Aim To compare the accuracy of shoulder ultrasound (US) in diagnosing rotator cuff tendon tears between junior and experienced musculoskeletal (MSK) radiologists. Also, to compare the overall ultrasound accuracy referenced to MRI. Methods A retrospective data collection for patients with clinically suspected rotator cuff tears who underwent ultrasound from June 2021 - June 2023 was conducted. Patients who also performed MRI for the same shoulder were only included in the study. US and MRI images were evaluated by two MSK radiologists with different experience levels. The diagnosis of rotator cuff tears was done on MRI through consensus. Ultrasound accuracy referenced to MRI was calculated for each radiologist. A second consensus was conducted for US images to calculate the overall US accuracy. The percentage of agreement and Cohen's kappa correlation coefficient were calculated before and after the US consensus. Results Forty-one patients were included in the study, 12 (29.3%) males and 29 (70.7%) females, with a mean age of 49.6 years. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of US interpreted by junior vs experienced MSK radiologists for supraspinatus full thickness tears (FTTs) were 100% vs 91%, 90% vs 93%, 79% vs 83%, 100% vs 97%, and 93% vs 93%, respectively. After the second consensus, sensitivity, specificity, PPV and NPV, and accuracy were 91%, 90%, 77%, 96%, and 90%, respectively. Conclusion The accuracy of shoulder ultrasound in diagnosing supraspinatus FTTs by junior MSK radiologists compares well to the more experienced ones, but not for partial thickness tears (PTTs).

Sacroiliitis is the inflammation of the sacroiliac joint, the largest axial joint in the human body, contributing to 25% of lower back pain cases. It can be detected using various imaging techniques like radiography, MRI, and CT scans. Treatments range from conservative methods to invasive procedures. Recent advancements in artificial intelligence offer precise detection of this condition through imaging. Treatment options range from physical therapy and medications to invasive methods like joint injections and surgery. Future management looks promising with advanced imaging, regenerative medicine, and biologic therapies, especially for conditions like ankylosing spondylitis. We conducted a review on sacroiliitis using imaging data from sources like PubMed and Scopus. Only English studies focusing on sacroiliitis’s radiological aspects were included. The findings were organized and presented narratively.

Introduction: Streptococcus pneumoniae infections are a major cause of mortality and morbidity worldwide. In Jordan, pneumococcal conjugate vaccines (PCVs) are not included in the national vaccination program. Due to the current availability of several PCVs, including PCV-10, PCV-13, and PCV-15, along with PCV-20, currently undergoing pediatric approvals globally, the decision to introduce PCVs and their selection should be based on valid local data on the common serotypes of Streptococcus pneumoniae. Methods: This cross-sectional study aimed to identify the frequency of serotypes of Streptococcus pneumoniae in children aged below 5 years hospitalized with invasive pneumococcal diseases (IPDs), including pneumonia, septicemia, and meningitis, during the study’s duration in representative areas of Jordan. Serotyping for culture-positive cases was based on the capsular reaction test, known as the Quellung reaction. qPCR was conducted on the blood samples of patients with lobar pneumonia identified via X-ray or on cerebrospinal fluid for those with a positive latex agglutination test for Streptococcus pneumoniae. Results: This study was based on the analysis of the serotypes of 1015 Streptococcus pneumoniae cases among children younger than the age of 5: 1006 cases with pneumonia, 6 cases with meningitis, and 3 cases with septicemia. Only 23 culture-positive cases were identified in comparison to 992 lobar pneumonia cases, which were PCR-positive but culture-negative, with a PCR positivity rate of 92%. Serotypes 6B, 6A, 14, and 19F were the most common serotypes identified in this study, with prevalence rates of 16.45%, 13.60%, 12.12%, and 8.18%, respectively. PCV-10, PCV-13, PCV-15, and PCV-20 coverage rates were 45.32%, 61.87%, 64.14%, and 68.47%, respectively. Discussion: To the best of our knowledge, this is the largest prospective study from the Middle East and one of the largest studies worldwide showing the serotypes of Streptococcus pneumoniae. It reveals the urgency for the introduction of a PCV vaccination in Jordan, utilizing recently developed vaccines with a broader serotype coverage.

