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1.
J Bone Joint Surg Am ; 105(3): 202-206, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36723464

RESUMO

BACKGROUND: We previously demonstrated that the White-Menelaus arithmetic formula combined with skeletal age as estimated with the Greulich and Pyle (GP) atlas was the most accurate method for predicting leg lengths and residual leg-length discrepancy (LLD) at maturity in a cohort of patients treated with epiphysiodesis. We sought to determine if an online artificial intelligence (AI)-based hand-and-wrist skeletal age system provided consistent readings and to evaluate how these readings influenced the prediction of the outcome of epiphysiodesis in this cohort. METHODS: JPEG images of perioperative hand radiographs for 76 subjects were independently submitted by 2 authors to an AI skeletal age web site (http://physis.16bit.ai/). We compared the accuracy of the predicted long-leg length (after epiphysiodesis), short-leg length, and residual LLD with use of the White-Menelaus formula and either human-estimated GP or AI-estimated skeletal age. RESULTS: The AI skeletal age readings had an intraclass correlation coefficient (ICC) of 0.99. AI-estimated skeletal age was generally greater than human-estimated GP skeletal age (average, 0.5 year greater in boys and 0.1 year greater in girls). Overall, the prediction accuracy was improved with AI readings; these differences reached significance for the short-leg and residual LLD prediction errors. Residual LLD was underestimated by ≥1.0 cm in 26 of 76 subjects when human-estimated GP skeletal age was used (range of underestimation, 1.0 to 3.2 cm), compared with only 10 of 76 subjects when AI skeletal age was used (range of underestimation, 1.1 cm to 2.2 cm) (p < 0.01). Residual LLD was overestimated by ≥1.0 cm in 3 of 76 subjects by both methods (range of overestimation, 1.0 to 1.3 cm for the human-estimated GP method and 1.0 to 1.6 cm for the AI method). CONCLUSIONS: The AI method of determining hand-and-wrist skeletal age was highly reproducible in this cohort and improved the accuracy of prediction of leg length and residual discrepancy when compared with traditional human interpretation of the GP atlas. This improvement could be explained by more accurate estimation of skeletal age via a machine-learning AI system calibrated with a large database. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Determinação da Idade pelo Esqueleto , Punho , Masculino , Feminino , Humanos , Determinação da Idade pelo Esqueleto/métodos , Inteligência Artificial , Mãos , Articulação do Punho , Desigualdade de Membros Inferiores/cirurgia
2.
Ann Hum Biol ; 50(1): 1-7, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36724737

RESUMO

BACKGROUND: Maturation of bones in the hand-wrist region varies among individuals of the same age and among world groups. Although some studies from Africa report differences to other ethnic groups, the lack of detailed bone-specific maturity data prevents meaningful comparisons. AIM: The aim of this study was to describe bone-specific maturity for developing hand-wrist bones in individuals in Khartoum, Sudan. SUBJECTS AND METHODS: The sample was selected from healthy patients attending a dental hospital in Khartoum with known age and ancestry (males = 280, females = 330; aged between 3 and 25 years). Bones were assessed from radiographs of the left hand and wrist after the Greulich and Pyle Atlas (1959). Median ages of attainment for bone stages were calculated using probit analysis for each stage in males and females separately. RESULTS: Maturity data for stages of the phalanges, metacarpals, carpals and radius and ulna in males and females are presented. Median ages in females were earlier compared to males for all stages. These results are largely earlier than previously published findings or where these could be calculated. CONCLUSION: These results of individual maturity stages of phalanges, metacarpals, carpals and the distal epiphyses of the radius and ulna are useful to assess maturity in growing individuals from Sudan.


