Real-time elastography in differentiating metastatic from nonmetastatic liver nodules.

The study was designed to evaluate the role of real-time elastography in differentiating metastatic from nonmetastatic liver nodules, which include various benign lesions, hepatocellular carcinoma (HCC) nodules and lymphoma. Out of 1000 prospective patients who underwent abdominal ultrasound (US) examination, 48 patients had liver nodules. Nodule stiffness was determined by real-time elastography (ES) using color maps and shear wave velocity (SWV) and nodules having marked stiffness or SWV of more than 2.5 m/s were diagnosed as metastatic. The final diagnosis was made on fine needle aspiration cytology. No statistically significant differences were seen on elastomaps in the stiffness of metastatic and nonmetastatic nodules (p = 0.16) while SWV showed statistically significant differences in the strain velocities of benign, metastatic and heptocellular carcinoma nodules p < 0.0001 and < 0.008, respectively. At a cutoff value of SWV 2.5 m/s, the sensitivity, specificity and false positive to detect metastatic nodules by ES were 88%, 83% and 16%, respectively. When the SWV cut off value was set at 2.0 m/s the sensitivity, specificity and false positive were 94%, 70% and 29%, respectively. The study showed that estimation of SWV by ES at a cut off value of 2.5 m/s was a better and a more useful tool in diagnosing both solid and necrotic metastatic liver nodules compared with the color stiffness maps alone.

Mycobacterium kansasii and osteoarticular lesions.

Four patients with an unusual type of bone lesion are reported. The histological diagnosis in two of them was non-specific chronic inflammation and one case was diagnosed as chronic eosinophilic granuloma. On subjecting the material to culture Mycobacterium Kansasii (a photochromogen) were isolated. It is suggested that M. Kansasii are capable of producing osteoarticular lesions with a rather vague clinical and radiological picture not typical of osteoarticular tuberculosis.

Patellar angle in Osgood-Schlatter disease.

A new patellar angle is described in lateral radiographs of the knee joint. One line is drawn along the articular surface of the patella and another from the end of the inferior articular cartilage to the patellar apex. The angle formed by these two lines averaged 33 degrees in 68 knees joints afflicted with Osgood-Schlatter disease and 47 degrees in 71 age-matched controls and 198 adult controls. The small angle in Osgood-Schlatter disease is proposed to be an important factor in the pathogenesis of the traction apophysitis.