Computed Tomogram Research Articles

Stress Distribution in Traumatized Teeth Splinted With Fiber Localizing on Incisal/Cervical Positions: A Three-Dimensional Finite Element Analysis.

The fiber splint represents an advanced treatment for traumatized dental injuries. The complete understanding of the localization of a splint on traumatized teeth remains elusive. The aim of this study was to assess the impact of the incisal/cervical positions of the fiber splint on the stress distribution of traumatized dental roots in various occlusal relationships. Three-dimensional finite element models were generated based on a cone beam computer tomogram of a patient. The incisal and cervical splints were simulated by strips that were bonded close to the incisal/cervical labial surface of traumatic teeth. Force was loaded on the incisal ridge, incisal and cervical positions on the palatal surface of each tooth to simulate the conditions of traumatized teeth during mastication. The equivalent stress (von Mises) on the traumatic teeth and abutment teeth was calculated by Ansys software (version 2021, R1). The incisal splint effectively transferred the stress from the traumatized tooth roots to the abutment teeth when force was loaded on the incisal ridge and incisal and cervical positions on the palatal surface. Nevertheless, the reduction effect was notably diminished when the cervical splint was used. Notably, in cases of cervical splints, with a loading force on the incisal ridge, there is an increase in stress on the roots of traumatized teeth, which poses a disadvantage in the management of traumatic dental injuries. The incisal splint demonstrated a more effective transfer of stress from the roots of the traumatic teeth to the abutment teeth than the cervical splint and the raw.

When the Jugular Bulb Contacts the Facial Nerve.

Dehiscences of the intrapetrous canal of the facial nerve (FN) and those of a high jugular bulb (HJB) have various incidences. However, the HJB-FN common dehiscent osseous wall is a scarce finding and rarely reported. Thus, this work aimed to study this peculiar intrapetrous morphology on computed tomograms (CTs). A batch of 60 archived CTs was used. In 28.33% of cases, no HJBs were found; in 51.67% of cases, there were unilateral HJBs, and in 20% of cases, bilateral HJBs were found. 83.87% of the unilateral HJBs were on the right side, and the rest on the left side. In 3 cases with right-sided HJBs, 1 male and 2 females, FNs were found directly contacting the HJB. Therefore, the contact HJB-FN occurred in 5% of cases and 2.5% of the petrous bones/sides. HJBs' dehiscences to the retrotympanum or the posterior cranial fossa were also found in those cases. A dehiscent posterior semicircular canal to the HJB was found in one of these. Incidences for the HJB and the HJB-FN contacts seem higher than in previous studies. However, as only a 60-case batch of study was used, an overestimation may have resulted. Although scarce, the HJB-FN contact could determine specific symptoms and must be documented before specific surgical procedures involving the mastoid, retrotympanum, and posterior cranial fossa.

Correlations of teleroentgenometric indicators according to the Steiner method with the dimensions of teeth and dental arches in young men and young women with a physiological bite without taking into account the type of face

Annotation. The importance of teleradiographic indicators in the diagnosis and planning of orthodontic treatment is difficult to overestimate, but their relationship with the size of teeth and dental arches in different age and sex groups remains insufficiently studied. This is especially relevant for the Ukrainian population, where individual anatomical features can affect the effectiveness of orthodontic interventions, which makes the study of such relationships important for improving approaches to diagnosis and treatment. The purpose of the study is to establish the specifics of correlations between teleroentgenometric parameters according to the Steiner method with the dimensions of teeth and dental arches in Ukrainian young men and young women with a physiological bite. A morphometric study of the teeth and dental arches was carried out, and teleroentgenometric indicators were determined using the Steiner method from the primary computer tomograms of 41 Ukrainian young men (aged 17 to 21) and 68 Ukrainian young women (aged 16 to 20), which were obtained from data bank of the Department of Pediatric Dentistry and Research Center of the National Pirogov Memorial Medical University, Vinnytsya. The evaluation of correlations between teleroentgenometric indicators according to the Steiner method and computed tomographic dimensions of teeth and dental arches was carried out in the license package “Statistica 6.0” using Spearman's non-parametric statistics. As a result of the analysis of the reliable and average strength of unreliable correlations between teleroentgenometric parameters according to the Steiner method with the sizes of teeth and dental arches, it was established: in young men – 5.71 % of similar relationships with the sizes of the teeth of the upper jaw (mostly reliable straight lines of average strength with the sizes of incisors and canines), only 1.79 % with the dimensions of the teeth of the lower jaw and 6.60 % with the dimensions of the dental arches (mainly reliable straight and reverse of medium strength with distances characterizing the position of canines and first premolars relative to the hard palate, as well as the distance between the crowns of the central incisors and the line that connects the molars of the upper jaw); in young women – 4.82 % of similar relationships with the dimensions of the teeth of the upper jaw (mostly reliable straight lines of weak force with the dimensions of canines), 5.00 % with the dimensions of the teeth of the lower jaw (mostly reliable straight lines of weak force with the dimensions of incisors), 14.58 % with the dimensions of dental arches (mainly reliable direct and reverse medium strength with the distances between the crowns of the central incisors and the line connecting the canines, the first premolars and molars of the upper jaw, as well as the distances between the distal and medial roots of the lower first molars). Thus, in Ukrainian young men and young women with a physiological bite, the peculiarities and gender differences of the correlations between teleroentgenometric indicators according to the Steiner method and computed tomographic dimensions of teeth and dental arches were established.

