Thin-section CT Scans Research Articles

BRONCHIECTASIS: MICROBIOME AND INFECTIONS

Due to the degradation of the muscles and elastic connective tissues, bronchiectasis is characterized by a chronic enlargement of the bronchi and bronchioles. The condition is characterized by an ongoing cough, the production of sputum, and infections and can strike at any age. Bronchiectasis may have been less frequent in the 20th century, but it still ranks third among the chronic inflammatory disorders of the airways, behind chronic obstructive pulmonary disease and asthma. Pseudomonas aeruginosa and Haemophilus influenzae are the most frequent bacteria detected in bronchiectasis airways worldwide, but proportions differ amongst bacterial communities. Additionally, Streptococcus, Prevotella, Veillonella, and Staphylococcus have been found in bronchiectasis patients' airways. The symptoms of bronchiectasis, which include worsened sputum production with more blood and purulent discharge, wheezing and dyspnea, as well as fever, are considered to be brought on by bacterial infection. On thin-section CT scans, morphologic criteria include the presence of bronchi within 1 cm of the pleural surface and bronchial dilatation in relation to the adjacent pulmonary artery (signet ring sign). The basic objectives of bronchiectasis care are to preserve adequate lung function, regulate symptoms and enhance patient quality of life while preventing and reducing exacerbations.

Case Report of a Patient With Posttraumatic Perilymphatic Fistula.

On a perilymphatic fistula, there is an extravasation of the perilymph fluid into the middle ear cavity. Cross-sectional imaging techniques have very important role in evaluation of inner and middle ear structures and temporal bone. While thin section CT scans can show successfully pneumolabyrinth and temporal bone fracture, high-resolution 3D volumetric MRI sequences can help to demonstrate posttraumatic ear effusion and cerebrospinal fluid fistula into inner ear or middle ear.

Impact of a content-based image retrieval system on the interpretation of chest CTs of patients with diffuse parenchymal lung disease

ObjectivesContent-based image retrieval systems (CBIRS) are a new and potentially impactful tool for radiological reporting, but their clinical evaluation is largely missing. This study aimed at assessing the effect of CBIRS on the interpretation of chest CT scans from patients with suspected diffuse parenchymal lung disease (DPLD).Materials and methodsA total of 108 retrospectively included chest CT scans with 22 unique, clinically and/or histopathologically verified diagnoses were read by eight radiologists (four residents, four attending, median years reading chest CT scans 2.1± 0.7 and 12 ± 1.8, respectively). The radiologists read and provided the suspected diagnosis at a certified radiological workstation to simulate clinical routine. Half of the readings were done without CBIRS and half with the additional support of the CBIRS. The CBIRS retrieved the most likely of 19 lung-specific patterns from a large database of 6542 thin-section CT scans and provided relevant information (e.g., a list of potential differential diagnoses).ResultsReading time decreased by 31.3% (p < 0.001) despite the radiologists searching for additional information more frequently when the CBIRS was available (154 [72%] vs. 95 [43%], p < 0.001). There was a trend towards higher overall diagnostic accuracy (42.2% vs 34.7%, p = 0.083) when the CBIRS was available.ConclusionThe use of the CBIRS had a beneficial impact on the reading time of chest CT scans in cases with DPLD. In addition, both resident and attending radiologists were more likely to consult informational resources if they had access to the CBIRS. Further studies are needed to confirm the observed trend towards increased diagnostic accuracy with the use of a CBIRS in practice.Key Points• A content-based image retrieval system for supporting the diagnostic process of reading chest CT scans can decrease reading time by 31.3% (p < 0.001).• The decrease in reading time was present despite frequent usage of the content-based image retrieval system.• Additionally, a trend towards higher diagnostic accuracy was observed when using the content-based image retrieval system (42.2% vs 34.7%, p = 0.083).

T1 invasive lung adenocarcinoma: Thin-section CT solid score and histological periostin expression predict tumor recurrence.

