WGA-M001, a Mixture of Total Extracts of Tagetes erecta and Ocimum basilicum, Synergistically Alleviates Cartilage Destruction by Inhibiting ERK and NF-κB Signaling.

Tagetes erecta and Ocimum basilicum are medicinal plants that exhibit anti-inflammatory effects against various diseases. However, their individual and combined effects on osteoarthritis (OA) are unknown. Herein, we aimed to demonstrate the effects of T. erecta, O. basilicum, and their mixture, WGA-M001, on OA pathogenesis. The administration of total extracts of T. erecta and O. basilicum reduced cartilage degradation and inflammation without causing cytotoxicity. Although WGA-M001 contained lower concentrations of the individual extracts, it strongly inhibited the expression of pathogenic factors. In vivo OA studies also supported that WGA-M001 had protective effects against cartilage destruction at lower doses than those of T. erecta and O. basilicum. Moreover, its effects were stronger than those observed using Boswellia and Perna canaliculus. WGA-M001 effectively inhibited the interleukin (IL)-1ß-induced nuclear factor kappa-light-chain-enhancer of the activated B cell (NF-κB) pathway and ERK phosphorylation. Furthermore, RNA-sequence analysis also showed that WGA-M001 decreased the expression of genes related to the IL-1ß-induced NF-κB and ERK signaling pathways. Therefore, WGA-M001 is more effective than the single total extracts of T. erecta and O. basilicum in attenuating OA progression by regulating ERK and NF-κB signaling. Our results open new possibilities for WGA-M001 as a potential therapeutic agent for OA treatment.

Revisiting Kümmell's disease: MRI findings beyond the intraosseous cavity for improved diagnosis.

PURPOSE: The diagnostic tool for Kümmell's disease (KD), including the intravertebral vacuum cavity on imaging, is still limited. The purpose of this study was to find other magnetic resonance imaging (MRI) findings that could help the diagnosis of KD. METHODS: A total of 289 patients (103 males and 186 females with a mean age of 69 ± 15 years) with thoracolumbar compression fracture were included. Medical records were reviewed to note symptom duration. MRIs were analyzed for intraosseous cavities (IOC), prevertebral soft-tissue changes (PreSC), posterior wall fracture (PoF), and posterior ligamentous complex tear (PLCT). KD was diagnosed based on surgical findings or clinical report. MRI findings and symptom duration in the presence or absence of KD were compared with chi-squared test, logistic regression, and Student's t-test and area under the curve (AUC) analyses. RESULTS: KD was diagnosed in 55 cases. IOC was noted in 33 (60%) cases in the KD group and 82 (35%) cases in non-KD group. Definite PreSC was noted in 44 (80%) cases in the KD group and 94 (40%) cases in the non-KD group. PoF was seen in 36 (65%) and 140 (60%) cases, and PLCT was seen in 7 (13%) and 26 (11%) cases in KD and non-KD groups, respectively. The IOC and PreSC MRI findings were significantly correlated with KD (p < 0.001), but not with PoF (p = 0.539) or PLCT (p = 0.814). AUC of combined IOC and PreSC was 0.72, higher than that of IOC alone (0.63) or PreSC alone (0.69) (both p < 0.001). The average duration of symptom was 64 days in the KD group and 14 days in the non-KD group (p < 0.001). Positive IOC and PreSC findings were associated with longer symptom duration (p < 0.001). CONCLUSIONS: Prevertebral soft-tissue changes and intraosseous cavity are associated with KD. Combined findings of prevertebral soft-tissue changes and intraosseous cavity can help the diagnosis of KD.

The effect of tube voltage combination on image artefact and radiation dose in dual-source dual-energy CT: comparison between conventional 80/140 kV and 80/150 kV plus tin filter for gout protocol.

