Multiplanar Imaging Research Articles

Estimación forense de la edad basada en el estudio de la epífisis proximal de la clavícula. Actualización y factores de interferencia

Forensic Age Estimation in migrant minors without family reference is a developing field within forensic sciences. The international and national action guides recommend for this expert reports the practice of multiplanar medical imaging studies, more precisely computed tomography, of the proximal end of the clavicle. This type of test is reserved for those cases in which a possible majority of the supposedly minor cannot be ruled out by other methods. This diagnostic test has peculiarities derived from its relative complexity of interpretation and the relatively high frequency of appearance of developmental anomalies that make it difficult to apply it as a test of expert value. This review aims to be an update of the state of the art in this field of expertise with a special focus on its expert value and the impact generated by the aforementioned anomalies in its practical application.

3D computed tomography intravascular endoscopy.

Using coronary computed tomography angiography (CCTA), coronary plaques can be characterized based on both their morphology and composition. Coronary plaques are generally assessed on 2D axial and multiplanar reformatted images. Nevertheless, these visualization tools are limited to observing extraluminal changes in the coronary artery. The presence of plaques prevents them from providing a visual representation of the intraluminal coronary wall. Since its invention in 2000, coronary fly-through or virtual angioscopy (VA) has been extensively studied. However, its application was limited because it required an optimal CT scan and time-consuming post-processing. In recent years, advances in post-processing software have made construction of VA easier, but until recently the quality of the images was insufficient for most patients. Using 3D intravascular endoscopy (3DIE) visualization, we present various intraluminal appearances of the coronary wall and plaque in relation to various types of plaque.

Assessment of the structural features of the hard palate in endonasal surgery

To study the anatomical structure of the hard palate from the point of view of rhinosurgery, using vector analysis of multispiral computed tomography (MSCT), and to establish anatomical features that should be taken into account when performing surgical interventions on the nasal septum. 107 patients (30 men, 77 women) were examined without congenital cleft palate and surgical interventions on the structures of the nasal cavity and hard palate. All patients underwent MSCT of the nose and paranasal sinuses (PNS) followed by multiplanar image reconstruction. The key point relative to which the measurements were carried out was the posterior wall of the incisor canal from the side of the nasal cavity. The line corresponding to the bottom of the nasal cavity was chosen as the main vector. In the work, measurements of the thickness of the hard palate (THP) at the level of the palatal suture and the width of the palatal suture (WPS) were carried out. Statistical analysis of the obtained results showed that the THP is 1.74 mm [min 0.28; max 6.46], the WPS is 0.9 mm [min 0.2; max 2.51] (conditional norm). In 19 patients (17.8%), the THP was 0.82 mm, in 2 patients (1.9%) - 0.2 mm. In 3 patients (2.8%), the WPS was equal to 2.5 mm. Thus, the data obtained by us indicate that the surgical anatomy of the hard palate is characterized by significant variability, while in some patients the THP can be reduced by 8.8 times, and the WPS increased by 2.7 times compared to normal values. Such anatomical features of the structure of the hard palate should be taken into account when planning septoplasty, since this contingent of patients has an increased risk of developing iatrogenic perforation of the nasal floor during surgical intervention on the lower floor of the nasal septum.

A token-mixer architecture for CAD-RADS classification of coronary stenosis on multiplanar reconstruction CT images

Background and objectiveIn patients with suspected Coronary Artery Disease (CAD), the severity of stenosis needs to be assessed for precise clinical management. An automatic deep learning-based algorithm to classify coronary stenosis lesions according to the Coronary Artery Disease Reporting and Data System (CAD-RADS) in multiplanar reconstruction images acquired with Coronary Computed Tomography Angiography (CCTA) is proposed. MethodsIn this retrospective study, 288 patients with suspected CAD who underwent CCTA scans were included. To model long-range semantic information, which is needed to identify and classify stenosis with challenging appearance, we adopted a token-mixer architecture (ConvMixer), which can learn structural relationship over the whole coronary artery. ConvMixer consists of a patch embedding layer followed by repeated convolutional blocks to enable the algorithm to learn long-range dependences between pixels. To visually assess ConvMixer performance, Gradient-Weighted Class Activation Mapping (Grad-CAM) analysis was used. ResultsExperimental results using 5-fold cross-validation showed that our ConvMixer can classify significant coronary artery stenosis (i.e., stenosis with luminal narrowing ≥50%) with accuracy and sensitivity of 87% and 90%, respectively. For CAD-RADS 0 vs. 1–2 vs. 3–4 vs. 5 classification, ConvMixer achieved accuracy and sensitivity of 72% and 75%, respectively. Additional experiments showed that ConvMixer achieved a better trade-off between performance and complexity compared to pyramid-shaped convolutional neural networks. ConclusionsOur algorithm might provide clinicians with decision support, potentially reducing the interobserver variability for coronary artery stenosis evaluation.

