Coronal Reconstruction Images Research Articles

Evaluation of the Relationship between Ossification of Sternal Joints and Age with Multi-Slice CT Scan

Objective: Sternum radiograph is used in determination of age after 21 years old according to manubriosternalbody (MB) and xiphisternal joint body (XB) ossification. In this study, we intend to estimate age usingmulti-slice CT images as radiographs have lower sensitivity and CT images demonstrate ossification better.Materials and Methods: Multi-slice thorax CT images found in PACS archive are evaluated retrospectively.Cases between 21-65 years old are selected. Coronal reconstruction images were obtained. MB and XB jointossification presence and degree are evaluated in respective age groups. MB joint ossification is gradedas 0-3 and XB joint ossification graded as 0-1. Relation between variables is examined with Spearmancorrelation coefficient. Threshold for age variable is calculated using ROC analysis.Results: Multi-slice CT images of 396 cases are examined (198 females, 198 males). In females and males,MB and XB fusion was seen to start between age group of 21-25 years but there were complete fusion ina few. In 61-65 age groups there were cases without complete fusion. There was statistically significantdifference in males and females according to MB and XB joint ossification in between age groups (p<0.001).Conclution: Evaluation of MB and XB joint ossification with CT scan in age estimation is not appropriatebetween wide age groups.

Selection of Guiding Plate Combined With Surgical Navigation for Microsurgical Mandibular Reconstruction.

The present study summarized selection of guiding plate combined with surgical navigation for microsurgical mandibular reconstruction. Data from preoperative maxillofacial enhanced computed tomography (CT) scans were imported to ProPlan CMF. The authors performed virtual mandibulectomy and superimposed 3-dimensional (3D) iliac images on mandibular defects. Guiding plates including mandibular fixation device, reconstruction plate, guiding model, and occlusal splint for various mandibular hemimandibular central lateral (HCL) defects were fabricated to fix bilateral residual mandible. The model was scanned, and data were imported into ProPlan CMF and the intraoperative navigation system. Through landmark points upon the guiding plate, position of the residual mandible was determined during surgical navigation. Intraoperative navigation was used to implement the virtual plan. Sagittal, coronal, axial, and 3D reconstruction images displayed by the navigation system were used to accurately determine osteotomy sites and osteotomy trajectory during surgery. Surgical probe guidance was used to mark the osteotomy line and transfer the virtual procedure to real-time surgery. Accuracy was evaluated using chromatographic analysis. Different guiding plates combined with surgical navigation could be used for various mandibular defects, including mandibular fixation devices for LCL defects, reconstruction plates for LC/L/C defects, and guiding models and occlusal splints for H/L/LC defects (including mandibular ramus). In our study, average and largest shift of the mandible and osteotomy site was <5 mm. The authors summarized different ways of combining guiding plates with surgical navigation for reconstruction of various mandibular defects, which could improve clinical outcomes of this procedure with high accuracy.

Diagnostic ability of contrast-enhanced computed tomography for metastatic cervical nodes in head and neck squamous cell carcinomas: significance of additional coronal reconstruction images.

PurposeTo evaluate the significance of additional coronal reconstruction images in the diagnostic ability of contrast-enhanced computed tomography (CECT) for metastatic cervical nodes in patients with head and neck squamous cell carcinomas (HNSCC).Material and methodsWe retrospectively assessed 97 metastatic and 141 reactive histologically proven cervical nodes of 38 patients with HNSCC, who underwent CECT before neck dissection. Observer #1, an expert radiologist in head and neck imaging, and observer #2, a general radiologist, reviewed all CECT images. The observers first assessed the presence of nodal metastasis using axial CECT alone (A-CECT). Three days later, they reassessed its presence using combined axial and coronal CECT (A&C-CECT).ResultsThe sensitivity of A-CECT vs. A&C-CECT was 73.2% vs. 75.3% for observer #1 (p = 0.73) and 69.1% vs. 69.1% for observer #2 (p = 1.00), respectively. The specificity of A-CECT versus A&C-CECT was 92.2% vs. 97.2% for observer #1 (p < 0.05) and 92.9% vs. 95.7% for observer #2 (p = 0.22), respectively. The accuracy of A-CECT versus A&C-CECT was 84.5% vs. 88.2% for observer #1 (p < 0.05) and 83.2% vs. 85.3% for observer #2 (p = 0.30), respectively. The area under the curve (AUC) of A-CECT vs. A&C-CECT was 0.86 vs. 0.91 for observer #1 (p < 0.05) and 0.85 vs. 0.85 for observer #2 (p = 0.80), respectively.ConclusionsThe specificity, accuracy, and AUC increased with the use of coronal images during the assessment by the expert radiologist. The appropriate use of coronal images allowed proper configuration recognition and improved diagnostic ability.