Adenocarcinoma is the most common histological type of non-small cell lung cancer (NSCLC), and various biomarkers for predicting its prognosis after surgical resection have been suggested, particularly in early-stage lung adenocarcinoma. Periostin (also referred to as POSTN, PN or osteoblast-specific factor) is an extracellular matrix protein, the expression of which is associated with tumor invasiveness in patients with NSCLC. In the present study, the novel approach, in which the thin-section CT findings prior to surgical resection and periostin expression of resected specimens were analyzed in combination, was undertaken to assess whether the findings could be a biomarker for predicting the outcomes following resection of T1 invasive lung adenocarcinoma. A total of 73 patients who underwent surgical resection between January 2000 and December 2009 were enrolled. A total of seven parameters were assessed in the thin-section CT scans: i) Contour; ii) part-solid ground-glass nodule or solid nodule; iii) percentage of solid component (the CT solid score); iv) presence of air-bronchogram and/or bubble-like lucencies; v) number of involved vessels; vi) shape linear strands between the nodule and the visceral pleura; and vii) number of linear strands between the nodule and the visceral pleura. Two chest radiologists independently assessed the parameters. Periostin expression was evaluated on the basis of the strength and extent of staining. Univariate and multivariate analyses were subsequently performed using the Cox proportional hazards model. There was a substantial to almost perfect agreement between the two observers with regard to classification of the seven thin-section CT parameters (κ=0.64-0.85). In the univariate analysis, a CT solid score >80%, pathological lymphatic invasion, tumor and lymph node status and high periostin expression were significantly associated with recurrence (all P<0.05). Multivariate analysis demonstrated that a CT solid score >80% and high periostin expression were risk factors for recurrence (P=0.002 and P=0.011, respectively). The cumulative recurrence rates among the three groups (both negative, CT solid score >80% or high periostin expression, or both positive) were significantly different (log-rank test, P<0.001). Although the solid component is already known to be a major predictor of outcome in lung adenocarcinomas according to previous studies, the combined analysis of CT solid score and periostin expression might predict the likelihood of tumor recurrence more precisely.

Pulmonary fibrosis and its related factors in discharged patients with new corona virus pneumonia: a cohort study

BackgroundThousands of Coronavirus Disease 2019 (COVID-19) patients have been discharged from hospitals Persistent follow-up studies are required to evaluate the prevalence of post-COVID-19 fibrosis.MethodsThis study involves 462 laboratory-confirmed patients with COVID-19 who were admitted to Shenzhen Third People’s Hospital from January 11, 2020 to April 26, 2020. A total of 457 patients underwent thin-section chest CT scans during the hospitalization or after discharge to identify the pulmonary lesion. A total of 287 patients were followed up from 90 to 150 days after the onset of the disease, and lung function tests were conducted about three months after the onset. The risk factors affecting the persistence of pulmonary fibrosis were identified through regression analysis and the prediction model of the persistence of pulmonary fibrosis was established.ResultsParenchymal bands, irregular interfaces, reticulation and traction bronchiectasis were the most common CT features in all COVID-19 patients. During the 0–30, 31–60, 61–90, 91–120 and > 120 days after onset, 86.87%, 74.40%, 79.56%, 68.12% and 62.03% patients developed with pulmonary fibrosis and 4.53%, 19.61%, 18.02%, 38.30% and 48.98% patients reversed pulmonary fibrosis, respectively. It was observed that Age, BMI, Fever, and Highest PCT were predictive factors for sustaining fibrosis even after 90 days from onset. A predictive model of the persistence with pulmonary fibrosis was developed based-on the Logistic Regression method with an accuracy, PPV, NPV, Sensitivity and Specificity of the model of 76%, 71%, 79%, 67%, and 82%, respectively. More than half of the COVID-19 patients revealed abnormal conditions in lung function after 90 days from onset, and the ratio of abnormal lung function did not differ on a statistically significant level between the fibrotic and non-fibrotic groups.ConclusionsPersistent pulmonary fibrosis was more likely to develop in patients with older age, higher BMI, severe/critical condition, fever, a longer viral clearance time, pre-existing disease and delayed hospitalization. Fibrosis developed in COVID-19 patients could be reversed in about a third of the patients after 120 days from onset. The pulmonary function of less than half of COVID-19 patients could turn to normal condition after three months from onset. An effective prediction model with an average area under the curve (AUC) of 0.84 was established to predict the persistence of pulmonary fibrosis in COVID-19 patients for early diagnosis.

