Multi Planar Research Articles

A comparison of virtual reality and three‐dimensional multiplanar educational methods for student learning of cone beam computed tomography interpretations

AbstractObjectivesThe purpose of this study was to compare student learning of cone beam computed tomography (CBCT) interpretation using immersive virtual reality (VR) and three‐dimensional multiplanar (MP) reconstructions.MethodsSixty first‐year dental students were randomly allocated to two groups, VR and MP, and underwent a one‐on‐one educational intervention to identify anatomic structures using CBCT data. All participants completed three multiple‐choice questionnaires (MCQs) before (T1), immediately after (T2), and 2 weeks following (T3) the intervention. Additionally, pre‐survey, post‐survey, NASA Task Load Index (NASA‐TLX), and presence questionnaires were completed. Analysis of objective measures of performance on MCQs and subjective data from the questionnaires was completed (α = 0.05).ResultsThere was a significant increase in test performance and informational recall between T1–T2 and T1–T3 for VR and MP groups (p < 0.001). However, there were no significant differences in performance on MCQs between T2 and T3. Analysis of the Presence questionnaire indicated that the VR group felt decreased distraction (p = 0.013), increased realism (p = 0.035), and increased involvement (p = 0.047) during the educational intervention when compared with the MP group. Analysis of the NASA‐TLX indicated that the VR group experienced more physical demand (p < 0.01) but similar cognitive demand when compared with the MP group. Qualitative responses indicated that the VR group had a more dynamic sense of visualization and manipulation compared to the MP group.ConclusionResults from this study show that VR is as effective as traditional MP methods of CBCT interpretation learning. Further benefits of VR educational intervention include increased involvement, realism and less distraction.

Systematic review of various 3D volume construction algorithms adopted in isocentric C-arm devices

C-arm systems are well established in clinical routines which produces two- dimensional (2D) projection images, which are not sufficient to provide the depth information required by surgeons during interventional procedures. Due to this, the procedural time and radiation dosage are significantly higher which leads to increased procedural cost. In order to extract depth information from 2D projection images acquired with stepwise rotation between 0 to 180 degrees, various 3D volume construction algorithms are developed. The purpose of this paper is to systematically review the various 3D volume construction algorithms in order to develop a cost-effective solution to be incorporated in the iso-centric C-arm machines without 3D volume construction algorithms. The proposed review process is done in the following aspects: i. State-of-the-art 3D volume construction algorithms ii. Comparing the different aspects of commercially available iso- centric C-arm machines incorporated with 3D volume construction algorithms. The impact of various 3D construction algorithms in improving different aspects such as image quality, resolution, procedure time, radiation dose, and accuracy of the final 3D model is discussed. Based on the findings we recommend a procedure to develop and validate a 3D volume construction algorithm. 3D volume construction from C-arm images helps to construct Multi Planar Reconstruction (MPR) views during interventional procedures which will provide in-depth information and minimize the procedure time, cost, and dosage to the patient.

Assessment of thin bony structures using cone-beam computed tomography.

To investigate the validity and reliability of marginal bone level measurements on cone-beam computed tomography (CBCT) images of thin bony structures using various reconstruction techniques, two image resolutions, and two viewing modes. CBCT and histologic measurements of the buccal and lingual aspects of 16 anterior mandibular teeth from 6 human specimens were compared. Multiplanar (MPR) and three-dimensional (3D) reconstructions, standard and high resolutions, and gray scale and inverted gray scale viewing modes were assessed. Validity of radiologic and histologic comparisons were highest using the standard protocol, MPR, and the inverted gray scale viewing mode (mean difference = 0.02 mm) and lowest using a high-resolution protocol and 3D-rendered images (mean difference = 1.10 mm). Mean differences were significant (P < .05) at the lingual surfaces for both reconstructions, viewing modes (MPR windows), and resolutions. Varying the reconstruction technique and viewing mode does not improve the observer's ability to visualize thin bony structures in the anterior mandibular region. The use of 3D-reconstructed images should be avoided when thin cortical borders are suspected. The small difference when using a high-resolution protocol is unjustified due to the higher radiation dose required. Previous studies have focused on technical parameters; the present study explores the next link in the imaging chain.

