Computed Tomography Studies Research Articles

Spheno-Occipital Synchondrosis Fusion Degree as an Age Estimation Tool: A Cone-Beam Computed Tomography Study

Background: Considering the late ossification potential of spheno-occipital synchondrosis (SOS), it can be used as a tool to estimate age in adolescents. The time of SOS fusion is known to vary in different populations. Objectives: This study aimed to assess the degree of SOS fusion in Iranian individuals, using cone-beam computed tomography (CBCT) scan. Patients and Methods: The CBCT images of 240 patients (126 females and 114 males), aged 6 - 25 years, were assessed regarding the degree of SOS fusion, based on a four-stage scoring system. Spearman’s correlation coefficient test and regression analysis were performed to assess the correlation between age and fusion stage. Mann-Whitney test was also applied to determine differences between males and females. Besides, Kruskal-Wallis test was used to assess differences in the median values. Results: The SOS was completely open at the mean age of 7.63 years in females and 8.85 years in males. The mean age of partially fused SOS (stage 1) was 8 years in females and 10 years in males. Besides, the mean age of completely fused SOS (stage 3) was 12 years in females and 16 years in males. The results of Spearman’s correlation coefficient test showed a significant positive relationship between age and the degree of SOS fusion in males and females (rs = 0.783, P < 0.001 in females and rs = 0.911, P < 0.001 in males). Conclusion: The SOS closure degree can be applied for age estimation in the Iranian population. This study presented a method which is highly accurate for age estimation.

Imaging the acute respiratory distress syndrome: past, present and future.

In patients with the acute respiratory distress syndrome (ARDS), lung imaging is a fundamental tool in the study of the morphological and mechanistic features of the lungs. Chest computed tomography studies led to major advances in the understanding of ARDS physiology. They allowed the in vivo study of the syndrome’s lung features in relation with its impact on respiratory physiology and physiology, but also explored the lungs’ response to mechanical ventilation, be it alveolar recruitment or ventilator-induced lung injuries. Coupled with positron emission tomography, morphological findings were put in relation with ventilation, perfusion or acute lung inflammation. Lung imaging has always been central in the care of patients with ARDS, with modern point-of-care tools such as electrical impedance tomography or lung ultrasounds guiding clinical reasoning beyond macro-respiratory mechanics. Finally, artificial intelligence and machine learning now assist imaging post-processing software, which allows real-time analysis of quantitative parameters that describe the syndrome’s complexity. This narrative review aims to draw a didactic and comprehensive picture of how modern imaging techniques improved our understanding of the syndrome, and have the potential to help the clinician guide ventilatory treatment and refine patient prognostication.

Factors Affecting the Success of Endodontic Microsurgery: A Cone-Beam Computed Tomography Study.

The purpose of this retrospective study was to verify preoperative local parameters of periapical lesions evaluated on cone-beam computed tomography (CBCT) scans as a potential prognostic factor in endodontic microsurgery (EMS). Among 89 cases, local factors (dimensions of lesion, bone destruction pattern, presence/absence of cortical bone destruction, height of buccal bone plate, apical extend of root canal filling, presence/absence of communication with anatomical cavities, type of lesion restriction) were measured on preoperative CBCT images before EMS. At least one year after surgery, the outcome of EMS was classified as a success or a failure. Ten cases (11.24%) were classified as a failure and 79 as a success (88.76%). Symptomatic lesions (OR = 0.088 (95% CI 0.011–0.731); p = 0.024), apicomarginal lesions (OR = 0.092 (0.021–0.402); p = 0.001) and an association with molar teeth (OR = 0.153 (0.032–0.732); p = 0.019) were found as negative predictive factors in the univariate analysis, whereas large apicocoronal dimension (OR = 0.664 (0.477–0.926); p = 0.016), apicomarginal lesions (OR = 0.058 (0.006–0.55); p = 0.013), and an association with molar teeth (OR = 0.047 (0.003–0.869); p = 0.04) were identified as negative predictive factors in the multivariate analysis model. Symptomatic lesions, apicomarginal lesions, lesions associated with molar teeth and large apicocoronal dimensions are significantly associated with the failure of EMS.

