Comparison Of Computed Tomography Research Articles

Impact of rapid iodine contrast agent infusion on tracheal diameter and lung volume in CT pulmonary angiography measured with deep learning-based algorithm.

To compare computed tomography (CT) pulmonary angiography and unenhanced CT to determine the effect of rapid iodine contrast agent infusion on tracheal diameter and lung volume. This retrospective study included 101 patients who underwent CT pulmonary angiography and unenhanced CT, for which the time interval between them was within 365 days. CT pulmonary angiography was scanned 20 s after starting the contrast agent injection at the end-inspiratory level. Commercial software, which was developed based on deep learning technique, was used to segment the lung, and its volume was automatically evaluated. The tracheal diameter at the thoracic inlet level was also measured. Then, the ratios for the CT pulmonary angiography to unenhanced CT of the tracheal diameter (TDPAU) and both lung volumes (BLVPAU) were calculated. Tracheal diameter and both lung volumes were significantly smaller in CT pulmonary angiography (17.2 ± 2.6mm and 3668 ± 1068ml, respectively) than those in unenhanced CT (17.7 ± 2.5mm and 3887 ± 1086ml, respectively) (p < 0.001 for both). A statistically significant correlation was found between TDPAU and BLVPAU with a correlation coefficient of 0.451 (95% confidence interval, 0.280-0.594) (p < 0.001). No factor showed a significant association with TDPAU. The type of contrast agent had a significant association for BLVPAU (p = 0.042). Rapid infusion of iodine contrast agent reduced the tracheal diameter and both lung volumes in CT pulmonary angiography, which was scanned at end-inspiratory level, compared with those in unenhanced CT.

Assessment of pulmonary vascular anatomy: comparing augmented reality by holograms versus standard CT images/reconstructions using surgical findings as reference standard

BackgroundWe compared computed tomography (CT) images and holograms (HG) to assess the number of arteries of the lung lobes undergoing lobectomy and assessed easiness in interpretation by radiologists and thoracic surgeons with both techniques.MethodsPatients scheduled for lobectomy for lung cancer were prospectively included and underwent CT for staging. A patient-specific three-dimensional model was generated and visualized in an augmented reality setting. One radiologist and one thoracic surgeon evaluated CT images and holograms to count lobar arteries, having as reference standard the number of arteries recorded at surgery. The easiness of vessel identification was graded according to a Likert scale. Wilcoxon signed-rank test and κ statistics were used.ResultsFifty-two patients were prospectively included. The two doctors detected the same number of arteries in 44/52 images (85%) and in 51/52 holograms (98%). The mean difference between the number of artery branches detected by surgery and CT images was 0.31 ± 0.98, whereas it was 0.09 ± 0.37 between surgery and HGs (p = 0.433). In particular, the mean difference in the number of arteries detected in the upper lobes was 0.67 ± 1.08 between surgery and CT images and 0.17 ± 0.46 between surgery and holograms (p = 0.029). Both radiologist and surgeon showed a higher agreement for holograms (κ = 0.99) than for CT (κ = 0.81) and found holograms easier to evaluate than CTs (p < 0.001).ConclusionsAugmented reality by holograms is an effective tool for preoperative vascular anatomy assessment of lungs, especially when evaluating the upper lobes, more prone to anatomical variations.Trial registrationClinicalTrials.gov, NCT04227444Relevance statementPreoperative evaluation of the lung lobe arteries through augmented reality may help the thoracic surgeons to carefully plan a lobectomy, thus contributing to optimize patients’ outcomes.Key points• Preoperative assessment of the lung arteries may help surgical planning.• Lung artery detection by augmented reality was more accurate than that by CT images, particularly for the upper lobes.• The assessment of the lung arterial vessels was easier by using holograms than CT images.Graphical

Pre-procedure 18F-FDG PET/CT imaging improves the performance of CT-guided transthoracic biopsy.

