Preoperative CT Scan Research Articles

Three-Part Fracture Dislocation and Four-Part Fracture Dislocation of the Proximal Humerus: How Different are the Glenoid Labrum and Capsular Injuries Between Them?

Anterior fracture dislocation of the shoulder may have associated injury to the glenoid labrum and/or capsule. There is a need to look at the possible patterns of capsulo-labral injuries intra-operatively and correlate them with pre-operative radiographs and CT scans. It can enable surgeons to predict the patterns of soft-tissue injuries in a specific fracture type. Patients operated for ORIF of 3- and 4-part anterior fracture dislocation between January 2017 and December 2022 were included in the study. The following data were collected: demographic details, fracture morphology and classification on radiograph and CT scan, neurovascular injury, the subtype of anterior dislocation, and intra-operative identifiable injury to glenoid labrum and/or capsule. A total of 24 cases (mean age 40 ± 10years) of anterior fracture dislocation of the shoulder were included in the study and were grouped based on Neer's classification. 12 patients had 3-part anterior fracture dislocation (3-part Group) with a mean age of 34 ± 9years, while 12 patients had 4-part anterior fracture dislocation (4-part Group) with a mean age of 46 ± 7years (p = 0.001). 10 out of 12 patients in the 3-part Group had the subcoracoid position of the dislocated head, whereas the head was present in 9 out of 12 patients of the 4-part Group at the preglenoid position (p = 0.003). The head position was at a mean distance of 1.85cm from the anterior glenoid rim in the 4-part Group, whereas the head was engaged at the anterior rim of the glenoid in the 3-part Group. The medial metaphyseal beak was present in 11 out of 12 patients in the 3-part Group, whereas it was absent in all the cases of the 4-part Group (p = 0.001). 92% of the included patients in our study had capsulo-labral injury. 11 out of 12 patients in the 3-part Group had labral injury compared to 10 out of 12 patients in the 4-part Group with severe capsular stripping (p = 0.001). The 3-part fracture dislocation with radiological findings such as the long medial metaphyseal beak and subcoracoid position of the dislocated head had a strong association with a glenoid labral injury, whereas the 4-part fracture dislocation type had a widely displaced preglenoid position of the dislocated head with an absent metaphyseal beak and had a strong association with a capsular type of soft-tissue injury. III.

Radiomic biomarkers of locoregional recurrence: prognostic insights from oral cavity squamous cell carcinoma preoperative CT scans.

This study aimed to identify CT-based imaging biomarkers for locoregional recurrence (LR) in Oral Cavity Squamous Cell Carcinoma (OSCC) patients. Computed tomography scans were collected from 78 patients with OSCC who underwent surgical treatment at a single medical center. We extracted 1,092 radiomic features from gross tumor volume in each patient's pre-treatment CT. Clinical characteristics were also obtained, including race, sex, age, tobacco and alcohol use, tumor staging, and treatment modality. A feature selection algorithm was used to eliminate the most redundant features, followed by a selection of the best subset of the Logistic regression model (LRM). The best LRM model was determined based on the best prediction accuracy in terms of the area under Receiver operating characteristic curve. Finally, significant radiomic features in the final LRM model were identified as imaging biomarkers. Two radiomics biomarkers, Large Dependence Emphasis (LDE) of the Gray Level Dependence Matrix (GLDM) and Long Run Emphasis (LRE) of the Gray Level Run Length Matrix (GLRLM) of the 3D Laplacian of Gaussian (LoG σ=3), have demonstrated the capability to preoperatively distinguish patients with and without LR, exhibiting exceptional testing specificity (1.00) and sensitivity (0.82). The group with LRE > 2.99 showed a 3-year recurrence-free survival rate of 0.81, in contrast to 0.49 for the group with LRE ≤ 2.99. Similarly, the group with LDE > 120 showed a rate of 0.82, compared to 0.49 for the group with LDE ≤ 120. These biomarkers broaden our understanding of using radiomics to predict OSCC progression, enabling personalized treatment plans to enhance patient survival.

Endovascular repair of bilateral isolated common iliac artery aneurysms with unsuitable anatomy utilizing an aortic bifurcated unibody endograft and modified sandwich technique to preserve pelvic blood flow: a case series

