Multislice Computed Tomography Data Research Articles

Feasibility, Accuracy, and Reproducibility of Aortic Valve Sizing for Transcatheter Aortic Valve Implantation Using Virtual Reality.

Detailed visualization and precise measurements of aortic valve dimensions are critical for the success of transcatheter aortic valve implantation and for the prevention of complications. Currently, multislice computed tomography is the gold standard for assessment of the aortic annulus and surrounding structures to determine the prosthesis size. New technologies such as virtual reality (VR) not only enable 3-dimensional (3D) visualization with the potential to improve understanding of anatomy and pathology but also allow measurements in 3D. This study aims to investigate the feasibility, accuracy, and reproducibility of VR for the visualization of the aortic valve, the surrounding structures, and its role in preprocedural sizing for transcatheter aortic valve implantation. Based on the preprocedural multislice computed tomography data, 3mensio measurements and 3D visualizations and measurements using VR software were performed retrospectively on 60 consecutive patients who underwent transcatheter aortic valve implantation at our heart center. There were no significant differences but strong correlations between the VR measurements compared with those performed with the 3mensio software. Furthermore, excellent or good intra- and interobserver reliability could be demonstrated for all values. In a structured questionnaire, users reported that VR simplified anatomical understanding, improved 3D comprehension of adjacent structures, and was associated with very good self-perceived depth perception. The use of VR for preprocedural transcatheter aortic valve implantation sizing is feasible and has precise and reproducible measurements. In addition, 3D visualization improves anatomical understanding and orientation. To evaluate the potential benefits of 3D visualization for planning further cardiovascular interventions, research in this field is needed.

MSCT-semiotics of vertebrae in patients with cervical spine stenosis

Introduction The number of surgical interventions on the cervical spine for stenosis has been constantly increasing. This fact proves that there is a need for careful preoperative preparation that would consider the complexity of the intervention and the age of the patients.Purpose To substantiate the need to include the MSCT data processing algorithm of bone tissue density of vertebral bodies and arches to assess their quality for planning osteoplastic decompressive laminoplasty in patients with cervical spine stenosis due to degenerative changes.Material and methods This single-center retrospective study investigated qualitative and quantitative characteristics of the spine with radiography and multislice computed tomography (MSCT) in 82 patients with degenerative diseases of the cervical spine and associated spinal canal stenosis (CSS).Results and discussion The data obtained indicate a tendency for the total density of the cervical vertebrae to increase from C3 to C5 and to decrease caudally, with minimal density in C7 without signs of osteoporosis. A similar trend is characteristic of trabecular bone. The density of the osteon layer of the vertebral arch cortex differs significantly from the density of the outer and inner plates. The total density of the compact layer of the vertebral arch cortex exceeds 785.15 ± 38.4 HU.Conclusion The data obtained justify the need to include the study of the density of vertebral bodies, vertebral arches, and its thickness in the MSCT data processing algorithm to develop a plan for surgical intervention in patients with cervical spine stenosis in order to obtain objective data on the quality of the bone.

Diagnostic and Management Value of Multi-Slice Computed Tomography in Esophageal Jujube Pit Impaction

Objective: The diagnostic value of multi-slice computed tomography (MSCT) in esophageal jujube pit impaction was explored in this study. Methods: A retrospective analysis was performed on MSCT data obtained from a cohort of 40 patients experiencing esophageal jujube pit impaction. The study period encompassed the interval from December 2018 to November 2019. The analysis involved examining the age distribution of the patients, the location of the jujube pit impaction, its connection to the esophagus, associated complications, and the methods used for treatment. All imaging results were compared with the outcomes of surgical or endoscopic interventions. Results: (1) Out of 40 patients, 30 individuals were 58 years old or above, constituting 75% of the study sample. (2) In 80% of the instances (32 cases), the jujube pit was located in the initial segment of the esophagus, exhibiting a spindle shape with varying levels of central low density. (3) We examined the correlation between the angle of the impacted jujube pit and the esophageal longitudinal axis, categorizing 2 cases as longitudinal impaction, 16 as oblique impaction, and 22 as transverse impaction. Among the 40 cases, 28 displayed only slight thickening of the esophageal wall at the impaction site, while 9 cases exhibited heightened periesophageal fat density, and 3 showed small periesophageal air bubbles. (4) Endoscopic evaluation identified damage to the esophageal mucosa in 35 instances and the formation of esophageal perforation in 5 cases. Among patients with perforation, one or both ends of the jujube pit had penetrated the esophageal wall, accompanied by different levels of surrounding inflammatory encapsulation. Conclusion: MSCT is crucial for pinpointing jujube pit impaction and its relation to the esophageal wall and nearby structures, aiding in preoperative and postoperative complications. It is highly feasible for endoscopic cases but limited in complex ones needing thoracoscopy or open-heart surgery.

