Soft Tissue Components Research Articles

Development of a novel 3D-printed and silicone live-wire model for thyroidectomy

PurposeWe present the development and validation of a novel and innovative low-cost model for thyroidectomy. The purpose is to provide a high-fidelity and inexpensive method to provide repetition to surgeons early on the learning curve. Materials and methodsThe model consists of a 3D-printed laryngeal and tracheal framework, with silicone components to replicate the thyroid gland, strap muscles, and skin. A copper wire models the recurrent laryngeal nerve and is circuited with a buzzer to indicate contact with instruments. Thirteen resident trainees successfully completed the simulated thyroidectomy after viewing an instructional video. Face validity of the model was assessed with a 19-item 5-point Likert scale survey. Subject performance was assessed using a checklist of procedure steps. ResultsParticipant feedback indicated enthusiasm for realism of the recurrent nerve (4.46 average Likert rating, 5 indicates strong agreement), dissection of the nerve (4.15), use of the buzzer (4.69), and overall satisfaction (4.46). Soft tissue components scored poorly including realism of the skin (3.08), thyroid gland (3.31), and mobilization of the lobe (3.23), identifying aspects to improve. All participants reported increased confidence with thyroid surgery after using the model; this was most pronounced among junior residents (1.5 ± 0.76 versus 3.13 ± 1.13; p = 0.016). ConclusionThyroidectomy requires repetition and volume to gain competence. Use of the simulator early in training will provide confidence and familiarity, to enhance the educational value of subsequent live surgery.

Outcome of patients with PSMA-PET/CT screen failure by VISION criteria and treated with 177Lu-PSMA therapy.

39 Background: The VISION trial showed that 177Lu-PSMA can prolong survival and improve the quality of life of patients with advanced mCRPC. The VISION trial used PSMA-PET/CT to select patients for inclusion. Here, we evaluated the outcome of patients treated with 177Lu-PSMA who would have been screen failure (SF) by VISION-PET criteria. Methods: We conducted a retrospective cohort study in our institutional database of patients treated with ≥1 cycle of 177LuPSMA between November 2017 and July 2021 (n = 74) and a multicenter dataset published previously (n = 230) (Gafita A, Lancet Oncol 2021). One dual certified reader (M.H.) in nuclear medicine and radiology blinded for patient outcomes reviewed the baseline PSMA-PET/CT scans to define eligible (VISION-PET-E) vs SF (VISION-PET-SF) patients. VISION-PET- SF criteria were defined as:1) absence of metastatic lesion with uptake > liver background (i.e., low PSMA expression) or 2) presence of ≥ 1 metastatic lesion measurable by CT (≥ 1 cm for bone lesions with soft-tissue component (M1b) and solid/visceral organs lesions (M1c); ≥ 2.5 cm for lymph nodes lesions (N1-M1a)) with uptake ≤ liver background (i.e., PSMA-negative lesions). Outcome measures included PSA response rates (decline of ≥50% (PSA50RR) and any decline (anyPSARR)), PSA-progression free-survival (PSA-PFS), and overall survival (OS). Results: 3/304 patients (1%) were excluded (lost to follow-up (n = 2), missing DICOM CT images (n = 1)). 272/301 (90.4%) of the analyzed patients were VISION-PET-E while 29/301 (9.6%) were VISION-PET-SF: 8/301 (2.7%) with low PSMA expression and 21/301 (7.0%) with PSMA-negative lesions, respectively. The median follow-up time was 12.6 months (IQR: 7.0-21.3, range: 0.6-62.3). VISION-PET-SF patients had a worse PSA50RR (21% vs 50%; p = 0.005), anyPSARR (41% vs 71%; p = 0.003), median PSA PFS (2.1 months (1.1-3.3) vs. 4.1 (4.0-5.8); p = 0.023)), and tended to have a shorter median OS (9.6 months (4.7-14.0) vs. 14.2 (12.6-15.9); p = 0.16) than the VISION-PET-E patients. Patients with PSMA-negative lesion (n = 21) tended to have a worse response than those with low PSMA expression (n = 8): median OS 8.2 months (4.4-11.0) vs. NA (11.1-NA) (p = 0.034), median PSA-PFS 1.8 months (1.4-3.3) vs. 2.8 (1.1-5.7) (p = 0.44), PSA50RR 19% vs 25% (p = 1.00), and any PSARR 38% vs 50% (p = 0.68). Conclusions: Some have argued that the low SF rate of 12.6% (126/1003) in the VISION trial may obviate the need for PSMA-PET eligibility screening prior to 177Lu-PSMA. Here we report that VISION-PET-SF patients had worse outcomes than VISION-PET-E patients in response to 177Lu-PSMA therapy. The best management of patients with negative or low PSMA expressing lesions is unknown. Combining 177Lu-PSMA with external-beam RT and/or with other systemic therapy may be an effective therapeutic approach. Refinements in patient selection for 177Lu-PSMA are needed to optimize patient outcomes.

