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A Framework for Data-Driven Adaptive GUI Generation Based on DICOM.

ter, 11/13/2018 - 08:30

A Framework for Data-Driven Adaptive GUI Generation Based on DICOM.

J Biomed Inform. 2018 Nov 09;:

Authors: Gambino O, Rundo L, Cannella V, Vitabile S, Pirrone R

Abstract
Computer applications for diagnostic medical imaging provide generally a wide range of tools to support physicians in their daily diagnosis activities. Unfortunately, some functionalities are specialized for specific diseases or imaging modalities, while other ones are useless for the images under investigation. Nevertheless, the corresponding Graphical User Interface (GUI) widgets are still present on the screen reducing the image visualization area. As a consequence, the physician may be affected by cognitive overload and visual stress causing a degradation of performances, mainly due to unuseful widgets. In clinical environments, a GUI must represent a sequence of steps for image investigation following a well-defined workflow. This paper proposes a software framework aimed at addressing the issues outlined before. Specifically, we designed a DICOM based mechanism of data-driven GUI generation, referring to the examined body part and imaging modality as well as to the medical image analysis task to perform. In this way, the self-configuring GUI is generated on-the-fly, so that just specific functionalities are active according to the current clinical scenario. Such a solution provides also a tight integration with the DICOM standard, which considers various aspects of the technology in medicine but does not address GUI specification issues. The proposed workflow is designed for diagnostic workstations with a local file system on an interchange media acting inside or outside the hospital ward. Accordingly, the DICOMDIR conceptual data model, defined by a hierarchical structure, is exploited and extended to include the GUI information thanks to a new Information Object Module (IOM), which reuses the DICOM information model. The proposed framework exploits the DICOM standard representing an enabling technology for an auto-consistent solution in medical diagnostic applications. In this paper we present a detailed description of the framework, its software design, and a proof-of-concept implementation as a suitable plug-in of the OsiriX imaging software.

PMID: 30419365 [PubMed - as supplied by publisher]

Efficacy of 18F-FDG and 18F-NaF PET/CT imaging: A novel semi-quantitative assessment of the effects of age and obesity on hip joint inflammation and bone degeneration.

sab, 11/10/2018 - 10:56
Related Articles

Efficacy of 18F-FDG and 18F-NaF PET/CT imaging: A novel semi-quantitative assessment of the effects of age and obesity on hip joint inflammation and bone degeneration.

Hell J Nucl Med. 2018 Nov 10;:

Authors: Yellanki DP, Kothekar E, Al-Zaghal A, Cheng N, Werner TJ, Høilund-Carlsen PF, Alavi A

Abstract
OBJECTIVE: Osteoarthritis (OA) is characterized by synovial tissue inflammation and underlying bone degeneration in the joints. Aging and obesity are among the major risk factors. This study evaluated the effects of aging and body mass index (BMI) on hip joint inflammation and bone degeneration using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and fluorine-18 sodium fluoride (18F-NaF) PET/CT imaging, respectively.
SUBJECTS AND METHODS: In this retrospective study, a total of 116 subjects (58 males and 58 females) who had undergone both 18F-FDG and 18F-NaF PET/CT imaging were analyzed. The mean age of these subjects was 48.6±14.5 with an age range of 21-75 years. Fluorine-18-FDG and 18F-NaF PET/CT imaging was conducted 180min and 90min (respectively) after intravenous administration of the appropriate tracer. The hip joint was segmented on fused PET/CT images using OsiriX MD v.9.5 (DICOM viewer and image-analysis program, Pixmeo SARL; Bernex, Switzerland). The region of interest (ROI) for the hip joint was indicated by using a 3D-growing region algorithm with upper/lower Hounsfield Units (HU) followed by a morphological closing algorithm. The metabolic activity for the left and right side of the joint was measured and correlated with age and BMI.
RESULTS: Fluorine-18-FDG uptake in the hip was 0.83±0.22 (right side: 0.83±0.23, left side: 0.83±0.22, P=0.82). Fluorine-18-NaF uptake in the hip was 3.20±1.07 (right side: 3.25±1.14, left side: 3.15±1.04, P=0.02). Body mass index positively correlated with both 18F-FDG (r=0.29, P=0.001) and NaF (r=0.26, P=0.005) uptake. No significant correlation was seen between age and either 18F-FDG (r=0.12, P=0.19) or 18F-NaF (r=0.03, P=0.78) uptake.
CONCLUSION: Body mass index had a significant impact on 18F-FDG and 18F-NaF uptake, whereas age had no correlation with either tracer uptake. Obesity increases the mechanical forces applied on weight-bearing joints such as the hip. Body mass index was related to increased joint inflammation and bone degeneration. These findings further support the studies explaining the role of adipose tissue in promoting OA.

