performed that compared MR imaging studies to direct MR arthrography studies and indirect MR arthrography studies, 3-T studies to 1.5-T studies, and low-bias MR imaging studies to low-bias direct MR arthrography studies. Study variation was analyzed by using the Cochran Q test of heterogeneity and the I2 statistic. Results Thirty-two studies met inclusion and exclusion criteria, including 3524 imaging examinations: 1963 direct MR arthrography examinations (23 studies), 1402 MR examinations (14 studies), and 159 indirect MR arthrography examinations (three studies). Twelve studies had low risk for bias, two had questionable risk, and 18 had high risk. Mean sensitivities of direct MR arthrography, MR imaging, and indirect MR arthrography for SLAP tear diagnosis were 80.4%, 63.0%, and 74.2%, respectively. Mean specificities of direct MR arthrography, MR imaging, and indirect MR arthrography were 90.7%, 87.2%, and 66.5%, respectively. Summary receiver operator characteristic (ROC) curve demonstrated superior accuracy of direct MR arthrography compared with those of MR imaging and indirect MR arthrography. Similar findings were observed in the low-bias subanalysis. Summary ROC curve demonstrated overall superiority of 3-T imaging, with or without intra-articular contrast material compared with 1.5-T imaging, with or without intra-articular contrast material. Significant variance was observed for MR imaging and direct MR arthrography (P < .001) studies for both mean sensitivity and specificity. Conclusion Direct MR arthrography appears to be more accurate than nonenhanced MR imaging for diagnosis of SLAP tears, whereas 3-T MR imaging with or without intra-articular contrast material appears to improve diagnostic accuracy compared with 1.5-T MR imaging with or without intra-articular contrast material. © RSNA, 2017 Online supplemental material is available for this article.
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Artrografía , Imagen por Resonancia Magnética , Lesiones del Hombro/diagnóstico por imagen , Adulto , Artrografía/métodos , Artrografía/estadística & datos numéricos , Humanos , Imagen por Resonancia Magnética/métodos , Imagen por Resonancia Magnética/estadística & datos numéricos , Persona de Mediana Edad , Curva ROC , Hombro/diagnóstico por imagenRESUMEN
OBJECTIVES: To determine the influence of treatment and radiographic parameters on patient-reported functional outcomes on a population of non-frail elderly with distal radius fractures. DESIGN: Prospective cohort study. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Patients older than 55 years presenting with a distal radius fracture and a Canadian Study of Health and Aging Clinical Frailty Scale score of 1 or 2. INTERVENTION: Closed reduction and casting or open reduction and internal fixation as per the treating surgeons' decision. MAIN OUTCOME MEASURES: Radiographic scores at baseline, 6 weeks, and 12 weeks, as well as Disabilities of the Arm, Shoulder and Hand, Short Form 36, and Patient-Reported Wrist Evaluation scores up to 1 year after injury. Univariate analysis and linear regression analysis were performed on outcome measures. RESULTS: No difference exists in outcomes based on treatment choice. Patients with ulnar positivity greater than 2 mm at baseline, after treatment, and at final follow-up had worse patient-reported scores at 1 year. Persistent articular gaps and/or steps greater than 2 mm after treatment were also associated with worse patient-reported outcomes. CONCLUSION: Even in high-functioning patients older than 55 years, there was no difference in patient-reported outcomes at 1 year in the open reduction group as compared with the closed reduction group. Instead, physicians should pay particular attention to radial shortening and persistent articular gaps following their chosen treatment plan for distal radial fractures. LEVEL OF EVIDENCE: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Actividades Cotidianas , Artrografía/estadística & datos numéricos , Curación de Fractura , Satisfacción del Paciente/estadística & datos numéricos , Fracturas del Radio/diagnóstico , Fracturas del Radio/cirugía , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Estudios de Cohortes , Autoevaluación Diagnóstica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Prevalencia , Pronóstico , Estudios Prospectivos , Calidad de Vida , Fracturas del Radio/epidemiología , Resultado del TratamientoRESUMEN
BACKGROUND: Latin America is a heterogeneous region made up of different populations, cultures, latitudes, altitudes, and immigrants from different areas and ethnic groups. OBJECTIVE: The purpose of this study is to describe the clinical and demographic profile of patients with osteoarthritis (OA) evaluated by a selected group of rheumatologists in 13 Latin American countries. METHODS: A descriptive, observational, cross-sectional study was conducted in 13 Latin American countries of patients with symptomatic OA. Data were collected over a 3-month period using an ad hoc questionnaire to evaluate the clinical and demographic features of OA seen by rheumatologists. RESULTS: Among the 3040 patients, their average age was 62.5 years, and female-to-male ratio was 4.8:1. Patients with body mass index of greater than 30 kg/m or obesity was found in 38.2%. Approximately 88% had primary OA. Joints with OA were as follows: knee 31.2%, hand 9.5%, hand and knee 22.9%, proximal and distal interphalangeal joints (erosive OA) 6.5%, axial 6.6%, and hip 1.3%. Approximately 88.5% had radiographic severity of grade 2 or 3 on Kellgren-Lawrence scale (0-4). Nonsteroidal anti-inflammatory drugs were the predominant OA treatment included in combinations with glucosamine sulfate/chondroitin and viscosupplementation. Associated comorbidities included hypertension (39%), obesity (36.3%), diabetes mellitus (12%), and without comorbidity (12.7%). CONCLUSIONS: This is 1 of the largest population studies that evaluated the characteristics of OA in 3040 patients evaluated by rheumatologists in 13 Latin American countries. This study provides important data for each Latin American country to develop new health care planning in management of OA.
