Paroxysmal nocturnal hemoglobinuria-related thrombosis in the era of novel therapies: a 2043 patient/years analysis.

Thrombophilia is one of the principal features of paroxysmal nocturnal hemoglobinuria (PNH) and constitutes the main cause of disease morbidity/mortality. Anti-complement treatment has revolutionized the natural history of PNH with control of the hemolytic process and abolition of thrombotic events (TE). However, no guidelines exist for the management of thromboembolic complications in this setting, with type and duration of anti-coagulation depending on individual practices. Besides, a scarcity of data is present on the efficacy of direct oral anti-coagulants (DOACs). Herein, we accrued a large real-world cohort of PNH patients from four US centers to explore features, predictors of TE and anti-coagulation strategies. Among 267 patients followed-up for a total of 2043 patient/years, 56 (21%) developed TE. This occurred at disease onset in 43% of cases, involving more frequently the venous system, typically as Budd-Chiari syndrome. Rate of TE was halved in patients receiving complement inhibitors (21 vs 40 TE per 1000 patient/years in untreated cases, with a 2-year cumulative incidence of thrombosis of 3.9% vs 18.3% respectively), and varied according to PNH granulocytes and erythrocytes clone size, type, disease activity parameters, as well as number (>2 mutations or less) and variant allelic frequency of PIGA mutations. Anti-coagulation with warfarin (39%), DOACs (37%), and low-molecular-weight heparin (16%) was administered for a median of 29 months (9-61.8). No thrombotic recurrence was observed in 19 patients treated with DOACs at a median observation of 17.1 months (8.9-45) while 14 cases discontinued anti-coagulation without TE recurrence at a median time of 51.4 months (29.9-86.8).

MRI Features of Pelvic Nerve Involvement in Endometriosis.

Endometriosis is a common condition that mostly affects people assigned as female at birth. The most common clinical symptom of endometriosis is pain. Although the mechanism for this pain is poorly understood, in some cases, the nerves are directly involved in endometriosis. Endometriosis is a multifocal disease, and the pelvis is the most common location involved. Nerves in the pelvis can become entrapped and involved in endometriosis. Pelvic nerves are visible at pelvic MRI, especially when imaging planes and sequences are tailored for neural evaluation. In particular, high-spatial-resolution anatomic imaging including three-dimensional isotropic imaging and contrast-enhanced three-dimensional short inversion time inversion-recovery (STIR) fast spin-echo sequences are useful for nerve imaging. The most commonly involved nerves are the sciatic, obturator, femoral, pudendal, and inferior hypogastric nerves and the inferior hypogastric and lumbosacral plexuses. Although it is thought to be rare, the true incidence of nerve involvement in endometriosis is not known. Symptoms of neural involvement include pain, weakness, numbness, incontinence, and paraplegia and may be constant or cyclic (catamenial). Early diagnosis of neural involvement in endometriosis is important to prevent irreversible nerve damage and chronic sensorimotor neuropathy. Evidence of irreversible damage can also be seen at MRI, and radiologists should evaluate pelvic nerves that are commonly involved in endometriosis in their search pattern and report template to ensure that this information is incorporated into treatment planning.

Posteromedial Tibial Bone Bruise After Anterior Cruciate Ligament Injury: An MRI Study of Bone Bruise Patterns in 208 Patients.

