Context The role of hyperglucagonemia in type 2 diabetes is still debated. Objective We analyzed glucagon dynamics during oral glucose tolerance testing (oGTT) in young women with 1 out of 3 metabolic phenotypes: healthy control (normoglycemic after a normoglycemic pregnancy); normoglycemic high-risk (normoglycemic after a pregnancy complicated by gestational diabetes); and prediabetes/screening-diagnosed T2D. We asked if glucagon patterns were homogeneous within the metabolic phenotypes. Design and Setting 5-point oGTT; sandwich ELISA for glucagon; functional data analysis with unsupervised clustering. Participants Cross-sectional analysis of 285 women from the mono-center observational study PPSDiab (“Prediction, Prevention and Subclassification of gestational and type 2 Diabetes”), recruited between November 2011 and May 2016. Results We found 4 patterns of glucagon dynamics that did not match the metabolic phenotypes. Elevated fasting glucagon and delayed glucagon suppression was overrepresented with prediabetes/diabetes, but this was only detected in 21% of this group. It also occurred in 8% of the control group. Conclusions We conclude that hyperglucagonemia may contribute to type 2 diabetes in a subgroup of affected individuals but that it is not a sine qua non for the disease. This should be taken into account in future pathophysiological studies and when testing pharmacotherapies addressing glucagon signaling.

Objective: To evaluate the performance of a 3D T1-weighted gradient-echo (3D T1GRE) computed tomography (CT)-like magnetic resonance imaging (MRI) sequence for detecting and assessing wrist and hand fractures compared to conventional CT. Methods: Subjects with acute wrist or hand fracture in CT underwent additional 3 T MRI including a CT-like 3D T1GRE sequence and were compared to patients without fractures. Two radiologists assessed fracture morphology on both modalities according to the Arbeitsgemeinschaft Osteosynthese (AO) and graded image quality and diagnostic confidence on a 5-point Likert scale. Besides diagnostic test evaluation, differences in image quality and diagnostic confidence between CT-like MRI and CT were calculated using the Wilcoxon test. Agreement of AO classification between modalities and readers was assessed using Cohen’s Kappa. Results: Twenty-eight patients with 43 fractures and 43 controls were included. Image quality (3D T1GRE 1.19 ± 0.37 vs. CT 1.22 ± 0.42; p = 0.65) and diagnostic confidence (3D T1GRE 1.28 ± 0.53 vs. CT 1.28 ± 0.55; p = 1.00) were rated excellent for both modalities. Regarding the AO classification, intra- (rater 1 and rater 2, κ = 0.89; 95% CI 0.80–0.97) and interrater agreement were excellent (3D T1GRE, κ = 0.82; 95% CI, 0.70–0.93; CT, κ = 0.85; 95% CI, 0.75–0.94). CT-like MRI showed excellent sensitivity, specificity and accuracy for fracture detection (reader 1: 1.00, 0.92, 0.96; reader 2: 0.98, 0.94, 0.96). Conclusion: CT-like MRI is a comparable alternative to CT for assessing hand and wrist fractures, offering the advantage of avoiding radiation exposure.

Objective: Correct identification of adhesive capsulitis of the shoulder (ACS) has an important impact on adequate therapy. The aim of our study was to investigate the influence of intravenous contrast administration and of reader’s experience on sensitivity and specificity of MRI in diagnosing ACS. Materials and methods: A total of 180 patients were included in a retrospective study: 60 subjects with at least 4 of 5 clinical signs of adhesive capsulitis of the shoulder and 120 patients with other shoulder diseases who underwent contrast-enhanced MRI. In a first session, only non-enhanced images and in a second session also contrast-enhanced (CE) series were independently evaluated by three radiologists with various levels of professional experience. Readers were blinded to all clinical information and had to rate the shoulder MRIs for absence or presence of adhesive capsulitis. Data analysis included McNemar’s test, t test, and U test (p < .05). Results: Using non-enhanced MRI, readers achieved a mean sensitivity of 63.9% and a mean specificity of 86.4%. By additional use of CE sequences, the mean sensitivity (85.5%) and the sensitivity for each reader increased significantly (p = .046, p < .01, p < .001, p = .045) while the improvement in mean specificity was not significant. Reader’s experience had a positive effect on sensitivity and specificity, which was in part but not consistently significant. Conclusion: The addition of CE sequences can significantly increase the sensitivity of MRI in the diagnosis of ACS. Reader’s experience has shown to be another important factor for the diagnostic outcome.

