Computed Tomography Studies Research Articles

Radix entomolaris and radix paramolaris: A cone-beam computed tomography study of permanent mandibular molars in a large sample from Slovenia

ObjectivesTo investigate the prevalence, unilateral/bilateral concurrency, and external morphology of permanent mandibular molars (PMMs) with radix entomolaris (RE) and radix paramolaris (RP) in a sample from Slovenia. DesignMedium field-of-view cone-beam computed tomography images of 1315 participants (681 males, 634 females) aged 13–90 years (mean age 45.5) were retrospectively examined. A total of 1363 first, 1824 second, and 1314 third PMMs were evaluated. The external morphology of the affected teeth was categorized according to Carlsen and Alexandersen’s classifications. ResultsThe individual-level RE frequencies in the first, second, and third PMMs were 1.6%, 1.9%, and 10.1%, respectively. The respective RP frequencies were 0%, 1.8%, and 3.2%. The first PMMs exclusively exhibited type A RE morphology, whereas in the second and third PMMs, types B and AC morphologies predominated. Bilateral concurrence rates were low (0–7.1%), with the exception of type A RE in first PMMs (62.5%). RE occurrences in the first and second PMMs were correlated (odds ratio = 70.2; 95% confidence interval 17.4 −282.7; P < 0.001). In concurrent cases, the second PMM followed its anterior neighbor in expressing type A morphology, and conversely, all affected second PMMs standing next to a two-rooted first PMM exhibited non-type A morphology. ConclusionsIn this sample, the first and second PMMs exhibited low supernumerary root frequencies comparable to those of other European samples. The third PMM was most often affected. The presence of RE on the first PMM increased the possibility of its presence on the adjacent second PMM and vice versa.

Diagnostic reference levels for common pediatric computed tomography studies: A retrospective study.

With the rapid increase in computed tomography (CT) examinations among pediatric patients, the concern about the effects of radiation exposure in this population has increased. Therefore, it is necessary to measure and regulate radiation exposure, which can be done using diagnostic reference levels (DRLs). This study aimed to calculate typical values for common pediatric studies at the radiology department of King Abdulaziz University Hospital Jeddah, Saudi Arabia. For a single institute, these are calculated as the median of computed tomography dose index (CTDIvol, mGy) or dose length product (DLP, mGy.cm) values. Pediatric patient data from January 2015 to December 2020 were collected, including CT examinations, dose descriptors, imaging protocols, and scanning parameters. A total of 8717 radiological studies were included in the sample. They were categorized into three age groups; more than half of the 5102 (58.5%) belonged to Group 1 (0–5 years), 1790 (20.5%) were in Group 2 (6–10 years), and 1826 (20.9%) were in Group 3 (11–15 years). Brain CT angiogram, non-enhanced brain CT, and Internal Auditory Canal (IAC) CT had the highest mean CTDI Vol and DLP, while virtual bronchoscopy contrast-enhanced chest and neck CT angiography had the lowest mean CTDI Vol. The values of DRLs in the current study were approximately lower than and comparable with those reported in other studies.

Longitudinal patterns of Alzheimer's disease subtypes: A follow-up magnetic resonance imaging and single-photon emission computed tomography study.

Alzheimer's disease (AD) is a biologically heterogenous disease. In a previous study, we classified 245 patients with probable AD into the typical AD (TAD), limbic-predominant (LP), hippocampal-sparing (HS) and minimal-change (MC) subtypes based on their medial temporal lobe atrophy on magnetic resonance imaging and posterior hypoperfusion on single-photon emission computed tomography, and described differences in clinical features among the patients with different AD subtypes. This study aimed to clarify the longitudinal patterns of changes in patients with the various AD subtypes by follow-up brain imaging analyses. Follow-up magnetic resonance imaging or single-photon emission computed tomography data obtained 12-48 months after the first brain imaging were investigated in 79 patients with probable AD, comprising 25 of the TAD subtype, 19 of the LP subtype, 17 of the HS subtype and 18 of the MC subtype. All patients of the TAD subtype remained as the same subtype at follow up. Approximately 37% of patients of the LP subtype and 29% of patients of the HS subtype progressed to the TAD subtype, and 17%, 33% and 6% of the MC subtype progressed to the TAD, LP and HS subtypes, respectively. The group of patients showing subtype progression was associated only with a longer follow-up duration. There might be different progression patterns and progression rates of changes among the atypical AD subtypes. Further longitudinal brain imaging studies might provide information regarding the pathophysiological association between the various AD subtypes, and might be helpful for determining appropriate therapies and management methods. Geriatr Gerontol Int 2023; 23: 919-924.

