CT Fusion Research Articles

CT and MR image information fusion scheme using a cascaded framework in ripplet and NSST domain

The fusion of multimodal medical information is considered as an assisted approach for the medical professionals. Computed tomography and magnetic resonance (CT–MR) medical image fusion are able to help the radiologist in precise diagnosis of disease and deciding the required treatment in accord with the patient's condition. Therefore, a cascaded framework is proposed in this study that presents a fusion approach for multimodal medical information in ripplet transform (RT) and non-subsampled shearlet (NSST) domain. The RT and NSST having different features are utilised in a cascade manner that provides several directional decomposition coefficients and increases shift invariance information in the fused images. At the first stage decomposition, a biologically inspired neural model, motivated by novel sum-modified Laplacian and spatial frequency is utilised to fuse the low- and high-frequency coefficients, respectively, and the max fusion rule based on regional energy is utilised at stage 2. This model is used to preserve the redundant information also. The fusion performance is also validated by extensive simulations performed on different CT–MR image datasets of different diseases. Experimental results demonstrate that the proposed method provides better fused images in terms of visual quality along with the quantitative indices compared with several existing fusion approaches.

Differential Dose Distribution in Transition from 3-D CRT to IMRT Treatment Plans for Glioblastoma Multiforme' at Stage III or IV: A Clinical Study of a Brain Tumor

<p><span>Advancement in Cancer Therapy Technology (CTT) due to Software, Hardware and precise delivery of radiation dose has enhanced the quality of life of cancer patients. This report aims at the application of 3-D CRT (Three Dimensional Conformal Radiation Therapy) and IMRT (Intensity Modulated Radiation Therapy) for a quality of treatment. Other anatomical sites viz. Prostate, Lung, etc. may also be treated provided a better tool is applied for target delineation for which FUSION of CT and MRI images are used to ascertain differences in tissue density. This Fusion image of 3 mm slices offer accurate contouring of the tumor. The oncologist and/or physicist perform delineation of (I) GTV (Gross Tumor Volume), (II) CTV (Clinical Target Volume), (III) PTV (Planning Target Volume), (IV) TV (Treated Volume) and (V) OARs (Organs at Risk). This is done to secure conformal dose distribution and justify the clinical objectives of Tumor Control Probability (TCP) by reducing the normal tissue complication probability (NTCP). <span> </span><span> </span>The implication of this study outlines the fundamental goal of effective treatment procedures by comparing treatment plans of 3-D CRT and IMRT. Tolerance levels of dose to different organs are optimized by the analysis of random and systemic geometrical deviations, margin on target volumes, conformity index (CI), patient selection process and, of course, the shape and stage of target. The comparative parameters of treatment plans are segmented and tabulated to implicate the application of necessary tools to decide on a treatment plan for similar patients.</span></p><p><span>Bangladesh J. Nuclear Med. 19(1): 64-67, January 2016</span></p>

Nonsubsampled shearlet domain fusion techniques for CT–MR neurological images using improved biological inspired neural model

The fusion of multimodality medical images performs a very crucial role in the clinical diagnosis, analysis and the treatment of especially in critical diseases. It is considered as an assisted approach for the radiologist by providing the composite images having significant diagnostic information acquired from the source images. The main purpose of this work is to develop an efficient framework for fusing the multimodal medical images. Three different fusion techniques are proposed in this paper that presents the CT and MR medical image fusion in nonsubsampled shearlet transform (NSST) domain using the adaptive spiking neural model. The NSST having different features and a competent depiction of the image coefficients provides several directional decomposition coefficients. Maximum selection approach and regional energy are utilized for low frequency coefficients fusion. Spatial frequency, novel modified spatial frequency and novel sum modified Laplacian motivated spiking model are used for every high frequency subimage component. Finally, fused images are reconstructed by applying inverse NSST. The performance of proposed fusion techniques is validated by extensive simulations performed on different CT-MR image datasets using proposed and other thirty seven existing fusion approaches in terms of both the subjective and objective manner. The results revealed that the proposed techniques provide better visualization of resultant images and higher quantitative measures compared to several existing fusion approaches.

