Sagittal Plane Images Research Articles

Patellar articular overlap is better associated with patellar alignment during weight-bearing than traditional measures of patellar height

BackgroundA consequence of a high riding patella is reduced osseous stability and malalignment of the patella (i.e., lateral patellar tilt and displacement). Although quantification of patellar height is a routine part of the radiographic examination of the patellofemoral joint, it is not clear which measure of patellar height is best associated with patella alignment. Hypothesis/PurposeTo determine if patellar articular overlap (PAO) is better associated with lateral patellar tilt and lateral patellar displacement compared to traditional measures of patellar height. Study Design: Cross-sectional. MethodsMagnetic resonance images were obtained from 50 female participants (21 with patellofemoral pain and 29 healthy controls) under loaded conditions (25–35% bodyweight) at 15–20 degrees of knee flexion. Measurements of lateral patellar tilt and displacement as well as the PAO, Insall-Salvati ratio (ISV), Caton Deschamps-index (CD-index), or the Blacburn Peel-index (BP-index) were obtained from sagittal and axial plane images. ResultsThe PAO was found to significantly correlated with lateral patellar tilt (r = −0.77, p < 0.001). In contrast, the ISV, CD-index, or the BP-index were not found to be associated with lateral patellar tilt (r = 0.13, p = 0.34; r = −0.14, p = 0.33; r = −0.08, p = 0.56, respectively). Both the PAO and ISV were found to be significantly correlated with lateral patellar displacement (r = −0.52, p < 0.001; r = 0.43, p = 0.002, respectively). Conversely, the CD-index and BP-index were not found to be associated with lateral patellar displacement (r = 0.03 p = 0.83; r = 0.05 p = 0.74, respectively). ConclusionOf the measures of patellar height evaluated, the PAO was found to provide the greatest association with lateral patellar tilt and displacement.

Evaluation of Cochlear Implantation in Children With Cochlear Nerve Absence or Deficiency.

To identify associations between cochleovestibular anatomy findings and hearing outcomes found in children with imaging evidence of an absent or hypoplastic cochlear nerve treated with cochlear implantation (CI). retrospective review. Cochlear implant program at tertiary care center. A retrospective review was performed to identify children with imaging evidence of cochlear nerve absence or deficiency who underwent CI evaluation. High-resolution 3-dimensional T2-weighted magnetic resonance imaging in the oblique sagittal and axial planes were reviewed by a neuroradiologist to identify cochleovestibular anatomy. Hearing was assessed pre and postoperatively with Speech Perception Category scores. Seven CI recipients were identified (n = 10 ears) who had bilateral severe to profound sensorineural hearing loss with lack of auditory development with binaural hearing aid trial and imaging evidence of cochlear nerve aplasia/hypoplasia. All ears had 2 nerves in the cerebellopontine angle (100%, n = 10), half of the ears had evidence of 2 or less nerves in the internal auditory canal (IAC). All children showed large improvement in speech perception after CI. Our experience with CIs for children with absent or hypoplastic cochlear nerves demonstrates that CI can be a viable option in select patients who satisfy preoperative audiological criteria. Radiological identification of a hypoplastic or aplastic cochlear nerve does not preclude auditory innervation of the cochlea. CI recipients in this subgroup must be counseled on difficulty in predicting postimplantation language and speech outcomes, and cautioned about facial nerve stimulation.

Agreement in the Postural Assessment of Older Adults by Physical Therapists Using Clinical and Imaging Methods.