Computer-aided diagnosis (CAD) systems have been the focus of many researchers in both computer and medical fields. In this paper, we build two convolutional neural network (CNN) based CAD systems for diagnosing lumbar disk herniation from Magnetic Resonance Imaging (MRI) axial scans. The first one is a disk herniation detection CAD system which is a binary CAD system that determines whether the case image contains disk herniation or not. The second system is a disk herniation type classification CAD system which can determine the type of the disk herniation in the image if one exists. To train and test the proposed systems, an image set is built and annotated with the help of a radiologist. In order to get rid of the “noisy” parts of the input images and reduce their complexity, we experiment with different ROI extraction methods. The image set is also preprocessed and enlarged using augmentation techniques to make it suitable to be used with CNN. There are many novel aspects of this work. First, the problems of disk herniation detection and recognition from axial scans are not well-studied in the literature. Second, we use deep learning techniques which produces ground-breaking results in many image processing tasks, but are yet to reach their full potential with medical image processing in general. Finally, we explore the use of many innovative techniques such as data augmentation and transfer learning, which greatly improves the accuracy of our models. The results of our systems are impressive with a 95.65% accuracy for the detection problem and a 91.38% accuracy for the recognition problem.

Magnetic resonance imaging (MRI) is the golden standard technique for spine disc disease diagnosis. Vertebral body endplate signal intensity on MRI is confirming lumber spine degenerative disc disease.The study aimed to record the lumbar spine degenerative relation between disc and diseaseusing magnetic resonance imaging. Our prospective and double blind investigation included 142 participants,having lumbar spine degenerativedisease confirmed by MRI. Pfirrmann score was used to record the relation between lumbar spine disc degeneration and lumbar spine degenerative disease. Modic modifications with the Pfirrmann and modified Pfirrmann scores of disc degeneration were assessed.Lumbar spine MRI was done for all participants using sagittal T1 and T2 WI. Modic was scored (0-III) The Pfirrmann scored I-V for disc degeneration. Lumbar disc degeneration was evaluated by modified Pfirrmann scoring from 1-8 according to signal intensity of the nucleus pulposus and inner annulus.Modic was recorded in 41.5%, 24.6%, 32.4% and 1.4% of participants with scores 0, I, II and III, respectively. Pfirrmann score was 13.4%, 73.9% and 12.7% of disc degeneration with scores III, IV and V, respectively, while,the modified Pfirrmann score was 2.1%, 15.5%, 38.7%, 26.8% and 16.9% of disc degeneration with scores of 4, 5, 6, 7 and 8, respectively. The modified Pfirrmann score showed notableinconsistencyin participants with Modic 0, I and II, but no difference between Modic I and II.There was significant relation between Modicand lumbar spine disc degeneration. In conclusion, there is a relation between Modic, Pfirrmann and modified Pfirrmann scores of lumbar spine disc degeneration in participants with lumbar spine degenerative disease.

Rationale: Parosteal lipomas are rare neoplasms comprising mature adipocytes situated in a proximity to bone. Although these tumors follow a benign course, the reactive osseous changes that may occur with such lesions might raise the suspicion of malignancy. Patient Concerns: Here we present a case of a 33-year-old male patient complaining of pain and swelling in the right anterior forearm without history of trauma. Diagnosis: An magnetic resonance imaging of the region revealed a lobulated intramuscular fat intensity mass within the supinator muscle. Bony projection inseparable from the anterolateral radial diaphyseal cortex and periosteum was also seen. The radiological features suggested the diagnosis of parosteal lipoma. Intervention: After the radiological diagnosis of a parosteal lipoma, the patient was offered a total surgical excision of the mass. Outcomes: The mass was removed successfully. Histopathology showed mature benign adipose tissue bordered by thin fibrous septa confirming the diagnosis of parosteal lipoma. Follow-up magnetic resonance imaging after 6 months did not reveal any signs of complications or recurrence. Lessons: Distinction of the features of parosteal lipomas is needed to establish the accurate diagnosis, discriminate it from malignant lesions, predict potential neurovascular compromises, and follow up until a curative action is planned.

This article studies and analyzes the use of 3D models, built from magnetic resonance imaging (MRI) axial scans of the lumbar intervertebral disk, that are needed for the diagnosis of disk herniation. We study the possibility of assisting radiologists and orthopedists and increasing their quality of experience (QoE) during the diagnosis process. The main aim is to build a 3D model for the desired area of interest and ask the specialists to consider the 3D models in the diagnosis process instead of considering multiple axial MRI scans. We further propose an automated framework to diagnose the lumber disk herniation using the constructed 3D models. We evaluate the effectiveness of increasing the specialists QoE by conducting a questionnaire on 14 specialists with different experiences ranging from residents to consultants. We then evaluate the effectiveness of the automated diagnosis framework by training it with a set of 83 cases and then testing it on an unseen test set. The results show that the the use of 3D models increases doctors QoE and the automated framework gets 90% of diagnosis accuracy.

