Axial CT Scans Research Articles

Study of neuromuscular activity in preparation for revision knee arthroplasty

The results of an electromyographic study of 13 patients, aged 50–87 years, with aseptic instability of the components of a knee joint endoprosthesis at the stage of preparation for revision arthroplasty, who were treated at the Republican Scientific and Practical Center of Trauma tology and Orthopedics in the period from 2013 to 2020, were analyzed. To assess the orthopedic status, we used: clinical examination, radiography of the knee joint in 2 standard and axial projections, topogram and CT scan. lectrophysiological studies provide important information for elucidating the etiopathogenesis of knee joint endoprosthesis instability. One of the causes of instability may be an imbalance in the activity of the flexor and extensor muscles that develops during walking, subsequently leading to periprosthetic osteolysis, which occurs as a response to the formation of wear and tear products of the components of the endoprosthesis.

C1-ring оsteosynthesis as a functionally preserving operation for unstable atlas fractures

Objective. To analyze the dynamics of pain syndrome, quality of life and functional status of patients with unstable atlas fractures after C1-ring osteosynthesis.Material and Methods. Study design: observational retrospective case series study (n = 15). The intensity of pain syndrome was assessed using the VAS scale before surgery, 3 days, and 3 and 6 months after surgery. The quality of life was assessed using the Neck Disability Index (NDI) before surgery, and 3 and 6 months after surgery. Functional status, as well as cervical spine range of motion (head turn left/right, flexion/extension) was assessed 3 and 6 months after surgery. The integrity of the atlas bone ring and the degree of fusion after fixation were assessed using axial CT scans; and the lateral mass separation was assessed using frontal CT scans. The criterion for transverse ligament injury was a separation of lateral masses of more than 8.1 mm. Results. All patients had C1 fractures type 3B according to Gehweiler, out of them 7 patients (46.7 %) had traumatic injury to the atlas transverse ligament according to Dickman type 1, and 8 patients (53.3 according to Dickman type 2. The average age of patients was 40 years (12; 71), the male/female ratio was 2/1. In 7 patients (46.7 %), the cause of injury was diving, in 6 (40.0 %) it was a traffic accident, and in 2 (13.3 %) – a fall from a standing height. Observation of patients revealed a positive dynamics in the form of statistically significant regression of pain according to VAS before and 6 months after surgery from 6.8 (6.0; 8.0) to 1.0 (1.0; 0.0) points (Z = -3.434; p = 0.001). A positive trend was also noted in the form of a decrease in NDI scores and an improvement in the quality of life after 3 (Z = -3.411; p = 0.001) and 6 months after surgery (Z = -3.410; p = 0.001). The range of motion (turn left/right, flexion/extension) increased statistically significantly by the 6th month after C1-ring osteosynthesis, and its indicators were close to physiological ones. Postoperative CT scans showed positive dynamics in the form of statistically significant regression of the lateral mass separation from 10.4 mm (8.9; 11.4) to 2.2 mm (1.8; 2.6); Z = -3.408; p = 0.001. Complete fusion of the atlas fracture was observed after 12.5 months (8.5; 16.5).Conclusion. Isolated posterior osteosynthesis of the atlas ring for Gehweiler type 3B injury using a repositioning compression maneuver under distraction conditions is physiologically justified. It is a reliable method of stabilization, ensures the restoration of congruence and the entire range of motion in the atlanto-occipital and atlantoaxial joints and stability of the occipital-atlantoaxial complex. This operation contributes to a considerable and long-term reduction in the intensity of pain syndrome and a significant improvement in the quality of life.

How Strong Is the Ligamentum Teres of the Hip? A Biomechanical Analysis.

Intraarticular hip pain represents a substantial clinical challenge, with recent studies implicating lesions in the ligamentum teres as potential contributors. Even more so, damage to the ligamentum teres is particularly prevalent among young patients undergoing joint-preserving interventions. Although several studies have investigated the biomechanical attributes of the ligamentum teres, inconsistencies in reported findings and reliance on cadaveric or animal models have raised concerns regarding the extrapolation of results to clinical practice. Furthermore, there is a lack of research examining ligamentum teres biomechanics specifically within the relevant patient cohort-individuals who benefit from joint-preserving surgical interventions. We sought (1) to determine the biomechanical properties (ultimate load to failure, tensile strength, stiffness, and elastic modulus) of fresh-frozen ligaments from patients undergoing surgical hip dislocation, and (2) to identify patient-specific factors that are associated with them. This was an institutional review board-approved study on intraoperatively harvested ligamentum teres from 74 consecutive patients undergoing surgical hip dislocation for joint preservation (August 2021 to September 2022). After the exclusion of patients with previous surgery, posttraumatic deformities, avascular necrosis, slipped capital femoral epiphysis, and Perthes disease, 31 ligaments from 31 patients were analyzed. The mean age of the study group was 27 ± 8 years, and 61% (19) of participants were male. The main indication for surgery was femoroacetabular impingement. Standardized AP pelvic and axial radiographs and CT scans were performed in all patients for better radiological description of the population and to identify associated radiological factors. The ligament was thoroughly transected at its origin on the fossa acetabuli and at the insertion area on the fovea capitis and stored at -20°C until utilization. Specimens were mounted to a materials testing machine via custom clamps that minimized slippage and the likelihood of failure at the clamp. Force-displacement and stress-strain curves were generated. Ultimate failure load (N), tensile strength (MPa), stiffness (N/mm), and elastic modulus (MPa) were determined. Using a multivariate regression analysis and a subgroup analysis, we tested demographic, degenerative, and radiographic factors as potential associated factors. The ligamentum teres demonstrated an ultimate load to failure of 126 ± 92 N, and the tensile strength was 1 ± 1 MPa. The ligaments exhibited a stiffness of 24 ± 15 N/mm and an elastic modulus of 7 ± 5 MPa. After controlling for potential confounding variables like age, fossa/fovea degeneration, and acetabular/femoral morphologies, we found that female sex was an independent factor for higher tensile strength, stiffness, and elastic modulus. Excessive femoral version was independently associated with lower load to failure (HR 122 [95% CI 47 to 197]) and stiffness (HR 15 [95% CI 2 to 27]). Damage to the acetabular fossa was associated with reduced load to failure (HR -93 [95% CI -159 to -27]). Overall, the ligamentum teres is a relatively weak ligament. Sex, degeneration, and excessive femoral version are influencing factors on strength of the ligamentum teres. The ligamentum teres exhibits lower strength compared with other joint-stabilizing ligaments, which calls into question its overall contribution to hip stability. Young patients undergoing hip-preserving surgery are the population at risk for ligamentum teres lesions. Baseline values for load to failure, tensile strength, elastic modulus, and stiffness are needed to better understand those lesions in this cohort of interest.