Radiomics in CT and MR imaging of the liver and pancreas: tools with potential for clinical application.

Radiomics allows the extraction of quantitative imaging features from clinical magnetic resonance imaging (MRI) and computerized tomography (CT) studies. The advantages of radiomics have primarily been exploited in oncological applications, including better characterization and staging of oncological lesions and prediction of patient outcomes and treatment response. The potential introduction of radiomics in the clinical setting requires the establishment of a standardized radiomics pipeline and a quality assurance program. Radiomics and texture analysis of the liver have improved the differentiation of hypervascular lesions such as adenomas, focal nodular hyperplasia, and hepatocellular carcinoma (HCC) during the arterial phase, and in the pretreatment determination of HCC prognostic factors (e.g., tumor grade, microvascular invasion, Ki-67 proliferation index). Radiomics of pancreatic CT and MR images has enhanced pancreatic ductal adenocarcinoma detection and its differentiation from pancreatic neuroendocrine tumors, mass-forming chronic pancreatitis, or autoimmune pancreatitis. Radiomics can further help to better characterize incidental pancreatic cystic lesions, accurately discriminating benign from malignant intrapancreatic mucinous neoplasms. Nonetheless, despite their encouraging results and exciting potential, these tools have yet to be implemented in the clinical setting. This non-systematic review will describe the essential steps in the implementation of the radiomics and feature extraction workflow from liver and pancreas CT and MRI studies for their potential clinical application. A succinct overview of reported radiomics applications in the liver and pancreas and the challenges and limitations of their implementation in the clinical setting is also discussed, concluding with a brief exploration of the future perspectives of radiomics in the gastroenterology field.

Fusion's Location and Quality within the Fixated Segment Following Transforaminal Interbody Fusion (TLIF).

Transforaminal interbody fusion (TLIF) has gained increased popularity over recent decades and is being employed as an established surgical treatment for several lumbar spine pathologies, including degenerative spondylosis, spondylolisthesis, infection, tumor and some cases of recurrent disc herniation. Despite the seemingly acceptable fusion rates after TLIF (up to 94%), the literature is still limited regarding the specific location and quality of fusion inside the fixated segment. In this single-institution, retrospective population-based study, we evaluated all post-operative computed tomography (CT) of patients who underwent TLIF surgery at a medium-sized medical center between 2010 and 2020. All CT studies were performed at a minimum of 1 year following the surgery, with a median of 2 years. Each CT study was evaluated for post-operative fusion, specifically in the posterolateral and intervertebral body areas. The fusion's quality was determined and classified in each area according to Lee's criteria, as follows: (1) definitive fusion: definitive bony trabecular bridging across the graft host interface; (2) probable fusion: no definitive bony trabecular crossing but with no gap at the graft host interface; (3) possible arthrosis: no bony trabecular crossing with identifiable gap at the graft host interface; (4) definite pseudarthrosis: no traversing trabecular bone with definitive gap. A total of 48 patients were included in this study. The median age was 55.6 years (SD ± 15.4). The median time from surgery to post-operative CT was 2 years (range: 1-10). Full definitive fusion in both posterolateral and intervertebral areas was observed in 48% of patients, and 92% showed definitive fusion in at least one area (either posterolateral or intervertebral body area). When comparing the posterolateral and the intervertebral area fusion rates, a significantly higher definitive fusion rate was observed in the posterolateral area as compared to the intervertebral body area in the long term follow-up (92% vs. 52%, p < 0.001). In the multivariable analysis, accounting for several confounding factors, including the number of fixated segments and cage size, the results remained statistically significant (p = 0.048). In conclusion, a significantly higher definitive fusion rate at the posterolateral area compared to the intervertebral body area following TLIF surgery was found. Surgeons are encouraged to employ bone augmentation material in the posterolateral area (as the primary site of fusion) when performing TLIF surgery.

