Bony Features Research Articles

Refinement of clinical X-ray computed tomography (CT) scans containing metal implants

X-ray computed tomography (CT) data contains artefacts from many sources, with sufficient prominence to affect diagnostic utility when metal is present in the scans. These artefacts can be reduced, usually by the removal and in-filling of any sinogram data which has been affected by metal, and several such techniques have been proposed. Most of them are prone to introducing new artefacts into the CT data or may take a long time to correct the data. It is the purpose of this paper to introduce a new technique which is fast, yet can effectively remove most artefacts without introducing significant new ones. The new metal artefact reduction technique (RMAR) consists of an iterative refinement of the CT data by alternately forward- and back-projecting the part of the reconstruction near to metal. The forward-projection is corrected by making use of a prior derived from the reconstructed data which is independently estimated for each projection angle, and smoothed using a newly developed Bitonic filter. The new technique is compared with previously published (LI, NMAR, MDT) and commercial (O-MAR, IMAR) alternatives, quantitatively on phantom data, and qualitatively on a selection of clinical scans, mostly of the hip. The phantom data is from two recently published studies, enabling direct comparison with previous results. The results show an increased reduction of artefacts on the four phantom data sets tested. On two of the phantom data sets, RMAR is significantly better (p<0.001) than all other techniques; on one it is as good as any other technique, and on the last it is only beaten by the Metal Deletion Technique (p<0.001), which is significantly slower. On the clinical data sets, RMAR shows visually similar performance to MDT, with better preservation of bony features close to metal implants, but perhaps slightly reduced homogeneity in the far field. For typical CT data, RMAR can correct each image in 3–8s, which is more than one hundred times faster than MDT. The new technique is demonstrated to have performance at least as good as MDT, with both out-performing other approaches. However, it is much faster then the latter technique, and shows better preservation of data very close to metal.

Effectiveness of Video Demonstration over Conventional Methods in Teaching Osteology in Anatomy.

Technology and its applications are the most happening things in the world. So, is it in the field of medical education. This study was an evaluation of whether the conventional methods can compete with the test of technology. A comparative study of traditional method of teaching osteology in human anatomy with an innovative visual aided method. The study was conducted on 94 students admitted to MBBS 2014 to 2015 batch of Travancore Medical College. The students were divided into two academically validated groups. They were taught using conventional and video demonstrational techniques in a systematic manner. Post evaluation tests were conducted. Analysis of the mark pattern revealed that the group taught using traditional method scored better when compared to the visual aided method. Feedback analysis showed that, the students were able to identify bony features better with clear visualisation and three dimensional view when taught using the video demonstration method. The students identified visual aided method as the more interesting one for learning which helped them in applying the knowledge gained. In most of the questions asked, the two methods of teaching were found to be comparable on the same scale. As the study ends, we discover that, no new technique can be substituted for time tested techniques of teaching and learning. The ideal method would be incorporating newer multimedia techniques into traditional classes.

Zygomatic Arch Cortical Area and Diet in Haplorhines.

The influence that various types of ingested foods have on the form (size and shape) of specific features of the masticatory system is an area in which many questions remain unanswered. The bony zygomatic arch, the focus of this study, is directly linked to the masticatory system because it serves as the anchor for the masseter muscle, a primary muscle of chewing and source of masticatory force. However, the influence of diet and the forces associated with different diet types on the arch's internal bone architecture is not well understood. Despite the breadth of work centered around the craniofacial complex and biomechanics of mastication, there is a need for further investigations into the functional relationships between specific bony features that experience high strains, (e.g., the zygomatic arch), and the masticatory forces generated by different diets (e.g., mechanically resistant versus non- mechanically resistant) across non-human primates. A hypothesis and series of predictions assessing diet in relation to variability in cortical area distributions and values of section moduli (measures of bone strength) throughout the zygomatic arch were tested in a sample of haplorhine primates. Cortical area and measures of section moduli appear to track with the known masticatory strain distribution along the zygomatic arch. Pairwise comparisons between closely related taxa of different diets reveal significant differences in anterior cortical area and section moduli values. These results imply that differences in masticatory loading due to diet manifest in the zygomatic arch's internal bone structure. Anat Rec, 299:1789-1800, 2016. © 2016 Wiley Periodicals, Inc.

