Spiral CT Scan Research Articles

The dimensions of the sphenoid sinuses: evaluation before the functional endoscopic sinus surgery.

The following study aimed to evaluate the dimensions (anteroposterior, transverse and vertical) of the sphenoid sinuses in the adult population. The study was conducted as a retrospective analysis of the computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females and 149 males), who did not present any pathology in the sphenoid sinuses. The CT scans of the paranasal sinuses were done with the spiral CT scanner, without using any contrast medium. After obtaining transverse planes, frontal and sagittal planes were created using secondary reconstruction tool. The anteroposterior dimension was found to be 2.65 cm on average, in the range of 0.5-4.3 cm. The transverse dimension was on average 1.98 cm, ranging from 0.5 cm to 4.9 cm. The average vertical dimension was found to be 2.1 cm, in the range of 0.7-3.7 cm. Due to the high incidence of the anatomical variants of the paranasal sinuses, a CT scan is recommended in all patients before a planned surgery in order to avoid the potential iatrogenic complications. Dimensions of the sphenoid sinuses might point towards more at risk variants, but there is still a substantial amount of research that needs to be done in that aspect.

Impact of epicardial fat on the duration of radiofrequency energydelivery during catheter ablation of atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Aims This study aimed to determine the impact of the volume of epicardial fat on the duration of radiofrequency (RF) energy delivery during the procedure of ablation of atrial fibrillation (AF). Methods The volume of epicardial fat was measured from spiral computerized tomography scan. The primary endpoint was the duration of RF delivery for pulmonary vein isolation (PVI), and the overall total duration of RF application. Secondary endpoint was conversion of AF to sinus rhythm or organisation of the arrhythmia after PVI. Results From March 2015 to May 2018, 222 patients (45,5% with persistent AF) underwent a first RF catheter ablation procedure for AF. The total duration of RF delivery, and the duration of RF delivery specifically for PVI were significantly associated with higher total volume of epicardial fat (p = 0,0002; p = 0,009 respectively), periatrial (p = 0,003; p = 0,045) and periventricular epicardial fat (p = 0,001; p = 0,012). In multivariate analysis, total epicardial fat volume was not significantly associated with total RF delivery duration (p = 0,743). For patients with arrhythmia at the time of the procedure, patients who achieved conversion or organisation of their arrhythmia after PVI had similar levels of total epicardial fat to those whose arrhythmia persisted (65 ± 35,2 vs 74,5 ± 31,2 ml ; p = 0,192). Conclusion We observed a significant relation between total, periatrial, and periventricular epicardial fat, and the duration of RF delivery during ablation of AF. This relation was not significant by multivariate analysis meaning that epicardial fat maybe a marker, but not an independent factor,of ablation complexity.

Analysis of epigenomic signatures in cell-free DNA (cfDNA) from cancer patients and high-risk controls: A blinded test cohort of THUNDER-II study.

e22518 Background: Early detection of cancer has the potential to provide a clinical benefit to patients, especially for those with hard-to-treat diseases like ovarian and pancreatic cancer. The THUNDER (the unintrusive detection of early-stage cancers) program was designed to develop and validate a multicancer detection blood test (ELSA-seq) through a series of prospective, observational case-control studies. The second sub-study of THUNDER program (THUNDER-II) includes a discovery, training/validation, and single-blind test (SBT) phase. This new analysis, comprising data from the SBT set of THUNDER-II, evaluated performance of ELSA-seq in an independent group of participants, including individuals at high risk of certain cancer types for the first time. Methods: In the SBT group reported here, all participants were recruited from sites that were not represented in training or validation. The cancer group focused on six deadly cancer types (lung, colorectal, liver, pancreatic, esophageal, and ovarian cancer), and the non-cancer controls were stratified to ‘healthy’ and ‘high-risk’ subgroups based on examination results of low-dose spiral chest CT scan (LDCT), abdominal ultrasound, and Hepatitis B serologic test (HBsAg). 10ml of blood from each participant was collected and methylation-sequencing libraries were prepared by ELSA-seq as described previously. The detection results were automatically reported by a locked computational pipeline to mimic a real-world test scenario (Burning Rock Biotech, China). All samples were delinked from the donors’ cancer status and experiments were performed by blinded personnel. Results: In general, the cancer and non-cancer groups were comparable with respect to age, sex, and tobacco/alcohol-consumption history. The assessment is still in progress, and we have studied 360 eligible participants including 202 cancer cases and 158 non-cancer controls (76 ‘healthy’; 82 ‘high-risk’). Overall, ELSA-seq achieved a specificity of 98.1% (95%CI: 94.1-99.5%) and a sensitivity of 74.8% (95%CI: 68.1-80.5%), consistent with the performance in training and validation1. Among six pre-specified cancer types, sensitivity was 53.0% (95%CI: 40.4-76.3%) in stage I, 73.3% (95%CI: 57.8-84.9%) in stage II, 90.4% (95%CI: 78.2-96.4%) in stage III, and 92.3% (95%CI: 78.0-98.0%) in stage IV. In terms of identifying the diseased organ(s), 80.8% (95%CI: 73.4-86.6%) of the predications matched the true TOO status. Conclusions: ELSA-seq demonstrated consistent results in sites that did not contribute to training, supporting that performance was not subject to sample-/site-dependent bias. It also showed a very low false positive rate in asymptomatic individuals with or without certain cancer-prone conditions, suggesting a potential applicability to broad populations.

