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The Use of Osirix for Surgical Planning Using Cranial Measures and Region of Interest Tools: Technical Note.

PubMED - ter, 09/10/2019 - 08:47
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The Use of Osirix for Surgical Planning Using Cranial Measures and Region of Interest Tools: Technical Note.

Asian J Neurosurg. 2019 Jul-Sep;14(3):762-766

Authors: Lovato RM, Araujo JLV, Paiva ALC, Pesente FS, Yaltirik CK, Harput MV, Esteves Veiga JC

Abstract
Background: During the surgery for intrinsic brain lesions, it is important to plan the proper site of the craniotomy and to identify the relations with the gyri and superficial veins. This might be a challenge, especially in small subcortical lesions and when there is a distortion of the cortical anatomy.
Materials and Methods: Using the free computer software Osirix, we have created a 3-dimensional reconstruction of the head and cerebral showing the gyri and superficial veins. With the aid of some tools, it is possible to create a colored image of the lesion and also to calculate the distance between the areas of interest and some easily identifiable structure, making it easier to plan the site of the craniotomy identify the topography of the lesion.
Results: The reconstructions were compared to the intraoperative view. We found this technique to be useful to help identify the gyri and cortical veins and use them to find the lesions. The use of a region of interest to show better the lesion under the cortical surface and in the three-dimensional reconstruction of the head was also helpful.
Conclusions: This is a low-cost and easy technique that can be quickly learned and performed before every surgery. It helps the surgeon to plan a safe craniotomy and lesionectomy.

PMID: 31497099 [PubMed]

A new way of presenting diagnostic imaging studies in surgical planning.

PubMED - qui, 09/05/2019 - 11:09
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A new way of presenting diagnostic imaging studies in surgical planning.

Pol Przegl Chir. 2018 Nov 07;91(4):48-51

Authors: Alzubedi A, Kusz M, Kuczyńska M, Białek W, Bicki J, Rudzki S

Abstract
Technological advancement, availability and common use of diagnostic imaging slowly but consistently leads to a change in its nature from being additional studies to becoming the basis for diagnostic process and treatment planning especially in complex cases that require surgical treatment. CT angiography study presentation using the illusion called "Pepper's Ghost" in comparison to a three-dimensional printout and regular CT scan has been made to point out the relevance of research and implementation of new technologies in the diagnosis and surgical planning. Our image, despite being far from ideal and being just an illusion of a hologram, was more appealing and detailed to surgeons in comparison to a printed 3D model and standard CT angiography displayed with Osirix software. In order to change the existing methods of presenting imaging studies, it is advisable to use latest technologies, and among those currently available, ones based on virtual or mixed reality deserve special attention.

PMID: 31481641 [PubMed - in process]

Exploring the pathological role of intervertebral disc and facet joint in the development of degenerative scoliosis by biomechanical methods.

PubMED - dom, 08/25/2019 - 09:36
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Exploring the pathological role of intervertebral disc and facet joint in the development of degenerative scoliosis by biomechanical methods.

Clin Biomech (Bristol, Avon). 2019 Aug 16;70:83-88

Authors: Zheng J, Yang Y, Cheng B, Cook D

Abstract
BACKGROUND: To investigate the biomechanical changes in the development of scoliosis due to intervertebral disc and facet joint degeneration.
METHODS: We enrolled 39 cases of fresh-frozen lumbar spine specimens and underwent CT scanning and 3D reconstruction. An Osirix Dicom imaging system was to assess the degeneration of the intervertebral disc and facet joints, and mechanical loading was conducted using a spine mechanical instrument with the frequency set at plus/minus 7.5 NM, 0.005 Hz. Range of motion (ROM) and neutral zone (NZ) of 39 cadaveric lumbar spines were tested.
FINDINGS: Degeneration existed in all 39 cases of the lumbar specimens: the Cobb angle >10° in 5 cases (degenerative scoliosis (DS) group), between 3° and 10° in 9 cases (pre-degenerative scoliosis (PS) group) and <3° in 25 cases (no scoliosis (NS) group). The axial torsion (AT) range of motion (ROMAT) and the NZ of the DS and PS groups was greater than in the NS group and increased with increasing Cobb angle. A significant correlation was found between the degeneration of the intervertebral disc and the AT and the AT correlated with the Cobb angle and facet joint degeneration.
INTERPRETATION: The AT correlated with intervertebral disc and facet joint degeneration, which might be a mechanic factor in the occurrence and development of degenerative scoliosis.

