Characteristic of Apparent Diffusion Coefficient and Time Intensity Curve Analysis of Dynamic Contrast Enhanced MRI in Osteosarcoma Histopathologic Subtypes.

Background: According to WHO criteria, osteosarcoma (OS) consists of various histopathological subtypes. Thus, contrast-enhanced MRI is a very useful modality in the diagnosis and evaluation of osteosarcoma. Magnetic resonance imaging with dynamic contrast enhancement (DCE-MRI) studies was used to determine the apparent diffusion coefficient (ADC) value and the slope of the time-intensity curve (TIC). This study aimed to determine the correlation between ADC and TIC analysis using %Slope and maximum enhancement (ME) of histopathological osteosarcoma subtypes. Methods: This was a retrospective study with observational analysis on OS patients. The obtained data were 43 samples. Moreover, the interpretation was conducted by placing three regions of interest (ROI) in determining ADC value. It was observed by two radiologist observers with more than 10 years of experience. In this case, as many as six obtained ROIs were averaged. The inter-observer agreement was evaluated by Kappa test. TIC curve was analyzed and slope value was obtained afterward. Through SPSS 21 software, the data was analyzed. Results: The mean of ADC values of OS was (1.031x10-3±0.31mm2/s), where the highest value was found in chondroblastic subtype (1.470 x10-3±0.31mm2/s). However, the mean of TIC %slope of OS was (45.3%/s), where the highest result was found in the osteoblastic subtype (70.8%/s) followed by small cell subtype (60.8%/s) and the mean of ME of OS was 100.55% with the highest values was in osteoblastic subtype 172.72% followed by chondroblastic subtype (144.92%). This study found a significant correlation between the mean of ADC value and the OS histopathologic results as well as the correlation between the mean of ADC value and ME. Conclusion: The various types of osteosarcoma have a characteristic of radiological appearances which may similar to some bone tumor entities. The analysis of ADC values and TIC curves using % slope and ME of osteosarcoma subtypes can improve the accuracy of diagnosis as well as the monitoring of the treatment response and the disease progression.

Anthropometric study using three-dimensional pelvic CT scan in sex determination among adult Indonesian population.

This study aims to determine pelvic anthropometry characteristics and logistic regression formula for adult sex identification obtained from adult three-dimensional pelvic computed tomography images. This study was an observational analytical study with retrospective regression and cross-sectional approach. The population was all patients at Radiology Installation of Dr. Soetomo General Academic Hospital as referral hospital in East Indonesian region, from September to December 2019 who underwent 3D pelvic CT examination. Then, age distribution and pelvic measurements data were obtained. In this case, statistical analysis was conducted for all the data obtained. A number of 204 samples were included in this study. All radiologic components were also significantly different between sexes (p < 0.05) except for transverse diameter of sacral segment (p = 0.180). Moreover, the conjugate pelvic inlet diameter (CPID), the left innominate height (LIH), and sub pubic angle (SPA) showed significant values for regression formula to determine an adult's sex using 3D pelvic CT. The calculation result > 0 is a prediction for female while < 0 is a prediction for male. From logistic regression model calculation, a high validity value (91.05%) was found with 100% sensitivity to identify male sex and 81.1% specificity to identify female sex. There were differences on radiometric variable characteristics in pelvic anthropometric study among adult Indonesians at Dr. Soetomo General Academic Hospital, Surabaya. The estimated values of pelvic measurements using 3D CT images could develop a pelvic model with a regression formula with high accuracy value using CPID, LIH, and SPA values.

The incidence of osteopenia of prematurity in preterm infants without phosphate supplementation: A prospective, observational study.

ABSTRACT: To meet their requirements for bone mineralization, it is recommended that preterm infants receive nutritional support containing calcium and phosphate. There are no clear data on the incidence of osteopenia of prematurity (OFP) in preterm infants without phosphate supplementation.This study aimed to investigate the incidence of OFP in preterm infants without phosphate supplementation and its relationship with the duration of parenteral nutrition (PN).This was a prospective and observational study.This study included 30 infants aged <32 gestational weeks and weighed <1500 g at birth. All infants received PN according to a standard protocol, beginning on day 1 with calcium, without phosphate. Starting from the first day of life, all infants received human milk without fortifiers. Oral vitamin D (400 IU/d) was administered when enteral nutrition reached 100 mL/kg/d.The diagnosis of OFP was based on radiographs that were taken of both wrists. Serum alkaline phosphatase (ALP) was measured 3 times: at the start of PN (ALP 1), at the end of PN (ALP 2), and at discharge or the expected due date (ALP 3). Radiographs were obtained on the same day as ALP 3. The duration of PN was analyzed in the presence of OFP using receiver operating characteristic curve analysis.Among the 30 infants, 13 (43%) were diagnosed with OFP. The duration of PN was significantly longer in the OFP group than in the group without OFP (16 vs 12 days; P < .05). The provision of PN for >15 days significantly increased the risk of OFP (odds ratio, 5.40; 95% confidence interval, 1.12-26.04; P = .035).We found a high incidence of OFP in preterm infants without phosphate supplementation. An association was found between the duration of PN and the incidence of OFP. Further research is needed to prevent the development of osteopenia in preterm infants.