Correlation between superficial and deep lymphatic systems using magnetic resonance lymphangiography in breast cancer-related lymphedema: Clinical implications

Magnetic resonance lymphangiography (MRL) has increased our knowledge of lymphatic anatomy and lymphedema pathophysiology and improved the efficacy of microsurgical procedures to manage peripheral lymphedema. The aim of this study is to investigate the ability of MRL to detect communications between superficial and deep lymphatic systems in breast cancer-related lymphedema (BRCL) and to investigate whether these communications could preserve lymphatic drainage of the hand. Between 2008 and 2017 we used MRL imaging in 59 women with BCRL. Lymphedema of the arm and hand was detected in 30 patients while the hand was spared in 29. Using axial and coronal MRL reconstruction images we investigated the existence of any communication between the superficial and deep lymphatic systems. Among the 29 patients with spared hand, MRL revealed that 24 had at least one communicating lymphatic perforator at the wrist region (p <0.001). Lymphatic flow at the axilla was clearly visualized in 16 of the 29 patients (55.2%), no perforating lymphatic vessels were detected in the group with lymphedema in the hand (30 patients). Communications between the deep and superficial lymphatic systems at the wrist region in BCRL patients without hand lymphedema should be considered when planning microsurgical lymphatic procedures at the wrist and in postoperative compression therapy.

Visibility of B1 and Right/Left Dissociation Using Gd-EOB-DTPA-enhanced T1-weighted Magnetic Resonance Cholangiography in Live Liver Transplant Donors

PurposeWe aimed to determine the visibility of bile ducts of the caudate lobe (B1s) and right/left (R/L) dissociation on contrast-enhanced T1-magentic resonance cholangiography after gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid administration (CE-T1-MRC) in live liver donors. Materials and MethodsIn 300 live liver donors who underwent CE-T1-MRC, the visibility and R/L dissociation of B1 were evaluated. Confidence level of B1 visibility and depiction of the presence of R/L dissociation on axial and coronal reconstruction images were compared. Strength of agreement between R/L dissociation on MRC and that on intraoperative cholangiography was evaluated. ResultsAt least 1 B1 was visible on CE-T1-MRC in 142 of 300 subjects (47.3%; a total of 195 B1s; 0.64 [SD, 0.80], 0-4 branches per person). Of 195 subjects with visible B1, 55 ducts showed R/L dissociation (28.2%; right-to-left crossover, n = 28; left-to-right crossover, n = 27). The confidence level of B1 visibility on axial images of MRC was significantly higher than that on coronal images of MRC (P < .001). Of 55 B1s with R/L dissociation, axial images were superior to coronal images in depicting B1 crossover in 31 and vice versa in 2 (equal between axial and coronal images in 22). The agreement for R/L dissociation between CE-T1-MRC and intraoperative cholangiography was excellent (κ = 0.819; 95% CI, 0.722-0.917). ConclusionBile ducts of the caudate lobe with R/L dissociation can be occasionally identified on CE-T1-MRC. Axial reconstruction is superior to coronal counterpart.

