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To compare volumetric CT with DL-based fully automated segmentation and dual-energy X-ray absorptiometry (DXA) in the measurement of thigh tissue composition.This prospective study was performed from January 2019 to December 2020. The participants underwent DXA to determine the body composition of the whole body and thigh. CT was performed in the thigh region; the images were automatically segmented into three muscle groups and adipose tissue by custom-developed DL-based automated segmentation software. Subsequently, the program reported the tissue composition of the thigh. The correlation and agreement between variables measured by DXA and CT were assessed. Then, CT thigh tissue volume prediction equations based on DXA-derived thigh tissue mass were developed using a general linear model.In total, 100 patients (mean age, 44.9 years; 60 women) were evaluated. There was a strong correlation between the CT and DXA measurements (R = 0.813~0.98, p0.001). There was no significant difference in total soft tissue mass between DXA and CT measurement (p = 0.183). However, DXA overestimated thigh lean (muscle) mass and underestimated thigh total fat mass (p0.001). The DXA-derived lean mass was an average of 10% higher than the CT-derived lean mass and 47% higher than the CT-derived lean muscle mass. The DXA-derived total fat mass was approximately 20% lower than the CT-derived total fat mass. The predicted CT tissue volume using DXA-derived data was highly correlated with actual CT-measured tissue volume in the validation group (RVolumetric CT measurements with DL-based fully automated segmentation are a rapid and more accurate method for measuring thigh tissue composition.• There was a positive correlation between CT and DXA measurements in both the whole body and thigh. • DXA overestimated thigh lean mass by 10%, lean muscle mass by 47%, but underestimated total fat mass by 20% compared to the CT method. • The equations for predicting CT volume (cm

The mapping between speech acoustics and phonemic representations is highly variable across talkers, and listeners are slower to recognize words when listening to multiple talkers compared with a single talker. Listeners' speech processing efficiency in mixed-talker settings improves when given time to reorient their attention to each new talker. However, it remains unknown how much time is needed to fully reorient attention to a new talker in mixed-talker settings so that speech processing becomes as efficient as when listening to a single talker. In this study, we examined how speech processing efficiency improves in mixed-talker settings as a function of the duration of continuous speech from a talker. In single-talker and mixed-talker conditions, listeners identified target words either in isolation or preceded by a carrier vowel of parametrically varying durations from 300 to 1,500 ms. Listeners' word identification was significantly slower in every mixed-talker condition compared with the corresponding single-talker condition. The costs associated with processing mixed-talker speech declined significantly as the duration of the speech carrier increased from 0 to 600 ms. However, increasing the carrier duration beyond 600 ms did not achieve further reduction in talker variability-related processing costs. These results suggest that two parallel mechanisms support processing talker variability: A stimulus-driven mechanism that operates on short timescales to reorient attention to new auditory sources, and a top-down mechanism that operates over longer timescales to allocate the cognitive resources needed to accommodate uncertainty in acoustic-phonemic correspondences during contexts where speech may come from multiple talkers.

Loss of knee cartilage can cause intense pain at the knee epiphysis and this is one of the most common diseases worldwide. To diagnose this condition, the distance between the femur and tibia is calculated based on X-ray images. Accurate segmentation of the femur and tibia is required to assist in the calculation process. Several studies have investigated the use of automatic knee segmentation to assist in the calculation process, but the results are of limited value owing to the complexity of the knee. To address this problem, this study exploits deep learning for robust segmentation not affected by the environment. In addition, the Taguchi method is applied to optimize the deep learning results. Deep learning architecture, optimizer, and learning rate are considered for the Taguchi table to check the impact and interaction of the results. When the Dilated-Resnet architecture is used with the Adam optimizer and a learning rate of 0.001, dice coefficients of 0.964 and 0.942 are obtained for the femur and tibia for knee segmentation. The implemented procedure and the results of this investigation may be beneficial to help in determining the correct margins for the femur and tibia and can be the basis for developing an automatic diagnosis algorithm for orthopedic diseases.

OBJECTIVE. The purpose of this study was to explore the temporal changes in fibrous dysplasia (FD) at radiographic follow-up. MATERIALS AND METHODS. A total of 138 patients with FD who had undergone extremity radiography at least twice with a minimum 12-month interval between examinations were enrolled in this study. FD was monostotic in 99 patients and polyostotic in 39 patients. Patients were also classified according to skeletal maturity as follows: Patients 16 years old or younger were classified in the skeletally immature group (n = 34), and patients 17 years old or older were classified in the skeletally mature group (n = 104). We compared the initial and follow-up radiographs for the following findings: lesion size, opacity, sclerotic rim, calcification, and trabeculation. RESULTS. Of the 138 patients, radiographic follow-up showed no change in lesion size in 101 patients (73.2%), progression in 31 (22.5%), and regression in six (4.3%). FD in immature bones progressed more often than FD in mature bones (23/34 [67.6%] vs 8/104 [7.7%], respectively; p = 0.000), and polyostotic FD had a greater chance of regressing than monostotic FD (4/39 [10.3%] vs 2/99 [2.0%]; p = 0.032). A temporal change in FD lesion opacity was noticed in a minority of patients (19/138, 13.8%). Variable changes were observed in the sclerotic rim, calcification, and trabeculation. CONCLUSION. The radiographic follow-up of FD showed that approximately a quarter of lesions changed in size over time. Regardless of the change in lesion size, opacity and several morphologic features of FD changed during the follow-up period, which might reflect the histopathologic evolution of FD.