Evaluation of MSCT severity scoring for prediction of mortality among patients with COVID-19

BackgroundLung CT imaging may reveal COVID-19 abnormalities earlier than RTPCR. CT may be more sensitive than RT-PCR for diagnosing COVID-19-related pneumonia.AimThis study assesses the accuracy of multi-slice computed tomography (MSCT) grading in predicting COVID-19 mortality.MethodsCOVID-19 RT-PCR. For severity scores, all patients’ clinical examinations, history, and chest MSCT data were collected.ResultsAccording to the chest MSCT score, 102 (51.5%), 70 (35%), and 28 (14%) patients had mild, moderate, and severe illness. Out of the patients, 62 (31%) died, and 69% survived. Patients with severe MSCT scores showed a considerably greater mean age than other groups (P < 0.001). Moreover, this group had a considerably higher mean BMI (P < 0.001), and a majority (57.1%) were obese (P < 0.001). Compared to the mild group, the moderate and severe groups had significantly increased rates of diabetes, hypertension, and liver disease (P < 0.001). The moderate group had a greater rate of no comorbidities (P < 0.001). A severe MSCT score was linked to increased leucocytes, C-reactive protein, ESR, ferritin, d-dimer, HbA1c, and fasting blood sugar, as well as decreased mean lymphocytes (P < 0.001). Severe MSCT scores were linked to increased ICU admissions (P < 0.001) and increased demand for advanced mechanical ventilation and oxygen assistance (P < 0.001). A severe MSCT score was associated with the highest death rate, followed by a moderate MSCT score. Low mortality rates were observed in mild MSCT-scored patients (P < 0.001).ConclusionMSC T score severity is a reliable and noninvasive way to predict COVID-19 mortality

Oblique projections in the analysis of multislice computed tomography data in gunshot wounds

Background. The purpose is to determine the place and role of oblique projections in the analysis of multislice computed tomography (MSCT) data in gunshot wounds. Materials and me­thods. More than 3,300 MSCT studies performed in wounded and traumatized patients over a certain period in the Military Medical Clinical Center of the Northern Region of the Medical Forces Command were prospectively studied. All the wounded were male, the average age was 42.1 ± 2.4 years. MSCT of the head, thoracic and abdominal organs, pelvis, and limbs was performed. The frequency of using oblique projections and their informativeness were studied. Results. A prospective study demonstrated that coronal, axial, sagittal projections, and 3D modeling were used in 100 % of cases, and in 21.4 % — oblique projections to improve MSCT results. The distribution by localization of MSCT was as follows: head — 32.9 %, neck — 7.6 %, chest organs — 32.2 %, abdominal organs — 22.3 %, limbs — 5.0 %. MSCT in angiomode was performed in 3.5 % of injured and traumatized patients: head — 27.2 %, neck — 18.4 %, chest organs — 28.9 %, abdominal organs — 23.7 %, limbs — 1.8 %. Oblique projections in MSCT data analysis were used when studying the wound channel in 82.3 % of cases, to improve the visualization of vessels during MSCT in angiomode — in 12.6 % and to improve the visualization of bone fracture lines — in 5.1 %. Conclusions. In the structure of MSCT studies, the head, thoracic organs, abdominal organs, neck, and limbs prevail by localization (in descending order). Oblique projections are used is 1/5 of cases and allow to improve the visualization of the direction of the wound channel, vessels during angiography and lines of flat and long tubular bone fractures.

Mathematical modeling of foreign bodies with different density in biological and non-biological models in the experiment