Utility of apparent diffusion coefficient (ADC) values in differentiating benign and malignant skull lesions with histopathological (HPE) correlation

AimAssess role of ADC in differentiating benign and malignant skull lesions and to evaluate the added value of ADC over conventional MRI in facilitating the differentiation. Materials and methods53 patients (24 males, 29 females; age 3–75 years) were subjected to both conventional and Diffusion weighted (DWI) MR imaging. DWI was performed using a single-shot SE EPI sequence with b-values of 0& 1000 s/mm2 on 1.5 T MR scanner. Margins of the lesion, number, soft-tissue component, local extension, periosteal reaction and enhancement pattern were the parameters used for differentiating benign & malignant lesions by conventional MRI. ADC values (mean of 3 ROIs over solid component) were calculated. Conventional MRI characteristics and ADC value of lesions were evaluated & compared using statistical analysis. These findings were compared and correlated with histopathology of the skull lesions. Results24 malignant and 29 benign lesions were identified on HPE (Histopathological examination) in 53 patients. ADC cut-off value of 0.96 × 10−3 mm2/s obtained from ROC curve was found to have 75.47% accuracy, 87.5% sensitivity, 65.52% specificity, 67.74% PPV and 86.36% NPV for differentiating malignant from benign lesions. Statistically significant differences (p < 0.05) were seen in the mean ADC values of malignant (0.64 ± 0.42 × 10−3 mm2/s) and benign lesions (1.14 ± 0.56 × 10−3 mm2/s). The sensitivity, specificity, PPV and NPV in differentiating benign & malignant skull lesions were found to be 58.33%, 62.07%, 56% and 64.29% respectively, with diagnostic accuracy of 60.38% on using conventional MRI alone and 75%, 72.41%, 69.23% and 77.78% respectively, with diagnostic accuracy of 73.58% on using conventional MRI with ADC. ConclusionADC is a promising non-invasive parameter that facilitates differentiation between benign and malignant skull lesions. It is a robust biomarker to narrow differentials when conventional imaging features are indeterminate.

Role of Radiology in Diagnosis of Temporomandibular Joint Disorders

The diagnosis and management of temporomandibular disorders (TMD) require both clinical andimaging examinations of the temporomandibular joint (TMJ). A variety of modalities can be used toimage the TMJ, including magnetic resonance imaging (MRI), computed tomography (CT), cone beamCT, ultrasonography, conventional radiography. The present review outlines the indications of the mostfrequently used imaging techniques in TMD diagnosis.Because of the anatomic complexity of the TMJ, imaging can be difficult. Choosing the properimaging technique is essential. Conventional radiography, nowadays, is of limited interest. The useof flat plane films for TMJ pathology is not sufficient, because this joint requires three dimensionalimaging views. Osseous changes are better visualized with CT and cone beam CT. Cone beam CTprovides high-resolution multiplanar reconstruction of the TMJ, with a low radiation dose, withoutsuperimposition of the bony structures. MRI is a noninvasive technique, considered to be the goldstandard in imaging the soft tissue components of the TMJ. MRI is used to evaluate the articular disc interms of location and morphology. Moreover, the early signs of TMD and the presence of joint effusioncan be determined. High-resolution ultrasonography is a noninvasive, dynamic, inexpensive imagingtechnique, which can be useful in diagnosing TMJ disc displacements. The diagnostic value of highresolutionultrasonography is strictly dependent on the examiner’s skills and on the equipment used.