Direct Vertebral Rotation versus Simple Rod Derotation Techniques in Correction of Adolescent Idiopathic Scoliosis

Abstract Background One method for treating adolescent idiopathic scoliosis (AIS), which is characterised by abnormal spinal alignment in the coronal, sagittal, and rotational planes, is surgical correction. The two surgical techniques most typically used to correct spine alignment are simple rod derotation (SRD) and direct vertebral rotation (DVR). Aim The study's goal was to assess the effectiveness of two treatment methods for adolescent idiopathic scoliosis: simple rod derotation and direct vertebral rotation. Subjects and Methods A randomised controlled research involving 36 adolescents with idiopathic scoliosis was done. patients were randomly split into one of two groups: 18 patients in group A had DVR treatment, while 18 patients in group B received SRD with a 2-year follow-up. Results Apical Vertebral Rotation measured from CT scans in DVR group was 24.4° ±8.38° preoperatively and it decreased significantly postoperatively to 14.4°±4.61 °with (42.22%) correction rate while in SRD group it was 25.03°±7.99° preoperatively and it also decreased significantly postoperatively to a mean value of 21.41°±7.01° with (14.65%) correction rate. There were statistically significant differences between both groups postoperative (P < 0.001) Conclusion The most noticeable difference between DVR and SRD was clinical rib hump correction, which was explained by apical vertebral rotation correction determined on an axial CT scan. It also demonstrates that there is no significant difference in coronal curve correction, shoulder height difference, or patient satisfaction between the two techniques.

The Quality of Life of the Patients with Thoracic Ossification of the Ligamentum Flavum after Surgery Using EQ-5D-5L.

There is a lack of studies on the quality of life (QoL) after posterior laminectomy in patients with thoracic ossification of the ligamentum flavum (TOLF), and risk factors associated with poor prognosis remain controversial. Therefore, the present study was conducted to illustrate the QoL for TOLF patients after surgery and determine its relationship with their demographic, surgery-related, clinical characteristics and imaging data. One hundred and eighteen patients diagnosed with thoracic myelopathy because of TOLF were enrolled in this retrospective study. They all underwent posterior decompressive laminectomy from August 2010 to January 2022. The QoL was evaluated based on the EQ-5D-5L. Collecting gender, age, number of operations, compressed segments, Frankel grade, complications, body mass index (BMI), symptoms and duration, modified Japanese Orthopaedic Association (mJOA) score (preoperative), follow-up time and type of ossification, increased signal on Sagittal T2-weighted Images (ISST2I), occupancy rate and analyzing by Mann-Whitney U-test, Kruskal-Wallis test, the χ2 -test, and logistic regression tests. Average follow-up 70.8 months (18-149), the mean age was 59.74 ± 9.81 years and the mean score for the QoL based on the EQ-5D-5 L and visual analogue scale (VAS) score were 0.71 ± 0.28 and 78.88 ± 10.21 at the final follow-up. Moderate and severe problems were found in the pain/discomfort in 22.0% of the patients. These mobility and usual activities numbers were slightly higher (24.6% and 30.4%, respectively). The mean scores for QoL and VAS were significantly higher in patients with mild and moderate neurological impairment, normal BMI, <60 years of age, no dural tears, symptom relief at hospital discharge, unilateral and bilateral ossification on axial CT scan, ≤ 50% spinal canal occupancy on CT and MRI, and none or fuzzy on ISST2I. QoL after posterior laminectomy in TOLF patients is generally satisfactory compared to preoperative levels. Preoperative mJOA score, Age, comorbid diabetes, the major symptom is activity limitation, BMI, ISST2I, Intraoperative dural tears and spinal canal occupancy rate correlate significantly with the corresponding dimensions and are predictive. Age, spinal canal occupancy rate, ISST2I, preoperative mJOA score, BMI are significantly associated with and have predictive value for overall postoperative QoL.

