3D Image Analysis System Research Articles

Alcohol-associated liver disease increases the risk of muscle loss and mortality in patients with cirrhosis

BackgroundRapid skeletal muscle loss adversely affects the clinical outcomes of liver cirrhosis. However, the relationships between the annual changes in skeletal muscle area (ΔSMA/year) and the etiology of cirrhosis, factors associated with muscle loss, and risk of mortality remains unclear.MethodsA total of 384 patients who underwent multiple computed tomography (CT) scans between March 2004 and June 2021 were enrolled in this study (median age, 67 years; 64% men; median model for end-stage liver disease score, 9). Body composition and ΔSMA/year were estimated using a 3D image analysis system and data from at least two distinct CT scans. Differences in ΔSMA/year among different etiologies of cirrhosis, factors associated with rapid muscle loss (defined as ΔSMA/year ≤ − 3.1%), and the association between ΔSMA/year and mortality were examined.ResultsPatients with alcohol-associated liver disease (ALD) cirrhosis experienced more rapid muscle loss (ΔSMA/year, − 5.7%) than those with hepatitis B (ΔSMA/year, − 2.8%) and hepatitis C cirrhosis (ΔSMA/year, − 3.1%). ALD cirrhosis was independently associated with ΔSMA/year ≤ − 3.1% after adjusting for age, sex, and liver functional reserve. Over a median follow-up period of 3.8 years, ALD cirrhosis, ΔSMA/year ≤ − 3.1%, and low subcutaneous adipose tissue level were found to be significantly associated with reduced survival. ALD cirrhosis (hazard ratio [HR], 2.43; 95% confidence interval [CI] 1.12–5.28) and ΔSMA/year ≤ − 3.1% (HR, 3.68; 95% CI 2.46–5.52) were also predictive of mortality.ConclusionsThese results suggest that ALD cirrhosis increases the risk of rapid muscle loss and mortality in affected patients.

Sonographically-guided Parasacrum Infrapiriformis Drainage of Deep Pelvic Abscesses: An Anatomical Safety Study Using SYNAPSE VINCENT.

Deep pelvic abscesses are surrounded by the pelvic bones, bladder, gynecological organs, intestinal tract, and nerve and vascular systems, and are approached by various routes for drainage. The transgluteal approach is often performed under computed tomography guidance; however, if ultrasonography can be used to confirm the approach, it is considered more effective because it reduces radiation exposure and allows for real-time puncture under sonographic and fluoroscopic guidance. This retrospective study was conducted at Tobata Kyoritsu Hospital (Fukuoka, Japan) between April 1, 2021, and December 31, 2022. Sonographically guided transgluteal drainage with fluoroscopy was performed in five consecutive cases of deep pelvic abscesses using a 3D image analysis system (SYNAPSE VINCENT) to study the anatomy for safe puncture. Three patients had postoperative abscesses from colorectal cancer, one caused by perforation of the appendicitis, and one caused by sigmoid diverticulitis. The average drainage duration was 11 days (SD = 6.7). No complications, such as bleeding or nerve damage, were observed. We constructed a 3D image of the puncture route of the trans greater sciatic foramen using SYNAPSE VINCENT to objectively comprehend the anatomy and puncture route. The ideal transgluteal approach is to insert the catheter as close to the sacrum as possible at the level of the infrapiriformis. The parasacrum infrapiriformis approach can be performed safely and easily using ultrasound guidance and fluoroscopy.

Skin moisturizing and anti-acne effect of acne moisturizer in healthy adult subjects with mild-to-moderate acne-an open label, single arm clinical study

