Mid-sagittal View Research Articles

Infracoccygeal/transperineal window: new method to prenatally diagnose and classify level of anal atresia.

To introduce a two-dimensional sonographic method to assess the fetal anus, and to evaluate the feasibility of this method to diagnose anal atresia prenatally and identify the presence or absence of anoperineal fistula (in males) and anovestibular fistula (in females). This was an observational study of suspected cases of anal atresia referred to a single center in Israel between August 2018 and October 2023. In addition to conventional evaluation of the perineum in the axial plane, fetuses referred to our center for suspected malformation were scanned with a new method termed the 'infracoccygeal/transperineal window'. This window consisted of a midsagittal view of the fetal pelvis, including the distal rectum and the anal canal. Normal anatomy was confirmed when the anal canal was continuous with the rectum and terminated at the expected location on the perineum. In female fetuses, the normal anal canal runs parallel to the vaginal canal and diverges posteriorly, terminating at the perineal skin, distant from the vestibule. In male fetuses, the normal anal canal diverges posteriorly in relation to the corpora cavernosa, terminating at the perineal skin, distant from the scrotum. High anal atresia was identified when a blind-ending rectal pouch was demonstrated in the pelvis without a fistula to the perineum or vestibule. Low anal atresia was determined when a rectal pouch was continuous with an anteriorly deflected fistula. In females, the fistula converges with the vaginal canal, terminating at the vestibule; in males, the fistula deflects anteriorly, terminating at the base of the scrotum. Postnatally, the diagnosis and type of anal atresia were confirmed through physical examination with direct visualization of the fistula, radiographic studies, surgical examination and/or postmortem autopsy. Of the 16 fetuses diagnosed prenatally with anal atresia, eight were suspected to have low anal atresia and eight were suspected to have high anal atresia. The median gestational age at diagnosis was 23 (range, 14-37) weeks. All cases showed additional structural malformation. Eleven patients opted for termination of pregnancy, of which four had low anal atresia and seven had high anal atresia. Postnatal confirmation was not available in four cases due to curettage-induced mutilation or in-utero degradation following selective termination of the affected twin, leaving 12 cases for analysis, of which seven were diagnosed with low anal atresia and five with high anal atresia. In these 12 cases, all prenatal diagnoses were confirmed as correct, rendering 100% sensitivity and 100% specificity in this high-risk fetal population. The infracoccygeal/transperineal window is an effective method to detect and classify the level of anal atresia prenatally. This may improve prediction of postnatal fetal continence and optimize prenatal counseling. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Transvaginal three-dimensional ultrasound assessment of embryonic genital tubercle at 8-10+6weeks of gestation.

To assess embryonic genital tubercle using transvaginal three-dimensional (3D) ultrasound at 8-10+6weeks of gestation. One-hundred and two transvaginal 3D ultrasound scans were performed for first-trimester dating at 8-10+6weeks of gestation. The genital tubercle angle (GTA) and genital tubercle length (GTL) were measured with a mid-sagittal view of the embryo using the 3D ultrasound multiplanar mode. Intra- and inter-observer agreements regarding GTA and GTL were also assessed with Bland-Altman plots and intra- and inter-correlation coefficients. There were no significant differences in GTA between male and female embryos at 8, 9, 10weeks, or 8-10+6weeks of gestation, respectively. There were also no significant differences in GTL between male and female embryos at 8, 9, 10weeks, or 8-10+6weeks of gestation, respectively. However, GTL increased linearly with advancing gestation (r=0.8276, p<0.00001). Mean GTL (SD) values at 8, 9, and 10weeks were 0.833 mm (0.274), 1.623 mm (0.262), and 2.152 mm (0.420), respectively (p<0.001). Intra- and inter-reproducibilities of GTA and GTL were excellent. The intra- and inter-correlation coefficients of GTA and GTL were 0.964 and 0.995, and 0.996 and 0.9933, respectively. The genital tubercle could be identified using transvaginal 3D ultrasound at 8-10+6weeks of gestation. However, sex differentiation could not be performed at this age. The genital tubercle linearly developed with advancing gestation during the mid-first trimester of pregnancy.

Title Isolated Absent or Hypoplastic Nasal Bone during Second Trimester Scan- Should it be Considered a Major Soft Marker?