A strong adjuvant based on glycol-chitosan-coated lipid-polymer hybrid nanoparticles potentiates mucosal immune responses against the recombinant Chlamydia trachomatis fusion antigen CTH522

Induction of mucosal immunity with vaccines is attractive for the immunological protection against pathogen entry directly at the site of infection. An example is infection with Chlamydia trachomatis (Ct), which is the most common sexually transmitted infection in the world, and there is an unmet medical need for an effective vaccine. A vaccine against Ct should elicit protective humoral and cell-mediated immune (CMI) responses in the genital tract mucosa. We previously designed an antibody- and CMI-inducing adjuvant based on poly(dl-lactic-co-glycolic acid) (PLGA) nanoparticles modified with the cationic surfactant dimethyldioctadecylammonium bromide and the immunopotentiator trehalose-6,6′-dibehenate. Here we show that immunization with these lipid-polymer hybrid nanoparticles (LPNs) coated with the mucoadhesive polymer chitosan enhances mucosal immune responses. Glycol chitosan (GC)-modified LPNs were engineered using an oil-in-water single emulsion solvent evaporation method. The nanoparticle design was optimized in a highly systematic way by using a quality-by-design approach to define the optimal operating space and to gain maximal mechanistic information about the GC coating of the LPNs. Cryo-transmission electron microscopy revealed a PLGA core coated with one or several concentric lipid bilayers. The GC coating of the surface was identified as a saturable, GC concentration-dependent increase in particle size and a reduction of the zeta-potential, and the coating layer could be compressed upon addition of salt. Increased antigen-specific mucosal immune responses were induced in the lungs and the genital tract with the optimized GC-coated LPN adjuvant upon nasal immunization of mice with the recombinant Ct fusion antigen CTH522. The mucosal responses were characterized by CTH522-specific IgG/IgA antibodies, together with CTH522-specific interferon γ-producing Th1 cells. This study demonstrates that mucosal administration of CTH522 adjuvanted with chitosan-coated LPNs represents a promising strategy to modulate the magnitude of mucosal vaccine responses.

Anatomical Road Mapping Using CT and MR Enterography for Ultrasound Molecular Imaging of Small Bowel Inflammation in Swine.

To evaluate the feasibility and time saving of fusing CT and MR enterography with ultrasound for ultrasound molecular imaging (USMI) of inflammation in an acute small bowel inflammation of swine. Nine swine with ileitis were scanned with either CT (n = 3) or MR (n = 6) enterography. Imaging times to load CT/MR images onto a clinical ultrasound machine, fuse them to ultrasound with an anatomical landmark-based approach, and identify ileitis were compared to the imaging times without anatomical road mapping. Inflammation was then assessed by USMI using dual selectin-targeted (MBSelectin) and control (MBControl) contrast agents in diseased and healthy control bowel segments, followed by ex vivo histology. Cross-sectional image fusion with ultrasound was feasible with an alignment error of 13.9 ± 9.7 mm. Anatomical road mapping significantly reduced (P < 0.001) scanning times by 40%. Localising ileitis was achieved within 1.0 min. Subsequently performed USMI demonstrated significantly (P < 0.001) higher imaging signal using MBSelectin compared to MBControl and histology confirmed a significantly higher inflammation score (P = 0.006) and P- and E-selectin expression (P ≤ 0.02) in inflamed vs. healthy bowel. Fusion of CT and MR enterography data sets with ultrasound in real time is feasible and allows rapid anatomical localisation of ileitis for subsequent quantification of inflammation using USMI. • Real-time fusion of CT/MRI with ultrasound to localise ileitis is feasible. • Anatomical road mapping using CT/MRI significantly decreases the scanning time for USMI. • USMI allows quantification of inflammation in swine, verified with ex vivo histology.

Ultrasound-Unenhanced CT Fusion for Detection and Localization of Ureteral Stones.