Background: Bone bruise patterns after anterior cruciate ligament (ACL) rupture may predict the presence of intra-articular pathology and help explain the mechanism of injury. Lateral femoral condyle (LFC) and lateral tibial plateau (LTP) bone bruises are pathognomic to ACL rupture. There is a lack of information regarding medial tibial plateau (MTP) and medial femoral condyle (MFC) bone bruises. Purpose: To summarize the prevalence and location of MTP bone bruises with acute ACL rupture and to determine the predictors of MTP bone bruises. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Inclusion criteria were patients who underwent ACL reconstruction between February 2015 and November 2017, magnetic resonance imaging (MRI) within 90 days of injury, and participation in the database. Exclusion criteria included previous ipsilateral surgery, multiligamentous injuries, and incomplete imaging. Due to the large number of cases remaining (n = 600), 150 patients were selected randomly from each year included in the study, for a total of 300 patients. Two readers independently reviewed injury MRI scans using the Costa-Paz bone bruise grading system. Logistic regression was used to identify factors associated with MTP bone bruises. Results: Included were 208 patients (mean age, 23.8 years; mean body mass index, 25.6). The mechanism of injury was noncontact in 59% of injuries, with over half from soccer, basketball, and football. The median time from injury to MRI scan was 12 days. Of the 208 patients, 98% (203/208) had a bone bruise, 79% (164/208) had an MTP bone bruise, and 83% (172/208) had bruises in both medial and lateral compartments. The most common pattern, representing 46.6% of patients (97/208), was a bruise in all 4 locations (MFC, LFC, MTP, and LTP). Of the 164 MTP bruises, 160 (98%) involved the posterior third of the plateau, and 161 were grade 1. The presence of an MFC bruise was the only independent risk factor for an MTP bruise (odds ratio, 3.71). The resulting nomogram demonstrated MFC bruise, sport, and mechanism of injury were the most important predictors of an MTP bruise. Conclusion: MTP bruise after acute ACL rupture was as prevalent as lateral bruises. The presence of a posterior MTP bruise suggested anterior tibial translation at the time of injury and could portend more medial compartment pathology at the time of injury than previously recognized.

Incidental Adrenal Nodules in Patients Without Known Malignancy: Prevalence of Malignancy and Utility of Washout CT for Characterization-A Multiinstitutional Study.

BACKGROUND. Washout CT is commonly used to evaluate indeterminate adrenal nodules, although its diagnostic performance is poorly established in true adrenal incidentalomas. OBJECTIVE. The purpose of this study was to compare, in patients without a known malignancy history, the prevalence of malignancy for incidental adrenal nodules with unenhanced attenuation more than 10 HU that do and do not show absolute washout of 60% or more, thereby determining the diagnostic performance of washout CT for differentiating benign from malignant incidental adrenal nodules. METHODS. This retrospective six-institution study included 299 patients (mean age, 57.3 years; 180 women, 119 men) without known malignancy or suspicion for functioning adrenal tumor who underwent washout CT, which showed a total of 336 adrenal nodules with a short-axis diameter of 1 cm or more, homogeneity, and unenhanced attenuation over 10 HU. The date of the first CT ranged across institutions from November 1, 2003, to January 1, 2017. Washout was determined for all nodules. Reference standard was pathology (n = 54), imaging follow-up (≥ 1 year) (n = 269), or clinical follow-up (≥ 5 years) (n = 13). RESULTS. Prevalence of malignancy among all nodules, nodules less than 4 cm, and nodules 4 cm or more was 1.5% (5/336; 95% CI, 0.5-3.4%), 0.3% (1/317; 95% CI, 0.0-1.7%), and 21.1% (4/19; 95% CI, 6.1-45.6%), respectively. Prevalence of malignancy was not significantly different for nodules smaller than 4 cm with (0% [0/241]; 95% CI, 0.0-1.2%) and without (1.3% [1/76]; 95% CI, 0.0-7.1%) washout of 60% or more (p = .08) or for nodules 4 cm or larger with (16.7% [1/6]; 95% CI, 0.4-64.1%) and without (23.1% [3/13]; 95% CI, 5.0-53.8%) washout of 60% or more (p = .75). Washout of 60% or more was observed in 75.5% (243/322; 95% CI, 70.4-80.1%) of benign nodules (excluding pheochromocytomas), 20.0% (1/5; 95% CI, 0.5-71.6%) of malignant nodules, and 33.3% (3/9; 95% CI, 7.5-70.1%) of pheochromocytomas. For differentiating benign nodules from malignant nodules and pheochromocytomas, washout of 60% or more had 77.5% sensitivity, 70.0% specificity, 98.8% PPV, and 9.2% NPV among nodules smaller than 4 cm. CONCLUSION. Prevalence of malignancy is low among incidental homogeneous adrenal nodules smaller than 4 cm with unenhanced attenuation more than 10 HU and does not significantly differ between those with and without washout of 60% or more; wash-out of 60% or more has suboptimal performance for characterizing nodules as benign. CLINICAL IMPACT. Washout CT has limited utility in evaluating incidental adrenal nodules in patients without known malignancy.