Background: For many years, absent or hypoplastic nasal bone during prenatal scans has been reported to be associated with increased risk of chromosomal abnormalities. We aimed to study the association of isolated absent or hypoplastic nasal bone with chromosomal abnormalities and genetic syndromes. Methods: a retrospective observational study conducted at BLK Max foetal medicine unit, in which women with absent or hypoplastic nasal bone during second trimester scan between 16-24weeks of gestation were recruited over a period of 2 years, from June 2021 to June 2023. Nasal bone was defined as absent when no calcification was seen below the skin of the nasal bridge in mid sagittal view of facial profile, while defined as hypoplastic nasal bone when nasal bone length was &lt;5th centile for gestation according to gestation corrected Indian charts. Absent or hypoplastic nasal bone was defined as isolated - when there was absence of other second trimester soft markers, no other structural abnormalities were seen on the ultrasound and biochemistry screen was low risk. Results :A total of 3008 women were scanned during this period, among these 21 (0.69%) foetuses were found to have absent or hypoplastic nasal bone during second trimester scan. Thirteen (61.9%) fetuses were defined to have isolated absent (n-9) or hypoplastic (n-4) nasal bone which were included in the final analysis. Out of 13, 11 women opted for invasive testing where fluorescence in situ hybridisation (FISH) for 5 common aneuploidies and Microarray (750K) were sent on the amniotic fluid as a unit protocol, and 2 parents opted against any further genetic testing. In all tested cases, FISH and chromosomal microarray reports were reported as normal. All pregnancies were continued in our study group and had favourable foetal outcomes.

Automating the Human Action of First-Trimester Biometry Measurement from Real-World Freehand Ultrasound

Objective: Automated medical image analysis solutions should closely mimic complete human actions to be useful in clinical practice. However, more often an automated image analysis solution only represents part of a human task which restricts its practical utility. In the case of ultrasound-based fetal biometry, an automated solution should ideally recognize key fetal structures in free-hand video guidance, select a standard plane from a video stream and perform biometry. A complete automated solution should automate all three sub-actions.Methods: This paper considers how to automate the complete human action of first-trimester biometry measurement from real-world freehand ultrasound. In the proposed hybrid Convolutional Neural Network (CNN) architecture design, a classification-regression-based guidance model detects and tracks fetal anatomical structures (using visual cues) in the ultrasound video. Several high-quality standard planes which contain the mid-sagittal view of the fetus are sampled at multiple timestamps (using a custom-designed confident-frame detector) based on the estimated probability values associated with predicted anatomical structures that define the biometry plane. Automated semantic segmentation is performed on the selected frames to extract fetal anatomical landmarks. A crown-rump length (CRL) estimate is calculated as the mean CRL from these multiple frames.Results: Our fully automated method shows a high correlation with clinical expert CRL measurement (Pearson ρ=0.92, R-Squared (R2)=0.84) and a low mean absolute error of 0.834 (weeks) for fetal age estimation on a test data set of 42 videos.Conclusion: A novel algorithm for standard plane detection employs a quality detection mechanism defined by clinical standards and ensuring precise biometric measurements.

Nasal Dorsum Anatomy of Major Different Ethnicities-Surgical Implications: A Multicenter Radiologic Study.

The heterogeneity of nasal features across different racial and ethnic groups is evident. This large-scale multicenter study was performed to evaluate the dorsal keystone area and its relation to superficial nasal anatomy through computed tomography (CT) scans. Six populations were included: South Caucasian, Middle Eastern, Black South African, Eastern Asian, Mestizo, and Eastern European. Each center obtained CT scans performed between January of 2020 and December of 2022 from patients presenting a nasal hump and from an age- and sex-matched control group. Osteocartilaginous measurements in relation to ethmoidal point and to rhinion, as well as their relation to superficial nasal anatomy, were collected from nasal CT scans in midsagittal view. These were compared between populations and, in each center, between patient groups (nasal hump versus no nasal hump). The study population included 600 patients (254 with nasal hump) with a mean age of 33.98 years (range, 18 to 59 years); 55.6% were women. Average distances from the ethmoidal point were 10.1 ± 3.5 mm to the rhinion and 1.68 ± 0.23 mm to the beginning point of the nasal hump. In 96% of cases, the ethmoidal point was cranial or no more than 5 mm caudal to the beginning of the nasal hump. S-shaped nasal bones were associated with nasal hump, but angulation (kyphion angle) did not correlate with nasal hump height. In most patients, the nasal hump has no ethmoid bone underneath it, and the apex is located over the septal cartilage. The ethmoidal point is a reliable landmark and should be considered when evaluating established and new preservation and structural rhinoplasty approaches.