Controlling Factors on Petrophysical and Acoustic Properties of Bioturbated Carbonates: (Upper Jurassic, Central Saudi Arabia)

Many of the world’s productive Jurassic reservoirs are intensively bioturbated, including the sediments of the Upper Jurassic Hanifa Formation. Hydrocarbon exploration and production from such reservoirs require a reliable prediction of petrophysical properties (i.e., porosity, permeability, acoustic velocity) by linking and assessment of ichnofabrics and trace fossils and determining their impact on reservoir quality. In this study, we utilized outcrop carbonate samples from the Hanifa Formation to understand the main controlling factors on reservoir quality (porosity and permeability) and acoustic velocity of bioturbated carbonates, by using thin-section petrography, SEM, XRD, CT scan, porosity, permeability, and acoustic velocity measurement. The studied samples are dominated by Thalassinoides burrows that have burrow intensity ranging from ~4% to 27%, with porosity and permeability values ranging from ~1% to 20%, and from 0.002 mD up to 1.9 mD, respectively. Samples with coarse grain-filled burrows have higher porosity (average µ = 14.44% ± 3.25%) and permeability (µ = 0.56 mD ± 0.55) than samples with fine grain-filled burrows (µ = 6.56% ± 3.96%, and 0.07 mD ± 0.16 mD). The acoustic velocity is controlled by an interplay of porosity, bioturbation, and mineralogy. Samples with relatively high porosity and permeability values (&gt;10% and &gt;0.1 mD) have lower velocities (&lt;5 km/s) compared to tight samples with low porosities and permeabilities (&lt;10% and &lt;0.1 mD). The mineralogy of the analyzed samples is dominated by calcite (~94% of total samples) with some quartz content (~6% of total samples). Samples characterized with higher quartz (&gt;10% quartz content) show lower velocities compared to the samples with lower quartz content. Bioturbation intensity, alone, has no control on velocity, but when combined with burrow fill, it can be easier to discriminate between high and low velocity samples. Fine grain-filled burrows have generally lower porosity and higher velocities (µ = 5.46 km/s) compared to coarse grain-filled burrows (µ = 4.52 km/s). Understanding the main controlling factor on petrophysical properties and acoustic velocity of bioturbated strata can enhance our competency in reservoir quality prediction and modeling for these bioturbated units.

Evaluation of fronto-orbital reconstruction surgery for the treatment of metopic synostosis in Chinese population.

To evaluate the efficacy of fronto-orbit reconstruction surgery on pediatric metopic synostosis via an image-based 3D reconstruction in Chinese population. Thirty pediatric metopic synostosis patients who received fronto-orbital reconstruction surgery in the Children's Hospital of Nanjing Medical University, Department of Neurosurgery, from January 2007 to December 2018 were analyzed in the study. Here we use the Mimics 20.0 software to reconstruct patients' cranial thin-section CT scan images from pre- and post-operation and control groups. Then the data of intracranial volume, frontal volume, orbital hypertelorism, ECA, ZF, and ORA were analyzed using the paired t-test or Wilcoxon matched-pairs signed-ranks test. The age of these patients was 15.83 ± 16.12 months. After surgery, the mean frontal volume was enlarged from 92.75 ± 26.97 to 138.62 ± 47.97 cm3 (P < 0.0001), and the intracranial volume was enhanced from 976.87 ± 230.83 to 1059.44 ± 217.98 cm3 (P < 0.0001). In the meantime, the ECA was changed from 108.02 ± 8.17 to 134 ± 5.59° (P < 0.0001). In line with the alteration of the parameters mentioned above, the head shapes in all patients were also significantly improved after the surgery with no obvious complications. Fronto-orbit reconstruction surgery is a safe and effective treatment for pediatric metopic synostosis. Computer-aided 3D reconstruction could serve as a quantitative strategy to evaluate the efficacy of craniofacial surgery.

Total Cranial Reconstruction for the Treatment of Sagittal Craniosynostosis in Children.

