Coronal Dimension Research Articles

A 3D Evaluation of Condyle Position of Skeletal Class I and III Patients: A Cone-Beam Computed Tomography Technique

Purpose: The present study aims to assess the differences in the condyle position for two skeletal classes using Cone-Beam Computed Tomography (CBCT) reconstructions for both sides and genders.
 Materials and Methods: In this cross-sectional descriptive study, the CBCT images of 96 patients (20-60 years) were assessed. The participants were divided according to their Angle malocclusion classifications (Angle Classes I and III). The variables of the Anterior-Posterior position of the Condyle (APC), condylar angle in the axial plane (ACA), the Lateral Position of the Condyle in the axial plane (LPC), the Vertical Position of the Condyle (VPC), condylar angle in coronal dimension (CCA), and the difference of APC and VPC on both sides were measured. The measurements were analyzed using a one‑way ANOVA and Tukey’s post hoc test.
 Results: The variables of APC, LPC, ACA, VDC, and the difference of the APC on both sides in the two skeletal classes were similar. The VPC and CCA were greater in Class III than in Class I. All variables representing the 3D position of the condyle were similar in men and women, as well as on the right and left in both skeletal classes, I and III.
 Conclusion: Based on the 3D evaluation results of the condylar position, the skeletal classes III and I differed in the VPC and CCA; however, for the rest variables, there were no statistical differences.

Size and vision: Impact of fluoroscopic navigation, digital tomosynthesis, and continuous catheter tip tracking on diagnostic yield of small, bronchus sign negative lung nodules

IntroductionAccurate biopsies of lung nodules, including small (<2 cm), bronchus sign negative lesions, remain challenging. Technological advances, however, may improve outcomes. We describe our experience using a novel system combining fluoroscopic navigation with digital tomosynthesis and continuous catheter tip tracking to guide lung nodule biopsies. MethodsDemographic data, procedural characteristics, and biopsy results from prospectively enrolled patients were collected. Results159 nodules (144 patients) were biopsied. Average nodule size was 22.2 ± 15.2 mm (axial), 21.7 ± 13.9 mm (coronal), and 33.2 ± 20.5 mm (sagittal), with 45% (n = 72) <2 cm in all dimensions and 66% (n = 105) without a bronchus sign.Diagnostic yield was 84% (134/159), with malignancy (n = 75, 47%) most common. A diagnosis was obtained in 75% (n = 54/72) of lesions that were <2 cm in all dimensions and 79% (n = 83/105) of bronchus sign negative lesions.Unadjusted generalized mixed-effects logistic regression models showed that nodule size as a categorical variable (>2 cm in any dimension) and as a continuous variable in the coronal dimension, the presence of a bronchus sign, and a concentric radial EBUS view had an increased odds ratio for diagnosis. A concentric radial EBUS view also had an increased OR for diagnosis in a fully adjusted mixed-effects logistic regression model. ConclusionFluoroscopic navigation with digital tomosynthesis and continuous catheter tip tracking shows an overall improved diagnostic accuracy compared to historical controls, including for small, bronchus sign negative lesions. Future studies clarifying the optimal modality for patients with different nodules will be of importance to provide the most appropriate procedure tailored to each individual lesion's unique characteristics.

Clinical and radiographic evaluation of the Periodontium with biologic width invasion

BackgroundThe biologic width is defined as the coronal dimension to the alveolar bone that is occupied by healthy gingival tissue. The objective of the present study was to correlate radiographic findings of biologic width invasion with the periodontium status.MethodsIt were included 14 patients with restored teeth with biological width invasion, on the proximal sites, observed clinically and radiographically. 122 proximal sites were evaluated, 61 in the test group (biological width invasion) and 61 in the control group (adequate biological width). Smokers and patients presenting periodontal disease or restorations with contact in eccentric movements, horizontal over-contour or secondary caries were excluded from the sample. The invasion of the biologic width was diagnosed when the distance from the gingival margin of restoration to the bony crest was less than 3 mm. Intrabony defect and bone crest level, as well as, their vertical and horizontal components were radiographically evaluated when present. Plaque index, bleeding on probing, probing depth, gingival recession height, keratinized gingival height and thickness, and clinical attachment level were clinically evaluated. Data were subjected to Spearman’s Correlation and Wilcoxon’s test.ResultThe most prevalent tooth with biological width invasion was the first molar. There was a statistically significant correlation between the bone crest (p < 0.001), vertical (p < 0.001) and horizontal (p = 0.001) components. In the test group, there was a statistically significant correlation between bleeding on probing (p < 0.001; r = 0.618) and width of gingival recession (p = 0.030; r = − 0.602) with the intraosseous component; and between keratinized gingival height and bone level (p = 0.037; r = − 0.267). In the control group, there was a correlation between plaque index (p = 0.027; r = − 0.283) with bone level and correlation between keratinized gingival thickness and bone level (p = 0.034; r = − 0.273) and intrabony component (p = 0.042; r = 0.226).ConclusionA statistically significant relationship was found between bleeding on probing and gingival recession in patients who presented intrabony defects due to the invasion of biological width, which may be also related to the thickness of the keratinized gingiva.