VARIABILITY REGULARITIES OF THE CEPHALOMETRICAL PARAMETERS OF THE HUMAN FETAL SKULL

The purpose of the study – to find out the regularities of the age dynamics of cephalometricparameters and critical periods of the development of the skull of human fetuses.Material and methods. 60 preparations of skulls and 63 computer tomograms of theheads of human fetuses aged from 4 to 10 months of intrauterine development werestudied. A complex of morphological research methods was applied, which includedanthropometry, morphometry, three- dimensional reconstruction and statistical analysis.Linear and angular parameters of the skull were measured, and their ratios, characterizingthe constitutional and cephalometric parameters of the individual (cranial and facialindices), were determined. Results. The analysis of absolute cephalometric parameters (longitudinal, transversediameters, skull circumference, height dimensions) demonstrated the predominanceof logarithmic dynamics of their changes in human fetuses, that is explained by theiraccelerated growth during the 4th month of intrauterine development and a slowdownduring the 7th month with subsequent acceleration in the 8th month of prenatal development.A straight trend line is characteristic of the V-S height (distance from the Sella turcica tothe highest point of the skull), which is explained by the accelerated growth of the anteriorand posterior cranial fossae, while the sphenoid bone and the region of anterior fontanelledevelop in a consistent direction and pace. The linear pattern of growth is typical for theforamen magnum, hard palate, length of the orbit, body and ramus of the mandible, aswell as for relative cephalometric parameters that show a wide range of morphometricvariability. Analysis of the scatter diagram using the method of weighted least squaresdistances showed a decrease in the angle of the front part of the cranial base until the5th month of intrauterine development, followed by an increase in the 7th-8th months ofprenatal development. Multivariate regression analysis of the relationship between fetalage, cranial index and the value of the angle of the front part of the cranial base showedpronounced anatomical variability, which depended on the craniotype. Before the end ofintrauterine development, the N-S-Ba angle increases, but at the beginning of the fetal periodof ontogenesis, it decreases. It has the smallest values in dolichocephals compared to othercraniotypes. The largest values of this angle are found in mesocephals at the beginning of thefetal period, and in brachiocephals and mesocephals at the end of intrauterine development.Conclusions. 1. Critical periods of skull development in the fetal period of humanontogenesis are the 4-5th and 7-8th months, during which uneven changes in absoluteand relative craniometric parameters are observed. 2. The value of the angle of the frontpart of the cranial base can be a diagnostic and prognostic indicator in combinationwith the cranial index, which characterize the craniotype of the individual, during themonitoring of the normal development of the skull and brain of the fetus.

Assessment of articulation parameters settings repeatability in Avantis 3D software

BACKGROUND: The three-dimensional (3D) space of a virtual articulator requires precise adjustment considering individual parameters for the precision work of orthopedic dentists, orthodontists, and dental technicians. A modern solution that includes a virtual articulator is the domestic Avantis 3D software, which simplifies and speeds up functional diagnostics by creating a 3D scene of the patient. AIM: To compare a repeatability of articulation parameters obtained when adjusting the domestic virtual articulator Avantis 3D using laboratory and intraoral scans of terminal positions of the lower jaw. MATERIALS AND METHODS: A group of 30 volunteers aged 18–35 years participated in this study. The group consisted of 18 women and 12 men. Each participant underwent a computed tomography of the maxillofacial region, including the temporomandibular joint region in a state of habitual occlusion; one-stage A-silicone impressions were obtained, plaster models were cast, and silicone bite registers of three terminal positions were made. An intraoral scan of the upper and lower jaws was performed, and optical bite scans were obtained in the position of maximum fissure-tubercle contact and in the terminal positions of the lower jaw, fixed by previously obtained silicone registers. The same protocol was conducted for plaster models of the patient’s dentition and silicone registers of terminal positions. Using intraoral scans, optical recorders of terminal positions and computer tomograms in the Avantis 3D program and 3D scenes were created, and a virtual articulator was configured. For each patient, the virtual articulator was adjusted in the Avantis 3D software, seven times using data from the intraoral scanner level and seven times from the laboratory level. The reproducibility of articulatory parameters was assessed for all types of scans obtained, examining the standard and individual intercondylar distances for each patient. RESULTS: The average values of the standard square deviation of articulatory parameters obtained when creating 3D scenes using laboratory scans at individual and standard intercondylar distances were higher than the similar values obtained using intraoral scans. CONCLUSION: The accuracy of creating a virtual copy of a patient can be influenced by several factors: the error in combining scans, repeated scanning, the error in combining scans and computer tomograms, the error in combining jaw and bite scans, and the presence of penetrating occlusal contacts between scans of the dentition.