Postural assessment is one of the indicators of health status in older adults. Since the number of older adults is on the rise, it is essential to assess simpler methods and automated ones in the future. Therefore, we focused on a visual method (imaging method). The purpose of this study is to determine the degree of agreement between the imaging method and the palpation and visual methods (clinical method). In addition, the influence of differences in the information content of the sagittal plane images on the assessment was also investigated. In this experiment, 28 sagittal photographs of older adults whose posture had already been assessed using the clinical method were used. Furthermore, based on these photographs, 28 gray and silhouette images (G and S images) were generated, respectively. The G and S images were assessed by 28 physical therapists (PTs) using the imaging method. The assessment was based on the Kendall classification, with one of four categories selected for each image: ideal, kyphosis lordosis, sway back, and flat back. Cross-tabulation matrices of the assessments using the clinical method and imaging method were created. In this table, four categories and two categories of ideal and non-ideal (KL, SB, and FB) were created. The agreement was evaluated using the prevalence-adjusted bias-adjusted kappa (PABAK). In addition, sensitivity and specificity were calculated to confirm the reliability. When comparing the clinical and imaging methods in the four posture categories, the PABAK values were -0.14 and -0.29 for the S and G images, respectively. In the case of the two categories, the PABAK values were 0.57 and 0.5 for the S and G images, respectively. The sensitivity and specificity were 86% and 57% for the S images and 76% and 71% for the G images, respectively. The four categories show that the imaging method is difficult to assess regardless of the image processing. However, in the case of the two categories, the same assessment of the clinical method applied to the imaging method for both the S and G images. Therefore, no differences in image processing were observed, suggesting that PTs can identify posture using the visual method.

Patellar Tendon-Lateral Femoral Condyle Friction Syndrome: About 5 Cases

Objective: The objective is to illustrate the MR imaging findings occurring in the posterior inferolateral patellar tendon and the lateral femoral condyle in patients experiencing chronic anterior and/or lateral knee pain. Material and methods: A retrospective review of the MR images in (patients who presented with chronic anterior or lateral knee pain. In all patients, postcontrast images were available. Results: Sagittal and axial imaging planes best demonstrated the patellar tendon and its relationship with the lateral femoral condyle. In all the patients, there was obliteration of the fat planes and abnormal signal intensity in the lateral soft tissues of the inferior patellofemoral joint. Enhancement after administration of gadolinium was noted in all cases in which contrast was administered. One patient showed cystic changes in the soft tissues adjacent to the lateral femoral condyle in addition to fat plane obliteration. Abnormal patellar alignment was noted in one patient. Patellar tendon pathology was seen in one patient. Conclusion: When assessing anterior knee symptoms, MR imaging facilitates the identification of changes associated with patellar tendon-lateral femoral condyle friction syndrome, which should be differentiated from other causes of anterior or lateral knee pain.

Exploring the Correlation Between Body Mass Index and Knee Hoffa Fat Pad Size in MRI Sagittal Plane

Objective and Background: The relationship between body mass index (BMI) and knee Hoffa fat pad size has garnered increasing attention due to its potential implications in orthopedic pathology. This study aimed to explore the correlation between BMI and Hoffa fat pad size as measured on MRI sagittal plane images. Materials and Methods: A retrospective analysis was conducted on MRI scans of the knee joint from a cohort of patients. Sagittal plane images were reviewed, and the size of the Hoffa fat pad was measured using standardized techniques. BMI data were collected from patient records. Correlation analysis was performed to assess the relationship between BMI and Hoffa fat pad size. Results: A total of 60 MRI scans were included in the analysis. The mean BMI of the cohort was Y 29.7990. The mean size of the Hoffa fat pad was 29.7990. The age range was between 45 and 75. Correlation analysis revealed a statistically significant positive correlation between age and Hoffa fat pad size (p &lt; 0.05). Specifically, as age increased, there was a corresponding increase in the size of the Hoffa fat pad. Conclusion: This study provides evidence of a positive correlation between age and Hoffa fat pad size as observed on MRI sagittal plane images. No significant relationship was found between body mass index and Hoffa fat pad size. Further research is warranted to elucidate the underlying mechanisms and clinical implications of this relationship.

Deep-Learning-Based Automated Rotator Cuff Tear Screening in Three Planes of Shoulder MRI.