To evaluate the effect of the combined use of virtual monochromatic imaging (VMI) and projection-based metal artifact reduction (PB-MAR) methods on further artifact reduction and image quality in total knee arthroplasty (TKA) patients. Fifty-seven knee joints from 36 patients who had a previous history of TKA for bilateral or unilateral knee joints were included in this study. Four sets of images were compared between non-MAR, PB-MAR, VMI, and VMI + PB-MAR. For quantitative analysis, the area, mean attenuation, artifact index (AI), and contrast-to-noise ratio (CNR) were calculated for each protocol. Regarding qualitative analysis, overall artifact and depiction of soft tissue and bony structure were compared using relative visual grading analysis. In the femoral region, the VMI + PB-MAR protocol showed the best MAR performance in quantitative measures including area, mean attenuation, and AI (p

The aim of this study was to develop a fetal cartilage-derived progenitor cell (FCPC) based cartilage gel through self-assembly for cartilage repair surgery, with clinically useful properties including adhesiveness, plasticity, and continued chondrogenic remodeling after transplantation. Characterization of the gels according to in vitro self-assembly period resulted in increased chondrogenic features over time. Adhesion strength of the cartilage gels were significantly higher compared to alginate gel, with the 2-wk group showing a near 20-fold higher strength (1.8 ± 0.15 kPa vs. 0.09 ± 0.01 kPa, p in vivo remodeling process analysis of the 2 wk cultured gels showed increased cartilage repair characteristics and stiffness over time, with higher integration-failure stress compared to osteochondral autograft controls at 4 weeks (p p

Objectives: The purpose of this study was to analyze the intraosseous tissue changes in recent vertebral compression fractures (VCFs) and to differentiate recent from remote VCFs using CT Hounsfield unit histogram analysis (HUHA). Methods: 65 patients with T11 to L3 VCFs were included. HUHA of 2 vertebral bodies (VBs)— a fractured VB and the closest lower-level unaffected VB—was done. The mean Hounsfield unit (HU) value and HU proportions of 5 ranges (HU ≤ 0, 0 < HU ≤ 50, 50 < HU ≤ 100, 100 < HU ≤ 150, and HU > 150) were obtained. Then, ΔHU value and ΔHU proportion were calculated by subtracting the values from the two vertebrae. Finally, the obtained values were compared between the recent and remote VCF groups and subjected to ROC curve analysis. Results: In recent VCF group, the ΔHU proportion (HU ≤ 0) corresponding to normal fatty marrow was lower (-0.17 vs 0.01) and the ΔHU proportion (HU > 150) representing trabecular bone was higher (0.23 vs 0.04) than in remote VCF group (p < 0.001). In the differentiation of recent from remote VCF, the ΔHU value and ΔHU proportion (HU > 150) showed high area under the curve (AUC, 0.939 and 0.912, respectively). Conclusion: CT HUHA demonstrated both trabecular bone and bone marrow changes in recent VCFs, and showed high diagnostic performance in differentiating between recent and remote VCFs. Advances in knowledge: With its vendor neutral applicability, CT HUHA can be used for the differentiation of recent and remote VCFs.

It has been reported that congenital muscular torticollis (CMT) may result in secondary scoliosis over long-term follow-ups. However, there are few reports on whether CMT causes pelvic malalignment syndrome (PMS). This study aimed to investigate the relationship between CMT and PMS and to determine the factors associated with the development of PMS in children with longstanding CMT. Medical records of 130 children with CMT who had long-term follow-up were reviewed retrospectively. The chi-squared test and logistic regression analysis were used to determine which initial clinical parameters contributed to the development of PMS. Among 130 children with CMT, 51 (39.2%) developed PMS with or without compensatory scoliosis during long-term follow-up, indicating a high prevalence of PMS in children with a CMT history. Initial clinical symptoms such as a limited range of motion of the neck or the presence of a neck mass could not predict the development of PMS. Even if the clinical symptoms are mild, long-term follow-up of children with CMT is essential to screen for PMS.

