Microsievert Wide-Volume Versus Spiral Computed Tomography Using an Automatic Exposure Control System in the Diagnosis of Foreign Body Aspiration in Children.

BACKGROUND: Foreign body aspiration (FBA) in childhood is a life-threatening condition that necessitates prompt management to prevent devastating complications. Different imaging methods are used in the diagnosis of FBA. OBJECTIVE: The aim of this study was to compare the diagnostic value and dose of microsievert wide-volume computed tomography (µSv-WV-CT) with multidetector computed tomography using an automatic exposure control system (MDCT-AEC) in children with FBA. MATERIAL AND METHODS: In this single-center cross-sectional study, 102 cases diagnosed with FBA between September 2013 and September 2021 were retrospectively evaluated. The patients were divided into 2 groups according to the diagnostic modality used: group A, µSv-WV-CT (2016-2021) and group B, MDCT-AEC (2013-2021). The diagnostic performance and radiation dose of the 2 groups were statistically compared. RESULTS: The diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of the 2 groups was similar. The mean effective radiation dose of group A was 34.89 ± 0.01 µSv, which was significantly lower than that of group B (179.75 ± 114.88 µSv) ( P < 0.001). CONCLUSION: In children with suspected FBA, µSv-WV-CT at a lower radiation dose had similar diagnostic performance to MDCT-AEC.

What is the Effect of Bevacizumab on Cartilage and Synovium in a Rabbit Model of Hemophilic Arthropathy?

BACKGROUND: Hemophilic arthropathy can cause recurrent hemarthroses and severe damage to the synovium and articular cartilage. Previous studies have shown that vascular endothelial growth factor (VEGF) plays an essential role in neoangiogenesis. Bevacizumab, a monoclonal VEGF inhibitor, is used clinically to prevent angiogenesis. However, its effects on hemophilic arthropathy are unknown. QUESTIONS/PURPOSES: Using a hemophilic arthropathy rabbit model, we asked: Does an intra-articular injection of bevacizumab (1) inhibit VEGF, (2) decrease signal intensity in dynamic contrast-enhanced MRI (DCE-MRI) as an assessment of capillary permeability and neoangiogenesis, (3) reduce cartilage damage, (4) reduce synovial changes, and (5) affect macroscopic changes during the development of hemophilic arthropathy? METHODS: Twenty-five male New Zealand rabbits were divided into four groups. Eight knees from four rabbits were used as the control group. We used an established animal model for hemophilic arthropathy in the remaining 21 rabbits. Animals were assigned randomly to three groups with seven rabbits in each group. One group was used to establish mild arthropathy, and the other two were used to establish severe arthropathy. Autologous blood from the rabbits' ears was injected into the right and left knees twice per week for 8 weeks to represent mild arthropathy and for 16 weeks to represent severe arthropathy. In the mild arthropathy group, bevacizumab was injected into the right knee once every 2 weeks. Bevacizumab was injected into the right knee of rabbits in one of the severe arthropathy groups once every 2 weeks for 16 weeks, and intra-articular bevacizumab injections were administered to the right knees of rabbits in the other severe arthropathy group once every 2 weeks after the eighth week. An equal volume of 0.9% saline was injected into the left knee of rabbits in all arthropathy groups. To explore the efficacy of bevacizumab, joint diameters were quantitatively measured, and cartilage and synovial changes were examined. Degeneration of articular cartilage was evaluated with the semiquantitative Osteoarthritis Research Society International grading system. Synovial damage was analyzed with a semiquantitative microscopic scoring system. In addition, we evaluated perfusion and angiogenesis using DCE-MRI (quantitative signal intensity changes). Immunohistochemical testing was used to measure VEGF levels (analyzed by Western blotting). RESULTS: Intra-articular bevacizumab treatment inhibited VEGF in our rabbit model of hemophilic arthropathy. VEGF protein expression levels were lower in the mild arthropathy group that received intra-articular bevacizumab (0.89 ± 0.45) than the mild arthropathy control group (1.41 ± 0.61) (mean difference -0.52 [95% CI -0.898 to -0.143]; p = 0.02). VEGF levels were lower in the severe arthropathy group that received treatment for 16 weeks (0.94 ± 0.27) than in the control knees (1.49 ± 0.36) (mean difference -0.55 [95% CI -0.935 to -0.161]; p = 0.01). In the severe arthropathy group, the Osteoarthritis Research Society International score indicating cartilage damage was lower in the group that received intra-articular bevacizumab treatment from the beginning than in the control group (median 17 [range 13 to 18] versus 18 [range 17 to 20]; difference of medians 1; p = 0.02). Additionally, the scores indicated synovial damage was lower in the group that received intra-articular bevacizumab treatment from the beginning than the control group (median 5 [range 4 to 9] versus 9 [range 8 to 12]; difference of medians 4; p = 0.02). The mean of mean values for signal intensity changes was higher in the nontreated severe groups than in the group of healthy knees. The signal intensity changes were higher in the severe arthropathy control groups (Groups BC and CC) (median 311.6 [range 301.4 to 361.2] and 315.1 [range 269.7 to 460.4]) than in the mild arthropathy control group (Group AC) (median 234.1 [range 212.5 to 304.2]; difference of medians 77.5 and 81, respectively; p = 0.02 and p = 0.04, respectively). In the severe arthropathy group, discoloration caused by hemosiderin deposition in the cartilage and synovium was more pronounced than in the mild arthropathy group. In the severe arthropathy group treated with intra-articular bevacizumab, joint diameters were smaller than in the control group (Group BT median 12.7 mm [range 12.3 to 14.0] versus Group BC median 14.0 mm [range 13.1 to 14.5]; difference of medians 1.3 mm; p = 0.02). CONCLUSION: Hemarthrosis damages the synovial tissues and cartilage in the knees of rabbits, regardless of whether they are treated with intra-articular bevacizumab. However, intra-articular injection of bevacizumab may reduce cartilage and synovial damage in rabbits when treatment is initiated early during the development of hemophilic arthropathy. CLINICAL RELEVANCE: If the findings in this study are replicated in larger-animal models that consider the limitations of our work, then a trial in humans might be appropriate to ascertain whether intra-articular injection of bevacizumab could reduce cartilage damage and synovial changes in patients with hemophilia whose hemarthroses cannot otherwise be controlled.