This study aimed to develop a screening model for rotator cuff tear detection in all three planes of routine shoulder MRI using a deep neural network. A total of 794 shoulder MRI scans (374 men and 420 women; aged 59 ± 11 years) were utilized. Three musculoskeletal radiologists labeled the rotator cuff tear. The YOLO v8 rotator cuff tear detection model was then trained; training was performed with all imaging planes simultaneously and with axial, coronal, and sagittal images separately. The performances of the models were evaluated and compared using receiver operating curves and the area under the curve (AUC). The AUC was the highest when using all imaging planes (0.94; p < 0.05). Among a single imaging plane, the axial plane showed the best performance (AUC: 0.71), followed by the sagittal (AUC: 0.70) and coronal (AUC: 0.68) imaging planes. The sensitivity and accuracy were also the highest in the model with all-plane training (0.98 and 0.96, respectively). Thus, deep-learning-based automatic rotator cuff tear detection can be useful for detecting torn areas in various regions of the rotator cuff in all three imaging planes.

Orbital Fractures: A New CT-Based Protocol to Guide the Surgical Approach and Reconstruction Material Decision-Making.

Preoperative computer-assisted planning and intraoperative navigation are becoming popular for orbital fracture treatment. However, not all institutions currently have access to these computer-aided applications. The authors present a simple and intuitive operative algorithm to guide orbital fracture reconstructions. The operative algorithm was based on linear measurements of orbital defects on high-resolution Computer tomography (CT) scans using specific axial, coronal, and sagittal plane images. The fractures were then divided into 3 types based on site and defect-size area. For each type, the authors suggested a surgical approach and material reconstruction. Between February 2022 and January 2023, 57 patients were treated according to the described CT-based protocol. The quality of reconstruction was classified as ideal, satisfactory, acceptable, and poor based on postoperative CT. Diplopia, enophthalmos, and postoperative complications were assessed. Fifty-seven patients were included. Forty-four (77.2%) patients were included in the type 1 group, 4 (7.01%) in the type 2 group, and 9 (15.79%) in the type 3 group. The reconstruction was considered ideal in 54 (94.7%) cases, satisfactory in 2 (3.5%), and acceptable in 1 (1.8%). No revision surgery was required. In all cases, preoperative diplopia was settled out, and only 1 patient reported postoperative enophthalmos. No complications occurred, with good clinical results and orbital symmetry. The linear CT measurement-based protocol is a simple and reliable workflow to guide the surgeon's choice of reconstruction material and surgical approach for primary orbital reconstruction. It allows good management of orbital trauma and could help standardize treatment decisions with an imaging technique available in all institutions.

Does Preoperative Modic Changes Influence the Short-term Fusion Rate of Single Level Transforaminal Lumbar Interbody Fusion?-a Matched-pair Case Control Study.