Ruptured Hydatid Cysts Resulted in Infectious Pericardial Effusion and Development of Cardiac Tamponade: A Rare Presentation

Introduction: Cardiac Hydatidosis is a rare and ominous complication of hydatid disease. Cardiac echinococcosis may be asymptomatic for several years but could be discovered after the development of lethal complications. Case Presentation: A 31-year-old-male referred with possible diagnosis of acute pericarditis. Abdominal and pelvic spiral CT scan showed focal and heterogeneous increased thickness of lateral left ventricular (LV) wall with protrusion into LV and bulging into pericardial space without central enhancement. His condition deteriorated suddenly due to cardiac tamponade with round cystic lesions suspected to hydatid cyst. Cardiac magnetic resonance imaging showed some round particles within effusion suggestive of possible scolex around the LV. There was round, and inhomogeneous cystic mass originated from sub-epicardial layer of mid-lateral LV that protruded into pericardial space. Diagnosis of hydatic cyst was confirmed by surgical specimen. Conclusions: We suggest that patients with pericarditis should be probed with echocardiography for the presence of hydatid cysts.

Lung cancer screening in Europe: where are we in 2021?

This manuscript reviews the recent evidence obtained in lung cancer screening with low dose spiral CT-scan (LDSCT) and focuses on the issues associated with its implementation in Europe. After a review of the magnitude of the lung cancer toll in lives, disease and Euro’s, the recently released data of the major lung cancer screening trials are reviewed and mirrored with the results of the US National Lung Screening Trial (NLST), comparing their strengths and weaknesses and areas of future research. The specific barriers and hurdles to be addressed for widely implementing this population screening in European countries are discussed, with special emphasis on the issues of inclusion of smokers, smoking cessation interventions, radiation injury and capacity planning. The pros and cons of including current smokers will be addressed together with the issue which is the better smoking cessation intervention. A medical physicist’s view on radiation exposure and quality control will address concerns about radiation induced cancers. The downstream effects of a LDSCT screening program on the capacity of CT-scans, radiologists, thoracic surgeons and radiation oncologists will follow. An estimated roadmap for the future is sketched with the expected role of all key stakeholders. This roadmap reflects the opinion leader’s reflections as expressed in a number of discussions with European health authorities, taking place as part of the recently released European Beating Cancer plan.

Application of 64-Slice Spiral CT Imaging Technology Based on Smart Medical Augmented Reality in the Diagnosis of Foreign Bodies in the Respiratory Tract in Children.