Assuntos
Ossos da Mão , Punho , Masculino , Feminino , Humanos , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Punho/diagnóstico por imagem , Sudão , Determinação da Idade pelo Esqueleto/métodos , Ossos da Mão/diagnóstico por imagem , Mãos/diagnóstico por imagem
3.
Jt Dis Relat Surg ; 34(1): 176-182, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36700280

RESUMO

OBJECTIVES: This study aims to identify the most accurate dorsovolar principal axis of the distal radius and carpus identified on axial computed tomography (CT) sections and to establish normative data for angular measurements among these axes. PATIENTS AND METHODS: Between December 2019 and December 2021, normal axial CT images of wrists of a total of 42 individuals (25 males, 17 females; mean age: 31±8.4 years; range, 18 to 45 years) were retrospectively analyzed. Eight axes were identified on axial CT images: four distal radial axes (the volar cortical, medial cortical, central, and sigmoid notch axes) and four carpal axes (the scapholunate, lunotriquetral, capitohamate, and pisotrapezial axes). Twenty-two angular parameters were measured with reference to four principal axes (the volar cortical, medial cortical, central, and pisotrapezial axes). RESULTS: The mean sigmoid notch rotation (version) angles relative to the four principal axes were 8±5° (range, -2° to 18°), 6±5° (range, -2° to 13°), 1±5° (range, -8° to 14°), and 4±4° (range, -3° to 15°), respectively. The mean scapholunate rotation angles were -13±5° (range, -27° to -6°), -15±6° (range, -29° to -8°), -21±5° (range, -30° to -11°), and -8±5° (range, -28° to -6°), respectively. Among four principal axes, the volar cortical and medial cortical axes were nearly collinear with both of relatively fixed carpal axes. The four principal axes showed angular differences between 2° and 8° with each other. There was no significant difference between men and women for all measurements. CONCLUSION: The axial CT sections can be used to describe the various angulations between the normal wrist axes such as the sigmoid notch and scapholunate joint rotation angles. Despite slight differences among the four principal axes, the volar cortical and medial cortical axes are more consistent with the relatively fixed carpal axes.


Assuntos
Articulação do Punho , Punho , Masculino , Humanos , Feminino , Adulto Jovem , Adulto , Punho/diagnóstico por imagem , Estudos Retrospectivos , Articulação do Punho/diagnóstico por imagem , Rádio (Anatomia) , Tomografia Computadorizada por Raios X/métodos
4.
In Vivo ; 37(1): 503-505, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36593012

RESUMO

BACKGROUND/AIM: Superficial angiomyxoma (SAM) is a rare benign soft-tissue tumor that usually occurs in the trunk, head and neck, and lower extremity of middle-aged adults. Herein, we describe an unusual case of SAM of the wrist, which was initially diagnosed as a ganglion cyst on imaging. CASE REPORT: The patient was a 71-year-old man with no history of trauma who presented with a 2-year history of a palpable mass in the left wrist. Physical examination revealed a 2.5-cm, elastic hard, mobile, nontender mass. Magnetic resonance imaging revealed a well-defined mass with iso-signal intensity relative to skeletal muscle on T1-weighted sequences and very high signal intensity on T2-weighted fat-suppressed sequences. Subtle internal enhancement was seen following gadolinium administration. Complete excision was performed under general anesthesia with tourniquet control. Histologically, the lesion was composed of bland spindle to stellate-shaped cells in an abundant myxoid stroma. Immunohistochemically, the lesional cells were positive for CD34 but negative for S-100 protein, smooth-muscle actin, desmin, epithelial membrane antigen and pancytokeratin. These findings were consistent with a diagnosis of SAM. There was no clinical evidence of recurrence during a follow-up period of 3 months. CONCLUSION: Although extremely rare, SAM should be considered in the differential diagnosis of a cyst-like solid lesion near small joints.