Objectives: Acne vulgaris is an extremely common condition that occurs mostly during adolescence. It often causes non-inflammatory lesions (open and closed comedones), inflammatory lesions (papules, pustules, and nodules), and varying degrees of scarring that leads to a negative impact on quality of life. This open label, single arm, and clinical study was conducted to evaluate the effectiveness of acne moisturizer on skin moisturization in adult subjects with mild-to-moderate acne. Material and Methods: An open label, single-arm, and clinical study was conducted on 36 enrolled healthy male and females aged 18–35 years having acne-prone skin and with mild-to-moderate acne. Acne moisturizer (Venusia Acne) was applied twice daily and safety and effectiveness of test product was assessed before application to post-application on day 15, day 30, day 45, and day 60 at the end of study. All enrolled subjects had undergone clinical evaluation by dermatologist, instruments evaluation, and subjective evaluation on various parameters. Results: Thirty-one (n = 31) subjects completed all study visits. After using Acne Moisturizer for 60 days, statistically significant (P < 0.0001) improvement from baseline was observed in skin moisturization. The product was also found effective in protecting skin barrier function (P < 0.0001) by reducing trans-epidermal water loss. Assessment of prevention of appearance of new acne and acne reduction using Investigator’s Global Assessment (IGA) Scale for acne vulgaris by dermatologist shows significant improvement from baseline to each study visit and at the end of study. Statistically significant reduction (P < 0.0001) in acne severity assessed by IGA was also observed. Moreover, significant reduction (P < 0.0001) in skin sebum level, skin blemishes, skin redness, skin pigmentation, and facial pores was also observed as assessed by instruments and 3D image analysis system. Assessment of the subject satisfaction questionnaire and subject response index was also found in parity of the outcome. Furthermore, no adverse event was recorded during the study conduction. Conclusion: The results of this clinical study suggest that acne moisturizer helps in significantly improving skin moisturization when applied for 15 days onward. It is also safe and effective in aiding reduction of skin sebum level, skin blemishes, skin redness, skin pigmentation, and facial pores; it can be effectively used as an adjunct for management of mild-to-moderate acne prevention and acne reduction, while providing sufficient moisturization to the skin.

Analysis of predicted factors for bronchoalveolar lavage recovery failure: An observational study.

The bronchoalveolar lavage (BAL) recovery rate should generally be more than 30% for effective diagnosis. However, there have been no reports investigating a target bronchus for BAL, and the cause of BAL recovery failure is uncertain. Therefore, this study detected predictive factors for BAL recovery failure through investigations on a target bronchus for BAL by using a 3D image analysis system. Therefore, this study detected predictive factors for BAL recovery failure. We retrospectively collected data from 338 adult patients who underwent BAL procedures at Fukujuji Hospital from June 2018-March 2022. Factors correlated with the BAL recovery rate were detected. Furthermore, the patients were divided into the failure group (recovery rate <30%; 36 patients) and the success group (recovery rate ≥30%; 302 patients), and data were compared between the two groups by analysing the target bronchus by using a 3D image analysis system. The patients in the failure group were older (median 74.5 years old [IQR 68.0-79.0] vs. median 70.0 years old [IQR 59.0-76.0], p = 0.016), more likely to be male (n = 27 [75.0%] vs. n = 172 [57.0%], p = 0.048), more likely to have COPD (n = 7 [19.4%] vs. n = 14 [4.6%], p = 0.003), and more likely to perform a target site of BAL other than the middle/lingual lobe (n = 11 [30.5%] vs. n = 35 [11.6%], p = 0.004) than those in the success group. The area of the bronchial wall was positively related to the recovery rate (r = 0.141, p = 0.009), and the area of the bronchial wall in the failure group was lower than that in the success group (median 10.5 mm2 [interquartile range (IQR) 8.1-14.6] vs. median 14.5 mm2 [11.4-19.0], p<0.001). The study shows that a thin bronchial wall, COPD, and a target site of BAL other than the middle/lingual lobe were identified as the predicted factors for BAL recovery failure. The weakness of the bronchial wall might cause bronchial collapse during the BAL procedure.

The thickness of erector spinae muscles can be easily measured by computed tomography for the assessment of physical activity: An observational study.