Cortical Impaction in Posterior Wall Acetabular Fractures

To report the incidence of patients with extra-articular posterosuperior acetabular cortical impaction associated with a posterior wall acetabular fracture-dislocation. Retrospective case series. Regional Level 1 trauma center. Ninety-seven patients who sustained an isolated posterior wall acetabular fracture-dislocation from July 2007 until July 2017. The medical record and the computed tomography (CT) scan of the abdomen and pelvis were reviewed including axial, coronal, and sagittal reconstruction images and 3D surface renderings. Each pelvic CT scan was evaluated for impaction of the extra-articular posterosuperior acetabular cortical surface associated with posterior wall acetabular fracture-dislocations. The reduction accuracy was assessed for each patient with cortical impaction using postoperative CT scans. The final attending radiology report was reviewed to see whether the cortical impaction was noted. Four of the 99 patients (4.12%) had identifiable areas of cortical impaction on preoperative CT imaging. Reduction accuracy demonstrated 1 anatomical reduction, 2 imperfect reductions, and 1 poor reduction. The final attending radiologist report did not comment on any patient with cortical impaction. Our study demonstrates that a small number of patients sustain cortical impaction of the posterosuperior acetabular cortical surface along with their posterior wall acetabular fracture-dislocation. Although uncommon, preoperative imaging should be scrutinized to identify this clinical entity. As part of the preoperative plan, the surgeon can anticipate the cortex available for reduction verification and whether any additional steps or altered surgical approaches are needed to achieve an anatomical reduction. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The accuracy of the lateral vertebral notch-referred pedicle screw insertion technique in subaxial cervical spine: a human cadaver study

This is a cadaver specimen study to confirm new pedicle screw (PS) entry point and trajectory for subaxial cervical PS insertion. To assess the accuracy of the lateral vertebral notch-referred PS insertion technique in subaxial cervical spine in cadaver cervical spine. Reported morphometric landmarks used to guide the surgeon in PS insertion show significant variability. In the previous study, we proposed a new technique (as called "notch-referred" technique) primarily based on coronal multiplane reconstruction images (CMRI) and cortical integrity after PS insertion in cadavers. However, the PS position in cadaveric cervical segment was not confirmed radiologically. Therefore, the difference between the pedicle trajectory and the PS trajectory using the notch-referred technique needs to be illuminated. Twelve cadaveric cervical spines were conducted with PS insertion using the lateral vertebral notch-referred technique. The guideline for entry point and trajectory for each vertebra was established based on the morphometric data from our previous study. After 3.5-mm diameter screw insertion, each vertebra was dissected and inspected for pedicle trajectory by CT scan. The pedicle trajectory and PS trajectory were measured and compared in axial plane. The perforation rate was assessed radiologically and was graded from ideal to unacceptable: Grade 0 = screw in pedicle; Grade I = perforation of pedicle wall less than one-fourth of the screw diameter; Grade II = perforation more than one-fourth of the screw diameter but less than one-second; Grade III = perforation more than one-second outside of the screw diameter. In addition, pedicle width between the acceptable and unacceptable screws was compared. A total of 120 pedicle screws were inserted. The perforation rate of pedicle screws was 78.3% in grade 0 (excellent PS position), 10.0% in grade I (good PS position), 8.3% in grade II (fair PS position), and 3.3% in grade III (poor PS position). The overall accepted accuracy of pedicle screws was 96.7% (Grade 0 + Grade I + Grade II), and only 3.3% had critical breach. There was no statistical difference between the pedicle trajectory and PS trajectory (p > 0.05). Compared to the pedicle width (4.4 ± 0.7mm) in acceptably inserted screw, the unacceptably screw is 3.2 ± 0.3mm which was statistically different (p < 0.05). The accuracy of the notch-referred PS insertion in cadaveric subaxial cervical spine is satisfactory.

Three-Dimensional Image Fusion of 18F-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography and Contrast-Enhanced Computed Tomography for Computer-Assisted Planning of Maxillectomy of Recurrent Maxillary Squamous Cell Carcinoma and Defect Reconstruction

The purpose of this study was to describe new technology assisted by 3-dimensional (3D) image fusion of 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) for computer planning of a maxillectomy of recurrent maxillary squamous cell carcinoma and defect reconstruction. Treatment of recurrent maxillary squamous cell carcinoma usually includes tumor resection and free flap reconstruction. FDG-PET/CT provided images of regions of abnormal glucose uptake and thus showed metabolic tumor volume to guide tumor resection. CECT data were used to create 3D reconstructed images of vessels to show the vascular diameters and locations, so that the most suitable vein and artery could be selected during anastomosis of the free flap. The data from preoperative maxillofacial CECT scans and FDG-PET/CT imaging were imported into the navigation system (iPlan 3.0; Brainlab, Feldkirchen, Germany). Three-dimensional image fusion between FDG-PET/CT and CECT was accomplished using Brainlab software according to the position of the 2 skulls simulated in the CECT image and PET/CT image, respectively. After verification of the image fusion accuracy, the 3D reconstruction images of the metabolic tumor, vessels, and other critical structures could be visualized within the same coordinate system. These sagittal, coronal, axial, and 3D reconstruction images were used to determine the virtual osteotomy sites and reconstruction plan, which was provided to the surgeon and used for surgical navigation. The average shift of the 3D image fusion between FDG-PET/CT and CECT was less than 1mm. This technique, by clearly showing the metabolic tumor volume and the most suitable vessels for anastomosis, facilitated resection and reconstruction of recurrent maxillary squamous cell carcinoma. We used 3D image fusion of FDG-PET/CT and CECT to successfully accomplish resection and reconstruction of recurrent maxillary squamous cell carcinoma. This method has the potential to improve the clinical outcomes of these challenging procedures.

Computed tomography features of small intestinal obstruction caused by primary abdominal cocoon

Objective To summarize the computed tomography (CT) features of small intestinal obstruction caused by primary abdominal cocoon and investigate the essentials of diagnosis and differential diagnosis. Methods The retrospective descriptive study was adopted. The clinical data of 1 patient with small intestinal obstruction caused by primary abdominal cocoon who was admitted to the Second Affiliated Hospital of Jiaxing University on October 6, 2014 were collected. The patient underwent abdominal CT on admission and at 10 hours after admission. The patient received emergency exploratory laparotomy after preoperative preparation, and then postoperative regular symptomatic treatment and pathological examination. Results of abdominal CT were observed, including imaging features of abdominal masses, extent of small intestinal obstruction, situation of intestinal tube within the masses, vessel distribution in the mesentery and fibrous capsules around the mesentery. Situation of operation, routine blood test, biochemical indicator, blood coagulation indexes, postoperative recovery, complications, results of pathological examination and situation of patient during follow-up were recorded. The follow-up by telephone interview and outpatient examination was applied to the patient till October 31, 2015, including detecting the dietary, with or without symptoms of abdominal pain and distension, haematemesis and hematochezia, routine blood retest, liver function, renal function and CT. Results Results of abdominal CT on admission: (1) coronal plain scan of abdominal CT showed that there were signs of incomplete intestinal obstruction, and local small intestinal dilatation and gas accumulation in left abdominal region without specific sign. (2) Plain scan of abdominal CT showed that there were the coated with thickened fibrous capsules around the intestinal tube, banana shape with agglomerate and expanding-distortion intestinal tube and aggregative, stretching and twisting mesentery with abnormal vessel distribution. (3) Sagittal reconstruction images of abdominal CT showed that a huge mass consisted of fibrous capsules as cocoon and agglomerate and expanding-distortion intestinal tube was petal-like and fixed on posterior abdominal wall. (4) Coronal reconstruction images of abdominal CT showed that agglomerate and expanding-distortion intestinal tube was annularly surrounded by uneven thickness fibrous capsules with abnormal vessel distribution in the mesentery. Results of abdominal CT at 10 hours after admission: (1) coronal plain scan of abdominal CT showed that small intestinal obstruction was obviously exacerbated and expanding intestinal tubes were increased and aggravated. (2) Plain scan of abdominal CT showed that a typical sign of small intestinal obstruction was exacerbated and there were multiple air-fluid levels in the agglomerate and expanding-distortion intestinal tube with fluid and gas accumulation. Patient underwent successful enterodialysis+ resection of fibrous capsules. During operation, a huge mass in the intestine from suspensory ligament of duodenum to ileocecum was fixed on posterior abdominal wall and surrounded by dense, smooth and white fibrous capsules, partial colon was also surrounded by fibrous capsules and greater omentum was missing. Patient received the postoperative supporting treatments of fasting, anti-infection and inhibition of acid. Number of white blood cells, absolute value and percentage of neutrophils, levels of high-sensitivity C-reactive protein and procalcitonin were 17.10×109/L, 15.70×109/L, 91.5%, 127.49 mg/L and 1.370 μg/L by blood routine retest at postoperative day 1, respectively. Patient had normal liver, renal and coagulation functions. Fluid diet intake at postoperative week 1 was gradually replaced by normal diet intake. Patient had normal liver and renal functions by blood routine retest at postoperative day 10 and a good recovery without intestinal fistula, abdominal and pulmonary infections and other complications. Postoperative pathological examination showed that gross specimen was mainly composed of cocoon-shaped, grayish white and tough fibrous capsules. Fibrous capsules were consisted of proliferative fibrofatty tissues by microscope observation, with small vascular hyperplasia and large numbers of the inflammatory cell infiltration. Patient was diagnosed with small intestinal obstruction caused by primary abdominal cocoon after operation, and followed up for 1 year with normal diet intake and without abdominal pain and distension, nausea and vomiting, melena and discomfort. There was normal blood routine retest, liver and renal functions and distribution of the intestine in abdomen by CT examination. No dilatation of the intestinal tube was found and strip-like high density shadow in ileocecum was detected and considered as remnant fibrous capsules. Conclusion Imaging features of small intestinal obstruction caused by primary abdominal cocoon include agglomerate and expanding-distortion intestinal tube fixed on abdomen, partial intestinal tubes dilatation, intestinal fluid accumulation and air-fluid level, aggregative, stretching and twisting mesentery with abnormal vessel distribution, thickened fibrous capsules around intestinal loops and among intestinal tubes. Key words: Abdominal cocoon; Intestinal obstruction; Tomography

A Revised Approach for Mandibular Reconstruction With the Vascularized Iliac Crest Flap Using Virtual Surgical Planning and Surgical Navigation

The purpose of this study was to describe a revised approach for mandibular reconstruction with vascularized iliac crest flap using virtual surgical planning and surgical navigation. Preoperative maxillofacial and iliac non-contrast-enhanced computed tomography (CT) scans were acquired, and CT data were imported into ProPlan CMF software (Materialise, Leuven, Belgium). We performed virtual mandibulectomy and superimposed the 3-dimensional iliac image on the mandibular defect. The surgeon shaped the iliac flap according to virtual parameters and the stereomodel. Surgical navigation was used to check and correct the shaped segments. The position of the osteotomy lines and relevant parameters regarding the shape of the iliac flap also were provided to the surgeon. After computer simulation, a reconstructed mandibular stereomodel was manufactured. A reconstruction plate was prebent and fixed on this model using titanium screws. The model was scanned, data were imported into ProPlan CMF, the mandible was segmented, and data were imported into the intraoperative navigation system. Then, the model was registered with the original CT data, and the reconstruction plate was eliminated. Navigation data were exported into a universal serial bus drive, which was connected to the terminal working station during surgery. Intraoperative navigation was used to implement the virtual plan for patients. The sagittal, coronal, axial, and 3-dimensional reconstruction images displayed by the navigation system were used to accurately determine the osteotomy sites and osteotomy trajectory during surgery. Surgical probe guidance was used to mark the osteotomy line and transfer the virtual procedure to real-time surgery. Using our method, we precisely recovered the original configuration of the mandible. The shift in the reconstructed mandible and plate was less than 5mm. We provided a new method for mandibular reconstruction with vascularized iliac crest flap and an individual reconstruction plate using computer-assisted techniques involving surgical navigation, which have the potential to improve the clinical outcomes of this procedure.

Reliability of Postoperative Multislice Computed Tomography in Assessment of Pedicle Screw Placement in Thoracic and Lumbar Spinal Fixation

Objective This study aims to evaluate the reliability of three-dimensional (3D) volume rendering computed tomography (CT) in postoperative assessment of pedicle screw placement. Methods A total of 98 patients with previous spinal fixation surgery were included. All inserted screws were evaluated postoperatively within the first week using CT. Degree of misplacement and difference between CT images were recorded. Results Overall, 76, 68, and 39 misplaced screws were detected in 3D reformatted image, coronal reconstruction, and axial CT images, respectively. Dorsal spine had higher rate of violation 46 (9.95%) with the highest rate at T4 (12.8%) comparing it with lumber 32 (6.9%). Statistically significant differences were found between lateral and medial violation ( p = 0.03), between findings of CT 3D reformatted and axial image ( p = 0.04), and also in detecting end plate perforation and anterior vertebral encroachment in different CT images ( p = 0.013). Sensitivity for 3D reformatted image and axial image compared with surgical finding in six revised screws was 100 and 95.8% and specificity 100 and 88.7%, respectively. Highly momentous agreement reported with Kappa coefficient = 0.95 Â ± &lt; 0.001. Conclusion The vertebral body and the pedicle are 3D structures. Therefore, we have to study them as they are. The postoperative evaluation of pedicle screw using CT 3D reconstruction was a reliable method and unveiled the deficiencies in conventional axial CT.

Usefulness of Coronal Reconstruction CT Images for Quantitative Evaluation of the Cross-Sectional Area of Small Pulmonary Vessels

Cross-sectional area <5 mm(2) (CSA<5) is a computed tomography (CT) metric that has been used for the evaluation of pulmonary vessel alterations and perfusion. CSA<5 is calculated from three axial slices; thus, whether CSA<5 represents the small pulmonary vessel alterations in the whole lung remains unclear. The purpose of this study was to compare the measurements of CSA<5 using three axial slices and coronal reconstructed slices in the relationship between the measured CSA<5 and pulmonary perfusion measured using lung perfusion scintigraphy. This study comprised 28 subjects who underwent both noncontrast CT and lung perfusion scintigraphy. The present study measured CSA<5 using both three axial CT images and coronal reconstruction images and then obtained the percentage of the CSA in right lung to that in whole lung (R/W-CSA<5). Using anteroposterior and posteroanterior projections on technetium-99m macroaggregated albumin (MAA) lung perfusion scintigraphy, we obtained right and total lung counts and calculated the percentage of the right to whole lung counts (R/W-MAA). The correlations of the R/W-CSA<5 calculated using three axial slices (R/W-CSA(A)x<5) and coronal reconstructed slices (R/W-CSA(COR)<5) with R/W-MAA were evaluated using Spearman rank correlation analysis. Both R/W-CSA(Ax)<5 and R/W-CSA(COR)<5 were significantly correlated with R/W-MAA; however, the correlation coefficient with R/W-CSA(COR)<5 (ρ = 0.842, P < .0001) was greater than that with R/W-CSA(Ax)<5 (ρ = 0.631, P = .0004). Coronal reconstruction images appear suitable for quantitative measurement of CSA of small pulmonary vessels.

Semicircular canal dehiscence: Frequency and distribution on temporal bone CT and its relationship with the clinical outcomes

PurposeIn this study, we aimed to investigate the frequency of SCD and its distribution and relationship with clinical outcomes on thin-section CT of the temporal bone. Materials and methodsDigital temporal bone CT images of 850 consecutive patients (1700 temporal bone CTs, 5100 SCs) who presented with a range of complaints such as vertigo, deafness, ear pain, fullness, and discharge between January 2008 and December 2011 were re-evaluated. Axial and oblique coronal reconstruction images of the temporal bone were made with a reconstruction thickness of 0.5mm. Additionally, superior SC was evaluated in two perpendicular planes. ResultsOut of 850 patients, 70 had completely normal temporal bone CT. Ninety-three patients had at least one SCD. In the temporal bone-based evaluation, 119 (26 bilateral, 67 unilateral) of 1700 temporal bones (7%) showed dehiscence. The SC-based evaluation revealed 125 SCD (2.5%) in 5100 SCs. The total number and rates of SCD were as follows: superior 103 (82.4%), posterior 13 (10.4%), and lateral nine (7.2%). Twenty of the 93 patients with SCD (21.5%) revealed no other findings on their temporal bone CTs. We determined a significant correlation between vestibular complaints, conductive hearing loss and SCD but there was no correlation between mixed, sensorineural hearing loss and SCD. ConclusionWe determined the frequency of SCD in 11% of patients and 7% of temporal bones. With regards to the distribution, the superior SC showed the highest dehiscence rate (82.4%). We found a significant correlation between vestibular symptoms, conductive hearing loss and SCD.

Role of postoperative multislice computed tomography in assessment of pedicle screw placement in spinal surgical fixation

ObjectiveTo evaluate the role of three-dimensional (3D) volume rendering computed tomography (CT), in the postoperative assessment of pedicle screw placement. MethodsNinety-eight patients with previous spinal fixation surgery were included. All inserted screws were evaluated post operatively within the first month using CT. Degree of misplacement and difference between CT images were recorded. ResultsSeventy six, 68 and 39 misplaced screws were detected in 3D reformatted image, coronal reconstruction and axial CT images, respectively. Dorsal spine had the higher rate of violation of 46 (9.95%) with the highest rate at T4 (12.8%) compared with lumbar of 32 (6.9%). Statistically significant differences were found between lateral and medial violation (P value −0.03), between findings of 3D CT reformatted and axial images (P=0.04), and also in detecting end plate perforation and anterior vertebral encroachment in different CT images (P value −0.013). Sensitivity for 3D reformatted image and axial image compared with surgical finding in six revised screws was 100% and 95.8% and specificity was 100% and 88.7%, respectively. Highly momentous agreement is reported with Kappa coefficient=0.95±<0.001. ConclusionWe conclude that postoperative evaluation of pedicle screw using 3D CT reconstruction was a reliable method.

Sternal fracture in the emergency department: Diagnostic value of multidetector CT with sagittal and coronal reconstruction images

Multidetector CT (MDCT) is being increasingly used for patients with traumatic injuries in the emergency room. This is the first study to evaluate the diagnostic performance of MDCT for sternal fracture. For 87 patients who had motor vehicle accidents, we evaluated the diagnostic performance of MDCT for the sternal fractures. For 31 patients who underwent both MDCT and lateral radiography for the sternum, we compared the diagnostic performance of two examinations for the evaluation of sternal fracture. Thirty-two patients had sternal fractures and all the sternal fractures (sensitivity=100%) were detected on MDCT, especially on the sagittal reconstruction images. However, the axial and coronal images detected 65% and 59% of all sternal fractures, respectively. For 31 patients who underwent both MDCT and lateral radiography for the sternum, MDCT showed superior diagnostic performance compared to that of radiography (accuracy=97% and 77%, respectively, P=.02). For the one case that showed false positivity for sternal fracture on MDCT due to respiratory artifact, the lateral radiography enabled making the correct diagnosis. Sternal fracture is frequently seen in patients who have blunt trauma injury secondary to motor vehicle accidents. MDCT, particularly sagittal images detect all of the sternal fractures, is superior to lateral radiography for diagnosis of sternal fracture. In the limited case that CT has severe motion artifact, additional radiography could help the diagnosis of sternal fracture.

Sectional anatomical analysis of auricular and middle ear malformation in patients with microtia

To analyze the sectional anatomical features of auricular and middle ear malformation in patients with microtia so as to improve the clinical classification and the instruction of surgery. From Jun. to Dec. 2009, 36 cases with microtia were selected in the center of auricular reconstruction in Plastic Surgery Hospital, including 22 cases of unilateral microtia and 14 cases of bilateral microtia. 22 patients with unilateral microtia were studied with the contralateral healthy ears as controls. Spiral CT was performed for high-resolution scan of the temporal bone. The coronal, sagittal and 3D reconstruction images were created with Mimic software. Several distances and degrees were measured. The patients were classified by Max classification. The anteroposterior diameter and the vertical diameter of tympanic cavity were (7.75 +/- 1.92) mm and (14.66 +/- 4.75) mm for type I; (6.17 +/- 2.56) mm and(14.35 +/- 5.12) mm for type II; (6.31 +/- 3.40) mm and (9.97 +/- 4.36) mm for type III (P = 0.001). The mastoid pneumatization degree for type I, II, III were 13.33%, 13.64%, 30.77% in sclerotic type, 13.33%, 18.18%, 7.69% in diploe type, 0, 9.09%, 38.46% in composite type, 73.33%, 59.09%, 23.08% in pneumatic type (chi2 = 24.11, P = 0.002). The cover of fenestra vestibuli by facial nerve was 21.43%, 47.62%, 54.55% (chi2 = 23.44, P = 0.002) for type I, II, III. There was a statistical difference between the microtia group and the control group. According to the Max classification, the middle ear malformation changed along the auricular malformation. The anatomical variations was complicated in type II microtia, which should be sub-classified.

Optic radiation damage can be assessed directly by tractography

Abstract Purpose: To verify the clinicoradiological correlation of tractographs of optic radiations (OR) involved by brain tumors and infarcts. Methods: We performed diffusion‐tensor magnetic resonance imaging (DT‐MRI) on 7 patients with brain lesions adjacent to or involving the visual pathway, 5 of whom underwent DT‐MRI before and after surgical excision of the brain lesions. Tractographic findings of OR on coronal reconstruction images, including those in the contralesional hemisphere, were analyzed with respect to their location and size and correlated with existing visual field defects. When the ipsilesional OR appeared to be reduced in craniocaudal height by 70% or more in coronal section than the contralesional OR, we considered the finding abnormal. Results: The contralesional ORs were successfully depicted in all cases. In 8 examinations the ipsilesional ORs were successfully depicted, in 4 they were not. The 8 depicted ORs in the ipsilesional hemisphere were abnormal either in size (n=8) and/or location (n=4). OR defects were noted in either the superior or inferior portions in 8 tractographs. OR deviation due to mass effect from the brain lesions was noted in 4 tractographs. In 5 tractographs with OR defects there was a good correlation with the location of the visual field defect. Conclusions: The tractography demonstrates the ORs all the time on the contralesional side, correlates some of our cases with the visual field defect on the ipsilesional side.

Focussed Assessment Sonograph Trauma (FAST) and CT scan in blunt abdominal trauma: surgeon's perspective.

Diagnosis of blunt abdominal trauma is a real challenge even for experienced trauma surgeons. Diagnostic tools that help the treating doctor in optimum management of blunt abdominal trauma include; Focussed Assessment Sonography for Trauma (FAST), Diagnostic peritoneal lavage (DPL) and CT scan. the aim of this communication is to define the recent role of FAST and CT scan of the abdomen in the diagnosis of blunt abdominal trauma. FAST is useful as the initial diagnostic tool for abdominal trauma to detect intraabdominal fluid. With proper training and understanding the limitations of ultrasound, the results of FAST can be optimized. DPL is indicated to diagnose suspected internal abdominal injury when ultrasound machine is not available, there is no trained person to perform FAST, or the results of FAST are equivocal or difficult to interpret in a haemodynamically unstable patient. In contrast, in haemodynamically stable patients the diagnostic modality of choice is CT with intravenous contrast. It is useful to detect free air and intraperitoneal fluid, delineate the extent of solid organ injury, detect retroperitoneal injuries, and help in the decision for conservative treatment. Helical CT is done rapidly which reduces the time the patient stays in the CT scan room. Furthermore, this improves sagittal and coronal reconstruction images which are useful for detecting ruptured diaphragm.

Diagnostic Value of Multislice Computed Tomography for Pancreas Divisum

To assess the capabilities of high-resolution oblique coronal reconstruction images obtained by multislice computed tomography (CT) in diagnosing pancreas divisum. This study included 11 patients with and 53 without pancreas divisum confirmed by direct cholangiopancreatography. Two blinded readers retrospectively interpreted oblique coronal reconstruction images with 0.5-mm continuous slices generated from isotropic or nearly isotropic pancreatic phase images with the scrolling mode and assessed the continuity of the ventral pancreatic duct, dorsal pancreatic duct, and main pancreatic duct in the body. The results were correlated with the findings of direct cholangiopancreatography. Other abnormal findings of the pancreatobiliary region on CT were also recorded in patients with pancreas divisum. The sensitivity and specificity of CT for diagnosing pancreas divisum were 100% and 89%, respectively. Computed tomography demonstrated all associated pancreatobiliary diseases. High-resolution oblique coronal reconstruction images allow us to make a diagnosis of pancreas divisum by depicting the continuity of the pancreatic ducts.

Relationship Between 3D Behavior of the Unilaterally Paralyzed Larynx and Aerodynamic Vocal Function

Objective—We used multi-slice helical computerized tomography (MSHCT) to evaluate the 3D characteristics of the laryngeal structures in patients with unilateral vocal fold paralysis (UVFP) during phonation, and compared the results with those obtained using an aerodynamic vocal function test. Material and methods—The subjects were 37 patients with UVFP. The region over the larynx was scanned during quiet phonation and again during inspiration using MSHCT, and 3D endoscopic and coronal reconstruction images were produced. Maximum phonation time (MPT) and mean airflow rate (MFR) during phonation were measured. Results—During phonation, the affected fold was thinner than the healthy fold in 30 subjects and located at a higher position than the healthy fold in 21 subjects. Abduction or thinning of the affected fold during phonation (paradoxical movement) was seen in seven subjects. MFR was significantly greater when the affected fold was thinner than the healthy fold during phonation, and MPT was significantly shorter when the affected fold showed paradoxical movement. Over-adduction of the healthy fold during phonation was present in 15 subjects. There were no significant differences in MPT or MFR between subjects with and without over-adduction. Conclusion—The combination of MSHCT endoscopic and coronal reconstruction images enables the 3D characteristics of the unilaterally paralyzed larynx to be visualized during phonation, and some of these characteristics are significantly correlated with vocal function in patients with UVFP.