To compare computed tomography (CT)-guided transthoracic lung biopsies (CTLB) with and without pre-procedure 18F-fluorodeoxgyglucose positron emission tomography (18F-FDG PET)/CT images in the diagnosis of pulmonary nodules/masses. This is a case-control study in a single center. The data of patients with a transthoracic lung biopsy guided by CT and pre-procedure 18F-FDG PET/CT (group 2, here called the "PETCTLB" group), including demographics, clinical characteristics, and biopsy-related parameters, were collected. The PET/CT scan was performed within 15 days before the biopsy. The data from patients with CTLB were used as controls (group 1). Biopsies for all patients were performed by the same physician between January 2019 and December 2021. The final diagnosis was based on surgical outcomes, or imaging findings, and the results of at least one 6-month follow-up. The demographics and clinical characteristics of patients, lesions and biopsy-related variables, diagnostic yields, and incidence of complications were compared between the two groups. Two-tailed t-tests were used to compare the mean values in the two independent groups, while categorical variables were compared using the Pearson chi-squared test, and P values < 0.05 were considered to be significant. A total of 84 patients were included, and 84 biopsies of 84 lung nodules/masses were analyzed. The demographics and clinical characteristics of group 2 (n = 39; 21 men; mean age, 63.2 ± 9.29 years) and group 1 (n = 45; 30 men; mean age, 61.2 ± 12.3 years) had no significant difference (P = 0.230 and 0.397, respectively). The procedure duration (11.1 ± 3.0 vs. 12.9 ± 3.3 minutes, P = 0.008), the number of samples (2.6 ± 0.5 vs. 3.1 ± 0.4, P < 0.001), diagnostic accuracy (97.4% vs. 82.2%, P = 0.033), and bleeding complication (25.6% vs. 42.2%, P = 0.034) of group 2 and group 1 were statistically different. A biopsy guided by CT plus pre-procedure 18F-FDG PET/CT (PETCTLB) is a safe procedure that can provide a precise diagnosis in the majority of lung nodules/masses. It has better diagnostic performance than CTLB.

Comparison of preoperative CT- and MRI-based multiparametric radiomics in the prediction of lymph node metastasis in rectal cancer

ObjectiveTo compare computed tomography (CT)- and magnetic resonance imaging (MRI)-based multiparametric radiomics models and validate a multi-modality, multiparametric clinical-radiomics nomogram for individual preoperative prediction of lymph node metastasis (LNM) in rectal cancer (RC) patients.Methods234 rectal adenocarcinoma patients from our retrospective study cohort were randomly selected as the training (n = 164) and testing (n = 70) cohorts. The radiomics features of the primary tumor were extracted from the non-contrast enhanced computed tomography (NCE-CT), the enhanced computed tomography (CE-CT), the T2-weighted imaging (T2WI) and the gadolinium contrast-enhanced T1-weighted imaging (CE-TIWI) of each patient. Three kinds of models were constructed based on training cohort, including the Clinical model (based on the clinical features), the radiomics models (based on NCE-CT, CE-CT, T2WI, CE-T1WI, CT, MRI, CT combing with MRI) and the clinical-radiomics models (based on CT or MRI radiomics model combing with clinical data) and Clinical-IMG model (based on CT and MRI radiomics model combing with clinical data). The performances of the 11 models were evaluated via the area under the receiver operator characteristic curve (AUC), accuracy, sensitivity, and specificity in the training and validation cohort. Differences in the AUCs among the 11 models were compared using DeLong’s test. Finally, the optimal model (Clinical-IMG model) was selected to create a radiomics nomogram. The performance of the nomogram to evaluate clinical efficacy was verified by ROC curves and decision curve analysis (DCA).ResultsThe MRI radiomics model in the validation cohort significantly outperformed than CT radiomics model (AUC, 0.785 vs. 0.721, p&amp;lt;0.05). The Clinical-IMG nomogram had the highest prediction efficiency than all other predictive models (p&amp;lt;0.05), of which the AUC was 0.947, the sensitivity was 0.870 and the specificity was 0.884.ConclusionMRI radiomics model performed better than both CT radiomics model and Clinical model in predicting LNM of RC. The clinical-radiomics nomogram that combines the radiomics features obtained from both CT and MRI along with preoperative clinical characteristics exhibits the best diagnostic performance.

Application of temperature-sensitive liquid embolic agent loaded with oxaliplatin in the TACE procedure for rabbit VX2 gastric cancer.