Sarcopenia in colorectal cancer is related to socio-economic deprivation and Body Mass Index alone misrepresents underlying muscle loss in the deprived

Background & AimsPatients with colorectal cancer who are more socio-economically deprived have worse outcomes; deprivation is also associated with higher obesity rates, defined as a body mass index (BMI) of greater than thirty. Body composition (BC) factors such as sarcopenia and myosteatosis are also known to predispose to poorer outcomes following colorectal cancer surgery. There is limited evidence to date to relate the effect of deprivation upon these host characteristics that are linked to prognosis. We aimed to examine the relationship between deprivation and body composition in colorectal cancer. MethodsAnalysis was performed on a prospectively collected database of preoperative primary colorectal cancer patients at St Mark’s – The National Bowel Hospital, UK. Body composition characteristics were identified by analysing the L3 axial slices of Computer Tomogram (CT) slices of preoperative staging using Slice-O-Matic software with Automatic Body composition Analyser using Computed tomography image Segmentation (ABACS) L3 plug-in. Deprivation status for each patient was determined using their postal code which was linked to the Index of Multiple Deprivation (IMD). Each domain of the IMD was examined individually in relation to BC characteristics. Binary logistic regression analysis was performed on the data using a model developed from previous published analyses of this dataset. Results419 patients were included in the final analysis, the median age was 69 years and 57% of the patient population was male. Patients who were more deprived were significantly more likely to be sarcopenic [OR 1.56 (95% CI 1.01-2.41, p=0.045)] and myosteatotic [OR 1.69 (95% CI 1.019-2.81, p=0.042)]. More deprived patients were also more likely to have a lower BMI [OR 0.60 (95% CI 0.38-0.94, p=0.026)] despite no significant difference in visceral obesity between the most and least deprived. ConclusionsDeprivation is an important independent determinant of sarcopenia in the colorectal cancer population. Identifying these patients early and addressing reversible factors may help improve post-operative surgical outcomes in this poor prognostic group. Sarcopenia may be a premorbid state in the deprived colorectal cancer patient that may not be wholly driven by tumour characteristics.

Intrapleural Migration of Ventriculoperitoneal Shunt due to Negative Intrathoracic Pressure.