OBJECTIVES: In dual-source CT, dual-energy (DE) performance is affected by various X-ray tube voltage combinations with and without tin filter (Sn). The purpose of this study was to assess the utility of the 80/150 Sn kV voltage combination in terms of image artefact and radiation dose for DECT gout protocol, compared with the conventional 80/140 kV. METHODS: Seventy-four patients with suspected gout who underwent dual-source DECT examinations scanned at 80/140 kV (n = 37) and at 80/150 Sn kV (n = 37) were included. Patients' age, sex, and serum uric acid levels were matched between the two groups. The types and incidence of image artefacts and radiation dose were evaluated. RESULTS: The 80/150 Sn kV group had significantly fewer patients with artefacts, compared to the 80/140 kV group [11 (30 %) of 37 vs 35 (94.6 %) of 37, p < 0.001]. Except for the motion artefact, the rest of the artefacts-skin, nail bed, submillimetre, motion, vascular, beam-hardening, clumpy artefact along tendon-were significantly less observed in the 80/150 Sn kV acquisitions. The dose-length product (DLP) and effective dose were significantly lower for the 80/150 Sn kV acquisitions compared with the 8s0/140 kV scans (DLP: 104.46 ± 10.66 mGy·cm vs 344.70 ± 56.39 mGy·cm, p < 0.001; effective dose: 1.04 ± 0.11 mSv vs 3.45 ± 0.56 mSv, p < 0.001). CONCLUSIONS: The 80/150 Sn kV voltage combination in dual-source DECT system could be used as one of the artefact reduction methods while reducing radiation dose for gout protocol when compared to the conventional 80/140 kV. KEY POINTS: • DECT has emerged as the leading modality for non-invasive diagnosis of gout. • Various X-ray tube voltage combinations are now feasible in dual-source DECT. • The 80/150 Sn kV acquisition could facilitate artefact reduction in gout protocol.

Sonographic diagnosis of neuritis ossificans of the median nerve.

We report the sonographic appearance of a rare case of neuritis ossificans of the median nerve at the wrist, which appeared as a hyperechoic lesion around the nerve. Diagnosis was confirmed with magnetic resonance imaging (MRI).

Prevalence of and Factors Associated with Sarcopenia in Korean Cancer Survivors: Based on Data Obtained by the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2011.

Using a representative dataset from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011, we analyzed anthropometric and dual-energy X-ray absorptiometry (DXA)-determined body composition findings for 493 cancer survivors (mean age a61.1 ± 12.6 years; 35.7% male). A much higher proportion of men (30.1%) than women (0.6%) met the criteria of sarcopenia. Subjects with a history of lung cancer, genitourinary cancer, or gastric cancer were prone to develop sarcopenia (31.6%, 26.3%, and 21.4%, respectively). Furthermore, sarcopenia was more prevalent among elderly (≥65 years; P < 0.001), those with a lower BMI level (<23 kg/m2; P < 0.001), heavy drinker (P = 0.012), or smoker (P < 0.001), and those with inadequate intakes of protein (P = 0.017) and vitamin A (P = 0.024). Multivariable logistic analyses revealed sarcopenia was significantly associated with male gender (odds ratio [OR], 68.14; 95% CI, 15.52-299.13), a BMI of <23 kg/m2 (OR 35.93, 95% CI, 8.24-156.67), and inadequate protein intake (OR 3.07, 95% CI, 1.30-7.22); these factors are significant predictors of sarcopenia in Korean cancer survivors.

Evaluation of sarcopenia in small-cell lung cancer patients by routine chest CT.

BACKGROUND: Single cross-sectional area of muscle at the third lumbar vertebra (L3MA) is gold standard to estimate skeletal muscle mass (SMM), and L3 muscle index (L3MI, L3MA/height(2)) is used to determine sarcopenia. The purposes of this study were to evaluate the relationship between SMM indices determined by routine chest CT and L3MI in patients with small-cell lung cancer (SCLC) and to suggest chest CT-derived diagnostic criteria for sarcopenia. METHODS: Area of pectoralis muscles at the aortic arch (PMA) and at L1 (L1MA) was retrospectively measured on chest CT images of 90 consecutive SCLC patients. Pearson's correlation and multiple linear regression analysis were used to assess relationships between L3MI determined by PET/CT and pectoralis muscle index (PMI) and L1 muscle index (L1MI) determined by chest CT. RESULTS: The correlation between L1MI and L3MI was stronger than that between PMI and L3MI (r = 0.851 vs. r = 0.447, p < 0.001). Multivariable regression analysis showed that L1MI was the only significant predictor of L3MI; L3MI = 0.963 × L1MI + 10.336 (R (2)  = 0.689, p < 0.001) for male and L3MI = 0.772 × L1MI + 16.518 (R (2)  = 0.777, p < 0.001) for female. Using this relationship, estimated cutoffs of L1MI for sarcopenia were 46 cm(2)/m(2) for male and 29 cm(2)/m(2) for female (L3MI cutoffs for sarcopenia are 55 cm(2)/m(2) for male and 39 cm(2)/m(2) for female). The sensitivity and specificity of L1MI cutoffs to determine sarcopenia were 98.2 and 100 %, respectively. CONCLUSIONS: Chest CT-determined L1MI is highly correlated with L3MI in SCLC patients. L1MI, as determined by chest CT, could be used to determine the presence of sarcopenia with suggested cutoffs of 46 cm(2)/m(2) for men and 29 cm(2)/m(2) for women.