Tela-choroidea-to-anterior-cerebral-artery distance (TACAD): novel marker on color Doppler to identify fetuses with complete or partial agenesis of corpus callosum.

To assess objectively the course of the anterior cerebral artery (ACA) by measuring its distance to the tela choroidea in the midsagittal view, and to compare this distance in normal fetuses with that in those with agenesis of the corpus callosum (ACC), a condition known to be associated with an abnormal course of the ACA. The tela-choroidea-to-anterior-cerebral-artery distance (TACAD) was measured in the midsagittal view of the brain on color Doppler, between the anterior border of the tela choroidea and the ACA at the level of the callosal genu. Reference ranges in relation to gestational age were established in a prospective, cross-sectional study of 253 normal healthy fetuses between 19 and 36 weeks of gestation. The study group included fetuses with complete ACC (n = 28) or partial ACC (n = 18). TACAD of normal fetuses showed an increase during the second half of pregnancy, with a mean value of 10.1 mm and 14.2 mm at 22 and 30 weeks of gestation, respectively. All (28/28) fetuses with complete ACC and 83% (15/18) of those with partial ACC had significantly shorter TACAD, with mean values of 3.9 mm and 6.6 mm, respectively. TACAD is a measurement that is simple to obtain during fetal color Doppler neurosonography, which enables quantification of the course of the ACA and pericallosal artery. TACAD is shorter in fetuses with complete or partial ACC than in normal fetuses and provides an objective, quantifiable value, rather than merely descriptive information. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Measuring and Comparing Cortical Surface Area of Paracentral Lobule in a Tertiary care Hospital, Bangladesh

Background: The paracentral lobule is the area on medial surface of the cerebral cortex which extends from precentral sulcus to postcentral sulcus. Any trauma, tumor, or cerebral ischemia cause lesions of motor and sensory cortex of paracentral lobule. The result of this study is very important to the radiologists and neurosurgeons for diagnosis of above mentioned diseases and the practice of safe neurosurgery. This study was carried out to observe the cortical surface area of paracentral lobule in adult male and female Bangladeshi population,may help for future research. Methods: This cross- sectional study was conducted in the Department of Anatomy, Dhaka Medical College, Dhaka, during the period of January 2017 to December 2017. Total 70 adult Bangladeshi male &amp;female people were selected, among them 35 male and 35 female, age ranging from 20-65 years. CT scan image of brain in mid sagittal view was used for this study. Data were analyzed by Unpaired Student’s ‘t’ tests. Results: The surface area of motor cortex of right and left paracentral lobule was significantly higher (p&lt;0.01) in male.Surface area of sensory cortex of both paracentral lobule was significantly higher (p&lt;0.05) in male than female. Conclusion: The present study reveals significant difference in morphological measurements of right and left paracentral lobule between male and female of adult Bangladeshi population. Bangladesh J Medicine 2023; 34(3): 235-238

Gender-related differences in the morphometry of the corpus callosum: MRI study

Background: The size and shape of the adult corpus callosum (CC) may vary with gender. There is, however, less literature available on data involving the morphometry of CC among the Indian population. Aims and Objectives: To measure the size of CC using magnetic resonance imaging (MRI) scans of normal Indian adult females and males and identify gender-related differences, if any. Materials and Methods: The dimensions of CC were measured on MRI scans on a midsagittal section view belonging to 150 (59 females, 91 males) normal Indian adults (North India) using e-measurement tools. The measurements included the maximum length and height of CC, the thickness of various parts of CC, the CC index (CCI), and the distance of CC from the frontal and occipital poles of the cerebral hemisphere. The study was carried out in the Department of Anatomy in collaboration with the Department of Radiodiagnosis, King George’s Medical University, U.P., Lucknow, India. The data was analyzed using the statistical package for social sciences, 23rd version. Means were compared for significant differences using the independent unpaired t-test. Results: The mean length of the CC was found to be 6.94±0.63 cm; mean height was 2.57±0.43 cm; the mean thickness of the genu was 9.16±2.26 mm; the mean thickness of the body was 5.09±0.99 mm; the mean thickness of splenium was 9.10±2.22 mm; the mean distance from the frontal pole was 3.66±0.35 cm; the mean distance from the occipital pole was 5.70±0.74 cm; and the mean CCI calculations showed to be 3.37±0.56. All measurements were found to be greater in males as compared to females except mean height (males 2.56±0.47 cm; females 2.59±0.37 cm) and mean thickness of the body (males 5.04±0.94 mm; females 5.17±1.06 mm). A statistically significant difference was observed in the distance of CC from the frontal pole in our population with respect to gender (P=0.03). Conclusion: Based on observations made in the study, normative data of CC measurements was generated, and it was found that there was no significant gender-related difference in the morphology of CC; the only significant difference was in the distance of the genu from the frontal pole, which was greater in females as compared to males.