Associated neonatal and maternal factors of osteopenia of prematurity in low resource setting: A cross-sectional study.

OBJECTIVE: Determining neonatal and maternal factors that are associated with the incidence of OFP. METHODS: This study employed a cross-sectional design, in which the participants were identified for clinical variables (sex, gestational age, birth weight, etc.), neonatal morbidity (sepsis, necrotizing enterocolitis (NEC), etc.), and maternal risk factors (premature rupture of membranes, preeclampsia, etc.). The data were analyzed using Chi-square test, independent t-test, and logistic regression test with p < 0.05. RESULTS: The birth weight ranged from 800 to 1495 g (1219 ± 225 g), of which 5 newborns (17%) were <1000 g. The gestational age ranged from 27 to 32 weeks, with a mean of 29 ± 1.5 weeks. The signs of OFP were observed in 13 (43%) infants, of which 2 (15%) OFP infants had a birth weight <1000 g. There was significant difference in parenteral nutrition duration (p = 0.018), onset of vitamin D supplementation (p = 0.019), and ALP level (p = 0.012) of infants between the OFP group and the non-OFP group. The variables associated with the incidence of OFP were parenteral nutrition duration >15 days (OR = 5.4; 95% CI 1.120-26.044; p = 0.036), ALP level >500 U/L (OR = 2.889; 95% CI 1.703-4.900; p = 0.014), and PROM (OR = 5.4; 95% CI 1.039-28.533; p = 0.045). CONCLUSION: The lack of phosphate intake, prolonged parenteral nutrition, ALP level >500 U/L, onset of vitamin D supplementation, and premature rupture of membranes are associated with the incidence of OFP.

Correlation of quantitative diffusion weighted MR imaging between benign, malignant chondrogenic and malignant non-chondrogenic bone tumors with histopathologic type.

OBJECTIVES: This study aims to determine the diffusion on weighted imaging which may help in providing characterization of Apparent Diffusion Coefficient (ADC) values in benign, malignant chondrogenic and malignant non-chondrogenic bone tumors. MATERIAL AND METHODS: A retrospective study with 84 samples was conducted from October 2017 to December 2019. The samples consisted of 44 males and 40 females; the age range of 10-73 years (mean age of 32.7 years old). A Diffusion-weighted Magnetic Resonance (MR) utilizes a single-shot echo-planar imaging sequence technique with the 3T MR Scanner. We classified the types of tumors into benign, malignant chondrogenic and malignant non-chondrogenic bone tumors. The mean of ADC values from the area with lowest ADC values was selected for statistical analysis. ADC values were compared between benign, malignant chondrogenic and malignant non-chondrogenic bone tumors. Therefore, Receiver Operating Curve (ROC) analysis was done to determine optimal cut-off values. The correlation of ADC values between benign, malignant chondrogenic and malignant non-chondrogenic bone tumor with histopathologic type was also evaluated. RESULTS: The mean of ADC values from the area of benign, malignant chondrogenic and malignant non-chondrogenic bone tumor were 1.55 × 10-3 mm2/s, 1.84 × 10-3 mm2/s and 1.12 × 10-3 mm2/s respectively. As a matter of fact, there was a significant difference between benign and malignant bone tumor with cut-off value of 1.15 × 10-3 mm2/s and had a sensitivity of 82%, and a specificity of 92.3%. Moreover, a significant correlation was also found between ADC values with the histopathology type of bone tumors. CONCLUSION: The ADC values of benign and malignant (chondrogenic and non-chondrogenic groups) bone tumors are different. Thus, the measurement of ADC values improves the accuracy of the diagnosis of bone tumors.

Evolution of chest CT scan manifestations in a patient recovered from COVID-19 severe pneumonia with acute respiratory distress syndrome.

