Burden of Ischemic and Hemorrhagic Stroke Across the US From 1990 to 2019.

Importance: Stroke is a leading cause of death and disability in the US. Accurate and updated measures of stroke burden are needed to guide public health policies. Objective: To present burden estimates of ischemic and hemorrhagic stroke in the US in 2019 and describe trends from 1990 to 2019 by age, sex, and geographic location. Design, Setting, and Participants: An in-depth cross-sectional analysis of the 2019 Global Burden of Disease study was conducted. The setting included the time period of 1990 to 2019 in the US. The study encompassed estimates for various types of strokes, including all strokes, ischemic strokes, intracerebral hemorrhages (ICHs), and subarachnoid hemorrhages (SAHs). The 2019 Global Burden of Disease results were released on October 20, 2020. Exposures: In this study, no particular exposure was specifically targeted. Main Outcomes and Measures: The primary focus of this analysis centered on both overall and age-standardized estimates, stroke incidence, prevalence, mortality, and DALYs per 100 000 individuals. Results: In 2019, the US recorded 7.09 million prevalent strokes (4.07 million women [57.4%]; 3.02 million men [42.6%]), with 5.87 million being ischemic strokes (82.7%). Prevalence also included 0.66 million ICHs and 0.85 million SAHs. Although the absolute numbers of stroke cases, mortality, and DALYs surged from 1990 to 2019, the age-standardized rates either declined or remained steady. Notably, hemorrhagic strokes manifested a substantial increase, especially in mortality, compared with ischemic strokes (incidence of ischemic stroke increased by 13% [95% uncertainty interval (UI), 14.2%-11.9%]; incidence of ICH increased by 39.8% [95% UI, 38.9%-39.7%]; incidence of SAH increased by 50.9% [95% UI, 49.2%-52.6%]). The downturn in stroke mortality plateaued in the recent decade. There was a discernible heterogeneity in stroke burden trends, with older adults (50-74 years) experiencing a decrease in incidence in coastal areas (decreases up to 3.9% in Vermont), in contrast to an uptick observed in younger demographics (15-49 years) in the South and Midwest US (with increases up to 8.4% in Minnesota). Conclusions and Relevance: In this cross-sectional study, the declining age-standardized stroke rates over the past 3 decades suggest progress in managing stroke-related outcomes. However, the increasing absolute burden of stroke, coupled with a notable rise in hemorrhagic stroke, suggests an evolving and substantial public health challenge in the US. Moreover, the significant disparities in stroke burden trends across different age groups and geographic locations underscore the necessity for region- and demography-specific interventions and policies to effectively mitigate the multifaceted and escalating burden of stroke in the country.

Serum lipoprotein(a) and reclassification of coronary heart disease risk; application of prediction in a cross-sectional analysis of an ongoing Iranian cohort.

INTRODUCTION: Recent studies have introduced elevated lipoprotein(a) (Lp(a)) as a risk factor for coronary heart disease (CHD). This study investigated whether the addition of Lp(a) as a novel biomarker to the Framingham Risk Score (FRS) model improves CHD risk prediction. METHODS: The study included 1101 Iranian subjects (443 non-diabetic and 658 diabetic patients) who were followed for 10 years (2003-2013). Lp(a) levels and CHD events were recorded for each participant. RESULTS: The Net Reclassification Index (NRI) after adding Lp(a) to the FRS model was 19.57% and the discrimination slope was improved (0.160 vs. 0.173). The Akaike Information Criterion (AIC), a measure of model complexity, decreased significantly after adding Lp(a) to the FRS model (691.9 vs. 685.4, P value: 0.007). CONCLUSIONS: The study concluded that adding Lp(a) to the FRS model improves CHD risk prediction in an Iranian population without making the model too complex. This could help clinicians to better identify individuals who are at risk of developing CHD and to implement appropriate preventive measures.