The effect of anterior cruciate ligament reconstruction and RAMP lesion repair on psychological status.

BACKGROUND: There are few studies examining anterior cruciate ligament reconstruction (ACLR) and RAMP lesion repair. However, no studies have investigated the level of functional performance and psychological state after ACLR and all-inside RAMP lesion repair. HYPOTHESIS/PURPOSE: The aim of this study is to determine the effect of ACLR and RAMP lesion repair on psychological status. ACLR and meniscal RAMP lesion repair were hypothesized to be associated with better psychological outcomes. STUDY DESIGN: This is a cohort study. METHODS: Patients who underwent ACLR with semitendinosus and gracilis autografts by a single surgeon were determined retrospectively. Fifteen patients who underwent ACLR and all-inside meniscus RAMP lesion repair (ACLR-RR) and 15 patients who underwent isolated ACLR were compared. Patients were evaluated by a physiotherapist at least 9 months after surgery. The primary outcome measure was anterior cruciate ligament-return to sports after injury (ACL-RSI), and the psychological status of the patients was examined. Secondary outcomes were visual analog scale (VAS), Tegner activity score, Lysholm knee score, single hop tests, and limb symmetry index (LSI). While pain intensity at rest and during movement was evaluated with VAS, functional performance level was evaluated with the Tegner activity score, the Lysholm knee score, single hop tests, and limb symmetry index (LSI). RESULTS: A significant difference was found in the ACL-RSI values in the ACLR-RR group compared to the isolated ACLR group (p = 0.02). The results of the groups in VAS scores at rest and during movement, Tegner activity levels, and Lysholm knee scores, in the intact and operated leg single hop tests (single leg hop, cross hop, triple hop, and six-meter hop test), and the LSI values in the single leg hop tests showed no significant difference. CONCLUSIONS: This study revealed different psychological outcomes and similar functional levels for ACLR and all-inside meniscus RAMP repair compared with isolated ACLR. It was observed that the psychological status of patients with RAMP lesions should also be evaluated.

