Can pixel value ratio be used in the assessment of ceramic bone substitute incorporation? : observations from a pilot study

Background: Assessment of bone graft substitute incorporation is critical in the clinical decision making process and requires special investigations. We examined if the pixel value ratio (PVR) obtained in routine follow-up digital radiographs could be used for such assessment. Material/Methods: Radiographic images were acquired using either computed radiography or flat panel digital radiography systems. The PVR from radiographs of thirty children with ceramic bone substitute grafting were analyzed using the software from the picture archival and communication system (PACS) workstation. Graft incorporation was also assessed using the van Hemert scale. Three independent observers (A, B, C) measured PVRs at two different time points during the first and the last follow-up visits. PVR was compared with the van Hemert scale scores and analyzed using Spearman's rank correlation. Results: The mean intra-observer reliability was 0.8996, and inter-observer reliabilities were 0.69 (A vs. C), 0.78 (A vs. B), and 0.85 (B vs. C) for the first follow-up visit and 0.74 (A vs. C), 0.82 (A vs. B), and 0.70 (B vs. C) for the last follow-up measurements. Spearman's correlation showed a strong negative association between PVR values and van Hemert scale scores, as the healing process advanced on serial measurements at each follow-up (r=-0.94, n=60, z=-7.24, p£0.0001). The reliability of the PVR measurements was assessed using an aluminum step wedge and ceramic graft. Conclusions: PVR is potentially a reliable indicator of bone graft incorporation and can aid in clinical decision making provided standard radiographic techniques are used

Correlation of quantitative and qualitative parameters of high-resolution computed tomography with pulmonary function test for diagnosing and assessing the severity of obstructive pulmonary disease

Purpose: The aim of the study was to evaluate the role of high-resolution computed tomography (HRCT) in the prediction of presence and severity of chronic obstructive pulmonary disease (COPD), based on the pulmonary function test (PFT), to correlate the various quantitative and qualitative indices of COPD in HRCT with PFT values, and to derive at the threshold values for various quantitative HRCT indices of COPD. Material and methods: A one-year retrospective and prospective evaluation of the HRCTs of 90 cases and 38 controls was performed. Quantitative and qualitative parameters of COPD were assessed in HRCT and were correlated with PFT. Results: Among the qualitative parameters, significant correlation with spirometry was found with the qualitative scoring for emphysema and presence and inhomogeneous attenuation. Among the quantitative indices, anterior junction line length, thoracic cage ratio at both aortic arch and inferior pulmonary vein level, thoracic cross-sectional area/[height]² at the aortic arch were found to have good correlation with spirometry. There was significant strong correlation of anterior junction line length and tracheal index with residual volume/total lung capacity (RV/TLC). The threshold values of chest X-ray and HRCT quantitative parameters were calculated and were found to be lower than those of the western population. Conclusion: HRCT has a definite role in the diagnosis of COPD and can be used to predict the severity of emphysema

Bipolar physeal injuries of the clavicle in a child

This article reports a type II Salter and Harris injury at either ends of the clavicle in a 13-year-old child with postero-inferior displacement at the lateral and antero-superior displacement at the medial end of the clavicle shaft. He was treated in a shoulder immobilizer. The mechanism of injury is postulated as pivoting of the clavicle on the first rib with shearing at either ends leading to a bipolar injury. The brachial plexus and subclavian vessels are at a risk of damage at the pivot as they lie in close vicinity to the first rib. In view of the intact periosteal sleeve as well as joint articulation at both ends, the fracture healed with no functional loss

Accuracy of various MRI sequences in determining the tumour margin in musculoskeletal tumours

BACKGROUND: It is imperative that bone tumour margin and extent of tumour involvement are accurately assessed pre-operatively in order for the surgeon to attain a safe surgical margin. In this study, we comprehensively assessed each of the findings that influence surgical planning, on various MRI sequences and compared them with the gold standard - pathology. MATERIAL AND METHODS: In this prospective study including 21 patients with extremity bone tumours, margins as seen on various MRI sequences (T1, T2, STIR, DWI, post-gadolinium T1 FS) were measured and biopsies were obtained from each of these sites during the surgical resection. The resected tumour specimen and individual biopsy samples were studied to assess the true tumour margin. Margins on each of the MRI sequences were then compared with the gold standard - pathology. In addition to the intramedullary tumour margin, we also assessed the extent of soft tissue component, neurovascular bundle involvement, epiphyseal and joint involvement, and the presence or absence of skip lesions. RESULTS: T1-weighted imaging was the best sequence to measure tumour margin without resulting in clinically significant underestimation or overestimation of the tumour extent (mean difference of 0.8 mm; 95% confidence interval between -0.9 mm to 2.5 mm; inter-class correlation coefficient of 0.998). STIR and T1 FS post-gadolinium imaging grossly overestimated tumour extent by an average of 16.7 mm and 16.8 mm, respectively (P values <0.05). Post-gadolinium imaging was better to assess joint involvement while T1 and STIR were the best to assess epiphyseal involvement. CONCLUSIONS: T1-weighted imaging was the best sequence to assess longitudinal intramedullary tumour extent. We suggest that osteotomy plane 1.5 cm beyond the T1 tumour margin is safe and also limits unwarranted surgical bone loss. However, this needs to be prospectively proven with a larger sample size

Clinical Radiology Case Presentation: Do’s and Don’ts

Clinical case presentation is part of daily routine for doctors to communicate with each other to facilitate learning, and ultimately patient management. Hence, the art of good clinical case presentation is a skill that needs to be mastered. Case presentations are a part of most undergraduate and postgraduate training programs aimed at nurturing oratory and presentation design skills. This article is an attempt at providing a trainee in radiology a guideline to good case presentation skills

The current status of pediatric radiology in India: A conference-based survey

Introduction: Like most other developing countries, India has a large proportion of children among its population. However, the facilities for adequate treatment of this large population is inadequate. The development of pediatric radiology as a subspecialty is still at an infant stage in India. The goal of our study was to assess the awareness about the current status of pediatric radiology in India. Materials and Methods: A questionnaire was handed over to all attendees of a pediatric radiology conference to assess their opinion regarding the adequacy of pediatric training and practice in India. The questionnaire consisted of 10 multiple-choice and two descriptive questions. Descriptive statistical methods were used for analyzing the results. Results: Eighty-one out of 400 delegates responded to the questionnaire. Among these 81 respondents, 50 (61.7%) felt that exposure to pediatric cases during postgraduate course was inadequate. Sixty-three out of 81 (77.7%) respondents thought that specialized training is required for practicing pediatric radiology, and 79 respondents (97%) felt that the number of such training programmes should increase. Forty-five out of 81 respondents (55.5%) were interested in pursuing pediatric radiology as a career. Conclusion: According to the opinion of the respondents of our survey, pediatric radiology remains an underdeveloped speciality in India. Considering the proportion of the population in the pediatric age and the poor health indicators in this age group, elaborate measures, as suggested, need to be implemented to improve pediatric radiology training and the care of sick children in India

Congenital nasal pyriform aperture stenosis: A rare cause of nasal airway obstruction in a neonate

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of nasal airway obstruction that clinically mimics choanal atresia, but needs to be differentiated from the latter because of the widely divergent modes of management. We present a case of CNPAS, to highlight the importance of recognizing the classic signs of CNPAS on cross-sectional imaging