Prevalence of Middle Mesial Canal in Mandibular Molars of a Saudi Subpopulation: A Prospective Cone-Beam Computed Tomography Study.

Root canal treatment is compromised when one or more root canals are left unmanaged, especially in the case of multirooted teeth. Cone-beam computed tomography (CBCT) has the advantage of clearly recognizing the anatomical structures without any blurring and superimposition. There are few studies that assess the middle mesial canal (MMC) prevalence in the Saudi population using CBCT imaging. Thus, the present study was conducted to assess the MMC prevalence in the first and second mandibular molars in the Saudi population using CBCT imaging. Data from 616 patients and 1014 teeth were assessed. The mesial roots of the mandibular first and second molars were examined using CBCT to assess the presence of the MMC in both axial and coronal sections. The potential correlation between the prevalence of MMC was assessed with gender and age. The data collected were subjected to statistical analysis using IBM SPSS version 20.0 software (IBM Corp., Armonk, NY). The mean age was 34.39 ± 12.12 years, showing male predominance. A total of 2.6% and 0.2% cases of MMC were found in the first and second molars, respectively.A significant difference (p-value < 0.05) was observed among both genders in relation to age groupsand the presence of MMC. MMC in the first molar was seen mainly in patients aged <20 yearsand only one case was reported with MMC in the second molar among patients aged 41-60 years. A higher incidence of MMC was found in the first than the second mandibular molar. For accessing the MMC, the patient's age, high magnification, and troughing are some influential factors. In the future, clinical studies with long-term follow-ups are required to assess the influence of biomechanical preparation of MMC on the result of nonsurgical endodontic management in mandibular first as well as second molars.

Bioprosthetic leaflet thrombosis and reduced leaflet motion after transcatheter aortic valve replacement: A systematic review and meta-analysis

BackgroundLeaflet thrombosis and reduced leaflet motion have become a concern with the expanding use of transcatheter aortic valve replacement in lower-risk patients. AimsTo assess the proportions, predictors and clinical impact of leaflet thrombosis and reduced leaflet motion after transcatheter aortic valve replacement. MethodsWe performed a meta-analysis of studies assessing the proportions of and/or clinical outcomes according to the presence of leaflet thrombosis after transcatheter aortic valve replacement identified with computed tomography and/or echocardiography. ResultsFifty-three studies, representing 25,258 patients undergoing transcatheter aortic valve replacement, were considered. The proportion of leaflet thrombosis was 5.2% overall, and was higher in computed tomography versus echocardiography (16.4% vs. 1.1%, respectively); reduced leaflet motion was identified in 11% of patients with four-dimensional computed tomography. Intra-annular bioprostheses were associated with a higher proportion of leaflet thrombosis, whereas chronic oral anticoagulation was protective for leaflet thrombosis in both computed tomography and echocardiographic studies (9.7% vs. 17.5%; relative risk [RR]: 0.51, 95% confidence interval [95% CI]: 0.37–0.71 and 0.9% vs. 2.7%; RR: 0.22, 95% CI: 0.06–0.79, respectively) and for reduced leaflet motion (2.5% vs. 12.4%; RR: 0.32, 95% CI: 0.13–0.76). Leaflet thrombosis was not associated with an increased risk of death, but with a higher risk of stroke in computed tomography studies (2.8% vs. 2.4%; RR: 1.63, 95% CI: 1.05–2.55), a difference more pronounced when considering reduced leaflet motion (3.5% vs. 1.7%; RR: 2.39, 95% CI: 0.63–8.34). ConclusionsThe proportion of leaflet thrombosis is highly variable according to the screening approach, the type of valve and the use of oral anticoagulation. The occurrence of cerebral events is increased when leaflet thrombosis and/or reduced leaflet motion are diagnosed, but leaflet thrombosis has no impact on survival.

Efficacy of cement-augmented pedicle screw fixation for osteoporotic mid-thoracic vertebral fractures.

