Comparison of MRI and CT for Detection of Acute Cerebral Haemorrahge

Objective: To compare the diagnostic accuracy of MRI and CT for detection of acute cerebral haemorrahge. Study Design: Comparative Study Place and Duration: Mohiuddin Islamic Teaching Hospital Mirpur AJK for period of six months from 1st August, 2020 to 31stJanuary, 2021. Methodology: A total of 20 patients of both genders with age of 25 years and onward with intracerebral hemorrhage who underwent MRI following CT in the first 6 hours of onset and last known well time and admission in stroke center were included in the study. The follow up time duration for both the scans was 24 hours to 48hours. The Mc-Nemar test was used to determine the comparison between MRI and CT on contingency table. Results: The mean age of the participants was 53.26±2.45. The frequency of the male participants was 13(65%) and that of female was 7(35%). All cases were of acute ICH 20(100%). The number of positive cases on MRI and CT scan was 17, while the frequency of positive cases on MRI and negative on CT scan was 3 with the p- value of less than 0.001 and a confidence interval of 95%. (See table 1 for details). The interrater reliability for acute ICH on MRI is from 0.72 to 0.80 on k statistics. The interrater reliability for acute ICH on CT is from 0.83 to 0.92. Conclusion: It is concluded that the findings of MRI scan were more accurate than CT in the detection of acute intracerebral hemorrhage. Keywords: Acute Cerebral Hemorrhage, MRI, CT, Diagnostic Accuracy

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Abstract TP336: Characteristics and Outcome of Patients With Acute Intracerebral Hemorrhage Who Overuse Alcohol

Stroke ◽

10.1161/str.48.suppl_1.tp336 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Carla Avellaneda-Gómez ◽

Maria Serra Martínez ◽

Alejandra Gómez González ◽

Ana Rodríguez-Campello ◽

Angel Ois ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Alcohol Intake ◽

Short Term ◽

Acute Intracerebral Hemorrhage ◽

Stroke Center ◽

Ich Score ◽

Heavy Alcohol Intake ◽

Long Term Mortality

Background: Alcohol overuse (AO) is considered a cause of spontaneous intracerebral hemorrhage (ICH), but the clinical and outcome characteristics of these patients (AO+ICH) are not well known. Methods: All patients with ICH admitted from January 2005 to June 2015 to a single university tertiary stroke center were prospectively studied and followed up during 5 years. Demographic features, radiological characteristics, and clinical outcome of patients with acute ICH and previous heavy alcohol intake (>40 gr/day or >300 gr/week) were analyzed. Results: During the study period, 609 patients with ICH were admitted. Nineteen patients were excluded because data on alcohol intake was not available. At admission, 83 patients (13.6%) were identified with AO (22.7% of men vs 2.9% of women; p< 0.0001) and was more frequent in younger patients (mean age, 63.11 years, compared to 72.7 years overall; p< 0.0001). Smoking was associated with AO (63,9% vs 13,8% non-AO; p< 0.0001) but not significant differences were found according with cardiovascular risk factors (dyslipidemia, diabetes and hypertension). ICH score was lower in the AO group (1.3 vs 1.8, p= 0.009) and deep ICH were more frequent (p= 0.036), compared to non-AO. Adjusted by sex, age, and high blood pressure, a trend in favor of increased deep ICH in AO patients remained (HR: 1.68 [95% CI: 0.92-3.05], p= 0.086). Adjusted mortality at 3-month, 12-month, and 5-year follow-up was similar in both groups. Conclusions: AO was present in 13.6% of ICH patients. These patients were an average of 11.5 years younger, predominantly men, and smokers, compared to the non-AO group. Adjusted short-term and long-term mortality was similar in AO and non-AO groups.

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Management of Vertical Sternal Fracture Nonunion in Elite-Level Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211010804 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110108

Author(s):

Andrea Bardos ◽

Sanjeeve Sabhrawal ◽

Graham Tytherleigh-Strong

Keyword(s):

