1.Wash-out of hepatocellular carcinoma: quantitative region of interest analysis on CT.
Cher Heng TAN ; Choon Hua THNG ; Albert S C LOW ; Veronique K M TAN ; Septian HARTONO ; Tong San KOH ; Brian K P GOH ; Peng Chung CHEOW ; Yu Meng TAN ; Alexander Y F CHUNG ; London L OOI ; Arul EARNEST ; Pierce K H CHOW
Annals of the Academy of Medicine, Singapore 2011;40(6):269-275
INTRODUCTIONThis study aims to determine if the quantitative method of region-of-interest (ROI) analysis of lesion attenuation on CT may be a useful adjunct to the conventional approach of diagnosis by visual assessment in assessing tracer wash-out in hepatocellular carcinomas.
MATERIALS AND METHODSFrom a surgical database of 289 patients from 2 institutions, all patients with complete surgical, pathological and preoperative multiphasic CT scans available for review were selected. For each phase of scanning, HU readings of lesion obtained (Lesion(arterial), Lesion(PV) and Lesion(equilibrium)) were analysed using receiver operating curves (ROC) to determine the optimal method and cut-off value for quantitative assessment of tumour wash-out (Lesion(arterial - equilibrium), Lesion(PV - equilibrium) or Lesion(peak - equilibrium)).
RESULTSNinety-four patients with one lesion each met the inclusion criteria. The area under the curve (AUC) values for Lesion(arterial - equilibrium) (0.941) was higher than the AUC for Lesion(pv - equilibrium) (0.484) and for Lesion(peak - equilibrium) (0.667). Based on ROC analysis, a cut-off of 10HU value for Lesion(arterial - equilibrium) would yield sensitivity and specificity of 91.5% and 80.9%, respectively. ROI analysis detected 9/21 (42.9%) of lesions missed by visual analysis. Combined ROI and visual analysis yields a sensitivity of 82/94 (87.2%) compared to 73/94 (77.7%) for visual analysis alone.
CONCLUSIONUsing a cut-off of 10 HU attenuation difference between the arterial and equilibrium phases is a simple and objective method that can be included as an adjunct to visual assessment to improve sensitivity for determining lesion wash-out on CT.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; diagnosis ; pathology ; surgery ; Confidence Intervals ; Databases, Factual ; Female ; Humans ; Liver ; pathology ; Liver Neoplasms ; diagnosis ; pathology ; surgery ; Male ; Middle Aged ; Preoperative Period ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; instrumentation ; Young Adult
2.Do We Ever Need to Fix Clavicle Fractures in Adolescents?
Lim KBL ; Olandres RA ; Cheow X ; Thng M ; Teo NMHZ ; Pereira N ; Chan PXE ; Lee NKL
Malaysian Orthopaedic Journal 2023;17(No.3):33-41
Introduction: Clavicle fractures in adults are increasingly
being treated by surgical fixation following reports of
symptomatic non-union, malunion and poor functional
outcome with conservative treatment. This has led to a
similar trend in the management of clavicle fractures in
adolescents. This study aims to evaluate the outcome and
complications of non-operatively treated clavicle fractures in
adolescents.
Materials and methods: This is a retrospective, single
institution study on adolescents aged 13-17 years who
sustained a closed, isolated clavicle fracture, between 1997-
2015. Clinical records were reviewed for demographic
information, injury mode, time to radiographic fracture
union, time to re-attainment of full shoulder range of motion
(ROM), and time to return to full activities and sports.
Complications and fracture-related issues were recorded.
Radiographs were analysed for fracture location,
displacement and shortening.
Results: A total of 115 patients (98 males, 17 females; mean
age:13.9 ± 0.89 years) were included for study. 101 (88%)
sustained a middle-third fracture while the remainder
sustained a lateral-third fracture. A total of 96 (95%) of the
middle-third fractures were displaced, and 12 (86%) of the
lateral-third fractures were displaced. All displaced fractures
in this study had shortening. Sports-related injuries and falls
accounted for 68 (59%) and 34 (30%) of the cases
respectively. Overall, the mean time to radiographic fracture
union was 7.8 ± 4.35 weeks; there were no cases of nonunion. Full shoulder ROM was re-attained in 6.6 ± 3.61
weeks, and full activities and sports was resumed in 11.4 ±
4.69 weeks. There were 5 cases of re-fracture and a single
case of intermittent fracture site pain.
Conclusion: Clavicle fractures in adolescents can and
should be treated non-operatively in the first instance with
the expectation of good outcomes in terms of time for
fracture union, reattainment of shoulder full range of motion,
and return to activities. Surgical stabilisation should be
reserved for cases for which there is an absolute indication.