Osteoporotic mid-thoracic vertebral fractures (OmTVF), often result in severe pain, and neurological deficits secondary to cord compression. Cement-augmented pedicle screw (CaPS) fixation with posterior spinal decompression (PSD) offers simultaneous decompression with stabilization of these osteoporotic vertebral fractures. The study involved 32 patients (2022-2023) with T8-T10 osteoporotic vertebral compression fractures resulting in cord compression. All patients underwent CaPS surgery with PSD. Pain reduction was measured using the visual analog scale (VAS), and outcomes with the Oswestry Disability Index, and the American Spinal Injury Association Grades. The local kyphotic angle was also tracked with computed tomography studies performed 1, 3, and 6 months post-operatively. The average pre-operative VAS score was 8.56 mm; this decreased at 1, 3, and 6 months post-operatively to 2.72 mm, 2.03 mm, and 1.44 mm, respectively. In addition, 31 of 32 patients fully recovered within 6 postoperative months. For 31 of 32 patients with T8-T10 osteoporotic vertebral fractures, CaPS fixation with PSD successfully alleviated pain and resulted in significant post-operative neurological recovery.

Comparative study of CT and MR guided microwave ablation in the treatment of para-vascular VX2 liver tumor model in rabbits.

Objective： To analyze the efficacy of microwave ablation (MWA) guided by computed tomography (CT) and 1.5T magnetic resonance (MR) in the treatment of VX2 para-vascular liver tumor model in rabbits. Materials and Methods Sixty para-vascular VX2 liver tumor models in rabbits were randomly divided into CT-guided microwave ablation group (CT group, n=35) and MR-guided microwave ablation group (MR group, n=35). The complete ablation rate, mean operation time, postoperative complication rate and mean survival time were compared between the two groups. Results In the CT group, the rate of complete ablation was 68.6% (24/35), and the mean operation time was 42.1 ± 9.7 minutes. Three cases had ascites and one case had abdominal wall injury. In the MR group, the rate of complete ablation was 94.2% (33/35), and the mean operation time was 53.4 ± 10.9 minutes. One case was complicated with ascites. No serious complications such as pneumothorax, liver abscess, pleural effusion and diaphragm perforation were found in both groups. Between the two groups, the difference in complete ablation rate was statistically significant (P=0.006 ＜ 0.05). A statistically significant difference can also be found in mean operation time (P ＜ 0.01). The follow-up time was 21 days after the operation. As for the postoperative complication rate (11.4% in the CT group and 2.9% in the MR group, P=0.353) and mean survival time (16.9 ± 1.8 days in CT group, 18.3 ± 2.3 days in the MR group, P=0.925), the differences were not statistically significant. Conclusion Compared with CT guidance, although the microwave ablation time under MR guidance was longer, the complete ablation rate under MR guidance was high, which proved that MR guidance was a more effective way of microwave ablation guidance and was worth promoting in the clinic. In this experiment, the postoperative complication rate was lower in the MR group, although the difference was not statistically significant, which may be related to the small sample size, and the subsequent study on the postoperative complication rate can increase the sample content.

Surgical management of craniocervical junction tuberculosis with atlanto-axial dislocation – A case report and review of the literature

Background: There are few guidelines on how to best manage craniovertebral junction (CVJ) tuberculosis (TB). Certainly, timely tissue diagnosis, immobilization of the neck, and decompression of CVJ with appropriate stabilization are the mainstays of treatment for TB at the CVJ. Case Description: Three patients, ages 16–68, presented with CVJ TB with atlanto-axial dislocation responsible for progressive quadriparesis/plegia. Based on X-rays, magnetic resonance, and computed tomography studies, patients underwent timely decompressions and fusions followed by antitubercular drug treatment. Conclusion: Early diagnosis, proper decompression with fusion, treated with anti-TB drug for proper period were keys to managing TB involving the craniocervical junction in these three patients.

Treatment-Related Factors Affecting the Success of Endodontic Microsurgery and the Influence of GTR on Radiographic Healing-A Cone-Beam Computed Tomography Study.