Abstract Rationale: Parosteal lipomas are rare neoplasms comprising mature adipocytes situated in a proximity to bone. Although these tumors follow a benign course, the reactive osseous changes that may occur with such lesions might raise the suspicion of malignancy. Patient Concerns: Here we present a case of a 33-year-old male patient complaining of pain and swelling in the right anterior forearm without history of trauma. Diagnosis: An magnetic resonance imaging of the region revealed a lobulated intramuscular fat intensity mass within the supinator muscle. Bony projection inseparable from the anterolateral radial diaphyseal cortex and periosteum was also seen. The radiological features suggested the diagnosis of parosteal lipoma. Intervention: After the radiological diagnosis of a parosteal lipoma, the patient was offered a total surgical excision of the mass. Outcomes: The mass was removed successfully. Histopathology showed mature benign adipose tissue bordered by thin fibrous septa confirming the diagnosis of parosteal lipoma. Follow-up magnetic resonance imaging after 6 months did not reveal any signs of complications or recurrence. Lessons: Distinction of the features of parosteal lipomas is needed to establish the accurate diagnosis, discriminate it from malignant lesions, predict potential neurovascular compromises, and follow up until a curative action is planned.

Background: Globally, breast cancer accounts for a third of womens' cancer cases. It is experinced in 1-3% of females with clinical breast findings, negative mammogram and ultrasound. Aim: This retrospective study aimed to compare the diagnostic precision of mammogram and ultrasound in detecting breast malignancy. Patients and methods: 332 females from the southern region of Jordan 34-75 years old were enrolled in the study. They were subjected to clinical examination, mammogram, ultrasound and histopathological study for their breast masses at Alkarak teaching hospital. The differential diagnostic precision of both imaging modalities were analyzed in terms of breast density and patient's age. Based on the breast imaging reporting and data system, mammograms were analyzed into five diagnostic categories (15), four grades of breast tissue density (I-IV), while, ultrasound diagnosis was based on five diagnostic categories of the same system. Results: The histopathological examination showed 155 (19.4%) malignant and 177 (4.5%) benign lesions. All malignancies were diagnosed by ultrasound and mammogram, respectively. The obtained results showed statistically significant difference of sensitivies and specificities between the overall ultrasound and mammogram (P<0.05). Regarding breast tissue density, mammogram sensitivity was 83.3% and 0% in grade I and grade IV, respectively. It was 66.7% and 40% in the same grades for ultrasound. Conclusion: The diagnostic precision of ultrasound in differentiating between benign and malignant lesions was significantly higher than mammogram in young Patients with clinical breast findings and dense breast tissue.

This paper studies the problem of clinical MRI analysis in the field of lumbar intervertebral disk herniation diagnosis. It discusses the possibility of assisting radiologists in reading the patients MRI images by constructing a 3D model for the region of interest using simple computer vision methods. We use axial MRI slices of the lumbar area. The proposed framework works with a very small number of MRI slices and goes through three main stages. Namely, the region of interest extraction and enhancement, inter-slice interpolation, and 3D model construction. We use the Marching Cubes algorithm to construct the 3D model of the the region of interest. The validation of our 3D models is based on a radiologist’s analysis of the models. We tested the proposed 3D model construction on 83 cases and We have a 95% accuracy according to the radiologist evaluation. This study shows that 3D model construction can greatly ease the task of the radiologist which enhances the working experience. This leads eventually to more accurate and easy diagnosis process.

Segond fracture is one of the most commonly encountered avulsion fractures of the knee joint, which was classically defined as avulsion injury of the tibial insertion of the lateral capsular ligament at its middle third though recent studies have pointed towards a complex mechanism related to the anterior oblique band and iliotibial tract. It is originally believed to occur due to internal rotation along with varus force and considered as one of the commonly involved structures that constitute postero-lateral corner injury. Several knee structures are known to be associated with Segond fracture most consistently the anterior cruciate ligament. In the current article we report an unusual combination of Segond fracture with osseous avulsion of the tibial attachment of both cruciate ligaments, which has not been described before.

