OsiriX Software Research Articles

Evaluation of aortic stent endoleaks in the renally impaired patient with ferumoxytol-enhanced MR angiography.

To evaluate ferumoxytol-enhanced magnetic resonance angiography (FE-MRA) for assessment of endoleaks in patients with abdominal aortic aneurysms (AAA) and chronic kidney disease (CKD) status post endovascular aneurysm repair (EVAR). Of 1854 patients who underwent FE-MRA at a single institution between 03/21/2014 and 08/21/2023, 21 patients with a history of AAA and CKD status post EVAR were retrospectively identified (IRB #13-001341). Multiplanar pre- and post-contrast HASTE, T1-VIBE, and high-resolution breath-held 3D MRA sequences were obtained, where a dose of 4mg/kg of Ferumoxytol was infused over six minutes. All examinations were performed on either a Siemens 3.0T Prisma Fit, a Siemens 3.0T TIM Trio, or a Siemens 1.5T Avanto MRI scanner. Image post-processing was performed using OsiriX and Vitrea software for endoleak identification and display. Twenty-six FE-MRA examinations were completed, where 24 were fully diagnostic and 2 were limited by metal artifact. Three patients underwent one follow-up examination, while one patient underwent two follow-up examinations. Endoleaks were identified in seven patients: one Type Ia, two Type Ib, and four Type II. The Type Ia endoleak patient received follow-up imaging two years after initial imaging. A Type II endoleak patient received follow-up imaging six months and one year after initial imaging. In both cases, the Type I and Type II endoleaks were reproducibly visualized. No contrast reactions occurred. For patients with a history of AAA and CKD status post EVAR, FE-MRA is a safe, practical and effective imaging solution for evaluation of Type I and Type II endoleaks.

The Eficiency in The Management of Facial Fracture Patients in Developing Country by Using OsiriX®, A Free 3D-Rendering Software

Background: Being a developing country with a GNI (Gross National Income) per capita of US$3,830, the cost for managing patients with facial fractures was often unaffordable. The use of a free 3D-rendering software presumably would decrease cost. With OsiriX, a free and open source 3D-rendering software, complex images manipulations and real-time 3D image visualization is easily accessible anytime and anywhere from the surgeon’s personal computer, making diagnosis and preoperative planning more convenient for the surgeons. Patients and methods: From December 2009 to January 2010, 14 patients with facial fracture were admitted to our unit. Seven of them underwent surgery. Preoperatively, diagnosis & surgery plan was developed using OsiriX. Results: By using OsiriX, more accurate diagnosis was made at a lower cost. Patients could save up to 48.1% from total diagnostic cost (19.2% from monthly income). OsiriX provided easier access to multidimensional navigation and visualization tools in personal computers, making easier planning possible for surgical steps and materials needed. Summary: OsiriX being free and open source is bene!cial from !nancial point of view, which is an important point for patients in a developing country. It is user friendly and ef!cient in developing treatment plan for facial fracture patients.

Sex estimation by CT image analysis of the rib cage in a Mediterranean population.

Sexual dimorphism in the human species is key to the development of sex estimation techniques in the human skeleton. This dimorphism is manifested, as in other regions of the skeleton, in the bones that constitute the thoracic cage, according to the existing bibliography. In this aspect, the study of the human skeleton through 3D images has also proved to be useful for the development and validation of sex estimation methodologies for the reconstruction of the osteobiological profile.For this purpose, a sample of 240 thoracic CT scans of adult individuals was selected from a collection of 3D images belonging to the University of Granada, provided by the Castilla-La Mancha Health Service (SESCAM). Different measurements of the thoracic bones (ribs R2 to R5 width, sternum length and width, and clavicles width) have been taken with OsiriX software, with the aim of developing discriminant functions for sex estimation.The obtained results are positive, allowing sex estimation through 3D images of the thorax with up to 89.6% accuracy through discriminant functions, which shows the usefulness of image analysis for the reconstruction of the osteobiological profile.

Using computed tomography to evaluate anatomic landmarks in Taiwanese trauma patients for insertion of resuscitative endovascular balloon occlusion of the aorta: a retrospective cohort study.