PMID: 30411728 [PubMed - as supplied by publisher]

Normal patterns of regional brain 18F-FDG uptake in normal aging.

sab, 11/10/2018 - 10:56
Related Articles

Normal patterns of regional brain 18F-FDG uptake in normal aging.

Hell J Nucl Med. 2018 Nov 10;:

Authors: Pourhassan Shamchi S, Khosravi M, Taghvaei R, Zirakchian Zadeh M, Paydary K, Emamzadehfard S, Werner TJ, Høilund-Carlsen PF, Alavi A

Abstract
OBJECTIVE: Normal aging alters the brain function even in the absence of recognizable structural changes, which can be detected using modern in vivo functional imaging modalities such as fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) scan. It is highly important to recognize normal age-dependent changes in order to correctly diagnose pathologic states. The goal of the current study was to evaluate the age-related changes in regional brain 18F-FDG uptake in normal healthy population.
SUBJECTS AND METHODS: This study was part of the cardiovascular molecular calcification assessed by 18F-sodium fluoride (NaF) (CAMONA) PET/computed tomography (CT) study. This study was approved by the Danish National Committee on Health Research Ethics registered at ClinicalTrials.gov (NCT01724749). Forty normal healthy subjects were prospectively recruited in group A (22-32 years) and B (56-75 years) and underwent 18F-FDG PET/CT. Static images were obtained 180 minutes following 18F-FDG injection. Supratentorial (including individual measurements for frontal, parieto-occipital and temporal lobes) and cerebellar 18F-FDG uptakes were measured by manual placement of region of interest (ROI) over these regions based on predefined criteria for each and standardized uptake value (SUVmean) values were calculated using OsiriX software.
RESULTS: The mean ages of the patients in group A was 26.1±3.4 versus 61±4.4 for group B. There were 10 females in group A and 10 females in group B. Mean SUV of cerebellum was 6.80±1.21 for the young subjects compared to 6.08±0.7 among old subjects (independent t-test, P=0.028). Mean SUV of supratentorial brain was 9.14±1.83 for the young subjects compared to 6.92±072 among old subjects (P<0.001). Mean SUV of frontal (9.72±1.97 vs. 7.03±0.69), temporal (7.37±1.52 vs. 5.65±0.68) and parieto-occipital region (10.7±2.28 vs. 7.41±0.79) was higher among young patients (P<0.001). More interestingly, SUVmean of supratentorial brain was significantly higher among female healthy volunteers in both groups (P= 0.025 and 0.047 for group A and B, respectively).
CONCLUSION: In conclusion, these findings confirm a significant age dependent reduction of supratentorial 18F-FDG uptake among healthy individuals. However, cerebellum 18F-FDG uptake reduction was not so redundant. Fluorine-18-FDG uptake of all cerebral lobes including frontal, parieto-occipital and temporal decreases with normal aging in a same fashion. Interestingly, among both young and old female subjects, higher uptake was seen in supratentorial brain.

PMID: 30411727 [PubMed - as supplied by publisher]

Anthropometric analysis of mandible: an important step for sex determination.

ter, 11/06/2018 - 10:16
Related Articles

Anthropometric analysis of mandible: an important step for sex determination.

Clin Ter. 2018 Sep-Oct;169(5):e217-e223

Authors: Alias A, Ibrahim A, Abu Bakar SN, Swarhib Shafie M, Das S, Abdullah N, Noor HM, Liao IY, Mohd Nor F

Abstract
INTRODUCTION: The first step in the forensic identification is sex determination followed by age and stature estimation, as both are sex-dependent. The mandible is the largest, strongest and most durable bone in the face. Mandible is important for sex confirmation in absence of a complete pelvis and skull.
AIM: The aim of the present study was to determine sex of human mandible from morphology, morphometric measurements as well as discriminant function analysis from the CT scan.
MATERIALS AND METHODS: The present retrospective study comprised 79 subjects (48 males, 31 females), with age group between 18 and 74 years, and were obtained from the post mortem computed tomography data in the Hospital Kuala Lumpur. The parameters were divided into three morphologic and nine morphometric parameters, which were measured by using Osirix MD Software 3D Volume Rendering.
RESULTS: The Chi-square test showed that men were significantly association with square-shaped chin (92%), prominent muscle marking (85%) and everted gonial glare, whereas women had pointed chin (84%), less prominent muscle marking (90%) and inverted gonial glare (80%). All parameter measurements showed significantly greater values in males than in females by independent t-test (p< 0.01). By discriminant analysis, the classification accuracy was 78.5%, the sensitivity was 79.2% and the specificity was 77.4%. The discriminant function equation was formulated based on bigonial breath and condylar height, which were the best predictors.
CONCLUSION: In conclusion, the mandible could be distinguished according to the sex. The results of the study can be used for identification of damaged and/or unknown mandible in the Malaysian population.