Background Ventriculoperitoneal (VP) shunt is still a mainstay of treatment in centers for infants with aqueductal stenosis which is the most common cause of congenital obstructive hydrocephalus. Shunt migration remains a common complication. Delayed distal shunt tip migration into the thoracic cavity due to negative intrathoracic pressure is a rare occurrence. Case Presentation Authors report a 1-year-old infant presenting with drowsy sensorium, increasing head circumference, and bulging anterior fontanelle. Magnetic resonance imaging of the brain revealed significant obstructive hydrocephalus with periventricular seepage. A large expansile diverticulum of the suprapineal recess extending infratentorially compressing the dorsal midbrain and cerebellum inferiorly. The child underwent an emergency right-side VP shunt (medium pressure) in view of clinical symptoms of raised intracranial pressure. A right iliac fossa infraumbilical transverse incision was taken for placing the abdominal end. Visual confirmation of bowel was done after opening the peritoneum by two operating surgeons prior to inserting the distal catheter. Postoperative course was uneventful. The child presented 3 months later with acute dyspnea and diminished breath sounds on the right hemithorax. Neurologically, the child was active, feeding well, and anterior fontanelle was lax. A chest roentgenogram and computed tomogram (CT) of the thorax revealed complete shunt migration into the pleural space with significant pleural effusion on the right side. The distal shunt system on CT appeared to enter the pleural space below the 8th rib, probably indicating that there was subcostal tunneling of the shunt below the 8th rib space during the first surgery which was inconspicuous and subsequently over a span of 3 months due to sucking effect of negative intrathoracic pressure the shunt gradually migrated into the pleural cavity which led to the effusion. An emergency VP shunt revision was performed. The distal end below the chamber was retunneled subcutaneously into a new incision in the left paraumbilical region. Postoperative chest and abdomen roentgenograms showed resolving effusion and accurate shunt placement. The child required elective ventilation temporarily to tide over the underlying lung collapse and an intercostal tube drainage for the cerebrospinal fluid (CSF) hydrothorax for 2 days to aid in quicker weaning. The child was discharged on the 5th postoperative day. Discussion Intrapleural migration of VP shunts has been contemplated to be due to trauma during surgery, migration across foramen of Bochdalek or Morgagni, and negative intrathoracic pressure. Taub and Lavyne have classified thoracic complications of VP shunt as thoracic trauma during shunt tunneling, supradiaphragmatic migration of shunt or transdiaphragmatic migration of shunt, and pleural effusion complicated by CSF ascites. Transdiaphragmatic migration is commonly seen in pediatric population and supradiaphragmatic migration can be seen in any age group. We believe our case to be a type of supradiaphragmatic migration of the shunt which has occurred slowly over a span of time due to the negative intrathoracic pressure. The idea behind this clinical case image is to edify neurosurgeons, pediatricians, and intensivists to remain wary of such a complication.

Single-Stage Combined Approach Sagittal En Bloc Spondylectomy for L3 Vertebral Chondrosarcoma: A Technical Note

Primary malignant tumors of the spine are rare and most commonly occur in lumbar and thoracic vertebrae. We report a rare case of retroperitoneal chondrosarcoma of L3 that was managed with sagittal en bloc spondylectomy following chemoradiation. A 26-year-old woman was evaluated for abdominal pain with contrast-enhanced computed tomography of the abdomen and pelvis, which revealed a soft tissue retroperitoneal mass arising from L3. She underwent laparotomy and biopsy, which revealed chondrosarcoma, and she received chemoradiation over a period of 28 weeks 6 days. After repeat imaging, she underwent single-stage combined approach sagittal en bloc spondylectomy of retroperitoneal chondrosarcoma of L3 with right nephrectomy and spine reconstruction. At 3-year follow-up, there was no evidence of recurrence on contrast-enhanced computed tomography of the abdomen and pelvis. She demonstrated no gait abnormality or spinal deformity. Sagittal en bloc spondylectomy is a preferred surgical approach for eccentrically placed spinal tumors that offers better oncological and functional outcomes.

The influence of radiographic marker registration versus a markerless trace registration method on the implant placement accuracy achieved by dynamic computer-assisted implant surgery. An in-vitro study

ObjectivesThis study aimed to compare the effect the radiographic marker registration (RMR) and markerless tracing registration (MTR) on implant placement accuracy using a dynamic computer-assisted implant surgery system (dCAIS). Additionally, this study aimed to assess the surgical time and whether the implant location influences the accuracy of the two registration methods. Methods136 dental implants were randomly allocated to the RMR or MTR group and were placed with a dCAIS in resin models. Preoperative and postoperative Cone Beam Computer Tomograms (CBCT) were overlaid and implant placement accuracy was assessed. Descriptive and multivariate analysis of the data was performed. ResultsSignificant differences (P < 0.001) were found for all accuracy variables except angular deviation (RMR:4.30° (SD:4.37°); MTR:3.89° (SD:3.32°)). The RMR had a mean 3D platform deviation of 1.53 mm (SD:0.98 mm) and mean apex 3D deviation of 1.63 mm (SD:1.05 mm) while the MTR had lower values (0.83 mm (SD:0.67 mm) and 1.07 mm (SD:0.86 mm), respectively). In the MTR group, implant placement in the anterior mandible was more accurate (p < 0.05). Additionally, MTR did not significantly increase the surgical time compared with RMR (P = 0.489). ConclusionsMTR seems to increase the accuracy of implant placement using dCAIS in comparison with the RMR method, without increasing the surgical time. The operated area seems to be relevant and might influence the implant deviations. Clinical significanceConsidering the limitations of this in-vitro study, MTR seems to provide a higher accuracy in implant placement using dCAIS without increasing the surgical time. Furthermore, this method does not require radiographic markers and allows re-registration during surgery.

Computed Tomographic Study of Frontal Sinus Cells and Opacification as Per the International Frontal Sinus Anatomy Classification.