Hemorrhage, particularly from noncompressible torso hemorrhage (NCTH) in the abdominopelvic region, is a leading cause of preventable trauma deaths. Resuscitative endovascular balloon occlusion of the aorta (REBOA), designed for aortic occlusion, has emerged as a tool for temporary hemorrhage control in recent years. However, attaining optimal REBOA placement in diverse demographic groups, such as Asian populations, may pose challenges owing to unique anatomical and physiological differences. This retrospective study analyzed trauma patients who underwent torso computed tomography (CT) at tertiary hospitals in Taiwan from January 2014 to January 2017. The OsiriX software was used to measure the endovascular lengths in the CT images. Among the 223 patients, the median vascular lengths and body measurements were higher in males. The optimal fixed insertion length was identified as 47.5cm for zone 1 with 99.43% accuracy and 25.5cm with 82.1% accuracy for zone 3. The landmark-guided method showed 100% accuracy for zone 1 when using the mid-sternum and 94.6% for zone 3 with the umbilicus as the guide with the distance between the umbilicus, xiphoid process, and pubic ramus. External validation confirmed the accuracy of the landmark-guided method. For zone 1 occlusions, a range of 44-48cm insertion length cross-referenced with the mid-sternal landmark is recommended. For zone 3 occlusions, using the umbilicus as a guide with the distance between the umbilicus, xiphoid process, and pubic ramus provided the highest accuracy.

MRI susceptibility artefacts caused by orthodontic wire.

To evaluate magnetic susceptibility artefacts produced by orthodontic wires on MRI and the influence of wire properties and MRI image sequences on the magnitude of the artefact. Arch form orthodontic wires [four stainless steels (SS), one cobalt chromium (CC) alloy, 13 titanium (Ti) alloys] were embedded in a polyester phantom, and scanned using a 1.5-T superconducting magnet scanner with an eight-channel phased-array coil. All wires were scanned with T1-weighted spin echo (SE) and gradient echo (GRE) sequences according to the American Society for Testing and Materials (ASTM) F2119-07 standard. The phantom also scanned other eight sequences. Artefacts were measured using the ASTM F2119-07 definition and OsiriX software. Artefact volume was analysed according to metal composition, wire length, number of wires, wire thickness, and imaging sequence as factors. With SE/GRE, black/white artefacts volumes from all SS wires were significantly larger than those produced by CC and Ti wires (P < .01). With the GRE, the black artefacts volume was the highest with the SS wires. With the SE, the black artefacts volume was small, whereas white artefacts were noticeable. The cranio-caudal extent of the artefacts was significantly longer with SS wires (P < .01). Although a direct relationship of wire length, number of wires, and wire thickness with artefact volume was noted, these factors did not influence artefact extension in the cranio-caudal direction. Ferromagnetic/paramagnetic orthodontic wires create artefacts due to local alteration of magnetic field homogeneity. The SS-type wires produced the largest artefacts followed by CC and Ti.

Potential and Pitfalls of Postoperative Volumetric Assessment of Extent of Resection in High-Grade Glioma in Resource-Constrained Settings.

While literature suggests the need for routine postoperative volumetric estimation of the EOR and residual tumour volume (RTV) in all cases of gliomas, the utility and feasibility of this protocol in resource-constrained centers remain underinvestigated. Our objective was to study the feasibility of volumetric EOR in routine neurosurgical practice and determine correlation with surgeons' intraoperative estimation of EOR. The secondary objective was to determine the survival impact of EOR and RTV on survival. A prospective study of pathologically proven high-grade gliomas (WHO grades 3 and 4) in adults was conducted at a tertiary care center. Pre- and postoperative magnetic resonance imaging (MRI) was obtained for volumetric analysis using OsiriX software and manual segmentation. Overall survival and predictors were studied using Kaplan-Meier and Cox regression analysis. Postoperative volumetry was feasible in 31% patients (n = 25) of study eligible patients (n = 84). The median EOR, CE-PTV, and CE-RTV were 79.1%, 69.8 cm3, and 8.7 cm3, respectively. There was a poor correlation of surgeons' intraoperative impression and volumetric data (P = 0.359). Interestingly, the EOR was not significantly associated with the survival time (P = 0.920), while tumor grade, molecular profile, Ki 67 score, and postoperative functional status showed statistically significant impact. Logistic difficulties impede routine implementation of this protocol in developing countries. MRI volumetry is clearly more accurate than surgeons' intraoperative estimation of EOR. Notwithstanding the role of EOR in survival, our study reveals a perhaps bigger impact of tumor biology and postoperative functional status in this equation.