Impact of Left Atrial Volume Index on Discrepancy in Mitral Valve Area Assessed by Two-Dimensional Planimetry and Three-Dimensional Multi-Planar Reconstruction Technique

Background: Mitral valve area (MVA) is technically measured using both two-dimensional (2D) planimetry and three dimensional multi planar reconstruction (3D-MPR) techniques; however, studies have always overestimated MVA using the former method. Objectives: This study aimed to assess the correlation between MVA assessed by 2D and 3D techniques and the impact of left atrial volume index (LAVI) on the discrepancy between MVA assessed by two echocardiography techniques. Methods: The data of 75 patients with moderate to severe mitral stenosis assessed by both 2D planimetry and 3D-MPR techniques were retrospectively reviewed. Clinical and echocardiographic variables were evaluated. Left atrial (LA) volume was determined using biplane area-length method. Results: The mean MVA assessed by the 2D and 3D techniques was 1.03±0.24 cm2 and 0.99±0.25 cm2 with a mean discrepancy of 0.04±0.15 cm2, respectively. A strong association was observed between the MVA values assessed by 2D planimetry and 3D-MPR methods (r coefficient = 0.817, P&lt;0.001) indicating a slight discrepancy between the two techniques in assessing MVA measure. The pointed discrepancy was affected by none of the baseline characteristics and LAVI value. There was an adverse association between LAVI value and MVA measured by both 2D planimetry (r coefficient = -0.291, P= 0.011) and 3D-MPR (r coefficient=-0.260, P=0.024). Conclusion: In contrast to the left atrial dimension, the discrepancy in MVA values assessed by 2D planimetry and 3D-MPR is not influenced by LAVI adjusted for baseline parameters.

Évaluation pronostique prénatale échographique de la myéloméningocèle à l’ère de la chirurgie fœtale

Myelomeningocele (MMC) is a severe congenital condition responsible for motor and sensory impairments of the lower limbs, incontinence and cognitive impairment. Its screening, sometimes as early as the first trimester, is one of the major goals of modern prenatal care, supported by the emergence of prenatal surgery that results in a significant improvement in motor function, ambulation and ventriculoperitoneal shunt rate in patients undergoing in-utero surgery. From screening to pre- and post-operative prognostic evaluation, prenatal ultrasound is now an essential tool in the antenatal management of this condition. Using the multi planar and three-dimensional modes, it can be used to assess the vertebral level of MMC, which remains the key antenatal prognostic marker for motor function and ambulation, incontinence and the need for a ventriculo-peritoneal shunt. A careful and systematic ultrasound examination also makes it possible to assess the severity and progression of ventriculomegaly, to search for associated cerebral, spinal cord or vertebral anomalies, or to rule out exclusion criteria for in-utero surgery such as severe kyphosis or serious cortical anomalies. New tools from post-natal evaluation, such as the “metameric” ultrasound assessment of lower limb mobility, appear to be promising either for the initial examination or after in-utero surgery. Ultrasonography, associated with fetal MRI, cytogenetic and next generation sequencing, now allows a highly customized prognostic evaluation of these fetuses affected by MMC and provides the parents with the best possible information on the expected benefits and limitations of fetal surgery.

Prosedur Pemeriksaan MRI Leher pada Kasus Karsinoma Nasofaring di Instalasi Radiologi RS Ken Saras Kabupaten Semarang

Background: Magnetic Resonance Imaging (MRI) is a diagnostic imaging modality that can generate slices anatomy body multiplanar by contrast in a very good resolution. The results of the of an MRI description is more accurate for diagnosing Carcinoma of the nasopharynx. On examination of of the neck MRI with the case of carcinoma, after infusion of contrast Moeller and Reif (2003) suggested to use T1 TSE Coronal and axial sequence and using the 4 mm slice thickness , but in Radiology instalation of Ken Saras Hospital using T1 and T1 TSE TSE Fat Saturation Coronal, sagittal and axial sequence as well as using slice thickness 2 mm in axial slices. The purpose of this research is to know the procedure of examination of of the neck MRI in the case of Carcinoma of the nasopharynx, justifying T1 Fat Saturation sequence after infusion media kontaras and reasons of wearing slice thickness 2 mm in axial slices.Methods: This type of research is qualitative research with case studies approach. Data retrieval is done by observation, documentation, interviews with two specialists in radiology, 2 radiografer and 1 doctor who send the patient. The data obtained analized by using the table categorisation and coding.Result: The results of the research showed that MRI examination procedure of the neck in the case of Carcinoma of nasopharynx in Radiology Installation of Ken Saras hospital using T1 TSE multi planar (coronal, sagittal and axial), T2 TSE multi planar and T2 TSE Fat Saturation multi planar sequences before infusion of contrast media, T1 and T1 TSE TSE Fat Saturation multi planar sequences after infusion contrast and using the slice thickness 2 mm in axial slices. Addition sequence T1 TSE Fat Saturation after infusion of contrast aimed to clarify the limits of the tumor with surrounding tissue and image of Lymphadenopathy.Conclusion: While using 2 mm slice thickness in axial slices aims to show the abnormalities or nodules-small nodules on the nasopharynx and to see the expansion Stadium in the surrounding area of the nasopharynx.

