Inorganic-Organic Double Network Ionogels Based on Silica Nanoparticles for High-Temperature Flexible Supercapacitors.

Herein, we demonstrate an inorganic-organic double network gel electrolyte consisting of a silica particle network and a poly-2-hydroxyethyl methacrylate network in which 1-butyl-3-methylimidazolium tetrafluoroborate ionic liquids are confined. The as-synthesized double network ionogel electrolytes exhibited high ion conductivity of 3.8 to 12.8 mS cm-1 over a wide temperature range of 30 to 150 °C and mechanical integrity with a maximum toughness of 1.8 MJ m-3 at 30 °C. These remarkable properties of the ionogel were associated with the formation of an optimal physical network of the silica nanoparticles in the colloidal dispersion. Accordingly, a flexible supercapacitor using ionogel electrolytes and reduced graphene oxide electrodes delivered energy and power densities of 48 Wh kg-1 and 4 kW kg-1, respectively, even at a high temperature of 120 °C, demonstrating excellent long-term stability that retains 93% of the initial capacitance even over 10,000 charge/discharge cycles at 120 °C.

Postoperative HbA1c Level as a Predictor of Rotator Cuff Integrity After Arthroscopic Rotator Cuff Repair in Patients With Type 2 Diabetes.

Background: In patients with type 2 diabetes mellitus (DM), preoperative glycosylated hemoglobin (HbA1c) is associated with outcomes after arthroscopic rotator cuff repair (ARCR); however, the relationship between outcomes and postoperative serum glycosylated hemoglobin (HbA1c) after ARCR has not been investigated. Purpose: To evaluate outcomes after ARCR in patients (1) with and without DM and (2) with DM according to their pre- and postoperative HbA1c levels. Study Design: Cohort study; Level of evidence, 3. Method: Included in this study were 148 patients without DM and 35 patients with type 2 DM who underwent ARCR between January 1, 2017, and December 31, 2019. Clinical and radiological outcomes were evaluated preoperatively and at the latest clinical follow-up. Postoperative magnetic resonance imaging was performed after 12 months. In patients with type 2 DM, HbA1c levels were evaluated preoperatively as well as 6 and 12 months postoperatively; patients with an HbA1c level of ≥7% were defined as having uncontrolled DM. Multivariate logistic regression analyses were performed to determine the factors for retears after ARCR. Results: The retear rates after ARCR were 22.9% (8/35) and 16.9% (25/148) in patients with and without DM, respectively. The retear rates were significantly higher in the 6-month postoperative uncontrolled DM group than in the controlled DM and non-DM groups (50% vs 8.7% and 16.8%; P < .05). The odds ratio for retears in the postoperative uncontrolled DM group was 5.555 (P =0.01) compared with the non-DM group. Among the patients with DM, in the uncontrolled DM group, 6-month postoperative hyperglycemia was superior in accuracy, sensitivity, and specificity for predicting retears after ARCR than preoperative hyperglycemia (77.1% vs 62.9%, 75% vs 37.5%, and 77.8% vs 70.4%, respectively). Conclusion: This study demonstrated the association between uncontrolled postoperative DM and an increased risk of retears compared with no DM or controlled DM. Furthermore, postoperative HbA1c values were correlated more closely with the risk of retears than preoperative HbA1c values.

Patient Acceptable Symptom State, Minimal Clinically Important Difference, and Substantial Clinical Benefit After Arthroscopic Superior Capsular Reconstruction.

BACKGROUND: Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) have rarely been assessed after arthroscopic superior capsular reconstruction (ASCR) with fascia lata autograft. PURPOSE: (1) To investigate PASS, MCID, and SCB values for pain visual analog scale (pVAS), American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Single Assessment Numeric Evaluation (SANE) after ASCR with fascia lata autograft, (2) to investigate factors for achieving PASS, MCID, and SCB. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: We retrospectively collected data from patients who underwent ASCR between June 2013 and October 2020. A total of 88 patients were included, and anchor questions for deriving PASS, MCID, and SCB values were applied at a minimum 1-year follow-up postoperatively. PASS, MCID, and SCB were derived using sensitivity- and specificity-based approaches. Univariable and multivariable logistic regression analyses were performed to determine factors for achieving PASS, MCID, and SCB. RESULTS: Based on receiver operating characteristic curves, all 4 scores had acceptable area under the curve values (>0.7) for PASS, MCID, and SCB values. The PASS, MCID, and SCB values were 1.5, 2.5, and 4.5 for pVAS; 81.0, 19.0, and 27.5 for the ASES score; 60.5, -0.5, and 5.5 for the Constant score; and 75.0, 27.5, and 32.5 for SANE, respectively. Poor preoperative scores were related to significantly higher odds ratios (ORs) for achieving MCID and SCB. Wide acromiohumeral distance and dominant side were related to higher ORs for achieving PASS for the ASES score, and subscapularis tear was related to lower ORs for achieving PASS for pVAS and SCB for the Constant score. CONCLUSION: Reliable PASS, MCID, and SCB values were achieved for at least 1 year after ASCR surgery. Poor preoperative score, wide acromiohumeral distance, and dominant side all demonstrated higher ORs for at least one value, but a subscapularis tear demonstrated lower ORs for achieving PASS for pVAS and SCB for the Constant score.

