Preoperative High-resolution Computed Tomography Scan Research Articles

Simulation Software to Plan the Treatment of Acetabular Fractures: The Patient-Specific Biomechanical Model.

The objective of this study was to assess the impact of using simulation software for preoperative planning: a patient-specific biomechanical model (PSBM) in acetabular surgery. The secondary objectives were to assess operating time, intraoperative bleeding, and peroperative complications. This is a prospective control study. Level 1 trauma center. Between January 2019 and December 2022, patients with operative acetabular fracture treated by the first author were prospectively enrolled. Patients were divided into 2 groups according to the use or not of PSBM for preoperative planning. When PSBM was used, data were extracted from the preoperative high-resolution computed tomography scans to build a biomechanical model implemented in a custom software [simulation (SIM group)]. When computed tomography scans were not performed in our hospital, PSBM was not feasible (non-SIM group). Radiological results, surgery duration, blood loss, and peroperative complications were recorded. Sixty-six patients were included; 26 in the PSBM group and 40 in the standard group. The 2 groups were comparable regarding fracture patterns and epidemiological data. After simulation, in the SIM group, a poor reduction (>3 mm) was found in 2 of 26 patients (7.7%) versus 11 of 40 patients (27.5%) in the non-SIM group, P = 0.048. The mean operative time was shorter after simulation (110 minutes vs. 155 minutes, P = 0.01), and the mean blood loss was reduced (420 vs. 670 mL, P = 0.01). By reducing the peroperative trials for reduction, PSBM allows better reduction in a shorter operative time and with less blood loss. Level II: prospective study.

High-Resolution Computed Tomography in Middle Ear Cholesteatoma: How Much Do We Need It?

Background and Objectives: The diagnosis of cholesteatoma is usually clinic, and the only efficient treatment is surgical. High-resolution computed tomography (HRCT) is not considered absolutely necessary for the management of an uncomplicated cholesteatoma, but unsuspected situations from a clinical point of view can be discovered using the scans, warning the surgeon. Our objective is to compare HRCT scan information with intraoperative findings in patients with cholesteatoma and analyze the usefulness of a preoperative HRCT scan from a surgical point of view. Materials and Methods: This is a prospective descriptive study conducted in the Department of Otolaryngology, Victor Babes University of Medicine and Pharmacy Timisoara, Romania, from May 2021 to April 2022. It was carried out on 46 patients with a clinical diagnosis of cholesteatoma who were consequently operated on in our department. All patients received full clinical and audiological examinations. In all cases, an HRCT scan was performed preoperatively as a mandatory investigation. Preoperative HRCT scans were analyzed, and their findings were compared to the intraoperative notes. The two sets of observations were analyzed using standard statistical methods. Results: Extensive cholesteatoma was the most common type of disease, involving 46% of the patients, followed by pars flaccida cholesteatoma (35%) and pars tensa cholesteatoma (19%). Eroded scutum was the most frequent lesion involving 70% of the patients, followed by incus erosion (67%). Comparison of the HRCT and intraoperative findings revealed a very good correlation for tegmen tympani erosion, sigmoid plate erosion, scutum and malleus erosion, and a moderate-to-good correlation for lateral semicircular canal erosion, incus and stapes erosion, and fallopian canal erosion. Conclusions: HRCT is a valuable tool in the preoperative assessment of cholesteatoma, helping in making surgical decisions. It can accurately predict the extent of disease and is helpful for detecting unapparent dangerous situations. However, it is not very accurate in detecting fallopian canal and stapes erosion.

Radiological Analysis of the Facial Recess: Impact on Posterior Tympanotomy Difficulty During Pediatric Cochlear Implantation.

