Which sequence should be used in the thorax magnetic resonance imaging of COVID-19: a comparative study.

Background and aim: To evaluate and compare magnetic resonance imaging (MRI) sequences that could potentially be used in the diagnosis of coronavirus disease 2019 (COVID-19). Materials and methods: Included in the study were 42 patient who underwent thorax computed tomography (CT) for COVID-19 pneumonia and thorax MRI for any reason within 24 h after CT. The T2-weighted fast spin echo periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) (T2W-FSE-P), fast imaging employing steady-state acquisition, T2 fat-saturated FSE, axial T1 liver acquisition with volume acceleration (LAVA) and single-shot FSE images were compared in terms of their ability to show COVID-19 findings. Results: The mean age of the patients was 47.2 ± 24 years. Of the patients, 22 were male (52.4%) and 20 (47.6%) were female. The interobserver intraclass coefficient (ICC) for the image quality score was the highest in the T2W-FSE-P sequence and lowest in the T1 LAVA sequence. All of the lesion-based evaluations of the interobserver agreement were statistically significant, with the kappa value varying between 0.798 and 0.998. Conclusion: All 5 sequences evaluated in the study were successful in showing the parenchymal findings of COVID-19. Since the T2W-FSE-P sequence had the best scores in both interobserver agreement and ICC for the image quality score, it was considered that it can be included in thorax MRI examinations to assist the diagnosis of COVID-19.

The importance of medial-lateral styloid process angulation/coronal plane angle in symptomatic eagle syndrome.

We used three-dimensional computerized tomography (3DCT) to obtain images of Eagle Syndrome (ES) cases and measurements of relevant variables. Twenty-five subjects with ES and 25 controls were included in this retrospective study. Styloid process length, anterior-posterior styloid process angulation (Sagittal plane angle) (APA), medial-lateral styloid process angulation (Coronal plane angle) (MLA), tonsil-stiloid distance and carotid-stiloid distance were measured on CT and 3DCT images, and cranial and neck angiography was obtained, from a total of 580 images. The styloid process lengths were 40.3 and 40.5 mm on the right and left sides in the ES group. The left MLA was lower in symptomatic (Median: 67.0°) than asymptomatic (Median: 72.6°) ES patients. In ES patients with styloid process length above 3 cm, MLA (coronal plane angle) is important, and the symptoms are more intense when this angle is smaller. Clin. Anat. 30:487-491, 2017. © 2017 Wiley Periodicals, Inc.

The overlooked symptom of coccydynia: evaluation of sacrococcygeal morphologic and morphometric findings.

BACKGROUND: Coccydynia is one of the most overlooked symptoms in daily clinical practice. Definitions for radiologic evaluation are controversial. OBJECTIVES: We aimed to compare the morphology and morphometric measurements of the sacrococcygeal region with those of a healthy population to support radiologic decision-making. MATERIALS AND METHODS: In total, 26 traumatic and 50 idiopathic cases of coccydynia as well as 74 healthy control cases were retrospectively compared. The morphologic type of the coccyx, the presence of fusion, and the number of coccygeal segments were evaluated in both groups. Morphometric parameters such as sacrococcygeal angle (SCA), sacrococcygeal joint angle (SCJA), intercoccygeal angle (ICA), sacral slope (SS), coccyx curved length (CCL), sacrum curved length (SCL), coccyx length (CL), sacrum length (SL), and sacrococcygeal total length (SCTL) were investigated. RESULTS: Significant differences were found between the coccydynia group and the healthy control group in morphologic parameters such as female gender, coccyx segment, coccyx morphology, presence of sacrococcygeal joint, and segment of sacrococcygeal joint fusion (p < 0.05). In morphologic measurements, SCJA, SCL, SL, coccyx and sacrum curvature indexes were significantly increased (p < 0.05). No significant difference was found in the morphologic and morphometric parameters evaluated when compared with the duration of coccydynia (p > 0.05). CONCLUSION: An increase in the SCJA, SCL, SL, SCI, and coccyx curvature index measurements predisposes to coccydynia. It would be more accurate to perform radiological evaluation by familiarization with these morphologic and morphometric parameters.

Intra- and inter-observer reliability of Dias-Tachdjian classification in pediatric ankle fractures: do clinical experience and expertise matter?

The Dias-Tachdjian classification is the most commonly used system for the classification of pediatric ankle fractures, but its inter- and intra-observer reliability has not been studied in detail. Also, the impact of the clinician's experience and expertise on the reliability of this system is unknown. This study aimed: (1) to determine the intra- and inter-observer reliability of the Dias-Tachdjian classification and (2) to investigate the effect of the clinician's experience and expertise on the reliability of this system. Anteroposterior and lateral ankle radiographs of 56 children (34 male, 22 female) with ankle fractures, aged between 3 and 14 years, with open growth cartilages, were retrospectively identified and included in the study. Each patient radiograph was examined by 10 observers from two different specialties with different levels of clinical experience (two orthopedic surgeons with interest in pediatric orthopedics, three orthopedic surgeons with no interest in pediatric orthopedics, three orthopedic residents, and two radiology specialists) from two different specialties (orthopedics and radiology). All observers were then asked to classify pediatric ankle fractures at 6-week intervals per the Dias-Tachdjian classification system. Overall, intra-observer reliability as substantial to very good (κ = 0.77-0.95, P < 0.01), but inter-observer reliability as fair for both assessments (κ = 0.21, P < 0.01 and κ = 0.20, P < 0.01 for the first and second occasions, respectively). Inter-observer reliability among pediatric orthopedic surgeons as very good (κ = 0.90, 95% CI = 0.86-0.94, P < 0.01 and κ = 0.82, 95% CI = 0.71-0.93, P < 0.01 for the first and second occasions, respectively). Orthopedic surgeons with no special interest in pediatric orthopedics demonstrated substantial agreement in the first occasion (κ = 0.63, 95% CI = 0.53-0.72, P < 0.01) but moderate in the second one. Orthopedic residents exhibited moderate levels of agreement in each assessment period (κ = 0.58, 95% CI = 0.47-0.68, P < 0.01 and κ = 0.44, 95% CI = 0.37-0.51, P < 0.01 for the first and second occasion, respectively). Considering that the specialists dealing with pediatric orthopedics show very good consistency for Dias-Tachdjian classification, both within and between observers, consistency in the identification of the ankle fracture models increases as the interest in the field of pediatric orthopedics intensifies.