Assuntos
Mixoma , Neoplasias de Tecidos Moles , Masculino , Pessoa de Meia-Idade , Adulto , Humanos , Idoso , Punho/patologia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/cirurgia , Neoplasias de Tecidos Moles/patologia , Diagnóstico Diferencial , Mixoma/diagnóstico , Mixoma/cirurgia , Mixoma/metabolismo , Imageamento por Ressonância Magnética
5.
Sensors (Basel) ; 23(1)2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36617136

RESUMO

The early diagnosis of diabetes mellitus in normal people or maintaining stable blood sugar concentrations in diabetic patients requires frequent monitoring of the blood sugar levels. However, regular monitoring of the sugar levels is problematic owing to the pain and inconvenience associated with pricking the fingertip or using minimally invasive patches. In this study, we devise a noninvasive method to estimate the percentage of the in vivo glycated hemoglobin (HbA1c) values from Monte Carlo photon propagation simulations, based on models of the wrist using 3D magnetic resonance (MR) image data. The MR image slices are first segmented for several different tissue types, and the proposed Monte Carlo photon propagation system with complex composite tissue support is then used to derive several models for the fingertip and wrist sections with different wavelengths of light sources and photodetector arrangements. The Pearson r values for the estimated percent HbA1c values are 0.94 and 0.96 for the fingertip transmission- and reflection-type measurements, respectively. This is found to be the best among the related studies. Furthermore, a single-detector multiple-source arrangement resulted in a Pearson r value of 0.97 for the wrist. The Bland-Altman bias values were found to be -0.003 ± 0.36, 0.01 ± 0.25, and 0.01 ± 0.21, for the two fingertip and wrist models, respectively, which conform to the standards of the current state-of-the-art invasive point-of-care devices. The implementation of these algorithms will be a suitable alternative to the invasive state-of-the-art methods.


Assuntos
Dispositivos Eletrônicos Vestíveis , Punho , Humanos , Punho/diagnóstico por imagem , Glicemia , Simulação por Computador , Imageamento por Ressonância Magnética , Método de Monte Carlo
6.
Sensors (Basel) ; 23(2)2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36679473

RESUMO

Standard industrial robotic manipulators use well-established high performing technologies. However, such manipulators do not guarantee a safe Human-Robot Interaction (HRI), limiting their usage in industrial and medical applications. This paper proposes a novel local path planner for spherical wrist manipulators to control the execution of tasks where the manipulator number of joints is redundant. Such redundancy is used to optimize robot motion and dexterity. We present an intuitive parametrization of the end-effector (EE) angular motion, which decouples the rotation of the third joint of the wrist from the rest of the angular motions. Manipulator EE motion is controlled through a decentralized linear system with closed-loop architecture. The local planner integrates a novel collision avoidance strategy based on a potential repulsive vector applied to the EE. Contrary to classic potential field approaches, the collision avoidance algorithm considers the entire manipulator surface, enhancing human safety. The local path planner is simulated in three generic scenarios: (i) following a periodic reference, (ii) a random sequence of step signal references, and (iii) avoiding instantly introduced obstacles. Time and frequency domain analysis demonstrated that the developed planner, aside from better parametrizing redundant tasks, is capable of successfully executing the simulated paths (max error = 0.25°) and avoiding obstacles.


Assuntos
Extremidade Superior , Punho , Humanos , Rotação , Algoritmos , Articulação do Punho
7.
Sensors (Basel) ; 23(2)2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36679632

RESUMO

The human radial artery pulse carries a rich array of biomedical information. Accurate detection of pulse signal waveform and the identification of the corresponding pulse condition are helpful in understanding the health status of the human body. In the process of pulse detection, there are some problems, such as inaccurate location of radial artery key points, poor signal noise reduction effect and low accuracy of pulse recognition. In this system, the pulse signal waveform is collected by the main control circuit and the new piezoelectric sensor array combined with the wearable wristband, creating the hardware circuit. The key points of radial artery are located by an adaptive pulse finding algorithm. The pulse signal is denoised by wavelet transform, iterative sliding window and prediction reconstruction algorithm. The slippery pulse and the normal pulse are recognized by feature extraction and classification algorithm, so as to analyze the health status of the human body. The system has accurate pulse positioning, good noise reduction effect, and the accuracy of intelligent analysis is up to 98.4%, which can meet the needs of family health care.