As a promising drug delivery system, the temperature-sensitive liquid embolic agent (TempSLE) has yet to be reported in animal experiments in treating gastric cancer. We observed and compared computed tomography (CT) imaging changes, tumor volume, HE staining, and immunohistochemistry after transcatheter arterial chemoembolization (TACE) treatment in rabbit VX2 gastric cancer models to clarify the effectiveness of TempSLE loaded with oxaliplatin (TempSLE/Oxa) in treating gastric cancer. One milliliter TempSLE can be loaded with 20 mg oxaliplatin. The accumulative drug release rate at 30 min was 38.76%, and after 24 h, it reached more than 90%. CT examination 1 week after TACE revealed that the TempSLE/Oxa group presents unenhanced hypodense necrotic foci, the iodinated oil loaded with oxaliplatin (Ioil/Oxa) group presents shrinking tumors but still visible speckled foci of enhancement, and the normal saline (NS) group presents heterogeneous enhancement with larger tumors than before. In the postoperative autopsy of TACE, the tumor volumes of TempSLE/Oxa, Ioil/Oxa, and NS groups were 0.15 ± 0.06 cm3, 0.37 ± 0.11 cm3, and 1.19 ± 0.16 cm3, respectively, all of which were statistically different. The positive vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA) expression percentages in the TempSLE/Oxa, Ioil/Oxa, and NS groups were statistically different and lowest in the TempSLE/Oxa group. In conclusion, the TempSLE can load a high dose of oxaliplatin to meet the demand of clinical applications. TempSLE/Oxa could effectively inhibit tumor cell proliferation and angiogenesis. This study provides experimental evidence for the further clinical application of the TempSLE/Oxa.

CT and MRI Features of Chondrosarcoma in the Mastoid Involving the Facial Nerve in Comparison to Facial Nerve Schwannoma.

Chondrosarcoma in the mastoid is extremely rare, and it is easily misdiagnosed as a facial nerve schwannoma. To identify and compare computed tomography (CT) and magnetic resonance imaging (MRI) features of chondrosarcoma in the mastoid involving the facial nerve, including diffusion-weighted MRI characteristics, with those of facial nerve schwannoma. CT and MRI features of 11 chondrosarcomas in the mastoid involving the facial nerve and 15 facial nerve schwannomas, confirmed by histopathology, were retrospectively reviewed. The tumor location, size, morphological features, bone change, calcification, signal intensity, texture, enhancement characteristics, the extent of lesions, and apparent diffusion coefficients (ADCs) were evaluated. On CT imaging, calcification could be found in 81.8% of chondrosarcomas (9/11) and 33.3% of facial nerve schwannomas (5/15). Chondrosarcoma in the mastoid appeared significantly hyperintense on T2-weighted images (T2WI) with low signal intensity septa in eight patients (72.7%, 8/11). After contrast, all chondrosarcomas showed inhomogeneous enhancement, and septal and peripheral enhancement could be found in six cases (54.5%, 6/11). Facial nerve schwannoma demonstrated inhomogeneous hyperintensity on T2WI in 12 cases (80%, 12/15), with obvious hyperintense cystic changes in seven cases. There were significant differences in calcification (P=0.014), T2 signal intensity (P=0.006), and septal and peripheral enhancement (P=0.001) between chondrosarcomas and facial nerve schwannomas. The ADCs of chondrosarcoma were significantly higher than those of facial nerve schwannomas (P<0.001). CT and MRI with ADCs had the potential to improve the diagnostic accuracy of chondrosarcoma in the mastoid involving the facial nerve.

Trabecular Bone Remodeling After Posterior Lumbar Interbody Fusion: Comparison of Three-Dimensional Porous Tantalum and Titanium-Coated Polyetheretherketone Interbody Cages.

Retrospective cohort study. The criteria for determining completion of intervertebral stability after posterior lumbar interbody fusion (PLIF) remain controversial. Several new radiological indicators of bone growth and osteointegration have been established. We compared computed tomography (CT) findings related to osteointegration after PLIF with interbody cages of two different materials and designs. We retrospectively analyzed data from 103 patients who underwent PLIF with three-dimensional porous tantalum (Tn) cages or titanium-coated polyetheretherketone (TiP) cages. CT images obtained 3months and 1year after surgery were examined for trabecular bone remodeling (TBR), cancellous condensation (CC), and vertebral endplate cyst (VEC) formation. The incidences of each finding were compared by cage type, and rates of instrument failure and pseudarthrosis were determined. Three months postoperatively, 87% of the levels with Tn cages exhibited TBR, whereas 96% of those with TiP cages did not (P < .001). Most levels with Tn cages levels exhibited TBR and no CC 3months (81%) and 1 year (94%) after surgery. Although 78% of levels with TiP cages exhibited CC and no TBR 3months after surgery, 59% exhibited both CC and TBR 1 year after surgery. Significantly fewer VECs formed around the Tn cages than around the TiP cages both 3months (P = .002) and 1year (P < .001) after surgery. Implant-related problems occurred at levels that exhibited neither TBR nor CC. The porous tantalum cage may enable intervertebral stability that is comparable to bony fusion soon after surgery.

