Three-dimensional Computed Tomography Images Research Articles

The Assessment of Airway Compression Due to Cervical Fusion in Klippel-Feil Syndrome Patients: A Report of Two Cases.

In general anesthesia for Klippel-Feil syndrome (KFS) patients, there is a potential risk of difficult intubation. However, airway assessment to predict difficult intubation for KFS patients is not known. In Patient 1, cervical spine computed tomography (CT) revealed airway compression due to cervical fusion. For airway assessment, bronchofiberscopy, three-dimensional (3-D) CT, and virtual bronchoscopic image (VBI) construction were performed. Based on these images, fiberoptic nasotracheal awake intubation was performed. In Patient 2, magnetic resonance imaging and bronchofiberscopy showed no airway compression due to cervical fusion; therefore, tracheal intubation was performed using a video laryngoscope after anesthetic administration. Airway compression due to cervical fusion is considered one of the risk factors for difficult intubation in KFS patients.

DP-GAN+B: A lightweight generative adversarial network based on depthwise separable convolutions for generating CT volumes

X-rays, commonly used in clinical settings, offer advantages such as low radiation and cost-efficiency. However, their limitation lies in the inability to distinctly visualize overlapping organs. In contrast, Computed Tomography (CT) scans provide a three-dimensional view, overcoming this drawback but at the expense of higher radiation doses and increased costs. Hence, from both the patient's and hospital's standpoints, there is substantial medical and practical value in attempting the reconstruction from two-dimensional X-ray images to three-dimensional CT images. In this paper, we introduce DP-GAN+B as a pioneering approach for transforming two-dimensional frontal and lateral lung X-rays into three-dimensional lung CT volumes. Our method innovatively employs depthwise separable convolutions instead of traditional convolutions and introduces vector and fusion loss for superior performance. Compared to prior models, DP-GAN+B significantly reduces the generator network parameters by 21.104 M and the discriminator network parameters by 10.82 M, resulting in a total reduction of 31.924 M (44.17%). Experimental results demonstrate that our network can effectively generate clinically relevant, high-quality CT images from X-ray data, presenting a promising solution for enhancing diagnostic imaging while mitigating cost and radiation concerns.

Evaluation of glenoid morphology and bony Bankart lesion in shoulders with traumatic anterior instability using zero echo time magnetic resonance imaging

BackgroundPreoperative computed tomography (CT) evaluation of bone morphometry aids in determining treatment strategies for shoulder instability. The use of zero echo time (ZTE) sequence in magnetic resonance imaging (MRI), a new bone cortex imaging technique, may help reduce radiation exposure and medical costs. Therefore, this study aimed to evaluate the glenoid morphology and detect the presence of bony Bankart lesion using ZTE MRI in shoulders with anterior instability and compare its diagnostic accuracy with that of CT. MethodsThirty-six patients (36 shoulders) with anterior instability who underwent preoperative CT and MRI examinations between April 2019 and October 2021 were retrospectively analyzed. The percentages of glenoid bone defects on three-dimensional (3D) CT and ZTE images were determined, and the correlation between these percentages was evaluated. The number of cases with bony Bankart lesion on CT and two types of ZTE (3D and CT-like) images was determined, and the diagnostic accuracy of ZTE for detecting bony Bankart lesion was assessed, with CT as the gold standard. Patients with bony Bankart lesion on CT images were divided into two groups based on whether the lesion was detectable on 3D ZTE or CT-like images. The longer diameters of bony Bankart lesion were compared between the groups. ResultsThe median percentage of glenoid bone loss was 12.1% (range, 1.3%–45.9%) and 12.3% (range, 0%–46.6%) on 3D CT and 3D ZTE images, respectively. The Spearman’s rank correlation coefficient was 0.89. Bony Bankart lesion was detected in 18, 13, and eight shoulders of the 36 patients on CT, 3D ZTE, and CT-like images, respectively. The overall diagnostic accuracy of the CT-like and 3D ZTE images for detecting bony Bankart lesion was 86.1% and 72.2%, respectively. A significant difference was observed between the groups with and without bony Bankart lesion on CT-like images in terms of the long diameter of the bone fragments on CT (p < 0.01). ConclusionsZTE MRI demonstrated high reproducibility for the evaluation of glenoid bone defect in shoulders with anterior instability. Although no significant difference in the measurement was observed compared with that on CT, the ability of ZTE MRI to delineate bone Bankart lesion remains limited.

