Neurol India. 2024 Jul 1;72(4):756-762. doi: 10.4103/neurol-india.Neurol-India-D-23-00585. Epub 2024 Aug 31.

ABSTRACT

BACKGROUND: While literature suggests the need for routine postoperative volumetric estimation of the EOR and residual tumour volume (RTV) in all cases of gliomas, the utility and feasibility of this protocol in resource-constrained centers remain underinvestigated.

OBJECTIVES: Our objective was to study the feasibility of volumetric EOR in routine neurosurgical practice and determine correlation with surgeons' intraoperative estimation of EOR. The secondary objective was to determine the survival impact of EOR and RTV on survival.

METHODS AND MATERIALS: A prospective study of pathologically proven high-grade gliomas (WHO grades 3 and 4) in adults was conducted at a tertiary care center. Pre- and postoperative magnetic resonance imaging (MRI) was obtained for volumetric analysis using OsiriX software and manual segmentation. Overall survival and predictors were studied using Kaplan-Meier and Cox regression analysis.

RESULTS: Postoperative volumetry was feasible in 31% patients (n = 25) of study eligible patients (n = 84). The median EOR, CE-PTV, and CE-RTV were 79.1%, 69.8 cm3, and 8.7 cm3, respectively. There was a poor correlation of surgeons' intraoperative impression and volumetric data (P = 0.359). Interestingly, the EOR was not significantly associated with the survival time (P = 0.920), while tumor grade, molecular profile, Ki 67 score, and postoperative functional status showed statistically significant impact.

CONCLUSION: Logistic difficulties impede routine implementation of this protocol in developing countries. MRI volumetry is clearly more accurate than surgeons' intraoperative estimation of EOR. Notwithstanding the role of EOR in survival, our study reveals a perhaps bigger impact of tumor biology and postoperative functional status in this equation.

PMID:39216029 | DOI:10.4103/neurol-india.Neurol-India-D-23-00585

Ann Vasc Surg. 2024 Jul 15:S0890-5096(24)00406-0. doi: 10.1016/j.avsg.2024.05.024. Online ahead of print.

ABSTRACT

OBJECTIVE: Post implantation syndrome (PIS) is a well-defined entity with unclear etiology, complicating a number of patients with AAAs treated with EVAR. The aim of this study was to assess the platelets' role and the influence of aneurysmal sac thrombus volumes in the development of PIS.

DESIGN: A retrospective analysis of prospectively collected data was performed and 76 patients that were treated by EVAR (2011-2013) were studied. Aneurysms with endoleak were not included in the study. Based on the criteria for SIRS (Systemic Inflammatory Response Syndrome), 17 patients (22%) developed PIS (which is considered a SIRS analogue), while 59 (78%) did not.

METHODS: The two groups were compared in relation to the following parameters: baseline platelet count (PLT), decrease of platelet count (PLT drop), volume of the arterial flow before the procedure (V Flow), volume of thrombus of the aneurysm (V thromb), ratio of thrombus volume to aneurysm sac volume (V ratio) and the volume of new formed thrombus (V new). Volume flow measurements were calculated by Osirix ™ software preoperatively and in the 1st month postoperatively. Parametric and non-parametric techniques (unpaired t-test, Mann-Whitney U test) were used accordingly.

RESULTS: Baseline platelets absolute count was greater in the PIS group (239000 ± 17000) vs. the non-PIS group (194000 ± 6900, p=0.004), and the PLT drop was larger in the PIS group (74000 ± 15600 vs. 45000 ± 5300, p=0.019). No difference was found regarding the aneurysm volumes (Vflow, Vthromb, Vratio, Vnew) between the two groups.

CONCLUSION: Platelets, in terms of their absolute baseline count and their decrease after the procedure, seem to be an important factor in developing PIS after EVAR. Further, more tailored studies are needed to elucidate the role of platelets and flow/thrombus volumes in the development of PIS.

