IDoR2018: Cardiac Imaging

The International Day of Radiology is an annual event held with the aim of building greater awareness of the value that radiology contributes to safe patient care, and improving understanding of the vital role radiologists and radiological technologists play in the healthcare continuum.

IDoR 2018 Theme is cardiac Imaging

Goal is highlighting the increasingly important role of radiologists in cardiac care, contributing to the diagnosis, pre-procedural work-up and follow-up of patients with a wide variety of cardiac pathology, from coronary artery disease and leaky heart valves to defects in the size and shape of the heart.

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Recurrence of adenomatoid odontogenic tumor

Abstract

We were impressed with the meticulous attention to detail regarding the recurrence of adenomatoid odontogenic tumor (AOT) in the recent article by Chrcanovic and Gomez.¹ It was a pleasure to learn that they had taken an interest in our report on AOT recurrence (see Supporting Information).¹ This letter focuses on the unanswered questions relating to two cases of recurrent AOT published in Japanese to which Chrcanovic and Gomez¹ referred.

This article is protected by copyright. All rights reserved.

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Treatment of end stage temporomandibular joint disorder using a temporomandibular joint total prosthesis: The Slovenian experience

The aim of this study was to analyse treatment results after alloplastic temporomandibular joint replacement surgery.

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Mechanical impairment on alveolar bone graft: a literature review

Cleft lip and palate represents the most common form of craniofacial malformation (1 in 700 newborns in Europe). Cleft lip and palate is usually closed within the first 2 years after birth. The alveolar cleft is left open so as not to impair on maxillary growth in the way that primary osteoplasty did (Robertson and Jolleys, 1968; Rehrmann et al., 1970). Secondary alveolar bone grafting has become well established since the original work of Boyne and Sands (1972). Cancellous iliac bone is most widely favored, but tibial shaft, mandible, rib, and calvaria have also been used.

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Immunology of the Ancestral Differences in Eosinophilic Esophagitis

Eosinophilic Esophagitis (EoE) is an allergen driven disease characterized by eosinophilic inflammation in the esophagus1. Like other atopic disorders such as atopic dermatitis (AD), food allergy (FA), allergic rhinitis (AR), and asthma, EoE has complex etiology with genetic predisposition and environmental factors playing a major role in disease development2. The genetic predisposition has been suggested as an important factor by familial and twin studies. Additionally, numerous genetic risk loci have been now described linked to EoE risk confirming that inheritability is associated with genetic predisposition3.

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Review of 400 Consecutive Oral Food Challenges to Almond

Diagnosis of almond allergy is complicated by a high rate of false positive test results. Accurate diagnosis of almond allergy is critical as almond is a source of nutrition and milk products for children with other food allergies.

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Synthetic polymeric barrier membrane associated with blood coagulum, human allograft, or bovine bone substitute for ridge preservation: a randomized, controlled, clinical and histological trial

Publication date: Available online 7 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s):

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A Review of Phospholipid Encapsulated Ultrasound Contrast Agent Microbubble Physics?

Publication date: Available online 7 November 2018

Source: Ultrasound in Medicine & Biology

Author(s): Brandon Helfield

Abstract

Ultrasound contrast agent microbubbles have expanded the utility of biomedical ultrasound from anatomic imaging to the assessment of microvascular blood flow characteristics and ultrasound-assisted therapeutic applications. Central to their effectiveness in these applications is their resonant and non-linear oscillation behaviour. This article reviews the salient physics of an oscillating microbubble in an ultrasound field, with particular emphasis on phospholipid-coated agents. Both the theoretical underpinnings of bubble vibration and the experimental evidence of non-linear encapsulated bubble dynamics and scattering are discussed and placed within the context of current and emerging applications.