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Antiinflamatorios no Esteroideos/uso terapéutico , Artrografía/estadística & datos numéricos , Glucosamina/uso terapéutico , Hipertensión/epidemiología , Obesidad/epidemiología , Osteoartritis , Viscosuplementos/uso terapéutico , Comorbilidad , Estudios Transversales , Demografía , Femenino , Humanos , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico , Osteoartritis/tratamiento farmacológico , Osteoartritis/epidemiología , Osteoartritis/fisiopatología , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Patients with rheumatoid arthritis (RA) undergo radiologic investigations for disease and comorbidity evaluation. The actual use of radiologic imaging in RA is unknown. METHODS: Using the Rochester Epidemiology Project medical record linkage system, adult patients from previously assembled population-based cohorts of Olmsted County, Minnesota, residents who fulfilled the 1987 American College of Rheumatology criteria for RA in 1988 to 2007 and comparator subjects without RA of similar age and gender were studied. Data on all radiologic procedures performed were collected. RESULTS: The study included 650 patients with RA and 650 patients without RA. Patients with RA had significantly more radiographs of the chest (rate ratio [RR], 1.33; 95% confidence interval [CI], 1.28-31.38), upper extremity (RR, 2.97; 95% CI, 2.80-83.17), lower extremity (RR, 2.05; 95% CI, 1.94-102.16), spine (RR, 1.46; 95% CI, 1.35-41.59), and hip, pelvis, or sacroiliac joints (RR, 1.14; 95% CI, 1.03-11.26), as well as bone radionuclide (RR, 1.90; 95% CI, 1.50-52.44) and dual-energy x-ray absorptiometry imaging (RR, 1.77; 95% CI, 1.59-61.98) compared with patients without RA. Among patients with RA, having a positive rheumatoid factor was associated with an increased likelihood of undergoing radiologic procedures (RR, 1.05; 95% CI, 1.02-11.07). Women with RA underwent more imaging procedures than men (RR, 1.20; 95% CI, 1.16-21.23). CONCLUSIONS: Patients with RA undergo more radiologic procedures than patients without RA. Among patients with RA, women and patients with a positive rheumatoid factor have more radiologic procedures. The utilization of radiography is likely a reflection of overall disease burden. Despite some guidelines, routine hand wrist radiographs were not obtained with regularity; "overuse" is unlikely.
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Artritis Reumatoide/diagnóstico por imagen , Artrografía/estadística & datos numéricos , Pacientes , Radiografía/estadística & datos numéricos , Costo de Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factor Reumatoide/sangre , Factores Sexuales , Factores de TiempoRESUMEN
Patients with developmental dysplasia of the hip (DDH) generally undergo multiple x-ray examinations of both hip joints. During these examinations, the gonads are completely exposed to radiation, unless shielded. Although many types and sizes of gonad shields exist, they often do not provide adequate protection because of size and placement issues; additionally, these shields are frequently omitted for female patients. Our aim was to assess gonad protection during x-ray examination that is provided by gonad shields designed for individual female patients with DDH.We retrospectively retrieved data from the Picture Archiving and Communication System database; pelvic plain x-ray films from 766 females, 18 years old or younger, were included in our analysis. Based on x-ray measurements of the anterior superior iliac spine, we developed a system of gonad shield design that depended on the distance between anterior superior iliac spine markers. We custom-made shields and then examined shielding rates and shielding accuracy before and after these new shields became available. Standard (general-purpose) shields were used before our custom design project was implemented. The shielding rate and shielding accuracy were, respectively, 14.5% and 8.4% before the project was implemented and 72.7% and 32.2% after it was implemented. A shield that is more anatomically correct and available in several different sizes may increase the likelihood of gonad protection during pelvic x-ray examinations.