Bilateral isolated common iliac artery aneurysms (CIAAs) are rare, and endovascular repair of CIAAs has emerged as an alternative to traditional open surgical repair. The primary goal of therapy is to exclude the aneurysm sac while maintaining perfusion of at least one internal iliac artery (IIA) to prevent pelvic ischemia. Although the iliac branch device (IBD) has improved the feasibility of preserving the IIA, its applicability is limited to a specific subset of aneurysm anatomy. We present a case series of three patients with bilateral isolated CIAAs in whom preoperative CT scans revealed an absence of a landing zone, the diameter of proximal CIA diameter was less than 13.0 mm, and normal diameter of the nonaneurysmal infrarenal aorta, making it challenging to use an IBD alone or a standard bifurcated aortic endograft to provide a proximal landing zone for iliac artery stenting. To overcome the small diameter of the infrarenal aorta, we implanted an aortic bifurcated unibody endograft. Then, we utilized a balloon-expandable covered stent-graft with overdilation as a modified sandwich technique to create an “eye of the tiger” configuration to prevent gutter leakage. The final angiography performed during the procedure revealed successful exclusion of the aneurysms, with blood flow to the right IIA and no type III endoleak. During the postoperative follow-up period, no patients exhibited symptoms associated with pelvic ischemia. There were no endoleaks or sac expansions on the two-year follow-up CT scans, and all external and internal iliac graft limbs were patent. This study demonstrated that a combination of an aortic bifurcated unibody endograft and a modified sandwich technique can effectively treat bilateral isolated CIAAs with certain anatomical constraints.

Presentation of Arteria Lusoria with Non Recurent Laryngeal Nerve.

Non-recurrent laryngeal nerve (NRLN) is an anatomic variation seen in about 0.52-0.7% patients, generally on right side. It exits the vagus nerve having a direct route to the larynx, unlike usual recurrent laryngeal nerve, supplying intrinsic laryngeal muscles except cricothyroid. It is sited over left side on extremely rare occasions, that is, 0.04% of the cases. Some cases of NRLN co-exists with aberrant right subclavian artery which courses behind the esophagus, also known as 'arteria lusoria'. Here we present a case of 60-years old patient, diagnosed as goiter presented to us in june 2023 at the department of head and neck surgery at a tertiary care setup of Karachi Pakistan. Intra-operatively, non-recurrent nerve was encountered, whose association was found with arteria lusoria, observed in pre-operative CT-scan. The nerve was saved and no post-operative complications were seen in patient. The association of arteria lusoria in this case emphasize its importance in predicting NRLN via pre-operative imaging techniques which can prevent its injury intra-operatively.

The Association Between Preoperative Pectoralis Muscle Quantity and Outcomes After Cardiac Transplantation

Background: Sarcopenia is underappreciated in advanced heart failure and is not routinely assessed. In patients receiving a left ventricular assist device (LVAD), preoperative sarcopenia, defined using CT-derived pectoralis muscle area index (muscle area indexed to body surface area), is an independent predictor of post-operative mortality. The association between preoperative sarcopenia and outcomes after heart transplant (HT) is unknown. Objectives: The primary aim was to determine if preoperative sarcopenia, diagnosed using pectoralis muscle area index, is an independent predictor of days alive and out of the hospital (DAOH) post-transplant. Methods: Patients who underwent HT from January 2018 to June 2022 with available preoperative chest CT scans were included. Sarcopenia was diagnosed as pectoralis muscle area index in the lowest sex-specific tertile. The primary endpoint was DAOH at 1-year post-transplant. Results: 169 patients were included. Patients with sarcopenia (n=55) had fewer DAOH compared to those without, with a median difference of 17 days (320 vs. 337 days, p=0.004). Patients with sarcopenia had a longer index hospitalization and were also more likely to be discharged to a facility other than home. In a Poisson regression model, sarcopenia was a significant univariable and the strongest multivariable predictor of DAOH at 1-year (Parameter estimate = -0.17, 95% CI -0.19 to -14, p = <0.0001). Conclusions: Preoperative sarcopenia, diagnosed using pectoralis muscle area index, is an independent predictor of poor outcomes after HT. This parameter is easily measurable from commonly obtained preoperative CT scans and may be considered in the transplant evaluation.

Clinical Utility of a CT-based AI Prognostic Model for Segmentectomy in Non-Small Cell Lung Cancer.

Background Currently, no tool exists for risk stratification in patients undergoing segmentectomy for non-small cell lung cancer (NSCLC). Purpose To develop and validate a deep learning (DL) prognostic model using preoperative CT scans and clinical and radiologic information for risk stratification in patients with clinical stage IA NSCLC undergoing segmentectomy. Materials and Methods In this single-center retrospective study, transfer learning of a pretrained model was performed for survival prediction in patients with clinical stage IA NSCLC who underwent lobectomy from January 2008 to March 2017. The internal set was divided into training, validation, and testing sets based on the assignments from the pretraining set. The model was tested on an independent test set of patients with clinical stage IA NSCLC who underwent segmentectomy from January 2010 to December 2017. Its prognostic performance was analyzed using the time-dependent area under the receiver operating characteristic curve (AUC), sensitivity, and specificity for freedom from recurrence (FFR) at 2 and 4 years and lung cancer-specific survival and overall survival at 4 and 6 years. The model sensitivity and specificity were compared with those of the Japan Clinical Oncology Group (JCOG) eligibility criteria for sublobar resection. Results The pretraining set included 1756 patients. Transfer learning was performed in an internal set of 730 patients (median age, 63 years [IQR, 56-70 years]; 366 male), and the segmentectomy test set included 222 patients (median age, 65 years [IQR, 58-71 years]; 114 male). The model performance for 2-year FFR was as follows: AUC, 0.86 (95% CI: 0.76, 0.96); sensitivity, 87.4% (7.17 of 8.21 patients; 95% CI: 59.4, 100); and specificity, 66.7% (136 of 204 patients; 95% CI: 60.2, 72.8). The model showed higher sensitivity for FFR than the JCOG criteria (87.4% vs 37.6% [3.08 of 8.21 patients], P = .02), with similar specificity. Conclusion The CT-based DL model identified patients at high risk among those with clinical stage IA NSCLC who underwent segmentectomy, outperforming the JCOG criteria. © RSNA, 2024 Supplemental material is available for this article.

