Computed Tomography Sections Research Articles

The Frequency of Presence of the Infraorbital Canal in the Maxillary Sinus and its Clinical Importance.

The infraorbital canal (IOC) houses critical structures like the infraorbital artery, vein, and nerve, and its atypical location within the maxillary sinus could pose risks during surgical procedures, making it crucial to understand its prevalence and distribution. The study aims to investigate the localization and frequency of the IOC within the maxillary sinus. This retrospective study analyzed computed tomography (CT) images from 1000 randomly selected patients (500 males, 500 females) aged 18 to 65 years who underwent paranasal region imaging at Istanbul Medipol University Medipol Mega University Hospital between 2015 and 2020. Exclusion criteria included major pathologies, prior surgeries, and poor image quality. The study focused on evaluating the localization of the IOC and its presence within the maxillary sinus, using coronal CT sections. The IOC was found within the maxillary sinus in 8% of cases (44 males, 36 females). This variation was bilateral in 34 cases and unilateral in 46 cases, with no statistically significant relationship between sex and the occurrence or type of variation. The study's findings align with previous research, which reported similar prevalence rates for this anatomical variation. The study confirms that the IOC is located within the maxillary sinus in a significant percentage of cases, emphasizing the importance of preoperative CT evaluation to prevent potential complications during maxillary sinus surgeries. These findings highlight the clinical relevance of considering individual anatomical differences in the localization of the IOC.

Simplifying the Orientation of S1 Iliosacral Screws for Placement in the Dysmorphic Sacrum.

Determining the proper iliosacral screw orientation in a dysmorphic S1 sacral segment using a C-arm is difficult, and pelvic computed tomography (CT) is often necessary for the preoperative planning. On the preoperative pelvic axial CT section, the intended screw trajectory can be delineated intraosseously along the axis of the oblique osseous corridor. An inherently accurate orientation would be determined by 2 factors: (1) the trajectory is in the pelvic transverse plane, and (2) it is oriented relative to the coronal plane at a patient-specific angle, which should be measured preoperatively. Based on the above reasoning, we aimed to simplify and verify the orientation. After establishing the starting point on the sacral lateral view, we tested a method of simplifying the guidewire orientation: placing the guidewire in the pelvic transverse plane and then manipulating it to be angled relative to the coronal plane at the preoperatively measured patient-specific angle. The guidewire orientation should then be reproducibly accurate on the pelvic outlet and inlet views. The feasibility and safety of our method were verified through computer-simulated virtual surgical procedures in 95 dysmorphic sacra and clinical surgical procedures in 12 patients. The primary outcome parameters were the guidewire orientation and screw placement accuracy. Using our method, the S1 guidewire orientation was reproducibly accurate on the pelvic outlet and inlet views in all of the virtual and clinical surgical procedures. Ninety-five virtual S1 screws (1 screw in each left hemipelvis) were placed intraosseously in the pelvic transverse plane. Fourteen unilateral S1 screws were placed intraosseously in the pelvic transverse plane in the 12 patients (2 patients had double screws) without iatrogenic injuries. The guidewire orientation can be simplified by placing the guidewire in the pelvic transverse plane and replicating the preoperatively measured patient-specific angle between the guidewire and the coronal plane. After establishing the starting point on the sacral lateral view, our simplified manipulation yields a reproducibly accurate orientation on the pelvic outlet and inlet views. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Open Latarjet reduces residual apprehension, redislocation and possibility of dislocation arthropathy compared to arthroscopic Bankart repair despite greater bipolar bone loss in anterior glenohumeral instability