Using three-dimensional isotropic SPACE MRI to detect posterolateral corner injury of the knee.

BACKGROUND: Reliable magnetic resonance imaging (MRI) diagnosis is important in cases of posterolateral corner (PLC) injury due to the limitations of physical examination in patients with multi-ligament injury. PURPOSE: To document the appearance of PLC of the knee on three-dimensional (3D) isotropic MR images, and to determine the significance of MRI findings in patients with confirmed posterolateral rotatory instability. MATERIAL AND METHODS: Twenty-five patients that underwent surgery for posterolateral instability, and 25 individuals with normal MRI constituted the study cohort. The PLC appearances (popliteofibular, fabellofibular, arcuate ligaments, popliteomeniscal fascicle) were analyzed using 3D isotropic proton density sequence and routine two-dimensional (2D) MRI. In addition, the "fibular cap" sign was evaluated. Statistical analysis was performed using the Chi-square and McNemar's tests. RESULTS: Thickening of popliteofibular, fabellofibular, arcuate ligaments, and popliteomeniscal fascicle was significantly more frequent in the PLC injury group than in the control group (P < 0.05). The sensitivity and specificity of 3D MRI for popliteofibular, fabellofibular, arcuate ligaments, and popliteomeniscal fascicle injury were 63/92%, 54/100%, 46/100%, and 58/92%, respectively. On comparing 3D and 2D images with respect to injury detectability (grade 3 or 4), both modalities visualized injuries, but 3D detected grade 3 or grade 1 rather than grade 4 or 0, respectively. The fibular cap sign was observed significantly more frequently in PLC group, with 58% sensitivity and 100% specificity, and was better observed by 3D than 2D (P < 0.05). CONCLUSION: 3D MRI is a valid modality for detecting PLC abnormalities as it visualizes pathologies in each component and exhibits the positive fibular cap sign.

A thrombotic primary venous aneurysm of an upper extremity causing pulmonary emboli after it was squeezed.

A 27-year-old Korean male complained of chest pain and dyspnea that began after he had squeezed a mass on the medial side of his right upper arm. Computed tomography angiography and venous Doppler ultrasonography revealed a right basilic vein aneurysm with an organized thrombosis causing pulmonary emboli. After 1 month of anticoagulation, the aneurysm was ligated and resected. During the operation, multiple venous aneurysms filled with organized thrombi were observed. This is the first reported case of a thrombotic primary venous aneurysm of an upper extremity causing pulmonary emboli after it was squeezed.

Digital therapeutics-based lumbar core exercise for patients with low back pain: A prospective exploratory pilot study.