Interest of computer tomography in the study of prognostic factors of otosclerosis.

Otosclerosis is a primary osteodystrophy of the otic capsule that causes stapedo-vestibular ankylosis. Its diagnosis is suspected on the basis of clinical and audiometric elements, basically in the presence of conductive hearing loss with a normal eardrum. The CT-scan is an essential examination for the preoperative evaluation of otosclerosis. The aim of our study was to evaluate the use of CT-scanning in predicting the functional outcome of otosclerosis surgery by correlating postoperative audiometric results and preoperative CT findings. We conducted a retrospective study at the ENT Department in association with the Medical Imaging Department of our hospital, over a period of 8years, from January 2014 to December 2022 and involving 90 patients (104 ears). The average age of our patients was 40years with extremes ranging from 22 to 61years. We noted a sex ratio of 0.38. The preoperative CT-scan showed signs of otosclerosis in 87% of the cases and infra-radiological forms in 13% of the cases. Veillon stage II was the most frequent radiological stage encountered with a percentage of 48%. A good audiometric evolution, defined by a closure of postoperative Air Bone Gap (ABG ≤ 20dB) and by an improvement of Bone Conduction (BC gain ≥ 0), was recorded in 86 cases (82.7%) for ABG and in 84 cases (80.8%) for BC gain. Scanographic predictive factors of poor postoperative outcome for ABG and BC gain were: advanced stages (Veillon stage III and IV), endosteal effraction, and round window involvement. According to multivariate analysis, only the extent of otosclerotic foci was directly and independently associated with the postoperative audiometric outcome. The CT-scan is an essential examination in the preoperative evaluation of otosclerosis. It allows a positive diagnosis to be made and evaluate the extension of otosclerosis. Moreover, thanks to the analysis of the extent of the otosclerosis foci, mainly by the Veillon classification, the CT-scan allows to predict the postoperative audiometric prognosis.

Development and in vivo biomechanics of goat mobile artificial lumbar spine complex

Mobile artificial lumbar complex (MALC) which suitable for reconstruction after subtotal lumbar resection in goats was developed,and to test stability of the complex and postoperative lumbar segmental motor function. Eighteen male boer goats aged from 1 to 2 years old (weighted from 35 to 45 kg) were selected and divided into control group,fusion group and non-fusion group,with 6 goats in each group. According to preoperative CT scans and MRI examinations of lumbar,the goat MALC was designed and performed by 3D printed for non-fusion group. Operation was performed on three groups respectively,and only vertebral body and disc were exposed in control group. In fusion group,L4 part of vertebral body and the upper and lower complete disc tissues were removed,and the lumbar spine bone plate fixation was performed with titanium mesh bone grafting. In non-fusion group,vertebral body and disc were removed in the same way,and MALC was implanted. AP and lateral X-rays of lumbar vertebrae in goat were taken at 6 months after surgery,in order to understand whether the plant was dislocated,displaced and fractured. Biomechanical tests were performed on the specimens by mechanical instrument to measure range of motion (ROM) of L2,3,L3,4,L4,5 intervertebral space and the overall ROM of L2-5 lumbar vertebrae. MALC of lumbar vertebra was designed by 3D printing,and its component artificial vertebrae and upper and lower artificial end plates were manufactured. The semi-spherical structure was fabricated by precision lathe using high-crosslinked polyethylene material,and the prosthesis was assembled. Postoperative AP and lateral X-rays of lumbar vertebra at 6 months showed the implant position of implant and MALC were good without displacement and dislocation. In vitro biomechanical test of lumbar vertebrae specimens:(1) There were no statistical significance in ROM of lumbar intervertebral space flexion and extension,lateral flexion and rotation on L3,4 and L4,5,between non-fusion group and control group (P>0.05),while ROM of fusion group was significantly reduced compared with the other two groups (P<0.05). There were no significant difference in ROM of L2,3 intervertebral flexion and extension,lateral flexion and rotation between non-fusion group and control group (P>0.05),while fusion group was significantly increased compared with the other two groups (P<0.001). (2) There was no significant difference in overall lumbar ROM of L2-5 (P> 0.05). The individual MALC could restore intervertebral height of lumbar vertebra while maintaining the stability of lumbar vertebra and re-establishing motor function of lumbar space.