Biochemical effect of a histidine phosphatase acid (phytase) of Aspergillus japonicus var. Saito on performance and bony characteristics of broiler.

Phytases are enzymes that hydrolyze the ester linkage of phytic acid, releasing inositol and inorganic phosphate. The phytic acid (phytate) is a major form of phosphorus in plant foods. Knowing that diet for animal of production has the cereal base (corn and soybean), primarily, broilers need for an alternative to use of the phosphate present in these ingredients, since it does not naturally produce the enzyme phytase, which makes it available. The aims of this work was studding the safe supplementation of Aspergillus japonicus var. Saito crude phytase in feeding broilers and check the biochemical effect on performance and bones of these animals. The enzymatic extract did not have aflatoxins B1, B2, G2 and G1 and zearalenone and ochratoxin, and low concentrations of this extract did not have cytotoxic effects on cells derived from lung tissue. The in vivo experiments showed that the phytase supplied the available phosphate reduction in the broiler feed formulation, with a live weight, weight gain, feed intake, feed conversion, viability, productive efficiency index and carcass yield similar to the control test. Furthermore, the phytase supplementation favored the formation of bone structure and performance of the broilers. The results show the high biotechnological potential of A. japonicus phytase on broiler food supplementation to reduce phosphorus addition in the food formulation. So, this enzyme could be used as a commercial alternative to animal diet supplementation.

Suppression of the low spatial frequency effects of scattered radiation in digital radiography

One of the deleterious effects of scattered radiation in the digital radiograph is to add a slowly varying background to the image. This can reduce the ability of the observer to discern low contrast signals if the background gradient over a signal feature prevents the use of a small enough display window to make the signal visible. This paper presents an image processing scheme for suppressing the low spatial frequency effects of scattered radiation in digital radiography and demonstrates it on a range of clinical and phantom images. The approach relies on the approximate separation of high atomic number bony features from the low atomic number soft tissue background, and the use of forward convolution with a scatter kernel to produce an estimate of the scatter distribution arising from the soft tissue background. This is then scaled by an estimate of the soft tissue scatter fraction and subtracted from the original image to produce the final scatter-suppressed image. The implementation employs many approximations in order to make use of information that is readily available in the image headers of current x-ray imaging systems. The performance of the image processing scheme is demonstrated on phantom and clinical images. It is argued that clinical application of the approach could employ a user-controlled scatter subtraction step that would reduce any risk of misinterpretation of the processed image.

CT-Based Morphological Analysis of Isolated Inferior and Medial Blow-out Orbital Fractures in Korean Adults

Purpose: To evaluate morphologic differences in isolated inferior medial orbital wall fractures (OWF) based on computed tomography scans.Methods: This was a retrospective observational case study of 22 patients with an isolated inferior OWF and 32 patients with an isolated medial fracture between January 2008 and August 2010. We analyzed patient demographics and bony radiologic characteristics on CT scans, including the length and height of the lamina papyracea, the number of ethmoid air cell septa, the length of the anterior and posterior border of the orbital floor, the thickness of the orbital floor maxillary bone, and the axial length of the eyeball.Results: There were no significant differences in sex, laterality, or concomitant intraocular injury between the two groups. The anteroposterior length (p = 0.391), the number of ethmoid septa (p = 0.869), and the thickness of the orbital floor (p = 0.419) did not differ significantly. The anterior (p < 0.001) or posterior (p = 0.014) height of the lamina papyracea, the lamina papyracea area (p < 0.001), and the lamina papyracea area/ethmoid air cell septa (p = 0.024) were significantly higher in the medial OWF group, while the anterior (p = 0.026) or posterior (p < 0.001) border length of the orbital floor and the axial length (p = 0.047) and volume (p = 0.034) of the eyeball were longer and smaller, respectively, in the inferior OWF group.Conclusions: Patients with a longer anterior or posterior border of the orbital floor, a shorter axial length, and a smaller eyeball volume are more likely to incur an isolated inferior OWF than an isolated medial OWF.