BackgroundArthroscopic Bankart repair (ABR) and the open Latarjet (OL) procedure are the most frequently preferred methods in the treatment of anterior glenohumeral instability. The aim of this study was to compare patients who underwent ABR or OL due to anterior glenohumeral instability in terms of functional capacity, glenohumeral bone loss, residual apprehension, redislocation and dislocation arthropathy. MethodsA total of 56 patients who underwent ABR or OL due to anterior glenohumeral instability between January 2018 and December 2021 were evaluated retrospectively. There were 32 patients in the ABR group and 24 patients in the OL group. Patients’ demographic characteristics, number of preoperative dislocations, and return-to-work and follow-up periods were recorded. Glenoid bone loss, Hill-Sachs interval, and Hill-Sachs depth were measured from preoperative computed tomography sections. The ASES score, WOSI score, Rowe score, and joint range of motion were calculated. Patients were also asked about residual apprehension, postoperative redislocations, dislocation arthropathy and surgery satisfaction. ResultsThe mean age of the ABR group was 22.5±3.9 years (28 men, 4 women), while that of the OL group was 25.0±4.8 years (22 men, 2 women). The mean number of dislocations was 2.7±1.3 in the ABR and 10.9±5.5 in the OL (p=0.001). Higher values of glenoid bone loss (%) (ABR: 6±2; OL: 20±4), Hill-Sachs interval (mm) (ABR: 8±3; OL: 21±3), and Hill-Sachs depth (mm) (ABR: 5±2; OL: 8±2) were measured in the OL (p=0.001 for all), reflecting significantly more bone loss. Residual apprehension was detected in 10 patients in the ABR and 2 patients in the OL (p=0.007). While 4 patients in the ABR had a history of redislocation, no redislocation occurred in the OL (p=0.012). Dislocation arthropathy development was observed in 9 patients in the ABR and 4 patients in the OL (p=0.038) according to the modified Samilson and Prieto classification. External rotation in adduction and external rotation in 90° abduction were approximately 5° higher in the OL (p=0.011 and p=0.016, respectively). ConclusionThe ABR and OL methods both provide satisfactory outcomes in the treatment of anterior glenohumeral instability with appropriate indications. The OL procedure is preferred for patients with more dislocations and greater bipolar bone loss. Despite greater bipolar bone loss, the OL procedure provides lower rates of residual apprehension, redislocation and dislocation arthropathy. Additionally, due to the stability it provides, there is less loss in external rotation.

Computed tomography-based radial endobronchial ultrasound image simulation of peripheral pulmonary lesions using deep learning.

Radial endobronchial ultrasound (R-EBUS) plays an important role during transbronchial sampling of peripheral pulmonary lesions (PPLs). However, existing navigational bronchoscopy systems provide no guidance for R-EBUS. To guide intraoperative R-EBUS probe manipulation, we aimed to simulate R-EBUS images of PPLs from preoperative computed tomography (CT) data using deep learning. Preoperative CT and intraoperative ultrasound data of PPLs in 250 patients who underwent R-EBUS-guided transbronchial lung biopsy were retrospectively collected. Two-dimensional CT sections perpendicular to the biopsy path were transformed into ultrasonic reflection and transmission images using an ultrasound propagation model to obtain the initial simulated R-EBUS images. A cycle generative adversarial network was trained to improve the realism of initial simulated images. Objective and subjective indicators were used to evaluate the similarity between real and simulated images. Wasserstein distances showed that utilizing the cycle generative adversarial network significantly improved the similarity between real and simulated R-EBUS images. There was no statistically significant difference in the long axis, short axis, and area between real and simulated lesions (all P > 0.05). Based on the experts' evaluation, a median similarity score of ≥4 on a 5-point scale was obtained for lesion size, shape, margin, internal echoes, and overall similarity. Simulated R-EBUS images of PPLs generated by our method can closely mimic the corresponding real images, demonstrating the potential of our method to provide guidance for intraoperative R-EBUS probe manipulation.

Increased combined anteversion is associated with larger posterior acetabular rim ossification in patients with femoroacetabular impingement syndrome.

(1) To determine the prevalence, magnitude and distribution pattern of acetabular rim ossification in patients with femoroacetabular impingement syndrome (FAIS) and (2) to determine the association between acetabular rim ossification and rotational abnormalities of the hip. Patients underwent hip arthroscopic surgery for FAIS at our institute between January 2021 and May 2022 were retrospectively reviewed. Patients were included if preoperative computed tomography (CT) images of the operated hip and ipsilateral distal femur were available for the measurement of femoral and acetabular anteversion. The presence and size of acetabular rim ossification were evaluated on coronal CT sections for the superior half of the acetabulum on each clockface location. The associations between acetabular rim ossification and radiographic parameters of hip rotational morphology were examined. A total of 214 hips were included. Acetabular rim ossification was found in 167 hips (78%) and the most common locations were 10 and 11 o'clock. Patients presenting with acetabular rim ossification had a mean size of 4.6 ± 1.6 mm. It was the largest at 9 o'clock position (4.9 ± 2.2 mm), with a decreasing trend in size from posterior to anterior. Logistics regression analysis found age was associated with the occurrence of posterior ossification (p = 0.002). Linear regression analysis found age (p = 0.049) and male sex (p < 0.001) were significantly correlated with the size of ossification. Patients with increased cranial combined anteversion had larger posterior ossification than patients with normal and decreased cranial combined anteversion (4.2 ± 2.9 vs. 3.1 ± 2.5 mm, p = 0.016; 4.2 ± 2.9 vs. 2.5 ± 2.4 mm, p = 0.005). Increased combined anteversion is associated with greater posterior acetabular rim ossification. The presence and size of acetabular rim ossification are positively associated with older age and male sex. Level III.