THE ROLE OF MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF TRAUMATIC INJURIES OF ANKLE JOINT

Background: Because of its wide array of advantages, MRI has gained popularity in evaluation of the musculoskeletal system. The advantages include non-invasiveness, lack of ionizing radiations, superior soft-tissue imaging and direct multiplanar imaging. Excellent visualization of cartilage, ligaments, tendons and bones can be achieved by the high resolution images of MRI. MRI can provide a comprehensive evaluation of ankle, including soft tissue and bone pathology. The soft tissue contrast resolution of MRI is superior to that of CT, and MRI is as good as or better than CT for most bone pathology. MRI is more sensitive than CT in the detection of stress fractures and trabecular bone injury.[4] Aim & Objective: 1.To study the normal anatomy of ankle joint on MRI.2 To assess acute traumatic injury patterns of ankle joint.3.To study the role of MRI in the evaluation of traumatic injuries of ankle joint..4 To study the chronic sequelae of ankle injuries. Methods: Study setting: Cross sectional study Tertiary care center. Study duration: 2 years ( from October 2019 to March 2021). Study population: The study population included all the cases with traumatic ankle injury referred to the Dept. of Radiodiagnosis our institute for MRI scan with or without X-ray ndings admitted at a tertiary care center such cases were included in the study. 50 Majority of cases found in 20-30 years age group 18( 36% Sample size: Results: ) followed by 40-50 group 12 cases (24%), 9 cases in 30-40, 7 cases in >50 and 4 cases in 10-20. Males contributing 34 (68%) and females 16 (32%). Deltoid ligament injuries are observed in 12 patients. However, isolated injuries are not seen. Deltoid ligament injuries are associated with bone, other ligamentous and tendon injuries. Anterior compartment tendon injuries were not observed in this study. 16 patients had a history of acute inversion injury. MRI plays an important role Conclusions: for planning further management and to decide whether the patient will require conservative or surgical management. Even though anatomical variants and technical artefacts can mimic a tear on MRI, it is still considered the primary imaging modality for optimal depiction of internal derangement in ankle injury. Common injuries observed in our study are - anterior talo- bular ligament injury, deltoid ligament injury, tenosynovitis, bone contusions and joint effusion.

MULTIDETECTOR COMPUTED TOMOGRAPHY IN BLUNT CHEST TRAUMA SINGLE TERTIARY CARE TRAUMA CENTRE EXPERIENCE.

Thoracic injuries are signicant causes of morbidity and mortality in trauma patients, second only to head injuries. In addition to conventional radiography, multidetector computed tomography (CT) is increasingly being used, since it can quickly and accurately help diagnose a wide variety of injuries in trauma patients. Furthermore, multiplanar and MiNIP, volumetric reformatted CT images provide improved visualization of injuries, increased understanding of trauma-related diseases, and enhanced communication between the radiologist and the referring clinician. To identify and accurately a Aims: ssess variety of injuries in blunt thoracic trauma with multidetector Computed Tomography (MDCT). To nd commonest pattern of intrathoracic injury related to blunt chest trauma. This Method: retrospective observational study included 50 patients who underwent Multidetector CT examination during the period from November 2020 to April 2021 at tertiary care trauma centre, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai. Blunt chest Conclusion: trauma injuries were classied into pleural injury, lung parenchymal injury, bony thorax, tracheobronchial and vascular injuries. The commonest injury detected was pleural (70%) followed by lung parenchymal injury (52%) and bony thorax injury in 50% cases. 50% of the pleural injury cases were associated with rib fractures. Multiple injuries were seen in the 47 patients, stating the importance of a detail evaluation of all chest components. No oesophageal and cardiac injury was detected in our CT studies' with its multiplanar, MinIP and volume reconstruction images increases the condence in imaging diagnosis and play a critical role in understanding thoracic trauma related complications.