Intraoperative CT as a registration benchmark for intervertebral motion compensation in image-guided open spinal surgery.

An accurate and reliable benchmark of registration accuracy and intervertebral motion compensation is important for spinal image guidance. In this study, we evaluated the utility of intraoperative CT (iCT) in place of bone-implanted screws as the ground-truth registration and illustrated its use to benchmark the performance of intraoperative stereovision (iSV). A template-based, multi-body registration scheme was developed to individually segment and pair corresponding vertebrae between preoperative CT and iCT of the spine. Intervertebral motion was determined from the resulting vertebral pair-wise registrations. The accuracy of the image-driven registration was evaluated using surface-to-surface distance error (SDE) based on segmented bony features and was independently verified using point-to-point target registration error (TRE) computed from bone-implanted mini-screws. Both SDE and TRE were used to assess the compensation accuracy using iSV. The iCT-based technique was evaluated on four explanted porcine spines (20 vertebral pairs) with artificially induced motion. We report a registration accuracy of 0.57 [Formula: see text] 0.32 mm (range 0.34-1.14mm) and 0.29 [Formula: see text] 0.15 mm (range 0.14-0.78mm) in SDE and TRE, respectively, for all vertebrae pooled, with an average intervertebral rotation of [Formula: see text] (range 1.5[Formula: see text]-7.9[Formula: see text]). The iSV-based compensation accuracy for one sample (four vertebrae) was 1.32 [Formula: see text] 0.19mm and 1.72 [Formula: see text] 0.55mm in SDE and TRE, respectively, exceeding the recommended accuracy of 2mm. This study demonstrates the effectiveness of iCT in place of invasive fiducials as a registration ground truth. These findings are important for future development of on-demand spinal image guidance using radiation-free images such as stereovision and ultrasound on human subjects.

The Human Shoulder Suspension Apparatus: A Causal Explanation for Bilateral Asymmetry and a Fresh Look at the Evolution of Human Bipedality.

The combination of large mastoid processes and clavicles is unique to humans, but the biomechanical and evolutionary significance of their special configuration is poorly understood. As part of the newly conceptualized shoulder suspension apparatus, the mastoid processes and clavicles are shaped by forces exerted by the musculo-fascial components of the cleidomastoid and clavotrapezius muscles as they suspend the shoulders from the head. Because both skeletal elements develop during infancy in tandem with the attainment of an upright posture, increased manual dexterity, and the capacity for walking, we hypothesized that the same forces would have shaped them as the shoulder suspension apparatus evolved in ancestral humans in tandem with an upright posture, increased manual dexterity, and bipedality with swinging arms. Because the shoulder suspension apparatus is subjected to asymmetrical forces from handedness, we predicted that its skeletal features would grow asymmetrically. We used this prediction to test our hypothesis in a natural experiment to correlate the size of the skeletal features with the forces exerted on them. We (1) measured biomechanically relevant bony features within the shoulder suspension apparatus in 101 male human specimens (62 of known handedness); and (2) modeled and analyzed the forces within the shoulder suspension apparatus from X-ray CT data. We identified eight right-handed characters and demonstrated the causal relationship between these right-handed characters and the magnitude and direction of forces acting on them. Our data suggest that the presence of the shoulder suspension apparatus in humans was a necessary precondition for human bipedality.

Genetically induced abnormal cranial development in human trisomy 18 with holoprosencephaly: comparisons with the normal tempo of osteogenic-neural development.