PMID: 31445401 [PubMed - as supplied by publisher]

In vitro qualitative and quantitative CT assessment of iodinated aerosol nasal deposition using a 3D-printed nasal replica.

PubMED - qui, 08/22/2019 - 12:08
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In vitro qualitative and quantitative CT assessment of iodinated aerosol nasal deposition using a 3D-printed nasal replica.

Eur Radiol Exp. 2019 Aug 21;3(1):32

Authors: Sartoretti T, Mannil M, Biendl S, Froehlich JM, Alkadhi H, Zadory M

Abstract
Computed tomography can provide high-resolution details on nasal anatomy being potentially useful for the assessment of nasal spray deposition. The purpose of this technical note was to present a method based on CT imaging to assess qualitatively and quantitatively the in vitro spray deposition patterns within the sinonasal cavities of a nasal replica obtained by three-dimensional (3D) printing, using iodinated contrast agent labelled solutions with high spatial and temporal resolution. Using a third generation dual-source CT scanner in single energy mode, scans of a nasal replica were acquired following application of iodinated contrast agent labelled aerosols with an iodine concentration of 92.5 mgl/mL. Two software programmes were then utilised (Osirix MD v.9.0, Pixmeo, Geneva, Switzerland; 3mensio, Pie Medical Imaging, Bilthoven, Netherlands) to generate three-dimensional reconstructions of the scans, thus enabling the rapid detection and visualisation of administered single droplets and their voxel-by-voxel localisation. Using this approach, we achieved recovery rates between 84-98% and 89-109% (depending on the software programme) of the total applied aerosol volume.

PMID: 31432300 [PubMed - in process]

The Anatomy of the Sigmoid-Transverse Junction According to the Tentorial Angle.

PubMED - sex, 08/02/2019 - 09:25
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The Anatomy of the Sigmoid-Transverse Junction According to the Tentorial Angle.

J Craniofac Surg. 2019 Jul 31;:

Authors: Vatansever A, Mut M, Ergun KM, Oğuz KK, Gümeler E, Bulut E, Tatar I

Abstract
Dural sinuses have critical importance during intracranial approaches. Detailed anatomical knowledge of the dural sinuses is crucial for surgeons to reduce unexpected venous bleeding. The aim of this study was to investigate anatomical relation of sigmoid sinus and tentorium cerebelli according to clinically palpable landmarks and cranial morphometry. The authors evaluated 222 individuals' (94 women, 128 men) 3-dimensional computed tomography angiograms, retrospectively. The authors also studied on 12 mid-sagittal cut dried hemiskulls and 8 formalin fixed cadaver heads hemisected midsagitally. All measurements were completed using Osirix-Lite version 9 software. Craniometrical values were measured to define cranium morphology. Furthermore, level of the sigmoid sinus according to asterion and tentorial angle were evaluated in detail. Our results demonstrated that there were significant differences between parameters and genders, except vertical angle of the tentorium cerebelli. Distance between asterion and sigmoid sinus was statistically different between right and left sides in favor of the left side. This also varied depending on the position of the sigmoid sinus, as well. Only transverse angle between the upper point of external acoustic meatus and asterion demonstrated a significant correlation with age. This study evaluated the detailed 3D anatomy of sigmoid sinus and tentorium cerebelli related with the cranium morphology. Determining to sigmoid sinus anatomy according to clinically palpable landmarks has advantages for setting surgical protocols and reducing to unexpected injuries while surgery to these structures.

PMID: 31369515 [PubMed - as supplied by publisher]

Post-mortem computed tomography as part of dental identification - a proposed guideline.