Beyond clinical examination, the various forms of carpal instability are assessed with radiologic methods and arthroscopy. For this purpose, the imaging demand for spatial and contrast resolution is particularly high because of the small ligamentous structures involved. The entities of carpal instability are classified into degrees of severity. Early (dynamic) forms of instability can either be indirectly detected with X-ray stress views and cineradiography or by direct visualization of ruptured ligaments in high-resolution magnetic resonance (MR) imaging and MR or computed tomography (CT) arthrography, with the latter the standard of reference in imaging. Advanced (static) forms of carpal instability are sufficiently well detected on radiographs; visualization of early carpal osteoarthritis is superior on CT. To prevent disability of the hand, the radiologist has to provide an early and precise diagnosis. This case-based review highlights the imaging procedures suitable for detection and classification of carpal instability.

Purpose: This study investigated the association of measurements from a clinical X-ray dark-field prototype system and CT-based finite element analysis (FEA) in lumbar spine specimens. Materials and Methods: In this prospective study, human cadaveric spine specimens (L2 to L4) were examined using a clinical prototype for dark-field radiography, yielding both attenuation and dark-field images. Specimens were scanned in vertical and horizontal positions. Volumetric bone mineral density (BMD) values were derived from quantitative CT measurements. Bone segmentation masks derived from CT-images were used for FEA-estimated fracture load (FL) calculations. FEA-estimated FL, dark-field, and attenuation signals were compared between osteoporotic/osteopenic (BMD < 120 mg/cm³) and non-osteoporotic/osteopenic specimens using the paired t-test and the Wilcoxon Mann–Whitney U test. Associations were tested using Spearman correlation. Results: Fifty-nine vertebrae from 20 lumbar spine specimens (mean age, 73 years ± 13; 11 women) were studied. FEA-estimated FL correlated with BMD (r = 0.75, p < .001) and was significantly lower in osteoporotic/osteopenic vertebrae (1222 ± 566 vs. 2880 ± 1182, p < .001). Dark-field and attenuation signals were positively correlated with FEA-estimated FL, in both vertical (r_darkfield = 0.64, p < .001, r_attenuation = 0.82, p  < .001) and horizontal position (r_darkfield = 0.55, p < .001, r_attenuation = 0.81, p < .001). Conclusion: Dark-field and attenuation signals assessed using a clinical X-ray dark-field system significantly correlated with FEA-estimated FL in human spine specimens with and without osteoporosis/osteopenia. Dark-Field imaging may complement existing assessment methods for bone strength as a dose-efficient, accessible tool.

Objective: The aim of this study was to evaluate the benefits and potential of structured reports (SR) for chest computed tomography after lung transplantation. Methods: Free-text reports (FTR) and SR were generated for 49 computed tomography scans. Clinical routine reports were used as FTR. Two pulmonologists rated formal aspects, completeness, clinical utility, and overall quality. Wilcoxon and McNemar tests were used for statistical analysis. Results: Structured reports received significantly higher ratings for all formals aspects (P < 0.001, respectively). Completeness was higher in SR with regard to evaluation of bronchiectases, bronchial anastomoses, bronchiolitic and fibrotic changes (P < 0.001, respectively), and air trapping (P = 0.012), but not signs of pneumonia (P = 0.5). Clinical utility and overall quality were rated significantly higher for SR than FTR (P < 0.001, respectively). However, report type did not influence initiation of further diagnostic or therapeutic measures (P = 0.307 and 1.0). Conclusions: Structured reports are superior to FTR with regard to formal aspects, completeness, clinical utility, and overall satisfaction of referring pulmonologists.