The Patient Acceptable Symptom State as a Predictor of the Sports Activity Available State After Arthroscopic Rotator Cuff Repair.

Background: The patient acceptable symptom state (PASS) has emerged as a metric for evaluating patient satisfaction after treatment. There is little research on the relationship between sports activity and PASS values after arthroscopic rotator cuff repair (ARCR). Purpose: To (1) introduce the sports activity available state (SAAS) as an indicator of whether sports activities are possible based on patient symptoms after ARCR, (2) investigate the correlation between the SAAS and PASS, (3) predict the SAAS using derived PASS values, and (4) identify factors for achieving the PASS and SAAS. Study Design: Case-control study; Level of evidence, 3. Methods: Included were 201 patients who underwent ARCR between January 2015 and December 2016. At a mean follow-up of 38.7 ± 7.0 months, anchor questions were used to classify patients as SAAS+ (sports group) or SAAS- (nonsports group) and derive the PASS values for the pain visual analog scale (pVAS), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE). The authors analyzed the correlation and difference between PASS and SAAS acquisition, and univariate and multivariate logistic regression analyses were performed to determine factors for PASS and SAAS achievement. Results: The final PASS values for the pVAS, ASES, and SANE were 0.5, 93.5, and 82.5, respectively. A significant correlation existed between PASS and SAAS acquisition (phi correlation coefficient, 0.647; P < .001). Sensitivity and specificity were >0.7 for all outcome scores when predicting SAAS using PASS values. A higher preoperative ASES score was significantly associated with achieving both the SAAS (OR, 1.032 [95% CI, 1.005-1.059]; P = .018) and PASS (OR, 2.556 [95% CI, 1.753-3.726]; P < .001). Diabetes (OR, 0.348 [95% CI, 0.130-0.931], P = .036) and a large to massive tear (OR, 0.378 [95% CI, 0.162-0.884]; P = .025) were significantly negatively associated with achieving the SAAS. Conclusion: The authors found the SAAS to be significantly correlated with the PASS. Also, SAAS was able to be predicted using the PASS value. Patients with higher preoperative ASES scores had higher odds of achieving both the PASS and SAAS, and patients with diabetes and those with large to massive tears had lower odds of achieving the SAAS.

Retear bigger than preoperative tear size would lead to treatment failure after rotator cuff repair.

BACKGROUND: This study aimed to (1) define treatment failure using the referred patient acceptable symptomatic state (PASS) values for pain visual analog scale (PVAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Single Assessment Numeric Evaluation (SANE) clinical scores and (2) identify the factors that lead to patient dissatisfaction after arthroscopic rotator cuff repair (ARCR). METHODS: We analyzed the arthroscopic rotator cuff surgery registry data from January 2015 to December 2016. Patients were followed for ≥2 years and categorized as dissatisfied or satisfied based on our own definition of treatment failure at 2 years postoperatively. For defining treatment failure, the referred PASS values for the PVAS, ASES, and SANE scores were used. Patients who failed to attain the PASS value for the PVAS, ASES, or SANE score were categorized into the dissatisfied group. Pre- and postoperative imaging and basic demographic data were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify the factors affecting patient satisfaction at 2 years after rotator cuff repair. RESULTS: Of 117 patients, 30 (25.6%) were defined as the dissatisfied group (mean follow-up period, 37.5 months). Seventeen patients (14.5%) had confirmed retear on follow-up magnetic resonance imaging. In the univariate analysis, sex significantly differed between the groups (female, satisfied vs. dissatisfied groups: 39 [44.8%] vs. 22 [73.3%]; P = .010). Retear alone did not affect patient satisfaction in the univariate analysis (P = .11). Progressed retear size featured a significantly higher risk of patient dissatisfaction (P = .024; odds ratio 6.430, 95% confidence interval 1.270-32.541) in the multivariable analysis using symptom duration, sex, preoperative ASES score, preoperative tear size, retear, and progressed retear size as variables. Moreover, female sex had an increased odds for dissatisfaction (odds ratio 4.646, 95% confidence interval 1.590-13.578; P = .005). CONCLUSION: Two years after ARCR, most patients (74.4%) reported satisfaction with their outcomes. However, satisfaction levels can be altered by female sex or progressed retear size compared with the preoperative state.