At present, the influence of Modic changes (MCs) on postoperative fusion rate of lumbar interbody fusion (LIF) is mainly focused on the medium- and long-term fusion rate, while the short-term fusion rate has not been reported. The aim of this study was to compare the short-term fusion rate of lumbar degenerative disease patients with and without MCs after single level transforaminal lumbar interbody fusion (TLIF). In this retrospective and matched-pair case control study, we included 100 patients who underwent TLIF from January 2017 to January 2020 and had at least two follow-up visits over a two-year period. Fifty patients with MCs (MCs group) were matched with 50 patients without MCs (non MCs group) for age, sex, surgical level, diagnosis, operative time, and intraoperative blood loss. We collected the X-ray and computed tomography (CT) data of patients from 3 months to 2 years after the operation to assess bony fusion and the cage union ratio. According to the type of cage, the MCs group was further divided into the nano-hydroxyapatite/polyamide 66 (n-HA/PA66) group and polyetheretherketone (PEEK) group, and the fusion performance between the two groups was compared. Finally, age, sex, body mass index (BMI), smoking and cage type were included in the logistic regression model for risk factor analysis. The bony fusion rates in the MCs group at 3 months, 6 months, 1 year and 2 years after surgery were significantly lower than those in the non MCs group (P < 0.05) (23.8% vs 62.5%, 52.6% vs 78.9%, 61.1% vs 83.3%, 74.0% vs 90.0%). The average coronal cage union ratios of the upper and lower endplates in the MCs group were significantly lower than those in the non MCs group (54.3% ± 17.5% vs 75.0% ± 17.2%, P < 0.05; 73.3% ± 12.0% vs 84.9% ± 8.0%, P < 0.05). Similarly, analogous results were obtained by comparing the MCs and non MCs groups' three-dimensional CT sagittal plane images (62.5% ± 16.5% vs 76.1% ± 12.4%, P < 0.05; 67.0% ± 13.9% vs 79.8% ± 11.5%, P < 0.05). Short-term fusion rates were lower in the MCs group than in the non MCs group. The coronal and sagittal cage union ratio in the MCs group was lower than that in the non MCs group. The fusion performance of n-HA/PA66 and PEEK cages in the MCs group was comparable.

Newly Developed Resorbable Magnesium Biomaterials for Orbital Floor Reconstruction in Caprine and Ovine Animal Models-A Prototype Design and Proof-of-Principle Study.

orbital floor fractures have not been reconstructed using magnesium biomaterials. To test technical feasibility, ex vivo caprine and ovine heads (n = 5) were used. Head tissues were harvested from pubescent animals (n = 5; mean age: 3.2 years; mean mass: 26.3 kg) and stored below 11 degrees for 7-10 days. All procedures were performed in a university animal resource facility. Two experienced maxillofacial surgeons performed orbital floor procedures in both orbits of all animals in a step-by-step preplanned dissection. A transconjunctival approach was chosen to repair the orbital floor with three different implants (i.e., magnesium implants; titanium mesh; and polydioxanone or PDO sheets). The position of each implant was evaluated by Cone-beam computed tomography (CBCT). Axial, coronal, and sagittal plane images showed good positioning of the magnesium plates. The magnesium plates had a radiographic visibility similar to that of the PDO sheets but lower than that of the titanium mesh. The prototype design study showed a novel indication for magnesium biomaterials. Further testing of this new biomaterial may lead to the first resorbable biomaterial with good mechanical properties for extensive orbital wall defects.

Skeletal Muscle Ultrasonography and Muscle Fitness Relationships: Effects of Scanning Plane and Echogenicity Correction

This study examines the relationships between ultrasonography measurements of skeletal muscle size and echo intensity (EI) with muscle strength and local muscle endurance in a habitually resistance-trained population. Twenty young, healthy participants underwent imaging of the biceps brachii in the sagittal and transverse planes and with the extended field of view (EFOV) technique. Linear regression was used to examine measures of muscle thickness (MT), muscle cross-sectional area (mCSA), EI, and corrected EI (cEI) in each scanning plane for their associations with strength (1RM biceps curl) and local muscle endurance (4x failure @ 50%1RM). The strongest predictor of 1RM strength and local muscle endurance was sagittal MT (adj. R2 = 0.682) and sagittal cEI (adj. R2 = 0.449), respectively. Strength and transverse MT (R2 = 0.661) and the EFOV mCSA (R2 = 0.643) demonstrated a positive relationship. Local muscle endurance and cEI in the transverse plane (R2 = 0.265) and the EFOV scan (R2 = 0.309) demonstrated a negative relationship. No associations were shown with uncorrected EI. While each scanning plane supports the muscle size-strength and echogenicity-endurance relationships, sagittal plane imaging demonstrated the strongest associations with muscle fitness. These findings provide important methodological insights regarding ultrasound imaging and muscle fitness relationships.

