Perioperative Imaging Research Articles

Multifidus Degeneration: The Key Imaging Predictor of Adjacent Segment Disease.

Retrospective cohort study. To identify imaging predictors on pre- and perioperative imaging that are associated with a future revision surgery for adjacent segment disease (ASD) following lumbar fusion. Patients undergoing open posterior lumbar fusion between 2014-2022 were followed-up for >2-year. The initial MRI was evaluated for disc degeneration by Pfirrmann (grade 1-5); Modic changes (0-3); as well as fatty infiltration and functional cross-sectional area (fCSA) of the multifidus, erector spinae, and psoas. Spinopelvic alignment was measured pre- and postoperatively. Of 216 patients, 14.8% (n = 32) required revision surgery for ASD in the further course. There were no significant differences in Modic changes or Pfirrmann grades between the ASD group and controls. Fatty infiltration was significantly higher in the ASD group for both the erector spinae (40.5% vs 36.9%, P = 0.043) and multifidus muscles (61.0% vs 53.9%, P = 0.003). Additionally, the multifidus fCSA was smaller in patients who developed ASD (5.7cm2 vs 6.7cm2). Pre- and postoperative spinopelvic parameters were not significantly different between groups, and no other MRI measurements showed a significant difference. In a multivariable logistic regression model adjusting for age and sex, multifidus fatty infiltration emerged as the only significant predictor of ASD revision surgery (P = 0.004). Patients with more than 58% multifidus fatty infiltration had over double the risk of developing ASD (OR 2.7, 95% CI: 1.1-6.5, P = 0.032). Multifidus fatty infiltration is the key imaging predictor for the development of ASD requiring surgical revision. Disc degeneration and spinopelvic alignment appear to have less impact.

Intracardiac vs transesophageal echocardiography for percutaneous LAA occlusion: a meta-analysis

Abstract Background Percutaneous left atrial appendage occlusion (LAAO) is typically performed under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. Intracardiac echocardiography (ICE) appears to be a potential alternative to guide implantation. Purpose We sought to perform a meta-analysis comparing ICE and TEE for endocardial LAAO. Methods A comprehensive literature search was performed in PubMed and Google Scholar regarding published abstracts and manuscripts on July 1, 2023. Studies reporting clinical outcomes comparing ICE vs TEE for endocardial LAAO were included. Results A total of 16 studies with 123,444 patients (ICE-5,122 patients and TEE-122,667 patients) (mean age 75±4 years, 59%male) fulfilled the criteria. Five included Watchman, four included the Amplatzer Cardiac Plug/ Amulet device, and seven included both devices. There was no significant difference in CHA2DS2VASC or HAS-BLED scores between both groups. Outcomes assessed including procedural success between ICE vs TEE (risk ratio [RR], 1.01; 95% CI, 1.00-1.01), fluoroscopy time (mean difference [MD], 1.25 minutes; 95% CI, -1.63- 4.14) and total procedure time (MD, −3.74 minutes; 95% CI, − 13.42-5.94) were found to be similar between both groups. There was also no significant difference in complications including vascular complications, bleeding events, device embolization, and stroke between both groups. Of note, patients undergoing LAA closure under ICE guidance had higher risk for pericardial effusion and/or cardiac tamponade compared to those in the TEE group (RR 1.72; 95% CI, 1.32-2.23). Conclusions Although TEE is the gold standard for perioperative guidance of LAAO, imaging with ICE is a feasible alternative associated with similar efficacy outcomes in LAAO procedures. However, further studies needed to clarify safety of ICE as an alternative perioperative imaging technique.

How to determine the course of preoperative chemotherapy for spinal tuberculosis: A single-center clinical study.