Objective: This study aimed to implement a digital therapeutics-based approach based on motion detection technology and analyze the clinical results for patients with chronic low back pain (LBP). Methods: A prospective, single-arm clinical trial was conducted with 22 patients who performed mobile app-based sitting core twist exercise for 12 weeks. Clinical outcomes were assessed using the visual analog scale (VAS) for LBP, Oswestry Disability Index-Korean version (K-ODI), and EuroQol-5 dimension 5-level version (EQ-5D-5L) every 4 weeks after the initiation of treatment. Laboratory tests for factors associated with muscle metabolism, plain X-ray for evaluating sagittal balance, and magnetic resonance imaging for calculating cross-sectional area (CSA) of back muscles were performed at pretreatment and 12 weeks post-treatment. Results: The study population included 20 female patients with an average age of 45.77 ± 15.45 years. The clinical outcomes gradually improved throughout the study period in the VAS for LBP (from 6.05 ± 2.27 to 2.86 ± 1.86), K-ODI (from 16.18 ± 6.19 to 8.64 ± 5.58), and EQ-5D-5L (from 11.09 ± 3.24 to 7.23 ± 3.89) (p < 0.001, respectively). The laboratory test results did not show significant changes. Pelvic incidence (from 53.99 ± 9.70° to 50.80 ± 9.20°, p = 0.002) and the mismatch between pelvic incidence and lumbar lordosis (from 8.97± .67° to 5.28 ± 8.57°, p = 0.027) decreased significantly. Additionally, CSA of erector spinae and total back muscles increased by 5.20% (p < 0.001) and 3.08% (p = 0.013), respectively. Conclusions: The results of this study suggest that the efficacy of digital therapy-based lumbar core exercise for LBP is favorable. However, further large-scale randomized controlled studies are necessary.

Evaluation of the growth pattern of carcinoma of colon and rectum by MDCT.

BACKGROUND: Colorectal cancer is a leading cause of cancer morbidity and mortality worldwide. Knowledge of colorectal cancer tumor growth is of importance for basic understanding of tumor biology and for the clinical handling of the disease. PURPOSE: To conduct a retrospective evaluation of the growth pattern of colorectal cancer by multidetector computed tomography (MDCT). MATERIAL AND METHODS: Pathologically proven adenocarcinomas of the colon and rectum in 44 patients were examined by MDCT on at least two separate occasions with an interval of >1 month in patients not receiving therapy. Maximal longitudinal diameters, wall thicknesses, and volume changes, as determined by serial CT scans, were used in calculation of growth rates. RESULTS: Mean longitudinal diameters of tumors at initial and follow-up investigations were 3.8 cm (1.0-9.1 cm) and 5.4 cm (2.5-12.2 cm), respectively. The mean growth rate of longitudinal tumor diameter was 3.4 cm/year (0-13.8 cm/year). Mean axial wall thicknesses at initial and follow-up investigations were 1.4 cm (0.6-6.6 cm) and 1.9 cm (0.8-6.8 cm), respectively. Mean growth rate of tumor axial wall thickness was 1.0 cm/year (0-3.1 cm/year). Mean tumor volumes at initial and follow-up investigations were 1975 cm(3) (172-9756 cm(3); median, 1490) and 3545 cm(3) (442-15211 cm(3); median, 2846), respectively. Mean growth rate of tumor volume was 2912 cm(3)/year (216-12548 cm(3)/year; median, 1698), and volume doubling times varied from 0.05 to 7.1 years (mean, 1.2; median, 0.7). Significant correlations were observed between initial wall thickness and volume growth rate (p = 0.004). No significant difference was observed between other initial tumor size and growth rate. CONCLUSION: The tumor growth doubling time of colorectal cancer has a very broad aspect. The initial wall thickness of the tumor on MDCT appears to be the most powerful parameter showing correlation with the volume growth rate.

Sagging posterior layer thoracolumbar fascia: can it be the cause or result of adjacent segment diseases?

STUDY DESIGN: A retrospective study. OBJECTIVE: Thoracolumbar fascia (TLF) is an important anatomic structure that plays a role in integrating back muscles and maintaining the stability of lower back. Functional failure of TLF can be one of the factors in the vicious cycle of progressive spinal instability. The purpose of this study is to assess the TLF and correlate it with spinal stability in the instrumented lumbar surgery patients. MATERIALS AND METHODS: From January 2008 to March 2009, 68 consecutive postoperative lumbar or thoracolumbar spine magnetic resonance images were retrospectively reviewed to evaluate the morphologic changes of TLF. It was considered as "sagging posterior layer TLF" when it showed abrupt bulging appearance on parasagittal planes. To determine the spinal stability, flexion and extension lumbar lateral films were also reviewed. The correlation between sagging TLF and adjacent segment disease (ASD) were analyzed. RESULT: Fifty patients (19 males and 31 females, mean age 52.4 y) showed sagging posterior layer TLF, and 32 of them developed ≥1 junctional problems, such as retrolistheses (n=25), compression fractures (n=5), spondylolistheses (n=4), progressive scoliosis (n=4), and segmental instability with bone marrow change (n=2). There was statistically significant correlation between the instrumented surgery and sagging TLF (P-value <0.001). And there was also significant correlation between the sagging TLF and ASD (P-value <0.001). CONCLUSIONS: Morphologic changes of the TLF in postoperative magnetic resonance imaging can be the earliest and predictable findings in the progressive development of the ASD.