Radiological assessment of alveolar bone loss associated with overhanging restorations: A retrospective cone beam computed tomography study

Background/purposeStudies suggested that presence and size of overhanging restoration margins play role in alveolar bone loss. The aim of this study was to determine the prevalence and distribution of overhanging approximal restorations, to evaluate the effect of presence and size of overhang on bone loss using cone beam computed tomography (CBCT) reformatted panoramic images, and to encourage the use of CBCT in retrospective studies on restorative dentistry. Materials and methodsCBCT images of 382 patients with approximal restorations were included in the study. On CBCT images, alveolar bone loss adjacent to each restored surface was determined and compared to the control tooth. The overhang size was measured and categorized as small, medium, or large. Data obtained were evaluated statistically using Kruskal Wallis, Mann Whitney U, chi-square, and one-sample chi-square tests with a significance level set at P < 0.05. ResultsA total of 216 (32.4%) surfaces with overhanging restorations were detected in CBCT images. The number of overhanging surfaces with alveolar bone loss (71.3%) was higher than the control surfaces with bone loss (49.1%) (P < 0.05). The amount of bone loss adjacent to overhanging surfaces (2.28 ± 1.69 mm) was significantly higher compared to control surfaces (1.53 ± 1.73 mm) (P < 0.05). However, the same trend applied to the surfaces without overhang and their controls. The amount of bone loss was not correlated with the overhang size (P > 0.05). ConclusionApproximal restorations with and without overhanging margins may often result in alveolar bone loss, the amount of which is not always correlated with the overhang size.

Condylar and ramus volume in asymmetric and symmetric skeletal class III malocclusion: A cone-beam computed tomography study

Background/purposeAmong the craniofacial structures, the mandible is the only bony structure with movable joints. Each part (including condyle process, coronoid process, and ramus) of mandible would interaction with the muscles and proceed different osteogenesis progress. The objective of this study was to evaluate the mandibles with symmetric and asymmetric skeletal Class III jaw relations by quantifying differences in the condyle process, coronoid process and ramus on CBCT (Cone-beam computer tomography) images. Our hypothesis was that CBCT would reveal no voluminal differences between deviated and non-deviated mandibular segments in asymmetric skeletal Class III. Materials and methodsCBCT imagines were collected from dental department, KMUH and then divided into symmetric Class III group (Menton deviation < 4mm) and asymmetric Class III group (Menton deviation≧4mm). The mandibular structure would be segmented to ramus, condylar and coronoid process. Each volume was measured. Independent t test was used for comparison between groups, and paired t test was applied for comparison between both segmented parts within each group. ResultsSignificant differences between deviation and non-deviation sides in the asymmetric group were found in condylar and ramus segments for volumetric quantitative measurements. There has no significant difference in ramus parts between groups. Significant greater condylar volume was found in non-deviation side of asymmetric group. ConclusionThe results demonstrated that in the side with greater mandible growth potential, the condylar and the ramus volume would be greater as well. CBCT is a useful and accurate modality for quantification and evaluation of mandibular asymmetry.

Variations of root and canal morphology of mandibular second molars in Chinese individuals: a cone-beam computed tomography study

BackgroundThe mandibular second molars demonstrate variations on root and canal morphology. The aim of this study was to investigate all the root canal morphology of mandibular second molars and analyze the morphological variations in patients by gender and age in a Chinese population use CBCT imaging.MethodsCone-beam computed tomographic images of 1200 bilateral mandibular second molars were obtained from 600 patients (300 females and 300 males) who required a preoperative assessment for implant surgery, surgical removal of impacted teeth, orthodontic treatment, surgery of maxillofacial tumour and cysts or LeFort I osteotomy. CBCT images were divided into 5 groups according to age: “15–24 years”, “25–34 years”, “35–44 years”, “45–54 years” and “≥ 55 years”; and 2 groups by gender: “females” and “males”. The following information were recorded: the number of roots and canals and their morphology, the frequency and configuration of C-shaped canals by gender, age and position (left and right). The chi-square test was used to analyse differences between groups. P value of < 0.05 was considered statistically significant.ResultsOf the 1200 teeth, 61% had two separate roots located mesiodistally, 35.6% had one C-shaped root. The 45.3% teeth had three canals in two-rooted mandibular second molars. The mesial root showed a Vertucci type II configuration in 28.9% cases followed by type IV(24.4%). While the distal root showed a significant higher prevalence of type I configuration in 95.6%. In the examined 1200 teeth, 430 teeth (35.8%) had C-shaped root canals. The prevalence of C-shaped root canal systems was significantly higher in females (42.5%) than in males (29.1%) (P = 0.000), and did not differ with age (P = 0.126). The 80.4% C-shaped canals were bilateral (P = 0.000) and did not differ with side (left and right) (P = 0.758).ConclusionsThe most commonly observed root morphology for the mandibular second molars was 2 separate roots with three canals.The prevalence of C-shaped root canal is 35.8% and is more higher in females than in males.