The role of CT scan in diagnosing neurocysticercosis in patients with seizures: a case report

Background: Neurocysticercosis is the most common parasitic infectious disease affecting the human central nervous system in endemic countries. It is caused by the ingestion of Taenia solium eggs excreted in the faeces of human tapeworm carriers. The disease is often asymptomatic, but can also cause seizures, disorientation, visual disturbances, focal neurologic deficits, psychiatric symptoms, strokes, and elevated intracranial blood pressure. Neuroimaging remains the gold standard for diagnosis, which includes the CT scan. This case report aimed to discuss the role of the CT scan in the diagnosis of neurocysticercosis in a 40-year-old male patient with a history of seizures. Case presentation: A 40-year-old male complained of seizures one hour before admission. Before the seizure, the patient reported that he was active as usual and had no complaints. The patient stated that he likes to eat pork and red lawar, which is made from raw pig blood. Physical examination revealed that the patient had a fever. Neurologic examination was within the normal range. Axial view CT scan of the head without contrast showed multiple calcifications with a hypodense area around them. Then, the patient was diagnosed with serial seizures due to symptomatic epilepsy and cerebral neurocysticercosis. He was treated with anthelmintic, antiseizure and symptomatic medication. After one month following therapy, there were no reports of headaches or seizures. The follow-up CT scan at the same slice as the lesion decreased the amount of calcifications, but the right frontal and left parietal regions were still visible. Conclusion: Neuroimaging studies such as CT scans are among the tests that can be performed on seizure patients to detect neurocysticercosis in endemic areas.

Do Syndesmotic Injury Patterns Influence Functional and Radiological Outcomes in Complex Ankle Fractures? A Retrospective Cohort Study

Category: Ankle; Trauma Introduction/Purpose: Syndesmosis injury can be of a varying magnitude; little information exists about the influence of degree of initial syndesmotic injury/instability on functional outcomes in ankle fractures, nor is there any correlation of this with follow up radiological parameters. Aims and Objectives: To identify and define morphological patterns of syndesmotic injury in ankle fractures according to a zone based evaluation, and correlate initial degree of instability with mid-term functional and radiological outcomes using validated scores Design: Retrospective cohort study, to review a prospective question. Methods: 40 complex ankle fractures out of 120 ankle fractures in our ankle registry met the inclusion criteria ie significant documented syndesmosis involvement needing stabilization, with all initial clinical and radiological records available. The patients were followed up between January 2020 to July 2021. Injury characteristics, fracture morphology of posterior malleolus, medial malleolus and fibula were noted and classified by validated classification systems based on x-rays and CT scan. The syndesmosis was analyzed on axial CT scan; it was divided into 3 zones, A,B,C from anterior to posterior, and degree of displacement and morphology was noted. Immediate post-operative radiographs were evaluated for fracture and syndesmosis reduction. The patients were evaluated at final follow up with both ankle specific scores (Olerud Molander score, Ankle-Hindfoot scale, Manchester-Oxford Foot questionnaire) and quality of life score (SF-12). Ankle Osteoarthritis grade was used to evaluate radiological outcomes. Results: Mean follow-up was 19 months. 22(55%) patients had syndesmotic widening on plain radiographs; however in pre- operative CT scan evaluation 40(100%) patients had syndesmotic injury based on the Zone evaluation of the syndesmosis. 22 patients had Zone A injury (widening, AITFL, Chaput, Wagstaff). 22 patients had widening of Zone B. Zone C was involved in 30 patients (PM fracture,PITFL involvement). At final follow up; the mean OMAS was 83.38±16.35, mean Ankle-Hindfoot scale= 88±9.98, mean Mox-FQ score=27.15±13.35 &amp; mean SF-12 were (MCS=56.59±8.24, PCS=51.18±8.48). There was no significant difference in outcome scores based on fracture types, Posterior malleolus morphology, or based on zones of syndesmosis injury. Syndesmosis malreduction contributed to significantly poorer outcomes (SF-12, OMAS, MoxFQ) Conclusion: Despite a zonal classification of syndesmotic injury on CT and more clarity of injury patterns, we could not corelate the site and extent of syndesmotic injury with final functional and radiological outcomes. The one factor that has significant influence is initial accurate reduction of both the malleolar fractures and syndesmosis injury. In this the CT based axial classification may play a role.

Comparison between CT-Scan Finding and Operative Finding of Patients with Chronic Rhinosinusitis Undergoing Functional Endoscopic Sinus Surgery

Background: Chronic rhinosinusitis is a group of disorders characterized by inflammation of the mucosa of the nose and Paranasal sinuses for at least 12 consecutive weeks. It is a common clinical problem that has a significant impact on quality of life. CT-scan has become the modality of choice for assessment of CRS and Endoscopic sinus surgery is a minimally invasive technique and the surgical management of choice for chronic rhinosinusitis.&#x0D; The Aim of this Study: To verify the agreement and associations between preoperative CT-scan and intraoperative ESS findings in patients with CRS and to evaluate the types and frequency of anatomical variants in the nasal fossa and paranasal sinuses as well as their clinical correlations in chronic rhinosinusitis.&#x0D; Patients and Methods: This study is experimental study in which 50 subjects were collected by simple randomization technique as they visited our department in a period from January to December 2015. All the participants were guided to conduct a coronal, axial, and sagittal CT scan of the nose and paranasal sinuses before functional endoscopic sinus surgery. The anatomical variations and mucosal abnormalities on CT Scan &amp; ESS were studied and analyzed.&#x0D; Results: Septal deviation is the most common anatomical abnormality, 37(74%) of the participants have these abnormalities. The presence of agar nasi cells 34(68%), and chonca bullosa 28(56%) are the second and third most common anatomical variants found on CT-scan images. There is a high level of agreement between both the diagnostic tools at the high numbers of both positive and negative results for each abnormal finding.&#x0D; Conclusions: There was a good correlation between CT and ESS findings and there was a slight difference between the diagnostic characteristics of these different tools.

Not All Osteophytes Are Located on the Right Side of the Vertebrae in Diffuse Idiopathic Skeletal Hyperostosis: A Quantitative Analysis in Relation to the Position of Aorta.