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Artrografía/instrumentación , Luxación Congénita de la Cadera/diagnóstico por imagen , Tratamientos Conservadores del Órgano/instrumentación , Órganos en Riesgo/efectos de la radiación , Ovario/efectos de la radiación , Protección Radiológica/instrumentación , Adolescente , Artrografía/estadística & datos numéricos , Carga Corporal (Radioterapia) , Niño , Preescolar , Diseño de Equipo , Análisis de Falla de Equipo , Femenino , Humanos , Lactante , Recién Nacido , Tratamientos Conservadores del Órgano/métodos , Seguridad del Paciente , Dosis de Radiación , Protección Radiológica/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
BACKGROUND AND PURPOSE: Adequate restoration of femoral offset (FO) is critical for successful outcome after hip arthroplasty or fixation of hip fracture. Previous studies have identified that hip rotation influences the projected femoral offset (FOP) on plain anteroposterior (AP) radiographs, but the precise effect of rotation is unknown. PATIENTS AND METHODS: We developed a novel method of assessing rotation-corrected femoral offset (FORC), tested its clinical application in 222 AP hip radiographs following proximal femoral nailing, and validated it in 25 cases with corresponding computed tomography (CT) scans. RESULTS: The mean FORC was 57 (29-93) mm, which differed significantly (p < 0.001) from the mean FOP 49 (22-65) mm and from the mean femoral offset determined by the standard method: 49 (23-66) mm. FORC correlated closely with femoral offset assessed by CT (FOCT); the Spearman correlation coefficient was 0.94 (95% CI: 0.88-0.97). The intraclass correlation coefficient for the assessment of FORC by AP hip radiographs correlating the repeated measurements of 1 observer and of 2 independent blinded observers was 1.0 and 1.0, respectively. INTERPRETATION: Hip rotation affects the FOP on plain AP radiographs of the hip in a predictable way and should be adequately accounted for.
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Artrografía/métodos , Artroplastia de Reemplazo de Cadera/métodos , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/cirugía , Modelos Biológicos , Rango del Movimiento Articular , Artrografía/normas , Artrografía/estadística & datos numéricos , Clavos Ortopédicos , Fémur/diagnóstico por imagen , Fémur/cirugía , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Prótesis de Cadera , Humanos , Variaciones Dependientes del Observador , Recuperación de la Función , Reproducibilidad de los Resultados , Rotación , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/normas , Tomografía Computarizada por Rayos X/estadística & datos numéricosRESUMEN
Successful biomechanical reconstruction is a major goal in total hip arthroplasty (THA). We measured leg length (LL), global (GO) and femoral offset (FO) change on anteroposterior pelvis radiographs and on three-dimensional computed-tomography (3D-CT) with fiducial landmarks after cementless THA on 18 hips of cadaveric specimens. Measurements on radiographs were performed twice by four examiners and showed high interobserver (mean CCC ≥0.79) and intraobserver agreements (mean ICC ≥0.88). Mean differences between radiographic and 3D-CT measurements were 1.0 (SD 2.0) mm for LL, 0.6 (SD 3.6) mm for GO and 1.4 (SD 5.2) mm for FO. 1% of radiographic LL-, 15% of GO- and 35% of FO measurements were outside a tolerance limit of 5mm. Radiographs seem acceptable for measuring LL/GO change but fail to reflect FO change in THA.
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Artrografía/normas , Artroplastia de Reemplazo de Cadera/métodos , Fémur/diagnóstico por imagen , Fémur/cirugía , Tomografía Computarizada por Rayos X/normas , Artrografía/métodos , Artrografía/estadística & datos numéricos , Cadáver , Marcadores Fiduciales , Humanos , Imagenología Tridimensional/métodos , Imagenología Tridimensional/normas , Imagenología Tridimensional/estadística & datos numéricos , Variaciones Dependientes del Observador , Pelvis/diagnóstico por imagen , Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/estadística & datos numéricosRESUMEN
We report the accuracy of positioning of the calibration ball in the process of pre-operative templating for total hip arthroplasty (THA). The ball should be placed in the coronal plane of the hip to provide suitable accuracy. We reviewed 112 post-operative THA radiographs where a calibration ball had been placed. We templated the femoral head size of the implant after calibrating the templating system from the ball. The calibrated femoral head diameter was compared to the known prosthetic head size. A percentage error was calculated. Overall, incorrect placement of the calibration ball resulted in a mean percentage error in templating of 6.8% (median 5.7%; range 0-26%). Such error carries implications with the templating process and may result in incorrect component sizes, leg lengths and offset.