We analyzed several radiological features of the facial recess to correlate them with the intraoperative findings to highlight the most reliable predictors of posterior tympanotomy difficulty. Retrospective observational cohort study. Multicenter study at tertiary referral institutions. We included 184 pediatric patients who underwent cochlear implantation through the posterior tympanotomy approach. The correlation was attempted between 8 radiological features in the preoperative high-resolution computed tomography scan and intraoperative surgical difficulty. Posterior tympanotomy was straightforward in 136 (73.9%) patients. In contrast, it was challenging in 48 (26.1%) patients. The facial recess was aerated in 74.5% of patients. The mean (SD) posterior tympanotomy depth was 3.98 (0.867) mm. The mean (SD) chorda-facial angle was 27.67° (3.406°). The mean (SD) chorda-facial to stylomastoid length was 3.898 (0.6304) mm. The mean (SD) facial nerve second genu angle was 94.54° (6.631)°. Deep-unaerated facial recess wall was associated with the most difficulty. There was a statistically significant difference in the unchallenging and challenging posterior tympanotomy groups regarding the surgical duration (P < .0001). According to this analytic study, the chorda-facial angle, the facial recess aeration, and the chorda-facial to stylomastoid length were respectively the strongest preoperative radiological predictors of the surgical difficulty of posterior tympanotomy during cochlear implantation. Chorda-facial angle <25.5° was associated with difficult posterior tympanotomy. The oblique parasagittal cut was essential for the radiological analysis of the facial recess.

English

BACKGROUND Chronic otitis media (COM) of squamosal type is associated with cholestatoma with potential complications. Clinical examination and high resolution computed tomography (HRCT) scans are necessary to assess the disease site and extension. The purpose of the study was to compare the preoperative HRCT findings with the intraoperative surgical findings in squamosal type of chronic otitis media as well as various parameters in HRCT temporal bone and intraoperative findings. METHODS A prospective study was conducted on 30 patients aged between 18 and 60 years of both the genders who presented with chronic otitis media squamosal type, for a period of 22 months who attended the outpatient department of ENT. RESULTS HRCT findings and intraoperative findings were compared and results were analysed. Facial canal erosion (P - 0.0031), tegmen plate erosion (P - 0.0001), sigmoid sinus plate erosion (P - 0.002) were found to be statistically significant. Lateral semicircular canal fistula (P - 0.36) and ossicular status malleus (P - 1.000), incus (P - 0.949), stapes suprastructure (P - 0.984), and stapes footplate erosion (P - 0.977) were found to be statistically insignificant. CONCLUSIONS In our study, HRCT imaging for COM squamosal type, accurately depicted the soft tissue mass, erosion of tegmen plate, sigmoid sinus plate, scutum, lateral semicircular canal fistula, incus and suprastructure of stapes erosion and the same were found intraoperatively as well. Our study showed good comparison between the preoperative HRCT scans and the surgical findings in cholesteatoma cases. HRCT is confirmed to be valuable in the diagnosis and in guiding the surgical management of cholesteatoma. KEY WORDS Chronic Otitis Media, Cholesteatoma, HRCT Temporal Bone, Modified Radical Mastoidectomy

Correlation of Preoperative Computerized Tomography Scoring System and the Surgical Encounters in Cochlear Implantation

Objective:To propose a numerical radiological scoring system of the pre-operative high-resolution computed tomography scan aiming to predict the surgical difficulty during cochlear implantation.Methods:This was a retrospective study of 272 pediatric patients who underwent cochlear implantation in 3 tertiary referral centers from April 2017 to August 2019. The correlation was attempted between our proposed scoring system (consisting of 8 radiological features) and the intraoperative surgical difficulty both objectively and subjectively.Results:our proposed scoring system showed a statistically significant correlation with surgical difficulty and also the duration of surgery. Scoring 5 or more predicted the surgical difficulty with a sensitivity of 80.85% and a specificity of 92.13%. The absence of air cells around the facial recess was the most independent predictor of difficulty (P value = .002).Conclusion: This proposed radiological scoring system is a simple reliable method to predict the difficulty which we may encounter during CI surgery. Scoring of 5 or more would predict intraoperative difficulty as opposed to less scoring which would predict a straightforward surgery.