Postoperative Pain Control After Arthroscopic Rotator Cuff Repair: Arthroscopy-Guided Continuous Suprascapular Nerve Block Versus Ultrasound-Guided Continuous Interscalene Block.

PURPOSE: To compare the clinical efficacy and safety of arthroscopy-guided continuous suprascapular nerve block and ultrasound-guided continuous interscalene block in postoperative analgesia in patients undergoing arthroscopic rotator cuff repair. METHODS: A prospective study was performed between March and November 2020. In total, 76 patients were enrolled and divided into 2 groups: in the 38 patients of group 1 (arthroscopy-guided continuous suprascapular nerve block), an indwelling catheter was introduced via the Neviaser portal under arthroscopic view before closing the portal at the end of the surgery; and in the 38 patients of group 2 (ultrasound-guided continuous interscalene block), an indwelling catheter was inserted and directed toward the interscalene brachial plexus prior to the surgery under ultrasound guidance. The primary outcome was the pain score measured by the visual analog scale at postoperative 24 hours during admission. Comparisons were conducted at different time points (postoperative 4, 8, 24, and 48 hours). The secondary outcome was any of these events: neurologic complications, such as sensory/motor change in the upper extremities; hemidiaphragmatic paresis; dyspnea; dysphonia; and Horner's syndrome. Opioid usage until postoperative 3 weeks was compared between the groups. RESULTS: The visual analog scale scores in groups 1 and 2 were comparable at each postoperative time point (analysis of variance, P = .919; trends, P = .132). Neurologic deficits were more common in group 2 than in group 1 (8 vs 32 patients, P < .001). Decreased excursion of the diaphragm was more common in group 2 (partial or complete paresis of the hemidiaphragm: 1 vs 29 patients, P < .001). Opioid consumption was similar in both groups (morphine milligram equivalents per kilogram; 1.75 vs 1.55, P = .195). CONCLUSIONS: Our findings show that arthroscopy-guided continuous suprascapular nerve block is not inferior to ultrasound-guided continuous interscalene block for postoperative pain control after arthroscopic rotator cuff repair while showing fewer temporary neurologic complications. LEVEL OF EVIDENCE: Level II, prospective cohort study, interventional study.

Poor Prognostic Factors in Patients With Rotator Cuff Retear.

BACKGROUND: The treatment for retears after arthroscopic rotator cuff repair (ARCR) has long been a challenge. PURPOSE: This study aimed to (1) summarize the characteristics of patients with a retear after primary ARCR and (2) determine the risk factors for poor clinical outcomes after a retear. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We collected the data of patients with a retear after primary ARCR between January 2011 and December 2016. There were 45 patients with retears included (19 men [42.2%] and 26 women [57.8%]; mean ± SD age, 63.11 ± 8.87 years). Initially, the demographic and outcome data of patients with a retear were analyzed. Patients were classified into good and poor outcome groups according to their overall satisfaction at final follow-up. Univariable and multivariable logistic regression analyses were performed to determine the factors for poor clinical outcomes after a retear. RESULTS: A total of 31 patients were classified into the good outcome group, and 14 patients were classified into the poor outcome group. Both the good and the poor outcome groups showed that clinical scores significantly improved at the time of the retear diagnosis, but the final scores were maintained or worse compared with scores at the time of the retear diagnosis. Final range of motion (ROM), except external rotation in the good outcome group, was worse or had no significant change compared with ROM at the time of the retear diagnosis. On multivariable logistic regression analysis, current smoking (odds ratio [OR], 45.580 [95% CI, 3.014-689.274]; P = .006), female sex (OR, 32.774 [95% CI, 2.433-441.575]; P = .009), and retears of the same or larger size than the initial tear (OR, 10.261 [95% CI, 1.544-68.202]; P = .016) showed a higher OR for poor clinical outcomes after a retear. CONCLUSION: Smoking, female sex, and retears of the same or larger size than the initial tear were independent risk factors for poor clinical outcomes after a rotator cuff retear. Final clinical scores and ROM were similar or worse compared with the scores and ROM at the time of the retear diagnosis. Therefore, revision surgery should be actively considered in female patients or those who smoke with poor clinical outcomes and a larger retear size than the preoperative tear size at the time of the retear diagnosis.

