Can neck pain be an initial symptom of rheumatoid arthritis? A case report and literature review.

Although rheumatoid arthritis (RA) is most commonly associated with peripheral joints, cervical spine involvement can be seen in almost 80% of patients in the presence of long-term disease, joint erosion, and risk factors such as male sex and rheumatoid factor positivity. It is very rare to have cervical involvement in the initial period of RA. If a patient has isolated cervical spine involvement without peripheral arthritis, it is highly likely that inappropriate investigations and delayed treatment may occur. Any damage that occurs in cervical spine may cause symptoms varying from slight instability to atlantoaxial subluxation, spinal cord and brain stem compression and even death. Therefore, physician should be aware that there may be isolated cervical involvement, albeit rare, in patients with RA. In this report, we presented a case of RA presenting with cervical spine involvement without peripheral arthritis to underline the importance of this kind of involvement in clinical practice. We also briefly reviewed other cases similar to ours in light of literature.

Evaluation of Labral Pathology and Hip Articular Cartilage in Patients with Femoroacetabular Impingement (FAI): Comparison of Multidetector CT Arthrography and MR Arthrography.

BACKGROUND: To compare the multidetector computed tomography (MDCT) arthrography (CTa) and magnetic resonance (MR) arthrography (MRa) findings with surgical findings in patients with femoroacetabular impingement (FAI) and to evaluate the diagnostic performance of these methods. MATERIAL/METHODS: Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 14 patients. The findings were evaluated by two musculoskeletal radiologists with 10 and 20 years of experience, respectively. Sensitivity, specificity, accuracy, and positive predictive value were determined using surgical findings as the standard of reference. RESULTS: While the disagreement between observers was recorded in two cases of labral tearing with MRa, there was a complete consensus with CTa. Disagreement between observers was found in four cases of femoral cartilage loss with both MRa and CTa. Disagreement was also recorded in only one case of acetabular cartilage loss with both methods. The percent sensitivity, specificity, and accuracy for correctly assessing the labral tearing were as follows for MRa/CTa, respectively: 100/100, 50/100, 86/100 (p<0.05). The same values for acetabular cartilage assessment were 89/56, 40/60, 71/71 (p>0.05) and for femoral cartilage assessment were 100/75, 90/70, 86/71 (p>0.05). Inter-observer reliability value showed excellent agreement for labral tearing with CTa (κ=1.0). Inter-observer agreement was substantial to excellent with regard to acetabular cartilage assessment with MRa and CTa (κ=0.76 for MRa and κ=0.86 for CTa). CONCLUSIONS: Inter-observer reliability with CTa is excellent for labral tearing assessment. CTa seems to have an equal sensitivity and a higher specificity than MRa for the detection of labral pathology. MRa is better, but not statistically significantly, in demonstrating acetabular and femoral cartilage pathology.

Are deep learning classification results obtained on CT scans fair and interpretable?

Following the great success of various deep learning methods in image and object classification, the biomedical image processing society is also overwhelmed with their applications to various automatic diagnosis cases. Unfortunately, most of the deep learning-based classification attempts in the literature solely focus on the aim of extreme accuracy scores, without considering interpretability, or patient-wise separation of training and test data. For example, most lung nodule classification papers using deep learning randomly shuffle data and split it into training, validation, and test sets, causing certain images from the Computed Tomography (CT) scan of a person to be in the training set, while other images of the same person to be in the validation or testing image sets. This can result in reporting misleading accuracy rates and the learning of irrelevant features, ultimately reducing the real-life usability of these models. When the deep neural networks trained on the traditional, unfair data shuffling method are challenged with new patient images, it is observed that the trained models perform poorly. In contrast, deep neural networks trained with strict patient-level separation maintain their accuracy rates even when new patient images are tested. Heat map visualizations of the activations of the deep neural networks trained with strict patient-level separation indicate a higher degree of focus on the relevant nodules. We argue that the research question posed in the title has a positive answer only if the deep neural networks are trained with images of patients that are strictly isolated from the validation and testing patient sets.

Inhalation therapy of calcitonin relieves osteoarthritis of the knee.