Assessing lower limb angles from sagittal plane images captured with a smartphone for post-stroke gait

BACKGROUND: Clinical gait analysis of sagittal plane lower-limb kinematics using video images is a quantitative tool for clinicians. However, the reliability and validity of limb kinematics after stroke using video images has not been fully investigated. OBJECTIVE: This study aimed to examine the within-session inter-rater reliability and criterion-related validity of lower limb angles measured in sagittal plane images captured using a smartphone for assessing post-stroke gait and to determine which asymmetric parameters are associated with faster gait velocity. METHODS: Thirty-two patients with stroke were included; video images were recorded as they walked at their preferred pace for 1–3 cycles. Lower limb angles (contact, push-off, and excursion angles) and degree of asymmetry were determined based on video images using markers of acromion, greater trochanter, and fifth metatarsal head. Measurement reliability was calculated using the two-way random effects model of intraclass correlation coefficients and minimal detectable change. The criterion validity investigated Pearson’s correlation between lower limb angles and their asymmetry and gait velocity. RESULTS: The lower value of the 95% confidence interval of intraclass correlation coefficients (2.3) of the lower limb was 0.891, and the maximum minimal detectable change was 9.6 degrees. Push-off angle showed a moderate-to-strong correlation with gait velocity, whereas the asymmetry of the push-off angle showed a weak correlation with gait velocity. CONCLUSIONS: Assessing post-stroke gait utilizing video images using a smartphone is feasible. The push-off angle, in particular, may provide insight into the clinical assessment of post-stroke gait.

Evaluation of Anatomical Variation of Human Coccyx on Magnetic Resonance Imaging

Introduction: The coccyx, a triangular bone forming the last part of the vertebral column, acts as the weight-bearing structure when a person is seated, and is the site of insertion of the pelvic floor tendons and numerous ligaments attached to it. The main objective of this study was to investigate the morphology and morphometry of the coccyx on lumbar spine MRI images in asymptomatic individuals among Nepalese adults. Methods: This study was conducted retrospectively on the lumbar spine images of 190 adult population without a history of trauma in the coccyx region, from April to September 2019. The coccygeal vertebrae count, the number of bone segments, and intercoccygeal and joint fusions were determined from the sagittal plane images. In addition, the length and angles were also measured. Results: One hundred and ninety patients, with a mean age of 43.91 years, were enrolled in the study. Among the 4 types of coccyx; the most common type was type II (46.3%), followed by type I (40.5%). The coccyx was formed from 4 vertebral segments in 21.1% (n=41) individuals, 3 vertebral segments in 45.3% (n=86) individuals, 2 vertebral segments in 31.1% (n=59) individuals and 1 vertebral segment in 2.1% (n=4) individuals. Conclusions: In our study, type II coccyxes predominated. The prevalence of sacrococcygeal and intercoccygeal fusion, as well as the number of coccygeal vertebrae, were similar in the Nepalese population and the Western population.

BgNet: Classification of benign and malignant tumors with MRI multi-plane attention learning.

To propose a deep learning-based classification framework, which can carry out patient-level benign and malignant tumors classification according to the patient's multi-plane images and clinical information. A total of 430 cases of spinal tumor, including axial and sagittal plane images by MRI, of which 297 cases for training (14072 images), and 133 cases for testing (6161 images) were included. Based on the bipartite graph and attention learning, this study proposed a multi-plane attention learning framework, BgNet, for benign and malignant tumor diagnosis. In a bipartite graph structure, the tumor area in each plane is used as the vertex of the graph, and the matching between different planes is used as the edge of the graph. The tumor areas from different plane images are spliced at the input layer. And based on the convolutional neural network ResNet and visual attention learning model Swin-Transformer, this study proposed a feature fusion model named ResNetST for combining both global and local information to extract the correlation features of multiple planes. The proposed BgNet consists of five modules including a multi-plane fusion module based on the bipartite graph, input layer fusion module, feature layer fusion module, decision layer fusion module, and output module. These modules are respectively used for multi-level fusion of patient multi-plane image data to realize the comprehensive diagnosis of benign and malignant tumors at the patient level. The accuracy (ACC: 79.7%) of the proposed BgNet with multi-plane was higher than that with a single plane, and higher than or equal to the four doctors' ACC (D1: 70.7%, p=0.219; D2: 54.1%, p<0.005; D3: 79.7%, p=0.006; D4: 72.9%, p=0.178). Moreover, the diagnostic accuracy and speed of doctors can be further improved with the aid of BgNet, the ACC of D1, D2, D3, and D4 improved by 4.5%, 21.8%, 0.8%, and 3.8%, respectively. The proposed deep learning framework BgNet can classify benign and malignant tumors effectively, and can help doctors improve their diagnostic efficiency and accuracy. The code is available at https://github.com/research-med/BgNet.

