Tarsal Navicular Stress Fracture: A Challenging Injury in Athletes

Background: Tarsal navicular stress fracture is a serious injury. Results from conservative treatment of early phase navicular stress fracture and surgical treatment of severe phase navicular stress fracture in athletes was evaluated.Methods: 34 athletes were diagnosed to have a tarsal navicular stress fracture. Seventeen patients were treated conservatively. Seventeen patients had surgical treatment. The follow-up time was >2 years and return to pre-injury level of sports was evaluated in all patients using four categories: excellent, good, moderate or poor.Results: The results from conservative treatment were excellent in all patients. Recovery from surgical treatment was excellent in 7 patients, good in 7, moderate in 2 and poor in 1 patient.Conclusions: Early diagnosis is very important for successful treatment of tarsal navicular stress fracture. The treating physician must keep in mind the symptoms and use an appropriate imaging method in the early phase of forefoot pain.</p

Myocardium assessment by relaxation along fictitious field, extracellular volume, feature tracking, and myocardial strain in hypertensive patients with left ventricular hypertrophy

Abstract Background: Previous research has shown impaired global longitudinal strain (GLS) and slightly elevated extracellular volume fraction (ECV) in hypertensive patients with left ventricular hypertrophy (HTN LVH). Up to now, only little attention has been paid to interactions between macromolecules and free water in hypertrophied myocardium. Purpose: To evaluate the feasibility of relaxation along a fictitious field with rank 2 (RAFF2) in HTN LVH patients. Study Type: Single institutional case control. Subjects: 9 HTN LVH (age, 69 ± 10 years) and 11 control subjects (age, 54 ± 12 years). Field Strength/Sequence: Relaxation time mapping (T1, T1p, and TRAFF2 with 11.8 μT maximum radio frequency field amplitude) was performed at 1.5 T using a Siemens Aera (Erlangen, Germany) scanner equipped with an 18-channel body array coil. Assessment: ECV was calculated using pre- and postcontrast T1, and global strains parameters were assessed by Segment CMR (Medviso AB Co, Sweden). The parametric maps of T1p and TRAFF2 were computed using a monoexponential model, while the Bloch-McConnell equations were solved numerically to model effect of the chemical exchange during radio frequency pulses. Statistical Tests: Parametric maps were averaged over myocardium for each subject to be used in statistical analysis. Kolmogorov-Smirnov was used as the normality test followed by Student’s t-test and Pearson’s correlation to determine the difference between the HTN LVH patients and controls along with Hedges’ g effect size and the association between variables, respectively. Results: TRAFF2 decreased statistically (83 ± 2 ms vs 88 ± 6 ms, P &lt; 0.031), and global longitudinal strain was impaired (GLS, −14 ± 3 vs −18 ± 2, P &lt; 0.002) in HTN LVH patients compared to the controls, respectively. Also, significant negative correlation was found between TRAFF2 and GLS (r = −0.53, P &lt; 0.05). Data conclusion: Our results suggest that TRAFF2 decrease in HTN LVH patients may be explained by gradual collagen accumulation which can be reflected in GLS changes. Most likely, it increases the water proton interactions and consequently decreases TRAFF2 before myocardial scarring

Relaxation along Fictitious Field (RAFF) provide an appropriate alternative method for imaging chronic myocardial infarct without exogenous contrast media

Abstract Background: Relaxation along Fictitious Field with rank 2 (RAFF2) has been shown to provide contrast agent-free alternative for gadolinium based Late Gadolinium Enhancement (LGE) measurement in mouse model. To characterize chronic Myocardial Infarction (MI) by using Relaxation along Fictitious Field in human myocardium without contrast agents. Methods and findings: Data for this study were collected in 18 patients with chronic infarct at 1.5 T. Scarred and remote area averages of RAFF2 relaxation time and steady state (TRAFF2 and SSRAFF2), native T₁ and T₂, Extra Cellular Volume (ECV) and LGE were calculated. Subsequently infarct sizes were determined and compared between LGE, ECV and RAFF2 maps. In addition, area of overestimation (AOE) was estimated for RAFF2 maps. The TRAFF2 and SSRAFF2, native T₁ and T₂ relaxation times, ECV and LGE values elevated at scar compared to remote area. Areas of increased LGE were highly correlated to the areas with increased SSRAFF2 (R=0.71, p&lt;0.01) and TRAFF2 (R=0.47, p&lt;0.05). Summary: RAFFn has been used to characterize myocardial infarction in humans and in mice. RAFFn owns potential to be used in the MI diagnosis without contrast agents

Prediction of prostate cancer aggressiveness using ¹⁸F-Fluciclovine (FACBC) PET and multisequence multiparametric MRI

Abstract The aim of this prospective single-institution clinical trial (NCT02002455) was to evaluate the potential of advanced post-processing methods for ¹⁸F-Fluciclovine PET and multisequence multiparametric MRI in the prediction of prostate cancer (PCa) aggressiveness, defined by Gleason Grade Group (GGG). 21 patients with PCa underwent PET/CT, PET/MRI and MRI before prostatectomy. DWI was post-processed using kurtosis (ADCₖ, K), mono- (ADCₘ), and biexponential functions (f, Dₚ, Df) while Logan plots were used to calculate volume of distribution (VT). In total, 16 unique PET (VT, SUV) and MRI derived quantitative parameters were evaluated. Univariate and multivariate analysis were carried out to estimate the potential of the quantitative parameters and their combinations to predict GGG 1 vs &gt;1, using logistic regression with a nested leave-pair out cross validation (LPOCV) scheme and recursive feature elimination technique applied for feature selection. The second order rotating frame imaging (RAFF), monoexponential and kurtosis derived parameters had LPOCV AUC in the range of 0.72 to 0.92 while the corresponding value for VT was 0.85. The best performance for GGG prediction was achieved by K parameter of kurtosis function followed by quantitative parameters based on DWI, RAFF and ¹⁸F-FACBC PET. No major improvement was achieved using parameter combinations with or without feature selection. Addition of ¹⁸F-FACBC PET derived parameters (VT, SUV) to DWI and RAFF derived parameters did not improve LPOCV AUC