To study the effect of total cranial reconstruction for sagittal synostosis (scaphocephaly) deformity in Chinese children. A retrospective analysis was performed involving 23 children with isolated non-syndromic sagittal synostosis who were treated by total calvarial vault remodeling after 1 year of age from May 2015 to June 2019 in the Department of Neurosurgery, Children's Hospital of Nanjing Medical University. The authors reconstruct patients' pre- and post-operative cranial thin-section CT scan images and those of the control group. The cephalic index (traditional, normative), intracranial volume, horizontal point of maximum width (H-PMW), vertical point of maximum width (V-PMW), frontal to head height ratio and occipital to head height ratio data were analyzed using a paired t test or Wilcoxon signed-rank test. Twenty-three patients met the inclusion criteria, including 19 males and 4 females. The ratio of males to females was 4.7:1. All patients underwent total cranial reconstruction. The average age was 26.52 months (13-48 months), the average operation time was 214.13 minutes (150-265 minutes), and the average amount of suspended erythrocytes was 200 ml (100-400 ml). The cranial morphology of all patients improved significantly after the operation. The traditional cephalic index (pre-operative: 0.70 (0.04); post-operative: 0.78 (0.02)) and normative cephalic index (pre-operative: 0.68 (0.03); post-operative: 0.77 (0.02)) were significantly increased (P < 0.0001). The mean horizontal point of maximum width improved from 0.54 to 0.56 (P = 0.0043), the mean vertical point of maximum width decreased from 0.59 to 0.54 (P = 0.0006), the frontal height decreased from 0.89 to 0.77 (P < 0.0001), and the occipital height improved from 0.78 to 0.88 (P < 0.0001). The intracranial volume increased from 1287.35 to 1426.90 cm3 (P < 0.0001). All of the children had a good skull shape and no recurrence of deformity. Total calvarial reconstruction can effectively correct scaphocephaly in Chinese children, expand cranial volume, reduce cranial height, shorten fronto-occipital diameters and enlarge biparietal diameters.

Quantitative CT Analysis in Patients with Pulmonary Emphysema: Do Calculated Differences Between Full Inspiration and Expiration Correlate with Lung Function?

PurposeThe aim of this retrospective study was to evaluate correlations between parameters of quantitative computed tomography (QCT) analysis, especially the 15th percentile of lung attenuation (P15), and parameters of clinical tests in a large group of patients with pulmonary emphysema.Patients and MethodsOne hundred and seventy-two patients with pulmonary emphysema and chronic obstructive pulmonary disease (COPD) global initiative for chronic obstructive lung disease (GOLD) stage 3 or 4 were assessed by nonenhanced thin-section CT scans in full inspiratory and expiratory breath-hold, pulmonary function test (PFT), a 6-minute walk test (6MWT), and quality of life questionnaires (SGRQ and CAT). QCT parameters included total lung volume (TLV), total emphysema score (TES), and P15, all measured at inspiration (IN) and expiration (EX). Differences between inspiration and expiration were calculated for TLV (TLVDiff), TES (TESDiff), and P15 (P15Diff). Spearman correlation analysis was performed.ResultsCT-measured lung volume in inspiration (TLVIN) correlated strongly with spirometry-measured total lung capacity (TLC) (r=0.81, p<0.001) and moderately to strongly with residual volume (RV), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1)/FVC (r=0.60, 0.56, and −0.49, each p<0.001). Lung volume in expiration (TLVEX) correlated moderately to strongly with TLC, RV and FEV1/FVC ratio (r=0.75, 0.66, and −0.43, each p<0.001). TES and P15 showed stronger correlations with the carbon monoxide transfer coefficient (KCO%) (r= −0.42, 0.44, both p<0.001), when measured during expiration. P15Diff correlated moderately with KCO% and carbon monoxide diffusing capacity (DLCO%) (r= 0.41, 0.40, both p<0.001). The 6MWT and most QCT parameters showed significant differences between COPD GOLD 3 and 4 groups.ConclusionOur results suggest that QCT can help predict the severity of lung function decrease in patients with pulmonary emphysema and COPD GOLD 3 or 4. Some QCT parameters, including P15EX and P15Diff, correlated moderately to strongly with parameters of pulmonary function tests.