This study was conducted to determine if nasal salmon calcitonin has additional beneficial effects on clinical symptoms, serum NO, IL-1ß, matrix metalloproteinase 3, urinary C-terminal telopeptide type II collagen (CTX-II) levels and MRI findings in knee osteoarthritis (OA) when used concomitantly with exercise therapy. Fifty female patients with knee OA were randomized into two groups. The first group (n = 30) received 200 IU/day nasal salmon calcitonin and a home exercise program; the second group (n = 20) received a home exercise program for 6 months. Compared with baseline,while significant improvements were observed in visual analogue scale (VAS), WOMAC pain, physical function scores, 20-m walking time (P < 0.001) and WOMAC stiffness score (P = 0.041) in the first group, walking and resting VAS, and WOMAC physical function scores were improved (P = 0.029) in the second group after treatment. Significantly increased levels of serum NO and urinary CTX-II (P < 0.001) and significant improvements in the area of medial femoral condyle (P < 0.05) were noted only in the first group. There were significant differences in VAS activation values (P = 0.032) and NO levels (P < 0.001) in the favor of the first group. In conclusion, nasal salmon calcitonin may have possible chondroprotective effects besides its known effects on symptoms in patients with knee OA.

Fracture-dislocation of the hip: what does volumetric computed tomography add to detection, characterization, and planning treatment?

Traumatic hip fracture-dislocations are serious injuries and may lead to long-term disability even if managed correctly. Standard radiographic procedures have a limited value in fully evaluating a traumatized hip. Multidetector computed tomography is, today, a valuable diagnostic tool for the evaluation of patients with traumatic hip fracture-dislocation. This article reviews the mechanism, clinical presentation, diagnostic algorithm, imaging findings, and the treatment associated with hip fracture-dislocations. The role of volumetric computed tomography in detection, characterization, and planning treatment of these injuries is discussed.

Factors affecting swallowing during thyroid fine-needle aspiration biopsy.

OBJECTIVE: This prospective study was conducted to examine the factors that affect swallowing during thyroid fine-needle aspiration biopsy (FNAB). METHODS: Consecutive patients who were to undergo FNAB were approached for inclusion in the study. The depth and size of the nodule were measured in all patients. In a random fashion, patients were told not to swallow during the procedure, or they were not given any instructions regarding swallowing. RESULTS: Regarding the 143 participants in the study, no significant differences in age (P = .07), diameter and depth of the thyroid nodules (P = .14; P = .46, respectively), or cytologic diagnosis of thyroid aspirates (P > .20) were found between the swallowing (n = 50) and nonswallowing (n = 93) patient groups. Swallowing was observed in 29 patients who were instructed not to swallow (36%) and in 21 patients who were not given any instructions regarding swallowing (34%; P = .95). The mean duration of the procedure for swallowing patients was 19.8 seconds, and it was 15.7 seconds for nonswallowing patients. The duration of the procedure was significantly shorter in patients who did not swallow (P = .001). More male patients swallowed than female patients (P = .003). CONCLUSIONS: Giving specific instructions about not swallowing did not make a difference regarding swallowing by patients during the FNAB procedure. More male patients swallowed than female patients. A longer duration of the FNAB procedure meant that the operator was more likely to encounter swallowing (and thus displacement of the thyroid) while doing the procedure. Completing the procedure quickly is the surest method to avoid a moving thyroid while performing FNAB.

Irreversiblity of remodeled features on high-resolution computerized tomography scans of asthmatic patients on conventional therapy: a 6-year longitudinal study.

Airway remodeling can be assessed using high-resolution computerized tomography (HRCT) scanning of both parenchymal-and airway abnormalities in patients with asthma. The aim of this study was to examine structural changes in large and small airways of asthmatic patients using HRCT to determine if remodeling changes had occurred after prolonged use of conventional anti-asthma therapy. HRCT scans were evaluated prospectively for evidence of the following abnormalities: bronchial wall thickening (BWT), bronchiectasis, mucoid impactions, small centrilobular opacities, thick linear opacities, focal hyperlucency, and emphysema. Fifty mild and moderate asthmatics were enrolled in the study group. These abnormalities were re-evaluated in the patients after the passage of 6 years of regular anti-asthma medication. Forty-six of the patients completed the study. The probability of finding at least one abnormality by HRCT investigation was statistically higher in the second scan than in the first (26 patients [56.5%] versus 18 patients [39.1%], p = 0.02]. Irreversibility ratios of abnormalities were 80%, 100%, 75%, 87.7%, 77.8%, and 100% for BWT, bronchiectasis, small centrilobular opacities, focal hyperlucency, thick linear opacity, and emphysema, respectively. The ratios for newly detected structural abnormalities were 25%, 2.5%, 0%, 7.9%, 8.1%, and 0% for BWT, bronchiectasis, small centrilobular opacities, focal hyperlucency, thick linear opacity, and emphysema, respectively. New occurrences and progression in BWT are associated with the duration of asthma affliction (p = 0.03). The results of our study indicate that HRCT remodeling features, once occurring, are irreversible in most of the patients, and new remodeling features also occur despite administering the standard asthma treatment.