The loss of muscle mass and changes in muscle composition are important factors for assessing skeletal muscle dysfunction. The cross-sectional area (CSA) of muscle is usually used to assess skeletal muscle function. However, the CSA of skeletal muscle can be difficult for clinicians to measure because a specific 3D image analysis system for computed tomography (CT) scans is needed. Therefore, we conducted a study to develop a new method of easily assessing physical activity, in which the thickness of the erector spinae muscles (ESMT) was measured by CT, and to compare ESMT to the CSA of the erector spinae muscles (ESMCSA) in patients with nontuberculous mycobacteria (NTM) pulmonary infections who underwent surgery after some preoperative examinations, such as laboratory tests, chest CT scans, spirometry, and 6-minute walk tests (6MWT). We retrospectively studied adult patients with NTM pulmonary infections who underwent a lobectomy at Fukujuji Hospital from April 2010 to March 2016. We assessed the correlations between ESMT and different variables, including ESMCSA. Sixty-one patients with NTM pulmonary infections were included. The median ESMT and ESMCSA were 1371 mm2 (IQR 1178–1784 mm2) and 28.5 mm (IQR 25.4–31.7 mm), respectively, and a very strong linear correlation was observed between ESMT and ESMCSA (R = 0.858, P < .001). ESMT and ESMCSA were positively associated with body weight (ESMT: R = 0.540, P < .001, ESMCSA: R = 0.714, P < .001), body mass index (ESMT: R = 0.421, P < .001, ESMCSA: R = 0.560, P < .001), the 6MWT value (ESMT: R = 0.413, P = .040, ESMCSA: R = 0.503, P = .010), vital capacity (ESMT: R = 0.527, P < .001, ESMCSA: R = 0.577, P < .001), and the forced expiratory volume in 1 second (ESMT: R = 0.460, P < .001, ESMCSA: R = 0.532, P < .001). We demonstrated that compared to ESMCSA, ESMT is easily measured by CT and can be a useful parameter for clinically evaluating physical activity. Furthermore, ESMT and ESMCSA were related to physical activity, as measured by the 6MWT and spirometry.

Selective enlargement of left lateral segment liver volume as a potential diagnostic predictor for biliary atresia.

To determine an early diagnostic indicator of biliary atresia (BA), we focused on morphological left-right differences of BA livers. Of 74 infants with suspected BA at our hospital in the last 12years, 25 met the conditions for investigation: 15 infants with BA (BA group) and 10 with other pathologies (non-BA group). CT volumetry of the liver in each patient was performed using a 3D image analysis system. Patient characteristics, blood data, and proportion of the left lateral segment to the total liver volume (LLS ratio) were compared between the two groups. Among the patient characteristics and liver function tests, only γ-glutamyl transpeptidase (GGT) were significantly higher in the BA group (p < 0.001). The LLS ratio was 0.321 (0.227-0.382) in the BA group and 0.243 (0.193-0.289) in the non-BA group (p = 0.01). The summary cut-off, area under the curve, sensitivity, and specificity were 0.322, 0.813, 53.3, and 100% for the LLS ratio and 94.26, 0.95, 86.7, and 100% for the GGT × LLS ratio, respectively. The LLS ratio is highly specific and may be an early diagnostic predictor of BA. Moreover, this segmental LLS enlargement may be associated with the etiology of BA.