Model-based pulse pileup and charge sharing compensation for photon counting detectors: A simulation study.

PurposeWe aim at developing a model‐based algorithm that compensates for the effect of both pulse pileup (PP) and charge sharing (CS) and evaluates the performance using computer simulations.MethodsThe proposed PCP algorithm for PP and CS compensation uses cascaded models for CS and PP we previously developed, maximizes Poisson log‐likelihood, and uses an efficient three‐step exhaustive search. For comparison, we also developed an LCP algorithm that combines models for a loss of counts (LCs) and CS. Two types of computer simulations, slab‐ and computed tomography (CT)‐based, were performed to assess the performance of both PCP and LCP with 200 and 800 mA, (300 µm)2 × 1.6‐mm cadmium telluride detector, and a dead‐time of 23 ns. A slab‐based assessment used a pair of adipose and iodine with different thicknesses, attenuated X‐rays, and assessed the bias and noise of the outputs from one detector pixel; a CT‐based assessment simulated a chest/cardiac scan and a head‐and‐neck scan using 3D phantom and noisy cone‐beam projections.ResultsWith the slab simulation, the PCP had little or no biases when the expected counts were sufficiently large, even though a probability of count loss (PCL) due to dead‐time loss or PP was as high as 0.8. In contrast, the LCP had significant biases (>±2 cm of adipose) when the PCL was higher than 0.15. Biases were present with both PCP and LCP when the expected counts were less than 10–120 per datum, which was attributed to the fact that the maximum likelihood did not approach the asymptote. The noise of PCP was within 8% from the Cramér–Rao lower bounds for most cases when no significant bias was present. The two CT studies essentially agreed with the slab simulation study. PCP had little or no biases in the estimated basis line integrals, reconstructed basis density maps, and synthesized monoenergetic CT images. But the LCP had significant biases in basis line integrals when X‐ray beams passed through lungs and near the body and neck contours, where the PCLs were above 0.15. As a consequence, basis density maps and monoenergetic CT images obtained by LCP had biases throughout the imaged space.ConclusionWe have developed the PCP algorithm that uses the PP–CS model. When the expected counts are more than 10–120 per datum, the PCP algorithm is statistically efficient and successfully compensates for the effect of the spectral distortion due to both PP and CS providing little or no biases in basis line integrals, basis density maps, and monoenergetic CT images regardless of count‐rates. In contrast, the LCP algorithm, which models an LC due to pileup, produces severe biases when incident count‐rates are high and the PCL is 0.15 or higher.

Response to PEEP in COVID-19 ARDS patients with and without extracorporeal membrane oxygenation. A multicenter case–control computed tomography study

