Coronal Scans Research Articles

A novel preoperative trajectory evaluation method for L5-S1 transforaminal percutaneous endoscopic lumbar discectomy

Background ContextL5-S1 transforaminal percutaneous endoscopic lumbar discectomy (PELD) is a demanding procedure because of structures such as iliac crest, L5 transverse process, hypertrophic L5-S1 facet joint, and sacral ala. There has been no definite preoperative evaluation method to evaluate the surgical validity of L5-S1 transforaminal PELD. PurposeThe authors report a new preoperative trajectory evaluation method for L5-S1 transforaminal PELD using magnetic resonance imaging (MRI) or computed tomography (CT) examinations. Study Design/SettingThis is a technical report study. Patient SamplePatients who were diagnosed L5-S1 soft disc herniation were included in the present study. Outcome MeasuresSuccess rate of transforaminal PELD according to height of iliac crest was measured. MethodsTwelve patients who were diagnosed L5-S1 disc herniation were preoperatively evaluated with this new method. A skin marker is attached to patient's back as a tentative skin entry point, which was determined by usual preoperative MRI or CT. A new tilted axial and coronal MRI or CT scan is performed according to axis of L5-S1 transforaminal working channel. The images show good relationship between working channel and iliac crest. ResultsSix patients underwent a transforaminal PELD, and the results were successful. The other six patients were considered to be “unsuitable” for transforaminal PELD because of the probable blockade by iliac crest. ConclusionsThe tilted MRI or CT provides precise evaluation for L5-S1 transforaminal PELD trajectory and may achieve good outcome.

A study of the relations of foramen rotundum structure direction and the approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia

Objective: To investigate the relations of foramen rotundum structure direction and surrounding structure systematically in order to choose the best approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia. Methods: A total of 122 patients with V2 of primary trigeminal neuralgia for radiofrequency thermocoagulation were enrolled from August 2012 to May 2017 at the First Hospital of Jiaxing. CT scan images were observed retrospectively, to find the inside and outside of the foramen rotundum. The direction of foramen rotundum were recorded and the best approach of puncturing were analyzed. Results: The images were divided into four quadrants with the semi - coronal CT scan plane of the lower margin of the zygomatic arch and the outer edge of foramen rotundum for horizontal axis, and the sagittal plane for the vertical axis. In 122 cases, foramen rotundum direction in outer upper quadrant were 77 cases(63.1%), and in outer under quadrant were 22 cases(18.0%), and in inner upper quadrant were 19 cases(15.6%), and in inner under quadrant were 4 cases(3.3%). Conclusion: The most common foramen rotundum direction is in outer upper quadrant, so the best approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia is the upper side against zygomatic and the inner side against the wall of maxillary sinus.

Prevalence of normal anatomical variations in the region of paranasal sinuses in patients with chronic rhinosinusitis

Background: Knowledge of the anatomical relationships and the anatomical variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery. It helps surgeons to avoid the potential complications of sinus surgery and to improve success of management strategies. Objective: The objective of this study was to show how prevalent are the anatomic variations in the region of the paranasal sinuses and nasal cavity in patients with chronic rhinosinusitis. Materials and Methods: A cross-sectional study was conducted from January 2018 to July 2018 at Al-Hilla general teaching hospital. We collected data of 75 patients (who have met the clinical criteria of chronic rhinosinusitis) subjected to computed tomography (CT) of the paranasal sinuses. CT was performed using SIEMENS SOMATOM Definition AS and Philips machines. Direct coronal scans (1 mm in thickness) were made, from the anterior wall of the frontal sinus to the posterior wall of the sphenoid sinus with axial and sagittal reconstruction images. Results: Anatomical variations found in 69 patients of a total 75 patients with age range from 18 to 60 years with 92%. Among these, nasal septal deviation was the most common (seen in 54/75 patients = 72%) followed by the Agger nasi cells in 52 patients (69%), concha bullosa in 31 patients (41.3%), Haller cells in 28 patients (37%), and Onodi cells in 18 patients (24%). Conclusion: Sinonasal anatomical variations are common findings in patients with chronic rhinosinusitis. Providing information on these anatomical variations will improve the success of endoscopic sinus surgery.