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Leadless Cardiac Pacemaker (LCP) without Diagnostic Relevant Artifacts in DualSource and DualEnergy-CT Examinations in First- to Third-Generation DSCT Scanner

Publication date: Available online 7 November 2018

Source: Academic Radiology

Author(s): Sebastian D. Reinartz, Robin F. Gohmann, Felix Hardt, Jonas Schmoee, Timm Dirrichs, Eric Tietz, Christiane K. Kuhl, Kerstin Fehrenbacher, Andreas Napp

Rationale and Objectives

To identify the influence and artifact burden in cardiac CT imaging of a leadless cardiac pacemaker (LCP) performed with all three generations of DualSource CT (DSCT) Scanners.

Materials and Methods

The LCP was examined in DSCT scanners of the first to third generation using DualEnergy (DECT) and DSCT as well as alterations of the current-time product. For DECT examinations, virtual monoenergetic images were computed manually on a dedicated workstation. Virtual voltage was manually selected by subjective assessment of the lowest artifact burden. Systematic variations of the pacemaker angle to the gantry were assessed, too. The angle was successively increased by 10°, ranging from 0° to 90°. Artifact burden was quantified on a five-point Likert scale (1- no artifacts, 2- few artifacts, 3- moderate artifacts, 4- many artifacts, and 5- massive artifacts). Likert values of 1–3 were considered diagnostic and assessed by two board-certified radiologists in consensus.

Results

In total, 200 examinations were analyzed, a mean Likert value of 1.93 ± 0.61 was found overall. None of the images were assessed Likert value >3. The positioning evaluation showed a clear and significant reduction of artifact burden toward lower angles, (0°: 1.4 ± 0.5 vs. 90° 2.55 ± 0.51). At scanner level, second-generation DSCT performed significantly better (1.68 ± 0.47) than both other scanners. Comparison of technique (DECT vs. DSCT) revealed a significantly improved image quality in DSCT examinations.

Conclusion

LCP can be safely examined in DSCT scanner of the first to third generation with the evaluated protocols and techniques, which are currently in use. Artifact burden can be significantly reduced by aligning or approaching the LCP's longitudinal axis toward the scanner's z-axis.

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Treatment of end stage temporomandibular joint disorder using a temporomandibular joint total prosthesis: The Slovenian experience

Publication date: Available online 7 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Peter Balon, Aleš Vesnaver, Andrej Kansky, Miha Kočar, Luka Prodnik

Summary

Purpose

The aim of this study was to analyse treatment results after alloplastic temporomandibular joint replacement surgery.

Materials and Methods

Twelve patients who met the inclusion criteria underwent operation between the years 2012 and 2016 at the Department of Maxillofacial and Oral Surgery of the University Medical Centre Ljubljana, Slovenia. Seven patients had posttraumatic sequelae, 4 osteoarthritis and 1 psoriatic arthritis. We inserted 12 temporomandibular joint prostheses (Biomet- Lorenz). A retrograde analysis of the patients' subjective assessment of the pre- and postoperative temporomandibular pain, opening the mouth, the ability to chew food, and quality of life (VAS scale, 0–10) was performed. Additionally, we evaluated the inter-incisal distance pre- and postoperatively. Complications that occurred were also included in our evaluation.

Results

During final examinations, at least 15 months after the surgery (on average 39.5 months), we observed an improved ability to open the mouth in all patients. The average preoperative inter-incisal distance was 22 mm (15–30 mm); the average postoperative distance was 37.5 mm (32.3–1.8 mm), (p<0.001). The analysis of pain and other subjective variables (opening the mouth, the ability to chew, quality of life) showed a statistically significant improvement (p<0.001).

Conclusion

According to our initial experience, replacement of the temporomandibular joint with a total prosthesis is a safe and effective treatment method.

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Active vaccination against Interleukin‐5 as long‐term treatment for insect bite hypersensitivity in horses

Abstract

Background

Insect‐bite hypersensitivity (IBH) in horses is a chronic allergic dermatitis caused by insect bites. Horses suffer from pruritic skin lesions, caused by type‐I/type‐IV allergic reactions accompanied by prominent eosinophil infiltration into the skin. Interleukin‐5 (IL‐5) is the key cytokine for eosinophils and we have previously shown that targeting IL‐5 by vaccination reduces disease symptoms in horses.

