Radiographic Detection of Marginal Impaction in Supination-Adduction Ankle Fractures

Background: The purpose of this study was to describe the incidence of plafond impaction in supination-adduction type II (SAD-II) ankle fractures and assess the accuracy of plain radiographs in detecting plafond impaction and predicting planned operative management compared to computed tomography (CT). Methods: Patients with SAD-II ankle fractures were retrospectively identified. All SAD-II plain radiographs were reviewed (120 fractures) and compared to CT images (55 fractures). For each plain radiograph or CT scan, 3 orthopedic surgeons were asked the following questions: (1) Is there impaction of the tibial plafond? (2) Does the impaction require direct visualization and articular reduction? The incidence of plafond impaction and the preoperative plan were calculated separately for plain radiographs and CT scans. The accuracy of plain radiographs was calculated using responses from corresponding CT imaging as the gold standard. Change in preoperative management decisions after reviewing CT images was also calculated. Results: In 120 SAD-II ankle fracture plain radiographs, marginal impaction of the plafond was visualized in 61% of fractures. The diagnosis of impaction using plain radiographs was correct in 84% of fractures when compared to CT imaging, resulting in a 91% positive predictive value (PPV) and a 55% negative predictive value (NPV). Plain radiographs were able to predict planned operative management after review of CT imaging with an 87% PPV and 75% NPV. Conclusion: The majority of SAD-II ankle fractures involved marginal impaction of the tibial plafond. Plain radiographs were accurate in diagnosing impaction when it was present, but were not accurate in ruling out impaction. In the presence of impaction, CT likely will not change planned operative management. Level of Evidence: Level III, comparative series.

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Discrimination of mediastinal metastatic lymph nodes in NSCLC based on radiomic features in different phases of CT imaging

10.21203/rs.2.11417/v2 ◽

2019 ◽

Author(s):

Xue Sha ◽

Guan Zhong Gong ◽

Qing Tao Qiu ◽

Jing Hao Duan ◽

Deng Wang Li ◽

...

Keyword(s):

Lymph Nodes ◽

Predictive Value ◽

Characteristic Curve ◽

Multivariate Logistic Regression Analysis ◽

Ct Images ◽

Ct Imaging ◽

Arterial Phase ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Venous Phase

Abstract Background: We aimed to develop radiomic models based on different phases of computed tomography (CT) imaging and to investigate the efficacy of models for diagnosing mediastinal metastatic lymph nodes (LNs) in non-small cell lung cancer (NSCLC). Methods: We selected 231 mediastinal LNs confirmed by pathology results as the subjects, which were divided into training (n=163) and validation cohorts (n=68). The regions of interest (ROIs) were delineated on CT scans in the plain phase, arterial phase and venous phase, respectively. Radiomic features were extracted from the CT images in each phase. A least absolute shrinkage and selection operator (LASSO) algorithm was used to select features, and multivariate logistic regression analysis was used to build models. We constructed six models (orders 1-6) based on the radiomic features of the single- and dual-phase CT images. The performance of the radiomic model was evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 846 features were extracted from each ROI, and 10, 9, 5, 2, 2, and 9 features were chosen to develop models 1-6, respectively. All of the models showed excellent discrimination, with AUCs greater than 0.8. The plain CT radiomic model, model 1, yielded the highest AUC, specificity, accuracy and PPV, which were 0.926 and 0.925; 0.860 and 0.769; 0.871 and 0.882; and 0.906 and 0.870 in the training and validation sets, respectively. When the plain and venous phase CT radiomic features were combined with the arterial phase CT images, the sensitivity increased from 0.879 and 0.919 to 0.949 and 0979 and the NPV increased from 0.821 and 0.789 to 0.878 and 0.900 in the training group, respectively. Conclusions: All of the CT radiomic models based on different phases all showed high accuracy and precision for the diagnosis of LN metastasis (LNM) in NSCLC patients. When combined with arterial phase CT, the sensitivity and NPV of the model was be further improved.

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Radiographic imaging of mastoid in chronic otitis media: need or tradition?