Classical Orbital Floor Post-Traumatic Reconstruction vs. Customized Reconstruction with the Support of "In-House" 3D-Printed Models: A Retrospective Study with an Analysis of Volumetric Measurement.

Orbital floor fractures (OFFs) represent an interesting chapter in maxillofacial surgery, and one of the main challenges in orbit reconstruction is shaping and cutting the precise contour of the implants due to its complex anatomy. The aim of the retrospective study was to demonstrate, through pre- and postoperative volumetric measurements of the orbit, how the use of a preformed titanium mesh based on the stereolithographic model produced with 3D printers ("In-House" reconstruction) provides a better reconstruction volumetric compared to the intraoperatively shaped titanium mesh. The patients with OFF enrolled in this study were divided into two groups according to the inclusion criteria. In Group 1 (G1), patients surgically treated for OFF were divided into two subgroups: G1a, patients undergoing orbital floor reconstruction with an intraoperatively shaped mesh, and G1b, patients undergoing orbital floor reconstruction with a preoperative mesh shaped on a 3D-printed stereolithographic model. Group 2 (G2) consisted of patients treated for other traumatic pathologies (mandible fractures and middle face fractures not involving orbit). Pre- and postoperative orbital volumetric measurements were performed on both G1 and G2. The patients of both groups were subjected to the measurement of orbital volume using Osirix software (Pixmeo SARL, CH-1233 Bernex, Switzerland) on the new CT examination. Both descriptive (using central tendency indices such as mean and range) and regressive (using the Bravais-Pearson index, calculated using the GraphPad program) statistical analyses were performed on the recorded data. From 1 January 2017 to 31 December 2021, of the 176 patients treated for OFF at the "Magna Graecia" University Hospital of Catanzaro 10 fulfilled the study's inclusion criteria: 5 were assigned to G1a and 5 to G1b, with a total of 30 volumetric measurements. In G2, we included 10 patients, with a total of 20 volumetric measurements. From the volumetric measurements and statistical analysis carried out, it emerged that the average of the volumetric differences of the healthy orbits was ±0.6351 cm3, the standard deviation of the volumetric differences was ±0.3383, and the relationship between the treated orbit and the healthy orbit was linear; therefore, the treated orbital volumes tend to approach the healthy ones after surgical treatment. This study demonstrates that if the volume is restored within the range of the standardized mean, the diplopia is completely recovered already after surgery or after one month. For orbital volumes that do not fall within this range, functional recovery could occur within 6 months or be lacking. The restoration of the orbital volume using pre-modeled networks on the patient's anatomical model, printed internally in 3D, allows for more accurate reconstructions of the orbital floor in less time, with clinical advantages also in terms of surgical timing.

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

The Global Track Concept for Assessment of Engaging Hill-Sachs Defects in Anterior Shoulder Instability

Background: The glenoid track concept is used to determine preoperatively whether a Hill-Sachs defect is engaging or not. Currently, the glenoid track concept relies on measurements of bony structures as well as on the confines and elasticity of the rotator cuff as a reference point, which varies extensively among individuals and therefore limits the reliability and accuracy of this concept. Purpose: To evaluate the reliability of the global track concept, which determines the angular distance of the Hill-Sachs defect from the center of the articular surface of the humeral head as a new reference point with the help of an automated image analysis software and 3-dimensional analysis of the humeral head. Study Design: Controlled laboratory study. Methods: Computed tomography scans of 100 patients treated for anterior shoulder instability with different sizes of Hill-Sachs defects were evaluated manually by 2 orthopaedic surgeons independently using the software OsiriX as well as automatically by using a dedicated prototype software (ImFusion). Obtained manual and automated measurements included the Hill-Sachs length, Hill-Sachs width, and Hill-Sachs depth of the defect; the Hill-Sachs interval (HSI); and the glenoid width for the glenoid track concept, as well as the angular distance of the Hill-Sachs defect from the center of the articular surface of the humeral head (global track concept). The reliability of the different measurement techniques was compared by calculating intraclass correlation coefficients (ICCs). Results: There was a significant difference for all obtained parameters comparing manual and automatic measurements. For manually obtained parameters, measurements referring to bony boundaries (glenoid width, Hill-Sachs length, and Hill-Sachs width) showed good to excellent agreement (ICC, 0.86, 0.82, and 0.62, respectively), while measurements referring to soft tissue boundaries (HSI and glenoid track; ICC, 0.56 and 0.53, respectively) or not directly identifiable reference points (center of articular surface and global track) only showed fair reliability (ICC middle excursion, 0.42). When the same parameters were measured with the help of an automated software, good reliability for the glenoid track concept and excellent reliability for the global track concept in the middle excursion were achieved. Conclusion: The present study showed that the more complex global track measurements of humeral defects are more reliable than the current standard HSI and glenoid track measurements. However, this is only true when automated software is used to perform the measurements. Clinical Relevance: Future studies using the new proposed method in combination with an automated software need to be conducted to determine critical threshold values for defects prone to engagement.