Ultra-low-dose computed tomography and its utility in wrist trauma in the emergency department.

BACKGROUND: The use and frequency of computed tomography (CT) are increasing day by day in emergency departments (ED). This increases the amount of radiation exposed. PURPOSE: To evaluate the image quality obtained by ultra-low-dose CT (ULDCT) in patients with suspected wrist fractures in the ED and to investigate whether it is an alternative to standard-dose CT (SDCT). MATERIAL AND METHODS: This is a study prospectively examining 336 patients who consulted the ED for wrist trauma. After exclusion criteria were applied, the patients were divided into the study and control groups. Then, SDCT (120 kVp and 100 mAs) and ULDCT (80 kVp and 5 mAs) wrist protocols were applied simultaneously. The images obtained were evaluated for image quality and fracture independently by a radiologist and an emergency medical specialist using a 5-point scale. RESULTS: The effective radiation dose calculated for the control group scans was 41.1 ± 2.1 µSv, whereas the effective radiation dose calculated for the study group scans was 0.5 ± 0.0 µSv. The effective radiation dose of the study group was significantly lower than that of the control group (P < 0.01). The CT images in the study group showed no significant differences in the mean image quality score between observer 1 and observer 2 (3.4 and 4.3, respectively; P = 0.58). Both observers could detect all fractures using the ULDCT images. CONCLUSION: ULDCT provides high-quality images in wrist traumas while reducing the radiation dose by approximately 98% compared to SDCT without any changes in diagnostic accuracy.

Association of Gallbladder Volume and Wall Thickness With Acute Appendicitis in Pediatric Patients.

OBJECTIVES: Ultrasonography in a child with suspected appendicitis is primarily performed to detect inflamed appendix, whereas secondary findings are important in patients with a nonvisualized appendix. The aim of this study is to evaluate the gallbladder wall thickness and volume in patients with suspected appendicitis and search an association between these parameters and appendicitis. METHODS: Between January 2018 and August 2018, 113 patients with suspected appendicitis were included in this prospective study. Gallbladder and right lower quadrant were evaluated in separate sessions by different radiologists. The wall thickness along with the width, length, and height of the gallbladder was measured and recorded for each patient. Assessment of the appendix was classified as acute appendicitis, normal, and equivocal. Statistically significant association was sought between the thickness of the gallbladder wall and diagnosis of appendicitis. RESULTS: Gallbladder wall thickness was significantly higher in patients without appendicitis (P = 0.017), whereas significantly increased gallbladder volume was observed in patients with appendicitis (P = 0.004). Receiver operating characteristic analysis showed gallbladder wall thickness threshold of 0.5 mm with a sensitivity of 83.3, specificity of 93.9, and volume threshold of 41.6 mL with a sensitivity of 100 and a specificity of 0.69. CONCLUSIONS: Gallbladder wall thickness and volume measurements were associated with the diagnosis of appendicitis in pediatric patients.

Radiological Findings of Nontraumatic Thrombosed Temporal Artery Aneurysm Mimicking Parotid Gland Mass.

ABSTRACT: A 54-year-old male patient had preauricular swelling mimicking parotid gland mass. Computed tomography and magnetic resonance imaging findings were showed a connection with the temporal artery. There wasn't a trauma history. The aneurysm wall showed contrast enhancement. The patient was diagnosed with true temporal artery aneurysm. The aneurysm was excised.

The Rare Anomaly That Can Be Confused With Fracture: Os Odontoideum.

Os odontoideum is a rare anomaly of the second cervical vertebra. The odontoid process is separated by a wide gap from the vertebral body in this anomaly. It can be associated with atlantoaxial instability.

A Rare Neurologic Disease that Mimics Cranial Hydatid Cyst: Leukoencephalopathy, Cerebral Calcifications, and Cysts.

A 33-year-old male patient was admitted to the clinic with seizures and progressive neurologic symptoms. In the family history of the patient, a first degree relative had a history of hydatid cyst surgery. Cranial computed tomography images showed intracranial cysts and calcifications. Thus, it was suspected that it might be hydatid cyst. However, the patient was diagnosed with leukoencephalopathy with intracranial calcifications and cysts, a rare neurologic entity by advanced radiologic imaging, serologic and pathologic evaluation.

