Vitrea Software Research Articles

Postmortem Computed Tomography: A Supplant Technique to Autopsy for Firearm Injuries in the Head

Background: Autopsy is more time-consuming if the bullet/bullets are lodged at the difficult-to-access sites of the head, especially maxillofacial regions. The procedure of suturing the deceased becomes even more difficult after the retrieval of bullets post-dissection of facial tissues. The altered aesthetics psychologically and emotionally disturb the already bereaved next of kin. The authors explored the utility of PMCT and propose a methodology of targeted dissection/minimally invasive approach to retrieve the bullet. The authors discussed the feasibility to conclude the cause of death in cases of single/multiple firearm injuries to the head using PMCT alone. Methods: The authors evaluated three cases of firearm deaths at a distance lesser than close range to the head. The deceased was subjected to PMCT scanning using a 16-slice Multi-Slice CT spiral scanner and findings were analyzed using the Vitrea software v.6.9.1 with the slice thickness ranging from 0.5mm to 5mm. A routine conventional autopsy was conducted post-scanning. Two of the three cases were suicide and succumbed to a single firearm injury while the third case was a homicide due to multiple firearm injuries. Conclusion: PMCT alone can be utilized and relied upon in deaths due to a single shot to the head and suggests a combined methodology of PMCT evaluation and minimally invasive approach in cases of multiple firearm injuries for better correlation of wound track. Lastly, PMCT helped in a targeted approach to reach the in situ bullets more precisely than any other radiological technique which upholds the humanitarian forensic aspect.

The potential of 3D models and augmented reality in teaching cross-sectional radiology

What was the educational challenge? The complexity and variability of cross-sectional imaging present a significant challenge in imparting knowledge of radiologic anatomy to medical students. What was the solution? Recent advancements in three-dimensional (3D) segmentation and augmented reality (AR) technology provide a promising solution. These advances allow for the creation of interactive, patient-specific 3D/AR models which incorporate multiple imaging modalities including MRI, CT, and 3D rotational angiography can help trainees understand cross-sectional imaging. How was the solution implemented? To create the model, DICOM files of patient scans with slice thicknesses of 1 mm or less are exported to a computer and imported to 3D Slicer for registration. Once registered, the files are segmented with Vitrea software utilizing thresholding, region growing, and edge detection. After the creation of the models, they are then imported to a web-based interactive viewing platform and/or AR application. What lessons were learned that are relevant to a wider global audience? Low-resource 3D/AR models offer an accessible and intuitive tool to teach radiologic anatomy and pathology. Our novel method of creating these models leverages recent advances in 3D/AR technology to create a better experience than traditional high and low-resource 3D/AR modeling techniques. This will allow trainees to better understand cross-sectional imaging. What are the next steps? The interactive and intuitive nature of 3D and AR models has the potential to significantly improve the teaching and presentation of radiologic anatomy and pathology to a medical student audience. We encourage educators to incorporate 3D segmentation models and AR in their teaching strategies.

Computed tomography-based preoperative muscle measurements as prognostic factors for anastomotic leakage following oncological sigmoid and rectal resections.

Oncological sigmoid and rectal resections are accompanied with substantial risk of anastomotic leakage. Preoperative risk assessment and patient selection remain difficult, highlighting the importance of finding easy-to-use parameters. This study evaluates the prognostic value of contrast-enhanced (CE) computed tomography (CT)-based muscle measurements for predicting anastomotic leakage. Patients that underwent oncological sigmoid and rectal resections in the LUMC between 2016 and 2020 were included. Preoperative CE-CT scans, were analyzed using Vitrea software to measure total abdominal muscle area (TAMA) and total psoas area (TPA). Muscle areas were standardized using patient's height into: psoas muscle index (PMI) and skeletal muscle index (SMI) (cm2 /m2 ). In total 46 patients were included, of which 13 (8.9%) suffered from anastomotic leakage. Patients with anastomotic leakage had a significantly lower PMI (22.1 vs. 25.1, p < 0.01) and SMI (41.8 vs. 46.6, p < 0.01). After adjusting for confounders (age and comorbidity), lower PMI (odds ratio [OR]: 0.85, 95% confidence interval [CI] 0.71-0.99, p = 0.03) and SMI (OR: 0.93, 95%CI 0.86-0.99, p = 0.02) were both associated with anastomotic leakage. This study showed that lower PMI and SMI were associated with anastomotic leakage. These results indicate that preoperative CT-based muscle measurements can be used as prognostic factor for risk stratification for anastomotic leakage.