Diagnostic Accuracy of Ileocolic Artery and Vein Diameter for Acute Appendicitis.

BACKGROUND Regional inflammation-induced local vasodilation may exist in cases of appendicitis. In this study, the diameters of the ileocolic artery (ICA) and ileocolic vein (ICV) were measured using contrast-enhanced abdominal computed tomography (CT) scans in acute appendicitis cases. The study aimed to measure the diagnostic value of these measurements in the diagnosis of acute appendicitis. MATERIAL AND METHODS A total of 508 patients, including those with a diagnosis of acute appendicitis and a control group without appendicitis, were systematically evaluated. In all cases, the appendix was analyzed simultaneously on axial and coronal CT sections, and all measurement procedures were conducted with an electronic ruler after the actual images were magnified. Measurements of the ICA and ICV diameters were taken from the proximal 2-cm segments of the superior mesenteric artery and superior mesenteric vein in the axial plane. Demographic information, sex distribution, and ICA and ICV diameters were collected. RESULTS Of the 508 patients, 53.74% were men, and 46.26% were women. ICA and ICV diameters were significantly increased in the appendicitis group (P<0.001). Binomial logistic regression confirmed the independent predictive value of ICA and ICV diameters. Receiver operating characteristic curve analysis determined optimal cut-off values for distinguishing between the non-appendicitis and appendicitis groups (ICA: 2.475 mm, ICV: 3.885 mm) with high sensitivity and specificity. CONCLUSIONS ICA and ICV diameter measurements, in conjunction with major radiological findings, can enhance diagnostic accuracy in acute appendicitis cases. The use of ICA and ICV diameter measurements in diagnosing acute appendicitis offers a novel perspective in clinical practice.

Stereological and computed tomography calculation of intracranial volume in Hamdani sheep

AbstractThe intracranial cavity contains vital organs such as the brain, cerebellum and meninges. The veterinary field employment in this region is limited. For this reason, obtaining information about the intracranial cavity, the operation to be performed on this region and information about the world will benefit our unit. It aimed to examine the width between gender differences and expectations by calculating the intracranial volume stereological and 3D models using computed tomography sections. In the study, 7 male and 6 female adult Hamdani sheep were used. The intracranial cavity was modelled in 3D using computed tomography sections. Intracranial volume was estimated using CT slices according to the Cavalieri principle. Morphometric measurements were obtained from the intracranial cavity. In the study, intracranial volume was calculated as 120.50±7.59 cm3 in females and 137.29±9.79 cm3 in males in measurements made using Computed Tomography. Intracranial volume calculation made using the Cavalieri's principle was calculated as 125.33±5.20cm3 in females and 136.89±9.13 cm3in males. In the configured CT models, a target difference was detected between the male and female volume values calculated on it (p &lt; 0.05). There was a difference between males and females in stereologically viable intracranial volume (p &lt; 0.05). A high level of density was observed between the results of both methods. In the mean of the data, there was no difference between the objectives (p &gt; 0.05). Morphometric measurements determined that the maximum cranial cavity width parameter was between females and males (p &lt; 0.005). In index1 and index2 calculated with the obtained partitions, a circulating difference between genders was observed (p &lt; 0.05). In the resulting state, the 3‐dimensional intracranial cavity models and the intracranial volume fraction estimated by the Cavalieri principle are conserved. There are high limits between the methods. Feeding future intracranial volume and clinical care.

P-48 Post-traumatic Panhypopitutarism after an in-vehicle traffic accident: A case report