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20203491 ◽

2020 ◽

Vol 6 (9) ◽

pp. 1592

Author(s):

Sabeeh Beig ◽

Saifullah Khalid ◽

Satish Chandra Sharma

Keyword(s):

Otitis Media ◽

Predictive Value ◽

Plain Radiograph ◽

Chronic Otitis Media ◽

Bone Destruction ◽

Limited Information ◽

Radiological Findings ◽

Plain Radiographs ◽

Operative Findings ◽

Mastoid Surgery

Background: Computed tomography is the imaging of choice in chronic otitis media (COM) but it is neither available at every centre nor is affordable to masses of economically weaker countries. In this situation where only X-ray facility is available should plain radiographs of mastoid be done ?. If yes then what is the analytical evidence? This study, was conducted to find the utility of plain radiographs of mastoid by comparing radiological findings vis-a-vis operative findings.Methods: Pre-operative radiographs of mastoids (Schuller’s view (s/v)) were taken and the radiological findings were statistically analysed with the operative findings. Results: Plain radiograph of mastoid (s/v) predicted some of the surgical landmarks of mastoid surgery viz tegmen and sinus plates with a fair degree of accuracy. The positive predictive value (PPV) for radiolucent shadow (assumed to indicate bone destruction and thus cholesteatoma) was also high but at the same time, a low negative predictive value and a Cohen’s kappa test showing only a fair agreement underscores the point that absence of a radiolucent shadow does not rule out the presence of cholesteatoma.Conclusions: Radiographs of mastoid are helpful in providing a prior knowledge of the surgical landmarks in mastoid surgery. Hence with this information, if a surgeon finds himself more at ease in operating a patient then this imaging should be done when CT scan facility is unavailable. However, citing the limited information on other aspects of the disease, its use as a ‘routine’ investigation in chronic otitis media is discouraged.

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Effect of CT on Management Plan in Malleolar Ankle Fractures

Foot & Ankle International ◽

10.1177/1071100717732746 ◽

2017 ◽

Vol 39 (1) ◽

pp. 59-66 ◽

Cited By ~ 9

Author(s):

Ashwani Kumar ◽

Puneet Mishra ◽

Anupama Tandon ◽

Rajesh Arora ◽

Manish Chadha

Keyword(s):

Ct Scan ◽

Case Series ◽

Management Plan ◽

Ankle Fractures ◽

X Rays ◽

Level Of Evidence ◽

Plain Radiographs ◽

Posterior Malleolus ◽

Trimalleolar Fractures ◽

Type C

Background: Conventionally ankle fractures have been classified using plain radiographs. Because of complex 3-dimensional anatomy and complexity of injuries, plain radiographs may not always be able to clearly depict the complete fracture pattern. There is a paucity of studies regarding the utility of computed tomography (CT) scanning in malleolar ankle fractures (MAFs). Hence, we conducted this study to further understand the role of the CT scan in MAFs. Methods: A prospective study of 56 consecutive malleolar ankle fractures was conducted. In the first evaluation by a team of 3 observers, a management plan was made based on plain radiographs. All patients received a CT scan evaluation with a standard protocol. The second evaluation by the same team included formulating an operative plan based on the CT. Results: In 13 (23.2%) cases, the management plan changed after CT evaluation. In most of the cases, the change in the management plan included an alteration in fixation of the posterior malleolus followed by lateral malleolus in 4 cases. Most of the changes took place in AO 44 type C followed by types B and A. Maximum change was noted in trimalleolar fractures followed by bimalleolar and unimalleolar. The most common morphological characteristic fracture identified on CT scan that was not evident on plain radiography was Chaput fracture in 17 cases. Conclusion: CT scan evaluation of MAFs changed the management plan in a significant number of cases, especially if the fractured fragment included a posterior malleolus, AO type C, and/or if 2 or more malleoli were fractured as noted on plain x rays. Level of Evidence: Level IV, case series.

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Differentiation of mediastinal metastatic lymph nodes in NSCLC based on radiomic features of different phase CT imaging

10.21203/rs.2.11417/v1 ◽

2019 ◽

Author(s):

Xue Sha ◽

Guan Zhong Gong ◽

Qing Tao Qiu ◽

Jing Hao Duan ◽

Deng Wang Li ◽

...