PubMED - qui, 08/01/2019 - 09:13
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Post-mortem computed tomography as part of dental identification - a proposed guideline.

Forensic Sci Med Pathol. 2019 Jul 30;:

Authors: Jensen ND, Arge S, Hansen NF, Lynnerup N

Abstract
PURPOSE: This paper presents a proposed guideline for the use of post-mortem computed tomography (PMCT) during forensic dental identification. Currently, whole-body PMCT is widely used prior to autopsies for the diagnosis of fractures, organ changes, hemorrhages, and for the localization of foreign bodies, but it may also facilitate the odontological identification process in single cases and in cases involving multiple fatalities. Several studies have described the use of PMCT in forensic odontological work, but we have not found any comprehensive set of guidelines on how to perform a forensic odontological examination using PMCT. The aim was to develop guidelines for creating post-mortem dental charts during forensic odontological identification examinations using the standard functions of PMCT.
METHODS: A proposed guideline was developed from 15 selected cases examined at the Section of Forensic Pathology, Department of Forensic Medicine at the University of Copenhagen in Denmark from October 2011 to May 2012. Using the functionalities and three-dimensional (3D) reconstructions of OsiriX DICOM-viewer software (Pixmeo Sarl, Bernex, Geneva, Switzerland) we adjusted the contrast and brightness settings and developed a proposed guideline for creating PMCT-based dental charts. A four-step guideline was produced.
CONCLUSION: In our casework, we are currently using the guidelines proposed herein. The use of PMCT has allowed us to target our clinical examinations, greatly improving their efficiency. Furthermore, PMCT allows the storage of data for later documentation and research. Further research is needed to validate the proposed guideline.

PMID: 31363909 [PubMed - as supplied by publisher]

Normal Lacrimal Gland Volumes by Magnetic Resonance Imaging in African-American and White Patients and the Relationship of Lacrimal Gland Volume to Orbital Size.

PubMED - sex, 07/26/2019 - 08:24
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Normal Lacrimal Gland Volumes by Magnetic Resonance Imaging in African-American and White Patients and the Relationship of Lacrimal Gland Volume to Orbital Size.

J Craniofac Surg. 2019 Jul 22;:

Authors: Tenzel PA, Moffa D, Decilveo AP, Reddy HS

Abstract
PURPOSE: The aim of this study was to measure volumes of normal lacrimal glands (LGs) using magnetic resonance imaging in African-Americans (AAs) and whites and to evaluate relationships of LG volumes to demographic factors.
METHODS: A retrospective chart review was performed searching for "optic neuropathy" and "optic neuritis," cross-referencing patients who had orbital MRI with and without contrast. Cases were excluded with known history of orbital trauma or surgery, previous diagnoses known to affect LG size, and poor image quality. LGs were outlined in consecutive axial and coronal slices, and volumes were generated using OsiriX software; cross-sectional area of the orbit was measured by outlining the bony orbit in largest axial section.
RESULTS: One hundred orbits from 50 patients were included (26 AAs, 24 whites). Mean LG volumes as measured in coronal and axial section were 0.714 and 0.671 cm, respectively; mean orbital area was 10.42 cm. Axial orbital size was found to be highly correlated (P < 0.01) with LG volume. No significant correlation was found with LG volume and age, sex, race, or laterality.
CONCLUSIONS: This article presents normal values for LG volumes by MRI of AAs and whites. LG volumes were highly correlated with orbital size, a relationship which has not been explored in the recent literature. Such an assessment of LG size relative to patients' orbital dimensions may be more clinically useful than comparison to population-based measures of normal LG volume alone. We found no statistically significant relationship between LG volume and race, sex, age, or laterality.

PMID: 31343589 [PubMed - as supplied by publisher]

Direct Three-Dimensional Diagnosis of Ex Vivo Facial Fractures.

PubMED - dom, 07/14/2019 - 09:46

Direct Three-Dimensional Diagnosis of Ex Vivo Facial Fractures.