PMID:39019256 | DOI:10.1016/j.avsg.2024.05.024

Diagnostics (Basel). 2024 Jun 13;14(12):1248. doi: 10.3390/diagnostics14121248.

ABSTRACT

BACKGROUND: Orbital floor fractures (OFFs) represent an interesting chapter in maxillofacial surgery, and one of the main challenges in orbit reconstruction is shaping and cutting the precise contour of the implants due to its complex anatomy.

OBJECTIVE: The aim of the retrospective study was to demonstrate, through pre- and postoperative volumetric measurements of the orbit, how the use of a preformed titanium mesh based on the stereolithographic model produced with 3D printers ("In-House" reconstruction) provides a better reconstruction volumetric compared to the intraoperatively shaped titanium mesh.

MATERIALS AND METHODS: The patients with OFF enrolled in this study were divided into two groups according to the inclusion criteria. In Group 1 (G1), patients surgically treated for OFF were divided into two subgroups: G1a, patients undergoing orbital floor reconstruction with an intraoperatively shaped mesh, and G1b, patients undergoing orbital floor reconstruction with a preoperative mesh shaped on a 3D-printed stereolithographic model. Group 2 (G2) consisted of patients treated for other traumatic pathologies (mandible fractures and middle face fractures not involving orbit). Pre- and postoperative orbital volumetric measurements were performed on both G1 and G2. The patients of both groups were subjected to the measurement of orbital volume using Osirix software (Pixmeo SARL, CH-1233 Bernex, Switzerland) on the new CT examination. Both descriptive (using central tendency indices such as mean and range) and regressive (using the Bravais-Pearson index, calculated using the GraphPad program) statistical analyses were performed on the recorded data.

RESULTS: From 1 January 2017 to 31 December 2021, of the 176 patients treated for OFF at the "Magna Graecia" University Hospital of Catanzaro 10 fulfilled the study's inclusion criteria: 5 were assigned to G1a and 5 to G1b, with a total of 30 volumetric measurements. In G2, we included 10 patients, with a total of 20 volumetric measurements. From the volumetric measurements and statistical analysis carried out, it emerged that the average of the volumetric differences of the healthy orbits was ±0.6351 cm3, the standard deviation of the volumetric differences was ±0.3383, and the relationship between the treated orbit and the healthy orbit was linear; therefore, the treated orbital volumes tend to approach the healthy ones after surgical treatment.

CONCLUSION: This study demonstrates that if the volume is restored within the range of the standardized mean, the diplopia is completely recovered already after surgery or after one month. For orbital volumes that do not fall within this range, functional recovery could occur within 6 months or be lacking. The restoration of the orbital volume using pre-modeled networks on the patient's anatomical model, printed internally in 3D, allows for more accurate reconstructions of the orbital floor in less time, with clinical advantages also in terms of surgical timing.

PMID:38928663 | DOI:10.3390/diagnostics14121248

Dentomaxillofac Radiol. 2024 Jun 13:twae023. doi: 10.1093/dmfr/twae023. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate magnetic susceptibility artefacts produced by orthodontic wires on MRI and the influence of wire properties and MRI image sequences on the magnitude of the artefact.

METHODS: Arch form orthodontic wires [four stainless steels (SS), one cobalt chromium (CC) alloy, 13 titanium (Ti) alloys] were embedded in a polyester phantom, and scanned using a 1.5-T superconducting magnet scanner with an eight-channel phased-array coil. All wires were scanned with T1-weighted spin echo (SE) and gradient echo (GRE) sequences according to the American Society for Testing and Materials (ASTM) F2119-07 standard. The phantom was also scanned other eight sequences. Artefacts were measured using the ASTM F2119-07 definition and OsiriX software. Artefact volume was analyzed according to metal composition, wire length, number of wires, wire thickness, and imaging sequence as factors.