Ct Scan ◽

Constant Score ◽

Case Series ◽

Sternal Fracture ◽

Elite Level ◽

The Mean ◽

Mean Time ◽

Time From Injury ◽

Sternal Fractures

Background: Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported. Purpose: To describe the management and surgical treatment of a series of elite-level athletes who presented with symptomatic nonunions of a vertical sternal fracture. Study Design: Case series; Level of evidence, 4. Methods: Patients with an established symptomatic nonunion of a vertical sternal fracture, as diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI), underwent open reduction and internal fixation using autologous bone graft and cannulated lag screws. The patients were assessed preoperatively and at the final follow-up using the Rockwood sternoclavicular joint (SCJ) score; Constant score; and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Bony union was confirmed on postoperative CT scan. Results: Five patients (4 men and 1 woman) were included; all were national- or international-level athletes (rugby, judo, show-jumping, and MotoGP). The mean age at surgery was 23.4 years (range, 19-27 years), the mean time from injury to referral was 13.6 months (range, 10-17 months), and the mean time from injury to surgery was 15.8 months (range, 11-20 months). The mean follow-up was 99.4 months (range, 25-168 months). There was a significant improvement after surgery in the mean Rockwood SCJ score (from 12.6 to 14.8 [ P < .05]), Constant score (from 84 to 96.4 [ P < .05]; 80% met the minimal clinically important difference [MCID] of 10.4 points), and QuickDASH (from 6.8 to 0.98 [ P < .05]; 0% met the MCID of 15.9 points). Four of the patients were able to return to sport at their preinjury level, and 1 patient retired for nonmedical reasons. All of the fractures had united on the postoperative CT scan. There were no postoperative complications. Conclusion: Vertical fractures of the sternum are very rare and tend to behave clinically like an avulsion fracture injury to the capsuloligamentous structure of the inferior SCJ. The requirement of advanced imaging to diagnose this injury means that the actual incidence and natural history are not known. For high-demand athletes, early identification, surgical reduction, and fixation are likely to achieve the best outcome.

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Abstract 2276: Microhemorrhage Burden Increases the Risk of Hematoma Growth in Patients with Intracerebral Hemorrhage

Stroke ◽

10.1161/str.43.suppl_1.a2276 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Joan Martí-Fàbregas ◽

Estrella Morenas ◽

Raquel Delgado-Mederos ◽

Lavinia Dinia ◽

Esther Granell ◽

...

Keyword(s):

Differential Diagnosis ◽

Statistical Analysis ◽

Intracerebral Hemorrhage ◽

Multicentre Study ◽

Symptom Onset ◽

Variable Time ◽

Hematoma Growth ◽

Acute Intracerebral Hemorrhage ◽

Radiological Studies

Introduction Microhemorrhages (MH) are lesions detected on radiological studies resulting from an underlying small-vessel angiopathy. We assesed the hypothesis that the presence of MH increases the risk of hematoma growth (HG) in patients with acute Intracerebral Hemorrhage (ICH). Methods We evaluated a series of patients in a prospective and multicentre study. We included patients with a spontaneous supratentorial ICH within the first 6 hours after symptom onset, that also had a follow-up CT 24-72 hours later and a MRI performed after a variable time after ICH. HG was defined as an increase >33% in the volume of hematoma on the follow-up CT, in comparison with the admission CT. The volume was calculated using the formula AxBxC/2. On MR scans we assessed the presence, number and distribution of MH. After differential diagnosis with other radiological lesions, MH were evaluated on echo-gradient sequences and defined as hypointense rounded lesions with a diameter <10mm. Statistical analysis: Bivariate tests with the whole sample and with the subgroup of patients with less than 3 hours from symptom onset. Results We studied 46 patients, whose mean age was 68.8±11.2 y and 68% were men. Mean baseline volume was 19.1±27.3 cc. We detected MH in 7/15 patients with HG and in 18/31 patients without HG (46.7% vs 58.1%, p=0.53). In the subgroup of patients with 10 MH, the risk of HG was higher than in patients with 0-10 MH (75% vs 28.6%, p=0.067), and this difference was significant when considering only patients with a <3 hours evolution (100% vs 31%, p=0.044). We did not observe any association between risk of HG and distribution of MH. Age and time to CT were equivalent in the two groups (with and without HG), either in the <6 or <3 hours subgroups. Conclusions In conclusion, in patients with hyperacute ICH, the presence of more than 10 MH increases the risk of HG. This is probably an indirect marker of a more severe underlying angiopathy.

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Abstract TP291: Hematoma Retraction and Perihematoma Hypodensity in Neutral Brain Model of Intracerebral Hemorrhage

Stroke ◽

10.1161/str.44.suppl_1.atp291 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Shahram Majidi ◽

Basit Rahim ◽

Sarwat I Gilani ◽

Waqas I Gilani ◽

Malik M Adil ◽

...