Background. Modeling allows investigating both existing and predicted processes and is widely used in basic science and in many industries. The aim is to develop a mathematical model for determining the size of the foreign bodies (FB) and their radiographic density in non-biological and biological models to improve the results of diagnosis for gunshot ricochet wounds. Materials and methods. In the biological non-living model (a piece of pork) and non-biological models (polystyrene, foam rubber), we place the FB made of paper, leather, rubber, plastic, and lithium-ion batteries. The number of the FB is 9 of each type. Number of models is 3 each: pork, polystyrene, foam rubber. We measure the dimensions of the FB and models with a metric ruler. For each model, we select the FB, which we label with the study number. We immerse the FB to the same depth using a Billroth general surgical medium hemostatic clamp in the following sequence: paper, leather, rubber, plastic, and lithium-ion battery. Multislice computed tomography (MSCT) of the models is performed on the Revolution EVO (2021) apparatus with measurement of the sizes and radiographic density of the FB and models. Radiographic density was measured in conventional units on the Hounsfield scale. For each study group, the ratio of the actual sizes of the removed FB and according to MSCT data was determined in the MathCad 15 computer math software, depending on the radiological density of the FB and the model. Results. According to MSCT data, the radiographic density of the models on the Hounsfield scale is as follows: polystyrene — –990.0 ± 0.3 units; foam rubber — –985.0 ± 0.2 units; pork — 62.0 ± 0.3 units; radiographic density of the foreign bodies: paper — –743.0 ± 10.3 units, leather — –258.0 ± 14.2 units, rubber — –12.0 ± 2.6 units, plastic — 183.0 ± 14.6 units, lithium-ion batteries — 3071 units. Visualization of paper in non-biological and biological models and leather in non-biological models is problematic due to the similar radiographic density of the models and the inability to measure the dimensions. When the FB (rubber, plastic, battery) is immersed in polystyrene, the coefficient of length (CL) is 1.0612, the coefficient of width (CW) is 1.928; in foam rubber: CL is 0.9926, CW is 1.9641; in pork: CL is 0.8394, CW is 1.534. Comparing the average coefficients of the ratio (CL and CW), we find that the coefficient in a biological model is closest to 1. This means that the FB from rubber, plastic, and batteries are best detected in pork. Conclusions. The actual dimensions of the FB placed in biological and non-biological models differ from those obtained by MSCT. Data correction is performed through calculated coefficients for length and width. The radiographic density of the model affects the radial visualization of the FB. The use of mathematical modeling in determining the sizes and radiographic density allows reducing the measurement error and determine the structure of the FB.

Equivalent density of calcium deposits – a new diagnostic pattern for atherocalcinosis

Objective. To assess the density of the calcified substrate of atherosclerotic plaques of the carotid arteries using data from the computed tomography of patients with multifocal atherosclerosis. Material and methods. In 251 patients with verified atherosclerosis of the coronary and carotid arteries, with a high prevalence of angina pectoris, a history of myocardial infarction and modifiable cardiovascular risk factors, multislice computed tomography (MSCT) of the carotid arteries was performed to assess the calcium index and determine the equivalent density of calcium deposits (EDCD). A morphological sub-study of the material from the removed atherosclerotic plaques was carried out using scanning electron microscopy (SEM) in 12 patients. Results. According to the MSCT data, we identified 5 main types of calcium deposit location in the thickness of the atherosclerotic plaque. We noted that totally calcified plaques were associated with carotid artery stenosis by more than 30 %. According to the SEM data, we identified 2 leading patterns: diffuse and compact types of microcalcification. There was a statistically significant association of a low level of EDCD with a diffuse type of calcification both in vivo (p=0.010) and ex vivo (p=0.008). Patients, having carotid artery EDCD less than 0.21 mg/mm3, reported a significantly higher incidence of type 2 diabetes mellitus (p=0.0001) and a history of stroke (p=0.021). When comparing the MSCT data on the calcium deposit density and their localization in the atherosclerotic plaque, we noted a statistically significant predominance of low EDCD with superficial calcification of the plaque (p=0.002). Conclusion. The use of a calculated indicator of the equivalent density of calcium deposits of the atherosclerotic substrate allows us to non-invasively obtain new data on the structure of plaques. The observed association of the superficial distribution of calcification with low calcification density according to the MSCT data may indicate potential plaque instability.

A comparison of conventional and advanced 3D imaging techniques for percutaneous left atrial appendage closure.