J Craniofac Surg. 2019 Jul;30(5):e420-e424

Authors: Sirin Y, Yildirimturk S, Horasan S, Guven K

Abstract
The aim of the present study is to assess the reliability and accuracy of different 3-dimensional (3D) reconstruction algorithms in detecting undisplaced condylar, zygomatic arc, and orbital rim fractures based on cone-beam computed tomography data set. Twenty sheep heads were used in the present study. Sixty fractured and 60 nonfractured (control) zones were randomly allocated. Three groups consisting of nondisplaced fractures of condyle (CF, n = 20), orbital (OF, n = 20), and zygomatic arc (ZF, n = 20) were created by using a diamond cutting disc. Soft tissues were only dissected and no fractures were generated in the control group (n = 60). The 3D reconstructions were created by using multiplanar reconstruction (MPR), surface rendering (SR), volume rendering (VR), and maximum intensity projection (MIP) algorithms. Final 3D models were examined in Osirix software (Pixmeo SARL, Bernex, Switzerland) by 6 observers. Diagnostic accuracies of each algorithm were statistically compared by receiver operating characteristics (ROC) and area under the ROC curves (AUCs). For the detection of CF, AUC for VR algorithm was found to be statistically larger than that of MIP while AUCs for VR and MIP were larger than those of MPR and SR for OF detection. For the detection of ZF, AUCs for MPR and VR were significantly larger than those of MIP and SR (P < 0.05 for each). Within the limitations of this experimental study, it can be concluded that for maxillofacial surgeons, it is more likely to detect condylar, orbital, and zygomatic fractures by using VR algorithm in 3D reconstruction.

PMID: 31299800 [PubMed - in process]

Urethral diverticula in women are associated with increased urethra-sphincter complex volumes: A potential role for high-tone nonrelaxing sphincter in their etiology?

PubMED - dom, 07/07/2019 - 08:43
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Urethral diverticula in women are associated with increased urethra-sphincter complex volumes: A potential role for high-tone nonrelaxing sphincter in their etiology?

Neurourol Urodyn. 2019 Jul 06;:

Authors: Mukhtar BMB, Solomon E, Naaseri S, Aughwane P, Pakzad M, Hamid R, Ockrim JL, Greenwell TJ

Abstract
AIMS: Functional obstruction secondary to a high-tone nonrelaxing sphincter (HTNRS) may lead to the formation of a proximal-to-mid-urethral diverticulum (pmUD) in patients without a history of anatomical obstruction, vaginal delivery, vaginal and/or urethral surgery, or periurethral gland infection, that is, a functional pmUD (fpmUD). We used measurements of the urethra-sphincter complex volume (USCv) as a proxy for the maximal urethral closure pressure to evaluate this potential etiological factor.
METHODS: We compared 17 consecutive women with fpmUD (mean age ± SD of 49.4 ± 13.2 years) with a control group consisting of 24 age-matched women (mean age: 50.8 ± 11.2 years) with no previous urological symptoms having MRI for posthysterectomy vesicovaginal fistula, and in all 71 women (mean age: 48.1 ± 11.6 years) with classical urethral diverticulum (cpmUD) referred in the same time period. The urethra-sphincter complex was measured using T2-weighted MRI and OsiriX© was then used to determine the USCv.
RESULTS: The mean USCv of the fpmUD group was 10.01 ± 6.97 cm3 . The mean USCv of the cpmUD was 5.19 ± 1.19 cm 3 and for the control group was 3.92 ± 1.60 cm 3 . There was a high statistically significant (P = .01) difference between the USCv in the fpmUD group and the USCv of both the cpmUD and the control groups.
CONCLUSIONS: Women with fpmUD demonstrated USCv that were significantly higher than those in women with cpmUD and the control group. These findings suggest that high pressure in the proximal urethra during voiding secondary to a HTNRS may contribute to the formation of urethral diverticula.