Automated Midline Shift Detection and Quantification in Traumatic Brain Injury: A Comprehensive Review

AbstractTraumatic brain injury (TBI) often results in midline shift (MLS) that is a critical indicator of the severity and prognosis of head injuries. Automated analysis of MLS from head computed tomography (CT) scans using artificial intelligence (AI) techniques has gained much attention in the past decade and has shown promise in improving diagnostic efficiency and accuracy. This review aims to summarize the current state of research on AI-based approaches for MLS analysis in TBI cases, identify the methodologies employed, evaluate the performance of the algorithms, and draw conclusions regarding their potential clinical applicability. A comprehensive literature search was conducted, identifying 15 distinctive publications. The identified articles were analyzed for their focus on MLS detection and quantification using AI techniques, including their choice of AI algorithms, dataset characteristics, and methodology. The reviewed articles covered various aspects related to MLS detection and quantification, employing deep neural networks trained on two-dimensional or three-dimensional CT imaging datasets. The dataset sizes ranged from 11 patients' CT scans to 25,000 CT images. The performance of the AI algorithms exhibited variations in accuracy, sensitivity, and specificity, with sensitivity ranging from 70 to 100%, and specificity ranging from 73 to 97.4%. AI-based approaches utilizing deep neural networks have demonstrated potential in the automated detection and quantification of MLS in TBI cases. However, different researchers have used different techniques; hence, critical comparison is difficult. Further research and standardization of evaluation protocols are needed to establish the reliability and generalizability of these AI algorithms for MLS detection and quantification in clinical practice. The findings highlight the importance of AI techniques in improving MLS diagnosis and guiding clinical decision-making in TBI management.

Predictive Value of Vertebral Bone Destruction Classification Based on Computed Tomography in Diagnosing on Adult Spinal Tuberculosis

Although magnetic resonance imaging (MRI) is well established for evaluation of spinal tuberculosis (TB), the importance of computed tomography (CT) should not be overlooked. The purpose of this study was to determine the characteristics of spinal TB and the relationship between spinal TB and the bone lesion pattern seen on three-dimensional CT images. One hundred and sixty-one subjects were divided into a TB-positive group and a TB-negative group based on laboratory (X-pert MTB/RIF) results and then subdivided further according to whether the bone lesion pattern seen on three-dimensional CT images was fragmentary, osteolytic, sclerotic, or had no evidence of bone destruction. The diagnostic value of the bone lesion pattern was compared between the TB-positive and TB-negative groups. Ninety-nine of the 161 patients were TB-positive and 62 were TB-negative. Fifty-six (34.8%) of the 161 patients had fragmentary/osteolytic lesions, seventy-four (45.9%) had absolute osteolytic lesions, 13 (8.1%) had osteosclerotic lesions, and 18 (11.2%) had no evidence of bone destruction. The fragmentary/osteolytic lesion pattern was strongly predictive of spinal TB (odds ratio 3.33), and when combined with three MRI findings (thin abscess wall, more than half of the vertebral body destroyed, and subligamentous spread) had an even stronger diagnostic value (odds ratio 15.58). The absolute osteolytic pattern was the most common of the bone lesion patterns. The fragmentary/osteolytic pattern is highly suggestive of spinal TB, especially when combined with MRI findings of a thin abscess wall, destruction of more than half of the vertebral body, and subligamentous spread.

Development of a Mind Map-based Predictive Nursing Protocol and its Impact on the Clarity of Images in Patients Undergoing High-concentration Contrast Three-dimensional Computed Tomography Imaging of Liver Blood Vessels.

