Plain Computed Tomography Scan Research Articles

Clinical outcome and complications after simultaneous bilateral medial opening-wedge high tibial osteotomy

BackgroundThe literature provides limited evidence regarding postoperative outcomes and complications following simultaneous bilateral medial opening-wedge high tibial osteotomy (MOWHTO). This study aimed to investigate the clinical outcomes and complications associated with simultaneous bilateral MOWHTO. MethodsWe retrospectively evaluated 72 knees from 36 patients (mean age, 58.6 ± 8.2 years) who underwent simultaneous bilateral MOWHTOs between December 2011 and January 2021. Locking compression plates were used for simultaneous bilateral MOWHTOs. The Oxford Knee Score (OKS) was used to assess clinical outcomes at the last follow up. Complications (lateral hinge fracture (LHF), nonunion, and loss of correction) were evaluated using postoperative serial plain radiography and computed tomography (CT). ResultsAt the last follow up (range, 2.0–11.1 years), the mean OKS for the 72 knees was 36.8 ± 10.4. According to the OKS, 42 knees (58.3%) scored ’excellent’, 16 (22.2%) scored ‘good’, eight (11.1%) scored ‘moderate’, and six (8.3%) scored ‘poor’. LHFs occurred in 11 of the 72 knees (15.3%). Among these, five LHFs were identified on postoperative plain radiographs and CT scans (acute LHFs), whereas six fractures were identified only on follow up plain radiographs (delayed LHFs). Loss of correction occurred in one patient with delayed LHFs. The patient required an additional surgical treatment to achieve bone healing at the osteotomy site. ConclusionSimultaneous bilateral MOWHTO is a viable treatment option for patients with bilateral medial osteoarthritis of the knee joint. Serial plain radiographs at short-term intervals are recommended to detect delayed LHFs and prevent complications such as fixation failure and loss of correction.

Radiographic and tomographic findings of excretory urography of avian kidneys after induced nephropathy in broiler chicken as a model.

Although kidney diseases have a high prevalence, initial recognition and diagnosis of renal disease are complicated in avian medicine. The aim of this study is to assess the intraosseous excretory urography (IOEU) in order to introduce a new method for evaluation of kidney's function in broilers as a primary model of birds. A total of 10 male broiler chickens at the age of 20 days were included and evaluated with plain and serial post-contrast radiography and computed tomography (CT) scan to check the time and concentration of the contrast media (CM) passage from the kidney. In the next step, after the nephropathy induction with gentamicin, plain and serial post-contrast radiography and CT scan were repeated. After the necropsy, kidney samples were sent for histopathology evaluation, and statistical analysis of data obtained from image analysis was conducted. After nephropathy induction, all of the chickens exhibited increase in kidney size and in histopathological evaluation, all the samples (30 of 30) showed severe tubular necrosis and mild glomerulopathy. In the IOEU, the average time to create the maximum concentration of CM, the average time to decrease the CM concentration from the kidney and the time of the complete clearance of CM indicated a significant incensement after nephropathy compared to the time before it. Intraosseous excretory urography (IOEU) is a safe contrast imaging modality and can be useful in the assessment of the urinary system in chickens to check the changes in kidney size and function.

Intratumoral calcification on CT assists in distinguishing benign and malignant upper abdomen neoplasm.

The significance of calcification and microcalcification in diagnosing malignant tumors is well established, but their role in the upper abdomen is less explored in routine radiology. To assess the effectiveness of computed tomography (CT) imaging in detecting intratumoral calcification within upper abdominal tumors. This study retrospectively enrolled patients with upper abdominal tumors featuring intratumoral calcifications who underwent plain and contrast-enhanced CT scans between January 2016 and December 2019. We examined the imaging characteristics of calcifications, including location, edges, shape, CT values, and association with necrosis. The diagnostic utility of calcification for distinguishing benign and malignant tumors was assessed using receiver operating characteristic curves. Univariate and multivariate logistic regression analyses were conducted to identify independent predictive factors for the diagnosis of malignancy characterized by intratumoral calcification. This study included 153 patients (median age 49 ± 21years; 83 men) with pathologically confirmed tumors of the upper abdomen (including liver, pancreas, and gastrointestinal tract) with intratumoral calcifications. Significant differences in CT values between benign and malignant tumors were observed (P < .001), with high diagnostic accuracy of calcification in CT imaging (receiver operating characteristic area = 0.884, sensitivity = 0.815, specificity = 0.976). The characteristics of calcification, including its edge and shape, were significantly correlated with tumor differentiation (P < .01). Multivariate logistic regression analysis revealed that the presence of adjacent necrosis around intracalcification is an independent predictor of malignancy (odds ratio = 5.48; 95% confidence interval: 1.55, 19.41; P = .008). Intratumoral calcification in CT imaging is a key marker for distinguishing between benign and malignant epigastric tumors, offering high specificity. Key message • What is already known on this topic - Intratumoral calcification, as a highly sensitive radiological marker, has shown potential in differentiating between benign and malignant tumors in thyroid and breast cancers. However, its discriminatory role in upper abdominal tumors is often overlooked. Therefore, assessing the diagnostic accuracy of intratumoral calcification on CT scans is crucial for improving diagnostic efficiency and avoiding unnecessary examinations. • What this study adds - Intratumoral calcification on CT exhibits high specificity in differentiating between benign and malignant upper abdominal tumors, providing a simple and reliable criterion for improving diagnostic accuracy. • How this study might affect research, practice or policy - This study highlights the significance of intratumoral calcification characteristics observed on CT in determining whether upper abdominal tumors are benign or malignant. The findings could pave the way for the development of a CT-based calcification scoring system, which would facilitate rapid and accurate diagnostics in clinical practice, thereby optimizing treatment strategies and enhancing patient prognosis.