Understanding complex cardiac anatomy is essential for percutaneous left atrial appendage (LAA) closure. Conventional multi-slice computed tomography (MSCT) and transesophageal echocardiography (TEE) are now supported by advanced 3D printing and virtual reality (VR) techniques for three-dimensional visualization of volumetric data sets. This study aimed to investigate their added value for LAA closure procedures. Ten patients scheduled for interventional LAA closure were evaluated with MSCT and TEE. Patient-specific 3D printings and VR models were fabricated based on MSCT data. Ten cardiologists then comparatively assessed LAA anatomy and its procedure relevant surrounding structures with all four imaging modalities and rated their procedural utility on a 5-point Likert scale questionnaire (from 1 = strongly agree to 5 = strongly disagree). Device sizing was rated highest in MSCT (MSCT: 1.9 ± 0.8; TEE: 2.6 ± 0.9; 3D printing: 2.5 ± 1.0; VR: 2.5 ± 1.1; p < 0.01); TEE, VR, and 3D printing were superior in the visualization of the Fossa ovalis compared to MSCT (MSCT: 3.3 ± 1.4; TEE: 2.2 ± 1.3; 3D printing: 2.2 ± 1.4; VR: 1.9 ± 1.3; all p < 0.01). The major strength of VR and 3D printing techniques was a superior depth perception (VR: 1.6 ± 0.5; 3D printing: 1.8 ± 0.4; TEE: 2.9 ± 0.7; MSCT: 2.6 ± 0.8; p < 0.01). The visualization of extracardiac structures was rated less accurate in TEE than MSCT (TEE: 2.6 ± 0.9; MSCT: 1.9 ± 0.8, p < 0.01). However, 3D printing and VR insufficiently visualized extracardiac structures in the present study. A true 3D visualization in VR or 3D printing provides an additional value in the evaluation of the LAA for the planning of percutaneous closure. In particular, the superior perception of depth was seen as a strength of a 3D visualization. This may contribute to a better overall understanding of the anatomy. Clinical studies are needed to evaluate whether a more comprehensive understanding through advanced multimodal imaging of patient-specific anatomy using VR may translate into improved procedural outcomes.

Three-dimensional printing technique aids screw insertion into the sustentaculum tali of the internal fixation of intra-articular calcaneal fractures

IntroductionTreating complex calcaneus fractures remains challenging. This study evaluated the influence of 3D printing and simulation on precision screw insertion into the calcaneus sustentaculum tali (ST). Hypothesis3D printing and simulation improve the treatment for calcaneal fracture. Patients and methodsThis retrospective cohort study included 85 patients admitted with 93 Sanders type II–IV intra-articular fractures from January 2015 to June 2020. Multi-slice computed tomography (MSCT) images were used in the conventional group, and MSCT data were used to construct a 3D model of the calcaneus to simulate screw insertion and verify parameter accuracy in the 3D group. ResultsThe designed parameters (upward and backward oblique angles and screw-path length) were similar to the actual values in the 3D group (p=0.428,0.287,0.585) but not in the conventional group (p=0.01,0.002,0.023). The Maryland foot functional score, accuracy rate, and average screw number were higher and operative time was shorter in the 3D group (p=0.005,0.007,0.000,0.000). DiscussionPreoperative simulation using the 3D printing model helped guide the screws into the ST more accurately, lending better-quality treatment for Sanders type II–IV calcaneal fractures. Level of proofIII; Retrospective case-control study.

3D-modeling Capabilities in Assessing Resectability of Pancreatic Head Tumors

Background. Pancreatic head cancer ranks 6–7th among oncologic diseases and 4–5th among causes of mortality, with only 5% of patients achieving 5-year survival rate to date. Despite the successes of modern diagnostics and surgical treatment, the problem of early detection, staging of oncologic process and, as a consequence, combined treatment of pancreatic head cancer remains actual.Objective: increasing the accuracy of diagnostics and estimation of resectability of the pancreatic head cancer on the basis of the complex use of the radiation methods of investigation with pancreaticoduodenal zone 3D-reconstructions.Material and methods. The study included 93 patients (44 (47.31%) males and 49 (52.69%) females) with complicated pancreatoduodenal masses treated from 2019 to 2022 at the Surgical Department of the City Mariinsky Hospital. The patients’ age varied from 44 to 90 years, the mean age was 67±0.74 years. All patients underwent magnetic resonance imaging (MRI) on an Ingenia MR tomograph (Philips Medical Systems, Netherlands) with a magnetic field induction of 3 Tesla. The native examination of the abdomen and retroperitoneum, supplemented with MR-cholangiopancreatography protocol, and dynamic contrast enhancement with data collection in arterial, portal, and delayed phases were carried out. T2-weighted images were then performed using turbospin-echo technology, including fat-suppressed images, to evaluate structural changes and the presence of fluid in fascial spaces. Patients also underwent endoscopic ultrasound of the pancreaticoduodenal zone using the push and pull method, and abdominal multislice computed tomography (MSCT). To build 3D models, we used free 3D-slicer and Mimics programs, which allowed to build semi-automatic model for further evaluation of anatomo-topographic relations.Results. MSCT 3D modeling revealed tumor invasion into the superior mesenteric vein in 6 (23.06%) patients, whereas MRI models showed tumor invasion in 4 (15.38%) patients, intraoperatively the results were confirmed in 5 patients (19.23%). According to both MSCT and MRI modeling data, the invasion of the ventral trunk occurred in 1 (5.2%) case, which was confirmed intraoperatively. Inferior vena cava invasion on MSCT and MRI models was detected in 3 (11.54%) patients, whereas intraoperatively – in 4 (15.38%) patients. The MSCT and MRI 3D models coincided with the data on invasion of the ventral trunk in 1 (3.85%) patient and the superior mesenteric artery in 2 (7.69%) patients, which was fully confirmed intraoperatively.Conclusion. 3D modeling on the basis of MRI and MSCT studies is an informative method in preoperative staging of pancreatic head cancer and its resectability. This method allows to objectively determine the localization and prevalence of the tumor process on adjacent anatomical structures, as well as visually demonstrate the metastatic lesion of regional lymph nodes. By the parameters of diagnostic efficiency, 3D models are maximally close to the intraoperative picture, which allows planning both the volume and the course of surgical intervention.