Anatomical Consideration for Posterior Atlantoaxial Transarticular Screw Fixation from Reformatted Two-Dimensional CT Images

Background: Posterior transarticular C1-C2 fixation by screw is a widely used technique to correct atlantoaxial instability. However, the screw trajectory must be precise because the adjacent vital organs include the spinal cord and vertebral artery in the transverse foramen. Due to the lack of an objective measuring method, clarifying the range of the safe zone of screw trajectory in both the sagittal and coronal planes is important. Objective: To clarify the safe zone and ideal trajectory for screw fixation ensuring safety and without violating the transverse foramen and spinal canal. Methods: Radiographs of the normal upper cervical spine and coronal reconstruction CT scans from the entry point of the screw on C2 was performed and the safe zone for the screw path was drawn. The points of screw intersection on the superior articular surface of C2 were measured from the posterior rim of the superior articular surface of C2 then the safe zone of the screw in the coronal plane was drawn in the coronal oblique plane along the screw direction. Results: Average safe zone in the sagittal plane was 51.6 – 61.2 relative to the superior articular of C2 and the safe zone in the coronal view was medially 9.5 and laterally 4.2 relative to the midline of the spinous process. The safe zone and ideal screw trajectory should intersect C2 at 8.03 and 4.5 mm from the posterior rim of the superior articular surface on C2. Conclusion: The result of this study showed the range of the safe zone of the posterior atlantoaxial screw trajectory that guides to minimize the risk of misdirection and violating the transverse foramen by the screw. The areas on the superior articular of C2 intersected by the trajectories making the longest paths are guides to purchase the longest path of bone to achieve more stability and pullout strength

MRI measurement of pancreatic fat fraction based on Dixon method and correlation analysis with clinical factors

Objective To analyze the pancreatic fat fraction based on magnetic resonance Dixon sequence and correlation with clinical factors. Methods A total of 95 cases of adult physical examinees who had underwent abdominal MRI were retrospectively studied. Age, blood pressure, height and weight were recorded for every subject, and BMI was then calculated. The venous blood sample were analyzed for fasting plasma glucose (FPC), total cholesterol (TC), triglycerides (TG), low density lipoprotein-cholesterol (LDL-c) and high density lipoprotein-cholesterol (HDL-c). All cases underwent water-fat separation T1WI, fat inhibition T2WI, DWI, and coronal T2WI scans. We measured PFF of all the examinees, subcutaneous fat area (SA), visceral fat area (VA), and total abdominal fat area (TA) on the images above 8 centimeter of L4 to L5 were also measured, subcutaneous fat percentage (SFP) and visceral fat percentage (VFP) were further calculated. PFF of the 95 cases ranged from 2.1% to 35.0%, and the median PFF was 8.9%. This cohort was divided into low-fat pancreas groups (PFF≤8.9%, n=51) and high-fat pancreas group (PFF>8.9%, n=44) according to the median PFF. Independent sample t test was used to test for differences in clinical index between the two groups, Pearson correlation coefficient was used to measure the strength of a linear association between clinical indexes and PFF. Results Excellent water only, fat only, in phase and out of phase images of all the 95 adults were obtained. Signals of MRI images of all pancreas were homogeneous, the anatomic structures of all images were sharp and clear, and all the images had no motion artifact. The levels of BMI, systolic blood pressure, TG, LDL-c, FPC, VA, TA, VFP of high-fat pancreas group were significantly higher than those of low-fat pancreas group, and SFP was lower (P 0.05). PFF was weakly to moderately positively correlated with age, BMI, systolic blood pressure, diastolic blood pressure, TG, LDL-c, FPG, SA, VA, TA and VFP (r=0.219 to 0.515, P<0.05), SFP was moderately negatively correlated with PFF(r=-0.434, P<0.01). Conclusions It's feasible and accurate to measure the PFF with Dixon technique. PFF have a certain correlation with age, BMI, blood pressure, abdominal fat area and blood lipid metabolism. Key words: Pancreas; Magnetic resonance imaging; Fat fraction

Relationship between voice function and skeletal effects of rapid maxillary expansion.