Asymmetric Implant Design for Posterolateral Overhang of the Femoral Component in Total Knee Arthroplasty: A Retrospective Computed Tomography-Based Study.

Introduction During total knee arthroplasty (TKA), also referred to as total knee replacement (TKR), patients may experience pain in the posterolateral knee. One possible cause is the impingement between the popliteus tendon and the femoral components. The purpose of this study was to analyze the posterolateral overhang of the femoral component using 3D template software. Methods Preoperative CT scan images of 50 knees (11 males and 39 females) with osteoarthritis of grade 2 or lower according to the Kellgren-Lawrence classification were analyzed. The mean age of the subjects was 73.8±7.6 years (range 52-84 years). The Athena (Soft Cube Co., Ltd., Osaka, Japan) knee 3D image-matching software was used for the analysis. The positions of the two femoral components (symmetrical and asymmetrical) were simulated. In the coronal plane, the component overhang was measured between the resected lateral part of the posterior femur and its corresponding component size, and the two designs were compared in three zones (proximal, central, and distal). Results In the simulated femoral component, the asymmetric design had a significantly lower component overhang than the symmetric design in the proximal zone of the lateral posterior condyle (0.2±1.9 mm vs. 3.5±1.6 mm, p<0.01). In the proximal zone, significant overhang (>3 mm) was observed in 30 knees (60.0%) with the symmetric design, but only three knees (6.0%) had asymmetric designs (p<0.01). Conclusions The posterolateral overhang of the lateral posterior condyle occurs when a symmetrical prosthesis is used. The use of an asymmetric implant with a small, rounded proximal portion of the lateral posterior condyle improves this overhang and is expected to decrease problems such as impingement of the popliteus tendon and improve patient satisfaction.

Does local fat thickness correlate with post-operative infection in open reduction and internal fixation of acetabulum fractures?

Obesity is an epidemic which increases risk of many surgical procedures. Previous studies in spine and hip arthroplasty have shown that fat thickness measured on preoperative imaging may be as or more reliable in assessment of risk of post-operative infection and/or wound complications than body mass index (BMI). We hypothesized that, similarly, increased local fat thickness at the surgical site is a predictor of wound complication in acetabulum fracture surgery. Patients who underwent open reduction and internal fixation (ORIF) of an acetabulum fracture through a Kocher-Langenbeck (K-L) approach at a single institution from 2013 to 2020 were identified. Pre-operative CT scans were used to measure fat thickness from the skin to the greater trochanter in line with the surgical approach. Post-operative infections and wound complications were recorded and associated with fat thickness and BMI. 238 patients met inclusion criteria. 12 patients had either infection or a wound complication (5.0%). There was no significant association with BMI or preoperative fat thickness on post-operative infection or wound complication (p-value 0.73 and 0.86). There is no statistically significant association of post-operative infection or wound complications in patients with increased soft tissue thickness or increased BMI. ORIF of acetabulum fractures through a K-L approach can be performed safely in patients with large subcutaneous fat thickness and high BMI with low risk of infection or wound complications.

Abstract 7379: Deep learning based risk stratification of pre-operative CT scans is prognostic of overall survival in kidney cancers