Keyword(s):

Lymph Nodes ◽

Predictive Value ◽

Characteristic Curve ◽

Multivariate Logistic Regression Analysis ◽

Ct Images ◽

Ct Imaging ◽

Arterial Phase ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Venous Phase

Abstract Background To develop radiomic models based on different phases of computed tomography (CT) imaging and investigate the efficacy of models to diagnose mediastinal metastatic lymph nodes in non-small cell lung cancer (NSCLC).Methods We selected 231 mediastinal lymph nodes confirmed by pathology results as the subjects, which were divided into training (n=163) and validation cohorts (n=68). The regions of interest (ROIs) were delineated on CT scans of the plain phase, arterial phase and venous phase, respectively. Radiomic features were extracted from the CT images of each phase. Least absolute shrinkage and selection operator (LASSO) was used to select features, and multivariate logistic regression analysis was used to build models. We constructed six models (orders of 1-6) based on radiomic features of the single- and dual-phase CT images. The performance of the radiomic model was evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV).Results A total of 846 features were extracted from each ROI, and 10, 9, 5, 2, 2, and 9 features were chosen to develop models 1-6. All of the models showed superior differentiation, with AUCs greater than 0.8. The plain CT radiomic model, model 1, yielded the highest AUC, specificity, accuracy and PPV, which were 0.926 VS 0.925, 0.860 VS 0.769, 0.871 VS 0.882 and 0.906 VS 0.870 in the training and validation sets, respectively. When the plain and venous phase CT radiomic features were combined with the arterial phase CT images, the sensitivity increased from 0.879, 0.919 to 0.949, 0979 and the NPV increased from 0.821, 0.789 to 0.878, 0.900 in the training group, respectively.Conclusion CT radiomic models based on different phases all showed high accuracy and precision in the diagnosis of LNM in NSCLC patients. When combined with arterial phase CT, the sensitivity and NPV of the model can be further improved.

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Advances in the Surgical Management of Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011419888505 ◽

2019 ◽

Vol 4 (4) ◽

pp. 247301141988850 ◽

Cited By ~ 1

Author(s):

David J. Wright ◽

Jason T. Bariteau ◽

Andrew R. Hsu

Keyword(s):

Intramedullary Nailing ◽

Operative Management ◽

Ankle Fractures ◽

Deltoid Ligament ◽

Evidence Based ◽

Level Of Evidence ◽

Orthopedic Surgeons ◽

Posterior Malleolus ◽

Operative Indications ◽

Operative Fixation

Ankle fractures are one of the most common injuries treated by orthopedic surgeons worldwide. However, operative indications, techniques, and reported outcomes following operative fixation vary widely in the literature. This evidence-based review focuses on recent advances in the operative management of ankle fractures including arthroscopic-assisted surgery, deltoid ligament complex repair, expanded indications for posterior malleolus fixation, fibula intramedullary nailing, and dynamic syndesmosis repair. Level of Evidence: Level V, expert opinion.

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Discrimination of mediastinal metastatic lymph nodes in NSCLC based on radiomic features in different phases of CT imaging

10.21203/rs.2.11417/v4 ◽

2020 ◽

Author(s):

Xue Sha ◽

Guan Zhong Gong ◽

Qing Tao Qiu ◽

Jing Hao Duan ◽

Deng Wang Li ◽

...

Keyword(s):

Lymph Nodes ◽

Predictive Value ◽

Multivariate Logistic Regression Analysis ◽

Ct Images ◽

Ct Imaging ◽

Arterial Phase ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Venous Phase ◽