Serum S100 calcium-binding protein A4 as a novel predictive marker of acute exacerbation of interstitial pneumonia after surgery for lung cancer

BackgroundAcute exacerbation (AE) of interstitial pneumonia (IP) is the most fatal complication after lung resection for lung cancer. To improve the prognosis of lung cancer with IP, the risk factors of AE of IP after lung resection should be assessed. S100 calcium-binding protein A4 (S100A4) is a member of the S100 family of proteins and is a known marker of tissue fibrosis. We examined the usefulness of S100A4 in predicting AE of IP after lung resection for lung cancer.MethodsThis study included 162 patients with IP findings on preoperative high-resolution computed tomography scan who underwent curative-intent lung resection for primary lung cancer between April 2007 and March 2019. Serum samples were collected preoperatively. Resected lung tissue from 76 patients exhibited usual IP (UIP) pattern in resected lung were performed immunohistochemistry (IHC). Relationship between S100A4 and the incidence of AE of IP and short-term mortality was analyzed.ResultsThe receiver operating characteristic area under the curve for serum S100A4 to predict postoperative AE of IP was 0.871 (95% confidence interval [CI], 0.799–0.943; P < 0.001), with a sensitivity of 93.8% and a specificity of 75.3% at the cutoff value of 17.13 ng/mL. Multivariable analysis revealed that a high serum S100A4 level (> 17.13 ng/mL) was a significant risk factor for AE of IP (odds ratio, 42.28; 95% CI, 3.98–449.29; P = 0.002). A 1-year overall survival (OS) was significantly shorter in patients with high serum levels of S100A4 (75.3%) than in those with low serum levels (92.3%; P = 0.003). IHC staining revealed that fibroblasts, lymphocytes, and macrophages expressed S100A4 in the UIP area, and the stroma and fibrosis in the primary tumor expressed S100A4, whereas tumor cells did not.ConclusionsSerum S100A4 had a high predictive value for postoperative AE of IP and short-term mortality after lung resection.

Sensitivity of High-Resolution Computed Tomography in Otosclerosis Patients undergoing Primary Stapedotomy.

To determine the incidence of abnormal otospongiotic or otosclerotic findings on high-resolution computed tomography (HRCT) as read by local radiologists in patients with surgically-confirmed otosclerosis. Retrospective chart review. Tertiary-referral private otology-neurotology practice. Adults (>18 years old) with surgically-confirmed otosclerosis between 2012 and 2017 with a HRCT performed preoperatively. Preoperative HRCT then stapedotomy. Positive identification and location of radiographic otosclerosis as reported by the local radiologist. We then correlated the CT with surgical location as documented at time of surgery. Audiometry, demographic data, intraoperative findings, and surgical technique were secondarily reviewed. Of the 708 stapes surgeries were performed during the study time frame. Preoperative HRCT scans were available for 68 primary stapedotomy surgeries performed in 54 patients. Otosclerosis was reported in 20/68 (29.4%). Following a negative report by the local radiologist, a re-review by the surgeon and/or collaborating neuroradiologist confirmed otosclerosis in 12/48 additional cases (25.0%). There was an overall sensitivity of 47.1%. Intraoperatively, cases with negative reads tended to have more limited localization at the ligament (8.7%) or anterior crus (39.1%), compared with positive reads, which demonstrated more extensive involvement, with bipolar foci (30.0%) or diffuse footplate manifestations (20.0%) more common. Acoustic reflexes were characteristically absent. While HRCT may aid in the diagnosis of otosclerosis and rule out concomitant pathology in certain cases of clinical uncertainty or unexplained symptoms, its sensitivity for otosclerosis remains low. HRCT should not be relied upon to diagnose routine fenestral otosclerosis.

Effect of mastoid bone pneumatization on the conformation and depth of the sinus tympani, a high-resolution computed tomography study.