To evaluate the effects of rapid maxillary expansion (RME) on the vocal quality, maxillary central incisors, midpalatal suture, and nasal cavity in patients with maxillary crossbite. Coronal CT scans of 30 subjects (14 boys, 16 girls; mean age, 12.01 ± 0.75) were taken before RME (T0), and at the end of the expansion phase (T1). Voice samples of all patients were recorded with a high-quality condenser microphone (RODE NT2-A) on a desktop computer at T0 and T1. Statistical analyses were performed using a paired-sample t-test. The degree of association between the changes in the voice parameters and nasal width was assessed with Pearson's correlation. RME treatment produced a significant increase in the transverse dimensions of the midpalatal suture and nasal cavity between T0 and T1 ( P < .05). The maximum F0 and jitter (%) results were shown to decrease statistically significantly from T0 to T1 ( P < .001 and P = .042, respectively). Between T0 and T1, shimmer (%) and shimmer (dB) exhibited statistically significant increases ( P = .037 and P = .019, respectively). After RME therapy, voice quality differences were found to be associated with increases in nasal width.

The Correlation Between Vertical Laminar Fractures and the Severity of Associated Burst Fractures.

Patients with laminar fractures have a higher chance of experiencing severe trauma and neurologic deficit. In previous studies, laminar fractures were divided into different types based on the axial plane of computed tomographic scans. No report described the morphology of vertical laminar fractures in the coronal plane. Furthermore, the correlation between a specific type of laminar fracture and the extent of severity of thoracolumbar (TL) burst fractures has rarely been mentioned. A retrospective evaluation of 341 patients with TL burst fractures with or without laminar fractures were divided into 6 groups based on the morphology observed across reconstructed coronal and axial computed tomographic planes. The Thoracolumbar Injury Classification and Severity Score (TLICS), Load Sharing Classification (LSC), and American Spinal Injury Association (ASIA) impairment scale were evaluated for each patient. Intergroup comparisons were also performed for all metrics. The TLICS, LSC, and ASIA impairment scale were determined for each laminar fracture group. Statistical differences were found in most intergroup comparisons across all metrics. Significantly higher injury scores were observed in the groups with a more severe coronal and axial laminar fracture, and the injury severity in the coronal scan played a more decisive role. The morphology of vertical laminar fractures as observed across multiple image planes was more complex and accurate than an analysis based solely on the axial plane. Different morphologies indicated differences in the severity of associated TL burst fractures. The laminar fracture in the coronal plane was associated with the severity of spinal injury.

Morphometric Study of C1 Pedicle and Feasibility Evaluation of C1 Pedicle Screw Placement with a Novel Clinically Relevant Radiological Classification in an Indian Population.

Study DesignA retrospective computed tomography (CT)-based morphometric study of 84 C1pedicles in an Indian population focusing on critical morphometric dimensions vis-a-vis C1 pedicle screw placement.PurposeTo determine the feasibility of C1 pedicle screw placement in an Indian population and propose a novel classification system for the same.Overview of LiteratureAt present, C1 pedicle screws are rarely used, and very few studies have focused on the feasibility of pedicle screw placement in terms of racial, gender, and ethnic variations in anatomical structures. There are no CT-based data on C1 pedicles that assess the feasibility of pedicle screw placement in the Indian population.MethodsWe measured C1 pedicle diameter on CT coronal scan images of 42 adult patients. Extramedullary height (EMH) and intramedullary height (IMH) were measured. We examined the differences between the right and left atlas pedicles and compared measures between males and females. These data were analyzed using significance tests. Based on the results, we propose a novel classification system, which we believe will help in determining the feasibility of C1 pedicle screw placement.ResultsForty-two adult patients (84 pedicles) were examined. Average EMH and IMH were 4.48±0.91 and 0.86±0.77, respectively. Approximately, 32% of the C1 pedicles had bone thicknesses of <4 mm, 49% had IMH of <1 mm, and 38% had no pedicles. The average thickness in women was 4.21±0.93 mm, which was significantly thinner than that in men (4.73±0.81 mm, p=0.004). Right and left pedicles were not significantly different.ConclusionsOur data indicate that approximately one-third of the Indian population may not be suitable candidates for C1 pedicle screw placement. Caution should be exercised while placing type 1B and type 2 pedicles based on our proposed classification system.