PURPOSE: To develop and validate deep radiomics models for the diagnosis of osteoporosis using hip radiographs. MATERIALS AND METHODS: A deep radiomics model was developed using 4924 hip radiographs from 4308 patients (3632 women; mean age, 62 years ± 13 [SD]) obtained between September 2009 and April 2020. Ten deep features, 16 texture features, and three clinical features were used to train the model. T score measured with dual-energy x-ray absorptiometry was used as a reference standard for osteoporosis. Seven deep radiomics models that combined different types of features were developed: clinical (model C); texture (model T); deep (model D); texture and clinical (model TC); deep and clinical (model DC); deep and texture (model DT); and deep, texture, and clinical features (model DTC). A total of 444 hip radiographs obtained between January 2019 and April 2020 from another institution were used for the external test. Six radiologists performed an observer performance test. The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic performance. RESULTS: For the external test set, model D (AUC, 0.92; 95% CI: 0.89, 0.95) demonstrated higher diagnostic performance than model T (AUC, 0.77; 95% CI: 0.70, 0.83; adjusted P < .001). Model DC (AUC, 0.95; 95% CI: 0.92, 0.97; adjusted P = .03) and model DTC (AUC, 0.95; 95% CI: 0.92, 0.97; adjusted P = .048) showed improved diagnostic performance compared with model D. When observer performance without and with the assistance of the model DTC prediction was compared, performance improved from a mean AUC of 0.77 to 0.87 (P = .002). CONCLUSION: Deep radiomics models using hip radiographs could be used to diagnose osteoporosis with high performance. Keywords: Skeletal-Appendicular, Hip, Absorptiometry/Bone Densitometry © RSNA, 2022

Case-control study.To quantify risk factors for cervical ossification of the posterior longitudinal ligament (OPLL) using a large nationwide cohort in Korea, a country with a high prevalence of OPLL.OPLL is a pathological calcification of the posterior longitudinal ligament of the spine. OPLL progression can cause spinal cord injury that results in disability. Considering neurologic deficits and disability caused by OPLL, identifying OPLL risk factors for early prediction have important health benefits.The nationwide population-based matched cohort study was conducted using the Korean National Health Insurance Service cohort data. We selected patients with a primary diagnosis of OPLL involving cervical lesion (International Classification of Diseases-10 code: M48.82, M48.83). A matched cohort without cervical OPLL was enrolled by randomly matching patients by sex, age, year of diagnosis, and residential area to the OPLL group with a ratio of 1:9. Logistic regression analyses were performed to identify risk associated with OPLL development using odds ratios (OR) and 95% confidence intervals (CI).Comorbidities, such as hypertension (OR = 1.283, 95% CI 1.071-1.538), ischemic stroke (OR = 1.386, 95% CI 1.017-1.889), diabetes mellitus (OR = 1.331, 95% CI 1.098-1.615), hypothyroidism (OR = 1.562, 95% CI 1.165-2.094), and osteoporosis (OR = 1.456, 95% CI 1.151-1.842), were significantly associated with the prospective development of OPLL, with low predictive value.OPLL was significantly associated with comorbidities such as hypertension, ischemic stroke diabetes mellitus, hypothyroidism, and osteoporosis. Our findings can provide helpful information for OPLL prediction and offer important health benefits.3.

Although accurate targeting of the causative muscles is of paramount importance in the treatment of focal dystonia, this is often challenging because of distortion of the affected anatomical structures and difficulty in proper positioning of injections. We report a case of idiopathic cervical dystonia that was treated by computed tomography-guided injection of botulinum toxin into multiple deep muscles. Based on clinical presentation of combined torticollis and retrocollis, and needle electromyography results, botulinum toxin was injected under electromyography guidance. This treatment resulted in no improvement. Subsequently, target muscles were identified using F-fludeoxyglucose fusion positron emission tomography/computed tomography. botulinum toxin was injected into the hypermetabolic muscles guided by computed tomography. This injection successfully relieved the symptoms, and nine months of follow-up using positron emission tomography/computed tomography confirmed that hypermetabolic muscles had been normalized. This case indicated that computed tomography guidance may facilitate accurate targeting of botulinum toxin injection. To the authors' knowledge, this is the first case reporting a positive effect of botulinum toxin on cervical dystonia symptoms that lasted 9 mos, confirmed by follow-up positron emission tomography/computed tomography.