MORPHOLOGICAL ANALYSIS OF 3D MR IMAGES OF PF JOINTS IN ASYMPTOMATIC SUBJECTS

Understanding the pathogenesis of patellofemoral osteoarthritis (PFOA) will be enhanced by elucidating the onset and progression in asymptomatic PFOA. Demonstrating of the cartilage defect of 3D MR images, obtained from a cohort population, in order from the smallest to the largest, can mimic the morphological progression process of PFOA. The purpose of this study was to clarify the frequency, classification, and morphological progression process of PFOA by observing MRI 3D images in a cohort population of subjects without a history of visiting hospitals for knee disease. The subjects were 561 at 30–79 years old who were registered in the Kanagawa Knee Study. The main exclusion criteria were those who have a past history of consecutive visits to the hospital for more than 3 months for knee symptoms. We obtained 3D MR images of the PF joints using 3D image analysis system volume analyzer (SYNAPSE 3D, Fujifilm Corporation, Tokyo). The cartilage defects were classified as medial and lateral type. MR images of the PF joints were displayed with cartilage area ratios of the patella and presented in order of highest to lowest, separated into the medial and lateral type. Of the 561 subjects, cartilage defects were detected on 3D images of the patella in 37 subjects (6.6%). Medial lesion was detected in 26 subjects (4.6%) and lateral lesion in 11 subjects (2.0%), showing that medial lesion was significantly more frequent (p=0.01). For the medial type, the patellar cartilage defect was located in the center of the medial facet, expanded to the surrounding area, and further distally and medially. 3D MR images of the patellofemoral joint showed the cartilage defect of the patella expanded along with the medial ridge of the femoral trochlea. For the lateral type, the patellar cartilage defect was located in the center of the lateral facet, expanded to the surrounding area, and further distally and laterally. 3D MR images of the patellofemoral joint showed the cartilage defect of the patella expanded along with the lateral ridge of the femoral trochlea (Fig. 1). According to 3D MR images, the frequency of the patella cartilage defect was 6.6% in 561 asymptomatic subjects. Patellar cartilage defects occurred more frequently on the medial facet than on the lateral facet. The patellar cartilage defect occurred at the center of each facet and expanded along with each side of the ridge of the femoral trochlea. Fujifilm Corporation and Japan Society for the Promotion of Science Grant JP22K09349 I Sekiya received a research grant from Fujifilm Corporation including lending of the analysis software used in this study. Kimiko Takanashi is to be thanked for technical assistance. CORRESPONDENCE ADDRESS: sekiya.arm@tmd.ac.jp

Functional transition: Inconsistently parallel to the increase in future liver remnant volume after preoperative portal vein embolization.

BACKGROUNDPreoperative portal vein embolization (PVE) is a widely used strategy to enable major hepatectomy in patients with insufficient liver remnant. PVE induces hypertrophy of the future liver remnant (FLR) and a shift of the functional reserve to the FLR. However, whether the increase of the FLR volume (FLRV) corresponds to the functional transition after PVE remains unclear.AIMTo investigate the sequential relationship between the increase in FLRV and functional transition after preoperative PVE using 3-dimensional (3D) computed tomography (CT) and 99mTc-galactosyl-human serum albumin (99mTc-GSA) single-photon emission computed tomography (SPECT) fusion images. METHODSThirty-three patients who underwent major hepatectomy following PVE at the Department of Gastroenterological Surgery I, Hokkaido University Hospital between October 2013 and March 2018 were enrolled. Three-phase dynamic multidetector CT and 99mTc-GSA SPECT scintigraphy were performed at pre-PVE, and at 1 and 2 wk after PVE; 3D 99mTc-GSA SPECT CT-fused images were constructed from the Digital Imaging and Communications in Medicine data using 3D image analysis system. Functional FLRV (FFLRV) was defined as the total liver volume × (FLR volume counts/total liver volume counts) on the 3D 99mTc-GSA SPECT CT-fused images. The calculated FFLRV was compared with FLRV.RESULTSFFLRV increased by a significantly larger extent than FLRV at 1 and 2 wk after PVE (P < 0.01). The increase in FFLRV and FLRV was 55.1% ± 41.6% and 26.7% ± 17.8% (P < 0.001), respectively, at 1 wk after PVE, and 64.2% ± 33.3% and 36.8% ± 18.9% (P < 0.001), respectively, at 2 wk after PVE. In 3 of the 33 patients, FFLRV levels decreased below FLRV at 2 wk. One of the three patients showed rapidly progressive fatty changes in FLR. The biopsy at 4 wk after PVE showed macro- and micro-vesicular steatosis of more than 40%, which improved to 10%. Radical resection was performed at 13 wk after PVE. The patient recovered uneventfully without any symptoms of pos-toperative liver failure.CONCLUSIONThe functional transition lagged behind the increase in FLRV after PVE in some cases. Evaluating both volume and function is needed to determine the optimal timing of hepatectomy after PVE.

Analysis of the Columellar-Labial Angle in Perioral Aging.