Introduction: The use of Electronic Cigarettes (ECs) has been increased over the last years but their long term effects on health and microbiota has not yet been explored fully. Aim: To examine the oral and nasal microbial profile and antibiotics susceptibility in the ECs users, smokers and non-smokers and to assess the microbial contamination of the ECs juice. Materials and Methods: Nasal and oral swabs were collected from 30 non-smokers, 30 tobacco smokers and 30 from candidates who have been using ECs for more than six months. Nasal Methicillin Susceptible Staphylococcus aureus (MSSA) and Methicillin Resistant Staphylococcus aureus (MRSA), and oral Streptococcus viridans and Candida albicans were isolated and identified using standard laboratory methods. ECs juice was also cultured to test for microbial presence and the antibiogram for all isolated bacteria was carried out by disc diffusion or broth dilution methods according to Clinical and Laboratory Standard Institute (CLSI) guidelines. The statistical analysis was performed with Stata Statistical Software: Release 13. Results: MSSA was isolated from 9 (30%) non-smokers, 5 (16.7%) ECs users and 2 (6.7%) smokers, respectively. Only 1 (3.3%) MRSA was isolated from a smoker. Streptococcus viridians was detected in 14 (46.7%) non-smokers, 9 (30%) ECs user and 5 (16.7%) smokers. Candida albicans was isolated from 7 (23.3%) smokers, 3 (10%) ECs users and in 1 (3.3%) non-smokers. When both groups of ECs users and smokers were compared to non-smokers; the statistical intergroups difference in carriage of MSSA and Streptococcus viridans using Chi-Square test was only significant in the smokers group (p-value <0.05), while the difference in carriage of MRSA and Candida albicans in both ECs users and smokers was not statistically significant compared to non-smokers (p-value <0.05). The cultures of ECs juices showed no growth. The highest resistance among MSSA isolates was for fusidic acid (43.8%) and the least was for mupirocin and linezolid (0%). Among Streptococcus viridans, the highest resistance was to penicillin (68%) and the least was for vancomycin (7.1%). Conclusion: The effect of ECs on carriage of MSSA and Streptococcus viridans commensals was not significant compared to non-smokers. Therefore, ECs might be less harmful on microbiota compared to tobacco smoking.

Background: Healthcare workers (HCWs) and medical students can be asymptomatic carriers in transmitting methicillin resistant and susceptible Staphylococcus aureus (MRSA and MSSA). Studying epidemiological and antibiotic susceptibility data is necessary to limit the spread of infections, help with treatment and understand the transmission dynamics of MSSA and MRSA. Our study assessed the rate of MSSA and MRSA nasal carriage and its antibiogram among medical students in basic and clinical years at the University of Jordan. Methods: A total of 210 nasal swabs were randomly collected from participants. MSSA and MRSA were identified by culture, biochemical and other phenotypical analysis methods. Antibiotic susceptibility was determined by the disc diffusion method. Results: The nasal carriage of MSSA was 6.6% and 11.4% and that of MRSA was 1.9% and 2.8% among basic and clinical years, respectively. There was no significant difference for the nasal carriage of MSSA and MRSA among basic and clinical year students (p value ≥ 0.05). MSSA resistance ranged between 25% and 33% for trimethoprim-sulfamethoxazole, tetracycline and ciprofloxacin. For MRSA, the highest resistance was to trimethoprim-sulfamethoxazole and tetracycline (67% to 100%), followed by gentamicin and ciprofloxacin (33% to 67%), in all participants in the study. Conclusion: The difference in the carriage rates of MSSA and MRSA among basic and clinical students was statistically insignificant. The continuous awareness and implementation of infection control procedures and guided patient contact are recommended. The results might also suggest that healthcare workers could be victims in the cycle of MRSA nasal carriage, a theory that needs further study.

Sternalis muscle (SM) is an anatomical variant that lies parallel to the sternum. It is present in (8%) of human population. Awareness about its presence during thoracic imaging is important, since it might be misdiagnosed as a tumor. This study is the first that discusses the prevalence of SM in the Jordanian population and document the level of awareness about SM among intern doctors and surgery and radiology residents. Our aims are to know the prevalence of SM in the Jordanian population, using thoracic multi-detector computerized tomography (CT) images, and to assess the awareness about SM among a sample of intern and resident Jordanian physicians. Random anonymous axial thoracic multi-detector CT images of 1,709 (801 females and 908 males) Jordanian patients, were examined for the presence or absence of unilateral and/or bilateral SM. A questionnaire aiming to identify SM was distributed among 175 intern doctors, 26 surgery resident and 28 radiology resident doctors, their answers were summarized. The prevalence of SM among Jordanians is 5.9%. The prevalence of unilateral SM is 2.1% on the right side of the thorax and 1.9% on the left side, bilateral prevalence was 1.8%. While 35.7% of the radiology residents could identify SM using CT and/or anatomy images, only 3.9% of surgery residents and none of the intern doctors could. We concluded that SM is present in the Jordanian population, with a prevalence of 5.9% which falls within the global average. Intern doctors and surgery and radiology residents are almost unaware and unfamiliar about SM.