PMID: 30393808 [PubMed - in process]

Radiologic changes in the aging nasal cavity.

qua, 10/24/2018 - 08:10

Radiologic changes in the aging nasal cavity.

Rhinology. 2018 Oct 23;:

Authors: Ganjaei KG, Soler ZM, Mappus ED, Worley ML, Rowan NR, Garcia GJM, Matthews LJ, Dubno JR, Eckert MA, Schlosser RJ

Abstract
BACKGROUND: With an aging population, it is important to understand age-related anatomic changes in the nasal cavity and cribriform plate (CP) that may have clinical implications.
METHODOLOGY: Computed tomography (CT) scans obtained for non-rhinologic conditions were divided into a young cohort (N=35, 18-34 years old) and an older adult cohort (N=32, 80-99 years old). Intranasal airspace volumes and bony anatomy of the CP were manually segmented using OsiriX software. The CP was assessed for mean Hounsfield Units (HU) and percentage of olfactory foramina. Deformation based morphometry (DBM) was then performed on the same cohort and correlated with manual measurements.
RESULTS: Individual nasal cavity volumes increased 17-75% with age. Regression analysis of all scans revealed age to be the predominant variable influencing intranasal volume differences when controlling for sex and head size. Mean HU of the CP negatively correlated with age. No age-related differences in bone stenosis of olfactory foramina were identified. Automated DBM measurements of intranasal volumes, as well as CP and zygoma mean HU correlated with manual measurements.
CONCLUSION: Older subjects have a global increase in intranasal volumes and diffuse bone density loss in the CP. The clinical impact of age-related anatomic changes in the nasal cavity and CP requires further investigation.

PMID: 30352446 [PubMed - as supplied by publisher]

Sequential prostate MRI reporting in men on active surveillance: initial experience of a dedicated PRECISE software program.

qua, 10/24/2018 - 08:10

Sequential prostate MRI reporting in men on active surveillance: initial experience of a dedicated PRECISE software program.

Magn Reson Imaging. 2018 Oct 20;:

Authors: Giganti F, Allen C, Piper JW, Mirando D, Stabile A, Punwani S, Kirkham A, Emberton M, Moore CM

Abstract
BACKGROUND AND OBJECTIVES: There is interest in using sequential multiparametric magnetic resonance imaging (mpMRI) to assess men on active surveillance (AS) for prostate cancer. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations propose standardised reporting mpMRI data for these men. This includes accurate size measurements of lesions over time, but such approach is time consuming for the radiologist and there is a strong need of dedicated tools to report serial scans in a systematic manner. We present the results from an initial validation cohort using dedicated PRECISE reporting software to allow automated comparison between sequential scans on AS.
MATERIALS AND METHODS: We retrospectively analysed baseline and follow-up scans of 20 men randomised to 6 months of daily dutasteride (n = 10) or placebo (n = 10) from the MAPPED trial. Men underwent 3T mpMRI at baseline and after 6 months, and a dedicated radiologist reported the scans using both a widespread commercially-available platform (Osirix®) and a semi-automated dedicated PRECISE reporting tool (MIM®). Tumour volume by planimetry in all sequences and conspicuity on diffusion-weighted imaging were assessed. Reporting time was recorded, and we used the Wilcoxon test for statistical analysis.
RESULTS: Median tumour volumes and conspicuity were similar using both approaches. The reporting time of the follow-up scan was quicker using the PRECISE reporting workflow both in the whole population (12'33″ vs 10'52″; p = 0.005) and in the dutasteride arm (15'50″ vs 12'59″; p = 0.01). A structured report including clinical and imaging data was generated according to the PRECISE recommendations and a comparison table between lesion characteristics at baseline and follow-up scans was also included.
CONCLUSION: We conclude that a dedicated PRECISE reporting tool for sequential scans in men on AS results in a significant reduction in the reporting time and allows the radiologist to easily compare scans over time. This tool will help with our understanding of the natural history of mpMRI changes during AS.

PMID: 30352271 [PubMed - as supplied by publisher]

Comparability of semiautomatic tortuosity measurements in the carotid artery.

sab, 10/20/2018 - 07:19
Related Articles

Comparability of semiautomatic tortuosity measurements in the carotid artery.

