Three-dimensional turbo spin-echo (TSE) MRI assessment of indirect acute muscle injuries in athletes: comparison with two-dimensional TSE MRI.

OBJECTIVE: To evaluate three-dimensional (3D) turbo spin-echo (TSE) magnetic resonance imaging (MRI) for the assessment of acute muscle injuries in elite athletes in comparison with two-dimensional (2D) MRI. METHODS: Elite athletes with clinically suspected acute muscle injury of the thigh who underwent both 2D and 3D MRI protocols on the same day were retrospectively included. Two musculoskeletal radiologists independently assessed 2D and 3D MRIs, with both techniques evaluated separately 1-month apart. Muscle injuries were evaluated using the BAMIC and the INSEP classifications. A second assessment of injuries was performed by each reader 2 months after the initial readings. Agreement was determined using weighted kappa statistics. The level of diagnostic confidence in classifying injuries was also assessed for both MRI protocols. RESULTS: A total of 40 athletes were included. Intra-reader agreement when comparing injury grades from 2D vs. 3D for both INSEP and BAMIC classifications was almost perfect for both readers and ranged between 0.84 and 0.98. Inter-reader agreement was substantial to almost perfect and ranged from 0.78 to 0.93 for the 2D protocol, and from 0.78 to 0.95 for the 3D protocol. Intra-reader agreement for each MRI protocol separately was almost perfect to perfect for both readers and ranged between 0.84 and 1.00. Diagnostic confidence for grading injuries improved for both readers when using the 3D protocol. CONCLUSIONS: Compared to 2D MRI, 3D TSE MRI is a reliable technique for acute muscular injury assessment, providing faster acquisition times and improving the diagnostic confidence. KEY POINTS: • Compared to 2D MRI, 3D TSE MRI is a reliable technique for the assessment of acute muscular injuries. • 3D TSE MRI has the advantage of faster total acquisition times, thinner sections, and multiplanar reconstruction, improving the confidence for structural assessment including connective tissue involvement.

Obstructive sleep apnoea and related comorbidities in incident idiopathic pulmonary fibrosis.

The objectives of this prospective study were: 1) to determine the prevalence and determinants of obstructive sleep apnoea (OSA) in patients with newly diagnosed idiopathic pulmonary fibrosis (IPF); 2) to determine whether OSA was associated with cardiovascular disease (CVD) as well as increased oxidative stress and levels of IPF biomarkers in the blood.A group of 45 patients with newly diagnosed IPF attended polysomnography. The prevalence of CVD and the severity of coronary artery calcification were investigated by high-resolution computed tomography. The levels of 8-hydroxydeoxyguanosine (8-OH-DG) and various IPF biomarkers in the blood were compared between patients with no or mild OSA (apnoea-hypopnoea index (AHI) <15 events·h-1), with moderate OSA (15 ≤AHI <30 events·h-1) and with severe OSA (AHI ≥30 events·h-1).The prevalence of moderate-to-severe OSA and severe OSA was 62% and 40%, respectively. AHI did not correlate with demographic or physiological data. All patients with severe OSA had a medical history of CVD, versus 41.2% and 40% of those with no or mild OSA, or with moderate OSA, respectively (p<0.0001). Ischaemic heart disease (IHD) and moderate-to-severe coronary artery calcifications were strongly associated with severe OSA. The 8-OH-DG and matrix metalloproteinase-7 serum levels were significantly increased in the severe OSA group.Moderate-to-severe OSA is highly prevalent in incident IPF and severe OSA is strongly associated with the presence of CVD, particularly IHD.

Testis ultrasound in Klinefelter syndrome infertile men: making the diagnosis and avoiding inappropriate management.

OBJECTIVE: To compare the testicular Color Doppler ultrasound (US), hormone levels, and histological results from 67 infertile men with Klinefelter syndrome (KS), vs. 66 non-KS non-obstructive azoospermic men. METHODS: Scrotal US images were collected from 67 infertile KS and 66 non-obstructive, non-KS azoospermic men. The testis volume, echotexture, vascularity, and microliths were evaluated and graded. We defined the following echo pattern alteration groups: normal, striated, coarse, and measurable nodules. The vascularization was classified as low, normal, moderate, or strong. Testosterone, follicle-stimulating hormone, luteinizing hormone, and inhibin B levels were determined. Large testicular nodules were removed. A testicular biopsy and sperm extraction was performed in 18 of the KS, and all of the 66 non-KS men. RESULTS: The mean testis volume was low in the KS, compared to the non-KS patients: i.e., 2 vs. 8 mL (P < 0.0001). The distributions in the echotexture groups differed markedly, with coarse or nodular patterns in the KS men, and normal/striated patterns in the control patients (P < 0.0001). The vascularization and microlithiasis grades were higher in the KS patients than the control men (P < 0.0001 and P < 0.001, respectively). All of the nodules removed from the KS patients were benign Leydig cell tumors, and all of the biopsies showed marked Leydig cell hyperplasia, with spermatogenesis in only two patients. The non-KS biopsies were predominantly Sertoli cell-only syndrome. CONCLUSIONS: Small testes, with a coarse or nodular echotexture, hypervascularization, and microlithiasis are associated with KS. The KS nodules were benign Leydig cell tumors/hyperplasias.