The standard of care for the diagnosis and follow-up of urolithiasis is unenhanced CT. The hypothesis of this study was that that by using image fusion of subsequent ultrasound (US) with the initial unenhanced CT, ureteral stones can be precisely localized. Of the 25 stones founds on unenhanced CT studies, 22 (88%) were confidently identified using US-unenhanced CT fusion within 72 hours after the initial CT scan was obtained. US-unenhanced CT fusion might obviate the need for repeated CT scans for monitoring urolithiasis.

Comparison of hybrid 68Ga-PSMA-PET/CT and 99mTc-DPD-SPECT/CT for the detection of bone metastases in prostate cancer patients: Additional value of morphologic information from low dose CT.

This study compared 68Gallium-prostate-specific-membrane-antigen based Positron-emission-tomography (68Ga-PSMA-PET) and 99metastabletechnetium-3,3-diphospho-1,2-propanedicarbonacid (99mTc-DPD-SPECT) in performing skeletal staging in prostate cancer (PC) patients and evaluated the additional value of the information from low-dose-computed tomography (CT). In this retrospective study, 54 patients who received 68Ga-PSMA-PET/CT and 99mTc-DPD-SPECT/CT within 80 days were extracted from our database. Osseous lesions were classified as benign, malignant or equivocal. Lesion, region and patient based analysis was performed with and without CT fusion. The reference standard was generated by defining a best valuable comparator (BVC) containing information from all available data. In the patient based analysis, accuracies measured as "area-under-the-curve" (AUC) for 68Ga-PSMA-PET, 99mTc-SPECT, 68Ga-PSMA-PET/CT and 99mTc-SPECT/CT were 0.97-0.96, 0.86-0.83, 1.00 and 0.83, respectively (p<0.05) (ranges = optimistic vs. pessimistic view). Region based analysis resulted in the following sensitivities and specificities: 91.8-97.7%, 100-99.5% (PET); 61.2-70.6%, 99.8-98.3% (SPECT); 97.7%, 100% (PET/CT), 69.4% and 98.3% (SPECT/CT) (p<0.05). The amount of correct classifications of equivocal lesions by CT was significantly higher in PET (100%) compared to SPECT (52.4%) (p<0.05). 68Ga-PSMA-PET outperforms 99mTc-DPD-SPECT in detecting bone metastases in PC patients. Additional information from low-dose-CT resulted in a significant reduction in equivocal lesions in both modalities, however 68Ga-PSMA-PET benefited most. • Ga-PSMA-PET outperforms 99m Tc-DPD-SPECT in skeletal staging in prostate cancer patients • Proportion of equivocal decisions was significantly reduced by CT-fusion in both modalities • Ga-PSMA-PET benefits more from CT information, compared to 99m Tc-DPD-SPECT.

Construction of the 3D digital models of maxillofacial region based on CT and MRI images fusion

Construction of the 3D digital models of maxillofacial region based on CT and MRI images fusion

CT and MRI Image Fusion Based on Discrete Wavelet Transform and Type-2 Fuzzy Logic

CT and MRI Image Fusion Based on Discrete Wavelet Transform and Type-2 Fuzzy Logic

IP007. Simplified Translumbar Treatment of a Type II Endoleak Using CT Fusion in Hybrid Room