Predictive Value of Different Computed Tomography Perfusion Software Regarding 90-Day Outcome of Acute Ischemic Stroke Patients After Endovascular Treatment: A Comparison With Magnetic Resonance Imaging.

This study compared ischemic core and penumbra volumes obtained using different computed tomography perfusion (CTP) software and evaluated the predictive value of CTP and magnetic resonance imaging (MRI) results for 90-day outcomes. In total, 105 acute ischemic stroke patients who underwent endovascular treatment from January 2016 to December 2020 were included. Patients were divided into good and poor outcome groups by a modified Rankin Scale score. Computed tomography perfusion core and penumbra volumes were obtained using OleaSphere and Vitrea software to assess the volumetric relationship with MRI using the Spearman correlation test, intraclass correlation coefficient (ICC), and Bland-Altman plot. Three multivariable models were developed: baseline variables with MRI infarct volume, baseline variables with OleaSphere core volume, and baseline variables with Vitrea core volume. The area under the receiver operating characteristic curve of the 3 models was compared using the DeLong test. Median core volumes were 27.5, 26.9, and 31.1 mL for OleaSphere, Vitrea, and MRI, respectively. There was substantial correlation and excellent agreement between OleaSphere and MRI core volume ( ρ = 0.84, P < 0.001; ICC = 0.84) and Vitrea and MRI core volume ( ρ = 0.80, P < 0.001; ICC = 0.83). The areas under curve for MRI volume, OleaSphere, and Vitrea were 0.86, 0.84, and 0.83, respectively. There were no significant differences ( P = 0.18) between the predictive value of the 3 models. Computed tomography perfusion core volumes showed substantial correlation and excellent agreement with MRI. There was no significant difference in the predictive value of the 3 models, suggesting that core volumes measured using CTP software can predict patient prognosis.

English

BACKGROUND Exposure of various tropical infections and infestations like tuberculosis, filariasis, malaria, anemia, kala-azar and poor sanitation are major health concerns in Bihar and it’s neighboring state. Spleen size increases in several other diseases e.g., metabolism or storage disorder, malignancies and hematological disorders. Determining the normal parameters of spleen is essential for assessment of splenomegaly in routine ultrasonography (USG) or in the computed tomography (CT) scan. In this study, we wanted to estimate the CT based measurement of splenic dimensions in various planes, splenic index (linear dimension) and splenic volume and also to estimate the relationship of splenic index and splenic volume with age, gender and other splenic dimensions. METHODS It was a retrospective study and data was collected from January 2019 to December 2019. A total of 154 cases (including both genders) of age range 18 - 60 years were collected from the vitrea system (Vitrea software used for the 3-D assessment of splenic volume) and clinical data was collected from the medical record section. CT scan data of only those patients were included who had the clinical history of pain in abdomen, abdominal trauma or other diseases not affecting the spleen. Various measurements including splenic length and thickness at hilum and maximum thickness in axial view and height (maximum interpolar and true vertical height) in coronal views were recorded. RESULTS 154 cases including both gender and age range of 18 - 60 years were included in our study. There were 60 males and 94 females. The average age of the male and female patients was 45.93 +/- 15.19 years and 45.87 +/- 15.12 years respectively. The mean splenic dimensions were 9.03 +/- 1.49 cm in length (axial view), 3.69 +/- 0.05 cm thickness at hilum (axial view) and 9.05 +/- 2.23 cm maximum craniocaudal length and 7.9 +/- 2.96 cm true vertical length (coronal view). Mean splenic index and mean splenic volume were 340.30 +/- 107.39 cm3 and 227.02 +/- 62.22 cm3 respectively. There was statistically significant correlation between splenic volume and maximum craniocaudal length (r2 = 0.4848, P = 0.001), maximum axial length (r2 = 0.4765, P &lt; 0.001) and true vertical length (r2 = 0.3142, P = 0.001) with 95 % confidence interval. For all splenic measurements, there was stronger correlation with maximum craniocaudal length followed by maximum axial length. However, there was no statistically significant correlation either of splenic volume with age in either gender (r2 = 0.019, P = 0.043) or splenic index with age in either gender present (r2 = 0.016, P = 0.059). CONCLUSIONS Maximum splenic length both in coronal (craniocaudal) and axial sections are positively and strongly correlated with splenic volume and splenic index but age of the individuals doesn’t show any correlation either with the splenic volume or with splenic index. Hence, a regional reference of splenic parameters was established with a slightly different range of values reported previously. KEY WORDS Splenic Volume, Splenic Index, Computed Tomography

Benefits of the Subdural Evacuating Port System (SEPS) Procedure Over Traditional Craniotomy for Subdural Hematoma Evacuation.