Determination of the patient acceptable symptomatic state after osteocapsular arthroplasty for primary elbow osteoarthritis.

BACKGROUND: The study aimed (1) to determine patient acceptable symptomatic state (PASS) values for the pain visual analog scale (PVAS), range-of-motion (ROM) scale difference, Mayo Elbow Performance Score (MEPS), and Self-evaluation Elbow (SEE) following osteocapsular arthroplasty for primary elbow osteoarthritis and (2) to determine factors for achieving the PASS. METHODS: The study analyzed retrospectively collected osteocapsular arthroplasty registry data from January 2010 to April 2019. Fifty patients were evaluated, and anchor questions for deriving PASS values were administered at a 1-year follow-up. PASS values for the PVAS score, ROM difference, MEPS, and SEE score were derived using a sensitivity- and specificity-based approach. Univariate and multivariate logistic regression analyses were performed to determine factors for achieving the PASS. A subgroup comparison analysis based on age was also conducted. RESULTS: The PASS value was 1.0 for the PVAS score, 15° for ROM difference, 75 for the MEPS, and 60 for the SEE score. Older age (≥65 years) showed significantly lower odds ratios for achieving the PASS for the PVAS score (0.888; 95% confidence interval, 0.804-0.981; P = .032) and ROM (0.861; 95% confidence interval, 0.760-0.976; P = .020). CONCLUSION: Reliable PASS values were derived for the PVAS score, ROM difference, MEPS, and SEE score after osteocapsular arthroplasty. The PASS values defined in this study can be implemented as clinically relevant targets in patients undergoing osteocapsular arthroplasty. An analysis of factors that affect clinical symptom improvement showed that older age (≥65 years) was significantly correlated with lower PASS values for the PVAS score and ROM.

Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State After Arthroscopic Rotator Cuff Repair.

BACKGROUND: Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) are emerging criteria for patient-based treatment assessments. However, few studies have investigated these measures after rotator cuff repair. PURPOSE: (1) To determine MCID, SCB, and PASS values for pain visual analog scale (pVAS), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, and University of California, Los Angeles (UCLA) score after arthroscopic rotator cuff repair. (2) To determine factors for achieving the MCID, SCB, and PASS. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: We analyzed prospectively collected data from a rotator cuff surgery registry between March 2018 and February 2019. Eighty-two patients were included, and anchor questions for deriving MCID, SCB, and PASS values were applied at 1-year follow-up after the surgery. The MCID and SCB for the pVAS, ASES, SANE, and UCLA scores were then derived via 2 methods: a sensitivity- and specificity-based approach, which was used alone to derive PASS values, and a between-patients approach. Additionally, univariable and multivariable logistic regression analyses were performed to determine factors for achieving the MCID, SCB, and PASS. RESULTS: All 4 scores showed acceptable areas under the curve. MCID, SCB, and PASS values for the pVAS were 1.5, 2.5, and 1.7; for ASES scores, 21.0, 26.0, and 78.0; for SANE, 13.0, 20.0, and 71.0; and for UCLA scores, 6.0, 8.0, and 23.0, respectively. Poor preoperative scores demonstrated significantly higher odds ratios (ORs) for achieving the MCID and SCB and lower ORs for achieving the PASS. Retear, large to massive tear, and older age showed lower ORs for achieving the MCID or SCB. For PASS items, male sex and biceps tenodesis had higher ORs, and older age had lower ORs. MCID, SCB, and PASS values per the sensitivity- and specificity-based approach were applied in factor analyses. CONCLUSION: Reliable MCID, SCB, and PASS values were obtained from patient evaluations 1 year after arthroscopic rotator cuff surgery. Poor preoperative score (MCID and SCB), male sex, and biceps tenodesis showed higher ORs, whereas poor preoperative score (PASS), retear, large to massive tear, and older age demonstrated lower ORs.