Complex congenital heart defects and thoracic computed tomography in 3D stereoscopic relief: A qualitative assessment

Management of patients with complex congenital heart defects (CHD) requires 3D imagination skills for the spatial evaluation of cardiac structures. Current 3D imaging [echocardiography, MRI, computed tomography (CT)], projected on a 2D screen, limits the appreciation of the relief and the interaction of anatomical structures. The contribution of 3D stereoscopic relief imagery (3D S/R), built by triangle-based mesh generation, is more qualitative than quantitative, which is why its use, rarely reported in the literature, must be evaluated. 3D S/R was used from 2009 to 2019, as much as the CT made it possible to define a Region of Interest. Data and segmentation processing have been used to obtain four different types of reconstructions: MultiPlanar (MPR), Volume Rendering Technique (VRT), Surface Rendering Technique (SRT), and 3D S/R. The anaglyph 3D S/R effect requires the wearing of glasses (red - cyan blue filters) distributed during the session ( Fig. 1 ). Five complex CHD will be presented in MPR, VRT, then in SRT and 3D S/R: – Ventriculo-Arterial Malposition, – multiple Ventricular Septal Defects, – Anomalous Aortic Origin of a Coronary Artery, – Coarctation and hypoplastic Aortic Arch, – abnormal Pulmonary Arterial Arborization with Major Aorto-Pulmonary Collateral Arteries. The qualitative evaluation [MPR + VRT versus SRT and 3D S/R] will be carried out by questions/answers [Wooclap™ interactive system - voting on smartphone, in streaming, using a code associated with the presentation], allowing a global rating of the five CHD, concerning: – the perception of the relief, – the understanding of the cardiopathy, – the probability of appropriation of this 3D S/R imagery. This presentation will allow: – to assess the potential influence of 3D S/R on the management strategy of CHD, – to compare these imaging studies with mesh generation techniques leading to the more commonly reported 3D printing.

Vein of Marshall visualization in cardiac computed tomography

Abstract The oblique vein of the left atrium (vein of Marshall) is a small vessel that descends obliquely on the back of the left atrium and ends in the coronary sinus near the area where great cardiac vein continues into the coronary sinus. Its cannulation can be useful, e.g. before selected electrophysiology procedures such as paroxysmal focal atrial fibrillation ablation. Because the vein of Marshall should also be avoided at the site of the implantation of the left ventricle lead, knowledge about its existence, position or diameters could be useful. There is a lack of complex data about the possibilities of visualizing the vein of Marshall in cardiac computed tomography. Methods 354 patients were included into the research. Cardiac computed tomography (Aquilion 64, Toshiba: 64 slices, 0.5 mm; retrospective gating; contrast enhanced) was performed for all of the patients. A precise retrospective analysis of the CT data in all phases (every 10%) of the cardiac cycle during post processing was performed including searching for the target vein by using Vitrea workstations (Vital Images). Both multi planar reformatted reconstructions (MPR) and 3D volume renderings were used. The analyses were performed by two experienced researchers (more than 200 coronary venous system analyses previously performed). Results The vein of Marshall was found in 66 of the 354 patients (16.6%). An example of the visualization is presented in the figure below (MPR and 3D volume rendering). Its ostium to coronary sinus was found an average of 42.6±10.8 mm from the coronary sinus ostium to the right atrium. This value was statistically higher (p=0.0082) in the men (45.3±11.2) compared to the women (38.5±9.7). The vein of Marshall is a small vessel; its average diameter was 1.8±0.8 mm and length of the visible vessel that was measured was 8.7±7.5 mm. It was visualized statistically more frequently (p=0.0009) in the end-systolic phases (30–40–50% RR; 68.85% cases) compared to the end-diastolic phases (70–80% RR; 21.31% cases). Occasionally, it was optimally visualized in the other phases (9.83%). Conclusion It is possible to visualize the vein of Marshall using cardiac computed tomography. Because it exists in about 20% of population, during visualization, special attention needs to paid to obtaining quality images in CT especially in the end-systolic phases. Vein of Marshall imaging (VR, MPR) Funding Acknowledgement Type of funding source: None

The value of coronal view as a stand-alone assessment in women undergoing automated breast ultrasound.