There remains no consensus on the optimal primary intervention for subdural hematoma (SDH). Although historically favored, craniotomy carries substantial morbidity and incurs significant costs. Contrastingly, the subdural evacuating port system (SEPS) is a minimally invasive bedside procedure. We assessed the benefits of SEPS over traditional craniotomy for SDH evacuation. A single-center retrospective cohort study of SDH patients receiving craniotomy or SEPS between 2012 and 2017 was performed. Information regarding demographics, medical history, presentation, surgical outcomes, cost, and complications was collected. Pre- and postoperative hematoma volumes were calculated using 3D image segmentation using Vitrea software. Multivariate regression models were employed to assess the influence of intervention choice. Of 107 patients, 68 underwent craniotomy and 39 underwent SEPS. There were no differences in age, sex, blood thinner use, platelet count, INR, hematoma lateralization, age, volume, or midline shift at presentation between intervention groups. Although there was no difference in percent residual hematoma volume 24-hour postintervention (44.1% vs 45.1%, P = .894), SEPS was associated with lower hospitalization costs ($108 391 vs $166 318, *P = .002), shorter length of stay (4.0 vs 5.8 days, *P = .0002), and fewer postoperative seizures (2.6% vs 17.7%, *P = .048). Reoperation rate was higher after SEPS overall (33.3% vs 13.2%, *P = .048) but comparable to craniotomy in chronic SDH (12.50% vs 7.69%, P = 1.000). In this retrospective cohort, SEPS was noninferior to craniotomy at reducing SDH hematoma volume. The SEPS procedure was also associated with decreased length of stay hospitalization costs, and postoperative seizures and demonstrated a comparable recurrence rate to craniotomy for chronic SDH in particular.

Variations In Glenoid Bony Morphology May Predict Recurrent Instability After Arthroscopic Bankart Repair

Objectives: Variations in bony anatomy may be a significant risk factor for failure of stabilization surgery and could help explain the etiology of recurrent dislocations. Identifying these variations may help guide surgical decision making. The aim of this study was to develop a method to quantify bony morphology and measure glenoid and humeral head volume on MRI to identify risk factors for failure after Bankart repair. We hypothesized that the ratio of humeral head to glenoid volume and a shallower glenoid socket or greater radius of curvature would be significant risk factors in patients who failed stabilization surgery. Methods: This was a retrospective case-control study of 289 patients from 2005-2015. Inclusion criteria were primary anterior arthroscopic shoulder stabilization, no prior shoulder surgery, and traumatic etiology. Exclusion criteria were posterior labral pathology, multidirectional instability, connective tissue disorder, or concomitant rotator cuff pathology. Surgical failure was defined as a redislocation event and these cases were compared 1:2 to an age- and sex-matched control without recurrent instability. Demographic data was obtained by chart review. Pre-operative MR arthrograms were analyzed by two trained reviewers. Vitrea software (Vital Images, Minnetonka, MN) was utilized to measure the volume and radius of curvature of both the humeral head (Figure 1) and glenoid on T1 sequences. A larger radius of curvature corresponded to an overall shallower glenoid socket. Fisher exact and the student t test were used for statistical analysis with significant defined as p &lt; 0.05. Results: Ninety-five patients met the inclusion criteria, 36 of whom were in the case group, with an average follow-up of 30.3 months. There was no difference between groups with regard to baseline demographic and radiographic parameters (Table 1). The average number of preoperative dislocations was significantly higher in the failure group (3.13 vs. 1.91, p &lt; 0.05). The humeral head (67.8 ml vs 62.3 ml, p =0.13) and glenoid volume (13.7 ml vs 13.0 ml, p=0.42) were similar between the two groups, as was the ratio of the two (5.1 vs 4.9, p=0.30). The radius of curvature of the glenoid was slightly larger, or shallower, in the case group compared to the control group (23.8 mm vs 22.6 mm, p=0.02). The ratio of the radius of curvature of the humeral head to the glenoid was similar between the two groups (1.1 vs 1.1, p=0.11). Further analysis demonstrated that a greater portion of patients with a glenoid radius of curvature greater than 24.5 experienced a postoperative dislocation compared to those who had a smaller radius of curvature (63.6% vs 26.0%, p &lt; 0.01) (Table 1). There was no significant difference between the number of preoperative dislocations between patients with larger or smaller glenoid radius of curvature (2.7 vs 2.3, p = 0.57). Conclusion: Using a novel method of quantifying the bony morphology, our results demonstrate that a larger radius of curvature, particularly greater than 24.5 mm, which is indicative of a shallower glenoid, may predispose patients to failure following a primary arthroscopic Bankart. These findings suggest that the overall bony concavity of the glenoid may play an inherent role regarding stability. [Table: see text]