Prevalence of elastofibroma dorsi on CT: Is it really an uncommon entity?

OBJECTIVE: The aim of this study was to determine the prevalence, demographic data of elastofibroma dorsi (ED) in adult population who had undergone chest CT examination and to discuss clinical, and radiological presentations, and treatment options of ED. METHODS: We retrospectively reviewed 4074 chest CT examinations for ED from July 2014 to April 2015. Lesion size, side, and patient demographics were analyzed for positive cases of ED. The initial radiology reports of patients with ED were also reviewed. RESULTS: Of the 4074 patients, 111 patients (2.73%) (77 women and 34 men; mean age: 68.2 years; range: 35-91 years) had a total of 168 ED. The females had a 1.96 -fold higher prevalence of ED than the males (OR, 1.96; 95% CI, 1.481-2.59). The mean lesion thickness was found to be significantly greater in the female patients compared with the male patients (p = 0.001). The prevalence of the disease was estimated to be 4.98 times higher in patients aged 65 years or older (CI 95%, 3.25-7.36). In 111 ED patients, the lesions were only noted in 9 patients' initial radiology report. CONCLUSION: Here, we present a prevalence study with the largest population in the literature concerning ED. Our study shows that ED is not as uncommon as previously thought and should be especially suspected in females and older age groups. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

Correlation of 3-T MRI and CT findings with patient symptoms and treatment outcome in radiofrequency ablation of osteoid osteoma.

OBJECTIVE: The aim of this prospective study was to evaluate pre- and post-treatment MRI and CT findings of osteoid osteoma (OO) patients treated with radiofrequency thermo-ablation (RFTA) and to compare these findings with visual analog scale (VAS) scores. METHODS: Sixteen patients (4 females and 12 males; mean age of 18.87 ± 8.75 years (range: 8-37)) with OO were examined with CT and MRI, at baseline and at an average of 3 months following the procedure. On pre- and post-procedural CT and MRIs, OO-related findings were recorded. Treatment success was evaluated with VAS scores. RESULTS: Baseline VAS scores were 8 or 9 and follow-up scores were 0 or 1, indicating no early recurrences. Nidus diameters decreased significantly after the procedure (p = 0.027, p = 0.002, and p = 0.002; and p = 0.001, p = 0.001, p = 0.001 for AP, ML and CC nidus diameters for CT and MRI, respectively). The mean nidus volume were significantly decreased after the procedure (p = 0.001, for CT and MRI). On post-procedural images, cortical thickening, the signal intensity and contrast enhancement of the nidus and the extent of periostitis were significantly decreased (p = 0.019, p = 0.001, p = 0.001 and p = 0.034, respectively). There was no significant change in nidus calcification, perinidal cortical and intramedullary sclerosis, periosteal reaction, bone deformity, bone marrow and soft tissue edema, joint effusion and synovitis after the procedure (p = 0.253, p = 0.062, p = 0.245, p = 1, p = 1, p = 0.429, p = 0.371, p = 0.625, p = 1). CONCLUSION: Although the changes in imaging findings may be helpful in early follow-up of OO patients treated with RFTA, these changes alone cannot be used with accuracy in predicting treatment response. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Post-traumatic pneumocele of the frontal sinus.

A pneumocele is an abnormal dilatation of a paranasal sinus, most commonly affecting the frontal sinus. Although the etiology of pneumocele is not entirely known, several causative factors have been suggested including trauma, surgery, tumor and infection. We report here a case of post-traumatic pneumocele of the frontal sinus following a head trauma.

The relationship between the breast arterial calcification detected by mammography and the hypertensive retinopathy in hypertensive women.