Aim of the study was to evaluate the value of automated breast ultrasound (AUS) in women with dense breast, in terms of reading times, diagnostic performance and interobserver agreement. The assessment of coronal images alone versus the complete multiplanar (MPR) views was evaluated. Between August and October 2017, consecutive patients with dense breast that were referred to our Institute, for post-mammography ultrasound assessment, pre-operative assessment or follow-up of known benign lesions, were invited to undergo an additional study with AUS. Three radiologists, (5, 15 and 25years of experience in breast imaging), reviewed the exams twice: first assessing reconstructed coronal images alone, second the complete MPR views. Reading times, diagnostic performance and interobserver agreement were assessed. One hundred eighty-eight women were included, for a total of 67 breast lesions, 25 (37%) malignant and 42 (63%) benign. Compared to MPR, coronal view was associated with: lower reading times, respectively, for the three readers: 83 ± 37, 84 ± 43 and 76 ± 30 versus 163 ± 109, 131 ± 57, 151 ± 42s (p < 0.035); lower sensitivity: 44.8%, 62.1%, 55.2% versus 69.0% (p = 0.059), 65.5% (p = 0.063), 72.4% (p = 0.076), respectively; better specificity: 94.1%, 93.7%, 94.2% versus 89.5% (p = 0.093), 87.4% (p = 0.002), 91.6% (p = 0.383), respectively. Agreement between the most and the least experienced reader was fair to moderate for categorical variables and significant for continuous ones. The coronal view allows significantly lower reading times, a valuable feature in the screening setting, but its diagnostic performance makes the complete multiplanar assessment mandatory.

来院時心停止の蘇生後に偶然診断された肺癌の1例(A case of lung cancer in a patient diagnosed by chance after resuscitation of cardiopulmonary arrest on arrival)

要旨症例は76歳の男性。4日前に階段を転落した後からの左側胸部痛と呼吸苦を主訴に当院を独歩受診し，外来の廊下で突然卒倒した。目撃者により心停止を認識され，心肺蘇生を受けつつERに搬入。初期心電図波形は無脈性電気活動で，アドレナリン1mg静脈内投与と気管挿管を含む二次救命処置により自己心拍再開。蘇生後の胸部単純X線写真にて大量の左胸水貯留と縦隔右方偏位を認め，鈍的胸部外傷に伴う大量血胸と診断し，直ちに胸腔ドレナージを施行。中等度血性胸水2,100mLが排出され，バイタルサインは改善した。その後に撮影した単純CT画像にて左多発肋骨骨折を確認。ICU入室後，集中治療により意識・呼吸・循環は順調に回復し，第2病日に気管挿管チューブを抜管。第5病日に撮影した造影CT画像にて最大径46mmの左肺腫瘍と縦隔リンパ節・骨・副腎転移を認め，胸水細胞診の結果class Vと判定され，肺癌と診断。第7病日にICUを退室して呼吸器内科に転科，第64病日に神経学的後遺症なく転院となった。本症例の心停止は，癌性胸水が緩徐に貯留した状態に外傷性の血性胸水が負荷されたことにより緊張性胸水の状態となり，それまで代償性に維持し得ていた呼吸循環動態が破綻して閉塞性ショックと低酸素血症に陥ったことが原因のoncologic emergencyであったと推定された。

Role of Multidetector Computed Tomography with Multiplanar and Curved Multiplanar Reformations in the Detection of Cause of Intestinal Obstruction: A Tertiary Care Experience.