Physician-modified endograft using three-dimensional model-assisted planning.

Case-specific and true-to-scale three-dimensional (3D) models have become increasingly useful tools for physician-modified endovascular grafting. This study aimed to validate the use of 3D model-assisted planning for fenestration design. Thirty-two consecutive patients (2019-2021) presenting with pararenal or juxtarenal abdominal aortic aneurysm (n= 16), paravisceral abdominal and Crawford's extent IV thoracoabdominal aortic aneurysm (n= 12), and type I endoleak after endovascular repair (n= 4) were analyzed retrospectively. All cases were planned manually with a standard method using curved planar reconstruction stretch images and multiplanar images perpendicular to the centerlines. The design was finalized by intraoperative 3D model-assisted planning. Intermethod agreements were assessed for geometrical relationships (separation heights and angles) between the superior mesenteric and renal arteries. The datasets from 55 double measurements of the entire cohort in this series were used to assess measurement discrepancies (≥3mm separation height or ≥15° angle difference) and fenestration mismatches (≥3mm separation between the manually planned and 3D model-assisted-planned renal arterial centers on the device surface) between manual and 3D model-assisted planning. Statistical analyses were performed to test the impact of anatomical factors on the discrepancies and mismatches. The imposition accuracy of 3D model-assisted planning and short-term clinical results of the 32 cases were also evaluated. Fourteen fenestration measurement discrepancies were detected. The size of the stent graft (P= .0381), the aortic angle (P= .0008), and the prior existence of stent graft (P= .0123) were found to have a statistically significant impact on the measurement discrepancy, using single logistic and Fisher's exact tests. Twelve fenestration mismatches were observed and found to be significantly affected (P= .0039) by aortic angle. A cutoff value for fenestration mismatch was found to be 36.5°, with a sensitivity and specificity of 69.2% and 80.5%, respectively, using receiver operating characteristic analysis (area under the curve, 0.782± 0.081; P= .0023). A high level of branch preservation (100%) was achieved. During the observation period (1.3years on average; range, 0.5-2.5years), no patient experienced complications related to fenestration. The differences between the planning methods were non-negligible. However, 3D model-assisted planning increased the precision of the fenestration design when the conformation of the stent graft to the aortic anatomy is taken into account.

Cone-Beam Computed Tomography for Temporomandibular Joint Imaging.

The temporomandibular joint (TMJ) can be viewed using various imaging techniques. Due to relatively low radiation doses and excellent spatial resolution, cone-beam computed tomography (CBCT) is being utilized more frequently in dental-maxillofacial imaging. For the diagnosis and treatment of TMJ disorders, an imaging examination is required. The osseous compartment is visualized using conventional CT, and CBCT and soft tissue imaging are extremely well appreciated on MRI. However, conventional TMJ imaging has its limitations due to its two-dimensional view and adjacent anatomical superimposition. TMJ imaging helps analyzethe cortical and the bony compartment's trabaculae and assessthe degree of skeletal abnormalities. TMJimaging protocols are also used to evaluate treatment responses. CBCT is the three-dimensional imaging of the bony compartment and joint space and the morphology of the bone visualized by removing superimposition and distortion. Compared to multislice CT, CBCT produces high-resolution multiplanar images with a reduced dose of radiation. The role of CBCT imaging in determining the normal bony anatomy and pathological changes is appropriately delineated in this paper. This work will focus on the use of CBCT for the examination of TMJ in various patientcategories, including those with osteoarthritis, remodeling, ankylosis, trauma, rheumatoid arthritis, synovial chondromatosis, and other intracapsular pathologies.