Evaluation of treatment planning discrepancies: CT versus plain radiographic findings in patients with foot and ankle trauma

This study aimed to compare the findings of plain radiography and computed tomography (CT) of foot and ankle in patients submitted to the emergency department with high-energy foot and ankle trauma, to demonstrate if missing fractures on plain radiographs will significantly alter the treatment plan considered for each patient based on the findings of each imaging modality. We retrospectively observed standard radiological foot and ankle x-rays and CT scans in patients who presented to our center from April 2019 to June 2020 with a history of foot and ankle trauma with either loss of consciousness, a history of high-energy trauma, or clinical presentation disproportionate to plain radiographic findings. We investigated the number of fractures of each bone detected on plain radiographs and CT scans and the treatments based on each modality’s findings in patients admitted to our center. Sixty-five out of 163 (39.87%) included in our study had at least one missed fracture on plain radiography that was detected on CT. Thirty-one (19%) patients had normal radiography despite actually having fractures. In 38 (23.31%) patients CT changed the treatment plan decided by our surgeons (P < 0.001). The two imaging modalities had a moderate agreement for detecting foot and ankle fractures overall (κ = 0.432). The failure to detect fractures in patients with high-energy trauma can significantly impact treatment effectiveness. Integrating CT scans into the diagnostic process can lead to changes in treatment planning and ultimately improve patient outcomes.Level of clinical evidenceIV.

A predictive model for ischemic colitis: Integrating clinical and laboratory parameters

AbstractObjectiveWe aimed to develop a predictive model for the clinical diagnosis of ischemic colitis (IC).MethodsClinical data were collected from patients with acute IC lesions who were diagnosed and admitted to Beijing Tsinghua Changgung Hospital from January 2016 to December 2022. These patients were included in the IC case group in this retrospective observational study. The control group comprised patients aged ≥40 years who were diagnosed with abdominal pain during the same period, excluding those with IC. All patients were divided into a training and test sets based on the time window. Least absolute shrinkage and selection operator regression was used to screen risk factors for the occurrence of IC. Logistic stepwise regression (maximum likelihood ratio method) was performed in multifactorial analysis, and a diagnostic prediction model for IC was established using R language. The area under the receiver operating characteristic (ROC) curve (AUC) was examined to assess differentiation using working ROC curves. We used bootstrap resampling (1000 times) for internal validation. Model calibration curves and decision curve analysis (DCA) were also applied.ResultsOur study indicates that constipation, hematochezia, neutrophil counts, and specific abdominal computed tomography (CT) (plain scan) findings, including intestinal wall edema and thickening, intestinal lumen stenosis, and dilation, are independent predictors of IC. The predictive model exhibited high discriminative ability with an AUC of 0.9788 in the training set, and the calibration and DCA curves demonstrated excellent model performance. After validation, the AUC remained robust at 0.9868, underscoring the model's reliability in predicting IC.ConclusionAccording to our model, constipation accompanied by hematochezia necessitates careful consideration of IC. Abdominal CT (plain scan) is an effective diagnostic tool for IC, and it is common for patients to exhibit elevated neutrophil counts. The predictive model, demonstrating high discriminative ability and accuracy, shows promise for practical application in clinical settings, aiding in the early diagnosis and management of IC.

Diagnostic Ability of Manual Calcification Length Assessment on Non-Electrocardiographically Gated Computed Tomography for Estimating the Presence of Coronary Artery Disease.