Abstract Introduction: Preoperative risk stratification of kidney cancer patients is critical for treatment selection and improving mortality rates. Current clinical approaches such as cancer grading are limited by inter-reviewer variability, require invasive biopsy procedures, and might not capture the full extent of patient risk. We sought to evaluate a deep learning (DL) model to quantify patient risk and prognosticate overall survival in kidney cancer patients via CT scans. Methods: This retrospective study used preoperative contrast CT scans from 4 public multi-institutional collections with date of death/censoring available. A deep learning (DL) network architecture was developed to analyze input CT scans via a convolutional feature extractor and a Cox proportional hazards-based cost function. The DL model assigned a risk score to each patient, with the median risk used as a cutoff for classifying patients as high-risk or low-risk. Model performance for prognosticating overall survival (OS) was evaluated separately in training, internal validation, and external validation cohorts via Kaplan-Meier analysis in terms of concordance index and hazard ratios, with risk groups compared via Wilcoxon log-rank tests (α = 0.05). Results: In the training/internal validation cohort (N=418, 8 institutions) and external validation cohort (N=102, 1 institution), the median age was 60 and 59 years, the male/female ratios were 62%/38% and 75%/25%, with a median follow up of 2.8 and 3.1 years, respectively. The DL model yielded a training c-index of 0.66 (95% CI: 0.63-0.68), internal validation c-index of 0.73 (95% CI: 0.70-0.76) and an external validation c-index of 0.67 (95% CI: 0.64-0.70). Kaplan-Meier analysis of associated survival curves based on DL-determined high- and low-risk patients demonstrated statistically significant separation in all cohorts: training (p = 0.003, HR = 8.63, 95% CI: 8.28-8.98), internal validation (p = 0.027, HR = 4.89, 95% CI: 4.52-5.26), and external validation (p = 0.01, HR = 6.54, 95% CI: 6.18-6.90). Baseline clinicopathological characteristics were not significantly different between DL high and low risk patients in external validation (chi-square testing; ISUP grade p=0.375, age p=0.824, race p=0.567, and sex p=0.440). ISUP grade was also not a significant predictor of OS in internal validation (HR=1.57, p=0.211, 95% CI: 1.28-1.85) or external validation (p = 0.465, HR=0.16, 95% CI: 0.33-0.74). Conclusion: A deep learning model based on pre-operative CT scans was found to accurately prognosticate overall survival in kidney cancers in a multi-institutional setting, independent of clinicopathological factors. This model is being validated on larger cohorts, and in the context of targeted therapies. Citation Format: Brennan Flannery, Mohsen Hariri, Thomas DeSilvio, Amir Sadri, Jane Nguyen, Erick M. Remer, Smitha Krishnamurthi, Satish E. Viswanath. Deep learning based risk stratification of pre-operative CT scans is prognostic of overall survival in kidney cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7379.

Development and validation of a Radiopathomics model based on CT scans and whole slide images for discriminating between Stage I-II and Stage III gastric cancer

ObjectiveThis study aimed to develop and validate an artificial intelligence radiopathological model using preoperative CT scans and postoperative hematoxylin and eosin (HE) stained slides to predict the pathological staging of gastric cancer (stage I-II and stage III).MethodsThis study included a total of 202 gastric cancer patients with confirmed pathological staging (training cohort: n = 141; validation cohort: n = 61). Pathological histological features were extracted from HE slides, and pathological models were constructed using logistic regression (LR), support vector machine (SVM), and NaiveBayes. The optimal pathological model was selected through receiver operating characteristic (ROC) curve analysis. Machine learnin algorithms were employed to construct radiomic models and radiopathological models using the optimal pathological model. Model performance was evaluated using ROC curve analysis, and clinical utility was estimated using decision curve analysis (DCA).ResultsA total of 311 pathological histological features were extracted from the HE images, including 101 Term Frequency-Inverse Document Frequency (TF-IDF) features and 210 deep learning features. A pathological model was constructed using 19 selected pathological features through dimension reduction, with the SVM model demonstrating superior predictive performance (AUC, training cohort: 0.949; validation cohort: 0.777). Radiomic features were constructed using 6 selected features from 1834 radiomic features extracted from CT scans via SVM machine algorithm. Simultaneously, a radiopathomics model was built using 17 non-zero coefficient features obtained through dimension reduction from a total of 2145 features (combining both radiomics and pathomics features). The best discriminative ability was observed in the SVM_radiopathomics model (AUC, training cohort: 0.953; validation cohort: 0.851), and clinical decision curve analysis (DCA) demonstrated excellent clinical utility.ConclusionThe radiopathomics model, combining pathological and radiomic features, exhibited superior performance in distinguishing between stage I-II and stage III gastric cancer. This study is based on the prediction of pathological staging using pathological tissue slides from surgical specimens after gastric cancer curative surgery and preoperative CT images, highlighting the feasibility of conducting research on pathological staging using pathological slides and CT images.

Abstract 2877: Enhancing diagnostic precision in peritoneal cancer metastasis: Photodynamic diagnosis-guided laparoscopy in a rabbit model

Abstract Introduction: Precise diagnostic workup is crucial for developing effective treatment strategies in cancer patients. Peritoneal carcinomatosis, often missed in preoperative CT scans and conventional laparoscopy, poses diagnostic challenges. This study aimed to assess the diagnostic accuracy of staging laparoscopy using photodynamic diagnosis (PDD) with the photosensitizer phonozen activated at 405 nm in a rabbit model of peritoneal carcinomatosis. Methods: Female New Zealand white rabbits (16-20 weeks old) were utilized to establish the model through peritoneal inoculation of VX2 sarcoma cells, resulting in distinct solid-tumor nodules for laparoscopic evaluation. A customized dual-emission laparoscope, capable of both white-light and 405 nm blue-light, was employed for PDD. To minimize blue-light background interference, a 550 nm long-pass filter was placed between the laparoscope and the video camera, optimizing the process. The PDD-enhanced diagnostic laparoscopy comprised a tripartite approach: 1) initial peritoneal cavity exploration under white-light and labeling of suspect nodules, followed by 2) utilization of blue light with the long-pass filter to identify red-light emissions from distinctly labeled tumor cells, and 3) open laparotomy served to palpate the peritoneal surface and identify additional or missed tumor nodules. Results: Analysis of data from 12 rabbits with 267 tumor nodules revealed that sensitivity and specificity of diagnostic laparoscopy for detecting tumor nodules increased from 84.9% and 18.8% with white light alone to 90.8% and 25.0% when aided by PDD, respectively. These findings underscore the substantial improvement in diagnostic accuracy achievable by combining the rabbit model of peritoneal carcinomatosis with PDD in laparoscopic procedures. Conclusion: The heightened sensitivity and specificity observed in this study hold significant promise for positively impacting clinical practice, providing a more accurate and effective approach to the diagnosis and management of peritoneal carcinomatosis. Citation Format: Hyoung-Il Kim, Adriana Rivera-Piza, Sunghwan Lee. Enhancing diagnostic precision in peritoneal cancer metastasis: Photodynamic diagnosis-guided laparoscopy in a rabbit model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2877.