Assuntos
Dispositivos Eletrônicos Vestíveis , Punho , Humanos , Frequência Cardíaca , Artéria Radial , Sinais Vitais , Pulso Arterial
8.
Sensors (Basel) ; 23(2)2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36679747

RESUMO

Current methods for ergonomic assessment often use video-analysis to estimate wrist postures during occupational tasks. Wearable sensing and machine learning have the potential to automate this tedious task, and in doing so greatly extend the amount of data available to clinicians and researchers. A method of predicting wrist posture from inertial measurement units placed on the wrist and hand via a deep convolutional neural network has been developed. This study has quantified the accuracy and reliability of the postures predicted by this system relative to the gold standard of optoelectronic motion capture. Ten participants performed 3 different simulated occupational tasks on 2 occasions while wearing inertial measurement units on the hand and wrist. Data from the occupational task recordings were used to train a convolutional neural network classifier to estimate wrist posture in flexion/extension, and radial/ulnar deviation. The model was trained and tested in a leave-one-out cross validation format. Agreement between the proposed system and optoelectronic motion capture was 65% with κ = 0.41 in flexion/extension and 60% with κ = 0.48 in radial/ulnar deviation. The proposed system can predict wrist posture in flexion/extension and radial/ulnar deviation with accuracy and reliability congruent with published values for human estimators. This system can estimate wrist posture during occupational tasks in a small fraction of the time it takes a human to perform the same task. This offers opportunity to expand the capabilities of practitioners by eliminating the tedium of manual postural assessment.


Assuntos
Articulação do Punho , Punho , Humanos , Reprodutibilidade dos Testes , Amplitude de Movimento Articular , Postura
9.
Sensors (Basel) ; 23(2)2023 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-36679760

RESUMO

The article deals with the detection of stress using the electrodermal activity (EDA) signal measured at the wrist. We present an approach for feature extraction from EDA. The approach uses frequency spectrum analysis in multiple frequency bands. We evaluate the proposed approach using the 4 Hz EDA signal measured at the wrist in the publicly available Wearable Stress and Affect Detection (WESAD) dataset. Seven existing approaches to stress detection using EDA signals measured by wrist-worn sensors are analysed and the reported results are compared with ours. The proposed approach represents an improvement in accuracy over the other techniques studied. Moreover, we focus on time to detection (TTD) and show that our approach is able to outperform competing techniques, with fewer data points. The proposed feature extraction is computationally inexpensive, thus the presented approach is suitable for use in real-world wearable applications where both short response times and high detection performance are important. We report both binary (stress vs. no stress) as well as three-class (baseline/stress/amusement) results.


Assuntos
Resposta Galvânica da Pele , Punho , Punho/fisiologia , Articulação do Punho
10.
J Neuroeng Rehabil ; 20(1): 9, 2023 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-36658605

RESUMO

BACKGROUND: Myoelectric prostheses are a popular choice for restoring motor capability following the loss of a limb, but they do not provide direct feedback to the user about the movements of the device-in other words, kinesthesia. The outcomes of studies providing artificial sensory feedback are often influenced by the availability of incidental feedback. When subjects are blindfolded and disconnected from the prosthesis, artificial sensory feedback consistently improves control; however, when subjects wear a prosthesis and can see the task, benefits often deteriorate or become inconsistent. We theorize that providing artificial sensory feedback about prosthesis speed, which cannot be precisely estimated via vision, will improve the learning and control of a myoelectric prosthesis. METHODS: In this study, we test a joint-speed feedback system with six transradial amputee subjects to evaluate how it affects myoelectric control and adaptation behavior during a virtual reaching task. RESULTS: Our results showed that joint-speed feedback lowered reaching errors and compensatory movements during steady-state reaches. However, the same feedback provided no improvement when control was perturbed. CONCLUSIONS: These outcomes suggest that the benefit of joint speed feedback may be dependent on the complexity of the myoelectric control and the context of the task.