A 74-year-old man underwent endovascular aneurysm repair (EVAR) of a 5.0-cm infrarenal abdominal aortic aneurysm (AAA) with a stent graft. Endoleaks were not detected at the time of the completion angiogram. Follow-up aortic duplex study obtained 1 month later showed the presence of a small type II endoleak arising from the inferior mesenteric artery (IMA). The endoleak persisted and increased in size, with a subsequent sac diameter increase 3 years after EVAR. A follow-up computed tomography angiogram (CTA) showed the presence of type II endoleak, with retrograde filling by the IMA and connection to a complex network of lumbar vessels. The AAA sac increased in size to 5.8 cm. Decision was made to proceed with treatment to obliterate this endoleak. We describe a novel approach in treating a persistent type II endoleak related to the IMA and the lumbar outflow vessels using a simplified translumbar approach. Using TrackVision software, we were able to delineate the track to the level of the endoleak. The software program allowed us to access the endoleak through a translumbar approach. A three-dimensional cone-beam CT scan without contrast injection was used to identify the location of the endograft to match the exact position of the endoleak noted on the previous CTA in the superimposed prone position. After the entry and target trajectories were identified using both of the fused data sets, the model and planned trajectories were then exported into the TrackVision software, creating a virtual needle track. A 20-cm long, 18-gauge Chiba needle was used to access the endoleak cavity. Using progress and bull’s eye views, we were able to track the needle into the endoleak. The endoleak was then visualized using contrast showing feeding of the endoleak through the IMA. This entire region was then coil embolized with a total of four 4-mm × 3-mm Tornado Embolization Coils followed by one 5-mm × 10-cm and two 10-mm × 15-cm Nester Embolization Coils. After coil embolization the IMA was not visualized. The patient was seen in follow-up 1 month following the procedure with complete obliteration of the endoleak and decrease in sac size to 5.3 cm. This simplified approach at treating complex endoleaks has allowed the procedure to be performed with minimal fluoroscopy and digital subtraction angiography imaging. In addition, the length of the procedure has become significantly shortened with the use of the virtual needle track.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Efficacy comparison between one-stage combined posterior and anterior approaches and simple posterior approach for lower lumbar tuberculosis

To compare the clinical efficacy between one-stage combined posterior and anterior approaches (PA-approach) and simple posterior approach (P-approach) for lower lumbar tuberculosis so as to provide some clinical reference for different surgical procedures of lower lumbar tuberculosis. A retrospective analysis was made on the clinical data of 48 patients with lower lumbar tuberculosis treated between January 2010 and November 2014. Of them, 28 patients underwent debridement, bone graft, and instrumentation by PA-approach (PA-approach group), and 20 patients underwent debridement, interbody fusion, and instrumentation by P-approach (P-approach group). There was no significant difference in gender, age, course of the disease, and destructive segment between 2 groups ( P>0.05). The operation time, blood loss, bed rest time, visual analogue scale (VAS) and complication were recorded and compared between 2 groups; American Spinal Injury Association (ASIA) grade was used to evaluate the nerve function, Bridwell classification and CT fusion criteria to assess bone fusion, erythrocyte sedimentation rate (ESR) to evaluate the tuberculosis control, and Oswestry disability index (ODI) to estimate lumbar function. The operation time, blood loss, and the bed rest time of the P-approach group were significantly less than those of the PA-approach group ( P<0.05). Iliac vessels rupture was observed in 1 case of the PA-approach group and sinus tract formed in 2 cases of the P-approach group. The patients were followed up 13-35 months (mean, 15.7 months) in the PA-approach group and 15-37 months (mean, 16.3 months) in the P-approach group. At last follow-up, common toxic symptom of tuberculosis disappeared and the ASIA scale was improved to grade E. The VAS score and ESR at 1 year after operation and last follow-up, and ODI at last follow-up were significantly improved when compared with preoperative ones in 2 groups ( P<0.05), but there was no significant difference between the 2 groups ( P>0.05). During follow-up, no internal fixation broken, loosening, or pulling was found. Bridwell bone fusion rates were 89.29% (25/28) and 80.00% (16/20) respectively, and CT fusion rates were 96.43% (27/28) and 90.00% (18/20) respectively, showing no significant difference between the 2 groups ( P>0.05). Both one-stage PA-approach and simple P-approach could obtain good clinical efficacy. The PA-approach should be selected for patients with anterior-vertebral destroy, presacral or psoas major muscles abscess, and multiple vertebral body destroy, while P-approach should be selected for patient who could gain a good debridement evaluated by imaging before operation, especially for patients with middle-vertebral body destroy, block the iliac blood vessels and old patients.

Value of Fusion of MRI and CT in Brachytherapy

Value of Fusion of MRI and CT in Brachytherapy

Usefulness of 2D fusion of postmortem CT and antemortem chest radiography studies for human identification.