Intraoperative Neuromonitoring during Peripheral Arteriovenous Malformation Embolization.

PURPOSE: To evaluate whether intraoperative neuromonitoring (IONM), including pre-embolization lidocaine injection challenge ("provocative testing") is associated with reduced risk of irreversible nerve injury during embolization of peripheral arteriovenous malformations (AVMs). MATERIALS AND METHODS: Medical records of patients with peripheral AVMs who underwent embolotherapy with IONM with provocative testing between 2012 and 2021 were reviewed retrospectively. Data collected included patient demographic characteristics, AVM location and size, embolic agent used, IONM signal changes after lidocaine and embolic agent injections, postprocedural adverse events, and clinical outcomes. Decisions regarding whether embolization would proceed at specific locations were based on IONM findings after the lidocaine challenge and as embolization proceeded. RESULTS: A cohort of 17 patients (mean age, 27 years ± 19; 5 women) who underwent 59 image-guided embolization procedures with adequate IONM data was identified. No permanent neurologic deficits occurred. Transient neurologic deficits were observed in 3 patients (4 sessions), comprising skin numbness (2 patients), extremity weakness (1 patient), and extremity weakness and numbness (1 patient). All neurologic deficits resolved by postoperative day 4 without additional treatment. CONCLUSIONS: IONM, including provocative testing, during AVM embolization may minimize potential nerve injury.

Performance and Usability of Code-Free Deep Learning for Chest Radiograph Classification, Object Detection, and Segmentation.

Purpose: To evaluate the performance and usability of code-free deep learning (CFDL) platforms in creating DL models for disease classification, object detection, and segmentation on chest radiographs. Materials and Methods: Six CFDL platforms were evaluated in this retrospective study (September 2021). Single- and multilabel classifiers were trained for thoracic pathologic conditions using Guangzhou pediatric and NIH-CXR14 (ie, National Institutes of Health ChestX-ray14) datasets, and external testing was performed using subsets of NIH-CXR14 and Stanford CheXpert datasets, respectively. Pneumonia detection and pneumothorax segmentation models were trained using the Radiological Society of North America (RSNA) Pneumonia and Society for Imaging Informatics in Medicine (SIIM) Pneumothorax datasets, respectively. Model performance was evaluated using F1 scores. Usability was evaluated based on feasibility of image uploading and model training, ease of use, and cost. Results: NIH-CXR14 and CheXpert datasets contained 112 120 (mean age, 47 years ± 17 [SD]; 63 340 male patients) and 151 522 images (mean age, 61 years ± 18; 88 931 male patients), respectively. The other datasets did not report demographics (Guangzhou, 5826 images; RSNA, 26 683 images; SIIM, 15 301 images). Six platforms offered single-label classifiers, four multilabel classifiers, five object detection models, and one segmentation model. Guangzhou pneumonia classifiers demonstrated good internal (F1, 0.93-0.99) and poor external (F1, 0.39-0.44) performance. Multilabel NIH-CXR14 classifiers showed poor internal and external performance (F1, 0.00-0.36 and 0.00-0.76, respectively). NIH-CXR14 single-label classifiers performed poorly (F1, 0.00, all). The single successfully trained pneumonia detection model had an F1 score of 0.48. No segmentation model was successfully trained. Platform usability was limited, with all requiring some type of coded solution. Conclusion: CFDL platforms demonstrated limited performance and usability for chest radiograph analysis.Keywords: Artificial Intelligence, Automated Machine Learning, Chest Radiographs, Deep Learning, Code-Free Deep Learning, Pneumonia, Pneumothorax, Radiology Supplemental material is available for this article. © RSNA, 2023.

Percutaneous Biliary Interventions: Clinical Indications, Comparative Effectiveness, Technical Considerations, Complications, and Outcomes.