This study aims to explore the clinical efficacy and feasibility of preoperative 1-week chemotherapy for patients with spinal tuberculosis (STB) undergoing complete lesion removal. Clinical data of 76 patients with STB who underwent complete focal debridement in our hospital were collected from June 2020 to September 2023. The patients were divided into 38 cases of preoperative 1-week chemotherapy group (Group A) according to the length of preoperative chemotherapy, and 38 cases of preoperative 2 to 4-week chemotherapy group (Group B). Perioperative related, imaging, and laboratory examination indices as well as postoperative neurological function recovery, postoperative pain recovery, related complications, and clinical efficacy were analyzed to compare the clinical efficacy of the 2 groups. All patients successfully completed the treatment of stage I complete lesion removal combined with bone grafting fusion and internal fixation. The difference in erythrocyte setting rate and C-reactive protein at the same postoperative observation time between the 2 groups was not statistically significant (P > .05). The visual analogue scale scores of patients in the 2 groups decreased significantly with prolonged time, and the difference was statistically significant (P < .05). All patients achieved satisfactory clinical efficacy (P < .05). All patients achieved good clinical outcomes, the difference between the groups was not statistically significant (P > .05). The difference in incision healing rate at 3 months postoperatively and bone graft fusion rate at 6 months postoperatively was not statistically significant between the 2 groups (P > .05). The dissemination and recurrence of Mycobacterium tuberculosis were not statistically significantly different between the 2 groups after surgery (P > .05). In summary, with complete lesion clearance, 1 week of preoperative chemotherapy is feasible in patients with STB with varying degrees of neurological dysfunction.

Two Patients With Ipsilateral Cerebellar Hemorrhage After Superficial Temporal Artery-Middle Cerebral Artery Bypass Grafting.

To summarize the clinical experience of ipsilateral cerebellar hemorrhage after superficial temporal artery-middle cerebral artery bypass surgery. The clinical data of 2 patients with cerebellar hemorrhage after superficial temporal artery-middle cerebral artery bypass grafting were retrospectively collected, including 1 case with left cerebellar hemorrhage after left cerebral artery bypass grafting and 1 case with right cerebellar hemorrhage after right cerebral artery bypass grafting. The perioperative blood pressure, laboratory, and imaging data were analyzed. All patients had a history of hypertension, and their perioperative blood pressure was stable. Low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were normal before the operation. Cerebral magnetic resonance imaging showed cerebral atherosclerosis and multiple ischemic cerebral infarcts. At 24 hours after surgery, the patients' continuous epidural low drainage was 260 mL and 160 mL, respectively. The amount of cerebellar bleeding was small, and no new sequelae were left after conservative treatment with drugs. Cerebellar hemorrhage after superficial temporal artery-middle cerebral artery bypass grafting is related to perioperative blood pressure fluctuation, hemodynamic changes, hemorrhagic transformation of ischemic lesions, and excessive cerebrospinal fluid drainage. Maintaining stable blood pressure during the perioperative period and avoiding excessive and rapid loss of cerebrospinal fluid after operation can reduce the occurrence of this complication.

Utility of ultrasound in the perioperative phase of carotid endarterectomy and carotid artery stent implantation.

This article reviews the latest research results of the use of ultrasound technology in the perioperative period of carotid endarterectomy and carotid stenting and discusses the role of ultrasound technology in accurately evaluating carotid stenosis and plaque stability, assisting in selecting the most suitable surgical method, and providing optimal perioperative imaging to guide carotid endarterectomy (CEA) and carotid artery stenting (CAS) to reduce the occurrence and progression of stroke. The research published in recent years on the application of ultrasound in the perioperative period of CEA and CAS was reviewed through the databases of CNKI, Pubmed, and Web of Science. Ultrasound has high clinical value in preoperative screening for indications, assessing the degree of carotid artery stenosis and the nature of plaque; monitoring hemodynamic changes intraoperatively to prevent cerebral ischemia or overperfusion; and evaluating surgical outcomes postoperatively and in late follow-up review. Ultrasound is currently widely used perioperatively in CEA and CAS and has even become the preferred choice of clinicians to evaluate the efficacy of surgery and follow-up. The presence of vulnerable plaque is an important risk factor for ischemic stroke. Contrast-enhanced ultrasound is an excellent tool to assess plaque stability. In most studies, ultrasound has been used only in a short follow-up period after CEA and CAS, and data from longer follow-ups are needed to provide more reliable evidence.