The burden of stroke can be substantially studied by establishing the functional consequences of stroke and its predictors on the population, economy and to guide rehabilitation efforts. This study aims to determine the subtypes, risk factors, and epidemiology of stroke in Jordan. Methods: A retrospective cohort study design was carried out to determine the risk factors and subtypes of stroke during 2017-2018. The study sample included 176 ischemic stroke patients of the King Abdullah University Hospital. Data was collected through medical records, which was then statistically analysed through frequencies and percentages. Results: Total 176 cases were identified out of which 101 (57.38%) were males and 75 (42.61%) were females and male to female ratio was 1.9:1. Hypertension was the commonest risk factor identified (50.56%), followed by diabetes mellitus (19.88%), hyperlipidaemia (15.34%), coronary artery disease (6.25%), atrial fibrillation (4.54%), and past history of stroke (1.13%). Risk factors such as hypertension (p = 0.007), diabetes (p = 0.000), coronary artery disease (p = 0.000) were significantly associated with subtypes of ischemic strokes. Conclusion: The study concludes that mean age of men was higher as compared to women in small vessel occlusion. The risk of ischemic stroke in patients with dyslipidaemia, diabetes mellitus, and hypertension was higher in middle-aged and old patients.

The World Health Organization declared COVID-19 as a pandemic on the 11th of March 2020. Since then, many efforts are being carried out to contain the virus. Knowledge and attitude of people should be directed towards strict preventive practices in order to halt the spread of the virus. The aim of the current cross-sectional study is to assess the knowledge, practice and attitude of university students from medical and non-medical colleges in Jordan using a structured questionnaire involving a total number of 592 students. A positive response regarding the overall knowledge about the symptoms of COVID-19 was observed in more than 90% of the students. In response to the attitude and practice, a good number of students nearly 99.7% agreed that hand washing is necessary for prevention of infection whereas 68.4% believed that mask wearing would prevent the infection. Around 6-7% students considered the virus as a stigma hence would not visit hospital. Also, around 10% students believed that their religious beliefs and body immunity might protect them from infection. More dangerously, 20.6% and 19.2% students believed antibiotics and smoking to be a protective measure against the infection respectively. Also, 96.8% do avoid hand shaking, 98.8% wash their hands and 93.3% use alcoholic rub, 95.8% cough or sneeze in a tissue and dispose it in waste bin, 51% will drink ginger with honey and 42.7% eat garlic for infection prevention. The main sources of knowledge were social media, internet and television. No significant difference was noticed between medical and non medical colleges. Thus, there is a need for more detailed and directed measures and awareness campaigns to improve the knowledge, attitude and practice in some critical aspects to contain the virus.

Helicobacter pylori (H. pylori) can cause gastritis, peptic ulcer diseases and gastric carcinoma. Endoscopy as the gold standard method of diagnosis is an invasive procedure that might not be suitable in all scenarios. Therefore, this first study in Jordan aimed to assess the non-invasive 13C urea breath test (UBT) and stool antigen test for diagnosis of H. pylori infection and the successfulness of eradication therapy as alternatives for endoscopy. Hence, a total of 30 patients attending the endoscopy units at Alkarak teaching hospital were asked to complete a questionnaire with demographic and clinical data. They were then tested for H. pylori using 13C UBT and H. pylori stool antigen before having endoscopy. Another 30 patients who were positive for H. pylori by endoscopy were tested using both tests 6 weeks post eradication therapy. Results showed that the rate of H. pylori detection using endoscopy was 56.7% (17/30). Heartburns (82.3%, p value = 0.019), epigastric pain (88.2%, p value = 0.007) and vomiting (70.5%, p value = 0.02) were the most significant symptoms. Family history of peptic ulcer diseases was significantly associated with an increased risk for having a H. pylori positive result (p value = 0.02). Compared to endoscopy, the sensitivity of 13C UBT for the diagnosis of H. pylori was 94.1% (16/17), while it was 76.5% (13/17) for the stool antigen test. The specificity of both tests was equal (76.9%). However, the positive predictive and negative predictive values (84.2% and 90.9%) for 13C UBT were higher than those (81.3% and 71.4%) for the stool antigen test. The accuracy of 13C UBT was 86.7% compared to 76.7% for the stool antigen test. There was an 87% agreement (20 patients out of 23) between both tests when used to assess success of the eradication therapy. In conclusion, the 13C UBT was found to be more sensitive and accurate than the stool antigen test when used for diagnosis; furthermore, it has a comparable outcome to the stool antigen test in assessing the successfulness of the eradication treatment.