Balloon-expandable transcatheter heart valves for treatment of aortic valve stenosis in patients with large aortic annuli: Evaluation of deployment balloon overfilling strategies.

Transcatheter aortic valve implantation (TAVI) using balloon-expandable (BE) transcatheter heart valves (THV) in aortic annuli above 29 mm includes particular procedural steps, mainly involving overfilling of the deployment balloon. Data on overfilling strategies in clinical daily practice is scarce. We herein aimed for a retrospective description of utilized overfilling strategies in those patients. Between January 2016 and December 2022, 45 patients (100% male, 76.9 ± 6.1 years) received TAVI in aortic annuli above 29 mm using a BE THV. Overfilling volumina of the deployment balloon were left to operators' discretion. Clinical and multislice computed tomography data were retrospectively collected. Clinical endpoints were adjudicated in accordance with the updated standardized VARC-3 definitions. Profound overfilling (+4/5 mL) was used in patients with a mild calcium burden (˂750 mm³) even in aortic annuli of 29.0-30.0 mm. Nominal/slight overfilling (+1 mL) was used in aortic annuli up to 32.5 mm but an intermediate to severe calcific burden (>750-3200 mm³). Accordingly, a low calcification group (˂750 mm³, n = 17) compared to a significant calcification group (≥750 mm³, n = 28), presented with higher overfilling volumina (2.1 ± 1.4 vs. 0.8 ± 1.0; p ˂ 0.001), although aortic annulus diameter was not different (29.8 ± 0.8 vs. 29.9 ± 0.9 mm; p = 0.7). All-cause 30-day mortality was 0%. Device success was 97.8%. Transvalvular mean pressure gradient at discharge was 9.5 ± 3.6 mmHg. No case of PVL >mild was documented. Extent of overfilling of the deployment balloon largely depends on calcification burden in addition to aortic annulus diameter with significant and profound overfilling particularly in patients with a calcification burden of the aortic valve complex ˂750 mm³.

Non-immunogenic staphylokinase in the treatment of high-risk massive pulmonary embolism in the early postoperative period due to femoral fragment wound

A case report of double thrombolytic therapy with non-immunogenic staphylokinase at a dose of 15 mg bolus over 15 s in a patient with a high-risk massive pulmonary embolism (PE) in the early postoperative period due to femoral wound is described. After the second thrombolysis, a decrease in the pulmonary arteries thrombotic lesions according to multislice computed tomography data, restoration of right ventricular function, and a decrease in pulmonary hypertension were observed. Reuse of the non-immunogenic staphylokinase did not lead to the major bleeding and hemorrhagic stroke, did not provoke a drop in hemoglobin and did not require blood transfusion. Upon discharge of the patient, normalization of the general blood test parameters was noted: the level of hemoglobin increased from 86 to 112 g/l, erythrocytes — from 2.8 to 3.5x1012/l, hematocrit — from 26 to 32%. Thus, non-immunogenic staphylokinase has demonstrated high efficacy and safety in the treatment of patient with a high-risk massive PE in the early postoperative period.

Left atrial appendage sizing for percutaneous closure in virtual reality-a feasibility study.

