Current Issue : October - December Volume : 2017 Issue Number : 4 Articles : 7 Articles
Background: Precise measurement of lateral femoral bowing is important to achieve postoperative lower limb\nalignment. We aimed to investigate factors that affect the precision of the radiographic lateral femoral bowing\n(RLFB) angle using three-dimensional (3D) models and whether the angle affects surgery design.\nMethods: Forty femurs in total were divided into two groups based on their preoperative RLFB angle. The flexion\ncontracture angle, preoperative and postoperative RLFB angles, and intersection angle between the mechanical and\nanatomical axes were compared. The angle between the arc and sagittal planes, varus and valgus angles, and\nintersection angle between the mechanical and anatomical axes were measured on a 3D model.\nResults: There was no significant between-group difference in 3D model measurements of the angle between the\narc and sagittal planes (p = 0.327). There was no significant difference between the mechanical and anatomical axes\nmeasured by both imaging modalities (p > 0.258). When the RLFB was >5�°, the flexion contracture angle and\nradiographic femoral bowing angle were positively correlated (r = 0.535, p < 0.05). Distal femur varus and valgus\nangles significantly differed between the two groups (p = 0.01). After total knee arthroplasty, the radiographic\nfemoral bowing angle decreased significantly. When the casesâ�� radiographic femoral bowing angle is larger and the\nangle between the arc and sagittal planes is smaller as measured in 3D models, the angle between the arc and\ncoronal planes is larger.\nConclusion: The radiographic femoral bowing angle does not reflect the actual size of lateral femoral bowing, does\nnot greatly affect surgery design, and is greatly affected by flexion contracture deformity. A RLFB angle larger than\n15�° indicates real lateral femoral bowing....
Background: Artefacts in images related to patient movement decrease image quality, potentially necessitating\nre-scanning, which leads to an extra radiation dose for the patient. Thus, avoiding patient motion reduces patient\nexposure to radiation. The aim of this study was to analyse image motion artefacts (MAs) and how they are\naffected by patient anxiety during cone beam computed tomography (CBCT) examination.\nMethods: A total of 100 patients undergoing CBCT examination were investigated. The State Trait Anxiety Inventory\n(STAI-S and STAI-T) form was used to measure patient anxiety. Patient�s age, gender, dental anxiety score, diagnostic\nreason for CBCT examination, field of view (FOV), acquisition time, anatomical area, and presence of motion artefacts\non images were recorded. Comparisons of the parameters were evaluated using Pearson�s correlation, the chi-square\ntest, the Mann-Whitney U test, the Kruskal-Wallis test and t-tests. The significance level was set at 0.05.\nResults: The mean values of the scores for the total population were 37.2 for the STAI-S and 41.6 for the STAI-T.\nWomen exhibited higher anxiety levels than men. The patients� anxiety scores were significantly correlated with dental\nfear. The prevalence of patients showing motion artefacts was 6%. The mean age of patients with motion artefacts on\ntheir images (56.83) was higher than that of patients without (39.14). There was no relationship between motion\nartefact presence and patient gender, anxiety score, diagnostic reason for CBCT examination, FOV, acquisition time, or\nanatomical area. Patients showing motion artefacts on their images had higher STAI scores than those with no motion\nartefacts (non-significant).\nConclusions: The population in this study experienced anxiety before CBCT scanning. Excessive anxiety did not clearly\naffect whether image motion artefacts were generated during CBCT examination, although a non-significant increase\nin STAI scores was noticed in patients with motion artefacts on their images....
Background: In limited metastatic burden of disease, stereotactic body radiotherapy (SBRT) has been shown to achieve\nhigh local control rates. It has been hypothesized that SBRT may translate to a better quality of life by delaying the need\nfor systemic chemotherapy and possibly increasing survival. There is limited published literature on the efficacy of SBRT in\nlimited nodal metastases. The primary aim is to review institutional outcomes of patients with solitary or oligometastatic\nlymph nodes treated with SBRT.\nMethods: A retrospective study of patients treated with SBRT to metastatic lymph nodes (March 2010ââ?¬â??June 2015) was\nconducted. Endpoints of this study were local control (LC), chemotherapy-free survival (CFS) following SBRT, toxicities,\nprogression free survival (PFS), and overall survival (OS).\nResults: Eighteen patients with a mean age of 65 years underwent SBRT to metastatic lymph nodes. Median follow-up\nwas 33.6 months. There were four hepatocellular carcinoma, seven colorectal, four pancreatic, one esophageal, one\ngallbladder and one lung primary. Eleven (61%) patients had lymph node metastases at initial presentation of metastatic\ndisease. Seven patients (39%) had systemic therapy prior to SBRT, with five patients receiving two lines of chemotherapy.\nEight patients had solitary metastatic disease at the time of radiotherapy. All patients had <5 metastases. Median size of\nlymph node metastases was 1.95 cm (range: 0.8ââ?¬â??6.2 cm). RT doses were 31 to 60 Gy in four to ten fractions, with 44% of\npatients receiving 35 Gy in 5 fractions. At 1 year, LC was 94% and CFS from SBRT was 60%. One-year PFS and OS were\n39% and 89% respectively. There were no grade 3 or higher toxicities.\nConclusions: In this single institution study, SBRT to oligometastatic lymph nodes provided excellent LC and a moderate\nchemotherapy-free interval with minimal toxicities. Disease progression remains prominent in these patients and larger\nstudies are warranted to identify those who benefit most from SBRT....