Abstract 2401: Changes in skeletal muscle mass after gastrointestinal cancer surgery by body composition

Abstract Background: Previous studies have extensively explored the correlation between preoperative skeletal muscle mass and long-term survival in gastrointestinal cancers. However, investigations into postoperative skeletal muscle mass alterations are limited. In gastrointestinal cancers, factors such as the tumor and surgical interventions can significantly impact dietary intake, nutritional status, and skeletal muscle mass, affecting postoperative body composition. This study aimed to examine these postoperative changes in skeletal muscle mass across different gastrointestinal cancers, including esophageal, gastric, and colorectum. Methods: This study encompassed 969 patients with Stage I-III esophageal (307 cases), gastric (278 cases), and colorectal (384 cases) cancers who underwent radical resection between 2005 and 2019. Skeletal muscle mass was quantified as the total psoas volume (TPV), measured using Ziostation2® imaging software from preoperative and postoperative CT scans at 1, 2, and 3 years. The study compared postoperative TPV trends across the different cancer types. Results: The study cohort comprised patients with esophageal (median age 66 years, 85% male), gastric (65 years, 60%), and colorectal cancers (67 years, 55%). Median BMIs were 21.5, 19.4, and 22.6 kg/m2, and median TPVs were 352.0, 305.8, and 309.5 cm3 for esophageal, gastric, and colorectal cancers, respectively. Esophageal cancer patients had significantly higher TPV and male predominance, while gastric cancer patients had notably lower BMI. Relative to preoperative TPV, the postoperative TPV at three years was 0.92, 0.91, and 0.96 for esophageal, gastric, and colorectal cancers, respectively. A year-by-year decrease in TPV was observed for each cancer type, with colorectal cancer demonstrating a less pronounced decrease compared to esophageal and gastric cancers (p&amp;lt;0.01). Stage-wise analysis revealed no significant differences among the cancer types. Regarding gender, no significant differences were noted between gastric and colorectal cancers, but esophageal cancer showed a more marked decrease in TPV in males compared to females. In recurrent cases, no significant TPV differences were observed in esophageal cancer, while recurrent gastric and colorectal cancers exhibited significant TPV decreases. Conclusions: The study indicates a general decline in TPV following gastrointestinal cancer surgery, with the extent of reduction varying according to the type of tumor and treatment. Citation Format: Yuto Maeda, Yuji Miyamoto, Mayuko Ohuchi, Yukiharu Hiyoshi, Naoya Yoshida, Hideo Baba. Changes in skeletal muscle mass after gastrointestinal cancer surgery by body composition [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2401.

The changes in abdominal wall muscles following incisional hernia wall reconstruction.

The objective of incisional hernia surgery is to achieve the restoration of abdominal wall anatomical and physiological functions. This study aims to investigate the impact of abdominal wall reconstruction on abdominal muscle alterations by measuring the preoperative and postoperative changes in abdominal wall muscles in patients undergoing incisional hernia repair. For patients undergoing open incisional hernia abdominal wall reconstruction, preoperative and postoperative abdominal CT scans were analyzed at a minimum of 3months post-surgery. 3D Slicer software was utilized for measuring preoperative and postoperative changes in abdominal cavity volume, abdominal muscle volume, as well as muscle volume, cross-sectional area, and abdominal circumference at specific levels. The acquired data were subjected to statistical analysis using SPSS software. A total of 40 patients meeting the inclusion criteria underwent open incisional hernia repair surgery. Some of these patients required component separation technique (CST) due to the larger size of the hernia sac. The abdominal muscles surrounding the hernia ring were defined as the "damaged group," while the remaining abdominal muscles were defined as the "undamaged group." Measurements revealed a significant increase in the volume of rectus abdominis, external oblique, internal oblique, and transversus abdominis muscles in the damaged group. Similarly, there was a corresponding increase in the volume of rectus abdominis, external oblique, internal oblique, and transversus abdominis muscles in the undamaged group. After abdominal wall reconstruction in incisional hernia patients, not only is their anatomical structure restored, but the overall biomechanical integrity of the abdominal wall is also repaired. The damaged muscles are subjected to renewed loading, leading to the reversal of disuse atrophy and an increase in muscle volume.