Abstract 11224: Anatomical Characteristics of Myocardial Bridging and Its Impact on Myocardial Ischemia in Patients With Nonobstructive Coronary Artery Disease

Introduction. Epicardial coronary arteries running through the myocardium (myocardial bridges: MBs) are compressed during myocardial contraction and may be involved in myocardial ischemia. However, the anatomical characteristics of MBs and their impact on myocardial ischemia have not been well characterized. Methods. We included 626 patients who underwent coronary artery computed tomography to evaluate ischemic signs and/or symptoms (mean age 66±13 years, 32% males). Curved multiplanar reformation images were used to assess MBs' presence, length, and thickness. In patients with positive noninvasive stress testing (NST), we compared the frequency and anatomical characteristics of MBs between patients with obstructive coronary arteries (OCA defined as >50% stenosis in main branches) and those with nonobstructive coronary arteries (INOCA). Results. MBs were found in 176 patients (28%), of which 45% were superficial (≤2 mm), 54% were deep (2-5 mm), and 1% were very deep (>5 mm) MBs (mean MB thickness 2.2±0.9 mm). The mean MB length was 18.2±5.7 mm with 14% long MBs (≥25 mm). Ninety-four out of 202 patients undergoing NST presented positive results, 62 of whom had OCA and 32 had INOCA. MBs were more frequently observed in patients with INOCA than in those with OCA (63% vs. 39%, P=0.03) (Figure A). Interestingly, INOCA patients tended to have longer MBs than those with OCA (20.7±6.0 mm vs. 17.6±5.4 mm, P=0.08), whereas MB thickness was not different between the two groups (2.3±0.7 vs. 2.0±0.6, P=0.19) (Figure B). Conclusion. Longer MBs may significantly impact myocardial perfusion, potentially producing positive results on stress tests in patients with INOCA.

MAGNETIC RESONANCE IMAGING FINDINGS OF PERIANAL FISTULAE AND ITS CORRELATION WITH DEMOGRAPHICS, CO-MORBITIES AND SURGICAL OUTCOMES IN A TERTIARY HEALTH CARE CENTRE IN MAHARASHTRA, INDIA :A CROSS SECTIONAL STUDY.

Introduction:. Perianal stulas have been traditionally imaged by conventional stulogram, CT stulography and endoanal USG. The advantages of MR imaging include multiplanar imaging and a high degree of soft-tissue differentiation, which show the stulous track in relation to the underlying anatomy in a projection relevant to surgical exploration, thus providing an edge over previous diagnostic modalities To . Objectives: identify the stulous track in relation to sphincter complex. To classify the perianal stula according to St James's University Hospital Classication. To correlate imaging ndings with demographics, commorbities and surgical outcomes. Methodology: A cross sectional, observational study was conducted on 60 patients with clinically diagnosed perianal stulae using 1.5 Tesla HDxt MRI machine over a period of 18 months. Results MRI helped in the adequate grading of the perianal stula as per the St James University Hospital grading and further surgical follow up showed good association in grade III, IV and V perianal stula. MRI of the peri Conclusion: anal stula provided information about the primary stulous track and their different stulizing patterns, internal openings with great anatomic detail of the surrounding pelvic organs and the sphincter complex

BgNet: Classification of benign and malignant tumors with MRI multi-plane attention learning.

To propose a deep learning-based classification framework, which can carry out patient-level benign and malignant tumors classification according to the patient's multi-plane images and clinical information. A total of 430 cases of spinal tumor, including axial and sagittal plane images by MRI, of which 297 cases for training (14072 images), and 133 cases for testing (6161 images) were included. Based on the bipartite graph and attention learning, this study proposed a multi-plane attention learning framework, BgNet, for benign and malignant tumor diagnosis. In a bipartite graph structure, the tumor area in each plane is used as the vertex of the graph, and the matching between different planes is used as the edge of the graph. The tumor areas from different plane images are spliced at the input layer. And based on the convolutional neural network ResNet and visual attention learning model Swin-Transformer, this study proposed a feature fusion model named ResNetST for combining both global and local information to extract the correlation features of multiple planes. The proposed BgNet consists of five modules including a multi-plane fusion module based on the bipartite graph, input layer fusion module, feature layer fusion module, decision layer fusion module, and output module. These modules are respectively used for multi-level fusion of patient multi-plane image data to realize the comprehensive diagnosis of benign and malignant tumors at the patient level. The accuracy (ACC: 79.7%) of the proposed BgNet with multi-plane was higher than that with a single plane, and higher than or equal to the four doctors' ACC (D1: 70.7%, p=0.219; D2: 54.1%, p<0.005; D3: 79.7%, p=0.006; D4: 72.9%, p=0.178). Moreover, the diagnostic accuracy and speed of doctors can be further improved with the aid of BgNet, the ACC of D1, D2, D3, and D4 improved by 4.5%, 21.8%, 0.8%, and 3.8%, respectively. The proposed deep learning framework BgNet can classify benign and malignant tumors effectively, and can help doctors improve their diagnostic efficiency and accuracy. The code is available at https://github.com/research-med/BgNet.