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by osteophytes in the anterior vertebrae, and the presence of aorta may have an impact on their formation. However, the anatomical positional relationship between the aorta and osteophytes in patients with DISH remains controversial. This study aimed to evaluate the position of osteophytes in relation to aorta in DISH, and the influence of aortic pulsation on the formation of osteophytes from the perspective of morphology. We conducted a retrospective review of 101 patients diagnosed with DISH and symptomatic lumbar spinal stenosis between June 2018 and December 2021. A total of 637 segments with heterotopic ossification in DISH were used for quantitative measurements on CT scans. The Cartesian coordinate system was built up on the axial CT scans to reflect the relative position between aorta and osteophytes. Osteophytes were divided into adjacent aorta group (AD group) and non-adjacent aorta group (N-AD group). In terms of the morphology, osteophytes in the AD group were further divided into convex, flat, and concave types. The relative position between aorta and osteophytes, and the aorta-osteophyte distance and morphology of osteophytes were compared. Univariate analysis of variance was performed for multiple groups, and two independent-samples t-tests were used for two groups. From T5 to L4, aorta gradually descended from left side to middle of vertebrae, and osteophytes gradually shifted from right side of vertebrae (T5-T10) to bilateral sides (T11-L4). Of 637 osteophytes in DISH, 60.1% (383/637) were in AD group, including convex type 0.6% (4/637), flat type 34.7% (221/637), and concave type 24.8% (158/637). The N-AD group accounted for 39.9% (254/637). Flat osteophytes were concentrated in T5-T12, while concave osteophytes in T11-L4. Overall, the aorta-osteophyte distance of concave type was significantly smaller than that of flat type. Osteophytes are not always located on the right side of vertebrae, but move with the position of the descending aorta. Furthermore, the morphology of osteophytes varies by vertebral segment in DISH, which is related to aorta descending anteriorly in the spine.

The utility of balloon dilation for piriform aperture stenosis - A first line surgical treatment.

Describe the long-term outcomes of patients with piriform aperture stenosis managed with balloon dilation. Review of current literature. A retrospective case series of 6 patients with piriform aperture stenosis initially managed with balloon dilation at a tertiary paediatric hospital. Six neonates diagnosed with piriform aperture were managed with balloon dilation under general anaesthesia after failing conservative treatment. Average age at first dilation was 28 days old (range 6-54). The piriform aperture was an average width of 5.15mm, with a 4-6.5mm range, as measured on axial CT scan. The average width at 25% of the nasal cavity, 50% and 75% was 7.7mm, 9.3mm and 9.98mm respectively. Four neonates required only a single balloon dilation - two of these were stented post-operatively. The remaining two neonates required multiple balloon dilations with eventual drill-out through a sublabial approach. There was a trend of smaller piriform and nasal cavity diameters in those who required multiple procedures. The mean follow-up was 30 months. Balloon dilation should be considered for primary operative management in neonates with piriform aperture stenosis who fail medical interventions. Balloon dilation can treat the narrowing at and beyond the piriform aperture. Patients who require more than one dilation are more likely to have a smaller piriform aperture and may need a drill-out procedure. The impact of nasal stents on outcomes is unclear.

MP50-14 A MULTICENTER EVALUATION OF THE PROGNOSTIC UTILITY OF CHANGES IN TREATMENT-ASSOCIATED BODY COMPOSITION IN MEN WITH GERM CELL TUMORS (GCT) OF THE TESTIS: IMPLICATIONS FOR ADVERSE EVENTS AND COMPLICATIONS