Radiological evaluation of temporal bone surgical landmarks for a transcanal transpromontorial approach to the internal auditory canal using three-dimensional computed tomography.

This study aimed to analyse a three-dimensional transcanal transpromontorial approach to the internal auditory canal using three-dimensional computed tomography. This study was a retrospective investigation of 48 ears of 24 patients using three-dimensional reconstruction data from normal temporal bone computed tomography. The inner structures of the temporal bone were three-dimensionally reconstructed. Eight points were marked in the three-dimensional object with reference to the axial, coronal and sagittal plane images of the computed tomography scans. Distances and angles to each point were measured from the oval and round windows. The point of the facial nerve from the internal auditory canal to the labyrinthine segment could be traced between the cochlear apex and the geniculate ganglion based on the oval window. This technique helps with identifying the locations of important surgical landmarks using three-dimensional reconstructions of pre-operative computed tomography scans and to identify the facial nerve from the internal auditory canal during surgery.

Automatic brain tumor segmentation from Multiparametric MRI based on cascaded 3D U-Net and 3D U-Net++

PurposeBrain tumor is often a deadly disease and its diagnosis and treatment are challenging tasks for physicians for the heterogeneous nature of the tumor cells. Automatic, accurate segmentation of brain tumors can be a significant tool to assist physicians in the diagnosis of brain diseases. Existing methods can achieve general results, the segmentation accuracy not comparable to that of manual segmentation by experienced physicians, especially in enhanced tumor regions. MethodsWe trained cascaded 3D U-Net and 3D U-Net++ networks to realize the automatic segmentation of brain tumors in Magnetic Resonance Imaging (MRI) images from the Brain Tumor Segmentation Challenge 2019 dataset (BRATS 2019). First, we decompose the segmentation of brain tumor into the segmentation of the whole tumor (WT), tumor core (TC) and enhanced tumor (ET). Second, we train the models in axial, coronal, and sagittal plane images. We then fuse the results from the three views to produce the final segmentation result. In particular, the U-Net++ is used to segment the enhanced tumor for the latter’s more complex structure compared with other sub-regions. We also tested the performance of the methods on a clinical MRI image dataset with manual standard tumor contours. ResultsThe networks’ performances were verified on BRATS 2019 images. On the clinical dataset, we got DSC metric values of 0.890, 0.842, and 0.835 for the complete, core, and enhanced regions respectively. Segmentation performance on the clinical dataset, especially the performance of 3D-UNet++, has been approved by physicians. ConclusionThe method’s performance is clinically of significance.

Feasibility of Constructing an Automatic Meniscus Injury Detection Model Based on Dual-Mode Magnetic Resonance Imaging (MRI) Radiomics of the Knee Joint.