Craniofacial Phenotype in Obstructive Sleep Apnea and Its Impact on Positive Airway Pressure (PAP) Adherence.

Positive airway pressure (PAP) is an important treatment tool for patients with moderate and severe obstructive sleep apnea (OSA), and adherence to PAP significantly affects treatment outcomes. Disease severity, adverse effects, and psychosocial factors are known to predict medication adherence. Cephalometric parameters have been reported to positively correlate with upper airway collapse. However, research on the correlation between these cephalometric parameters and PAP adherence remains insufficient. This study aimed to identify this relationship. This study included 185 patients with OSA who were prescribed PAP. Polysomnography (PSG) was performed to diagnose OSA, and paranasal sinus computed tomography (PNS CT) was performed to check for comorbidities of the upper airway. In addition, cephalometric parameters such as the hyoid-posterior nasal spine (H-PNS), posterior nasal spine-mandibular plane (PNS-MP), and hyoid-mandibular plane (H-MP) were measured in the midsagittal and axial CT views. Adherence was evaluated 3-12 months after the PAP prescription. A total of 136 patients were PAP-adherent, and 49 were nonadherent. There were more males in the adherent group and a higher average height in the adherent group. The PSG results showed that the apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), arousal index (AI), rapid eye movement (REM) AHI, and supine AHI were significantly higher, and the lowest oxygen saturation was lower in the adherent group. In the analysis of covariance (ANCOVA) model adjusted for sex and height, among the cephalometric parameters, H-MP was significantly longer in the adherent group (p = 0.027), and H-PNS showed a longer tendency (p = 0.074). In the logistic regression analysis model, the odds ratio (OR) and 95% confidence intervals (95% CI) of adherence and severe OSA in the third tertile compared to the first tertile of H-MP were 2.93 (1.25-6.86) and 4.00 (1.87-8.56). In the case of H-PNS, they were 2.58 (1.14-5.81) and 4.86 (2.24-10.54), respectively. This study concluded that an inferiorly placed hyoid bone in adult patients is associated with PAP adherence and disease severity.

Cleft palate in fetuses: feasibility of early diagnosis by Crystal and Realistic Vue rendering 3D ultrasound technology in the first trimester.

This study aimed to evaluate the feasibility of direct visualization of a normal fetal palate and detect cleft palate in the first trimester with a novel three-dimensional ultrasound (3D US) technique, Crystal and Realistic Vue (CRV) rendering technology. Two-dimensional (2D) images and 3D volumes of healthy and cleft palate fetuses at 11-13+6 weeks were obtained prospectively. 2D ultrasound views included the coronal view of the retronasal triangle and the midsagittal view of the face. 3D-CRV views were analyzed by multiplanar mode display. The pregnancy outcomes of all fetuses were determined during the follow-up period. In our study, 124 fetuses were recruited, including 100 healthy fetuses and 24 cleft palate fetuses. The cleft palate with lip was observed in 23 fetuses (bilateral in 15, unilateral in 6, median in 2), and one cleft palate was only found in the abnormal group. The bilateral (n = 12) and median (n = 2) cleft palates with lips and the cleft palate alone (n = 1) were associated with other anatomical or chromosomal abnormalities, and one unilateral cleft palate with cleft lip had concomitant NT thickening. In the cleft palate fetus group, 16 fetuses suffered intrauterine death, which was associated with other structural or chromosomal abnormalities in 14 fetuses, seven cases were terminated after consultation, and one was delivered at term. The coronal view of the retronasal triangle and the midsagittal view was easily obtained in all fetuses. 3D-CRV images of palatal parts were clearly obtained in all cases. Unilateral, bilateral, and median cleft palates with cleft lips were visually demonstrated and classified by the 3D-CRV technique. It is feasible to identify the palate by 3D-CRV in the first trimester in both healthy and cleft palate fetuses. Together with 2D ultrasonography as a complementary diagnostic tool, 3D-CRV is helpful in classifying the cleft palate with a reasonable degree of certainty.