Pulmonary Venous Index as Additional Diagnostic Criteria for Fontan Palliation

Backgroud. The results of the Fontan operation, depending on the anatomy of the pulmonary arteries, have been studied quite well. Various indices have been proposed to assess the degree of hypoplasia of the pulmonary arterial bed (Nakata, Reddy, and McGoon indexes). At the same time, an obstruction of pulmonary venous blood return may be considered as a contraindication to Fontan operation. Aim of the Study. To present an optimal method for pulmonary venous index (PVI) calculation based on computed tomography angiography (CTA) enhancement of the heart data in patients with a functional single ventricle. Materials and Methods. 63 patients with a functional single ventricle (SV) underwent CTА (Philips, Brilliance iCT) before the Fontan operation. Axial sections were reconstructed to a thickness of 0.75–3 mm using soft tissue and lung filters, followed by postprocessing of the data (Horos and OsiriX software) and construction of multiplanar and 3D images. The diagnoses were presented by various types of SV of the heart. The age of the patients ranged from 3 to 30 years (median 7 years). Comparison of PVI was carried out in patients of two groups: those who survived the intervention (n = 55 patients) and those who died (n = 8). The evaluation of the pulmonary veins (PV) and the calculation of the pulmonary venous index (PVI) were carried out based on the measurement of each pulmonary vein at 2 levels (at the level of the orifices and bifurcation). The calculation of the PVI was carried out according to the formula: the sum of the cross-sectional area of the main pulmonary veins, related to the body surface area. 3 variants of PVI calculation were compared: taking into account the values of the PV areas at the level of the orifices, the bifurcation, and the sum of the minimum areas of each of the PVs. Results. In the group of survived patients, the median PVI at the level of the PV orifices was 292 mm/m2, and in the group of deceased, it was 242 mm/m2p=0.0326; at the level of PV bifurcation in the group of survivors, it was 299 mm/m2, and in the group of dead patients, it was 281 mm/m2p=0.0776; the minimum PVI was 257 mm/m2 in the survivor group and 218 mm/m2 in the deceased group p=0.006. An ROC analysis performed to determine the critical value of the minimum PVI affecting survival after Fontan operation revealed that PVI measured taking into account the minimum dimensions of the areas of the PV is a significant risk factor for death after Fontan operation p=0.00015, with its value (cutoff) &lt;233.5 mm2/m2. Conclusion. The value of the minimum PVI can be an important morphological indicator of the state of PV blood return and serve as an additional criterion in determining indications for the Fontan operation.

Reliability of Manual Measurements Versus Semiautomated Software for Glenoid Bone Loss Quantification in Patients With Anterior Shoulder Instability.

The presence of glenoid bone defects is indicative in the choice of treatment for patients with anterior shoulder instability. In contrast to traditional linear- and area-based measurements, techniques such as the consideration of glenoid concavity have been proposed and validated. To compare the reliability of linear (1-dimensional [1D]), area (2-dimensional [2D]), and concavity (3-dimensional [3D]) measurements to quantify glenoid bone loss performed manually and to analyze how automated measurements affect reliability. Cohort study (diagnosis); Level of evidence, 3. Computed tomography images of 100 patients treated for anterior shoulder instability with differently sized glenoid defects were evaluated independently by 2 orthopaedic surgeons manually using conventional software (OsiriX; Pixmeo) as well as automatically with a dedicated prototype software program (ImFusion Suite; ImFusion). Parameters obtained included 1D (defect diameter, best-fit circle diameter), 2D (defect area, best-fit circle area), and 3D (bony shoulder stability ratio) measurements. Mean values and reliability as expressed by the intraclass correlation coefficient [ICC]) were compared between the manual and automated measurements. When manually obtained, the measurements showed almost perfect agreement for 1D parameters (ICC = 0.83), substantial agreement for 2D parameters (ICC = 0.79), and moderate agreement for the 3D parameter (ICC = 0.48). When measurements were aided by automated software, the agreement between raters was almost perfect for all parameters (ICC = 0.90 for 1D, 2D, and 3D). There was a significant difference in mean values between manually versus automatically obtained measurements for 1D, 2D, and 3D parameters (P < .001 for all). While more advanced measurement techniques that take glenoid concavity into account are more accurate in determining the biomechanical relevance of glenoid bone loss, our study showed that the reliability of manually performed, more complex measurements was moderate.