ObjectiveTo determine the role of multidetector computed tomography (MDCT) with multiplanar (MPR) and curved multiplanar reformations (CMPR) in the detection of the cause of intestinal obstruction.Materials and methodsA retrospective analysis of 200 patients with a clinical suspicion of intestinal obstruction referred to the department of radiology, Dr. Ziauddin University Hospital, Clifton campus, from September 2016 to October 2019, was done. All patients who underwent an MDCT scan with oral and intravenous (I/V) contrast were included in the study. Patients with deranged serum creatinine and an allergic reaction to contrast were excluded from the study. MPR and CMPR images were acquired in each patient in addition to routine axial images. The causes of intestinal obstruction as determined by a computed tomography (CT) scan were confirmed on surgery and colonoscopy. The CT scans were analyzed by an independent radiologist with five years of experience blinded to the surgical and colonoscopy findings in detecting the cause of bowel obstruction using the axial, MPR, and CMPR images. Data analysis was done on IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY).ResultsOut of 200 patients with a clinical suspicion of intestinal obstruction, 120 patients with intestinal obstruction was confirmed on CT scan. Fifty-eight patients were males (48.33%) and 62 patients were females (51.66%) with a male-to-female ratio of 1:1.06. The mean age of the patients was 54.7 years (age range from 06 years to 85 years). Abdominal distension was the most common presentation seen in 37 patients (30.83%) followed by vomiting in 25 patients (20.83%). Small bowel obstruction was seen in 96 patients (80.00%) with the ileum being the most common site of obstruction seen in 76 patients (63.33%). Among the patients with the ileum being the site of obstruction, distal ileal obstruction was seen in the majority of patients (30 patients, with a frequency of 25.00%). Twenty-three patients (19.16%) had a large bowel obstruction, with sigmoid colon involvement seen as the most common site in 10 patients (8.33%). Adhesions were the leading extrinsic cause of bowel obstruction seen in 32 patients (26.6%). Intraluminal causes of obstruction were seen in 36 patients (30.0%) with carcinoma being the commonest cause (12 patients with a frequency of 10.0%). A foreign body is the primary cause of intraluminal obstruction (three patients, with a frequency of 2.5%). The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT were 86.2%, 92.7%, 90.1%, and 96.4%, respectively.ConclusionMDCT has high sensitivity and specificity to diagnose and determine the cause of bowel obstruction. It not only determines the site of obstruction but also the cause of obstruction, including intrinsic, extrinsic, and intraluminal causes.

PROSEDUR PEMERIKSAAN MSCT ANGIOGRAFI KEPALA DENGAN KLINIS STROKE

Background : Reconstruction used to showing the patology of stroke is MPR (Multi Planar Reconstruction). Procedure reformat and filming of MSCT Angiography examination with the clinical of stroke in Radiology Hospital Dr. Moewardi just used 3D MIP, but there was dissatisfaction with the radiologist, so the radiologist do additional reformat independently. The purpose of this study was to explain the procedure of head angiography with MSCT examination in case of stroke to know the reason for head Angiography scanning and to know the reason for using reformat and filming just in 3D MIP.&#x0D; Methods : The type of research used a qualitative researchwith case study appoarch. The data were collected from March to April at Radiologi Hospital Dr. Moewardi by observation, interview with radiology technologist, radiologost and referring physician, and also documentation. Data were analyzed by using interactive model.&#x0D; Results : The result of the research shows that the procedure of Head Angiography examination with MSCT in stroke cases is done by the area from mandibula to vertex. Injection contrast media 370 mg/mL in intra vena with 90 mL and ringer laktat 30 mL. The examination began with scanning of the scanogram, pre contrast, and post contrast. Reformat and filming just in 3D MIP with AP projection, lateral, right oblique and left oblique several in positive and negative.&#x0D; Conclusion : The reason reformat and filming just in 3D MIP because it has revealed vascularization from various angles to be evaluated and the results obtained look like a picture of Digital Substraction Angiography (DSA), making it easier for the referring physician to carry out further examination of coiling with the DSA method.&#x0D;

Two column classification of tibial plateau fractures; description, clinical application and reliability