International frontal sinus anatomy classification (IFAC) was introduced in 2016 to standardize the nomenclature of the cells in the frontal recess region, facilitate better communication between surgeons and precision in surgical planning, and improve surgical teaching. This study aims to estimate the radiological prevalence of the different frontal recess cells according to the IFAC and to evaluate the relationship of these cells with the frontal sinus opacification in patients with chronic rhinosinusitis. In this study, 90 participants diagnosed with chronic rhinosinusitis (CRS) who underwent computed tomogram (CT) of the para nasal sinuses were enrolled consecutively. The CT images were were studied in detail using RadiAnt DICOM viewer. The frontal recess cells were grouped as per the IFAC guidelines and their respective prevalence was calculated. The frontal recess cells were grouped as per the Opacification or mucosal thickening within these cells and the frontal sinuses were noted. A multivariate logistic regression analysis was done to evaluate the association between frontal sinus opacification and presence of various IFAC cells. A total of 640 IFAC cells were documented in 180 sides, of which 326 were anterior cells, 263 were posterior cells and 51 were medial cells. The most prevalent cell was the agger nasi cells(ANC), present in 91.7% of 180 sides, the supra agger nasi cells(SANC), Supra agger nasi frontal cells(SAFC), supra bulla cells(SBC), supra bulla frontal cells(SBFC), supra orbital ethmoidal cells(SOEC) and frontal septal cells(FSC) were present in 47.8%,37.8%, 65.6%,28.9%, 51.1% and 28.3% respectively. There was no significant association of presence of IFAC cells and frontal sinus opacification except for SBFC(p = 0.038). A significantly higher number of diseased frontal recess cells were seen with involved frontal sinuses when compared with non-involved frontal sinuses across all types of IFAC cells. The ANC were the most prevalent among all the IFAC cells and the FSC were the least prevalent. There was no significant association with the presence of different types of IFAC cells and frontal sinus opacification except for SBFC. However, there was a significantly higher number of diseased IFAC cells associated with frontal sinus opacification than in those without frontal sinus opacification.

Splenic abscess presenting as pneumonia with pleural effusion initially: A rare case in a 2-year-old girl: A case report

Rationale: Splenic abscess is rarely discovered during the toddler period. Although most of the cases are typically marked by fever, abdominal pain, and vomiting, some of them may suffer life-threatening situations. This study aimed to explore how early detection can prevent serious disease complications. Patient concerns: A 2-year-old child with persisted fever and shortness of breathing was admitted. Physical examination was decreasing breathing sound on the left side. We gave empirical antibiotics use with chest tube drainage for 2 days in vain. No fever dropping and persistent left upper abdominal pain were noted. A huge mass was found on left spleen incidentally during abdominal ultrasound screen. Diagnosis: Huge splenic abscess. Intervention: High-resolution ultrasound and abdominal computer tomogram were conducted to confirm the diagnosis. Percutaneous drainage under computer tomography-guided with antibiotic use was smoothly. No obvious adverse effects were noted during the treatment course. Rapid clinical improvement with decreasing size was observed by ultrasound 10 days after the treatment and fever subsided. Outcomes: A period of 3-month follow-up revealed no evidence of recurrence of abscess. Lessons: Early diagnosis and intervention are mandatory for splenic abscess to prevent possible ominous consequences. The case study has shown that computer tomography-guided percutaneous drainage, along with appropriate antibiotic therapy, can significantly impact solitary unilocular splenic abscesses, even if they are large. This approach demonstrates the potential to effectively manage splenic abscesses and avoid the need for more invasive procedures such as splenectomy.

Review of materials and technological solutions for creating phantoms used in computed tomography

The use of computed tomography during diagnostic examinations makes it a source of additional radiation exposure to patients. In this regard, the development of test objects (phantoms) that simulate the X-ray properties of tissues, including for preliminary assessment of the ionizing radiation distribution, becomes relevant. These test objects play an important role in quality control and the development of new medical imaging methods in conditions where test scans of patients are not possible. Although a range of ready-made solutions is available on the market, there is a lack of prototypes with a certain set of properties to test scientific and practical hypotheses in solving specific clinical and technical problems. Finding materials for a fast and inexpensive production process and studying their properties could provide insight into the effectiveness of their use in making phantoms. The purpose of the work is to search and analyze materials for creating phantoms used in computed tomography. The article discusses materials for the production of non-anthropomorphic and anthropomorphic phantoms, including those printed on a 3D printer. The development of three-dimensional printing has facilitated the transition from simple test objects to high-precision anthropomorphic phantoms made from tissue-mimicking materials that have equivalent signals on computer tomograms. Plastics, silicones, polyvinyl chloride, resins, liquids are used for visualizations identical to soft tissues; plastics, gypsum, photopolymers, potassium hydrogen orthophosphate, calcium hydroxyapatite, plexiglass — for hard tissues. Commercial phantoms are made from materials with reproducible, stable properties, but these same materials must be retested to create test objects specific to a particular clinical task.