Specific compartmental analysis of cartilage status in double-bundle ACL reconstruction patients: a comparative study using pre- and postoperative MR images.

PURPOSE: The purpose of this study was to evaluate the changes in the site-specific cartilage status after a double-bundle ACL reconstruction using preoperative and follow-up MR images. METHODS: Thirty-six knees that underwent a double-bundle ACL reconstruction from 2001 to 2009 with the available preoperative and follow-up magnetic resonance imaging were included. Patients with a meniscal injury were compared with those without a meniscal injury. The cartilage morphology was classified using a 6-grade scale [from 0 = normal thickness and signal, to 6 = diffuse full-thickness loss (>75 % of the region)]. The changes in cartilage status were evaluated at 14 sites. RESULTS: Cartilage changes were observed in all sites and were classified according to the site and degree of change. The majority of changes were grade 0 and 1, which accounted for 68 and 16.8 % of changes, respectively. The patella medial facet and anterolateral and centromedial femoral regions showed significantly more cartilage loss than the posteromedial, centrolateral, anterolateral, and anteromedial tibial regions. No significance was observed between the knees with or without combined injuries (n.s.). On the other hand, knees with or without combined injuries showed a different pattern of cartilage change, as demonstrated by different levels of grade change at sites. CONCLUSIONS: The change in cartilage status was minimal after a double-bundle ACL reconstruction. The patella medial facet, lateral femur anterior region, and medial femur central region showed significantly more cartilage loss than the medial tibia posterior, lateral tibia central, lateral tibia anterior, and medial tibia anterior regions. The presence of a combined injury did not affect the cartilage status changes, even though it was underpowered and too short term to assess the influence of the meniscal injury. LEVEL OF EVIDENCE: Case series, Level IV.

A New Grading System for Migrated Lumbar Disc Herniation on Sagittal Magnetic Resonance Imaging: An Agreement Study.

Understanding the degree of disc migration is essential in order to diagnose, treat, and assess the prognosis of migrated lumbar disc herniation (LDH). Based on anatomical configuration, we developed a simple six-level grading system for migrated lumbar disc herniation. We aimed to evaluate whether the new grading system was reliable and could replace the previous grading system. We selected 101 cases from our database. Two independent raters evaluated the magnetic resonance images using each grading system. Interobserver, intraobserver, and inter-grading system agreements were assessed using kappa statistics. The most common migration pattern was low-grade inferior migration. Interobserver agreements between the two readers showed substantial agreement in the first and second assessments (k = 0.753 and 0.756, respectively). The intraobserver agreement of reader 1 revealed substantial agreement (k = 0.733), while that of reader 2 revealed almost perfect agreement (k = 0.829). The strengths of the agreements of the new grading system were higher than those of the Lee-Kim grading system. The two grading systems agreed almost perfectly for most measurements. The new grading system was reliable and feasible to determine migrated LDH grade. It allowed for a more intuitive, objective measurement and helped select surgical options.

Analysis of critical report notification from musculoskeletal radiology in a tertiary academic medical institution with a regional trauma center.