A Longitudinal Analysis of Pre- and Post-Operative Dysmorphology in Metopic Craniosynostosis.

The purpose of this study is to objectively quantify the degree of overcorrection in our current practice and to evaluate longitudinal morphological changes using CranioRateTM, a novel machine learning skull morphology assessment tool. . Retrospective cohort study across multiple time points. Tertiary care children's hospital. Patients with preoperative and postoperative CT scans who underwent fronto-orbital advancement (FOA) for metopic craniosynostosis. We evaluated preoperative, postoperative, and two-year follow-up skull morphology using CranioRateTM to generate a Metopic Severity Score (MSS), a measure of degree of metopic dysmorphology, and Cranial Morphology Deviation (CMD) score, a measure of deviation from normal skull morphology. Fifty-five patients were included, average age at surgery was 1.3 years. Sixteen patients underwent follow-up CT imaging at an average of 3.1 years. Preoperative MSS was 6.3 ± 2.5 (CMD 199.0 ± 39.1), immediate postoperative MSS was -2.0 ± 1.9 (CMD 208.0 ± 27.1), and longitudinal MSS was 1.3 ± 1.1 (CMD 179.8 ± 28.1). MSS approached normal at two-year follow-up (defined as MSS = 0). There was a significant relationship between preoperative MSS and follow-up MSS (R2 = 0.70). MSS quantifies overcorrection and normalization of head shape, as patients with negative values were less "metopic" than normal postoperatively and approached 0 at 2-year follow-up. CMD worsened postoperatively due to postoperative bony changes associated with surgical displacements following FOA. All patients had similar postoperative metopic dysmorphology, with no significant association with preoperative severity. More severe patients had worse longitudinal dysmorphology, reinforcing that regression to the metopic shape is a postoperative risk which increases with preoperative severity.

Calcifications in the descending thoracic aorta predict postoperative anastomotic leakages after esophagectomy for cancer.

Anastomotic leak is one of the most feared complications of esophagectomy. Previous studies have suggested a potential link between aortic calcifications detected on routine preoperative CT scans and increased risk of anastomotic leak after esophagectomy. This study aims to investigate whether clinicians' assessment of aortic calcifications can predict the occurrence of anastomotic leaks in patients undergoing esophagectomy for cancer. A long-term follow-up was conducted on consecutive patients with esophageal cancer who underwent elective open esophagectomy at a Finnish tertiary hospital. Aortic calcifications were evaluated based on CT scans and categorized on a 0-3 scale reflecting the number of calcifications in the affected segment of the aorta. Reviewers assessing the calcifications were blinded to clinical details and postoperative outcomes. The study included 97 patients (median age: 64years and range: 43-78; 20% female), with a median follow-up time of 1307 (2-1540) days. Among them, 22 patients (23%) had postoperative anastomotic leak. We observed a significant association between calcifications in the descending aorta and a higher risk of anastomotic leak (p=0.007), as well as an earlier occurrence of leak postoperatively (p=0.013). However, there was no association between aortic calcifications and increased mortality. Presence of calcifications in the descending aorta is independently associated with an increased risk of anastomotic leaks following esophagectomy for cancer. Identifying patients at higher risk for this complication could facilitate appropriate pre- and postoperative interventions, as well as enable earlier diagnosis and treatment to mitigate the severity of the complication.

Preoperative detection of hepatocellular carcinoma's microvascular invasion on CT-scan by machine learning and radiomics: A preliminary analysis

IntroductionMicrovascular invasion (MVI) is the main risk factor for overall mortality and recurrence after surgery for hepatocellular carcinoma (HCC).The aim was to train machine-learning models to predict MVI on preoperative CT scan. Methods3-phases CT scans were retrospectively collected among 4 Italian centers. DICOM files were manually segmented to detect the liver and the tumor(s). Radiomics features were extracted from the tumoral, peritumoral and healthy liver areas in each phase. Principal component analysis (PCA) was performed to reduce the dimensions of the dataset. Data were divided between training (70%) and test (30%) sets. Random-Forest (RF), fully connected MLP Artificial neural network (neuralnet) and extreme gradient boosting (XGB) models were fitted to predict MVI. Prediction accuracy was estimated in the test set. ResultsBetween 2008 and 2022, 218 preoperative CT scans were collected. At the histological specimen, 72(33.02%) patients had MVI. First and second order radiomics features were extracted, obtaining 672 variables. PCA selected 58 dimensions explaining >95% of the variance.In the test set, the XGB model obtained Accuracy = 68.7% (Sens: 38.1%, Spec: 83.7%, PPV: 53.3% and NPV: 73.4%). The neuralnet showed an Accuracy = 50% (Sens: 52.3%, Spec: 48.8%, PPV: 33.3%, NPV: 67.7%). RF was the best performer (Acc = 96.8%, 95%CI: 0.91–0.99, Sens: 95.2%, Spec: 97.6%, PPV: 95.2% and NPV: 97.6%). ConclusionOur model allowed a high prediction accuracy of the presence of MVI at the time of HCC diagnosis. This could lead to change the treatment allocation, the surgical extension and the follow-up strategy for those patients.