Percutaneous biliary interventions (PBIs) are commonly performed by interventional radiologists for a variety of clinical indications including biliary infections, strictures, leaks, and postoperative complications. PBIs have high technical and clinical success rates and are relatively safe when compared with more invasive surgical techniques. Percutaneous transhepatic cholangiography and percutaneous biliary drainage play an essential role in the management of common posthepatobiliary complications including biliary strictures and leaks. Percutaneous biliary endoscopy can be used for direct visualization of the biliary tree and a variety of interventions including tissue biopsy, lithotripsy, stone removal, as well as stent placement and removal.

Kinematic Tibiofibular Syndesmotic Measurements as Indicators of Tibiotalar Osteoarthritis: Exploratory Analysis Using 4-Dimensional Computed Tomography.

OBJECTIVE: The aim of this study was to evaluate the association between 4-dimensional computed tomography (4DCT)-derived measurements of tibiofibular syndesmosis during active dorsiflexion-plantarflexion motion and the presence of tibiotalar osteoarthritis (OA). METHODS: Sixteen ankle joints underwent 4DCT imaging during active dorsiflexion-plantarflexion. Syndesmotic anterior distance (SAD) and syndesmotic translation (ST) were obtained by a foot-and-ankle surgeon. We used Kellgren-Lawrence (KL) grading to determine tibiotalar OA. RESULTS: Of 16 scanned ankles, 12 ankles had KL ≥2 at the tibiotalar joint. In these ankles, SAD (-0.4, P = 0.02) and ST (-0.9, P = 0.006) measurements significantly changed during the dorsiflexion-plantarflexion motion. Changes in SAD measurements were significantly correlated with the KL grades (correlation coefficient: -0.688, P = 0.003); however, the changes in ST measurements were not significantly correlated with the KL grade. CONCLUSIONS: Our exploratory cross-sectional analysis shows that SAD measurement changes during motion using 4DCT are correlated with the tibiotalar OA grading. This measurement may be used but requires confirmation in larger studies including patients with actual syndesmotic injuries.

Bibliometric analysis of interventional radiology studies in PubMed-indexed literature from 1991 to 2020.

PURPOSE: To evaluate interventional radiology (IR) research over time based on the study type of published articles and the visibility of articles to non-radiology clinicians. METHODS: We performed a search of all PubMed-indexed literature from January 1, 1991, through November 11, 2020, for clinical IR articles classified by their study type, categorized as: 1) meta-analyses/systematic reviews/practice guidelines; 2) randomized controlled trials; 3) non-randomized controlled trials; and 4) longitudinal/observational studies. Clinical IR articles were defined as those that met keyword criteria constructed from Society of Interventional Radiology procedure guides. Data were also collected on medical specialty journal categories that published IR-related articles. RESULTS: When we examined the first vs. the last decade of our study period, the number of IR articles published increased across all study types: randomized controlled trials (374 to 2620; 601% change), longitudinal/observational studies (2324 to 12,447; 436%), meta-analyses/systematic reviews/practice guidelines (1179 to 6135; 420%), non-randomized controlled trials (471 to 2161; 359%). The journal categories with the highest mean percentage increase of IR articles across all study types were obstetrics and gynecology (659%), peripheral vascular disease (342%), and emergency medicine (221%). We found a decrease of IR articles published in surgery (-6.0%), pediatrics (-14%), and pulmonary (-21%) journals. CONCLUSION: The number of IR articles grew quickly and at a similar rate compared with all PubMed-indexed articles and increased as a proportion of articles published in non-imaging specialty journals. This indicates greater visibility of IR studies for all clinicians and is encouraging towards the advancement of IR techniques.

Does Intraprocedural CT Improve the Success Rate of Adrenal Venous Sampling? A Systematic Review and Meta-Analysis of Data from 809 Patients.