Automated knee cartilage segmentation for heterogeneous clinical MRI using generative adversarial networks with transfer learning.

Background: This study aimed to build a deep learning model to automatically segment heterogeneous clinical MRI scans by optimizing a pre-trained model built from a homogeneous research dataset with transfer learning. Methods: Conditional generative adversarial networks pretrained on the Osteoarthritis Initiative MR images was transferred to 30 sets of heterogenous MR images collected from clinical routines. Two trained radiologists manually segmented the 30 sets of clinical MR images for model training, validation and test. The model performance was compared to models trained from scratch with different datasets, as well as two radiologists. A 5-fold cross validation was performed. Results: The transfer learning model obtained an overall averaged Dice coefficient of 0.819, an averaged 95 percentile Hausdorff distance of 1.463 mm, and an averaged average symmetric surface distance of 0.350 mm on the 5 random holdout test sets. A 5-fold cross validation had a mean Dice coefficient of 0.801, mean 95 percentile Hausdorff distance of 1.746 mm, and mean average symmetric surface distance of 0.364 mm. It outperformed other models and performed similarly as the radiologists. Conclusions: A transfer learning model was able to automatically segment knee cartilage, with performance comparable to human, using heterogeneous clinical MR images with a small training data size. In addition, the model proved robust when tested through cross validation and on images from a different vendor. We found it feasible to perform fully automated cartilage segmentation of clinical knee MR images, which would facilitate the clinical application of quantitative MRI techniques and other prediction models for improved patient treatment planning.

Extra-abdominal desmoid fibromatosis: Cryoablation versus traditional therapies.

PURPOSE: To retrospectively review the various methods used to treat extra-abdominal desmoid fibromatosis (EDF) at our institution to compare treatment response and complications with those for the emerging option of percutaneous cryoablation therapy. METHODS: A single-center retrospective review was conducted to identify patients with EDF who underwent some form of treatment for EDF in any combination (including medical therapy, surgery, percutaneous ablation and radiation therapy) at our institution between January 2007 and January 2020. Patients with pathological evidence of EDF and pretreatment and posttreatment images were included. Medical records and imaging data were also reviewed. Treatment response assessment was based on tumor size on follow-up imaging. RESULTS: A total of 41 patients (30 women; mean age, 34 y; range, 18-79 y) were included in the study. The extremities (44%) and back (22%) were the most common locations of EDF. Patients underwent a variety of treatment methods, including medical therapy (31 patients), surgery (24 patients), cryoablation (7 patients), radiation therapy (6 patients), and radiofrequency ablation (4 patients). Reduction in lesion size after at least 3 months of follow-up was most common in patients who underwent surgery alone (5 patients) or cryoablation (4 patients). Among all study patients, there were 10 minor complications and 3 major complications. Complication rates were lowest in patients who underwent cryoablation (no complications). CONCLUSION: Although further work is needed, the early data in this study offers promising results regarding the clinical application of cryoablation for EDF, which appears safer than radiofrequency ablation and a potentially effective.

Preoperative and Postoperative Magnetic Resonance Imaging of the Cruciate Ligaments.

The anterior cruciate ligament and posterior cruciate ligament are key stabilizers of the knee. Magnetic resonance (MR) imaging excels at depiction of injury in both the native and reconstructed cruciate ligaments as well as associated injuries. This article reviews the anatomy, injury patterns, and relevant surgical techniques crucial to making accurate interpretation of MR imaging of the cruciate ligaments.

Preoperative cryoablation of a hypervascular bone metastasis: A case of effective devascularization before preoperative embolization.