To investigate the relationship between mastoid pneumatization and the conformation and depth of the sinus tympani (ST) in patients with chronic otitis media (COM), based on the high-resolution computed tomography (HRCT) scans. Two hundred and two patients affected by COM were included in the study. The patients were divided into three groups according to the extent of mastoid pneumatization on HRCT scans; pneumatized (group 1), diploic (group 2) or sclerotic (group 3). The variation in the ST area (types A, B, C) was assessed using a radiomorphological classification based on the relationship between the medial boundary of the ST and the third portion of the facial nerve. Depth of the ST was calculated by measuring the distance between the medial boundary of the ST and medial boundary of the third portion of the facial nerve RESULTS: There was a statistically significant difference between the groups in terms of the type of ST (p < 0.001). The mean depths of the ST were 1.59 ± 0.82mm (0.00-2.80mm) in group 1, 1.10 ± 0.79mm (0.00-3.00mm) in group 2 and 0.53 ± 0.63mm (0.00-2.60mm) in group 3. The groups were significantly different in terms of the depth of the ST (p < 0.001). A well-pneumatized mastoid is highly associated with a deep and posteriorly positioned ST with respect to the facial nerve. The preoperative HRCT scans of patients with cholesteatoma should be carefully evaluated to determine the conformation and depth of the ST.

Predicting depth of electrode insertion by cochlear measurements on computed tomography scans.

To evaluate the effectiveness of cochlear measures obtained by high-resolution computed tomography (HRCT) scan in predicting depth of cochlear implant insertion. Retrospective case review. Patients who underwent cochlear implantation in an academic referral center between 2010 and 2013 were considered. Inclusion criteria included available preoperative HRCT scan and complete operative data. Subjects with labyrinthitis ossificans, cochlear hypoplasia, or major inner ear malformations were excluded. Subsequently, measures of cochlear height in the coronal plane and basal turn width in the axial plane were obtained using electronic calipers of the stored digital HRCT images by a blinded investigator. The insertion was considered deep when the electrode was placed at least 23 mm into the cochlea. Subjects were divided into those who had a deep insertion and those who did not. Regression analyses were done to associate cochlear measures with deep insertion. A deep insertion was possible in 25 patients out of 35. There was no statistically significant association between deep insertion and age at implantation, gender, and type of cochleostomy. The mean cochlear height was 6.22 mm (standard deviation [SD] = 0.32 mm) and 5.80 mm (SD = 0.3mm) in subjects with and without deep insertion, respectively (Student t test, P = .0015). Only cochlear height showed an association with deep insertion (logistic regression, P = .0007). For a cochlear height of 6.27 mm, the probability of deep insertion was 0.90. Linear measurements of standard CT scans of the cochlea can predict the depth of insertion and may help the selection of the appropriate electrode array preoperatively. 4. Laryngoscope, 126:1656-1661, 2016.

A novel tool for three-dimensional roadmapping reduces radiation exposure and contrast agent dose in complex endovascular interventions

The volume and complexity of endovascular procedures are increasing. Multidetector computed tomography (CT) made precise three-dimensional (3D) planning of these procedures possible, but intraoperative imaging, even with the use of modern flat-panel detectors, is limited to two dimensions. Flat detectors, however, allow C-arm cone-beam CT. This technology can be used to generate a 3D data set that can be fused with a preoperative high-resolution CT scan, thus generating a live 3D roadmap. We hypothesized that use of a novel image fusion software, VesselNavigator (Philips Healthcare, Best, The Netherlands), facilitates precise and expeditious procedures and therefore reduces radiation exposure and contrast agent dose. A retrospective review of patients undergoing standard aortobi-iliac endovascular aneurysm repair at our institution between January 2011 and April 2014 was performed. Conventional imaging was compared with VesselNavigator-assisted imaging, and a matched analysis based on body mass index (BMI) was performed because of the dependence of radiation dose on body habitus. Outcome parameters were procedure time, fluoroscopy time, radiation, and contrast agent dose. A total of 75 patients were identified. After matching based on BMI, control and VesselNavigator groups each had 16 patients with BMI of 27.0 ± 3.6 kg/m(2) and 27.0 ± 3.6 kg/m(2), respectively (mean ± standard deviation). R(2) was 6.37 × 10(-7). Radiation dose measured as air kerma was lower with VesselNavigator (1067 ± 470.4 mGy vs 1768 ± 696.2 mGy; P = .004). Fluoroscopy time was shorter (18.4 ± 6.8 minutes vs 26.8 ± 10.0 minutes; P = .01) and contrast agent dose was lower (37.4 ± 21.3 mL vs 77.3 ± 23.0 mL; P < .001) with VesselNavigator compared with control. Procedure time was also shorter with VesselNavigator (80.4 ± 21.2 minutes vs 110.0 ± 29.1 minutes; P = .005). Image fusion using VesselNavigator enhances the functionality of conventional fluoroscopy in standard endovascular aneurysm repair. It reduces radiation exposure to patients and providers. It also limits the amount of contrast agent and shortens the overall procedure length. The benefit of this technology is demonstrated on this typically straightforward procedure but may be even more useful for complex procedures.