Keyword(s):

Biological Activity ◽

Intracerebral Hemorrhage ◽

Ct Scan ◽

Early Period ◽

Ct Scans ◽

Hematoma Expansion ◽

Human Cadaver ◽

Fresh Blood ◽

The Right

Background: The temporal evolution of intracerebral hematomas and perihematoma edema in the ultra-early period on computed tomographic (CT) scans in patients with intracerebral hemorrhage (ICH) is not well understood. We aimed to investigate hematoma and perihematoma changes in “neutral brain” models of ICH. Methods: One human and 6 goat cadaveric heads were used as “neutral brains” to provide physical properties of the brain without any biological activity or new bleeding. ICH was induced by slow injection of 4 ml of fresh blood into the right basal ganglia of the goat brains. Similarly, 20 ml of fresh blood was injected deep into the white matter of the human cadaver head in each hemisphere. Serial CT scans of the heads were performed at 0, 1, 3, and 5 hours after inducing ICH. Analyze software (AnalyzeDirect, Overland Park, KS) was used to measure hematoma and perihematoma hypodensity volumes in the baseline and follow up CT scans. Results: The initial hematoma volumes of 11.6 ml and 10.5 ml in the right and the left hemispheres of the human cadaver brain gradually decreased to 6.6 ml and 5.4 ml at 5 hours, showing 43% and 48% retraction of hematoma, respectively. The volume of the perihematoma hypodensity in the right and left hemisphere increased from 2.6 ml and 2.2 ml in the 1 hour follow up CT scans to 4.9 ml and 4.4 ml in the 5 hour CT scan, respectively. Hematoma retraction was also observed in all six ICH models in the goat brains. The mean ICH volume in the goat heads was decreased from 1.49 ml in the baseline CT scan to 1.01 ml in the 5 hour follow up CT scan showing 29.6% hematoma retraction. Perihematoma hypodensity was visualized in 70% of ICH in goat brains, with an increasing mean hypodensity volume of 0.4 ml in the baseline CT scan to 0.8 ml in the 5 hour follow up CT scan. Conclusion: Our study demonstrated that substantial hematoma retraction and perihematoma hypodensity occurs in intracerebral hematomas in the absence of any new bleeding or biological activity of the surrounding brain. Such observations suggest that active bleeding is underestimated in patients with no or small hematoma expansion and our understanding of perihematoma hypodesity needs to be reconsidered.

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Time to achieve best postoperative visual acuity following Boston keratoprosthesis surgery

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317483 ◽

2021 ◽

pp. bjophthalmol-2020-317483

Author(s):

Jonathan El-Khoury ◽

Majd Mustafa ◽

Roy Daoud ◽

Mona Harissi-Dagher

Keyword(s):

Visual Acuity ◽

Contributing Factors ◽

Time Duration ◽

Patient Demographics ◽

Snellen Visual Acuity ◽

Boston Type 1 Keratoprosthesis ◽

The Mean ◽

Retroprosthetic Membrane

Background/aimsTo evaluate the time needed for patients with Boston type 1 keratoprosthesis (KPro) to reach their best-corrected visual acuity (BCVA) and all contributing factors.MethodsWe retrospectively reviewed 137 consecutive eyes from 118 patients, measured how long they needed to reach their BCVA and looked at factors that might affect this time duration including patient demographics, ocular comorbidities and postoperative complications.ResultsThe mean follow-up was 5.49 years. The median time to BCVA postoperatively was 6 months, with 47% of patients achieving their BCVA by 3 months. The mean best achieved logMAR visual acuity was 0.71, representing a gain of 6 lines on the Snellen visual acuity chart. Postoperative glaucoma, retroprosthetic membrane (RPM) and endophthalmitis prolonged this duration. We found no correlation between the following factors and time to BCVA: gender, age, indication for KPro surgery, primary versus secondary KPro, number of previous penetrating keratoplasties, previous retinal surgery, intraoperative anterior vitrectomy and preoperative glaucoma.ConclusionIn our retrospective cohort, the majority of subjects reached their BCVA between 3 and 6 months after KPro implantation. This duration was significantly prolonged by the development of postoperative glaucoma, RPM and endophthalmitis.

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Abstract P394: Association Between Admission Dehydration and In-Hospital Mortality in Patients With Intracerebral Hemorrhage

Stroke ◽

10.1161/str.52.suppl_1.p394 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Bin Gao ◽

Hongqiu Gu ◽

Shimeng Liu ◽

Qi Zhou ◽

Kang Kaijiang ◽

...

