Transverse Computed Tomography Images Research Articles

A Cadaveric Study Using Anatomical Cross-Section and Computed Tomography for the Coelomic Cavity in Juvenile Cory's Shearwater (Aves, Procellariidae, Calonectris borealis).

Birds play a crucial role in ecosystems, engaging in key functions such as pollination, pest control, and seed dispersal. The anatomical understanding of these species is essential to addressing emerging challenges, including climate change and habitat loss, which directly impact their survival. Detailed knowledge of avian anatomy is fundamental for research across various disciplines, ranging from ornithology to veterinary medicine. Therefore, this study aims to disseminate the understanding of avian anatomy and the application of computed tomography (CT) for visualizing the coelomic cavity in Cory's Shearwater (Calonectris borealis). Recent advances in comprehending the anatomical structures of this region in avian species are highlighted, with a specific focus on Cory's Shearwater as a study model. Various anatomical cross-sections and transverse CT images were described and analyzed in detail, offering a comprehensive insight into the coelomic cavity from different perspectives. The correlation between anatomical cross-sections and CT images is emphasized as crucial for a profound understanding of avian anatomy. This research contributes to the broader knowledge of avian anatomy, with potential implications for conservation efforts and veterinary practices.

Swin-textural: A novel textural features-based image classification model for COVID-19 detection on chest computed tomography

BackgroundChest computed tomography (CT) has a high sensitivity for detecting COVID-19 lung involvement and is widely used for diagnosis and disease monitoring. We proposed a new image classification model, swin-textural, that combined swin-based patch division with textual feature extraction for automated diagnosis of COVID-19 on chest CT images. The main objective of this work is to evaluate the performance of the swin architecture in feature engineering. Material and methodWe used a public dataset comprising 2167, 1247, and 757 (total 4171) transverse chest CT images belonging to 80, 80, and 50 (total 210) subjects with COVID-19, other non-COVID lung conditions, and normal lung findings. In our model, resized 420 × 420 input images were divided using uniform square patches of incremental dimensions, which yielded ten feature extraction layers. At each layer, local binary pattern and local phase quantization operations extracted textural features from individual patches as well as the undivided input image. Iterative neighborhood component analysis was used to select the most informative set of features to form ten selected feature vectors and also used to select the 11th vector from among the top selected feature vectors with accuracy >97.5%. The downstream kNN classifier calculated 11 prediction vectors. From these, iterative hard majority voting generated another nine voted prediction vectors. Finally, the best result among the twenty was determined using a greedy algorithm. ResultsSwin-textural attained 98.71% three-class classification accuracy, outperforming published deep learning models trained on the same dataset. The model has linear time complexity. ConclusionsOur handcrafted computationally lightweight swin-textural model can detect COVID-19 accurately on chest CT images with low misclassification rates. The model can be implemented in hospitals for efficient automated screening of COVID-19 on chest CT images. Moreover, findings demonstrate that our presented swin-textural is a self-organized, highly accurate, and lightweight image classification model and is better than the compared deep learning models for this dataset.

Low thoracic skeletal muscle index is associated with negative outcomes in 244 patients with respiratory COVID-19

Sarcopenia is associated with negative outcomes in intensive care unit (ICU) patients and during chronic diseases. We aimed to evaluate if low skeletal muscle index (SMI) measured by computed tomography (CT) at the thoracic level is associated with poor outcomes in hospitalized patients with respiratory COVID-19. Patients admitted to the hospital between March 1st and June 9, 2020 with a confirmed diagnosis of respiratory COVID-19 in the Emergency Department were included in this retrospective cohort study. SMI was assessed from a transverse CT image at the T12 level. We analysed the association between thoracic SMI and mortality, ICU admissions, infections, length of stay and gravity scores. We included 244 patients, whose median age was 62 (20-95) years, mean body mass index was 28,6kg/m2, and 34% were obese patients. 102 patients (41,8%) had low thoracic SMI. On multivariable analysis, low thoracic SMI was associated with more infections (OR=1,88 [1,06-2,98]) and increased length of stay (OR=1,87 [1,14-3,49]) but not with mortality (OR=1.37 [0.54-3.52]), whereas it was inversely associated with ICU admission (OR=5,56 [1,96-16,67]. Low SMI measured by CT at the thoracic level T12 is associated with negative outcomes in patients with respiratory COVID-19.

