Three-dimensional Reformatted Images Research Articles

Diagnostic Accuracy of MDCT (Multidetector Computed Tomography) for Staging of Renal Cell Carcinoma

Background: The advancement in technology has introduced multi-detector CT scanners and achievement of better spatial resolution with faster acquisition has become a possibility. The three-dimensional reformatted images along with multiplanar reconstructions upgrade the staging capabilities for RCC. Aim: To check accuracy of MDCT (Multi-detector Computed tomography) in staging renal cell carcinoma with histopathology taken as the gold standard. Study design: The study is a descriptive cross sectional study. Settings: Radiology Department, Bahawal Victoria Hospital, Bahawalpur Study duration: 16"' January 2019 to 15"' July 2019. Methods 157 patients (including both genders) were included with age range of 25-60 years, showing features of renal cell carcinoma on ultrasonography. Those Patients with renal mass other than renal cell carcinoma, solitary functioning kidney and pregnant females were eliminated from the study. All the selected patients had Multi-detector CT scan abdomen performed. Results: Mean age was 44.66+9.3 I years. Out of these 157 patients, there were 90(57.32) male patients and 67 (42.68°/c) females with ratio of I.3: I. All the patients had CT scan of abdomen and pelvis. The results showed that 8I of the patients were True Positive and only 08 were False Positive. Out of 68 CT negative patients, 07 (False Negative) showed renal cell carcinoma on histopathology while 6 I True Negative patients had no evidence of RCC on histopathology (p=0.0001). Conclusion: Multi-detector CT scan is a very sensitive yet accurate non - invasive method for staging renal cell ca. Keywords: Renal cell carcinoma, multidetector CT scan, imaging, sensitivity

Role of multidetector computed tomography in evaluation of calcaneal fracture

Background Calcaneal fracture represents nearly 60% of fractured tarsal bones. Multidetector computed tomography (MDCT) assessment is important for excluding articular surface involvement and determining the extent of the fracture. Aim The purpose of this study was to assess the usefulness of multidetector computed tomography (MDCT) in diagnosis and classification of calcaneal fractures. Patients and methods A total of 50 patients presented to the emergency room with ankle swelling and pain following fall from height or motor car accident. They presented from January 2018 and March 2019. Their ages ranged from 24 to 64 years (mean age, 33 years). Overall, 40 cases were males and 10 were females. All patients were subjected to MDCT with three-dimensional reformatted images. Results A total of 54 calcaneal fractures were found (four extra-articular calcaneal fractures and 50 intra-articular calcaneal fractures). Overall, five fractures were type I, three were of type II, 18 were of type III, and 24 fractures were type IV according to Sanders classification. In addition, 20 fractures were tongue type and 30 fractures were joint depression type according to Essex-Lopresti classification. Moreover, four fractures were bilateral and 46 fractures were unilateral. Additionally, 40 fractures had associated soft tissue edema. Conservative management was done on three extra-articular calcaneal fractures and 29 types I and IV intra-articular fractures, whereas operative treatment was done on 21 intra-articular types II and III and one extra-articular fracture. Conclusion The use of MDCT was essential in the diagnosis, classification, and management planning of calcaneal fractures.

Skull base development and craniosynostosis.

Abnormal skull shape resulting in craniofacial deformity is a relatively common clinical finding, with deformity either positional (positional plagiocephaly) or related to premature ossification and fusion of the skull sutures (craniosynostosis). Growth restriction occurring at a stenosed suture is associated with exaggerated growth at the open sutures, resulting in fairly predictable craniofacial phenotypes in single-suture non-syndromic pathologies. Multi-suture syndromic subtypes are not so easy to understand without imaging. Imaging is performed to define the site and extent of craniosynostosis, to determine the presence or absence of underlying brain anomalies, and to evaluate both pre- and postoperative complications of craniosynostosis. Evidence for intracranial hypertension may be seen both pre- and postoperatively, associated with jugular foraminal stenosis, sinovenous occlusion, hydrocephalus and Chiari 1 malformations. Following clinical assessment, imaging evaluation may include radiographs, high-frequency US of the involved sutures, low-dose (20-30 mAs) CT with three-dimensional reformatted images, MRI and nuclear medicine brain imaging. Anomalous or vigorous collateral venous drainage may be mapped preoperatively with CT or MR venography or catheter angiography.

The Use of Detachable Flanges on Customized Titanium Orbital Implants: A Technical Note

The combined use of three-dimensional reformatted images, stereolithographic models, and rapid prototyping allows the construction of an accurate, individually made titanium implant for the reconstruction of orbital floor defects. Despite the perfect fit of the custom-made plate to the model, there might be several locations on the bone where the plate may reside intraoperatively. Most titanium orbital plates therefore contain extensions over the inferior orbital rim to help locate and stabilize the plate in its position on the bone. Such over-the-rim extensions may be palpable and can cause discomfort postoperatively. We describe the use of two small detachable flanges that help to accurately locate the orbital plate in place and allow its fixation. The locating flanges are then detached and discarded, leaving a smooth implant surface within the confines of the bony orbit.