The primary objective of this retrospective study was to assess the correlation between treatment-related factors (resection angle, depth of retrograde filling, length of resected root and use of guided tissue regeneration-GTR) evaluated using cone-beam computed tomography (CBCT) scans and the treatment outcomes of endodontic microsurgery (EMS). The secondary purpose of this research was to evaluate the influence of the GTR technique on the radiographic healing state, taking into account the initial parameters of periapical lesions. In 161 cases, the local factors (volume of a lesion, bone destruction pattern, presence/absence of cortical bone destruction) were measured using preoperative CBCT images before undergoing EMS. At least one year after surgery, the outcome of EMS was classified as a success or a failure (based on radiographic and clinical criteria). Using postoperative CBCT, treatment-related factors (resection angle, depth of retrograde filling, and length of resected root) were measured. Additionally, the status of radiographic healing was evaluated (in accordance with modified PENN 3D criteria). Eighteen cases (11.18%) were classified as failures, and 143 were classified as successes (88.82%). Univariate analysis showed that there was no statistically significant influence of treatment-related factors on the healing outcome of EMS. An exact Fischer's test showed the significant impact of GTR on radiographic healing (P < 0.001) in apical lesions (P < 0.001), lesions with a volume between 100 mm3 and 450 mm3 (P < 0.009) and over 450 mm3 (P < 0.001), lesions with the destruction of one plate (P < 0.001), and lesions with the destruction of two plates (through and through) (P = 0.022). The use of GTR in apical lesions, lesions with volumes over 100 mm3, and lesions with the destruction of at least one plate is significantly associated with better radiographic healing.

Evaluation of inferior mesenteric vein drainage patterns in the Turkish population: A multidetector computed tomography study

Background/Aim: The inferior mesenteric vein (IMV) plays a crucial role in the venous system as it joins the superior mesenteric vein (SMV) and splenic vein to form the portal vein. The widespread adoption of multidetector computed tomography (MDCT) has greatly enhanced our ability to assess abdominal vascular structures. This study aimed to investigate the IMV drainage patterns in a Turkish population using MDCT. Methods: This descriptive, single-center, retrospective study included patients who had undergone abdominal computed tomography (CT) in the portal phase at our hospital for various clinical indications. Excluded from the study were patients who did not undergo imaging in the portal venous phase, those with incomplete evaluation of all IMV segments, and individuals who had undergone pancreaticoduodenal or intestinal surgery for any reason. We retrospectively analyzed a total of 877 contrast-enhanced MDCT examinations performed at our hospital between March 2022 and March 2023. Patients were classified based on their IMV drainage patterns into the following categories: type 1 (drainage into the splenic vein), type 2 (drainage into the SMV), type 3 (drainage at the junction level), type 4 (drainage into the branches of the SMV), and type 5 (patients in whom IMV assessment was not possible). Results: The mean age of the patients was 48.7 years (range: 24–92 years), with 449 (51.2%) being male and 428 (48.8%) female. The distribution of patients according to IMV drainage patterns was as follows: type 1, n=379 (43.2%); type 2, n=398 (45.4%); type 3, n=71 (8.1%); type 4, n=15 (1.7%); and type 5, n=14 (1.6%). Conclusion: Our study findings indicate that in the Turkish population, the IMV predominantly drains into the SMV before joining the splenic vein. This disparity from certain studies in the literature underscores the variability in IMV drainage patterns, emphasizing the importance of individualized patient evaluation in this regard.

The intraoperative visualisation technique during lead implantation into the cardiac conductive system: aspects of computed tomography: prospective study