Assuntos
Amputados , Membros Artificiais , Humanos , Punho , Cotovelo , Retroalimentação , Eletromiografia/métodos , Retroalimentação Sensorial , Desenho de Prótese
11.
PLoS One ; 18(1): e0279210, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36662743

RESUMO

BACKGROUND: Ulna styloid fracture occurs approximately about 55% of all distal end of radius fractures. However, the clinical and functional outcome of these fractures remains indefinite. RESULTS: Only 56 patients with distal radius fractures had concomitant ulna styloid fractures. The mean age was 32 years (range: 18-69; SD: ± 12.7). The majority were men. The mean time from injury was 18.7 months (range: 6-84; SD: ± 13.3). The most common was Frykman 2, followed by 6, type 8, and type 4. All were closed fractures; 60.7% were base, and 39.3% were tip fractures. 50% were treated with casting, 48.3% plating, and 1.8% external fixation. The mean period of casting was 7.67 weeks (range: 4-16; SD ± 3.1). The ulna styloid was united in 35.7%. There is no significant difference in the range of movement between those with ulna styloid union and non-union. The Ballottement test and Piano key sign was statistically insignificant between both groups. All the displacements were dorsal except in 1 case. The mean displacement of ulna styloid is 1.88mm (SD±1.08, Range: 0.20-4.60mm). The mean VAS score at rest and work is not statistically significant. The mean grip strength and functional score (DASH) are similar in both groups. CONCLUSION: Ulna styloid fractures do not contribute to the DRUJ instability and the status of the union of the ulna styloid and the site of the ulna styloid fracture (tip or base) did not have a bearing on the range of movement and functional status of the affected wrist. Temporary DRUJ immobilization might allow TFCC recovery.


Assuntos
Fraturas do Rádio , Fraturas da Ulna , Masculino , Humanos , Feminino , Gravidez , Adulto , Resultado do Tratamento , Articulação do Punho/diagnóstico por imagem , Punho , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Ulna
14.
Mymensingh Med J ; 32(1): 135-143, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36594313

RESUMO

Tumors in the hand are relatively uncommon but 95% are benign. Tumors occurring in the hand, forearm and arm often have unique growth patterns and potential for metastasis that may be different from those seen elsewhere in the body. Secondary metastatic tumors in the hand are very rare (0.1%). Diagnosis is mainly clinical, but X-ray, USG and MRI help as a diagnostic aid. The aim of the study was to early diagnosis, see the pattern and proper management of the hand tumor and ensure good hand function. This prospective study was done from January 2004 to July 2019. We found 220 hand tumors in the hand unit, Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Bangladesh. Among 220 patients, male were 114(51.81%) and female were 106 (48.19%). Out of 220 patients we found 190(86.36%) benign tumor and tumor like lesions and 30(13.64%) was malignant hand tumors. Out of 190 benign lesions, benign tumor was 158(83.15%) and 32(16.85%) was tumor like lesions. Among 158 benign tumor, bone tumors were 40(25.31%) and soft tissue tumours were 138(74.69%). Out of soft tissue tumor, peripheral nerve tumor was 20(12.66%). Enchondroma and Giant cell tumors are the most common among the benign bone tumors, on the other hand giant cell tumors of tendon sheath, Glomus tumor, haemangioma, neurofibroma, schwanoma are the common soft tissue tumors. Compound palmar ganglion, fibromatosis and tuberculosis of phalanx are the most common tumor like lesions. Synovial sarcoma 10(33.33%), osteosarcoma 03(10%), chondrosarcoma 03(10%), ewings sarcoma 02(6.66%), fibrosarcoma 04 (13.33%), Malignant fibrous histocytoma 01(3.33%), soft tissue sarcoma 01(3.33%), Merkel cell tumor 01(3.33%), pleomorphic Rabdomyosarcoma 01(3.33%), malignant melanoma 01(3.33%), clear cell sarcoma of tendon and aponeurosis 01(3.33%), undifferentiated carcinoma 01(3.33%) and extra skeletal chondro sarcoma 01(3.33%) were the malignant tumors. Most of the benign lesions recovered fully after excision except neurofibroma and malignant tumors were treated with excision (including amputation) and chemo-radiotherapy successfully, but 4 patients were refereed to higher center due to recurrence and deteriation of hand function and one patient died due to metastasis. Malignant hand tumor management is very difficult even after amputation with multidisciplinary approach. Hand tumor is uncommon and malignant tumors are rare but any abnormal lump or bump in the hand or wrist is considered as tumor. Early detection and intervention are essential for better prognosis and survival for malignant tumors of hands and upper limbs.