Radiological Assessment of Giant Cell Tumour of Bone in the Sacrum: From Diagnosis to Treatment Response Evaluation.

Giant cell tumour of bone (GCTB) typically occurs in young adults from 20-40 years old. Although the majority of lesions are located in the epi-metaphyses of the long bones, approximately one third of tumours are located in the axial skeleton, of which only 4% in the sacrum. Sacral tumours tend to be large at the time of presentation, and they present with aggressive features such as marked cortical destruction and an associated soft tissue component. The 2020 World Health Organisation classification of Soft Tissue and Bone Tumours describes GCTB as a neoplasm which is locally aggressive and rarely metastasizing. The tumour contains three different cell types: neoplastic mononuclear stromal cells, macrophages and osteoclast-like giant cells. Two tumour subtypes were defined: conventional GCTB and malignant GCTB. Only 1-4% of GCTB is malignant. In this review article, we will discuss imaging findings at the time of diagnosis to guide the musculoskeletal radiologist in reporting these tumours. In addition, imaging for response evaluation after various treatment options will be addressed, such as surgery, radiotherapy, embolization and denosumab. Specific findings will be presented per imaging modality and illustrated by cases from our tertiary sarcoma referral center. Common postoperative and post-radiotherapy findings in GCTB of the sacrum on MRI will be discussed.

Evaluation of mandibular indices and cephalometric parameters in adolescents with impacted maxillary canines

Objectives: Maxillary impacted canines have an important place in orthodontics for the reason of being a common anomaly and its treatment is time consuming and difficult. The aim of this study was to investigate the mandibular indexes and cephalometric parameters in adolescents with impacted maxillary canines. Materials and Methods: The radiographs of 4026 patients aged 12–19 years old were scanned and a total of 155 patients were included in the study. Subjects were divided into three groups according to the permanent maxillary canines: Bilateral impacted canine (BIC) (52 subjects; mean age 15.02 ± 1.74 years), unilaterally impacted canine (UIC) (51 subjects; mean age 14.89 ± 1.39 years), and the control (52 subjects; mean age 14.84 ± 1.65 years) groups. Skeletal, soft tissue and dental measurements were performed on cephalometric radiographs. Mandibular index analyzes including the panoramic mandibular index (PMI), mental index (MI), antegonial index (AI), and gonial index (GI) measurements and also angular measurements of impacted maxillary canines were performed on panoramic radiographs. Data were analyzed statistically and P &lt; 0.05 was considered significant. Results: Maxillary skeletal and dental measurements showed retrusive positioned maxillary dental arch in the sagittal direction in the impacted canine groups (P &lt; 0.05). PMI and MI values were greater in the BIC and UIC groups than in control group (P &lt; 0.05). There was no statistically significant difference in AI value among groups (P &lt; 0.05). GI value of BIC group was found statistically lower than other groups (P &lt; 0.05). Conclusion: Individuals with impacted maxillary canines have more retrusive maxillary dental arch and soft-tissue components. Furthermore, mandibular cortex was thicker in subjects with impacted maxillary canine than individuals with not and clinicians should keep in mind this when examine the panoramic radiographs in terms of early diagnosis of impacted maxillary canine teeth.

Incidental Detection of Adrenal Myelolipoma in a middle age female patient: a case report

Adrenal myelolipoma is a rare benign neoplastic lesion, mostly asymptomatic and unilateral. It originates from the adrenal gland and is made up of mature adipose tissues with the hematopoietic series. Adrenal lipomas are extremely rare and always benign and non-secreting. We describe a case of a hypertensive female patient who presented with abdominal pain. Physical examination and investigations were unremarkable. Ultrasound abdomen showed a hyperechoic mass on the left side of the abdomen. Contrast-enhanced abdomen illustrated a large heterogeneous mix density lesion in the left suprarenal gland showing enhancing soft tissue and macroscopic fat components suggesting adrenal myelolipoma. Although the patient did not have any related complications but owing to the large size of the tumor, surgical resection was planned which was later done successfully.