A foreign body in the respiratory tract is one of the common accidental injuries of children in our country, and is usually an important and serious event. Injuries caused by foreign substances in the respiratory tract seriously threaten the health and life of children in Korea and are a great challenge for parents as well. In the process of diagnosis of foreign bodies in the respiratory tract, there is often missed diagnosis or serious complications. Therefore, this article proposes the application of 64-slice spiral CT imaging technology based on smart medical augmented reality in the diagnosis of foreign bodies in the respiratory tract in order to improve the diagnosis of foreign bodies in the respiratory tract, provide help with treatment to improve the prognosis of foreign bodies in the respiratory tract, and reduce the incidence of foreign bodies in the respiratory tract. In this paper, 36 children underwent a 64-slice spiral CT scan of their lungs, and images were transferred to a workstation for multiplanar reconstruction, minimal density projection, three-dimensional volume reconstruction imaging, and CT virtual endoscopic reconstruction, the location, shape, size, and size of the foreign body in contrast with adjacent structural lesions and lesions seen during surgery. Experiments have shown that the left bronchial granulation accounted for 27.3%, the right bronchial granulation 18.75%, the main tracheal granulation 28.6%; there was no significant difference between the left and right bronchial granulation (P > 0.05), while the main tracheal granulation and bilateral bronchial granulation there are significant differences between the shape distributions (P < 0.05). This shows that CT imaging technology has enabled more patients to avoid surgical operations and ensure that the spiral computer can bring the greatest benefits to children. A 64-slice spiral CT scan can diagnose foreign bodies in the child's respiratory tract. The detection rate is high and the diagnostic failure rate is low. The diagnostic rationale provides a reference for early clinical treatment.

Incorporation of residual attention modules into two neural networks for low-dose CT denoising.

The low-dose computed tomography (CT) imaging can reduce the damage caused by x-ray radiation to the human body. However, low-dose CT images have a different degree of artifacts than conventional CT images, and their resolution is lower than that of conventional CT images, which can affect disease diagnosis by clinicians. Therefore, methods for noise-level reduction and resolution improvement in low-dose CT images have inevitably become a research hotspot in the field of low-dose CT imaging. In this paper, residual attention modules (RAMs) are incorporated into the residual encoder-decoder convolutional neural network (RED-CNN) and generative adversarial network with Wasserstein distance (WGAN) to learn features that are beneficial to improving the performances of denoising networks, and developed models are denoted as RED-CNN-RAM and WGAN-RAM, respectively. In detail, RAM is composed of a multi-scale convolution module and an attention module built on the residual network architecture, where the attention module consists of a channel attention module and a spatial attention module. The residual network architecture solves the problem of network degradation with increased network depth. The function of the attention module is to learn which features are beneficial to reduce the noise level of low-dose CT images to reduce the loss of detail in the final denoising images, which is also the key point of the proposed algorithms. To develop a robust network for low-dose CT image denoising, multidose-level torso phantom images provided by a cooperating equipment vendor are used to train the network, which can improve the network's adaptability to clinical application. In addition, a clinical dataset is used to test the network's migration capabilities and clinical applicability. The experimental results demonstrate that these proposed networks can effectively remove noise and artifacts from multidose CT scans. Subjective and objective analyses of multiple groups of comparison experiments show that the proposed networks achieve good noise suppression performance while preserving the image texture details. In this study, two deep learning network models are developed using multidose-level CT images acquired from a commercial spiral CT scanner. The two network models can reduce and even remove streaking artifacts, and noise from low-dose CT images confirms the effectiveness of the proposed algorithms.

یافته های سی تی سینه در بیماران با ترومای قفسه سینه مراجعه کننده به بیمارستان امام رضا (ع) تبریز در سال ۹۵: يك گزارش كوتاه

Introduction: Imaging technique plays an important role in management of chest trauma and chest x-ray, ultrasonography, and computed tomography (CT) scan are used to diagnose chest injuries. Chest CT scan is the Gold standard for diagnosing chest injuries. The aim of this study was to evaluate the positive findings of chest CT scan in patients referring to the emergency department of Imam Reza Hospital, Tabriz, in 2016-2017. Methods: This is a descriptive study performed on multiple trauma patients referring to Imam Reza Hospital in Tabriz from April 2016 to March 2017. The sampling method was census and all patients with multiple trauma and chest trauma who had referred to Imam Reza Hospital during the study period and had undergone a chest spiral CT were included in the study. Independent t-test was used to compare quantitative data and chi-square was used to compare qualitative data. Results: During the study period, 390 patients with chest trauma and multiple trauma had undergone chest CT. Of which, 296 were male (75.9%) and 94 (24.1%) were female. The mean age of the patients was 48.35 years. Traffic accidents were the most common cause of trauma. In nearly half of the patients there was no positive finding on chest spiral CT scan. However, there were multiple findings in 21 patients. The most common injuries were: rib fracture (11.3%), pneumothorax (12.3%), pneumomediastinum (2%), hemothorax (4.6%), and pulmonary contusion (4.9%). Conclusion: In patients with multiple trauma, the most common positive CT findings were rib fractures, followed by pneumothorax, subcutaneous emphysema and hemothorax. In cases where there is a fracture of the first three ribs or flail chest, or a fracture of the scapula and high-energy trauma, the rate of visceral damage inside the chest and abdomen is higher, and chest CT scan can diagnose hemothorax and minor pneumothorax, which are not detectable in chest x-ray.