A Pilot Study of Brentuximab Vedotin Combined with AVD Chemotherapy and Radiotherapy in Patients with Newly Diagnosed Early Stage, Unfavorable Risk Hodgkin Lymphoma

A Pilot Study of Brentuximab Vedotin Combined with AVD Chemotherapy and Radiotherapy in Patients with Newly Diagnosed Early Stage, Unfavorable Risk Hodgkin Lymphoma

Growth and Late Detection of Post-Operative Cholesteatoma on Long Term Follow-Up With Diffusion Weighted Magnetic Resonance Imaging (DWI MRI): A Retrospective Analysis From a Single UK Centre.

To evaluate the growth rate and late detection of residual cholesteatoma on long-term follow-up with diffusion weighted magnetic resonance imaging (DWI MRI) in clinically stable ears following definitive surgery, in order to define surveillance imaging protocols. Retrospective case review. Tertiary referral center. Patients who underwent DWI MRI at our institution between February 2007 and May 2013 for postoperative cholesteatoma follow-up. Non-echo planar imaging (non-EPI) Half-Fourier Acquisition Single-shot Turbo spin Echo (HASTE) DWI MRI. Intervals between the definitive surgery and the first and subsequent DWI MRI, the maximum coronal dimension of the lesion on DWI and length of follow-up. The study evaluated 152 postoperative DWI studies performed for 88 patients. In 12 cases, DWI was initially negative but became positive on repeat imaging after a mean interval of 3.8 years from the initial cholesteatoma surgery (median 3.7 years, range 1.6-7.9). Of these, 3/12 had more than one negative/indeterminate DWI before disease was eventually detected on imaging; in this subgroup, the mean interval between surgery and positive DWI was 3.2 years (median 2.6 years, range 2.3-4.2). 39 DWI positive foci with serial imaging demonstrated a mean growth rate of 4 mm/year (median 2 mm, range 0-18). After negative initial DWI, it is proposed that interval imaging should be considered for a minimum of 5 years in stable ears following definitive cholesteatoma surgery. In view of the marked variability in growth rate, an additional interval scan between 2 and 3 years postoperatively is indicated.

Ureteral Stone Diameter on Computerized Tomography Coronal Reconstructions Is Clinically Important and Under-reported

To compare the maximum stone diameter of ureteral stones in the coronal plane to that of stones in the axial plane and to determine the clinical significance of the coronal diameter. A retrospective chart review was performed on patients seen in the clinic between September 2013 and November 2015. Patients were included if they had a history of ureteral stone noted on computerized tomography (CT) performed with coronal reconstructions. Patients were excluded if they had multiple ureteral stones, a history of upper urinary tract abnormalities, a need for urgent intervention, or no follow-up. Management of the ureteral stone and pertinent medical history related to patients' stone disease, including stone diameter on axial and coronal CT imaging, were captured. Multivariate regression was performed to identify predictive factors for stone passage. A total of 150 patients met inclusion criteria. Fifty-four patients spontaneously passed stones and 96 required surgery. The reading radiologist reported the stone measurement in the coronal dimension in 17% of the cases. In 75% of the cases, the coronal diameter was larger than the axial diameter by an average of 1.2 mm. On univariate analysis, stone passage was associated with axial diameter (P <.001), coronal diameter (P <.001), stone location (P = .001), age (P <.001), and medical expulsive therapy (P = .008). On multivariate analysis, only coronal diameter (P <.001), stone location (P = .01), and age (P = .03) remained significant factors associated with spontaneous passage. In the current series, only stone size as measured in the coronal diameter was associated with stone passage vs need for surgical intervention on multivariate analysis. We strongly recommend obtaining coronal reconstructions when CT is performed for ureteral stone to guide management decisions and appropriately counsel patients on the probability of stone passage.