Background: Coronary artery calcification score (CACS) on electrocardiography (ECG)-gated computed tomography (CT) is used for risk stratification of atherosclerotic cardiovascular disease, which requires dedicated analytic software. In this study, we evaluated the diagnostic ability of manual calcification length assessment on non-ECG-gated CT for epicardial coronary artery disease (CAD). Methods: A total of 100 patients undergoing both non-ECG-gated plain CT scans with a slice interval of 1.25 mm and invasive coronary angiography were retrospectively included. We manually measured the length of the longest calcified lesions of coronary arteries on each branch. The relationship between the number of coronary arteries with the length of coronary calcium > 5, 10, or 15 mm and the presence of epicardial CAD on invasive angiography was evaluated. Standard CACS was also evaluated using established software. Results: Of 100 patients, 49 (49.0%) had significant epicardial CAD on angiography. The median standard CACS was 346 [7, 1965]. In both manual calcium assessment and standard CACS, the increase in calcium burden was progressively associated with the presence of epicardial CAD on angiography. The receiver operating characteristic curve analysis showed similar diagnostic abilities of the two diagnostic methods. The best cut-off values for CAD were 2, 1, and 1 for the number of vessels with calcium > 5, 10, and 15 mm, respectively. Overall, the diagnostic ability of manual calcium assessment was similar to that of standard CACS > 400. Conclusions: Manual assessment of coronary calcium length on non-ECG-gated plain CT provided similar diagnostic ability for the presence of significant epicardial CAD on invasive angiography, as compared to standard CACS.

Myocardial extracellular volume derived from contrast-enhanced chest computed tomography in longitudinal evaluation of cardiac toxicity in patients treated with immune checkpoint inhibitors.

The immune-related adverse effects after immune checkpoint inhibitors (ICIs) treatment have always been a hot topic. Although the incidence of myocarditis is not high among the related adverse effects, the mortality rate is extremely high once it occurs. In the past, the risk of cancer therapy-related cardiac dysfunction (CTRCD) after drug treatment was evaluated based on imaging examinations, but this evaluation still had certain limitations. Currently, the extracellular volume (ECV) score measurement calculated using cardiac magnetic resonance T1 mapping has become a reliable method for evaluating myocardial toxicity and computed tomography (CT) examination may become an alternative. This study aimed to longitudinally evaluate the cardiac toxicity of patients treated with ICIs using myocardial ECV derived from contrast-enhanced chest CT. A total of 500 patients with III-IV lung cancer and esophageal cancer treated with ICIs were evaluated. Participants underwent baseline examination and at least 1 follow-up examination after treatment. Contrast-enhanced chest CT-ECV, left ventricular ejection fraction (LVEF), and measurement of cardiac troponin T (cTnT) were conducted before the first treatment, 3-6 months after the first treatment, and about 12 months after the first treatment, respectively. The ECV value of the middle part of the left ventricular septum was evaluated on CT venography and plain scan, the LVEF value was evaluated by color Doppler ultrasound, and the quantity of cTnT was detected by chemiluminescence. Cancer therapy-related cardiac dysfunction was recorded. The mean baseline LVEF value was 68.51%±4.81% (N0=500), and those of LVEF1, LVEF2, and LVEF3 were 68.77%±4.30%, 68.16%±3.59%, and 66.23%±4.20%, respectively (N1=500, N2=467, and N3=361, respectively). There was no significant difference between LVEF1, LVEF2, and LVEF0 (P1=0.095, P2=0.062), whereas LVEF3 was significantly lower than LVEF0 (P<0.001). The average baseline cTnT0 value was 7.42±3.95 (N0=500). The values of cTnT1, cTnT2, and cTnT3 were 10.05±11.40, 12.24±13.59, and 14.54±14.49, respectively (N1=500, N2=467, N3=361). The values of cTnT1, cTnT2, and cTnT3 were significantly higher than cTnT0 (P1<0.001, P2<0.001, P3<0.001). The average ECV0 was 47.14%±7.48% (N0=500). ECV1, ECV2, and ECV3 were 50.85%±6.79%, 53.44%±6.96% and 52.64%±7.58% respectively (N1=500, N2=467 and N3=361). ECV1, ECV2, and ECV3 were significantly higher than ECV0 (P1<0.001, P2<0.001, P3<0.001). CTRCD occurred in 49 patients. There were significant differences between the CTRCD (+) group and the CTRCD (-) group in cTnT1, cTnT2, and cTnT3 (P1<0.001, P2<0.001, and P3<0.001, respectively) and in ECV1, ECV2, and ECV3 (P1=0.039, P2=0.041, and P3=0.013, respectively). CT-ECV began to increase at the early stage after the treatment of ICIs. CT-ECV is a potential biomarker for dynamically monitoring the cardiac toxicity of tumor patients after receiving ICIs. ECV may be used to speculate the CTRCD caused by the treatment of ICIs.

A Retrospective Analysis of the Computed Tomography Findings and Diagnosis of 53 Cases of Elastofibroma in the Infrascapular Region.

In this work, we have used histopathology as the gold standard for the diagnosis, calculated the sensitivity and positive predictive value (PPV) of computed tomography (CT), and analyzed the CT and clinical characteristics of pathologically proven elastofibromas. A systematic retrospective analysis was performed on all patients with infrascapular lesions who were treated in the hospital from 2006 to 2018. CT and histopathological examinations were performed for all cases, and the CT sensitivity and PPV for the diagnosis of elastofibroma were calculated. 12 of 53 cases (20 lesions) underwent enhanced CT scan after CT plain scan, and the related clinical and CT features of elastofibromas have been discussed. Of the 54 patients treated during the study, CT diagnosis was consistent with histopathology in 53 cases. One was a false-positive patient. The PPV and sensitivity of the CT in the diagnosis of elastofibroma were 93.3% (95% CI 68.0%-99.8%) and 100%, respectively. The CT values of 12 patients with 20 lesions on plain and enhanced scans were statistically significant (P=0.001). The prevalence of elastofibromas in males and females was statistically significant (P=.000). There was no statistically significant difference in the incidence of left and right elastofibromas (P=0.752). There was no significant difference in the volume of left and right lesions (P=0.209) and the volume of elastofibromas between males and females (P=.474). CT is the most practical tool for the evaluation of elastofibromas in the infrascapular region.