To explore the development of a mind map-based predictive nursing protocol and assess its impact on the quality of images in patients undergoing high-concentration contrast three-dimensional computed tomography (CT) imaging of liver blood vessels. A total of 600 patients who were admitted to Beijing You an Hospital were chosen for this prospective study and underwent high-concentration contrast three-dimensional CT imaging of liver blood vessels between April 2021 and December 2021. The patients were divided into two groups using the digital table method, with 300 cases. The control group received conventional nursing intervention, while the research group was provided with a mind map-based predictive nursing protocol. We recorded the image quality of three-dimensional CT imaging of liver blood vessels, satisfaction scores regarding nurse examination guidance, and the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) in both groups. The research group achieved a perfect rate of 100.00% for the high-quality three-dimensional CT imaging of liver blood vessels, which was noticeably higher compared to the rate of the control group of 98.67%. Patients in the research group expressed higher satisfaction levels regarding the guidance provided by nurses, including their attitude, timeliness, accuracy, and overall satisfaction, compared to the control group. Initially, the two groups had no notable differences in the SAS and SDS scores. However, after the intervention, both groups experienced a significant decrease in SAS and SDS scores, with the research group showing an even more substantial decline. Through the creation of a mind map-based predictive nursing protocol and its implementation on patients undergoing high-concentration contrast three-dimensional CT imaging of liver blood vessels, it is possible to significantly enhance the quality of CT scans, alleviate feelings of anxiety and depression, increase patient satisfaction with examination guidance by nurses, and effectively decrease the occurrences of contrast agent leakage and allergic reactions to iodine.

Three-Dimensional Computed Tomography Image Reformation for Comparison of Foraminal Cross-Sectional Dimension in Patients Who Have Undergone Laminoplasty and Laminectomy with Fusion.

Laminectomy with fusion (LF) is commonly performed with laminoplasty (LP) for cervical myelopathy. Foraminal stenosis is important in the surgical treatment of cervical myelopathy. LF and LP can affect foraminal size in different ways. This study aimed to compare foraminal dimensions after LF and LP using a medical computer-assisted design (CAD) program. Computed tomography (CT) scans of the cervical vertebrae of 16 patients with cervical myelopathy were retrospectively viewed in the Digital Imaging and Communications in Medicine format on a CAD program. CT images were reformatted in an oblique plane perpendicular to the long axis of each foramen from C2-C3 to C6-C7. The narrowest foraminal crosssectional dimension (FCD) was measured and compared between the LF and LP groups at the operated, non-operated, and C4-C5 levels. The difference between the preoperative and postoperative FCDs was also calculated and compared between the operated and C4-C5 levels. Intra- and interobserver reliabilities for FCD measurements were evaluated using intraclass correlation coefficients. At the operated spinal levels, the LF and LP groups showed decreased and increased mean FCDs, respectively. At the adjacent non-operated levels, the mean FCD slightly increased in both the groups. In the LF group, the difference between the preoperative and postoperative FCDs in the C4-C5 levels was larger than that in the other operated levels, but this difference was insignificant. LF and LP showed contrary results for FCD. Therefore, FCD and kyphosis should be considered for LF and LP. three-dimensional, foraminal cross-sectional dimension, laminoplasty, laminectomy fusion, computer-aided design, drafting system, preoperative-postoperative comparison.