To determine the feasibility of human identification through the two-dimensional (2D) fusion of postmortem computed tomography (PMCT) and antemortem chest radiography. The study population consisted of 15 subjects who had undergone chest radiography studies more than 12months before death. Fused images in which a chest radiograph was fused with a PMCT image were obtained for those subjects using a workstation, and the minimum distance gaps between corresponding anatomical landmarks (located at soft tissue and bone sites) in the images obtained with the two modalities were calculated. For each fused image, the mean of all these minimum distance gaps was recorded as the mean distance gap (MDG). For each subject, the MDG obtained for the same-subject fused image (i.e., where both of the images that were fused derived from that subject) was compared with the MDGs for different-subject fused images (i.e., where only one of the images that were fused derived from that subject; the other image derived from a different subject) in order to determine whether same-subject fused images can be reliably distinguished from different-subject fused images. The MDGs of the same-subject fused images were found to be significantly smaller than the MDGs of the different-subject fused images (p<0.01). When bone landmarks were used, the same-subject fused image was found to be the fused image with the lowest MDG for 33.3% of the subjects, the fused image with the lowest or second-lowest MDG for 73.3% of the subjects, and the fused image with the lowest, second-lowest, or third-lowest MDG for 86.7% of the subjects. The application of bone landmarks rather than soft-tissue landmarks made it significantly more likely that, for each subject, the same-subject fused image would have the lowest MDG (or one of the lowest MDGs) of all the fused images compared (p<0.05). The 2D fusion of antemortem chest radiography and postmortem CT images may assist in human identification.

Structure tensor and nonsubsampled shearlet transform based algorithm for CT and MRI image fusion

Multimodal medical image fusion technique contributes to the reduction of information uncertainty and improves the clinical diagnosis accuracy, the aim of which is to preserve salient image features and detail information of multiple source images to produce a visual enhanced single fused image. In this paper, by taking full advantages of structure tensor and nonsubsampled shearlet transform (NSST) to effectively extract geometric features, a novel unified optimization model is proposed for fusing computed tomography and magnetic resonance imaging images. The proposed model includes two terms, which constrain the gradient and NSST coefficients of the final fused image close to the pre-fused gradient and NSST coefficients. The pre-fused gradient is obtained from weighted structure tensor and the pre-fused NSST coefficients are generated by fusing NSST coefficients of source images with proposed fusion rules. The final fused image can be obtained by solving the constructed optimization problem via conjugate gradient method. Experimental results demonstrate that the proposed approach outperforms the compared multi-resolution and gradient based methods in both visual effects and quantitative assessments.

MAGNETIC RESONANCE IMAGING IN THE PLANNING OF STEREOTACTIC BODY RADIATION THERAPY IN PATIENTS WITH LIVER METASTASES

Background: Extracranial stereotactic body radiation therapy is non-invasive alternative to other local treatment methods of patients with liver metastases. One of the main criteria for successful planning of the irradiation volume is a clear visualization of the contour of the tumor. MRI provides more valuable information about the boundaries of the tumor and critical structures, which makes its implementation mandatory when collecting anatomical and topographic data for the planning of stereotactic radiotherapy in patients with metastases in the liver. The use of different pulse sequences and the thickness of the slices affects the quality of visualization of the contour of the target, the fusion of CT and MRI data to select the irradiation volume. Objective: Improving the quality of anatomo-topographic data collection using the MRI for planning stereotactic radiation therapy in patients with liver metastases. Design and methods: Magnetom Siemens Avanto and Aera RT 1.5T. MRI protocol: overview T2 Cor and T2 Sag 5mm, T1ax VIBE DIXION 1.5mm, T2ax SPACE 2mm, DWI (ADC), T2ax TSE BLADE FS 3mm. With the help of this technique 15 patients with a total of 20 liver metastases was planned and executed stereotactic radiation therapy. Results: Used slice thickness and pulse sequences provide high spatial resolution, clear visualization of the contour of the tumor, the absence of technical difficulties with the fusion of CT and MRI tomograms at the station planning and the selection of the volume exposure. Conclusion: Optimization of the MRI protocol to collect anatomo-topographic data allowed to increase their informative value and diagnostic value for planning of SBRT in patients with liver metastases.