Gastrogastric Intussusception Caused by Gastric Mass

A 65-year-old woman with a past medical history of peptic ulcer disease and migraine headaches presented to our GI clinic complaining of dull left upper quadrant abdominal pain without radiation for the past 3 years. In addition she complained of unintentional weight loss and intermittent melena. She denied use of NSAIDs or a family history of gastric cancer. On exam, a palpable left upper quadrant mass was appreciated. A CT scan of the abdomen and pelvis with oral and intravenous contrast showed a gastrogastric intussusception without a clear lead point. Upper endoscopy revealed a 4.5 cm subepithelial mass with an overlying ulceration arising from the anterior wall of the body of the stomach. Mucosal biopsies of the mass were non-diagnostic however given the clinical presentation and concern for GIST, surgery was recommended. Patient underwent a laparoscopic partial gastrectomy with pathology showing GIST.Figure: (A) portable Chest x-ray (CXR) revealing left hemi-thorax findings were suspicious for left diaphragmatic hernia containing bowel loops. (B, C,D) Axial and Coronal contrast-enhanced CT scan of the Abdomen with 3D reconstruction showing left hemi-diaphragm defect with a large portion of the stomach herniating through it. (L:liver; St:stomach; K:kidney; Sp:spleen).Figure: EGD findings: (A) ulcerative esophagitis. (B and C) Endoscopic exam of the stomach fundus showed hyperemic gastric mucosa, with two outlet channels, one of which was blind and other one was going into the pylorus with significant looping through this area. (D) pylorus. (E) Pyloric sphincter (F) Duodenum.Most documented cases of intussusception occur in children (90%) rather than adults (10%). 95% of children have primary intussusception, whereby the etiology is benign and idiopathic without defined causes. In contrast, almost 90% of the cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point, such as carcinomas, polyps, Meckel's diverticulum, colonic diverticulum, strictures or benign neoplasms. Secondary intussusception is believed to initiate from any pathologic lesion of the bowel wall or irritant within the lumen that alters normal peristaltic activity and serves as a lead point, which is able to initiate an invagination of one segment (intussusceptum) of the bowel into the other (intussuscipien). Classic triad of cramping abdominal pain, bloody diarrhea and a palpable mass is rare in adults. Symptoms could range from nausea, vomiting, and gastrointestinal bleeding to a change in bowel habits, constipation or abdominal distension. CT scan is the most sensitive radiologic modality to confirm intussusception with a characteristic “target” sign when the intussusception is perpendicular to the long axis or a “sausage” sign when it is parallel to the long axis. Intussusception in adult needs surgical resection or investigation given the high risks of secondary causes such as neoplasm.Figure: Sausage-shaped mass indicates gastrogastric intussusceptions.Figure. 4: 5 cm smooth with central ulceration mass arising from body of the stomach.Gastrogastric intussusception is rare. Fortunately for our patient the intussusception was transient allowing time for work up and elective surgery.

A Case of Colonic ALK-Positive Anaplastic Large Cell Lymphoma

Background: Primary colonic lymphoma is rare, comprising 0.2 - 1.2% of colonic malignancies1, the majority are cecal diffuse large b cell lymphoma. Gastric lymphoma is the most common gastrointestinal lymphoma followed by the small intestine. Anaplastic Large Cell Lymphoma (ALCL) is a peripheral T-Cell lymphoma divided into primary cutaneous or systemic. Systemic ALCL is further categorized by the presence of a surface protein Anaplastic Lymphoma Kinase (ALK). ALK positive ALCL denotes a better prognosis.3 Here we report a case of colonic ALK positive ALCL. Case Presentation: A previously well 23-year-old male presented with three weeks of non-bloody diarrhea, sweats, nausea and vomiting. Upon presentation to hospital, the patient was tachypnic and requiring O2. Physical examination revealed bibasilar crackles, his abdomen was tender throughout, he did not have hepatosplenomegaly, nor lymphadenopathy. He was admitted with presumed aspiration pneumonia secondary to gastroenteritis and started on empiric antibiotics. His WBC was 28 x 10ˆ9/L, lactate 3.3 mmol/L, CRP 421. CT showed multiple enlarged abdominal lymph nodes. He had positive EBNA serology in keeping with prior EBV infection. Colonoscopy showed small erosions and polypoid lesions in the transverse colon. He was transferred to a tertiary care center because of increasing O2 requirements and multi-organ failure requiring intubation, ECMO and dialysis. Pathology of the colonic polypoid lesion revealed ALK positive ALCL. CHOP chemotherapy began during his ICU stay, vincristine and doxorubicin were held because of deteriorating liver dysfunction. With treatment, his organ failure improved and within days he was extubated, dialysis and ECMO were stopped and he was transferred to the hematology ward where he continues with chemotherapy.Figure: Enhanced coronal CT scan demonstrating massive abdominal lymphadenopathy.Figure: Enhanced axial CT scan demonstrating massive abdominal lymphadenopathy.Figure: Enhanced sagittal CT scan demonstrating massive abdominal lymphadenopathy.Discussion: Lymphoma is an important diagnosis to consider when evaluating a patient with diarrhea and lymphadenopathy. Few cases report ALCL involving the gastric mucosa, most include the stomach in isolation or the colon.4,5,6 Despite active cancer being a relative contraindication to ECMO, the severity of this patient's presentation necessitated this intervention. There have been case series reporting the use of ECMO in patients with active hematologic malignancies, where ECMO preceded the diagnosis of malignancy7. This case illustrates the importance of a high index of suspicion for lymphoma given diffuse adenopathy and taking biopsies.