You have accessJournal of UrologyCME1 Apr 2023MP50-14 A MULTICENTER EVALUATION OF THE PROGNOSTIC UTILITY OF CHANGES IN TREATMENT-ASSOCIATED BODY COMPOSITION IN MEN WITH GERM CELL TUMORS (GCT) OF THE TESTIS: IMPLICATIONS FOR ADVERSE EVENTS AND COMPLICATIONS Claire Buxton, Benjamin N. Schmeusser, Sarah K. Holt, Datta Patil, Anthea Phuong, J. Peter Marquardt, Ryan O'malley, Grace Laidlaw, George R. Schade, Daniel W. Lin, Michael T. Schweizer, Todd Yezefski, Evan Y. Yu, Bruce Montgomery, Florian J. Fintelmann, Sophia Chahine, Viraj A. Master, and Sarah P. Psutka Claire BuxtonClaire Buxton More articles by this author , Benjamin N. SchmeusserBenjamin N. Schmeusser More articles by this author , Sarah K. HoltSarah K. Holt More articles by this author , Datta PatilDatta Patil More articles by this author , Anthea PhuongAnthea Phuong More articles by this author , J. Peter MarquardtJ. Peter Marquardt More articles by this author , Ryan O'malleyRyan O'malley More articles by this author , Grace LaidlawGrace Laidlaw More articles by this author , George R. SchadeGeorge R. Schade More articles by this author , Daniel W. LinDaniel W. Lin More articles by this author , Michael T. SchweizerMichael T. Schweizer More articles by this author , Todd YezefskiTodd Yezefski More articles by this author , Evan Y. YuEvan Y. Yu More articles by this author , Bruce MontgomeryBruce Montgomery More articles by this author , Florian J. FintelmannFlorian J. Fintelmann More articles by this author , Sophia ChahineSophia Chahine More articles by this author , Viraj A. MasterViraj A. Master More articles by this author , and Sarah P. PsutkaSarah P. Psutka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Skeletal muscle mass is associated with oncologic outcomes and treatment-associated toxicity across malignancies. However, men with GCT are younger and less likely to suffer baseline age-related muscle loss. As such, the prognostic utility of body composition metrics in GCT is undefined. We aimed to quantify changes in body composition following cytotoxic chemotherapy (CC) for GCT and evaluate associations between these changes and rates of CC-associated adverse events (AEs) and post-retroperitoneal lymphadenectomy (RPLND) complications. METHODS: This retrospective study included 216 patients with GCT (N=152 from Fred Hutchinson Cancer Center/ University of Washington; N=64 from Emory University Hospital) treated with CC and/or RPLND, with CT scans within 75 days before initiation and after completion of treatment. We analyzed L3 axial CT scans for skeletal muscle index (SMI), subcutaneous adipose index (SAI), and visceral adipose index (VAI). Logistic regression was used to evaluate associations between body composition metrics and grade 3+ AEs and Clavien 3+ post-RPLND complications. RESULTS: Median age for the cohort was 30 years (IQR 25-39) of whom, 47% of men had nonseminomatous GCT (Stage IS, II, and III in 17%, 39%, and 42%, respectively). 182 men received CC including BEP (67%), EP (19%), and VIP (7%), with a median of 3 cycles while 34 men (33%) and 69 men underwent primary and post-CC RPLND, respectively. Median time between CTs was 114 days. Median change in SMI, VAI, and SAI was -6% (Figure 1), +13%, and +11%, respectively. Overall, 79 men (43%) experienced grade 3+ AEs, and 24 men (23%) experienced Clavien 3+ post-RPLND complications. On regression analysis, higher baseline VAI (p=0.048), lower post-CC SMI (p=0.008), and decreased SMI (p=0.047) were associated with increased risk of grade 3+ AE. No baseline body composition metrics or changes therein during CC predicted risk of post-RPLND complications. CONCLUSIONS: We observed a decline in skeletal muscle and an increase in adipose tissue following CC in men with GCT. Both skeletal muscle and adipose tissue metrics were associated with the incidence of chemotherapy-associated adverse events and may have the potential for use in risk evaluation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e690 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claire Buxton More articles by this author Benjamin N. Schmeusser More articles by this author Sarah K. Holt More articles by this author Datta Patil More articles by this author Anthea Phuong More articles by this author J. Peter Marquardt More articles by this author Ryan O'malley More articles by this author Grace Laidlaw More articles by this author George R. Schade More articles by this author Daniel W. Lin More articles by this author Michael T. Schweizer More articles by this author Todd Yezefski More articles by this author Evan Y. Yu More articles by this author Bruce Montgomery More articles by this author Florian J. Fintelmann More articles by this author Sophia Chahine More articles by this author Viraj A. Master More articles by this author Sarah P. Psutka More articles by this author Expand All Advertisement PDF downloadLoading ...

Post-Traumatic Atlanto-Axial Instability: A Combined Clinical and Radiological Approach for the Diagnosis of Pathological Rotational Movement in the Upper Cervical Spine

Post-traumatic rotational instability at the atlanto-axial (C1-2) joint is difficult to assess, much less quantify, due to the orientation and motion plane of the joint. Prior investigations have demonstrated that a dynamic axial CT scan, during which the patient maximally rotates the head right and left, can be used to evaluate and quantify the amount of residual overlap between the inferior articulating facet of C1 and the superior facet of C2, as an index of ligamentous laxity at the joint. We have previously demonstrated that a novel orthopedic test of rotational instability, the atlas-axis rotational test (A-ART), may have utility in identifying patients with imaging evidence of upper cervical ligament injury. In the present investigation, we assessed the correlation between a positive A-ART and a CT scan assessment of the relative quantity of residual C1-2 overlap, as a percent of the superior articulating facet surface area of C2. A retrospective review was conducted of the records of consecutive patients presenting to a physical therapy and rehabilitation clinic, over a 5-year period (2015-20) for chronic head and neck pain after whiplash trauma. The primary inclusion criteria were that the patient had undergone both a clinical evaluation with A-ART and a dynamic axial CT to evaluate for C1-2 residual facet overlap at maximum rotation. The records for a total of 57 patients (44 female/13 male) were identified who fit the selection criteria, and among these, there were 43 with a positive A-ART (i.e., "cases") and 14 with a negative A-ART (i.e., "controls). The analysis demonstrated that a positive A-ART was highly predictive of decreased residual C1-2 facet overlap: the average overlap area among the cases was approximately one-third that of the control group (on the left, 10.7% versus 29.1%, and 13.6% versus 31.0% on the right). These results suggest that a positive A-ART is a reliable indicator of underlying rotational instability at C1-2 in patients with chronic head and neck symptoms following whiplash trauma.

Research on congenital severe-to-profound sensorineural hearing loss associated with central lucency of the bony island of the lateral semicircular canal

Background Central lucency of the bony island of the lateral semicircular canal (LSCC) is commonly found in patients with congenital severe-to-profound sensorineural hearing loss (SNHL). Objective Exploring the significance of bony island lucency of LSCC in congenital severe-to-profound SNHL patients. Material and Methods Retrospective measurements of the inner ear structures were made on axial temporal bone CT scans from 182 (364 ears) congenital severe-to-profound SNHL patients and 50 (100 ears) tympanic membrane perforation (TMP) patients. Results The incidence of bony island lucency of LSCC was 46.7% in the congenital severe-to-profound SNHL group and 0% in the TMP group. There was a statistically significant difference in inner ear structures among congenital severe-to-profound SNHL patients with normal inner ear structure and bony island lucency of LSCC, congenital severe-to-profound SNHL patients with normal inner ear structure and no bony island lucency of LSCC, and TMP patients. The importance of the bony island lucency of LSCC was further confirmed through multiple linear regression analysis. Conclusions and Significance Bony island lucency may have significance in congenital severe-to-profound SNHL and may be a manifestation of largely overlooked SCC malformation or hypoplasia of the inner ear.