Keyword(s):

Logistic Regression ◽

Intracerebral Hemorrhage ◽

Hospital Mortality ◽

Blood Urea Nitrogen ◽

Regression Models ◽

Fluid Management ◽

Urea Nitrogen ◽

Logistic Regression Models ◽

Acute Intracerebral Hemorrhage ◽

Stroke Center

Background and purpose: Our aim was to investigate the associations between dehydration status at admission and in-hospital mortality in patients with intracerebral hemorrhage. Methods: Data of consecutive patients with intracerebral hemorrhage between August 2015 and July 2019 based on China Stroke Center Alliance (CSCA) were analyzed. The patients were stratified based on the blood urea nitrogen (BUN) to creatinine (CR) ratio (BUN/CR) on admission, into dehydrated (BUN/CR ≥ 15) and non-dehydrated (BUN/CR < 15) groups. Data were analyzed with multi-variate logistic regression models to analyze the risks of death at hospital and baseline dehydration status. Results: A total number of 84043 patients with intracerebral hemorrhage were included in the study. The median age of patients on admission was 63.0 years, and 37.5% of them were women. Based on the baseline BUN/CR, 59153 (70.4%) patients were classified into dehydration group. Patients with admission dehydration (BUN/CR ≥ 15) had 13% lower risks of in-hospital mortality than those without dehydration (BUN/CR < 15, adjusted OR=0.87, 95%CI: [0.78-0.96]). In patients aged <65 years, patients with baseline dehydration (BUN/CR ≥ 15) showed 19% lower risks of in-hospital mortality (adjusted OR=0.81, 95%CI: [0.70-0.94].adjusted p=0.0049) than non-dehydrated patients (BUN/CR<15). Conclusion: Admission dehydration is associated with lower in-hospital mortality in intracerebral hemorrhage,which provides an imaging clue that fluid management could be important for acute intracerebral hemorrhage.

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Lack of Prognostic Significance of Pre-Treatment Total Metabolic Tumor Volume (TMTV) in Diffuse Large B-Cell Lymphoma (DLBCL)

Blood ◽

10.1182/blood-2018-99-113791 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 1720-1720

Author(s):

Mayur Narkhede ◽

Sadaf Qureshi ◽

Maryam Yazdy ◽

Roxanna Juarez ◽

Giuseppe Esposito

Keyword(s):

Ct Scan ◽

B Cell ◽

Prognostic Significance ◽

B Cell Lymphoma ◽

Pet Ct ◽

The Mean ◽

Pre Treatment ◽

Pet Ct Scan ◽

Stage Stage

Abstract Background DLBCL is the most common non-Hodgkin lymphoma (NHL), making up about 30%-40% of NHL in the U.S. PET-CT is recommended as the most accurate imaging technique in DLBCL for staging and response assessment. Pretreatment assessment of PET-CT scan derived metrics such as TMTV has been shown to correlate with PFS and/or overall survival (OS) in DLBCL (Sasanelli 2014) We attempted to replicate this finding using EFS at 24 months as a primary endpoint and compare it with pre-treatment TMTV, TLG and cell of origin (COO). Methods 47 pts with newly diagnosed DLBCL and treated with R-CHOP at our institution between 2014 to 2018 were identified from our electronic medical record system for retrospective analysis after IRB approval. All pts had a pretreatment PET-CT scan available for TMTV measurement. All pts had a pretreatment biopsy which were reviewed along with their clinical information regarding treatment outcome and follow up. Patients were classified as to germinal center B cell (GCB) and non-GCB based on immunochemistry using the Hahn's algorithm. PET-CT scans were reviewed by two nuclear medicine physicians using synovia software, and measurements for TMTV and TLG were recorded. TMTV was calculated using a threshold of 41% of the max pixel value (based on prior studies) to draw the volume of interest (VOI) for a lesion. Pooled t-test was performed to compare TMTV, TLG and COO with EFS at 24 mos. Chi-Square test compared TMTV with COO Results Median age of pts was 58 years, with a median duration of follow up of 26 months. There were 33% with limited stage (Stage I or II) and 67% were advanced stage (Stage III or IV). The mean pretreatment TMTV and pretreatment TLG was 295cm3 and 4519 units. 49% were GCB subtype and 47 % non-GCB. Amongst all patients 19.2 % had an event within 24 mos. When TMTV was compared to EFS at 24 months the mean TMTV was 304 for those who had an event versus 294 without (p=0.95). TLG compared to EFS at 24 months showed a mean TLG of 3391 for those who had an event versus 4914 without (P=0.40). GCB and non-GCB had mean TMTV of 264 and 339 respectively with p =0.59. COO when compared to TLG had means of 4365 and 4933 for GCB and non-GBB respectively with p=0.79.Whereas there was no correlation between stage and COO (p=0.4296) TMTV correlated with Ann Arbor staging (p=0.0002). Conclusion This retrospective study failed to demonstrate a correlation between pre-treatment TMTV, TLG, COO and EFS at 24 months revealing the lack of prognostic significance of pretreatment PET scan derived metrics in DLBCL. Prior studies with TMTV did not evaluate EFS at 24 months as an endpoint and therefore, longer follow up might be needed to demonstrate prognostic significance of pretreatment TMTV minimizing it clinical significance. The different subtypes of DLBCL based on COO as assessed by Hahns algorithm also did not differ in their disease burden as measured by TMTV. Disclosures No relevant conflicts of interest to declare.