Craniofacial malformations are common congenital defects caused by failed midline inductive signals. These midline defects are associated with exposure of the fetus to exogenous teratogens and with inborn genetic errors such as those found in Down, Patau, Edwards' and Smith-Lemli-Opitz syndromes. Yet, there are no studies that analyze contributions of synchronous neurocranial and neural development in these disorders.Here we present the first in-depth analysis of malformations of the basicranium of a holoprosencephalic (HPE) trisomy 18 (T18; Edwards' syndrome) fetus with synophthalmic cyclopia and alobar HPE. With a combination of traditional gross dissection and state-of-the-art computed tomography, we demonstrate the deleterious effects of T18 caused by a translocation at 18p11.31.Bony features included a single developmentally unseparated frontal bone, and complete dual absence of the anterior cranial fossa and ethmoid bone. From a superior view with the calvarium plates removed, there was direct visual access to the orbital foramen and hard palate. Both the eyes and the pituitary gland, normally protected by bony structures, were exposed in the cranial cavity and in direct contact with the brain. The middle cranial fossa was shifted anteriorly, and foramina were either missing or displaced to an abnormal location due to the absence or misplacement of its respective cranial nerve (CN). When CN development was conserved in its induction and placement, the respective foramen developed in its normal location albeit with abnormal gross anatomical features, as seen in the facial nerve (CNVII) and the internal acoustic meatus. More anteriorly localized CNs and their foramina were absent or heavily disrupted compared with posterior ones. The severe malformations exhibited in the cranial fossae, orbital region, pituitary gland and sella turcica highlight the crucial involvement of transcription factors such as TGIF, which is located on chromosome 18 and contributes to neural patterning, in the proper development of neural and cranial structures. Our study of a T18 specimen emphasizes the intricate interplay between bone and brain development in midline craniofacial abnormalities in general.

The Predictability from Skull Morphology of Temporalis and Masseter Muscle Cross-Sectional Areas in Humans.

To carry out functional simulations of the masticatory system that aim to predict strain magnitudes it is important to apply appropriate jaw-elevator muscle forces. Force magnitude estimation from directly measured muscle physiological cross-sectional area or anatomical cross-sectional area (CSA) is not possible for fossils and skeletal material from museum collections. In these cases, muscle CSAs are often estimated from bony features. This approach has been shown to be inaccurate in a prior study based on direct measurements from cadavers. Postmortem alterations as well as age changes in muscle form might explain this discrepancy. As such, the present study uses CT images from 20 living individuals to directly measure temporalis and masseter muscle CSAs and estimated cross-sectional areas (ECSAs) from bony features. The relationships between CSAs and ECSAs were assessed by comparing mean values and by examining correlations. ECSAs are up to 100% greater than CSA and the means of these variables for each muscle differ significantly. Further, ECSA is significantly correlated with CSA for temporalis but not masseter. Cranial centroid size is only significantly associated with CSA for temporalis. These findings indicate that ECSAs should be employed with caution in simulations of human masticatory system functioning; they do not reflect CSAs and it is plausible that this also applies to studies of closely related living and fossil taxa. When ECSAs are used, sensitivity analyses are required to determine the impact of potential errors.

