[Hyperostosis frontalis interna : etiology and differential diagnosis]

Hyperostosis frontalis interna was first described in 1719 in association with obesity and hirsutism, forming Morgagni's syndrome. A high prevalence and a lack of studies demonstrating a strong correlation between these different signs currently question the existence of such a syndrome. Hyperostosis frontalis interna predominates in women. The anomaly exclusively involves the inner table and constantly spares the diploe and the external table. The main differential diagnosis of cranial hyperostosis is made between meningioma, osteoma, Paget's disease and fibrous dysplasia. The clinical implication of hyperostosis as well as its etiology are also debated.

Coronary Computed Tomography Angiography: Patient-related factors determining image quality using a second-generation 320-slice CT scanner

PURPOSE

To investigate the diagnostic confidence of Coronary Computed Tomography Angiography (CCTA) and the effect of patient-related factors on CCTA image quality using a second-generation 320-slice scanner.

METHODS AND RESULTS

200 consecutive patients (mean age 60±12years; 109 men) prospectively underwent CCTA. The mean body mass index (BMI) was 27.1±4.9kg/m(2); the median heart rate (HR) was 60.0 (interquartile range (IQR), 53.9-66.1) beats per minute (bpm). The median segment's diameter was 2.8 (IQR, 2.2-3.4) mm. For each coronary segment ≥1.5mm in diameter, two readers scored: diameter narrowing as < or ≥50%, overall diagnostic confidence and motion-related image quality, with interobserver agreement kappa-values of 0.89, 0.91 and 0.61 respectively. Seventy-nine of the 2505 evaluated segments (3.2%) had non-diagnostic image quality because of coronary calcifications (66/79; 83.5%), stent- (6/79; 7.5%), pacemaker- (2/79; 2.5%) or motion-related artifacts (5/79; 6.5%). The effect of patient-related factors on motion-related image quality was investigated by multinomial logistic regression in 181 patients with calcium score (IQR, 0-446.5). Increasing coronary diameter was the most improving image quality factor (odds ratio (OR), 1.8637; p<0.001), marginally followed by lower HR (OR, 0.9547; p<0.001) and calcium score (OR, 0.9997; p=0.04). Gender (p=0.70), age (p=0.24) and BMI (p=0.45) did not affect image quality.

CONCLUSION

Using a second-generation 320-slice scanner, CCTA diagnostic confidence is predominantly affected by coronary calcifications, whereas motion-related image quality is non-diagnostic only in exceptional cases and mainly influenced by the coronary diameter. For future developments, our study findings therefore suggest greater requirements concerning spatial resolution and calcium-related artifact removal than concerning temporal resolution, especially to improve diagnostic confidence in patient groups with smaller coronary diameters.

[Screening of asymptomatic coronaropathy with adenosine stress myocardial perfusion MRI: a pilot study]

The aim of the study was to evaluate the incidence of asymptomatic coronary heart disease in patients with cardiovascular risk factors and evaluate the diagnostic value of myocardial stress perfusion magnetic resonance as screening test in these patients. We performed a retrospective analysis of 103 consecutive asymptomatic patients with at least one clinical risk factor for cardiovascular disease, who have undergone myocardial stress perfusion magnetic resonance. For respective evaluation of ischemic myocardium and infracted myocardium, magnetic resonance imaging protocol included the study of both myocardial viability by late enhancement imaging and first-pass perfusion at rest and during maximal stress (adenosine). The reference standard was catheter coronary angiography for 10 patients and clinical follow-up for 93 patients. The incidence of coronary heart disease was 22/103 (21%), including 6/103 (6%) ischemia and 16/103 (15%) infarcts. Respective sensitivity, specificity, negative and positive predictive values for myocardial stress perfusion magnetic resonance in detecting ischemic myocardium were 100, 97, 67 and 100%. Myocardial stress perfusion magnetic resonance can be regarded and further investigated as screening test for the detection of asymptomatic coronary heart disease in high-risk subjects. Prospective studies, larger study groups and cost-effectiveness analysis are needed.

A comparative study between proximal radial morphology and the floating radial head prosthesis

A morphometric study of the proximal radius was performed with computed tomography scanning in 51 healthy adults. These dimensions were then compared with those of a commercially available floating radial head prosthesis. Results were expressed as mean values, SD, and minimum and maximum values. The minimum and maximum diameters of the radial head were 21.9 +/- 1.9 mm and 22.9 +/- 1.9 mm, respectively. The minimum and maximum intramedullary diameters of the radial neck were 8.3 +/- 1.3 mm and 9.3 +/- 1.5 mm, respectively. The combined length of the radial head and neck was 22.47 +/- 2.84 mm. The implications for prosthetic design are as follows: the small floating cup (19 mm in diameter) is too small for the large majority of adults, the large floating cup (22 mm in diameter) is closer to the radial anatomy, the mean values are significantly different between male and female patients, and a single component would suffice for right and left elbows.

[Prevention of secondary mortality after type B aortic dissection]

Only few dissecting aneurysms type A survive without surgery. Opposingly, the dissecting aneurysms type B are successfully managed by the medical treatment "anti-impulsion". A personal series is reported, that evidence important cardiovascular mortality in the follow-up in chronic dissecting aneurysms type B; one part of this late mortality is linked to rupture of the thoracic descending aorta. Thus, the prevention of this late mortality depends on a strict follow-up of the characters and dimensions of descending aortic thoracic aorta.