BackgroundPEEP selection in severe COVID-19 patients under extracorporeal membrane oxygenation (ECMO) is challenging as no study has assessed the alveolar recruitability in this setting. The aim of the study was to compare lung recruitability and the impact of PEEP on lung aeration in moderate and severe ARDS patients with or without ECMO, using computed tomography (CT).MethodsWe conducted a two-center prospective observational case–control study in adult COVID-19-related patients who had an indication for CT within 72 h of ARDS onset in non-ECMO patients or within 72 h after ECMO onset. Ninety-nine patients were included, of whom 24 had severe ARDS under ECMO, 59 severe ARDS without ECMO and 16 moderate ARDS.ResultsNon-inflated lung at PEEP 5 cmH2O was significantly greater in ECMO than in non-ECMO patients. Recruitment induced by increasing PEEP from 5 to 15 cmH2O was not significantly different between ECMO and non-ECMO patients, while PEEP-induced hyperinflation was significantly lower in the ECMO group and virtually nonexistent. The median [IQR] fraction of recruitable lung mass between PEEP 5 and 15 cmH2O was 6 [4–10]%. Total superimposed pressure at PEEP 5 cmH2O was significantly higher in ECMO patients and amounted to 12 [11–13] cmH2O. The hyperinflation-to-recruitment ratio (i.e., a trade-off index of the adverse effects and benefits of PEEP) was significantly lower in ECMO patients and was lower than one in 23 (96%) ECMO patients, 41 (69%) severe non-ECMO patients and 8 (50%) moderate ARDS patients. Compliance of the aerated lung at PEEP 5 cmH2O corrected for PEEP-induced recruitment (CBABY LUNG) was significantly lower in ECMO patients than in non-ECMO patients and was linearly related to the logarithm of the hyperinflation-to-recruitment ratio.ConclusionsLung recruitability of COVID-19 pneumonia is not significantly different between ECMO and non-ECMO patients, with substantial interindividual variations. The balance between hyperinflation and recruitment induced by PEEP increase from 5 to 15 cmH2O appears favorable in virtually all ECMO patients, while this PEEP level is required to counteract compressive forces leading to lung collapse. CBABY LUNG is significantly lower in ECMO patients, independently of lung recruitability.

Differences in pulmonary nodular consolidation and pulmonary cavity among drug-sensitive, rifampicin-resistant and multi-drug resistant tuberculosis patients: a computerized tomography study with history length matched cases.

BackgroundThere have been concerns that literature described radiological feature differences between drug-sensitive pulmonary tuberculosis (DS-PTB) and multidrug-resistant (MDR)-PTB were confounded by that MDR-PTB cases tend to have a longer history. Using history length matched DS-PTB and MDR-PTB cases from a well-defined urban region in Dalian, we retrospectively analysed the CT feature differences of these paired cases with a focus on pulmonary nodular (PN) consolidation and pulmonary cavity (PC).MethodsThere were 33 consecutive MDR-PTB cases [inclusive of rifampicin-resistant (RR) cases, 27 males and 6 females, mean age: 49.2 years], with 19 cases had a history of <1 month and 8 and 6 cases had a history of 1–6 and >6 months respectively. To pair the MDR-PTB cases with history length, matched 33 cases of DS-PTB patients (21 males and 12 females, mean age: 56.5 years) were included. All patients were new PTB without HIV infection. The first CT exams prior to treatment were analysed.ResultsCompared with DS cases, MDR cases had a much higher prevalence of PN (75.76% vs. 45.45%) and a higher number of PN per positive case for PN (6.2 vs.1.53). For the cases >1 month history, MDR-PTB had a higher number of PC per positive case than that of DS-PTB cases (7.18 vs. 2.36). To differentiate DS-PTB from MDR-PTB, receiver operating characteristic (ROC) analysis showed a cutoff PN number of ≥3 had 48.5% sensitivity and 93.9% specificity, and a cutoff PC number of ≥4 had 39.4% sensitivity and 84.9% specificity. The lung field distribution of all lesions tended to be wider for MDR-PTB cases. MDR-PTB cases appeared to be associated with a faster progression in the absence of treatment.ConclusionsMDR-TB is likely intrinsically more invasive than DS-TB. Multiple PN and Multiple PC are promising signs for the suspicion of MDR-PTB on chest imaging.

Double Adjacent Ventral Slots in Cervical Disc Extrusion with Epidural Haemorrhage in Four French Bulldogs

AbstractFour French bulldogs were presented with a history of cervical pain and/or signs of myelopathy and were diagnosed with an acute cervical intervertebral disc extrusion (IVDE), associated with epidural haemorrhage (EH). The lesion was classified as IVDE with EH by a board-certified radiologist based on contrast-enhanced computed tomography images. All dogs were treated with two adjacent ventral slots that confirmed diagnosis. The decompression was assessed by measurement of the amount of residual material on computed tomography studies, and the outcome was evaluated by clinical recheck. All dogs recovered uneventfully after the surgery. This case series describes the first detailed report of extensive cervical IVDE with EH where double adjacent ventral slots was used in a treatment of such lesion.