Medial Orbital Wall Landmarks in Three Different North American Populations

Purpose: We sought to measure the medial orbital wall foramina distances in two previously unstudied populations, to describe a new bony medial wall feature, and to validate the accuracy of a new coordinate measurement device within the orbit.Methods: Dried, well-preserved, complete human skulls without orbital defects were studied. Age, gender, birthplace, ethnicity, and laterality of the orbit were recorded for each skull. Supranumerary ethmoidal foramina were recorded, and the fronto-ethmoidal groove depth was measured. The distances between the anterior lacrimal crest (ALC) – anterior ethmoidal foramen (AEF), AEF – posterior ethmoidal foramen (PEF), and PEF – optic canal (OC) were measured first by surgical ruler and wire and then by the Microscribe coordinate measurement device.Results: One hundred and forty-six orbits were studied. Fifty-seven orbits were of European or Caucasian descent, 68 orbits of African American descent, 2 orbits of West African descent, 11 orbits of Eskimo descent, and 8 orbits of unknown origin. No significant differences existed between the manual and Microscribe measurements for the ALC-AEF, AEF-PEF, and PEF-OF distances (p < 0.0001). A significant frontoethmoidal groove was observed in 27/146 (19%) orbits, in 6/57 (11%) Caucasian orbits, in 17/70 (24%) African American orbits, and in 4/11 (36%) Eskimo orbits. Supranumerary ethmoidal foramina were found in 50/146 orbits (34.2%) and in 17/27 (63%) orbits with a significant frontoethmoidal grooves.Conclusions: No significant differences in medial wall foramina distances exist between African American and Caucasian orbits; however, a frontoethmoidal groove occurs more commonly in African American orbits. This groove often occurs in the presence of supernumerary ethmoidal foramina. The Microscribe coordinate measurement system represents a valid tool to measure distances within the orbit.

Three-dimensional stereotactic atlas of the adult human skull correlated with the brain, cranial nerves, and intracranial vasculature

BackgroundAlthough the adult human skull is a complex and multifunctional structure, its 3D, complete, realistic, and stereotactic atlas has not yet been created. This work addresses the construction of a 3D interactive atlas of the adult human skull spatially correlated with the brain, cranial nerves, and intracranial vasculature. New methodThe process of atlas construction included computed tomography (CT) high-resolution scan acquisition, skull extraction, skull parcellation, 3D disarticulated bone surface modeling, 3D model simplification, brain–skull registration, 3D surface editing, 3D surface naming and color-coding, integration of the CT-derived 3D bony models with the existing brain atlas, and validation. ResultsThe virtual skull model created is complete with all 29 bones, including the auditory ossicles (being among the smallest bones). It contains all typical bony features and landmarks. Comparison with existing method(s)The created skull model is superior to the existing skull models in terms of completeness, realism, and integration with the brain along with blood vessels and cranial nerves. ConclusionsThis skull atlas is valuable for medical students and residents to easily get familiarized with the skull and surrounding anatomy with a few clicks. The atlas is also useful for educators to prepare teaching materials. It may potentially serve as a reference aid in the reading and operating rooms.

Predicting anatomical landmarks and bone morphology of the femur using local region matching.

Anatomical landmarks and bony features are frequently used in biomechanical and surgical applications. The purpose of this study was to develop a local region matching-based anatomical landmark prediction method. A reference femur model with anatomical landmarks and a surface division map was prepared. Initial registration between the reference femur model and a target femur model was performed in three-dimensional Cartesian space, and closest point pairs were determined by the initial surface correspondence. The models were mapped to unit spheres through spherical parameterization. Spherical registration using the closest point pairs in the spherical parametric space enabled the application of a division map from the reference model to the target model. The reference and target models were divided into local regions defined in the division map, and the corresponding regions were again registered in Cartesian space. Anatomical landmarks in the local regions were identified in the target model. The accuracy of the proposed method was tested for anatomical landmarks marked by a clinician on 35 femoral models. The effectiveness of local region matching was demonstrated by automatic measurements of the femoral neck-shaft angle. The average prediction error for all eight anatomical landmarks of the femur was 2.74 (±1.78) mm. The average of the predicted neck-shaft angle for our Korean subjects was 126.41° (±4.92°), which was comparable to previous studies in Japanese and Chinese populations. Anatomical landmarks and features could be accurately predicted using the proposed local region matching method. This method offers robustness and accuracy in determining anatomical bony landmarks and bone morphology for clinical and biomechanical applications.