Short-term skeletal and dental changes following bone-borne versus tooth-borne surgically assisted rapid maxillary expansion: A randomized clinical trial study

AimTo evaluate and compare the short-term (post-retention) skeletal and dental changes following bone-borne and tooth-borne surgically assisted rapid maxillary expansion (SARME) using cone beam computed tomography (CBCT). Subjects and methodsIn this randomized clinical study, 30 patients with transverse maxillary deficiency underwent either tooth-borne (n = 15) or bone-borne (n = 15) SARME. Before treatment and immediately after the consolidation period, CBCT was obtained and the nasal floor width, interdental root distance, palatal bone width and interdental cusp distance were measured at first premolar and first molar regions of maxilla. ResultsTwenty eight patients completed the study protocol. In both tooth-borne (n = 13) and bone-borne (n = 15) groups the highest degree of expansion occurred in the dental arch, followed by palatal bone, and nasal floor (V-shaped widening in coronal dimension). The amount and pattern of expansion was comparable between anterior and posterior maxillary regions in each group (parallel posteroanterior expansion) and between the two groups. ConclusionDental and skeletal effects of tooth-borne and bone-borne devices were comparable. The overall complication rate was negligible. Selection of an expansion device should be based on each individual patient's requirements. Future long-term clinical trial studies to evaluate the stability and relapse of these two techniques are recommended.

Preoperative Agreement on the Geometric Classification and 2-Dimensional Measurement of Rotator Cuff Tears Based on Magnetic Resonance Arthrography

To determine the intraobserver and interobserver agreement on the geometric classification and 2-dimensional measurements of rotator cuff tears based on magnetic resonance arthrography. We retrospectively reviewed preoperative magnetic resonance arthrograms of 73 consecutive patients who were surgically treated for their full-thickness rotator cuff tears. The images were blinded and evaluated by 2 orthopaedic shoulder surgeons and 2 musculoskeletal radiologists using the geometric classification of rotator cuff tears (type 1, crescent-shaped tear; type 2, longitudinal U- or L-shaped tear; type 3a, massive tear measuring between 20 and 30 mm; and type 3b, massive contracted tear measuring >30 mm) and measuring the sagittal/coronal dimensions of the tear. Review was performed twice with an interval of at least 8 weeks. Agreement was calculated using the linear weighted κ coefficient and the intraclass correlation coefficient (ICC). The intraobserver agreement was excellent for both the geometric classification and the sagittal/coronal dimension measurement (κ, 0.81 to 0.92; ICC, 0.84 to 0.98). The ICC for the interobserver agreement was excellent for all sagittal and coronal dimension measurements (ICC, 0.95 to 0.97). The interobserver agreement for the geometric classification was good for the orthopaedic surgeons (κ, 0.75 for round 1 and 0.73 for round 2). The interobserver agreement for the radiologists was excellent in observation round 1 (κ, 0.82) and good in observation round 2 (κ, 0.71). The interobserver agreement between orthopaedic surgeons and radiologists was found to be moderate to good (κ, 0.52 to 0.66). The Fleiss κ was 0.66 for round 1 and 0.62 for round 2. The geometric classification and the 2-dimensional measurement of rotator cuff tears using magnetic resonance arthrography have good to excellent intraobserver agreement and moderate to good interobserver agreement among experienced observers. Level III, diagnostic study of nonconsecutive patients without consistently applied gold standard.

Papillae reconstruction: clinical considerations

Implant restorations in the anterior maxilla are challenging, especially when treating patients with a high lip line and a lack of available tissue. These patients will exhibit large and unsightly dark embrasures reminiscent of severe gingival recession. The action of augmenting or regenerating soft tissue is more difficult to perform in the coronal direction than in other directions. Unfortunately, there is usually a need to replace lost tissue in the coronal dimension. Today’s dental implantology is not only focused on function but also aesthetics. Papilla reconstruction or preservation is a key factor for a successful aesthetic outcome.