Volumetric Analysis of Sphenoid Sinus in Patients with Symptomatic Nasal Septal Deviation: A Cross-sectional Study

Introduction: Nasal Septal Deviation (NSD) is known to influence the anatomy of the paraseptal structures, such as the lateral nasal wall and middle turbinate, thereby causing changes in ethmoid cell volume and maxillary sinus. However, there is not much literature on the influence of NSD on sphenoid sinus volume. Aim: To evaluate the effect of NSD on the volume of sphenoid sinus. Materials and Methods: A cross-sectional study was conducted over a period of one year at a tertiary care hospital in Karnataka, India on 45 patients with symptomatic NSD. Diagnostic Nasal Endoscopy (DNE) and Computed Tomography (CT) scans of the nose and Paranasal Sinuses (PNS) were performed on all patients. NSD was classified into three types based on the degree of septal deviation on CT scan. Sphenoid sinus volumes were measured, and the relationship between NSD and sphenoid sinus volume was analysed using OSIRIX software on the MAC system. Statistical analysis was done using the Wilcoxon signed-rank test and the Kruskal-Wallis test. Results: The mean age of the patients included in the study was 30.89±10.19 years. The male-to-female ratio was 2.75:1. The majority of the patients had NSD to the right (57%). NSD was found to be 1.3 times more frequent on the right-side compared to the left. The angle of NSD ranged between 2.10° and 18°. The majority of the patients were in group I (n=35), while group II and III had seven and three patients, respectively. The total ipsilateral volume was found to be 7.43±3.46 cm3 and the contralateral volume was 7.98±4.19 cm3 . There was no statistically significant difference between ipsilateral and contralateral sphenoid sinus volumes in the population (p-value=0.781). When each group was compared, no significant difference between the total sphenoid cell volumes on the ipsilateral (p-value=0.557) and contralateral (p-value=0.405) sides of the NSD was seen. Conclusion: NSD does not affect the volume of the sphenoid sinus, irrespective of the degree of septal deviation.

Evaluation of the reliability and accuracy of femur measurements acquired from computed tomography images

The biological profile holds notable significance within forensic assessments, as it plays a crucial role in determining biological identity. Moreover, it possesses substantial potential for applications in fields such as medical legal cases and forensic anthropology. Recent advancements in technology, specifically in the field of computed tomography, have enabled the accurate acquisition of detailed anatomical data from CT scans present in extensive medical repositories. The validity of new methods developed through the application of these techniques should therefore be analyzed. The primary intent of this research was to investigate the measurement accuracy obtained from CT-generated 3D femur models. To investigate the accuracy and reliability of measurements obtained from CT-generated 3D femur models, 3 different studies were conducted. A dataset comprising fifteen femurs was employed for analysis and measurement purposes. The obtained images were subsequently compared to twelve measurements acquired from the dry femora, enabling an assessment of the reliability and accuracy of both measurement protocols. To investigate the effect of CT parameters and soft tissue, 4 femurs were used. The analysis of twelve femur measurements obtained from the CT images processed with OsiriX software was carried out using Excel software packages and SPSS 24.0. From the results of this study, it can be observed that there is no discernible pattern regarding the reliability of image acquisition in any particular way. This implies that both dry femur bone and 3D virtual femur models can be used interchangeably for the 12 metric measurements used in this study, and at the same time, different scanning parameters or soft tissue influence for these measurements do not make a statistically significant difference.

Inter-rater reliability of a novel objective endpoint for benign central airway stenosis interventions: Segmentation-based volume rendering of computed tomography scans.