Computer-assisted anatomical evaluation of the nasal sinuses in 2-3 years old children

Objective:To analyze the anatomical and developmental characteristics of nasal sinuses in 2-3 years old children.Method:Coronal CT scans of 62 cases (2-3 years old children) were studied with the imaging station. The gasification conditions of the sinuses were identified and measured.Result:The mean of the transverse and vertical diameters for the left side of the maxillary sinuse was (17.51±2.92)mm and (16.63±3.46)mm. Those for the right side were (17.28±2.51)mm and (17.24±3.72)mm. The mean for the left side of the anterior ethmoid sinus were (5.06±1.18)mm and (13.61±2.49)mm. Those for its right side were (5.00±1.45)mm and (13.64±2.30)mm. The mean for the left side of the posterior ethmoid sinus were (7.94±1.72)mm and (12.80±1.78)mm. Those for the right side were (7.88±1.85)mm and (12.64±.96)mm.96.77%(120 sides) of the sphenoid sinuses were developed. The mean for the left side of the sphenoid sinus were (7.38±3.11)mm and (8.67±3.14)mm. Those for the right side were (7.48±2.70)mm and (8.63±2.42)mm. 30.65% (38 sides) of the frontal sinuses were developed.Conclusion:The all nasal sinuses in 2-3 years old children have been already developed. The pneumatization of the frontal sinus was defined in some babies. It can help radiologist make correct diagnosis of paranasal sinuses in children.

Endoscopic Sinus and Nasal Surgery Training Using Sheep as Animal Model

Background: Endoscopic sinus surgery (ESS) is a technique which carries great potential benefits for the treatment of many nasal conditions. However, it also carries substantial risks. The key to safe surgery lies with adequate training .While dissection of cadaveric human heads is essential in learning nasal and sinus anatomy, and in practicing techniques, it is often difficult to obtain a supply of human heads that are accessible to trainees.Aim of work: Was comparing CT scan of sheep nose and paranasal sinuseswith that of human and studying the anatomy of the lateral wall of the nose of the sheep and comparing with that of human.Material and Methods: It was be performed on 14 heads of sheep (rahmani) purchased fresh from an abattoir. The 14 heads were classified into: Group (1) 4 heads were subjected to CT scan. Group (2) 6 heads were subjected to anatomical dissection. Group (3) 4 heads were subjected to Endoscopic examination. The following was performed: Coronal CT scan was done to 4 heads with cuts at 5 mm spacing 2 mm slice thickness . Scan was started just after the nares, 30 slices were acquired. Anatomical dissection of the head by :Heads were divided two subgroups: Subgroup A Included 3 heads and were dissected sagittally.subgroup B Included 3 heads and were dissected coronally. The endoscopic examination was carried out on group(3) using a rigid endoscope with a diameter of 4 mm. The endoscope was inserted into the ventral nasal passage of the left side and moved forward along the nasal septum up to the region of the pharynx.Results: The CT scans and anatomical dissection showed that, the shape of sheep nose is conical, it is narrow anteriorly and wide posteriorly with a length ranging from (16-20) cm, a height was measuring 6-10cm and a width of 7.5-9cm at widest points. The opening of Para nasal sinuses lies in the middle meatus like that of the human. CT scan and anatomical dissection showed that the nasal cavity of the sheep was narrowed by the bullous nature of the inferior concha.Conclusion: Using the sheep head model provides a cheap, practical and safe method for teaching basic nasal and sinus endoscopy techniques. The sheep proved to be the most useful animal both in terms of general nasal anatomy and in the depth of the nose being accessible to the endoscope used in humans. Although the anatomy of the head of the sheep is evidently different from that of the human, the nasal cavity itself is very similar in appearance, though somewhat wider.