Image-guided cryoablation has become a common approach for the palliative treatment of painful metastatic bone lesions, and indications for this procedure have expanded to include local control of bone metastases. We report a case in which cryoablation was performed on a large hypervascular renal cell carcinoma bone metastasis before surgical fixation of an impending fracture. In this case, cryoablation reduced the patient's pain but also appeared to result in devascularization of the tumor, thus obviating the need for preoperative embolization. This case raises the possibility that image-guided cryoablation may represent an alternative to preoperative embolization for vascular tumors while also serving a palliative function.

Magnetic resonance imaging of deltoid muscle/tendon tears: a descriptive study.

OBJECTIVE: To describe the MRI features of deltoid tears and to evaluate tear characteristics in patient groups based on history of trauma and rotator cuff tear (RCT). MATERIALS AND METHODS: The records of patients who underwent shoulder MRI at our institution between July 2007 and June 2018 were retrospectively reviewed to identify deltoid tears, and patients were divided into groups based on history of recent trauma and presence of RCT. Images were reviewed to identify the location and size of the deltoid tear; the presence or absence of RCT, muscle atrophy, tendon retraction, humeral head subluxation, soft tissue edema, and additional pathologies were also noted. Medical records were reviewed for information about history of steroid injection, previous rotator cuff surgery, and treatments used. RESULTS: Among 69 patients with deltoid tears (45 men; mean age, 65.2 years; range, 19-89 years), patients with RCTs and no trauma had the highest frequency of deltoid tears in the middle portion (p = 0.005). Only patients with RCTs had undergone steroid injection or rotator cuff surgery. Two patients had deltoid tear without RCT and without recent trauma; these patients demonstrated evidence of calcific tendinopathy and chronic subacromial-subdeltoid bursitis. CONCLUSION: The middle (acromial) portion of the deltoid is more frequently affected in patients with RCTs than in those with trauma. Although deltoid tears are commonly associated with RCT, calcific tendinopathy and chronic bursitis may also be seen in patients with deltoid tears.

Specimen specific imaging and joint mechanical testing data for next generation virtual knees.

Virtual knees, with specimen-specific anatomy and mechanics, require heterogeneous data collected on the same knee. Specimen-specific data such as the specimen geometry, physiological joint kinematics-kinetics and contact mechanics are necessary in the development of virtual knee specimens for clinical and scientific simulations. These data are also required to capture or evaluate the predictive capacity of the model to represent joint and tissue mechanical response. This document details the collection of magnetic resonance imaging data and, tibiofemoral joint and patellofemoral joint mechanical testing data. These data were acquired for a cohort of eight knee specimens representing different populations with varying gender, age and perceived health of the joint. These data were collected as part of the Open Knee(s) initiative. Imaging data when combined with joint mechanics data, may enable development and assessment of authentic specimen-specific finite element models of the knee. The data may also guide prospective studies for association of anatomical and biomechanical markers in a specimen-specific manner.

Radiographic evaluation of knee osteoarthritis in predicting outcomes after arthroscopic partial meniscectomy.

BACKGROUND: Knee osteoarthritis (OA) severity is a predictor of outcomes after arthroscopic partial meniscectomy (APM). Magnetic resonance imaging (MRI) grading of OA is predictive of postoperative outcomes; this prospective study assessed whether radiographic grading is also predictive of outcomes. METHODS: Patients who underwent APM between February 2015 and January 2016, underwent radiography and MRI ≤6 months before surgery, and had outcomes from the surgery date and one year later were included. Surgical failure was defined as <10-point improvement in the Knee Osteoarthritis Outcome Score pain subscore. Radiographs were evaluated using Kellgren-Lawrence (KL) grading and continuous and ordinal minimum joint space width (mJSW) measurements; cartilage loss on MRI was evaluated using a modified Outerbridge system. Predictive abilities were estimated using area under the receiver operating characteristic curve (AUC) with 95% confidence intervals (CIs). RESULTS: The study cohort included 66 knees from 64 patients (32 women; mean age, 57.1 years; range, 45-77). Radiographic grading was not predictive of outcomes (KL, AUC = 0.541 [95% CI: 0.358, 0.724]; continuous mJSW, AUC = 0.482 [95% CI: 0.305, 0.659]; ordinal mJSW, AUC = 0.534 [95% CI: 0.433, 0.634]). Comparison of radiographs showing no joint space narrowing (KL grade 0-2) with corresponding MR images demonstrated that 48% of radiographs missed a clinically significant lesion (modified Outerbridge grade ≥ 3). MRI grading was predictive of outcomes (AUC = 0.720 [95% CI: 0.581, 0.859]). CONCLUSIONS: Radiographic grading of OA is not predictive of outcomes after APM; radiographs may miss clinically significant lesions. For outcome prediction, MRI should be used.