Search for Optimal MRI Protocol for the Diagnosis of Vaginal Tumor

Background. A wide variety of pulse sequences, the possibility of multiplanar imaging significantly increase the capabilities of magnetic resonance imaging (MRI) in diagnosing diseases of the female reproductive system. At the same time, the lack of a regulated scanning protocol, especially in patients who have undergone anticancer treatment, requires standardization of the technique and the search for an optimal set of pulse sequences that allows to visualize the vagina throughout its entire length and to perform differential diagnosis between continued tumor growth and post-radiation changes while maintaining an adequate examination time.Objective: to determine the optimal set of MRI pulse sequences for pelvic organs examination in patients with vaginal tumors and to form an original research protocol based on diagnostic information content.Material and methods. The study included 141 patients with vaginal tumors. A comparative analysis of four MRI protocols was carried out, built according to the principle “from simple to complex” (from native to multiparametric MRI).Results. A significant difference was obtained between all information content indicators of Protocol 4 compared to Protocol 1 (sensitivity p = 0.00006, specificity p = 0.00443, AUC p = 0.00000). Data analysis also showed a significant difference between sensitivity and AUC for Protocols 2 and 4 (p = 0.00150 and p = 0.00087, respectively), and Protocols 3 and 4 (p = 0.01333 and p = 0.01333, respectively).Conclusion. Significant increase in the information content of Protocol 4 compared to other protocols (sensitivity up to 93%, specificity up to 94%, accuracy up to 93%) indicates the expediency of the priority use of multiparametric MRI in the primary diagnosis of vaginal tumor lesions.

Evaluating prostate cancer bone metastasis using accelerated whole-body isotropic 3D T1-weighted Dixon MRI with compressed SENSE: a feasibility study.

The study aimed to assess the efficiency of whole-body high-resolution compressed sensing-sensitivity encoding isotropic T1-Weighted Dixon (CSI-T1W-Dixon) scans in evaluating bone metastasis. Forty-five high-risk prostate cancer patients with bone metastases were enrolled prospectively and underwent whole-body MRI sequences, which included the following: pre- and post-contrast CSI-T1W-Dixon and conventional multi-planar T1-Weighted Dixon (CMP-T1W-Dixon) (coronal, sagittal, and axial scans), short tau inversion recovery (STIR), and DWI. Comparison between the CMP-T1W-Dixon and CSI-T1W-Dixon images was done for the subjective image quality, the quantitative contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR). Furthermore, the diagnostic performance based on per-lesion and per-patient basis utilizing non-contrast T1-weighted (T1)/T1+ contrasted T1-weighted (T1C)/T1 + T1C + STIR + DWI sequences was compared between the CSI-T1W-Dixon and CMP-T1W-Dixon methods using reference standards (combining biopsy data and 6-month imaging follow-up). The CSI-T1W-Dixon images produced fewer image artifacts in the axial and coronal planes compared to the CMP-T1W-Dixon images. Also, the CSI-T1W-Dixon images provided better a CNR in fat-only images of all three planes and water-only images of the axial plane (p < 0.05). The CSI-T1W-Dixon showed a higher sensitivity than the CMP-T1W-Dixon techniques in analyzing T1-only images on a per-lesion basis (82.7% vs. 53.8% for sensitivity, p = 0.03). On a per-patient basis, no difference was found in the diagnostic capacity between the CSI-T1W-Dixon and CMP-T1W-Dixon sequences either alone or in combinations (p = 0.57-1). High-resolution CSI-T1W-Dixon with higher image quality and diagnostic capacity can replace the CMP-T1W-Dixon method in evaluating bone metastasis in clinical practice. • Compressed sensing isotropic acquisition for 3D T1-weighted Dixon images can improve the image quality with fewer artifacts compared to the anisotropic multiplanar acquisition. • Compressed sensing isotropic acquisition can save 67% of scanning time compared to anisotropic multiplanar acquisition. • Compressed sensing isotropic 3D T1-weighted Dixon images can offer better diagnostic performance with higher sensitivity compared to anisotropic multiplanar images.