The young face presents a convex and rounded aspect; with aging, this changes to a more concave and flattened aspect, with the angles of the face undergoing changes through soft tissue repositioning and bone remodeling. The columellar-labial angle is one of the features that change. The objective of the present study was to analyze the columellar-labial angle at different stages of adult life and assess its contribution to facial changes during aging. We analyzed a database (December 2017-March 2018) of 722 female patients, aged 21 to 88 years, and obtained anthropometric measurements of the columellar-labial angle with a Canfield Vectra 3D image analysis system. Our database originates from a private clinic where all patients were registered and photographed. Our analysis showed a decrease in the columellar-labial angle, mainly observed from patients aged 60 years and older. This decrease can be explained by the absorption of body structures that occurs during aging. The columellar-labial angle decreases with age, and this finding may provide a better understanding of the transformation that occurs with aging. Obtaining a clearer view of the changes that occur in the face will improve treatments for facial rejuvenation, either conservative or surgical, and provide a basis for future studies and knowledge expansion.

What factors affect the operative time of robot-assisted laparoscopic radical prostatectomy?

Robot-assisted radical prostatectomy (RARP) has gained prominence since the da Vinci surgical system was introduced in 2000. RARP has now become a standard procedure for treating cases with localized prostate cancer. However, no study has examined its surgical time by accurately measuring the pelvic visceral fat (PVF) volume. This study aimed to investigate the factors associated with prolonged console time and surgical difficulty by RARP surgeons. This study included 405 patients who underwent RARP between 2014 and 2019 at our institution. Given that the anatomical characteristics were considered to affect RARP, PVF and working space (WS) were estimated preoperatively by computed tomography using a 3D image analysis system. Univariate and multivariate logistic regression analyses were performed to identify the factors prolonging console time, such as body mass index (BMI), prostate volume, previous abdominal surgery, nerve-sparing procedure, PVF, and WS. We also investigated whether post-operative complications were associated with any of these factors. Larger PVF (p = 0.028, odds ratio (OR) 1.43), smaller WS (p < 0.001, OR 2.48), and the nerve-sparing procedure (p = 0.037, OR 1.61) were statistically significant factors associated with prolonged console time. Furthermore, higher BMI (p = 0.013, OR 1.49) and smaller pelvic width (p < 0.001, OR 2.63) were the alternative and more practical factors associated with prolonged console time. The post-operative anastomotic leakage occurrence rate increased with the number of risk factors, while post-operative complications did not change even in high-risk cases. PVF and WS are significant factors associated with prolonged console time in RARP cases. However, BMI can be as useful as PVF, since BMI significantly correlated with PVF. Additionally, pelvic width (PW) can be an alternative to WS, since PW correlated with WS. This study demonstrated that preoperative BMI and PW might predict the surgical risk and identify suitable RARP cases for novice surgeons.

Comparison of G-guide and Image-free Navigation System in Accuracy of Stem Anteversion Assessment During Total Hip Arthroplasty

Introduction: We have developed and utilized the Gravity-guide (G-guide) as a simple manual instrument for intraoperative assessment and adjustment of stem anteversion (AV). Since 2013, we simultaneously measured stem AV using the G-guide and image-free navigation during THA procedure. The purpose of this study was to compare the measurement accuracy of the G-guide and navigation system using the postoperative CT results as a reference. Methods: In total, 59 hips in 56 patients who underwent primary THA using both the G-guide and image-free navigation system were included in the study. All patients underwent postoperative CT examination, and the femoral stem AV was assessed using a 3D image analysis system (Zed hip, LEXI, Japan). The AV angle derived from the postoperative CT image analysis was used as the reference value to assess the accuracy of the two intraoperative measurement systems. Results: The discrepancy between the G-guide and the postoperative CT-measured values averaged 5.0° ± 3.9°, while the corresponding value for the navigation system was 5.2° ± 4.1°. Acceptable accuracy with a measurement error of less than 10° was achieved in 86% and 90% of the cases for the G-guide and navigation measurements respectively. Conclusion: Consequently, it was shown that both navigation and G-guide measurements can achieve comparative accuracy and are clinically useful.