PMID: 31278796 [PubMed - as supplied by publisher]

Technical Note: Are Currently Used Measurements of Fluorescence Intensity in Near Infrared Fluorescence Imaging During Laparoscopic Cholecystectomy Comparable?

PubMED - ter, 07/02/2019 - 07:51

Technical Note: Are Currently Used Measurements of Fluorescence Intensity in Near Infrared Fluorescence Imaging During Laparoscopic Cholecystectomy Comparable?

J Laparoendosc Adv Surg Tech A. 2019 Jun 28;:

Authors: van den Bos J, Schols RM, van Kuijk SMJ, Wieringa FP, Stassen LPS

Abstract
Aims: To investigate whether different calculation methods to express fluorescence intensity (FI) as target-to-background (BG) ratio are comparable and which method(s) match with human perception. Materials and Methods: Comparison of three calculation methods from current literature (OsiriX®, ImageJ®, and Photoshop®) to objectify FI during laparoscopic cholecystectomy measured at the exact same locations within recorded images of two categories: ex vivo and in vivo. Currently applied formulas to present FI in relation to the BG signal are compared with the subjective assessment by the human observers. These three formulas are Signal contrast = (FI in fluorescence regions-FI in BG)/255; Target-to-background ratio = (FI of target-FI of BG)/FI of BG; Signal-to-background ratio = FI of cystic duct/FI of liver and Target-to-background ratio = (FI of target-noise)/(FI of BG-noise). Results: In our evaluation OsiriX and ImageJ provided similar results, whereas OsiriX values were structurally slightly lower compared with ImageJ. Values obtained through Photoshop were less evidently related to those obtained with OsiriX and ImageJ. The formula Target-to-background ratio = (FI of target-noise)/(FI of BG-noise) was less corresponding with human perception compared with the other used formulas. Conclusions: FI results based on measurements using the programs OsiriX and ImageJ are similar, allowing for comparison of results between these programs. Results using Photoshop differ significantly, making direct comparison impossible. This is an important finding when interpreting study results. We propose to report both target and BG FI in articles, so that proper interpretation between articles can be made.

PMID: 31259650 [PubMed - as supplied by publisher]

Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging.

PubMED - qui, 06/27/2019 - 10:02
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Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging.

Spinal Cord Ser Cases. 2019;5:20

Authors: Cummins DP, Connor JR, Heller KA, Hubert JS, Kates MJ, Wisniewski KR, Berliner JC, O'Dell DR, Elliott JM, Weber KA, Smith AC

Abstract
Study design: Retrospective study.
Objectives: To establish the inter-rater reliability in the quantitative evaluation of spinal cord damage following cervical incomplete spinal cord injury (SCI) utilizing magnetic resonance imaging (MRI). MRI was used to perform manual measurements of the cranial and caudal boundaries of edema, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume in 10 participants with cervical incomplete SCI.
Setting: Academic university setting.
Methods: Structural MRIs of 10 participants with SCI were collected from Northwestern University's Neuromuscular Imaging and Research Lab. All manual measures were performed using OsiriX (Pixmeo Sarl, Geneva, Switzerland). Intraclass correlation coefficients (ICC) were used to determine inter-rater reliability across seven raters of varying experience.
Results: High-to-excellent inter-rater reliability was found for all measures. ICC values for cranial/caudal levels of involvement, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume were 0.99, 0.98, 0.90, 0.84, and 0.93, respectively.
Conclusions: Manual MRI measures of spinal cord damage are reliable between raters. Researchers and clinicians may confidently utilize manual MRI measures to quantify cord damage. Future research to predict functional recovery following SCI and better inform clinical management is warranted.

PMID: 31240117 [PubMed - in process]

Pure Endoscopic Lateral Orbitotomy Approach to the Cavernous Sinus, Posterior, and Infratemporal Fossae: Anatomic Study.

PubMED - sex, 05/31/2019 - 14:23
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Pure Endoscopic Lateral Orbitotomy Approach to the Cavernous Sinus, Posterior, and Infratemporal Fossae: Anatomic Study.