INTRODUCTION: The lead implantation into the cardiac conduction system (CCS) is the most physiological method of pacing nowadays. «The method of intraoperative visualization and control of the lead position for permanent electrocardiostimulation during implantation of the lead in the CCS» has been developed for reduce the number of non-targeted implantations. This method based on the integration into the angiograph system 3D-reconstruction of the heart converted to computed tomography (CT) in the form of a mask against the background of fluoroscopy. CT is an important stage of the intraoperative visualization technique (IVT).OBJECTIVE: The aim of the study was to adapt the protocol of CT examination of the heart with contrast to construct a partially segmented 3D-reconstruction of the heart on an angiographic complex for subsequent use during of the lead implantation in the CCS within the framework of the author’s IVT.MATERIALS AND METHODS: As part of the development of the IVT, 21 CT studies of the heart were selected from own database. The step of the gradient of the density difference of the contrasted blood is about 10 HU, the range of the difference of densitometric parameters of the «left ventricle (LV) — right ventricle (RV)» from 0 HU to 200 HU. As well as selected 11 CT studies of the heart. The step of the gradient of the difference of densitometric indicators the contrasted blood in «the RV cavity — myocardium» is about 10 HU, the range is from 0 HU to 100 HU. All CT scans are alternately loaded into the angiograph, followed by the creation of a 3D model of the heart using basic software.RESULTS: It’s necessary to exceed the degree of contrast of the LV cavity over the RV cavity by at least 80 HU to perform partial segmentation on the left and right chambers of a 3D-model of the heart in an angiographic complex that does not have a specialized segmentation module. A sufficiently large part of the left ventricular cavity (LV) disappears with a smaller gradient when the right ventricular cavity (RV) is suppressed. The minimum gradient of «the ventricular cavity — myocardium» is at least 20 HU. The boundaries of the right ventricular edge of the interventricular septum (IVS) are not visualized with a smaller contrast gradient. It’s important for determining the insertion place of the lead into the IVS.CONCLUSION: It’s necessary to exceed the contrast of the LV cavities above the RV cavity by at least 80 HU, the RV cavity above the myocardium by at least 20 HU to perform partial segmentation on the left and right chambers of a 3D-model of the heart in an angiographic complex that does not have a specialized segmentation module

Correlation Analysis Between Computed Tomography and Magnetic Resonance Imaging for Assessing Thoracic Pedicle Morphology

This study aimed to determine the accuracy and reliability of using magnetic resonance imaging (MRI) to characterize thoracic pedicle morphology in the normal population. Computed tomography (CT) and MRI datasets of 63 surgically treated patients were included in the study. Bilateral T3, T6, T9, and T12 vertebral levels were evaluated for the type of pedicle, pedicle chord length, and pedicle isthmic diameter on both MRI and CT scans. Pedicles were classified according to Sarwahi etal. into type A (normal pedicle), >4 mm cancellous channel; type B, 2-4 mm channel; type C, completely cortical channels >2 mm; and type D, <2 mm cortical bone channel. Of 504 pedicles, 294 were classified as type A, 173 as type B, 24 as type C, and 13 as type D based on a CT scan. MRI had an overall accuracy rate of 92.86% for detecting type A, 96.53% for type B, and 100% for type C and type D compared with CT scans. Regarding the thoracic levels, MRI had an overall concordance of 97.98% at T3 level, 94.43% at T6 level, 98.11% at T9 level, and 99.3% at T12 level with CT readings. Comparing measurements between MRI and CT studies for pedicle isthmic diameter and pedicle chord length showed moderate to good reliability at all measured levels. Pedicle measurements obtained by MRI may be used to estimate pedicle dimensions, allowing surgeons to preoperatively determine pedicle screw sizes based on MRI scans alone.

Investigation of Root Canal Anatomy of Mandibular Permanent canine in Egyptian Subpopulation: A Cone-Beam Computed Tomography Study

Investigation of Root Canal Anatomy of Mandibular Permanent canine in Egyptian Subpopulation: A Cone-Beam Computed Tomography Study

Evaluation of Bizygomatic Distance and Intermaxillary Distance as Sexual Dimorphic tools in Egyptian Adults: A Cone Beam Computed Tomography Study

Evaluation of Bizygomatic Distance and Intermaxillary Distance as Sexual Dimorphic tools in Egyptian Adults: A Cone Beam Computed Tomography Study

Three-dimensional Assessment of Temporomandibular Joint Volume, and Condylar and Glenoid-fossa Morphology: A Cone-beam Computed Tomography Study.

