Images Of Limbs Research Articles

Three-Dimensional Imaging Analysis of the Developmental Process of Posterior Meniscofemoral Ligaments in Rat Embryos

Introduction: The posterior meniscofemoral ligament (pMFL) of knee joint is a ligament that runs posterior to the posterior cruciate ligament and it is known that the height of the pMFL attachment site causes meniscus avulsion. Therefore, understanding the three-dimensional (3D) structure of the pMFL attachment site is essential to better understand the pathogenesis of meniscus disorders. However, the developmental process of pMFL has not been well investigated. The purpose of this study was to analyze pMFL development in rat knee joints using 3D reconstructed images produced from episcopic fluorescence image capture (EFIC) images and examine its relationship with other knee joint components. Methods: Knee joints of Wistar rat embryos between embryonic day (E) 16 and E21 were observed with HE-stained tissues. Serial EFIC images of the hind limbs of E17–E21 were, respectively, captured from which 3D images were reconstructed and the features of pMFL structure: length and angle were measured. Besides, the chronological volume changes and the volume ratio of the knee joint components compared to E17 were calculated to identify the differences in growth by components. Results: pMFL was observed from E17 and was attached to the medial femoral condyle and lateral meniscus at all developmental stages, as in mature rats. The lack of marked variation in the attachment site and angle of the pMFL with the developmental stage indicates that the pMFL and surrounding knee joint components developed while maintaining their positional relationship from the onset of development. Conclusion: Current results may support to congenital etiology of meniscus disorder.

Thinner femoral cortical thickness in patients with destructive rheumatoid arthritis of the knee

BackgroundThe examination of femoral cortical bone thickness in patients with rheumatoid arthritis (RA) has been notably limited in prior research. We aimed to compare femoral cortical thickness in patients with rheumatoid arthritis (RA) and healthy controls and to investigate the association between femoral cortical thickness and clinical parameters within the RA group.MethodsForty-four patients (58 limbs) with RA who underwent total knee arthroplasty were enrolled. Preoperative computed tomography images of the lower limbs were analyzed. The femoral cortex was divided into the proximal, central, and distal diaphysis regions and further into the anterior, posterior, medial, and lateral regions. The divisions were measured using Stradwin® software and standardized by femoral length. Femoral cortical thickness was compared between RA and healthy control (n = 25) groups. Correlation analyses between standardized cortical thickness and disease parameters were performed in the RA group.ResultsThe RA group had significantly lower standardized femoral cortical thickness at the anterior and medial distal diaphysis than healthy controls. Standardized proximal lateral and central lateral in the RA group were significantly larger than those in the healthy control groups. Standardized femoral cortical thickness was significantly correlated with bone mineral density (BMD) in 11 areas, except the posterior central diaphysis, and with body mass index in 8 areas, except the central posterior, distal lateral, distal anterior, and distal medial diaphysis.ConclusionsFemoral cortical thinning was noted in patients with RA complicated with destructive knee, particularly at the anterior and medial distal diaphysis. Femoral cortical thickness was significantly correlated with BMD and body mass index (BMI); thus, patients with RA and low BMD and BMI should be cared for to prevent fragility fractures.

Smartphone-Based Infrared Thermography as an Option for Evaluating the Treatment Effect of Revascularization Procedure in Patients With Peripheral Arterial Disease, a Prospective Study