Objective

Here we analyzed the potential for long‐term therapy by assessing a second follow‐up year of the previously published study.

Methods

The vaccine consisted of equine IL‐5 (eIL‐5) covalently linked to a cucumber mosaic virus‐like particle (VLP) containing a universal T cell epitope (CuMV_TT) using a semi‐cross over design to follow vaccinated horses during a second treatment season. Thirty Icelandic horses were immunized with 300 μg of eIL‐5‐CuMV_TT without adjuvant.

Results

The vaccine was well tolerated and did not reveal any safety concerns throughout the study. Upon vaccination all horses developed reversible anti‐eIL‐5 auto‐antibody titers. The mean course of eosinophil levels was reduced compared to placebo treatment leading to significant reduction of clinical lesion scores. Horses in their second vaccination year showed a more pronounced improvement of disease symptoms when compared to first treatment year, most likely due to more stable antibody titers induced by a single booster injection. Hence, responses could be maintained over two seasons and the horses remained protected against disease symptoms.

Conclusion

Yearly vaccination against IL‐5 may be a long‐term solution for the treatment of IBH and other eosinophil‐mediated diseases in horses and other species including humans.

This article is protected by copyright. All rights reserved.

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Predicción de los resultados clínicos en el tratamiento personalizado con yodo radiactivo de la enfermedad de Graves, mediante gammagrafía tiroidea con 99mTc-pertecnetato

Publication date: Available online 6 November 2018

Source: Revista Española de Medicina Nuclear e Imagen Molecular

Author(s): L. Zhao, W. Zhang, Y. Xin, Q. Wen, L. Bail, F. Guan, B. Ji Bin

Resumen

Objetivo

El objetivo de este estudio fue, en primer lugar, la comprobación de la eficacia de la terapia con yodo radiactivo (TIR) en la enfermedad de Graves (EG) basándonos en un régimen de cálculo de dosis y, en segundo lugar, determinar el valor de la gammagrafía tiroidea con ^99mTc-pertecnetato a la hora de predecir los resultados clínicos de la TIR.

Métodos

Evaluamos retrospectivamente a 139 pacientes consecutivos con EG tratados mediante TIR utilizando un método de cálculo de dosis en nuestro hospital desde enero del 2015 hasta septiembre del 2015. La dosis de yodo radiactivo se calculó utilizando la fórmula de Marinelli. Se evaluaron la captación de ^99mTc-pertecnetato, edad, sexo, masa tiroidea, duración de la enfermedad, tratamiento previo con antitiroideos, niveles séricos de TSH, FT3 Y FT4, tasa positiva de TPOAb y anti-TRAb, dosis de yodo radiactivo y seguimiento, como factores potenciales de interferencia para el éxito de la TIR.

Resultados

El tratamiento fue exitoso en 108 pacientes con EG (77,7%), incluyendo 71 pacientes eutiroideos (51,1%) y 37 hipotiroideos (26,6%), aunque 31 pacientes (22,3%) siguieron siendo hipertiroideos (fracaso terapéutico). Encontramos diferencias significativas entre el grupo de tratamiento exitoso y el grupo de fracaso terapéutico en cuanto a captación de ^99mTc-pertecnetato (p < 0,0001), duración de la enfermedad (p = 0,0140) y tasa positiva de anti-TRAb (p = 0,0103). La captación de ^99mTc-pertecnetato es un factor de riesgo independiente para la predicción del fracaso terapéutico (p = 0,0394). Utilizando un valor de corte del 18,4%, la captación de ^99mTc-pertecnetato podría predecir el fracaso terapéutico con una sensibilidad del 84,3% y una especificidad del 80,6%.

Conclusión

Nuestro estudio ha reflejado que el cálculo de dosis de yodo radiactivo es eficaz para el tratamiento de los pacientes con EG, lo que redunda en una tasa baja de hipotiroidismo. Un porcentaje de captación de ^99mTc-pertecnetato superior al 18,4% constituye un factor predictivo significativo de fracaso terapéutico, por lo que los pacientes deberían recibir una dosis superior de yodo radiactivo en este caso.