Ultrasound visualization of the central nervous system during embryonic and fetal periods: Neurosonoembryology utilizing multiple three-dimensional transvaginal ultrasound technology.

To study the ultrasonographic features of the central nervous system (CNS) in normally developing embryos and fetuses with a crown-rump length (CRL) of 10-84mm, utilizing a high-frequency transvaginal probe in conjunction with various three-dimensional (3D) imaging modes. From January 2020 to February 2021, 210 normally developing embryos and fetuses in early pregnancy were enrolled and classified based on their gestational age. A high-frequency transvaginal transducer was used to perform 2D and 3D ultrasounds, and the 3D images were saved. These images were then processed using multiple 3D technologies, such as HD live silhouette, OmniView, and TUI. Additionally, the circumference of the vermis was measured through the posterior fontanelle. Beginning at the 10mm CRL stage of embryonic development, high-frequency transvaginal 3D ultrasound imaging was able to clearly visualize the prosencephalon, mesencephalon, and rhombencephalon. Notable changes were observed in the rhombencephalon during the 16-22mm CRL stage, including the visualization of the pontine flexure and cerebellar primordium. At 23-40mm CRL, there was a distinct pontine flexure, and the developing cerebellum, the fourth ventricle, and choroid plexus of the fourth ventricle (4th VCP) could be observed. The roof of the rhombencephalon was partitioned by the 4th VCP into the anterior membranous area (AMA) located rostrally and the posterior membranous area situated caudally. Additionally, the original Blake's pouch was identifiable. Among fetuses measuring 41-84mm CRL, the AMA progressively decreased in size as the vermis developed. From the mid-sagittal view, the orientation of the 4th VCP seemed to shift from being perpendicular to the neural tube's long axis to being parallel to it. Furthermore, there was a significant correlation between CRL and vermis circumference. Using three-dimensional transvaginal ultrasound scanning, detailed visualization of the morphological changes in the CNS during normal embryonic development from 7 to 13+6 weeks is possible. This technology can aid in accurately characterizing the embryonic origin of the CNS.

First trimester identification of fetal sex by ultrasound.

The hypothesis was fetal sex determination by ultrasound at 11-14weeks' gestation has sufficient accuracy to be clinically relevant. Fetal sex assessment by transabdominal ultrasound was performed in 567 fetuses at 11-14weeks' gestation (CRL: 45-84mm). A mid-sagittal view of the genital region was obtained. The angle of the genital tubercle to a horizontal line through the lumbosacral skin surface was measured. The fetus was assigned male sex if the angle was > 30°, and female sex if the genital tubercle was parallel or convergent (< 10°). At an intermediate angle of 10-30°, the sex was not assigned. The results were divided into three categories based on gestational age: 11 + 2 to 12 + 1, 12 + 2 to 13 + 1, and 13 + 2 to 14 + 1weeks' gestation. To establish its accuracy, the first trimester fetal sex determination was compared to fetal sex determined on a mid-second trimester ultrasound. Sex assignment was successful in 534/683 (78%) of the cases. The overall accuracy of fetal sex assignment across all gestational ages studied was 94.4%. It was 88.3%, 94.7%, and 98.6% at 11 + 2 to 12 + 1, 12 + 2 to 13 + 1, and 13 + 2 to 14 + 1weeks' gestation, respectively. Prenatal sex assignment at the time of first trimester ultrasound screening has a high accuracy rate. The accuracy improved with increasing gestational age, which suggests that if clinically important decisions, such as chorionic villus sampling, are to be made based on fetal sex, they should be delayed until the latter part of the first trimester.

The endorectal incision level of transanal total mesorectal excision (taTME): An emphasis on the distance from the anterior vs. posterior mesorectal ends to the anal verge.