Combined Dual-Energy and Single-Energy Metal Artifact Reduction Techniques Versus Single-Energy Techniques Alone for Lesion Detection Near an Arthroplasty.

OBJECTIVE. The purpose of this study was to compare a combined dual-energy CT (DECT) and single-energy CT (SECT) metal artifact reduction technique with a SECT metal artifact reduction technique for detecting lesions near an arthroplasty in a phantom model. MATERIALS AND METHODS. Two CT phantoms with a cobalt chromium sphere attached to a titanium rod, simulating an arthroplasty, within a background of soft-tissue attenuation containing spherical lesions (range, 10-20 mm) around the head and stem of different attenuations from the background (range of attenuation, 10-70 HU) were scanned with a single CT scanner individually (unilateral) and together (bilateral) with the following three dose-equivalent techniques: the currently used clinical protocol (140 kVp, 300 Reference mAs); 100 kVp; and DECT (100 kVp and 150 kVp with a tin filter). Three radiologists reviewed the datasets to identify lesions. Nonparametric AUC was estimated for each reader with each technique. Multireader ANOVA was performed to compare AUCs. Multiple-variable logistic regression analysis was used to identify factors affecting sensitivity and specificity. RESULTS. Accuracy was lower (p < 0.001) for the DECT 130-keV technique than for the 100-, 70-, and 140-kVp techniques. Sensitivity was higher with unilateral arthroplasties (p = 0.037), with greater contrast differences from background (p < 0.001), and with the SECT 100-kVp technique versus other techniques (p < 0.001). The difference in specificities of modalities was not statistically significant (p = 0.148). CONCLUSION. Combining DECT and SECT techniques does not provide additional benefits for lesion detection as opposed to using SECT alone.

Comparison of Clinical and Semiquantitative Cartilage Grading Systems in Predicting Outcomes After Arthroscopic Partial Meniscectomy.

OBJECTIVE. Cartilage loss on preoperative knee MRI is a predictor of poor outcomes after arthroscopic partial meniscectomy. The purpose of this study was to compare the ability to predict outcomes after arthroscopic partial meniscectomy with a clinically used modified Outerbridge system versus a semiquantitative MRI Osteoarthritis Knee Score system for grading cartilage loss. MATERIALS AND METHODS. Patients who underwent preoperative knee MRI within 6 months of arthroscopic partial meniscectomy and who had outcomes available from the time of surgery and 1 year later were eligible for inclusion. Cases were evaluated by two radiologists and one radiology fellow with the use of both grading systems. The accuracy of each system in discriminating between surgical success and failure was estimated using the ROC curve (AUC) with 95% CIs. A Wald test was used to assess noninferiority of the clinical grading system. Interreader agreement regarding the accuracy of the grading systems in predicting outcomes was also compared. RESULTS. A total of 78 patients (38 women and 40 men; mean age, 56.6 years) were included in the study. A prediction model using clinical grading (AUC = 0.695; 95% CI, 0.566-0.824) was noninferior (p = 0.047) to a model using MRI Osteoarthritis Knee Score grading (AUC = 0.683; 95% CI, 0.539-0.827). Both MRI prediction models performed better than a model using demographic characteristics only (AUC = 0.667; 95% CI, 0.522-0.812). Inter-reader agreement with clinical grading (80.8%) was higher than that with MRI Osteoarthritis Knee Score grading (65.0%; p = 0.012). CONCLUSION. A clinically used system to grade cartilage loss on MRI is as effective as a semiquantitative system for predicting outcomes after arthroscopic partial meniscectomy, while also offering improved interreader agreement.