Imaging features of the initial chest thin-section CT scans from 110 patients after admission with suspected or confirmed diagnosis of COVID-19

BackgroundIn December 2019, an outbreak of a novel coronavirus pneumonia, now called COVID-19, occurred in Wuhan, Hubei Province, China. COVID-19, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread quickly across China and the rest of the world. This study aims to evaluate initial chest thin-section CT findings of COVID-19 patients after their admission at our hospital.MethodsRetrospective study in a tertiary referral hospital in Anhui, China. From January 22, 2020 to February 16, 2020, 110 suspected or confirmed COVID-19 patients were examined using chest thin-section CT. Patients in group 1 (n = 51) presented with symptoms of COVID-19 according to the diagnostic criteria. Group 2 (n = 29) patients were identified as a high degree of clinical suspicion. Patients in group 3 (n = 30) presented with mild symptoms and normal chest radiographs. The characteristics, positions, and distribution of intrapulmonary lesions were analyzed. Moreover, interstitial lesions, pleural thickening and effusion, lymph node enlargement, and other CT abnormalities were reviewed.ResultsCT abnormalities were found only in groups 1 and 2. The segments involved were mainly distributed in the lower lobes (58.3%) and the peripheral zone (73.8%). The peripheral lesions, adjacent subpleural lesions, accounted for 51.8%. Commonly observed CT patterns were ground-glass opacification (GGO) (with or without consolidation), interlobular septal thickening, and intralobular interstitial thickening. Compared with group 1, patients in group 2 presented with smaller lesions, and all lesions were distributed in fewer lung segments. Localized pleural thickening was observed in 51.0% of group 1 patients and 48.2% of group 2 patients. The prevalence of lymph node enlargement in groups 1 and 2 combined was extremely low (1 of 80 patients), and no significant pleural effusion or pneumothorax was observed (0 of 80 patients).ConclusionThe common features of chest thin-section CT of COVID-19 are multiple areas of GGO, sometimes accompanied by consolidation. The lesions are mainly distributed in the lower lobes and peripheral zone, and a large proportion of peripheral lesions are accompanied by localized pleural thickening adjacent to the subpleural region.

CT imaging features of 34 patients infected with COVID-19

ObjectiveTo retrospectively analyze the CT findings in patients infected with Coronavirus disease 2019 (COVID-19). Materials and methodsThe thirty-four cases, 15 females and 19 males, with an age ranging from 7 to 88 years old, confirmed by real-time reverse-transcriptase-polymerase chain reaction (RT-PCR), were used for our study. All thin-section CT scans of the lungs were performed in all of patients. The clinical, laboratory and CT imaging were available to evaluate in all patients. ResultsThe patients present with fever (85.29%, n = 29), cough (67.65%, n = 23), fatigue or myalgia (26.47%, n = 9), and pharyngalgia (8.82%, n = 3). The 4 patients (11.76%) with no symptoms were identified during screening for close contacts, who had typical CT findings. On initial CT scans, the bilateral lung involved was shown in 24 cases (70.59%), while 29 (82.35%) cases were distributed in peripheral. The pure ground glass opacity (GGO) was shown in 18 cases (52.94%), the GGO with consolidation was in 12 cases (35.29%), and full consolidation only in 3 cases. The lesion with air bronchogram was seen in 14 (41.18%) cases, with enlarged blood vessel in 17 (50.00%) cases, with crazy-paving pattern in 8 (23.53%) cases, with fine reticular pattern in 4 (11.77%) cases, and with intralesional vacuole sign in 6 (17.65%) cases. The pleural effusion was seen in one patient. Follow-up imaging in 19 patients during the study time window demonstrated mild, moderate or severe progression of disease, as manifested by increasing extent and density of lung opacities. ConclusionsThe bilateral GGO with air bronchogram, enlarged blood vessel, fine reticular pattern, and peripheral distribution are the early CT findings of COVID-19. The crazy-paving pattern and intralesional vacuole sign are the features of progressive stage.

Pulmonary Fibrosis and Its Related Factors in Discharged Patients with New Coronavirus Pneumonia: A Cohort Study of 90-150 Days Follow-Up after Onset