Renal Artery Perfusion Evaluation Before Transplantation via a 3-Dimensional Image Analysis System

Background: The perfusion areas of renal arteries in renal transplantation are assessed via subjective observations during perfusion in a bench surgery; however, this evaluation method lacks reliability and objectivity. In this study, we aimed to evaluate the perfusion area of each main and side artery kidney graft using a 3-dimensional (3D) image analysis system. Methods: We enrolled 50 patients who had undergone living kidney transplantation with multiple renal artery grafting at our center between 2005 and 2017. All computed tomography images from donors were retrospectively analyzed using a 3D image analysis system. We then calculated the artery perfusion areas associated with the artery reconstruction method used. Results: The perfusion areas of side arteries, which were evaluated after surgery, were statistically different among cases employing different reconstruction methods (P &amp;lt; 0.001). The perfusion area of the ligated side arteries (volume, 10 mL; proportion, 6.1%) was smaller than that of the ligated side arteries where different reconstruction methods were used. Conclusion: A 3D image analysis system could provide an accurate visual representation of the vasculature prior to living donor transplantation. It could also enable calculation of perfusion area for each artery and preoperative prediction of the need for arterial reconstruction, thereby promoting safe kidney transplantation surgery.

Benefits of lung modeling by high-quality three-dimensional computed tomography for thoracoscopic surgery

Although video-assisted thoracoscopic surgery (VATS) has become widely used as a less invasive therapeutic procedure for lung cancer, precise anatomical knowledge of each case remains crucial and greatly contributes to the safety of thoracoscopic surgery. Thus, the development of three-dimensional (3D) imaging technology is anticipated to provide surgeons with essential visualized information of anatomical structures. In this review, we evaluate the pragmatic features of 3D imaging technology for thoracoscopic lung cancer surgery, focusing on complicated surgeries and preoperative evaluation of pulmonary functions or tumor features. We also discuss 3D imaging software and the applications of the 3D image analysis system. Finally, we present our perspectives on the 3D imaging technology for thoracoscopic surgery.

Novel semi-automated kidney volume measurements in autosomal dominant polycystic kidney disease.

We assessed the effectiveness and convenience of a novel semi-automatic kidney volume (KV) measuring high-speed 3D-image analysis system SYNAPSE VINCENT® (Fuji Medical Systems, Tokyo, Japan) for autosomal dominant polycystic kidney disease (ADPKD) patients. We developed a novel semi-automated KV measurement software for patients with ADPKD to be included in the imaging analysis software SYNAPSE VINCENT®. The software extracts renal regions using image recognition software and measures KV (VINCENT KV). The algorithm was designed to work with the manual designation of a long axis of a kidney including cysts. After using the software to assess the predictive accuracy of the VINCENT method, we performed an external validation study and compared accurate KV and ellipsoid KV based on geometric modeling by linear regression analysis and Bland-Altman analysis. Median eGFR was 46.9ml/min/1.73m2. Median accurate KV, Vincent KV and ellipsoid KV were 627.7, 619.4ml (IQR 431.5-947.0) and 694.0ml (IQR 488.1-1107.4), respectively. Compared with ellipsoid KV (r=0.9504), Vincent KV correlated strongly with accurate KV (r=0.9968), without systematic underestimation or overestimation (ellipsoid KV; 14.2±22.0%, Vincent KV; -0.6±6.0%). There were no significant slice thickness-specific differences (p=0.2980). The VINCENT method is an accurate and convenient semi-automatic method to measure KV in patients with ADPKD compared with the conventional ellipsoid method.

Age, Preoperative Subcutaneous Fat Area, and Open Laparotomy are Risk Factors for Incisional Hernia following Colorectal Cancer Surgery.

Although incisional hernia (IH) is a common complication of abdominal surgery, the incidence rate and risk factors are not well known. The objectives of this study are to determine the incidence rate of IH following colorectal cancer surgery and to describe the associated risk factors. Between 2005 and 2010, patients who underwent surgery to treat colorectal cancer were examined. The diagnosis of IH was performed by CT scan, and the visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus were calculated using a 3D-image analysis system. Survival analysis was used to assess the incidence and risk factors of IH. A total of 626 patients (326 open, 300 laparoscopic) were included in this study, with median follow-up of 54 (range 2-97) months. Forty patients were diagnosed with postoperative IH, and the cumulative, 5-year incidence of IH was 7.3 %. Univariate analysis revealed that age, body mass index, waist circumference, hip circumference, open laparotomy, wound infection, VFA, and SFA were significantly associated with incidence of IH. Multivariate analysis revealed that age [hazard ratio (HR) 1.043 (1.005-1.083), p = 0.027], open laparotomy [HR 4.410 (1.018-19.095), p = 0.047], and SFA [HR 1.013 (1.004-1.022), p = 0.005] were significant risk factors for developing IH. Higher age and SFA, along with open surgery, are risk factors for developing IH.