Labral Morphology and Number of Preoperative Dislocations Are Associated With Recurrent Instability After Arthroscopic Bankart Repair

To develop a method to measure capsule and labral volume on preoperative magnetic resonance imaging to predict surgical failure after primary Bankart repair. A retrospective case-control study was conducted on patients undergoing primary anterior arthroscopic shoulder stabilization. Surgical failure was defined as a recurrent dislocation event. Cases were matched to controls based on age and sex in a 1:2 ratio. Preoperative magnetic resonance (MR) arthrograms were analyzed by 2 trained reviewers using Vitrea software to measure labral and capsular volume with a 3-dimensional model. Labral size was also qualitatively measured on axial images. A "diffusely small" labrum was defined as labral height less than the width of the glenoid tidemark cartilage. Of the 289 patients who had an arthroscopic Bankart repair from 2006 to 2015, 33 who had a postoperative dislocation met the inclusion criteria and were matched to 62 control patients who did not. There was no difference between groups with regard to age (P= .88), sex (P= .82), contact sport participation (P= .79), proportion of overhead athletes (P= .33), proportion of throwers (P= 1), surgical positioning in lateral decubitus (P= .18), or number of repair anchors used (P= .91). The average number of preoperative dislocations was significantly higher in the failure group (3.2 vs. 2.0, P < .0001). In patients with normal labrum morphology, the odds of having surgical failure increased by 26% for a 1-unit increase in the number of prior dislocations (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.02 to 1.55). The case and control groups had similar labral and capsular volume as measured in Vitrea. The failure group had a significantly higher proportion of patients with a diffusely small labral morphology (47% vs. 17%, P= .03). Controlling for number of preoperative dislocations, the odds of having a diffusely small labral morphology was 3.2 times more likely in the case group than the control group (95% CI 1.259 to 8.188). Interrater reliability between 2 independent reviewers was excellent for measurement of capsule volume (r= 0.91) and good for measurement of labral volume (r= 0.74). This study presents a novel method of measuring labral and capsule volume with high interrater reliability. An increased number of recurrent dislocations prior to primary Bankart repair was associated with increased odds of recurrent instability after surgery. The OR for failure also increased with increasing number of preoperative dislocations. Diffusely small labral morphology was associated with having a postoperative redislocation. III (case-control study).

Spleen enlargement assessment using computed tomography: which coefficient correlates the strongest with the real volume of the spleen?

PurposeThe aim of the study was to find which linear measurements, field and volume coefficients correlate the best with real volume of the spleen and can be further used for identification of splenomegaly.MethodsAbdominal computed tomography (CT) examinations of 264 patients were retrospectively analyzed in terms of maximal length, maximal thickness, hilum thickness, maximal height, vertical height and estimated height. Spleen volume was manually measured in Vitrea software. Two- and three-dimensional coefficients were calculated through proper mathematical formulas from linear measurements. Splenomegaly cut-off: 314.5 cm3. Data were analyzed with use of Pearson correlation and χ2 test with statistical significance at p < 0.05.ResultsFor single measurements, the correlation with real spleen volume was the strongest for maximal height (r = 0.804; p < 0.05). Among two-dimensional indexes, multiplication product of maximal length and vertical height reached the highest level of correlation with spleen volume (r = 0.923; p < 0.05) and had the highest sensitivity and specificity (94.3% and 93.0%, respectively) for splenomegaly detection (threshold 115 cm2). In case of three-dimensional ones, the coefficient calculated from maximal length, vertical height and hilum thickness established the strongest link with spleen volume (r = 0.956; p < 0.05).ConclusionsCoefficient calculated from maximal length, vertical height and hilum thickness correlates the strongest with spleen volume and can be utilized for monitoring of spleen volume instead of obsolete splenic index. The most suitable for quick splenomegaly screening is two-dimensional coefficient (maximal length × vertical height), with the cut-off 115 cm2.