Abstract Introduction Hypopituitarism, occurs most commonly from pituitary tumors and a head injury, though a fracture of the base of the skull is considered a rare cause. Traumatic brain injury causes severe disability and endocrine dysfunction in a significant proportion of patients. Hypopituitarism diagnosed with endocrine symptoms related to hypoadrenocorticotropinemia, hypothyroidism and hypogonadism. We describe a case of posttraumatic panhypopitutarism presenting with symptoms of secondary amenorrhea, loss of appetite, nausea, vomiting, hearing loss and hypoglycemia after an in-vehicle traffic accident. Clinical Case A 28-year-old female patient with no medical history was admitted with symptoms of nausea, vomiting, anorexia, amenorrhea, and hypoglycemia after an in-vehicle traffic accident. It was learned that the patient's menstrual periods were regular before the accident and she did not have any complaints. Panhypopitutarism was observed in the examinations performed (Table 1). In the follow-ups, 10% intravenous dextrose solution and 20 mg prednisolone every 6 hours were started due to the hypoglycemic course. Prednisolone was reduced and discontinued, and hydrocortisone treatment was started from 30 mg/day. L-thyroxine replacement was started one week after the steroid treatment. Computed tomography (CT) showed deformity and collapse secondary to the fracture at the base of the sella and on contrast-enhanced pituitary magnetic resonance (MRI) imaging, it was observed that the morphology of the sella was distorted in T1-weighted sections, pituitary tissue could not be clearly distinguished, and there was collapse at the base of the sella in the right lateral section; the present findings were thought to support pituitary insufficiency (Figure 1). Hormone replacement therapy was given for secondary amenorrhea. One year after the accident, she wanted to be a pregnant and ovulation was induced by the injection of human menopausal gonadotrophin (HMG) following human chorionic gonadotrophin (HCG) at a large dose. She got pregnant in the first cycle. Conclusion In a patient with Panhypopituitarism, who could not be pregnant spontaneously, clinical practice of ovulation–induction treatment including administration of hCG and follicle-stimulating hormone, pulsatile GnRH (gonadotropin-releasing hormone), and in vitro fertilization, enabled the hypopituitary women to become ovulation and pregnancy. In our case, pregnancy was achieved after adequate hormone replacement therapy.Figure 1.CT and MRI images of the patientFigure. (a) Coronal CT section showing deformity-subsidence at the base of the sella secondary to fracture, (b and c) sagittal and coronal contrast-enhanced MRI showing subsidence at the base of the sella (thick arrow) with herniation of pituitary tissue (short arrow) and distorted-deformed infundibular stalk (thin arrow), respectively. Table 1.Laboratory workup*ACTH: Adrenocorticotropic hormone; FSH: follicle-stimulating hormone; LH: Luteinizing hormone; TSH: thyroid stimulating hormone; fT4: thyroxine; GH: Growth hormone; IGF-1: Insulin-like growth factor 1

PECULIARITIES OF THE IDENTIFICATION OF DIFFERENT TYPES OF TISSUES DURING 3D-RECONSTRUCTION OF HUMAN MICROSCOPIC STRUCTURES

3D reconstruction is an informative, objective method of morphological research that consists in transforming a seriesof successive sections (histological, macroscopic, anatomical sections, computed tomography (CT), etc.) into a virtual threedimensional (digital) image that can be studied in diff erent projections and measure volumes, areas, diameters, angles, save, copy, edit.The aim of the study. The aim of this work was to compare the eff ectiveness of 3D reconstruction methods of various tissuesand microscopic anatomical structures of the human body in the prenatal period of development.Material and methods. The research was carried out on 6 series of consecutive histological sections of human embryos atthe age of 4 to 6 weeks of intrauterine development (IUD), 15 samples of organ complexes of the head, limbs and trunk of human fetuses at the age of 7 to 12 weeks of IUD, human fetuses aged 4-9 months of IUD by the method of making histological (5), as well as histotopographic sections (10) directly from the paraffi n block and their digitization, and 14 CT of human fetuses aged 4 to 9 months of IUD. The studies were conducted in accordance with the most important regulations of the resolution of the First National Bioethics Congress «General Ethical Principles of Experiments on Animals» (2001), ICH GCP (1996), the European Union Convention on Human Rights and Biomedicine (April 4, 1997) and the European Convention for the Protection of Vertebrate Animals used in Experimental and Other Scientifi c Research (March 18, 1986). 1997) and the European Convention for the Protection of Vertebrate Animals Used for Experimental and Other Scientifi c Purposes (18.03.1986), the Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects (1964-2008), EU Directives № 609 (24.11.1986), Orders of the Ministry of Health of Ukraine № 690 dated 23.09.2009, № 944 dated 14.12.2009, № 616 dated 03.08.2012. The work is carried out within the framework of the initiative research work of the Department of Histology, Cytology and Embryology of the Bukovinian State Medical University «Structural and functional peculiarities of tissues and organs in ontogenesis, regularities of variant, constitutional, gender, age and comparative human morphology». State registration number: 0121U110121. Terms of execution: 01.2021-12.2025.Results. 3D reconstruction of series of consecutive histological sections is eff ective for the study of embryonic specimens,organ complexes of prefetuses and certain microscopic structures of human fetuses due to easy identifi cation of histological structures, however, it is necessary to improve the methods of alignment of histological sections both in the correct sequence of the series and in the natural position. 3D reconstruction of histotopographic sections is recommended for the study of specimens of organ complexes of human prefetuses and fetuses. 3D reconstruction of CT sections is an eff ective and highly accurate tool for the study of X-ray contrast anatomical structures in the fetal period of IUD (bone tissue, contrasting blood vessels), allows using a certain research algorithm to detect and measure ossifi cation centers and syntopy of blood vessels with bones.Conclusions. For wide application in morphology, the method of 3D reconstruction requires technical improvement of thesoftware- hardware complex for reconstruction, namely: automation of segmentation of sections, as well as improvement ofmethods of polychrome marking of anatomical structures for their clear diff erentiation.