A C-arm photon counting CT prototype with volumetric coverage using multi-sweep step-and-shoot acquisitions

Objective. Existing clinical C-arm interventional systems use scintillator-based energy-integrating flat panel detectors (FPDs) to generate cone-beam CT (CBCT) images. Despite its volumetric coverage, FPD-CBCT does not provide sufficient low-contrast detectability desired for certain interventional procedures. The purpose of this work was to develop a C-arm photon counting detector (PCD) CT system with a step-and-shoot data acquisition method to further improve the tomographic imaging performance of interventional systems. Approach. As a proof-of-concept, a cadmium telluride-based 51 cm × 0.6 cm PCD was mounted in front of a FPD in an Artis Zee biplane system. A total of 10 C-arm sweeps (5 forward and 5 backward) were prescribed. A motorized patient table prototype was synchronized with the C-arm system such that it translates the object by a designated distance during the sub-second rest time in between gantry sweeps. To evaluate whether this multi-sweep step-and-shoot acquisition strategy can generate high-quality and volumetric PCD-CT images without geometric distortion artifacts, experiments were performed using physical phantoms, a human cadaver head, and an in vivo swine subject. Comparison with FPD-CT was made under matched narrow beam collimation and radiation dose conditions. Main results. Compared with FPD-CT images, PCD-CT images had lower noise and improved visualization of low-contrast lesion models, as well as improved visibility of small iodinated blood vessels. Fine structures were visualized more clearly by the PCD-CT than the highest-available resolution provided by FPD-CBCT and MDCT. No perceivable geometric distortion artifacts were observed in the multi-planar PCD-CT images. Significance. This work is the first demonstration of the feasibility of high-quality and multi-planar (volumetric) PCD-CT imaging with a rotating C-arm gantry.

Cardiac gated multidetector computed tomography (MDCT) to determine valvular leaflet thrombosis and leaflet restriction.

The evaluation of patients following aortic valve replacement has evolved, with multiple imaging modalities available that complement each other and permit better and prompt delineation of specific structural or functional valve complications. Multidetector computed tomography (MDCT) is one of the diagnostic modalities with significant technologic advancements that have made possible to evaluate high detail of the moving heart. The ability to deliver three-dimensional and multiplanar dynamic imaging with fine detail has demonstrated the technique is well suited to investigate valve complications. In this review article, we focus on some of the most contributing roles of MDCT in the diagnosis of complications associated with valvular pathology.

Role of advanced imaging techniques in cardiac surgery: Aortic dissection.

Collaboration among cardiac surgeons and radiologists is essential to fully leverage advanced imaging technologies and improve the care of cardiac surgery patients. In this review, a cardiac surgeon and cardiovascular radiologist discuss imaging pearls and considerations in aortic dissection cases. The surgeon and the radiologist discuss imaging considerations in two aortic dissection cases. It is essential to obtain and review all phases of a CTA when diagnosing acute aortic pathology. Optimizing scan parameters and careful multiplanar image review is necessary for adept interpretation. Current CT technology allows ECG gating to eliminate motion artifact and allow for dynamic assessment of the aortic pathology. Concurrent evaluation of thoracic aorta and coronary arteries is feasible. A systematic review of the scan using landmarks is critical for appropriate diagnosis and reporting. As TEVAR is increasingly used for arch repair, collaboration with radiologists is essential for preoperative planning in redo cases. Collaboration among cardiac surgeons and radiologists is mutually beneficial for surgeons, radiologists, and their patients.

Anatomical Variations of the Maxillary Sinus – A Cone Beam Computed Tomography Study

Abstract Objectives: The knowledge of the normal morphology of the maxillary sinuses and their variations is important for maxillofacial radiologists to achieve a better evaluation and delineation of pathologies and for pre-implant evaluation of the maxilla. The aim of our study was to evaluate anatomical variations of maxillary sinuses using Cone Beam Computed Tomography (CBCT). Materials and methods: 150 CBCT images where bilateral maxillary sinuses were scanned were included in the study following the inclusion and exclusion criteria. 75 CBCT scans each of males and females were studied using the Planmeca Romexis software (Version 4.6.2). Multiplanar images were searched for the presence of anatomical variations such as septae, haller cells and ethmomaxillary sinus. The data were subjected to Chi square test using SPSS software to compare and relate gender and site based differences in the occurrence of the anatomical variations. Results: Sinus septa was the predominant variation in both males and females with significantly higher prevalence in females and on the right side. An ethmomaxillary sinus was seen significantly more often in males, while Haller cells did not show any gender based differences in their occurrence. Ethmomaxillary sinus and Haller cells showed no difference in occurrence on the right and left side. Conclusions: Anatomic variations of the maxillary sinuses are a common finding. It necessary for the clinicians to be familiar with these variations to avoid clinical complications especially in cases of implant placements.

