Search

Background: Glenoid bone defect is frequently associated with anterior shoulder instability and is considered one of the major causes of recurrence of instability after shoulder stabilization.Hypothesis: Some risk factors are significantly associated with the presence, size, and type of glenoid bone defect.Study Design: Cohort study (prognosis); Level of evidence, 2.Methods: One hundred sixty-one patients affected by anterior shoulder instability underwent morphologic evaluation of the glenoid by computed tomography scans to assess the presence, size, and type of glenoid bone defect (erosion or bony Bankart lesion). Bone loss greater than 20% of the area of the inferior glenoid was considered “critical” bone defect (at risk of recurrence). Outcomes were correlated with the following predictors: age, gender, arm dominance, frequency of dislocation, age at first dislocation, timing from first dislocation, number of dislocations, cause of first dislocation, generalized ligamentous laxity, type of sport, and manual work.Results: Glenoid bone defect was observed in 72% of the cases. Presence of the defect was significantly associated with recurrence of dislocation compared with a single episode of dislocation, increasing number of dislocations, male gender, and type of sport. Size of the defect was significantly associated with recurrent dislocation, increasing number of dislocations, timing from first dislocation, and manual work. Presence of a critical defect was significantly associated with number of dislocations and age at first dislocation. Bony Bankart lesion was significantly associated with male gender and age at first dislocation.Conclusion: The number of dislocations and age at first dislocation are the most significant predictors of glenoid bone loss in anterior shoulder instability. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to present the results of the Italian survey on the management of pulmonary nodules incidentally identified at computed tomography (CT)., Materials and Methods: An online electronic survey, consisting of 23 multiple-choice questions, was created using the SurveyMonkey web-based tool. The questionnaire was developed by the Board of the Italian College of Chest Radiology of the Italian Society of Medical and Interventional Radiology (SIRM) and by an experienced group of Italian Academic Chest Radiologists. The link to the online electronic survey was submitted by email to all the SIRM members., Results: A total of 767 radiologists, corresponding to 7.5% of all the SIRM members, participated in the online survey. The majority of participants (92%) routinely describe the attenuation of pulmonary nodules in the report, and 84.1% recommend the further follow-up, with 92.7% of respondents taking CT nodule morphological features into consideration. The 57.7% of participants adhere to the Fleischner Society guidelines for the management of incidental pulmonary nodules. However, 56.6% and 75.6% of respondents have a more cautious approach than that recommended by the guidelines and tend to use a shorter follow-up for both solid and ground-glass nodules, respectively. Finally, 94.5% of participants favor congresses and refresher courses dedicated to insights on lung nodule diagnosis and management., Conclusions: This survey demonstrates that the management of pulmonary nodules incidentally detected on CT is still complex and controversial. The majority of SIRM members express a need for an update on this topic.

Background and Aims: Dynamic contrast enhanced magnetic resonance improves prostate cancer detection. The aims of this paper are to verify whether wash-in-rate parameter (speed of contrast uptake in dynamic contrast enhanced magnetic resonance) can help to differentiate prostate cancer from non-neoplastic T2-weighted hypointense lesions within prostate gland and to assess a cut-off for prostate cancer diagnosis., Methods: Prospective, monocentric, multi-departmental study. Thirty consecutive patients underwent T2-weighted and dynamic contrast enhanced magnetic resonance, and re-biopsy. T2-weighted hypointense lesions, >5mm in size, were noted. Lesions were assessed as cancerous (showing mass effect, or no defined margin within transitional zone) and non cancerous (no mass effect) and were compared with histopathology by 2×2 tables. Wash-in-rate of each lesion was calculated and was correlated with histopathology. Student's t-test was adopted to assess significant differences. Receiver operating characteristic (ROC) analysis was employed to identify the best cut-off for wash-in-rate in detecting prostate cancer., Results: At re-biopsy, cancer was proven in 43% of patients. On T2-weighted MRI, 111 hypointense lesions ≥5 mm in size were found. Sensitivity, specificity and accuracy of T2-weighted MRI were 80% (±12.4 CI 95%), 74.6% (±10.1 CI 95%), and 76.5% (±7.9 CI 95%), respectively. Mean WR was 5.8±1.9/s for PCa zones and 2.96±1.44/s for non-PCa zones (p<0.00000001). At ROC analysis, the best area under curve (AUC) for wash-in-rate parameter was associated to 4.2/s threshold with 82.5% sensitivity (CI±7.07), 97.2% specificity (CI±4.99) and 91.2% accuracy (CI±5.27). Eighteen false positive lesions on T2-weighted MRI showed low wash-in-rate values suggesting non-cancer lesions, while in 5/8 false negative cases high wash-in-rate values correctly suggested prostate cancer. Nine lesions with surgically proven cancer were not included in the saturation biopsy scheme, in 2/9 cases the only site of cancer., Conclusions: Wash-in-rate parameter allows to differentiate prostate cancer from non-neoplastic lesions, helping cancer detection in areas not included in the biopsy scheme., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)