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Artrografía/normas , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/normas , Prótesis de Cadera/normas , Cuidados Preoperatorios/normas , Anciano , Anciano de 80 o más Años , Artrografía/métodos , Artrografía/estadística & datos numéricos , Calibración/normas , Precisión de la Medición Dimensional , Femenino , Fémur/diagnóstico por imagen , Fémur/cirugía , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Posicionamiento del Paciente , Cuidados Preoperatorios/métodos , Cuidados Preoperatorios/estadística & datos numéricos , Estudios Retrospectivos , Método Simple Ciego , Programas Informáticos/normasRESUMEN
OBJECTIVE: To compare the utility of radiography and magnetic resonance imaging (MRI) for the diagnosis of juvenile-onset spondyloarthritis in pediatric patients presenting with low back and/or sacroiliac (SI) pain of potentially inflammatory etiology. METHODS: Radiographs and MRI studies of the SI joints in 26 patients with juvenile spondyloarthritis (JSpA) and 35 controls were assessed independently by 2 radiologists, with discrepancies arbitrated by a third. Radiographs and MRI were blinded and read in separate batches in random order. RESULTS: Erosion was common and was the most useful diagnostic feature on radiography [positive likelihood ratio (LR) = 3.5] and was especially diagnostic of SpA on MRI (LR = 6.7). Subchondral sclerosis was common but was the least specific feature for both modalities. Joint space narrowing had some utility on radiography (LR = 2.0) and MRI (LR = 2.7) but was uncommon and had poor reader reliability. Bone marrow edema (LR = 3.1) and subarticular fat infiltration (LR = 4.5), detectable only on MRI, were both useful features. Global diagnostic impression of MRI (LR = 9.4) had very high utility for the diagnosis of JSpA, exceeding radiography (LR = 4.4) because of superior specificity. In addition, global diagnosis of SpA is much more reliably made on MRI (κ = 0.80) compared to radiography (κ = 0.30). CONCLUSION: Specificity and reliability of MRI of the SI joints are superior to radiography for the diagnosis of juvenile-onset SpA and, where available, MRI should replace radiography as the first line of investigation.
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Artrografía/métodos , Imagen por Resonancia Magnética/métodos , Espondiloartropatías/diagnóstico por imagen , Espondiloartropatías/patología , Espondilitis Anquilosante/diagnóstico por imagen , Espondilitis Anquilosante/patología , Adolescente , Artrografía/normas , Artrografía/estadística & datos numéricos , Médula Ósea/diagnóstico por imagen , Médula Ósea/patología , Bases de Datos Factuales , Edema/diagnóstico por imagen , Edema/patología , Femenino , Humanos , Imagen por Resonancia Magnética/normas , Imagen por Resonancia Magnética/estadística & datos numéricos , Masculino , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sacroileítis/diagnóstico por imagen , Sacroileítis/patología , Sensibilidad y EspecificidadRESUMEN
To determine whether femoral implant position can be reproducibly measured on plain digital radiographs, we prospectively studied 40 patients after hip resurfacing arthroplasty. Three observers performed double blinded randomized analysis of calibrated digital radiographs meeting strict quality criteria. The implant stem-shaft angle and femoral anteversion angle were measured by the trapezoid method of axis determination using OsiriX software. The upper and lower offset and the anterior and posterior offset were measured. The statistical analysis was performed using Pearson correlation tests (intra-observer reproducibility) and Fisher F tests (inter-observer reproducibility). Intra-observer reproducibility was very good for all parameters and all observers. Inter-observer reproducibility was excellent except for superior offset measurement. Thus, this study validates a radiographic method for assessing the femoral implant position in hip resurfacing. We believe this could be useful for future studies on hip resurfacing devices.