COVID-associated rhino-orbito-cerebral mucormycosis

INTRODUCTION: Rhino-orbito-cerebral mucormycosis (ROCM), a life-threatening, acute fungal infection of the nasal cavities and paranasal sinuses, once considered a rare and lethal complication in immunocompromised patients, is now having a massive increase in ROCM incidence in India associated with COVID-19, i.e., COVID-associated mucormycosis with more than 15,000 cases as of May 2021. Early imaging by computed tomography (CT) and magnetic resonance imaging (MRI) is not only helpful in assessing the extent of involvement of this lethal disease but also helps in early diagnosis leading to prompt and aggressive treatment. The present study is aimed at determining and comparing the imaging findings on CT and MRI in ROCM patients, for early diagnosis in suspected cases of ROCM. MATERIALS AND METHODS: The present study is a comparative study of CT and MRI done on 11 patients suspected of ROCM, for 2 months from May to June 2021. RESULTS: Among 11 patients in the study group, ranging from 29 to 65 years of age, 45.4% belonged in 41–60 years of age group, with female predominance. 90.90% cases (10 patients) had maxillary sinus involvement among which 7 cases were diagnosed with ROCM, followed by 63.60% cases (7 patients) had ethmoidal sinus involvement among which 6 cases were diagnosed with ROCM. The involvement of retromaxillary space, pterygopalatine fossa space and masticator space, and cellulitis in premaxillary and preseptal spaces were findings seen only in diagnosed cases of ROCM. Erosions of bones were seen in ROCM cases, 27.20% cases (3 patients) had erosions of walls of maxillary sinus and lamina papyracea each. Orbital involvement in the form of intraconal space and extraocular muscles involvement was seen in 27.20% cases (3 patients) each. Optic nerve involvement was seen in 18.10% cases (2 patients) followed by extraconal space involvement in 9.01% cases (1 patient). Taking KOH staining and/or histopathology (HPR) as standard of reference, CT has a Sensitivity (Sn) of 71.40%, Specificity (Sp) of 100%, Positive predictive value (PPV) of 100%, Negative Predictive Value (NPV) of 66%, and Diagnostic accuracy (DA) of 81% as compared to MRI which has a Sn of 85.7%, Sp of 100%, PPV of 100%, NPV of 80%, and DA of 90.9%. CONCLUSIOIN: CT and MRI play a complementary role in diagnosis of ROCM, as CT is better in detecting bone erosions, whereas MRI is better in detecting soft tissue, orbital and central nervous system involvement. In the acute state of emergency as in the current pandemic with rising cases of ROCM and acute shortage of amphotericin-B, MRI is the single best modality for accurate detection of ROC, helping clinicians in the judicious use of Amphotericin-B.

471 Ecg Gating Matters: Thoracic Aortic Size Varies By Cardiac Phase

Introduction: Thoracic aortic (TA) surveillance is commonly performed using computed tomography (CT). Variation in size between systole and diastole is known from echocardiographic data, however, in clinical practice most TA CT studies are not ECG-gated. We hypothesize that a significant variance in size exists on TA CT depending on the cardiac phase of acquisition.

Paper 20: The Relationship of Schottle’s Point to the Medial Distal Femoral Physis: A Digitally Reconstructed Radiograph and 3-Dimensional Computed Tomography Study