Image Fusion of CT and MR with Sparse Representation in NSST Domain.

Multimodal image fusion techniques can integrate the information from different medical images to get an informative image that is more suitable for joint diagnosis, preoperative planning, intraoperative guidance, and interventional treatment. Fusing images of CT and different MR modalities are studied in this paper. Firstly, the CT and MR images are both transformed to nonsubsampled shearlet transform (NSST) domain. So the low-frequency components and high-frequency components are obtained. Then the high-frequency components are merged using the absolute-maximum rule, while the low-frequency components are merged by a sparse representation- (SR-) based approach. And the dynamic group sparsity recovery (DGSR) algorithm is proposed to improve the performance of the SR-based approach. Finally, the fused image is obtained by performing the inverse NSST on the merged components. The proposed fusion method is tested on a number of clinical CT and MR images and compared with several popular image fusion methods. The experimental results demonstrate that the proposed fusion method can provide better fusion results in terms of subjective quality and objective evaluation.

A Registration Method Based on Contour Point Cloud for 3D Whole-Body PET and CT Images.

The PET and CT fusion image, combining the anatomical and functional information, has important clinical meaning. An effective registration of PET and CT images is the basis of image fusion. This paper presents a multithread registration method based on contour point cloud for 3D whole-body PET and CT images. Firstly, a geometric feature-based segmentation (GFS) method and a dynamic threshold denoising (DTD) method are creatively proposed to preprocess CT and PET images, respectively. Next, a new automated trunk slices extraction method is presented for extracting feature point clouds. Finally, the multithread Iterative Closet Point is adopted to drive an affine transform. We compare our method with a multiresolution registration method based on Mattes Mutual Information on 13 pairs (246~286 slices per pair) of 3D whole-body PET and CT data. Experimental results demonstrate the registration effectiveness of our method with lower negative normalization correlation (NC = −0.933) on feature images and less Euclidean distance error (ED = 2.826) on landmark points, outperforming the source data (NC = −0.496, ED = 25.847) and the compared method (NC = −0.614, ED = 16.085). Moreover, our method is about ten times faster than the compared one.

A Novel Fusion Framework Based on Adaptive PCNN in NSCT Domain for Whole-Body PET and CT Images.

The PET and CT fusion images, combining the anatomical and functional information, have important clinical meaning. This paper proposes a novel fusion framework based on adaptive pulse-coupled neural networks (PCNNs) in nonsubsampled contourlet transform (NSCT) domain for fusing whole-body PET and CT images. Firstly, the gradient average of each pixel is chosen as the linking strength of PCNN model to implement self-adaptability. Secondly, to improve the fusion performance, the novel sum-modified Laplacian (NSML) and energy of edge (EOE) are extracted as the external inputs of the PCNN models for low- and high-pass subbands, respectively. Lastly, the rule of max region energy is adopted as the fusion rule and different energy templates are employed in the low- and high-pass subbands. The experimental results on whole-body PET and CT data (239 slices contained by each modality) show that the proposed framework outperforms the other six methods in terms of the seven commonly used fusion performance metrics.

The Evaluation of SPECT-CT in the Early Management of Acute Charcot Osteoarthropathy (CN)