Abstract

Objective

The aim of this study was, first, to ascertain the efficacy of radioiodine therapy (RIT) for Graves' disease (GD) based on a calculated-dose regime and, second, to determine the value of ^99mTc-pertechnetate thyroid scintigraphy in predicting the clinical outcomes of RIT.

Methods

One hundred and thirty 9 consecutive GD patients who underwent RIT using a calculated-dose method in our hospital from January 2015 to September 2015 were retrospectively evaluated. Radioiodine dose was calculated based on the Marinelli's formula. ^99mTc-pertechnetate uptake, age, gender, thyroid mass, duration of the disease, previous antithyroid drugs treatment, serum levels of TSH, FT3 and FT4, a positive rate of TPOAb and Anti-TRAb, radioiodine dose and follow-up were evaluated as potential interference factors for RIT success.

Results

One hundred and 8 (77.7%) GD patients including 71 (51.1%) euthyroid and 37 (26.6%) hypothyroid were successful, but 31 (22.3%) remained hyperthyroid (treatment failure). Significant differences were found between the treatment success group and the failure group in ^99mTc-pertechnetate uptake (p<0.0001), the duration of disease (P=.0140) and positive rate of Anti-TRAb (P=.0103). ^99mTc-pertechnetate uptake is an independent risk factor for predicting treatment failure (P=.0394). Using a cut-off value of 18.4%, ^99mTc-pertechnetate uptake could predict treatment failure with a sensitivity of 84.3%, and a specificity of 80.6%.

Conclusion

Our study has shown that a calculated radioiodine dose is effective in treating GD patients with a consequent low rate of hypothyroid. A ^99mTc-pertechnetate uptake above 18.4% is a significant predictor of treatment failure and these patients should receive a higher radioiodine dose in this scenario.

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Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma

Abstract

Purpose

The purpose of this study was to determine the accuracy of "black bone" (BB) MRI for the detection of skull fractures in children with potential abusive head trauma.

Methods

A total of 34 pediatric patients were evaluated for potential abusive head trauma. All patients had both a non-contrast head CT (HCT) with multiplanar reformatted images and 3D volumetric reformatted images where available (gold standard) for fracture diagnosis and BB of the head with multiplanar reformatted images and 3D volumetric images. BB was performed using an ultrashort TE pointwise encoding time reduction with radial acquisition (PETRA) sequence at 1.5 T or 3 T. BB datasets were post-processed and 3D images created using Fovia's High Definition Volume Rendering® software. Two board-certified pediatric neuroradiologists independently reviewed the HCT and BB imaging, blinded to the findings from the other modality.

Results

Median patient age was 4 months (range 1.2–30 months). A total of 20 skull fractures in six patients (18% incidence of skull fractures) were detected on HCT. BB demonstrated 83% sensitivity (95%[CI] 36–99%), 100% specificity (95%[CI] 88–100%), 100% PPV (95%[CI] 46–100%), 97% NPV (95%[CI] 82–99%), and 97% accuracy (95%[CI] 85–99%) for diagnosis of a skull fracture. BB detected 95% (19/20) of the skull fractures detected by CT.

Conclusion

A black bone MRI sequence may provide high sensitivity and specificity for detection of skull fractures in pediatric patients with abusive head trauma.

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Determination of nicotine content in teeth submitted to prophylaxis and in-office bleaching by gas chromatography–mass spectrometry (GC-MS)

Abstract

Objectives

The objective of this study was to evaluate the dental color exposed to acute cigarette smoke treatment and quantify the amount of nicotine in samples exposed to cigarette smoke, after dental prophylaxis and after in-office bleaching.