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Artrografía/estadística & datos numéricos , Artrografía/normas , Artroplastia de Reemplazo de Cadera/métodos , Cuello Femoral/diagnóstico por imagen , Cuello Femoral/cirugía , Artrografía/métodos , Método Doble Ciego , Femenino , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Procesamiento de Imagen Asistido por Computador/normas , Procesamiento de Imagen Asistido por Computador/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: For hip complaints in the paediatric population, it is common practice to acquire both anteroposterior (AP) and frog-leg lateral (FL) radiographs. This combination of views provides a high diagnostic yield, but also doubles radiation exposure. We investigated the diagnostic accuracy of obtaining a solitary FL view as compared to a combination of the AP and FL view. METHODS: Hip radiographs of 524 children (aged 2-15 years) referred for acute hip pain were retrospectively assessed by two independent radiologists. Cases of trauma, neuromuscular disorders or a history of known hip disease were excluded. Radiologists were blinded to the AP radiograph while assessing the solitary FL radiograph. We used Cohen's kappa test to calculate agreement between the assessment of both views and the solitary FL view. RESULTS: Agreement between the assessment of the solitary FL view and the combination of the AP and FL view was very high with a kappa value of 0.989. CONCLUSION: The diagnostic accuracy of the FL radiograph in cases of hip complaints in children is as high as the current standard employing both AP and FL views. Therefore a solitary FL radiograph appears sufficient. This practice would substantially reduce radiation exposure. KEY POINTS: ⢠Radiation exposure in children should be kept to a minimum. ⢠In paediatric hip radiography a solitary frog-leg lateral view suffices. ⢠This reduces radiation exposure and costs of imaging.
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Artralgia/diagnóstico por imagen , Artrografía/métodos , Articulación de la Cadera/diagnóstico por imagen , Pierna/diagnóstico por imagen , Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Adolescente , Artrografía/estadística & datos numéricos , Niño , Preescolar , Epífisis/diagnóstico por imagen , Femenino , Fémur/diagnóstico por imagen , Humanos , Masculino , Variaciones Dependientes del Observador , Posicionamiento del Paciente/métodos , Dosis de Radiación , Estudios RetrospectivosRESUMEN
Statistical analysis plays a critical role in data interpretation in all fields and particularly so for clinical data where important treatment decisions are made. We provide here an in-depth and illustrative analysis to examine patterns and radiographic scores in an early disease rheumatoid arthritis cohort over a 3-year follow-up period. The total Sharp radiographic scores were interpolated from the rates at 6 months, 1, 2, and 3 years and were transformed to count data after rounding. The generalized estimating equations approach and two-part models were applied to analyze the longitudinal radiographic scores using the clinical, demographic, and therapeutic characteristics of the patients after adjusting for the pattern outcomes. Total Sharp scores were modeled, assuming that they were Poisson distributed or had a negative binomial distribution with either an AR(1) working correlation matrix or an exchangeable working correlation matrix. To account for the excessive zero counts, we used two-part models that include the zero-inflated Poisson and the zero-inflated negative binomial to fit the data. This is an innovation because two-part models have not been used in rheumatology even though they are highly appropriate for analyzing data from rheumatic studies. In addition, we analyzed data using generalized estimating equations and compared results from different models using formal statistical goodness-of-fit criteria and arrive at the best model for predicting purposes.
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Artritis Reumatoide/diagnóstico por imagen , Artrografía , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Artrografía/estadística & datos numéricos , Interpretación Estadística de Datos , Humanos , Modelos Estadísticos , Valor Predictivo de las Pruebas , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: Our prospective study aimed to demonstrate that the cumulative synovial power Doppler (PD) ultrasound scores correlate with radiographic progression better than conventional measures in patients with rheumatoid arthritis (RA). We also investigated the difference between antirheumatic agents. METHODS: Sixty-nine patients with RA who had recently received either methotrexate (MTX; n = 23), tumor necrosis factor (TNF) antagonists (n = 28), or tocilizumab (TCZ; n = 18) were enrolled. Patients underwent clinical, laboratory, and ultrasonographic assessment at baseline, 12 weeks, and 24 weeks. Radiographic damage was evaluated using van der Heijde modified total Sharp score (TSS) at baseline and 24 weeks. RESULTS: Fifty-seven patients continued the same treatment regimen for 24 weeks and completed the study, and 21 patients (36.8%) showed radiographic progression during the study period. In all patients, ΔTSS significantly correlated both with cumulative 28-joint Disease Activity Score-C-reactive protein (DAS28-CRP; ρ = 0.342, p = 0.009) and cumulative total PD scores (ρ = 0.357, p = 0.006). In MTX-treated patients, cumulative total PD scores significantly correlated with ΔTSS (ρ = 0.679, p = 0.004), whereas cumulative DAS28-CRP did not (ρ = 0.487, p = 0.056). However, cumulative total PD scores did not correlate with ΔTSS in TNF antagonist-treated or TCZ-treated patients. CONCLUSION: Our data confirm the evidence that synovial PD activity more accurately reflects active synovial inflammation (which actually causes joint destruction) than do conventional measures in patients treated with MTX. Our data also indicate that TNF antagonists can inhibit short-term radiographic progression in the presence of active synovitis.