PurposeIn this era of life highly comminuted and multi planar tibial plateau fractures involving the posterior corners are more commonly seen and addressed in the literature than before. Among these several types have not been described in the currently used classification systems. In fact simple classification systems ignore several fracture types and leniently grouped the fractures with different mechanism, morphology, treatment modalities and prognosis in same category. On the other hand, more extensive nature classifications with detailed subdivisions are difficult to remember for clinicians. The clinical reliability of these classifications is another problem. All these issues demand the potential need of a new classification. The aim of this study was to describe a quadrant specific two column classification of tibial plateau fractures and to analyse its inter-observer and intra-observer reliability, clinical assessment and application. Materials and methodsFrom January 2009 to December 2015, 44 patients with tibial plateau fractures were studied retrospectively. The antero-posterior (AP), lateral X-rays and computed tomography (CT) with axial transverse, sagittal, coronal and three dimensional (3D) reconstruction images were performed for all the patients. All of the fractures were categorized according to quadrant specific two column classification and the traditional Schatzker’s classification. The comparative analysis for inter-observer and intra-observer reliability of the new classification and the Schatzker’s classification was conducted by four observers. ResultsThree cases didn’t match any type in the Schatzker’s classification. While on the other hand, all cases were classified by two column classification. The mean kappa values for inter-observer reliability by using the Schatzker’s classification was 0.723 (range, 0.674-0.823), representing substantial agreement, whereas the mean kappa value was 0.939 (range: 0.897-0.974), representing almost perfect agreement according to two column classification. The mean kappa values for intra-observer reliability using the Schatzker’s classification and two column classification were 0.789 (range: 0.590-0.864) and 0.955 (range:0.923-0.948) showing substantial agreement and almost perfect agreement. ConclusionThe quadrant specific two column classification is anatomically oriented, CT based and clinically valid. The different fracture types according to anatomic location are represented alphanumerically so that treatment matched to specific fracture type (quadrant specific anatomic fixation) for optimal outcomes. Furthermore, it demonstrates higher inter-observer and intra-observer reliability. This classification can be adopted to strengthen the traditional Schatzker’s classification, particularly in the multi planar and posteriorly extended plateau fractures. It can be used as a reliable research tool. The database can be used to distinguish different fracture types, individual type incidences, specific treatment and also prognosis. Authors suggest a large multi-centre study.

A novel method of studying the collapsed cell of eucalyptus wood using X-ray CT scanning

Collapse is the severest defect for collapse-prone species used as solid wood product materials. Previous study focused on the morphological structures by scanning electron microscopy (SEM) to observe the change of the collapsed cells during the drying processes. The multi planar reconstruction by X-ray computed tomography (CT) scanning provided a new method for cell microstructure observation. In this study, cell collapse of Eucalyptus urophylla were observed by SEM and X-ray CT scanning during the continuous and intermittent drying process. The cell shapes, cell types, cell collapsed quantities and the shrinkage curves were determined. The results demonstrated that layered scanning technique by X-ray CT scanning provided a top-down approach to investigate the structure in depth at different layers in a fast and nondestructive way. Compared with SEM observation, this approach emphasized more specific aspects and information for collapse quantitative analysis. Quantitative analysis of collapsed cells by X-ray CT scanning not only indicated the cell deformation but quantified the extent of cells collapse. The shrinkage rate was also measured by calculating the areas change in porosity at tissue level before and after drying through X-ray CT scanning. It indicates that intermittent drying process may decrease the extent of cell collapse or accelerate the recovery of collapsed cells. These results further confirm that the X-ray CT scanning provides another effective method for wood cell collapse study at the morphological level.

The earliest known case of frontal sinus osteoma in man.

Frontal sinus osteoma is a relatively common finding in the modern clinical setting. Although, its paleopathological record is not in dispute, its presence in Ancient Egypt has never been clarified. The aim of this article is to contribute to the debate. An Egyptian mummy head from the Musée d'Éthnographie de Neuchâtel (Switzerland) was studied radiologically and the obtained evidence was contextualized in the wider frame of multidisciplinary paleopathology. A 128-slice CT scanner was used for further investigation; datasets were processed with OsiriX-64 bit (version 5.8.5), and multiplanar (MPR) and volumetric reconstructions were performed. A small hyperdense and well-defined structure, most likely an osteoma, was identified in the right frontal sinus. Frontal sinus osteoma definitely existed in Ancient Egypt. Finally, this represents the oldest case in anatomically modern humans so far reported. Clin. Anat.32:105-109, 2019. © 2018 Wiley Periodicals, Inc.