The coracoclavicular ligaments: an anatomic study

The treatment for the acromioclavicular joint dislocations has focused on anatomic restoration of the coracoclavicular ligaments. We reviewed the detailed anatomy of trapezoid ligaments and conoid ligaments using cadavers. The subjects were 40 shoulders of the 20 cadavers. We investigated the distributed direction and attachment sites of both trapezoid and conoid ligaments. The trapezoid ligaments began at about 2 cm away the central point of the distal coracoid process and directed toward the undersurface of the clavicle. The attachments extended from 13 to 26 mm in sagittal dimension and from 13 to 15 mm in coronal dimension. The conoid ligaments began at the medial posterior margin of the coracoid process and directed toward to the conoid tubercle in the clavicle. The attachments extended from 15 to 30 mm in sagittal dimension and from 3 to 6 mm in coronal dimension. The findings are important indices for the accurate reconstruction of the coracoclavicular ligaments in acromioclavicular joint dislocations.

Outcome of Arthroscopic Rotator Cuff Repair for Tears over 2-cm in Coronal Dimension: A Comparison of Repair with Alternative Methods of Mobilization and Fixation

Outcome of Arthroscopic Rotator Cuff Repair for Tears over 2-cm in Coronal Dimension: A Comparison of Repair with Alternative Methods of Mobilization and Fixation

CORONAL IMAGING TO ASSESS URINARY TRACT STONE SIZE

Urinary tract stones are typically measured using axial images from computerized tomography (CT). Such images provide a precise measurement of stone length and width. However, cephalocaudad dimensions can be difficult to determine from axial images. Coronal reconstructions, which can more accurately measure cephalocaudad dimensions, are seldom used to measure stones. We determined if coronal reconstructions could aid in more precisely determining stone size. CT in patients who had undergone CT to evaluate urolithiasis at our institution during the 9-month period of January 2001 to September 2001 were reviewed. Length and width were measured using axial images, and cephalocaudad length and width were measured using coronal reconstructions. Cephalocaudad length was also estimated from axial images. Total area was calculated from axial and coronal reconstructions. The paired t test was used to assess statistical significance. The CT images of 102 patients with a total of 151 stones had undergone coronal reconstructions and, thus, were included in the study. Mean area in the axial and coronal reconstruction groups was 22.23 and 31.29 mm, respectively. Mean greatest axial dimension (length or width) was 4.87 mm and mean greatest coronal dimension (cephalocaudad length) was 6.51 mm. Cephalocaudad length estimated from axial images was 8.8 mm. Differences for all 3 of these comparisons (axial vs coronal area, greatest axial vs coronal dimension and estimated vs actual cephalocaudad length) proved to be statistically significant (p <0.0001). While urinary tract stones have typically been measured using axial images, coronal images provide a different impression of stone size. These data demonstrate that examining only axial images provides an inaccurate measure of stone size. We suggest that coronal images should also be used to measure more accurately stone size, which is critical for clinical decision making.

Postoperative MRI appearance after transsphenoidal pituitary tumor resection

BACKGROUND Knowledge of the magnetic resonance imaging (MRI) appearance of the pituitary fossa following transsphenoidal resection of a pituitary adenoma, in the early and late postoperative period, is important for detecting complications and for assessing extent of tumor excision. Few prospective studies have addressed this issue. METHODS Fourteen patients with pituitary macroadenomas were prospectively studied with MRI. Maximal tumor resection was accomplished in each patient, and the postoperative histological diagnoses included non-secreting adenoma in 11 patients, prolactinoma in 2 and necrosis in one. Early postoperative scans were obtained within 14 days after surgery, and late studies between 3 and 4 months, in all patients. Four patients also had delayed scans between 8 months and a year. The maximum coronal dimension (MCTD) of the sellar and suprasellar contents was measured on T1-weighted contrast enhanced scans. RESULTS All patients had normal or improved visual examinations and normal or improved hormonal function postoperatively. The preoperative MCTD ranged from 11 mm to 59 mm in height (mean 30.3 mm). There was little change in MCTD on the early postoperative MRI scans (range 7–49 mm, mean 23.5 mm). However, in all patients the MCTD decreased in height by 4 months (range 2–35 mm, mean 12.7 mm). This change represented a 58% mean reduction in size compared to the preoperative measurements. CONCLUSIONS We conclude that the appearance of the sellar contents on early postoperative MRI may appear remarkably similar to that seen before surgery, even after technically adequate resection. The postoperative mass may represent a combination of residual tumor, edema, postoperative hemorrhage and hemostatic material. Routine follow-up MRI after transsphenoidal resection of pituitary tumors may be delayed until at least 4 months after surgery in patients who are clinically stable.

