Irreducible Traumatic Radial Head Dislocation Due to Annular Ligament Interposition in a Child with Ulnar Plastic Deformation: A Case Report.

BACKGROUND: The traumatic dislocation of the radial head in children is commonly treated by closed reduction. Sometimes, however, this strategy of treatment may not be effective due to the location of soft tissues in the radio-shoulder joint. The literature presents a few cases of the irreducible radial head dislocation with ulnar plastic deformation. Because it is a relatively rare condition, such a traumatic dislocation can be easily missed. Neglected injuries can lead to unwanted complications and unpredictable surgical outcomes. CASE PRESENTATION: This study presents a relatively rare case of traumatic radial head dislocation with ulnar plastic deformation in a 3-year-old child, which was successfully treated by open reduction. The examined case did not require osteotomy and ligamentous reconstruction. The initial attempt of closed reduction failed due to annular ligament interposition, which has been detected on MRI. After 3 months of treatment, the range of motion of the operated arm gradually improved. At the 6-month follow-up, the Mayo elbow-performance score indicated an excellent treatment outcome. CONCLUSIONS: The delayed treatment of radial head dislocation with ulnar plastic deformation can hinder the supination and pronation of the forearm, resulting in elbow/forearm deformity. The earlier this condition is detected, the easier it will be to treat it and the better the treatment outcome will be. The examined case of irreversible traumatic dislocation, successfully treated by open reduction, may help to treat radial head dislocation better.

Performance evaluation of HiPET, a high sensitivity and high resolution preclinical PET tomograph.

HiPET is a recently developed prototype preclinical PET scanner dedicated to high sensitivity and high resolution molecular imaging. The HiPET system employs a phoswich depth of interaction (DOI) detector design, which also allows identification of the large majority of the cross layer crystal scatter (CLCS) events. This work evaluates its performance characteristics following the National Electrical Manufacturers Association (NEMA) NU4-2008 protocol. The HiPET consists of twenty flat panel type detectors arranged in two rings. The inner diameter is 160 mm and the axial field of view (FOV) is 104 mm. Each detector is comprised of two layers of phoswich scintillator crystal arrays, a tapered, pixelated glass lightguide and a multi anode photomultiplier tube (MAPMT). The front (gamma ray entrance) layer is a 48 × 48 pixelated cerium doped lutetium yttrium orthosilicate (LYSO) scintillator array with individual crystals measuring 1.01 × 1.01 × 6.1 mm. The back (towards the PMT) layer is a 32 × 32 pixelated bismuth germanate (BGO) scintillator array with individual crystals measuring 1.55 × 1.55 × 8.9 mm. For energy windows of 250-650 keV and 350-650 keV, the peak absolute sensitivity at the center of the FOV was 13.5% and 10.4% including CLCS events, and 11.8% and 8.9% excluding CLCS events, respectively. The average detector energy resolution derived by averaging the individual crystal spectra was 11.7% ± 1.4% for LYSO and 17.0% ± 1.4% for BGO. The 3D ordered-subsets expectation maximization (OSEM) reconstructed image of a point source in air, ranged from 0.73 mm to 1.19 mm, with an average value of 0.93 ± 0.09 mm at all measured locations. The peak noise equivalent count rate (NECR) and scatter fraction were 179 kcps at 12.4 MBq and 6.9% for the mouse-sized phantom, and 63 kcps at 11.3 MBq and 18.3% for the rat-sized phantom. For the NEMA image quality phantom, the uniformity was 5.8%, and the spillover ratios measured in the water- and air-filled cold region chambers were 0.047 and 0.044, respectively. The recovery coefficients (RC) ranged from 0.31 to 0.92. These results and in vivo evaluation demonstrate that the HiPET can achieve high quality molecular imaging for biomedical applications.

Performance Evaluation of G8, a High-Sensitivity Benchtop Preclinical PET/CT Tomograph.

G8 is a benchtop integrated PET/CT scanner dedicated to high-sensitivity and high-resolution imaging of mice. This work characterizes its National Electrical Manufacturers Association NU 4-2008 performance where applicable and also assesses the basic imaging performance of the CT subsystem. Methods: The PET subsystem in G8 consists of 4 flat-panel detectors arranged in a boxlike geometry. Each panel consists of 2 modules of a 26 × 26 pixelated bismuth germanate scintillator array with individual crystals measuring 1.75 × 1.75 × 7.2 mm. The crystal arrays are coupled to multichannel photomultiplier tubes via a tapered, pixelated glass lightguide. A cone-beam CT scanner consisting of a MicroFocus x-ray source and a complementary metal oxide semiconductor detector provides anatomic information. Sensitivity, spatial resolution, energy resolution, scatter fraction, count-rate performance, and the capability of performing phantom and mouse imaging were evaluated for the PET subsystem. Noise, dose level, contrast, and resolution were evaluated for the CT subsystem. Results: With an energy window of 350-650 keV, the peak sensitivity was 9.0% near the center of the field of view. The crystal energy resolution ranged from 15.0% to 69.6% in full width at half maximum (FWHM), with a mean of 19.3% ± 3.7%. The average intrinsic spatial resolution was 1.30 and 1.38 mm FWHM in the transverse and axial directions, respectively. The maximum-likelihood expectation maximization reconstructed image of a point source in air averaged 0.81 ± 0.11 mm FWHM. The peak noise-equivalent count rate for the mouse-sized phantom was 44 kcps for a total activity of 2.9 MBq (78 µCi), and the scatter fraction was 11%. For the CT subsystem, the value of the modulation transfer function at 10% was 2.05 cycles/mm. Conclusion: The overall performance demonstrates that the G8 can produce high-quality images for molecular imaging-based biomedical research.