Renal Artery Orientation Influences the Renal Outcome in Endovascular Thoraco-abdominal Aortic Aneurysm Repair

To evaluate the impact of renal artery (RA) anatomy on the renal outcome of fenestrated-branched endografts (FB-EVAR) for thoraco-abdominal aortic aneurysms (TAAA). Between 2010 and 2016, all patients undergoing FB-EVAR for TAAA were prospectively collected. Anatomical, procedural, and post-operative data were retrospectively analysed. RA anatomy was assessed on volume rendering, multi planar and centre line reconstructions by dedicated software (3Mensio). RA diameter, length, ostial stenosis/calcification, orientation and aortic angles of the para-visceral aorta were evaluated. RA orientation was classified in four types: A (horizontal), B (upward), C (downward), D (downward+upward). RA revascularisation by fenestrations or branches was considered. Inability to cannulate and stent RA (RA loss), early RA occlusion (within three months), and composite RA events (one among RA loss, intra-operative RA lesion, RA related re-interventions, RA occlusion) were assessed. Seventy-three patients (male 77%; age 73±6 years) with 39 (53%) type I, II, III and 34 (47%) type IV TAAA, underwent FB-EVAR, for a total of 128 RAs. The mean RA diameter and length were 6±1mm and 43±12mm, respectively. Type A, B, C, and D orientations were 51 (40%), 18 (14%), 48 (36%), and 11 (10%) RAs, respectively. Angulation of para-visceral aorta >45° was present in 14 cases (19%). Ostial stenosis and calcifications were detected in 20 (16%) and 16 (13%) RAs, respectively. Branches and fenestrations were used in 43 (34%) and 85 (66%) RAs, respectively. There were four (3%) intra-operative RA lesions (2 ruptures, 2 dissections). Ten (8%) RAs were lost intra-operatively because of the inability to cannulating and stenting. On univariable analysis, type B RA orientation (p=.001; OR 13.2; 95% CI 3.2-53.6), para-visceral aortic angle>45° (p=.02; OR 4.9; 95% CI 1.3-18.5) and branches (p=.003; OR 9.0; 95% CI 1.9-46.9) were risk factors for intra-operative RA loss; type C RA orientation was a protective factor (p=.02; OR 0.1; 95% CI 0.01-0.9). On multivariable analysis, type B RA orientation (p=.03; OR 5.9; 95% CI 1.1-31.1) and branches (p=.03; OR 7.3; 95% CI 1.1-47.9) were independent risk factors for intra-operative RA loss. Fourteen patients suffered post-operative renal function worsening (> 30% of the baseline). The mean follow up was 19±12 months. Four (3%) early RA occlusions occurred in three patients (2 single kidney patients required permanent haemodialysis). Type D RA orientation (p=.00; RR 17.8; 8.6-37.0) and branches (p=.004; RR 3.2; 2.4-4.1) were risk factors for early RA occlusion on univariable analysis. Five patients (7%) required early RA related re-interventions (recanalisation+relining 3; stent graft extension 1; parenchymal embolisation 1). No late RA occlusion or re-interventions were reported during follow up. Composite RA events occurred in 17 (13%) cases. Type B (p=.05; OR 3.9; 95% CI 1.1-15.7) or D (p=.006; OR 10.9; 95% CI 2.3-50.8) RA orientations and branches (p=.006; OR 5.7; 95% CI 1.6-20.3) were independent predictors of composite RA events on multivariable analysis. Renal artery orientation significantly affects the early RA outcome of FB-EVAR for TAAA. Intra-operative RA loss is predicted by type B RA orientation and branches, while early RA occlusion is predicted by type D orientation and branches. The present data suggest that in TAAA, fenestrations should be the first choice for renal revascularisation in type B and D RA orientations.

Concordance of tomographic ultrasound and multiplanar ultrasound in detecting levator ani muscle injury in patients with pelvic organ prolapse.

AimTo compare the evaluations of evaluate levator ani muscle injury (LAMI) by tomographic ultrasound imaging (TUI) and multiplanar (MP) ultrasound in patients with pelvic organ prolapse (POP).MethodThis retrospective analysis studied women who underwent International Continence Society POP quantification examination between October 2015 and June 2016. LAMI was assessed by both TUI and MP ultrasounds. Concordance of these two testing results was analyzed. Their correlations with clinical symptoms were also studied.ResultsA total of 135 women were included. All the patients with POP had a minimal LAMI depth ≥ 7 mm. Two examinations, TUI and MP, had satisfactory concordance (k = 0.71, P < 0.01). Depth of LAMI in the coronal plane demonstrated good agreement with TUI scores (r = 0.84; P < 0.01). After controlling for age, BMI, and parity, to have clinically significant POP and POP symptoms, the odds ratios (ORs) for the depth of LAMI in the coronal plane were 1.31 (95% CI 1.19–1.44) and 1.25 (95% CI 1.14–1.36), and for TUI scores were 1.72 (95% CI 1.37–2.17) and 1.63 (95% CI 1.31–2.03). Receiver operating characteristic curve analyses showed a cutoff depth of 7 mm of LAMI yielded a sensitivity of 62% and specificity of 80% for POP symptoms.ConclusionsTUI and MP had satisfactory concordance in detecting LAMI and correlated with clinical symptoms of POP.