Clinical and Imaging Outcomes After Revision Open Rotator Cuff Repair: A Retrospective Review of a Midterm Follow-Up Study.

BACKGROUND: Revision open rotator cuff repair (ORCR) has been associated with unpredictable functional outcome with concerns of deltoid detachment. The aim of this study was to evaluate the clinical and imaging outcomes of revision ORCR. MATERIALS AND METHODS: The study retrospectively reviewed 30 consecutive patients (mean age 60.4 ± 7.2 years) who underwent revision ORCR after failed rotator cuff repair. Pain visual analog scale (VAS), Constant and American Shoulder Elbow Surgeon (ASES) score were assessed preoperatively and at mean 58-month follow-up (range 24-120 months). The acromio-humeral distance (AHD) was measured on pre- and postoperative radiograph. Tear size and fatty infiltration of rotator cuff were evaluated by preoperative magnetic resonance imaging (MRI) study. The retear rate, change of fatty infiltration and deltoid origin integrity were evaluated by postoperative MRI. RESULTS: There was significant improvement of pain VAS and functional outcome scores (all p < 0.001). AHD showed no significant change after surgery. On postoperative MRI, the retear rate was 43% (13/30). However, the size of the tendon defect was smaller than that of pre-revision tear (p = 0.006). The patients who had intact tendon had significantly better functional outcomes than those with retear. The intact group had significantly higher AHD both pre- and postoperatively than the retear group. There was no change of fatty infiltration after surgery. Four patients (13%, 4/30) showed thinning of deltoid origin on postoperative MRI, but showed no weakness on clinical examination. CONCLUSION: Revision ORCR resulted in improved outcomes in pain relief and shoulder function, with low rate of subclinical deltoid thinning.

Interfacially Polymerized Polyamide Interlayer onto Ozonated Carbon Nanotube Networks for Improved Stability of Sulfur Cathodes.

Lithium-sulfur (Li-S) batteries are considered promising energy-storage devices owing to the high specific capacity and low cost of the S cathode. However, they suffer from capacity decay and poor coulombic efficiency arising from the dissolution of long-chain polysulfides and their shuttling. A facile and scalable method was developed to directly coat a thin (≈57.3 nm) and porous polyamide (PA) interlayer onto a S cathode by interfacial polymerization. This PA interlayer prevented the shuttling of polysulfides by creating a physical barrier and, through chemical interactions between the amide functionalities of PA and the polysulfides, allowing access to the S electrode by the Li ions. The resulting PA-coated cathode exhibited approximately 64.2 % capacity retention over 1000 cycles at 1 C with only 0.0358 % decay per cycle and a moderate capacity of 1008 mAh g-1 at 0.1 C.

Diagnostic performance of static single-scan stress perfusion cardiac computed tomography in detecting hemodynamically significant coronary artery stenosis: a comparison with combined invasive coronary angiography and cardiovascular magnetic resonance-myocardial perfusion imaging.

Background Non-invasive anatomical and physiological evaluations of coronary artery disease (CAD) may be obtained with static single-scan stress perfusion cardiac computed tomography (SSPCT). Purpose To determine the diagnostic performance of static SSPCT for identifying hemodynamically significant CAD. Material and Methods This prospective study included 29 patients with suspected or known CAD who underwent static SSPCT, cardiovascular magnetic resonance myocardial perfusion imaging (CMR-MPI), and invasive coronary angiography (ICA). CT was performed as follows: (i) coronary calcium scan; (ii) static SSPCT for both coronary artery (coronary CT angiography [CCTA]) and myocardial perfusion (perfusion CT [PCT]) during adenosine infusion; (iii) late-phase scan. The diagnostic performance of CCTA alone, PCT alone, and SSPCT for the detection of a hemodynamically significant CAD (a perfusion defect in a vascular territory subtended by a coronary vessel with ≥ 50% stenosis) was compared with that of combined ICA/CMR-MPI representing the standard of reference. Results Twenty-three (79%) patients and 47 (54%) vascular territories manifested ischemia-causing coronary stenoses by combined ICA/CMR-MPI. The per-vessel sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) of the SSPCT were 92%, 88%, 90%, 90%, and 0.90, respectively, compared to those of the combined ICA/CMR-MPI. These values for the CCTA alone were 96%, 63%, 75%, 93%, and 0.79, respectively; and the values for the PCT alone were 94%, 83%, 86%, 92%, and 0.88, respectively. The AUC of SSPCT was significantly ( P = 0.013) higher than that of the CCTA alone. Conclusion Static SSPCT may facilitate detection of hemodynamically significant CAD.