What do you do with a normal appearing appendix? A national study of Pediatric Surgeons.

Surgeons may encounter a grossly normal appearing appendix in a patient with clinically suspected appendicitis. The purpose of this study is to determine the practice of pediatric surgeons in Saudi Arabia when this is encountered, and determine the reasons behind their decision making. An electronic survey was sent to all pediatric surgeons in Saudi Arabia. Data points collected included demographics, peri-operative imaging preference, and personal practice when managing an intra-operative grossly normal appendix in symptomatic children. A total of 105 responses were obtained yielding a response rate of 33.8% The majority of respondents, 88 (87.1%) would remove the appendix while 13 (12.9%) would leave it in situ. The most common reason for removing the appendix was the possibility of microscopic/Endo appendicitis 71 (34.8%) while the most common reason for leaving the appendix in situ was the possible usage of the appendix for reconstructive benefits in the future 11 (50%). The overwhelming majority 87 (86.1%) felt that there were no sufficient guidelines on removal of the normal appearing appendix at the time of surgery for suspected acute appendicitis. The majority of pediatric surgeons in Saudi Arabia would proceed with an appendectomy when an intra-operative grossly normal appendix is seen in patients suspected to have acute appendicitis. There is a clear lack of published pediatric guidelines and large studies to guide the correct course of action.

Adjacent Vertebral Refracture Prediction Model Based on Imaging Data After Vertebroplasty for Osteoporotic Vertebral Compression Fracture

To establish a predictive model to evaluate the risk of adjacent vertebral refracture (VRF) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) based on perioperative imaging data. This study was a retrospective cohort study which established a predictive model of VRF after PKP for OVCF. Patients who underwent PKP for OVCF in our hospital between January 2018 and December 2020 were enrolled and divided into a refracture group and normal group. Perioperative imaging data including preoperative bone mineral density (BMD), fatty infiltration (FI%) of paravertebral muscle, sagittal parameters of the spine and pelvis, and recovery rate of vertebral height were collected. The prediction model is obtained by multifactor logistic regression analysis. A total of 242 patients were included, including 23 cases in the VRF group and 219 cases in the normal group. There were statistical differences in BMD, FI%, recovery rate of vertebral height, and sagittal imbalance between the 2 groups. Receiver operating characteristic curve analysis of continuous variables showed that BMD≤-2.80, FI% ≥40%, and recovery rate of vertebral height≥10% were the cutoff values. Logistic regression analysis showed that BMD≤-2.80, FI% ≥40%, and sagittal imbalance were independent risk factors for VRF. The area under the curve according to the predicted probability was 0.85 (P < 0.05). After simplifying the model, the total point of the model was 7 points, with a cutoff value of 5 points. The prediction model obtained in this study can predict refracture after PKP for OVCF early and effectively. It has an excellent predictive effect which is suitable for clinicians.

Predictors of Acute Cerebellar Bulge Prior to Posterior Fossa Lesion Resection

ObjectiveA cerebellar bulge prior to posterior fossa resection is an emergency condition during surgery. Intraoperative cerebellar bulging not only increases the difficulty of lesion resection but also brings additional postoperative complications. Currently, there are few systematic reports on this topic. The predictors of cerebellar bulge and how to effectively prevent intraoperative cerebellar bulge are discussed in this article. MethodsThe clinical and imaging data of 527 patients with posterior fossa lesions who underwent resection at our hospital were retrospectively collected and analyzed. Perioperative clinical and imaging data were assessed. Variables were analyzed using univariate and multivariate regression analyses. ResultsOverall, 10.4% (55/527) of patients had intraoperative acute bulges. Multivariate analysis revealed that age <60 years, BMI ≥24, lesion size ≥30 (mm), cerebellar tonsillar herniation and/or hydrocephalus, and perilesional edema (moderate-severe) were predictors of cerebellar bulging. Relief of the cerebellar bulge can be accomplished by excising the lesion, releasing cerebrospinal fluid, and removing the cerebellum (the outer 1/3). Obvious cerebellar-related complications occurred in 4 patients postoperatively, and the symptoms disappeared after 6 months of follow-up. ConclusionsCerebellar bulging during intraoperative posterior fossa resection deserves attention. Through the analysis of multiple factors related to cerebellar bulge, comprehensive evaluation and early intervention during the perioperative period are necessary. The incidence of cerebellar bulges can be reduced, and surgical complications related to cerebellar bulges can be avoided.