Lumbar vertebral morphology of flying, gliding, and suspensory mammals: Implications for the locomotor behavior of the subfossil lemurs Palaeopropithecus and Babakotia

Lumbar vertebral morphology has been used as an indicator of locomotor behavior in living and fossil mammals. Rigidity within the lumbar region is thought to be important for increasing overall axial rigidity during various forms of locomotion, including bridging between supports, inverted quadrupedalism, gliding, and flying. However, distinguishing between those behaviors using bony features has been challenging. This study used osteological characters of the lumbar vertebrae to attempt to develop fine-grade functional distinctions among different mammalian species in order to make more complete inferences about how the axial skeleton affects locomotor behavior in extant mammals. These same lumbar characters were measured in two extinct species for which locomotor behaviors are well known, the sloth lemurs (Palaeopropithecus and Babakotia radofilai), in order to further evaluate their locomotor behaviors.Results from a principal components analysis of seven measurements, determined to be functionally significant from previous studies, demonstrate that inverted quadrupeds in the sample are characterized by dorsoventrally short and cranio-caudally expanded spinous processes, dorsally oriented transverse processes, and mediolaterally short and dorsoventrally high vertebral bodies compared with mammals that are relatively pronograde, vertical clingers, or gliders. Antipronograde mammals, dermopterans, and chiropterans also exhibit these traits, but not to the same extent as the inverted quadrupeds. In accordance with previous studies, our data show that the sloth lemur B. radofilai groups closely with antipronograde mammals like lorises, while Palaeopropithecus groups with extant sloths. These findings suggest that Palaeopropithecus was engaged in inverted quadrupedalism at a high frequency, while B. radofilai may have engaged in a more diverse array of locomotor and positional behaviors. The osteological features used here reflect differences in lumbar mobility and suggest that axial rigidity is advantageous for suspensory locomotion and possibly flight in bats.

Differences in the Association of Hip Cartilage Lesions and Cam-Type Femoroacetabular Impingement With Movement Patterns: A Preliminary Study

To investigate the differences in hip movement patterns during different daily and athletic activities in persons with cam-type femoroacetabular impingement (FAI) with and without cartilage lesions compared with control subjects in a preliminary study. Controlled laboratory study using a cross-sectional design. Research institution with a tertiary care medical center. Fifteen subjects [M:F, 13:2; age, 31.6 ± 9.7 years (range, 22-52 years); body mass index, 24.9 ± 4.6 (range, 18.8-38.4); FAI:control, 7:8]. All subjects had 3-Tesla magnetic resonance imaging of the hip and also underwent 3-dimensional motion capture during walking, deep-squat, and drop-landing tasks. Experienced radiologists graded cartilage lesions on clinical magnetic resonance images. Peak kinematic and kinetic variables were compared between subjects who did and did not have FAI, and subjects who had FAI and cartilage lesions were compared with subjects who did not have cartilage lesions. Subjects who had FAI demonstrated no significant differences for walking or drop landing compared with control subjects. However, during the deep-squat task, subjects with FAI adducted more and had a greater internal rotation moment. Subjects who had cartilage lesions in the presence of a cam lesion demonstrated (1) no difference for walking; (2) greater adduction, greater internal rotation moment, and lower transverse plane range of motion during the deep-squat task; and (3) greater adduction and lower internal rotation during the drop-landing task compared with subjects who did not have cartilage lesions. We observed differences in movement patterns between subjects who had FAI compared with control subjects. However, the differences were more pronounced between subjects with FAI who had cartilage lesions compared with subjects who did not have cartilage lesions. These findings highlight the importance of understanding the complex interplay between bony morphologic features, cartilage lesions, and movement patterns in persons with cam-type FAI.

