- 作者列表："Best MJ","Tanaka MJ","Demehri S","Cosgarea AJ
BACKGROUND:Abnormal patellar tracking is described as a "J-sign" when the patella exhibits excessive lateral displacement during active knee extension. PURPOSE:To determine (1) the accuracy and reliability of the visual assessment of patellar tracking when viewed by surgeons with patellofemoral expertise and (2) whether surgeon experience (in years) correlates with the ability to accurately identify the presence and severity of patellar maltracking. STUDY DESIGN:Cohort study (diagnosis); Level of evidence, 2. METHODS:Using a web-based assessment, 32 orthopaedic surgeon members of the International Patellofemoral Study Group determined the presence or absence of maltracking (≥2 quadrants of lateral translation) in 10 single-knee videos of patients with patellar instability during active knee extension (qualitative analysis). Surgeons then graded patellar tracking in 20 single-knee videos as follows: 0 (<1 patellar quadrant of lateral translation), 1 (1 to <2 quadrants), 2 (2 to <3 quadrants), or 3 (≥3 quadrants) (quantitative analysis). Responses were compared with a previously described grading system using patellar bisect offset measured with 4-dimensional computed tomography. We evaluated the association between number of years of surgeon experience and the ability to correctly identify and grade patellar tracking. A total of 22 surgeons repeated the survey 3 months later, and their answers were matched to the first survey, allowing for assessment of intraobserver reliability. RESULTS:In the qualitative analysis, surgeons correctly identified videos as showing patellar maltracking 68% of the time (κ = 0.45). In the quantitative analysis, 53%, 51%, 48%, and 68% of surgeons correctly identified maltracking of grades 3, 2, 1, and 0, respectively (κ = 0.42). Surgeon experience did not correlate with ability to identify the presence (P = .59) or grade (P = .35) of patellar maltracking. Respondent answers from the second survey demonstrated inadequate intraobserver reliability (κ = 0.48). CONCLUSION:Using visual assessment alone, surgeons correctly identified patellar maltracking in approximately two-thirds of videos and correctly graded patellar maltracking in half. Inter- and intraobserver reliability were inadequate to support the use of visual assessment alone for detecting the presence or grade of patellar maltracking. Surgeon experience did not correlate with ability to identify the presence or grade of patellar maltracking.
背景: 当髌骨在主动膝关节伸展过程中表现出过度的外侧移位时，异常髌骨跟踪被描述为 “J征”。 目的: 确定 (1) 由具有髌股专业知识的外科医生观察髌骨跟踪的视觉评估的准确性和可靠性，以及 (2) 外科医生经验 (以年计) 是否与准确识别髌骨跟踪不良的存在和严重程度的能力相关。 研究设计: 队列研究 (诊断); 证据水平，2. 方法: 使用基于网络的评估，国际髌股研究组的32名骨科医生成员在10个主动膝关节伸展期间髌骨不稳定患者的单膝关节视频中确定了是否存在错位 (≥ 2个外侧平移象限) (定性分析)。然后，外科医生在20个单膝视频中对髌骨跟踪进行分级，如下所示: 0 (外侧平移的髌骨象限 <1) 、1 (1至 <2象限) 、2 (2至 <3象限) 或3 (≥ 3象限) (定量分析)。使用4维计算机断层扫描测量的髌骨平分偏移，将反应与先前描述的分级系统进行比较。我们评估了外科医生经验的年数与正确识别和分级髌骨追踪的能力之间的关联。3个月后，共有22名外科医生重复了调查，他们的回答与第一次调查相匹配，从而评估了观察者内的可靠性。 结果: 在定性分析中，外科医生正确地将视频识别为68% 的时间显示髌骨异常 (κ = 0.45)。在定量分析中，分别有53% 、51% 、48% 和68% 的外科医生正确识别出3、2、1和0级的失访 (κ = 0.42)。外科医生的经验与确定髌骨畸形的存在 (P = .59) 或分级 (P = .35) 的能力无关。第二次调查的受访者回答显示观察者内可靠性不足 (κ = 0.48)。 结论: 单独使用视觉评估，外科医生在大约3分之2的视频中正确识别髌骨畸形，在一半中正确分级髌骨畸形。观察者间和观察者内的可靠性不足以支持单独使用视觉评估来检测髌骨畸形的存在或程度.外科医生的经验与确定髌骨畸形的存在或分级的能力无关。
METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.
METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.
METHODS:OBJECTIVE:The primary purpose of this study was to evaluate the effectiveness of a three-dimensional (3D) software tool (smart planes) for displaying fetal brain planes, and the secondary purpose was to evaluate its accuracy in performing automatic measurements. MATERIAL AND METHODS:This prospective study included singleton fetuses with a gestational age (GA) greater than 18 weeks. Transabdominal two-dimensional ultrasound (2DUS) and 3D smart planes images were respectively used to obtain the basic planes of the fetal brain, with five parameters measured. The images, by either two-dimensional (2D) manual or 3D automatic operation, were reviewed by two experienced sonographers. The agreements between two measurements were analyzed. RESULTS:A total of 226 cases were included. The rates of successful detection by automatic display were as high as 80%. There was substantial agreement between the measurements of the biparietal diameter, head circumference and transcerebellar diameter, but poor agreement between the measurements of cisterna magna and lateral ventricle width. CONCLUSIONS:Smart Planes might be valuable for the rapid evaluation of fetal brain, because it simplifies the evaluation process. However, the technology requires improvement. In addition, this technology cannot replace the conventional manual US scans; it can only be used as an additional approach.