The condylar and glenoid fossa morphology can alter in patients with temporomandibular disorders (TMD), which can lead to changes in the temporomandibular joint (TMJ) space volume. Volumetric evaluation of TMJ can represent the entire three-dimensional (3D)-joint space between the condyle and glenoid fossa. To perform 3D assessment of TMJ volume, condylar, and glenoid-fossa morphology using cone-beam computed tomography and evaluate the correlation between these parameters. Thirty-four patients (age: 13.50 years) who had no previous history of TMD were included. The volume of TMJ space was measured and divided into anterior, posterior, medial, and lateral TMJ volume. The antero-posterior (AP) and medio-lateral (ML) condylar width, AP and ML glenoid-fossa width, and glenoid-fossa depth were evaluated. Statistical analyses were performed with R software at a 0.05 significance level. Each parameter was compared between the left and right sides using a paired-t test. The correlations between the parameters were obtained by the Pearson correlation coefficient. There was no significant difference between lateral and medial TMJ volume; however, posterior TMJ volume was significantly greater than anterior TMJ volume. A significant correlation was observed between AP glenoid-fossa width and TMJ volume, glenoid-fossa depth and TMJ volume, AP position of the condyle and anterior TMJ volume, ML position of the condyle and medial TMJ volume, glenoid-fossa width and condyle width in AP and ML dimension, glenoid-fossa depth and AP glenoid-fossa width. In addition to the evaluation of condylar and glenoid-fossa morphology, assessment of TMJ space volume is important for comprehensive evaluation of the joint.

Characterizing Three-Dimensional Alignment of the Hip, Knee, Ankle and Foot under Physiological Upright Load. A Weight-Bearing Computed Tomography Study in Arthritic Joints and Healthy Controls

Category: Ankle Arthritis; Other Introduction/ Purpose: Lower limb alignment assessment is commonly performed using two-dimensional (2D) conventional- radiographs. Weight-Bearing Computed-Tomography (WBCT) imaging that allows concomitant 3D imaging of the hip, knee, ankle, and foot, a more complete and multidimensional assessment of the entire overall lower limb alignment is now possible. The aims of this study were: (1) to characterize the normal relative 3D alignment of the center of the Hip, Knee, and Ankle joints in relation to the weight bearing Foot Tripod in a cohort of healthy control volunteers with no lower extremity pathologies, using WBCT imaging. (2) to perform the same 3D WBCT assessment in a cohort of patients with either hip osteoarthritis (HOA), knee osteoarthritis (KOA) or ankle osteoarthritis (AOA), and to compare the results between arthritic cases and controls. Methods: Prospective comparative and controlled cohort-study contained 7 HOA limbs (4 patients), 17 KOA limbs (10 patients), 7 AOA limbs (4 patients) and 10 control limbs (5 patients) that received WBCT imaging of the full lower extremity. Using multiplanar reconstruction WBCT images, 3D landmark coordinates (on X, Y, and Z planes) were manually measured by two observers. The utilized software (CubeVue®) generated an automatic calculation of the Foot-Hip Offset (FHO), Foot-Knee Offset (FKO) and Foot and Ankle Offset (FAO). The relationship between the center of the hip, knee and ankle joints and the bisecting line of the foot tripod was assessed and compared between HOA, KOA, AOA patients and controls. Examples of measurements for arthritic patients and controls is presented in Figure 1. Continuous data was assessed for normality with the Shapiro-Wilk test, and variables were compared using ANOVA or Kruskal- Wallis Rank Sum. P-Values of less than 0.05 were considered significant. Results: The average FAO and 95%-Confidence-intervals-(CI) for respectively HOA, KOA, AOA and controls were respectively: 3.62% (0.4 to 6.8) (neutral), 2.8% (0.78 to 4.9) (neutral), -4.68% (-7.8 to -1.4) (varus), and 2.12% (-0.5 to 4.8) (neutral). The FAO- differences were found to be significant between the groups (p=0.0077), with AOA patients being significantly different than all the other groups (Figure 2). Similarly, the HFO was found to be significantly different-between the groups (p=0.002), with the following average values and 95%CI for respectively HOA, KOA, AOA and controls: 0.7% (-6.4 to 7.8), 2.3% (-2.3 to 6.8), -10.1% (-17.2 to -3.0), and 5.3% (-0.6 to 11.3). Again, the AOA patients were found to be significantly different than the other groups. No significant differences were found between the groups when assessing the KFO (p=0.37). Conclusion: The baseline 3D lower limb alignment and relative position of the hip, knee, ankle and foot was assessed and established for the first time in the literature. When comparing 3D alignment in arthritic patients with hip, knee or ankle OA and controls, we observed that AOA was found to be the one affecting more the overall 3D alignment of the lower extremity, with no complete compensation of the deformity through the other joints, resulting in significantly different values of HFO, KFO and FAO in patients with ankle OA. Additional prospective studies with longer cohorts of patients are needed.