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Observations on radiological correction of acetabular dysplasia by Dega transiliac osteotomy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20171831 ◽

2017 ◽

Vol 5 (5) ◽

pp. 1991

Author(s):

Wazir Fahad Jan ◽

Sanjay Sarup ◽

Mohd Yahya Dar ◽

Alamgir Jahan ◽

Ovais Nazir Khan

Keyword(s):

Acetabular Dysplasia ◽

Mean Value ◽

P Value ◽

Preoperative Period ◽

Radiological Parameters ◽

Male Patients ◽

The Mean ◽

Paediatric Orthopaedic ◽

Age Range

Background: Several osteotomies have been described for the correction of acetabular dysplasia associated with variable outcomes. The purpose of our study was to evaluate the effect of Dega transiliac osteotomy in radiological correction of acetabular dysplasia by assessing the change in various radiological parameters from preoperative period to postoperative period and at a follow up of two years.Methods: This was a prospective observational study conducted on 35 patients of either sex, in the age range of 18 months to 8 years, presenting to the paediatric orthopaedic OPD, of Artemis Health Institute, Gurgaon, Haryana, India between January 2012 and September 2014 in whom a diagnosis of acetabular dysplasia was made. All the patients underwent Dega transiliac osteotomy and the effectiveness of this osteotomy in the correction of acetabular dysplasia was assessed by measuring various radiological parameters preoperatively, postoperatively, and at a follow up of two years. The various radiological parameters included acetabular index (AI), centre edge angle of wiberg (CEAW), reimer’s extrusion index (REI) and the shenton’s line (SL).Results: In present study sample of 35 cases, 29 had DDH, 4 were secondary to cerebral palsy and 2 had developed dysplasia following septic arthritis of the hip. The sex distribution showed 19 females and 16 male patients. All the patients underwent Dega transiliac osteotomy at a mean age of 42.94±21.68 months. The mean value of AI improved from 42.43±4.77 degrees in preoperative period to 19.86±2.45 degrees at follow up. The mean value of CEAW improved from - 32.49±21.60 degrees in preoperative period to 32.06±5.48 degrees at follow up. The mean value of REI, improved from 91.06±21.43 % in preoperative period to 0.29±1.18 % at follow up. The SL was broken in all the 35 patients preoperatively, while at follow up it was continuous in all the patients. These changes in all the four parameters were statistically highly significant (p value<0.001).Conclusions: Thus results of present study demonstrate that Dega osteotomy is a safe, effective and versatile surgical procedure for the treatment of acetabular dysplasia secondary to DDH and other disorders. Since the majority of the patients included in this study had the diagnosis of DDH, the results of this study are more representative of dysplasia associated with DDH.

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375. Cryptococcal Antigenemia in Advanced HIV Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.448 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S196-S196

Author(s):

Jatin Ahuja ◽

Manish Soneja ◽

Naveet Wig ◽

Immaculata Xess ◽

Ashutosh Biswas ◽

...