Математическое моделирование и визуализация сложнонапряженного состояния при переломе диафиза бедренной кости

The purpose of this work is to establish the possibility of using the finite element analysis method to study complex stress states in case of a femur fracture with subsequent data visualization. Experimental data were obtained on a solid-state mathematical parametric model of the femur, created on the basis of computer tomogram data, and repeating studies on native biological objects. As a result of mathematical modeling, oblique transverse and helical fractures of the diaphysis of the femur with elements of helical deformation were studied. The application of finite element analysis made it possible to visualize and predict the stresses arising in bone tissue under the impact of a blunt solid object in a complex stress state and the morphological features of femoral shaft fractures under different torsional loading forces of the proximal part of the femur. The data on the mechanism and morphology of the femoral shaft fracture obtained during modeling are confirmed by the results of original full-scale experiments.

Correcting for asymmetry of the proximal tibial epiphysis is warranted to determine postoperative alignment deviations in kinematic alignment from planned alignment of the tibial component on the native tibia

BackgroundIn total knee arthroplasty, unrestricted kinematic alignment aims to restore pre-arthritic lower limb alignment and joint lines. Joint line orientations of the contralateral healthy proximal tibia might be used to evaluate accuracy of tibial component alignment post-operatively if asymmetry is minimal. Our objective was to evaluate left-to-right asymmetry of the proximal tibial epiphysis in posterior tibial slope and varus-valgus orientation as related to unrestricted kinematic alignment principles. MethodsHigh resolution CT images (0.5 mm slice thickness) were acquired from bilateral lower limbs of 11 skeletally mature subjects with no skeletal abnormalities. Images were segmented to generate 3D tibia models. Asymmetry was quantified by differences in orientations required to shape-match the proximal epiphysis of the mirror 3D tibia model to the proximal epiphysis of the contralateral 3D tibia model. FindingsSystematic and random differences (i.e. mean ± standard deviation) in tibial slope and varus-valgus orientation were − 0.8° ± 1.2° and − 0.2° ± 0.8°, respectively. Ninety five percent confidence intervals on the means included 0° indicating that systematic differences were minimal. InterpretationSince random differences due to asymmetry are substantial in relation to random surgical deviations from pre-arthritic joint lines previously reported, post-operative computer tomograms of the contralateral healthy tibia should not be used to directly assess accuracy of tibial component alignment on a group level without correcting for differences in tibial slope and varus-valgus orientation due to asymmetry.

A unified strategy to focal brachytherapy incorporating transperineal biopsy, image fusion, and real-time implantation with and without rectal spacer simulated in prostate phantoms.

To develop an approach to the diagnosis and treatment of prostate cancer using one platform for fusion biopsy, followed by focal gland ablation utilizing permanent prostate brachytherapy with and without a rectal spacer. Prostate phantoms containing multiparametric magnetic resonance imaging (mpMRI) regions of interest (ROI) underwent fusion biopsy, followed by image co-registration of positive sites to a treatment planning brachytherapy program. A partial hemi-ablation and both posterior lobes using a Mick applicator and linked stranded seeds were simulated. Dummy sources were modeled as iodine-125 (125I) with a prescribed dose of at least 210 Gy to gross tumor (GTV) and clinical target volume (CTV), as defined by mpMRI visible ROI and surrounding negative biopsy sites. Computer tomograms (CT) were performed post-implant prior to and after rectal spacer insertion. Different prostate and rectal constraints were compared with and without the spacer. The intra-operative focal volumes of CTV ranged from 6.2 to 14.9 cc (mean, 11.3 cc), and the ratio of focal volume/whole prostate volume ranged between 0.19 and 0.42 (mean, 0.31). The intra- and post-operative mean focal D90 of GTV, CTV, and for the entire prostate gland was 265 Gy and 235 Gy, 214 Gy and 213 Gy, and 66.1 Gy and 57 Gy, respectively. On average, 13 mm separation was achieved between the prostate and the rectum (range, 12-14 mm) on post-operative CT. The mean doses in Gy to 2 cc of the rectum (D2cc) without spacer vs. with spacer were 39.8 Gy vs. 32.6 Gy, respectively. Doses above 200 Gy and the implantation of seeds in clinically significant region for focal therapy in phantoms are feasible. All rectal dosimetric parameters improved for the spacer implants, as compared with the non-spacer implants. Further validation of this concept is warranted in clinical trials.