Impact of CT-assessed changes in tumor size after neoadjuvant chemotherapy on pathological response and survival of patients with esophageal squamous cell carcinoma.

Neoadjuvant chemotherapy (NAC) followed by surgery is the standard treatment for advanced esophageal squamous cell carcinoma (ESCC) in Japan. Computed tomography (CT) is usually used to assess the therapeutic effect of NAC; however, there are no reliable criteria for predicting pathological response or patient prognosis. We included 84 patients who underwent esophagectomy between January 2009 and December 2018 and retrospectively reviewed their CT scans performed before and after NAC. The reduction rate of the largest tumor area (TA), long diameter (LD), and short diameter (SD) were measured on a transverse CT image. The pathological response and cutoff values were calculated using the receiver operating characteristic curve, and the most suitable ones for determining the effect were examined. The areas under the curve for predicting responders to NAC based on the reduction rate of the TA, LD, and SD were 0.755, 0.761, and 0.781, respectively. The optimal cutoff value of the SD reduction rate for predicting responders to NAC was 22%. An SD reduction ≥ 22% was an independent prognostic factor for overall survival in univariate (p = 0.005, hazard ratio [HR] = 2.755) and multivariate analyses (p = 0.030 HR 2.690). Furthermore, an SD reduction of ≥ 22% was also an independent prognostic factor for relapse-free survival in the univariate (p = 0.007, HR = 2.491) and multivariate analyses (p = 0.007, HR = 0.030). The reduction rate of the tumor SD is a simple predictor of pathological response and patient prognosis.

Defining reference values for low skeletal muscle index at the L3 vertebra level based on computed tomography in healthy adults: A multicentre study

Skeletal muscle mass loss is an important aspect of malnutrition and is closely related to adverse clinical outcomes. Computed tomography (CT) is the gold standard for analysing muscle mass, and the skeletal muscle index at the third lumbar vertebra (L3-SMI), measured using CT, is an important indicator to evaluate total skeletal tissue. The aims of this study were to establish reference values for low L3-SMI in Northern China, and to investigate the correlation between L3-SMI and age, and the correlation between L3-SMI and body mass index (BMI). This was a multicentre, retrospective, cross-sectional study. A search of abdominal CT imaging reports, using specific keywords, was conducted in four representative cities in northern China, from January 2016 to March 2021. Transverse CT images at the level of the third lumbar vertebra (L3) were identified, exported from the Radiology Information System, and measured using the analysis software SliceOmatic. Statistical analyses were performed using SPSS 24.0, and significance level was set at p<0.05. Mean, standard deviations (SD) and percentiles (p5, p10, p25, p50, p75, p90, p95) were used to describe the distribution of L3-SMI in the study population. Low skeletal muscle index was defined as a 5% percentile, or two standard deviations below the mean value of younger healthy individuals (age 20-39 years). The study included 1787 healthy individuals, with a median age of 45 (25) years (range 20-88 years), and a median BMI of 23.1 (4.1) kg/m2 (range 18.5-38.7kg/m2). Among them, 700 healthy individuals (39.1%) were aged 20-39 years. L3-SMI had a negative linear correlation with age, and a positive linear correlation with BMI. The L3-SMI reference values used to define low skeletal muscle mass loss in the Northern Chinese population, using the 5% percentile, were 40.2cm2/m2 in men, and 31.6cm2/m2 in women. Using the mean minus two standard deviations protocol, the reference values were 37.9cm2/m2 and 28.6cm2/m2 in men and women, respectively. This study analysed the human body composition of 1787 healthy people in four cities in northern China, using CT, and established diagnostic thresholds of skeletal muscle mass depletion based on 700 younger healthy adults, using the 5% percentile and mean-2SD methods. These reference values can be used to diagnose malnutrition in patients and may aide clinicians in predicting prognosis and improving nutritional therapy. Further research is warranted to determine the prognostic role of reference values against clinical outcomes in different disease populations.