Use of Intraoperative Computed Tomography in Complex Facial Fracture Reduction and Fixation

Using conventional complex facial fracture management principles, confirmation of adequate facial fracture reduction can be achieved only by obtaining a postoperative computed tomography (CT) scan. If the CT scan revealed any discrepancy in fracture alignment, additional procedures for correction may be required. The concept of intraoperative CT scanning provides immediate postreduction or intraoperative information that orients the surgeon to the potential need for additional maneuvers for improved fracture reduction and osseous fixation. We assessed the early technical feasibility of real-time intraoperative CT scanning using the xCAT ENT (Xoran Technologies, Inc, Ann Arbor, MI), for monitoring of fracture reduction with the possibility of immediate intraoperative revision if needed, potentially obviating the need for revision procedures. Three adult patients were studied who were admitted from the emergency department. During their respective reconstructive procedures, the xCAT ENT was used to provide images: Axial, coronal, sagittal, and three-dimensional reformatted images with segmentation of the CT data set and mirroring of the reconstructed side to the unaffected side were used for precise measurement and comparison of the reconstruction. The scans were examined by the operating surgeon and an intraoperative decision was made as to whether immediate revision was required. Facial fracture management with intraoperative CT monitoring was changed in 2 of the 3 cases. One patient who underwent immediate revision had an open reduction-internal fixation after cranialization. The second patient who had a revision had a persistent subcondylar fracture that was found not amenable to closed reduction. The intraoperative CT scan may positively change the outcome of facial fracture reduction especially when dealing with complex fractures. Additional studies are needed for studying its potential impact in monitoring reduction of facial fractures.

Dental Multisection CT for the Placement of Oral Implants: Technique and Applications

Dental computed tomography (CT) is a diagnostic examination for the preoperative evaluation of patients who will undergo placement of oral implants. It can be performed with multidetector CT or more recently with cone-beam CT. The growing older population and the consequent development of edentulism have increased the number of imaging studies performed for preoperative evaluation of dental implantation. Thus, radiologists are becoming more frequently involved in this type of testing. Dental CT is superior to conventional x-ray techniques because superimposition and distortion are eliminated; therefore, possible complications such as injury of the neurovascular bundle and perforation of the maxillary sinuses can be avoided. This noninvasive and fast method provides accurate information about the positions of important structures to allow one to determine the implant required. Dental CT enables analysis of the state, quality, and quantity of bone on two-dimensional and three-dimensional reformatted images, and its high spatial resolution allows exact measurements of the length and width of the alveolar ridge. Inclusion of all this information in the radiology report facilitates achievement of a successful implantation.

Replaced right hepatic artery coursing ventral to the portal vein: demonstration with 64-row CT and 3D reformatted images

We report one case of replaced right hepatic artery coursing ventral to the portal vein. This variation, which was demonstrated by 64-row CT angiography and three-dimensional reformatted images, has never been reported. Surgeons involved in hepatic and biliopancreatic procedures should be aware of this possible variation, which has important surgical implications.

A study of multi-detector row CT scan on greater omentum in 50 individuals: correlating with anatomical basis and clinical application

In view of the descriptions of the CT manifestations on the greater omentum (GO) were not precise and detailed enough in the previous literature, we tried to evaluate the radiologic-anatomical features of the GO and to address the related clinical implications for the radiologic diagnosis and surgical application. We evaluated the GO by using multi-detector row CT (MDCT) scanning in 50 individuals correlating with anatomical basis and clinical application. Emphasis was placed on the following items: the anatomical distribution and location of the GO; the CT manifestations of the vasculature, fatty tissue and lymph nodes. The gastro-epiploic vessel, the landmark for delineating the GO, was visualized in 50/50 cases (100%). The gastro-colic vein was detected in 34/50 cases (68%). The free-hanging portion, 48 cases revealed, seemed to have the capability of 'migration': it is located in the subphrenic spaces in 9/48 cases (19%) and distributed in the right lower quadrant predominantly in 10/48 cases (21%). Three-dimensional reformatted images, obtained in five cases, demonstrated the return of the gastro-epiploic vein distinctly. Lymph nodes were rarely detected within the GO. The depicted omental vessels, visualized by using multi-planar reconstruction images together with three-dimensional reformatted images, played a crucial role in delineating the GO comprehensively. It can provide the valuable data for the radiologic diagnosis and surgical therapy planning including surgery of reconstruction, pancreas, portal hypertension as well as infections and neoplastic diseases.

CT urography.

With the recent introduction of multi-detector row helical computed tomography (CT), the radiologic evaluation of patients with urologic disease has changed rapidly. Two major approaches to CT urography have been developed. The first approach combines axial CT with timed excretory urography (EU) performed by using conventional radiography, digital radiography, or CT scanned projection radiography (SPR). This approach produces traditional projection urograms, and the timed imaging technique is familiar to radiologists and clinicians. Additional excretory phase CT can be performed when the EU findings are positive or indeterminate. Improved CT SPR processing technology produces radiographlike images, thus eliminating patient transportation between the CT and urography suites or the necessity for a CT suite with a ceiling-mounted x-ray tube and a modified CT tabletop for performance of EU. The second approach to CT urography combines axial CT with thin-section excretory phase CT. The near-isotropic volume data set enables creation of high-resolution two- and three-dimensional reformatted images. However, the increased amount of radiation and the time required for data manipulation are concerns. Further studies evaluating large numbers of patients with various urothelial abnormalities will be necessary to determine the optimal CT urography technique for clinical practice.

CT scan as a radiologic data base for optimum implant orientation

There are many factors directly related to the longevity of implant osseointegration. Overload has been considered an etiologic factor in implant failure after a prosthesis has been constructed. Optimum implant orientation can be aided by the three-dimensional radiographic data base provided by a CT scan. The reformatted sectional images, when related to each other, facilitate a thorough visualization of the bone topography, sinus and nerve location, and bone density. The fundamentals of the CT imaging and the interrelationship of the cross-sectional, panoramic, and three-dimensional reformatted images are described.