Assuntos
Neoplasias Ósseas , Tumores de Células Gigantes , Tumor Glômico , Neurofibroma , Neoplasias de Tecidos Moles , Humanos , Masculino , Feminino , Estudos Prospectivos , Bangladesh/epidemiologia , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/terapia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/terapia , Neoplasias de Tecidos Moles/patologia , Punho/patologia
16.
BMJ ; 380: e070708, 2023 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-36634961
17.
Eur J Radiol ; 159: 110662, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36565594

RESUMO

PURPOSE: To quantitatively and qualitatively assess the visibility of bone structures in the wrist on photon-counting detector computed tomography (PCD-CT) images compared to state-of-the-art energy-integrating detector CT (EID-CT). METHOD: Four human cadaveric wrist specimens were scanned with EID-CT and PCD-CT at identical CTDIvol of 12.2 mGy and with 6.1 mGy (half dose PCD-CT). Axial images were reconstructed using the thinnest possible slice thickness, i.e. 0.4 mm on EID-CT and 0.2 mm on PCD-CT, with the largest image matrix size possible using reconstruction kernels optimized for bone (EID-CT: Ur68, PCD-CT: Br92). Quantitative evaluation was performed to determine contrast-noise ratio (CNR) of bone/ fat, cortical and trabecular sharpness. An observer study using visual grading characteristics (VGC) analysis was performed by six observers to assess the visibility of nutrient canals, trabecular architecture, cortical bone and the general image quality. RESULTS: At equal dose, images obtained with PCD-CT had 39 ± 6 % lower CNR (p = 0.001), 71 ± 57 % higher trabecular sharpness in the radius (p = 0.02) and 42 ± 8 % (p < 0.05) sharper cortical edges than those obtained with EID-CT. This was confirmed by VGC analysis showing a superior visibility of nutrient canals, trabeculae and cortical bone area under the curve (AUC) > 0.89) for PCD-CT, even at half dose. CONCLUSIONS: Despite a lower CNR and increased noise, the trabecular and cortical sharpness were twofold higher with PCD-CT. Visual grading analysis demonstrated superior visibility of cortical bone, trabeculae, nutrient canals and an overall improved image quality with PCD-CT over EID-CT. At half dose, PCD-CT also yielded superior image quality, both in quantitative measures and as evaluated by radiologists.


Assuntos
Fótons , Punho , Humanos , Punho/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Osso e Ossos/diagnóstico por imagem , Doses de Radiação , Imagens de Fantasmas
18.
Sports Med Arthrosc Rev ; 31(1): 15-18, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36563120

RESUMO

Golf is unique in this compendium of sports-related hand and wrist injury management. It is the only sport where the ball is stationary and there is no opponent against whom the player is defending. This distinctive sport dates to the 15th century in Scotland and is one of the oldest sports, but it is one where technology has changed many of the fundamental elements-from the "playing field (through advanced in agronomy) and the equipment (club and ball technology).