Abdominal fat content assessment by computed tomography in toy breed dogs

The aim of this retrospective study was to assess the abdominal fat distribution in toy breed dogs using computed tomography (CT) in relation to the breed, age, and sexual status. In 140 dogs (52 Maltese, 33 Poodles, 32 Shih-Tzus, and 23 Yorkshire Terriers), the total fat area (TA), visceral fat area (VA), subcutaneous fat area (SA) and body area (BA) were measured at the third and sixth lumbar vertebral level on non-contrast transverse CT images. The differences in the TA/BA and VA/SA according to the breed, age, and sexual status, and correlations with the age were analysed. The differences in the TA/BA and VA/SA among the breeds were revealed (P &amp;lt; 0.05). There was no difference for the TA/BA among the sexual statuses, but the VA/SA was higher in spayed females than in intact females (P = 0.001). Positive correlation of the age with the TA/BA in the Maltese, Poodles, and intact females, and the age with the VA/SA in the Maltese, Shih-Tzus, Yorkshire Terriers, neutered males, and spayed females were found. The results showed that the abdominal fat composition varied according to the breed, age, and sex, which may have implications on defining obesity-related disease risks in different populations. Careful monitoring of the VA/SA in the breed (Maltese, Shih-Tzu, and Yorkshire Terrier), age (senior dogs), and sexual status (neutered dogs) may be required.

Stress distribution pattern in the distal radioulnar joint before and after ulnar shortening osteotomy in patients with ulnar impaction syndrome

Ulnar shortening osteotomy (USO) for ulnar impaction syndrome potentially leads to degenerative changes of the distal radioulnar joint (DRUJ). This study was performed to evaluate the effect of the sigmoid notch morphology on the stress distribution pattern of the DRUJ using computed tomography (CT) osteoabsorptiometry (CT-OAM). We reviewed the pre- and postoperative transverse CT images of 15 wrists that had undergone USO. The examined wrists were classified into two groups based on the sigmoid notch morphology: the linear-type notch (type L) and the curved-type notch (type C). We calculated and statistically compared the percentage of the high-density area (%HDA) in each divided region of the sigmoid notch. In type L, %HDA was significantly larger in the distal-dorsal region of the sigmoid notch before USO. Postoperatively, in type L, no specific regions showed a significantly different %HDA. In type C, %HDA was significantly larger in the distal-volar region of the sigmoid notch before USO. Postoperatively, %HDA of type C was significantly larger in the proximal-volar region. Our results suggest that in patients with ulnar impaction syndrome, morphological evaluation of the sigmoid notch can serve as a predictor of osteoarthritis in the DRUJ with or without USO.

Low skeletal muscle density combined with muscle dysfunction predicts adverse events after adult cardiovascular surgery