Computed tomography findings of paranasal sinuses in patients with eosinophilic granulomatosis with polyangiitis: Comparison with other eosinophilic sinus diseases and clinical relevance of their severity

BackgroundAlthough paranasal sinuses are one of the most representative organs affected by eosinophilic granulomatosis with polyangiitis (EGPA), they have not been studied sufficiently. The aim of this study was to compare computed tomography (CT) findings in paranasal sinuses of EGPA with those of other eosinophilic sinus diseases and elucidate the clinical relevance of their severity. MethodsCT findings of paranasal sinuses in EGPA patients prior to therapeutic intervention (n = 30) were evaluated using the Lund–Mackay staging (LMS) system and compared with those of three control diseases [(NSAID-exacerbated respiratory disease (N-ERD), aspirin-tolerant asthma, and eosinophilic chronic rhinosinusitis without asthma (ECRS)]. We divided EGPA patients into three groups based on their LMS scores and examined their association with disease manifestation. ResultsTotal scores of the LMS system in EGPA were significantly lower than those of N-ERD and ECRS without asthma. There was a large variation in total LMS scores in EGPA, suggesting considerable heterogeneity of their sinus lesions. Although EGPA with low LMS system scores showed only minor findings in maxillary and anterior ethmoid regions, those with high LMS system scores were characterized by high scores in the ostiomeatal complex. However, the frequencies of patients with a Five-Factor Score ≥2 and with cardiac involvement were significantly higher for EGPA with low LMS system scores. ConclusionsAlthough paranasal sinus lesions in EGPA were less severe than those of other eosinophilic sinus diseases, their milder CT findings may be associated with a higher frequency of extra-respiratory organ involvement.

Correlation Between Computed Tomography Findings and the Laboratory Test-Derived Severity Score in Patients With Severe Acute Alcoholic Hepatitis.

This study aimed to compare computed tomography (CT) findings between patients with severe and nonsevere acute alcoholic hepatitis (AAH). We included 96 patients diagnosed with AAH between January 2011 and October 2021 who underwent 4-phase liver CT and laboratory blood tests. Two radiologists reviewed the initial CT images with respect to distribution and grade of hepatic steatosis; transient parenchymal arterial enhancement (TPAE); and presence of cirrhosis, ascites, and hepatosplenomegaly. A Maddrey discriminant function score (4.6 × [patient's prothrombin time - control] + total bilirubin [mg/mL]) was used as cutoff indicator for severity, with a score of 32 or higher indicating severe disease. The image findings were compared between the severe (n = 24) and nonsevere (n = 72) groups using the χ 2 test or Fisher exact test. After univariate analysis, the most significant factor was identified using a logistic regression analysis. In the univariate analysis, there were significant between-group differences in the TPAE, liver cirrhosis, splenomegaly, and ascites ( P < 0.0001, P < 0.0001, P = 0.0002, and P = 0.0163, respectively). Among them, TPAE was the only significant factor for severe AAH ( P < 0.0001; odds ratio, 48.1; 95% confidence interval, 8.3-280.6). Using this single indicator, the estimated accuracy, positive predictive, and negative predictive values were 86%, 67%, and 97%, respectively. Transient parenchymal arterial enhancement was the only significant CT finding in severe AAH.

The osteopontin expression and microvascular density in thyroid cancer, comparison of CT and ultrasound in diagnosis of thyroid cancer and correlations of CT features and thyroid cancer.

The aim of this study was to explore the osteopontin expression and microvascular density in thyroid cancer, compare computed tomography (CT) and ultrasound in diagnosis of thyroid cancer and investigate the correlations of CT Features and thyroid cancer. A total of 80 patients with thyroid masses admitted to our hospital from April 2017 to August 2019 were selected, of which there were 40 with benign tumor and 40 with malignant tumor. All patients with thyroid cancer confirmed by pathological tissue biopsy were examined by ultrasound (ultrasound group) and CT (CT group). The expression of osteopontin was detected by PCR while microvascular density was tested by immunohistochemistry. Then univariate analysis and multivariate logistic regression analysis of risk factors were carried out for CT imaging diagnosis of thyroid cancer. The levels of osteopontin and microvascular density in malignant group were significantly higher than those in benign group. The incidence rates of unclear boundary and peripheral lymph node enlargement in CT group were remarkably higher than those in ultrasound group. The diagnostic rate of masses ≥1 cm in diameter was notably higher than that of masses <1 cm in diameter in thyroid cancer patients in CT group and ultrasound group (P<0.05). In addition, the diagnostic rates of follicular carcinoma and papillary carcinoma were higher, whereas those of medullary carcinoma and undifferentiated carcinoma were lower in CT group and ultrasound group. There was no significant difference in the accuracy of thyroid cancer diagnosis between CT group and ultrasound group. Moreover, diameter ≥1 cm, irregular shape, unclear boundary, calcified foci, uneven density/echo and peripheral lymph node enlargement were related risk factors for the CT imaging diagnosis of thyroid cancer, in which irregular shape, unclear boundary, calcified foci and uneven density/echo were independent risk factors for the CT imaging diagnosis of thyroid cancer. The levels of osteopontin and microvascular density were increased in thyroid cancer. CT examination may be of higher diagnostic value in diagnosis of thyroid cancer compared with ultrasound. Irregular shape, unclear boundary, calcified foci, and uneven density/echo were independent risk factors for the CT imaging diagnosis of thyroid cancer.