Background: The Coronavirus Disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic, posing a serious threat to public health worldwide. Whether survivors of COVID-19 pneumonia may be at risk of pulmonary fibrosis is still unknown.Methods: This study involves 462 laboratory confirmed patients with COVID-19 who were admitted to Shenzhen Third People’s Hospital. A total of 457 patients underwent thin-section chest CT scans during the hospitalization or after discharge to identify the pulmonary lesion. A total of 287 patients were followed up from 90 days to 150 days after the onset of the disease.Finding: 397 (86.87%), 311 (74.40%), 222 (79.56%), 141 (68.12%) and 49 (62.03%) patients developed with pulmonary fibrosis during the 0-30, 31-60, 61-90, 91-120 and >120 days after onset, respectively. Reversal of pulmonary fibrosis were found in 18 (4.53%), 61 (19.61%), 40 (18.02%), 54 (38.30%) and 24 (48.98%) COVID-19 patients during the 0-30, 31-60, 61-90, 91-120 and >120 days after onset, respectively. It was observed that Age, BMI, Fever, and Highest PCT were predictive factors for sustaining fibrosis even after 90 days from onset. Only a fraction of COVID-19 patients suffered with abnormal lung function after 90 days from onset.Interpretation: Long-term pulmonary fibrosis was more likely to develop in patients with older age, high BMI, severe/critical condition, fever, long time to turn the viral RNA negative, pre-existing disease and delay to admission. Fibrosis developed in COVID-19 patients could be reversed in about a half of the patients after 120 days from onset. The pulmonary function of most of COVID-19 patients with pulmonary fibrosis could turn to normal condition after three months from onset.Funding Statement: Shenzhen Science and Technology Research and Development Project (202002073000001 and 202002073000002), Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties (SZGSP011).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was conducted at Shenzhen Third People's Hospital and approved by the Ethics Committees, each patient gave written informed consent.

Patterns and predictors of isolated oculomotor nerve palsy recovery following mild traumatic brain injury

Introduction: Oculomotor nerve palsy following mild traumatic brain injury is uncommon. The exact pathogenesis, management protocol and outcome of such patients is unclear in the absence of large series. This article attempts to analyze the patterns of injury and recovery in a series of twenty one patients with third cranial nerve palsy following mild traumatic brain injury (TBI). Materials and Methods: All patients admitted with mild head injury and third nerve involvement were included in the study. This retrospective study covered a three-year period from January 2015 to December 2017. Mild head injury was defined as patients with a Glasgow Coma score of 14 -15 and having a normal CT scan at admission. The clinical profile of the injury and recovery of the oculomotor nerve were jointly evaluated and followed up in the department of neurosurgery and ophthalmology. Results: Our study group included twenty one patients. Levator palpebrae superioris involvement with ptosis (95.23%) was the most consistently affected third nerve function followed by extraocular muscles (90.47%) and pupillary fibers (80.9%). Ptosis was partial in 11 patients and complete in nine. Of the extra ocular muscles, the most common muscles to be involved were the inferior rectus and the medial rectus which were involved in 19 patients (90.47%). Superior rectus involvement was seen in 13 patients and inferior oblique in nine patients. Imaging including thin section CT scans (all patients) and FIESTA MRI sequence (2 patients) did not reveal any significant abnormality. All our patients were managed conservatively. Steroids and corrective surgery was not tried in any patient. On follow up, after a mean period of 6 months, partial ptosis recovered completely while complete ptosis recovered only in four patients (44.4%). Of the seventeen patients with pupillary involvement, pupillary size and reaction improved in four (23.5%) and remained static in 13 patients. Of the extraocular muscles superior

Lung Injuries on Computerized Tomography Due to Pellet Gun

Pellet gun used by law enforcement agencies have the potential to cause grevious or life threatening injuries as metallic projectiles fired at high speeds from pellet gun have potential to damage air containing organs like lungs which occupy a large portion of chest cavity and lie in close approximation to chest wall. Thoracic injury overall is the third most common cause of trauma following injury to the head and extremities.&#x0D; Objective. The objective of this study was to evaluate lung pellet gun injuries in patients of a conflict zone by a so called non-lethal weapon.&#x0D; Methods. The study was conducted in post graduate department of Radiodiagnosis and Imaging, Government Medical College, Srinagar Jammu and Kashmir. Our study was performed between the 6th January 2019 to the 22th May 2019. A total of 40 patients with pellet injuries were taken up for study.&#x0D; Inclusion criteria were patients with pellet gun injuries without any immediate life threatening injury like head injury; patients willing to be part of study. Radiographs of all the patients were studied. Whenever there was suspicion of severe injury, CT scan was done. We obtained thin-section axial CT scans (0.625– 1.25 mm) with multiplanar reformation with an interval of 3-5 mm.&#x0D; Results. All of the patients were males with most of patients in age group of 20 to 30 years.&#x0D; About 14 patients out of 40 had lung injuries. The most common pattern of lung injury was pneumothorax followed by pulmonary hemorrhage.&#x0D; In conclusion, a so called non-lethal pellet gun used by law enforcement agencies has the potential to cause lung injuries which can sometimes be lethal to life especially when fired from short distance.