Intraobserver and Interobserver Reliability of the Computed Tomography-Based Classifications Used in Posterior Malleolar Fractures: The Haraguchi and Bartoníček-Rammelt Classifications.

Three main computed tomography (CT)-based classification systems have been defined and used for posterior malleolar fractures. The intraobserver and interobserver reliability of two of these systems has never been investigated. The aim of this study was to investigate the intraobserver and interobserver reliability of the Haraguchi (HC) and Bartoníček-Rammelt (BRC) classifications. Axial and sagittal CT sections and three-dimensional reconstruction images of 60 fractures were evaluated twice by six observers at a 6-week interval. Cohen κ values for intraobserver reliability and Fleiss κ values for interobserver reliability were calculated. The interobserver reliability of the HC was fair in both assessments (Fleiss κ: 0.263 and 0.249 for the first and second evaluations, respectively). The interobserver reliability of the BRC was moderate in both evaluations (Fleiss κ: 0.535 and 0.447, respectively). The intraobserver reliability values (Cohen κ) of the HC were determined to be between 0.532 and 0.927 for the six observers. These values indicated moderate agreement for one observer, substantial for four, and very good for one. Intraobserver reliability values for the BRC were determined to be between Cohen κ of 0.626 and 0.884. Based on these values, the BRC's intraobserver reliability indicated substantial agreement for two observers and very good for four observers. Intraobserver and interobserver reliability values of the BRC were higher than those of the HC.

Evaluation of the effect of pelvis type in percutaneous acetabular column fixation: a computed tomography study.

This study aimed to evaluate the effect of pelvis type in percutaneous acetabular column fixation. What is the effect of pelvis type in percutaneous acetabular colon fixation? The available pelvic computed tomography (CT) scans which were obtained in the diagnostic imaging center with a 1 mm slice width were evaluated. The pelvic type was classified with the help of MPR (Multiplanar Reformat) and 3D (Three Dimensional) imaging modes. All evaluated bony pelvic structures were anatomically intact. 40 types of android, gynecoid, anthropoid, and platypelloid pelvis were determined. CT sections were created in MPR imaging mode. Anterior obturator oblique (AOO) and inlet images were created for anterior column evaluation, while iliac oblique (IO) and outlet images were created for posterior column evaluation. The possibility of obtaining a linear corridor for acetabular columns was investigated by measuring corridor width and lengthon images of pelvic CTs. A linear corridor could not be obtained between the pubic tubercle and the supraacetabular region of 12 (30%) CTs in the anterior column of gynecoid pelvis group. The diameter of the anterior column corridor was below 5.5 mm in 10 (25%) of Gynecoid pelvis group, 5 (12.5%) of Anthropoid pelvis group, and 10 of Platypelloid pelvis group, , and all those scans belonged to the female gender. There was a statistically significant difference between pelvis types in terms of anterior and posterior column diameters (p <0.001). While the android pelvis type had the highest diameter and corridor length in both anterior column and posterior column measurements, the gynecoid pelvic type had the lowest diameter and corridor length. In the evaluations made according to gender, both anterior and posterior column diameters were larger and longer in males than in females (p <0.001). Pelvis type is an important factor which can affect anterior and posterior column diameter and length of acetabulum. Pelvic typing before acetabular surgery can help the surgeon determining the most appropriate patient position, surgical approach, and implant selection. Level of Evidence: Level 2.