Evaluation of spleen volume: Practical diagnostic role of linear measurements, 2D and 3D coefficients in computed tomography

Aim: The aim of the study was to find which linear measurements, field and volume coefficients correlate best with the real volume of the spleen and can be further used for determination of splenomegaly. Introduction: Spleen is involved in a wide spectrum of abnormalities, which might lead to an increase in organ size. Splenic enlargement on CT is diagnosed basing on rather subjective criteria. The product of the length, estimated height and thickness of the spleen (“splenic index”, cut-off ≥480) has also been proposed as an indicator for evaluating splenic size on CT. Methods: Abdominal CT examinations of 153 patients' (77 females, 76 males) were retrospectively analysed in terms of maximal length, thickness, hilum thickness (axial plane), height (longest measurement in coronal plane), 90° height (maximum vertical height at coronal section), estimated height (number of axial scans where spleen was visible multiplied by the thickness of CT scans) (Impax Software) and real spleen volume (Vitrea software). Two-dimensional and three-dimensional coefficients were acquired through proper mathematical formulas. Splenomegaly cut-off: 314.5ml. Pearson's correlation coefficient was calculated for the relationship between single, field, volume measurements and real volume (Statistica software). Results: There was a statistically significant correlation between all single, field and volume measurements and real volume (p<0.05). For single measurements, the correlation is the strongest for height (r=0.813, sensitivity 65%, specificity 91.7%, PPV 71.4%, NPV 95.6%). For two-dimensional, it is the coefficient calculated from length and 90° height (r=0.918, 85%, 94.7%, 70.8%, 97.7%). For three-dimensional, it is the coefficient calculated from length, 90° height and hilum thickness (r=0.919, 75%, 96.2%, 75%, 96.2%). Cut-off for splenic index from our calculations was ≥1148. Conclusion: Coefficient from length, 90° height and hilum thickness correlate best with the real volume of the spleen. Splenic index in our study is far from the perfection for clinical practice.

Relationship of the sinus anatomy to surface landmarks is a function of the sinus size difference between the right and left side: Anatomical study based on CT angiography.

Background:Several cadaveric studies demonstrate reliable localization of the transverse sinus and the transverse sigmoid junction (TSJ). These studies use the line drawn from the inion to the posterior root of the zygoma (IZ) and the asterion, respectively. We investigated how the size difference between the right and left transverse sinuses (TS) and sigmoid sinuses (SS) affected the accuracy of their respective superficial landmarks, particularly with regards to where this relationship may result in unsafe and/or complicated surgical access.Methods:We utilized Vitrea software to render three-dimensional images based on computed tomographic angiography (CTA). We measured the relationship between the TS and SS to their respective superficial landmarks.Results:We analyzed 50 patients in this study. The distal TS was found caudal to the inion-to-zygoma (IZ) line on average by 5.0 ± 4.3 mm on the right and 6.4 ± 9.3 mm on the left. The mid TS was found cranial on average 3.5 ± 5.7 mm on the right and 3.2 ± 6.0 mm cranial on the left to the superior nuchal line (SNL). The distance from the asterion to the SS was 11.5 ± 2.4 mm medial on the right and 12.1 ± 4.4 mm medial on the left. The average distance was greater on the left than the right when using the IZ landmark. This was directly proportional to the size difference of the sinuses (r2 = 0.15, P = 0.03).Conclusions:Statistically significant differences between the right and left TS and SS were seen in terms of size. This appeared to correlate nicely to the differences observed between the locations of the TSs’ and their respective superficial landmarks.

Intranasal volume increases with age: Computed tomography volumetric analysis in adults

It is theorized that intranasal cavity volumes change throughout the aging process, possibly secondary to hormonal changes and atrophy of the sinonasal mucosa. Our objective is to compare intranasal volumes from different age groups to test the hypothesis that intranasal cavity volume increases with age. Case series. An analysis of computed tomography (CT) scans performed for reasons other than sinonasal complaints. Intranasal volumes of three groups (age 20-30 years, 40-50 years, and 70 years and above) were calculated using Vitrea software. The total intranasal volume was measured from the nasal vestibule anteriorly, the nasopharynx posteriorly, the olfactory cleft superiorly, and the nasal floor inferiorly. The total volume included the sum of the right and left sides. Sixty-two CT scans were analyzed. There was a progressive, relatively linear, increase in intranasal volume with increasing age: 20 to 30 years = 15.73 mL, 40 to 50 years = 17.30 mL, and 70 years and above = 18.38 mL. Mean intranasal volume for males was 19.07 mL, and for females was 15.23 mL. Analysis of variance demonstrated significant group differences in mean intranasal volume for age (P = .003) and gender (P < .001), with moderate-to-large effect size of 0.206 and 0.289 (partial η(2) ), respectively. Post hoc testing revealed a significant difference between the 20 to 30-year and >70-year age groups (P = .006). There was no significant difference in intranasal volume dependent upon body mass index. Intranasal volume increases with age and is larger in males. Specific etiologies responsible for increased intranasal cavity volume with age are actively being evaluated. 4 Laryngoscope, 126:2212-2215, 2016.