OBJECTIVE: The purpose of this study was to investigate the relationship between the breast arterial calcification (BAC) detected by mammograms and the hypertensive retinopathy (HR) in hypertensive women who underwent ophthalmologic examination. MATERIALS AND METHODS: Screening mammography was performed in 99 hypertensive women and these women also underwent an ophthalmologic examination. The presence of arterial calcification and the number of calcified blood vessels in each breast were evaluated. The grade of HR was determined. The presence of BAC and the number of blood vessels involved was compared according to the presence of HR and the grade of HR. RESULTS: Among the 99 patients, HR was detected in 70 patients, and of these 70 patients, 42 patients had grade I HR and 28 had grade II HR. BAC was detected in 54 cases. Forty-six patients with HR (66%) and eight patients without HR (27%) were diagnosed with BAC after they underwent mammographic examination. The prevalence of BAC in the subjects who had HR was statistically higher than that in those subjects who did not have HR (p < 0.01). The grade of HR was not significantly associated with BAC (p > 0.05). The positive predictive value of the BAC detected on mammography for HR was 0.80 in those subjects who were > or = 60 years old. CONCLUSION: The detection of BAC by mammography is associated with an increased risk of HR, and particularly for patients after the age of 60. The findings of BAC may be related to hypertensive end-organ damage, and performing mammograms might contribute to predicting the presence of ophthalmologic hypertensive complications in these patients.

The interobserver agreement between residents and experienced radiologists for detecting pulmonary embolism and DVT with using CT pulmonary angiography and indirect CT venography.

OBJECTIVE: We wanted to prospectively evaluate the interobserver agreement between radiology residents and expert radiologists for interpreting CT images for making the diagnosis of pulmonary embolism (PE). MATERIALS AND METHODS: We assessed 112 consecutive patients, from April 2007 to August 2007, who were referred for combined CT pulmonary angiography and indirect CT venography for clinically suspected acute PE. CT scanning was performed with a 64x0.5 collimation multi-detector CT scanner. The CT studies were initially interpreted by the radiology residents alone and then the CT images were subsequently interpreted by a consensus of the resident plus an experienced general radiologist and an experienced chest radiologist. RESULTS: Two of the 112 CTs were unable to be interpreted (1.7%). Pulmonary artery clots were seen on 36 of the thoracic CT angiographies (32%). The interobserver agreement between the radiology residents and the consensus interpretation was good (a kappa index of 0.73). All of the disagreements (15 cases) were instances of overcall by the resident on the initial interpretation. Deep venous thrombosis was detected in 72% (26 of 36) of the patients who had PE seen on thoracic CT. The initial and consensus interpretations of the CT venography images disagreed for two cases (kappa statistic: 0.96). CONCLUSION: It does not seem adequate to base the final long-term treatment of PE on only the resident's reading, as false positives occurred in 13% of such cases. Timely interpretation of the CT pulmonary angiography and CT venography images should be performed by experienced radiologists for the patients with suspected PE.

Mazabraud's syndrome coexisting with a uterine tumor resembling an ovarian sex cord tumor (UTROSCT): a case report.

The association of intramuscular myxoma and fibrous dysplasia is a rare disease known as Mazabraud's syndrome. We present a case of Mazabraud's syndrome coexisting with a uterine tumor and resembling an ovarian sex cord tumor (UTROSCT). This uterine tumor showed a high mitotic index and cytological atypia. To the best of our knowledge, the coexistence of the two different entities has not been reported in the literature.

Variations in the popliteal artery branching in 342 patients studied with peripheral CT angiography using 64-MDCT.

PURPOSE: The objective of this study was to assess the utility of peripheral computed tomography angiography (CTA) using 64-multidetector computed tomography (64-MDCT) in the detection of variations in branching patterns of the popliteal artery. MATERIALS AND METHODS: The peripheral CTAs of 742 limbs in 342 patients who underwent peripheral CTA using 64-MDCT of the lower extremity due to various reasons were retrospectively reviewed. The anatomical variations in popliteal artery branching were assessed in 636 limbs from the same cohort of patients. RESULTS: Five hundred fifty-three (87 %) limbs had the usual branching pattern (type IA). Variations in the branching pattern of the popliteal artery were seen in 83 (13 %) limbs. The most common anatomical variation was trifurcation of the popliteal artery in 27 (4.2 %) limbs, with anterior tibial, posterior tibial, and peroneal arteries arising together with no true tibioperoneal trunk (type IB). CONCLUSION: The presence of variations in the anatomy of the popliteal artery could be of radiological and surgical importance in orthopedic interventions and various vascular surgery procedures. Peripheral CTA using MDCT is a suitable imaging modality for noninvasive evaluation of lower extremity arteries, and it may become the preferred method for evaluating variations in popliteal artery branching.

A novel KIF7 mutation in two affected siblings with acrocallosal syndrome.