Radiological Imaging of Nail Disorders (PART II) - Radiological Features of Nail Disease.

We have seen that radiological techniques like digital x-ray, high-frequency ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) have their unique roles in assessing a complex anatomical structure like the nail unit. Broadly speaking, USG and MRI help evaluate soft tissue components well; while, radiographs and CT scans help assess bony lesions better. In the second part of this review, salient radiological features of various nail disorders, as seen on these modalities are detailed. The radiological features mostly play a supportive role and help rule out differential diagnoses. However, in some diseases like retronychia and some nail tumors, radiological findings help clinch the diagnosis. The diagnostic features as well as the investigative modality of choice for a particular disease are highlighted based on the best level of evidence (LoE) available. This narrative review includes both infectious and non-infectious nail unit diseases, with special emphasis on nail unit tumors.

The effects of lyophilised platelet-rich plasma in third molar extraction sockets and its surrounding tissues

ObjectiveTo determine the effects of repeated placement of quantified lyophilised platelet-rich plasma (LPRP) on the soft and hard tissue components. MethodsLyophilised platelet-rich plasma was topically placed, and later injected, into fresh sockets using the third molar surgical model, randomised according to the split-mouth approach. The control site received placebo. The application of LPRP was done intraoperatively, one month and two months postoperatively. The measured endpoints included post-operative pain, swelling, trismus, pocket depth at mid-distal adjacent second molar, soft tissue healing, and bone formation (which was assessed radiographically). Fifteen healthy young adults, aged between 21 and 35 years, visiting the Oral and Maxillofacial Surgery Clinic at the University of Malaya were recruited for this study. ResultsThere was no significant difference in post-operative pain, swelling size, trismus, and bone healing within their specific timelines during this study. However, the LPRP group showed significant reduction in pocket depth at the two-month post-operative period, suggesting that LPRP improves soft tissue healing. ConclusionSoft tissue healing, measured as the change of periodontal pocket depth, showed significant reduction, suggesting the benefit of LPRP for soft tissue healing. However, bone regeneration and reduction of post-operative sequelae showed no improvement even after quantification and repeated LPRP application.

Mediastinal mass in a young man with a previous history of dermatofibrosarcoma protuberans: metastatic disease or different entity—a case report

A 34-year-old man presented to the clinician with a persisting cutaneous swelling in the lower back. Diagnosis of dermatofibrosarcoma protuberans (DFSP) was made based on histopathologic examination of the resected mass and molecular testing. Further diagnostic workup with computed tomography (CT) showed a mass in the prevascular mediastinum, composed of a soft tissue component, areas of fat density and some small foci of calcification. Location of the mass and typical imaging findings of fat component and calcification were suggestive for a teratoma. Robotic assisted surgery with complete resection of the mediastinal mass was performed. Histopathological examination showed that there was no relationship with the primary tumor and confirmed the diagnosis of a teratoma. Teratomas are to be classified as mature, immature and teratomas with malignant transformation. In this patient, histopathology shows a teratoma with somatic-type malignancy. The patient was treated with adjuvant radiotherapy. Upon progressive disease with lung metastasis, pleural metastasis and lymph node metastasis, palliative chemotherapy was started. Knowledge of classic metastatic patterns is essential in imaging oncologic patient. Since DFSP rarely metastasizes, a metastatic origin of the mediastinal mass would not be likely. In a patient with typical imaging findings of a mature teratoma, associated findings such as adenopathy and pulmonary nodules should alert the radiologist to the possibility of a teratoma with somatic-type malignancy.