Neuroradiology. 2018 Oct 18;:

Authors: de Vries EE, Pourier VEC, van Laarhoven CJHCM, Vonken EJ, van Herwaarden JA, de Borst GJ

Abstract
PURPOSE: Increased arterial tortuosity has been suggested as a predisposing factor for carotid artery dissection, which is an important risk factor for development of extracranial carotid artery aneurysms (ECAA). Prior to comparison with non-ECAA controls, the optimal measurement technique should be defined. This study describes the difference between software packages in terms of reproducibility and absolute outcome of arterial tortuosity measurements in ECAA patients.
METHODS: CT-angiography analysis was performed on 12 ECAA patients selected from our registry, using four software packages: 3mensio Vascular, TeraRecon, Vital Images, and Aycan OsiriX PRO. The tortuosity index (TI) was calculated from the skull base until the carotid bifurcation and aortic arch, and was defined as the centerline's true length divided by the straight line distance. Intraclass correlation coefficients (ICC) with 95% confidence intervals were calculated to quantify inter- and intra-observer variability within one software package, and differences in measured TI between packages.
RESULTS: Inter-observer agreement was nearly perfect for 3mensio, excellent for Vital Images and OsiriX, and substantial for TeraRecon, with ICC 0.99 (0.96-1.0), 0.90 (0.69-0.97), 0.84 (0.53-0.95), and 0.72 (0.28-0.91), respectively. Intra-observer agreement ranged from ICC 1.0 for 3mensio to 0.91 for TeraRecon. Agreements in TI ranged from ICC 0.99 (0.98-1.0) for 3mensio vs. OsiriX, to 0.95 (0.82-0.98) for 3mensio vs. TeraRecon. Median time needed to complete one round of measurements was highest for OsiriX (p = 0.013).
CONCLUSIONS: Carotid artery tortuosity measurements are reproducible and comparable between current commercially available software packages, with high intra-observer agreement. Although the reproducibility differed per software packages, all packages scored an acceptable inter-observer agreement.

PMID: 30338348 [PubMed - as supplied by publisher]

The earliest known case of frontal sinus osteoma in man.

qua, 10/17/2018 - 09:47
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The earliest known case of frontal sinus osteoma in man.

Clin Anat. 2018 Oct 15;:

Authors: Seiler R, Öhrström LM, Eppenberger P, Gascho D, Rühli FJ, Galassi FM

Abstract
Frontal sinus osteoma is a relatively common finding in the modern clinical setting. Although its paleopathological record is not in dispute, its presence in Ancient Egypt has never been clarified. The aim of this article is to contribute to the debate. An Egyptian mummy head from the Musée d'Éthnographie de Neuchâtel (Switzerland) was studied radiologically and the paleopathological evidence obtained was contextualized in the wider frame of evolutionary medicine. A 128-slice CT scanner was used for further investigation; datasets were processed with OsiriX-64 bit (version 5.8.5), and multi-planar (MPR) and volumetric reconstructions were performed. A small hyperdense and well-defined structure, most likely an osteoma, was identified in the right frontal sinus. Frontal sinus osteoma definitely existed in Ancient Egypt. Finally, this represents the oldest case in anatomically modern humans so far reported. This article is protected by copyright. All rights reserved.

PMID: 30324624 [PubMed - as supplied by publisher]

Sphenoid Sinus in Relation to Age, Gender, and Cephalometric Indices.

ter, 10/16/2018 - 09:31
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Sphenoid Sinus in Relation to Age, Gender, and Cephalometric Indices.

J Craniofac Surg. 2018 Oct 12;:

Authors: Özer CM, Atalar K, Öz II, Toprak S, Barut Ç

Abstract
The sphenoid sinus is located in the center of the cranial base and is surrounded by numerous neurovascular structures. The aim of this study was to determine sphenoid sinus types and subtypes, dimensions of the sinus and cranium, and the relations of these to age and gender.Computed tomography data was obtained from 144 patients to determine right sphenoidal volume (sphVOLR), left sphenoidal volume (sphVOLL), total sphenoidal volume (sphVOLT), anteroposterior length of the sphenoid sinus (sphAP), laterolateral length of the sphenoid sinus (sphLL), head circumference (crHC), fronto-occipital length (crFO), and biparietal length (crBP), with OSIRIX software. The patients' ages ranged between 9 and 83 years (mean age 38 ± 15.5 years). The study included 89 males (mean age 39 ± 15.5 years) and 55 females (mean age 38 ± 15.6 years).Conchal (1.4%), presellar (8.3%), sellar (23.6%), and postsellar (66.7%) type sphenoid sinuses were determined based on the extension of pneumatization around the sella turcica. Each type of sphenoid sinus was classified into the following 5 types based on the direction of pneumatization: body, full lateral, pterygoid, lesser wing, and greater wing subtypes. Mean sphAP was determined as 29.72 mm and mean sphLL as 37.73 mm. In 5 patients only (3.4%), the sphenoid sinus was not divided into right and left by the intersphenoidal septum.The variations in the extensions of pneumatization of the sphenoid sinus and its dimensions might be used to estimate the selection of a surgical approach to lesions bordering the sinus.