Indirect CT Venography at 80 kVp with Sinogram-Affirmed Iterative Reconstruction Compared to 120 kVp with Filtered Back Projection: Assessment of Image Quality and Radiation Dose.

OBJECTIVE: To evaluate the image quality and radiation dose of indirect computed tomographic venography (CTV) using 80 kVp with sinogram-affirmed iterative reconstruction (SAFIRE) and 120 kVp with filtered back projection (FBP). MATERIALS AND METHODS: This retrospective study was approved by our institution and informed consent was waived. Sixty-one consecutive patients (M: F = 27: 34, mean age 60 ± 16, mean BMI 23.6 ± 3.6 kg/m2) underwent pelvic and lower extremity CTVs [group A (n = 31, 120 kVp, reconstructed with FBP) vs. group B (n = 30, 80 kVp, reconstructed with SAFIRE)]. The vascular enhancement, image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were compared. Subjective image analysis for image quality and noise was performed by two radiologists. Radiation dose was compared between the two groups. RESULTS: Compared with group A, higher mean vascular enhancement was observed in the group B (group A vs. B, 118.8 ± 15.7 HU vs. 178.6 ± 39.6 HU, p < 0.001), as well as image noise (12.0 ± 3.8 HU vs. 17.9 ± 6.1 HU, p < 0.001) and CNR (5.1 ± 1.9 vs. 7.6 ± 3.0, p < 0.001). The SNRs were not significantly different in both groups (11.2 ± 4.8 vs. 10.8 ± 3.7, p = 0.617). There was no significant difference in subjective image quality between the two groups (all p > 0.05). The subjective image noise was higher in the group B (p = 0.036 in reader 1, p = 0.005 in reader 2). The inter-observer reliability for assessing subjective image quality was good (ICC 0.746~0.784, p < 0.001). The mean CT dose index volume (CTDIvol) and mean dose length product (DLP) were significantly lower in group B than group A [CTDIvol, 6.4 ± 1.3 vs. 2.2 ± 2.2 mGy (p < 0.001); DLP, 499.1 ± 116.0 vs. 133.1 ± 45.7 mGy × cm (p < 0.001)]. CONCLUSIONS: CTV using 80 kVp combined with SAFIRE provides lower radiation dose and improved CNR compared to CTV using 120 kVp with FBP.

Color radiography in lung nodule detection and characterization: comparison with conventional gray scale radiography.

BACKGROUND: To compare the capability of lung nodule detection and characterization between dual-energy radiography with color-representation (DCR) and conventional gray scale chest radiography (GSR). METHODS: A total of 130 paired chest radiographs (DCR and GSR) obtained from 65 patients (14 with normal scans and 51 with pulmonary nodules) were evaluated. After analysis, 45 non-calcified and 21 calcified nodules were identified. DCR was obtained by adding color space within material-decomposed data (blue for high attenuation and red for low attenuation) and by compounding the manipulated data to one color image. Three radiologists marked suggested nodules on radiographic images and assessed the level of confidence of lesion presence and probability of nodule calcification by using a nine-point rating scale. The jackknife active free-response receiver operating characteristics (JAFROC) analysis was used to evaluate lesion detectability, and multi-reader multi-case receiver operating characteristics (MRMC ROC) analysis was used for the evaluation of the accuracy of nodule calcification prediction. RESULTS: Figures of merit (FOM) from JAFROC was 0.807 for DCR and 0.811 for GSR, respectively; nodule detectability was not significantly different between DCR and GSR (p = 0.93). Areas under curve (AUC) from MRMC ROC were 0.944 for DCR and 0.828 for GSR, respectively; performance of DCR in predicting lung nodule calcification was significantly higher than that of GSR (p = 0.04). CONCLUSIONS: DCR showed similar performance in terms of lung nodule detection compared with GSR. However, DCR does provide a significant benefit in predicting the presence of nodule calcification.

Virtual Non-Contrast CT Using Dual-Energy Spectral CT: Feasibility of Coronary Artery Calcium Scoring.