A new radiological measurement method used to evaluate the modified transconjunctival orbital fat decompression surgery

PurposeA new radiological method was used to evaluate the plastic effect of modified transconjunctival orbital fat decompression surgery in patients with inactive thyroid-associated ophthalmopathy.MethodsIn this study, 10 inactive patients (14 eyes) with moderate to severe thyroid-associated ophthalmopathy were selected. The patients underwent modified transconjunctival orbital fat decompression surgery. According to the results of a spiral CT scan before and 6 months after the surgery, the INFINITT system workstation was used to measure the eyeball protrusion value. According to the results obtained by the PHLIPS IntelliSpace Portal elliptical area and line segment measurement tools, the standard elliptical vertebral volume formula was used to calculate the muscular cone inner volume. Changes in eyeball protrusion and the inner volume of the muscular cone before and after surgery were examined. Statistical analysis of the correlation between the two parameters was performed.ResultsRadiological measurement results confirmed that removing the orbital fat in the muscle cone during surgery was effective for alleviating eyeball protrusion in patients with thyroid-associated ophthalmopathy (P < 0.05). This surgery caused an obvious change in the muscle cone inner volume (P < 0.05). And there was significant correlation between changes in eyeball protrusion and muscle cone inner volume (r = 0.797, P = 0.0006, P < 0.05).ConclusionThe radiological assessment method used in this study is simple and easy to implement. For inactive patients with moderate to severe thyroid-associated ophthalmopathy who just want to improve their appearance, the modified orbital fat decompression surgery is worth considering.

Intestinal Tuberculosis or Crohn's Disease: A Diagnostic Challenge Case Report

Background and Aim: Crohn's disease is a chronic idiopathic disease in the category of gastrointestinal tract inflammation without any obvious reason. Clinical signs include abdominal pain, and diarrhea, which may be accompanied by a fistula or intestinal obstruction. Differential diagnosis of Crohn's disease and intestinal tuberculosis is a complex and difficult challenge. Case presentation: The patient was a 70-year-old woman who had been hospitalized due to fistulas with 4 years of discharge in the left inguinal and gluteal area. The patient's vital signs were stable, and she did not report any fever, chills, or gastrointestinal symptoms. Diagnostic tuberculosis procedures were performed for this patient and despite the lack of evidence in favor of intestinal tuberculosis, experimental tuberculosis treatment was started for him. Despite 10 months of anti-tuberculosis treatment, the symptoms and fistulas of the patient did not recover in 2016. On spiral computed tomography scan of the lung and mediastinum without injection, the presence of cardiomegaly, evidence of ground glass was seen along with an increased thickness of the interlobular septa in the middle lobe of the right lung and ground-glass opacities at the base of both lungs. Since the patient had typical intestinal tuberculosis symptoms, discharge cultivation and smear were performed and it did not grow on Mycobacterium tuberculosis bacillus acid staining. The patient underwent biopsy with MR Enterography, and Crohn's diagnosis was confirmed. The patient was treated with Metronidazole, Ciprofloxacin, and a combination of Azathioprine and Infliximab. Conclusion: According to the rare case reported, advanced diagnostic measures should be taken in dealing with patients with intestinal tuberculosis or Crohn disease

Application of CT Angiography in the Diagnosis of Acute Cerebrovascular Disease in Neurology