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This study was supported by the Grant for Japan Society for the Promotion of Science (JSPS) KAKENHI. Introduction Although muscle dysfunction is widely known as a poor prognostic factor in patients with cardiovascular disease, no study has examined whether the addition of low skeletal muscle density (SMD) assessed by computed tomography (CT) to muscle dysfunction is useful. Purpose The present study aimed to examine whether SMDs can strengthen the predictive ability of muscle dysfunction for adverse events in patients who underwent cardiovascular surgery. Methods We retrospectively reviewed 853 patients (median age: 69 years, 65.1% male) aged ≥40 years who had preoperative CT for risk management purposes and muscle dysfunctions measured during postoperative cardiac rehabilitation. Muscle dysfunctions were determined from weakness (low grip strength) and slowness (slow gait speed) based on the Asia Working Group for Sarcopenia. Low SMD based on transverse abdominal CT images was defined as a mean Hounsfield unit of the psoas muscle &amp;lt;45. To examine the complementary prognostic value for all-cause deaths, all-cause events, and cardiovascular-related events when low SMDs were added to four patterns of muscle dysfunction (weakness only, slowness only, weakness or slowness, and weakness and slowness), the continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) index were calculated. Results For all definitions of muscle dysfunction, the addition of SMDs was shown to significantly improve the cNRI (estimates: 0.377 to 0.468 for all-cause death, 0.220 to 0.248 for all-cause events, 0.308 to 0.322 for cardiovascular-related events) and IDI (estimates: 0.005 to 0.011 for all-cause death, 0.005 to 0.010 for all-cause events, 0.009 to 0.012 for cardiovascular-related events) in all analyses. Low SMDs combined with muscle dysfunctions were associated with the highest risk of all-cause death (Figure 1: A-D). Patients with neither low SMDs nor muscle dysfunction had the lowest risk of all-cause events and cardiovascular-related events (Figure1: E-L). Conclusion The predictive ability of muscle dysfunction for adverse events was consistently increased by addition of SMDs in patients who underwent cardiovascular surgery. Our results suggest that when CT is performed for any clinical investigation, the addition of the organic assessment of skeletal muscle can strengthen the diagnostic accuracy of muscle wasting. Abstract Figure 1

Ex vivo comparison of standing and recumbent repair of incomplete parasagittal fractures of the first phalanx in horses.

To assess suspensory ligament extensor branch location and fracture gap reduction with simulation of standing and recumbent cortical bone screw repair of experimental incomplete parasagittal proximal phalanx (P1) fractures. Controlled laboratory study. Twenty equine cadaver forelimbs. Simulated fractures were repaired twice in random order. A proximal cortical bone screw was placed in lag fashion with the limb unloaded (simulated recumbent repair) and loaded to 38% of body weight (range, 375-568 kg; simulated standing repair). Changes in fracture gap width were assessed on computed tomography (CT) images and with intraplanar force-sensitive resistors measuring voltage ratios (V△ ) between loaded recumbent (R-1) and standing repair simulations (R-2). Extensor branch borders were determined relative to implant position and sagittal P1 width on transverse CT images. P ≤ .05 was considered significant. Standing repair simulation-associated fracture gaps were not wider than in R-1 while controlling for confounding factors (loading weight, implant position, or animal age; P > .7, repeated-measures analysis of variance). Voltage ratio data associated with R-2 were not smaller than with R-1 (mean difference, 0.002 ± 0.052; one-sided Wilcoxon signed-rank test, P = .27). More of P1 width was approachable palmar to extensor branches when limbs were loaded (0.804 ± 0.314 cm) vs unloaded (0.651 ± 0.31 cm; paired Student's t test, P < .001). Simulated standing repair was not associated with inferior fracture reduction compared with loaded simulations of recumbent repairs. Limb loading affected extensor branch location relevant to implant positioning. Unloading during standing repair of incomplete parasagittal proximal P1 fractures may not be required to optimize fracture reduction.