Category: Diabetes Introduction/Purpose: Charcot osteooarthropathy (CN) is a debilitating condition afflicting the bone, soft tissue and joints of foot and ankle and is related to pain insensitivity. Its pathogenesis and natural progression is poorly understood. In patients with high clinical suspicion, treatment with immediate off-loading and immobilisation may halt and (help to) reverse or prevent deformity. We aim to establish the role of SPECT CT in the diagnosis of acute charcot osteoarthropathy of the red swollen foot prior to radiographic changes and assess its reliability in diagnostic accuracy and guiding treatment. Methods: A prospective, observational review of all patients presenting to the multidisciplinary diabetic foot clinic from 1st Jan 2009 to 1st Jan 2013 with clinically suspected acute active charcot arthropathy was performed. All patients with a high clinical suspicion of acute CN and normal radiographs, underwent SPECT-CT within 10 days of the assessment after emergency off-loading in a TCC. A positive SPECT CT scan for new onset acute CN was diagnosed if radioisotope uptake was seen in all 3 phases of scanning. Further CT fusion images provided localization of ongoing activity. All patients were followed up for 1-year or until treatment ceased and treated in concordance with clinical symptoms and SPECT CT imaging. Results: In total 137 patients were referred or self referred with a high suspicion of new onset acute CN. The majority being diabetic (98%), including 116 unilaterally symptomatic feet with normal radiographs; 86 were consequently positively confirmed on SPECT-CT CN; 15 new ‘diabetic’ fractures were diagnosed on the CT component. At 1 year – only 5 patients went on to develop radiological changes consistent with charcot arthropathy even with accepted off loading in TCC. Thirty negative scans were recorded where no triple phase trace response &amp; localisation was uni-focal or not associated with skeletal structures. Differential diagnosis included cellulitis, degenerative changes, old fractures, and planter fasciitis were made. At 1-year none of the patients were found to have developed CN in neither in the form of foot deformity nor radiological evidence of fragmentation or loss of normal bone anatomy. Conclusion: A combination of symptoms including swelling, pain and/or heat, positive three phase tracer uptake and localisation on SPECT CT can identify and aid the management of acute active CN in radiographically normal feet. Positive scans seem to identify an intermediate grade of charcot arthropathy where cortical fractures have occurred with significant subchondral bone turnover. A negative scan excludes high-risk feet for CN confidently and thus can direct treatment. We find SPECT CT a valuable addition to the armamentarium of the treating physician in instituting off loading to prevent the possible progression and onset of deformity and avoiding unnecessary treatment.

One-stage posterior retaining part facet joint in laminectomy and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis

?To evaluate the feasibility and effectiveness of one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis. ?Between January 2010 and December 2014, 32 cases of lumbosacral spinal tuberculosis (L4-S1) were treated by one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation. There were 20 males and 12 females, aged 17-62 years (mean, 43 years). The disease duration was 12-48 months (mean, 18 months). The involved segments included L5, S1 level in 19 cases and L4, 5 level in 13 cases. The effectiveness was evaluated by Oswestry disability index (ODI) and imaging parameters (lumbar-sacral angle correction and Bridwell classification and CT fusion criteria) after operation. ?The operation was successfully completed in all patients; the average operation time was 180 minutes, and the average intraoperative blood loss was 400 mL. All cases were followed up 12 to 67 months (mean, 15.6 months). At last follow-up, common toxic symptom of tuberculosis disappeared, and no internal fixation failure occurred. Neurological function was recovered to normal in 7 patients with neurological symptoms, and American Spinal Injury Association (ASIA) scale was improved to grade E from grade C (2 cases) and grade D (5 cases) before operation. At 1 year and last follow-up, the ODI scores were significantly improved when compared with preoperative score (P<0.05), but no significant difference was found between at 1 year and last follow-up (P>0.05). The lumbarsacral angle was significantly increased at 7 days, 1 year and last follow-up when compared with preoperative one (P<0.05), but there was no significant difference between different time points after operation (P>0.05). The bone graft fusion time was 9-24 months (mean, 12 months). At 1 year after operation and last follow-up, X-ray Bridwill bone fusion rates were 87.50% (28/32) and 93.75% (30/32) respectively, and CT fusion rates were 87.50% (28/32) and 90.63% (29/32) respectively; and there was significant difference in interbody fusion between at 1 year and last follow-up (P<0.05). Drug resistance was observed in 4 cases; Bridwill grade Ⅲ and grade Ⅳ fusion was shown in 3 cases and 1 case after adjusting the anti-tuberculosis scheme after 1 year. ?One-stage posterior retaining part facet joint in laminectomy and debridement can effectively clear the tuberculose focus, intervertebral bone graft combined with short segment pedicle screw fixation can maintain postoperative spinal reliable stability and get satisfactory bone fusion rate, so it is an effective method for the treatment of lumbosacral tuberculosis.