Computed tomography-based radiomics machine learning classifiers to differentiate type I and type II epithelial ovarian cancers.

To compare computed tomography (CT)-based radiomics for preoperatively differentiating type I and II epithelial ovarian cancers (EOCs) using different machine learning classifiers and to construct and validate the best diagnostic model. A total of 470 patients with EOCs were included retrospectively. Patients were divided into a training dataset (N = 329) and a test dataset (N = 141). A total of 1316 radiomics features were extracted from the portal venous phase of contrast-enhanced CT images for each patient, followed by dimension reduction of the features. The support vector machine (SVM), k-nearest neighbor (KNN), random forest (RF), naïve Bayes (NB), logistic regression (LR), and eXtreme Gradient Boosting (XGBoost) classifiers were trained to obtain the radiomics signatures. The performance of each radiomics signature was evaluated and compared by the area under the receiver operating characteristic curve (AUC) and relative standard deviation (RSD). The best radiomics signature was selected and combined with clinical and radiological features to establish a combined model. The diagnostic value of the combined model was assessed. The LR-based radiomics signature performed well in the test dataset, with an AUC of 0.879 and an accuracy of 0.773. The combined model performed best in both the training and test datasets, with AUCs of 0.900 and 0.934 and accuracies of 0.848 and 0.823, respectively. The combined model showed the best diagnostic performance for distinguishing between type I and II EOCs preoperatively. Therefore, it can be a useful tool for clinical individualized EOC classification. • Radiomics features extracted from computed tomography (CT) could be used to differentiate type I and II epithelial ovarian cancers (EOCs). • Machine learning can improve the performance of differentiating type I and II EOCs. • The combined model exhibited the best diagnostic capability over the other models in both the training and test datasets.

Comparative Effect of Multi-Dose Contrast Median on Contrast-Enhanced Computed Tomography Workflow of Nurses and Hospital Efficiency: A Multi-CenterReal-World Prospective Observational Study in China.

This study aims to evaluate and compare computed tomography (CT)-contrast operational workflow and hospital imaging efficiency when using a multi-dose bulk IV contrast delivery system and when using a single-dose packaging contrast. A multi-center prospective observational study was conducted in six regions in China. The operating time and workflow of radiology nursing staff were evaluated and observed using an investigational tool and recorded by the investigators using a stopwatch. Nursing staff's knowledge and the imaging capabilities of hospitals were collected using a questionnaire. Rate, t-test, χ 2 test, and partial correlation analysis were used to describe the knowledge of nursing staff. The operation time and frequency of the two contrast agent packages were further compared using the Stata 15.0 software. A total of 42 radiology nurses and 1,167 CT contrast-operating procedures in six provinces in China were evaluated. The total operating times for the 100 ml contrast agent versus the 200 ml contrast agent were 80.67 s and 63.81 s, respectively (P < 0.01). According to the average annual hospital CT scans (49,807 scans) and the power injector (PI) market share, approximately 233 h yearly could be saved in a hospital. Regarding CT contrast knowledge, approximately 57.14% nurses expressed their willingness to use multi-dose packaging contrast agents. Through difference and correlation analysis on real-world data, this study suggests that, considering safety, the use of a multi-dose bulk IV contrast agent is more time-saving and efficient for Chinese nurses and medical institutions compared with that of a single-dose package.

Associations between visceral fat chronic low back pain and central sensitization in patients with lumbar spinal stenosis.