OBJECTIVE: To evaluate the feasibility of coronary artery calcium scoring based on three virtual noncontrast-enhanced (VNC) images derived from single-source spectral dual-energy CT (DECT) as compared with true noncontrast-enhanced (TNC) images. MATERIALS AND METHODS: This prospective study was conducted with the approval of our Institutional Review Board. Ninety-seven patients underwent noncontrast CT followed by contrast-enhanced chest CT using single-source spectral DECT. Iodine eliminated VNC images were reconstructed using two kinds of 2-material decomposition algorithms (material density iodine-water pair [MDW], material density iodine-calcium pair [MDC]) and a material suppressed algorithm (material suppressed iodine [MSI]). Two readers independently quantified calcium on VNC and TNC images. The Spearman correlation coefficient test and Bland-Altman method were used for statistical analyses. RESULTS: Coronary artery calcium scores from all three VNC images showed excellent correlation with those from the TNC images (Spearman's correlation coefficient [ρ] = 0.94, 0.88, and 0.89 for MDW, MDC, and MSI, respectively; p < 0.001 for all pairs). Measured coronary calcium volumes from VNC images also correlated well with those from TNC images (ρ = 0.92, 0.87, and 0.91 for MDW, MDC, and MSI, respectively; p < 0.001 for all pairs). Among the three VNC images, coronary calcium from MDW correlated best with that from TNC. The coronary artery calcium scores and volumes were significantly lower from the VNC images than from the TNC images (p < 0.001 for all pairs). CONCLUSION: The use of VNC images from contrast-enhanced CT using dual-energy material decomposition/suppression is feasible for coronary calcium scoring. The absolute value from VNC tends to be smaller than that from TNC.

Assessment of the regurgitant orifice area in aortic regurgitation with dual-source CT: Comparison with cardiovascular magnetic resonance.

BACKGROUND: Regurgitant orifice area (ROA) measurements by cardiac CT have not been compared with a quantitative classification of aortic regurgitation (AR) severity based on regurgitant fraction by phase-contrast cardiovascular magnetic resonance (PC-CMR). OBJECTIVES: To compare ROA using dual-source CT (DSCT) with the grade of AR using PC-CMR for obtaining the cutoff values of the ROA allowing for grading of AR severity. METHODS: We retrospectively enrolled 208 patients (81 women, mean age 53.3 ± 14.4 years) with AR who underwent DSCT and CMR. DSCT data sets were reconstructed in 10% steps from 0% to 90% of the R-R interval to measure ROA. Grades of AR were determined by regurgitant fraction using PC-CMR. Receiver operating characteristic curves were calculated to differentiate between grades of AR and ROA. RESULTS: Sixty-three patients with mild AR, 80 with moderate AR, and 65 with severe AR by PC-CMR were enrolled. Quantification of the ROA by DSCT (mean, 27 ± 21 mm2) was significantly correlated with the grade of AR by PC-CMR (r = 0.83). In the receiver operating characteristic analysis, discrimination (mild vs moderate and moderate vs severe) among grades of AR with DSCT was accurate when cutoff ROAs of 15 mm2 and 23 mm2 in comparison with PC-CMR were used. CONCLUSIONS: The cutoff values of the ROA by DSCT allow for grading of AR severity determined by PC-CMR but are lower than those previously published, using transthoracic echocardiography as the reference standard. A multicenter study is necessary with a wide range of population for obtaining cutoff ROAs.

Detection of skeletal muscle metastasis: torso FDG PET-CT versus contrast-enhanced chest or abdomen CT.

BACKGROUND: Skeletal muscle metastasis (SMM) in cancer patients has not been sufficiently evaluated regarding prevalence and proper method of detection. PURPOSE: To determine the prevalence of SMM and compare the diagnostic competencies for SMM of torso F-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) and contrast-enhanced chest or abdomen CT. MATERIAL AND METHODS: We investigated 18,225 PET-CT studies of 6359 cancer patients performed from 2005 to 2012. The PET-CT studies describing potential SMM were retrieved and the corresponding medical records were reviewed. The gold standard for SMM was histopathologically-proven SMM or imaging study-based disease progression. The detectability of SMM was compared between PET-CT and contrast-enhanced CT. RESULTS: Twenty-six patients had 84 SMM lesions, representing a SMM prevalence of 0.41%. Lung cancer was the most common SMM-associated malignancy (54%) and the gluteal/pelvic girdle muscle was the most frequently involved SMM site (37%). All 84 SMM lesions were visualized on PET-CT (100%). Of these PET-CT positive 84 SMM lesions, 51 lesions were in the CT field of view (FOV) (61%), whereas 33 lesions were out of the CT FOV (39%). Among these 51 lesions, 17 lesions showed rim-enhancing nodules/masses (33%), eight lesions showed homogeneously enhancing nodules (16%), three lesions showed heterogeneously enhancing nodules (6%), and 23 SMM lesions (45%) were non-diagnostic by CT. All 51 SMM lesions within CT FOV were detected on PET-CT (100%), whereas only 28 were visualized on CT (54.9%), resulting in a significant difference (P < 0.005). On average, 2.6 more organs with concomitant metastases were found when SMM was revealed by PET-CT. CONCLUSION: The prevalence of SMM was as low as 0.41% in the current large cohort of cancer patients. Torso PET-CT was a more competent modality than contrast-enhanced CT in the detection of SMM.

