Attention fusion network with self-supervised learning for staging of osteonecrosis of the femoral head (ONFH) using multiple MR protocols.

BACKGROUND: Osteonecrosis of the femoral head (ONFH) is characterized as bone cell death in the hip joint, involving a severe pain in the groin. The staging of ONFH is commonly based on Magnetic resonance imaging and computed tomography (CT), which are important for establishing effective treatment plans. There have been some attempts to automate ONFH staging using deep learning, but few of them used only MR images. PURPOSE: To propose a deep learning model for MR-only ONFH staging, which can reduce additional cost and radiation exposure from the acquisition of CT images. METHODS: We integrated information from the MR images of five different imaging protocols by a newly proposed attention fusion method, which was composed of intra-modality attention and inter-modality attention. In addition, a self-supervised learning was used to learn deep representations from a large amount of paired MR-CT dataset. The encoder part of the MR-CT translation network was used as a pretraining network for the staging, which aimed to overcome the lack of annotated data for staging. Ablation studies were performed to investigate the contributions of each proposed method. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the performance of the networks. RESULTS: Our model improved the performance of the four-way classification of the association research circulation osseous (ARCO) stage using MR images of the multiple protocols by 6.8%p in AUROC over a plain VGG network. Each proposed method increased the performance by 4.7%p (self-supervised learning) and 2.6%p (attention fusion) in AUROC, which was demonstrated by the ablation experiments. CONCLUSIONS: We have shown the feasibility of the MR-only ONFH staging by using self-supervised learning and attention fusion. A large amount of paired MR-CT data in hospitals can be used to further improve the performance of the staging, and the proposed method has potential to be used in the diagnosis of various diseases that require staging from multiple MR protocols.

A Fibroma of Tendon Sheath Causing Carpal Tunnel Syndrome: A Case Report of an Atypical Clinical Presentation.

Fibroma of the tendon sheath is a benign slow-growing fibrous tumor. Although rare, cases occurring in the upper extremities usually involve the fingers. It appears as a well-defined, roundor oval-shaped mass originating from the flexor tendon. Abundant fibrous stroma makes fibromas appear as a low intensity mass in all MRI sequences. Most of the fibromas manifest as painless soft tissue masses. Herein, we report a case of fibroma of the tendon sheath with an unusual clinical presentation, triggering carpal tunnel syndrome during wrist movement.

Effects of Preservative-free 3% Diquafosol in Patients with Pre-existing Dry Eye Disease after Cataract Surgery: A Randomized Clinical Trial.

Dry eye disease (DED) after cataract surgery has become a critical concern, and various therapeutic options have been developed. Recently, preservative-free diquafosol ophthalmic solution has been introduced; however, its therapeutic effect on DED after cataract surgery has not been reported. We investigated the efficacy of preservative-free diquafosol in patients with pre-existing DED after cataract surgery. We divided subjects who were diagnosed with DED and scheduled to undergo cataract surgery, into 3 groups (preservative-free diquafosol, group 1; preservative-containing diquafosol, group 2; preservative-free hyaluronate, group 3), and each eye drops was administered 6 times daily after surgery. Tear break up time (TBUT), Ocular Surface Disease Index (OSDI), corneal staining score, lid margin abnormality, and meibum quality improved over time in group 1. Groups 1 and 2 had significantly superior TBUT, meibomian gland dysfunction grade, and meibomian gland expressibility throughout the study period than group 3. Meibum quality of group 1 was significantly better than group 2 at 1 and 3 months after surgery. Preservative-free diquafosol showed better efficacy in treating DED after cataract surgery than preservative-containing diquafosol or preservative-free hyaluronate. Preservative-free diquafosol may serve as a reliable option for the management of patients with pre-existing DED after phacoemulsification.

Lunate subchondral cysts: Are there specific radiologic findings for patients with symptomatic ulnocarpal impaction?

