Classification and Radiological Diagnosis of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

The aim of this review to determine recommendations for classification and radiological diagnosis of thoracolumbar spine fractures. Recommendation was made through a literature review of the last 10 years. The statements created by the authors were discussed and voted on during 2 consensus meetings organized by the WFNS (World Federation Neurosurgical Societies) Spine Committee. The literature review was yielded 256 abstracts, of which 32 were chosen for full-text analysis. Thirteen papers evaluated the reliability of a classification system by our expert members and were also chosen in this guideline analysis. This literature review-based recommendation provides the classification and radiologic diagnosis in thoracolumbar spine fractures that can elucidate the management decision-making in clinical practice.

Intra-articular fibrous bands at the tibiotalar joint: diagnosis and outcomes of arthroscopic removal in 4 ankles

The authors retrieved the records of 4 patients that exhibited unusual structural anomalies or pathologies, notably the presence of a fibrous band at the anterior aspect of the tibiotalar joint, observed during arthroscopic exploration or treatment between January and December 2019. Only 1 patient had surgical antecedents on the ipsilateral ankle (extra-articular tenodesis 10 years earlier). The remaining 3 patients had no surgical antecedents on the ipsilateral ankle. The fibrous band was removed in all patients during arthroscopic Brostöm procedure or exploration. For the first 3 patients, the intra-articular fibrous band was not observed prior to arthroscopy by either the senior surgeon or radiologist on any of the images (2 MRIs and 1 CTA), but retrospective inspection confirmed that the intra-articular fibrous band was present but had been overlooked.At a follow-up of 22.3 ± 5.0 months (range, 15–26), all patients reported a decrease in pVAS (− 5.0 ± 2.6, range, 2–8), and an improvement in AOFAS (51.0 ± 17.7, range, 26–65), EFAS (14.5 ± 8.7, range, 6–23) and EFAS sport (8.0 ± 5.3, range, 2–10).This case report corroborates the findings of an earlier discovery of an intra-articular fibrous band in 4 ankles, with more detailed information for clinical and radiologic diagnosis, as well as outcomes of arthroscopic removal. Clinicians should beware of such foreign bodies in the ankle, particularly in patients with history of sprains, and consider arthroscopic removal in cases with persistent pain and/or functional impairment.

THE ROLE OF ULTRASOUND AND MRI IN THE DIAGNOSIS OF OVARIAN TUMOURS

Background: Ovarian cancer is the fth leading cause of cancer related death in the USA, and has the highest mortality rate due to late diagnosis. The most common modalities used in diagnoses are B-Mode USG, Conventional MRI and DW-MRI. This study aims to statistically analyze and compare the sensitivity, specicity and measurement of agreement for these modalities. From March 2019 to September 2020, 103 pat Method: ients with ovarian masses underwent radiodiagnostic testing with USG and MRI, and subsequently 85 patients underwent surgery and the gold standard histopathological examination. The radiologic diagnosis was correlated with the histopathologic diagnosis for these patients and the sensitivities, specicities and area under the ROC curve were calculated. The Results: area under ROC curve increased in the following order: B- Mode USG < B-Mode USG & Doppler combined < conventional MRI < DW-MRI. The measurement of agreement Kappa increased in the following order: B- Mode USG < B-Mode USG & Doppler combined < conventional MRI < DW-MRI. The study showed that addition of Doppler to B-Mode USG reduced its sensitivity and NPV. Both USG and conventional MRI were found to have comparable sensitivities. While DW-MRI is superior t Conclusion: o other modalities in its high specicity in diagnosing ovarian tumors, USG has equal sensitivity and can be used for initial presumptive diagnosis in patients with suspected ovarian malignancies.

Early Radiologic Diagnosis of Pulmonary Infection in Febrile Neutropenic Patients: A Comparison of Serial Chest Radiography and Single CT Chest

Objective. The purpose of this study is to compare the early radiologic diagnosis of pulmonary infection between serial chest radiography (chest film) and single chest computed tomography (CT chest) in the first seven days of febrile neutropenia. Methods. This study included 78 patients with hematologic malignancies who developed 107 episodes of febrile neutropenia from January 2012 to October 2017 and had a chest film performed within the first seven days. Demographic and radiographic data were retrospectively reviewed. Three radiologists independently and blindly evaluated chest films and CT chests. The sensitivity, specificity, and correlation of chest film with absolute neutrophil count were carried out. Results. A total of 222 chest films were performed during this period and found thirty-nine episodes (36.4%) of radiographic active pulmonary infection. The diagnosis of clinical positive for pulmonary infection is 44.8% (48/107). Sensitivity, specificity, positive predictive value, and negative predictive value of serial chest film in the early radiologic diagnosis of pulmonary infection are 50%, 74%, 61%, and 64%, respectively. The false-positive rate was 14%, and the false-negative rate was 22%. For single CT chest examinations, twenty-six studies were assessed, and 42.3% was indicative of radiographic active pulmonary infection. Sensitivity, specificity, positive predictive value, and negative predictive value of CT chest in the early radiologic diagnosis of pulmonary infection are 91%, 40%, 53%, and 86%, respectively. The false-positive rate was 60%. The absolute neutrophil count was not useful for predicting radiographic active pulmonary infection. Conclusion. Serial chest film for early radiologic diagnosis of pulmonary infection within the first seven days of febrile neutropenia has lower sensitivity with higher specificity as compared to a single CT chest. Conversely, CT chest may not only have a higher sensitivity in determining early pulmonary infection but also has a higher rate of false-positives.