The complex and highly variable three-dimensional anatomy of the left atrial appendage (LAA) makes planning and device sizing for interventional occlusion procedures (LAAC) challenging. Several imaging modalities [e.g. echocardiography, multi-slice computed tomography (MSCT)] are used for this purpose. Virtual reality (VR) is an emerging imaging technique to immerse into a three-dimensional left atrium and appendage, offering unprecedented options of visualization and measurement. This study aimed to investigate the feasibility, accuracy and reproducibility of visualizing the LAA in VR for preprocedural planning of LAAC. Twenty-one patients (79 ± 7 years, 62% male) who underwent LAAC at University Hospital Düsseldorf were included in our study. A dedicated software generated three-dimensional VR models from preprocedural MSCT imaging data. Conventional measurements of LAA dimensions (ostium, landing zone and depth) using a commercially available software were compared to measurements in VR: MSCT and VR ostium min. (r = 0.93), max. (r = 0.80) and mean (r = 0.88, all p < 0.001) diameters as well as landing zone (LZ) min. (r = 0.84), max. (r = 0.86) and mean diameters (r = 0.90, all p < 0.001) showed strong correlations. Three-dimensional orientation was judged superior by physicians in VR compared to MSCT (p < 0.05). Virtual reality visualization of the left atrium and appendage based on MSCT data is feasible and allows precise and reproducible measurements in planning of LAA occlusion procedures with enhanced 3D orientation. Further studies need to explore additional benefits of three-dimensional visualization for operators in preprocedural planning.

Evaluation of hemodynamic significance for paraprosthetic fistula after transcatheter aortic valve implantation

Highlights. Using ECHO and MSCT data, a numerical assessment of hemodynamic effects of paraprosthetic regurgitation following transcatheter aortic valve replacement was performed. A significant increase in the fluid flow, wall and viscous shear stresses in the area of regurgitation is shown. The modeling technique described in the paper can be used prospectively in assessing the optimal treatment modality in terms of predicting the quantitative characteristics of the flow, associated with the risks of destruction of red blood cells and thrombosisAim. To make a numerical assessment of hemodynamic effects of paraprosthetic regurgitation following transcatheter aortic valve replacement based on retrospective clinical data.Methods. The study included echocardiography and multi-slice computed tomography data as input data for modeling one pulsation of a fluid similar in properties to blood. Reconstruction of the paraprosthetic fistula and the ascending aorta was performed in the Mimics medium (Materialise, Belgium). The obtained 3D models were processed in the Salome software (OPEN CASCADE SAS, France), after which they were exported to HELYX-OS (ENGYS, Great Britain) to build a finite element mesh. The flows were modeled using the OpenFOAM software package version 6 (The OpenFOAM Foundation Ltd, UK).Results. The simulation result, expressed quantitatively and qualitatively in the form of diagrams of the measured parameters – fluid flow velocities, wall and viscous shear stresses, shows a significant increase in indicators in the area of paraprosthetic regurgitation. Thus, the velocity in the affected area was 1.9–4.2 m/s, which is 3.8 higher than the average value in the entire computational area. The wall shear stress value was up to 61 Pa in the critical area, which may indicate an increased risk of thrombus formation due to the initiation of the clotting cascade through the von Willebrand factor. The value of viscous shear stress, the main component of the destruction of red blood cells in laminar flow, amounted to 20–26 Pa, which, in general, is not enough for mechanical hemolysis.Conclusion. The modeling technique described in the paper can be used prospectively in assessing the optimal treatment modality in terms of predicting the quantitative characteristics of the flow, associated with the risks of destruction of red blood cells and thrombosis.

Radiological Semiotics of Different Types of Nontuberculous Pulmonary Mycobacterioses

Objective: to determine, evaluate, and describe different radiological patterns of microbiologically identified nontuberculous pulmonary mycobacterioses (NTPM) based on multislice computed tomography data. Material and methods. The study included 102 patients with radiological signs of lung disease and different types of NTPM. Slowly growing types of NTPM were detected in 62 (60.8 %) patients, and rapidly growing NTPM – in 40 (39.2 %). The diagnosis was established considering a patient’s complaints, a specified case history, radiological and clinical laboratory data including microscopic studies of sputum from 63 (61.8 %) patients, bronchoalveolar lavage and different types of bronchial biopsies data from 19 (18.6 %) patients, samples of lung video-assisted thoracoscopic surgery from 17 (16.7%) patients, pleural fluid samples from 2 (1.9 %) patients, and oropharyngeal wash samples from 1 (1 %) patient. We used the Somatom Emotion 16 multislice computed tomograph (Siemens) and the high-resolution algorithm (HRCT) with 0.8 mm slice thickness and 1.5 mm slice increment. Results. The HRCT data were highly polymorphic and showed interstitial focal changes, different calibre bronchiectasis, conglomerates or cavities, involvements of vessels or pleural layers. In some patients, changes in the axial interstitium were accompanied by single small focal consolidations located either discretely or in small groups. Peribronchovascular spread of dissemination foci in NTPM was detected by HRCT as irregular infiltration of the axial interstitium (vasculitis type). Changes in the bronchial tree in NTPM were characterized by bronchiolitis symptoms (extensive thickening of bronchial walls, bronchioles) with development of the tree-in-bud sign predominantly in the subpleural lung regions. In some cases, bronchiectatic changes formed conglomerate consolidations of sublobular or lobular extent. Changes of the bronchial tree were detected by HRCT predominantly as signs of deforming bronchitis, cylindrical, varicose, or cystic bronchiectasis, either restricted or spread. Changes might be accompanied by single multi-dimensional cystic bronchiectatic cavities. Conclusion. Typical HRCT signs of NTPM are endobronchial and peribronchovascular spread of foci, development of multi-dimensional conglomerates, deforming bronchitis, bronchiectasis, and presence of single multi-dimensional cystic bronchiectatic cavities.