There is no intraluminal guidance to ensure complete inclusion of the mesorectum in transanal total mesorectal excision (taTME). This study aimed to assess the distance difference between the anterior and posterior mesorectal terminal ends and the anal verge as a potential risk for residual mesorectum after resection. Forty-four surgical specimens of extra-levator abdominoperineal excision (ELAPE) and 28 mid-sagittal cadaveric specimens were included to this study. The distance between the mesorectum terminal end (T) and the endoluminal landmarks (dentate line (D)/anal verge (A)) was measured and compared between men and women. Furthermore, 66 MRI images from The Cancer Imaging Archive (TCIA) were used to validate the same concept in a non-Asian population. The mesorectal terminal end was found to be aligned along with the levator hiatus. From the midsagittal view, the ELAPE specimens showed that the distance between T and A anteriorly was significantly longer than the same distance posteriorly (34.74±7.79mm vs 23.74±4.24mm, P<0.001). Similarly, the distance measured in the cadaveric specimens was significantlylongeranteriorly than posteriorly (P<0.001). The validation cohort of non-Asian MRI image has confirmed the same (56.68±14.17mm vs. 38.18 ±10.42mm, P<0.001(. There was no significant difference between men and women. Because of the remarkable distance difference between the anterior and posterior mesorectal terminal ends away from the anal verge, the taTME proctectomy level may not meet the required mesorectal end. Thus, if TME is planned, aligning the proctectomy level around the levator hiatus would be the best place that can ensure complete TME.

Sonographic Dimension of Fetal Nuchal Translucency in Kano Metropolis: A single Center Study

Background: Nuchal Translucency Thickness (NTT) is a hypo-echoic region of subcutaneous fluid accumulation in the posterior neck region at the level of the cervical spine between the skin and soft tissues and is mostly found at 11–13 weeks of fetal gestation. It is visualised with a mid-sagittal ultrasound view of the fetus in a neutral position. The NTT provides a risk assessment for chromosomal abnormalities which has been used as a marker of possible fetal abnormalities. Hence, the justification to conduct the present study.&#x0D; Aim: To establish the mean fetal nuchal translucency thickness with corresponding gestational age (GA) and to assess the correlation between Crown Rump Length (CRL), GA, and NTT among apparently healthy pregnant women.&#x0D; Methods: A cross-sectional study was conducted among 150 apparently normal consenting pregnant women in their late first trimester in the Radiology department of Muhammad Abdullahi Wase Teaching Hospital, Kano from February 2021 to May 2021. Ultrasonographic measurements of the crown-rump length (CRL), gestational age (GA), and NTT were performed on pregnancies within 11 to 13 weeks of gestation. Their 2.5th, 25th, median and 97.5th percentiles of the NTT, GA, and CRL were determined using SPSS version 23 (IBM, 2017). Indicate correlation… as part of the analysis.&#x0D; Results: Median NTT at 11-13+6 weeks of gestation was found as 3.0±0.10mm. The NT thickness increased with increasing CRL and gestational week in the first trimester. The correlation coefficient between NTT and CRL as well as GA were 0.472 and 0.451, respectively.&#x0D; Conclusion: The overall mean NTT in Kano fetuses was determined. These should be useful for first-trimester screening in ruling out potential fetal chromosomal abnormalities in Kano, Nigeria.

An Innovative method for intraoperative guidance of nasal shape in rhinoplasty: Application of a convenient, sterilizable, patient-specific film model

3D simulation is increasingly used in rhinoplasty. However, during the operation, there is no tool to directly link the 3D simulation results with the intraoperative operation. Doctors rely on 3D simulation results only according to their intuition. Recently, the authors have discovered a simple, low-cost, and practical method for intraoperative assessment: a film model can be made according to the contour of the nose shape in its midsagittal view. The authors aimed to evaluate the effectiveness of the innovative method for intraoperative assessment of nasal shape in rhinoplasty. Thirty-nine patients who underwent rhinoplasty for the first time between January 2019 and January 2021 were included in this study. All the patients confirmed ideal nasal shape based on preoperative three-dimensional photography (INOVA 3D-EX). In the guide group, procedures were based on guide of the film model and a picture of 3D simulation, and in the control group, procedures were performed based on the surgeon's intuition and a picture of 3D simulation. There were no statistical differences in basic data between the two groups before operation. Both groups showed a satisfactory correlation. Except for the columellar lobular angle, the ICC of nasal length, nasal depth, dorsum height, columella length, nasofrontal angle, nasorostral angle, and nasolabial angle were all stronger in the guide group than in the control group. This study demonstrates the usefulness of the nasal-shaped film model, which is made according to the contour of the nose shape in its midsagittal view. This approach is simple, low-cost, and practical.