Impact of a one-day three-dimensional transesophageal echocardiography workshop on clinical practice at a single academic centre.

Transesophageal echocardiography (TEE) is a powerful diagnostic tool which has become an integral part in the management of cardiac surgery patients. We developed a one-day 3D TEE workshop specifically designed to meet the needs of perioperative cardiac anaesthesiologists. We hypothesized that participation in the workshop would increase the uptake of 3D TEE in routine perioperative practice. To examine the impact of one-day 3D TEE workshop on 3D TEE image acquisition and incorporation into routine perioperative practice. Tertiary care hospital. Prospective observational monocentric study. A convenience sample of 20 cardiac anesthesiologists (with an option to attend the one- day workshop midway through the study) from a single center consented to have their intraoperative TEE images collected during the course of the study reviewed for research purposes. Images acquired 6 months before, immediately after, and 6 months following the workshop and images were examined by a blinded, expert echocardiographer. Data collected for 16 participants (8 workshop attendees, 8 non-attendees) indicate that the TEE workshop increased the number of 3D TEE images, but not x images acquired immediately following the workshop (P=0.006). No difference was observed in number of 3D images at six months' post workshop. Workshop participants obtained more 3D and multi-plane images after the workshop and more 3D images at 6 months compared to those who did not attend the workshop. Our study suggests that a single day hands-on 3D TEE workshop may have had an impact on the implementation of intraoperative 3D TEE in experienced echocardiographers.

МСКТДИАГНОСТИКА ОСТЕОМИЕЛИТА ВЕРХНЕЙ ЧЕЛЮСТИ У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ COVID-19

Abstract. Introduction. COVID-19 is widely known as a disease that causes respiratory dysfunction, however, it is also associated with a mass of extrapulmonary manifestations and complications, gastrointestinal, hepatocellular complications, neurological diseases, as well as complications in the maxillofacial region. Aim. The aim of this study was to diagnose osteomyelitis of the upper jaw in post COVID-19 patients using multispiral computed tomography. Material and methods. We retrospectively evaluated radiation imaging and clinical data of 37 patients, aged 28 to 52 years with osteomyelitis of the upper jaw, who underwent COVID-19. The male sex prevailed among the patients. Results and discussion. All patients had sinusitis and ophthalmic symptoms. The pattern of anatomical lesions of the upper jaw, nasal cavity, maxillary sinus, orbit, and lattice cells was consistently observed in all patients. Conclusion. Progressive and rapid course, involvement of the cavernous sinus, vascular structures, and further upward spread (intracranial) complications may be the usual evolution of rhinophthalmocerebral mucormycosis. Multiplanar tomographic imaging shows the localization, nature, as well as relationship of the surrounding structures, helping in turn to plan the operation. However, the prognosis remains difficult, despite radical surgery and, in particular, antifungal treatment.

3D Cinematic Volume-Rendering Technique of Traumatic Spine Injuries: A Powerful Tool for Radiology Education

Spine trauma represents a common indication for imaging in the emergency department. Multidetector CT imaging, with its advantage of multiplanar reconstructions and fast image acquisition, is the technique of choice in the initial assessment of a patient with polytrauma. While many simple spinal fractures are adequately evaluated on 2D multiplanar reconstruction images, more complex, potentially displaced fracture patterns can be more fully highlighted on 3D reconstructions. Compared with conventional volume-rendering techniques, cinematic rendering uses a complex illumination model to create a more photorealistic representation of the fracture patterns, images that are certain to excite both trainees and clinicians. This review demonstrates the educational value and clinical utility of 3D cinematic rendering images in understanding complex spinal column injuries.Learning Objective: To demonstrate the methodology, clinical applicability, and educational utility behind 3D photorealistic cinematic rendering images of spine injuries, with emphasis on the “tension bands” biomechanical concept