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Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models, part II: anatomy of relevance to surgeons operating splenic flexure cancer
Surg Endosc. 2022 Jun 30. doi: 10.1007/s00464-022-09394-5. Online ahead of print.
BACKGROUND: The splenic flexure is irrigated from two vascular areas, both from the middle colic and the left colic artery. The challenge for the surgeon is to connect these two vascular areas in an oncological safe procedure.
MATERIALS AND METHODS: The vascular anatomy, manually 3D reconstructed from 32 preoperative high-resolution CT datasets using Osirix MD, Mimics Medical and 3-matic Medical Datasets, were exported as STL-files, video clips, stills and supplemented with 3D printed models.
RESULTS: Our first major finding was the difference in level between the middle colic and the inferior mesenteric artery origins. We have named this relationship a mesenteric inter-arterial stair. The middle colic artery origin could be found cranial (median 3.38 cm) or caudal (median 0.58 cm) to the inferior mesenteric artery. The lateral distance between the two origins was 2.63 cm (median), and the straight distance 4.23 cm (median). The second finding was the different trajectories and confluence pattern of the inferior mesenteric vein. This vein ended in the superior mesenteric/jejunal vein (21 patients) or in the splenic vein (11 patients). The inferior mesenteric vein confluence could be infrapancreatic (17 patients), infrapancreatic with retropancreatic arch (7 patients) or retropancreatic (8 patients). Lastly, the accessory middle colic artery was present in ten patients presenting another pathway for lymphatic dissemination.
CONCLUSION: The IMV trajectory when accessible, is the solution to the mesenteric inter-arterial stair. The surgeon could safely follow the IMV to its confluence. When the IMV trajectory is not accessible, the surgeon could follow the caudal border of the pancreas.
Ann Plast Surg. 2022 Jul 1;89(1):95-99. doi: 10.1097/SAP.0000000000003060. Epub 2022 Jan 24.
OBJECTIVE: Caudal septal deviation (CSD) correction during septorhinoplasty is challenging, and various surgical modifications and evaluations remain controversial. This study aimed to introduce an objective evaluation method based on computed tomography (CT) images to measure the effectiveness of septorhinoplasty for CSD treatment.
METHODS: We retrospectively analyzed preoperative and postoperative CT images of patients who had undergone functional open septorhinoplasty by the plastic surgery and otorhinolaryngology teams between January and September 2019. Using OsiriX Lite (Pixmeo, Switzerland), CSD was calculated as the distance between the septum midline and palatal plane. Deformation was categorized as C-shaped unilateral or S-shaped bilateral deviations. The change in the distance between preoperative and postoperative images was considered because of surgical intervention.
RESULTS: Twenty patients (mean age, 35 years; 13 males [65%], 7 females [35%]) were included. The median deviation was 3.01 mm (range, 0.45-7.34 mm) preoperatively and 1.6 mm (range, 0.5-2.86 mm) postoperatively, indicating a reduction of 1.26 mm (median, P < 0.05) due to surgical intervention. C- and S-shaped deviations were seen preoperatively in 9 (45%) and 11 (55%) patients and postoperatively in 6 (30%) and 14 (70%) patients, respectively. The mean ± SD time of analysis was 7 ± 2.1 minutes.
CONCLUSIONS: Caudal septal deviation showed significant changes from preoperative to postoperative CT images, based on the distance between the actual septum midline and the constructed straight septum. This allowed effective evaluation of surgical efficacy for septum straightening. Although additional studies are needed, this method allows clearer stratification of surgical outcomes.
MR Enterography in Crohn's Disease: Comparison of Contrast Imaging with Diffusion-weighted Imaging and a special Form of Color Coding
Rofo. 2022 Jun 15. doi: 10.1055/a-1826-0049. Online ahead of print.
PURPOSE: We compared contrast-enhanced MR enterography with diffusion-weighted sequences to evaluate the validity of diffusion-weighted sequences for activity assessment in Crohn's disease compared to endoscopy. In addition, we investigated a new color-coded image post-processing technique in comparison with standard sequences and endoscopy.
MATERIALS AND METHODS: Included were 197 MR enterographies (2015-2017) performed by using standardized examination protocols. The intestine was divided into 7 segments, which were compared separately. The accuracy of the MR examinations with regard to disease activity was validated using the Seo and MaRIA score and endoscopy findings. In addition, the image data were post-processed using a color-coded evaluation method (DCE tool on OsiriX).