Nsclc Patients

Abstract Background: We aimed to develop radiomic models based on different phases of computed tomography (CT) imaging and to investigate the efficacy of models for diagnosing mediastinal metastatic lymph nodes (LNs) in non-small cell lung cancer (NSCLC). Methods: Eighty-six NSCLC patients were enrolled in this study, and we selected 231 mediastinal LNs confirmed by pathology results as the subjects which were divided into training (n=163) and validation cohorts (n=68). The regions of interest (ROIs) were delineated on CT scans in the plain phase, arterial phase and venous phase, respectively. Radiomic features were extracted from the CT images in each phase. A least absolute shrinkage and selection operator (LASSO) algorithm was used to select features, and multivariate logistic regression analysis was used to build models. We constructed six models (orders 1-6) based on the radiomic features of the single- and dual-phase CT images. The performance of the radiomic model was evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 846 features were extracted from each ROI, and 10, 9, 5, 2, 2, and 9 features were chosen to develop models 1-6, respectively. All of the models showed excellent discrimination, with AUCs greater than 0.8. The plain CT radiomic model, model 1, yielded the highest AUC, specificity, accuracy and PPV, which were 0.926 and 0.925; 0.860 and 0.769; 0.871 and 0.882; and 0.906 and 0.870 in the training and validation sets, respectively. When the plain and venous phase CT radiomic features were combined with the arterial phase CT images, the sensitivity increased from 0.879 and 0.919 to 0.949 and 0979 and the NPV increased from 0.821 and 0.789 to 0.878 and 0.900 in the training group, respectively. Conclusions: All of the CT radiomic models based on different phases all showed high accuracy and precision for the diagnosis of LN metastasis (LNM) in NSCLC patients. When combined with arterial phase CT, the sensitivity and NPV of the model was be further improved.

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Discrimination of mediastinal metastatic lymph nodes in NSCLC based on radiomic features in different phases of CT imaging

10.21203/rs.2.11417/v5 ◽

2020 ◽

Author(s):

Xue Sha ◽

Guan Zhong Gong ◽

Qing Tao Qiu ◽

Jing Hao Duan ◽

Deng Wang Li ◽

...

Keyword(s):

Lymph Nodes ◽

Predictive Value ◽

Multivariate Logistic Regression Analysis ◽

Ct Images ◽

Ct Imaging ◽

Arterial Phase ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Venous Phase ◽

Nsclc Patients

Abstract Background: We aimed to develop radiomic models based on different phases of computed tomography (CT) imaging and to investigate the efficacy of models for diagnosing mediastinal metastatic lymph nodes (LNs) in non-small cell lung cancer (NSCLC). Methods: Eighty-six NSCLC patients were enrolled in this study, and we selected 231 mediastinal LNs confirmed by pathology results as the subjects which were divided into training (n=163) and validation cohorts (n=68). The regions of interest (ROIs) were delineated on CT scans in the plain phase, arterial phase and venous phase, respectively. Radiomic features were extracted from the CT images in each phase. A least absolute shrinkage and selection operator (LASSO) algorithm was used to select features, and multivariate logistic regression analysis was used to build models. We constructed six models (orders 1-6) based on the radiomic features of the single- and dual-phase CT images. The performance of the radiomic model was evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 846 features were extracted from each ROI, and 10, 9, 5, 2, 2, and 9 features were chosen to develop models 1-6, respectively. All of the models showed excellent discrimination, with AUCs greater than 0.8. The plain CT radiomic model, model 1, yielded the highest AUC, specificity, accuracy and PPV, which were 0.926 and 0.925; 0.860 and 0.769; 0.871 and 0.882; and 0.906 and 0.870 in the training and validation sets, respectively. When the plain and venous phase CT radiomic features were combined with the arterial phase CT images, the sensitivity increased from 0.879 and 0.919 to 0.949 and 0979 and the NPV increased from 0.821 and 0.789 to 0.878 and 0.900 in the training group, respectively. Conclusions: All of the CT radiomic models based on different phases all showed high accuracy and precision for the diagnosis of LN metastasis (LNM) in NSCLC patients. When combined with arterial phase CT, the sensitivity and NPV of the model was be further improved.

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Limb Salvage After Failed Initial Operative Management of Bimalleolar Ankle Fractures in Diabetic Neuropathy

Foot & Ankle International ◽

10.1177/1071100716676063 ◽

2016 ◽

Vol 38 (3) ◽

pp. 248-254 ◽

Cited By ~ 4

Author(s):

Nicholas J. Vaudreuil ◽

Mitchell S. Fourman ◽

Dane K. Wukich

Keyword(s):