Introduction The role of MRI in surveillance for local recurrence (LR) remains uncertain in extremity soft tissue sarcoma (STS). The aims of this study were 1) to examine the usefulness of MRI in detecting LR, 2) to identify the characteristics of LR detected by MRI, and 3) to examine whether MRI surveillance is associated with oncologic outcome. Materials and Methods 477 patients who had regular surveillance for LR after surgery for extremity STS were reviewed. Surveillance was performed by routine MRI in 325 patients or other imaging modalities in 152 patients. Results The rate of MRI-detected LR, defined as clinically undetectable LR identified on MRI, was 10.5% in the MRI surveillance cohort. The detection rates of MRI-detected LR were significantly higher in the patients with high risk of LR. MRI-detected LRs were more commonly located in the thigh or buttock (p = 0.005), were smaller (p = 0.001) and had LRs without mass formation (p = 0.007) than non-MRI-detected LRs. On Kaplan-Meier analysis, patients with MRI-detected LR tended to have better post-LR survival (p = 0.104). Conclusion Routine MRI surveillance can detect a significant number of clinically undetectable LRs in extremity STS especially for LRs in the thigh or buttock, small LRs or LRs without mass formation.

Hypoxic–ischemic encephalopathy (HIE) is a devastating neonatal brain condition caused by lack of oxygen and limited blood flow. Environmental enrichment (EE) is a classic paradigm with a complex stimulation of physical, cognitive, and social components. EE can exert neuroplasticity and neuroprotective effects in immature brains. However, the exact mechanism of EE on the chronic condition of HIE remains unclear. HIE was induced by a permanent ligation of the right carotid artery, followed by an 8% O2 hypoxic condition for 1 h. At 6 weeks of age, HIE mice were randomly assigned to either standard cages or EE cages. In the behavioral assessments, EE mice showed significantly improved motor performances in rotarod tests, ladder walking tests, and hanging wire tests, compared with HIE control mice. EE mice also significantly enhanced cognitive performances in Y-maze tests. Particularly, EE mice showed a significant increase in Cav 2.1 (P/Q type) and presynaptic proteins by molecular assessments, and a significant increase of Cav 2.1 in histological assessments of the cerebral cortex and hippocampus. These results indicate that EE can upregulate the expression of the Cav 2.1 channel and presynaptic proteins related to the synaptic vesicle cycle and neurotransmitter release, which may be responsible for motor and cognitive improvements in HIE.

Background There is paucity of studies applying fat suppressed (FS) technique to T2 mapping to overcome chemical shift artifacts. The purpose of the study is to difference between FS T2 and conventional T2 mapping and reproducibility of FS T2 mapping in the femoral articular cartilage. Methods Eighteen patients who had normal-looking femoral cartilage and underwent knee MRI with conventional T2 and FS T2 mapping were included. T2 values of each mapping were measured by two readers independently from nine regions in the medial femoral condyle (MFC) and lateral femoral condyle (LFC). Each anatomical region was divided by lines at ± 10°, 30°, 50°, 70°, 90°, and 110°. Comparisons of T2 values between conventional and FS T2 mapping were statistically analyzed. The T2 values between FS and conventional T2 mapping in the anterior, central and posterior femoral condyles were compared. Results The overall femoral condyle T2 values from the FS T2 map were significantly lower than those from the conventional T2 map (48.5ms vs. 51.0ms, p p = 0.009) and MFC (p = 0.031). The intra-class correlation coefficients indicated higher agreement in the FS T2 map than in the conventional T2 map (0.943 vs. 0.872). Conclusions The T2 values of knee femoral cartilage are significantly lower on FS T2 mapping than on conventional T2 mapping. FS T2 mapping is a more reproducible method for evaluating knee femoral cartilage.

OBJECTIVE. The purpose of this study was to evaluate the diagnostic utility of dual-layer CT (DLCT) for evaluating wrist injuries and to compare it with MRI. MATERIALS AND METHODS. The cases of 62 patients with suspected wrist fractures who underwent imaging with both DLCT and MRI from January 2018 through February 2019 were retrospectively reviewed. By means of a calcium suppression algorithm, virtual noncalcium (VNCa) image reconstruction was performed, and the images were reviewed by two readers to identify fractures, bone contusions, and nontraumatic lesions in the radius, ulna, and carpal bones. Sensitivity, specificity, PPV, and NPV were calculated and compared between standard CT and VNCa images with a combination of standard CT and MRI as the reference standard. RESULTS. Use of DLCT with VNCa reconstruction increased the sensitivity of diagnosis of fractures in the radius and carpal bones over that of standard CT alone; occult fractures were detected that were not seen with standard CT. The sensitivity and specificity for detecting radius fracture were 98.1% and 93.8% for DLCT and 96.3% and 93.8% for standard CT. For detecting carpal bone fracture, sensitivity and specificity were 100% and 98.9% for DLCT and 93.8% and 100% for standard CT. VNCa reconstruction also had good diagnostic accuracy with regard to diagnosing nonfracture bone contusions in carpal bones. The accuracy was comparable to that of MRI with sensitivity of 92.9% and specificity of 94.5%. Interreader agreement in interpreting VNCa images was generally good to excellent. CONCLUSION. DLCT with VNCa reconstruction is a promising tool for identifying occult wrist fractures and nonfracture contusion injuries in patients with wrist trauma.

