PET in Brain Arteriovenous Malformations and Cerebral Proliferative Angiopathy

A brain arteriovenous malformation (BAVM) is a neurovascular entity that consists of a localized dense network of abnormal blood vessels (a nidus) that holds arteries shunting directly into veins in the absence of a capillary bed. In their natural history, BAVMs carry a risk of hemorrhage or other neurological complications, for which reason they are frequently treated. Cerebral proliferative angiopathy (CPA) is a different type of neurovascular malformation with distinct angiographic and clinical features that can be used to differentiate it from a classical BAVM. The basic difference between CPA and a BAVM is that CPA has normal brain tissue intermingled in between its network of vessels. Treatment of CPA by surgery, radiosurgery, or embolization consequently harbors a high risk of neurological complications. As such, reliable diagnostic discrimination between CPA and BAVM is crucial to adequately treat patients. However, despite the fact that CPA has some characteristic imaging features, the differentiation between CPA and a brain AVM may be difficult. PET imaging as a technique that reveals functional brain tissue is therefore likely to be of additional diagnostic value.<br/

Reliability of the Q Force; a mobile instrument for measuring isometric quadriceps muscle strength

BACKGROUND: The ability to generate muscle strength is a pre-requisite for all human movement. Decreased quadriceps muscle strength is frequently observed in older adults and is associated with a decreased performance and activity limitations. To quantify the quadriceps muscle strength and to monitor changes over time, instruments and procedures with a sufficient reliability are needed. The Q Force is an innovative mobile muscle strength measurement instrument suitable to measure in various degrees of extension. Measurements between 110 and 130° extension present the highest values and the most significant increase after training. The objective of this study is to determine the test-retest reliability of muscle strength measurements by the Q Force in older adults in 110° extension. METHODS: Forty-one healthy older adults, 13 males and 28 females were included in the study. Mean (SD) age was 81.9 (4.89) years. Isometric muscle strength of the Quadriceps muscle was assessed with the Q Force at 110° of knee extension. Participants were measured at two sessions with a three to eight day interval between sessions. To determine relative reliability, the intraclass correlation coefficient (ICC) was calculated. To determine absolute reliability, Bland and Altman Limits of Agreement (LOA) were calculated and t-tests were performed. RESULTS: Relative reliability of the Q Force is good to excellent as all ICC coefficients are higher than 0.75. Generally a large 95 % LOA, reflecting only moderate absolute reliability, is found as exemplified for the peak torque left leg of -18.6 N to 33.8 N and the right leg of -9.2 N to 26.4 N was between 15.7 and 23.6 Newton representing 25.2 % to 39.9 % of the size of the mean. Small systematic differences in mean were found between measurement session 1 and 2. CONCLUSION: The present study shows that the Q Force has excellent relative test-retest reliability, but limited absolute test-retest reliability. Since the Q Force is relatively cheap and mobile it is suitable for application in various clinical settings, however, its capability to detect changes in muscle force over time is limited but comparable to existing instruments