Pain sensitization may be one of the mechanisms contributing to chronic low back pain (CLBP). To evaluate the association between visceral fat, CLBP, and central sensitization (CS); describe the relationship between low back pain (LBP) intensity and CS; and identify possible correlation between visceral fat and LBP intensity. Patients with CLBP were divided using their CS inventory (CSI) scores into low- (CSI < 40) and high-CSI (CSI ⩾ 40) subgroups. We compared computed tomography (CT) measurements and scores for association with pain according to the visual analogue scale (VAS) between the two groups. The low-CSI and the high-CSI groups had 47 patients (67.1%; 21 men, 26 women) and 23 patients (32.9%; 11 men and 12 women), respectively. The high-CSI group had a significantly higher mean VAS score (p< 0.01) and estimated mean visceral fat area (p< 0.05) than the low-CSI group. There was a moderate positive correlation between VAS score and visceral fat (standardised partial regression coefficient: 0.659, p< 0.01) in the high-CSI group according to multiple linear regression analysis adjusted for age and sex. Visceral fat is associated with CLBP, regardless of sex or age, and may be a potential therapeutic target for CLBP with CS.

Measurement of external deviation angle of patellar tendon and its application on diagnosis of recurrent patellar dislocation

To compare computed tomography (CT) measurement results of external deviation angle of patellar tendon and tibia tubercle-trochlea groove (TT-TG), as well as the diagnostic ability and pathology in recurrent patellar dislocation threshold. From January 2015 to March 2020, 46 patients with recurrent patella dislocation and 112 patients with non-patella dislocation were retrospectively analyzed. Forty-six patients with recurrent patella dislocation were divived into 2 groups according to TT-TG value, 11 patients with patellar dislocation with TT-TG≥20 mm(group A), including 7 males and 4 females, aged from 16 to 27 years old with an average of(21.00±3.98) years old; 35 patients with patellar dislocation with TT-TG<20 mm(group B), including 14 males and 21 females, aged from 16 to 37 years old with an average of(22.83±6.09) years old. While 112 patients with non-patella dislocation(group C) included 63 males and 49 females, aged 16 to 36 years old with an average of(22.87±5.69) years old. The measurement data of external deviation angle of patellar tendon and TT-TG value among three groups were compared. Spearman analysis was used to analyze correlation among them. Intraclass correlation coefficient (ICC) was used to determine repeatability within group. Receiver operating characteristic (ROC) area under the curve was used to evaluate diagnostic ability of parameters, and calculate osteotomy parameters of external deviation angle of patellar tendon, as well as external deviation angle of patellar tendon and TT-TG value in the diagnosis of recurrent patella diagnostic parameters of dislocation. External deviation angle of patellar tendon in group A, B and C was (22.04±3.09)°, (17.20±4.43)°and (10.22±3.45)° respectively;while TT-TG value was(21.15±0.71) mm, (15.97±2.69) mm and (11.12±3.77) mm, there were significance among three groups (P<0.01), and had difference between group A and B(P<0.01). There was strong positive correlation between external deviation angle of patellar tendon and TT-TG value (r=0.735, P<0.000 1). The intra-group ICC value(0.980, 0.982) of external deviation angle of patellar tendon in group A and B have better repeatability than TT-TG value (0.594, 0.775). The external deviation angle of patellar tendon in group C(0.956) and repeatability of TT-TG value(0.906) was very good. In the diagnosis of recurrent patellar dislocation, the area under ROC curve of external deviation angle of patellar tendon (0.916) was greater than TT-TG value(0.886), and diagnostic parameters were 13.84°and 14.69 mm, respectively;in tibial osteotomy, the area under ROC curve of external deviation angle of patellar tendon was 0.821, and osteotomy parameter was 20.15°. CT imaging could reliably measure external deviation angle of patellar tendon.There is a strong positive correlation between external deviation angle of patellar tendon and value of TT-TG, which could be used to determine pathological state of recurrent patellar dislocation, and external deviation angle of patellar tendon is superior to the TT-TG value in the diagnosis of recurrent patellar dislocation. The external deviation angle of patellar tendon could also be used to guide the formulation of the tibial osteotomy plan for recurrent patellar dislocation.

What's New in Spine Surgery.

What's New in Spine Surgery.

Change of Computed Tomography-Based Body Composition after Adrenalectomy in Patients with Pheochromocytoma.