Critical distance of the sacroiliac joint for open reduction using screw fixation for traumatic sacroiliac joint diastasis: a retrospective study

BackgroundOsteosynthesis for sacroiliac joint (SIJ) diastasis using an iliosacral screw (ISS) and a trans-iliac-trans-sacral screw (TITSS) can be performed using a closed or an open method. However, no clear indication for open reduction has been established.MethodsData on patients with unilateral traumatic SIJ diastasis who underwent ISS and TITSS fixation were retrospectively collected and separated into groups according to the reduction method: closed reduction group (C group) and open reduction group (O group). Demographic data and perioperative image assessments were compared between the groups. The critical distance of the SIJ was identified to elucidate the indication for open reduction of the diastatic SIJ.ResultsFifty-six patients met the inclusion criteria over a 3-year period. There was no significant difference in the reduction quality of pelvic ring injuries between the groups, according to Matta’s and Lefaivre’s criteria. The improvement in the SIJ distance was significantly greater in the O group than in the C group in the axial plane on multiplanar computed tomography (p = 0.021). This model predicted that a difference of > 3.71 mm between the injured and healthy SIJ was a recommended indication for open reduction, with an area under the curve of 0.791 (95% confidence interval 0.627–0.955, p = 0.004).ConclusionsOpen reduction for SIJ diastasis might achieve better reduction quality than does closed reduction in the axial plane in selected cases. When the difference between the injured and healthy SIJ was wider than 3.71 mm, open reduction was recommended for satisfactory radiological outcomes.

Humeral Condylar Fractures in French Bulldogs: Prevalence of Contralateral Intracondylar Fissure, Treatment, and Outcome.

The aim of this study was to report (1) the prevalence of contralateral humeral intracondylar GAP/HIF (HIF) in French Bulldogs with humeral condylar fractures (HCF) and (2) treatment and short- and long-term outcome in French Bulldogs with HCF. Medical records of French Bulldogs treated surgically for HCF between January 2011 and November 2022 were reviewed. Perioperative imaging, surgical technique, complications, and long-term outcome were assessed. Eighty-nine dogs with HCF were included and 36/89 were diagnosed with HIF. Surgical repair was performed in all HCF and a prophylactic transcondylar screw was placed in 20/36 HIF. For prophylactic transcondylar screw placement, two dogs required immediate revision surgery. Complications occurred in 12/89 HCF, and there were major complications in 6/89 HCF. Long-term outcome evaluated by owner questionnaire (n = 27) was rated as being excellent in 18/27 dogs, good in 8/27 dogs, and fair in 1/27 dogs. Forty percent of French Bulldogs with HCF had a contralateral HIF. HIF as a cause of HCF should be considered in the French Bulldog, and a computed tomography (CT) scan of both elbows may be advisable prior to HCF repair. The complication rate of HCF surgery in the French Bulldog is significant.

Comparison of effectiveness between unilateral biportal endoscopic and uniportal interlaminar endoscopic decompression in the treatment of lumbar spinal stenosis