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Anticuerpos Monoclonales Humanizados/uso terapéutico , Artritis Reumatoide , Metotrexato/uso terapéutico , Sinovitis , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Ultrasonografía Doppler/métodos , Adalimumab , Adulto , Anciano , Anticuerpos Monoclonales/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/tratamiento farmacológico , Artrografía/métodos , Artrografía/estadística & datos numéricos , Progresión de la Enfermedad , Etanercept , Femenino , Humanos , Inmunoglobulina G/uso terapéutico , Infliximab , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Sensibilidad y Especificidad , Sinovitis/diagnóstico por imagen , Sinovitis/tratamiento farmacológico , Ultrasonografía Doppler/estadística & datos numéricosRESUMEN
PURPOSE: A possible complication after total disc replacement (TDR) is subsidence, presumably caused by asymmetric implantation, implant undersizing or reduced bone quality. This study aims to quantify the degree of subsidence of an SB Charité TDR, and investigate whether undersizing is related to subsidence. METHODS: A custom developed software package (Mathworks) reconstructed 3D bone-implant geometry. A threshold for subsidence was determined by comparing penetrated bone volume (PBV) and rotation angles. Inter- and intra-observer reproducibilities were calculated. Subsidence was correlated to undersizing. RESULTS: High inter- and intra-observer correlation coefficients were found for the method (R > 0.92). Subsidence was quantified as PBV 700 mm(3) combined with a rotation angle >7.5°. A reduced risk of subsidence was correlated to >60 and >62 % of the bony endplate covered by the TDR endplate for L4 and L5, respectively. CONCLUSIONS: A reproducible method to determine undersizing was developed. Thresholds were determined related to a reduced risk of subsidence.
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Degeneración del Disco Intervertebral/cirugía , Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Falla de Prótesis/efectos adversos , Ajuste de Prótesis/métodos , Reeemplazo Total de Disco/métodos , Adulto , Artrografía/métodos , Artrografía/normas , Artrografía/estadística & datos numéricos , Femenino , Humanos , Disco Intervertebral/diagnóstico por imagen , Disco Intervertebral/patología , Degeneración del Disco Intervertebral/diagnóstico por imagen , Degeneración del Disco Intervertebral/patología , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/patología , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Modelos Biológicos , Variaciones Dependientes del Observador , Tamaño de los Órganos , Ajuste de Prótesis/normas , Ajuste de Prótesis/estadística & datos numéricos , Curva ROC , Estudios Retrospectivos , Rotación , Reeemplazo Total de Disco/efectos adversosRESUMEN
OBJECTIVE: To correlate histopathological and radiographic features of distal and proximal interphalangeal (DIP and PIP) joints in order to test whether the use of an x-ray examination would be beneficial to the classification/diagnosis process of hand osteoarthritis (OA). METHODS: DIP and PIP joints were obtained from post mortem specimens (n=40). Plain x-rays of the DIP and PIP joints were taken and radiographic OA was determined by the Kellgren and Lawrence classification. Individual radiographic features were scored according to the method described by Altman. Joint samples were prepared for histological analysis; cartilage damage was graded according to the Mankin scoring system. Spearman's correlation was applied to examine the relationship between histological and radiographical changes. Differences between groups (bony swelling vs no bony swelling) were determined by Student t test. RESULTS: A highly significant correlation was found between histological (Mankin score) and radiographic (Kellgren/Lawrence score) changes in the investigated DIP (r(s)=0.87, p<0.0001) and PIP (r(s)=0.79, p<0.0001) joints. A subgroup of patients (37.5% for DIP and 18.8% for PIP joints) showed advanced radiographic changes (Kellgren/Lawrence score ≥2) in joints without clinical bony swelling. Histologically, the mean Mankin scores accounted for 11±1.66 for DIP and 9.67±2.4 for PIP joints. CONCLUSION: On the basis of histopathological changes of DIP and PIP joints, this investigation demonstrates the validity of x-ray examinations and supports the use of plain radiography in the diagnosis of hand OA and in the classification of hand OA in clinical trials.