Magnetic Resonance Arthrographic Demonstration of Association of Superior Labrum Anterior and Posterior Lesions With Extended Anterior Labral Tears.

OBJECTIVE: The objective of this study was to evaluate retrospectively the full extent of anterior labral tear and associated other labral tears on magnetic resonance arthrographic images in patients with anterior shoulder instability. MATERIALS AND METHODS: One hundred ten magnetic resonance arthrography images with anterior labral tear were retrieved from the database of the Radiology Department. Two skeletal radiologists, one with 15 years of experience and the other with 5 years of experience analyzed the images in random order. Approval for the study was granted by the Ethics Committee. Statistical analyses were performed using SPSS software. RESULTS: The most common localization of the labral lesions was at the anterior-inferior part of the glenoid labrum (22.7%). The anterior labral tears were commonly associate with superior labrum anterior and posterior (SLAP) lesions (45%). The most common type of SLAP lesion was type V (23.6%). Superior Labrum Anterior and Posterior type V lesion was more often detected in patients with Bankart lesion (27.7%, P = 0.043). CONCLUSIONS: Isolated anterior labral tears are less than expected. In majority of the cases, a distinct tear at a different site of the labrum accompanies the anterior labral tear. Massive anterior labral tears are mostly seen together with SLAP lesions.

Efficacy of the Rotational Traction Method in the Assessment of Glenohumeral Cartilage Surface Area in Computed Tomography Arthrography.

OBJECTIVE: We aimed to investigate the efficacy of the rotational traction method in expanding the joint space and enabling the assessment of an extended surface area. METHODS: Sixty patients who underwent computed tomography arthrography were evaluated in the study: 30 with and 30 without the help of rotational traction. The subgroups consisted of patients with adhesive capsulitis, habitual luxation, or labral tears. Areas of obscured joint surface by coalescent cartilages were calculated using computer software, and those belonging to the traction and nontraction groups along with subgroups were compared statistically. RESULTS: There was a significant difference between the traction and nontraction group regarding the contact surface area (P < 0.001 for both observers). In patients with adhesive capsulitis, the contact surface area was larger compared with the other subgroups (P = 0.002 for observer 1 and P = 0.002 for observer 2). In patients with habitual luxation, the contact surface area was smaller compared with the other subgroups (P = 0.002 for observer 1 and P = 0.001 for observer 2). CONCLUSIONS: Expansion of joint distance is important for assessing the joint cartilage. The rotational traction method provides effective separation of the joint space. For this reason, rotational traction can be used effectively in patients in whom the joint cartilage is to be evaluated.

An Ancillary Sign in the Diagnosis of Bankart and Bankart Variants in Patients With Glenohumeral Instability on Nonarthrographic Magnetic Resonance Imaging: Preglenoid Fat Thickness.

OBJECTIVE: We investigated whether preglenoid fat thickness can be used as an ancillary sign for preliminary diagnosis of Bankart and its variants on nonarthrographic magnetic resonance imaging. MATERIALS AND METHODS: Sixty-eight anterior dislocation patients were included in this retrospective study. Forty-eight patients with Bankart and its variants, as detected by arthroscopy and magnetic resonance arthrography, were included in the study group. The study group was divided into osseous Bankart, labral Bankart, Perthes, and anterior labroligamentous periosteal sleeve avulsion subgroups. Twenty patients with no detected labral pathologies by arthroscopy and magnetic resonance arthrography were included in the control group. In these patients, preglenoid fat tissue thickness at the anteroinferior portion was measured at the level of the glenoid tubercle. Thickness of preglenoid fat tissue was compared between groups with different labral pathologies and those with normal labrum. RESULTS: The preglenoid fat tissue thickness was 2.65 ± 1.05 mm in the control group and 0.90 ± 0.59 mm in the study group (P < 0.0001). Patients with preglenoid fat tissue thinner than 1.6 mm showed a significantly increased likelihood of having Bankart and its variants in receiver operating characteristic analysis (sensitivity of 95.8% and specificity of 85%). There was no significant difference in preglenoid fat tissue thickness between the subgroups of the study group (osseous Bankart, labral Bankart, Perthes, and anterior labroligamentous periosteal sleeve avulsion). CONCLUSION: Preglenoid fat tissue measurement can be used as an ancillary sign in the diagnosis of Bankart and Bankart variants in glenohumeral instability patients.

