Multiplanar Imaging Research Articles

MR imaging of the penis: What a radiologist needs to know!

Magnetic resonance imaging (MRI) plays an important role in imaging of penile pathologies due to its excellent soft tissue resolution and multiplanar imaging capabilities. This imaging review describes the MRI protocols and anatomical considerations in penile pathologies. MRI not only serves as a complementary tool to ultrasound in evaluation of trauma, infections, inflammatory diseases, and malignancies, but is also used as the definitive imaging modality for evaluation of penile prosthesis and complex cases.

Tirzepatide Reduces LV Mass and Paracardiac Adipose Tissue in Obesity-Related Heart Failure: SUMMIT CMR Substudy.

Obesity is a known risk factor for heart failure with preserved ejection fraction (HFpEF) and is considered a distinct phenotype with more concentric remodeling. Epicardial adipose tissue (EAT) is also increased in obesity-related HFpEF and is associated with adverse events. The Cardiac Magnetic Resonance (CMR) Substudy of the SUMMIT trial was aimed to examine the effects of tirzepatide on cardiac structure and function with the underlying hypothesis that it would reduce left ventricular (LV) mass and EAT in obesity-related HFpEF. One hundred seventy-five patients with obesity-related HFpEF from the parent study of tirzepatide (2.5mg SQ weekly, increasing to a maximum of 15mg weekly) or matching placebo underwent CMR at baseline, which consisted of multiplanar cine imaging. One hundred six patients completed the CMR and had adequate image quality for analysis of LV and LA structure and function and paracardiac (epicardial plus pericardial) adipose tissue at both baseline and 52 weeks. The prespecified primary endpoint of this substudy was between-group changes in LV mass. LV mass decreased by 11 g (95% C.I. -19 to -4) in the treated group (n = 50) when corrected for placebo (n =56) (p=0.004). Paracardiac adipose tissue decreased in the treated group by 45 ml (95% C.I. -69 to -22) when corrected for placebo (p<0.001). The change in LV mass in the treated group correlated with changes in body weight (p<0.02) and, tended to correlate with changes in waist circumference and blood pressure (p=0.06 for both). The LV mass change also correlated with changes in LV end diastolic volume and LA end diastolic and end systolic volumes (p<0.03 for all). The CMR substudy of the SUMMIT trial demonstrated that tirzepatide therapy in obesity-related HFpEF led to reduced LV mass and paracardiac adipose tissue as compared to placebo and the change in LV mass paralleled weight loss. These physiologic changes may contribute to the reduction in heart failure events seen in the main SUMMIT trial.

Magnetic Resonance Imaging Guidance for Percutaneous Needle Intervention.

Magnetic resonance imaging (MRI) is one of the guiding modalities used for percutaneous needle insertion during interventional procedures. MRI guidance has several advantages, including multiplanar imaging capability, superior soft tissue contrast resolution, and the absence of ionizing radiation. When performing MRI-guided procedures, it is important to understand the suitable MRI systems, instruments, and imaging sequences for intervention. Furthermore, needle artifact characteristics must be fully understood to ensure safe and accurate needle insertion. In this article, we present the fundamental knowledge as regards the use of MRI guidance for percutaneous needle insertion and review its usefulness in representative interventional procedures, such as biopsy and tumor ablation.

Image quality assessments in abdominal CT: Relative importance of dose, iterative reconstruction strength and slice thickness