Objectives:There is significant controversy regarding ideal medial patellofemoral ligament reconstruction (MPFLR) femoral tunnel position in the pediatric setting. The authors identified 3 main gaps in knowledge. First, the position of the radiographic MPFLR start point (Schottle’s point) relative to the medial distal femoral epiphysis is not well defined. Second, although anatomic studies have suggested tunnel trajectories that avoid physeal contact, these trajectories are not based upon the widely used Schottle’s point, providing limited intraoperative utility. Third, prior studies provide conflicting data regarding position of the MPFL origin relative to the distal femoral physis, particularly in younger patients. The purpose of this study was to determine the proximity of Schottle’s point to the medial distal femoral physis and the medial epicondyle using a digitally reconstructed radiographs (DRR) and three-dimensional computed tomography (CT) models.Methods:The institutional picture archiving and communication system (PACS) was queried for CT imaging studies of pediatric knees with open physes. CT data were imported to a Python based, open-source image processing software and were transformed to create true lateral digitally reconstructed radiographs (DRR) (Figure 1) and 3-dimensional (3D) renderings of the distal femur (Figure 2). Schottle’s point and the medial epicondyle were registered using fiducial markers and 3D distance measurements were then obtained from Schottle’s point on the medial cortex to 1) the medial epicondyle, 2) the physeal point directly superior to Schottle’s point, and 3) the shortest distance to the medial physis on the cortical surface. A 6-millimeter circle was used to simulate reaming diameter and physeal intersections were tabulated.Results:49 pediatric knee CT scans with open physes were included in the data. Average patient age was 13.0 ± 2.3 years (range: 6-17 years). Mean minimum distance from the medial physis to Schottle’s point was 9.9 mm ± 3.0mm (range: 3.4-16.1 mm) (Figure 3). In 49 of 49 cases (100%), Schottle’s point was distal to the physis. Schottle’s point was localized at a mean distance of 7.5mm ± 3.14mm posterior to the medial epicondyle and 6.1mm ± 2.9mm superior to the medial epicondyle. Using a 6mm reaming diameter, 3 (6%) femurs in our study would have violation of the medial distal femoral physis. Moving the start point 3mm distally would result in 0 of 49 (0%) having physeal injury.Conclusions:Historically, characterizing the position of the origin of the MPFL on the medial condyle relative to the medial distal femoral physis has been challenging. Prior cadaveric studies have suggested the MPFL originates proximal to the physis in younger patients (<7 years). However, more recent cadaveric studies have challenged this idea, finding the bony landmarks of the MPFL origin to be distal to the physis. Although these studies have sparked significant discussion regarding the pediatric MPFL origin, they have small numbers of specimens. Using a more surgically relevant approach, the present study demonstrates that Schottle’s point is consistently distal to the distal femoral physis.Prior studies have suggested anterior and distal drill trajectories that may minimize physeal injury. Although useful, these studies do not assess drilling path relative to the commonly used radiographically identified starting point, Schottle’s point. The present study complements this prior work by addressing the radiographic start point upon which the drill trajectory is based intraoperatively. Based on the present study, the use of Schottle’s point without distalization would lead to physeal injury in 6% of cases.Further, prior cadaveric anatomic studies are subject to limitations of the availability and expense of pediatric specimens and are therefore limited to small sample sizes. The methodology of the present study, by using readily available fine cut CT data, is not subject to such constraints. The present investigation offers a larger sample size than any previously published pediatric MPFL anatomic study and uses a highly accurate and repeatable methodology. This unique methodology may be more broadly applicable to the study of pediatric procedures near the physis.The radiographically defined surgical start point for MPFL femoral tunnel placement (Schottle’s point), is consistently distal to the medial distal femoral physis. Mean minimum distance from Schottle’s point to the physis on the medial cortex is 9.9mm. Using Schottle’s point for the start of tunnel drilling leads to physis violation in 6% of cases, when using a 6mm reamer. Distalization of the start point by 3mm leads to avoidance of physeal injury in all cases.Figure 1.Digitally Reconstructed Radiograph with Identification of Schottle’s PointFigure 2.3D Rendering with Physeal Distance MeasurementFigure 3.Saggital Plane Plot of Schottle’s Point and Closest Point on Medial Physis

Cone-Beam computed tomography study of root and canal morphology of mandibular premolars in Kashmiri population

Aim: The current study’s goal was to employ CBCT to determine the accurate root anatomy, as well as root canal configuration, of mandibular first and second premolars in Kashmiri Population.Materials and Methods: CBCT scans data of the patients who were scanned for some diagnostic purposes were collected. The collected data were subjected to a retrospective examination. All of the data related to patients who were scanned at the Bright X-rays CBCT centre between Jan 2018 and December 2021 were evaluated.Results: Table 1 shows the number of roots on the right and left sides in relation to gender and tooth location. Of the 250 teeth assessed, 243 mandibular premolars had one root (97.2%), whereas 7 (2.8%) were two-rooted. There was no statistically significant difference (p > 0.05) between gender and the number of roots or tooth position and the number of roots.Conclusion: The prevalence of multiple canals in mandibular first premolars was mainly of Type V, and mandibular second premolars had a low rate of canal variation. Root canal bifurcation occurred at the middle or apical third in most bicanal mandibular premolars. CBCT scanning can be used in the management of mandibular premolars with complex canal morphology.

Computed tomography study of bovine arch in patients with coarctation of aorta: A retrospective report analysis.