Radiology reporting of incidental osteoporotic vertebral fragility fractures present on CT studies: results of UK national re-audit

To describe a UK-wide re-audit of the 2019 Royal College of Radiologists (RCR) audit evaluating patient-related data and organisational infrastructure in the radiological reporting of vertebral fragility fractures (VFFs) on computed tomography (CT) studies and to assess the impact of a series of RCR interventions, initiated to raise VFF awareness, on reporting practice and outcomes. Patient specific and organisational questionnaires largely replicated those utilised in 2019. The patient questionnaire involved retrospective analysis of between 50 and 100 consecutive, non-traumatic CT studies which included the thoracolumbar spine. All RCR radiology audit leads were invited to participate. Data collection commenced from 1 April 2022. Data were supplied by 129/194 (67%) departments. One thousand five hundred and eighty-six of 7,316 patients (21.7%) had a VFF on auditor review. Overall improvements were demonstrated in key initial/provisional reporting results; comment on spine/bone (93.2%, 14.4% improvement, p<0.0002); fracture severity assessment (34.7%, 8.5% improvement, p=0.0007); use of recommended terminology (67.8%, 7.5% improvement, p=0.0034); recommendations for further management (11.7%, 9.1% improvement, p<0.0002). The 2022 national re-audit confirms improvements in diagnostic performance and practice in VFF reporting. Continuing work is required to build on this improvement and to further embed best practice.

Cardiac hydatidosis complicated by vascular involvement: a case report

BackgroundHydatid disease is a parasitic infection which is endemic in multiple regions across the globe including Indian subcontinent. Although it commonly affects the liver and other solid organs, isolated involvement of the heart is relatively uncommon. Cardiac hydatidosis can be confidently diagnosed on echocardiography, but cross-sectional imaging by computed tomography (CT) or magnetic resonance imaging (MRI) provides accurate information about its location, extent, and multiplicity. Multiple case studies of cardiac hydatid disease have been reported in the literature. However, cardiac hydatidosis with extension into pulmonary vasculature has not been reported commonly. This case report highlights this rare association, with stress upon the altered surgical management.Case presentationA 50-year-old patient presented with atypical chest pain to the cardiology department of a tertiary care hospital where he underwent multiple blood tests as well as electrocardiography (ECG) and echocardiography as part of the routine examination. Echocardiography revealed a large, multicystic mass invading the posterolateral wall of left ventricle (LV) with no internal vascularity and was provisionally diagnosed as hydatid disease. Subsequent CT study confirmed a large multicystic lesion with the presence of another smaller lesion invading the left atrial appendage (LAA). In order to evaluate the vascular and mediastinal invasion, cardiac MRI was then performed which revealed invasion of right pulmonary artery (PA), right superior pulmonary vein (PV) as well as compression of superior vena cava (SVC) by the smaller lesion. A final diagnosis of cardiac hydatidosis with invasion into right PA and right superior PV was made. Treatment plan for the patient changed, who then underwent an additional reconstruction of right PA and right superior PV after cyst removal.ConclusionsCardiac hydatid disease is a rare but potentially lethal condition, which tends to show slow growth and local invasion. The diversity of findings in such rare cases makes individual surgical approach extremely valuable with preoperative radiological imaging becoming indispensable for correct localization and appropriate planning. Our case report highlights rare association of cardiac hydatidosis with invasion of both pulmonary artery and vein, which eventually altered the surgical management of patient.