This article explores the application and value of CT angiography in the diagnosis of acute cerebrovascular disease in neurology. We selected 260 patients in our hospital as the research object, analyzed their data in detail, and then used the spiral CT scan to obtain the most original image. According to the projection technology with the strongest intensity and the scanned image, a three-dimensional image was formed on the surface. The images were studied and the results were compared with the results of postoperative and DSA techniques to finally evaluate the value of CTA technology in the diagnosis of cerebrovascular diseases. A retrospective analysis and study of angiographic results of 260 patients with ischemic cerebrovascular disease who underwent digital silhouette angiography (DSA). According to the age of patients, patients can be divided into three groups: young group, middle-aged group and elderly group, aged 18–45 years old, 45–60 years old, 60 years old or older. According to the classification of ischemic cerebrovascular disease, we can divide 260 patients into cerebral infarction group and transient ischemic attack group. The calculation of stenosis rate is based on the research methods of symptomatic carotid endarterectomy abroad. The rate of detection of stenoses in 8 patients with TIA was 87%, and the rate of detection in 30 patients with cerebral infarction was 96%. The rate of aneurysms detected in the diagnosis of SAH is 83%. The diagnosis of cerebrovascular disease in the etiology and treatment of CTA in neurology department has a statistically significant difference in the ratio of confirmed diagnosis and positive rate of protection (P &gt;0.05). Finally, we conclude that CT angiography is widely used in the diagnosis of acute cerebrovascular disease in neurology, and its therapeutic effect is quite significant, which is worthy of promotion in clinical diagnosis and treatment.

The effect of topical administration of simvastatin on entochondrostosis and intramembranous ossification: An animal experiment.

BackgroundSimvastatin, a drug for lowering serum cholesterol, has been shown to enhance bone regeneration, but few studies have qualitatively and quantitatively tested its effect when used topically in different animal models. This study aims to investigate topical administration of simvastatin as a bone regeneration inducer by testing its effect on bone formation in both long tubular bone and flat bone defect, and the mechanism involved.MethodsTwo animal models were used for testing the effect of simvastatin on entochondrostosis and intramembranous ossification respectively. Simvastatin of different dosages combined with poly lactic acid were implanted in extreme radial defects of 12 adult male New Zealand rabbits. Bone formation was monitored using x-ray and CT-scan and measured using x-ray scales, pixel values and spiral CT-scan for 16 weeks before being subject to histological and immunohistochemistry examination. The result was compared with that of autograft and blank control groups. Simvastatin with thrombin and fibrin sealant were implanted in calvarial defects of three Rhesus monkeys and monitored for 18 weeks. Bone formation was compared between the simvastatin and the blank control group using spiral CT-scan and histological examination.ResultsBoth visual and quantitative measurements by x-ray and spiral CT-scan indicated significant bone formation in radial defects in all simvastatin groups and the autograft group whereas no bone formation was found in control groups. There was no significant difference in bone formation quantity between 100 ​mg simvastatin and autograft. Histological and immunohistochemistry examination indicated entochondrostosis in association with positive expression of BMP-2 and HIF-1 alpha. Spiral CT-scan and histological examination of calvarial defects of monkeys showed intramembranous ossification after simvastatin implantation. No change was found in the control group.ConclusionsTopical administration of simvastatin induces entochondrostosis and intramembranous ossification by enhancing expression of BMP-2 and HIF-1 alpha. The effect of simvastatin on bone regeneration is comparable to autograft.The translational potential of this articleTopical administration of simvastatin can repair bone defect in both long tubular bones and flat bones of rabbits and monkeys as effectively as autograft. Given that it is cheap, safe and already in clinical use, simvastatin might be considered as a bone regeneration inducer with great potential.

Cross-sectional anatomy, computed tomography, and magnetic resonance imaging of the banded houndshark (Triakis scyllium)