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Automatic quantification of bone marrow edema on MRI of the wrist in patients with early arthritis: A feasibility study.

PurposeTo investigate the feasibility of automatic quantification of bone marrow edema (BME) on MRI of the wrist in patients with early arthritis.MethodsFor 485 early arthritis patients (clinically confirmed arthritis of one or more joints, symptoms for less than 2 years), MR scans of the wrist were processed in three automatic stages. First, super‐resolution reconstruction was applied to fuse coronal and axial scans into a single high‐resolution 3D image. Next, the carpal bones were located and delineated using atlas‐based segmentation. Finally, the extent of BME within each bone was quantified by identifying image intensity values characteristic of BME by fuzzy clustering and measuring the fraction of voxels with these characteristic intensities within each bone. Correlation with visual BME scores was assessed through Pearson correlation coefficient.ResultsPearson correlation between quantitative and visual BME scores across 485 patients was r=0.83, P<0.001.ConclusionsQuantitative measurement of BME on MRI of the wrist has the potential to provide a feasible alternative to visual scoring. Complete automation requires automatic detection and compensation of acquisition artifacts. Magn Reson Med 79:1127–1134, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Retropectoral Cystic Echinococcosis: A Case Report

Background: Cystic echinococcosis of soft tissue is rare even in endemic areas. Intermuscular and intramuscular cystic echinococcoses have been occasionally reported in the literature. Case Presentation: A 40-year-old male was referred to the surgery clinic of Alzahra Hospital, Isfahan, Iran, with a swelling over the right side of his chest in September 2015. In physical examination, a nontender soft bulging in depth of the right pectoralis major muscle with no skin manifestation was noticeable. The axial and coronal contrast-enhanced CT scan showed a multicystic mass lesion between the right pectoralis major and minor muscles with extension beneath the pectoralis minor muscle. The patient underwent a surgery for resection of the mass. After dissection of the pectoralis major fascia, a large cystic mass was visualized just beneath the muscle with some adhesion to the chest wall. Histopatholgic study of the surgical specimen also revealed cystic echinococcosis. Conclusions: This case reveals that cystic echinococcosis should be considered in differential diagnoses of any chest wall swelling.

Regional Ventilation Is the Main Determinant of Alveolar Deposition of Coarse Particles in the Supine Healthy Human Lung During Tidal Breathing.

To quantify the relationship between regional lung ventilation and coarse aerosol deposition in the supine healthy human lung, we used oxygen-enhanced magnetic resonance imaging and planar gamma scintigraphy in seven subjects. Regional ventilation was measured in the supine posture in a 15 mm sagittal slice of the right lung. Deposition was measured by using planar gamma scintigraphy (coronal scans, 40 cm FOV) immediately postdeposition, 1 hour 30 minutes and 22 hours after deposition of 99mTc-labeled particles (4.9 μm MMAD, GSD 2.5), inhaled in the supine posture (flow 0.5 L/s, 15 breaths/min). The distribution of retained particles at different times was used to infer deposition in different airway regions, with 22 hours representing alveolar deposition. The fraction of total slice ventilation per quartile of lung height from the lung apex to the dome of the diaphragm at functional residual capacity was computed, and co-registered with deposition data-apices aligned-using a transmission scan as reference. The ratio of fractional alveolar deposition to fractional ventilation of each quartile (r) was used to evaluate ventilation and deposition matching (r > 1, regional aerosol deposition fraction larger than regional ventilation fraction). r was not significantly different from 1 for all regions (1.04 ± 0.25, 1.08 ± 0.22, 1.03 ± 0.17, 0.92 ± 0.13, apex to diaphragm, p > 0.40) at the alveolar level (r22h). For retention times r0h and r1h30, only the diaphragmatic region at r1h30 differed significantly from 1. These results support the hypothesis that alveolar deposition is directly proportional to ventilation for ∼5 μm particles that are inhaled in the supine posture and are consistent with previous simulation predictions that show that convective flow is the main determinant of aerosol transport to the lung periphery.