To compare the effectiveness between unilateral laminotomy and bilateral decompression (ULBD) with unilateral biportal endoscopy (UBE) and uniportal interlaminar endoscopy (UIE) in the treatment of lumbar spinal stenosis. A clinical data of 52 patients with lumbar spinal stenosis, who met the selection criteria and treated with ULBD between March 2021 and November 2022, was retrospectively analyzed. The patients were allocated into UBE group (23 cases) and UIE group (29 cases) according to the surgical methods. There was no significant difference ( P>0.05) in age, gender, body mass index, surgical segment, type of lumbar stenosis, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of leg pain, Oswestry disability index (ODI), disc height, and dural sac area between the two groups. Perioperative indexes (incision length, operation time, hospital stay, and surgical complications), clinical indicators (VAS score of low back pain, VAS score of leg pain, and ODI before operation and at 3 days, 1 month, 6 months, and 12 months after operation), and imaging indicators (disc height and dural sac area before operation and at 1, 12 months after operation, and dural sac expansion area) were recorded and compared between the two group. All operations in both groups were successfully completed. Compared with the UIE group, the UBE group had shorter operation time and longer incision length, with significant differences ( P<0.05). But there was no significant difference in hospital stay and incidence of complications between the two groups ( P>0.05). All patients were followed up 12-20 months (mean, 14 months). The VAS scores of low back pain and leg pain and ODI after operation significantly improved when compared with preoperative values ( P<0.05), and there was no significant difference in the above indicators between different time points after operation ( P>0.05). There was no significant difference between the two groups at different time points ( P>0.05). Imaging examination showed that there was no significant difference in disc height between the two groups at different time points after operation ( P>0.05). However, the dural sac area and dural sac expansion area were significantly larger in the UBE group than in the UIE group ( P<0.05). ULBD with UBE and UIE can achieve satisfactory effectiveness in the treatment of lumbar spinal stenosis. But the former has more thorough decompression and better dural sac expansion than the latter.

Risk factors for postoperative ventriculoperitoneal shunt requirement in pediatric patients with brain tumors invading or adjacent to CSF circulation pathways.

Hydrocephalus is a common comorbidity of brain tumors in children that may persist following brain tumor resection. This study aimed to explore perioperative risk factors associated with postoperative ventriculoperitoneal shunt (VPS) placement for tumors located at or adjacent to the CSF circulation pathway. Patients aged 0-18 years with tumors invading or adjacent to the CSF circulation pathways who underwent brain tumor resection between October 2015 and September 2021 were included in this study. The outcome metric was whether patients underwent VPS placement within 6 months of tumor resection. Patients were followed up every 3-6 months after surgery. Demographic and perioperative imaging characteristics, clinical variables, and long-term treatments, including radiotherapy or chemotherapy, were included in the analysis. Two hundred sixty-five children were included in this study. Of these patients, 38 (14.34%) underwent VPS placement within 6 months of tumor resection. One hundred thirty-two patients (49.81%) presented with preoperative hydrocephalus. Results from the multivariate analysis showed that medulloblastoma (OR 4.15, 95% CI 1.74-9.91, p = 0.001), lateral/third ventricle tumors (OR 4.07, 95% CI 1.33-12.30, p = 0.014), postoperative intraventricular hematoma (OR 3.36, 95% CI 1.53-7.38, p = 0.003), and presence of subdural hygroma in the nonoperated area within 48 hours after tumor resection (OR 2.78, 95% CI 1.15-6.74, p = 0.024) were independent risk factors for postoperative VPS placement. Postoperative lateral/third ventricle hematoma and subdural hygroma in the nonoperated area, anatomical location, and tumor histology may be potential risk factors for a postoperative VPS after brain tumor resection.

European Society of Pediatric Radiology survey of perioperative imaging in pediatric liver transplantation: (3) postoperative imaging

BackgroundLiver transplantation is the state-of-the-art curative treatment for end-stage liver disease. Imaging is a key element in the detection of postoperative complications. So far, limited data is available regarding the best radiologic approach to monitor children after liver transplantation.ObjectiveTo harmonize the imaging of pediatric liver transplantation, the European Society of Pediatric Radiology Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra-, and postoperative phases. This paper reports the responses related to postoperative imaging.Materials and methodsAn online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted, and 22 institutions from 11 countries returned the survey.ResultsAll sites commence ultrasound (US) monitoring within 24 h after liver transplantation. Monitoring frequency varies across sites, ranging from every 8 h to 72 h in early, and from daily to sporadic use in late postoperative phases. Predefined US protocols are used by 73% of sites. This commonly includes gray scale, color Doppler, and quantitative flow assessment. Alternative flow imaging techniques, contrast-enhanced US, and elastography are applied at 31.8%, 18.2%, and 63.6% of sites, respectively. Computed tomography is performed at 86.4% of sites when clarification is needed. Magnetic resonance imaging is used for selected cases at 36.4% of sites, mainly for assessment of biliary abnormalities or when blood tests are abnormal.ConclusionDiagnostic imaging is extensively used for postoperative surveillance of children after liver transplantation. While US is generally prioritized, substantial differences were noted in US protocol, timing, and monitoring frequency. The study highlights potential areas for future optimization and standardization of imaging, essential for conducting multicenter studies.