Bioabsorbable Versus Titanium Screws in Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft: A Prospective, Randomized Controlled Trial With 13-Year Follow-up.

BACKGROUND: Bioabsorbable screws for anterior cruciate ligament reconstruction (ACLR) have been a popular choice, with theoretical advantages in imaging and surgery. Titanium and poly-L-lactic acid with hydroxyapatite (PLLA-HA) screws have been compared, but with less than a decade of follow-up. PURPOSE/HYPOTHESIS: The purpose was to compare long-term outcomes of hamstring autograft ACLR using either PLLA-HA screws or titanium screws. We hypothesized there would be no difference at 13 years in clinical scores or tunnel widening between PLLA-HA and titanium screw types, along with high-grade resorption and ossification of PLLA-HA screws. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Forty patients undergoing ACLR were randomized to receive either a PLLA-HA screw or a titanium screw for ACL hamstring autograft fixation. Blinded evaluation was performed at 2, 5, and 13 years using the International Knee Documentation Committee score, Lysholm knee score, and KT-1000 arthrometer. Magnetic resonance imaging (MRI) was performed at 2 or 5 years and 13 years to evaluate tunnel volumes, ossification around the screw, graft integration, and cyst formation. Computed tomography (CT) of patients with PLLA-HA was performed at 13 years to evaluate tunnel volumes and intratunnel ossification. RESULTS: No differences were seen in clinical outcomes at 2, 5, or 13 years between the 2 groups. At 13 years, tibial tunnel volumes were smaller for the PLLA-HA group (2.17 cm3) compared with the titanium group (3.33 cm3; P = .004). By 13 years, the PLLA-HA group had complete or nearly complete resorption on MRI or CT scan. CONCLUSION: Equivalent clinical results were found between PLLA-HA and titanium groups at 2, 5, and 13 years. Although PLLA-HA screws had complete or nearly complete resorption by 13 years, tunnel volumes remained largely unchanged, with minimal ossification.

Bony changes of the tibia secondary to pes anserine bursitis mimicking neoplasm.

OBJECTIVE: To describe the radiological features of pes anserine bursitis with intramedullary extension and cortical scalloping and to determine the prevalence of these bony changes among patients with pes anserine bursitis. MATERIALS AND METHODS: Reports of knee magnetic resonance imaging (MRI) examinations performed at our institution between July 2007 and June 2017 in patients with pes anserine bursitis were retrospectively reviewed, and a total of 542 cases showing MR evidence of pes anserine bursitis were identified. From these, cases of pes anserine bursitis with intramedullary extension and cortical scalloping were identified. Two experienced musculoskeletal radiologists evaluated the MRI by consensus. The medical records of these patients were also reviewed. RESULTS: Eight patients were diagnosed with pes anserine bursitis with bony changes (prevalence, 1.47% [8 out of 542]), over the study period. All of these patients had a history of chronic knee pain. Seven patients also underwent radiography at the time of diagnosis; these images demonstrated variable appearances depending on the depth of the cortical scalloping and intramedullary extension. On MRI, all patients demonstrated a mass-like fluid extension around the pes anserine bursa and into the bone. None of the patients underwent biopsy; diagnosis was based on MRI features alone. CONCLUSION: Pes anserine bursitis with intramedullary extension is an unusual presentation of bursitis that may simulate a neoplasm clinically and radiologically. To avoid misdiagnosis, radiologists should be aware of the occurrence of osseous changes in the tibia confluent with pes anserine bursitis.

Upper extremity myxofibrosarcoma mimicking an erosive inflammatory arthritis: a case report.