Role of high-resolution computed tomography scan in the evaluation of cholesteatoma: A correlation of high-resolution computed tomography with intra-operative findings

Context: Correlation of the extent of disease on a high-resolution computed tomography (HRCT) temporal bone with intraoperative findings. Aim: This study was done to find the correlation between the preoperative HRCT scan and intra-operative findings in patients diagnosed with chronic suppurative otitis media (CSOM) attico-antral type of disease. Settings and Design: The study was done at a tertiary care hospital, and a cross-sectional study design was employed. Subjects and Methods: The findings of HRCT scan of 25 patients clinically diagnosed to have CSOM attico-antral type of disease were compared with the intraoperative findings. The commonly affected structural parameters were compared. Statistical Analysis Used: Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 11.5 (SPSS: An IBM company). For the current study, kappa, frequency and percentage were considered. Results: HRCT scan was found to have a high sensitivity for identification of the disease at most of the sites within the temporal bone except for the sinus tympani and the stapes region. Conclusion: A HRCT scan acts a good preoperative imaging modality for the otologist to predict disease during the surgery and to explain the possible outcomes to the patient.

Why Do We Not Need CT in Patients Who Undergo Type I Tympanoplasty?

Introduction Since its advent in the 1980s, high-resolution computed tomography (HRCT) of the temporal bone has played an important role in the evaluation of chronic otitis media (COM) (1). It provides a detailed assessment of complex bony structures of the middle ear and mastoid cavity; thus, surgeons can visualize the extent of disease, status of the ossicular chain, presence of bony erosion, or existing cholesteatoma prior to surgery (2, 3). HRCT has gained wide acceptance in the diagnostic workup of suppurative COM. Most ear surgeons order HRCT to make a rational operative plan, especially in the presence of symptoms, such as refractory otorrhea with bad odor, epithelial debris at retraction pockets, and defects in bony walls of the middle ear. Previous studies showed contradictory results with regard to the sensitivity and specificity of the preoperative HRCT scan. A preoperative HRCT scan was suggested to underestimate the actual pathology in the middle ear and was unreliable in some of the articles (4, 5). The study group in those studies included patients with diverse clinical findings and different surgical plans, including tympanomastoidectomy or open cavity mastoidectomy. This diversity of patient groups may cause certain shortcomings in the assessment of the necessity for preoperative HRCT. It is a common belief that preoperative HRCT is not necessary in patients with dry perforation and mild hearing loss in the absence of destructive middle ear pathology. But, unfortunately, few surgeons insist on ordering HRCT prior to tympanoplasty in their daily practice. This malpractice leads patients to exposure to avoidable radiation. Although there is almost a consensus that HRCT prior to surgery is unnecessary in these patients, it has not been proven yet objectively. Thus, we aimed to show the lack of necessity of preoperative HRCT by assessing its predictive value in patients who undergo type I tympanoplasty. Methods This retrospective study with data collection was conducted at department of Otolaryngology in Uludag University. The study group was selected from patients who underwent tympanoplasty with or without ossicular reconstruction with a diagnosis of chronic otitis media between August 2010 and February 2013. The inclusion criteria were as follows: i) presence of tympanic membrane perforation, ii) no refractory ear drainage, iii) dry ear for at least 3 months, iv) no cholesteatoma on microotoscopic examination, and v) no bony erosion or retraction pocket. At our institution, we certainly do not order preoperative CT in patients who undergo type I tympanoplasty. However, we have other patients who were referred by other colleagues for surgery with a prior HRCT. We had 43 patients who fulfilled the aforementioned criteria with a prior HRCT in the study group. The mean age of the study group was 32.44±13.78 77