IntroductionLow contrast resolution in abdominal computed tomography (CT) may be negatively affected by attempts to lower patient doses. Iterative reconstruction (IR) algorithms play a key role in mitigating this problem. The reconstructed slice thickness also influences image quality. The aim was to assess the interaction and influence of patient dose, slice thickness, and IR strength on image quality in abdominal CT. MethodWith a simultaneous acquisition, images at 42 and 98 mAs were obtained in 25 patients. Multiplanar images with slice thicknesses of 1, 2, and 3 mm and advanced modeled iterative reconstruction (ADMIRE) strengths of 3 (AD3) and 5 (AD5) were reconstructed. Four radiologists evaluated the images in a pairwise manner based on five image criteria. Ordinal logistic regression with mixed effects was used to evaluate the effect of tube load, ADMIRE strength, and slice thickness using the visual grading regression technique. ResultsFor all assessed image criteria, the regression analysis showed significantly (p < 0.001) higher image quality for AD5, but lower for tube load 42 mAs, and slice thicknesses of 1 mm and 2 mm, compared to the reference categories of AD3, 98 mAs, and 3 mm, respectively. AD5 at 2 mm was superior to AD3 at 3 mm for all image criteria studied. AD5 1 mm produced inferior image quality for liver parenchyma and overall image quality compared to AD3 3 mm. Interobserver agreement (ICC) ranged from 0.874 to 0.920. ConclusionADMIRE 5 at 2 mm slice thickness may allow for further dose reductions due to its superiority when compared to ADMIRE 3 at 3 mm slice thickness. Implications for practiceCombination of thinner slices and higher ADMIRE strength facilitates imaging at low dose.

Quality assessment of expedited AI generated reformatted images for ED acquired CT abdomen and pelvis imaging.

Retrospectively compare image quality, radiologist diagnostic confidence, and time for images to reach PACS for contrast enhanced abdominopelvic CT examinations created on the scanner console by technologists versus those generated automatically by thin-client artificial intelligence (AI) mechanisms. A retrospective PACS search identified adults who underwent an emergency department contrast-enhanced abdominopelvic CT in 07/2022 (Console Cohort) and 07/2023 (Server Cohort). Coronal and sagittal multiplanar reformatted images (MPR) were created by AI software in the Server cohort. Time to completion of MPR images was compared using 2-sample t-tests for all patients in both cohorts. Two radiologists qualitatively assessed image quality and diagnostic confidence on 5-point Likert scales for 50 consecutive examinations from each cohort. Additionally, they assessed for acute abdominopelvic findings. Continuous variables and qualitative scores were compared with the Mann-Whitney U test. A p < .05 indicated statistical significance. Mean[SD] time to exam completion in PACS was 8.7[11.1] minutes in the Console cohort (n = 728) and 4.6[6.6] minutes in the Server cohort (n = 892), p < .001. 50 examinations in the Console Cohort (28 women 22 men, 51[19] years) and Server cohort (27 women 23 men, 57[19] years) were included for radiologist review. Age, sex, CTDlvol, and DLP were not statistically different between the cohorts (all p > .05). There was no significant difference in image quality or diagnostic confidence for either reader when comparing the Console and Server cohorts (all p > .05). Examinations utilizing AI generated MPRs on a thin-client architecture were completed approximately 50% faster than those utilizing reconstructions generated at the console with no statistical difference in diagnostic confidence or image quality.

MRI for endometriosis in adolescent patients.

Endometriosis, a chronic condition that often starts in adolescence, can have a significant impact on quality of life due to symptoms of dysmenorrhea and pelvic pain. Although laparoscopy with direct visualization and pathologic correlation is the reference standard for the diagnosis of endometriosis, some authors have called for a greater emphasis on clinical diagnosis - including imaging. Magnetic resonance imaging (MRI) provides highly reproducible, large field of view, multiplanar, and multiparametric imaging of pelvic endometriosis and is well tolerated in adolescent patients. As such, pediatric radiologists need to be familiar with the manifestations of endometriosis on MRI and how these findings may differ from those seen in adult populations.

Prevalence of pneumatisation patterns of Onodi cells among the North-East Indian population

BackgroundThe posterior ethmoid sinuses have a complex anatomy and a highly variable normal structure. The posterior ethmoid Onodi cell needs careful assessment because of its proximity to the optic nerve and the internal carotid artery canal. Recognising the distinctions is essential for optimal pre-op preparation. Sphenoid sinus surgery can now be performed without worrying about compromising vital structures like the internal carotid artery or optic nerve. Preoperative radiological assessment is a quick and easy way to check for ethmoid cell pneumatisation differences.Aim and objectivesTo determine the pneumatisation patterns of Onodi cells among the North-East Indian population using 16-slice multidetector computed tomography (MDCT).ResultsNine-hundred MDCT paranasal sinuses were analysed over a period of 0–2 years, out of which 220 cases showed the presence of Onodi cell. Type I were 89 cases (40.45%, CI 32.00–48.90), Type II were 128 cases (58.18%, CI 49.72–66.63), and 3 cases with Type III cell (1.36%, CI 0.18–2.54).ConclusionThe most prevalent pneumatisation pattern is Type II. The pneumatisation patterns of Onodi cells can be best detected and evaluated by multiplanar MDCT imaging. Sinus surgeons need a firm grasp of pneumatisation patterns to avoid damaging the optic nerve and internal carotid artery canal during operations.