Computed tomography-guided frame-based stereotactic brain biopsy of non-enhancing lesions using indirect evidence of target selection, technical consideration, and early clinical experience.

The objective was to study the effectiveness and diagnostic outcome of frame-based stereotactic brain biopsy (STB) done for contrast non-enhancing lesions using indirect evidence of target selection observed in a plain computed tomography (CT) scan of the head. Data of patients with contrast non-enhancing brain lesions who underwent STB are collected retrospectively from NIMHANS Bangalore, hospital neurosurgery database from January 2021 to March 2023. Those cases subjected to plain CT scans after fixing the stereotactic frame to the head were included in the study. A final histopathological report analysis of these cases was done to assess the diagnostic accuracy. A total of 27 such cases were biopsied. The mean age of subjects was 44.04 ± 17.812 years. Most subjects were in the age group 31-40 years (29.6%). About 55.6% were male and 44.4% were female. The most common site of biopsy was the frontal lobe. The most common indirect evidence on CT was perilesional edema at 33.3% and periventricular location at 33.3%, followed by intralesional calcification at 11.1%. Our diagnostic accuracy was 92.59%. The asymptomatic hemorrhage rate was 2%, and an increase in perilesional edema was seen in 2% of cases. Indirect targeting is a safe and intuitive method for biopsy of contrast non-enhancing lesions. Due consideration is to be given to various findings visible in non-contrast CT scans of the head as indirect evidence of target selection while performing frame-based STB of contrast non-enhancing lesions. This method will also be helpful in resource-limited centers, especially in low-income countries.

Diagnostic value of a CT-based radiomics nomogram for discrimination of benign and early stage malignant ovarian tumors

BackgroundThis study aimed to identify the diagnostic value of models constructed using computed tomography-based radiomics features for discrimination of benign and early stage malignant ovarian tumors.MethodsThe imaging and clinicopathological data of 197 cases of benign and early stage malignant ovarian tumors (FIGO stage I/II), were retrospectively analyzed. The patients were randomly assigned into training data set and validation data set. Radiomics features were extracted from images of plain computed tomography scan and contrast-enhanced computed tomography scan, were then screened in the training data set, and a radiomics model was constructed. Multivariate logistic regression analysis was used to construct a radiomic nomogram, containing the traditional diagnostic model and the radiomics model. Moreover, the decision curve analysis was used to assess the clinical application value of the radiomics nomogram.ResultsSix textural features with the greatest diagnostic efficiency were finally screened. The value of the area under the receiver operating characteristic curve showed that the radiomics nomogram was superior to the traditional diagnostic model and the radiomics model (P < 0.05) in the training data set. In the validation data set, the radiomics nomogram was superior to the traditional diagnostic model (P < 0.05), but there was no statistically significant difference compared to the radiomics model (P > 0.05). The calibration curve and the Hosmer–Lemeshow test revealed that the three models all had a great degree of fit (All P > 0.05). The results of decision curve analysis indicated that utilization of the radiomics nomogram to distinguish benign and early stage malignant ovarian tumors had a greater clinical application value when the risk threshold was 0.4–1.0.ConclusionsThe computed tomography-based radiomics nomogram could be a non-invasive and reliable imaging method to discriminate benign and early stage malignant ovarian tumors.

Glioblastoma multiforme: Case report of an unusual presentation

Abstract Glial tumors account for about 60% of all primary brain tumors. About one-third of patients suffer deficits in one or more cognitive domains, of which language difficulties may be mistaken for confusion. A 60-year-old male who was brought to the medical outpatient department (OPD) on November 14, 2022, with complaints of mental confusion, talking irrelevantly, and increased sleep for 20 days. As the patient had irrelevant talk, he was referred to psychiatry OPD. The psychiatric evaluation revealed word-finding difficulty, memory impairment, and confabulation. His physical examination was normal, but the Montreal Cognitive Assessment Scale score was 8. A provisional diagnosis of organic amnesic syndrome, not induced by alcohol and other psychoactive substances (F04), was made. Plain computed tomography scan brain revealed a large cystic and solid lesion in the left capsuloganglionic region extending to left thalamic and temporal regions with severe perilesional vasogenic edema suggestive of glioblastoma multiforme with midline shift of 5.6 mm. The case was immediately referred to the neurosurgery department for further management. He was treated there with dexamethasone to reduce edema and was referred to a cancer center for chemotherapy and radiotherapy. The patient was put on chemotherapy and passed away on January 21, 2023, before that could happen. Any case with recent onset of neuropsychiatric symptoms needs thorough cognitive assessment and a high index of suspicion to rule out organic causes. Informed consent to submit the case report for publication was obtained from the son of the patient.