Will Adding Fibrotic Score to the GAP Score Help Predict Patient Survival?

Will Adding Fibrotic Score to the GAP Score Help Predict Patient Survival?

Lung CT Densitometry in Idiopathic Pulmonary Fibrosis for the Prediction of Natural Course, Severity, and Mortality

In this study, we retrospectively assessed the relationships among physiologic measurements, survival, and quantitative high-resolution CT (HRCT) scanning indexes in patients with idiopathic pulmonary fibrosis (IPF). Seventy patients (48 male; mean [SD] age, 66.4 [9.0] years) with IPF were enrolled in the study. After segmentation of the lungs in thin-section CT scanning with the patient in the supine position at full inspiration, we assessed following parameters: mean lung attenuation (MLA), skewness, kurtosis, peak attenuation, total lung area, inflexion point with slope, and area right of the inflexion point (AROIP). Additionally, FVC, FEV1, total lung capacity, diffusing capacity or transfer factor of the lung for carbon monoxide (Dlco), and 6-min walk distance were analyzed. Univariate and multivariate analysis were used for the prediction of physiologic outcomes by HRCT scanning indexes and then were correlated to survival in a proportional hazards analysis. The strongest correlation was observed between MLA and FEV1, with an r of-0.63. MLA, peak attenuation, slope, attenuation, and AROIP correlated negatively with all physiologic measurements. AROIP was the best predictor of Dlco. Analysis for prediction of mortality showed that AROIP, kurtosis, and FVC were related significantly to survival. Multivariate regression revealed a significant impact of only AROIP (among age, sex, MLA, skewness, kurtosis, FVC, and Dlco) on survival. These data indicate that HRCT scanning indexes are correlated to physiologic measurements. The newly defined parameter, AROIP, is of additive value for prediction of outcome. ClinicalTrials.gov; No.: NCT02951416; URL: www.clinicaltrials.gov.

Assessment of pedicle screw malposition rates in thoracolumbosacral spine: results of postoperative computed tomography in 100 patients

Purpose: The purpose of this retrospective study was to evaluate the screw malpositions of patients who underwent transpedicular screw application in various elective and emergency conditions.Material and Methods: 100 patients who underwent transpedicular screw application with various spinal pathologies between January 2012 and September 2016 were included in this retrospective study. Anteroposterior and lateral X-rays and thin section spinal computed tomography scans were performed within 72 hours after the operation. The data including age, gender, operation levels, number of screws placed, preoperative and postoperative neurological conditions, complications, number of screw malpositions and revision surgeries of the patients were gathered.Results: A total of 692 transpedicular screws were applied to 100 cases. 610 (88.15%) of the 692 transpedicular screws placed were evaluated as normal. 82 screws (11.85%) were evaluated as malpositions and 5 of them were revised. According to Gertzbein classification; 20 screws were grade 1, 44 screws were grade 2 and 18 screws were grade 3. 4 patients had anterior perforation, 39 patients had medial perforation, 38 patients had lateral perforation and 1 patient had inferior perforation. There was a dominancy of thoracal levels in screw malpositions.Conclusion: Thin section CT scans taken postoperatively was found to be the gold standard for detecting screw malpositions. We identified that malpositions were most frequently seen as medial pedicle wall perforations in the thoracal region due to anatomical structure of the pedicles.

Application of technique of HRCT and multipliate plane reconstruction in analysis of image features of superior semicircular canal dehiscence