MP19-07 THREE-DIMENSIONAL EVALUATION OF PERIRENAL ADIPOSE TISSUE VOLUME PREDICTS RENAL CORTICAL NEOPLASM HISTOPATHOLOGY

INTRODUCTION AND OBJECTIVES: Contemporary imaging technology allows for three-dimensional (3D) visualization of human anatomy. Volumetric data acquisition allows for 3D imaging and accurate estimation of organ sizes and volumes. Visceral and perirenal adipose tissue (PAT) have been shown to be metabolically active. Previously, we have demonstrated that linear two-dimensional PAT measurements are associated with more aggressive renal cell carcinoma (RCC) subtypes. In this study, we evaluated total PAT volume as a predictor of renal tumor histopathology using novel 3D imaging software. METHODS: We retrospectively evaluated patients who underwent laparoscopic radical or partial nephrectomy for renal cortical neoplasms (RCN). We measured the PAT volume through post-processing of preoperative CT images using Vitrea software (Vital Images, Inc., Minnetonka, MN). We measured the total perirenal space volume by manual contouring. We subtracted out the structures with densities greater than adipose tissue using organ segmentation, thereby yielding only a total PAT volume. We recorded and analyzed demographic, clinical and operative parameters, PAT volume, and their association with tumor histopathology. RESULTS: In this pilot analysis, a total of 102 patients with 104 tumors were included: 50 (49%) men and 52 (51%) women with a median body mass index (BMI) of 28.5 kg/m. The median tumor size for overall cohort was 2.7 cm (0.9-4.4 cm), and the median PAT volume was 395.4 cm. Mean PAT for malignant and benign histopathology was 436.7 cm and 269.3 cm respectively (p1⁄40.002). The mean PAT for each subtype showed 396.8, 633.3, 119.8, and 269.3 cm for clear cell (n1⁄457), papillary (n1⁄413), chromophobe (n1⁄45), and benign (n1⁄425) tumors, respectively (p1⁄40.000). To date, a total of 42 patients underwent bilateral PAT volume determination. The mean PAT volume was 19.6% higher on the tumor side (p1⁄40.001). CONCLUSIONS: In this preliminary pilot analysis, increased PAT volume is a significant predictor of RCC histopathology for small RCN. Similarly, there was a significant direct correlation for tumor laterality and PAT volume versus the contralateral kidney for the individual patient. Further data is being collected.

Preoperative Computerized Tomography and Magnetic Resonance Imaging of the Pancreas Predicts Pancreatic Mass and Functional Outcomes After Total Pancreatectomy and Islet Autotransplant.

Approximately two thirds of patients will remain on insulin therapy after total pancreatectomy with islet autotransplant (TPIAT) for chronic pancreatitis. We investigated the relationship between measured pancreas volume on computerized tomography or magnetic resonance imaging and features of chronic pancreatitis on imaging, with subsequent islet isolation and diabetes outcomes. Computerized tomography or magnetic resonance imaging was reviewed for pancreas volume (Vitrea software) and presence or absence of calcifications, atrophy, and dilated pancreatic duct in 97 patients undergoing TPIAT. Relationship between these features and (1) islet mass isolated and (2) diabetes status at 1-year post-TPIAT were evaluated. Pancreas volume correlated with islet mass measured as total islet equivalents (r = 0.50, P < 0.0001). Mean islet equivalents were reduced by more than half if any one of calcifications, atrophy, or ductal dilatation were observed. Pancreatic calcifications increased the odds of insulin dependence 4.0 fold (1.1, 15). Collectively, the pancreas volume and 3 imaging features strongly associated with 1-year insulin use (P = 0.07), islet graft failure (P = 0.003), hemoglobin A1c (P = 0.0004), fasting glucose (P = 0.027), and fasting C-peptide level (P = 0.008). Measures of pancreatic parenchymal destruction on imaging, including smaller pancreas volume and calcifications, associate strongly with impaired islet mass and 1-year diabetes outcomes.