Infrared imaging has been used to assess peripheral perfusion; however, large, heavy, and prohibitively expensive cameras have precluded its adoption for widespread clinical applications. With advent of more affordable and portable infrared cameras in recent years, they have become more accessible for clinical use. In this study, we aim to introduce the use of smart phone based thermal camera using thermal ankle-brachial index (TABI) to assess the perfusion in peripheral arterial disease (PAD)-affected lower extremities both preintervention and postintervention and simultaneously comparing with ABI. To our knowledge, this is the first study in the Indian scenario. We included 52 patients with 67 lower limbs with PAD requiring revascularization who presented to our institute between July 2020 and December 2021 in the study. Revascularization procedures included endovascular or open surgical bypass. ABI was measured in affected lower limb using Handheld Doppler device before revascularization, after revascularization at discharge and at 1-month follow-up after revascularization. Thermal images of upper and lower limbs were obtained using FLIR ONE PRO (a smartphone-based infrared thermal camera) at the time of measuring ABI. TABI was calculated by dividing maximum lower limb temperature by maximum upper limb temperature. ABI and TABI were compared for correlation using Pearson analysis. After revascularization, there was statistically significant improvement in ABI, 0.38 ± 0.20, t(66) = 15.1; P < .001, and TABI, 0.09 ± 0.053, t(66)=14.2; P < .001, at discharge when compared with before intervention (Table). Before intervention, positive correlation was found between ABI and Lower limb temperature (r = 0.973; P < .001) and ABI and TABI (r = 0.810; P < .001). After intervention at discharge, positive correlation was found between ABI and Lower limb temperature (r = 0.682; P < .001) and ABI and TABI (r = 0.662; P < .001). At the 1-month follow-up after intervention, positive correlation was found between ABI and Lower limb temperature (r = 0.874; P < .001) and ABI and TABI (r = 0.663; P < .001). Smart phone-based thermal imaging can be used to assess perfusion status in PAD in clinical settings as non-invasive, portable, cost effective and reproducible alternative to ABI. It has shown improvement in perfusion status corresponding to standard Doppler ABI.TableShowing descriptive analysis of revascularized lower limbsBefore interventionAfter intervention at dischargeAt the 1-month follow-upABITABILower extremity temperature (℉)Ambient temperature (℉)ABITABILower extremity temperature (℉)Ambient temperature (℉)ABITABILower extremity temperature (℉)Ambient temperature (℉)Mean.28.8382.786.4.67.9392.986.8.68.9492.987.7Median.27.8382.988.4.67.9592.688.4.67.9692.688.2Std deviation.21.044.219.40.22.065.779.54.17.055.348.64Minimum.00.7574.864.0.00.7879.560.8.00.7878.664.2Maximum.83.9796.6101.41.11.02103.6102.31.11.02103.1102.3Range.83.2221.837.41.1.2424.141.51.1.2424.538.1Interquartile range.28.045.37.90.21.1010.137.35.19.099.456.67TABI, Thermal ankle-brachial index. Open table in a new tab

Thermographic evaluation of acupoints in lower limb region of individuals with osteoarthritis: A cross-sectional case-control study protocol.

Acupuncture has been widely used in the treatment of knee osteoarthritis (KOA), but the selection of acupoints is indeterminate and lacks biological basis. The skin temperature of acupoints can reflect the state of local tissue and may be a potential factor for guiding acupoint selection. This study aims to compare the skin temperature of acupoints between KOA patients and the healthy population. This is a protocol for a cross-sectional case-control study with 170 KOA patients and 170 age- and gender-matched healthy individuals. Diagnosed patients aged 45 to 70 will be recruited in the KOA group. Participants in the healthy group will be matched with the KOA group based on mean age and gender distribution. Skin temperature of 11 acupoints (ST35, EX-LE5, GB33, GB34, EX-LE2, ST34, ST36, GB39, BL40, SP9, SP10) will be extracted from infrared thermography (IRT) images of the lower limbs. Other measurements will include demographic data (gender, age, ethnicity, education, height, weight, BMI) and disease-related data (numerical rating scale, pain sites, duration of pain, pain descriptors, pain activities). The results of this study will provide biological evidence for acupoint selection. This study is a precondition for follow-up studies, in which the value of optimized acupoint selection will be verified. ChiCTR2200058867.

Two Cases of Myofibrillar Myopathies: Genetic and Quality of Life Study

We describe two cases of myofibrillar myopathies, due to different gene mutations. The first was a girl with cardiomyopathy and sensory axonal neuropathy that underwent cardiac transplantation at 15 years and suffers from rotatory scoliosis due to BAG3 mutation. The second is a male patient, with evident limb-girdle weakness since age 3. Two muscle biopsies were performed at ages 3 and 15, with muscle MRI, and LDB3 gene sequence analysis also carried out. Muscle biopsies revealed the presence of dystrophic changes in the first biopsy and myopathic abnormalities in the second, and the MRI images of the lower limbs showed an asymmetrical involvement in the thigh of quadriceps muscles and in the calf of gastrocnemius muscles. The patient was responsive to treatment with an intermittent steroid regimen and muscle-strengthening exercises. Considerations on both muscle–bone interaction and psychological and socioeconomic conditions are carried out for both cases.