Polyetheretherketone implants for the repair of large cranial defects: a 3-center experience.

Calvarial reconstruction of large cranial defects following decompressive surgery is challenging. Autologous bone cannot always be used due to infection, fragmentation, bone resorption, and other causes. Polyetheretherketone (PEEK) is a synthetic material that has many advantages in cranial-repair surgery, including strength, stiffness, durability, and inertness. To describe our experience with custom-made PEEK implants for the repair of large cranial defects in 3 institutions: San Francisco General Hospital, Hadassah-Hebrew University Hospital, and the National Neuroscience Institute, Singapore. A preoperative high-resolution computed tomography scan was obtained for each patient for design of the PEEK implant. Cranioplasty was performed via standard technique with the use of self-tapping titanium screws and miniplates. Between 2006 and 2012, 66 cranioplasties with PEEK implants were performed in 65 patients (46 men, 19 women, mean age 35 ± 14 years) for repair of large cranial defects. There were 5 infections of implants and 1 wound breakdown requiring removal of the implant (infection and surgical removal rates of 7.6% and 9.1%, respectively). Two patients required drainage of postoperative hematoma (overall surgical complication rate, 12.7%). Nonsurgical complications in 5 patients included seizures, nonoperative collection, and cerebrospinal fluid rhinorrhea that resolved spontaneously. Overall median patient or family satisfaction with the cranioplasty and aesthetic result was good, 4 on a scale of 5. Temporal wasting was the main aesthetic concern. Custom-designed PEEK implants are a good option for patients with large cranial defects. The rate of complications is comparable to other implants or autologous bone. Given the large size of these defects, the aesthetic results are good.

Management of labyrinthine fistulae in Kyoto University Hospital

Conclusion: In cases of labyrinthine fistulae, we performed complete removal of the cholesteatoma matrix in a one-stage procedure, resulting in a satisfactory bone conduction (BC) hearing preservation rate. Preoperative evaluation of labyrinthine fistulae using high resolution computed tomography (HRCT) detected 86% of cases, and this contributed to favorable results achieved with the surgical treatment of labyrinthine fistulae. We aimed to review cases of labyrinthine fistulae to summarize their outcomes and establish standards of management. Methods: This was a retrospective chart review of 22 patients with labyrinthine fistulae at Kyoto University Hospital from 2001 to 2009. Patient background (age and sex), location and stage of the fistulae, facial nerve status, preoperative and postoperative BC hearing levels, preoperative CT diagnosis, and surgical procedures were analyzed. Results: The incidence rate of the labyrinthine fistulae was 11.2%. All but one patient had labyrinthine fistula due to cholesteatoma. The fistulae were found in the lateral semicircular canal in 17 cases (77%) and in multiple organs in 4 cases (18%). The BC hearing level was preoperatively scaled out in seven cases. Preoperative HRCT scan revealed the presence of fistulae in 19 cases (86%). For all cases of cholesteatoma, the matrix was completely removed in a one-stage procedure and the fistulae were sealed using bone pate, temporal fascia, and temporal bones. Of the 15 cases with residual BC hearing ability, BC hearing was preserved in up to 12 cases. Two cases with postoperative deterioration of BC hearing had stage 4 fistulae in the cochleae.