Gunshot Fracture of the Mandible

A 51-year-old male was transferred to the hospital with a gunshot injury of the lower face. Three-dimensional scan of the multislice computed tomography (MSCT) revealed a severely comminuted fracture (Panel A: arrow) of the left mandibular body at the inferior margin area (what corresponds to the gunshot marginal mandible fracture diagnosis among 12 variants of gunshot mandibular fractures)1. Also, the implantation of multiple different shape radiopaque foreign bodies (arrowhead) was also visualized along with metal artifacts. A rotated coronal scan of the MSCT (Panel B) showed linear continuation (waved arrow) of the fracture to the ramus (visualized as incomplete fracture)2, partially splitting it into medial and lateral fragments. Although the incomplete fractures are more common for the pediatric jaw fractures, in this gunshot injury the MSCT data also indicates an incomplete fracture. In this particular case, it was a gunshot compound fracture (also known as open fracture) of the mandible. 3 Intermaxillary fixation (also known as maxilla-mandibular4 or maxillomandibular fixation5) was performed for 3 weeks without open intervention in the mandible margin area. Antibiotic therapy (Ceftriaxone 1.0 g 2 times daily applying intramuscular administration) was done during 7 days after trauma.

МСКТ-семиотика мышц при хроническом остеомиелите бедра и голени

Introduction It is known that the function and structure of the muscles of the thigh and lower leg are closely related to the function of the lower limb, which is impaired to one degree or another in all patients with chronic osteomyelitis. However, the nature of structural changes in the muscles, which, in turn, affect the condition of the bones, has not been well studied. Purpose of the work To study the features of changes in the muscles of the thigh and lower leg in patients with chronic osteomyelitis according to MSCT data. Material and methods The study is retrospective conducted at a single centre of Evidence level IV. Multislice computed tomography (MSCT) was used in 112 patients with chronic osteomyelitis of long bones of the lower extremities to study the radiological morphology of the muscles of the thigh and lower leg, including density, muscle belly area, and anatomical features. Twenty patients had chronic osteomyelitis in the area of transosseous elements (pins). The mean age of the patients was 48.5 ± 9.8 years. Males prevailed among the patients (87.5 %). The cause of osteomyelitis in 107 cases was trauma or surgery, five patients had consequences of hematogenous osteomyelitis. Results The results of the study showed that the muscles of the thigh and lower leg in patients with chronic osteomyelitis have pronounced dystrophic changes. In 89.4 % of patients, they were manifested by an increase in the density of the anterior tibial muscle, long extensor of the toes (84.7 %), peroneal muscles (78.5 %) and a decrease in the density of the head of the gastrocnemius muscle (91.3 %). In 10.6 % of the patients, there was a decrease in the density of the anterior tibial muscle, the long extensor of the fingers. In all patients with chronic osteomyelitis of the femur, the density of the muscles of the anterior and posterior groups was reduced, except for the musculus vastus intermedius of the thigh that was characterized by fibrotic changes with an increase in density. Conclusion The data obtained indicate that radiological morphological changes in muscles occur in all patients with chronic osteomyelitis of the femur and lower leg. The most pronounced alterations in the architectonics were in the anterior tibial and gastrocnemius muscles, and the intermediate broad muscle of the thigh.