Objective: Application of technique of high resolution CT (HRCT) and multipliate plane reconstruction, analyzed the image features of suspicious superior semicircular canal dehiscence (SSCD) to improve the understanding of the SSCD.Method:From January 2016 to April 2017, a total of 230 adult patients who checked temporal bone HRCT were collected in this retrospective study, of which 160 cases (320 ears) of the non-SSCD, 73 cases were male (146 ears), 87 cases were female (174 ears), aged 18 to 70 years old; 70 cases (113 ears) were suspicious diagnosed with SSCD, 33 cases were male (55 ears), 37 cases were female (58 ears), and 18 to 71 years old. The thin section CT scan of the temporal bone translocation was performed on all subjects, then the CT post processing workstation was used for multipliate plane reconstruction (MPR), and the main rows of coronal and oblique sagittal image reconstruction was performed. To observe, measure and record the HRCT features and datas of the suspicious SSCD and non-SSCD, then analyze the collected data.Result:There were 160 cases (320 ears) in non-SSCD group, and the height of the superior semicircular canal was (6.43±0.51)mm, the outer tube diameter was (0.83±0.13)mm, the thickness of the tympanic cavity was (2.19±0.62)mm, the anteroposterior diameter of mastoid was (14.55±1.98)mm; There were 70 cases (113 ears) in the suspicious SSCD group, the above results were (6.42±0.60)mm, (0.85±0.16)mm, (1.62±0.55)mm, (13.24±1.97)mm, respectively. Statistical analysis showed that there were no significant difference in the height of the superior semicircular canal (P=0.94) and the outer tube diameter (P=0.64), There were significant differences in the thickness of the tympanic cavity (P=0.002) and the anteroposterior diameter of mastoid (P=0.004). There were 70 cases (113 ears) in group suspicious SSCD, the unilateral defect had 27 cases (27 ears), and bilateral defect had 43 cases (86 ears). The defect was located in the middle of the parietal wall in 48 ears, located in the anterior wall of 20 ears, located in the posterior wall of 32 ears, more than two defects in 13 ears; 7 ears were mastoid pneumatic type, 90 ears were mastoid sclerotic type, 16 ears were mastoid mixed type.Conclusion:The SSCD was more common in the sclerotic mastoid. The bilateral defect was common, mostly located in the middle of the parietal wall. The occurrence of the lesion is not related to the height and diameter of the superior semicircular canal, but may be related to the thinning of the whole temporal bone.

Evaluation of functional outcome of lumbar spondylolisthesis treated with posterior lumbar interbody fusion with instrumentation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Spondylolisthesis with or without spondylolysis occurs in 5% to 8% of the adult population. It is commonly believed that spondylolysis does not exist at birth. The incidence is 4.4% to 5% at the age of 6 years, increasing to 6% at the age of 18 years, which is quite similar to that observed in adulthood.To analyze the functional outcome of posterior stabilization by pedicle screws with decompression and interbody fusion by PLIF (Posterior Lumbar Interbody Fusion) technique in adult single level spondylolisthesis. In this study our aim is to analyze the correlation between the degrees of fusion with functional outcomes.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study of 20 patients carried out in the Department of Orthopaedics, Govt. Dharmapuri Medical College Hospital, Dharmapuri from January 2016 to December 2017. All patients were evaluated with anteroposterior, lateral and oblique radiographs of the lumbosacral spine. Dynamic plain radiographs of all our patients showed instability. CT/MRI evaluation of all patients was done.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study four patients (20%) had a complete reduction of the preoperative slip, fourteen patients (70%) showed a reduction of slip by one grade, while in two patients (10%) there was no change from the preoperative slip percentage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Further, three dimensional multislice thin section CT scans with multiplanar reconstruction are ideal to study the incorporation of the bone graft within the disc space.&lt;/p&gt;

Application of 3D printing osteotomy plate in osteotomy for correction of cubitus varus in children

Objective To study the application value of 3D printing osteotomy plate technique in the correction of cubitus varus deformity in children. Methods From July 2014 to December 2015, 7 patients with cubitus varus deformity were treated with wedge-shaped osteotomy of lateral humeral supracondylar. Before surgery thin-section CT scan and elbow joint three-dimensional reconstruction were performed. According to the cubitus varus situation, the best osteotomy angle was designed and then a guide plate was established which was anatomically consistent with the osteotomy range. Three-dimensional data model of the guide plate were input into 3D printer for producing guide plate. During the operation, the established guide plate of osteotomy was matched with the part of humeral osteotomy. After osteotomy along the plate, the osteotomy gap was slowly closed and fixed by plate. Results The osteotomy angle was satisfactory in 7 cases after operation. Postoperative follow-up time ranged from 3 to 6 months with an average of 4 months. The elbow function was evaluated according to the Mayo elbow function score. The results were excellent in 5 cases, good in 1 case and fair in 1 case. Conclusion The osteotomy plate which is 3D printed can provide a personalized and accurate osteotomy for correction of cubitus varus deformity in children. Key words: Elbow joint; Osteotomy; Cubitus varus; 3D printing