Radiographic scoliosis angle estimation: spline-based measurement reveals superior reliability compared to traditional COBB method.

INTRODUCTION AND OBJECTIVE: Although being standard for scoliosis curve size estimation, COBB angle measurement is well known to be inaccurate, due to a high interobserver variance in end vertebra selection and end plate contour delineation. We propose a stepwise improvement by using a spline constructed from vertebra centroids to resemble spinal curve characteristics more closely. To enhance precision even further, a neural net was trained to detect the centroids automatically. MATERIALS & METHODS: Vertebra centroids in AP spinal X-ray images of varying quality from 551 scoliosis patients were manually labeled by 4 investigators. With these inputs, splines were generated and the computed curve sizes were compared to the manually measured COBB angles and to the curve estimation obtained from the neural net. RESULTS: Splines achieved a higher interobserver correlation of 0.92-0.95 compared to manual COBB measurements (0.83-0.92) and showed 1.5-2 times less variance, depending on the anatomic region. This translates into an average of 1° of interobserver measurement deviation for spline-based curve estimation compared to 3°-8° for COBB measurements. The neural net was even more precise and achieved mean deviations below 0.5°. CONCLUSION: In conclusion, our data suggest an advantage of spline-based automated measuring systems, so further investigations are warranted to abandon manual COBB measurements.

Prognosis in myocardial infarction of young patients: Results of a prospective registry.

BACKGROUND: Myocardial infarction (MI) in young patients is rare. To address the gap in published all comers German studies concerning the clinical course and outcome of young patients aged ≤40 years with acute MI, the aim of this study was to identify differences between young and older, consecutive patients with MI and to compare these findings with previously published data. METHODS: This analysis used data of the prospective Dresden Myocardial Infarction Registry (1/2005-9/2014), an all comers, prospective registry in the department of Internal Medicine and Cardiology at the Heart Center Dresden, University Hospital Dresden. RESULTS: In total, data from 119 patients ≤40 years and 5754 patients >40 years were included in the analysis. In contrast to the older patients, younger patients were more often male (79.0% vs. 70.5%), smokers, had a positive family history for MI, lower educational qualifications, and lived alone. Young patients experienced more frequently STEMI than NSTEMI (70% vs. 30%), while the older patient group showed an equal distribution of infarction types (50% vs. 50%). The in-hospital mortality of young patients (2.5% vs. 7.6%) was lower. The survival rate of young patients in the 2-year follow-up was significantly higher (95% vs. 82.7%). Lifestyle modifications as part of secondary prevention were only moderately implemented. CONCLUSIONS: Compared to older patients, the outcome of young patients is significantly better and the acute event resolved without serious sequelae in most cases. Despite good cardiologic follow-up, implementation of secondary prevention was only moderate, indicating a need for more efficient patient education.