Simple SummaryPheochromocytoma is regarded as a good human model for investigating the impact of sympathetic hyperactivity on various pathologic conditions. To determine the influence of catecholamine excess on human body composition, we compared computed tomography (CT)-based fat and skeletal muscle indices over time in a large patient population with histologically confirmed pheochromocytoma who underwent surgery. We observed considerable elevation in CT-measured visceral fat area and subcutaneous fat area, and the prevalence of visceral obesity after adrenalectomy in patients with pheochromocytoma. In contrast, there were no changes in skeletal muscle area, skeletal muscle index, and prevalence of sarcopenia. Furthermore, we observed that the severity of catecholamine excess was associated with a higher increase, especially in the subcutaneous fat area after surgery. These data provide important clinical evidence that sympathetic hyperactivity contributes to lipolysis in visceral and subcutaneous adipose tissues, whereas its impact on human skeletal muscle remains undetermined.Despite the potential biological importance of the sympathetic nervous system on fat and skeletal muscle metabolism in animal and in vitro studies, its relevance in humans remains undetermined. To clarify the influence of catecholamine excess on human body composition, we performed a retrospective longitudinal cohort study including 313 consecutive patients with histologically confirmed pheochromocytoma who underwent repeat abdominal computed tomography (CT) scans before and after adrenalectomy. Changes in CT-determined visceral fat area (VFA), subcutaneous fat area (SFA), skeletal muscle area (SMA), and skeletal muscle index (SMI) were measured at the level of the third lumbar vertebra. The mean age of all patients was 50.6 ± 13.6 years, and 171/313 (54.6%) were women. The median follow-up duration for repeat CTs was 25.0 months. VFA and SFA were 14.5% and 15.8% higher, respectively (both p < 0.001), after adrenalectomy, whereas SMA and SMI remained unchanged. Similarly, patients with visceral obesity significantly increased from 103 (32.9%) at baseline to 138 (44.1%) following surgery (p < 0.001); however, the prevalence of sarcopenia was unchanged. This study provides important clinical evidence that sympathetic hyperactivity can contribute to lipolysis in visceral and subcutaneous adipose tissues, but its impact on human skeletal muscle is unclear.

Preoperative planning using computed tomography in tibial plateau levelling osteotomy: A comparison with conventional radiography.

BackgroundTibial plateau levelling osteotomy (TPLO) is currently one of the most common surgical procedures for the correction of the stifle joint with a ruptured cranial cruciate ligament. TPLO is based on the preoperative tibial plateau angle (TPA); therefore, it is essential to optimise the consistency and repeatability of TPA measurements.ObjectivesThis study aims to compare computed tomography (CT) with conventional radiography in the preoperative planning of TPLO.MethodsThis prospective study included six dogs (12 hindlimbs) and 13 canine cadaveric hindlimbs. In the six beagle dogs, TPAs were measured by three radiologists using digital radiographic and CT images to evaluate the intra‐ and inter‐observer agreement. To evaluate the intra‐observer agreement of the TPA before and after surgery, and the intended angle of the postoperative TPA according to the preoperative planning method, 13 cadaveric hindlimbs were evaluated thrice at random by a single radiologist.ResultsThe intra‐ and inter‐observer intraclass correlation coefficients (ICCs) of the CT method were higher than those of the radiographic method in normal beagle dogs. The intra‐observer ICC of the CT method before and after TPLO was generally higher than that of the radiographic method in the cadaver. However, no significant difference was noted in the evaluation of the intended postoperative TPA according to the preoperative planning method.ConclusionsThe intra‐ and inter‐observer ICCs allowed for easy identification of landmarks required to consistently determine the TPA in the preoperative planning of TPLO based on CT images.

Ultrahigh-Resolution Computed Tomography Improves Preoperative Computed Tomography Angiography for Deep Inferior Epigastric Artery Perforator Flap Reconstruction.

The aim of the study was to compare computed tomography (CT) angiography (CTA) imaging of deep inferior epigastric artery perforator (DIEP) using the ultrahigh-resolution CT (UHRCT) and conventional multidetector CT (MDCT). This retrospective study enrolled 20 patients who underwent CTA of DIEP flap with UHRCT and MDCT. Computed tomography values were measured at 4 large vessels (thoracic aorta, abdominal aorta, common iliac artery, and external iliac artery) and 5 peripheral vessels (proximal and distal internal thoracic artery, proximal and distal deep inferior epigastric artery, and DIEP). There were no significant differences in mean CT values of the major vessel between UHRCT and MDCT. Ultrahigh-resolution CT shows higher CT values of the peripheral vessels than MDCT (P < 0.05 for all). The median CT values of the DIEP in UHRCT were approximately 3 times higher than those in MDCT (P < 0.001). Ultrahigh-resolution CT provides higher-quality CTA of DIEP compared with MDCT.

Radiation Versus Immune Checkpoint Inhibitor Associated Pneumonitis: Distinct Radiologic Morphologies.