Accuracy of surgical navigation for patient-specific reconstructions of orbital fractures: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to review the recent literature on the technical accuracy of surgical navigation for patient-specific reconstruction of orbital fractures using a patient-specific implant, and to compare surgical navigation with conventional techniques. A systematic literature search was conducted in PubMed (Medline), Embase, Web of Science, and Cochrane (Core Collection) databases on May 16, 2023. Literature comparing surgical navigation with a conventional method using postoperative three-dimensional computed tomography imaging was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy (angular accuracy, linear accuracy, volumetric accuracy, and degree of enophthalmos), preoperative and perioperative times, need for revision, complications, and total cost of the intervention. MINORS criteria were used to evaluate the quality of the articles. After screening 3733 articles, 696 patients from 27 studies were included. A meta-analysis was conducted to evaluate volumetric accuracy and revision rates. Meta-analysis proved a significant better volumetric accuracy (0.93 cm3 ± 0.47 cm3) when surgical navigation was used compared with conventional surgery (2.17 cm3 ± 1.35 cm3). No meta-analysis of linear accuracy, angular accuracy, or enophthalmos was possible due to methodological heterogeneity. Surgical navigation had a revision rate of 4.9%, which was significantly lower than that of the conventional surgery (17%). Costs were increased when surgical navigation was used. Studies with higher MINORS scores demonstrated enhanced volumetric precision compared with traditional approaches. Surgical navigation has proven effective in reducing revision rates compared to conventional approaches, despite increased costs.

Reference Range of CT Value in NC-CBBCT Based on Female Breast Structure.

As a new high-resolution three-dimensional CT imaging technology, the essential reference range of CT values in Cone-beam breast computed tomography (CBBCT) has not been established to date. To determine the reference range of computed tomography (CT) values in CBBCT for clinical breast examination. In total, 913 cases (1167 lateral) were subject to CBBCT. CT values of the glandular tissue, fat and different quadrants and different distances of CBBCT images were analyzed. The nipple and muscle were also evaluated. A total of 672 lateral breasts were included in the normal group for investigation. The reference range of the absolute CT value of the chest wall muscle is -136.68~43.36 HU. The reference range of the absolute CT value of the nipple is 176.39~334.02 HU. The reference range of the absolute CT value of fat is -190.4~-63.67HU, and of glandular tissue is -12.2~199.07HU. Our results firstly established the baseline CT values of Non-contrast CBBCT in female breasts, which will benefit cancer screening and lesion locating. The closer the normal breast fat and glandular tissue is to the nipple, the greater the CT value. The older the age, the lower the density. The CT values of fat are unstable in a distance of less than 5 cm, and the CT values of glandular tissues are relatively stable. The difference between the upper and lower quadrants is significant in the same lateral breast and the same section.

Anatomical Analysis of the S1 Neural Foramen Using Three-Dimensional Computed Tomography Imaging: Insights for Effective S1 Nerve Root Block

The first sacral nerve root block (S1 NRB) is used to diagnose and treat lumbosacral and radicular pain. This study aims to clarify the anatomy of the S1 neural foramen using three-dimensional (3D) computed tomography (CT) images and to establish the optimal fluoroscopic angle, localize the S1 neural foramen on fluoroscopy, and determine the safe puncture depth for S1 NRB. In this single-center cohort study, 200 patients with lumbar degenerative disease who underwent preoperative CT were enrolled. Four distinct studies were conducted using the CT data. Study 1 examined the correlation of the sacral slope angle and the supine and prone positions. Study 2 analyzed the tunnel view angle (TVA) using 3D reconstruction. Study 3 ascertained the location of the S1 neural foramen in fluoroscopy images. Study 4 investigated the safe depth for performing S1 NRB. The regression analysis in Study 1 revealed a correlation of the sacral slope angle and the supine and prone positions. Study 2 determined an optimal fluoroscopic TVA of approximately 30° for the S1 NRB. Study 3 found that the S1 neural foramen was located caudal to the L5 pedicle 1.7±0.2 times the distance between the L4 and L5 pedicles. Study 4 revealed that the depths of the S1 neural foramen and root were 27.0±2.1mm and 16.5±2.0mm, respectively. Our study suggests an optimal fluoroscopic angle, a simple method to locate the S1 neural foramen on fluoroscopy, and an ideal puncture depth for a safe and effective S1 NRB.