MARS: a mouse atlas registration system based on a planar x-ray projector and an optical camera.

This paper introduces a mouse atlas registration system (MARS), composed of a stationary top-view x-ray projector and a side-view optical camera, coupled to a mouse atlas registration algorithm. This system uses the x-ray and optical images to guide a fully automatic co-registration of a mouse atlas with each subject, in order to provide anatomical reference for small animal molecular imaging systems such as positron emission tomography (PET). To facilitate the registration, a statistical atlas that accounts for inter-subject anatomical variations was constructed based on 83 organ-labeled mouse micro-computed tomography (CT) images. The statistical shape model and conditional Gaussian model techniques were used to register the atlas with the x-ray image and optical photo. The accuracy of the atlas registration was evaluated by comparing the registered atlas with the organ-labeled micro-CT images of the test subjects. The results showed excellent registration accuracy of the whole-body region, and good accuracy for the brain, liver, heart, lungs and kidneys. In its implementation, the MARS was integrated with a preclinical PET scanner to deliver combined PET/MARS imaging, and to facilitate atlas-assisted analysis of the preclinical PET images.

A beta-camera integrated with a microfluidic chip for radioassays based on real-time imaging of glycolysis in small cell populations.

UNLABELLED: An integrated ß-camera and microfluidic chip was developed that is capable of quantitative imaging of glycolysis radioassays using (18)F-FDG in small cell populations down to a single cell. This paper demonstrates that the integrated system enables digital control and quantitative measurements of glycolysis in B-Raf(V600E)-mutated melanoma cell lines in response to specific B-Raf inhibition. METHODS: The ß-camera uses a position-sensitive avalanche photodiode to detect charged particle-emitting probes within a microfluidic chip. The integrated ß-camera and microfluidic chip system was calibrated, and the linearity was measured using 4 different melanoma cell lines (M257, M202, M233, and M229). Microfluidic radioassays were performed with cell populations ranging from hundreds of cells down to a single cell. The M229 cell line has a homozygous B-Raf(V600E) mutation and is highly sensitive to a B-Raf inhibitor, PLX4032. A microfluidic radioassay was performed over the course of 3 days to assess the cytotoxicity of PLX4032 on cellular (18)F-FDG uptake. RESULTS: The ß-camera is capable of imaging radioactive uptake of (18)F-FDG in microfluidic chips. (18)F-FDG uptake for a single cell was measured using a radioactivity concentration of 37 MBq/mL during the radiotracer incubation period. For in vitro cytotoxicity monitoring, the ß-camera showed that exposure to 1 µM PLX4032 for 3 days decreased the (18)F-FDG uptake per cell in highly sensitive M229 cells, compared with vehicle controls. CONCLUSION: The integrated ß-camera and microfluidic chip can provide digital control of live cell cultures and allow in vitro quantitative radioassays for multiple samples simultaneously.

Performance evaluation of PETbox: a low cost bench top preclinical PET scanner.

PURPOSE: PETbox is a low cost bench top preclinical PET scanner dedicated to pharmacokinetic and pharmacodynamic mouse studies. A prototype system was developed at our institute, and this manuscript characterizes the performance of the prototype system. PROCEDURES: The PETbox detector consists of a 20 × 44 bismuth germanate crystal array with a thickness of 5 mm and cross-section size of 2.05 × 2.05 mm. Two such detectors are placed facing each other at a spacing of 5 cm, forming a dual-head geometry optimized for imaging mice. The detectors are kept stationary during the scan, making PETbox a limited angle tomography system. 3D images are reconstructed using a maximum likelihood and expectation maximization (ML-EM) method. The performance of the prototype system was characterized based on a modified set of the NEMA NU 4-2008 standards. RESULTS: In-plane image spatial resolution was measured to be an average of 1.53 mm full width at half maximum for coronal images and 2.65 mm for the anterior-posterior direction. The volumetric reconstructed resolution was below 8 mm(3) at most locations in the field of view (FOV). The sensitivity, scatter fraction, and noise equivalent count rate (NECR) were measured for different energy windows. With an energy window of 150 - 650 keV and a timing window of 20 ns optimized for mouse imaging, the peak absolute sensitivity was 3.99% at the center of FOV and a peak NECR of 20 kcps was achieved for a total activity of 3.2 MBq (86.8 µCi). Phantom and in vivo imaging studies were performed and demonstrated the utility of the system at low activity levels. The quantitation capabilities of the system were also characterized showing that despite the limited angle tomography, reasonably good quantification accuracy was achieved over a large dynamic range of activity levels. CONCLUSIONS: The presented results demonstrate the potential of this new tomograph for small animal imaging.

Integrated microfluidic and imaging platform for a kinase activity radioassay to analyze minute patient cancer samples.

Oncogenic kinase activity and the resulting aberrant growth and survival signaling are a common driving force of cancer. Accordingly, many successful molecularly targeted anticancer therapeutics are directed at inhibiting kinase activity. To assess kinase activity in minute patient samples, we have developed an immunocapture-based in vitro kinase assay on an integrated polydimethylsiloxane microfluidics platform that can reproducibly measure kinase activity from as few as 3,000 cells. For this platform, we adopted the standard radiometric (32)P-ATP-labeled phosphate transfer assay. Implementation on a microfluidic device required us to develop methods for repeated trapping and mixing of solid-phase affinity microbeads. We also developed a solid-state beta-particle camera imbedded directly below the microfluidic device for real-time quantitative detection of the signal from this and other microfluidic radiobioassays. We show that the resulting integrated device can measure ABL kinase activity from BCR-ABL-positive leukemia patient samples. The low sample input requirement of the device creates new potential for direct kinase activity experimentation and diagnostics on patient blood, bone marrow, and needle biopsy samples.