75 Years of Excellence: The Story of Reconstructive Surgery

75 Years of Excellence: The Story of Reconstructive Surgery

Multicentric epithelioid hemangioendothelioma of humerus and scapula

Epithelioid hemangioendothelioma (EH) is a rare malignant vascular tumor occurring mainly in the liver and lungs, with bones being a rare site and primarily seen in the adult population. We present a rare case of multicentric EH in the right humerus in an adolescent male, who presented with complaints of pain and swelling in the right shoulder. Radiographs and Computed tomography showed a large expansile lytic lesion in the proximal end of the right humerus with areas of cortical destruction and matrix calcification. On Magnetic resonance imaging, the lesion was predominantly isointense on T1-weighted image, hyperintense on T2-weighted, and Short Tau Inversion Recovery images with prominent flow voids within. On post-contrast sequences, the lesion showed intense heterogenous enhancement with a non-enhancing central necrotic area. Multiple smaller lytic lesions with similar imaging characteristics were also found in the mid and distal shaft of the right humerus and the right coracoid process. Differentials of Telangiectatic osteosarcoma, Giant cell tumor, brown tumors of hyperparathyroidism, and metastasis were considered. Core biopsy revealed that the lesion was an EH. Though the imaging features of EH are non-specific, it may be considered in the differential diagnosis of an expansile lytic bone lesion with no periosteal reaction, showing cortical break and soft tissue component, especially if it is multifocal and multicentric.

Revision Quadriceps Tendon Repair With Bone-Achilles Allograft Augmentation

Background: Surgical repair of chronic quadriceps tendon ruptures can be daunting, especially after failure of a prior repair. In this setting, tissue quality is usually poor, necessitating graft augmentation. In this video, we describe our technique for Achilles tendon allograft augmentation for revision quadriceps tendon repair. Indications: Failed quadriceps tendon repair defined as ongoing extensor mechanism deficit including patella baja, functional deficit, or palpable quadriceps defect with confirmed retear on advanced imaging. Technique Description: Patient is placed in the supine position, and a midline incision is extended to the tibial tubercle. Full thickness medial and lateral flaps are raised, nonviable scar tissue is excised, and suprapatellar adhesions are released to ensure full mobilization of the viable remnant quadriceps. A plane is then developed deep to the patellar tendon paratenon from proximal to distal. A reamer is used to prepare a socket just medial to the tibial tubercle. The calcaneal bone block of the Achilles allograft is fashioned to match the recipient site on the tibia with a sagittal saw. The graft is shuttled deep to the paratenon, and the bone plug is fixed to the tibia with an interference screw. Suture from the patellar anchors is then used to place 2 running Krackow stitches spanning the remnant quadriceps tendon proximally. The remnant tissue is subsequently reduced and tied with an anchor pull-through technique. The soft tissue component of the Achilles graft is laid over the repair and oversewn with free nonabsorbable suture. Patient is placed in a brace locked in extension for 6 weeks and allowed to be weight bearing as tolerated. Results: Long-term patient-reported outcomes of Achilles allograft reconstruction for revision extensor mechanism repairs are limited. Two studies of 17 reconstructions each reported this to be a reliable and durable option at a mean follow-up of 65 and 52 months, respectively. Discussion/Conclusion: Revision surgery for extensor mechanism deficits can be a challenging procedure. Our preference is to perform augmentation with Achilles allograft with bone plug fixation on the tibial side. This allows for augmentation of the entire extensor mechanism, as well as bone-to-bone healing on the tibial side.

STUDY OF MRI MORPHOLOGY OF SPINAL TUBERCULOSIS

OBJECTIVE: To study the morphology of tuberculosis of spine on MRI. METHODS AND MATERIALS: A retrospective study was done in the department of Radiodiagnosis, PESIMSR, Kuppam.This study includes 37 patients with suspected Spinal Tuberculosis, who were referred to the department of Radiodiagnosis between 2019 Jan to 2021 July. Informed consent was taken from all the patients. This study was done on GE Signa Explorer 1.5 Tesla. RESULTS: A total of 37 cases were included in the study. Of these 37 cases, 31 were males and 6 were females. The most common age group involved was between 20-40 years, seen in 15 cases followed by 41-60 yrs seen in 14 cases and 61-90 yrs seen in 8 cases. Lumbar vertebrae were commonly affected accounting for 86% of total cases (32cases) followed by dorsal and cervical vertebrae accounting for 8% and 5 % respectively (3 and 2 cases respectively). Intervertebral disc involvement (Discitis) was most commonly seen in 32 cases followed by vertebral endplate involvement (27 cases) in our study. Prevertebral &amp; paravertebral involvement were found in 20 and 23 cases respectively . In our study,19 cases had shown the involvement of posterior elements .Epidural soft tissue component was seen in 22 cases. Psoas abscess and paraspinal involvement were seen in 9 and 8 cases respectively. CONCLUSION: MRI helps in the early assessment of the extent and severity of disease compared to X-ray and CT scan. It is valuable in detecting early marrow changes, intervertebral disc involvement, extradural abscess and cord compression.