Impact of different fracture types in the pyriform buttress area on nasal airway function

IntroductionFractures in the pyriform buttress area adversely affect facial appearance and nasal airway patency. Nasal airway function has received less attention than aesthetic problems in the literature. This retrospective study classified the different fracture types in this area and determined their impact on nasal airway function.MathodsThree-dimensional computed tomography images of patients with fractures in the pyriform buttress area were analyzed to identify the exact fracture pattern. The nasal airway functions were evaluated and compared between patients with different fracture patterns using acoustic rhinometry, rhinomanometry, and the nasal obstruction symptom evaluation scale.Results Overall, 47 patients, including 16 with type I fractures (high fracture line; group I), 16 with type II fractures (intermediate fracture line; group II), and 15 with type III fractures (low fracture line; group III), were included in the study. The mean minimal cross-sectional area (MCA), total nasal inspiratory resistance (Tri) and total nasal expiratory resistance (Tre) of group I were 0.51 ± 0.06 cm2, 1.67 ± 0.11 kPa L−1 s−1, and 1.66 ± 0.12 kPa L−1 s−1, respectively; those of group II were 0.48 ± 0.07 cm2, 1.89 ± 0.15 kPa L−1 s−1, and 1.88 ± 0.14 kPa L−1 s−1, respectively; and those of group III were 0.36 ± 0.04 cm2, 1.94 ± 0.21 kPa L−1 s−1, and 2.01 ± 0.34 kPa L−1 s−1, respectively. The nasal obstruction symptom evaluation (NOSE) scale scores for groups I, II, and III were 7.188, 9.813, and 13.27, respectively.Conclusion Therefore, the severity of the nasal airway obstruction depends on the displacement of the fractured bones in patients with fractures in the pyriform buttress area. The most profound nasal obstruction occurs in patients with the lowest fracture line.

IODA-shoulder®, a 3-dimensional automated software for glenoid bone loss quantification in shoulder instability. A validation study

BackgroundGlenoid bone loss (GBL) calculation in patients with shoulder instability has a wide variability in methods and their reliability. The purpose of this study was to describe and validate a new semi-automated software developed to improve GBL calculation using a 3D imaging modeling (IODA-shoulder) and to compare the method to the PICO area method. Patients and methodsA semi-automated software to assess GBL was preliminarily developed and validated on 7 fresh frozen specimens (scapulae with artificially created glenoid defect), using water displacement method. Afterwards, the software was retrospectively used on CT images of 20 patients affected by recurrent shoulder dislocation. Inclusion criteria were: unilateral dislocation, minimum 2 dislocation episodes. Exclusion criteria were bone reconstruction of the glenoid, failed shoulder stabilization, bilateral dislocation, shoulder arthritis. Three-dimensional computed tomography images of bilateral shoulder were retrieved for each patient. Two methods to determine GBL were compared. The PICO surface area method and the new IODA method. We assessed the intra- and inter-rater reliability of the two methods with the Intraclass Correlation Coefficient (ICC), the Bland-Alman analysis, and Lin's concordance correlation coefficient (CCC). ResultsWe did not find a statistically significant difference between the mean volumes calculated with PICO and IODA methods, respectively 914 vs. 815 mm3, p=0.155. The analysis carried out by using the traditional PICO method showed a lower concordance rate among four observers than the higher concordance found using IODA method, regardless of the size and the location of the defect. The ICC agreement with PICO was significantly lower than with IODA (0.76 vs. 0.97). We found a poor CCC with PICO (from 0.65 to 0.81) and a substantial one with IODA (from 0.96 to 0.98). DiscussionThe intra- and inter-rater reliability using IODA method is significantly better than PICO method. The assessment of GBL using IODA method is time saving, avoiding significant inter- and intra-observer variation, mainly due to individual skill and experience in the method. Level of evidenceIV, experimental study.

Tree Core Analysis with X-ray Computed Tomography.

