Surgical treatment of congenital muscular torticollis. When to refer to surgery?

Aim: The aim of the study was to evaluate our results of treatment and to improve treatment and referral practices regarding congenital muscular torticollis (CMT) among physiotherapists. Design: Children operated for congenital muscular torticollis (CMT) were clinically reviewed to evaluate satisfaction, function, cosmetics and quality of life.. Methods: 16 operated children were included from a cohort of 24 and examined in average 4 years postoperatively. Active and passive range of motion, strength and endurance was measured by two physiotherapists. Cheng score was used to rate functional and cosmetic parameters, and the Pediatric Quality of Life Initiative (PedsQL) was used to assess quality of life. Results: Fourteen of 16 patients were satisfied and perceived a high quality of life. Neck movement and muscle strength was close to normal at the follow-up. Fifteen of 16 patients still had some facial asymmetry. The results were independent of age. Our results are consistent with other studies. Conclusions: Current guidelines recommend early surgery. To counteract persistent malposition and facial asymmetry, psychological distress and unnecessary use of time and resources, these children should be referred to surgery when conservative treatment is unsuccessful within the first year of life

Metal artifact reduction on musculoskeletal CT: a phantom and clinical study

Abstract Background Artifacts caused by metal implants are challenging when undertaking computed tomography (CT). Dedicated algorithms have shown promising results although with limitations. Tin filtration (Sn) in combination with high tube voltage also shows promise but with limitations. There is a need to examine these limitations in more detail. The purpose of this study was to investigate the impact of different metal artefact reduction (MAR) algorithms, tin filtration, and ultra-high-resolution (UHR) scanning, alone or in different combinations in both phantom and clinical settings. Methods An ethically approved clinical and phantom study was conducted. A modified Catphan® phantom with titanium and stainless-steel inserts was scanned with six different MAR protocols with tube voltage ranging from 80 to 150 kVp. Other scan parameters were kept identical. The differences (∆) in mean HU and standard deviation (SD) in images, with and without metal, were measured and compared. In the clinical study, three independent readers performed visual image quality assessments on eight different protocols using retrospectively acquired images. Results Iterative MAR had the lowest ∆HU and ∆SD in the phantom study. For images of the forearm, the soft tissue noise for Sn-based 150-kVp UHR protocol with was significantly higher (p = 0.037) than for single-energy MAR protocols. All Sn-based 150-kVp protocols were rated significantly higher (p < 0.046 than the single-energy MAR protocols in the visual assessment. Conclusions All Sn-based 150-kVp UHR protocols showed similar objective MAR in the phantom study, and higher objective MAR and significantly improved visual image quality than single-energy MAR. Relevance statement Images with less metal artifacts and higher visual image quality may be more clinically optimal in CT examination of musculoskeletal patients with metal implants. Key points • Metal artifact reduction algorithms and Sn filter combined with high kVp reduce artifacts. • Metal artifact reduction algorithms introduce new artifacts in certain metals. • Sn-based protocols alone may be considered as low metal artifact protocols. Graphical Abstrac