To evaluate the reliability of a novel segmentation-based volume rendering approach for quantification of benign central airway obstruction (BCAO). A retrospective single-center cohort study. Data were ascertained using electronic health records at a tertiary academic medical center in the United States. Patients with airway stenosis located within the trachea on two-dimensional (2D) computed tomography (CT) imaging and documentation of suspected benign etiology were included. Four readers with varying expertise in quantifying tracheal stenosis severity were selected to manually segment each CT using a volume rendering approach with the available free tools in the medical imaging viewing software OsiriX (Bernex, Switzerland). Three expert thoracic radiologists were recruited to quantify the same CTs using traditional subjective methods on a continuous and categorical scale. The interrater reliability for continuous variables was calculated by the intraclass correlation coefficient (ICC) using a two-way mixed model with 95% confidence intervals (CI). Thirty-eight patients met the inclusion criteria, and fifty CT scans were selected for measurement. The most common etiology of BCAO was iatrogenic in 22 patients (58%). There was an even distribution of chest and neck CT imaging within our cohort. The average ICC across all four readers for the volume rendering approach was 0.88 (95% CI, 0.84 to 0.93), suggesting good to excellent agreement. The average ICC for thoracic radiologists for subjective methods on the continuous scale was 0.38 (95% CI, 0.20 to 0.55), suggesting poor to fair agreement. The kappa for the categorical approach was 0.26, suggesting a slight to fair agreement amongst the raters. In this retrospective cohort study, agreement was good to excellent for raters with varying expertise in airway cross-sectional imaging using a novel segmentation-based volume rendering approach to quantify BCAO. This proposed measurement outperformed our expert thoracic radiologists using conventional subjective grading methods.

Investigating the Role of Proximal Femoral Morphology in Noncontact ACL Injuries: A Comparative Study

Background: Non-contact anterior cruciate ligament (ACL) injury is a common and debilitating injury among athletes, with high recurrence rates and long-term consequences. Identifying individuals at risk of ACL injury can help prevent or reduce the severity of these injuries. The present study aimed to assess the alpha angle (AA) in ACL rupture patients in both the injured (ipsilateral) and non-affected (contralateral) extremities, compared to a control group. Methods and Results: This case-control study included 105 subjects (78.1% male and 21.9% female) aged between 15 and 45 years of both sexes involved in sports. The case group consisted of 54 patients with sport-related, noncontact ACL ruptures identified by MRI. Fifty-one patients, 10(19.6%) of whom were female, with no ACL rupture, were included in the study as a control group. Hip radiographs were taken in all the subjects using the modified Dunn View with the patient in the supine position, hip flexed 45o and abducted 20o. OsiriX software was used to obtain the measurements. Most injuries were caused by football (58.1%), followed by jumping sports (23.8%) and skiing (18.1%). The mean AA was 49.27 o (SD=4.93) for subjects without ACL rupture and 54.84o (SD=6.17) for subjects with ACL rupture, and the difference was statistically significant (P&lt;0.001). Results also showed a statistically significant difference in the AA on the ipsilateral (54.84o [SD=6.17]) and contralateral (49.48o [SD=7.04]) hips of the case subjects (P&lt;0.001). The logistic regression analysis indicated a statistically significant difference in AA between the case and control groups and between hips of the same subject with an OR of 1.12 (P=0.041) and 1.2 (P=0.000), respectively. Conclusion: Alterations in proximal femur morphology should be considered a potential risk factor for ACL injury, and AA can be a significant predictor of ACL injury. We recommend that young athletes actively participating in sports have their hip AA measured so those with higher AA can follow special prevention programs.

Anatomical Implications of Chiari I and Basilar Invagination (Type B) in the IV Ventricle and Cisterna Magna

To analyze the anatomical changes of the IV ventricle and cisterna magna in the Chiari malformation I (CMI) and basilar invagination (type B). This is a controlled study with 161 exams of magnetic resonance imaging (MRI) of adults grouped into control (n= 37), basilar invagination (BI; n= 31), Chiari malformation I (CMI; n= 37), and CMI+BI (n= 56). The MRIs were analyzed using the visualization software Osirix (Pixmeo, Bernex, Geneva, version 3.8.2). The morphometric variables were: distance from the obex to the McRae line; length of the IV ventricle floor; and the area and volume of the cisterna magna. The univariate ANOVA followed by Tukey's post-hoc test was applied to evaluate the difference between the groups. The difference between sexes was evaluated by the t test for each group. Alterations in the cisterna magna and IV ventricle were more evident only in the CMI and CMI+BI groups. For both sexes, the CMI and CMI+BI groups showed: a reduction in the CSF space (P < 0.001), cisterna magna with volume reduction (P < 0.001), low position of the obex (P < 0.001), and IV ventricle more elongated (male P= 0.007 and female P < 0.001). The BI group had no significant change in the analysis by sex. The CMI (isolated and associated with BI) showed a low obex position and elongation of the IV ventricle due to traction towards the spinal canal. The reduction of cisterna magna volume added to the occupation of the cerebellar tonsils can impact in the cerebrospinal fluid dynamics. The BI when isolated was not related to alterations in the parameters of cerebrospinal fluid spaces studied.

