Background: Multiple published studies quantitatively analysing the diagnostic value of MRI, MR arthrography (MRA) and CT arthrography (CTA) for labral lesions of the shoulder have had inconsistent results. The aim of this meta-analysis was to systematically compare the diagnostic performance of MRI, MRA, CTA and CT. Methods: Two databases, PubMed and EMBASE, were used to retrieve studies targeting the accuracy of MRI, MRA, CTA and CT in detecting labral lesions of the shoulder. After carefully screening and excluding studies, the studies that met the inclusion criteria were used for a pooled analysis, including calculation of sensitivity and specificity with 95% confidence intervals (CIs) and the area under the hierarchical summary receiver operating characteristic (HSROC) curves. Results: The retrieval process identified 2633 studies, out of which two reviewers screened out all but 14 studies, involving a total of 1216 patients who were deemed eligible for inclusion in the metaanalysis. The results assessing the diagnostic performance of MRI vs. MRA for detecting labral lesions showed a pooled sensitivity of 0.77 (95% CI 0.70-0.84) vs. 0.92 (95% CI 0.84-0.96), a specificity of 0.95 (95% CI 0.85-0.98) vs. 0.98 (95% CI 0.91-0.99), and an area under the HSROC curve of 3.78 (95% CI 2.73-4.83) vs. 6.01 (95% CI 4.30-7.73), respectively. Conclusion: MRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality. MRI is by far the first choice recommendation for the detection of acute labral lesions. CT should be a necessary supplemental imaging technique when there is highly suspected glenoid bone damage.

AIm: Supplementing anterior cervical diskectomy and fusion (ACDF) with plates enhances stabilization, increases fusion and reduces failure rates. Zero-P implant for stand-alone anterior interbody fusion procedures of the cervical spine was recently developed to avoid complications associated with anterior cervical plates. We evaluate the outcome of its use in our patients undergoing ACDF. mATeRIAL and meTHods: 84 patients were selected to undergo ACDF with Zero-P implant of whom 75 (52 male and 23 female) were followed up for 12 to 16 months (mean 14.2 months) with a total of 94 operated levels (54 single, 21 double level). Patients underwent pre-and postoperative clinical evaluation with full neurological examination, visual analogue scale (VAS), Neck Pain and Disability Scale (NPAD) and Bazaz-Yoo dysphagia index for postoperative dysphagia. Postoperative plain X-ray evaluation of fusion and implant-associated complications was done.ResuLTs: All patients had significant reduction in arm and neck pain and NPAD maintained over 12 months, no implant-associated complications during follow-up, and radiological fusion by 3 months. None had dysphagia after 3 months postoperatively. CoNCLusIoN:The Zero-P implant is a valid alternative to anterior cervical plating after ACDF with a very low incidence of postoperative dysphagia and no implant-related complications.KeywoRds: Anterior, Cervical, Diskectomy, Zero-profile, Plate, Dysphagia ÖZ AmAÇ: Anterior servikal diskektomi ve füzyonu (ACDF) plakalarla desteklemek stabilizasyonu güçlendirir, füzyonu arttırır ve başarısızlık oranını azaltır. Anterior servikal plakalarla ilişkili komplikasyonlardan kaçınmak üzere yakın zamanda servikal omurganın tek başına anterior interbody füzyon işlemleri için Zero-P implantı geliştirilmiştir. ACDF yapılan hastalarımızda bu implantın kullanılmasının sonuçlarını değerlendirdik. BuLGuLAR: Tüm hastalarda 12 ay boyunca devam edecek şekilde kol ve boyun ağrısı ve NPAD bakımından önemli azalma oldu, takip boyunca implantla ilişkili komplikasyon görülmedi ve 3 ay içinde radyolojik füzyon gerçekleşti. Ameliyattan 3 ay sonra hiçbirinde disfaji yoktu.soNuÇ: Zero-P implantı ACDF sonrasında servikal plakalama için geçerli bir alternatiftir ve postoperatif disfaji insidansı çok düşük olup implantla ilişkili bir komplikasyon görülmemiştir.