RESULTS: With SE/GRE, black/white artefacts volumes from all SS wires were significantly larger than those produced by CC and Ti wires (P < 0.01). With the GRE, the black artefacts volume was highest with the SS wires. With the SE, the black artefacts volume was small, whereas white artefacts were noticeable. The cranio-caudal extent of the artefacts was significantly longer with SS wires (P < 0.01). Although a direct relationship of wire length, number of wires and wire thickness with artefact volume was noted, these factors did not influence artefact extension in the cranio-caudal direction.

CONCLUSIONS: Ferromagnetic/paramagnetic orthodontic wires create artefacts due to local alteration of magnetic field homogeneity. The SS-type wires produced the largest artefacts followed by CC and Ti.

PMID:38870528 | DOI:10.1093/dmfr/twae023

Int J Legal Med. 2024 Jun 12. doi: 10.1007/s00414-024-03266-4. Online ahead of print.

ABSTRACT

Klales et al. (2012) is a popular standard for the estimation of skeletal sex. Since its publication, a number of studies have demonstrated that population-specific applications of Klales improve classification accuracy. However, it has also been shown that age appears to affect the expression of dimorphism in the pelvis across the lifespan. As such, the present study examines the accuracy of Klales, and the modified global standard of Kenyhercz et al. (2017), in a contemporary Indonesian population, including quantifying the effect of age. Pelvic multi-slice CT scans of 378 individuals (213 female; 165 male) were analysed in OsiriX®. Both standards were tested and Indonesian-specific models thereafter derived.When applied to the Indonesian sample, both the Klales and Kenyhercz standards resulted in lower classification accuracy relative to the original studies. In considering the Indonesian-specific models, the ventral arc was the most accurate for the classification of sex, at 93.3% with a - 3.0% sex bias. The accuracy of the three-trait model was 94.4%, with a - 5.5% sex bias. Age was shown to significantly affect the distribution of pelvic trait scores. As such, age-dependent models were also derived, with the standard for individuals between 30 and 49 years the most accurate, at 93.1% and a sex bias of - 4.0%. Accuracy was lower in individuals aged ≥ 50 years, at 91.3% and a sex bias of 4.1%. These findings support the importance of establishing population-specific standards and to facilitate improved accuracy and capabilities for forensic practitioners in Indonesia.

PMID:38862819 | DOI:10.1007/s00414-024-03266-4

Int Orthop. 2024 Jun 4. doi: 10.1007/s00264-024-06226-0. Online ahead of print.

ABSTRACT

PURPOSE: Measurement of glenoid bone loss in the shoulder instability can be assessed by CT or MRI multiplanar imaging and is crucial for pre-operative planning. The aim of this study is to determine the intra and interobserver reliability of glenoid deficiency measurement using MRI multiplanar reconstruction with 2D assessment in the sagittal plane (MPR MRI).

METHODS: We reviewed MRI images of 80 patients with anterior shoulder instability with Osirix software using MPR. Six observers with basic experience measured the glenoid, erosion edge length, and bone loss twice, with at least one-week interval between measurements. We calculated reliability and repeatability using the intra-class correlation coefficient (ICC) and minimal detectable change with 95% confidence (MDC95%).

RESULTS: Intra and Inter-observer ICC and MDC95% for glenoid width and height were excellent (ICC 0,89-0,96). For erosion edge length and area of the glenoid were acceptable/good (ICC 0,61-0,89). Bone loss and Pico Index were associated with acceptable/good ICC (0,63 -0,86)) but poor MDC95% (45 - 84 %). Intra-observer reliability improved with time, while inter-observer remained unchanged.

CONCLUSION: The MPR MRI measurement of the anterior glenoid lesion is very good tool for linear parameters. This method is not valid for Pico index measurement, as the area of bone loss is variable. The pace of learning is individual, therefore complex calculations based on MPR MRI are not resistant to low experience as opposed to true 3D CT.

PMID:38833167 | DOI:10.1007/s00264-024-06226-0