Sarcopenia is a Poor Predictor of Outcomes in Elective Colectomy for Diverticulitis.

Sarcopenia is associated with adverse perioperative outcomes in patients undergoing operations for malignancy, but its influence on patients undergoing elective colectomy for diverticulitis is unknown. We hypothesized that sarcopenia is associated with adverse perioperative events in patients undergoing elective colectomy for diverticulitis. Comorbidities, operative characteristics, and postoperative complications were extrapolated from our institutional EMR in patients undergoing elective colectomy for diverticulitis from 2016 to 2020. Sarcopenia was calculated using perioperative imaging and defined by standard skeletal muscle index (SMI) and psoas muscle index (PMI) thresholds. Univariate analysis was used to compare sarcopenic and non-sarcopenic patients. 148 patients met inclusion criteria. Using SMI thresholds, 95 patients (64%) were sarcopenic. With SMI criteria, sarcopenic patients were older (67 vs 52years old; P < .01) and had lower BMIs (26.2 vs 34.0, respectively; P < .001) than non-sarcopenic patients. There were no differences in baseline characteristics, postoperative complications, and non-home discharge between groups (P > .05 for all). Postoperative length of stay was greater in sarcopenic patients (3 IQR 2-5 vs 2 IQR 2-3days; P < .01). Using PMI thresholds, 68 (46%) met criteria for sarcopenia. Using PMI thresholds, sarcopenic patients were older (68 vs 57.5years old; P < .01) and had lower BMIs (25.8 vs 32.8; P < .01). There were no differences in comorbidities or measured operative outcomes between groups (P > .05 for all), other than postoperative length of stay which was longer in the sarcopenic group (3.5 IQR 3-5 vs 2 IQR 2-3; P < .01). Incidence of sarcopenia was high in patients undergoing elective colectomy for diverticulitis in our practice, but sarcopenia was not associated with adverse perioperative outcomes. In select patients, elective colectomy for diverticulitis can be safely performed in the presence of sarcopenia.

Hidden blood loss and bleeding characteristics in children with congenital scoliosis undergoing spinal osteotomies.

Spinal osteotomies are often essential in the treatment of congenital scoliosis. Risk factors for bleeding in these patients needing extracavitatory approaches, especially hidden blood loss, are sparsely investigated. We aimed to investigate the bleeding characteristics and hidden blood loss in paediatric patients undergoing spinal osteotomies for congenital scoliosis. A retrospective analysis identified all patients with congenital scoliosis were retrospectively identified from the prospectively collected spine register from 2010 to 2022. Operative technique, perioperative laboratory results and imaging studies were extracted. The primary outcome was total blood loss including intraoperative, drain output and hidden blood loss. Fifty-seven children (32 boys) with a mean age of 8.3 years underwent spinal osteotomy for congenital scoliosis. Posterolateral hemivertebrectomy was sufficient in 34 (59%) patients, while vertebral column resection (VCR) was required in 23 patients. Total bleeding averaged 792 (523) ml accounting for 42% of the estimated blood volume. Hidden blood loss accounted for 40% of total bleeding and 21% of estimated blood volume with a mean of 317 (256) ml. VCR was associated with greater intraoperative and total bleeding than hemivertebrectomies (p = 0.001 and 0.007, respectively). After adjusting for patient weight and fusion levels, hidden blood loss was larger in hemivertebrectomies (4.18 vs. 1.77 ml/kg/fused level, p = 0.049). In multivariable analysis, intraoperative blood loss was inversely correlated with preoperative erythrocyte levels. Younger age was associated with significantly greater drain, hidden and total blood loss. Hidden blood loss constitutes a significant portion (40%) of total bleeding in congenital scoliosis surgery. Younger age is a risk factor for bleeding and the hidden blood loss should be taken into consideration in their perioperative management.