Materials and methods

Sixty-nine healthy human molars were subjected to cigarette smoke in a cigarette machine. The teeth were divided into three groups: positive control, prophylaxis, and bleaching. Forty cycles of smoke exposition with duration of 15 min each were performed using 10 cigarettes (positive control). Dental prophylaxis was performed with a rotating brush and prophylaxis paste; in-office bleaching was performed with 35% hydrogen peroxide, in two sessions of three 15-min applications, with a 1-week interval between sessions. The color was evaluated at the baseline, after exposure to cigarette smoke, after dental prophylaxis, and after in-office bleaching. Teeth from each group were powdered and analyzed by gas chromatography–mass spectrometry in order to measure the amount of nicotine present in each group. Data from quantification of nicotine and color change were analyzed by one-way ANOVA and Tukey's test (α = 0.05).

Data for subjective and objective color evaluation, a perceptible dental darkening occurred in teeth after exposure to cigarette smoke. Dental prophylaxis was able to recover the original color of teeth however, only after bleaching teeth became whiter than at the baseline (p < 0.001). The amount of nicotine was significantly different and higher in positive control group (3.3 ± 1.3 μg/g of tooth), followed by the prophylaxis group (2.1 ± 1.4 μg/g) and the bleaching group (0.8 ± 0.3 μg/g) (p < 0.001).

Conclusions

Cigarette smoke penetrates into the dental structure. Dental prophylaxis and bleaching with 35% hydrogen peroxide can partially remove the nicotine from tobacco smoke. However, when in-office bleaching was applied, a more significant nicotine removal was achieved.

Clinical significance

Dental prophylaxis could remove most of the external nicotine-staining on the tooth surfaces while bleaching could further reduce the external and internal nicotine-staining of teeth.

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Oral health in Alzheimer’s disease: a multicenter case-control study

Abstract

Objectives

The aim of this case-control study was to carry out an oral health assessment on a group of Alzheimer's patients and to establish a hypothesis regarding the implication of the characteristics of the disease and the treatment of oral health.

Materials and methods

A total of 70 Alzheimer's patients, residents at the Alzheimer Center Reina Sofia Foundation (Madrid, Spain) and at the Alzheimer State Reference Center (Salamanca, Spain), and 36 controls (companions/acquaintances), were studied by oral examination and saliva sampling. The oral health indices DMFT/DMFS, CPI, the prosthetic condition, oral hygiene, saliva volume, and pH, as well as the specific microbiological parameters governing the risk of developing caries were assessed.

Results

Alzheimer's patients exhibited, as compared to the control group, (1) fewer teeth (10.9 ± 10.5 vs 23.7 ± 6.5), (2) fewer obturations (2.2 ± 3.4 vs 6.6 ± 5.6), (3) fewer periodontally healthy sextants (0.1 ± 0.4 vs 1.4 ± 2.2), (4) worse oral hygiene (43.1 vs 72.2% brushed), (5) greater use of removable prostheses (47.8 vs 8.4%), (6) higher incidence of candida infection (11.8 vs 0.0%) and cheilitis (15.9 vs 0.0%), (7) lower salivary flow (0.6 ± 0.6 vs 1.1 ± 0.6), and (8) lower buffering capacity (46 vs 80%).

Conclusions

After taking into account the influence of age, Alzheimer's patients had worse oral health (caries and periodontal disease), more mucosal lesions (cheilitis and candidiasis), and worse saliva quantity and quality.

Clinical relevance

Clinicians should be aware of the implications of Alzheimer's disease in oral health, in order to stablish the effective preventive measures and the optimal treatment plan.

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The use of throat packs in pediatric cleft lip/palate surgery: a retrospective study

Abstract

Objectives

Throat packs are commonly used to prevent ingestion or aspiration of blood and other debris during cleft lip/palate surgery. However, dislodgement or (partial) retainment after extubation could have serious consequences. The aim of the present study was to investigate the effect of omitting pharyngeal packing during cleft lip/palate surgery on the incidence of early postoperative complications in children.

Materials and methods

A retrospective study was performed on all children who underwent cleft lip/palate surgery at the Wilhelmina Children's Hospital. This study compared the period January 2010 through December 2012 when pharyngeal packing was applied according to local protocol (group A) with the period January 2013 till December 2015 when pharyngeal packing was no longer applied after removal from the protocol (group B). Data were collected for sex, age at operation, cleft lip/palate type, type of repair, lateral incisions, length of hospital stay, and complications in the first 6 weeks after surgery. Early complications included wound dehiscence, postoperative bleeding, infection, fever, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI).