Frequency of bile duct variant anatomy on MRCP on 3.0t in liver donors.

Objective: To determine the frequency of bile duct variant using magnetic resonance cholangiopancreatography (MRCP) on a magnetic field strength of 3.0 Tesla in liver donors. Study Design: Descriptive Cross-sectional study. Setting: Department of Radiology, Armed Forces Institute of Radiology and Imaging, Military Hospital Rawalpindi. Period: May 2019 to November 2019. Methods: The research comprised people who went to the hospital for magnetic resonance cholangiopancreatography. 85 liver transplant recipients between the ages of 20 and 70 were chosen for the research. According to Yoshida categorization, bile duct variation was noted. The MRCP methodology includes multiplanar imaging, maximum intensity projection pictures, thin slab axial HASTE, thick slab coronal HASTE, and T2 3D sequence. The Siemens Avanto 3 Tesla machine was used for the study. Results: The study's participants ranged in age from 20 to 70, with a mean age of 41.73 ± 10.03 years. The majority of the 54 patients (63.53 percent) were aged 20 to 45. The male to female ratio was 1:1 among the 85 patients, with 43 (50.59 percent) men and 42 (49.41 percent) women. In my research of liver donors, 57 (67.05 percent) showed normal biliary tree structure and 28 (32.95 percent) exhibited abnormalities. Conclusion: This study concluded that normal biliary tree anatomy was seen in 67.05% and 32.95% had variations in biliary anatomy on MRCP on 3.0T in liver donors.

Skeletal computed tomography findings of upper extremities in middle-aged persons with thalidomide embryopathy.

Individuals with thalidomide embryopathy are now approximately 60 years old. For years, they have been compensating for their hypoplastic limbs in various aspects of daily living, and they face secondary problems such as limb and back pain. Imaging analysis is beneficial for understanding the pathogenesis of these problems. However, previous studies on skeletal imaging were mainly radiographic studies conducted at young ages, and there are few studies on skeletal imaging after aging, with most of them being case reports. In this study, detailed analyses of the skeletons of the upper extremities were performed using three-dimensional computed tomography and multiplanar reconstruction images in five individuals with thalidomide embryopathy aged approximately 60 years. Each individual frequently complained of neck, shoulder, and/or back pain. Dislocation, subluxation, and osteoarthritis were observed in the shoulder joints in some individuals. Hypoplasia of the trochlea and/or capitulum of the humerus, coronoid fossa, olecranon, and coronoid processes was observed in the elbow joints. Fusion and hypoplasia of the carpal bones were frequently observed in wrist joints. Radiocarpal and ulnocarpal synostoses were also observed. The joint instability and osteoarthritis found in this study may have contribute to upper limb pain in individuals with thalidomide embryopathy.

DOES TOTAL HIP ARTHROPLASTY BENEFIT PATIENTS WITH MINIMAL RADIOLOGICAL OSTEOARTHRITIS?