Inter-software and inter-scan variability in measurement of epicardial adipose tissue: a three-way comparison of a research-specific, a freeware and a coronary application software platform

ObjectivesEpicardial adipose tissue (EAT) is a proposed marker of cardiovascular risk; however, clinical application may be limited by variability in post-processing software platforms. We assessed inter-vendor agreement of EAT volume (EATv) and attenuation on both contrast-enhanced (CE) and non-contrast CT (NCT) using a standard coronary CT reporting software (Vitrea), an EAT research-specific software (QFAT) and a freeware imaging software (OsiriX).MethodsSeventy-six consecutive patients undergoing simultaneous CE and NCT had complete volumetric EAT measurement. Between-software, within-software NCT vs. CE, and inter- and intra-observer agreement were evaluated with analysis by ANOVA (with post hoc adjustment), Bland-Altman with 95% levels of agreement (LoA) and intraclass correlation coefficient (ICC).ResultsMean EATv (freeware 53 ± 31 mL vs. research 93 ± 43 mL vs. coronary 157 ± 64 mL) and attenuation (freeware − 72 ± 25 HU vs. research − 75 ± 3 HU vs. coronary − 61 ± 10 HU) were significantly different between all vendors (ANOVA p < 0.001). EATv was consistently higher in NCT vs. CE for all software packages, with most reproducibility found in research software (bias 26 mL, 95% LoA: 2 to 56 mL), compared to freeware (bias 11 mL 95% LoA: − 46 mL to 69 mL) and coronary software (bias 10 mL 95% LoA: − 127 to 147 mL). Research software had more comparable NCT vs. CE attenuation (− 75 vs. − 72 HU) compared to freeware (− 72 vs. − 57 HU) and coronary (− 61 vs. − 39 HU). Excellent inter-observer agreement was seen with research (ICC 0.98) compared to freeware (ICC 0.73) and coronary software (ICC 0.75) with narrow LoA on Bland-Altman analysis.ConclusionThere are significant inter-vendor differences in EAT assessment. Our study suggests that research-specific software has better agreement and reproducibility compared to freeware or coronary software platforms.Key Points• There are significant differences between EAT volume and attenuation values between software platforms, regardless of scan type.• Non-contrast scans routinely have higher mean EAT volume and attenuation; however, this finding is only consistently seen with research-specific software.• Of the three analyzed packages, research-specific software demonstrates the highest reproducibility, agreement, and reliability for both inter-scan and inter-observer agreement.

Computer aided volumetric assessment of orbital structures in patients with Graves' orbitopathy: correlation with serum thyroid antiperoxidase antibodies and disease activity

IntroductionGraves' disease is an autoimmune disorder. Goiter and Graves' orbitopathy are frequently seen clinically. It would be helpful for the diagnosis, grading, prognosis, and treatment of this condition if it was possible to find serum biomarkers to establish a connection between the plasma levels of these compounds and orbital changes.MethodsA retrospective study was performed by revising the medical records of 44 patients with Graves' orbitopathy and 15 controls. The Osirix software (Pixmeo, Geneva, Switzerland) was used for manual orbital measurements. Plasma levels of Graves' orbitopathy substances were obtained in the analytical review of the patients.ResultsA greater muscle volume was observed in patients with Graves' orbitopathy in relation to the control group (p < 0.001). The clinical activity score (CAS) was associated to total muscle mass (p = 0.013) and retrorbital fat (p = 0.048). Our results indicated a direct relationship between serum concentrations of anti-thyroid peroxidase antibodies and inferior rectus thickening (p = 0.036); however, we did not observe a positive correlation between other muscle volumes and serum concentrations of various thyroid-related substances.ConclusionsThis study is the first that uses Osirix measurement software to manually assess orbital features in patients with Graves' orbitopathy. These measurements were compared to the outcomes of tests performed in a laboratory. Among several serum biomarkers, anti-thyroid peroxidase appears to be a reliable biomarker that correlates positively with inferior rectus muscle thickness in patients with thyroid eye disease. This may help to improve the management of this disease.

