AimPostmortem Computed Tomography (PMCT) is gradually introduced at forensic institutes. Image reconstruction software can increase diagnostic potential in CT by increasing distinction between structures and reduction of artifacts. The aim of this study was to develop and evaluate novel image reconstruction parameters for postmortem conditions, to increase image quality and diagnostic potential of CT scans.MethodTwenty PMCT scans of deceased hereof two in severe decay were subjected to four reconstruction techniques: a standard reconstruction algorithm, the detail reconstruction algorithm and two novel algorithms based on the standard algorithm, but with different Hounsfield settings. Image quality was evaluated by visual grading analysis (VGA) by four forensic radiologist observers.ResultsThe VGA did not prove that any of the reconstruction techniques were superior to the others. For standard and detail, the two pre-defined reconstruction algorithms, VGA scores were indiscernible and were superior to the equally indiscernible Hounsfield reconstructions on parameters translated into Sharpness and Low Contrast Resolution. The two alternative Hounsfield settings were superior with respect to Noise and Artifacts/Beam Hardening.ConclusionThe study elucidates the possiblity for multiple reconstructions specialized for PMCT conditions, to accommodate the special conditions when working with the deceased. Despite the lack of clear improvements in the tested reconstructions, this study provides an insight into some of the possibilities of improving PMCT quality using reconstruction techniques.

Hip dysplasia (HD) is a frequent cause of hip pain in skeletally mature patients and may lead to osteoarthritis (OA). An accurate and early diagnosis may postpone, reduce or even prevent the onset of OA and ultimately hip arthroplasty at a young age. The overall aim of this study was to assess the reliability of an algorithm, designed to read pelvic anterior-posterior (AP) radiographs and to estimate the agreement between the algorithm and human readers for measuring (i) lateral center edge angle of Wiberg (LCEA) and (ii) Acetabular index angle (AIA). The algorithm was based on deep-learning models developed using a modified U-net architecture and ResNet 34. The newly developed algorithm was found to be highly reliable when identifying the anatomical landmarks used for measuring LCEA and AIA in pelvic radiographs, thus offering highly consistent measurement outputs. The study showed that manual identification of the same landmarks made by five specialist readers were subject to variance and the level of agreement between the algorithm and human readers was consequently poor with mean measured differences from 0.37 to 9.56° for right LCEA measurements. The algorithm displayed the highest agreement with the senior orthopedic surgeon. With further development, the algorithm may be a good alternative to humans when screening for HD.

Background Shoulder dislocation is a common injury, particularly in the younger population. Common long-term sequelae include pain, recurrence, and shoulder arthritis. Immediate and correct diagnosis following shoulder dislocation is key to achieving optimum outcomes. Although magnetic resonance arthrography (MRA) is frequently used for diagnosing shoulder instabilities, arthroscopy is still considered the gold standard. Purpose This study aims to compare the diagnostic value of arthroscopy and MRA of the shoulder joint. Materials and methods This retrospective study estimates the sensitivity and specificity of MRA of the shoulder. Data from patients who had undergone shoulder MRA and subsequent arthroscopy during a 5-year period were retrospectively collected. Sensitivity and specificity were calculated using the arthroscopic findings as the gold standard. Moreover, diagnostic accuracy was estimated using McNemar’s test. Results In total, 205 cases were included from which 372 pathological findings were uncovered during the arthroscopic procedures as opposed to 360 findings diagnosed from the MRA images. The glenoid labral tear was the most common finding reported by MRA and arthroscopy. For the detection of glenoid labral tears on MRA, the sensitivity was 0.955 but with eight missed lesions; the specificity was 0.679. Capsular tears, rotator cuff tears, and cartilage lesions proved the most difficult to correctly diagnose using MRA with sensitivities of 0.2, 0.346, and 0.366, respectively. Conclusions With a sensitivity of 95%, MRA is a valuable diagnostic tool for assessing shoulder instabilities, particularly when diagnosing labral lesions, including bony and soft-tissue Bankart lesions. Sensitivities and specificities for other glenohumeral lesions are less convincing, however.

Objectives In a prospective cohort study of patients with undifferentiated arthritis (UA) to investigate the ability of ACR/EULAR 2010 criteria with or without different MRI variables to diagnose RA, considering ACR 1987 criteria as gold standard reference Methods 119 pts (≥2 tender/swollen joints in MCP, PIP, wrist or MTP joints for >6 wks but <24 mths) without a rheumatological diagnosis, underwent clinical (68SJC/68TJC), biochemical, X-ray and MRI (unilateral wrist, MCP, PIP and MTP, scored by OMERACT RAMRIS (MTP not scored for synovitis (syn))) examinations and were followed for >12 mths. Sensitivity, specificity, accuracy, positive/negative predictive value (PPV/NPV) for diagnosing RA by 1) using ACR/EULAR 2010 criteria with and without including MRI syn, 2) substituting 68SJC/68TJC with MRI syn or 3) incorporating MRI bone oedema (BE) in the criteria are shown in Table. Results ACR/EULAR criteria with MRI syn variables included, gave a slight increase in sensitivity (Table, row 2-4) compared to without MRI (row 1). BE increased the sensitivity even more, highest with BE in wrist and/or MTP joint (row 5-8). Highest sensitivity, specificity, agreement and PPV were demonstrated when 68SJC/68TJC was replaced with counting only joints with MRI syn (row 9-11). Using syn ≥1 as cut-off (row 9) the sens, spec, accuracy, PPV and NPV were all higher than using the criteria based on clinical examination (row 1). Conclusions When fulfilment of the ACR 1987 criteria at follow-up is considered the gold standard reference, substituting IJC with MRI synovitis in joints of one hand, markedly increases the sensitivity and specificity of the ACR/EULAR 2010 criteria in UA. Disclosure of Interest None Declared

OBJECTIVE:To study magnetic resonance imaging (MRI) as a tool for early diagnosis of rheumatoid arthritis (RA) in patients with early undifferentiated arthritis (UA). METHODS:Patients (n = 116) without a specific rheumatologic diagnosis, but with ≥2 tender joints and/or ≥2 swollen joints among the metacarpophalangeal, proximal interphalangeal, wrist, or metatarsophalangeal (MTP) joints for >6 weeks but <24 months, underwent clinical, biochemical, conventional radiographic, and MRI examinations and were followed up for >12 months for the final diagnosis of RA or non-RA. Based on univariate analyses, clinical, biochemical, and imaging parameters were selected for inclusion as explanatory variables in multiple logistic regression analysis, with development of RA as the dependent variable. A prediction model was developed, and its performance was tested and compared with that of a previous model developed by van der Helm-van Mil et al (the vdHvM model). RESULTS:Of the 116 patients with early UA, 27 (23.3%) developed RA. When the prediction model was applied, which included as explanatory variables presence of hand arthritis, positivity for rheumatoid factor (RF), morning stiffness lasting >1 hour, and the Outcome Measures in Rheumatology Clinical Trials MRI summary score for bone edema in the MTP and wrist joints, the outcome of RA or non-RA was correctly identified in 82% of the patients (sensitivity 81%, specificity 82%). Another cutoff value for the prediction index in the model would allow a higher specificity (98%) and higher accuracy (83%), but lower sensitivity (36%). With the vdHvM model, RA/non-RA was predicted in 60.2% of the population. CONCLUSION:MRI evidence of bone edema in the MTP and wrist joints is an independent predictor of future RA in patients with early UA. A prediction model that includes the variables clinical hand arthritis, morning stiffness, positivity for RF, and bone edema on MRI in the MTP and wrist joints correctly identified the development or lack of development of RA in 82% of patients.