A male patient with severe pneumonia due to coronavirus disease 2019 (COVID-19) had acute respiratory distress syndrome (ARDS) which developed in the second week since the first symptoms and improved without mechanical ventilation. The patient had epilepsy as a comorbid disease and his routinely consumed antiepileptic drugs were likely to cause alterations of the immune system. Ground-glass opacity (GGO), consolidation, and reticular pattern are typical radiological features of COVID-19 pneumonia. Less common findings were septal thickening, bronchiectasis, pleural thickening, and subpleural involvement. These radiological abnormalities evolve throughout the course of the disease. In this case report, a GGO lesion was seen in thin-section CT scans on the 30th and 45th day since the onset of symptoms. The consolidation subsided with time and on the 65th day, minimal GGO was seen in CT scan without pulmonary fibrosis and bronchiectasis.

Advance MR evaluation of synchronous multifocal osteosarcoma with pathologic fracture.

OBJECTIVE: Synchronous multifocal osteosarcoma is a rare condition in which the osteosarcoma presents with multiple bone lesions at the time of diagnosis, usually without any visceral metastases. The first case was described in early 1930s by Silverman. To report a case of synchronous multifocal osteosarcoma in adolescent with pathologic fracture. METHODS: An 18-year-old girl presented with a painful mass in the right thigh of 4 months' duration and a history of thigh bone fracture a month ago. Patient's medical records and family history was unremarkable. Physical examination showed angulation and shortening at right femoral region with tenderness and swelling. Initial radiograph and magnetic resonance (MR) images showed multiple lesions in right femoral shaft and pelvic bone with primary tumor in right distal femur with pathologic fracture and multiple bone marrow lesions found in the contralateral bones. Imaging and histopathological results supported the diagnosis of synchronous multifocal osteosarcoma. After following the chemotherapy as the treatment of choice, the radiograph and MRI evaluation were done and showed reduction of the mass size with union of the destructed part with the formation of callus. The advance MRI revealed reduction of the overall mass and the composition of the viable area compared to previous study. The patient had satisfying response to chemotherapy series and a better functional outcome on subsequent visits. RESULTS: Diagnosis of synchronous multifocal osteosarcoma was based on patient and family history and finding of multiple lesions in the MR images, meanwhile the plain radiograph only revealed the primary tumor. Amstutz described multifocal osteosarcoma as presence of one primary tumor and several smaller lesions. Most recent reviews concluded that multifocal osteosarcoma is bone-to-bone metastatic process rather than multicentric origin. The limitation in this case was absence of thoracic CT which is suggested to rule out any pulmonary metastases instead of routine chest radiograph. CONCLUSION: Although satisfying improvement was clinically achieved, further advanced MRI would be indicated to evaluate the progression of tumor and its respond to therapy.

Quantitative Assessment of Abdominal Aortic Calcifications Using Lateral Lumbar Radiograph, Dual-Energy X-ray Absorptiometry, and Quantitative Computed Tomography of the Spine.

Abdominal aortic calcifications (AACs) represent an independent determinant of cardiovascular events and are strongly associated with cardiovascular disease. To our knowledge, a comparison between lateral lumbar radiography, lateral spine dual-energy x-ray absorptiometry (DXA), and quantitative computed tomography (QCT) in the assessment of AAC has not been performed. Our objective was to compare those methods in the detection and quantification of AAC using a simplified 8-point score system (AAC-8). Three hundred twenty-three postmenopausal women underwent lateral lumbar radiography, lateral spine DXA, and QCT for osteoporosis screening and were scored for AAC using the AAC-8. Lateral lumbar radiographs, lateral spine DXA, and QCT detected AAC in 58%, 55%, and 60% of the subjects, respectively. The nonparametric intraclass correlation coefficient between lateral lumbar radiograph and lateral spine DXA and lateral lumbar radiograph and QCT were 0.699 (95% confidence interval [CI]: 0.638-0.752) and 0.829 (95% CI: 0.783-0.865). Area under operating curve (receiver operating characteristic [ROC]) for lateral spine DXA was 0.826 (95% CI: 0.764-0.888), whereas for QCT was 0.948 (95% CI: 0.922-0.974) considering lateral lumbar radiograph as gold standard. AAC has been shown to be a significant predictive marker of overall cardiovascular disease. DXA may be a screening tool among asymptomatic patients with low radiation exposure to identify an important cardiovascular disease risk factor. QCT represents a reliable technique that may be applied as a future standard to facilitate the detection of abdominal aortic calcification as well as to provide more accurate measurement of bone densitometry.