Трабекуляризация корковой пластинки при хроническом остеомиелите

Introduction Literature data and analysis of our own material indicate a change in the density of the long bone cortical plate in patients with chronic osteomyelitis along its extension; however, the nature and degree of structural disorders of the cortical layer beyond the inflammation zone is an unexplored area of radiomorphology. Objective To study the structural features of the cortical plate of the femur and tibia outside the inflammation nidus and the change in its structure in the form of trabecularization. Material and methods The study is retrospective single-center work of level of evidence IV. In 86 patients with chronic osteomyelitis of the long bones of the lower extremities, using polypositional radiography and multislice computed tomography (MSCT), the features of radiological morphology of the femur and tibia were studied in order to identify structural features and quantify the density of the cortical plate and its trabecularization. Results The cause of the inflammatory process in the bone in 83 cases was trauma or surgery, and consequences of hematogenous osteomyelitis in three cases. The most common location of chronic osteomyelitis was the distal femur (24) and tibia (25) bones. Due to long-term disease, nonunion or a bone defect developed in 11 patients. Analysis of MSCT data in 86 patients with chronic osteomyelitis showed that anatomical changes in the femur and tibia and the density characteristics of the cortical plate near the focus of destruction were manifested in 79.5 % of patients with a decrease in the thickness of the cortical plate (up to 2 mm) with complete trabecularization in separate areas with density from 290 to 360HU in 47.7 % of the examined. Conclusion Radiological morphological changes in the cortical plate of the femur and tibia in patients with chronic osteomyelitis near the focus of destruction were characterized by a decrease in the thickness and density of the cortical plate, accompanied by its complete or partial trabecularization with a density not exceeding 315.5 ± 38.6 Hounsfield units (HU) in 41 ( 47.7 %) of 86 patients.

Evaluation of the idiopathic scoliosis of varying severity treatment effectiveness with transpedicular systems

Introduction Significant success has been achieved in the development of new methods of treatment and rehabilitation of patients with idiopathic scoliosis, however, in many aspects of this problem there is no unambiguous approach to the choice of a correction method, assessment of treatment results.Objective To study the results of treatment of patients with idiopathic scoliosis according to X-ray and MSCT data, as well as according to the questionnaire – the SRS-30, depending on the degrees of the deformity, the type of scoliosis.Material and methods The study is retrospective, single center. Evidence level – IV. In 300 patients with idiopathic scoliosis of varying severity at the age from 10 to 50 years, the immediate and long-term results of elimination of spinal deformity by the method of internal transpedicular fixation were studied. In the study we used polypositional radiography, multislice computed tomography (MSCT) and questionnaire SRS-30.Results In patients with spinal deformity up to 60 ° a year after surgery, no loss of correction was found. After elimination of the deformity at 60–90 °, loss of correction up to 2 ° was observed in 3.6% of patients. In patients with deformity greater than 90 °, the average postoperative progression of scoliotic deformity was 3.5 ± 0.7 °. When examining patients after 2–5 years, there was no loss of correction in the group with initial spinal deformity up to 60 ° and in the group from 60–90 °. In patients with deformity greater than 90 °, the postoperative progression of scoliotic deformity in persons over 25 years old was 4.5 ± 0.6 °, which is associated with degenerative changes in the spine.Conclusion The study of immediate and long-term results showed that 1 year after treatment, 94% of patients rated the treatment result as excellent and good, in 6% – as satisfactory. All patients noted a positive effect of the cosmetic and functional results of treatment, while 56% believed that they looked “better” than before surgery (4 points), 44% rated the effect at 5 points and noted that they looked “much better”. Long-term results were studied in 50 patients 10 years after surgery.

Operator preference and determinants of size selection when additional intermediate-size aortic transcatheter heart valves are made available

BackgroundAppropriate size selection of transcatheter heart valves (THVs) is fundamental to reduce transcatheter aortic valve implantation (TAVI) related complications, particularly paravalvular aortic regurgitation, new permanent pacemaker implantation, and annular rupture. We sought to investigate the frequency of operator selection of intermediate-size balloon-expandable Myval THVs (Meril Life Sciences Pvt. Ltd., India) for TAVI in a real-world dataset. MethodsIn this retrospective survey of patients treated with TAVI using the Myval THV, 20, 23, 26, and 29 mm are conventional-size THVs, 21.5, 24.5 and 27.5 mm are intermediate-size THVs, and 30.5 and 32 mm are extra-large THVs. Operator size selection for implantation was based on multislice computed tomography (MSCT) derived aortic-root dimensions. ResultsA total of 1115 patients underwent Myval THV implantation in 27 countries worldwide. The Myval intermediate-size THVs were used in 468 (42.0%) patients. MSCT data were available in 562 patients. There was no statistical difference between the Intermediate/Upsized and Appropriately sized groups or Intermediate/Downsized and Appropriately sized groups in terms of different variables measured with MSCT except for annular dimensions and degree of calcification. ConclusionsIntermediate-size Myval balloon-expandable THVs are used in nearly half of all cases in contemporary real-world TAVI practice, addressing the unmet need of TAVI operators for a more calibrated THV choice. Our hypothesis should be tested in randomized prospective studies currently initiated in Europe, including clinical outcomes of patients treated with both conventional- and intermediate-size THVs.