Low skeletal muscle density combined with muscle dysfunction predicts adverse events after adult cardiovascular surgery

Background and aimsAlthough muscle dysfunctions are widely known as a poor prognostic factor in patients with cardiovascular disease, no study has examined whether the addition of low skeletal muscle density (SMD) assessed by computed tomography (CT) to muscle dysfunctions is useful. This study examined whether SMDs can strengthen the predictive ability of muscle dysfunctions for adverse events in patients who underwent cardiovascular surgery. Methods and resultsWe retrospectively reviewed 853 patients aged ≥40 years who had preoperative CT for risk management purposes and who measured muscle dysfunctions (weakness: low grip strength and slowness: slow gait speed). Low SMD based on transverse abdominal CT images was defined as a mean Hounsfield unit of the psoas muscle <45. All definitions of muscle dysfunction (weakness only, slowness only, weakness or slowness, weakness and slowness), the addition of SMDs was shown to significantly improve the continuous net reclassification improvement and integrated discrimination improvement for adverse events in all analyses (p < 0.05). Low SMDs combined with each definition of muscle dysfunction had the highest risk of all-cause death (hazard ratio: lowest 3.666 to highest 6.002), and patients with neither low SMDs nor muscle dysfunction had the lowest risk of all-cause and cardiovascular-related events. ConclusionThe addition of SMDs consistently increased the predictive ability of muscle dysfunctions for adverse events. Our results suggest that when CT is performed for any clinical investigation, the addition of the organic assessment of skeletal muscle can strengthen the diagnostic accuracy of muscle wasting.

Low Thoracic Skeletal Muscle Area Is Not Associated With Negative Outcomes in Patients With COVID-19.

Sarcopenia has been related to negative outcomes in different clinical scenarios from critical illness to chronic conditions. The aim of this study was to verify whether there was an association between low skeletal muscle index and in-hospital mortality, intensive care unit admission, and invasive mechanical ventilation need in hospitalized patients with COVID-19. This was a retrospective cohort study of a referral center for COVID-19. We included all consecutive patients admitted to the hospital between February 26 and May 15, 2020, with a confirmed diagnosis of COVID-19. Skeletal muscle index was assessed from a transverse computed tomography image at the level of twelfth thoracic vertebra with National Institutes of Health ImageJ software, and statistical analysis was performed to find an association between skeletal muscle index and in-hospital mortality, need of invasive mechanical ventilation, and intensive care unit admission. We included 519 patients, the median age was 51 (42-61) yrs, and 115 patients (22%) had low skeletal muscle index. On multivariable analysis, skeletal muscle index was not associated with mortality, intensive care unit admission, or invasive mechanical ventilation need nor in a subanalysis of patients 65 yrs or older. Skeletal muscle index determined by computed tomography at the level of twelfth thoracic vertebra was not associated with negative outcomes in hospitalized patients with COVID-19.

Anatomic Interactive Atlas of the Loggerhead Sea Turtle (Caretta caretta) Head.

Simple SummaryBecause several diseases have been reported affecting the head of sea turtles, accurate anatomic knowledge of this body part is necessary. We provide an open access, anatomic, interactive atlas of the head of the loggerhead sea turtle (Caretta caretta), to facilitate anatomic learning using osteology, gross dissection, and computed tomography (CT) images. Using segmentation and visualization software, relevant anatomic structures were identified and colored in all images, and a computer atlas was developed. This atlas, composed of 55 images, provides an interactive anatomic resource for veterinarians, biologists, researchers, and students involved in loggerhead sea turtle conservation.The head of the sea turtle is susceptible to congenital, developmental, traumatic, and infectious disorders. An accurate interpretation and thorough understanding of the anatomy of this region could be useful for veterinary practice on sea turtles. The purpose of this study was to develop an interactive two-dimensional (2D) atlas viewing software of the head of the loggerhead sea turtle (Caretta caretta) using images obtained via osteology, gross dissections, and computed tomography (CT). The atlas is composed of 10 osteology, 13 gross dissection, 10 sagittal multiplanar reconstructed CT (bone and soft tissue kernels), and 22 transverse CT (bone and soft tissue windows) images. All images were segmented and colored using ITK-SNAP software. The visualization and image assessment were performed using the Unity 3D platform to facilitate the development of interactive content in 2D. This atlas can be useful as an interactive anatomic resource for assessment of the head of loggerhead sea turtles.

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.