An X-ray computed tomography (CT) toolchain is presented to obtain tree-ring width (TRW), maximum latewood density (MXD), other density parameters, and quantitative wood anatomy (QWA) data without the need for labor-intensive surface treatment or any physical sample preparation. The focus here is on increment cores and scanning procedures at resolutions ranging from 60 µm down to 4 µm. Three scales are defined at which wood should be looked at: (i) inter-ring scale, (ii) ring scale, i.e., tree-ring analysis and densitometry scale, as well as (iii) anatomical scale, the latter approaching the conventional thin-section quality. Custom-designed sample holders for each of these scales enable high-throughput scanning of multiple increment cores. A series of software routines were specifically developed to efficiently treat three-dimensional X-ray CT images of the tree cores for TRW and densitometry. This work briefly explains the basic principles of CT, which are needed for a proper understanding of the protocol. The protocol is presented for some known species that are commonly used in dendrochronology. The combination of rough density estimates, TRW and MXD data, as well as quantitative anatomy data, allows us to broaden and deepen current analyses for climate reconstructions or tree response, as well as further develop the field of dendroecology/climatology and archeology.

Objective analysis of facial bone fracture CT images using curvature measurement in a surface mesh model

The human facial skeleton consists of multiple segments and causes difficulty during analytic processes. We developed image analysis software to quantify the amount of injury and validate the smooth curvature of the surface after facial bone reduction surgery. Three-dimensional computed tomography images of facial bone were obtained from 40 patients who had undergone open reduction surgery to treat unilateral zygomaticomaxillary fractures. Analytic software was developed based on the discrete curvature of a triangular mesh model. The discrete curvature values were compared before and after surgery using two regions of interest. For the inferior orbital rim, the weighted average of curvature changed from 0.543 ± 0.034 to 0.458 ± 0.042. For the anterior maxilla, the weighted average of curvature changed from 0.596 ± 0.02 to 0.481 ± 0.031, showing a significant decrement (P < 0.05). The curvature was further compared with the unaffected side using the Bray–Curtis similarity index (BCSI). The BCSI of the inferior orbital rim changed from 0.802 ± 0.041 to 0.904 ± 0.015, and that for the anterior maxilla changed from 0.797 ± 0.029 to 0.84 ± 0.025, demonstrating increased similarity (P < 0.05). In computational biology, adequate analytic software is crucial. The newly developed software demonstrated significant differentiation between pre- and postoperative curvature values. Modification of formulas and software will lead to further advancements.

The Critical Shoulder Angle Can be Accurately and Reliably Determined from Three-Dimensional Computed Tomography Images.

Anteroposterior (AP) radiographs do not necessarily offer the optimal approach to measuring the critical shoulder angle (CSA) due to the malposition of the scapula. Three-dimensional computed tomography (3D-CT) may offer some advantages, including the ability to rotate the scapula for position alignment and pre-operative planning for reducing CSA. This study aimed to investigate the accuracy and reliability of CSA measurement in 3D-CT and to determine whether there is an association between CSA and rotator cuff tears (RCTs). In this retrospective study we identified 200 patients who received shoulder arthroscopy from 2019 to 2021, including 142 patients (81 females, 61 males) with RCTs and 58 patients (14 females, 44 males) with non-RCTs. For each participant, CSA was measured from standard shoulder AP radiographs and anterior views of 3D-CT of the scapula by two independent assessors. Inter- and intra-observer agreements were assessed by the intraclass correlation coefficient (ICC). The relationship between the two measurement methodologies was determined by Spearman's correlation coefficient and Bland-Altman plots. Discriminative capacity was calculated by using receiver operating curve (ROC) analyses in the whole cohort and age sub-groups above and below 45 years. We found perfect inter-observer (ICC >0.96) and intra-observer (ICC >0.97) reliabilities for CSA measurements obtained from the standard AP radiographs and the 3D-CT. There was a strong correlation between the two methods (r=0.960, P < 0.001). The mean CSA was 31.7° ± 4.2° in the standard AP radiographs and 31.8° ± 4.4° in the 3D-CT (mean difference 0.02°, P=0.940; bias 0.02°, limits of agreement -2.29° to +2.33°). ROC analysis of the whole cohort showed that the CSA measured in the standard AP radiographs (area under the ROC curve [AUC]=0.812, P < 0.001) and the 3D-CT (AUC=0.815, P < 0.001) predicted RCT with high confidence. ROC analysis of patients aged ≥45 years showed that the CSA measured from the standard AP radiographs (AUC=0.869, P < 0.001) and the 3D-CT (AUC=0.870, P < 0.001) were very good at predicting RCTs. CSA measured from standard AP radiographs and 3D-CT showed high consistency, and the CSA could be accurately and reliably measured using 3D-CT. CSAs measured from standard AP radiographs and 3D-CT could predict RCTs, especially in patients aged ≥45 years.