BACKGROUND: There are few clinical studies evaluating the relationship between lunate cysts and symptomatic ulnar impaction syndrome (UIS). The purpose of this study was to investigate the prevalence and relationship between lunate cysts and UIS by comparing data from patients with UIS against those without. MATERIALS AND METHODS: From March 2012 to January 2015, 375 patients who had undergone MRI or CT for reasons other than ulnar-sided wrist pain were classified into the 'asymptomatic group' (Group I). Thirty three patients who had been diagnosed with UIS were classified in the 'UIS group' (Group II). We determined whether any differences were present between the two groups and evaluated prognostic factors for lunate cysts. RESULTS: The prevalence of lunate cysts was significantly higher in Group II but only reached just above 50% (10.4% vs. 57.6%, p < 0.001]. Dorsal-side lunate cysts were more frequent than palmar side in Group I, while Group II had more cysts on the palmar side (74.4% vs. 52.6%, p = 0.001). Logistic regression analysis revealed that UIS and patient age was a significant factor for the presence of lunate cysts (odds ratio: 11.692, p < 0.001; odds ratio: 1.063, p < 0.001, respectively). However, positive ulnar variance or duration of symptom in Group II was not a predisposing factor for lunate cysts (odds ratio: 1.035, p = 0.598; odds ratio: 1.007, p = 0.877, respectively). CONCLUSION: Since positive ulnar variance or duration of symptom did not affect the formation of the lunate cyst and only slightly more than 50% (57.6%) of patients with UIS had a lunate cyst, it seems unlikely that these cysts are a pathognomonic finding. Surgeons can obtain some evidence from lunate cysts on radiographic exams, but care must be taken that this diagnosis is not made hastily or without due consideration.

Anterolateral ligament injury has a synergic impact on the anterolateral rotatory laxity in acute anterior cruciate ligament-injured knees.

PURPOSE: To investigate the prevalence of the anterolateral ligament (ALL) injuries and its role in rotatory laxity in acute anterior cruciate ligament (ACL)-injured knees. METHODS: Two-hundred and ninety-six consecutive patients with acute ACL injuries were evaluated retrospectively, excluding those with other ligament injury and undetectable path of ALL in MRI. Patients were divided into two groups based on the degree of ACL injury in arthroscopy (complete versus partial group). Logistic regression and discriminant analysis were performed to assess the risk of pivot shift test. RESULTS: A total of 169 patients were included (128 with complete and 41 with partial ACL rupture). Overall, 106/169 (62.7%) of ALL injuries were characterized, 87/128 (67.9%) in complete group, and 19/41 (46.3%) in partial group. The incidence of pivot shift was 120/128 (93.8%) and 14/41 (34.1%) in the complete and partial groups, respectively. The odds ratio in the pivot shift of combined ALL injury was found as 3.8 (95% CI 1.8-8.4) with the overall ACL injury, but higher as 17.1 (95% CI 3.1-96.4) with partial group. Higher grade of pivot shift showed a greater incidence of injury of ALL. Degree of ACL injury and ALL injury allowed 87.0% of correct classification of subsequent anterolateral rotatory laxity. CONCLUSION: Injury to the ALL could have a synergetic effect on anterolateral rotatory laxity in acute ACL-injured knee, however, its effect might be minor in case of complete tear. Careful assessment about combined ALL injury should be considered, especially in knees with high-grade pivot shift in acute ACL-injured knees. LEVEL OF EVIDENCE: Retrospective prognostic study, Level IV.

An intra-articular synovial lipoma of the hip, possibly causing osteoarthritis: a case report and review of the literature.

In this report, we present the case of an intra-articular synovial lipoma in a 58-year-old female with a coincident marked unilateral hip osteoarthritis. This patient suffered from right hip pain that developed gradually over 2 years. Physical examination noted decreased range of motion and evidence of impingement. MR and CT images showed an intra-articular fat-intense mass in the hip joint that was excised and confirmed as a synovial lipoma on histology. This case reveals that an intra-articular lipoma of the hip could be accompanied by pain or impingement and followed by hip osteoarthritis even in the absence of trauma.