Аналіз комп’ютерних томограм після лікування дисфункції скронево- нижньощелепного суглоба

The aim. To define the dimensions of upper joint space during TMJ disc displacement, associated with limited mouth opening by analyzing computer tomography images. Materials and methods. 79 patients were clinically examined by means of an anamnesis collection, isometric tests, palpation of TMJ and masticatory muscles, detection of occlusal supra contacts in habitual and dynamic occlusion. For all the examined patients with permanently limited mouth opening up to 35 mm between incisors a TMJ computer tomography (CT) in habitual occlusion was performed before and after gnathological treatment. Computer tomogram images are represented by sagittal plane where dimensions of upper joint space were measured. The distance between the upper and lower central incisors was measured in millimetres at the largest mouth opening position during clinical examination. Results. For 48 (60, 7%) examined patients chewing food wearing a gnathological splint was considered as an optional recommendation and was aimed at maintaining the therapeutic effect achieved during the first three months of treatment, and for 31 (39,2%) patients consuming food in a gnathological splint was a necessity for achieving physiological measurements of mouth opening, within 43-53 mm between the incisors. Conclusions. During the comparison of TMJ computer tomogram images in the closed jaws position on both sides before and after treatment of TMJ disc displacement, which is accompanied by limited mouth opening, it was found out that the maximum admissible asymmetry in articular condyle position after gnathological treatment, measured along the upper joint space was 2,8 ± 0,31 mm and was found in 11,3% of examined patients. Key words: TMJ (Temporomandibular joint), limited mouth opening, computer tomography (CT).

Decreased femur tunnel widening after augmented suspensory fixation compared to suspensory fixation for single bundle hamstring ACL reconstruction

BackgroundTunnel widening after Anterior cruciate ligament (ACL) reconstruction using a hamstring graft is known to occur at follow-up. Our study aimed to investigate the effect of suspensory fixation augmentation using an interference screw on tunnel widening in single-bundle hamstring ACL reconstruction. Methods48 patients who had single bundle ACL reconstruction with femoral fixed loop fixation technique in 15 knees, and, fixed loop with augmented aperture (bio screw) fixation in 33 knees were analyzed. The width of the tunnel was measured using radiographs immediate post-op and at follow-up within 1 year. Computerized Tomogram (CT) measurements of the tunnels and functional scores were also done with overall follow-up for the fixed loop group being 21.33 months (Standard Deviation (SD)11.14) and the Augmentation group 9.12 months (SD 3.83) ResultsMidpoint femur tunnel widening was reduced in the augmentation group, with measurements of 0.74 (SD 1.05) mm Antero Posterior (AP) and 1.01 (SD 1.04) mm in the Lateral view, compared to 1.54 (SD 1.48) mm AP and 1.79 (SD1.47 mm) in the Lateral for the fixed button group. The radiological widening was considerably less in the augmentation group with a p-value of 0.07. AP aperture widening in the augmentation group was 1.25(SD 1.10 mm), and 1.09(SD0.98) mm in the lateral view. The fixed button-only group measured 1.53 (SD1.30) mm in the AP, and 1.65 (SD 1.29) mm in the lateral view, both of which were not statistically significant. The follow-up Lysholm and International Knee Documentation Committee (IKDC) scores were similar for the 2 groups. ConclusionFemoral tunnel midpoint and aperture widening were reduced with the fixed loop with aperture (bio screw) augmentation technique for hamstring grafts in single bundle ACL fixation within 1 year with comparable functional scores. Level of evidence4.

SAT562 Metastatic Oncocytic (Formerly Hürthle Cell) Thyroid Carcinoma in a Patient With Birt-Hogg-Dubé Syndrome