RESULTS: The comparison between contrast-enhanced and diffusion-weighted sequences showed a highly significant correlation for all bowel sections with a mean Spearman correlation coefficient of 0.876 (0.809-0.928). The color-coded image post-processing showed a sensitivity of 83.2 % and a specificity of 70.5 % in comparison with the MaRIA score. In comparison to endoscopy, a sensitivity of 81.3 % and a specificity of 70.5 %. In comparison with endoscopy, the MaRIA score showed a sensitivity of 80.2 % and a specificity of 84.0 % at a cut-off of 7. The visual score according to Seo showed a sensitivity of 85.7 % with a specificity of 77.0 % in the contrast-weighted examination and a sensitivity of 87.9 % and a specificity of 71.8 % for diffusion weighted images.
CONCLUSION: Diffusion-weighted sequences are as good as contrast-weighted sequences for assessing inflammatory activity in Crohn's disease. Contrast is often helpful for assessing complications, but this was not the purpose of this study. Visual imaging using color-coded data sets was similarly good at detecting inflammation.
KEY POINTS: · MR enterography is possible without contrast using diffusion-weighted imaging with comparable high informative value.. · Inflammatory activity in MR correlates sufficiently well with endoscopy. · The MaRIA and Seo scores are comparable in their validity.. · The colored representation of inflamed bowel sections is a promising technique..
CITATION FORMAT: · Jakob M, Backes M, Schaefer C et al. MR Enterography in Crohn's Disease: Comparison of Contrast Imaging with Diffusion-weighted Imaging and a special Form of Color Coding. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1826-0049.
Prediction of shunt failure facilitated by rapid and accurate volumetric analysis: a single institution's preliminary experience
Childs Nerv Syst. 2022 May 20. doi: 10.1007/s00381-022-05552-1. Online ahead of print.
BACKGROUND: Shunt malfunction is a common complication and often presents with hydrocephalus. While the diagnosis is often supported by radiographic studies, subtle changes in CSF volume may not be detectable on routine evaluation. The purpose of this study was to develop a novel automated volumetric software for evaluation of shunt failure in pediatric patients, especially in patients who may not manifest a significant change in their ventricular size.
METHODS: A single-institution retrospective review of shunted patients was conducted. Ventricular volume measurements were performed using manual and automated methods by three independent analysts. Manual measurements were produced using OsiriX software, whereas automated measurements were produced using the proprietary software. A p value < 0.05 was considered statistically significant.
RESULTS: Twenty-two patients met the inclusion criteria (13 males, 9 females). Mean age of the cohort was 4.9 years (range 0.1-18 years). Average measured CSF volume was similar between the manual and automated methods (169.8 mL vs 172.5 mL, p = 0.56). However, the average time to generate results was significantly shorter with the automated algorithm compared to the manual method (2244 s vs 38.3 s, p < 0.01). In 3/5 symptomatic patients whose neuroimaging was interpreted as stable, the novel algorithm detected the otherwise radiographically undetectable CSF volume changes.
CONCLUSION: The automated software accurately measures the ventricular volumes in pediatric patients with hydrocephalus. The application of this technology is valuable in patients who present clinically without obvious radiographic changes. Future studies with larger cohorts are needed to validate our preliminary findings and further assess the utility of this technology.
Commercial 3-dimensional imaging programs are not created equal: version and inclination measurement positions vary among preoperative planning software
JSES Int. 2022 Feb 11;6(3):413-420. doi: 10.1016/j.jseint.2022.01.006. eCollection 2022 May.
BACKGROUND: Variability exists between total shoulder arthroplasty preoperative planning software (PPS) systems for glenoid angular measurements. The purpose of this study is to locate the region on the glenoid at which inclination and version are measured on the PPS modalities of Blueprint and VIP.
METHODS: Preoperative computed tomography scans of 30 consecutive patients undergoing primary arthroplasty were analyzed using two PPS systems (VIP and Blueprint) to independently obtain glenoid version and inclination measurements through their respective protocols. Three-dimensional equivalent images were independently analyzed utilizing open-source OsiriX DICOM software by two board-certified orthopedic sports medicine surgeons measuring glenoid version and inclination along ten equal intervals of the glenoid from superior to inferior and anterior to posterior. Manual version and inclination measurements were compared to both the VIP and the Blueprint measurements, and variances were analyzed by calculating root mean square error (RMSE). The closest interval (1, 2, 3, 4, 5, 6, 7, 8, 9, 10) to the VIP and Blueprint measurement was identified for both version and inclination to determine the region of the glenoid both software programs obtained their measurements.