There is some evidence to suggest that outcomes of THA in patients with minimal radiographic osteoarthritis may not be associated with predictable outcomes. The aim of this study was to:Assess the outcome of patients with hip pain who underwent THA with no or minimal radiographic signs of osteoarthritis,Identify patient comorbidities and multiplanar imaging findings which are predictive of outcome,Compare the outcome in these patients to the expected outcome of THA in hip OA.A retrospective review of 107 hips (102 patients, 90F:12M, median age 40.6, IQR 35.1–45.8 years, range 18–73) were included for analysis. Plain radiographs were evaluated using the Tonnis grading scale of hip OA. Outcome measures were all-cause revision; iHOT12; EQ-5D; Oxford Hip Score; UCLA Activity Scale; and whether THA had resulted in the patient's hip pain and function being Better/Same/Worse.The median Oxford Hip Score was 33.3 (IQR 13.9, range 13–48), and 36/107 (33.6%) hips achieved an OHS≥42. There was no association between primary hip diagnosis and post-operative PROMs. A total of 91 of the 102 patients (89.2%, 93 hips) reported that their hip pain and function was Better than prior to THA and would have the surgery again, 7 patients (6.8%, 10 hips) felt the Same, and 4 patients (3.9%, 4 hips) felt Worse and would not have the surgery again.Younger patients undergoing total hip arthroplasty with no or minimal radiographic osteoarthritis had lower postoperative Oxford Hip Scores than the general population; though most felt symptomatically better and knowing what they know now, would have surgery again. Those with chronic pain syndrome or hypermobility were likely to benefit less. Those with subchondral cysts or joint space narrowing on CT imaging were more likely to achieve higher functional scores and satisfaction.

Age-related changes in mitral annular disjunction: A retrospective analysis using enhanced cardiac CT

AimsThe current recognition of mitral annular disjunction (MAD) as an anatomical abnormality potentially associated with ventricular arrhythmias has sparked controversy regarding its prevalence and clinical implications. This study aimed to investigate the prevalence and extent of MAD in individuals with no significant structural abnormalities involving the left heart using enhanced cardiac CT, while also exploring potential factors, such as age, that may be associated with MAD. MethodsSystolic datasets of cardiac CT from 742 subjects were retrospectively included. MAD was determined by rotating orthogonal multiplanar reconstruction images around the central axis of the mitral annulus. The maximal distance of disjunction (DMAD) and segments involved (SI, 0 to 5 basal segments at left ventricular wall) was quantified to evaluate the extent of separation. ResultsIn total, 449 (60.5%) had MAD. Subjects with MAD were significantly older (51.3 ± 19.9 years vs. 29.6 ± 20.3 years, P < 0.001). Age was found to be an independent relevant factor for MAD (OR = 1.059; 95%CI: 1.033, 1.085; P < 0.001). Subjects with MAD were then divided into 4 subgroups (G1: ≤20 years, G2: 21–40 years, G3: 41–60 years, G4: ≥61 years). DMAD and SI of each age subgroup were 1.9 ± 0.2 mm, 2.0 ± 1.2 (G1, n = 36), 2.7 ± 0.8 mm, 2.9 ± 1.3 (G2, n = 51), 3.0 ± 0.8 mm, 3.0 ± 1.3 (G3, n = 183), and 3.0 ± 1.0 mm, 3.7 ± 1.1 (G4, n = 179). Age was an independent relevant factor associated with DMAD (R2 = 0.132; β = 0.014; 95%CI: 0.004, 0.024; P = 0.007) and SI (OR = 1.030; 95%CI: 1.005, 1.055; P = 0.016). ConclusionsMAD is a common finding on cardiac CT. Its prevalence and extent increase with age.

Assessing the relationship of agger nasi pneumatization to the lacrimal sac: a dynamic computed tomography-dacryocystography analysis.

An understanding of the anatomical structure is crucial for completing successful endoscopic dacryocystorhinostomy (DCR) surgery. This study aimed to precisely delineate the spatial relationship between the lacrimal sac and the agger nasi cell (ANC) and evaluate the impact of ANC on surgical strategies in endoscopic DCR. This retrospective cross-sectional study included 110 Han Chinese patients diagnosed with unilateral primary acquired nasolacrimal duct obstruction (PANDO) from January 2021 to June 2023. This study was conducted in Eye, Ear, Nose, and Throat Hospital of Fudan University and involved inpatient participants who were scheduled for DCR surgery under general anesthesia. Patients were consecutively enrolled. The patients underwent preoperative computed tomography-dacryocystography (CT-DCG), and contrast-enhanced images were used to locate the positions of the lacrimal sac and the common canaliculus. A dynamic approach was adopted to analyze the multiplanar CT imaging, facilitating a detailed assessment of the morphology of the lacrimal drainage system and potential overlap of the lacrimal sac. Patient ages and measured values are presented as the mean ± standard deviation, which were measured three times by the same observer and averaged for statistical analysis. The prevalence of ANC in this study was 90.9% (100/110). Dynamic examination revealed that only 42.7% (47/110) of ANCs appeared as discrete cells, while the majority were connected to nearby sinus openings. Spatial analysis showed that in 57 out of 110 cases, ANCs were situated below the common canaliculus and not posterior to the lacrimal sac, indicating an overlap rate of 51.8%. Notably, our dynamic approach identified five critical cases of overlap below the level of the common canaliculus, which might have been missed by prior studies that used different methodologies. More than half of the ANCs exhibited overlap with the lacrimal sac, suggesting a significant proportion may necessitate opening during endoscopic DCR procedures. ANCs are often interconnected with adjacent nasal sinuses, necessitating careful consideration in the decision to open the ANCs during surgery. The dynamic evaluation employed in CT-DCG effectively assessed the extent of ANC coverage over the lacrimal sac.