Peripheral Neuropathy ◽

Limb Salvage ◽

Ankle Joint ◽

Treatment Algorithm ◽

Case Series ◽

Operative Management ◽

Ankle Fractures ◽

High Rate ◽

Retrospective Case ◽

Level Of Evidence

Background: Ankle fractures in patients with diabetes mellitus (DM) can be difficult to manage, especially in the presence of peripheral neuropathy. In patients who fail initial operative management, attempts at limb salvage can be challenging, and no clear treatment algorithm exists. This study examined outcomes of different procedures performed for limb salvage in this population. Methods: This study retrospectively reviewed 17 patients with DM complicated by peripheral neuropathy who sustained a bimalleolar ankle fracture and failed initial operative management. Patients were treated with revision open reduction internal fixation (ORIF) (3/17), closed reduction external fixation (CREF) (8/17), or primary ankle joint fusion (3/17 tibiotalocalcaneal fusion with hindfoot nail [TTCN] and 3/17 with tibiotalar arthrodesis using plates and screws [TTA]). Median follow-up was 20 months. Results: The overall rate of limb salvage was 82.3% (14/17). All patients who went on to amputation presented with infection and were treated initially with CREF (3/3). All patients who achieved successful limb salvage ended up with a clinically fused ankle joint (14/14); 9 underwent a primary or delayed formal fusion and 5 had a clinically fused ankle joint at study conclusion after undergoing revision ORIF or CREF with adjunctive procedures. Conclusion: This small study suggests that in this complicated group of patients it is difficult to achieve limb salvage with an end result of a functional ankle joint. CREF can be a viable option in cases where underlying infection or poor bone quality is present. Treatment with revision ORIF frequently requires supplementary external fixator or tibiotalar Steinman pin placement for additional stability. All patients who underwent revision ORIF ended up with clinically fused ankle joints at the end of the study period. Primary fusion procedures (TTA, TTCN) were associated with a high rate of limb salvage and a decreased number of operations. Level of Evidence: Level III, retrospective case series.

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Discrimination of mediastinal metastatic lymph nodes in NSCLC based on radiomic features in different phases of CT imaging

10.21203/rs.2.11417/v3 ◽

2019 ◽

Author(s):

Xue Sha ◽

Guan Zhong Gong ◽

Qing Tao Qiu ◽

Jing Hao Duan ◽

Deng Wang Li ◽

...

Keyword(s):

Lymph Nodes ◽

Predictive Value ◽

Multivariate Logistic Regression Analysis ◽

Ct Images ◽

Ct Imaging ◽

Arterial Phase ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Venous Phase ◽

Nsclc Patients

Abstract Background: We aimed to develop radiomic models based on different phases of computed tomography (CT) imaging and to investigate the efficacy of models for diagnosing mediastinal metastatic lymph nodes (LNs) in non-small cell lung cancer (NSCLC). Methods: Eighty-six NSCLC patients were enrolled in this study, and we selected 231 mediastinal LNs confirmed by pathology results as the subjects which were divided into training (n=163) and validation cohorts (n=68). The regions of interest (ROIs) were delineated on CT scans in the plain phase, arterial phase and venous phase, respectively. Radiomic features were extracted from the CT images in each phase. A least absolute shrinkage and selection operator (LASSO) algorithm was used to select features, and multivariate logistic regression analysis was used to build models. We constructed six models (orders 1-6) based on the radiomic features of the single- and dual-phase CT images. The performance of the radiomic model was evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 846 features were extracted from each ROI, and 10, 9, 5, 2, 2, and 9 features were chosen to develop models 1-6, respectively. All of the models showed excellent discrimination, with AUCs greater than 0.8. The plain CT radiomic model, model 1, yielded the highest AUC, specificity, accuracy and PPV, which were 0.926 and 0.925; 0.860 and 0.769; 0.871 and 0.882; and 0.906 and 0.870 in the training and validation sets, respectively. When the plain and venous phase CT radiomic features were combined with the arterial phase CT images, the sensitivity increased from 0.879 and 0.919 to 0.949 and 0979 and the NPV increased from 0.821 and 0.789 to 0.878 and 0.900 in the training group, respectively. Conclusions: All of the CT radiomic models based on different phases all showed high accuracy and precision for the diagnosis of LN metastasis (LNM) in NSCLC patients. When combined with arterial phase CT, the sensitivity and NPV of the model was be further improved.

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