BackgroundPatients with non‐small cell lung cancer may develop pneumonitis after thoracic radiotherapy (RT) and immune checkpoint inhibitors (ICIs). We hypothesized that distinct morphologic features are associated with different pneumonitis etiologies.Materials and MethodsWe systematically compared computed tomography (CT) features of RT‐ versus ICI‐pneumonitis. Clinical and imaging features were tested for association with pneumonitis severity. Lastly, we constructed an exploratory radiomics‐based machine learning (ML) model to discern pneumonitis etiology.ResultsBetween 2009 and 2019, 82 patients developed pneumonitis: 29 after thoracic RT, 23 after ICI, and 30 after RT + ICI. Fifty patients had grade 2 pneumonitis, 22 grade 3, and 7 grade 4. ICI‐pneumonitis was more likely bilateral (65% vs. 28%; p = .01) and involved more lobes (66% vs. 45% involving at least three lobes) and was less likely to have sharp border (17% vs. 59%; p = .004) compared with RT‐pneumonitis. Pneumonitis morphology after RT + ICI was heterogeneous, with 47% bilateral, 37% involving at least three lobes, and 40% sharp borders. Among all patients, risk factors for severe pneumonitis included poor performance status, smoking history, worse lung function, and bilateral and multifocal involvement on CT. An ML model based on seven radiomic features alone could distinguish ICI‐ from RT‐pneumonitis with an area under the receiver‐operating curve of 0.76 and identified the predominant etiology after RT + ICI concordant with multidisciplinary consensus.ConclusionRT‐ and ICI‐pneumonitis exhibit distinct spatial features on CT. Bilateral and multifocal lung involvement is associated with severe pneumonitis. Integrating these morphologic features in the clinical management of patients who develop pneumonitis after RT and ICIs may improve treatment decision‐making.Implications for PracticePatients with non‐small cell lung cancer often receive thoracic radiation and immune checkpoint inhibitors (ICIs), both of which can cause pneumonitis. This study identified similarities and differences in pneumonitis morphology on computed tomography (CT) scans among pneumonitis due to radiotherapy (RT) alone, ICI alone, and the combination of both. Patients who have bilateral CT changes involving at least three lobes are more likely to have ICI‐pneumonitis, whereas those with unilateral CT changes with sharp borders are more likely to have radiation pneumonitis. After RT and/or ICI, severe pneumonitis is associated with bilateral and multifocal CT changes. These results can help guide clinicians in triaging patients who develop pneumonitis after radiation and during ICI treatment.

Cyclophosphamide for interstitial lung disease-associated acute respiratory failure: mortality, clinical response and radiological characteristics

BackgroundTreatment for interstitial lung disease (ILD) patients with acute respiratory failure (ARF) is challenging, and literature to guide such treatment is scarce. The reported in-hospital mortality rates of ILD patients with ARF are high (62–66%). Cyclophosphamide is considered a second-line treatment in steroid-refractory ILD-associated ARF. The first aim of this study was to evaluate the in-hospital mortality in patients with ILD-associated ARF treated with cyclophosphamide. The second aim was to compare computed tomographic (CT) patterns and physiological and ventilator parameters between survivors and non-survivors.MethodsRetrospective analysis of patients with ILD-associated ARF treated with cyclophosphamide between February 2016 and October 2017. Patients were categorized into three subgroups: connective tissue disease (CTD)-associated ILD, other ILD or vasculitis. In-hospital mortality was evaluated in the whole cohort and in these subgroups. Clinical response was determined using physiological and ventilator parameters: Sequential Organ Failure Assessment Score (SOFA), PaO2/FiO2 (P/F) ratio and dynamic compliance (Cdyn) before and after cyclophosphamide treatment. The following CT features were quantified: ground-glass opacification (GGO) proportion, reticulation proportion, overall extent of parenchymal disease and fibrosis coarseness score.ResultsFifteen patients were included. The overall in-hospital mortality rate was 40%. In-hospital mortality rates for CTD-associated ILD, other ILD and vasculitis were 20, 57, and 33%, respectively. The GGO proportion (71% vs 45%) was higher in non-survivors. There were no significant differences in the SOFA score, P/F ratio or Cdyn between survivors and non-survivors. However, in survivors the P/F ratio increased from 129 to 220 mmHg and Cdyn from 75 to 92 mL/cmH2O 3 days after cyclophosphamide treatment. In non-survivors the P/F ratio hardly changed (113–114 mmHg) and Cdyn even decreased (27–20 mL/cmH2O).ConclusionIn this study, we found a mortality rate of 40% in patients treated with cyclophosphamide for ILD-associated ARF. Connective tissue disease-associated ILD and vasculitis were associated with a lower risk of death. In non-survivors, the CT GGO proportion was significantly higher. The P/F ratio and Cdyn in survivors increased after 3 days of cyclophosphamide treatment.