Background A high false-negative rate has been reported for the diagnosis of ossification of the posterior longitudinal ligament (OPLL) using plain radiography. We investigated whether deep learning (DL) can improve the diagnostic performance of radiologists for cervical OPLL using plain radiographs. Materials and methods The training set consisted of 915 radiographs from 207 patients diagnosed with OPLL. For the test set, we used 200 lateral cervical radiographs from 100 patients with cervical OPLL and 100 patients without OPLL. An observer performance study was conducted over two reading sessions. In the first session, we compared the diagnostic performance of the DL-model and the six observers. The diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC) at the vertebra and patient level. The sensitivity and specificity of the DL model and average observers were calculated in per-patient analysis. Subgroup analysis was performed according to the morphologic classification of OPLL. In the second session, observers evaluated the radiographs by referring to the results of the DL-model. Results In the vertebra-level analysis, the DL-model showed an AUC of 0.854, which was higher than the average AUC of observers (0.826), but the difference was not significant (p = 0.292). In the patient-level analysis, the performance of the DL-model had an AUC of 0.851, and the average AUC of observers was 0.841 (p = 0.739). The patient-level sensitivity and specificity were 91% and 69% in the DL model, and 83% and 68% for the average observers, respectively. Both the DL-model and observers showed decreases in overall performance in the segmental and circumscribed types. With knowledge of the results of the DL-model, the average AUC of observers increased to 0.893 (p = 0.001) at the vertebra level and 0.911 (p < 0.001) at the patient level. In the subgroup analysis, the improvement was largest in segmental-type (AUC difference 0.087; p = 0.002). Conclusions The DL-based OPLL detection model can significantly improve the diagnostic performance of radiologists on cervical radiographs.

AIM To investigate the efficacy of a virtual reality rehabilitation system of wearable multi-inertial sensors to improve upper-limb function in children with brain injury. METHOD Eighty children (39 males, 41 females) with brain injury including cerebral palsy aged 3 to 16 years (mean age 5y 8mo, SD 2y 10mo) were assessed as part of a multicentre, single-blind, randomized controlled trial. The intervention group received a 30-minute virtual reality intervention and a 30-minute session of conventional occupational therapy while the control group received 60 minutes of conventional occupational therapy per session, with 20 sessions over 4 weeks. The virtual reality rehabilitation system consisted of games promoting wrist and forearm articular movements using wearable inertial sensors. The Melbourne Assessment of Unilateral Upper Limb Function-2 (MA-2), Upper Limb Physician's Rating Scale, Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and computerized three-dimensional motion analysis were performed. RESULTS Both groups (virtual reality, n=40; control, n=38) significantly improved after treatment compared to baseline; however, the virtual reality group showed more significant improvements in upper-limb dexterity functions (MA-2, virtual reality group: Δ=10.09±10.50; control: Δ=3.65±6.92), performance of activities of daily living, and forearm supination by kinematic analysis (p

Purpose: The effectiveness of robot-assisted gait training (RAGT) in children with cerebral palsy (CP), especially in terms of improving the performance of daily activities, remains unclear. Therefore, we aimed to investigate the effectiveness of RAGT in children with CP. Methods: In this single-center, single-blinded, randomized cross-over trial, we enrolled 20 children with CP with Gross Motor Function Classification System (GMFCS) levels II&ndash, IV (13 males, age range, 6.75 &plusmn, 2.15 years). The participants were randomized into the RAGT/standard care (SC) (n = 10) and SC/RAGT/SC sequence groups (n = 10). Using a Walkbot-K system, the RAGT program comprised 3 &times, 30-min sessions/week for 6 weeks with a continued SC program. The SC program comprised 2&ndash, 4 conventional physiotherapy sessions/week for 6 weeks. The Gross Motor Function Measure-88 (GMFM-88), the pediatric functional independence measure (WeeFIM), and the Canadian occupational performance measure (COPM) scores were assessed pre- and post-RAGT or SC periods and treatment, period, follow-up, and carry-over effects were analyzed. Energy expenditure and body composition were measured pre- and post-RAGT. Results: Significant treatment effects were observed in dimensions D and E of the GMFM (D: p = 0.018, E: p = 0.021) scores, WeeFIM mobility subtotal (p = 0.007), and COPM performance (p &lt, 0.001) and satisfaction (p = 0.001) measure scores. The period, follow-up, and carry-over effects were not statistically significant. The gross energy cost significantly decreased (p = 0.041) and the skeletal muscle mass increased (p = 0.014) at post-RAGT assessment. The factors associated with functional outcomes showed significant improvements in the GMFM D scores and were mainly observed in children with GMFCS levels II&ndash, III compared to those classified at level IV (p = 0.038). Conclusion: RAGT had training benefits for children with CP. Specifically, it improved locomotor function and functional capability for daily activities. These effects were better in ambulatory children with CP. However, as SC interventions continued during the RAGT period, these improvements may be also related to multiple treatment effects.