The aim of this study was to assess with MRI morphometric ultrastructural changes in nerves affected by diabetic peripheral\nneuropathy (DPN).We used an MR micro-neurography imaging protocol and a semiautomated technique of tissue segmentation\nto visualize and measure the volume of internal nerve components, such as the epineurium and nerve fascicles. The tibial nerves\nof 16 patients affected by DPN and of 15 healthy volunteers were imaged. Nerves volume (NV), fascicles volume (FV), fascicles to\nnerve ratio (FNR), and nerves cross-sectional areas (CSA) were obtained. In patients with DPN the NV was increased and the FNR\nwas decreased, as a result of an increase of the epineurium (FNR in diabetic neuropathy 0,665; in controls 0,699, ...
Aim: To evaluate the patterns of loco-regional recurrences in head and neck cancer patients\nMethods: Twenty-six out of 112 patients treated with primary or postoperative 3D CRT or IMRT for their primary\nand recurrent disease between 2007 and 2013 were included. The CT images of recurrent disease were rigidly\nregistered with the primary CT images for each patient. To assess overlaps and overlap localization, the recurrence\nvolume overlapping with the primary target volume was identified. For relapses occurring in the regional lymph\nnodes, the epicenter distance in recurrences and primary volumes and dose in recurrences were also identified. The\nrecurrences were defined as in-field, marginal or out-of-field.\nResults: The majority of the failures occurred within 1 year after completed primary treatment. The dose differences\nin recurrence volume were not statistically significant when patients were treated with IMRT or 3D CRT. Recurrence\nin 15/26 of the included patients occurred in the regional lymph nodes located fully or partly inside the primary\ntarget volume or the elective lymph node region. The majority of recurrences were recognized as in-field,\nindependent of the primary treatment.\nConclusion: Recurrence in the majority of the patients occurred in the regional lymph nodes located in high dose\narea. The cause of recurrence may be due to inadequate total dose in the primary treatment and/or lack of optimal\nprimary diagnosis leading to inadequate primary target delineation...
Background: Sclerosing mesenteritis (SM) is sometimes used as an umbrella-term for idiopathic inflammatory\nconditions in the mesentery. Mesenteric panniculitis (MP) is a radiological finding and its relation to clinical\nSM is not fully understood. The aims of this study were to determine whether any correlation could be found\nbetween the radiological findings and the clinical disease course.\nMethods: Patients observed due to idiopathic inflammation of the mesentery were identified. If SM could be\nverified histologically or MP radiologically, the patients were included in this descriptive retro perspective study.\nResults: Typical radiological changes were observed in 27 patients. A majority (23/27) of these patients had mild to\nmoderate symptoms. This group with typical radiology was labelled MP. Four patients were included due to\nhistologically verified disease but had uncharacteristic radiology involving multiple compartments of the abdomen. All\nfour had marked systemic inflammation, fever and fluctuating radiologic findings. Three had severe disease with\nmultiple hospitalisations and complications but responded promptly to corticosteroids. This group was denoted SM.\nConclusions: We have identified two subgroups of patients; firstly, MP with stable and characteristic radiologic\nchanges and secondly SM with atypical radiology and a more aggressive clinical course. We propose that the\nterm SM should be reserved for this latter condition....
Background: Semi-quantitative evaluation of Modic changes (MCs) has recently been proposed as a way to\nstandardise and increase repeatability of clinical studies. This study is aimed at developing semi-quantitative\nmeasures of enhancement, given by contrast agent injection, on T1-weighted images in MCs, and to investigate\ntheir reliability and relation with MC types.\nMethods: Thirty-seven subjects suffering from low back pain underwent T1-weighted and T2-weighted turbo\nspin-echo sequences. Five minutes after the injection of a paramagnetic contrast agent, a second T1-weighted\nsequence was acquired. Regions of interest (ROIs) corresponding to MCs were selected manually on the\nunenhanced image; control ROIs in the ââ?¬Å?healthyââ?¬Â bone marrow were selected. For each ROI, the mean signal\nintensity (SI) of unenhanced pixels and the mean absolute and normalised difference in SI between\nunenhanced and contrast-enhanced pixels values were calculated.\nResults: A total of 103 MCs were recognised and 61 were semi-quantitatively analysed: 16 type I, 34 type II\nand 11 type I/II. Regarding controls, MCs I showed a lower SI on the unenhanced T1-weighted images and a\nmarked contrast enhancement (CE); MCs II showed a higher SI than controls on unenhanced images and a\nlower or comparable CE; and MCs I/II presented an intermediate SI on the unenhanced images and a marked\nCE. Inter-rater and intra-rater agreements were found to be excellent or substantial.\nConclusions: Semi-quantitative measurements could differentiate MC types in terms of unenhanced SI and of\nCE with respect to ââ?¬Å?healthyââ?¬Â bone marrow....
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