Results

This study included 489 cleft lip/palate operations (group A n = 246, group B n = 243). A total of 39 (15.9%) early complications were recorded in group A and a total of 40 (16.5%) in group B. There were no significant differences (P = 0.902) in complications between the two groups; however, there was a significant difference (P < 0.001) in length of hospital stay between the two groups (group A 3.6 days vs group B 3.2 days).

Conclusion

Omitting routine placement of throat packs in cleft lip/palate surgery was not associated with an increased early postoperative complication rate. Therefore, the traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.

Clinical relevance

The traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.

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The potential association between periodontitis and non-alcoholic fatty liver disease: a systematic review

Abstract

Objectives

Many animal and human studies have shown associations between periodontitis and non-alcoholic fatty liver disease (NAFLD). Hence, the present systematic review sought to investigate such a potential association.

Methods

PubMed/Medline, Scopus, Embase, and Web of Science databases were thoroughly searched to identify all relevant studies. The eligibility criteria were all observational (cross-sectional studies, case-control, cohort studies, and case reports) and interventional studies that assessed the relationship between periodontitis and NAFLD in humans. Due to remarkable heterogeneity and inconsistency among the included studies, no statistical analyses were conducted.

Results

A total of 12 studies comprising 53,384 patients were included in the present systematic review. The sample size in the individual studies ranged from 52 to 24,470 patients. All studies except one found significant associations between clinical and/or microbial periodontal parameters and NAFLD. Eight studies found significant associations between clinical periodontal parameters and NAFLD. Four microbial studies found a significant association between periodontal pathogens, especially Porphyromonas gingivalis and NAFLD development and progression.

Conclusions

The available evidence suggests that periodontitis may be a risk factor for development and progression of NAFLD. However, due to limited number of prospective cohort studies included in this review along with the substantial heterogeneity among the included studies, further well-designed prospective cohort studies are highly warranted.

Clinical relevance

Given the potential association between periodontitis and NAFLD, it can be assumed that healthy periodontium may be essential for liver health.

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A randomized triple-blind crossover trial of a hydrocolloid-containing dentifrice as a controlled-release system for fluoride

Abstract

Objective

To evaluate retention of intraoral fluoride in biofilm and saliva, an experimental dentifrice containing hydrocolloid (tara gum) was used as a controlled-release system for fluoride (F).

Materials and methods

In a triple-blind randomized crossover trial with washout, 18 individuals used the following different dentifrices for a week: 100-TGF (sodium fluoride NaF associated with tara gum, 1100 mg/L), 50-TGF (50% NaF associated with tara gum + 50% free NaF, 1100 mg/L), PC (free NaF, 1100 mg/L), TG (with tara gum and without F), and placebo (without F or tara gum). On the seventh day of dentifrice use, biofilm was collected at 1 and 12 h, and saliva was collected up to 60 min and 12 h after the last toothbrushing. F concentrations were determined by physico-chemical analysis of fluoride using the hexamethyldisiloxane-facilitated diffusion technique. Data were subjected to two-way analysis of variance (repeated measures) and Spearman's correlation coefficient (p < 0.05) testing.

Results

No significant difference was observed with the same dentifrice regarding F retention in biofilm at 1 and 12 h after toothbrushing for the 100-TGF, placebo, and TG groups (p > 0.05). The highest area under the curve values in saliva were found for the 50-TGF, 100-TGF, and PC groups.

Conclusion

The dentifrice containing hydrocolloid as a controlled-release system for F promoted F retention in the oral cavity, even at 12 h after brushing.

Clinical relevance

Hydrocolloid added to dentifrices as a controlled-release system for F might contribute to a higher anti-caries effect.

Trial registration

NCT02809014

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“Pseudo” T1-weighted appearance of the brain on FLAIR: unmasking the extent of gray matter involvement on susceptibility-weighted imaging in chronic toluene abuse

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