A genderwise study on the morphometry of infraorbital foramen and its laterally in dry adult skulls of South Indian population

Background: The infraorbital foramen is situated in the maxilla and it conveys infraorbital nerve and vessel, the knowledge of its morphometry and variations is therefore mandatory to do therapeutic infraorbital nerve block or any clinical procedures. Aims & Objective: To study the gender wise morphometry of infraorbital foramen and its laterality in dry adult skulls of south Indian population. Materials and Methods: In the present study we examined 100 infraorbital foramina and measured its distance with bony features adjacent to it and the shape, presence of accessory foramina were analysed in relation to gender. The infraorbital foramen was the landmark from which the distance between the following bony structures were examined; Nasion (NAS), Zygomatico-maxillary suture (ZMS), Anterior nasal spine (ANS), and the distance between the inferior orbital rim(IOR) to optic canal (OC), infraorbital foramen IOF), inferior and superior orbital fissure (IF & SF). The average mean and standard deviation were calculated for every measurement. Paired t – test was used to compare the parameters between sides and gender for each measurement. Results: The most common shape of infraorbital foramen found in the present study is oval (39%) followed by semilunar (27%). Round shaped foramen was found in 22% of skulls, triangle shaped foramen was found in 12% and accessory foramina were present in 11% of the skulls. In the present study, we found triangle shaped foramen in 12% skulls and also the number of accessory foramina was found to be higher which emphasise the need to take ethnicity into account as triangle shaped foramen is unique in south Indian population as affirmed by previous authors. Conclusion: The results show significance with respect to gender and side which makes the knowledge of its morphometry obligatory for clinical procedures.

Authors’ reply to the letter to the editor of P.M. Foye et al. concerning “CT Morphology and Morphometry of the normal adult coccyx” by Woon JT et al. (2013); Eur Spine J 22(4):863–870

We thank the correspondents for their kind comments about our recently published study [1]. We agree with their statement that certain bony features present in normal adults could nevertheless be a potential source of pain in some patients with coccydynia. Indeed, this prompted us to complete a further study comparing the bony morphology of the coccyx in normal adults with that in patients with coccydynia, which we have recently published [2]. In this study, women with coccydynia were found to have a significantly higher frequency of bony spicule formation than normal women (44 vs. 19 %; P < 0.01). Affected women also had a significantly more ventrally curved coccyx and a lower prevalence of sacrococcygeal joint fusion. These data will hopefully provide a better understanding of the static bony changes present on cross-sectional imaging in patients with coccydynia.

Magnetic Resonance Imaging Morphology and Morphometry of the Coccyx in Coccydynia

Retrospective case-control study. To determine if differences exists between the bony anatomy of the coccyx in patients with coccydynia and that in subjects with no known coccygeal pathology. Numerous bony characteristics of the coccyx have been described in patients with coccydynia but their significance is uncertain. This study aimed to evaluate these in patients with coccydynia and compare them with normal coccyges. Magnetic resonance scans of the coccyx from 107 adults (mean age, 43 ± 12 yr; 84 females) with clinically diagnosed coccydynia were retrospectively analyzed and compared with 112 computed tomographic scans from sex-matched adults with normal coccyges. The following were assessed: coccygeal segmentation; sacrococcygeal and intercoccygeal joint fusion, angles, and curvature; bony spicule formation; and subluxation. Compared with normal, females with coccydynia had a more ventrally curved coccyx (curvature index, 85 ± 7 vs. 90 ± 5; P< 0.01), a lower prevalence of sacrococcygeal joint fusion (27% vs. 58%, P< 0.01), and a higher frequency of bony spicule formation (44% vs. 19%, P< 0.01). Males with coccydynia showed a trend toward a more ventrally curved coccyx (curvature index: 86 ± 6 vs. 89 ± 5, P< 0.08), and a lower prevalence of sacrococcygeal (27% vs. 60%, P< 0.02) and intercoccygeal (0% vs. 22%, P< 0.02) joint fusion. Combining statistically significant coccygeal parameters in a logistic regression model yielded sensitivity, specificity, and positive predictive values of 72%, 71%, and 73%, respectively in females and 52%, 92%, and 73%, respectively in males. This is the most detailed comparison of coccygeal morphology and morphometry in adults with and without coccydynia investigated using cross-sectional imaging. Anatomical differences in joint fusion and coccygeal curvature may either predispose to the development of coccydynia or arise as a result of this condition.