RESULTS: Mean glenoid retroversion manually measured using OsiriX was 13.5° compared with 15.1° recorded by Blueprint (P = .516) and 12.2° by VIP (P = .621). Mean inclination using OsiriX was 5.5°, compared with 7.1° (P = .314) and 9.0° (P = .024) recorded by Blueprint and VIP, respectively. RMSE for version between Osirix and VIP was 4.65°, for Osirix and Blueprint was 4.44°, and for VIP and Blueprint was 4.45°. RMSE for inclination between Osirix and VIP was 6.43°, for Osirix and Blueprint was 5.25°, and for VIP and Blueprint was 5.13°. For version, VIP measurements most frequently aligned with the inferior quadrant of the glenoid (n = 13) with a median interval of 7, while Blueprint aligned with the superior quadrant of the glenoid (n = 13) with a median interval of 4. Inclination measurements aligned with the posterior quadrant of the glenoid for both VIP (n = 19) and Blueprint (n = 15) with a median interval of 8.
CONCLUSION: PPS systems for shoulder arthroplasty vary in the region of the glenoid for which version and inclination are measured, which may affect the absolute values generated. Location of version measurement was different among the two commercial software programs, with VIP corresponding closest to the most inferior region of the glenoid, while Blueprint to the most superior one. Further research should assist in determining the version and inclination variations among commercial planning software.
Morphometric Aspects ot the Alba and Lunate Lineas and Correlations with the Physiological Diastasis of the Rectus Abdominis Muscles: Prospective Study
FASEB J. 2022 May;36 Suppl 1. doi: 10.1096/fasebj.2022.36.S1.R5378.
INTRODUCTION: The anatomical study of the aponeuroses of the anterolateral abdominal wall (AAW) is described, but the AAW aspects remain without clarification. The decussation of the myoaponeurotic of the external oblique (EO), internal oblique (IO) and transversus abdominis (TA) muscles form the abdominal rectus muscle sheath. Theses muscles are not tangential in their respective lateral margins, then they form the semilunar linea (LS), and on the medial margin of the abdominal rectus muscle they form the alba linea. Even having few citations on the width of the LS and the LA, the literature presents clinical aspects, classifications and proposals for the correction of the pathological width of this line: the diastasis. The measurements of the LA and the LS need reliability for the establishment of criteria for normality or for disorder.
OBJECTIVE: The aim of this study was to measure the width of the LA and LS, the length of the LA, the distance from the umbilicus (CU) to the anterior margin of the lumbar vertebra (VL) in the plane passing through the CU and to establish whether there is a correlation between the measurements of the LS, LA and the distance from the CU to the anterior margin of the VL.
METHOD: Trough the tridimensional reconstruction of computerized tomographies of the AAW in adults, measurements were made of the distances to the LA and LS in five levels from the xifoid process to the pubic symphysis using Osirix MD software.
RESULTS: A total of fifteen individuals were studied as the pilot sample for the calculation of the sample, with the standard deviation for the average and 95%IC. The calculation led to the evaluation of 29 individuals (15 men and 14 women). The analyzed outcomes were: 1. Dpx_sp_reta; 2. Dpx_sp_pela_LA; 3. Dcu+VL; 4. DLA_NSu1; 5. DLA_NSu2; 6. DLA_NSu3; 7. DLS_dir_NSu3; 8. DLS_esq_NSu3; 9. DLA_NU; 10. DLS_dir_NU; 11. DLS_esq_NU; 12. DLA_Niu1; 13. DLS_dir_Niu1; 14. DLS_esq_Niu1; 15. DLA_Niu2; 16. DLS_dir_Niu2; 17. DLS_esq_Niu2. Considering that the DLA - distance from alba linea, DLS - distance from semilunar linea, sp - pubic symphysis; vL - lumbar vertebra; NSu - supraumbilical level; Niu - infraumbilical level. The maximum and average measurements were established for each outcome for men and women and the measurements (DLA_NSu1) e (DLA_Niu1) presented significant differences between men and women.
CONCLUSION: The results may lead to a relevant discussion on the concept and the classifications of diastasis, producing a deeper knowledge of the morphological variations of the abdominal wall and the normal and unnormal functional aspects of these muscles and fáscias. This anthopometric anatomical parameter will fill in a blank with relevant data for the determinations of the criteria of normality, anatomical variation or disorder.