Due to their important phylogenetic position among extant vertebrates, sharks are an invaluable group in evolutionary developmental biology studies. A thorough understanding of shark anatomy is essential to facilitate these studies and documentation of this iconic taxon. With the increasing availability of cross-sectional imaging techniques, the complicated anatomy of both cartilaginous and soft tissues can be analyzed non-invasively, quickly, and accurately. The aim of this study is to provide a detailed anatomical description of the normal banded houndshark (Triakis scyllium) using computed tomography (CT) and magnetic resonance imaging (MRI) along with cryosection images. Three banded houndsharks were scanned using a 64-detector row spiral CT scanner and a 3 T MRI scanner. All images were digitally stored and assessed using open-source Digital Imaging and Communications in Medicine viewer software in the transverse, sagittal, and dorsal dimensions. The banded houndshark cadavers were then cryosectioned at approximately 1-cm intervals. Corresponding transverse cryosection images were chosen to identify the best anatomical correlations for transverse CT and MRI images. The resulting images provided excellent detail of the major anatomical structures of the banded houndshark. The illustrations in the present study could be considered as a useful reference for interpretation of normal and pathological imaging studies of sharks.

Comparison of intelligent 4D CT sequence scanning and conventional spiral 4D CT: a first comprehensive phantom study

4D CT imaging is a cornerstone of 4D radiotherapy treatment. Clinical 4D CT data are, however, often affected by severe artifacts. The artifacts are mainly caused by breathing irregularity and retrospective correlation of breathing phase information and acquired projection data, which leads to insufficient projection data coverage to allow for proper reconstruction of 4D CT phase images. The recently introduced 4D CT approach i4DCT (intelligent 4D CT sequence scanning) aims to overcome this problem by breathing signal-driven tube control. The present motion phantom study describes the first in-depth evaluation of i4DCT in a real-world scenario. Twenty-eight 4D CT breathing curves of lung and liver tumor patients with pronounced breathing irregularity were selected to program the motion phantom. For every motion pattern, 4D CT imaging was performed with i4DCT and a conventional spiral 4D CT mode. For qualitative evaluation, the reconstructed 4D CT images were presented to clinical experts, who scored image quality. Further quantitative evaluation was based on established image intensity-based artifact metrics to measure (dis)similarity of neighboring image slices. In addition, beam-on and scan times of the scan modes were analyzed. The expert rating revealed a significantly higher image quality for the i4DCT data. The quantitative evaluation further supported the qualitative: While 20% of the slices of the conventional spiral 4D CT images were found to be artifact-affected, the corresponding fraction was only 4% for i4DCT. The beam-on time (surrogate of imaging dose) did not significantly differ between i4DCT and spiral 4D CT. Overall i4DCT scan times (time between first beam-on and last beam-on event, including scan breaks to compensate for breathing irregularity) were, on average, 53% longer compared to spiral CT. Thus, the results underline that i4DCT significantly improves 4D CT image quality compared to standard spiral CT scanning in the case of breathing irregularity during scanning.

Computed Tomographic Comparison of Length, Width and Angulation of Ethmoidal Infundibulum in Patients With and Without Maxillary Sinusitis.

Ethmoidal infundibulum (EI) is an important part of the osteomeatal complex, which provides the main pathway for the maxillary sinus drainage. This study aimed to compare the length, width, and angulation of EI in patients with/without maxillary sinusitis using computed tomography (CT). This cross-sectional study evaluated 818 spiral CT scans of patients with/without maxillary sinusitis (n = 409 maxillary sinuses in each group) classified according to the clinical symptoms and the Lund-Mackay score for mucosal thickening. The degree of mucosal thickening (on axial and coronal sections), anatomical variations namely concha bullosa (CB), ethmoidal bulla (EB), and Haller cells (HCs), the form of EI (on coronal sections), the length, width and angulation of EI, and degree of nasal septal deviation (on coronal sections) were all evaluated. Data were analyzed by parametric and non-parametric tests (alpha = 0.05). The frequency of EB (P < 0.001), EI form (P < 0.001) and HC (P = 0.011), and the length and width of EI (P < 0.001) were significantly different in patients with and without maxillary sinusitis. The length and width of EI were significantly correlated with the degree of mucosal thickening (P < 0.01). The frequency of CB (P = 0.002), EB (P < 0.001), and HC (P = 0.002), and the EI form (P < 0.001) were significantly different in groups with different degrees of mucosal thickening. EI was wider and shorter in patients with maxillary sinusitis. By an increase in mucosal thickness, the length of EI decreased while its width increased. Also, the frequency of EB and HC, and the EI form were significantly different in the two groups.

The course of the main septum in the sphenoid sinuses - evaluation before the FESS.