PURPOSE: We aimed to analyze the prevalence, causes, and clinical settings of 4-year critical radiologic reports (CRRs) notified from the musculoskeletal section of the radiology department. Then, we investigated the communication outcomes. METHODS: This study was approved by our institutional review board. We retrospectively included 175 musculoskeletal CRRs from our database between January 2017 and December 2020. The CRRs were analyzed by two musculoskeletal radiologists, who categorized the CRRs by clinical setting (emergency department(ED) patient, outpatient, and inpatient), body part, type of image modality, reason for CRR, incidental lesion, and clinical outcome. The clinical outcome was retrieved from the electronic medical records. RESULTS: The 175 musculoskeletal CRRs accounted for 5.4% of the CRRs (n = 3217) available in the study period. Most CRRs (94.9%, 166/175) corresponded to the musculoskeletal system, while the remaining ones (5.1%, 9/175) corresponded to the non-musculoskeletal system. In addition, the spine, extremities, and thoracic cage accounted for 52.6%, 40.6%, and 1.7% of the musculoskeletal CRRs, respectively. Moreover, most patients presented to the ED (50.3%, 88/175), followed by inpatients (30.9%, 54/175), and outpatients (18.9%, 33/175). The CRR reasons included missed fracture (54.3%), suspected malignancy (16%), clinical emergency (10.3%), unexpected infection/inflammation (11.4%), and others (8%). Furthermore, 11 (6.3%) incidental lesions were not related to the primary imaging purpose. Referring clinicians actively acknowledged 80% of the CRRs. The loss to follow-up action was the highest in the ED patients (35.2%, 31/88; p < 0.001), being significantly higher than that in outpatients (6.1%, 2/33) and inpatients (3.7%, 2/54). CONCLUSION: Missed fractures were the most common cause of musculoskeletal CRRs. ED showed prevalence in musculoskeletal CRRs and reflected the highest loss to follow-up action. ED physicians should pay more attention to CRRs to enhance patient care.

Triaging deep vein thrombosis using ultrasonography after lower-extremity orthopedic surgery: analysis of a single-center experience.

PURPOSE: This study aimed to stratify risk factors and vein levels for postoperative deep vein thrombosis (DVT) after lower-extremity orthopedic surgery. METHODS: Ninety-nine patients who underwent Doppler ultrasonography after lower-extremity orthopedic surgery were enrolled. Medical records were reviewed for anesthesia duration, type of surgery, body weight, height, and cardiovascular risk factors (including history of smoking, diabetes mellitus or hypertension, blood pressure, and total cholesterol and high-density lipoprotein [HDL] cholesterol levels), and the DVT treatment. Ultrasound diagnosis of DVT was made according to a routine protocol. The relationships between selected factors and the presence of DVT were assessed using univariate and multivariate regression analyses. RESULTS: Thirty-three (33%) patients were found to have calf DVT. The mean age, weight, and height of the non-DVT and postoperative DVT patients were 55.1 years versus 65.4 years, 70.5 kg versus 61.2 kg, and 163.3 cm versus 157.0 cm, respectively. Total cholesterol/HDL levels in the non-DVT and DVT patients were 70.6/20.7 mg/dL and 90.8/26.0 mg/dL, retrospectively. Systolic and diastolic blood pressure in the non-DVT and DVT patients were 133.6/80.2 mm Hg and 132.2/78.1 mmHg, respectively. The mean duration of anesthesia was 173.9 versus 199.9 minutes, and the operative time was 136.4 minutes versus 161.0 minutes. Older age (P=0.005) and lower body weight (P=0.002) were significantly associated with postoperative DVT. No other significant between-group differences were found (P>0.05). The patients with ultrasound-identified DVT received antithrombotic treatment. None of them had distant thromboembolism. CONCLUSION: After lower-extremity orthopedic surgery, the calf veins in elderly patients with low body weight are susceptible to thrombosis; they would most likely benefit from postoperative ultrasonography.

Added value of color-coded virtual non-calcium dual-energy CT in the detection of acute knee fractures in non-radiology inexpert readers.