Treatment of intra articular fracture calcaneus using sinus tarsi approach, bone block substitute, and screws

Abstract Objective To evaluate the results of fixation of intra articular calcaneus fracture using Sinus Tarsi Approach, bone block substitute, and screws fixation. Background Minimal invasive techniques for treatment calcaneus fractures have developed to overcome soft tissue complications associated with the traditional lateral approach. Sinus Tarsi approach has the advantage of visualization of posterior part of subtalar joint. Methods All patients underwent preoperative calcaneal lateral and axial radiographs and CT scan of the injured foot. The injured type was graded according to the Sanders classification on the basis of the CT scan findings. Bohler and Gissane angles were measured as anatomical parameters before surgery. Sinus Tarsi Approach was done for all patients, in addition to use of percutaneous screws fixation and bone block graft substitute. Results A total of 17 patients were included in our study. The mean age was 37.8 years. At the end of follow-up, radiological evaluation was done by measuring the Bohler angle and the angle of Gissan. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score was calculated at the end of the follow-up for all cases. Excellent results were found in7 patients, good results in 8 patients and fair results in only 2 patients. There was a statistically significant improvement of Bohler angle at the end of the follow-up. Conclusion Treatment of intra articular calcaneal fractures using Sinus Tarsi Approach with a bone block substitute and screws can provide satisfactory clinical outcomes.

Uremic Encephalopathy.

HomeRadiologyVol. 307, No. 1 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyUremic EncephalopathyDavid A. Lizarazo , Jairo LizarazoDavid A. Lizarazo , Jairo LizarazoAuthor AffiliationsFrom the Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá, Universidad El Bosque, Ave 116 No. 9-02, Bogotá 110246, Colombia (D.A.L.); and Department of Internal Medicine, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cúcuta, Colombia (J.L.).Address correspondence to D.A.L. (email: [email protected]).David A. Lizarazo Jairo LizarazoPublished Online:Dec 20 2022https://doi.org/10.1148/radiol.221602MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 54-year-old man was admitted for a 3-day history of dysarthria, hand tremors, hypokinesia, and generalized muscle rigidity. His past medical history included diabetes mellitus and end-stage renal disease on hemodialysis. On admission, there were elevated blood urea nitrogen and creatinine levels with a metabolic acidosis. Axial CT scan of the brain showed symmetrical hypoattenuation of both basal ganglia (Figure). Noncontrast brain T2-weighted MRI demonstrated symmetrical high signal intensity in the basal ganglia surrounded by a more hyperintense rim delineating the lentiform nucleus (Figure). This is the lentiform fork sign, wherein the internal and external capsules and the medullary laminae become hyperintense with axial T2-weighted images (Figure). After correction of the metabolic acidosis with prompt dialysis and glycemic control, the neurologic examination returned to normal, and his symptoms completely resolved. A follow-up MRI examination was not performed.Images in a 54-year-old man who presented with a 3-day evolution of dysarthria, hand tremors, hypokinesia, and generalized muscle rigidity. He had diabetes mellitus and end-stage renal disease and was undergoing hemodialysis. Laboratory tests showed azotemia and metabolic acidosis. (A) Axial CT scan of brain shows symmetrical hypoattenuation in the bilateral basal ganglia. (B) Axial T2-weighted fluid-attenuated inversion recovery noncontrast brain MRI scan demonstrates bilateral symmetrical swollen lentiform nuclei with a hyperintense rim delineating the lentiform nucleus with a typical fork-like appearance representing the “lentiform fork sign.” (C) Schematic drawing shows the “lentiform fork sign.” At follow-up after correction of metabolic acidosis with prompt dialysis and glycaemic control, the neurologic examination was normal, and symptoms completely resolved. Follow-up scan was not performed. EC = external capsule, IC = internal capsule, LME = external medullary lamina, LMI = internal medullary lamina, TS = the stem.Download as PowerPointOpen in Image Viewer Uremic encephalopathy is a neurologic complication resulting from endogenous uremic toxins in patients with severe renal failure. The pathogenesis is complex and unclear (1). The lentiform fork sign (Figure) is attributed to metabolic acidosis in patients with diabetes and renal failure with a history of incomplete dialysis leading to reversible basal ganglia and adjacent white matter injury (2). The edematous external capsule represents the lateral arm of the fork, with both the external and internal capsule joining to build the stem of the fork. Edema of the medial lentiform margin forms the medial arm, which splits into two along the medullary laminae to envelop the globus pallidus (3). The lentiform fork sign is nonspecific for uremic encephalopathy. Differential diagnosis of pathologic conditions manifesting with this sign includes severe metabolic acidosis, ketoacidosis, dialysis disequilibrium syndrome, and intoxication (ie, methanol, ethylene glycol); this can also be drug induced (ie, metformin) (4).Disclosures of conflicts of interest: D.A.L. No relevant relationships. J.L. No relevant relationships.