The contact index method of electropalatographic data reduction

This paper presents a new method of electropalatographic data reduction, namely, the contact index method. It provides accurate information about the distribution and size of linguopalatal contact based on values for an anteriority index, a posteriority index and a centrality index. These values are calculated using coefficients specific to each row of electrodes along the sagittal dimension and to each column of electrodes along the coronal dimension. The contact index method is applied to the analysis of two research topics: V-to-C coarticulation effects at the palatal zone for consonants differing in place and manner of articulation characteristics; and intraconsonantal variability across repetitions of a given VCV sequence. Results are evaluated in the light of the theory of speech production.

Decompression for Degenerative Spondylolisthesis and Spinal Stenosis at L4-5

Anatomic variations exist in the facet joint orientation, shape, and size at L4-5. This morphology is further modified by degenerative changes in spinal stenosis and degenerative spondylolisthesis. This study explored the morphologic alteration of "pedicle-to-pedicle" decompression on the facet joints in normal patients, spinal stenosis patients, and degenerative spondylolisthesis patients. Using computerized digitization, computed tomographic scan images of the facet joint at L4-5 and the medial border of the pedicle at L5 were superimposed. The facet joint orientation, coronal dimension, percentage, and absolute reduction in coronal dimension after pedicle-to-pedicle decompression, and residual coronal dimension after decompression at L4-5 were measured for the three groups. There is a significantly reduced coronal dimension of the facet joint in degenerative spondylolisthesis patients compared with spinal stenosis and normal patients (P < 0.01). The average reduction of the facet joint coronal dimension is 34% (SD 30%) in degenerative spondylolisthesis, and 36% (SD 25%) in spinal stenosis. The smaller preoperative coronal dimension in degenerative spondylolisthesis leads to a significantly reduced residual coronal dimension in degenerative spondylolisthesis compared with normal patients (5.9 mm [SD 4.3 mm] vs. 9.3 mm [SD 3.5 mm]), respectively. Wide variations in facet joint reduction and residual facet joint coronal dimension exist. The significantly reduced coronal dimension after decompression in degenerative spondylolisthesis may be correlated to a trend to further anterior displacement if it is treated with decompression alone. Case-specific assessment of residual facet joint morphology after decompression in both spinal stenosis and degenerative spondylolisthesis patients should be integrated into decisions about fusion for stability at the L4-5 level.

Postoperative Spondylolisthesis at L4-5

Thirty-three patients underwent decompression without fusion at the L4-5 level for spinal stenosis or degenerative spondylolisthesis. Using preoperative and 1-year postoperative lateral lumbar spine radiographs, the incidence of postoperative spondylolisthesis of greater than 5% was found to be 58%. Computed tomographic scans were used to analyze the presurgical facet joint morphology and facet joint-pedicle spatial relationship. This allowed calculation of the facet joint orientation for each side; the coronal dimension of each facet joint; the amount of the facet joint coronal dimension removed if a decompression was performed up to the medial border of the L5 pedicle (facet joint reduction); and the residual coronal dimension of facet joint after such a decompression (residual facet joint). The lateral radiographs were analyzed for presurgical disc height and the presence of traction spurs or spondylophytes. A well-maintained disc height was associated with an increase slip (7.47%) compared with those cases with a narrow or complete loss of disc space before surgery (4.84% P < 0.1 trend). Presence of spondylophytes was associated with a reduced tendency to slip. When spondylophytes were controlled for there was a significant relationship between slip of greater than 10% and sagittal facet joint orientation. Although there was a lesser residual facet joint after decompression in the group that slipped these values were not statistically significant. This study suggests that the development of postoperative spondylolisthesis is related to facet joint orientation and dimensions, rather than the absolute amount of joint removed. The stabilizing effects of reduced disc height and spondylophytes were confirmed.