PURPOSE: To perform a systematic review and meta-analysis to quantify the technical success rate of adrenal venous sampling (AVS) with and without intraprocedural computed tomography (CT). METHODS: A systematic search of the Medline, Scopus, EMBASE, and Web of Science databases for comparative studies using intraprocedural CT was undertaken. More than 1,000 records were screened using titles and abstracts. Full texts of 121 studies were reviewed and 14 eligible studies were identified. Nine studies had adequate comparative data and were included in the meta-analysis. RESULTS: A research synthesis was performed and data from 809 patients were pooled in multiple random effect models. Overall success rate of AVS without and with intraprocedural CT was 72.7% (59.3-83.0%) and 92.5% (86.6-95.9), respectively. The addition of intraprocedural CT increased the technical success rate by 19.8% (P < 0.001), with an odds ratio (OR) of 5.5 (3.3-9.2; P < 0.01). In meta-regression, odds of success with intraprocedural CT was associated with younger age (beta: 0.16 ± 0.05; P:0.001), higher body mass index (BMI; beta:0.08 ± 0.03; P:0.002), and higher selectivity index (defined as the ratio of cortisol in the adrenal vein to that in the inferior vena cava; beta:0.35 ± 0.08, P < 0.001). We found a linear inverse association between operator's success without CT and improved success with intraprocedural CT (R2: 0.86). CONCLUSIONS: Intraprocedural CT is not required for every case, but can be performed in difficult cases or when operators' success is limited. The benefit was more pronounced in younger patients with higher BMI, female gender, and with higher selectivity. LEVEL OF EVIDENCE: III Systematic review and meta-analysis of non-randomized clinical trials.

Can AI distinguish a bone radiograph from photos of flowers or cars? Evaluation of bone age deep learning model on inappropriate data inputs.

OBJECTIVE: To evaluate the behavior of a publicly available deep convolutional neural network (DCNN) bone age algorithm when presented with inappropriate data inputs in both radiological and non-radiological domains. METHODS: We evaluated a publicly available DCNN-based bone age application. The DCNN was trained on 12,612 pediatric hand radiographs and won the 2017 RSNA Pediatric Bone Age Challenge (concordance of 0.991 with radiologist ground-truth). We used the application to analyze 50 left-hand radiographs (appropriate data inputs) and seven classes of inappropriate data inputs in radiological (i.e., chest radiographs) and non-radiological (i.e., image of street numbers) domains. For each image, we noted if (1) the application distinguished between appropriate and inappropriate data inputs and (2) inference time per image. Mean inference times were compared using ANOVA. RESULTS: The 16Bit Bone Age application calculated bone age for all pediatric hand radiographs with mean inference time of 1.1 s. The application did not distinguish between pediatric hand radiographs and inappropriate image types, including radiological and non-radiological domains. The application inappropriately calculated bone age for all inappropriate image types, with mean inference time of 1.1 s for all categories (p = 1). CONCLUSION: A publicly available DCNN-based bone age application failed to distinguish between appropriate and inappropriate data inputs and calculated bone age for inappropriate images. The awareness of inappropriate outputs based on inappropriate DCNN input is important if tasks such as bone age determination are automated, emphasizing the need for appropriate oversight at the data input and verification stage to avoid unrecognized erroneous results.

Prevalence of and Factors Associated with Arterial Aneurysms in Patients with Hereditary Hemorrhagic Telangiectasia: 17-Year Retrospective Series of 418 Patients.

