Volume and landmark analysis: comparison of MRI measurements obtained with an endorectal coil and with a phased-array coil.

AIM: To compare prostate volumes and distances between anatomical landmarks on MRI images obtained with a phased-array coil (PAC) only and with a PAC and an endorectal coil (ERC). MATERIALS AND METHODS: Informed consent was waived for this Health Insurance Portability and Accountability Act-compliant study. Fifty-nine men underwent PAC-MRI and ERC-MRI at 1.5 (n = 3) or 3 T (n = 56). On MRI images, two radiologists independently measured prostate volume and distances between the anterior rectal wall (ARW) and symphysis pubis at the level of the verumontanum; ARW and symphysis pubis at the level of the mid-symphysis pubis; and bladder neck and mid-symphysis pubis. Differences between measurements from PAC-MRI and ERC-MRI were assessed with the Wilcoxon RANK SUM test. Inter-reader agreement was assessed using the concordance correlation coefficient (CCC). RESULTS: Differences in prostate volume between PAC-MRI and ERC-MRI [median: -0.75 mm(3) (p = 0.10) and median: -0.84 mm(3) (p = 0.06) for readers 1 and 2, respectively] were not significant. For readers 1 and 2, median differences between distances were as follows: -10.20 and -12.75 mm, respectively, ARW to symphysis pubis at the level of the verumontanum; -6.60 and -6.08 mm, respectively, ARW to symphysis pubis at the level of the mid-symphysis pubis; -3 and -3 mm respectively, bladder neck to mid-symphysis pubis. All differences in distance were significant for both readers (p ≤ 0.0005). Distances were larger on PAC-MRI (p ≤ 0.0005). Inter-reader agreement regarding prostate volume was almost perfect on PAC-MRI (CCC: 0.99; 95% CI: 0.98-1.00) and ERC-MRI (CCC: 0.99; 95% CI: 0.99-1.00); inter-reader agreement for distance measurements varied (CCCs: 0.54-0.86). CONCLUSION: Measurements of distances between anatomical landmarks differed significantly between ERC-MRI and PAC-MRI, although prostate volume measurements did not.

Ultrasound in the selective screening of developmental dysplasia of the hip.

INTRODUCTION: Developmental dysplasia of the hip (DDH) can result in chronic pain, gait abnormalities and degenerative arthritis. Infants with a family history, Breech delivery or unstable/"clicking" of the hip on examination are at higher risk. The goal is to detect cases early enough for normal hip development and function by the end of adolescence, but clinical examination alone is ineffective. MATERIALS AND METHODS: All infants born at the West Middlesex University Hospital, Isle-worth, U.K., between 3/3/2005 and 21/10/2006 underwent prospective clinical screening to reveal risk factors of unstable hip on examination, family history of DDH and Breech delivery. Infants with risk factors underwent static and dynamic ultrasound of the hips (Harke's method with Terjesen measurements), performed by a consultant radiologist or sonographer. The infant was then examined by an Orthopaedic Surgeon who was blinded to the ultrasound findings until after creating a management plan. RESULTS: 5772 infants were born during the study period. 200 (3.5%) at-risk infants were identified, resulting in 400 hip ultrasounds. Following review of ultrasound findings, the majority of cases (163/200, 81.5%) lead to no change in management. Change in timing or type of clinical follow up occurred in 31 cases with normal ultrasounds and 20 cases with abnormal (immature hip) ultrasounds. Dysplasia was demonstrated in 6 infants (3%) on ultrasound, who were treated with Parvlik Harness. Of these, only 5 were detected on examination. Therefore, the ultrasound findings lead to 1 intervention with Parvlik Harness which would have otherwise gone undiagnosed from clinical examination. CONCLUSION: Whereas type and timing of follow up was adjusted in 18.5% of the at-risk infants, targeted screening of at-risk with ultrasound lead to only one intervention. This encourages discussion on the resource implication and viability of ultrasound screening, as only one from two hundred lead to an intervention.