J Neurol Surg B Skull Base. 2019 Jun;80(3):295-305

Authors: Laleva L, Spiriev T, Dallan I, Prats-Galino A, Catapano G, Nakov V, de Notaris M

Abstract
Objective  The aim of this anatomic study is to describe a fully endoscopic lateral orbitotomy extradural approach to the cavernous sinus, posterior, and infratemporal fossae. Material and Methods  Three prefixed latex-injected head specimens (six orbital exposures) were used in the study. Before and after dissection, a computed tomography scan was performed on each cadaver head and a neuronavigation system was used to guide the approach. The extent of bone removal and the area of exposure of the targeted corridor were evaluated with the aid of OsiriX software (Pixmeo, Bernex, Switzerland). Results  The lateral orbital approach offers four main endoscopic extradural routes: the anteromedial, posteromedial, posterior, and inferior. The anteromedial route allows a direct route to the optic canal by removal of the anterior clinoid process, whereas the posteromedial route allows for exposure of the lateral wall of the cavernous sinus. The posterior route is targeted to Meckel's cave and provides access to the posterior cranial fossa by exposure and drilling of the petrous apex, whereas the inferior route gives access to the pterygopalatine and infratemporal fossae by drilling the floor of the middle cranial fossa and the bone between the second and third branches of the trigeminal nerve. Conclusion  The lateral orbitotomy endoscopic approach provides direct access to the cavernous sinus, posterior, and infratemporal fossae. Advantages of the approach include a favorable angle of attack, minimal brain retraction, and the possibility of dissection within the two dural layers of the cavernous sinus without entering its neurovascular compartment.

PMID: 31143574 [PubMed]

S122: impact of fluorescence and 3D images to completeness of lateral pelvic node dissection.

PubMED - qui, 05/30/2019 - 08:09
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S122: impact of fluorescence and 3D images to completeness of lateral pelvic node dissection.

Surg Endosc. 2019 May 28;:

Authors: Kim HJ, Choi GS, Park JS, Park SY, Cho SH, Seo AN, Yoon GS

Abstract
BACKGROUND: Lateral pelvic lymph node dissection (LPND) is a technically demanding procedure. Consequently, there is a possibility of incomplete dissection of lateral pelvic lymph nodes (LPNs). We aimed to identify metastatic LPNs intraoperatively in real-time under dual guidance of fluorescence imaging and 3D lymphovascular reconstruction, and then to remove them completely.
METHODS: Rectal cancer patients who were scheduled to undergo LPND after preoperative chemoradiotherapy (CRT) were prospectively enrolled. We traced changes in suspected metastatic LPNs during preoperative CRT and defined them as index LPNs on post-CRT imaging studies. For fluorescence imaging, indocyanine green (ICG) at a dose of 2.5 mg was injected transanally around the tumor before the operation. For 3D reconstruction images, each patient underwent preoperative axial CT scan with contrast (0.6 mm slice thickness). These images were then manipulated with OsiriX. Index LPNs and essential structures in the pelvic sidewall, such as the obturator nerve, were reconstructed with abdominal arteries from 3D volume rendering. All surgical procedures were performed via laparoscopic or robotic approach.
RESULTS: From March to July 2017, ten rectal cancer patients underwent total mesorectal excision with LPND after preoperative CRT under dual image guidance. Bilateral LPND was performed in five patients. All index LPNs among ICG-bearing lymph nodes were clearly identified intraoperatively by matching with their corresponding 3D images. Pathologic LPN metastasis was confirmed in four patients (40.0%) and in five of the 15 dissected pelvic sidewalls (33.0%). All metastatic LPNs were identified among index LPNs. Four (80.0%) of the five metastatic LPNs were located in the internal iliac area.
CONCLUSION: Index LPNs among ICG-bearing lymph nodes in pelvic sidewall were clearly identified and completely removed by matching with their corresponding 3D reconstruction images. Further studies and long-term oncologic outcomes are required to determine the real impact of dual image guidance in LPND.

PMID: 31139999 [PubMed - as supplied by publisher]