Abstract 313: Association Of Gray-White Matter Ratio With Severe Cerebral Edema In Comatose Cardiac Arrest Patients

Introduction: Previous studies have shown that lower gray:white matter ratio (GWR) is associated with poor outcomes in patients initially comatose after cardiac arrest. However, those studies focused on survival, a measure that may be confounded by withdrawal of life-sustaining therapy (WLST) decisions. We assessed the association of GWR with severe cerebral edema (SCE), a more objective imaging surrogate for neurologic injury. Methods: We retrospectively analyzed datasets acquired as part of a prospective observational study of 500 cardiac arrest patients with non-traumatic coma. Our analyses were limited to patients who underwent CT within 72 h of arrest, resulting in 151 patients. Some patients underwent repeat imaging, leading to a total of 175 imaging studies. Regions of interests (ROIs; 3x3) were drawn bilaterally in the caudate nuclei (CN) and posterior limbs of the internal capsule (PLIC) at the level of the basal ganglia on non-contrast axial CT scans. GWR was calculated as the ratio of mean x-ray attenuation in the CN to that in the PLIC. Scans whose radiology report described herniation or more than minimal ventricular effacement were classified as SCE. Poor outcome was defined as modified Rankin Scale Score &gt; 4 at 6 months. Results: Patients with SCE were more likely to be younger (P&lt;.0001), have a non-shockable rhythm (P=0.028), have a worse Glasgow Coma Scale (GCS) score on hospital admission (P=0.0047) and have a significantly lower GWR (P&lt;.0001) compared to patients without SCE (see Table 1). Patients with SCE had a higher proportion of deaths at discharge due to brain death (P&lt;0.0001). There was no significant difference in the proportion of patients with poor outcomes between the groups (P=0.13). Conclusion: For patients initially comatose after cardiac arrest, significant reductions in GWR are associated with SCE. Since this study utilized SCE as intermediate outcome measure for neurologic injury, these GWR results are not confounded by WLST decisions.

Posterior acetabular wall morphology is an independent risk factor that affects the occurrence of acetabular wall fracture in patients with traumatic, posterior hip dislocation

PurposeSmaller posterior acetabular walls have been shown to independently influence the risk for bipolar hip dislocation. We asked whether differences would also be observed in patients with traumatic posterior hip dislocation with and without posterior wall fractures.MethodsBetween 2012 and 2020 we observed 67 traumatic posterior hip dislocations. Of these, 43 traumatic posterior hip dislocations in 41 patients met the inclusion criteria. Eighteen dislocations were excluded with an acetabular fracture other than posterior wall fracture and six dislocations had insufficient computed tomography (CT) data. The mean age was 41 ± 11 years, 32 males and nine females. We observed 26 traumatic hip dislocations with posterior wall fractures and 17 without. All patients underwent polytrauma CT scans and postoperative/postinterventional pelvic CT scans. On axial CT-scans, posterior wall determining angles were measured.ResultsPatients with posterior wall fractures were not significantly older than patients without posterior wall fractures (42 ± 12 vs. 38 ± 10 years; p = 0.17). Patients without posterior wall fractures had significantly smaller posterior acetabular sector angles (84° ± 10°) than did patients with posterior wall fractures (105° ± 12°) (p < 0.01; OR 1.178). Likewise, the posterior wall angle was significantly smaller in patients without posterior wall fracture (62° ± 9°) than in those with posterior wall fractures (71° ± 8°) (p < 0.01; OR 1.141).ConclusionBoth posterior acetabular sector angle and posterior wall angle are independent factors determining the posterior wall fracture morphology in patients with traumatic posterior hip dislocation. Age and the observed trauma mechanism did not differentiate between traumatic posterior hip dislocations with and without posterior wall fractures.

S1836 Six Years of Evolution With Portal Cavernomatosis and Portal Biliopathy

Introduction: In patients with Portal Biliopathy (PB), It is paramount to engage several branches of gastroenterology to interject the aggressive evolution of this condition. Case Description/Methods: Our patient is a Man of 45 years old. Medical history of pancreatic divisum, chronic pancreatitis, biliary litho extraction, cholecystectomy, use of endoprosthesis, and pancreatic conduct stenosis. On CT scans in February 2015 he presented a pancreatitis Baltazar E, generating a perfusion defect, and multiple collaterals, in Abril 2015 portal cavernomatosis, and by January 2018 the collateral veins provoked biliary ectasis. During the next 2 years, he presented two events of mild cholangitis. To solve the choledochal impingement, on October 8, 2019, it took place a portal vein angioplasty with a balloon. The direct extrahepatic portal vein pressure was 30 mmHg pre-plasty, diminishing to 22 mmHg post-plasty. Posterior to the intervention, he had a new severe healthcare-associated colangitis plus acute pancreatitis, with a 7 mm dilatation only in the intrahepatic biliary pathway. To improve the biliary stasis, by CPRE it was placed a metallic stent covered with a Wallflex 10 mm x 8 cm. By February 2020, a CT scan still showed a permeable porta in the confluence, yet the portal prosthesis was not visible. Finally in September 2021, without clinic traits of portal hypertension, events of cholestasis, and improvement in hepatic function. (Figure) Discussion: In the biliary tract, venous drainage passes through two venous plexus named, the epicholedochal venous plexus of Saint and the paracholedochal venous plexus of Petren. In portal biliopathy, changes are a result of dilatation of veins of the plexus of Saint, causing bile duct impingement. It has been hypothesized that this lead to fibrous scarring of porta hepatis, and ischemic injury to the bile ducts resulting in stricture formation and caliber irregularity with upstream dilatation. Several studies have shown that bile duct changes occur in 81–100% of patients with extrahepatic portal vein obstruction, but only 5–30% of patients present symptoms of biliary obstruction. In adults conditions such as thrombophilia, intra-abdominal infection, malignancy, myeloproliferative disorders and cirrhosis have been implicated PB is mainly a feature of extrahepatic portal venous obstruction, patients presenting with symptoms require an integrated management addressing biliary obstruction and portal hypertension in tandem. However, the relief of both conditions is only temporary.Figure 1.: Top. Initial axial CT scan following the known event of acute pancreatitis, showing acute splenic-portal venous thrombosis demonstrated by unenhanced and distended portal vein (yellow arrow in a). The middle image three months later shows the formation of small collateral vessels in the hepatic hilium, (yellow arrow in b), and also notes new-onset ascites due to impaired liver function. Coronal reformat image two years later, points to the focal area of chronic portal thrombosis, yellow arrow in (c) with more prominent appearance collateral vessels “cavernomatosis” (asterisk), several perfusion defects in the liver parenchyma, and marked splenomegaly. Middle. DSA images, in (a) transhepatic percutaneous venography with opacification of intrahepatic portal vasculature with a sudden interruption in the site of thrombosis (yellow arrow in a). (b) splenic approach with opacification of the extrahepatic portal vein and aneurismatic collateral vessels due to cavernomatosis and upstream thrombotic interruption (yellow arrow in b). (c) final imagen after portal vein angioplasty demonstrates adequate and complete opacification of the portal vein and its branches. Bottom. ERCP in (a) shows intrahepatic bile duct dilatation and impingement and (b) after stent placement with diminished dilatation.