PURPOSE: To evaluated the added value of dual-energy CT (DECT) virtual non-calcium (VNCa) protocol on conventional CT in the detection of acute knee fractures in non-radiology inexpert readers. METHOD: One hundred fifty-six patients (mean age, 51.97 years; age range, 17-86 years) with knee trauma, who underwent DECT and MRI within 3 days between April 2017 and October 2018, were retrospectively analyzed. Three readers (intern, 1st-year general surgery resident, 1st-year emergency medicine resident) independently analyzed CT alone and then with the additional color-coded DECT VNCa for fractures. A board-certified radiologist, analyzed CT and MRI series to define the reference standard. Sensitivity, specificity, and AUC were compared between the two reading sessions. RESULTS: Fifty-seven patients had acute fractures and 99 had no fractures. Thirteen of 57 fractures were nondisplaced. The additional use of VNCa images significantly increased the mean AUC (reader 1: 0.813 vs. 0.919; reader 2: 0.842 vs. 0.930; reader 3: 0.837 vs. 0.921; P < 0.05). When only nondisplaced fractures included, the mean AUC was more increased in the combined analysis of CT and DECT VNCa (reader 1: 0.521 vs. 0.916; reader 2: 0.542 vs. 0.926; reader 3: 0.575 vs. 0.926; P <  .01). Sensitivity increased by 15 %-20 % in total fracture group and by 69 %-77 % in nondisplaced fracture group over that with CT alone when both CT and DECT VNCa were used. Specificity did not differ significantly. CONCLUSIONS: The additional use of color-coded DECT VNCa protocol to conventional CT improved diagnostic performance in detecting acute knee fractures for inexperienced non-radiology readers.

Opportunistic use of chest CT for screening osteoporosis and predicting the risk of incidental fracture in breast cancer patients: A retrospective longitudinal study.

This study aimed to investigate the diagnostic performance of chest computed tomography (CT) for opportunistic screening and longitudinal follow-up of osteoporosis in breast cancer patients, compared to dual-energy X-ray absorptiometry (DXA). The association between L1 vertebral attenuation on chest CT and incidental fracture was also evaluated. We retrospectively reviewed 414 consecutive breast cancer patients who underwent both non-enhanced chest CT and DXA within a 3-month interval and had at least two DXA and two chest CT examinations over more than 1 year. The attenuation value of the L1 trabecular bone was measured on an axial CT image and compared to the corresponding DXA T-score. The diagnostic performance of L1 vertebral attenuation on CT for osteoporosis was calculated at different thresholds (90 HU, 100 HU, 110 HU), and the correlation between L1 vertebral attenuation values and DXA T-scores was statistically analyzed. Overall fracture-free survival was estimated and compared with the threshold of 90 HU on CT and -2.5 T-score on DXA. Of 414 patients (median age, 53.0 years), 88 (21.3%) had either vertebral or non-vertebral fractures. The median follow-up duration between initial and final DXA was 902.9 days. There was a moderate correlation between L1 vertebral attenuation value and DXA T-score (ρ = 0.684, CI 0.653-0.712). Fracture-free survival was significantly lower in patients with attenuation values ≤90 HU on CT and T-scores ≤-2.5 on DXA (P < .001). Multivariate analysis revealed that attenuation values ≤90 HU on CT (P < .001), T-scores ≤-2.5 on DXA (P = .003), and age ≥65 years (P = .03) were independent significant prognostic factors associated with overall fracture-free survival. The sensitivities and specificities of L1 attenuation value were 54.9% and 85.8% at 90-HU threshold, 74.0% and78.4% at 100-HU threshold, and 83.9% and 70.1% at 110-HU threshold, respectively. In conclusion, CT can be used for predicting osteoporosis and discriminating incidental fracture risk in breast cancer patients.

Dual-source abdominopelvic computed tomography: Comparison of image quality and radiation dose of 80 kVp and 80/150 kVp with tin filter.