PURPOSE: To estimate the prevalence of and identify characteristics associated with the presence of aneurysms in a cohort of patients with hereditary hemorrhagic telangiectasia (HHT). MATERIALS AND METHODS: In the study institution's HHT database, 418 patients with a definite HHT diagnosis were identified based on the clinical Curaçao criteria and/or an HHT-associated genetic mutation. Regression modeling was used to evaluate the association between arterial aneurysms and older age, male sex, smoking, alcohol consumption, hypertension, hyperlipidemia, genetic mutations, the presence of arteriovenous malformations (AVMs) unrelated to the aneurysms, and HHT-related genetic mutations. RESULTS: Forty-three (10.3%) patients had at least 1 aneurysm. Sixteen (3.8%) patients had multiple aneurysms. Of the variables analyzed, older age (odds ratio [OR] = 1.02; 95% confidence interval [CI]: 1.0-1.1), the presence of anatomically and flow-unrelated AVMs (OR = 3.2; 95% CI: 1.3-8.0), and the presence of activin A receptor type II-like 1 (ACVRL1) mutation (OR = 4.0; 95% CI: 1.5-10) were associated with the presence of at least 1 aneurysm. CONCLUSIONS: In this cohort of patients with HHT, the prevalence of intracranial and visceral arterial aneurysms was estimated to be 10.3%. Older age, the presence of unrelated AVMs, and the presence of the ACVRL1 mutation were associated with the presence of arterial aneurysms. Further study is required to assess the clinical importance and risk of rupture of aneurysms in patients with HHT.

Characteristics and Outcomes of Percutaneous Biliary Interventions in the United States.

OBJECTIVE: To explore baseline characteristics, comorbidities, and clinical diagnoses in the prediction of outcomes for inpatient percutaneous biliary interventions in the United States. METHODS: Hospitalizations for percutaneous transhepatic cholangiography and percutaneous biliary drainage were studied using the National Inpatient Sample 2012 to 2015. Associations between baseline characteristics, comorbidities, clinical diagnoses, and outcomes were analyzed using multivariable regression modeling. Regional variations were studied in an exploratory analysis. RESULTS: Hospitalizations for percutaneous biliary interventions had average inpatient mortality of 3.8% ± 0.8% and length of stay of 7.6 ± 0.3 days. Hypertension was the most common comorbidity (50.5% ± 0.8%), and paralysis was associated with the highest inpatient mortality (19.1% ± 5.7%) and length of stay (11.4 ± 1.3 days). Compared with nonmalignant biliary-pancreatic disorders, sepsis was associated with the highest inpatient mortality (6.5% ± 1.1%; adjusted odds ratio [aOR]: 5.2 [3.9-7.0]) and length of stay (9.0 ± 3.0 days; aOR: 2.2 [1.9-2.5]), followed by underlying malignancy (mortality of 5.5% ± 0.6%; aOR: 2.3 [1.7-3.0]; length of stay of 8.3 ± 0.2 days; aOR: 1.6 [1.4-1.8]). The observed associations were independent of baseline characteristics and comorbidities. With regard to regional variations, the Middle Atlantic states had the lengthiest hospital stays (38.8% ± 2.0% >8 days) and the East South Central states had the highest inpatient mortality (6.6% ± 1.6%) while having the highest frequency of malignancy (37.9% ± 3.7%) and the lowest frequency of postoperative cases (15.2% ± 2.4%). CONCLUSION: In addition to baseline characteristics and comorbidities, sepsis and malignancy were determinants of higher mortality and increased length of stay in hospitalizations for percutaneous biliary interventions. We observed significant regional variations in clinical diagnoses and outcomes across the United States.

Vertebroplasty and kyphoplasty in the USA from 2004 to 2017: national inpatient trends, regional variations, associated diagnoses, and outcomes.