European Society of Pediatric Radiology survey of perioperative imaging in pediatric liver transplantation: (2) intraoperative imaging

BackgroundLiver transplantation is the state-of-the-art curative treatment for end-stage liver disease. Imaging is a key element in the detection of intraoperative and postoperative complications. So far, only limited data regarding the best radiological approach to monitor children during liver transplantation is available.ObjectiveTo harmonize the imaging of pediatric liver transplantation, the European Society of Pediatric Radiology Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra- and postoperative phase. This paper reports the responses related to intraoperative imaging.Materials and methodsAn online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted, and 22 institutions from 11 countries returned the survey.ResultsIntraoperative ultrasound (US) is used by all sites to assess the quality of the vascular anastomosis in order to ensure optimal perfusion of the liver transplant. Vessel depiction is commonly achieved using color Doppler (95.3%). Additional US-based techniques are employed by fewer centers (power angio mode, 28.6%; B-flow, 19%; contrast-enhanced US, 14.3%). Most centers prefer a collaborative approach, with surgeons responsible for probe handling, while radiologists operate the US machine (47.6%). Less commonly, the intraoperative US is performed by the surgeon alone (28.6%) or by the radiologist alone (23.8%). Timing of US, imaging frequency, and documentation practices vary among centers.ConclusionIntraoperative US is consistently utilized across all sites during pediatric liver transplantation. However, considerable variations were observed in terms of the US setup, technique preferences, timing of controls, and documentation practices. These differences provide valuable insights for future optimization and harmonization studies.

3D-printed guides versus computer navigation for pedicle screw placement in the surgical treatment of congenital scoliosis deformities.

To compare the safety and clinical outcomes of 3D-printed guides versus computer navigation for pedicle screw placement in the correction of congenital scoliosis deformities. The study was a single-centre retrospective controlled study and was approved by the hospital ethics committee for the analysis all patients under the age of 18years with at least 2years of follow-up. Sixty-three patients who underwent surgical correction for congenital scoliosis deformities in our hospital from January 2015 to December 2020 were divided into two groups based on the decision following preoperative doctor‒patient communication. Among them, 43 patients had pedicle screws placed with 3D-printed guider plates, while the remaining 20 patients had screws inserted with the assistance of computer navigation. The perioperative period, follow-up results and imaging data were compared between the groups. The operation was completed successfully for patients in both groups. The 3D-printed guide-assisted screw placement technique proved to be significantly superior to the computer navigation technique in terms of operation time, screw placement time, and intraoperative blood loss (p < .05), although the former had more frequent intraoperative fluoroscopies than the latter (p < .05). The mean follow-up time was 41.4months, and the SRS-22 scores significantly improved in both groups over time postoperatively (p < .05). The 3D-printing group had better SRS-22 scores than the navigation group 6months after surgery and at the last follow-up (p < .05). Compared with preoperative values, the coronal Cobb angle, local kyphotic Cobb angle, C7-S1 coronal deviation (C7PL-CSVL), and sagittal deviation (SVA) were significantly improved in both groups after surgery (p < .05). Both techniques achieve the purpose of precise screw placement and proper correction of the deformities. In contrast, the 3D-printed guide-assisted screw placement technique showed advantages in terms of operation time, screw placement time, intraoperative blood loss and patient satisfaction with outcomes.

Current Trends in Total Ankle Replacement.