Validity and Reliability of Spinopelvic Parameters Measured on Computed Tomography.

This study aimed to measure pelvic incidence (PI) and other spinopelvic sagittal parameters on supine computed tomography (CT) and to assess the validity and reliability of measurements from supine CT images when compared with standing x-ray images. Difficulties in superimposition of femur heads and obtaining the perfect midsagittal view of the sacral endplate may cause relatively low intra- and interobserver agreements. Some authors reported that PI values measured by CT had higher reliability, but both validity and reliability of CT measurement of spinopelvic parameters compared with standing x-ray imaging methods have not been reported previously. PI, pelvic tilt (PT), and sacral slope (SS) were measured on standing lateral x-ray and spinopelvic supine CT images of 33 asymptomatic volunteers. The mean PI, PT, and SS in standing x-ray images were 45.2°, 10°, and 35.3°, respectively, whereas those in supine CT images were 44.5°, 8.2°, and 36.2°, respectively. No significant differences were found in each parameter. Excellent correlations were found between each parameter obtained from x-ray and CT images. Intra- and interobserver reliabilities were excellent in both x-ray and CT image measurements, although those from CT images were higher. Spinopelvic sagittal parameters could be measured on supine CT by using a simple method with high reliability and validity; thus, CT could be a good alternative to standing x-ray imaging. In the supine position, PI does not change but PT decreases by a small amount and SS increases almost by the same amount because of the mathematical relationship between PT and SS (PI = PT + SS). Supine CT is an efficient diagnostic tool for the reliable extraction of spinopelvic sagittal parameters.

Automated Diagnosis of Autism Spectrum Disorder Condition Using Shape Based Features Extracted from Brainstem.

Alterations to the brainstem can hamper cognitive functioning, including audiovisual and behavioral disintegration, leading to individuals with Autism Spectrum Disorder (ASD) face challenges in social interaction. In this study, a process pipeline for the diagnosis of ASD has been proposed, based on geometrical and Zernike moments features, extracted from the brainstem of ASD subjects. The subjects considered for this study are obtained from publicly available data base ABIDE (300 ASD and 300 typically developing (TD)). Distance regularized level set (DRLSE) method has been used to segment the brainstem region from the midsagittal view of MRI data. Similarity measures were used to validate the segmented images against the ground truth images. Geometrical and Zernike moments features were extracted from the segmented images. The significant features were used to train Support vector machine (SVM) classifier to perform classification between ASD and TD subjects. The similarity results show high matching between DRLSE segmented brainstem and ground truth with high similarity index scores of Pearson Heron-II (PH II) = 0.9740 and Sokal and Sneath-II (SS II) = 0.9727. The SVM classifier achieved 70.53% accuracy to classify ASD and TD subjects. Thus, the process pipeline proposed in this study is able to achieve good accuracy in the classification of ASD subjects.

C5 Palsy of Patients with Proximal-Type Cervical Spondylotic Amyotrophy.

An observational cohort study design was adopted in this study. This study was designed to investigate preoperative factors that predict poor outcomes following surgery in patients with proximal-type cervical spondylotic amyotrophy (PCSA) using radiological findings. We evaluated the preoperative factors associated with poor outcomes using electrophysiological and neurological findings. However, the preoperative factors associated with poor outcomes remained unclear. Sixty patients with PCSA who underwent surgical treatment of the cervical spine were enrolled. The radiological findings on plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) were evaluated. The cervical lordotic angles, C2-C7 sagittal vertical axis (SVA), and T1 slope were assessed on a lateral radiograph in the neutral position. CT was used to assess the width of the intervertebral foramen and the anterior protrusion of the superior articular process on the axial view. MRI was used to determine the number of levels of compression (NLC) and the presence of a high-intensity area in the spinal cord in the T2- weighted midsagittal view. The preoperative and postoperative strengths of the most atrophic muscles were evaluated using manual muscle testing. Improvements in strength were classified as excellent (five grades recovered), good (more than one grade recovered), fair (no improvement), or poor (worsened). The prevalence of C5 palsy was 17% (10/60). Patients with poor outcomes had higher NLC and Δ C2-C7 SVA than patients with excellent, good, and fair outcomes (p =0.015; odds ratio [OR], 5.758; 95% confidence interval [CI], 1.397-23.726 for a change of 10% and p =0.048; OR, 1.068; 95% CI, 0.992-1.141 for a change of 10%, respectively). ΔC2-C7 SVA and NLC may be used as prognostic factors for achieving a poor outcome following surgery in patients with PCSA. More focus is needed on preventing the increase in ΔC2-C7 SVA.