BACKGROUND: To explore the national inpatient trends, regional variations, associated diagnoses, and outcomes of vertebral augmentation (vertebroplasty and kyphoplasty) in the USA from 2004 to 2017. METHODS: Data from the National Inpatient Sample were used to study hospitalization records for percutaneous vertebroplasty and kyphoplasty. Longitudinal projections of trends and outcomes, including mortality, post-procedural complications, length of stay, disposition, and total hospital charges were analyzed. RESULTS: Following a period of decreased utilization from 2008 to 2012, hospitalizations for vertebroplasty and kyphoplasty plateaued after 2013. Total hospital charges and overall financial burden of hospitalizations for vertebroplasty and kyphoplasty increased to a peak of $1.9 billion (range $1.7-$2.2 billion) in 2017. Overall, 8% of procedures were performed in patients with a history of malignancy. In multivariable modeling, lung cancer (adjusted OR (aOR) 2.6 (range 1.4-5.1)) and prostate cancer (aOR 3.4 (range 1.2-9.4)) were associated with a higher risk of mortality. The New England region had the lowest frequency of routine disposition (14.1±1.1%) and the lowest average hospital charges ($47 885±$1351). In contrast, 34.0±0.8% had routine disposition in the West Central South region, and average hospital charges were as high as $99 836±$2259 in the Pacific region. The Mountain region had the lowest number of procedures (5365±272) and the highest mortality rate (1.2±0.3%). CONCLUSION: National inpatient trends of vertebroplasty and kyphoplasty utilization remained stable after a period of decline from 2008 to 2012, while the financial burden of hospitalizations increased. Despite recent improvements in outcomes, significant regional variations persisted across the USA.

Transcatheter and Endoscopic Treatment of Gastric and Duodenal Bleeding: Population-Based Analysis of National Inpatient Trends and Outcomes in the United States.

BACKGROUND: Upper gastrointestinal (GI) bleeding is a common cause of hospital admission in the United States and is frequently treated by endoscopy. Recent studies have shown an increasing role for treatment using transcatheter embolization. METHODS: Data from the national inpatient sample (1993-2015) were used for trend analysis and to compare patient characteristics, comorbidities, and outcomes for endoscopic and transcatheter treatments of gastric and duodenal bleeding. RESULTS: Despite the continued decline in the rate of hospitalization for upper GI bleeding (-43% since 1993, P < .01), admissions for embolization (21.1% per year since 2005, P < .01) and endoscopic treatments (1.2%-6.1% per year since 1993, P < .01) have increased in the past decade. Patients with multiple comorbidities that include coagulopathy (25.6% versus 11.9%, P < .05), liver disease (16.0% versus 10.7%, P < .05), fluid and electrolyte disorder (51.0% versus 35.4%, P < .05), and metastatic cancer (6.9% versus 2.4%, P < .05) were more likely to receive embolization. Embolization was associated with higher crude risk of death (9.2% versus 2.1%, P < .01), lengthier hospital stays (9.1 days versus 5.1 days, P < .01), and greater average total hospital charges (US$135,000 versus US$46,000). The association between embolization (versus endoscopy) and mortality and length of stay diminished after controlling for disease severity and other procedures in propensity score-matched groups and by covariate adjustment. DISCUSSION: Though endoscopy remains the main treatment of upper GI bleeding, embolization is associated with comparable mortality and length of stay after accounting for disease severity and the need for additional procedures.

Burden of Neurological Disorders Across the US From 1990-2017: A Global Burden of Disease Study.