Pilot study to establish the myocardium native T1 mapping reference values in 1.5 Tesla cardiac magnetic resonance of healthy Malaysians

BackgroundCardiac magnetic resonance (CMR) is a powerful and robust imaging modality with the capability for tissue characterisation by quantifying the intrinsic magnetic properties of tissues. The current international consensus recommendation is to determine the local normal T1 mapping value. Recent advancement suggests pooled data or benchmarking of CMR mapping reference values. We present the adult myocardial native T1 mapping value of a common MR acquisition in healthy Malaysians who are predominantly brown skin Asians.MethodsThis is a prospective, cross-sectional study in a single centre. CMR was performed on a 1.5 T MR using 5(3s)3 MOLLI sequence with motion correction, TE = 1.31 ms, TR = 2.78 ms. The analysis of the mid-septal T1 value was done using third-party software (CVi42) and the OsiriX software by two blinded cardiac radiologists.ResultsA total of 51 eligible adults were recruited of which 1 was excluded due to incidental finding of moderate mitral regurgitation. The mean age was 30 years ± 7.0, the majority (64%) was female, the median heart rate was 72 ± 20 bpm and mean the BSA was 1.6 ± 0.1 m2. The ethnicity distribution is Malay 76%, Indian 12%, Chinese 8% and Sabahan 4%. The normal range for mid-septum myocardial T1 using CVi42 was 1012 ± 33 ms and using OsiriX was 1018 ± 37 ms. There is no correlation observed against gender, ethnicity and heart rate. The moderate correlation observed with age is not gender specified. The interobserver reliability was good (coefficient 0.813).ConclusionsFor T1 mapping to be applied clinically, it is imperative to determine the local normal value as recommended by international consensus. The first-ever database on native T1 mapping for 1.5 T CMR reference value for Malaysians who are predominantly brown skin Asians is provided in this pilot study.

Sarcopenia Is a Prognostic Factor in Patients Undergoing Percutaneous Endoscopic Gastrostomy.

(1) Background: Percutaneous endoscopic gastrostomy (PEG) is a widely used long-term enteral nutrition method, but little is known about the associated prognostic factors in patients with PEG. Sarcopenia, a condition characterized by a loss of skeletal muscle mass, increases the risk of developing various gastrointestinal disorders. Yet, the relationship between sarcopenia and the prognosis after PEG remains unclear. (2) Methods: We conducted a retrospective study of patients who underwent PEG consecutively from March 2008 to April 2020. We analyzed preoperative sarcopenia and the prognosis of patients after PEG. We defined sarcopenia as a skeletal muscle index at the level of the third lumbar vertebra of ≤29.6 cm2/m2 for women and ≤36.2 cm2/m2 for men. Cross-sectional computed tomography images of skeletal muscle at the level of the third lumbar vertebra were evaluated using DICOM image analysis software (OsiriX). The primary outcome was the difference in overall survival after PEG based on the status of sarcopenia. We also performed a covariate balancing propensity score matching analysis. (3) Results: Of 127 patients (99 men, 28 women), 71 (56%) were diagnosed with sarcopenia, and 64 patients died during the observation period. The median follow-up period did not differ between patients with and without sarcopenia (p = 0.5). The median survival time after PEG was 273 days in patients with sarcopenia and 1133 days in those without (p < 0.001). Cox proportional hazard model analyses identified three factors that were significantly associated with overall survival: sarcopenia (adjusted hazard ratio [HR]: 2.9, 95% confidence interval [CI]: 1.6-5.4, p < 0.001), serum albumin level (adjusted HR: 0.34, 95% CI: 0.21-0.55, p < 0.001) and male sex (adjusted HR: 2.0, 95% CI: 1.1-3.7, p = 0.03). Propensity score-matched analysis (n = 37 vs. 37) showed that the survival rate was lower in the sarcopenia group than in the non-sarcopenia group (at 90 days: 77% (95% CI, 59-88) vs. 92% (76-97), at 180 days: 56% (38-71) vs. 92% (76-97), and at one year: 35% (19-51) vs. 81% (63-91), p = 0.0014). (4) Conclusions: Sarcopenia was associated with poor prognosis in patients having undergone PEG.