Congenital Forearm Pseudarthrosis, a Systematic Review for a Treatment Algorithm on a Rare Condition

Background: A congenital forearm pseudarthrosis is a rare condition and is strongly associated with neurofibromatosis type 1. Several surgical techniques are described in the literature, but the most optimal treatment strategy remains unclear. This systematic review aims to develop a treatment algorithm that may aid i

A 3D-printed anatomical pancreas and kidney phantom for optimizing SPECT/CT reconstruction settings in beta cell imaging using 111In-exendin

Contains fulltext : 165641.pdf (publisher's version ) (Open Access)BACKGROUND: Quantitative single photon emission computed tomography (SPECT) is challenging, especially for pancreatic beta cell imaging with 111In-exendin due to high uptake in the kidneys versus much lower uptake in the nearby pancreas. Therefore, we designed a three-dimensionally (3D) printed phantom representing the pancreas and kidneys to mimic the human situation in beta cell imaging. The phantom was used to assess the effect of different reconstruction settings on the quantification of the pancreas uptake for two different, commercially available software packages. METHODS: 3D-printed, hollow pancreas and kidney compartments were inserted into the National Electrical Manufacturers Association (NEMA) NU2 image quality phantom casing. These organs and the background compartment were filled with activities simulating relatively high and low pancreatic 111In-exendin uptake for, respectively, healthy humans and type 1 diabetes patients. Images were reconstructed using Siemens Flash 3D and Hermes Hybrid Recon, with varying numbers of iterations and subsets and corrections. Images were visually assessed on homogeneity and artefacts, and quantitatively by the pancreas-to-kidney activity concentration ratio. RESULTS: Phantom images were similar to clinical images and showed comparable artefacts. All corrections were required to clearly visualize the pancreas. Increased numbers of subsets and iterations improved the quantitative performance but decreased homogeneity both in the pancreas and the background. Based on the phantom analyses, the Hybrid Recon reconstruction with 6 iterations and 16 subsets was found to be most suitable for clinical use. CONCLUSIONS: This work strongly contributed to quantification of pancreatic 111In-exendin uptake. It showed how clinical images of 111In-exendin can be interpreted and enabled selection of the most appropriate protocol for clinical use

3D Ultrasound assessment of rotator cuff tear morphology

Objective: To compare clinical examination, 2D and 3D ultrasound with arthroscopic findings for the assessment of rotator cuff tear size, extent and area. Subject and Methods: Fourteen patients underwent consecutively clinical examination, 2D and 3D ultrasound and arthroscopic rotator cuff repair. After assessment, the size of the tear was measured and the area calculated. Results: The size of the rotator cuff tear in the anterior-posterior direction was not significantly different in clinical examination, 2D and 3D ultrasound compared with arthroscopic findings (p=0,537, p=0,509, p=0,222). In the medial-lateral direction a larger tear size was estimated in the three examinations compared to the arthroscopic findings (p<0,05). The area of the tear was not significantly different in clinical examination (p=0,122) and it was larger in 2D and 3D ultrasound (p<0,05) compared to arthroscopy. The accuracy for clinical examination in predicting partial and full thickness tears was 50% and 100%. For 2D and 3D ultrasound an accuracy of 50% and 83% was found. The tear size correlated well in all three examinations except the tear size in medial-lateral direction in 2D ultrasound (rs=0,547). The area of the tear also correlated well with the arthroscopic findings (rs=0,78 for clinical estimation, rs=0,741 for 2D ultrasound, rs=0,723 for 3D ultrasound). Conclusion: Conclusions are limited due to small sample size. There is a surprisingly good accuracy and good correlation between clinical examination and actual tear size. 3D ultrasound was only in predicting the tear size in the medial-lateral direction better than 2D ultrasound examination.

Congenital Forearm Pseudarthrosis, a Systematic Review for a Treatment Algorithm on a Rare Condition

Background: A congenital forearm pseudarthrosis is a rare condition and is strongly associated with neurofibromatosis type 1. Several surgical techniques are described in the literature, but the most optimal treatment strategy remains unclear. This systematic review aims to develop a treatment algorithm that may aid in clinical decision making. Methods: The PROSPERO registration number for this study was CRD42018099602 and adheres to the PRISMA guidelines for systematic reviews. Embase, MEDLINE, Cochrane Central, Web of Science, and Google Scholar databases were searched for published studies reporting on congenital forearm pseudarthrosis not related to other underlying pathologies like bacterial infection or fibrous dysplasia. Results were not restricted by date or study type, only English literature was allowed. Studies were assessed for quality using the critical appraisal checklist for case reports from the Joanna Briggs Institute. Patient characteristics, underlying disease, type of surgery, union rate, and functional outcome were extracted from included studies. Results: Of 829 studies identified, 47 were included in this review (17 case series and 30 case reports, a total of 84 cases). A onebone forearm procedure showed highest union rates (92%), however, it results in loss of forearm rotation. Free vascularized fibula grafting showed high union rates (87%) and was related to good functional outcome of elbow flexion and forearm rotations. Other procedures showed disappointing outcomes. Conclusions: Congenital forearm pseudarthrosis is best treated with a free vascularized fibula grafting, a one-bone forearm procedure should be used as a salvage procedure. Evidence extracted from the case reports was sufficient to generate a treatment algorithm to be used in clinical pediatric practice. Level of Evidence: Level IV-therapeutic