Medical decision support system using weakly-labeled lung CT scans.

PurposeDetermination and development of an effective set of models leveraging Artificial Intelligence techniques to generate a system able to support clinical practitioners working with COVID-19 patients. It involves a pipeline including classification, lung and lesion segmentation, as well as lesion quantification of axial lung CT studies.ApproachA deep neural network architecture based on DenseNet is introduced for the classification of weakly-labeled, variable-sized (and possibly sparse) axial lung CT scans. The models are trained and tested on aggregated, publicly available data sets with over 10 categories. To further assess the models, a data set was collected from multiple medical institutions in Colombia, which includes healthy, COVID-19 and patients with other diseases. It is composed of 1,322 CT studies from a diverse set of CT machines and institutions that make over 550,000 slices. Each CT study was labeled based on a clinical test, and no per-slice annotation took place. This enabled a classification into Normal vs. Abnormal patients, and for those that were considered abnormal, an extra classification step into Abnormal (other diseases) vs. COVID-19. Additionally, the pipeline features a methodology to segment and quantify lesions of COVID-19 patients on the complete CT study, enabling easier localization and progress tracking. Moreover, multiple ablation studies were performed to appropriately assess the elements composing the classification pipeline.ResultsThe best performing lung CT study classification models achieved 0.83 accuracy, 0.79 sensitivity, 0.87 specificity, 0.82 F1 score and 0.85 precision for the Normal vs. Abnormal task. For the Abnormal vs COVID-19 task, the model obtained 0.86 accuracy, 0.81 sensitivity, 0.91 specificity, 0.84 F1 score and 0.88 precision. The ablation studies showed that using the complete CT study in the pipeline resulted in greater classification performance, restating that relevant COVID-19 patterns cannot be ignored towards the top and bottom of the lung volume.DiscussionThe lung CT classification architecture introduced has shown that it can handle weakly-labeled, variable-sized and possibly sparse axial lung studies, reducing the need for expert annotations at a per-slice level.ConclusionsThis work presents a working methodology that can guide the development of decision support systems for clinical reasoning in future interventionist or prospective studies.

Changes in Patellar Morphology Following Soft Tissue Surgical Correction of Recurrent Patellar Dislocation in Children with Low-Grade Trochlear Dysplasia.

ObjectiveTo investigate the changes in patellar morphology following soft tissue surgical correction of recurrent patellar dislocation in children with low‐grade trochlear dysplasia.MethodsThe prospective cohort study was performed between November 2007 and December 2012. Finally, 25 cases, with the mean age of 8.4 years (range from 7 to 10 years), were admitted to the study. All patients were diagnosed as bilateral recurrent patellar dislocation associated with femoral trochlear dysplasia. The knee that suffered injury or was dislocated was treated with medial patellar retinacular plasty (surgery group). The contralateral knee, which served as a control, was treated conservatively (conservative group). Axial CT scans were undertaken in all patients to assess the patellar morphological characteristics.ResultsThe mean follow‐up time was 60.8 months (range 48 to 75 months). Preoperatively, there were no statistically significant differences between the patellar morphology in the two groups (P > 0.05). Many radiological parameters of patellar morphology were significantly different between the two groups at the final follow‐up, including well‐known parameters, such as the mean patellar width (surgery group, 40.58 mm [SD 1.26]; conservative group, 36.41 mm [SD 1.17]; P < 0.05), the mean patellar thickness (surgery group, 11.59 mm [SD 0.74]; conservative group, 9.38 mm [SD 0.56]; P < 0.05) and the mean Wiberg index (surgery group, 0.54 [SD 0.06]; conservative group, 0.72 [SD 0.08]; P < 0.05). There are also little‐known parameters, such as the ratio of length of lateral patella to medial patella (surgery group, 1.26 [SD 0.17]; conservative group, 1.69 [SD 0.21]; P < 0.05), which was a measurement of facet asymmetry. However, the Wiberg angle was not significantly different between the two groups (surgery group, 128.63° [SD 9.05]; conservative group, 125.47° [SD 13.96°]; P > 0.05) at the final follow‐up. No complications were found.ConclusionsThe patellar morphology can be significantly improved by early soft tissue surgical correction in children with patellar instability associated with low‐grade femoral trochlear dysplasia.