Novel radiological technique to recognize acute liver failure caused by yellow phosphorous containing rodenticides.

Yellow phosphorous rodenticide (YPR) poisoning is the commonest cause for acute liver failure (ALF) in southern and western India. Due to medicolegal issues, history of YPR ingestion may not be available. As early recognition of YPR poisoning is important and there are no specific biochemical assays, other early predictors to identify this entity is necessary. We evaluated the diagnostic role of plain computed tomography (CT) in identifying YPR-induced ALF. All patients admitted to the liver unit with a diagnosis of ALF underwent a plain CT scan abdomen. Demographic details, clinical history, laboratory parameters, liver attenuation index (LAI) calculated on CT scan, treatment details, need for liver transplantation and clinical outcome were analyzed. Parameters for YPR-induced ALF (ALF-YPR) and other causes (ALF-OTH) were compared. Ability of LAI to distinguish ALF-YPR and ALF-OTH was analyzed using receiver operating characteristic (ROC) curve analysis. Twenty-four patients (15 female [62.5%]) were included in the study. Thirteen patients (54%) had YPR poisoning, while the rest formed the ALF-OTH group (11,46%). ALF-YPR patients had higher transaminase levels, lower peak serum bilirubin levels. ALF-YPR livers had significantly lower LAI as compared to ALF-OTH (- 30 vs. - 8, p = 0.001). On ROC curve analysis, an LAI greater than - 18 ruled out YPR as the cause for ALF with 91% sensitivity and 85% specificity. On regression analysis, LAI was the only independent factor predicting ALF-YPR (odds ratio - 0.86, [0.76, 0.96] p = 0.008). Our data shows that LAI on plain abdominal CT scan can be used to quickly recognize ALF-YPR in unclear cases so that necessary treatment protocol can be activated, or patient transfer arranged. Our analysis shows that an LAI greater than - 18 can reliably rule out YPR ingestion as the cause for ALF.

A Study of Fixed Current and Automatic Tube Current Modulation at a Fixed Low Tube Voltage in Low-dose Computed Tomography (CT) Imaging of Infant Lungs

Background: With the development of computed tomography (CT) technology, the number of infants undergoing CT examination has increased. Recently, problems associated with radiation exposure have attracted the public attention, and low-dose CT examination has become the research focus. Objectives: This study aimed to explore the feasibility of a fixed ultralow tube current combined with iDose4 iterative reconstruction at a low tube voltage (80 kV) in low-dose CT scanning of infant lungs. Patients and Methods: Ninety infants, aged 0 - 3 years, undergoing enhanced chest CT scan (including plain CT scan and arterial scan), were included in the experimental group. In the experimental group, plain CT scan was performed at 80 kV under a fixed tube current (30 mA), and arterial phase CT scan was carried out at 80 kV with automatic tube current modulation (30 - 150 mA). Meanwhile, 90 infants, aged 0 - 3 years, undergoing non-enhanced chest CT scan, were randomly recruited as the control group. For the control group, plain CT scan was performed at 80 kV with automatic tube current modulation (30-150 mA). In each examination, the iDose4 iterative reconstruction technique was used for reconstruction. The volume CT dose index (CTDIvol), dose-length product (DLP), effective dose (ED, measured using a 32-cm diameter phantom), signal-to-noise ratio (SNR), and overall subjective quality of plain CT scans were analyzed and compared between the experimental and control groups. Results: Regarding the radiation dose in different age groups, the ED (mSv) was significantly lower in the experimental group compared to the control group (0-1-year-old subgroup: 0.48 ± 0.05 mSv in the experimental group vs. 0.91 ± 0.19 mSv in the control group, P &lt; 0.05; 1-2-year-old subgroup: 0.50 ± 0.01 mSv in the experimental group vs. 0.75 ± 0.10 mSv in the control group, P &lt; 0.05; and 2-3-year-old subgroup: 0.46 ± 0.05 mSv in the experimental group vs. 0.79 ± 0.11 mSv in the control group, P &lt; 0.05). The image SNR was higher in the control group compared to the experimental group (P &lt; 0.05), while the difference in subjective image quality was not significant between the experimental and control groups (P &lt; 0.05). Conclusion: The chest CT examination of infants, aged 0 - 3 years, at a low tube voltage (80 kV) and a fixed tube current (30 mA), combined with the iDose4 iterative reconstruction technique, and the obtained images met the diagnostic criteria...

Diagnosis of Fungal Sinusitis; Is Fungal Culture a Must?