Imaging diagnosis of temporomandibular disorders based on DC/TMD

Proper diagnosis and management of temporomandibular disorder (TMD) is essential. For this purpose, clinical examination as well as imaging examination of the temporomandibular joint (TMJ), surrounding structures, and mas-ticatory muscles are required. Confirmation of diagnosis by imaging prevents delay in diagnosis and prevents chronic progression of TMD signs and symptoms. TMJ can be imaged using a variety of modalities, including convention-al radiography represented by panoramic radiography, magnetic resonance imaging (MRI), computed tomography (CT), cone-beam CT (CBCT), and bone scans. The present study briefly explains the characteristics and indications of the imaging modalities used in the diagnosis of TMD according to the diagnostic criteria for temporomandibular disorders (DC/TMD), and presents representative images. However, imaging of TMJ can be challenging due to the anatomical complexity of the TMJ area. The use of panoramic radiography for pathological changes in the TMJ area is not enough due to overlapping of anatomical structures. With CT and CBCT, bony changes can be better identified. A three-dimensional image view is required for an accurate imaging diagnosis of TMJ. CBCT provides a high-resolution multiplanar reconstruction of the TMJ with low radiation dose without overlap of bone structures. Furthermore, MRI is a non-invasive dynamic imaging modality that is considered the gold standard for imaging the soft tissue components of the TMJ. MRI can be useful in evaluating the position and shape of the articular disc, and diagnosing TMJ disc displacement. It can also determine the early signs of TMD and the presence of joint effusion.Bone scans show whether bone changes and inflammatory reactions observed on other imaging modalities are active. The diagnostic value of imaging depends to a large extent on the equipment used and the experience of the examiner. It is recommended that the results of imaging examination be interpreted in conjunction with those of clinical examination. The information presented here is of great help to clinicians and researchers who are treating and studying TMD.

Low-velocity, civilian firearm extremity injuries-review and update for radiologists.

Firearm injuries are a preventable epidemic in the USA. Extremities are commonly affected in gunshot injuries. Such injuries may be complex with concomitant osseous, soft tissue, and neurovascular components. The maximum wounding potential of a projectile is determined by its kinetic energy and the proportion of the kinetic energy that is transmitted to the target. Accurate assessment of ballistic injuries is dependent on utilizing the principles of wound ballistics, accurate bullet count, and ballistic trajectory analysis. The goals of this article are to review wound ballistics and the imaging evaluation of extremity civilian firearm injuries in the adult population, with emphasis on ballistic trajectory analysis, specific ballistic fracture patterns, and diffuse, secondary soft tissue ballistic injuries.

A bilayered tissue engineered in vitro model simulating the tooth periodontium.

Due to the complexity of the structure of the tooth periodontium, regeneration of the full tooth attachment is not a trivial task. There is also a gap in models that can represent human tooth attachment in vitro and in vivo. The aim of this study was to develop a bilayered in vitro construct that simulated the tooth periodontal ligament and attached alveolar bone, for the purpose of tissue regeneration and investigation of physiological and orthodontic loading. Two types of materials were used to develop this construct: sol-gel 60S10Mg derived scaffold, representing the hard tissue component of the periodontium, and commercially available Geistlich Bio-Gide® collagen membrane, representing the soft tissue component of the tooth attachment. Each scaffold was dynamically seeded with human periodontal ligament cells (HPDLCs). Scaffolds were either cultured separately, or combined in a bilayered construct, for 2 weeks. Characterisation of the individual scaffolds and the bilayered constructs included biological characterisation (cell viability, scanning electron microscopy to confirm cell attachment, gene expression of periodontium regeneration markers), and mechanical characterisation of scaffolds and constructs. HPDLCs enjoyed a biocompatible 3-dimensional environment within the bilayered construct components. There was no drop in cellular gene expression in the bilayered construct, compared to the separate scaffolds.