Importance: Accurate and up-to-date estimates on incidence, prevalence, mortality, and disability-adjusted life-years (burden) of neurological disorders are the backbone of evidence-based health care planning and resource allocation for these disorders. It appears that no such estimates have been reported at the state level for the US. Objective: To present burden estimates of major neurological disorders in the US states by age and sex from 1990 to 2017. Design, Setting, and Participants: This is a systematic analysis of the Global Burden of Disease (GBD) 2017 study. Data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of major neurological disorders were derived from the GBD 2017 study of the 48 contiguous US states, Alaska, and Hawaii. Fourteen major neurological disorders were analyzed: stroke, Alzheimer disease and other dementias, Parkinson disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, traumatic brain injury, spinal cord injuries, brain and other nervous system cancers, meningitis, encephalitis, and tetanus. Exposures: Any of the 14 listed neurological diseases. Main Outcome and Measure: Absolute numbers in detail by age and sex and age-standardized rates (with 95% uncertainty intervals) were calculated. Results: The 3 most burdensome neurological disorders in the US in terms of absolute number of DALYs were stroke (3.58 [95% uncertainty interval [UI], 3.25-3.92] million DALYs), Alzheimer disease and other dementias (2.55 [95% UI, 2.43-2.68] million DALYs), and migraine (2.40 [95% UI, 1.53-3.44] million DALYs). The burden of almost all neurological disorders (in terms of absolute number of incident, prevalent, and fatal cases, as well as DALYs) increased from 1990 to 2017, largely because of the aging of the population. Exceptions for this trend included traumatic brain injury incidence (-29.1% [95% UI, -32.4% to -25.8%]); spinal cord injury prevalence (-38.5% [95% UI, -43.1% to -34.0%]); meningitis prevalence (-44.8% [95% UI, -47.3% to -42.3%]), deaths (-64.4% [95% UI, -67.7% to -50.3%]), and DALYs (-66.9% [95% UI, -70.1% to -55.9%]); and encephalitis DALYs (-25.8% [95% UI, -30.7% to -5.8%]). The different metrics of age-standardized rates varied between the US states from a 1.2-fold difference for tension-type headache to 7.5-fold for tetanus; southeastern states and Arkansas had a relatively higher burden for stroke, while northern states had a relatively higher burden of multiple sclerosis and eastern states had higher rates of Parkinson disease, idiopathic epilepsy, migraine and tension-type headache, and meningitis, encephalitis, and tetanus. Conclusions and Relevance: There is a large and increasing burden of noncommunicable neurological disorders in the US, with up to a 5-fold variation in the burden of and trends in particular neurological disorders across the US states. The information reported in this article can be used by health care professionals and policy makers at the national and state levels to advance their health care planning and resource allocation to prevent and reduce the burden of neurological disorders.

Association Between MRI-Based Tibial Slope Measurements and Mucoid Degeneration of the Anterior Cruciate Ligament: A Propensity Score-Matched Case-Control Study.

BACKGROUND: The cause of mucoid degeneration (MD) of the anterior cruciate ligament (ACL), which is commonly observed on magnetic resonance imaging (MRI) of patients with knee pain, has yet to be elucidated. Despite the limited evidence on the relationship between ACL lesions (injury and MD) and tibial morphologic features (ie, posterior tibial slope), the potential association between the presence of ACL MD and medial and lateral tibial slope (MTS and LTS) has not been well-established. PURPOSE: To investigate whether MTS and LTS measurements are associated with the presence of ACL MD. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Consecutive knee MRI examinations of patients referred by an orthopaedic surgeon for potential internal joint derangements were identified within a 4-year period. The presence of ACL MD and the MTS/LTS values were assessed by independent expert observers in consensus in a blinded fashion. From 413 consecutive knee MRI scans, a sample of 80 knees, including 32 knees with ACL MD (cases) and 48 knees with normal ACL (controls), were selected using propensity score matching method for age, sex, body mass index, and presence of severe medial tibiofemoral compartment cartilage damage. The association between ACL MD and MTS/LTS was evaluated using conditional regression models. RESULTS: Knees with ACL MD had higher values of LTS (mean ± SD, 7.18° ± 3.58°) in comparison with control knees (5.32° ± 3.35°). Conditional regression analysis revealed a significant association between LTS measurements (not MTS) and ACL MD; every 1° increase in LTS was associated with a 17% (95% CI, 1%-35%) higher probability of having ACL MD. CONCLUSION: Excessive LTS was associated with the presence of ACL MD, independent of participants' age, sex, BMI, and cartilage damage severity.

Optimal Choice of Ultrasound-Based Measurements for the Diagnosis of Ulnar Neuropathy at the Elbow: A Meta-Analysis of 1961 Examinations.