Assessing Leg Length Discrepancy Is Necessary Before Arthroplasty in Patients With Unilateral Crowe Type IV Hip Dislocation.

THA for high-riding developmental dysplasia of the hip (DDH) is challenging in terms of length equalization. Although previous studies suggested preoperative templating on AP pelvic radiographs is insufficient in patients with unilateral high-riding DDH because of hypoplasia of the hemipelvis on the affected side and unequal femoral and tibial length on scanograms, the results were controversial. The EOS™ (EOS™ Imaging) is a biplane X-ray imaging system using slot-scanning technology. Length and alignment measurements have been shown to be accurate. We used the EOS to compare the lower limb length and alignment in patients with unilateral high-riding DDH. (1) Is there an overall leg length difference in patients with unilateral Crowe Type IV hip dysplasia? (2) In patients with unilateral Crowe Type IV hip dysplasia with an overall leg length difference, is there a consistent pattern of abnormalities in the femur or tibia that account for observed differences? (3) What is the impact of unilateral high-riding Crowe Type IV dysplasia on femoral neck offset and knee coronal alignment? Between March 2018 and April 2021, we treated 61 patients with THA for Crowe Type IV DDH (high-riding dislocation). EOS imaging was performed preoperatively in all patients. Eighteen percent (11 of 61) of the patients were excluded because of involvement of the opposite hip, 3% (two of 61) were excluded for neuromuscular involvement, and 13% (eight of 61) had previous surgery or fracture, leaving 40 patients for analysis in this prospective, cross-sectional study. Each patient's demographic, clinical, and radiographic information was collected with a checklist using charts, Picture Archiving and Communication System, and an EOS database. EOS-related measurements that were related to the proximal femur, limb length, and knee-related angles were recorded for both sides by two examiners. The findings of the two sides were statistically compared. The overall limb length was not different between the dislocated and nondislocated sides (mean 725 ± 40 mm versus 722 ± 45 mm, mean difference 3 mm [95% CI -3 to 9 mm); p = 0.08). Apparent leg length was shorter on the dislocated side (mean 742 ± 44 mm versus 767 ± 52 mm, mean difference -25 mm [95% CI -32 to 3 mm]; p < 0.001). We observed that a longer tibia on the dislocated side was the only consistent pattern (mean 338 ± 19 mm versus 335 ± 20 mm, mean difference 4 [95% CI 2 to 6 mm]; p = 0.002), but there was no difference between the femur length (mean 346 ± 21 mm versus 343 ± 19 mm, mean difference 3 mm [95% CI -1 to 7]; p = 0.10). The femur of the dislocated side was longer by greater than 5 mm in 40% (16 of 40) of patients and shorter in 20% (eight of 40). The mean femoral neck offset of the involved side was shorter than that of the normal side (mean 28 ± 8 mm versus 39 ± 8 mm, mean difference -11 mm [95% CI -14 to -8 mm]; p < 0.001). There was a higher valgus alignment of the knee on the dislocated side with a decreased lateral distal femoral angle (mean 84° ± 3° versus 89° ± 3°, mean difference - 5° [95% CI -6° to -4°]; p < 0.001) and increased medial proximal tibia angle (mean 89° ± 3° versus 87° ± 3°, mean difference 1° [95% CI 0° to 2°]; p = 0.04). A consistent pattern of anatomic alteration on the contralateral side does not exist in Crowe Type IV hips except for the length of the tibia. All parameters of the limb length could be shorter, equal to, or longer on the dislocated side. Given this unpredictability, AP pelvis radiographs are not sufficient for preoperative planning, and individualized preoperative planning using full-length images of the lower limbs should be performed before arthroplasty in Crowe Type IV hips. Level I, prognostic study.

Perforator anastomosis of the sural artery system and its application in extended gastrocnemius flap