Evaluation of hip joint laxity in crab-eating foxes (Cerdocyon thous)

ABSTRACT: Like canids, crab-eating foxes may probably be predisposed to similar orthopedic diseases of domestic dogs, such as hip dysplasia. However, for the adequate hip dysplasia diagnosis in wild animals, the normality characteristics of each species must be determined. This study aimed to estimate radiographic and computed tomographic (CT) values of hip joint laxity in healthy crab-eating foxes. Fifteen intact crab-eating foxes, eight males and seven females, ages 1 to 5 and mean body mass of 6.66kg were used. Norberg angle (NA) was calculated from ventrodorsal hip-extended radiographs. To calculate the dorsolateral subluxation (DLS) score, the center distance (CD) index, the lateral center edge angle (LCEA), and the dorsal acetabular rim angle (DARA), measurements obtained from transverse CT images were used. No statistically significant differences were observed between the right and left sides in the radiographic and tomographic parameters. The mean NA was 107.57°. The mean DLS score, the CD index, the LCEA, and the DARA were 60.79%, 0.16, 98.25° and 13.47°, respectively. The data obtained are helpful in characterizing mean values of the hip joint in healthy crab-eating foxes, and can contribute to the knowledge of the species.

The accuracy of a novel pedicle screw insertion technique assisted by a special angular scale in the subaxial cervical spine using lateral mass as a reference marker

BackgroundPosterior cervical pedicle screw (CPS) internal fixation has better biomechanical stability than other posterior cervical fixation methods. However, this technique is limited in clinical practice due to the complex anatomical structure and the adjacent relationship of the cervical pedicle, and the high risk of neurovascular injury. The purpose of this study was to describe a novel subaxial CPS insertion technique assisted by a special angular scale using lateral mass as a reference marker and to evaluate the accuracy of CPS placement and the distribution characteristics of CPS misplacement.MethodsA total of 36 patients with subaxial cervical spine diseases who underwent posterior CPS fixation were consecutively selected. The optimal entry point on the posterior surface of the lateral mass was identified on the three-dimensional cervical model reconstructed from preoperative computed tomography (CT) images. The pedicle transverse angle (PTA) and pedicle-lateral mass angle (PLMA) were measured on the transverse and sagittal CT images respectively. The pedicle screws were inserted according to the preoperatively planned entry point and angles. We analysed the postoperative CT images for CPS misplacement rates and perforation directions following the Lee classification.ResultsOverall, 177 pedicle screws were inserted, of which 119 (67.2%) were classified as grade 0, 43 (24.3%) as grade 1, 12 (6.8%) as grade 2 and 3 (1.7%) as grade 3 by the postoperative CT images. The accuracy rate of CPS placement was 91.5%. Of the 15 misplaced pedicle screws (grades 2 and 3), 11 were lateral pedicle perforations, 3 were superior perforations and 1 was an inferior perforation. There were no neurovascular injuries related to CPS misplacement.ConclusionsWith our technique, the optimal entry point and two angles (PTA and PLMA) were identified for CPS insertion. The novel CPS insertion technique assisted by a special angular scale provides high accuracy and few complications.

Anatomy of the Tarsometatarsal Region and Digits in the Ostrich (Struthio Camelus): A Computed Tomography and Cross-Sectional Study.

The ostrich is the largest living bird and has unique characteristics in its locomotor system that differentiate it from other bird species. The purpose of this study was to provide a reference atlas of reference-interval computed tomography (CT) and cross-sectional anatomy of the tarsometatarsal region and digits in the ostrich (Struthio camelus). The pelvic limbs of 25 ostriches were used for this imaging study. The transverse CT images were obtained from the middle third of the tarsometatarsal bone to the distal end of the third digit. The specimens were frozen and sectioned with an electric band saw at 1.5-2 cm intervals. The CT images were compared with the corresponding frozen cross sections. The bones, ligaments, and tendons were identified and labeled at each 1.5-2 cm intervals. The CT images provided anatomic details of the tendons and ligaments in the tarsometatarsal region and digits of the ostrich. The transverse CT images provided an excellent depiction of the anatomic structures of the leg and foot when compared with the corresponding frozen cross sections. The information presented in this study may be used as an initial reference when evaluating the CT images of an ostrich's tarsometatarsal region and digits. Moreover, the information provided in this report may be helpful in determining definitive diagnoses of musculoskeletal disorders affecting the lower leg in this species.