Fracture in porous bone analysed with a numerical phase-field dynamical model

A dynamic phase-field fracture finite element model is applied to discretized high-resolution three-dimensional computed tomography images of human trabecular bone to analyse rapid bone fracture. The model is contrasted to quasi-static experimental results and a quasi-static phase-field finite element model. The experiment revealed complex stepwise crack evolution with multiple crack fronts, and crack arrests, as the global tensile displacement load was incrementally increased. The quasi-static phase-field fracture model captures the fractures in the experiment reasonably well, and the dynamic model converges towards the quasi-static model when mechanically loaded at low rates. At higher load rates, i.e., at larger impulses, inertia effects significantly contribute to an increased initial global stiffness, higher peak forces and a larger number of cracks spread over a larger volume. Since the fracture process clearly is different at large impulses compared to small impulses, it is concluded that dynamic fracture models are necessary when simulating rapid bone fracture.

The Effect of Residual Gastric Volume on Body Mass Index, Excess Weight Loss Rate and Metabolic Response after Sleeve Gastrectomy.

To investigate the metabolic response and body mass index reduction according to the remaining stomach volume between 6-12 months after the operation in patients who underwent sleeve gastrectomy surgery for obesity and to determine the relationship between the remaining stomach volume and metabolic improvement. Materials and Methods: Patients underwent sleeve gastrectomy in a single center by the same team and with the same standardized method. Residual gastric volumes were calculated from three-dimensional computed tomography images obtained 6-12 months postoperatively. BMI, excess weight loss (EWL), total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), very low density lipoprotein (VLDL), triglyceride, hemoglobin A1c (HbA1c), total protein, albumin values were recorded preoperatively and at the time of residual volume measurement. Results: There were 49 subjects with a mean SD preoperative BMI of 47.26+-6.21 kg/m2 and mean age 37.51+-10.88 years. Mean residual volume was 155.36+-56.71 cc. Residual volume was associated with postoperative mean BMI (28.44+-3.23 kg/m2; p 0.001) and postperative mean EWL%(29.27+-7.66; p=0.001). Residual gastric volume was also negative correlated with postoperative mean HbA1c (p=0.004). HbA1c (p=0.828), LDL (p=0.661), HDL (p=0.848), triglycerides (p=0.641), VLDL (p=0.794), total protein relation (p=0.539) and albumin (p=0.824) were analyzed before and after surgery and were not correlated with residual gastric volume. The smaller the residual gastric volume after laparoscopic sleeve gastrectomy, the higher the %EWL and the greater the decrease in HbA1c. This study show that laparoscopic sleeve gastrectomy is an effective surgical procedure in patients with Type 2 diabetes mellitus.

Application of three-dimensional computed tomography imaging and reconstructive techniques in lung surgery: A mini-review.