IntroductionThe conventional management for long defects involving the middle one third of leg with exposed bone is cover by a combination of soleus with fasciocutaneous or gastrocnemius flap. To decrease operative time, donor site morbidity and complexity of surgery we offer a simpler flap where the territory of the gastrocnemius myocutaneous flap can be extended by including the septocutaneous perforators in the leg. Material & MethodsThe vascular basis of the flap was determined by studying Digital Subtraction Angiography(DSA) images of lower limbs of 10 patients who had undergone the procedure for pathology in systems other than the lower limb.Following this study, we operated 18 cases over 2 years. All cases were of post-traumatic defects of middle and proximal part of lower third of leg that were treated with extended gastrocnemius myocutaneous flap in department of plastic surgery. The length of defect, length of flap used, means operative time and flap complications in the post op Period would be recorded. ResultsThe DSA study revealed various perforator anastomosis between the distal branch of the sural with the posterior tibial and peroneal system. Of these a grade 2- grade 2 perforator anastomosis was most common.On evaluation of the 18 patients of Gustillo Type 3b fracture that were covered with the extended flap, we found the mean operative time for the procedure to be 86 min (range 68–108 min). The average length of defect covered was 9.7 cm and the average dimension of flap was 23.09 cm in length and 7.9 cm in breadth. In the postoperative period no patient has a flap failure of necrosis of the distal stich line. ConclusionThis extended gastrocnemius myocutaneous flap is a good option to tackle long defects overlying the middle and lower thirds of tibia. It offers a much simpler and faster alternative to using two flaps in combination. The vascular basis of the flap appears sound as there is usually a grade 2-grade 2 perforator anastomosis between the sural system with the posterior tibial and peroneal systems.

Accessory Lymphatic Drainage Pathways on Indocyanine Green Lymphography in Patients with Breast Cancer-Related Lymphedema.

Current predictive models of lymphedema risk cannot predict with 100% certainty which patients will go on to develop lymphedema and which will not. Patient-specific anatomic and physiologic differences may be the missing factor. The authors hypothesize that patients with accessory lymphatic pathways may have improved lymphatic drainage, resulting in smaller limb volumes. The authors reviewed indocyanine green (ICG) lymphography images of all patients who presented to their institution for evaluation of breast cancer-related lymphedema. Patients with unilateral upper extremity lymphedema, a full set of bilateral limb measurements, and ICG images of both limbs were included. Other variables of interest included patient demographics and length of follow-up. Patients with accessory pathways were determined independently, and conflicts were resolved with discussion. Abnormal images were also evaluated for common drainage pathways. Thirty patients were identified as having accessory lymphatic drainage pathways. These patients had significantly smaller limb volume differences [8.19% (SD, 11.22)] compared with patients who did not exhibit these pathways [20.74% (SD, 19.76); P < 0.001]. The most common pathway was absence or rerouting of the radial bundle to the ulnar or volar bundles ( n = 16). The ability to create accessory lymphatic drainage pathways may be associated with improved lymphatic drainage, resulting in smaller limb volumes. Furthermore, certain drainage pathways appear to be more common than others. Description of these pathways should be considered for inclusion in ICG lymphography image grading criteria. Further study is needed to clarify the nature of these pathways and whether these pathways affect subjective symptoms and quality of life. Risk, II.

Analysis of clinical phenotype and genetic variant in a Chinese pedigree affected with cleidocranial dysplasia

To analyze the clinical features and pathogenic variant in a Chinese pedigree affected with cleidocranial dysplasia (CCD). Clinical data of 8 patients from the pedigree was collected, including physical examination and X-ray images of head, face, spine, limbs, and mouth. Peripheral blood samples were collected from 6 affected members for the extraction of genomic DNA. The proband and other 3 patients were subjected to trio-whole exome sequencing. Candidate variant was verified by Sanger sequencing of the other 2 affected members from the pedigree. This pedigree has included 22 members (8 affected) from four generations. Genetic testing revealed that the proband has harbored a novel pathogenic variant of the RUNX2 gene [NM_001024630: c.1268_1277del (p.P425Afs*56)], which was inherited from her mother and carried by all affected members in the pedigree. The same variant was not detected among the unaffected members, suggesting co-segregation with the phenotype. The c.1268_1277del (p.P425Afs*56) variant of the RUNX2 gene probably underlay the pathogenesis of CCD in this pedigree. Genetic testing has facilitated the definite diagnosis and enabled prenatal diagnosis.

Muscle Atrophy Evaluation via Radiomics Analysis Using Ultrasound Images: A Cohort Data Study.