Background There are various tools that measure upper limb function in children with cerebral palsy(CP) clinically, but these measurement methods are examiner-dependent and scale values are not proportional to the upper limb function which makes it difficult to quantify the function. Research question The purpose of this study was to investigate whether the new parameters derived from 3D motion analysis reflect the upper limb function which measured by Melbourne Assessment 2 (MA2) in children with cerebral palsy (CP) compared to the clinical measurements. Methods Forty children with CP (24 boys, 16 girls; mean [SD] age, 6 years 11 months [3 years 5 months]) were recruited. Motion capture was conducted during phases T1–T4 of Reach and Grasp Cycles. New parameters (movement time, number of movement units, index of curvature) were derived from wrist marker data. Range of motion (ROM), accuracy, dexterity, and fluency of unilateral upper limb function were assessed using MA2. Spearman rank coefficients were determined to evaluate correlations between MA2 and the new parameters. Results and significance Index of curvature correlated negatively with MA2 accuracy scores during T1 (rs -0.347, p

To assess the usefulness of various metal artifact reduction (MAR) methods in patients with hip prostheses.This retrospective study included 47 consecutive patients who underwent hip arthroplasty and dual-energy CT. Conventional polyenergetic image (CI), orthopedic-MAR (O-MAR), and virtual monoenergetic image (VMI, 50-200 keV) were tested for MAR. Quantitative analysis was performed in seven regions around the prostheses. Qualitative assessments included evaluation of the degree of artifacts and the presence of secondary artifacts.The lowest amount of image noise was observed in the O-MAR, followed by the VMI. O-MAR also showed the lowest artifact index, followed by high-keV VMI in the range of 120-200 keV (soft tissue) or 200 keV (bone). O-MAR had the highest contrast-to-noise ratio (CNR) in regions with severe hypodense artifacts, while VMI had the highest CNR in other regions, including the periprosthetic bone. On assessment of the CI of pelvic soft tissues, VMI showed a higher structural similarity than O-MAR. Upon qualitative analysis, metal artifacts were significantly reduced in O-MAR, followed by that in VMI, while secondary artifacts were the most frequently found in the O-MAR (O-MAR is the best technique for severe MAR, but it can generate secondary artifacts. VMI at high keV can be advantageous for evaluating periprosthetic bone.고관절 인공치환물을 가진 환자에서 여러 가지 금속인공물 감소 효과를 비교하였다.이 연구는 고관절 인공치환술과 이중에너지 전산화단층촬영을 시행한 47명 환자에서 시행하였다. 금속에서 발생한 인공물 감소효과는 서로 다른 3개의 영상(고식적 영상, 금속인공물 감소영상, 가상 단일에너지 영상)에서 비교하였다. 이를 위해 인공관절 주변 7곳에서 금속인공물에 대한 정량적 분석과 정성적 분석을 시행하였다.금속인공물 감소영상에서 가장 낮은 영상잡음과 인공물 지수를 보였고, 다음으로는 가상 단일에너지 영상이었다. 금속인공물 감소영상은 저음영 인공물이 매우 심한 영역에서만 높은 대조도를 보인 반면, 가상 단일에너지 영상은 인공물 주변 골조직과 그 외 영역에서 높은 대조도를 보였다. 연부조직 분석에서도 금속인공물 감소영상이 더 우수함을 보여 주었다. 정성적 분석에서도 금속인공물 감소영상이 가상 단일에너지 영상보다 인공물 감소 효과가 뛰어남을 밝혔지만, 이차적인 인공물 발생도 가장 흔히 발생하였다.금속인공물 감소영상이 심한 금속인공물감소에 가장 뛰어난 효과를 보였지만 새로운 이차적 인공물을 발생시켰다. 가상 단일에너지 영상은 인공물 주변 골조직 평가에서 우수함을 보였다.