A Novel 3-Dimensional Image Analysis System for Case-specific Kidney Anatomy and Surgical Simulation to Facilitate Clampless Partial Nephrectomy

To report our initial experience with the novel 3-dimensional (3D) image analysis system Synapse Vincent in clampless partial nephrectomy (PN), describing its advantages with regard to short-term surgical outcomes and its usefulness as an informed consent tool. Twenty-six patients with renal cell carcinoma underwent clampless PN navigated with the aid of case-specific 3D anatomic video images of the kidney, after surgical simulation using the same video system. Baseline characteristics were reviewed, and short-term surgical outcomes were recorded. Of the 26, 6 had imperative indications, and 22 were treated with a minimally invasive approach. Before tumor excision, the renal hilar vessels were meticulously dissected, and definite tumor feeders were selectively ligated. Before patients consented to PN, the surgical procedure and perioperative risks were explained to each patient using case-specific 3D video images; subsequently, surgeons asked patients whether the 3D images had helped them understand PN more clearly than 2D images would have. All operations were successfully completed without clamping, with negative surgical margins. No patients required blood transfusions. During PN, the surgeons confirmed the accuracy of the reconstructed 3D images and surgical simulations in all cases. All patients answered that the 3D images had helped them understand their disease status and surgical risks. This is the first report on the Synapse Vincent 3D image analysis system for kidney surgery. Its 3D images and surgical simulation helped not only surgeons in their performance of clampless PN but also patients in their understanding of the operation.

A 2D/3D image analysis system to track fluorescently labeled structures in rod-shaped cells: application to measure spindle pole asymmetry during mitosis

BackgroundThe yeast Schizosaccharomyces pombe is frequently used as a model for studying the cell cycle. The cells are rod-shaped and divide by medial fission. The process of cell division, or cytokinesis, is controlled by a network of signaling proteins called the Septation Initiation Network (SIN); SIN proteins associate with the SPBs during nuclear division (mitosis). Some SIN proteins associate with both SPBs early in mitosis, and then display strongly asymmetric signal intensity at the SPBs in late mitosis, just before cytokinesis. This asymmetry is thought to be important for correct regulation of SIN signaling, and coordination of cytokinesis and mitosis. In order to study the dynamics of organelles or large protein complexes such as the spindle pole body (SPB), which have been labeled with a fluorescent protein tag in living cells, a number of the image analysis problems must be solved; the cell outline must be detected automatically, and the position and signal intensity associated with the structures of interest within the cell must be determined.ResultsWe present a new 2D and 3D image analysis system that permits versatile and robust analysis of motile, fluorescently labeled structures in rod-shaped cells. We have designed an image analysis system that we have implemented as a user-friendly software package allowing the fast and robust image-analysis of large numbers of rod-shaped cells. We have developed new robust algorithms, which we combined with existing methodologies to facilitate fast and accurate analysis. Our software permits the detection and segmentation of rod-shaped cells in either static or dynamic (i.e. time lapse) multi-channel images. It enables tracking of two structures (for example SPBs) in two different image channels. For 2D or 3D static images, the locations of the structures are identified, and then intensity values are extracted together with several quantitative parameters, such as length, width, cell orientation, background fluorescence and the distance between the structures of interest. Furthermore, two kinds of kymographs of the tracked structures can be established, one representing the migration with respect to their relative position, the other representing their individual trajectories inside the cell. This software package, called “RodCellJ”, allowed us to analyze a large number of S. pombe cells to understand the rules that govern SIN protein asymmetry. (Continued on next page)(Continued from previous page)Conclusions“RodCellJ” is freely available to the community as a package of several ImageJ plugins to simultaneously analyze the behavior of a large number of rod-shaped cells in an extensive manner. The integration of different image-processing techniques in a single package, as well as the development of novel algorithms does not only allow to speed up the analysis with respect to the usage of existing tools, but also accounts for higher accuracy. Its utility was demonstrated on both 2D and 3D static and dynamic images to study the septation initiation network of the yeast Schizosaccharomyces pombe. More generally, it can be used in any kind of biological context where fluorescent-protein labeled structures need to be analyzed in rod-shaped cells.AvailabilityRodCellJ is freely available under http://bigwww.epfl.ch/algorithms.html.