Existing methods for muscle atrophy evaluation based on muscle size measures from ultrasound images are inadequate in precision. Radiomics has been widely used in various medical studies, but its validity for the evaluation of muscle atrophy has not been fully explored. This study presents a radiomics analysis for muscle atrophy evaluation using ultrasound images. The hindlimb unloading rat model was developed to simulate weightlessness muscle atrophy and ultrasound images of the hind limbs were acquired for both the hindlimb unloaded (HU) and control groups during a 21-day HU period. A total of 368 radiomics features were extracted and the stable and informative features were selected through a two-stage feature selection procedure. The feature change trajectory of the stable features was analyzed using the hierarchical clustering method. Finally, an adaptive longitudinal feature selection and grading network, ALNet, was developed to evaluate muscle atrophy. The clustering trajectories of ultrasound image features showed similar trends to the changes in muscle atrophy at the molecular level. The best grading accuracy achieved by the ALNet was 79.5% for the Soleus (Sol) muscle and 82.6% for the Gastrocnemius (Gas) muscle. The test-retest is essential in performing radiomics analysis on ultrasound images. The longitudinal feature selection is important for muscle atrophy grading. The ultrasound image features of the Gas muscle have better discrimination ability than that of the Sol muscle. This study proves for the first time the capability of ultrasound image features for muscle atrophy evaluation.

Imaging study and clinical application of peroneal perforating chimeric tissue flap

To explore the feasibility of peroneal perforating chimeric tissue flap in repairing the composite defects of calf and heel based on lower limb angiography, and the clinical effect. The digital subtraction angiography images of lower limbs of 50 patients met the selection criteria between May 2011 and October 2014 were used as the research object to observe the course of peroneal artery and its perforating vessels. Based on the observation results, between April 2015 and October 2020, the peroneal perforating chimeric tissue flap was designed to repair 7 cases of composite defects of the calf and heel. There were 5 males and 2 females with an average age of 38 years (range, 25-55 years). The causes of injury included traffic accident in 4 cases, falling from height in 2 cases, and machine strangulation in 1 case. There were 5 cases of calf skin defect and tibial defect. The size of skin defect ranged from 5 cm×3 cm to 11 cm×7 cm, and the length of bone defect was 5-8 cm. There were 2 cases of heel skin defect and calcaneal defect. The sizes of skin defects were 5.0 cm×4.0 cm and 7.5 cm×6.5 cm, and the bone defects were 3.0 cm×2.6 cm and 4.0 cm× 3.0 cm. For the calf defect, the size of skin flap ranged from 6 cm×4 cm to 12 cm×8 cm, and the length of the fibula was the same as that of the tibial defect. For the heel defect, the sizes of the skin flaps were 8.5 cm×5.5 cm and 13.0 cm×5.0 cm, and the lengths of the fibulae were 10 cm and 12 cm. Free transplantation was performed in 5 cases and pedicle transplantation in 2 cases. The wound at donor site was repaired with skin grafting or sutured directly. The peroneal artery ran close to the fibula 7.25-8.40 cm below the fibula head and send out 5-7 perforating vessels, with an average of 6.5 vessels. Perforating vessels mainly appeared in four places, which were (9.75±0.91), (13.21±0.74), (18.15±1.22), and (21.40±0.75) cm below the fibular head, with the occurrence rates of 94%, 90%, 96%, and 88%, respectively. Clinical application of 7 cases of peroneal perforating chimeric tissue flap all survived, all wounds healed by first intention. The skin graft at donor site survived and the incision healed by first intention. All patients were followed up 6-36 months, with an average of 12 months. Peroneal perforator chimeric tissue flap had good shape and soft texture. X-ray films showed that the bone graft healed well, and the healing time was 6-11 months (mean, 7 months). No obvious bone resorption was observed during follow-up. Five patients had no pain when walking, and 1 had mild pain with claudication. Postoperative heel ulcers formed in 1 case and healed after wearing custom plantar pressure dispersing shoes. At 6 months after operation, 2 patients were rated as grade Ⅳ and 5 patients as grade Ⅴ according to Holden walking function score. The peroneal perforating vessel distribution is constant and the peroneal perforating chimeric tissue flap is safe and reliable for repairing the composite defects of calf and heel.

Quantitative Sound Speed Imaging of Cortical Bone and Soft Tissue: Results From Observational Data Sets.