Myxofibrosarcoma is a malignant fibroblastic soft tissue neoplasm containing a variable amount of myxoid stroma that commonly presents as a slow-growing mass in elderly patients. The neoplasm may be superficial or deep to the muscle fascia and characteristically has an infiltrative growth pattern with a dominant or multinodular mass. We describe an unusual case of high-grade myxofibrosarcoma of the wrist and forearm that infiltrated the muscles, tendons, and wrist joint, causing bone erosions. The tumor was mistakenly diagnosed as synovitis and a chronic, erosive, inflammatory process. The diffuse nature, absence of a dominant mass, and radiographic appearance complicated the diagnosis. Although neoplasms of the synovial spaces are rare, this case demonstrates that tumors with a highly infiltrative growth pattern can mimic inflammatory synovitis and that neoplasms should be considered in the differential diagnosis when clinical and laboratory features are discordant with the imaging appearance.

Does the Degree of the Mastoid Pneumatization Affect the Side of Bell Palsy?

OBJECTIVE: The aim is to investigate the impact of degree of mastoid pneumatization on the affected side of Bell palsy (BP). STUDY DESIGN: Retrospective study in tertiary academic hospital. METHODS: In total, 52 patients who were diagnosed with as BP were included in the study. Each patient was staged using House-Brackmann (HB) staging system. All patients underwent temporal bone computed tomography imaging. House-Brackmann scores, side of the BP, and mastoid pneumatization of all of patients were evaluated in the present study. RESULTS: Regarding the degree of the mastoid pneumatization, there were no significant differences between the affected side and the unaffected side (P = 0.439). The degree of the mastoid pneumatization of the affected side and the unaffected side did not differ between males and females (P = 0.918 for the affected side, P = 0.765 for the unaffected side, respectively). A negative correlation between the age and mastoid pneumatization of each side was found (P = 0.001, P = 0.025, respectively). There was no significant correlation between HB score and the degree of the mastoid pneumatization of each side (P = 0.789, P = 0.703). CONCLUSION: As a conclusion, the degree of the mastoid pneumatization is not one of the risk factors for BP. Further randomized studies with larger numbers of patients are needed to confirm these findings.

Do the Angle and Length of the Eustachian Tube Affect the Success Rate of Pediatric Cartilage Type 1 Tympanoplasty?

OBJECTIVES: To investigate the relationships between the angle and length of the Eustachian tube (ET) (the ETa and the ETl) and the success rates of pediatric type 1 tympanoplasty. STUDY DESIGN: A retrospective clinical chart review. METHODS: In total, 51 children (31 females and 20 males; average age, 11.92 ±â€Š3.46 years; age range: 7-18 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. In group A, all patients had intact grafts without perforation, retraction, or lateralization, and a dry ear, at 6 months postoperatively. In group B, reperforation of the tympanic membrane was evident 6 months postoperatively. The average ETa and ETl values of each group were measured on computed tomography images using a multiplanar reconstruction technique, and compared. RESULTS: The ETa values of diseased ears of males and females were, respectively, 26.60 ±â€Š6.42° and 23.29 ±â€Š6.51°, compared to 27.25 ±â€Š5.23° and 23.32 ±â€Š4.61° for normal male and female ears, respectively. In group A, the ETa was 26.46 ±â€Š6.82° in males and 22.95 ±â€Š7.50° in females. In group B, the ETa was 26.85 ±â€Š6.12° in males and 23.90 ±â€Š4.45° in females. In group A, the mean ETl was 41.0 mm (29.6-45.3 mm) in males and 37.9 mm (32.0-44.5 mm) in females. In group B, the mean ETl was 40.5 mm (30.5-47.1 mm) in males and 38.0 mm (32.8-45.0 mm) in females. In group A, the ETa value of diseased ears did not differ between females and males, but in normal ears, the ETa was higher in males than females (P = 0.020 and P < 0.05, respectively). In group B, no difference was evident between the ETa values of normal and diseased ears (P > 0.05). No difference in the ETl values of diseased and normal ears, in either group, was apparent between females and males (both P > 0.05). CONCLUSIONS: Neither the ETa nor the ETl affected the success rate of pediatric cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to compare anatomical outcomes after placement of various graft types and the effects of anatomical features of the ET on the success rate of pediatric tympanoplasty.