Acromegalic arthropathy in various stages of the disease: an MRI study.

BACKGROUND: Arthropathy is a prevalent and invalidating complication of acromegaly with a characteristic radiographic phenotype. We aimed to further characterize cartilage and bone abnormalities associated with acromegalic arthropathy using magnetic resonance imaging (MRI). METHODS: Twenty-six patients (23% women, mean age 56.8 ± 13.4 years), with active (n = 10) and controlled acromegaly (n = 16) underwent a 3.0 T MRI of the right knee. Osteophytes, cartilage defects, bone marrow lesions and subchondral cysts were assessed by the Knee Osteoarthritis Scoring System (KOSS) method. Cartilage thickness and cartilage T2 relaxation times, in which higher values reflect increased water content and/or structural changes, were measured. Twenty-five controls (52% women, mean age: 59.6 ± 8.0 years) with primary knee OA were included for comparison. RESULTS: Both in active and controlled acromegaly, structural OA defects were highly prevalent, with thickest cartilage and highest cartilage T2 relaxation times in the active patients. When compared to primary OA subjects, patients with acromegaly seem to have less cysts (12% vs 48%, P = 0.001) and bone marrow lesions (15% vs 80%, P = 0.006), but comparable prevalence of osteophytosis and cartilage defects. Patients with acromegaly had 31% thicker total joint cartilage (P < 0.001) with higher cartilage T2 relaxation times at all measured sites than primary OA subjects (P < 0.01). CONCLUSIONS: Patients with active acromegaly have a high prevalence of structural OA abnormalities in combination with thick joint cartilage. In addition, T2 relaxation times of cartilage are high in active patients, indicating unhealthy cartilage with increased water content, which is (partially) reversible by adequate treatment. Patients with acromegaly have a different distribution of structural OA abnormalities visualized by MRI than primary OA subjects, especially of cartilage defects.

Radiation exposure and mortality risk from CT and PET imaging of patients with malignant lymphoma.

OBJECTIVE: To quantify radiation exposure and mortality risk from computed tomography (CT) and positron emission tomography (PET) imaging with (18)F-fluorodeoxyglucose ((18)F-FDG) in patients with malignant lymphoma (Hodgkin's disease [HD] or non-Hodgkin's lymphoma [NHL]). METHODS: First, organ doses were assessed for a typical diagnostic work-up in children with HD and adults with NHL. Subsequently, life tables were constructed for assessment of radiation risks, also taking into account the disease-related mortality. RESULTS: In children with HD, cumulative effective dose from medical imaging ranged from 66 mSv (newborn) to 113 mSv (15 years old). In adults with NHL the cumulative effective dose from medical imaging was 97 mSv. Average fractions of radiation-induced deaths for children with HD [without correction for disease-related mortality in brackets] were 0.4% [0.6%] for boys and 0.7% [1.1%] for girls, and for adults with NHL 0.07% [0.28%] for men and 0.09% [0.37%] for women. CONCLUSION: Taking into account the disease-related reduction in life expectancy of patients with malignant lymphoma results in a higher overall mortality but substantial lower incidence of radiation induced deaths. The modest radiation risk that results from imaging with CT and (18)F-FDG PET can be considered as justified, but imaging should be performed with care, especially in children.

Evaluation of bone impingement prediction in pre-operative planning for shoulder arthroplasty.

In shoulder arthroplasty, malpositioning of prostheses often leads to reduced postoperative range of motion (ROM) and complications such as impingement, loosening, and dislocation. Furthermore, the risk of impingement complications increases when reverse total prostheses are used. For this purpose a pre-operative planning system was developed that enables surgeons to perform a virtual shoulder replacement procedure. The present authors' pre-operative planning system simulates patient-specific bone-determined ROM meant to reduce the risk of impingement complications and to improve the ROM of patients undergoing shoulder replacement surgery. This paper describes a validation experiment with the purpose of ratifying the clinical applicability and usefulness of the ROM simulation module for shoulder replacement surgery. The experiment was performed on cadaveric shoulders. A data connection was set up between the software environment and an existing intra-operative guidance system to track the relative positions of the bones. This allowed the patient-specific surface models to be visualized within the software for the position and alignment of the tracked bones. For both shoulders, ROM measurements were recorded and tagged with relevant information such as the type of prosthesis and the type of movement that was performed. The observed ROM and occurrences of impingement were compared with the simulated equivalents. The median deviation between observed impingement angles and simulated impingement angles was -0.30 degrees with an interquartile range of 5.20 degrees (from -3.40 degrees to 1.80 degrees). It was concluded that the ROM simulator is sufficiently accurate to fulfil its role as a supportive instrument for orthopaedic surgeons during shoulder replacement surgery.

Interactive 3D segmentation using connected orthogonal contours.

This paper describes a new method for interactive segmentation that is based on cross-sectional design and 3D modelling. The method represents a 3D model by a set of connected contours that are planar and orthogonal. Planar contours overlayed on image data are easily manipulated and linked contours reduce the amount of user interaction.1 This method solves the contour-to-contour correspondence problem and can capture extrema of objects in a more flexible way than manual segmentation of a stack of 2D images. The resulting 3D model is guaranteed to be free of geometric and topological errors. We show that manual segmentation using connected orthogonal contours has great advantages over conventional manual segmentation. Furthermore, the method provides effective feedback and control for creating an initial model for, and control and steering of, (semi-)automatic segmentation methods.