This work presents the first quantitative ultrasonic sound speed images of ex vivo limb cross-sections containing both soft tissue and bone using Full Waveform Inversion (FWI) with level set (LS) and travel time regularization. The estimated bulk sound speed of bone and soft tissue are within 10% and 1%, respectively, of ground truth estimates. The sound speed imagery shows muscle, connective tissue and bone features. Typically, ultrasound tomography (UST) using FWI is applied to imaging breast tissue properties (e.g. sound speed and density) that correlate with cancer. With further development, UST systems have the potential to deliver volumetric operator independent tissue property images of limbs with non-ionizing and portable hardware platforms. This work addresses the algorithmic challenges of imaging the sound speed of bone and soft tissue by combining FWI with LS regularization and travel time methods to recover soft tissue and bone sound speed with improved accuracy and reduced soft tissue artifacts when compared to conventional FWI. The value of leveraging LS and travel time methods is realized by evidence of improved bone geometry estimates as well as promising convergence properties and reduced risk of final model errors due to un-modeled shear wave propagation. Ex vivo bulk measurements of sound speed and MRI cross-sections validates the final inversion results.

Trichlorfon for Treatment of Cutaneous Habronemosis - Evaluation of Intravenous Regional Perfusion in the Distal Equine Limbs

Background: Equine cutaneous habronemiasis is common in the distal regions of the limbs. Organophosphates, applied systemically, one previously used treatment, which is highly effective, but currently in disuse, due to the risks of intoxica-tion. Regional perfusion is a potential technique for distal limb wounds, since, in addition to being used in low doses, it prevents systemic circulation of the drug and possible intoxication, and has a lower treatment cost. The current work aimed to perform clinical, laboratory, and venography evaluations of the use of trichlorfon in regional intravenous perfusion, as a possible form of treatment for cutaneous habronemosis in the distal region of equine limbs.Materials, Methods &amp; Results: Twelve horses were used, divided into two groups, with the left thoracic limb (LTL) being the test limb, and the right thoracic limb (RTL) the control limb. At moment zero (M0), distal radiography and venography were performed. The tourniquet was then loosened and after five minutes, at moment one (M1), the tourniquet was repositioned for 1.25 mg/kg (G1) and 5.5mg/kg (G2) trichlorfon injections into the left thoracic limb, diluted in 20 mL of Ringer's lactate solution, and 20 mL of Ringer's lactate solution was applied to the right thoracic limb. The tourniquet was maintained for 30 minutes after infusion in both groups. At moment two (M2), four days later, blood tests, radiography, and venography were repeated. Every day between M0 and M2, physical examinations were performed, including measurement of the pastern, fetlock, and coronet band, and a lameness examination. There were no significant alterations in clinical parameters, behavior, and appetite. In the blood cell count, there was an increase in leukocytes on D4 in G2, although remaining within the reference values for the species. The biochemical tests showed no alterations. There were no changes in the circumferences evaluated and 4 horses from G2 presented lameness in the LTL and one in the RTL. In the venograms, one G2 animal was noticed to be hypoperfused in all LTL plexuses. Discussion: The use of trichlorfon in regional perfusion at a dose of 1.25 mg/kg demonstrated safety, with no clinical, laboratory, and lameness changes in any of the animals. At the highest dose (5.5 mg/kg), individual reactions were observed, such as different degrees of lameness, swelling, and heat in foot. Serial venographies document the response to treatment used, it was decided to perform the second venography 4 days after the trichlorfon perfusion and the first initial venography evaluation, following the recommendations for the repetition time of the examination and evaluation of the use of the drug. The evaluation of radiographic images of venography, in a grading system created considering the range of contrast in five regions by the three examiners experienced in podiatry and the analysis of radiographic images of limbs of horses, without having participated in the previous procedures was important for the reliability of the assessment. The areas of hypoperfusion observed in the venography were not related to trichlorfon perfusion. It is essential that the application of trichlorfon be performed correctly, intravenously, to avoid reactions such as necrosis, pain, edema, erythema, lameness, and even more severe inflammatory reactions, such as phlegmon and thrombophlebitis. Although a small number of animals were used in this study, trichlorfon regional perfusion of equine limbs, at a dose of 1.25 mg/kg may be a technique appears to be inert to hoof vascularization.

Improving the protocol for whole-body CT scans in trauma patients.