OBJECTIVE: To compare the radiation dose and the objective and subjective image quality of 80 kVp and 80/150 kVp with tin filter (80/Sn150 kVp) computed tomography (CT) in oncology patients. METHODS: One-hundred-and-forty-five consecutive oncology patients who underwent third-generation dual-source dual-energy CT of the abdomen for evaluation of malignant visceral, peritoneal, extraperitoneal, and bone tumor were retrospectively recruited. Two radiologists independently reviewed each observation in 80 kVp CT and 80/Sn150 kVp CT. Modified line-density profile of the tumor and contrast-to-noise ratio (CNR) were measured. Diagnostic confidence, lesion conspicuity, and subjective image quality were calculated and compared between image sets. The effective dose and size-specific dose estimate (SSDE) were calculated in the image sets. RESULTS: Modified line-density profile analysis revealed higher attenuation differences between the tumor and normal tissue in 80 kVp CT than in 80/Sn150 kVp CT (127 vs. 107, P = 0.05). The 80 kVp CT showed increased CNR in the liver (8.0 vs. 7.6) and the aorta (18.9 vs. 16.3) than the 80/Sn150 kVp CT. The 80 kVp CT yielded higher enhancement of organs (4.9 ± 0.2 vs. 4.7 ± 0.4, P<0.001) and lesion conspicuity (4.9 ± 0.3 vs. 4.8 ± 0.5, P = 0.035) than the 80/Sn150 kVp CT; overall image quality and confidence index were comparable. The effective dose was reduced by 45.2% with 80 kVp CT (2.3 mSv ± 0.9) compared to 80/Sn150 kVp CT (4.1 mSv ± 1.5). The SSDE was 7.4 ± 3.8 mGy on 80/Sn150 kVp CT and 4.1 ± 2.2 mGy on 80 kVp CT. CONCLUSIONS: The 80 kVp CT reduced the radiation dose by 45.2% in oncology patients while showing comparable or superior image quality to that of 80/Sn150 kVp CT for abdominal tumor evaluation.

The utility of dual-energy CT collagen material decomposition technique for the visualization of tendon grafts after knee ligament reconstruction.

OBJECTIVE: The purpose of this article is to assess whether dual-energy CT (DECT) collagen material decomposition technique could reliably depict graft integrity in patients with knee ligament reconstruction. METHODS: Seventy patients (mean age, 29.8 years; age range, 15-57 years; 61 men, 9 women) who underwent knee DECT, from June 2016 to January 2018, after knee ligament reconstruction were included in our study. A total of 92 intact tendon grafts (autograft, n = 37; allograft, n = 50), confirmed by MRI and clinical assessment or second-look arthroscopy of the operated knee, were evaluated. The type and number of reconstructed ligaments were as follows: anterior cruciate ligament (ACL) (n = 30), posterior cruciate ligament (PCL) (n = 20), medial collateral ligament (MCL) (n = 12), lateral collateral ligament (LCL) (n = 10), posterolateral ligamentous complex (PLC) (n = 7), anterolateral ligament (ALL) (n = 6), and medial patellofemoral ligament (MPFL) (n = 7). All DECT tendon-specific color mapping images were analyzed by two radiologists independently. Each reconstructed ligament was divided into proximal, middle, and distal portion and rated separately using a three-point scale (0 = absent 'dual-energy color staining'; 1 = partial 'dual-energy color staining'; 2 = full 'dual-energy color staining'). RESULTS: The mean of total visualization scores of reconstructed ligaments were 5 or more out of 6 points (PCL: 5.0 ± 0.8; MCL: 5.4 ± 0.7; LCL: 5.5 ± 0.5; PLC: 5.4 ± 1.0; ALL: 5.3 ± 0.6; MPFL: 5.8 ± 0.5), except for ACL (4.3 ± 1.7). No significant difference was observed in the mean of total visualization scores between the autografts and allografts (p > 0.05). The frequency of the score 0 was greater than 10% for the ACL group (15.7%), while less than 5% or 0% for the other groups. Overall, substantial to almost perfect interobserver agreement (range 0.71-0.93) was found for all types of ligaments. CONCLUSION: DECT collagen material decomposition technique could be a valuable tool to qualitatively display tendon grafts in the patients with knee ligament reconstruction, but more caution would be needed to assess ACL graft.

Sonographic findings of mass-forming extramammary Paget's disease in the scrotum.

Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy involving the scrotum and may be confused with other scrotal malignancy. We describe the sonographic findings of an extremely rare case of mass-forming EMPD of the scrotal wall. Ultrasonography, which shows mild heterogeneous hyperechoic masses with a stalk connected to the dermis, can help predict the depth of vertical invasion of the lesion. The lesion extent should be precisely evaluated because the presence of dermal invasion of EMPD is the risk factor in distant metastasis and is known to result in a worse prognosis. Ultrasonography is a primary imaging modality to evaluate the extent and vertical invasion of EMPD. Surgical local wide excision is the treatment of choice for EMPD and histopathology confirmed the diagnosis.