OBJECTIVE. The purpose of this study was to determine the optimal ultrasound (US) measurement technique and cutoff value for the diagnosis of ulnar neuropathy at the elbow. MATERIALS AND METHODS. A systematic literature search was conducted of the PubMed, Embase, Scopus, and Web of Science databases for studies evaluating the diagnostic accuracy of US of patients with ulnar neuropathy at the elbow before April 2019. Random-effects modeling was performed to compare the sensitivity, specificity, and diagnostic odds ratio (DOR) of different US measurements, including diameter and cross-sectional area (CSA) of the nerve at the medial epicondyle or proximal and distal levels, maximal diameter, maximal CSA, and nerve ratios. Sensitivity and metaregression analyses were performed to assess the impact of clinical and imaging-based variables on the DOR of US. RESULTS. Among 820 retrieved studies, 19 studies (1961 examinations) were included. Measuring the CSA of the ulnar nerve at the medial epicondyle with a cutoff value greater than 10-10.5 mm2 had higher sensitivity (80.4%, 95% CI, 75.4-84.7%) than other techniques. Nerve ratios had higher specificity (89.1%, 95% CI, 85.8-91.8%) than other measurements; however, the definition of ratios and cutoff values varied across studies. ROC analysis showed higher diagnostic performance for measuring CSA at the medial epicondyle (AUC, 0.931). The mean CSA value was a significant predictor of the DOR of US (ß coefficient, 0.307 ± 0.074; p < 0.001). Every 1-mm2 larger CSA was associated with a 36% increase in DOR. The diagnostic performance of US was the same in any degree of elbow flexion. CONCLUSION. Measuring CSA of the ulnar nerve at the medial epicondyle has sensitivity and diagnostic performance superior to those of other techniques for the diagnosis of ulnar neuropathy at the elbow.

Bariatric Embolization: A Narrative Review of Clinical Data From Human Trials.

Bariatric arterial embolization (BAE) is a novel technique that is investigated as an alternative, often supplementary, method for weight management. BAE reduces blood perfusion to the gastric fundus, and thus, reduces the production of appetite-inducing hormones. No randomized controlled trial has evaluated the efficacy of BAE to date. Available evidence from published studies include retrospective evaluations of patients undergoing left gastric artery embolization for gastrointestinal bleeding, and early prospective, single-arm clinical trials. Review of clinical data from human trials suggest an average weight loss of about 8-9 kg (ranging 7.6-22.0 kg), corresponding to 8-9% (ranging 4.8-17.2%) of the patients' baseline weight. Common complications include superficial gastric ulcers. Though uncommon, gastric perforation and splenic infarct are important major complication that may arise after left gastric artery embolization. Overall, BAE is an effective, relatively safe procedure that may be associated with clinically significant weight loss in patients with obesity.

Weight Loss after Left Gastric Artery Embolization: A Systematic Review and Meta-Analysis.

A systematic review of clinical trials investigating the safety and efficacy of left gastric artery (LGA) embolization as a bariatric procedure was performed. The Methodological Index for Nonrandomized Studies (MINORS) instrument was used for quality assessment. Patient characteristics, weight loss after embolization, and complications were reviewed. Meta-regression was performed to assess associations of age, sex, body mass index, and ghrelin and leptin levels with weight change after LGA embolization. The final meta-analysis included 6 nonrandomized prospective trials. Findings of 3 additional studies reporting weight changes after LGA embolization for control of gastrointestinal bleeding were also reviewed. Pooled analysis of 47 subjects with overweight/obesity showed mean ± SD weight loss after embolization of 8.1% ± 1.5% and 8.85 kg ± 1.24 kg (both P < .001) after a mean 12-month follow-up. Male sex (ß = 11.36 ± 5.79, P = .049) was associated with greater weight loss. Transient superficial mucosal ulcers were common after LGA embolization. One major adverse event comprising severe pancreatitis, splenic infarct, and gastric perforation was reported; treatment was supportive care. LGA embolization was associated with statistically significant weight loss and limited complications during short-term follow-up. Given that LGA embolization is an investigative method, it is important for researchers to follow standardized protocols and techniques to avoid complications.