While whole-body computed tomography is an established diagnostic method for the work up of polytraumatized patients, the protocols used differ between trauma centers. This study aimed to compare scan duration and estimated radiation of two protocols. Secondary aim was to assess if using the revised CT protocol reduced the number of additional images of the upper extremities. Two groups of consecutive trauma patients, which both received a whole-body CT, were analyzed. Patients, who received a three-phased CT during which their arms needed to be repositioned from their side to above the head, were assigned to group A. Those, who received a CT with their arms placed on a pillow ventral to the abdomen throughout the entire scan were assigned to group B. Estimated radiation dose, scan duration, number of upper limb injuries and number of additional images of the upper limbs within 24h after initial CT were assessed. Group A consisted of 182 patients, group B of 218. The scan duration was 3min shorter (p < 0.001) and the estimated radiation dose lower (15.0 vs 22.9mSv, p < 0.001) in group B. There was no difference in the number of upper limb injuries detected or the number of upper limb additional images required within 24h. Using a whole-body CT scan protocol in which the arms remain on a pillow ventral to the torso instead of one which requires a repositioning of the arms, both scan duration and estimated radiation dose can be reduced. Despite the arms being within the scanned area in the revised protocol, the number of additional imaging of the upper extremities could not be reduced.

External waveguide magnetic resonance imaging for lower limbs at 3 T.

We report a method based on the traveling-wave MRI approach, in order to acquire images of human lower limbs with an external waveguide at 3T. We use a parallel-plate waveguide and an RF surface coil for reception, while a whole-body birdcage is used for transmission. The waveguide and the surface coil are located right outside the magnet, in the magnetic resonance (MR) conditional devices zone. We ran numerical simulations to investigate the field generated by the surface coil located at one of the waveguides, as well as a saline-solution phantom positioned on the opposite side (150cm away) inside the magnet. We obtained phantom images by varying the distance between the coil and the phantom, in order to investigate the signal-to-noise ratio and to validate our numerical simulations. Lower limb images of a healthy volunteer were also acquired, demonstrating the viability of this approach. Standard pulse sequences were used and no physical modifications were made to the MR imager. These numerical and experimental results show that traveling-wave MRI can produce high-quality images with only a simple waveguide and an RF coil located outside the magnet. This can be particularly favorable when acquiring images of lower limbs requiring a larger field ofview.

Application of digital subtraction angiography in canine hindlimb arteriography

Research in the field of lower extremity vascular disease has increased in popularity over the years. To adequately characterize and validate the effectiveness of vascular interventions, in vivo experimentation in large animals is required. Thus, it is necessary to find a method to detect the shape and density of blood vessels in the lower extremities that can evaluate and verify the treatment measures' effectiveness and have high accuracy and repeatability. This study characterized factors that determined both the accuracy and overall value of digital subtraction angiography in lower limb arteriography using a canine animal model. Six beagle dogs were anesthetized and immobilized on the motorized table. The femoral artery was accessed using an indwelling needle. A bolus of contrast agent was injected into the access site, and digital subtraction angiography with bolus chase technology was used to collect contrast images for analysis. At the end of the procedure, the anesthetized dogs were euthanized using an overdose of potassium chloride. After confirming the euthanasia of the dogs, the cadavers were taken to the experimental animal center of Xinjiang Medical University and processed by qualified institutional personnel. The final arteriographic images of the hind limbs from all six dogs were precise, and the branches of small vessels could be distinguished without any visible artifacts. These results suggested that arteriography using digital subtraction angiography could reveal the shape and density of blood vessels in canine animal models. This method has great potential to significantly improve research related to limb ischemia due to its simple and reproducible results.

Study on the Design and Optimization of a Portable Monitoring and Auxiliary Treatment Device for Upper Extremity Lymphedema-Focus on the Rehabilitation Function of the Device.

Female patients suffer from the risk of upper limb lymphedema after breast cancer removal surgery. At present, the detection and the adjuvant treatment of this disease are not convenient enough, leading to delay of the disease and increase in the burden of patients. This paper presents a portable monitoring and treatment device for upper extremity lymphedema, enabling patients to monitor the symptoms of upper limb lymphedema and auxiliary rehabilitation. This design utilizes the arm circumference measurement and contrast method to realize symptom monitoring. The device realizes auxiliary rehabilitation using the regional pressure method to imitate traditional manual lymphatic drainage technology. According to the MRI images of volunteers’ upper limbs, the upper arm and forearm’s finite element models are reconstructed in ANSYS. The static simulation experiment is completed. The working mode and parameter design of each rehabilitation module of the device are obtained. The experimental results show that the integrated design principle of monitoring and treatment proposed in this paper has good feasibility, has auxiliary rehabilitation effect, and meets the principle of human comfort. The device can help patients find lymphedema in time and implement auxiliary treatment, which can effectively avoid the further deterioration of lymphedema.