Correlation between the position of hyoid bone and subregions of the pharyngeal airway space in lateral cephalometry and cone beam computed tomography.

To correlate the pharyngeal airway subregions with the positioning of the hyoid bone. The study examined 107 lateral cephalometric (LC) and cone beam computed tomography (CBCT) images. Linear and volumetric measurements of the pharyngeal subregions were made and correlated to linear measurements using hyoid triangle analysis on images of LC and multiplanar (MPR) and three-dimensional (3D) reconstructions of CBCT. There was significant correlation between linear measurements of the pharyngeal subregions and hyoid bone position in LC images and in MPR and 3D reconstructions of the CBCT. Correlations were more frequent in the oropharynx and hypopharynx, especially for LC images. No correlations were observed between LC images or CBCT reconstructions and the volumetric measurements of the pharyngeal subregions and the position of the hyoid bone. The hyoid bone position showed more correlations with oropharynx and hypopharynx airway measurements. The hyoid triangle method was not applicable to 3D images, since it showed a smaller number of measures correlated to the hyoid bone position.

MRI Evaluation of Lumbar Disc Degenerative Disease

Aim of the work: lumbar disc degenerative disease is most leading cause of back pain, it is the most common cause of disability at age above 45 years and 2nd most common reason for primary care physician visit. Magnetic Resonance Imaging (MRI) is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multi planar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs’ changes. this study aimed to evaluate the characterization, extent and changes associated with the degenerative lumbar disc disease by Magnetic Resonance Imaging. Study Design: cross-sectional and observational study. Study Sample: forty consecutive and clinically examined patients with lower back pain suggestive of lumbar disc disease. Material and Methods: 40 patients with age group between 17 and 80 years with low back pain were diagnosed on 1.5 Tesla MRI machine. The following MRI findings were noted: lumbar lordosis preserved or not, ligamentum flavum hypertrophy, facet joint arthrosis or osteophytes formation and Endplate (modic) changes, decreased disc height as compared to the upper and lower vertebral levels and loss of signals, disc bulge at different levels, Disc protrusion and disc extrusion was observed. Result: most of patient showed lossof lumbar lordosis, facet joint arthrosis, ligamentum flavum hypertrophy, Endplate (modic) changes, and osteophytes formation. Disc dehydration which is one of the earliest features of aging and disc degeneration was present in (42%) patients with the most dehydrated disc seen at L4/L5 and L5/S1. Patients with degenerative disc disease had the following disc contour abnormalities. Disc bulges (26.5%) and herniations (10.5%). Herniations were further reported as broad based herniations (9.5%), extrusions (19.0%) and the protrusions (71.4%). The most common site for bulges and herniations was L4/L5 (33.6%) and (57.1%) respectively. The most common complication of bulges and herniations was impingement of exiting nerve roots (40%) and compression of exiting nerve roots and cauda equina (47.6%) respectively. Conclusion: lumbar disc degeneration is the most common cause of low back pain. It is the most common cause of disability at age above 45 years. Plain radiograph can be helpful, but MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multi planar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes.

Extraskeletal and Skeletal Ewing Sarcoma Family of Tumours in Adults: A Clinico Radiological Review of 50 Cases

This review describes the imaging characteristics of Ewing sarcoma family of tumours ESFT exclusively in an adult population The magnetic resonance imaging MRI and computed tomography CT appearances in adult patients with ESFT is described The imaging characteristics in this largest case series of adult ESFT reported so far were similar to those reported in the paediatric ESFT Our incidence of extra skeletal ESFT of is the highest reported so far in the adult population and is higher than the reported incidence of in the paediatric and adolescent population MRI was found to be superior to CT scan in identifying tumour involvement of the bone marrow and in delineating the soft tissue involvement due to its multi planar imaging capability