Painful knee prosthesis: CT scan to assess patellar angle and implant malrotation

According to literature, the incidence of pain in knee prostheses is on the increase. In the last decade Authors have focused attention on rotational alignment of the prosthetic components. The aim of this study is to evaluate the efficiency of a new angle, which we define as patellar angle, in order to achieve early diagnosis of malrotation. We set up a retrospective observational study recruiting 100 subjects who had undergone total knee prosthesis. 50 subjects suffered from knee anterior pain and 50 without any symptoms. Through CAT scan and VITREA software®, we were able to study the rotation of prosthetic components. We defined a new angle, which links the tibial component and the patella margins. The angles were measured by two different orthopaedic surgeons blinded to the study. The patella angle ranged from 10 to 28°, with an average value of 23.2° in the control group; in the study group the angle ranged from 26 to 34°, with an average value of 29.9°. Our data supported the reproducibility and efficacy of new angular value. It would represent a new method to detect tibial rotational malalignment. IV.

A Non-Invasive Method of Quantifying Pancreatic Volume in Mice Using Micro-MRI

In experimental models of pancreatic growth and recovery, changes in pancreatic size are assessed by euthanizing a large cohort of animals at varying time points and measuring organ mass. However, to ascertain this information in clinical practice, patients with pancreatic disorders routinely undergo non-invasive cross-sectional imaging of the pancreas using magnetic resonance imaging (MRI) or computed tomography (CT). The aim of the current study was to develop a thin-sliced, optimized sequence protocol using a high field MRI to accurately calculate pancreatic volumes in the most common experimental animal, the mouse. Using a 7 Telsa Bruker micro-MRI system, we performed abdominal imaging in whole-fixed mice in three standard planes: axial, sagittal, and coronal. The contour of the pancreas was traced using Vitrea software and then transformed into a 3-dimensional (3D) reconstruction, from which volumetric measurements were calculated. Images were optimized using heart perfusion-fixation, T1 sequence analysis, and 0.2 to 0.4 mm thick slices. As proof of principle, increases in pancreatic volume among mice of different ages correlated tightly with increasing body weight. In summary, this is the first study to measure pancreatic volumes in mice, using a high field 7 Tesla micro-MRI and a thin-sliced, optimized sequence protocol. We anticipate that micro-MRI will improve the ability to non-invasively quantify changes in pancreatic size and will dramatically reduce the number of animals required to serially assess pancreatic growth and recovery.

Validity of three-dimensional computed tomography measurements for Le Fort I osteotomy

The purpose of this study was to test the precision and accuracy of three-dimensional (3D) linear measurements for Le Fort I osteotomy, obtained from multi-slice computed tomography (MSCT) and cone beam computed tomography (CBCT) scans. The study population consisted of 11 dried skulls submitted to 64-row MSCT and CBCT scans. Three-dimensional reconstructed images (3D-CT) were generated, and linear measurements (n=11) based on anatomical structures and landmarks of interest for Le Fort I osteotomy were performed independently by two oral and maxillofacial radiologists, twice each, using Vitrea software; this allows true 3D measurement on 3D-CT images. The results demonstrated no statistically significant differences between the inter-examiner and intra-examiner analyses, and physical and true 3D linear measurements using MSCT and CBCT images. Regarding examiner accuracy, no statistically significant differences were found for the comparisons among the physical and the MSCT and the CBCT linear measurements by either examiner. For examiners 1 and 2, the analysis intra-examiner correlation coefficient ranged from 0.87 to 0.96 and 0.82 to 0.98, respectively, using MSCT, and from 0.84 to 0.98 and 0.80 to 0.98, respectively, using CBCT, indicating almost perfect agreement for all analyses performed. 3D linear measurements obtained from MSCT and CBCT images were considered precise and accurate for Le Fort I osteotomy and thus accurate and helpful for Le Fort I osteotomy planning.