Distal clavicle autograft for large glenoid defects during revision reverse total shoulder arthroplasty

IntroductionRevision reverse total shoulder arthroplasty (rTSA) can be complicated by significant glenoid bone loss and require augmented baseplates or structural bone grafts to fill the defect while optimizing glenosphere lateralization. Distal clavicle autografting is a newly described type of structural graft that has shown promising outcomes in revision reverse rTSA to address severe glenoid bone loss. Additionally, distal clavicle autografts are an option that is proposed to be more cost effective and have low morbidity in addressing glenoid bone defects. The technique for distal clavicle autografting during revision rTSA and the outcomes of a series of cases are contained within this report. Materials and MethodsA retrospective chart review was conducted for 9 patients who underwent revision rTSA with a distal clavicle autograft for glenoid bone loss between January 2013 to January 2022. The primary outcome was component survivorship at two years postoperatively. Patient charts were reviewed for clinical and radiographic information, and any complications were recorded. Postoperative radiographs were assessed for evidence of component loosening or failure. Distal clavicle and glenoid defect dimensions were measured using preoperative CT scans and compared. Results9 patients were identified who underwent revision rTSA with distal clavicle autograft to address glenoid bone loss. All patients had clinical and radiographic data available two years postoperatively. There was significant improvement in active forward flexion and abduction, and no-significant change in external rotation compared to preoperative measurements. Patient-reported QuickDASH score improved significantly with non-significant improvements in VAS function, SANE, and ASES scores. 8 of 9 (88.9%) of patients had stable prostheses with no evidence of loosening or failure at two years. One patient experienced component failure and graft osteolysis requiring conversion to hemiarthroplasty. No other complications were noted. Dimensions of the distal clavicle are similar to the dimensions of contained glenoid vault defects and glenoid defects with minimal loss of containment. ConclusionUsing a distal clavicle autograft during revision rTSA is an effective technique that can address severe glenoid bone loss. This technique has excellent radiographic outcomes at short-term follow-up and is a fortuitous autograft option in revision rTSA due to its location, dimensions, and low cost.

Excessive posterior pelvic tilt from preoperative supine to postoperative standing after total hip arthroplasty.

Excessive posterior pelvic tilt (PT) may increase the risk of anterior instability after total hip arthroplasty (THA). The aim of this study was to investigate the changes in PT occurring from the preoperative supine to postoperative standing position following THA, and identify factors associated with significant changes in PT. Supine PT was measured on preoperative CT scans and standing PT was measured on preoperative and one-year postoperative standing lateral radiographs in 933 patients who underwent primary THA. Negative values indicate posterior PT. Patients with > 13° of posterior PT from preoperative supine to postoperative standing (ΔPT ≤ -13°) radiographs, which corresponds to approximately a 10° increase in functional anteversion of the acetabular component, were compared with patients with less change (ΔPT > -13°). Logistic regression analysis was used to assess preoperative demographic and spinopelvic parameters predictive of PT changes of ≤ -13°. The area under receiver operating characteristic curve (AUC) determined the diagnostic accuracy of the predictive factors. PT changed from a mean of 3.8° (SD 6.0°)) preoperatively to -3.5° (SD 6.9°) postoperatively, a mean change of -7.4 (SD 4.5°; p < 0.001). A total of 95 patients (10.2%) had ≤ -13° change in PT from preoperative supine to postoperative standing. The strongest predictive preoperative factors of large changes in PT (≤ -13°) from preoperative supine to postoperative standing were a large posterior change in PT from supine to standing, increased supine PT, and decreased standing PT (p < 0.001). Flexed-seated PT (p = 0.006) and female sex (p = 0.045) were weaker significant predictive factors. When including all predictive factors, the accuracy of the AUC prediction was 84.9%, with 83.5% sensitivity and 71.2% specificity. A total of 10% of patients had > 13° of posterior PT postoperatively compared with their supine pelvic position, resulting in an increased functional anteversion of > 10°. The strongest predictive factors of changes in postoperative PT were the preoperative supine-to-standing differences, the anterior supine PT, and the posterior standing PT. Surgeons who introduce the acetabular component with the patient supine using an anterior approach should be aware of the potentially large increase in functional anteversion occurring in these patients.