No abstract

Methodologies that improve estimation of caliber from cranial bone defects are necessary to meet the ever increasing admissibility standards. The relationship between caliber, wound diameter, and bone mineral density (BMD) was examined. The formation of the permanent cavity is influenced by bullet yaw, velocity, distance, and tissue properties. The hypothesis was that including BMD, wound diameter could be explained by differences in caliber. The sample consists of 68 autopsy sections and 101 specimens from Phelps (1898). A subsample of 18 was scanned using dual energy x-ray absorptiometry (DEXA) for BMD measurement to test whether an increase in BMD affects wound diameter. Pearson product-moment correlations of the subsample indicate the strongest correlation is between BMD and minimum diameter (r = 0.7101), followed by a correlation between minimum diameter and caliber (r = 0.6854). Despite the previous use of thickness as a proxy for BMD, no correlation was found between BMD and thickness (r = 0.0143). A multivariate analysis of variance (MANOVA) detected a significant influence of BMD and minimum diameter on caliber size (Prob > F = 0.0003). The logistic regression shows that caliber can be estimated from minimum diameter. Using the subsample, the results show that the inclusion of BMD strengthens the model for estimating caliber from entrance gunshot defects.

Accurate detection of lymph node involvement on pre-operative imaging in patients diagnosed with renal cell carcinoma (RCC) is critical for determination of disease stage, one of the most significant prognostic factors in RCC. The presence of lymph node involvement in RCC doubles a patient’s risk of distant metastasis and significantly reduces their 5-year survival. Currently, lymph node involvement in patients with RCC is evaluated with numerous modalities, with rapid advancements occurring across these modalities. The purpose of this study was to evaluate the advantages and disadvantages of each modality and utilize sensitivities and specificities to determine the highest performing modalities for accurate lymph node involvement in renal cancer. A comprehensive computer-based literature search of full-length original research English language studies of human subjects with biopsy-proven RCC was performed to evaluate publications on the diagnostic performance of color Doppler sonography (CDS), magnetic resonance imaging (MRI), lymphotrophic nanoparticle enhanced MRI (LNMRI), multidetector-row computed tomography (MDCT), F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET), and PET/CT for evaluation of lymph node status in kidney cancers in articles that were published prior to May 2018. Limited studies were available for evaluating CDS performance for determination of lymph node involvement in renal cancer. While CT is the most common modality for nodal staging, due to its availability and relatively low expense, it did not demonstrate the highest performance of the modalities examined for determination of lymph node status in patients with RCC. Of the modalities examined, MRI demonstrated the highest sensitivity (92–95.7%) for detection of lymph node involvement in RCC. Studies of lymph node involvement in RCC using both MRI and CT indicated that using the current diameter criteria (greater than 1 cm) for determination of positive lymph nodes should be re-evaluated as micro-metastases are frequently overlooked. Studies evaluating lymph node involvement with FDG-PET had the highest specificity (100%), indicating FDG-PET is the preferred modality for confirming lymph node involvement and extent of involvement. However, due to the low sensitivity of FDG-PET, clinicians should be skeptical of negative reports of lymph node involvement in RCC patients. Further studies examining determination of lymph node involvement in renal cancer across modalities are greatly needed, current literature suggests utilizing a combination of MRI and FDG-PET may offer the highest accuracy.

No abstract

The objective methodology of whole-lesion volumetric ADC measurements maintains the sensitivity/specificity of conventional expert-based ROI analysis, provides information on lesion heterogeneity, and reduces observer bias.