Keyword(s):

Multivariate Analysis ◽

Care Center ◽

Tertiary Care ◽

Latex Agglutination ◽

Cd4 Count ◽

North India ◽

World Health ◽

P Value ◽

The Mean

Abstract Background Diagnostic importance of asymptomatic cryptococcal antigenemia is being increasingly recognized in the last few years. Recently, WHO (World Health Organization) has recommended routine screening of CrAg (cryptococcal antigen) among PLHA with CD4 ≤100/mm3, albeit this procedure is not yet adopted by many developing countries including India. Methods We conducted a prospective observational study in a large tertiary care center of North India, upon ethical clearance. Latex agglutination test was performed to assess serum CrAg levels, followed by the lumbar puncture for detection of CrAg levels in the CSF. We analyzed the prevalence and treatment outcomes of cryptococcal antigenemia among PLHA with CD4 ≤ 100 cells/mm3. Detailed clinical examination was conducted, with follow-up of upto 3 months. Multivariate analysis was performed for the estimation of risk factors. Results The mean age (years) and BMI (kg/m2) of all the participants were 41.4 ± 11.2 and 22.1 ± 2.6, respectively. Notably, the mean CD4 count (cu.mm) at the time of recruitment was 62.3 ± 20.5. Noteworthy, 62 (60.8%) of the patients were ART naïve. We found 9.8% (n = 10) of the patients were positive for serum CrAg, and only 2.9% (n = 3) had clinical features of meningitis and 6.8% (n = 7) were asymptomatic (subclinical) CrAg positive. Strikingly, 3.9% (n = 4) of the asymptomatic cryptococcal antigenemia patients were also positive for CrAg in CSF, with 1.9% (n = 2) were only serum CrAg positive, and 1 patient was lost to follow-up (Graph 1). Multivariate analysis revealed that patients with long duration of HIV (P = 0.04), headache symptoms (P = 0.004) and possessing features of meningismus (P value=0.08) are more likely to be CrAg positive. Conversely, patients on fluconazole were protective against cryptococcal antigenemia (P = 0.1) as shown in Table 1. Overall mortality observed was 11.3% among advanced HIV patients. Moreover, mortality in CrAg-positive patients was 33.3% in comparison to CrAg-negative patients who had 9% (P = 0.06) in 3-months follow-up. Conclusion Cryptococcal antigenemia is common (9.8%) among patients with CD4 count ≤100/mm3 in India. Screening for CrAg should be made routine for PLHA with CD4 count ≤100/mm3 and if required preemptive treatment to be given in this regard. Disclosures All authors: No reported disclosures.

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Diagnostic Accuracy of Lever Sign Test in Acute, Chronic, and Postreconstructive ACL Injuries

BioMed Research International ◽

10.1155/2019/3639693 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Tahsin Gürpınar ◽

Barış Polat ◽

Ayşe Esin Polat ◽

Engin Çarkçı ◽

Yusuf Öztürkmen

Keyword(s):

Diagnostic Accuracy ◽

Pivot Shift ◽

High Sensitivity ◽

Sign Test ◽

Good Test ◽

Acl Injuries ◽

Anterior Drawer ◽

Clinical Instability ◽

The Mean

Background. The aim of this study is to determine the diagnostic accuracy of lever sign test in acute, chronic, and postreconstructive ACL injuries. Methods. In total, 78 patients (69 male, 9 female) were subjected to clinical instability tests including Lachman, anterior drawer, pivot shift, and lever sign when an injury of the ACL was suspected. All tests were performed bilaterally in all patients in acute, chronic period and patients who underwent surgery after the anaesthesia and after the reconstruction at the last follow-up by two senior orthopaedic surgeons. MRI was taken from all patients and MRI image was taken as the reference test when evaluating the accuracy of the tests. Results. The mean age of patients was 26.2±6.4 years (range, 17-44 years). Sensitivity and accuracy values of the Lachman, anterior drawer, pivot shift, and lever tests in the acute phase were calculated as 80.6%, 77.4%, 51.6%, 91.9% and 76.9%, 75.6%, 60.3%, 92.3%, respectively, and in the chronic (preanaesthesia) phase were calculated as 83.9%, 79.0%, 56.5%, 91.9% and 80.8%, 78.2%, 64.1%, 92.3%, respectively. Lachman, anterior drawer, pivot shift, and lever sign Acute’s significant [AUC: 0.716, 0.731, 0.727, 0.928, respectively] activity were observed in the prediction of ACL rupture in MRI. Conclusion. An ideal test to diagnose the integrity of the ACL should be easy to perform and reproducible with high sensitivity and specificity. From this perspective, the lever test seems to be a good test for clinicians in acute, chronic and postreconstructive ACL injuries.

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