The objective of this study was to define the frequency of the bovine aortic arch in patients with coarctation using the tomographic studies.This is a descriptive retrospective study involving analysis of reports of computed tomographic angiography done at the Prince Sultan Cardiac center for 700 children with congenital heart diseases over a span of about 10 years from April 1, 2008, to August 1, 2018. Cases with coarctation of aorta were chosen to determine the frequency of the bovine aortic arch using the tomographic studies.From a total of 700 cases which underwent computed tomographic angiography, 117 (16.71%) were diagnosed with coarctation and 19 (2.71%) had bovine arch. Among the 117 patients with coarctation, the total number of patients with bovine arch was 7 patients representing 5.98%, while in patients without coarctation we found a total number of bovine arches of 12 out of 583 patients representing 2.06%. Patients having coarctation with normal branching pattern were at a slight increased incidence of atrial septal defect, ventricular septal defect and anomalous pulmonary venous return than patients having coarctation with bovine arch.In the face of increased incidence of bovine aortic arch in patients with coarctation, we recommend multislice computed tomographic angiography as a noninvasive and potentially safe and accurate method to precisely delineate the branching pattern of the arch of aorta in patients with coarctation before the interventional procedures and surgeries.

Clinical observation of endovascular thoracic aortic prosthetics in a patient with distal anastomosis aneurysm of a vascular prosthesis formed "end-to-side" after extraanatomic prosthetics

A clinical observation of successful prosthetics of an aneurysm of distal anastomosis of a vascular prosthesis of the thoracic aorta with a stent graft in a patient 24 years after extraanatomic bypass surgery with an end-to-side anastomosis for aortic coarctation is presented. During a routine examination, an aneurysm of the distal anastomosis of the vascular prosthesis was revealed in the patient. After further examination, thoracic aorta endoprosthesis was performed from vascular prosthesis to native aorta with Ankura 2020B120 stent graft (Lifetech Scientific Co., LTD. Shenzhen, China). Intraoperative results of endoprosthetics were assessed as good. The aneurysm of the distal anastomosis was not contrasted, the patency of the vessels of the aortic arch was preserved. According to the control computed tomography study performed 3 months after the operation, the aneurysm of the distal anastomosis is not contrasted, there is no dislocation of the prosthesis, there are no endolics. The above clinical observation demonstrates the effectiveness and safety of thoracic aortic endoprosthesis from a vascular prosthesis to a native aorta with anastomosis aneurysms of a vascular prosthesis, which allows avoiding complex and traumatic repeated open surgical intervention on the aorta and achieving good immediate and long-term treatment results. Received 25 November 2021. Revised 29 December 2021. Accepted 31 January 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authors Literature review: N.S. GorshkovDrafting the article: N.S. Gorshkov, N.R. ChernayaCritical revision of the article: R.Sh. Muslimov, L.S. KokovSurgical treatment: N.S. Gorshkov, N.R. Chernaya, M.V. Parhomenko, V.S. SelyaevFinal approval of the version to be published: N.S. Gorshkov, N.R. Chernaya, M.V. Parhomenko, V.S. Selyaev, L.S. Kokov

Rheumatoid arthritis overlapping systemic sclerosis with interstitial lung disease

Lung disease is the second most frequent extra articular manifestation in rheumatoid arthritis (RA) patients. It can be present in up to 80% RA cases and represents a major cause of morbidity and mortality. One of the most common types of lung involvement in RA patients is the interstitial lung disease (ILD). Computed tomography studies show evidence of ILD in a large proportion of patients with RA (over 50% in some studies) and it can be clinically symptomatic in 5% of cases. The CT aspect classifies four forms of ILD, listed in order of frequency: usual interstitial pneumonia (UIP) - the most common form, non-specific interstitial pneumonia (NSIP), organizing pneumonia (OP) and diffuse alveolar damage (DAD) which is the least common form. We present a long-standing case of rheumatoid arthritis overlapping systemic sclerosis with interstitial lung disease.