Clinical profile and outcomes of management of orbital cellulitis in Upper Egypt

BackgroundThe purpose of this paper is to study the etiology, clinical findings, and outcomes of management of cases of orbital cellulitis treated in Minia University Hospital in Upper Egypt over the period of 6 years from July 2009 to July 2015. One-hundred two patients diagnosed to have orbital cellulitis were admitted to the hospital and treated on inpatient basis from July 2009 to July 2015. All patients were subjected to full ophthalmological examination, systemic evaluation, and ear, nose, and throat (ENT) consultation. Axial and coronal CT scan and orbital echography were done for all patients. All patients received medical treatments, and 20 patients needed surgical intervention.ResultsThe source of infection was paranasal sinusitis in 66 patients, trauma in 14 cases, panophthalmitis in 6 patients, and dental infection in 2 cases, and no definite source was detected in 14 cases. Subperiosteal abscess (SPA) developed in 16 patients. The final best corrected visual acuity improved in 58% of the cases, decreased in 4%, and remained unchanged in 38% of cases. No intracranial complication was recorded.ConclusionsGood presenting visual acuity and appropriate medical treatment together with early surgical intervention in cases of SPA are important factors to achieve favorable outcomes in orbital cellulitis. All cases with SPA had paranasal sinusitis, and contrary to previous studies, superior SPA location was the most common followed by the medial location.

Spectrum of Magnetic Resonance Imaging Features in Unilateral Optic Tract Dysfunction.

Optic tract dysfunction may be the predominant or only clinical manifestation of an intracranial disorder including mass legion, ischemic infarct, inflammatory disease, and trauma. Documentation of the neuroimaging features of these lesions is limited to reports mostly published before the availability of MRI. This study was undertaken to document the spectrum of MRI features in patients presenting with optic tract dysfunction. A retrospective study from 2004 to 2015 at a single tertiary care neuro-ophthalmology service of 24 patients who had unilateral optic tract dysfunction defined by a homonymous hemianopia and a relative afferent pupil defect that could not be attributed to optic neuropathy or retinopathy. Two institutional neuroradiologists, who were privy to the presence of optic tract dysfunction but not to its side or cause, independently documented the MRI abnormalities on a standard data collection form and then convened for a consensus review of the imaging abnormalities with the 2 clinician authors. The clinical diagnoses were 6 ischemic strokes, 5 malignant brain tumors, 5 postoperative neurosurgical cases, 4 intracranial hemorrhages, 2 traumatic brain injuries, 1 midbrain/optic tract primary demyelination, and 1 temporal lobe herpes simplex encephalitis. In their independent review, both neuroradiologists identified MRI abnormalities in 20 (83%) cases that were extrinsic to the optic tract in the neighboring temporal lobe, midbrain, thalamus, basal ganglia, or suprasellar space. In 5 of those cases, the extrinsic abnormality included features suggesting compression of the optic tract, but these compressive features were not appreciated by either neuroradiologist until the consensus conference. In 15 cases, MRI abnormalities intrinsic to the optic tract itself were eventually identified, including T2 or fluid-attenuated inversion recovery image (FLAIR) hyperintensity (9 cases) or hypointensity (1 case), thinning (6 cases), thickening (2 cases), and contrast enhancement (1 case). However, none of these intrinsic MRI abnormalities was identified during the independent review, being detected only in the consensus conference. Neuroradiologists aware of unilateral optic tract dysfunction but not of its side detected extrinsic (neighborhood) MRI abnormalities in most cases but did not appreciate that these extrinsic features sometimes included compression of the optic tract. MRI abnormalities intrinsic to the optic tract were entirely overlooked during independent review, being recognized only in a consensus conference with clinician authors. Neuroradiologists are more likely to detect MRI abnormalities pertinent to optic tract dysfunction once they have more complete clinical information and with higher resolution imaging, especially T1 postcontrast axial and coronal sequences and T2 or FLAIR coronal scans.

Observation of Anterior Ethmoidal Artery in Coronal CT Scans of Paranasal Sinuses in Patients Attending Katihar Medical College, Katihar

Observation of Anterior Ethmoidal Artery in Coronal CT Scans of Paranasal Sinuses in Patients Attending Katihar Medical College, Katihar

A decreased response to the NMDAR antagonist MK-801 is shown by pharmacological MRI in a maternal immune activation model