Radiologic Appearance of Cranial Involvement of Rosai-Dorfman Disease.

Rosai-Dorfman disease is very an important histoproliferative disorders. It rarely involves cranial and facial bones. It can make intracranial and extracranial region extension. Therefore, it can mimic dermal and dural pathologies. Target sign is an important sign for diagnosis on computed tomography and magnetic resonance imaging.

MR arthrographic evaluation of the association between anterolateral soft tissue impingement and osteochondral lesion of the tibiotalar joint.

PURPOSE: To retrospectively evaluate on magnetic resonance (MR) arthrography the relationship between joint capsule thickness and the stage of osteochondral lesions of the tibiotalar joint, as well as to evaluate the ankle joint capacity in patients with osteochondritis dissecans (OCD). Also, we demonstrate the unusual locations of osteochondral lesions of the ankle joint. METHODS: MR arthrography images were analyzed by two staff radiologists in consensus. The normality of the data was analyzed by the Kolmogorov-Smirnov test. The Mann-Whitney U test was used to compare the relationship between joint capsule thickness and patient groups with OCD. RESULTS: The anterolateral joint capsule thickness was significantly higher than the anteromedial and posterior joint capsule thickness in the OCD with loose bodies group (p = 0.049). Osteochondral defects were most commonly detected at the medial talar dome: in 29 of 37 patients (78.3%) in the OCD without loose bodies group and in 16 of 29 (55.2%) patients in the OCD with loose bodies group. The second most common localization of the osteochondral defect in the OCD with loose bodies group was the medial plafond of distal tibia [in 9 of 29 (31.1%) patients]. CONCLUSIONS: Clinical and radiological evidence of anterolateral impingement syndrome often accompanies stage 4 OCDs. OCDs of the distal tibial plafond are not rare in the ankle joint and are often associated with loose bodies.

Advanced Neuroimaging Techniques for Difficult Diagnoses: Giant Hemorrhagic Venous Infarct Or Not?

An 51-year-old female presented with a headache, nausea, vomiting, and weakness. The lesion resembling a hemorrhagic mass was observed in the brain tomography and magnetic resonance imaging of the patient. However, thrombosis was suspected in the cerebral venules adjacent to the lesion. Magnetic resonance spectroscopy and magnetic resonance perfusion data excluded neoplastic lesions. Thus, the patient was treated for venous infarction. Hemorrhagic venous infarcts may mimic hemorrhagic masses. For this reason, the distinction of the lesions is important for the treatment procedure. Advanced neuroimaging in lesions resembling hemorrhagic masses must be performed for accurate diagnosis.

Radiologic Imaging of Ludwig Angina in a Pediatric Patient.

Ludwig angina is an important disease with deadly consequences. Especially in the pediatric patient group, recognition of the disease may be difficult due to patient incompatibility. For this reason, radiologic imaging methods should be carefully selected. Diffusion-weighted magnetic resonance imaging and contrast-enhanced examinations are the most important methods for the diagnosis of the disease.

High Rates of Psychiatric Disorders and Below Normal Mental Capacity Associated With Spastic Peroneal Flatfoot: A New Relationship.