Giant Eustachian Valve Mimicking an Inter-atrial Septal Defect

A 68-year-old woman presented with dyspnoea attributed to acute pulmonary oedema. Due to an audible diastolic murmur, a transthoracic and transoesophageal echocardiogram (TEE) was performed revealing severe rheumatic mitral stenosis and regurgitation. Although initial assessment of the interatrial septum did not reveal any atrial septal defects, upon TEE evaluation using a 112° window, an interatrial defect was seen, with turbulent flow seen through this. However, using multiplanar imaging, a separate elongated Eustachian valve was shown to be mimicking an ‘arm’ of the interatrial septum and giving rise to the illusion of a defect. The Eustachian valve is a congenital remnant which often regresses at birth but can exist as an elongated structure originating from the inferior portion of the right atrium and may appear as an atrial septal defect. By employing multiplanar imaging on TEE, we were able to systematically discern the reason behind the apparent defect and avoid further delays to the patient’s care.

Identification of Terminal Syrinx in a 5-day-old Infant: The Role of Magnetic Resonance Imaging in Diagnosing Back Swellings – A Clinical Review

Abstract A 5-day-old male neonate presented with a palpable lumbar region swelling, leading to the suspicion of a neural tube defect (NTD) or other spinal abnormalities. The infant was born through cesarean section and appeared well-nourished, alert, and interactive with no neurological deficits or signs of infection. Brain screening using ultrasound and head magnetic resonance imaging (MRI) ruled out hydrocephalus and Arnold–Chiari malformation. Spinal imaging using MRI revealed a terminal syrinx in the conus medullaris, which was not apparent on clinical examination. Considering the potential complications and future neurological deterioration, a syringostomy was performed. Neonatal back swellings can be challenging diagnoses due to their broad spectrum of pathologies, including NTDs and terminal syringes. Terminal syringes involve the conus medullaris and cauda equina and may present as a palpable back swelling. These infants are typically asymptomatic at birth but can develop neurological deficits over time. MRI is the gold standard for evaluating suspected NTDs or terminal syringes due to its high resolution, multiplanar imaging capabilities, and lack of ionizing radiation. Ultrasound and computed tomography scans have limitations in diagnosing terminal syringes accurately. Early diagnosis and intervention are crucial to prevent potential complications and improve outcomes for these patients. The management strategy depends on how severe the underlying condition is. For infants without symptoms, close monitoring is recommended. If the baby shows symptoms or is at high risk, surgery can be considered. Syringostomy involves placing a shunt to drain cerebrospinal fluid from the syrinx into the abdominal cavity, reducing pressure and potentially improving neurological function. In conclusion, neonatal back swellings, particularly those caused by terminal syringes, require a thorough diagnostic evaluation and close follow-up. MRI is an essential diagnostic tool due to its high resolution and ability to delineate intracranial and spinal structures effectively. Early diagnosis and intervention can improve outcomes for these patients and prevent complications. Clinicians should maintain a high index of suspicion for terminal syringes in neonates with back swellings and pursue appropriate diagnostic tests, such as MRI, to ensure accurate diagnosis and timely management.