Objective: To determine the diagnostic accuracy of computed tomography (CT) of paranasal sinuses (PNS) in detecting fungal sinusitis keeping fungal culture as the gold standard.&#x0D; Study Design: Cross-sectional validation study.&#x0D; Place and Duration of Study: Department of Radiology, Combined Military Hospital, Rawalpindi Pakistan, from Jun 2018 to Jun 2019.&#x0D; Methodology: A total of 323 patients of either gender were included in the study (aged from 10-70 years). All the patients underwent plain CT scans of paranasal sinuses, and the CT scan findings were reported and recorded on pre-designed proforma. Results were then compared with the culture report of each patient respectively.&#x0D; Results: Among all the patients undergoing CT scans, paranasal sinuses 177 were True Positives, while 07 were False Positives. Out of a total of 139 CT scan-negative patients, 6 (False Negative) had fungal sinusitis on culture, whereas 133 (True Negative) had no fungal sinusitis on culture (p=0.001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CT scan Paranasal sinuses were 96.72%, 95.0%, 96.20%, 95.68% and 95.98%,respectively.&#x0D; Conclusion: CT scan of paranasal sinuses is a highly sensitive and accurate non-invasive investigation in detecting fungal sinusitis.

Diagnostic value of CT enhancement degree in lymph node metastasis of papillary thyroid cancer: A comparison of enhancement, ratio, and difference.

To evaluate the value of computed tomography (CT) enhancement degree in diagnosing lymph node (LN) metastasis in papillary thyroid carcinoma (PTC) by determining the ratio and difference between the Hounsfield units (HU) of CT enhancement and plain scan of the LNs, as well as between the HU of CT-enhanced LNs and the sternocleidomastoid muscle. The plain and enhanced CT findings of 114 metastasis-positive LNs in 89 cases and 143 metastasis-negative LNs in 114 cases of PTC were analyzed retrospectively. Plain HU of LNs (PNHU), enhanced HU of LNs (ENHU), and enhanced HU of the sternocleidomastoid muscle (EMHU) were measured. The ENHU, difference between ENHU and PNHU (EN-PNHU), ratio of ENHU to PNHU (EN/PNHU), difference between ENHU and EMHU (EN-EMHU), and ratio of ENHU to EMHU (EN/EMHU) in metastasis-positive and metastasis-negative LN groups were calculated, the corresponding diagnostic efficacy for differentiating metastasis-positive from metastasis-negative LNs in PTC were sought using the receiver-operating curve. The interobserver agreement between readers was assessed using the interobserver correlation coefficient (ICC). The ENHU of 114 metastasis-positive LNs and 143 metastasis-negative LNs was 113.39 ± 24.13 and 77.65 ± 15.93, EN-PNHU was 65.84 ± 21.72 HU and 34.07 ± 13.63 HU, EN/PNHU was 2.36 (1.98, 2.75) and 1.76 (1.54, 2.02), EN-EMHU was 49.42 ± 24.59 HU and 13.27 ± 15.41 HU, and EN/EMHU was 1.79 ± 0.40 and 1.21 ± 0.24, respectively (all P < 0.001). The area under the curve, cutoff value, sensitivity, specificity, and accuracy of ENHU for identifying metastasis-positive and metastasis-negative LNs were 0.895, 97.3 HU, 0.746, 0.895, and 0.829, EN-PNHU was 0.894, 47.8 HU, 0.807, 0.874, and 0.844, EN/PNHU was 0.831, 1.9, 0.877, 0.650, and 0.751, EN-EMHU was 0.890, 26.4 HU, 0.807, 0.839, and 0.825, and EN/EMHU was 0.888, 1.5, 0.728, 0.902, and 0.825, respectively. The readers had an excellent interobserver agreement on these five parameters (ICC = 0.874-0.994). In the preoperative evaluation of LN metastasis in PTC, ENHU, EN-PNHU, EN-EMHU, and EN/EMHU had similarly high diagnostic efficacy, with ENHU, EN-PNHU, and EN/EMHU having higher specificity and EN-PNHU and EN-EMHU having higher sensitivity.

Posterior Protrusion Measures (PPM) as an Innovative Index in Classifying Plain Lateral Radiograph Images of Pertrochanteric Fracture Using the Revised AO Foundation/Orthopaedic Trauma Association (AO/OTA) Classification.