Objective To explore the feasibility of automatically detecting the degree of meniscus injury by radiomics fusion of dual-mode magnetic resonance imaging (MRI) features of sagittal and coronal planes of the knee joint. Methods This retrospective study included 164 arthroscopically confirmed meniscus injuries in 152 patients admitted to the Department of Orthopaedics of our hospital from July 2018 to March 2021. A total of 1316-dimensional radiomics signatures were extracted from single-mode sagittal and coronal plane images of menisci, respectively. Then, the sagittal and coronal plane features were fused to form a dual-mode joint feature group with a total of 2632-dimensional radiomics signatures. The minimum redundancy maximum relevance (mRMR) algorithm and the least absolute shrinkage and selection operator (LASSO) regression were used to select features and generate optimal radiomics signatures. The single-mode sagittal plane feature model (Model 1), single-mode coronal plane feature model (Model 2), and the combined sagittal and coronal plane feature model (Model 3) performance were tested by receiver operating characteristic (ROC) curves and Delong test. The calibration curve test was used to verify the reliability of radiomics signatures of the three models. Results The average intra- and interobserver intraclass correlation coefficients (ICCs) of the most significant 8-dimensional radiomics signatures of Model 1 and Model 2 were 0.935 (range 0.832-0.998) and 0.928 (range 0.845-0.998), respectively. All the three models had good detection performance; Model 3 had the most significant performance (the areas under the curve (AUCs) of training, and validation sets were 0.947 and 0.923, respectively), which was superior to Model 1 (AUCs of training set and validation set were 0.889 and 0.876, respectively) and Model 2 (AUCs of training set and validation set were 0.831 and 0.851, respectively). The detection probability of training and validation sets in the three models was highly consistent with the actual clinical probability. Conclusions It is feasible to establish a model for automatic detection of meniscus damage by means of radiomics. The detection performance of the dual-mode knee MRI model is better than that of any single-mode model, showing potent feature analysis ability and outstanding detection performance.

Pre-FESS Imaging of Paranasal Sinuses and Nasal Cavity: Using Multi-detector Computed Tomography (MDCT) in Understanding Normal Anatomy and Anatomical Variations: Tips and Tricks.

With the advent of Multi-detector Computed Tomography (MDCT), imaging evaluation of paranasal sinuses (PNS) and nasal cavity has witnessed a paradigm shift. Submillimetric slice thickness with superior quality multiplanar reconstructions in orthogonal as well as non-orthogonal planes have resulted in better understanding of the intricate details of complex sino-nasal anatomy and their normal variations. Sagittal plane images have gained increasing acceptance among the sinus surgeons for understanding frontal sinus drainage pathway as well as lateral nasal wall. Analyzing the axial volume dataset in three dimensions has become a routine both for the radiologists as well as sinus surgeon. Besides default window settings, customized window settings enable better appreciation of air containing structures and their boundaries. Mandatory scan check list and template based structured reporting helps the sinus surgeon in better pre-operative planning. Regular mutual interaction between radiologists and sinus surgeon helps better understanding of the surgically relevant anatomy and anatomical variations.

A New Coordinate System for Magnetic Resonance Imaging of the Vestibular System.

Objectives: To develop and evaluate a new coordinate system for MRI of the vestibular system.Methods: In this study, 53 internal auditory canal MRI and 78 temporal bone CT datasets were analyzed. Mimics Medical software version 21.0 was used to visualize and three-dimensionally reconstruct the image data. We established a new coordinate system, named W–X, based on the center of the bilateral eyeballs and vertex of the bilateral superior semicircular canals. Using the W–X coordinate system and Reid's coordinate system, we measured the orientations of the planes of the anterior semicircular canal (ASCC), the lateral semicircular canal (LSCC), and the posterior semicircular canal (PSCC).Results: No significant differences between the angles measured using CT and MRI were found for any of the semicircular canal planes (p > 0.05). No statistical differences were found between the angles measured using Reid's coordinate system (CT) and the W–X coordinate system (MRI). The mean values of ∠ASCC & LSCC, ∠ASCC & PSCC, and ∠LSCC & PSCC were 84.67 ± 5.76, 94.21 ± 3.81, and 91.79 ± 5.22 degrees, respectively. The angle between the LSCC plane and the horizontal imaging plane was 15.64 ± 3.92 degrees, and the angle between the PSCC plane and the sagittal imaging plane was 48.79 ± 4.46 degrees.Conclusion: A new W–X coordinate system was developed for MRI studies of the vestibular system and can be used to measure the orientations of the semicircular canals.