Curve-on-curve technique does not improve tibial coverage in total knee arthroplasty in comparison to tibial tuberosity technique with use of anatomical implants: randomized controlled trial

IntroductionDuring the last years, main attention while performing total knee replacement was paid to femoral component alignment; however, there is still lack of studies concerning tibial baseplate rotational alignment, especially in terms of anatomical designs of knee prosthesis. Some recent studies proved that tibial baseplate malrotation might be a cause of knee pain and patients’ dissatisfaction. The aim of this study was to compare tibial component rotation and its coverage on the tibial plateau achieved with curve-on-curve and tibial tuberosity techniques (t-t technique) with use of anatomic knee designs with asymmetric tibial baseplate.Materials and methodsA total of 88 patients were randomly assigned in a 1:1 ratio to undergo total knee arthroplasty with use of the PERSONA PS (Zimmer Biomet) knee design with an asymmetric baseplate. The rotation of the tibial component was assessed and performed with two different techniques: curve-on-curve technique and tibial tuberosity technique. Tibial component rotation was measured on computed tomography (CT) scans using the method suggested by Benazzo et al. and designed for asymmetrical implants. For the measurement of the tibial bone coverage, the component surface area was outlined and measured on a proper CT section, then the tibial cut surface area was outlined and measured on a section just below the cement level. Pre- and post-operative range of motion was measured by another independent researcher 12 months post-operatively during follow-up visit.ResultsThere was a statistically significant difference between both groups in median value of tibial rotation angle: 7° (interquartile range (IQR) = 0–12) in curve-on-curve technique group vs 2° (IQR-1–7) in tibial tuberosity technique group, probability value (p) = 0.0041, with values above 0 meaning external rotation of the component. There was no statistically significant difference between both groups in terms of range of motion (ROM) with average values of 124.3° ± 13.0° for curve-on-curve technique and 125.6° ± 12.8° for t-t technique with p = 0.45. There was a statistically insignificant difference between both groups in terms of coverage percentage in slight favor for curve-on-curve technique (85.9 ± 4.2 vs 84.5 ± 4.8, p = 0.17).ConclusionIn this study, no difference between the groups in terms of tibial bone coverage and range of motion was proved, even though both techniques differed significantly with values of tibial rotation. Future studies should be focused on influence of specific values of tibial rotation on patient-reported outcomes and survivorship of anatomic knee implants.

Radiographic analysis of skull in Van Cats, British Shorthairs and Scottish Folds.

The most significant bone used in taxonomic research is the skull. This study attempted to identify differences between the three cat species by measuring the skulls of each using computed tomography sections. The study used a total of 32 cat skulls, including 16 Van Cats, eight British Shorthairs and eight Scottish Folds. Van Cat had the highest values for cranial and skull length, whereas British Shorthair had the lowest values. The difference between the British Shorthair and Scottish Fold skull length and cranial length measures was not statistically significant. However, the Van Cat skull length result was statistically different from other species (p < 0.05). Scottish Fold had the broadest head (cranial width: 41.02 ± 0.79 mm). These results demonstrated that the scull of the Van Cat was longer but thinner than that of other species. In comparison to other species, the form of the Scottish Fold skull was more rounded. Internal height of cranium measurements for Van Cat and British Shorthair were statistically significant. In Van Cats, this measurement was 27.81 ± 1.58 mm, while in British Shorthairs, it was 30.23 ± 1.89 mm. Measurements of the foremen magnum were not statistically significant for any species. Van Cat's measures for the foramen magnum were the highest (Foramen magnum height: 11.59 ± 0.93 mm; Foramen magnum width: 14.18 ± 0.70 mm). Scottish Fold had the highest cranial index (Cranial index: 55.50 ± 4.02). Van Cat had the lowest value for this (Cranial index: 50.19 ± 2.16). Van Cat's cranial index value differed statistically from that of other species (p < 0.05). Between species, the foramen magnum index was not significant. None of the index values were statistically significant for Scottish Fold and British Shorthair. Foramen magnum width had the highest age-to-measurement value correlation (r=0.310), although it was statistically insignificant. Skull length had the highest weight-to-measurement value correlations (R=0.809), and it proved to be statistically significant. Skull length was the measuring value that distinguished male and female the most clearly (p=0.000).

Computed Tomography Perfusion Imaging in Acute Ischemic Stroke: Accurate Interpretation Matters.

Computed Tomography Perfusion Imaging in Acute Ischemic Stroke: Accurate Interpretation Matters.

A radiographic study of dorsovolar wrist axes and a database of angular measurements on axial computed tomography images.