Pulmonary surgery is an innovative discipline with increasing demands for minimally invasive techniques in complicated anatomical resections, warranting adequate preoperative imaging of relevant surgical anatomy to ensure safe and radical resection of target lesions. Over the recent years, the emergence of imaging techniques enabling three-dimensional reconstruction has exerted promising influence on pulmonary surgery, facilitating optimal surgical planning and easier identification of the spatial relationship between bronchovascular structures in the individual patient and aiding the safe resection of target pulmonary lesions. The goal of this mini-review is to provide an overview of three-dimensional computed tomography imaging within pulmonary surgery. The authors performed a targeted qualitative review of the literature to identify current trends and to provide better understanding of three-dimensional reconstruction within the boundaries of pulmonary surgery. Three-dimensional reconstructive techniques can be used for resectability assessment, identification of surgically relevant interindividual anatomic variance and may improve perioperative outcomes. Three-dimensional reconstruction using computed tomography imaging improves surgical planning and there is evidence that it results in shorter operative times, less intraoperative blood loss and lower rates of surgical conversion, as it can be applied both pre- and intraoperatively.

Radial head volume measurements using quantitative three-dimensional computed tomography images for radial head deformation following missed Monteggia lesions

<h2>Abstract</h2><h3>Introduction</h3> In chronic radial head dislocation, the radial head may enlarge and become dome-shaped. To date there is no validated tool to quantify radial head deformation and predict its influence on surgical outcome. This study assesses the potential value of volume and surface calculations obtained by quantitative three dimensional CT scanning (Q3DCT) in the workup for corrective surgery in pediatric patients with missed Monteggia lesions. <h3>Material and methods</h3> Ten consecutive pediatric patients with a missed Monteggia lesion were included (2012-2020). The volume and the articular surface size of the radial head were calculated using Q3DCT and a three dimensional reconstruction of the articular surface relief was depicted in a heat map. The head/neck ratio was calculated and compared to Q3DCT data of missed Monteggia patients and their age/sex matched controls. <h3>Results</h3> The radial head volume and radial articular surface size did not differ significantly between patients with missed Monteggia lesions and age/sex matched controls (volume 1487 mm³ versus 1163 mm³, p=0,32; articular surface size 282 mm³ versus 236 mm³ ,p=0,33). Optically, heat maps of the articular surface of missed Monteggia patients did not differ notably from control heat maps.. A higher head/neck ratio correlated to a larger radial head volume (Pearson r=0,73; p=0,02). <h3>Discussion and conclusion</h3> Q3DCT may be an interesting tool in the preoperative workup of pediatric missed Monteggia lesions. Prospective research with larger cohort sizes and data that compares the affected side to the contralateral elbow is needed to assess its true clinical potential.

A CT Radiomics-Based Risk Score for Preoperative Estimation of Intraoperative Superior Mesenteric-Portal Vein Involvement in Pancreatic Ductal Adenocarcinoma.

The current radiologic criteria for assessing intraoperative superior mesenteric-portal vein (SMPV) involvement (i.e., presence of tumor-SMPV contact >180° or venous deformity) in pancreatic ductal adenocarcinoma (PDAC) are highly specific but insufficiently sensitive. Therefore, development of improved markers for a more accurate prediction is essential. This study aimed to develop a risk score model to estimate SMPV involvement in PDAC using radiomics analysis of computed tomography (CT) images. Data from two institution-based cohorts of PDAC patients undergoing preoperative CT scans were used to develop (n = 173) and validate (n = 156) a radiomics-based risk score of SMPV involvement using clinical and imaging variables. A radiomics signature was developed based on 2436 radiomic features extracted from the semi-automatic three-dimensional segmentation ofn CT images. The SMPV involvement risk score was built using multivariate logistic regression and compared with the current radiologic criteria. The study surgically identified SMPV involvement in 59 (34.1%) and 57(36.5 %) patients with PDAC in the development and validation cohorts, respectively. A 12-feature-based radiomics signature achieved areas under receiver operating characteristics curves (AUCs) of 0.89 or greater for estimating SMPV involvement. Multivariate regression identified the radiomics signature and SMPV deformity as associated with SMPV involvement. The risk score model had significantly improved AUC (0.928 vs. 0.768; P < 0.001) and sensitivity (84.2% vs. 66.7%; P = 0.025) in the radiologic evaluation. The novel risk score in this study, combining radiomics signature and venous deformity, demonstrated promising performance for estimating SMPV involvement preoperatively for patients with PDAC.