Endotracheal tube cuff position in relation to the cricoid in children: A retrospective computed tomography-based analysis.

Background:The use of cuffed endotracheal tubes (ETT) has become the standard of care in pediatric practice. The rationale for the use of a cuffed ETT is to minimize pressure around the cricoid while providing an effective airway seal. However, safe care requires that the cuff lie distal to the cricoid ring following endotracheal intubation. The current study demonstrates the capability of computed tomography (CT) imaging in identifying the position of the cuff of the ETT in intubated patients.Methods:In this retrospective study, the ETT cuff position was examined on the sagittal plane images of neck and chest CT scans of 44 children. The position of the proximal and the distal aspect of the ETT cuff inside the trachea was recorded in relation to the vertebral levels. The vertebral levels were used to estimate the location of the cricoid ring and its relationship to the cuff.Results:The vertebrae were used as the primary landmarks to define the position of the cricoid and its relationship to the cuff of the ETT. Correlating vertebral levels with the cricoid for different age groups, the proximal (cephalad) edge of the ETT cuff was below the cricoid in 41 of 44 patients (93%). The ETT cuff was deep in 6 patients, below the 1st thoracic vertebra, with 2 ETTs in the right mainstem bronchus.Conclusion:This is the first study demonstrating that the cuff of the ETT and its position in the trachea can be identified on CT imaging in children. The ETT cuff was below the level of the cricoid in the majority of patients irrespective of the patient's age as well as the size, make, and type of ETT.

Effect of Time on MRI Appearance of Graft After ACL Reconstruction: A Comparison of Autologous Hamstring and Quadriceps Tendon Grafts

Background:After anterior cruciate ligament (ACL) reconstruction (ACLR), changes in the appearance of the ACL graft can be monitored using magnetic resonance imaging (MRI).Purpose:The purpose of this study was to evaluate and compare the MRI signal intensity (SI) of hamstring and quadriceps tendon grafts during the first postoperative year after ACLR. As a secondary aim, the relationship of SI to clinical and anatomic measurements was analyzed.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 78 patients who underwent ACLR with an autologous graft were reviewed; 55 received hamstring grafts and 23 received quadriceps tendon grafts. At 3 and 9 months postoperatively, 3-T MRI was performed using a dedicated knee coil, and the median SI of the intra-articular ACL graft was measured on sagittal-plane images. Postoperative lateral radiographs were analyzed to determine medial and lateral posterior tibial slope (PTS). Side-to-side difference in anterior knee laxity between injured and uninjured limbs was measured at 6 and 12 months postoperatively.Results:The median SI of quadriceps grafts was significantly greater than hamstring grafts at 3 months after ACLR (P = .02). Between 3 and 9 months, the median SI of quadriceps grafts decreased (P < .001), while that of hamstring grafts did not significantly change (P = .55). The lateral PTS was significantly correlated with median SI measurements at 3 and 9 months such that greater lateral PTS values were associated with greater median SI. The side-to-side difference in anterior knee laxity decreased for the quadriceps group (P = .04) between 6 and 12 months but did not change for the hamstring group (P = .88).Conclusion:The median SI of quadriceps grafts significantly decreased on MRI between 3 and 9 months after ACLR, while the median SI of hamstring grafts did not significantly change. The change in MRI appearance of the quadriceps grafts was paralleled by a reduction in anterior knee laxity between 6 and 12 months after surgery. In the absence of standardized imaging techniques and imaging analysis methods, the role of MRI in determining graft maturation, and the implications for progression through rehabilitation to return to sport, remain uncertain.