Cystatin C and Sarcopenia Predict Acute on Chronic Liver Failure Development and Mortality in Patients on the Liver Transplant Waiting List.

Cystatin C (CysC) is an early biomarker of renal dysfunction scarcely studied in patients awaiting liver transplantation (LT). Sarcopenia is frequent in cirrhosis and impacts prognosis. We aimed to assess the capability of these factors to predict survival and acute-on-chronic liver failure (ACLF) in patients awaiting LT, as well as early post-LT outcomes. Single-center study that included all cirrhotic patients listed for LT between 2014 and 2017. Competing risk regression analysis was used to evaluate the capability of liver-, kidney-, and global status-related variables at waitlist (WL) inclusion to predict WL mortality and ACLF. Variables associated with post-LT outcomes were evaluated with logistic regression analysis. One-hundred-and-eighty patients were included. Fifty-six (31%) patients developed ACLF, 54 (30%) underwent LT and 35 (19%) died. In the adjusted competing risk regression analysis, CysC ≥ 1.5 mg/L, sarcopenia and MELD-Na were independent predictors of ACLF in the WL, while CysC ≥ 1.5 mg/L, sarcopenia and albumin were independent predictors of mortality. The cumulative incidence of ACLF and mortality at 12 months were 50% and 34% in patients with sarcopenia and CysC ≥1.5 mg/L. An estimated glomerular filtration rate by chronic kidney disease (CKD)-EPI-CysC-creatinine <60 mL/min/1.73 m at WL inclusion was an independent predictor of the need for renal replacement therapy (RRT) in the first month post-LT. Higher levels of CysC and sarcopenia are strongly associated with the ACLF and mortality in WL. The assessment of both risk factors may improve the prognostic evaluation and allow identifying a group of patients with a very high risk of poor outcomes while awaiting LT.

Sacroiliac joint morphologic changes from infancy to adulthood

BACKGROUND CONTEXTReport of sacroiliac morphology changes during growth is limited in the literature and the interest of such morphology and its consequence for surgery is increasing. PURPOSEAims of this work are (1) to anatomically define the sacroiliac joint (SIJ), and (2) to assess the influence of growth on the sacroiliac morphology and the pelvic parameters. STUDY DESIGNForty-nine young subjects from 6 months to 18 years old (y/o) and 20 adults aged from 18 to 50 y/o were selected from our institutional patient database. METHODSThey underwent a computed tomography (CT) examination on a 128-MDCT (GE Healthcare Optima CT660). Transverse CT image datasets were reconstructed, anonymized, and segmented with ITK-SNAP. Landmarks and surfaces were selected and a SIJ orientation analysis was performed using costumed Python scripts. RESULTSThe subjects were divided into four groups: infants (1.9±1 y/o), children (6.9±1.7 y/o), adolescents (13.7±1.8 y/o), and adults (27.3±5.6 y/o). Differences between SIJ orientation were found significant between young subject groups for synovial sacrum SIJ orientation (p<.001) and iliac total SIJ orientation (p=.036). Both orientations of younger subjects were found significantly different from the adult group (p<.035). SIJ synovial sacrum and iliac total orientations correlated significantly with age (p<.03). All orientations correlated with pelvic incidence (p<.04) except for synovial sacrum SIJ orientation (p=.2). No gender or symmetrical differences were found significant in any group. CONCLUSIONSMorphologic definition of the SIJ confirmed the independency of the gender during growth. Such results will be beneficial for the analysis and management of vertebral pathology.