The aim of this study was to describe cuboid pulley lesions and associated abnormalities on the basis of clinical findings and the results of MRI examinations of the ankle.A retrospective search was performed to identify patients who had a cuboid pulley lesion during a 10-year period. A cuboid pulley lesion was defined as bone marrow edema in the lateroplantar ridge of the cuboid that was shown to be wrapped by the peroneus longus tendon on MRI of the ankle. A total of 19 patients (11 men and eight women; mean age, 45.4 years) were included in the group of patients with a cuboid pulley lesion, and 38 age-and sex-matched patients without a cuboid pulley lesion were randomly selected as the control group. We reviewed medical records and assessed MRI findings that could be associated with a cuboid pulley lesion.The mean (± SD) diameter of the cuboid pulley lesion was 8.9 ± 4.7 mm. Cuboid pulley lesions were associated with peroneal tenosynovitis (p0.001), Achilles enthesitis (p = 0.004), and a clinical diagnosis of inflammatory arthritis (p0.001). Eleven of the 19 patients in the group with cuboid pulley lesions had inflammatory arthritis (either rheumatoid arthritis [n = 7] or spondyloarthritis [n = 4]). The cuboid pulley lesions did not cause localized lateral foot pain and tenderness, except in one patient who had an accompanying stress fracture of the cuboid.MRI of the ankle rarely but clearly shows cuboid pulley lesions, which themselves are not likely to cause localized pain, and cuboid pulley lesions show significant associations with peroneal tenosynovitis, Achilles enthesitis, and clinically diagnosed inflammatory arthritis.

The nondeterministic relationship between speech acoustics and abstract phonemic representations imposes a challenge for listeners to maintain perceptual constancy despite the highly variable acoustic realization of speech. Talker normalization facilitates speech processing by reducing the degrees of freedom for mapping between encountered speech and phonemic representations. While this process has been proposed to facilitate the perception of ambiguous speech sounds, it is currently unknown whether talker normalization is affected by the degree of potential ambiguity in acoustic-phonemic mapping. We explored the effects of talker normalization on speech processing in a series of speeded classification paradigms, parametrically manipulating the potential for inconsistent acoustic-phonemic relationships across talkers for both consonants and vowels. Listeners identified words with varying potential acoustic-phonemic ambiguity across talkers (e.g., beet/boat vs. boot/boat) spoken by single or mixed talkers. Auditory categorization of words was always slower when listening to mixed talkers compared to a single talker, even when there was no potential acoustic ambiguity between target sounds. Moreover, the processing cost imposed by mixed talkers was greatest when words had the most potential acoustic-phonemic overlap across talkers. Models of acoustic dissimilarity between target speech sounds did not account for the pattern of results. These results suggest (i) that talker normalization incurs the greatest processing cost when disambiguating highly-confusable sounds and (ii) that talker normalization appears to be an obligatory component of speech perception, taking place even when the acoustic-phonemic relationships across sounds are unambiguous.

The purpose of this study was to differentiate malignant compression fractures from acute osteoporotic compression fractures of the spine by use of a Dixon MRI sequence to quantify fat fraction (FF).Forty-four vertebral compression fractures were assessed with turbo spin-echo T1-weighted and six-echo Dixon sequences for FF quantification at 3-T MRI. The fractures were divided into malignant compression fractures (n = 24) and acute osteoporotic compression fractures (n = 20). Two radiologists independently measured quantitative parameters from ROIs in the fractures, including the T1 signal intensity of the fracture, the FF of the fracture, and the FF ratio (fracture FF divided by normal marrow FF). The mean values of the parameters were compared between the two groups, interobserver reliability between two radiologists was assessed, ROC curves were analyzed, and logistic regression analysis was performed.The fracture FF and FF ratio of malignant compression fractures were significantly lower than those of acute osteoporotic compression fractures (fracture FF, 2.73% vs 14.36% [p0.001]; FF ratio, 0.05 vs 0.22 [p0.001]). There was no difference in T1 signal intensity of the fracture. The ROC AUC of fracture FF was 0.98 and of FF ratio was 0.95. In logistic regression analysis, fracture FF remained a significant variable that could be used to independently differentiate malignant from acute osteoporotic compression fractures (odds ratio, 0.33; p0.005).FF and FF ratio obtained from FF maps obtained with a six-echo Dixon MRI sequence may be useful for differentiating acute osteoporotic compression fractures from malignant compression fractures.

MINI: Bone scan remains the modality of choice for the screening of bone metastases. This study demonstrated the diagnostic value of bone scan in detecting bone metastases limited to the cervical spine in oncological patients remains uncertain due to the moderately high false-negative diagnostic rate.A retrospective cohort, radiographic study.To assess the diagnostic accuracy of bone scintigraphy (BS) for the detection of cervical spine metastases in oncological patients.BS remains the modality of choice for the screening of bone metastases, because of its feasibility in whole-body scanning and its widespread availability at low cost. Current practice guidelines for patients with malignant diseases recommend BS imaging as the primary screening method for detecting both axial and appendicular skeletal metastases.Of 481 patients, 242 were diagnosed with cervical spinal metastases from a primary cancer. The BS findings of these patients, evaluated by nuclear medicine physicians, were assessed with respect to their usefulness for detecting cervical spine metastases. Magnetic resonance imaging findings, evaluated by radiologists, were used as the reference standards. The diagnostic value of BS was compared between subgroups according to the order in which the diagnostic procedures (magnetic resonance imaging and BS) were completed, the presence of pathological fractures, the location of the primary malignancy, and the number of cervical metastases.The sensitivity of BS in the detection of cervical spine metastases was 59.1%, with a 40.9% rate of false-negative diagnoses; the specificity was 94.6%, with a 5.4% rate of false-positive diagnoses. The sensitivity tended to be higher in the presence of pathological fractures (72.1% in cases with a fracture vs. 3% in cases without a fracture) and a greater number of lesions (r = 0.921). Neither the order in which the diagnostic examinations were performed nor the location of the primary cancer, except for those in the stomach and liver, appeared to affect the diagnostic accuracy of BS.Considering the moderately high false-negative diagnostic rate obtained in the present study, BS alone cannot accurately diagnose metastases in the cervical spine in oncological patients.3.