Spastic peroneal flatfoot (SPFF) is a rare hindfoot pathology usually seen in the adolescent age group that is characterized by painful spasms in the peroneal muscles. We have clinically observed that patients with SPFF also have some behavioral and emotional difficulties and problems in their academic achievements. Because of these observations, we investigated the prevalence and patterns of psychiatric disorders and intellectual disability among young subjects with SPFF. Our cohort consisted of 16 patients with SPFF. Their mean age at presentation was 21 (range 13 to 31) years. Only 6 patients had a tarsal coalition as an underlying condition. The psychometric evaluation was conducted using validated instruments (Wechsler Intelligence Scale for Children-revised form, Stanford Binet intelligence quotient [IQ] test, and Cattell IQ test). Psychiatric disorders were assessed using a semistructured diagnostic instrument (Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version). The testers and psychiatrists were unaware of the orthopedic condition and the preliminary psychiatric diagnoses. The ethical committee approved the study protocol. The mean follow-up period was 41 (range 12 to 97) months. The mean IQ score of the patients was 75.1 ± 17.9 (range 52 to 107). Compared with the general population, the rate of intellectual disability was significantly greater (p = .0001) and the rate of normal intelligence significantly lower (p = .0015) in our patient group. Furthermore, according to the community schooling ratio, our cohort also had lower junior high and secondary education rates compared with the general population. The rate of most psychiatric disorders diagnosed in the SPFF patients was greater than that in the normal population. The most commonly identified psychiatric disorders were social phobia and attention deficit and hyperactivity disorder (75%). Timely interventions of the psychosocial and academic problems of patients with SPFF might increase their compliance with orthopedic treatment and help with their psychological well-being and academic achievement. In addition, this relationship might be a clue for uncovering the etiology of this disease, which has not yet been clarified.

Calvarial Mass Confused With Trichilemmal Cyst: Hepatocellular Cancer Metastasis.

The hepatocellular cancer calvarial metastasis is a rare condition that commonly presents cranial swelling. Therefore, calvarial swelling may confuse with frequent lesions of the scalp. The authors' patient was operated as trichilemmal cyst. But, intracranial extension was seen in operation. Calvarial metastasis of hepatocellular cancer was observed by examination of the patient.

Rare and Serious Complications of Sinusitis in Pediatric Patients: Epidural Abscess.

Intracranial abscess has serious mortality. Therefore, early diagnosis and treatment is important. Intracranial abscess is rarely seen as a complication of sinusitis. Specially in children it has been reported rarely. Fever and headache can indicate complications in children.

Cerebral and Spinal Tuberculous Leptomeningitis: Advanced Magnetic Resonance Imaging Findings.

At diagnosis of the cerebral and spinal tuberculous meningitis magnetic resonance (MR) imaging is the primary imaging technique. Magnetic resonance images reveal cerebrospinal fluid collection and obliteration of the spinal subarachnoid space. The contrast-enhanced MR imaging shows nodular and thick intradural enhancement. Herein, the authors reported advanced MR imaging findings of the cerebral and spinal tuberculous leptomeningitis.

Long-term results of microfracture in the treatment of talus osteochondral lesions.

PURPOSE: Osteochondral lesions of the talus are common injuries, and many clinicians consider arthroscopic debridement and microfracture as the first-stage treatment. This study assessed the long-term clinical and radiographic outcomes of arthroscopic debridement and microfracture for osteochondral lesions of the talus. METHODS: A total of 82 patients (48 males, 34 females) who were treated with arthroscopic debridement and microfracture for osteochondral lesions of the talus between 1996 and 2009 with a minimum 5-year follow-up were included in our study group. Functional scores (AOFAS, VAS) and ankle range of motion were determined, and an arthrosis evaluation was performed. Subgroup evaluations based on age, lesion localization, and defect size were performed using functional outcome correlations. RESULTS: The mean age of the patients was 35.9 ± 13.4 years (14-69 years), and the mean follow-up period was 121.3 months (61-217 months). The mean defect size was 1.7 ± 0.7 cm2 (0.25-5). The mean pre-operative AOFAS score was 58.7 ± 5.2 (49-75), and the mean post-operative AOFAS score was 85.5 ± 9.9 (56-100). At the last follow-up, 35 patients (42.6%) had no symptoms and 19 patients (23.1%) had pain after walking more than 2 h or after competitive sports activities. Radiological assessments of arthrosis revealed that no patient had grade 4 arthritis but that 27 patients (32.9%) had a one-stage increase in their arthrosis level. Subgroup analyses of the lesion location demonstrated that lateral lesions had significantly better functional results (p = 0.02). CONCLUSIONS: Arthroscopic debridement and microfracture provide a good option for the treatment of osteochondral lesions of the talus over the long term in select patients. Functional outcomes do not correlate with defect size or patient age. Orthopaedic surgeons should adopt the microfracture technique, which is minimally invasive and effective for treating osteochondral lesions of the talus. LEVEL OF EVIDENCE: IV.