A Deep Learning-Based Model That Reduces Speed of Sound Aberrations for Improved In Vivo Photoacoustic Imaging.

Photoacoustic imaging (PAI) has attracted great attention as a medical imaging method. Typically, photoacoustic (PA) images are reconstructed via beamforming, but many factors still hinder the beamforming techniques in reconstructing optimal images in terms of image resolution, imaging depth, or processing speed. Here, we demonstrate a novel deep learning PAI that uses multiple speed of sound (SoS) inputs. With this novel method, we achieved SoS aberration mitigation, streak artifact removal, and temporal resolution improvement all at once in structural and functional in vivo PA images of healthy human limbs and melanoma patients. The presented method produces high-contrast PA images in vivo with reduced distortion, even in adverse conditions where the medium is heterogeneous and/or the data sampling is sparse. Thus, we believe that this new method can achieve high image quality with fast data acquisition and can contribute to the advance of clinical PAI.

Analysis of collateral lymphatic circulation in patients with lower limb lymphedema using magnetic resonance lymphangiography

ObjectiveAlthough the development of lymphatic collaterals is expected following lymphedema, little is known about the anatomic details of such compensatory pathways or their association with symptoms. Magnetic resonance lymphangiography (MRL) has been shown to be superior to lymphoscintigraphy and indocyanine green lymphography in visualizing lymphatics. This study aimed to analyze MRL images of lower limbs to elucidate the patterns of lymphatic collateral formation and their association with the clinical stages of lymphedema. MethodsWe enrolled 56 consecutive patients (112 lower limbs) with lymphedema who underwent MRL. Two radiologists performed a consensus reading of MRL images for the presence or absence of collateral lymphatic pathways, and the results were compared with the clinical stages. Furthermore, the frequency of abnormal MRL findings in 43 asymptomatic lower limbs of patients with unilateral lymphedema was analyzed and compared with that in the 69 symptomatic lower limbs of the patients. The imaging findings were also compared with the cause of lymphedema. ResultsAll three collateral pathways (anterolateral, deep, and posteromedial lymphatics) were visualized at a higher (P < .05) frequency in stage II than in stage 0 lower limbs. The frequency of visualization of the three collaterals was significantly higher in symptomatic (stages I-III) lower limbs than in asymptomatic (stage 0) lower limbs. Most (76.8%) of the symptomatic limbs exhibited at least one of these collaterals, and the frequency was significantly higher than in the asymptomatic limbs (P < .001). Most (81.4%) of the asymptomatic (stage 0) lower limbs had at least one abnormal finding in terms of lymphatic circulation, although this proportion was significantly lower compared with the symptomatic limbs (98.6%). The collaterals tended to appear less frequently in primary lymphedema than in secondary lymphedema, reaching statistical significance in the posteromedial lymphatics. ConclusionsThese results suggested that the two superficial lymphatic groups and the deep lymphatic system act as major collaterals of the lower limbs in patients with lymphedema. Furthermore, MRL of most patients with unilateral lymphedema demonstrated abnormal findings, including collateral formation, not only in the affected lower limb but also in the asymptomatic lower limb. In primary lymphedema, the collaterals may appear less frequently than in secondary lymphedema. Collaterals should be taken into consideration in planning the site of lymphaticovenous anastomosis and assessing disease progression. MRL can visualize preclinical alterations in lymphatic flow and compensatory pathways; therefore, we expect that it will be useful for the early diagnosis of lymphedema.

Human Acupoint Positioning System Based on Binocular Vision

To realize accurate positioning and recognition of human acupoints in medical treatment, the automatic human acupoints recognition system based on computer binocular vision technology is considered by us. We studied a camera calibration method by plane calibration lattice. To verify and accurately locate human acupoints in medical treatment, the method adopted the principle of binocular vision technology to collect different images of human body limbs to obtain three-dimensional coordinates of space, and the positioning errors of each marker point measured by binocular vision calculation and three-dimensional coordinate measuring instrument are compared. The results show that the system can assist medical personnel to complete the human acupoints recognition and positioning, and respond to the needs of the clinical application.