Acrocallosal syndrome (ACLS) is a rare genetic disorder typically characterized by craniofacial dysmorphism, agenesis, or hypoplasia of the corpus callosum, and duplication of the phalanges of halluces and/or the thumbs. ACLS is a recessive ciliopathy caused by mutations in KIF7. We identified a Turkish family who had a novel homozygous sequence change, c.2593-2A>C, located at the acceptor splice site of intron 12 of KIF7 (IVS12-2A>C). The present report will contribute towards further understanding of the genotype-phenotype correlation in ACLS caused by KIF7 mutations.

Definition of a quantitative measurement method for acetabular version in a plain radiograph in the healthy adult hip.

OBJECTIVES: This study aims to define a quantitative measurement method for acetabular version in a standard anteroposterior hip radiograph, assess the intraobserver and interobserver agreements of this method, and compare it with the gold standard computed tomography (CT). PATIENTS AND METHODS: Anteroposterior standard hip radiographs and simultaneously taken transverse acetabular CT sections of 78 hips of 39 patients (10 males, 29 females; mean age 60 years; range 40 to 81 years) were used in the study. In standard anteroposterior hip radiographs, "acetabular anterior wall line" was identified as the line between the most lateral edge of the acetabulum and the inferolateral edge of the teardrop. "Acetabular posterior wall line" was identified as the line between the most lateral edge of the subchondral sclerosis and the outmost point of acetabulum posterior lunate surface sclerosis. To assess the reliability of this technique, mentioned angles in 78 hips were measured by two authors independently two weeks apart. Direct radiographic values were compared with the acetabular version measurement values in CT examination. RESULTS: Mean acetabular version angles of 78 hips in plain radiographs and CT were 18.0° (9-25°) and 17.2° (12-25°), respectively. Mean intraobserver measurement differences were 1.3° (0-5°) and 1.5° (0-6°). Mean interobserver measurement difference was 1.4° (0-5°). The mean difference between plain radiography measurements and CT measurements was 2.5° (0-6°). A significant correlation was detected between plain radiographic measurements and CT measurements. CONCLUSION: By this quantitative method, acetabular morphology may be measured less invasively, easily, quickly and reliably in plain radiograph in transverse plane.

Comparison of the symptomatic and chondroprotective effects of glucosamine sulphate and exercise treatments in patients with knee osteoarthritis.

OBJECTIVES: The aim of the present study was to evaluate the symptomatic effects of glucosamine sulphate (GS) in comparison to the exercise therapy, as well effects on Magnetic Resonance Imaging (MRI) findings of cartilage loss in patients with knee osteoarthritis (OA). MATERIALS AND METHODS: Seventy patients with a diagnosis of knee OA were randomly divided into two groups. First group of patients (n=40) were treated with 1500 mg/day oral glucosamine sulphate and the second group (n=30) performed a home exercise program for a period of 6 months. RESULTS: Compared with baseline, significant improvements were observed in the visual analogue scale pain scores and the Western Ontario and McMaster Universities osteoarthritis index and 20-min walking time in both groups (p< 0.001); there were no significant differences between the two treatment groups. Upon the evaluation of joint cartilage thickness by MRI, an improvement was evident in only in the area of medial femoral condyle of patients who had performed a home exercise program (p< 0.05). CONCLUSION: The results of the present study suggest that both oral GS treatment and exercise therapy are efficient in the symptomatic treatment of patients with knee OA. However, exercise therapy found to have a better chondroprotective effect than oral GS treatment in this patient population.

Imaging findings of an extradigital fibro-osseous pseudotumor.

Fibro-osseous pseudotumor (FOPT) is a rare and benign ossifying lesion. Described as the superficial variant of myositis ossificans (MO), this rare entity mostly occurs in the subcutaneous tissues of the digits. The FOPT clinicopathological features may mimic a variety of benign and malignant soft tissue lesions, and the diagnosis can be difficult when it arises in an unusual anatomic location. In this report we describe the clinical and radiological features of a case of an FOPT that involved the hypothenar region of the hand.

Recognition, assessment, and treatment of non-union after surgical fixation of fractures: emphasis on 3D CT.

For the post-operative patient, conventional axial computed tomography (CT) imaging and 2D multiplanar reconstruction are of limited value because of the beam-hardening artifact. However, three-dimensional (3D) CT imaging is an effective means of detecting subtle fracture healing, or confirming non-union, and for evaluating the integrity of metal hardware. In this article we emphasize the advantages of 3D CT imaging in the assessment and preoperative planning of non-union for patients who have been surgically treated for fractures.