Analysis of the Anatomic Changes of the Aging Facial Skeleton Using Computer-Assisted Tomography

The bony skeleton serves as the scaffolding for the soft tissues of the face; however, age-related changes of bony morphology are not well defined. This study sought to compare the anatomic relationships of the facial skeleton and soft tissue structures between young and old men and women. A retrospective review of CT scans of 100 consecutive patients imaged at Duke University Medical Center between 2004 and 2007 was performed using the Vitrea software package. The study population included 25 younger women (aged 18-30 years), 25 younger men, 25 older women (aged 55-65 years), and 25 older men. Using a standardized reference line, the distances from the anterior corneal plane to the superior orbital rim, lateral orbital rim, lower eyelid fat pad, inferior orbital rim, anterior cheek mass, and pyriform aperture were measured. Three-dimensional bony reconstructions were used to record the angular measurements of 4 bony regions: glabellar, orbital, maxillary, and pyriform aperture. The glabellar (p = 0.02), orbital (p = 0.0007), maxillary (p = 0.0001), and pyriform (p = 0.008) angles all decreased with age. The maxillary pyriform (p = 0.003) and infraorbital rim (p = 0.02) regressed with age. Anterior cheek mass became less prominent with age (p = 0.001), but the lower eyelid fat pad migrated anteriorly over time (p = 0.007). The facial skeleton appears to remodel throughout adulthood. Relative to the globe, the facial skeleton appears to rotate such that the frontal bone moves anteriorly and inferiorly while the maxilla moves posteriorly and superiorly. This rotation causes bony angles to become more acute and likely has an effect on the position of overlying soft tissues. These changes appear to be more dramatic in women.

Clinical Presentation of Asbestosis with Intractable Pleural Pain in the Adult Child of a Taconite Miner and Radiographic Demonstration of the Probable Pathology Causing the Pain

Taconite, although not classified by the United States Government as asbestos or asbestiform material, has been associated with asbestos-related diseases. The mineral is used in the production of steel and as a road-patch material and is mined in Michigan and Minnesota. This report describes the case of a middle-aged Caucasian woman with exposure to taconite mining dust from her miner father's clothing in childhood with a resultant presentation consistent with asbestosis and intractable pleural pain. Intractable pleural pain has been described in asbestos-exposed patients with theorized etiologies. However, no in vivo reported mechanism has demonstrated a plausible, anatomically apparent mechanism for the pain. We utilize an application of the Vitrea software for enhancement of high-resolution computerized tomography which demonstrates at least one likely mechanism for intractable pleural pain.

Clinical Value of CT Colonography in Patients with Strong Relative Medical Contraindications for Colonoscopy

Purpose: CT colonography (CTC) is a potentially valuable complimentary tool to conventional colonoscopy (CC). CTC may be particularly valuable in patients who are at high risk for CC due to severe medical illness, administration of anticoagulant therapy, blood dyscrasia, or intraabdominal conditions. We analyze the clinical feasibility and efficacy of CTC in this previously unstudied subgroup of patients. Methods: Of 160 patients undergoing CTC at our institution from April 2005 through May 2006, 31 patients underwent CTC, rather than CC, due to medical contraindications. Patients undergoing CTC for colon cancer screening or for prior incomplete CC were excluded. CTC was performed by 64 or 16 slice detectors and read using Vitrea software. The colonic preparation was Fleet's prep 1. Adequacy of colonic evaluation was quantitatively scored by dividing the colon into 9 segments e.g. cecum = 9, asc.colon = 8, rectum = 1. Results: Of 31 patients satisfying the study criteria, 17 (55%) were female, 55% were black, and 42% were Caucasian. The mean age was 73.8 ± 13.3 years. Relative contraindications to CC included severe medical illness in 14 (45%), anticoagulation in 13 (42%), and other in 4. Twenty-nine (94%) of patients tolerated the procedure (2 [6%] did not tolerate air insufflation). Evaluation of all colonic segments was performed in 17 patients (55%), but was not possible in 14 patients (45%) due to inadequate colonic preparation. Colonic visualization at CTC was inferior in these 31 patients compared to 100 patients undergoing CTC for incomplete CC (mean visualization: 6.3 ± 3.7 vs 7.6 ± 2.6, p= 0.03). Eleven patients had colonic polyps (total 28 polyps). Nine had at least one polyp ≥ 0.5 cm or ≥ 3 polyps. The yield of colonic polyps was similar when CTC was performed for medical contraindications versus CTC performed for prior incomplete CC (p= 0.56). One suspected colon cancer on CTC (poor prep) was a false positive. One villous carpet of cecum was missed at CTC (poor prep). Diverticulosis was reported in 52% of patients. Conclusions: CTC is technically feasible in patients with relative medical contraindications to CC, but often (45%) have incomplete colonic evaluation due to poor colonic preparation. False positive or false negative reporting can occur due to poor colonic preparation. Better colonic preparation may improve colonic evaluation by CTC in these patients.