Assuntos
Golfe , Mãos , Humanos , Mãos/cirurgia , Consultores , Punho , Golfe/lesões , Articulação do Punho
19.
Skeletal Radiol ; 52(1): 23-29, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35831718

RESUMO

OBJECTIVE: To compare the image quality of ultra-high-resolution wrist CTs acquired on photon-counting detector CT versus conventional energy-integrating-detector CT systems. MATERIALS AND METHODS: Participants were scanned on a photon-counting-detector CT system after clinical energy-integrating detector CTs. Energy-integrating-detector CT scan parameters: comb filter-based ultra-high-resolution mode, 120 kV, 250 mAs, Ur70 or Ur73 kernel, 0.4- or 0.6-mm section thickness. Photon-counting-detector CT scan parameters: non-comb-based ultra-high-resolution mode, 120 kV, 120 mAs, Br84 kernel, 0.4-mm section thickness. Two musculoskeletal radiologists blinded to CT system, scored specific osseous structures using a 5-point Likert scale (1 to 5). The Wilcoxon rank-sum test was used for statistical analysis of reader scores. Paired t-test was used to compare volume CT dose index, bone CT number, and image noise between CT systems. P-value < 0.05 was considered statistically significant. RESULTS: Twelve wrists (mean participant age 55.3 ± 17.8, 6 females, 6 males) were included. The mean volume CT dose index was lower for photon-counting detector CT (9.6 ± 0.1 mGy versus 19.0 ± 6.7 mGy, p < .001). Photon-counting-detector CT images had higher Likert scores for visualization of osseous structures (median score = 4, p < 0.001). The mean bone CT number was higher in photon-counting-detector CT images (1946 ± 77 HU versus 1727 ± 49 HU, p < 0.001). Conversely, there was no difference in the mean image noise of the two CT systems (63 ± 6 HU versus 61 ± 6 HU, p = 0.13). CONCLUSION: Ultra-high-resolution imaging with photon-counting-detector CT depicted wrist structures more clearly than conventional energy-integrating-detector CT despite a 49% radiation dose reduction.


Assuntos
Fótons , Punho , Masculino , Feminino , Humanos , Imagens de Fantasmas , Punho/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doses de Radiação
20.
Skeletal Radiol ; 52(1): 67-72, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35920932

RESUMO

OBJECTIVE: To quantify the shear velocity and stiffness of the median nerve (MN) with shear wave elastography (SWE) at the carpal tunnel entrance and determine whether SWE is useful for diagnosing and staging carpal tunnel syndrome (CTS). MATERIALS AND METHODS: The study included 58 patients (79 wrists) with clinical and electroneuromyographic diagnoses of CTS and 55 healthy controls (63 wrists). MN shear velocity and stiffness were measured by SWE on the axial plane in both groups. The differences between CTS patients and controls and between different grades of CTS based on electrodiagnostic tests were studied using Student's t test and ANOVA with ROC analysis. RESULTS: The mean MN shear velocity and stiffness were significantly greater in CTS patients (2.5 ± 0.37 m/s and 19.4 ± 5.8 kPa) than in controls (1.91 ± 0.24 m/s and 11.1 ± 3.0 kPa) (p < 0.001) and greater in the severe CTS group (2.69 ± 0.39 m/s and 22.4 ± 7.1 kPa) than in the mild CTS group (2.37 ± 0.35 m/s and 17.3 ± 4,8 kPa). The cutoff value for the shear velocity was 2.13 m/s, with 86% and 82% sensitivity and specificity, respectively, and the cutoff value for stiffness was 13.6 kPa, with 87% and 82% sensitivity and specificity. CONCLUSION: MN shear velocity and stiffness are significantly higher in CTS patients. SWE can be used to diagnose CTS and distinguish between patients with mild and severe disease.


Assuntos
Síndrome do Túnel Carpal , Técnicas de Imagem por Elasticidade , Humanos , Síndrome do Túnel Carpal/diagnóstico por imagem , Nervo Mediano/diagnóstico por imagem , Punho/diagnóstico por imagem , Sensibilidade e Especificidade
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