Introduction The absence of a precise fracture classification system that classifies pertrochanteric fractures into either stable or unstable contributes to a burden on healthcare and has several major implications. We propose an innovative graphical index, which we refer to as posterior protrusion measures (PPM), using plain lateral view radiograph images for the revised AO Foundation (Arbeitsgemeinschaft für Osteosynthesesfragen)/Orthopedic Trauma Association (AO/OTA) classification system. This study aims to: (i) introduce the use of PPM for classifying fractures into stable or unstable under the revised AO/OTA classification system and set the threshold numeric value, (ii) elucidate the reproducibility of inter and intra-observer agreement, and investigate the consistency of fracture classification using PPM versus computed tomography (CT) scan images. Materials and methods Out of 146 patients identified from the database, a total of 126 patients were enrolled in the study. Pertrochanteric fractures were classified as either stable or unstable. Three surgeons were assigned for PPM determination. Regarding the demographical data, the chi-square test was used to assess the significance of each parameter on a categorical scale between the two groups. The independent sample t-test or the Mann-Whitney U test was used to compare the two independent groups. Interclass correlation coefficient (ICC) values for continuous variables and kappa values (κ) for categorical variables were calculated to assess inter-observer and intra-observer agreement. Receiver-operating characteristic (ROC) analysis was used to determine optimal cut-off points of PPM to predict consistency between separate fracture classification groups, one using PPM values with a threshold derived from plain radiograph images, and the other using CT scan images. Results Among a total of 126 pertrochanteric fractures, the A1 (stable) group consisted of 39 patients (10 males, 29 females), whereas the A2 (unstable) group consisted of 87 patients (14 males, 73 females) (not significant, NS). Intraclass correlation coefficient (ICC) values of PPM for the inter-observer agreement were 0.796 (0.723-0.852), 0.664 (0.554-0.751), and 0.702 (0.601-0.781) at first examination and 0.729 (0.635-0.801) at the second. The intra-observer agreement was 0.869 (0.819-0.906) and 0.603 (0.480-0.703). We examined for consistency of fracture classification group of PPM values with a threshold of 0.4 (A1<0.4, A2=0.4 or more) and CT-based group. For the first examination, there was mostly "moderate" agreement in fracture classification (stable or unstable) between plain radiograph and CT scan images, κ (95%CI): 0.427 (0.266-0.588), 0.493 (0.335-0.651), and 0.359 (0.176-0.544), and for the second,0.418 (0.251-0.585), and 0.451 (0.284-0.620), respectively. Conclusion We propose a supplementary tool, namely PPM that allows for possible alternative classification of pertrochanteric fractures into A1 (stable) and A2 (unstable) using plain radiograph images under the revised AO/OTA classification system. In this study, a PPM threshold value of 0.4 demonstrated a moderate inter- and intra-observer agreement. It is noteworthy to mention that there was a satisfactory consistency of fracture classification using PPM derived from plain radiograph images when compared to classification using CT scan images. In addition, the PPM method provides a numerical score.

Predictive Factors for Lateral Hinge Fracture in Medial Closing Wedge Distal Femoral Osteotomy

Background: Recent studies have reported that lateral hinge fracture (LHF) has a negative effect on bone healing at the osteotomy site after medial closing wedge distal femoral osteotomy (MCDFO). However, limited evidence exists in the literature regarding the predictive factors for LHF in MCDFO. Hypothesis: A large medial closing gap and a lateral hinge position in the supracondylar area would increase plain radiography–based and/or computed tomography (CT)–based LHF in MCDFO. Study Design: Case control study; Level of evidence, 3. Methods: We retrospectively evaluated 67 knees of 53 patients (mean age, 37.4 ± 16.9 years) who underwent MCDFO between May 2009 and June 2021. The surgical indications for MCDFO were genu valgum deformity combined with either lateral compartment osteoarthritis or recurrent patellar dislocation. The presence of LHF was evaluated based on immediate postoperative plain radiography and CT scans. The predictive factors for LHF in MCDFO were investigated using multivariate logistic regression analysis. Results: LHFs were identified in 21 knees (31.3%) through plain radiography and in 40 knees (59.7%) through CT. Multivariate logistic regression analysis showed that the medial closing gap and lateral hinge position were predictive factors for plain radiography– and CT-based LHF after MCDFO. Controlling for other variables, we found that an increase in the medial opening gap by 1 mm increased the likelihood of plain radiography–based LHF by a factor of 1.805 (95% CI, 1.291-2.525; P = .001) and CT-based LHF by 1.333 (95% CI, 1.003-1.772; P = .048). Moreover, a lateral hinge position in the supracondylar area increased the likelihood of plain radiography–based LHF by a factor of 9.870 (95% CI, 2.179-44.720; P = .003) and CT-based LHF by 5.686 (95% CI, 1.124-28.754; P = .036). Conclusion: A large medial closing gap and lateral hinge position in the supracondylar area are associated with LHF in MCDFO. Care should be taken to prevent LHF in MCDFO with a large medial closing gap. Moreover, a lateral hinge position in the supracondylar area should be avoided to decrease the incidence of LHF in MCDFO.