Bronchiectasis is a chronic pulmonary disease characterized by the permanent dilatation of the airways, with recurrent infections. As the disease progresses, extrapulmonary symptoms manifest. If the patient with bronchiectasis has an underlying central nervous system disease such as cerebral palsy (CP), extrapulmonary functions decline faster. The co-occurrence of these 2 diseases may make care more complex, and there have been no reports about pulmonary rehabilitation (PR) in this class of patients. Here, we present a patient with bronchiectasis and underlying CP who showed marked improvement of pulmonary function and clinical symptoms after 6 weeks of a patient-specific intensive PR program. Level of Evidence IV

OBJECTIVE To investigate the immediate effect of a single session of whole body vibration (WBV) on lower extremity spasticity in children with cerebral palsy (CP). METHODS Seventeen children with spastic CP were included. A single session of WBV was administered: 10-minute WBV, 1-minute rest, and 10-minute WBV. The effects of WBV were clinically assessed with the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) before and immediately, 30 minutes, 1 hour, 2 hours, 3 hours, and 4 hours after WBV. RESULTS Spasticity of the ankle plantarflexor, as assessed by MAS and MTS scores, was reduced after WBV. Post-hoc analysis demonstrated that, compared to baseline, the MAS significantly improved for a period of 1 hour after WBV, and the R1 and R2-R1 of the MTS significantly improved for a period of 2 hours after WBV. CONCLUSION A single session of WBV improves spasticity of ankle plantarflexors for 1-2 hours in children with CP. Future studies are needed to test whether WBV is an effective preparation before physiotherapy and occupational therapy.

Gadolinium-based contrast agents with a double negative charge produced better contrast between normal and degenerated cartilage on delayed gadolinium-enhanced MR images than did those with a single negative charge and nonionic gadolinium-based contrast agents at the same concentration, and gadobenate dimeglumine may be useful as an alternative to gadopentetate dimeglumine for delayed gadolinium-enhanced MR imaging of cartilage.

Our objective was to determine whether there is an association between pisotriquetral (PT) malalignment and acute distal radius fracture by using magnetic resonance imaging (MRI). We evaluated 138 patients who underwent 3-T MRI of the wrists. Group A comprised 85 patients with acute distal radius fracture, and group B comprised 53 patients without trauma. PT interval and angle and pisiform excursion were measured on oblique axial and sagittal multiplanar reformats. The presence of abnormalities in the flexor carpi ulnaris tendon (FCU), pisometacarpal ligament (PML), and pisohamate ligament (PHL) were evaluated. PT interval was wider in group A on both the axial and sagittal planes (P

Congenital muscular torticollis (CMT) results from unilateral shortening of the sternocleidomastoid (SCM) muscle, usually associated with a fibrotic mass. Although CMT may resolve with physical therapy, some cases persist, resulting in long-term musculoskeletal problems. It is therefore helpful to be able to monitor and predict the outcomes of physical therapy. Shear-wave velocity (SWV) determined by acoustic radiation force impulse (ARFI) elastography can provide a quantitative measure of muscle stiffness. We therefore measured SCM SWV in 22 infants with unilateral CMT before and after 3 months of physical therapy and evaluated the relationships between SWV and SCM thickness and various clinical features, including cervical range of motion (ROM). SWV was initially higher and the ROM was smaller in affected muscles before physical therapy. SWV decreased significantly (2.33 ± 0.47 to 1.56 ± 0.63 m/s, p < 0.001), indicating reduced stiffness, and muscle thickness also decreased after physical therapy (15.64 ± 5.24 to 11.36 ± 5.71 mm, p < 0.001), both in line with increased neck ROM of rotation (64.77 ± 18.87 to 87.27 ± 6.31°, p < 0.001) and lateral flexion (37.50 ± 11.31 to 53.64 ± 9.41°, p < 0.001). However, the improved ROM more closely reflected the changes in SWV than in muscle thickness. These results suggest that a change in SWV detected by ARFI elastography could help to predict improvements in clinical outcomes, such as stiffness-related loss of motion, in patients with CMT undergoing physical therapy.