Assessment of pericallosal artery at 11-14 weeks of gestation: Cohort study and meta-analysis.

To report the rate of visualization of the pericallosal artery (PCA) in the first trimester of pregnancy (11-14 weeks). Prospective observational study of consecutive fetuses undergoing first trimester risk assessment for chromosomal anomalies. The presence of PCA was assessed in a midsagittal view of fetal brain using high-definition power Color Doppler. A normal course of the PCA was defined as the visualization of an artery emerging from the anterior cerebral artery running parallel the corpus callosum (CC). The reference standard was the visualization of CC and PCA between the 20 and 22 weeks of gestation. We also performed a systematic review and meta-analysis of the published literature. Multivariate logistic regression and random-effect meta-analyses of proportion were used to analyze the data. Cohort study: Five-hundred women were included. PCA was identified trans-abdominally or transvaginally at 11-14 weeks of gestation in 98.8% (95% CI 97.4-99.6: 494/500); of the four cases of PCA not identified one had a diagnosis of complete agenesis of the corpus callosum during the anomaly scan which was confirmed at birth. Systematic review of the published literature: Six studies (1093 fetuses, including the present series) were included. The PCA was detected at the 11-14 weeks scan and confirmed to co-exist with a normal CC at time of the anomaly scan in 96.9% (95% CI 93.8-99.0); 20.6% (95% CI 5.7-41.7) of fetuses with no clear identification of the PCA at the 11-14 weeks scan had a normal appearance of the CC at the time of anomaly scan. Prenatal ultrasonography has a high diagnostic accuracy in detecting PCA in the first trimester. Visualization of the PCA at the time of 11-14 scan is highly specific for the presence of a normal CC later in pregnancy.

Early second-trimester three-dimensional transvaginal neurosonography of fetal midbrain and hindbrain: normative data and technical aspects.

To provide a detailed description of the sonographic appearance and development of various fetal structures of the midbrain and hindbrain (MBHB) during the early second trimester, and to evaluate the impact of the frequency of the transvaginal sonography (TVS) transducer on the early recognition of these structures. This was a retrospective analysis of three-dimensional volumetric datasets of the MBHB from apparently normal fetuses at 14-19 gestational weeks, acquired by TVS in the midsagittal view through the posterior fontanelle. Using a multiplanar approach, we measured the tectal thickness and length, aqueductal thickness, tegmental thickness and width and height of the Blake's pouch (BP) neck. In addition, we assessed the existence of early vermian fissures, the linear shape of the brainstem and the components of the fastigium. The correlation between gestational age according to last menstrual period and sonographic measurements of MBHB structures was evaluated using Pearson's correlation (r). A subanalysis was performed to assess the performance of a 5-9-MHz vs a 6-12-MHz TVS transducer in visualizing the MBHB structures in the early second trimester. Sixty brain volumes were included in the study, obtained at a mean gestational age of 16.2 weeks (range, 14.1-19.0 weeks), with a transverse cerebellar diameter range of 13.0-19.8 mm. We found a strong correlation between gestational age and all MBHB measurements, with the exception of the tectal, tegmental and aqueductal thicknesses, for which the correlation was moderate. There was good-to-excellent intraobserver and moderate-to-good interobserver correlation for most MBHB measurements. We observed that the BP neck was patent in all fetuses between 14 and 18 weeks with decreasing diameter, and that the aqueductal thickness was significantly smaller at ≥ 18 weeks compared with at < 16 weeks. The early vermian fissures and the linear shape of the brainstem were present in all fetuses from 14 weeks. We found that, in the early second trimester, the horizontal arm of the presumed 'fastigium' evolves from the fourth ventricular choroid plexus and not the posterior vermis, indicating that this is not the fastigium. Standard- and high-resolution TVS transducers performed similarly in the assessment of MBHB anatomy. Detailed early second-trimester assessment of the MBHB is feasible by transvaginal neurosonography and provides reference data which may help in the early detection of brain pathology involving the MBHB. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.