Event Abstract Back to Event A decreased response to the NMDAR antagonist MK-801 is shown by pharmacological MRI in a maternal immune activation model Stephan Missault1, 2*, Cynthia Anckaerts2, Soumaya Ahmadoun1, Ines Blockx2, Disha Shah2, Annemie Van Der Linden2, Marleen Verhoye2 and Stefanie Dedeurwaerdere1 1 University of Antwerp, Translational Neurosciences, Belgium 2 University of Antwerp, Biomedical Sciences, Belgium Introduction. Maternal immune activation (MIA) is a primer for several neurological disorders including schizophrenia. Hypofunction of the NMDA receptor (NMDAR) is currently the most accepted hypothesis regarding the pathophysiology of schizophrenia. One of the best animal models for schizophrenia is the MIA model1. Altered NMDAR function is commonly tested in this model by assessing the hyperlocomotor response to the NMDAR antagonist MK-801. However, the outcome of this test has been inconsistent. A differential response to MK-801 has been described in MIA offspring depending on the presence of maternal weight loss2. The aim of this study was to assess the response to MK-801 using pharmacological MRI (phMRI) in MIA offspring. Methods. Pregnant Wistar dams were injected with 4 mg/kg Poly I:C (MIA) or saline on gestational day 15 and weight change was recorded at 24h post-injection. Male offspring of dams that lost (Poly I:C WL, n=14) and gained weight post-MIA (Poly I:C WG, n=8) and control offspring (n=7) were subjected to phMRI and behavioural assessment with 0.2 mg/kg MK-801 in adulthood. For phMRI, coronal scans were continuously acquired on a 7T PharmaScan (Bruker) 10min before until 30min after i.v. MK-801 administration under 2% isoflurane. Breathing rate and blood oxygenation were monitored. Pre- and post-processing was performed in SPM12. Statistical analysis was done to explore BOLD signal differences between pre- and post-MK-801 in the three groups for the following regions of interest: anterior cingulate cortex, motor cortex, striatum, thalamus and hippocampus. For the behavioural test, locomotion was recorded 1h before until 3h after s.c. injection with MK-801. Results. PhMRI showed that Poly I:C WG offspring had a smaller response to MK-801 compared to controls in striatum and thalamus (p≤0.05), anterior cingulate cortex and motor cortex (p<0.1) but not in hippocampus. Poly I:C WL offspring only exhibited a smaller response in thalamus vs controls (p≤0.05). In the behavioural test, Poly I:C WG offspring showed a slightly attenuated hyperlocomotor response to MK-801 vs controls. Conclusion. PhMRI showed a differential response to MK-801 in MIA offspring, primarily in Poly I:C WG offspring. The behavioural read-out showed a subtle difference between Poly I:C WG offspring and controls. PhMRI may prove to be a more sensitive alternative to assess altered responses to MK-801 than the classic behavioural read-out. References. 1Zuckerman et al., 2003; 2Missault et al., 2014. Figure 1 Keywords: maternal immune activation, Schizophrenia, NMDA receptor, pharmacological MRI, BOLD response Conference: 12th National Congress of the Belgian Society for Neuroscience, Gent, Belgium, 22 May - 22 May, 2017. Presentation Type: Poster Presentation Topic: Disorders of the Nervous System Citation: Missault S, Anckaerts C, Ahmadoun S, Blockx I, Shah D, Van Der Linden A, Verhoye M and Dedeurwaerdere S (2019). A decreased response to the NMDAR antagonist MK-801 is shown by pharmacological MRI in a maternal immune activation model. Front. Neurosci. Conference Abstract: 12th National Congress of the Belgian Society for Neuroscience. doi: 10.3389/conf.fnins.2017.94.00065 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 24 Apr 2017; Published Online: 25 Jan 2019. * Correspondence: Mr. Stephan Missault, University of Antwerp, Translational Neurosciences, Wilrijk, Belgium, Stephan.Missault@uantwerpen.be Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Stephan Missault Cynthia Anckaerts Soumaya Ahmadoun Ines Blockx Disha Shah Annemie Van Der Linden Marleen Verhoye Stefanie Dedeurwaerdere Google Stephan Missault Cynthia Anckaerts Soumaya Ahmadoun Ines Blockx Disha Shah Annemie Van Der Linden Marleen Verhoye Stefanie Dedeurwaerdere Google Scholar Stephan Missault Cynthia Anckaerts Soumaya Ahmadoun Ines Blockx Disha Shah Annemie Van Der Linden Marleen Verhoye Stefanie Dedeurwaerdere PubMed Stephan Missault Cynthia Anckaerts Soumaya Ahmadoun Ines Blockx Disha Shah Annemie Van Der Linden Marleen Verhoye Stefanie Dedeurwaerdere Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.