FASEB J. 2022 May;36 Suppl 1. doi: 10.1096/fasebj.2022.36.S1.R5991.
INTRODUCTION: Clinical anatomy of the external ear canal (EEC) has a significant role in the diagnosis of Otitis Media (OM) and other auditory system diseases. OM is one of the most common infections and major causes of morbidity in adults if the complications of the OM take place. In the developing and low-income countries, the OM has a direct and indirect role in their life, because it's one of the causes leading to doctors' visits, and the indirect costs may affect the families and economy. EC measurements are needed in daily life, as an example; in the ears plugs manufacturing.
METHOD: This study was conducted by the Declaration of Helsinki, and approved by the research ethics committee at the Faculty of Medicine, University of Gezira, Sudan, this observational case-control study. Informed consent was obtained from all-volunteer participants enrolled in the study. From January 2015-2018, temporal bone computed tomography (CT) images of volunteer patients and healthy subjects, were collected from Khartoum State. ImageJ software (V 1.52a), used in the measurement of EC; OsiriX image processing application for Mac (OsiriX Lite) to display images for the external ear area of the skull's temporal bone, statistical analysis was performed by Statistical Package for the Social Sciences SPSS V.22, and statistical software suite developed by SAS Institute (The SAS System V.9). The level of significance was set at P-value <0.05. Chi-Square test was used and Receiver Operating Characteristic (ROC) analysis was applied to determine the power of straight length (SL) in predicting patient.
RESULTS: In the cases the total number is 140 (patient 70 and healthy 70), with a range of 18-40 years, 52.9 % (n=74) of the patients were females and 47.1% (n=66) are males. The distribution of quantitative variables shows that the mean of the straight length (SL) is ±34.13, Standard Deviation (SD) ± 5.83, and the minimum and maximum SL are 11.33 and 47.00, respectively. Distribution of quantitative variables by a case in SL, shown that the patients mean ±32.69, SD ±6.58; and the healthy mean ±35.58 SD ±4.66, t ±3.106 and the P-value <0.003. Distribution of SL by Gender shown that in male mean ±34.89, SD ±6.22, female mean ±33.45, SD ±5.42. Distribution of SL by Side shown that left side means ±34.14, and SD ±5.66, right side mean ± 34.12, and SD ±6.04.
CONCLUSION: If the straight length (SL) value is equal to 31.33 or less, the case sample is classified as an otitis media patient. There is a highly significant difference in the SL between male patients and healthy a p-value <0.061 and between females' patients and healthy as a p-value<0.016. and significance differences comparing the patients and healthy groups with the gender, result shown that t =2.909 in males and females t=2,456.
Surg Radiol Anat. 2022 May 11. doi: 10.1007/s00276-022-02956-1. Online ahead of print.
PURPOSE: The literature reports the presence of the intermesenteric artery (IA), an anastomosis connecting the superior mesenteric artery (SMA) to the inferior mesenteric artery (IMA) in 9-18% of human cadaver dissections. This is the first study describing the morphological and demographic characteristics of the IA based on in vivo imaging.
METHODS: A total of 150 consecutive abdominal computed tomography (CT) angiographies of adult patients identified by sex and age were analyzed. The IA was assessed for its presence, point of origin, pathway, point of insertion, and diameter at its origin. The diameters of the SMA, IMA, and other arteries from which the IA originated and into which it inserted were measured by CT angiography using Radiant™ and Osirix MD™ software.
RESULTS: The IA was found in 17 (51.5%) of the females and 60 (51.3%) of the males. The diameters of the SMA and IMA were larger in the males than in the females, but there was no sex difference in the diameter of the IA. The diameter of the SMA was larger than that of the IMA, and the diameter of the IA was smaller than that of the other arteries evaluated. An IA connecting the SMA and IMA trunks was found in 25.9% of the cases, while other connections between the branches of those trunks through an IA occurred less frequently.
CONCLUSIONS: The intermesenteric artery is more frequently found than the literature refers and in most of cases directly connects the upper and lower arterial mesenteric circulations.
Estimating the optimal entry point of the antegrade femoral nailing: Previous and novel morphometric measurements
Acta Orthop Traumatol Turc. 2022 Mar;56(2):81-87. doi: 10.5152/j.aott.2022.21107.