This study aims to identify the most accurate dorsovolar principal axis of the distal radius and carpus identified on axial computed tomography (CT) sections and to establish normative data for angular measurements among these axes. Between December 2019 and December 2021, normal axial CT images of wrists of a total of 42 individuals (25 males, 17 females; mean age: 31±8.4 years; range, 18 to 45 years) were retrospectively analyzed. Eight axes were identified on axial CT images: four distal radial axes (the volar cortical, medial cortical, central, and sigmoid notch axes) and four carpal axes (the scapholunate, lunotriquetral, capitohamate, and pisotrapezial axes). Twenty-two angular parameters were measured with reference to four principal axes (the volar cortical, medial cortical, central, and pisotrapezial axes). The mean sigmoid notch rotation (version) angles relative to the four principal axes were 8±5° (range, -2° to 18°), 6±5° (range, -2° to 13°), 1±5° (range, -8° to 14°), and 4±4° (range, -3° to 15°), respectively. The mean scapholunate rotation angles were -13±5° (range, -27° to -6°), -15±6° (range, -29° to -8°), -21±5° (range, -30° to -11°), and -8±5° (range, -28° to -6°), respectively. Among four principal axes, the volar cortical and medial cortical axes were nearly collinear with both of relatively fixed carpal axes. The four principal axes showed angular differences between 2° and 8° with each other. There was no significant difference between men and women for all measurements. The axial CT sections can be used to describe the various angulations between the normal wrist axes such as the sigmoid notch and scapholunate joint rotation angles. Despite slight differences among the four principal axes, the volar cortical and medial cortical axes are more consistent with the relatively fixed carpal axes.

Condylar Position is Maintained in Maxillomandibular Advancement Surgery Utilizing Custom Cutting Guides and Plates

The objective of this study is to compare virtual surgical planned (VSP) and postoperative condylar positioning outcomes in patients who underwent maxillomandibular advancement surgery with custom mandibular cutting guides and osteosynthesis plates to establish reliability and effectiveness using these forms of technology. An ambispective case series was performed by obtaining preoperative and postoperative computed tomography (CT) scans of obstructive sleep apnea patients who underwent maxillomandibular advancement surgery with VSP and custom printed mandibular cutting guides and plates at the San Francisco Veterans Affairs Healthcare System from February 2019 to October 2021. The primary predictor variables were the use of custom guides and plates compared to VSP over the course of a year. The outcome variable was the maintained condylar position, defined as the mean differences between the VSP and postoperative positioning. The comparison group was the preoperative VSP position. Covariates were planned surgical movements, age, and gender. Measurements were taken bilaterally in sagittal CT sections measuring the condylar positioning within the posterior space, superior space, and anterior space of the glenoid fossae. Similarly, coronal CT section measurements were taken to measure the condylar positioning within the coronal lateral space, coronal central space, and coronal medial space. A Wilcoxon signed rank test was used. This study included 6 male participants (n=6) aged 32 to 57 years (mean 46.5). The median differences for the posterior space, superior space, and anterior space planned versus postoperative position were 0.25 (0.40), 0.40 (0.35), and 0.40 (0.55) mm, respectively. The median differences for the coronal lateral space, coronal central space, and coronal medial space planned versus postoperative position were 0.30 (0.30), 0.78 (0.70), and 0.40 (0.30) mm, respectively. There was no statistically significant difference in the planned and postoperative condylar position (Wilcoxon signed rank test, P>.5). A qualitative analysis showed little to no displacement or rotation of the condyle in the virtually planned and postoperative condylar positions. Qualitative and quantitative comparisons of the preoperative virtual surgical planned and the postoperative condylar position with the use of custom-printed mandibular cutting guides and plates support the null hypothesis that there is no difference between planned and postoperative positioning.

Relationship between sarcopenia classification and thigh muscle mass, fat area, muscle CT value and osteoporosis in middle-aged and older Japanese adults.

Sarcopenia is one of the most important health issues in today's ageing society. As an evaluation method, computed tomography (CT) is an effective means of assessing not only the quantity but also the quality of skeletal muscle. We aimed to examine the relationship between sarcopenia severity and muscle/fat area, and osteoporosis. 321 patients (116 men and 205 women, mean age 77.2±7.1years, age range 53-96years) who visited the Integrated Healthy Aging Clinic from 2016 to 2017 were included in this study. Based on the Asia Working Group for Sarcopenia2019 criteria, patients were divided into four groups: normal group, low-functional group (with normal skeletal muscle mass, but reduced muscle strength or physical function), sarcopenia group, and severe sarcopenia group. We measured the skeletal muscle (SM), intermuscular adipose tissue (IMAT), and subcutaneous adipose tissue (SAT) areas and the CT attenuation values (CTV) using cross sections of the mid-thigh CT. We also measured bone mineral density. Then, we compared each result among the four groups. We found a significant decrease in SM area in both men and women with sarcopenia (p<0.001 for both sexes). In women, a decrease in SAT area was observed in the sarcopenia group (p<0.001), and an increase in IMAT was observed in the low functional group (p<0.001). The CTV decreased in men with sarcopenia and severe sarcopenia; similarly, women in the low functional and severe sarcopenia groups had decreased CTV (p<0.001 for both sexes). An association between sarcopenia and osteoporosis in men was detected (p=0.004). By using not only muscle mass but also fat mass and CTV, we were able to better examine the pathogenesis of sarcopenia and differences between men and women in Japanese middle-aged and older adults.

