Preauricular sulcus: Radiological incidence in the female gender in a multicultural population.

INTRODUCTION: The preauricular sulcus is a bony groove seen on the inferior aspect of the iliac bone. It is thought and accepted to be an indicator of female gender. To our knowledge, this study would be the first to examine the sulcal incidence in a multicultural population. To date, there are limited studies to also test the existing hypothesis that the sulcus is only seen in the female gender. The results of this study would be applicable to the field of forensic medicine and gender identification in the post-mortem setting. METHODS: Retrospective review of 500 adult pelvic X-ray radiographs (250 female and 250 male) obtained as part of routine medical care in a metropolitan public health service (encompassing three hospitals) was performed. The radiographs were examined by two post-FRANZCR examination senior registrars who recorded their results independently. RESULTS: The mean age of the female population was 70.1 years, and the mean age of the male population was 75.5 years. This study found that the preauricular sulcus is only present in the female pelvis. The incidence was 41.2% (103 of 250) in the examined female patient population. The sulcal incidence in this study was also found to be significantly higher than previously reported in prior studies. CONCLUSION: This study supports the previous notion that the presence of preauricular sulcus in a pelvic specimen would indicate the female gender. The absence of the sulcus does not necessarily confer the male gender.

Ability of malnutrition screening and assessment tools to identify computed tomography defined low muscle mass in colorectal cancer surgery.

BACKGROUND: Malnutrition and low muscle mass are independently associated with poor outcomes in colorectal cancer (CRC). However, tools to identify low muscle mass are limited in the clinical setting. We investigated the ability of existing malnutrition screening and assessment tools to identify low muscle mass assessed by computed tomography (CT). Secondary aims were to determine the feasibility of CT analysis and handgrip strength (HGS). METHODS AND ANALYSIS: An exploratory study of patients who underwent curative surgery for CRC between February and September 2019. Nutrition tools used included body mass index (BMI), Malnutrition Screening Tool (MST), and Patient-Generated Subjective Global Assessment (PG-SGA). Muscle mass was determined by preoperative CT image at the third lumbar vertebral level (L3), and muscle strength was determined by HGS dynamometry. Fisher's exact and Mann-Whitney U tests were used to compare results of nutrition tools with CT muscle assessment. RESULTS: In total, 57 patients were included. MST classified 18 patients (32%) as at risk of malnutrition, and PG-SGA classified 10 patients (17%) as malnourished. Fifty-one (90%) CT scans were analysable and 21 (47%) had low muscle mass. Of those with low muscle mass, PG-SGA classified 22 patients (92%) as well nourished and MST classified 17 patients (71%) as not being at nutrition risk. No tool was able to identify CT-diagnosed low muscle mass. Inability to complete HGS was associated with malnutrition (P = .001). CONCLUSION: In this cohort, nutrition screening and assessment tools did not identify CT-diagnosed low muscle mass. Feasible tools to identify low muscle mass in the clinical setting are required.

The association between sarcopenia and quality of life in patients undergoing colorectal cancer surgery: an exploratory study.

OBJECTIVE: To describe changes in health-related quality of life (QoL) from before colorectal cancer (CRC) surgery to 1 and 3-month post-surgery in patients diagnosed pre-operatively as sarcopenic or non-sarcopenic by computed tomography (CT) analysis. METHODS: Secondary analysis of a prospective observational cohort study with one pre-operative and two post-operative assessments. Patient-reported outcome measures (PROMs) were collected at each timepoint using Functional Assessment of Cancer Therapy-Colorectal and the EuroQol-5D (EQ-5D) questionnaires. Pre-operative staging CT scans of the third lumbar vertebra (axial slice) were analysed using Slice-O-Matic Software to determine if patients had CT defined sarcopenia by employing sex-specific threshold values for skeletal muscle index. Patient-reported outcome measure scores were compared with minimal clinical important difference estimates to determine if changes were clinically significant. RESULTS: Twenty-five of 40 patients were found to be sarcopenic. The difference between sarcopenic groups on the EQ-5D was medium-sized and clinically significant, with the sarcopenic group reporting lower health status. The non-sarcopenic group displayed a clinically significant reduction in physical wellbeing post-operatively. The sarcopenic group did not demonstrate a clinically important reduction in physical wellbeing. For functional wellbeing, the sarcopenic group recorded a clinically significant reduction at the 1-month timepoint, trending back towards baseline by the 3-month timepoint. The non-sarcopenic group recorded almost no change in functional scores. CONCLUSION: This study explored the novel concept of the effect of sarcopenia on QoL in the CRC surgical setting. Clinically significant changes were identified at both post-operative timepoints. This highlights an important proof of concept that PROMs can detect meaningful clinical change in CRC patients in the context of sarcopenia and should be further explored.

Does dual-energy computed tomography pulmonary angiography (CTPA) have improved image quality over routine single-energy CTPA?

INTRODUCTION: The aim of this study is to compare the diagnostic sensitivity between dual-energy computed tomography pulmonary angiography (CTPA) studies and routine single-energy CTPA studies. METHODS: A total of 117 patients with clinically suspected pulmonary embolism were examined with dual-energy CTPA (DECT) and reformatted single-energy multidetector CTPA (MDCT) studies. Two independent radiologists assessed the image quality of the CTPAs with objective and subjective parameters, including by assigning an image quality score out of 10 for each study. Dose length product and effective dose were also calculated and compared. RESULTS: The subjective image quality score for DECT and MDCT studies was 9.19 and 7.88, respectively; however, the increased level of detail in DECT may not be clinically applicable. Pulmonary artery filling defects were found in 12 patients, with no subjective diagnostic differences between dual-energy or single-energy studies with either radiologist. The effective dose for DECT ranged from 1.8 to 7.8 mSv. The effective dose for MDCT ranged from 1.2 to 6.4 mSv. CONCLUSIONS: Radiologists are trained to look at routine MDCTs with high specificity and sensitivity. DECTs do not appear to offer trained radiologists improved detection of clinically relevant pulmonary emboli.