P-015: Is it time to revisit role of PET-CT imaging and its integration with other parameters in International Myeloma Working Group (IMWG) response assessment criteria?

<h3>Background</h3> The landscape of imaging in multiple myeloma has changed drastically since the publication of IMWG 2016 criteria. 18 F-FDG PET-CT (PET-CT) is being used more frequently, for staging, prognosis and clinical decision making. PET-CT is useful for both morphological and the metabolic activity of the plasma cells to predict and monitor clinical response. Studies have shown that subjects who achieved complete response by hematologic criteria but have PET positive lesions have poorer outcome. PET-CT has high sensitivity and specificity for detecting all lesions types. PET negativity has been equated to Minimal residual disease (MRD) negativity, and hence role of both positive and negative PET in IMWG response assessment need to be better defined. Until now extramedullary disease (EMD) and plasmacytoma evaluation have been the focus of response assessment in IMWG, although plasmacytoma is a histological, not an imaging diagnosis. Paramedullary lesions (lytic bone lesions with extraosseous soft tissue component), intramedullary lesions (soft tissue lesions in the medullary cavity) as well as pure lytic bone lesions have not been fully included in the evaluation. There is a need to better define various lesions and disease presentations seen on imaging in myeloma and their role in overall response. Additionally, role of different imaging modalities in clinical trials as well as a standardized imaging schedule, based on the presence of baseline disease burden, should be defined. The purpose of this study is to define and incorporate the imaging manifestations of myeloma of PET-CT into the IMWG criteria. A standardized PET-CT assessment approach is lacking in IMWG 2016, although Italian Myeloma Criteria for PET Use (IMPeTUs), has described PET-CT evaluation in detail, including the cut off for positivity and negativity, aligning it to 5-point Deauville Scoring (5PS). This study will also highlight the importance of PET-CT as a modality of choice in myeloma and provide a standardized methodology to integrate PET in overall assessment. We propose that myeloma lesions should be assessed in two broad categories, target (measurable) and non-target (non-measurable) lesions. Targets should include up to a total of six extramedullary and/or paramedullary lesions. Non-target lesions should include any additional measurable lesions, other soft tissue and bone lesions characteristic of myeloma, which do not meet criteria for target lesions. The status of these lesions along with any new lesions will drive an overall anatomical response. For PET-CT assessments, 5PS should be followed with liver as comparator for positivity. Metabolic responses like Complete metabolic response(CMR) etc. should be derived. An integrated imaging response can then be combined with clinical parameters to provide an overall IMWG response. This proposed guidance will help standardize integration of PET imaging in IMWG response assessment more efficiently and consistently across trials.

Soft-Tissue Simulation for Computational Planning of Orthognathic Surgery.

Simulation technologies offer interesting opportunities for computer planning of orthognathic surgery. However, the methods used to date require tedious set up of simulation meshes based on patient imaging data, and they rely on complex simulation models that require long computations. In this work, we propose a modeling and simulation methodology that addresses model set up and runtime simulation in a holistic manner. We pay special attention to modeling the coupling of rigid-bone and soft-tissue components of the facial model, such that the resulting model is computationally simple yet accurate. The proposed simulation methodology has been evaluated on a cohort of 10 patients of orthognathic surgery, comparing quantitatively simulation results to post-operative scans. The results suggest that the proposed simulation methods admit the use of coarse simulation meshes, with planning computation times of less than 10 seconds in most cases, and with clinically viable accuracy.

Transnasal Surgical Treatment Of Patients With A Fracture Of The Medial Wall Of The Orbit

The article presents the method of transnasal surgical treatment of patients with a fracture of the medial wall of the orbit using the Volkov elevator as a repositioning tool and an iodine tampon as a fixation material, which allows efficient fixation of the medial orbit wall fragments and its soft tissue components, allowing to reduce the trauma of surgical intervention, to restore the eyeball position, and to eliminate the cause of emphysema and dynamic correction of postoperative diplopia in one-time operation.