Donnelly Griffith (storyend58)
The main function of the posterior talocalcaneal ligament (PTL) is to stabilize the posterior subtalar joint in the ankle. PTL is a potential source of pain in chronic subtalar instability. Our knowledge of the anatomy and function of PTL is limited and there are not many studies regarding its morphology. The aim of this study is to provide detailed information about imaging anatomy and morphology of PTL. This retrospective study included 197 ankle images of 184 patients (13 bilateral) obtained from MR arthrography (MRA) and conventional MRI between 2012 and 2019. The incidence of PTL was evaluated using both methods. The location of the ligament to the calcaneus, shape, and intraarticular extension was determined by MRA. In addition, thickness and lengths were measured in millimeters, and the presence of os trigonum, contrast agent extravasation into adjacent anatomical structures, was evaluated. The upper surface of the calcaneus was divided into nine regions in the axial view and three regions in the sagittal view. The incidence of PTL was 65.5% (n= 129). In axial view, the most common calcaneal attachment was in the 5th zone. The ligament was mostly fan-shaped (n= 104) and the extraarticular course was 87%. The average length was 15.9mm and the average thickness was 1.1mm. buy 2-APV There were os trigonum in 18 cases. Having knowledge of the morphology and variations of PTL and defining its relationship with adjacent anatomical structures can help evaluate subtalar instability. Having knowledge of the morphology and variations of PTL and defining its relationship with adjacent anatomical structures can help evaluate subtalar instability. To describe the MRI features of paediatric conventional central chondrosarcoma (CC-CS) and correlate with histological grade. A retrospective review of children/adolescents with histologically confirmed CC-CS. Data collected included age, sex, skeletal location, and histology from needle biopsy or resection, which was classified as atypical cartilaginous tumours/grade 1 CS (ACT/Gd 1 CS), high-grade chondrosarcoma (HGCS), and dedifferentiated chondrosarcoma (DD-CS). MRI studies were reviewed independently by 2 radiologists blinded to the histology grade, who graded the tumours as ACT/Gd 1 CS, HGCS, and DD-CS based on MRI features. The study included 7 males and 10 females with mean age 13.9years (range 6-18years). Tumours were located in the femur (n = 6), humerus (n = 3), tibia, ilium, scapula, and ulna (n = 1 each), and the small bones of the hands or feet (n = 4). Final histology grade was ACT/Gd 1 CS in 15 cases and HGCS in 2 (both grade 1 CS with focal transition to grade 2), 15 based on surgical specimens, 1 based on open biopsy, and 1 on needle biopsy alone. Predicted MRI grade for the 2 readers was ACT/Gd 1 CS in 11 cases each and HGCS in 6 cases each, indicating a mismatch between predicted MRI grade and histological grade in 8 (47%) cases (4 cases with one reader mismatch and 4 cases with both). MRI findings in paediatric CC-CS may be misleading, showing features suggestive of HGCS 7 of 17 (41.2%) of cases. This should be taken into consideration when planning surgical treatment. MRI findings in paediatric CC-CS may be misleading, showing features suggestive of HGCS 7 of 17 (41.2%) of cases. This should be taken into consideration when planning surgical treatment. Patients with ischemic stroke are often treated with clopidogrel monotherapy as part of secondary stroke prevention. The prevalence of loss of function (LOF) mutations in the CYP2C19 gene is higher in Asians than in Western populations. Patients with loss of function (LOF) mutations are at risk for poorer secondary outcomes when prescribed clopidogrel. We aimed to determine the cost effectiveness of genotype-guided antiplatelet therapy in an Asian population with the aim of prescribing ticagrelor as an alternativ