OBJECTIVE: This anatomical study aimed to investigate the possible relationships between the proximal femur parameters and verify the optimal entry point in line with the medullary canal.
METHODS: Both in single image series and 3D-MPR views, 63 femur bones were evaluated. One-millimeter multidetector computed tomography scans were collected and assessed by OsiriX-Lite version 8 and Horos v3.3.5. Entry point locations, projected and true femoral neck-shaft, anteversion, and newly defined nail entrance angles were measured.
RESULTS: The entry points of 16 femurs were placed at the tip of the greater trochanter, and the remaining 47 femurs were in the trochanteric fossa (i.e., piriformis fossa). Thirty-three of the entry points found in the trochanteric fossa were overlapped by the greater trochanter. When the parameters of the right and left sides were compared, it was found that; projected neck angle, nail entrance angle, and the differences between true neck angle and nail entrance angle were found significantly different. The relationship between nail entrance angle and entry point localization was assessed, and the probability of the entry point being at the tip of the greater trochanter is 63 times greater when the NEA is below 90.
CONCLUSION: This study has demonstrated that the ideal entry point for straight nails, which is based on the anatomic axis of the femur, is found mainly at the trochanteric fossa, and the greater trochanter overlapped 70.21% of them.
LEVEL OF EVIDENCE: Level IV, Diagnostic Study.
CT imaging of dogs with perineal hernia reveals large prostates with morphological and spatial abnormalities
Vet Radiol Ultrasound. 2022 Mar 29. doi: 10.1111/vru.13087. Online ahead of print.
The etiology of canine perineal hernia (PH) remains unclear, although as a disease of older male dogs, it is likely to be hormonal. The role of the prostate in the formation of PH has been questioned; however, prospective and systematic evaluation of prostates in these dogs is absent in the literature. In this prospective case-control study, CT imaging was used to assess prostatic changes in dogs with PH (n = 46) and compare these findings with those of intact age-matched male dogs (n = 23). Using the OsiriX® DICOM viewer, we measured prostatic volume and correlated it with the size of the dog by using the length of the sixth lumbar vertebra. In addition, we recorded spatial and morphological changes of the prostate, such as heterogenicity, intra- and paraprostatic cysts, and mineralizations, as well as prostatic location and rotation. We found that dogs with PH had larger prostates (P < .001) that more often contained cysts (P < .001) and had larger cyst diameters (P = .013) than age-matched controls. Prostates of PH dogs also contained paraprostatic cysts (17.4%) and focal mineralizations (32.6%), which were absent in the control group. Abnormal rotation and location of the prostate were common in dogs with PH. In conclusion, these findings support the use of CT as an adjunct diagnostic imaging modality for the evaluation of the prostate in dogs with PH. Further studies are needed to evaluate nonprostatic CT findings in the pelvic cavity of PH dogs.
Epaxial muscle atrophy is more evident in large dogs with intervertebral disc disease than in dogs with ischaemic myelopathy
Res Vet Sci. 2022 Mar 17;146:60-69. doi: 10.1016/j.rvsc.2022.03.011. Online ahead of print.
Cross-sectional area (CSA) decreases and fat infiltration increases in epaxial muscles of Dachshunds with intervertebral disc disease (IVDD), but less is known about large breed dogs with IVDD. The aim here was to investigate thoracolumbar epaxial muscle CSA and fat infiltration in large breed dogs with compressive IVDD and acute non-compressive nucleus pulposus extrusion (ANNPE) or fibrocartilaginous embolism (FCE). This retrospective study included large breed dogs with MRI-confirmed IVDD (n = 17) and ANNPE or FCE (n = 13). The CSA and fat infiltration of the thoracolumbar M. longissimus and Mm. multifidi were assessed from T1-weighted transverse MR images using Osirix. The CSA was significantly smaller in dogs with compressive IVDD than in dogs with non-compressive ANNPE or FCE for Mm. multifidi (p = 0.015), M. longissimus (p = 0.070), and these two muscles combined (p = 0.016). Fat infiltration in all muscle measurements was significantly higher in dogs with compressive IVDD than in dogs with non-compressive ANNPE or FCE (all P < 0.050). A significant positive correlation existed between age, duration of clinical signs, and fat infiltration, suggesting more fat infiltration in older dogs with more chronic signs. These signs of muscle atrophy are likely caused by denervation and secondary disuse due to chronic spinal cord compression and prolonged duration of clinical signs.