The purpose of this study was to determine the course of the main septum (MS) in the sphenoid sinuses in the adult population. Materials and Methods: 296 patients (147 females, 149 males), who did not present any pathology in the paranasal sinuses, were included in this retrospective analysis of the computed tomography (CT) scans. Spiral CT scanner (Siemens Somatom Sensation 16) was used in order to glean the images of the paranasal sinuses, using standard procedure, in the option Siemens CARE Dose 4D, without using any contrast medium. Secondary reconstructions of the sagittal and frontal planes were obtained using multi- plans reconstruction (MPR) tool after obtaining transverse planes in the first instance. R e s u l t s: The course of the MS changed the most often from the anterior to the posterior part of the sphenoid sinuses. Such situation took place in 83.78% of the patients, in 32.43% of whom a clear shift to the lateral side was noticed only in the posterior part of the MS: in 18.24% of the patients to the right side, and in 14.19% of the patients to the left side. In 17.57% of the patients the lateral shift was visible in both anterior and posterior parts of the septum, where in 9.46% of the patients it was from the left side to the right, whereas in 8.11% of the patients the shift took place from the right side to the left. The MS had the shape of the letter 'C' in 22.29% of the cases, and 11.82% had the typical shape of the letter 'C,' and in 10.47% of the patients it paralleled the inverted letter 'C' (upside down). Amongst the types of the MS shifting directions the rarest was the MS that resembled the letter 'S' - 11.48% of the patients. In 5.74% of the cases it looked like the typical letter 'S,' and in 5.74% of the cases it was similar to the inverted letter 'S.' Only 16.22% of the cases had the MS that did not change its course nor its shape and ran medially in the sagittal plane from the anterior to the posterior part of the sinuses. Conclusions: In furtherance of reducing the risk of problems occurring during a surgery in the paranasal sinuses, it is prudent to have a CT scan done in all the patients beforehand, due to the high prevalence of the anatomical variations in the sinuses.

Magnetic resonance imaging-based synthetic computed tomography of the lumbar spine for surgical planning: a clinical proof-of-concept.

Computed tomography scanning of the lumbar spine incurs a radiation dose ranging from 3.5 mSv to 19.5 mSv as well as relevant costs and is commonly necessary for spinal neuronavigation. Mitigation of the need for treatment-planning CT scans in the presence of MRI facilitated by MRI-based synthetic CT (sCT) would revolutionize navigated lumbar spine surgery. The authors aim to demonstrate, as a proof of concept, the capability of deep learning-based generation of sCT scans from MRI of the lumbar spine in 3 cases and to evaluate the potential of sCT for surgical planning. Synthetic CT reconstructions were made using a prototype version of the "BoneMRI" software. This deep learning-based image synthesis method relies on a convolutional neural network trained on paired MRI-CT data. A specific but generally available 4-minute 3D radiofrequency-spoiled T1-weighted multiple gradient echo MRI sequence was supplemented to a 1.5T lumbar spine MRI acquisition protocol. In the 3 presented cases, the prototype sCT method allowed voxel-wise radiodensity estimation from MRI, resulting in qualitatively adequate CT images of the lumbar spine based on visual inspection. Normal as well as pathological structures were reliably visualized. In the first case, in which a spiral CT scan was available as a control, a volume CT dose index (CTDIvol) of 12.9 mGy could thus have been avoided. Pedicle screw trajectories and screw thickness were estimable based on sCT findings. The evaluated prototype BoneMRI method enables generation of sCT scans from MRI images with only minor changes in the acquisition protocol, with a potential to reduce workflow complexity, radiation exposure, and costs. The quality of the generated CT scans was adequate based on visual inspection and could potentially be used for surgical planning, intraoperative neuronavigation, or for diagnostic purposes in an adjunctive manner.

Diagnostic value of chest spiral CT scan and Doppler echocardiography compared to right heart catheterization to predict pulmonary arterial hypertension in patients with scleroderma.