BackgroundMR arthrography (MRA) is commonly used in the assessment of shoulder internal derangements. Correct intra‐articular contrast injection is required for this modality. Anterior injections under fluoroscopic, ultrasound‐guidance, or without image‐guidance have been described in the literature. However, no simultaneous comparison has been performed between the three techniques.PurposeTo compare the accuracy and performance of fluoroscopy (FL)‐guided, ultrasound (US)‐guided and non‐image‐guided intra‐articular contrast injection via an anterior approach for performing shoulder MRA.Study TypeProspective.SubjectsTwo‐hundred and ten patients (180 men and 30 women; mean age, 33 ± 12 years; range 20–60 years) with clinically suspected shoulder pathology.Field Strength/Sequence1.5T/fat‐suppressed T1‐weighted, T2‐weighted, and 3D‐gradient‐echo images.AssessmentPatients underwent shoulder MRA after anterior intra‐articular contrast injection under FL‐ or US‐guidance or without image‐guidance. Patients were randomized among the three techniques with each group comprising 70. The techniques were compared according to the accuracy of intra‐articular needle placement, attempts success rate, pain during and 24 hours after injection, procedure times, contrast extravasation rate, joint distension, and MRA diagnostic efficacy. Pain was assessed by the visual analog scale (VAS) pain‐score.Statistical TestsPearson's chi‐squared and Kruskal–Wallis tests.ResultsFL‐ and US‐guided injections (100% accuracy) were significantly more accurate than non‐image‐guided (85.7% accuracy) (P < 0.05). US‐guidance was the least painful, with statistical differences between image‐guided and non‐image‐guided techniques regarding the first attempt success rate (95.7% and 92.8% for FL‐ and US‐guided vs. 78.6% for blinded), VAS‐score 24 hours‐post‐procedure (1.7 ± 1.7, and 1.5 ± 1.4 vs. 2.2 ± 1.4), procedure time (11.9 ± 1.6, and 7.4 ± 1.7 vs. 4.3 ± 0.76 minutes), and contrast extravasation rate (5.7%, and 8.6% vs. 30%) (all P < 0.05). Procedure time was also significantly different between FL and US‐guidance (P < 0.05).Data ConclusionImaging‐guided injections are more accurate and tolerable than non‐image‐guided and should be considered to confirm intra‐articular needle position, hence adequate capsular distension and good diagnostic quality of shoulder MRA. US guidance is a less painful, rapid, and safe alternative to the FL approach.Evidence Level: 2Technical Efficacy Stage: 5.J. MAGN. RESON. IMAGING 2021;53:481–490.

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Spirometry is the most widely used lung function test both in the diagnosis and stratification of severity of lung disease. The Forced Expiratory Flow between 25 and 75% of the FVC (FEF25_75) is one of the most commonly cited measures of small airways pathology. This study aimed at evaluation of early effect of smoking on small airways. It included: 50 asymptomatic smokers (Group 1) and 50 non smokers (Group 2) as a control. The result revealed: The subjects age was ranged from 18 to 75 years with mean age 43.12 ± 13.231SD in smokers, and range from 15-62 with mean age 41.74 years with ± 14.512SD in nonsmokers. 62 % of the a symptomatic smokers were Manual workers which are the majority of the smokers, and 38 % for Mental worker while the majority of non-smokers were Mental worker 64 %, with 36 % for Manual worker. Smoking cigarette was most common (54 %), then marijuana (46 %). The mean values of all the pulmonary function tests are significantly reduced in smokers compared to non smokers, although, they are within the normal range. The association of impaired PFTs in smokers was found to be statistically highly significant to FEF 25-75 (small airway). Otherwise; there were no significance to other values applying unpaired T test. The most affected age group in significant FEF25-75 reduction was found in 36-55years old, females were more affected than males. The duration of smoking was the most independent risk factor that affects the small airways, than the type of smoking and number of cigarettes or stones per day.