The right azygos lobe is a rare anatomical variant of the upper lung lobe that can be misdiagnosed as a neoplasm, a lung abscess, or a bulla. The aim of this study was to assess the prevalence of right azygos lobe and to evaluate the ability of postgraduate doctors to correctly identify right azygos lobe. We analyzed a total of 1709 axial thoracic multi-detector computed tomography (CT) images for the presence of an azygos lobe. Additionally, a paper-based survey was distributed among a sample of intern doctors and radiology and surgery residents, asking them to identify the right azygos lobe in a CT image and in an anatomy figure. Results showed that the prevalence of the right azygos lobe in the study sample was 0.88%. Men have more right azygos lobes than women. None of the intern doctors or surgery residents identified the right azygos lobe correctly, whereas more than half (57.1%) of the radiology residents did. Most of the incorrect answers about the CT scan were related to the bronchi (25.0%). The apex of the lung (17.7%) and the superior vena cava (17.7%) were the most common incorrect answers about the anatomy figure. In conclusion, the prevalence of the right azygos lobe in the current study is within the range of previously published literature. More education should be given for the identification of the right azygos lobe during anatomy and clinical teaching.

Eine Vielzahl an Krankheitsentitäten kann sich in Form von multizystischen Veränderungen am Lungenparenchym manifestieren. Bildgebung mittels High-Resolution-Computer-Tomografy (HRCT) hat hierbei die Diagnostik mittels Gewebepunktion weitestgehend ersetzt. Die Kenntnis der wichtigsten Differenzialdiagnosen und der zugrunde liegenden Entitäten bei multizystischen Lungenerkrankungen mit dem jeweiligen charakteristischen Erscheinungsbild ist von immanenter Wichtigkeit für die tägliche radiologische Routinearbeit. Das Ziel dieser Arbeit ist ein Überblick der wichtigsten pulmonalen Krankheitsmanifestationen mit zystischen Parenchym-Veränderungen und deren Charakteristika im HRCT.

Background: To demonstrate whether the distance between the middle point of the patellar tendon and posterior cruciate ligament (PT-PCL) calculated on a single axial MR image could be an alternative measure to tibial tubercle-PCL (TT-PCL) distance for TT lateralization without the need of imaging processing. To show that normalization of PT-PCL (nPT-PCL) against the maximum diameter of the tibial plateau may help to identify patients with patellar instability (PI). Methods: MR scans of 30 patients (13 females, age 32 13 years) with known PI and 60 patients (31 females, age 39 19 years) with no history of PI were reviewed. Two operators calculated TT-PCL, and PT-PCL nPT-PCL. Intraclass correlation coefficient, Student's t-test, Receiver Operator Characteristic curves, Spearman's Rho and McNemar's test were used. Results: Interobserver reproducibility was 0.894 for PT-PCL for TT-PCL (95% CI = 0.839-0.930) and 0.866 for TT-PCL (95% CI = 0.796-0.912). The PT-PCL was 23.5 +/- 3.8 mm in patients and 20.0 +/- 2.7 mm in controls (P < 0.001). The TT-PCL was 22.9 +/- 3.9 mm in patients and 20.5 +/- 2.7 mm in controls (P = 0.002). Correlation between the PT-PCL and TT-PCL was R = 0.838, P < 0.001. The PT-PCL had 66.6% (95% CI = 0.542-0.790) diagnostic yield. The nPT-PCL was significantly higher in patients (0.302 +/- 0.03) than controls (0.271 +/- 0.03; P < 0.001) with 73.9% (95% CI = 0.628-0.851) diagnostic yield. Conclusion: The PT-PCL correlated with TT-PCL, with 66.6% diagnostic yield. The nPT-PCL may represent an additional index, with 73.9% diagnostic yield. (C) 2018 Elsevier B.V. All rights reserved.