Fibrous dysplasia in a 120,000+ year old Neandertal from Krapina, Croatia.

We describe the first definitive case of a fibrous dysplastic neoplasm in a Neandertal rib (120.71) from the site of Krapina in present-day Croatia. The tumor predates other evidence for these kinds of tumor by well over 100,000 years. Tumors of any sort are a rare occurrence in recent archaeological periods or in living primates, but especially in the human fossil record. Several studies have surveyed bone diseases in past human populations and living primates and fibrous dysplasias occur in a low incidence. Within the class of bone tumors of the rib, fibrous dysplasia is present in living humans at a higher frequency than other bone tumors. The bony features leading to our diagnosis are described in detail. In living humans effects of the neoplasm present a broad spectrum of symptoms, from asymptomatic to debilitating. Given the incomplete nature of this rib and the lack of associated skeletal elements, we resist commenting on the health effects the tumor had on the individual. Yet, the occurrence of this neoplasm shows that at least one Neandertal suffered a common bone tumor found in modern humans.

Transient high density vertebral bone lesions

The contrast-enhanced CTexamination revealed sclerotic-like lesions associated with consecutive anterior and posterior elements from the fourth cervical vertebra to the fifth thoracic vertebra, without any lytic components, which could at first be considered as bony metastases (Fig. 1a–b). CT scan also highlighted significant collateral venous circulation secondary to a brachiocephalic left venous thrombosis. A PET-CT performed at the same time was negative. A non-contrast CT scan performed 10 days later did not reveal the initially noted bone lesions (Fig. 2a–b) and suggested diagnosis of intraosseous venous contrast media. The 1-year non-contrast CT follow-up did not show any progression of the disease. Given the lack of corresponding findings on the unenhanced CT, in the setting of central venous obstruction and collateral pathway formation, the high-attenuation lesions seen on the enhanced CTexamination can be explained by the presence of intraosseous venous collaterals. In fact, the left brachiocephalic vein obstruction was responsible for the development of an extensive collateral venous pathway (Fig. 2c–d) involving the mediastinum, anterior jugular veins, anterior, and basivertebral venous plexi. The venous pressure in the dilated capillaries allowed marrow enhancement through the anastomosis capillary sites: basivertebral veins bed (between the anterior external plexus and the posterior internal plexi) and pedicular sites (between the intervertebral veins and the vertebral plexi) (Fig. 3a–b). Our patient remained asymptomatic despite the huge collateral venous substitution. The rate of injection of contrast and the time of image acquisition following contrast injection might be factors influencing the appearance of these findings. Chest collateral veins usually occur in superior vena cava obstruction and then develop through four classic pathways: azygos and hemiazygos, internal thoracic and laterothoracic, superficial thoracoabdominal, and vertebral venous plexus (posterior way) [1, 2]. These patients usually present with a symptomatic superior vena cava syndrome [3]. Less frequently, chest collateral veins can develop secondary to unilateral thrombosis of the brachiocephalic venous trunk, as in our case where the posterior pathway was involved [4]. Several cases of visceral abnormalities related to superior vena cava syndrome, including pericardial and hepatic enhancement, have been described [5]. However, bone involvement is uncommon. Only, two cases of cervical vertebral bone high-density abnormalities have been described in the context of superior vena cava syndrome secondary to a mediastinal mass (epidermoid lung carcinoma and small-cell lung carcinoma) [6, 7]. To our knowledge, there are no reports of similar cases of vertebral marrow abnormalities in asymptomatic patients, without any mass syndrome or obstructed superior cava vein. In the case presented, the findings could be misinterpreted as lymphomatous bone marrow involvement because of the patient’s history even though bony features of osseous lymphoma are usually lytic and seldom sclerotic, with soft tissue involvement. In summary, the present case illustrates a benign lesion entity related to retrograde contrast filling in bone marrow. The case presentation can be found at doi: 10.1007/s00256-013-1619-2