The Utility of Lesser Trochanter Version to Estimate Femoral Anteversion in Total Hip Arthroplasty: A Three-Dimensional Computed Tomography Study

Objective: Femoral anteversion is an important parameter that can prevent complication following total hip arthroplasty (THA) caused by improper positioning of the implant. However, assessing the femoral anteversion can be challenging in situations with significant defect of the femoral neck. In this study, the lesser trochanter version was nominated as alternative parameter to femoral anteversion. So, the main objective of this study is to determine whether the femoral anteversion correlates with the lesser trochanter version. Design: Retrospective study. Methods: Three-dimensional images of 100 femora were generated and their femoral anteversion and lesser trochanter version was measured. Correlation between the parameters were calculated. Results: The mean lesser trochanter version was 38.54° ± 7.86° (mean ± SD), while the mean femoral anteversion was 11.84° ± 10.06°. The lesser trochanter version was inversely correlated with the femoral anteversion with a correlation coefficient of −0.72. Conclusions: The lesser trochanter should be considered as an additional bony landmark to assess proper implant positioning in THA.

A cone beam computed tomography study based on three-dimensional cephalometric analysis of relationships between the lip-line and jaw deformity

ObjectiveThe aim of this study was to use the cone beam computed tomography (CBCT) to study the relationships between the lip-line and mandible deformity. DesignCBCT data of 20 patients with jaw deformity (experimental group) and 20 patients without mandible deformity (control group) were selected. Use three-dimensional cephalometry to measure the reconstructed images of CBCT data simulated by the Materialise Interactive Medical Image Control System (Mimics), mark the related points, lines and planes of the three-dimensional craniomaxillofacial structure, and measure relevant distances and angles. The T-test, Pearson correlation analysis and Linear regression were used to analyze the characteristics of the lip-line and jaw deformity. ResultsThere was a significant difference in the lip-line between mandible deformity group and control group. Significant positive correlations could been found among the lip-line cant, the occlusal plane cant, the mandibular plane cant and the degree of mandible deformity (r=0.964, 0.942, 0.611, P < 0.01). A linear relationship was found between the left lip-line cant Y and the menton deviation X [the mandible deflection to the right was defined as positive, and the left lip-line below frankfort horizontal was viewed as positive] as Y= 0.340 + 0.505X. ConclusionsThe lip-line of patients with jaw deformity was inclined, and the lip-line cant was positively correlated with the degree of mandible deformity, and there was a certain linear relationship between the two, which could provide a theoretical reference for clinicians to diagnose and treat patients with mandible deformity.

Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis

An incidental finding is defined as a newly discovered mass or lesion detected on imaging performed for an unrelated reason. The identification of an incidental finding may be an opportunity for the early detection of a serious medical condition, including a malignancy. However, little is known about the prevalence of incidental findings in the emergency department (ED) setting and the strategies that can be used to mitigate the risk associated with them in the ED. This study aimed to estimate the overall prevalence of incidental findings and to summarize the currently described measures to mitigate the risks associated with incidental findings. On November 22, 2020, a systematic literature search of PubMed, EMBASE, and Scopus was performed for studies that were published in peer-reviewed journals and reported the prevalence of incidental findings in computed tomography (CT) scans in patients in the ED. Patients who received CT scans that included the head, neck, chest, or abdomen/pelvis were included. The study characteristics, overall prevalence of incidental findings, prevalence of incidental findings by body region, and prespecified subgroups were extracted. The criteria used for risk stratification within individual studies were also extracted. Pooled estimates were calculated using a random-effects meta-analysis. A total of 1,385 studies were identified, and 69 studies met the inclusion criteria. The included studies represented 147,763 ED encounters or radiology reports across 16 countries, and 83% of studies were observational, cross-sectional studies. A total of 35 studies (50.7%) were in trauma patients. A large degree of heterogeneity was observed across the included studies. The overall pooled prevalence estimate for any incidental finding was 31.3% (95% confidence interval 24.4% to 39.1%). We found great variation in the methods described to mitigate the risk associated with incidental findings, including a lack of standardized risk stratification, inconsistent documentation practices, and only a small subset of studies describing prospective interventions aimed at improving the recognition and management of incidental findings from the ED. In patients in the ED receiving CT scans, incidental findings are commonly encountered across a broad range of ED chief complaints. This review highlights the existence of great heterogeneity in the definitions used to classify incidental findings. Future studies are needed to determine a clinically feasible categorization standard or terminology for commonly encountered incidental findings in the ED setting to standardize classification and documentation.