Impact of myosteatosis on skeletal muscle volume loss in patients with chronic liver disease.

Severe muscle volume loss is a recognized negative prognostic factor in patients with chronic liver disease. However, the effect of skeletal muscle fat deposition, referred to as myosteatosis on muscle volume loss remains unclear. The aim of this study was to investigate the relationships between myosteatosis and skeletal muscle volume loss. We enrolled 362 patients with chronic liver disease (186 men, 176 women; mean age 68.4±10.0years, 94 with cirrhosis) who underwent liver biopsy and computed tomography scanning between January 2013 and February 2017. A transverse computed tomography image of each scan at the third lumbar vertebra was used to evaluate skeletal muscle tissues. Prevalence of skeletal muscle volume loss and myosteatosis were 36% and 82%, respectively. Of those with skeletal muscle volume loss, 93% have concomitant myosteatosis. Univariate analysis revealed that higher age, female, lower body mass index (BMI), higher serum albumin, lower alanine aminotransferase (ALT), lower gamma-glutamyl transpeptidase, lower total bilirubin, lower α-fetoprotein, lower skeletal muscle attenuation, and liver steatosis were significantly associated with skeletal muscle volume loss. Multivariate logistic regression analysis confirmed that lower BMI (odds ratio [OR] 5.26, 95% confidence interval [CI], 3.21-8.54; P<0.001), presence of myosteatosis (OR, 2.82; 95% CI, 1.26-6.30; P<0.001), lower ALT (OR, 2.04; 95% CI, 1.18-3.52; P=0.010), and female (OR, 1.71; 95% CI, 1.04-2.28; P=0.034) were significant independent factors associated with skeletal volume loss. Myosteatosis, low BMI, low ALT, and female are associated with skeletal muscle volume loss in patients with chronic liver disease.

Evaluation of interthalamic adhesion size as an indicator of brain atrophy in dogs with and without cognitive dysfunction.

Interthalamic adhesion thickness has been previously described as a parameter for quantifying canine brain atrophy and hypothesized to correlate with brain height or ventricular size. However, studies testing this hypothesis are lacking. This retrospective cross-sectional study aimed to compare interthalamic adhesion thickness, interthalamic adhesion thickness/brain height ratio, and interthalamic adhesion thickness/brain height ratio/lateral ventricle to brain height ratio values in dogs with and without cognitive dysfunction. Medical records for dogs meeting the following inclusion criteria were retrieved from two hospitals: available brain magnetic resonance imaging (MRI) or computed tomography (CT) studies, no cerebral parenchymal lesions, and no prior neurological treatment. For each included dog, values of interthalamic adhesion thickness, interthalamic adhesion thickness/brain height ratio, and interthalamic adhesion thickness/brain height ratio/lateral ventricle to brain height ratio were measured by one observer from transverse CT or MRI images and a consensus was reached. A total of 113 dogs met inclusion criteria. Dogs were divided into three groups based on the following criteria: Young group (no cognitive dysfunction, <9-year-old, n = 43), Aging group (no cognitive dysfunction, ≥9-year-old, n = 61), and Dementia group (n = 9). All three parameters were significantly lower in the dementia group than in the Young and Aging groups. In the Young and Aging groups, there was significant negative correlation of all three parameters with age and positive correlation of interthalamic adhesion thickness and interthalamic adhesion thickness/brain height ratio/lateral ventricle to brain height ratio with body weight, while there was no correlation of interthalamic adhesion thickness/brain height ratio with body weight (P < 0.05). There were no differences in all three parameters according to skull type or gender. Findings from the current study supported the use of interthalamic adhesion thickness, interthalamic adhesion thickness/brain height ratio, and interthalamic adhesion thickness/brain height ratio/lateral ventricle to brain height ratio for quantifying brain atrophy in dogs with cognitive dysfunction.