Magnification of a multi-focus infinity corrected microscope

The problem of image magnification in a bright field multi-focus imaging microscope is discussed. Such microscope allows simultaneous observation of two objects axially separated by a distance that exceeds the depth-of-field of the microscope, so-called multi-planar imaging. It is shown that the tunable lens required for operation of the microscope can be used in constant magnification imaging in the single focus regime, but not in multi-focus. Additionally, it is presented that the microscope allows for multi-planar imaging with satisfactory quality with a selected magnification of the image of one of the two objects. While the microscope uses a thermal lens as the tunable lens, the scheme of the optical setup needed to achieve the desired operation of the microscope is universal and applies to all kinds of tunable lenses used in microscopy.

A prospective observational study on magnetic resonance imaging (MRI) based evaluation of pelvic masses in females in tertiary care hospital in central India

Background Pelvic masses in females often present a diagnostic challenge, necessitating accurate detection and characterization for appropriate clinical management. Magnetic Resonance Imaging (MRI) has emerged as a valuable tool in pelvic mass evaluation, offering superior soft tissue contrast and multiplanar imaging capabilities. This prospective observational study aims to assess the diagnostic accuracy of pelvic MRI, determine anatomic origin, classify masses, estimate local spread, and evaluate the impact of gadolinium contrast in a tertiary care hospital in Central India. Methods The study will be conducted over a two-year period, enrolling female patients with lower back pain and clinical suspicion or inconclusive ultrasonographic findings of pelvic masses. A systematic approach to participant identification, recruitment, and engagement will be employed, with both verbal and written informed consent obtained. The imaging protocol will involve T1 and T2 weighted images, and gadolinium contrast administration when necessary. Data collection will encompass demographic information, medical history, clinical details, and MRI findings. Statistical analyses, including sensitivity, specificity, prevalence estimates, and regression analyses, will be performed to evaluate the diagnostic accuracy of pelvic MRI. Expected outcome We anticipate that pelvic MRI will exhibit high diagnostic accuracy in detecting and characterizing pelvic masses, providing valuable information on anatomic origin and pelvic compartment localization. The study aims to contribute evidence on the impact of gadolinium contrast in enhancing diagnostic capabilities. The findings are expected to optimize clinical decision-making for effective management of females with pelvic masses, leading to timely interventions and improved patient outcomes.

Reliability of glenoid measurements performed using Multiplanar Reconstruction (MPR) of Magnetic Resonance (MRI) in patients with shoulder instability

PurposeMeasurement of glenoid bone loss in the shoulder instability can be assessed by CT or MRI multiplanar imaging and is crucial for pre-operative planning. The aim of this study is to determine the intra and interobserver reliability of glenoid deficiency measurement using MRI multiplanar reconstruction with 2D assessment in the sagittal plane (MPR MRI).MethodsWe reviewed MRI images of 80 patients with anterior shoulder instability with Osirix software using MPR. Six observers with basic experience measured the glenoid, erosion edge length, and bone loss twice, with at least one-week interval between measurements. We calculated reliability and repeatability using the intra-class correlation coefficient (ICC) and minimal detectable change with 95% confidence (MDC95%).ResultsIntra and Inter-observer ICC and MDC95% for glenoid width and height were excellent (ICC 0,89-0,96). For erosion edge length and area of the glenoid were acceptable/good (ICC 0,61-0,89). Bone loss and Pico Index were associated with acceptable/good ICC (0,63 -0,86)) but poor MDC95% (45 - 84 %). Intra-observer reliability improved with time, while inter-observer remained unchanged.ConclusionThe MPR MRI measurement of the anterior glenoid lesion is very good tool for linear parameters. This method is not valid for Pico index measurement, as the area of bone loss is variable. The pace of learning is individual, therefore complex calculations based on MPR MRI are not resistant to low experience as opposed to true 3D CT