Background:Because of invasive nature of catheterization, using other noninvasive tools is more preferred to assess pulmonary arterial hypertension (PAH). The present study assessed the value of chest spiral CT scan and Doppler echocardiography compared to right heart catheterization (RHC) to predict PAH in patients with scleroderma.Methods:This cross-sectional study was performed on 15 patients with limited scleroderma. All subjects underwent Doppler echocardiography (to assess PAP) and chest spiral CT scan without injection (to assess pulmonary trunk length or PUL), followed by RHC to assess PAH.Results:Comparing PUL in spiral CT scan with PAP in RHC yielded a sensitivity of 75.0% and a specificity of 100% for predicting PAH. Similarly, comparing PAP value in echocardiography with PAP in RHC achieved a sensitivity of 100% and a specificity of 63.6% to discriminate PAH from normal PAP condition. Analysis of the area under the ROC curve showed high power of CT scan to predict PAH (AUC = 1.000). The best cutoff point for PUL to predict PAH was 29.95 yielding a sensitivity of 100% and a specificity of 100%. Also, ROC curve analysis showed high value of echocardiography to discriminate PAH from normal PAP status (AUC = 0.841) that considering a cutoff value of 22.88 for PAP assessed by echocardiography reached to a sensitivity of 72.7% and a specificity of 100%.Conclusion:Both chest spiral CT scan and Doppler echocardiography are very useful to diagnose PAH and its severity in patients with scleroderma. (www.actabiomedica.it)

Management of a Lost Stone During Laparoscopic Ureterolithotomy: Video Article

IntroductionLaparoscopic ureterolithotomy (LU) is a viable option for large ureteral stones (1, 2). The lost stone during laparoscopy is a rare event and most reports are in gallstone surgeries. Most experts recommended that the lost gallstone should be extracted from the abdominal cavity to prevent abscess formation but in laparoscopic ureterolithotomy with lost stone the optimal management is controversial (3-5). We report our experience with a lost ureteral stone during laparoscopy and the technique that was successful to find it.Case presentationThe patient was a 28-year-old man, presented with a 22 millimetres stone in the proximal part of the left ureter. The spiral computed tomography scan revealed severe hydronephrosis. The patient was positioned in the left flank and camera port inserted in the lateral border of rectus muscle then two 5 mm working ports inserted in the left upper quadrant and left lower quadrant, respectively. The ureterolithotomy process was performed uneventfully with Double-J stent insertion, but during the extraction of stone from 10 mm port, the stone was lost in abdominal space due to rupture of our endobag (which was a finger of a surgical glove). We extract the lost stone with stepwise searching of the dependent part of the abdominal cavity and found the stone in the dependent part of the right lower quadrant. The operative time was 165 minutes. The patient had no complication in the Post-operative course, the Foley catheter was removed on post-operative day 2 and the drain was removed on post-operative day 3. The patient was discharged home at post-operation day 4 and stent removed four weeks later.ConclusionsWe believe that any effort should be performed to extract lost stone in laparoscopic ureterolithotomy cases due to the potential risk of abscess formation and the probability of misleading imaging in the future follow-up of patients.

Intramuscular Fat Influences Neuromuscular Activation of the Gluteus Medius in Older Adults.

The amount of tissue between the muscle and surface electromyography (sEMG) electrode influences the sEMG signals. Increased intramuscular adipose tissue (IMAT) of the hip abductor muscles negatively impacts balance in older individuals, but it is unknown if this is related to the ability to activate the muscles. The aim of this preliminary study was to investigate the influence of gluteus medius (GM) IMAT on sEMG amplitude during maximal voluntary isometric contractions (MVIC) of the hip abductors in older adults. We recruited 12 healthy community-dwelling older adults that underwent a spiral computerized tomography scan. High density lean (HDL), IMAT, and subcutaneous adipose tissue (SUBFAT) cross-sectional area of the GM were assessed. sEMG signal from the GM was recorded while participants performed an MVIC of the hip abductors. There was a negative correlation between GM activation and IMAT (r = −0.58, P = 0.046), and also SUBFAT (r = −0.78, P = 0.002) and a positive correlation with HDL (r = 0.73, P = 0.006). When controlling for SUBFAT, the partial correlations demonstrated a consistent negative correlation between GM activation and IMAT (r = −0.60, P = 0.050) but no relationship with HDL. The current results are important for helping to interpret the results from sEMG by accounting for IMAT. In conclusion, the neuromuscular activation of the GM may be reduced by the quantity of IMAT.