Ankle arthritis can result in significant pain and restriction in range of motion. Total ankle replacement (TAR) is a motion-preserving surgical option used as an alternative to total ankle arthrodesis to treat end-stage ankle arthritis. There are several generations of TAR techniques based on component design, implant material, and surgical technique. With more recent TAR implants, an attempt is made to minimize bone resection and mirror the native anatomy. There are more than 20 implant devices currently available. Implant survivorship varies among prosthesis types and generations, with improved outcomes reported with use of the more recent third- and fourth-generation ankle implants. Pre- and postoperative assessments of TAR are primarily performed by using weight-bearing radiography, with weight-bearing CT emerging as an additional imaging tool. Preoperative assessments include those of the tibiotalar angle, offset, and adjacent areas of arthritis requiring additional surgical procedures. US, nuclear medicine studies, and MRI can be used to troubleshoot complications. Effective radiologic assessment requires an understanding of the component design and corresponding normal perioperative imaging features of ankle implants, as well as recognition of common and device-specific complications. General complications seen at radiography include aseptic loosening, osteolysis, hardware subsidence, periprosthetic fracture, infection, gutter impingement, heterotopic ossification, and syndesmotic nonunion. The authors review several recent generations of TAR implants commonly used in the United States, normal pre- and postoperative imaging assessment, and imaging complications of TAR. Indications for advanced imaging of TAR are also reviewed. ©RSNA, 2023 Supplemental material is available for this article. Test Your Knowledge questions for this article are available through the Online Learning Center.

Imaging in Third Molar Surgery: A Clinical Update.

Third molar surgery is one of the most common surgical procedures performed in oral and maxillofacial surgery. Considering the patient's young age and the often-elective nature of the procedure, a comprehensive preoperative evaluation of the surgical site, relying heavily on preoperative imaging, is key to providing accurate diagnostic work-up, evidence-based clinical decision making, and, when appropriate, indication-specific surgical planning. Given the rapid developments of dental imaging in the field, the aim of this article is to provide a comprehensive, up-to-date clinical overview of various imaging techniques related to perioperative imaging in third molar surgery, ranging from panoramic radiography to emerging technologies, such as photon-counting computed tomography and magnetic resonance imaging. Each modality's advantages, limitations, and recent improvements are evaluated, highlighting their role in treatment planning, complication prevention, and postoperative follow-ups. The integration of recent technological advances, including artificial intelligence and machine learning in biomedical imaging, coupled with a thorough preoperative clinical evaluation, marks another step towards personalized dentistry in high-risk third molar surgery. This approach enables minimally invasive surgical approaches while reducing inefficiencies and risks by incorporating additional imaging modality- and patient-specific parameters, potentially facilitating and improving patient management.

European Society of Pediatric Radiology survey of perioperative imaging in pediatric liver transplantation: (1) pre-transplant evaluation

BackgroundLiver transplantation is the state-of-the-art curative treatment in end-stage liver disease. Imaging is a key element for successful organ-transplantation to assist surgical planning. So far, only limited data regarding the best radiological approach to prepare children for liver transplantation is available.ObjectivesIn an attempt to harmonize imaging surrounding pediatric liver transplantation, the European Society of Pediatric Radiology (ESPR) Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra-, and postoperative phase. This paper reports the responses on preoperative imaging.Material and methodsAn online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted and 22 institutions from 11 countries returned the survey. From 2018 to 2020, the participating centers collectively conducted 1,524 transplantations, with a median of 20 transplantations per center per annum (range, 8–60).ResultsMost sites (64%) consider ultrasound their preferred modality to define anatomy and to plan surgery in children before liver transplantation, and additional cross-sectional imaging is only used to answer specific questions (computed tomography [CT], 90.9%; magnetic resonance imaging [MRI], 54.5%). One-third of centers (31.8%) rely primarily on CT for pre-transplant evaluation. Imaging protocols differed substantially regarding applied CT scan ranges, number of contrast phases (range 1–4 phases), and applied MRI techniques.ConclusionDiagnostic imaging is generally used in the work-up of children before liver transplantation. Substantial differences were noted regarding choice of modalities and protocols. We have identified starting points for future optimization and harmonization of the imaging approach to multicenter studies.