UNDIFFERENTIATED HIGH-GRADE PLEOMORPHIC SARCOMA OF THE MAXILLARY SINUS: CLINICAL REPORT

Undifferentiated pleomorphic sarcoma (UPS) is a rare high-grade malignant tumor. A 74-year-old woman was referred for evaluation of a large lesion on the left side of maxillary alveolar mucosa. Intraoral examination revealed an ulcerated nodule of fibrous consistency on palpation. Computed tomography (CT) was requested to assess bone involvement and a biopsy was scheduled. After 4 days, there was an exorbitant growth of the lesion, accompanied by the appearance of whitish and blackish areas. CT sections showed a destructive lesion in the left maxillary sinus spreading to the nasal cavity and sphenoid and ethmoid sinuses. Histopathologic examination revealed poorly differentiated malignancy with numerous spindle cells. Immunohistochemistry reactions were negative for CD30, CD34, CD45, CD68, S-100, pan-cytokeratin, desmin, and smooth muscle actin. The findings led to the diagnosis of UPS of the maxillary sinus. The patient was started on chemotherapy and is being monitored by the multidisciplinary oncology team.

Using the Axial Oblique View of Computed Tomography (CT) in Evaluating Femoral Anteversion: A Comparative Cadaveric Study.

Twenty-five cadaveric adult femora’s anteversion angles were measured to develop a highly efficient and reproducible femoral anteversion measurement method using computed tomography (CT). Digital photography captured the proximal femur’s two reference lines, head-to-neck (H-N) and head-to-greater trochanter (H-G). Six reference lines (A/B in transverse section; C, axial oblique section; D/E, conventional 3D reconstruction; and M, volumetric 3D reconstruction) from CT scans were used. The posterior condylar line was used as a distal femoral reference. As measured with the H-N and H-G lines, the anteversion means were 10.43° and 19.50°, respectively. Gross anteversion measured with the H-G line had less interobserver bias (ICC; H-N = 0.956, H-G = 0.982). The 2D transverse and volumetric 3D CT sections’ B/M lines were consistent with the H-N line (p: B = 0.925, M = 0.122) and the 2D axial oblique section’s C line was consistent with the H-G line (p < 0.1). The D/E lines differed significantly from the actual gross images (p < 0.05). Among several CT scan femoral anteversion measurement methods, the novel anteversion angle measurement method using CT scans’ axial oblique section was approximated with actual gross femoral anteversion angle from the femoral head to the greater trochanter.

Swing Door Compressive Fracture Technique for Turbinoplasty: Retrospective Study Based on Computed Tomography and NOSE Scale.

Treatment of inferior turbinate hypertrophy is performed using different techniques in rhinoplasty. However, the reported results are not consistent. In this study, we aimed to evaluate the outcomes of Swing door compressive fracture (SDCF) technique for turbinoplasty using computed tomography (CT) and Nasal Obstruction Symptom Evaluation (NOSE) scale. This study involved retrospective analysis of 24 patients who underwent inferior turbinoplasty using Swing door compressive fracture (SDCF) technique with or without septoplasty. The angle between the inferior turbinate and lateral nasal wall, total area, inferior turbinate area and the area medial to inferior turbinate were measured preoperatively and postoperatively using coronal section CT images for objective evaluation. Moreover, the NOSE scale was used for subjective evaluation. The angle between inferior turbinate and lateral nasal wall was decreased by 25.3% after the treatment (p <0.0001). Inevitably, postoperative total nasal airway area (area 1) did not face a statistically significant change (p = 0.6878). On the other hand, the area of inferior turbinate (area 2) decreased significantly compared to preoperative value (p = 0.0021), while the area 3, the area medial to inferior turbinate was widened 1.5 times postoperatively. The total preoperative NOSE score was moderate (39.58 ± 22.31%) and it was decreased to mild (5.83 ± 8.81%) after the treatment (p <0.0001). The Swing door compressive fracture (SDCF) technique for turbinoplasty is an effective and straightforward modality. However, the further study involving more patients and longer follow-up period is mandatory. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .