Coronal Reformations Research Articles

Puffed-Cheek CT Improved Evaluation of Buccal Mucosal Neoplasm in Contest to Conventional CT Scan

Background: Oral cancer is a frequent cancer in our country, most people are affected by this cancer are older age. Accurate evaluation of this cancer difficult due to close proximity of bones and soft tissue. So for improve diagnostic accuracy Puffed cheek maneuver should be used with traditional Multidetector Computed Tomography (MDCT).Objective: To determine the improved diagnostic accuracy of Puffed cheek Computed Tomography (PCCT) in evaluation of buccal mucosa tumors in contest to non puffed cheek Computed Tomography.Materials and Methods: This descriptive cross sectional study was carried out in Radiology and Imaging department of Khwaja Yunus Ali Medical College and Hospital from 2022(January) to 2023(July). Cases were referred from different department. After meeting the inclusion criteria patients were subjected for CT scan. Imaging was performed from paranasal sinus and neck region with axial sections from pituitary fossa to arch of aorta, after injection of intravenous iodinated contrast media, multiplanar sagittal, coronal reformation images were obtained. Puffed cheek manoeuvre was performed to separate gingival and oral buccal mucosa in all the cases for improved detailed evaluation. The CT result were then compared with non puffed cheek scans results. Results: Among 30 patients 7 cases were missed by conventional CT scan, thirteen patients showed a mass in the oral cavity that were inseparable from 2 mucosal surfaces. Puffed-cheek images clearly showed the mass and surface of tumor involvement. Other 10 patients in conventional CT showed mass in the margins of tongue, oral cavity but extension and infiltration of surrounding structures by the lesion could not be well delineated, puffed-cheek images clearly showed the specific location, extension, adjacent muscles and other structures infiltration. Conclusion: Puffed cheek CT gives better performance to diagnosis the small buccal mucosal tumors, any irregularity, thickening, more detailing of mucosal surface of oral cavity than conventional CT scan, so can helps in choosing the management & surgical approach also. KYAMC Journal Volume: 15, No: 01, April 2024: 29-32.

Morphological CBCT parameters for an accurate differentiation between nasopalatine duct cyst and the normal nasopalatine canal

BackgroundThe incisive foramen width was a traditional imaging criterion for diagnosing nasopalatine duct (NPD) cysts. Recent CBCT studies demonstrated significant dimensional variations of the nasopalatine canal, which raised questions about the accuracy of this criterion. This study investigated whether nasopalatine canal diameters assessed on CBCT images can accurately differentiate NPD cysts from normal nasopalatine canals.MethodsThe study included 19 patients with NPD cysts (12 (63.2%) males, 7 (36.8%) females, mean age 44.7 ± 13.3), and a control group of 164 patients (72 (43.9%) males, 92 (56.1%) females, mean age 47.25 ± 17.74). CBCT images were retrospectively evaluated. The following nasopalatine canal diameters were measured on reference sagittal, coronal, and axial reformation images: nasal opening anteroposterior (AP) and mediolateral (ML) diameter, oral opening AP (APOO) and ML (MLOO) diameter, nasopalatine canal length, minimum ML (minML) diameter, anterior wall expansion (AWE), nasopalatine canal angle, and the mid-level AP diameter (midAP). All parameters were compared between groups. Discriminant functional analysis (DFA) was applied to detect CBCT parameters that best differentiate the NPD cyst from the normal canal.ResultsPatients with NPD cyst had significantly greater values of APOO (7.06 ± 2.09 vs. 5.61 ± 1.70), MLOO (6.89 ± 2.95 vs. 3.48 ± 1.24), minML (2.88 ± 1.53 vs. 2.25 ± 1.09), AWE (2.15 ± 0.65 vs. 0.41 ± 0.67), and midAP (4.58 ± 1.61 vs. 2.48 ± 0.96). DFA showed MLOO, AWE, and midAP as the most accurate in distinguishing NPD cyst from the normal canal. When combined in the discriminant function equation X = 0.390·MLOO + 1.010·AWE + 0.288·midAP (cut score 1.669), the differentiation can be performed with a sensitivity and specificity of 98.8% and 76.9%, respectively.ConclusionNPD cysts can be accurately distinguished from the normal nasopalatine canal by measuring MLOO, AWE, and midAP diameter on CBCT images.

Symptomatic and Morphometric Analysis of Lumbosacral Transitional Vertebrae: Assessments by Age and Gender

Aim: Lumbosakral transitional vertebrae (LSTV) are anatomical variations where a vertebra exhibits characteristics of both lumbar and sacral vertebrae. This study aims to assess anatomical changes in LSTV patients by measuring intervertebral disc height (IVDh), vertebral foramen anteroposterior diameter (FVAPd), and intervertebral foramen height (FIVh), with consideration of age and gender differences. Materials and Methods: This retrospective study included 274 patients diagnosed with LSTV. All MRI images were acquired with a 1.5T MRI machine and a 32-channel lumbar coil. The presence of LSTV, forming the morphological data, was identified from coronal and sagittal reformat images and was classified as either lumbarization or sacralization. Morphometric data (IVDh, FIVh and FVAPd) were acquired from axial, sagittal, and coronal planes using both soft tissue and bone window settings. Results: The mean patient age was 41.6±13.0 years, with a female majority (55.8%). LSTV was predominantly lumbarization (96.4%), with sacralization in the remaining cases. The overall mean FVAPd was 11.2±2.4 mm, mean IVDh was 9.1±1.8 mm, and mean FIVh was 18.8±2.4 mm on the right and 19.1±2.4 mm on the left. IVDh levels were consistent across age groups, while FVAPd values were similar between genders. Patients aged 40 and under had higher FVAPd and FIVh levels, and male patients had higher IVDh and FIVh levels compared to females. Conclusions: The morphometric characteristics of LSTV may vary according to age and gender. Considering these factors in accurately identifying the anatomical variations of LSTV may play a significant role in determining appropriate treatment and management strategies.

Early Bone and Suture Reformations in Different Cranial Regions After Cranial Vault Remodeling for Sagittal Craniosynostosis.

Cranial vault remodeling (CVR) is a common procedure for correcting sagittal craniosynostosis. Some approaches leave significant craniectomy defects. The authors investigated the reosteogenesis in different cranial defect areas after CVR. A cross-sectional study was conducted in nonsyndromic sagittal craniosynostosis. Available early postoperative computed tomography (CT) scans were analyzed. The segmentation of three-dimensional reconstructed images was performed. Different cranial defect areas, including coronal, vertex, and occipital regions, were further investigated using an automated three-dimensional analysis software for reosteogenesis percentage. Forty-four CT scans were included. The average age at CVR was 8.8 months. The median time of postoperative CT scans was 6.1 weeks. The median bone reformation percentage of the entire cranial defect was 56.7%. Given the similar postoperative CT timing, the median bone reformation at the coronal, vertex, and occipital areas demonstrated 44.21%, 41.13%, and 77.75%, respectively (P < 0.001). In the simultaneously removed coronal and lambdoid sutures, there were 45% with coronal and lambdoid sutures reformation, followed by lambdoid suture reformation alone, no suture reformation and coronal reformation alone in 35%, 20%, and 0%, respectively (P = 0.013). There was no coronal reformation in the removed coronal suture group. However, 40% demonstrated lambdoid suture reformation after the isolated lambdoid suture removal. The occipital region has the highest reosteogenesis compared with the other cranial defects after CVR in nonsyndromic sagittal craniosynostosis. Within the removed previous patent sutures, the lambdoid suture reformation showed a higher rate than the coronal suture.

Biomechanical Motion Changes in Adjacent and Noncontiguous Segments Following Single-Level Anterior Cervical Discectomy and Fusion: A Computed Tomography-Based 3D Motion Capture Study.

Anterior cervical discectomy and fusion (ACDF) is known to elicit adverse biomechanical effects on immediately adjacent segments; however, its impact on the kinematics of the remaining nonadjacent cervical levels has not been understood. This study aimed to explore the biomechanical impact of ACDF on kinematics beyond the immediate fusion site. We hypothesized that compensatory motion following single-level ACDF is not predictably distributed to adjacent segments due to compensation from noncontiguous levels. Six fresh-frozen cervical spines (C2-T1) underwent fluoroscopic screening and sagittal and coronal reformats from computed tomography scans and were utilized to grade segmental degeneration. Each specimen was tested to 30° of flexion and extension intact and following single-level ACDF at the C5-C6 level. The motions of each vertebral body were tracked using 3-dimensional (3D) motion capture into an inverse kinematics model, facilitating correlations between the 3D reconstruction from computed tomography images and the 3D motion capture data. This model was used to calculate each level's flexion/extension range of motion (ROM). Single-level fusion at the C5-C6 level across all specimens resulted in a significant motion reduction of -6.8° (P = 0.002). No significant change in ROM occurred in the immediate adjacent segments C4-C5 (P = 0.07) or C6-C7 (P = 0.15). Hypermobility was observed in 2 specimens (33%) exclusively in adjacent segments. In contrast, the other 4 spines (66%) displayed hypermobility at noncontiguous segments. Hypermobility occurred in 42% (5/12) of the adjacent segments, 28% (5/18) of the noncontiguous segments, and 50% (3/6) of the cervicothoracic segments. Single-level ACDF impacts ROM beyond adjacent segments, extending to noncontiguous levels. Compensatory motion, not limited to adjacent levels, may be influenced by degenerative changes in noncontiguous segments. Surprisingly, hypermobility may not occur in adjacent segments after ACDF. Overall, the multifaceted biomechanical effects of ACDF underscore the need for a comprehensive understanding of cervical spine dynamics beyond immediate adjacency, and it needs to be taken into consideration when planning single-level ACDF.

The role of computed tomography in the detection of traumatic arthrotomies of the elbow: a cadaveric study

Abstract Purpose: To evaluate the use of computed tomography (CT) imaging as a diagnostic tool for elbow arthrotomies using a standardized cadaveric arthrotomy model. Method: Nineteen intact fresh frozen cadaver elbows were CT scanned using 2 mm cuts with sagittal and coronal reformats in the plane of the joint and used as controls. An elbow arthrotomy at the posterocentral arthroscopic portal site was performed in all specimens using a 4.5 millimeter trocar. After arthrotomy, all elbows underwent a second CT scan followed by a standard saline load test (SLT). Images were randomized and reviewed by 2 blinded, independent reviewers. Bimodal scoring was performed for each specimen with regard to the presence of an arthrotomy indicated by presence of air in the joint. Regarding the SLT, saline exiting the arthrotomy wound was considered a positive test. Results: CT scans were found to have 100% sensitivity and 86% specificity for diagnosing elbow arthrotomies. Interrater reliability calculated with Cohen kappa statistic was near perfect at r = 0.89. The SLT had a sensitivity of 79% when 20 mL was injected. A total of 25 mL of saline was required to be injected for a sensitivity greater than 95%. Conclusion: This study demonstrates that CT scan is a reliable and less technically demanding method of diagnosis arthrotomies with high interrater reliability and high sensitivity and with results comparable with SLT. This technique may be useful in centers where trained providers are not readily available to perform SLT. Clinical study is required to validate our results. Level of Evidence: Level II.

Targeted Training Reduces Search Errors but Not Classification Errors for Hepatic Metastasis Detection at Contrast-Enhanced CT

Methods are needed to improve the detection of hepatic metastases. Errors occur in both lesion detection (search) and decisions of benign versus malignant (classification). Our purpose was to evaluate a training program to reduce search errors and classification errors in the detection of hepatic metastases in contrast-enhanced abdominal computed tomography (CT). After Institutional Review Boardapproval, we conducted a single-group prospective pretest-posttest study. Pretest and posttest were identical and consisted of interpreting 40 contrast-enhanced abdominal CT exams containing 91 liver metastases under eye tracking. Between pretest and posttest, readers completed search training with eye-tracker feedback and coaching to increase interpretation time, use liver windows, and use coronal reformations. They also completed classification training with part-task practice, rating lesions as benign or malignant. The primary outcome was metastases missed due to search errors (<2seconds gaze under eye tracker) and classification errors (>2seconds). Jackknife free-response receiver operator characteristic (JAFROC) analysis was also conducted. A total of 31 radiologist readers (8 abdominal subspecialists, 8 nonabdominal subspecialists, 15 senior residents/fellows) participated. Search errors were reduced (pretest 11%, posttest 8%, difference 3% [95% confidence interval, 0.3%-5.1%], P =.01), but there was no difference in classification errors (difference 0%, P=.97) or in JAFROC figure of merit (difference -0.01, P=.36). In subgroup analysis, abdominal subspecialists demonstrated no evidence of change. Targeted training reduced search errors but not classification errors for the detection of hepatic metastases at contrast-enhanced abdominal CT. Improvements were not seen in all subgroups.

DeepKOA: a deep-learning model for predicting progression in knee osteoarthritis using multimodal magnetic resonance images from the osteoarthritis initiative.

No investigations have thoroughly explored the feasibility of combining magnetic resonance (MR) images and deep-learning methods for predicting the progression of knee osteoarthritis (KOA). We thus aimed to develop a potential deep-learning model for predicting OA progression based on MR images for the clinical setting. A longitudinal case-control study was performed using data from the Foundation for the National Institutes of Health (FNIH), composed of progressive cases [182 osteoarthritis (OA) knees with both radiographic and pain progression for 24-48 months] and matched controls (182 OA knees not meeting the case definition). DeepKOA was developed through 3-dimensional (3D) DenseNet169 to predict KOA progression over 24-48 months based on sagittal intermediate-weighted turbo-spin echo sequences with fat-suppression (SAG-IW-TSE-FS), sagittal 3D dual-echo steady-state water excitation (SAG-3D-DESS-WE) and its axial and coronal multiplanar reformation, and their combined MR images with patient-level labels at baseline, 12, and 24 months to eventually determine the probability of progression. The classification performance of the DeepKOA was evaluated using 5-fold cross-validation. An X-ray-based model and traditional models that used clinical variables via multilayer perceptron were built. Combined models were also constructed, which integrated clinical variables with DeepKOA. The area under the curve (AUC) was used as the evaluation metric. The performance of SAG-IW-TSE-FS in predicting OA progression was similar or higher to that of other single and combined sequences. The DeepKOA based on SAG-IW-TSE-FS achieved an AUC of 0.664 (95% CI: 0.585-0.743) at baseline, 0.739 (95% CI: 0.703-0.775) at 12 months, and 0.775 (95% CI: 0.686-0.865) at 24 months. The X-ray-based model achieved an AUC ranging from 0.573 to 0.613 at 3 time points. However, adding clinical variables to DeepKOA did not improve performance (P>0.05). Initial visualizations from gradient-weighted class activation mapping (Grad-CAM) indicated that the frequency with which the patellofemoral joint was highlighted increased as time progressed, which contrasted the trend observed in the tibiofemoral joint. The meniscus, the infrapatellar fat pad, and muscles posterior to the knee were highlighted to varying degrees. This study initially demonstrated the feasibility of DeepKOA in the prediction of KOA progression and identified the potential responsible structures which may enlighten the future development of more clinically practical methods.

Bone Mass Changes Following Percutaneous Radiofrequency Ablation, Osteoplasty, Reinforcement, and Internal Fixation of Periacetabular Osteolytic Metastases.

The success of orthopedic interventions for periacetabular osteolytic metastases depends on the progression or regression of cancer-induced bone loss. To characterize relative bone mass changes following percutaneous radiofrequency ablation, osteoplasty, cement reinforcement, and internal screw fixation (AORIF). Of 70 patients who underwent AORIF at a single institution, 21 patients (22 periacetabular sites; average follow-up of 18.5 ± 12.3 months) had high-resolution pelvic bone CT scans, with at least one scan within 3 months following their operation (baseline) and a comparative scan at least 6 months post-operatively. In total, 73 CT scans were measured for bone mass changes using Hounsfield Units (HU). A region of interest was defined for the periacetabular area in the coronal, axial, and sagittal reformation planes for all CT scans. For 6-month and 1-year scans, the coronal and sagittal HU were combined to create a weight-bearing HU (wbHU). Three-dimensional volumetric analysis was performed on the baseline and longest available CT scans. Cohort survival was compared to predicted PathFx 3.0 survival. HU increased from baseline post-operative (1.2 ± 1.1 months) to most recent follow-up (20.2 ± 12.1 months) on coronal (124.0 ± 112.3), axial (140.3 ± 153.0), and sagittal (151.9 ± 162.4), p < 0.05. Grayscale volumetric measurements increased by 173.4 ± 166.4 (p < 0.05). AORIF median survival was 27.7 months (6.0 months PathFx3.0 predicted; p < 0.05). At 12 months, patients with >10% increase in wbHU demonstrated superior median survival of 36.5 months (vs. 26.4 months, p < 0.05). Percutaneous stabilization leads to improvements in bone mass and may allow for delays in extensive open reconstruction procedures.

A training program to reduce reader search errors for liver metastasis detection in CT.

Detection of low contrast liver metastases varies between radiologists. Training may improve performance for lower-performing readers and reduce inter-radiologist variability. We recruited 31 radiologists (15 trainees, 8 non-abdominal staff, and 8 abdominal staff) to participate in four separate reading sessions: pre-test, search training, classification training, and post-test. In the pre-test, each radiologist interpreted 40 liver CT exams containing 91 metastases, circumscribed suspected hepatic metastases while under eye tracker observation, and rated confidence. In search training, radiologists interpreted a separate set of 30 liver CT exams while receiving eye tracker feedback and after coaching to increase use of coronal reformations, interpretation time, and use of liver windows. In classification training, radiologists interpreted up to 100 liver CT image patches, most with benign or malignant lesions, and compared their annotations to ground truth. Post-test was identical to pre-test. Between pre- and post-test, sensitivity increased by 2.8% (p = 0.01) but AUC did not change significantly. Missed metastases were classified as search errors (<2 seconds gaze time) or classification errors (>2 seconds gaze time) using the eye tracker. Out of 2775 possible detections, search errors decreased (10.8% to 8.1%; p < 0.01) but classification errors were unchanged (5.7% vs 5.7%). When stratified by difficulty, easier metastases showed larger reductions in search errors: for metastases with average sensitivity of 0-50%, 50-90%, and 90-100%, reductions in search errors were 16%, 35%, and 58%, respectively. The training program studied here may be able to improve radiologist performance by reducing errors but not classification errors.

COMPARISON AND CORRELATION OF CARDIOTHORACIC RATIO ON CHEST RADIOGRAPH AND COMPUTED TOMOGRAPHY

Chest radiograph is an easily available non invasive tool in evaluation of health. The cardiothoracic ratio (CTR) is commonly used as an indicator of cardiomegaly in clinical radiology. It can promptly diagnose congestive cardiomegaly apart from other lung and pleural pathologies and also depicts repsonse to treatment given, like diuretics in heart failure. Although there are better modalities available like echocardiography, computed tomography and magentic resonance imaging, chest radiography and cardiothoracic ratio are still being used by clinicians, especially in emergency department, intensive care unit and for frequent follow ups . CTR is calculated by dividing the cardiac diameter (CD) by the thoracic diameter (TD) as measured on posteroanterior chest radiography (chest PA). CTR of &gt;0.5 is abnormal on an inspiratory breath-hold chest radiograph. The purpose of this study was to compare the statistical correlation of CTR between chest radiograph with CT and to present real Heart Size (HS), Thoracic Size (TS), and Cardiothoracic Ratio (CTR) on chest PA and chest AP in the DR system and in computed tomography (CT). The conclusion of the study is that the measurement of CTR from radiograph &amp; computed tomography (CT) from both axial &amp; coronal reformations were concordant with another

Atrioesophageal Fistula: imaging for a definitive diagnosis

Aim: Atrial fibrillation is a common arrhythmia, with a prevalence of 37.574 million cases worldwide. Atrioesophageal fistula is a rare but potentially fatal complication of ablation of atrial fibrillation developing up to 60-days post-ablation with a prevalence of 0.07% to 0.25%, and a 63% mortality. While chest CTs are abnormal in most of these patients (76%-93%), definitive atrioesophageal fistula is noted in only 23-35% of cases, complicating pre-intervention diagnosis. Surgical repair of the left atrial and primary esophageal defect is essential for these patients, resulting in reduced mortality compared to nonsurgical management (33.71% vs. 94.19%). Methods: Our case series and comprehensive review of the literature highlights the diagnostic and treatment challenges of atrioesophageal fistula. Results/Conclusions: For symptomatic patients within 60-days post-ablation, IV contrast-enhanced helical chest CT with thin section collimation as initial imaging and axial reconstruction utilizing a 1mm-mm detector with sagittal and coronal reformats should be completed to allow for optimal identification of abnormalities consistent with atrioesophageal fistula. Patients with neurologic symptoms with the presence of pneumocephalus, infarcts involving one or more vascular territories, or diffuse air emboli that are highly suggestive of atrioesophageal fistula, warrant a chest CT with IV contrast to evaluate the presence of AEF. An initial unremarkable chest CT does not rule out atrioesophageal fistula and repeat chest CT with IV contrast within 1-3 days increases the likelihood of a definitive AEF diagnosis. Surgery is the only recommended management in patients with atrioesophageal fistula who are clinically stable enough to endure the procedures.

THE RELATIONSHIP BETWEEN KNEE JOINT ALIGNMENT, 3-D JOINT SPACE WIDTH AND SUBCHONDRAL BONE PARAMETERS IN INVIDUALS WITH RADIOGRAPHIC OSTEOARTHRITIS: A MOST INVESTIGATION

Joint alignment is an important factor in OA affecting how forces pass through the knee. The increasing use of weight bearing computed tomography (WBCT) in OA research has made the weight bearing stance an important consideration in 3-D imaging analysis, but its influence through biomechanics on the joint and subchondral bone is not fully understood. To investigate the relationship between knee joint alignment and 3-D joint parameters derived from joint space mapping of WBCT imaging in individuals with radiographic OA. WBCT of both knees was acquired at the 144-month visit of the Multicenter Osteoarthritis Study (MOST). Knees with a KLG ≥2 were included in the analysis, taking the side with higher KLG or averaging subsequent results from both sides if equal. Joint space mapping was performed to obtain the 3-D JSW distribution along with femoral (f) and tibial (t) subchondral bone thickness (ST) and trabecular attenuation (TA). Everyone's knee parameter maps were then transferred to a canonical joint surface. Alignment of the knee joint was measured as the angle between the central axis of the distal femur and proximal tibia in a coronal multiplanar reformat slab of the WBCT data: neutral alignment was set as zero with varus signed positive (figure part (a)). Statistical parametric mapping (SPM) was performed using a general linear model to test the dependence of each 3-D parameter distribution on alignment controlling for age, sex, mass, height, and joint space shape modes. SPM results were plotted on the canonical joint surface with unmasked regions representing a significance level of P<0.05. 136 knees were included in the analysis, 84 of which were females. Mean ± SD age was 66.4 ± 9.8 yrs; mass 85.3 ± 17.8 kg; height 1.69 ± 0.1 m. The distribution of radiographic grading was KL2 = 103; KL3 = 32; KL4 = 1. Mean alignment was 0.38 ± 3.80°. For each degree from valgus to varus, JSW was significantly narrower in the medial compartment and wider in the lateral compartment by up to 0.1 mm (figure part (d)). While TA was significantly greater by up to 10 AU in the medial femur (figure part (b)) and medial tibia (figure part (f)), there was up to 0.05 mm significantly thinner ST in the lateral femur (figure part (c)) and lateral tibia (figure part (e)). The opposite effects can be inferred for each degree towards valgus. The same analysis on KLG 0 and 1 knees in the same cohort (mean ± SD alignment 0.66 ± 2.94°) revealed no significant relationships. Subchondral bone plate and trabecular bone appear to behave differently in the medial and lateral compartments when considering knee joint alignment in individuals with OA. Greater subchondral trabecular bone attenuation was seen in the medial compartment with varus alignment, while greater subchondral bone plate thickness was seen in the lateral compartment with valgus alignment. Whether alignment is the cause or effect of OA and any altered biomechanics that may influence bone and joint space behaviour requires further investigation, but this study does establish that the forces associated with alignment appear to have different effects on subchondral bone in different compartments. National Institutes of Health, University of Kansas (R01AR071648), University of Iowa (U01AG18832) and University of California-San Francisco (U01AG19069). NS is a consultant for Integra BioLife, Trice Medical and Pacira Biosciences. TT has been a consultant for Curvebeam AI. The authors would like to thank participants and staff of the MOST study. CORRESPONDENCE ADDRESS: [email protected]

Prevalence of hepatic vascular anomalies in consecutive contrast-enhanced computed tomography images — a retrospective observational study

BackgroundLiver is a complex, highly vascular organ, where anatomical variations are the norm. This study aimed to analyze all the three hepatic vascular anatomical variations in a single study which would help us understand the prevalence of hepatic vascular (arterial, portal, venous) anomalies in the population catered to by our institution.MethodsA retrospective analysis of 545 contrast-enhanced CT scans was done from November 2019 from the institute PACS after satisfying the inclusion and exclusion criteria. The raw imaging data were processed in PACS software — Centricity™ Universal Viewer and Syngo.via Vb20 platform, for axial, coronal, and axial-oblique multiplanar reformation, maximum intensity projection (MIP), and volume rendering (VR) images. Data were analyzed in the three vascular phases to determine the anatomical variations. Analysis was done by two surgical residents in the division of HPB surgery, which was verified by a certified radiologist.ResultsThere were no major differences in the prevalence rates of the vascular anomalies across gender and domicile distributions. The prevalence of normal hepatic artery and variant hepatic artery in our study was 69% and 31%, respectively. Accessory left hepatic artery (10%) was the most common hepatic artery variant in our study. Single RHV was seen in 77.4%, and other RHV variants like two RHV with common trunk, two RHV with independent drainage, and three RHV with common trunk contribute 22.6% of our study population. Accessory inferior RHV was seen in 19.8% of the study population. Normal portal vein anatomy was found in 81.1% in our study, and the most common variant in our study population was trifurcation of portal vein (16.1%).ConclusionThis was the largest study until date from South India, studying all three hepatic vascular anatomical variations in a single study. Variations in the anatomy of hepatic arteries, portal veins, and hepatic veins are common. A good knowledge of the same is necessary especially for a hepatobiliary surgeon or for an interventional radiologist, to plan and avoid complications during a procedure. Preoperative contrast-enhanced CT scan and whenever necessary a VR or a MIP reconstruction will precisely help in identifying these variations.

S1836 Six Years of Evolution With Portal Cavernomatosis and Portal Biliopathy

Introduction: In patients with Portal Biliopathy (PB), It is paramount to engage several branches of gastroenterology to interject the aggressive evolution of this condition. Case Description/Methods: Our patient is a Man of 45 years old. Medical history of pancreatic divisum, chronic pancreatitis, biliary litho extraction, cholecystectomy, use of endoprosthesis, and pancreatic conduct stenosis. On CT scans in February 2015 he presented a pancreatitis Baltazar E, generating a perfusion defect, and multiple collaterals, in Abril 2015 portal cavernomatosis, and by January 2018 the collateral veins provoked biliary ectasis. During the next 2 years, he presented two events of mild cholangitis. To solve the choledochal impingement, on October 8, 2019, it took place a portal vein angioplasty with a balloon. The direct extrahepatic portal vein pressure was 30 mmHg pre-plasty, diminishing to 22 mmHg post-plasty. Posterior to the intervention, he had a new severe healthcare-associated colangitis plus acute pancreatitis, with a 7 mm dilatation only in the intrahepatic biliary pathway. To improve the biliary stasis, by CPRE it was placed a metallic stent covered with a Wallflex 10 mm x 8 cm. By February 2020, a CT scan still showed a permeable porta in the confluence, yet the portal prosthesis was not visible. Finally in September 2021, without clinic traits of portal hypertension, events of cholestasis, and improvement in hepatic function. (Figure) Discussion: In the biliary tract, venous drainage passes through two venous plexus named, the epicholedochal venous plexus of Saint and the paracholedochal venous plexus of Petren. In portal biliopathy, changes are a result of dilatation of veins of the plexus of Saint, causing bile duct impingement. It has been hypothesized that this lead to fibrous scarring of porta hepatis, and ischemic injury to the bile ducts resulting in stricture formation and caliber irregularity with upstream dilatation. Several studies have shown that bile duct changes occur in 81–100% of patients with extrahepatic portal vein obstruction, but only 5–30% of patients present symptoms of biliary obstruction. In adults conditions such as thrombophilia, intra-abdominal infection, malignancy, myeloproliferative disorders and cirrhosis have been implicated PB is mainly a feature of extrahepatic portal venous obstruction, patients presenting with symptoms require an integrated management addressing biliary obstruction and portal hypertension in tandem. However, the relief of both conditions is only temporary.Figure 1.: Top. Initial axial CT scan following the known event of acute pancreatitis, showing acute splenic-portal venous thrombosis demonstrated by unenhanced and distended portal vein (yellow arrow in a). The middle image three months later shows the formation of small collateral vessels in the hepatic hilium, (yellow arrow in b), and also notes new-onset ascites due to impaired liver function. Coronal reformat image two years later, points to the focal area of chronic portal thrombosis, yellow arrow in (c) with more prominent appearance collateral vessels “cavernomatosis” (asterisk), several perfusion defects in the liver parenchyma, and marked splenomegaly. Middle. DSA images, in (a) transhepatic percutaneous venography with opacification of intrahepatic portal vasculature with a sudden interruption in the site of thrombosis (yellow arrow in a). (b) splenic approach with opacification of the extrahepatic portal vein and aneurismatic collateral vessels due to cavernomatosis and upstream thrombotic interruption (yellow arrow in b). (c) final imagen after portal vein angioplasty demonstrates adequate and complete opacification of the portal vein and its branches. Bottom. ERCP in (a) shows intrahepatic bile duct dilatation and impingement and (b) after stent placement with diminished dilatation.

Collapse-Related Bone Changes in Osteonecrotic Femoral Heads at Multidetector CT: Comparison between Femoral Heads with Limited and Advanced Collapse.

Aim:To assess the frequency of bone changes in resected osteonecrotic femoral head (ONFH) specimens at multidetector computed tomography (MDCT) and compare their frequencies between ONFH with limited or advanced collapse.Method:Fourteen ONFH were imaged using MDCT (n = 14) and microcomputed tomography ([µCT]; n = 8). Preoperative staging was performed using radiographs and MRI. Coronal reformats of MDCT images of the specimens were analyzed using the grid overlay method. There were 2,933 grid boxes containing cortical bone and 10,596 containing trabecular bone. Two MSK radiologists assessed in every grid box the presence of interface-related sclerosis, cortical bone interruption, trabecular bone interruption, and trabecular bone resorption. The frequency of grid boxes with bone changes at MDCT was calculated and compared between ONFH with limited (<1.5 mm) or advanced (≥1.5 mm) collapse.Results:For both readers R1 and R2, there were 1111/10596 (10.5%) and 1362/10596 (12.9%) grid boxes with interface-related bone sclerosis, 557/2933 (19%) and 413/2933 (14.1%) with cortical bone interruption, 796/10596 (7.5%) and 665/10596 (6.3%) with trabecular bone interruption, and 331/10596 (3.1%) and 595/10596 (5.6%) with trabecular bone resorption. The frequency of grid boxes with cortical interruption and trabecular bone resorption was significantly higher in ONFH with advanced than in ONFH with limited collapse. There was no significant difference in frequency of grid boxes with trabecular interruption and interface-related bone sclerosis between ONFH with advanced or limited collapse.Conclusion:Cortical interruption and trabecular resorption, but not trabecular interruption, were more frequent in osteonecrotic femoral heads with advanced than with limited collapse.

Craniocaudal nodal length (CCNL) as a risk-factor for relapse in stage I non-seminomatous germ cell tumors (NSGCT).

e17011 Background: Lymphovascular invasion and embryonal carcinoma predominant (ECP) subtype are the only consistent factors predictive of relapse on active surveillance (AS) in Stage I NSGCT. Current practice guidelines define stage I disease by axial dimensions only, despite routine coronal reformations of axial CT images permitting CCNL measurement. CCNL was previously reported to be associated with increased risk of relapse in stage I NSGCT, independent of other risk factors (Howard et al, 2014). We sought to validate this finding through time-to-event (TTE) analyses in a larger, independent cohort. Methods: Patients with NSGCT who had undergone orchiectomy between 2/1/10 and 10/31/2017 and had baseline CT imaging performed within 90 days of orchiectomy were included. CCNL was measured using the largest lymph node by axial dimensions, with nodal morphological descriptors recorded. Median CCNL (17mm) was rounded to the nearest 5mm (15mm) and dichotomized into &lt;15mm or &gt; 15mm, deemed the most clinically translatable landmark. TTE was a composite of either relapse on AS, a positive primary retroperitoneal lymph node dissection (PRPLND), or relapse after negative PRPLND. TTE was estimated using Kaplan-Meier method, with time calculated from date of orchiectomy to date of event or censoring at last follow-up. Results: 134 stage I NSGCT patients were included, 64 (48%) with stage IA and 70 (52%) with stage IB. Median age at diagnosis was 30 years (range 18 to 34). ECP histology was seen in 82 (61%) patients. Median CCNL was 17mm (range 5 to 34) and 71 patients (53%) had a CCNL &gt; 15mm. Presence of fatty hilum and suspicious morphology were observed in 86 (66%) and 11 patients (8%) respectively. CCNL did not differ by stage at diagnosis (Wilcoxon p = 0.26) or ECP histology (Wilcoxon p = 0.95). PRPLND was performed in 7 of 64 stage IA (11%) and 45 of 70 stage IB (64%) patients. Twenty-six patients relapsed on AS, 9 had positive PRPLND histology and 3 with a negative PRPLND later relapsed. All 38 events occurred in the first year after orchiectomy except for relapse on AS in three stage IA patients at 1.2, 2.8 and 4.0 years. Median follow-up time is 5.0 years (range 1.5 months to 10 years). The one-year event-free rate was 72.7% (95% CI: 64.0, 79.6). TTE differed significantly by stage at diagnosis and did not differ significantly by ECP histology, CCNL (&gt; 15mm versus ≤15mm), presence of fatty hilum, or presence of suspicious morphology (all p &gt; 0.05). In a stratified analysis, event rate did not differ by CCNL &gt; 15mm versus ≤15mm within stage IA or IB patients (p = 0.58 and 0.60, respectively). Conclusions: Using TTE analyses in a larger, contemporary patient cohort, CCLN was not associated with increased risk of relapse in stage I NSGCT and does not lend support to its addition to staging or risk prediction models. The association between CCNL and relapse risk in stage I seminoma is currently being analyzed.

Feasibility of Deep Learning-Based Noise and Artifact Reduction in Coronal Reformation of Contrast-Enhanced Chest Computed Tomography.

This study aimed to evaluate the feasibility of a deep learning method for imaging artifact and noise reduction in coronal reformation of contrast-enhanced chest computed tomography (CT). A total of 19,052 coronal reformatted chest CT images of 110 CT image sets (55 pairs of concordant 16- and 320-row CT image sets) were included and used to train a deep learning algorithm for artifact and noise correction. For internal validation, 4093 coronal reformatted CT images of 25 patients from 16-row CT images underwent correction processing. For external validation, chest CT images of 30 patients (1028 coronal reformatted CT images), acquired in other institutions using different scanners, were subjected to correction processing. For both validations, image quality was compared between original ("CT origin ") and deep learning-based corrected ("CT correct ") CT images. Quantitative analysis for stair-step artifact (coefficient of variance of CT density on coronal reformation), image noise, signal-to-noise ratio, and contrast-to-noise ratio were evaluated. Subjective image quality scores were assigned for image contrast, artifact, and conspicuity of major structures. CT correct showed significantly reduced stair-step artifact (mean coefficient of variance: CT origin 7.35 ± 2.0 vs CT correct 5.17 ± 2.4, P < 0.001) and image noise and improved signal-to-noise ratio and contrast-to-noise ratio in the aorta, pulmonary artery, and liver, compared with those of CT origin ( P < 0.01). On subjective analysis, CT correct had higher image contrast, lower artifact, and better conspicuity than CT origin . Most results of the external validation were consistent with those obtained from the internal validation, except for those concerning the pulmonary artery. Deep learning-based artifact correction significantly improved the image quality of coronal reformation chest CT by reducing image noise and artifacts.

3T MRI of wrist ligaments and TFCC using true plane oblique 3D T2 Dual Echo Steady State (DESS) - a study of diagnostic accuracy.

This study was designed to assess the accuracy of unenhanced 3T MRI supplemented with dedicated true plane reformats of 3D T2 Dual Echo Steady State (DESS), in assessing tears of scapholunate, lunotriquetral ligaments and triangular fibrocartilage complex, using arthroscopy as gold-standard. In a retrospective cohort review, patients who underwent wrist arthroscopy and MRI over 2 years (n=46) were identified. Dedicated axial and coronal reformats were obtained from 3D T2 DESS sequence for assessing intrinsic ligaments and triangular fibrocartilage (TFCC). At arthroscopy, tears were classified using Geissler's classification and compared to MRI findings. The sensitivity of unenhanced 3T MRI in detecting scapholunate ligament tears was 87%, specificity was 90% and negative predictive value of 93%. The lunate triquetral ligament was assessed with a high specificity (97%) and negative predictive value (93%), sensitivity was 63%. TFCC tears were assessed with a sensitivity of 100%. The overall diagnostic accuracy of unenhanced 3T MRI of wrist in detecting ligament tears was 91%. 3T wrist MRI with dedicated reformats from 3D T2 DESS has a high diagnostic accuracy in assessing acute intrinsic ligament and TFCC injuries. High strength 3T MRI with good technical quality isotropic 3D T2 DESS is critical for accurate wrist ligament assessment. Negative predictive values of 3T MRI of 95% can lead to reduced need for diagnostic arthroscopy of the wrist. This study assesses the diagnostic performance of unenhanced 3T MRI with 3D T2 DESS in assessing traumatic wrist ligament tears. The accuracy of T2 DESS in wrist imaging has not been previously reported.

Use of Digital Tomosynthesis in Assessing Accurate Medial Epicondyle Fracture Displacement as Compared With Conventional Radiography and Computed Tomography.

Introduction:Medial epicondyle fracture displacement is notoriously difficult to determine on conventional radiography, and follow-up computed tomography (CT) is often obtained to measure precise displacement. Another option for fracture characterization is digital tomosynthesis (DT), a technology providing high in-plane resolution of bony anatomy by acquiring multiple low-dose images in a linear arc. Advantages of DT include lower radiation exposure and lower cost than CT, rapid image acquisition, and a similar patient experience to conventional radiography. The digital application of tomosynthesis is relatively new and is integrated as an add-on feature with modern radiography equipment. This study compares DT, CT and conventional radiography for measurement accuracy in medial epicondyle fractures with the goal of determining relative accuracy in measuring medial epicondyle fracture displacement.Methods:Medial epicondyle fractures were created in 5 cadaveric elbow specimens. Each specimen was imaged with conventional radiography, DT, and CT. True displacement measured by digital calipers was compared with “measured” displacement for each image acquisition. CT images included axial, sagittal, and coronal reformats. DT images of the elbow included anteroposterior (AP) longitudinal and transverse, lateral longitudinal and transverse, and axial longitudinal and transverse. Conventional radiographs included AP, lateral, and axial distal humerus images. Four physicians reviewed all images 3 months later. Each reviewer independently measured maximum apparent fracture displacement to the nearest 0.1 mm. Measurement accuracy was calculated as percent difference [(measured displacement−actual displacement)/actual displacement] for each acquisition. Mean, median, and SD for measurement accuracy were calculated. Two-tailed paired t tests were performed on each acquisition to compare the measurement accuracy.Results:Compared with conventional radiographs, accuracy of DT was superior in AP longitudinal (P=0.03), AP transverse (P=0.01), axial longitudinal (P=0.0001), and axial transverse projections (P=0.001). Accuracy of CT was superior to conventional radiography in the AP projection (P=0.03), but was equivalent in the axial projection (P=0.9). Accuracy of CT was similar to DT in AP longitudinal (P=0.6), AP transverse (P=0.5), and axial longitudinal projections (P=0.07). Accuracy of DT in the axial transverse projection was superior to CT (P=0.03).Conclusion:DT is more accurate than conventional radiography (both AP and axial views) and as accurate as CT in assessing millimeters of displacement of medial epicondyle fracture fragments.Level of Evidence:Level IV—diagnostic study.