Direct comparison of stress- and rest-dual-energy computed tomography for detection of myocardial perfusion defect.

We assessed the diagnostic performance of stress- and rest-dual-energy computed tomography (DECT) and their incremental value when used with coronary CT angiography (CCTA) compared with combined invasive coronary angiography (ICA)/cardiovascular magnetic resonance (CMR) for detecting hemodynamically significant stenosis causing a myocardial perfusion defect. Forty patients (30 men; mean age, 63.4 ± 8.8 years) with known or suspected coronary artery disease detected by CCTA underwent stress- and rest-DECT, CMR, and ICA. DECT iodine maps were compared with CMR on a per-segment and per-vessel basis. Diagnostic value of CCTA was assessed on a per-vessel basis before and after stress- and rest-DECT and compared to that of ICA/CMR. Compared to CMR, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of rest-DECT for detecting segment (vessel)-based perfusion defects were 29% (46%), 88% (79%), 56% (61%), and 70% (67%), respectively. Corresponding values using stress-DECT were 73% (94%), 83% (74%), 70% (72%), and 85% (95%), respectively. There was fair (κ = 0.39) agreement between rest- and stress-DECT iodine maps in identifying segments with perfusion defects. Compared with the ICA/CMR for identifying hemodynamically significant stenoses, per-vessel territory sensitivity, specificity, PPV, and NPV of CCTA were 91, 56, 55, and 91%, respectively; those using CCTA/rest-DECT were 42, 83, 59, and 70%, respectively; and those using CCTA/stress-DECT were 87, 79, 71, and 91%, respectively. The area under the receiver operating characteristic curve decreased from 0.74 to 0.62 (P = 0.06) using CCTA/rest-DECT but increased to 0.83 (P = 0.02) using CCTA/stress-DECT. Stress-DECT has incremental value when used with CCTA for detecting hemodynamically significant stenoses.

Sildenafil vaginal suppositories: preparation, characterization, in vitro and in vivo evaluation.

AIM: The main objective was to investigate the in vitro release profile/kinetics, and in vivo plasma pharmacokinetics (PK) and organ biodistribution (BD) of the prepared sildenafil vaginal suppositories (SVS). METHODS: Suppositories containing 25 mg of sildenafil were prepared by the cream melting technique using Witepsol H-15 as a suppository base. The suppositories were characterized for weight variation, content uniformity, hardness, disintegration time and crystallinity change. The in vitro dissolution in pH 4.5, and in vivo plasma PK and organ BD of sildenafil from SVS in female Sprague Dawley rats, were also investigated. RESULTS: The mean weight variation, content uniformity, hardness and disintegration time of the prepared SVS were 1.127 ± 0.020 g, 98.25 ± 2.50%, 2.5 ± 0.08 kg and 9 ± 1.0 min, respectively. The release of sildenafil from the SVS was more than 90% at 30 min, with a release kinetic of Hixson--Crowell model and non-Fickian diffusion (n = 0.464). The plasma PK study demonstrated a significantly lower Cmax (∼10 times) and AUC0-24 h (∼13 times) of sildenafil in plasma following intravaginal (IVG) administration of suppositories compared to oral (PO) administration of sildenafil solution. Nevertheless, the organ BD study showed a phenomenally higher Cmax (∼40 times) and AUC0-24 h (∼20 times) of sildenafil in uterus following IVG administration of suppositories than PO administration of sildenafil solution. CONCLUSION: This study demonstrated enhanced sildenafil exposure in the uterus following IVG administration of SVS, which could be used to target the uterus for therapeutic benefits.