On‐Chip‐Driven Multicolor 3D Meta‐Display

AbstractIntegrating metasurfaces on‐chip provides a promising approach to modulating and extracting the in‐plane waves, which bridges the conversion between guided and free‐space waves and suggests tremendous applications, including guided‐wave‐driven holography, photonic integrated lasers, and on‐chip routers. However, despite these efforts, it remains challenging to achieve multicolor 3D holographic projections via on‐chip meta‐optics, along with switchability. Here, the multicolor 3D holography free from zero‐order diffraction and the immersion switchable display enabled by the on‐chip integrated metasurface is proposed and demonstrated. By leveraging the propagation‐accumulated phase of the guided waves and exploiting an optimization algorithm, an on‐chip meta‐hologram driven by guided waves is developed to project both multicolor and multiplane images with independent encoding freedom. Moreover, the switch between two colorful holographic images is also demonstrated via an easily accessible immersion tuning scheme. Such an on‐chip‐driven meta‐hologram exhibits low background noise or crosstalk with high information quality and is also free from sophisticated nanostructure searching or elaborate target‐image predesigning. The proposed on‐chip‐driven metasurface for multicolor 3D holography promises future applications in dynamic display, virtual/augmented reality, and liquid sensing.

Unveiling the Integral Role of Magnetic Resonance Imaging in the Comprehensive Evaluation and Diagnosis of Spinal Dysraphism.

Background Spinal dysraphism, characterized by incomplete closure of neural and bone spinal structures, manifests as congenital fusion abnormalities along the dorsal midline, involving the skin, subcutaneous tissue, meninges, vertebrae, and neural tissue. Magnetic resonance imaging (MRI), the preferred imaging modality for assessing spinal dysraphism across all age groups, provides direct visualization of the spinal cord without the need for contrast or ionizing radiation while also eliminating bone artifacts and allowing multiplanar imaging. The objective of this study was to evaluate the range of spinal dysraphism lesions and assess the significance of MRI in their evaluation. Methodology Thirty patients with suspected spinal dysraphism underwent evaluation at the Medical College Hospital and Study Centre in Vijayapur, India. This cross-sectional observational study included patients diagnosed or provisionally diagnosed with spinal dysraphism based on clinical and imaging profiles. Cases were identified through preliminary findings on radiographs. Results The study encompassed individuals aged one month to 20 years, with the largest proportion of patients (36.67%) falling within the 1-5-year age group. Spina bifida was the most prevalent spinal abnormality, accounting for 70% of cases. In 12 patients (40%), the most prevalent location of involvement was the lumbosacral spine. Conclusion MRI provides excellent tissue differentiation, particularly of lipomatous tissue, with reproducible and comprehensive section planes and relative operator independence. Moreover, MRI is beneficial for children with suspected spinal dysraphism as it can be performed without ionizing radiation, biological risks, or the need for intrathecal contrast media.

Modified double-pulley fixation provides better reduction of bone fragments and union compared to single-point fixation in bony Bankart lesions.

The purpose of this study was to compare clinical scores and imaging outcomes of bony Bankart lesions that underwent single-point and modified double-pulley fixation after at least 2 years of follow-up. Patients who underwent surgery to treat bony Bankart injuries were included and divided into groups A and B. A total of 69 patients were included (32 in group A and 37 in group B). Patients in group A underwent arthroscopic modified double-pulley fixation and patients in group B underwent arthroscopic single-point fixation. Three-dimensional computed tomography (3D-CT) was used to assess glenoid reduction one day after surgery. Postoperative bony union was assessed using 3D-CT and multiplanar reconstruction images 6 months after surgery. Constant-Murley, Rowe rating system, visual analogue scale and University of California at Los Angeles and American Shoulder and Elbow Surgeons scores were recorded before and after surgery. In terms of imaging measurements, there was no significant group difference in the preoperative size of the glenoid defect, the size of the bony fragment or the expected postoperative size of the glenoid defect. The sizes of the actual postoperative glenoid defects differed significantly between the groups (p = 0.027), as did the absolute difference between the expected and actual glenoid defect sizes (p < 0.001). At 6 months postoperatively, 50.0% of group A patients and 24.3% of group B patients exhibited complete bony union (p = 0.027); the rates of partial union were 37.5% and 56.8%, respectively. At the final follow-up, all clinical scores were significantly better than the preoperative scores (all p < 0.05), with no significant group differences (not significant). The use of the modified double-pulley technique with two anchors to treat bony Bankart injuries provides a better reduction of bone fragments than single-point fixation with two anchors and was associated with a higher rate of early bone union. Level III.