The usefulness of a high-speed 3D-image analysis system in pediatric living donor liver transplantation

Since March 2010, we have used a high-speed 3D-image analysis system (SYNAPSE VINCENT) to calculate the graft volume in living donor liver transplantation (LDLT) to replace CT volumetry. The SYNAPSE VINCENT is capable of extracting each vessel territory in the liver and displaying 3D images simply, quickly, and accurately. Therefore, we report here the usefulness of the SYNAPSE VINCENT in pediatric LDLTs in overcoming issues with perfusion area of hepatic venous tributaries in monosegmental grafts. The SYNAPSE VINCENT was used in three pediatric patients. In two of these cases, the possibility of monosegmental grafts was assessed when calculating graft volumetry of segment III. The graft recipient weight ratio (GRWR) with graft volumetry measurements of the left lateral segment were 1.8-5.6%. GRWR of segment III were 2.3 and 2.0%. Since donor V2, venous branch to segment II and V3, venous branch to segment III were independently branching in one case, the monosegmental graft could be evaluated preoperatively according to the venous perfusion. Graft volumetry using the SYNAPSE VINCENT was useful for planning the LDLT operative procedures, especially in infants possibly in need of monosegmental graft.

Cosmetic efficacy evaluation of an anti-acne cream using the 3D image analysis system

Acne is a skin disease which accompanies pathological and morphological changes. Although acne severity is scored by clinicians based on pathological status, aesthetic aspect of acne symptom is also concerned by patients. This study was conducted to examine the usefulness of a 3D image analysis method for the cosmetic efficacy evaluation of an anti-acne cream. Twenty-one healthy volunteers with acne lesions were recruited for the study and treated with an 'anti-acne cream' for 4 weeks. Acne symptoms on the facial skin were graded by the visual evaluation of photographs taken before and after the treatment. Skin color of acne lesions was and measured by a spectrophotometer. In addition, a 3D image analysis system was used to quantify skin surface roughness and acne volumes. Both visual and spectrophotometric assessments of acne lesions provided similar results indicating that the cream treatment improved acne symptoms significantly. The 3D image analysis of acne lesions confirmed that the cream treatment decreased skin surface roughness and acne volumes. The current study demonstrated that the 3D image-based analysis of the skin may be useful for the quantification of acne symptoms of cosmetic relevance.

Optimised reflection imaging for surface roughness analysis using confocal laser scanning microscopy and height encoded image processing

Quantitative surface measurement is an important field in engineering. Due to the complexity of surface topography, accurate surface characterisation requires three-dimensional (3D) surface measurements not provided by many current measurement systems. A nondestructive and versatile technique for quantifying 3D surface features is Confocal Laser Scanning Microscopy (CLSM). However, there is little documentation on standard CLSM hardware settings required to capture images of suitable quality for 3D surface measurements. Understanding the complex relationship between CLSM settings, specimen properties and image quality is crucial to optimising the acquisition process for quantitative 3D surface measurements. The response of image quality to variations in CLSM hardware settings and specimen properties has been investigated in the study. Through the investigations, criteria have been developed to select optimal CLSM hardware settings to minimise image noise, eliminate image distortion, maximise contrast and resolution for reliable and accurate 3D numerical surface measurements. A reliable 3D image analysis system has been developed for image processing and surface measurement of engineering surfaces and small particles. The image analysis system developed in Matlab for the confocal system provides a new means to quantitatively characterise a wide range of engineering surfaces with accuracy and efficiency.