Abstract Disclosure: S. Vaid: None. R. Klein: None. P. Veeraraghavan: None. D.M. Blakaj: None. A. Agrawal: None. J. Sipos: None. S.I. Sherman: None. J. Klubo-Gwiezdzinska: None. S. Gubbi: None. Introduction: Birt-Hogg-Dubé syndrome (BHD) is a rare, autosomal dominant disorder due to a germline loss-of-function mutation in the folliculin (FLCN) gene. Clinical manifestations include pulmonary cysts, renal cell carcinoma, and skin tumors, while tumors of other sites such as thyroid are uncommon. Here, we report an extremely rare case of oncocytic thyroid carcinoma (OTC) in a patient with BHD. Clinical case: A 55-year-old male with BHD noted a lump in his neck which was identified as a 3 cm right thyroid nodule on sonogram. Medical history only included BHD, which was diagnosed based on the presence of pulmonary cysts and two family members with BHD. No family members had thyroid tumors, and the patient denied any history of radiation exposure. Fine needle aspiration biopsy was indeterminate (Bethesda III). A total thyroidectomy and central lymph node (LN) dissection was performed as LN metastases were identified on intraoperative frozen section. Histopathology revealed 3 foci of OTC, largest being 3.8 cm, with extrathyroidal extension into fibroadipose tissue, 3/31 LN metastases with the largest deposit of 0.5 cm without extranodal extension. A 156.6 mCi dose of I-131 radioiodine (RAI) was administered. No uptake was noted on the post-therapy scan. Four months later, new right lateral cervical lymphadenopathy was noted on computed tomogram (CT). A right lateral selective neck dissection was performed, which identified 3/28 metastatic LNs without extranodal extension. Next generation gene sequencing testing of the metastatic tumor revealed the pathogenic FLCN (H429fs*27) variant, along with TP53 (R248Q), and DAXX (L666fs*29) pathogenic variants. Over the next 20 months, serum thyroglobulin increased from 1.8 ng/ml to 121 ng/mL (normal: 1.6 - 59.9 ng/mL). Several sub-centimeter lung nodules and new right cervical lymphadenopathy were noted on CT, and these lesions demonstrated increased uptake on fluorodeoxyglucose positron emission tomography (PET/CT) and on Ga-68 DOTATATE PET/CT scans. Due to close proximity to the right internal jugular vein, the cervical lymphadenopathy was deemed to be inoperable. Stereotactic radiation was administered to the neck, which resulted in substantial shrinkage of the neck metastases. The patient continues to be on active surveillance, with tyrosine kinase inhibitors or peptide receptor radionuclide therapy being potential future systemic therapy options in case of disease progression. Conclusion: Thyroid tumors have been occasionally reported in BHD. While most of them are papillary or follicular tumors, only one case of OTC in BHD has been previously reported in the literature [1]. This report underscores the importance of screening for thyroid neoplasms in patients with BHD. Reference: 1. Panagiotidis et al. World J Nucl Med. 2018;17(2):123-125 Presentation Date: Saturday, June 17, 2023

Delirium, confusion, or altered mental status as a risk for abnormal head CT in older adults in the emergency department: A systematic review and meta-analysis

BackgroundAltered mental status (including delirium) is a common presentations among older adults to the emergency department (ED). We aimed to report the association between altered mental status in older ED patients and acute abnormal findings on head computed tomogram (CT). MethodsA systematic review was conducted using Ovid Medline, Embase, Clinicaltrials.gov, Web of Science, and Cochrane Central from conception to April 8th, 2021. We included citations if they described patients aged 65 years or older who received head imaging at the time of ED assessment, and reported whether patients had delirium, confusion, or altered mental status. Screening, data extraction, and bias assessment were performed in duplicate. We estimated the odds ratios (OR) for abnormal neuroimaging in patients with altered mental status. ResultsThe search strategy identified 3031 unique citations, of which two studies reporting on 909 patients with delirium, confusion or altered mental status were included. No identified study formally assessed for delirium. The OR for abnormal head CT findings in patients with delirium, confusion or altered mental status was 0.35 (95% CI 0.031 to 3.97) compared to patients without delirium, confusion or altered mental status. ConclusionWe did not find a statistically significant association between delirium, confusion or altered mental status and abnormal head CT findings in older ED patients.

Renal Mass Mimicking Prominent Columns of Bertin: A Case Series

Prominent column of Bertin (PCB), also known as hypertrophic column of Bertin, are often referred to as pseudo tumors, given that they can mimic the appearance of renal tumors. This case series demonstrates a reverse situation where renal masses mimicked PCB. Two patient cases are presented to demonstrate how renal masses mimicked PCB, and a third comparative case is presented to demonstrate a split sinus sign that represents a PCB, a pseudo tumor confirmed with a computed tomogram (CT). Considering the renal masses mimicking PCB, CT, and histology confirmed the presence of renal cell carcinoma. Renal masses which present sonographically as PCB, are most likely to be overlooked and have negative impacts when undetected. Early detection of renal tumors is vital in improving a patient’s prognosis. This case series is useful in providing further evidence of how renal masses can mimic PCB, with sonography. Careful sonographic examination of PCB should be encouraged, and if sonographic features are uncertain, consider further evaluation by urology, especially for those patients with a background of hematuria and no previous imaging studies.