Application of “key and lock” principle in the treatment of traumatic cervical Spondyloptosis of c6-7: Case report and literature review

Purpose: Traumatic cervical spondyloptosis is a rare clinical pathology that often causes complete paralysis. When a patient presents neurologically intact or incomplete paralysis, the management becomes more complicated. Preservation of neural function and restoration of anatomic alignment collectively remain the golden goals of therapy. There are still few reports on this issue, however, the existing literature did not clearly define severity of injuries and the treatment strategy in such cases. On the occasion of reporting one treated traumatic C6-7 spondyloptosis case, we reviewed existing literatures. Material and Methods: The patient was a 48-year-old man who had motorcycle accident and was presented with post-operation for right frontal epidural hematoma in 3 days before admitting to hospital. Neurological assessment showed motor strength grade 3/5 in the proximal upper and lower-extremity muscle groups on the right side, and 1/5 on the left side with incontinence of sphincters. X-rays and computed tomography (CT) scan revealed a three-column ligamentous injury with complete anterior displacement of C6 to C7 vertebral body. We applied the “Key - Lock” principle for better understanding of the biomechanics of the injury and found out the favorable strategy. The patient underwent posterior approach with decompression and anterior approach with reduction and anterior cervical discectomy fusion for C6-7. Results: After 8 months follow-up, the patient had recovered muscular strength in bilateral upper and lower-extremities muscle groups, sphincter function had fully recovered, and he was able to ambulate by himself. Plain radiograph and CT scan showed good aligment and progressive maturation of his fusion procedure. Conclusion: Traumatic cervical spondyloptosis of C6-7 is a high-energy unstable fracture and rare. This report develops a new principle called “Key and Lock” for more understand the biomechanics of the injury and treatment. Our patient was successfully treated with open reduction, decompression, and anterior cervical discectomy fusion.

Clinical Importance of Hounsfield Unit in Computed Tomography of Sub-Axial Cervical Vertebral Body.

Objective: Computed tomography (CT) is an often-used diagnostic imaging tool during the evaluation of the cervical spine pathology. CT scan can provide one’s bone density by measuring Hounsfield’s unit. In anterior cervical discectomy and fusion (ACDF) surgeries, bone density may play an important role as it may relate to non-union. Therefore, the evaluation and consideration of the Hounsfield’s unit of sub-axial cervical vertebral body is important, especially during multi-level ACDF.Methods: Patients who have taken cervical CT scan pre-operatively to multi-level (3 or 4 levels) anterior cervical discectomy and fusion with anterior plating between June 2010 and August 2018, at our department were retrospectively reviewed. The bone density was estimated by measuring Hounsfield Unit (HU) of sub-axial vertebrae - C3 to T1 - by using PiViewStar imaging software program. Radiological evaluation of fusion was done by assessing postoperative plain X-rays and CT scans of 4 months and 1-year follow-up. The difference in HU were evaluated between different segments of sub-axial vertebrae. Then the fusion rate of the ACDF ending at C6 were compared to C7. All grouped values were tested for normality using the Shapiro-Wilk test. Matched-ANOVA and Fisher’s exact test was used.Results: A total of eighty patients were who underwent 3 or 4 level ACDF with anterior plate fixation were retrospectively reviewed. Bone density estimated from Hounsfield unit (HU) measurement of the sub-axial vertebral bodies ranges from 112.2 to 594.9 with the mean of 280.91. When comparing C5 with 6, 6 with 7, and 7 with T1 they showed significantly decreasing HU value with p-value&lt;0.01 with mean difference of 49.10, 30.98, and 31.25, respectively. ACDF ending at C7 showed significantly lower fusion rate than C6 at 4 months and 1-year follow-up, respectively.Conclusion: The HU show a decreasing trend towards lower sub-axial cervical vertebral body. Furthermore, multi-level ACDF ending at C7 showed higher non-union rate than ending at C6. Although, there is no direct evidence that lower bone density at lower sub-axial cervical vertebrae is causative for non-union, it should be considered for pre-operative planning.

Diagnostic values of 2 different techniques for controversial lumbar disc herniation by conventional imaging examination: 3D-DESS vs. CT plain scan.

Background: The aim of this study was to explore the significance of three-dimensional double-echo steady-state (3D-DESS) sequence and multidetector computed tomography (CT) plain scan in the diagnosis of lumbar disc herniation (LDH) remaining controversial in conventional magnetic resonance imaging (MRI), and to compare the efficiency between 3D-DESS and CT in diagnosing controversial patients by conventional MRI. Methods: A total of 61 patients with controversial LDH diagnosed by conventional MRI were collected. Before operation, the disease of these patients was further confirmed by 3D-DESS sequences and continuous CT plain scan from L3 to S1. Finally, for patients whose postoperative curative effect was marked and symptoms were obviously alleviated, the sensitivity, specificity and accuracy. Results: Among, 59 patients with remarkably relieved symptoms after operation were included, and 2 patients with varying degrees of non-remission of pain and partial dysfunction after operation were excluded. The sensitivity, specificity and accuracy of 3D-DESS were 94.6, 100 and 94.9%, respectively, and those of CT were 75.0, 33.3 and 72.9%, respectively. Conclusion: 3D-DESS is a very useful diagnostic method for patients with some special types of LDH that remain controversial in conventional imaging diagnostic methods. Through 3D-DESS, the morphology of lumbosacral nerve roots can be directly observed, which is conducive to the improvement of the sensitivity, specificity and accuracy, thus further reducing the misdiagnosis rate. Moreover, 3D-DESS plays a guiding role in the formulation of operative methods.