PMID: 30320684 [PubMed - as supplied by publisher]

Planes of Reference for Orbital Fractures: A Technique for Reproducible Measurements of the Orbit on Computed Tomography Scans.

dom, 10/07/2018 - 07:45
Related Articles

Planes of Reference for Orbital Fractures: A Technique for Reproducible Measurements of the Orbit on Computed Tomography Scans.

J Craniofac Surg. 2018 Oct;29(7):1817-1820

Authors: Cai EZ, Chong XT, Ong WL, Chan LSF, Goh JY, Sundar G, Lim TC

Abstract
PURPOSE: Planes of reference for orbital fractures (PROF) was developed to standardize measurements made on orbital computed tomography scans. This study describes the use of PROF in determining the location along the orbital floor where the posterior ledge (PL) most commonly occurs. The transverse inclination and anterior-posterior inclination of the orbital floor will also be measured.
METHODS: This study evaluates 104 patients with unilateral orbital fracture. Fifty-two patients had intact infra-orbital margin (IM) and 52 had fractured IM. Facial computed tomography scans were analyzed using Osirix Lite Digital Imaging and Communications in Medicine Viewer version 7.0.1 (Geneva, Switzerland). All skull positions were standardized by orientation according to Frankfurt and mid-sagittal planes. Measurements of distance of PL from IM were determined in the sagittal view. Measurements of the inclination of the orbital floor in the transverse and anterior-posterior sections were done on the coronal and sagittal views respectively.
RESULTS: For patients with intact and fractured IM, the mean distances of PL from IM were 22.1 mm (95% CI: 21.2-23.0) and 21.1 mm (95% CI: 20.2-21.9) respectively. Mean transverse inclination was 19.4° (95% CI: 18.3-20.5). Mean anterior-posterior inclination was 15.5° (95% CI: 14.5-16.5).
CONCLUSION: Planes of reference for orbital fractures is a simple and effective method to acquire standardized measurements of the orbital cavity on computed tomography scans. Understanding the commonest location of PL and the orientation of the orbital floor in 3-dimensional space allows surgeons to perform dissection with greater precision.

PMID: 30290582 [PubMed - in process]

Predictors of enophthalmos among adult patients with pure orbital blowout fractures.

sab, 10/06/2018 - 07:35

Predictors of enophthalmos among adult patients with pure orbital blowout fractures.

PLoS One. 2018;13(10):e0204946

Authors: Ahmad Nasir S, Ramli R, Abd Jabar N

Abstract
The aim of this study was to determine the predictors of post-traumatic enophthalmos (PE) in relation to the internal orbital changes following pure orbital blowout fractures. The design was a 10-year retrospective cross-sectional study analysing 629 medical records and computed tomography (CT) data of patients with orbital fractures from January 2008 to January 2017. Demographic, etiology, co-morbidity and clinical characteristics were obtained from the medical records. Assessment of the PE, fracture site and size, intraorbital structures and muscle change were performed using the Digital Imaging and Communications in Medicine (DICOM) viewer software, OsiriX v5.8.2. Of the 629 patients with orbital fractures, 87 were pure orbital blowout fractures. Demographic pattern showed that males outnumbered females in the series, with male: female ratio of 5.7:1. The mean age was 37.2 ± 14.7 and the main etiology was motor vehicle accident. Orbital floor fracture was the most common fracture location (67.8%). The involvement of the posterior ledge and inferior orbital fissure showed statistical significant difference with PE (Fisher's exact test, p = 0.03). Binary logistic regression showed that after controlling for age, patients with fracture size of more than 150 mm2 had three times the odds of sustaining a PE, (adjusted odds ratio (AOR) = 3.01 (95% CI 1.17-7.92). Fracture size larger than 150 mm2 was a radiological predictor of PE. Additional research investigating further on the role of concurrent fracture of the posterior ledge and inferior orbital fissure is advocated.

PMID: 30289909 [PubMed - in process]

Sarcopenia and Post-Operative Morbidity and Mortality in Patients with Gastric Cancer.

qua, 10/03/2018 - 07:10
Related Articles

Sarcopenia and Post-Operative Morbidity and Mortality in Patients with Gastric Cancer.

J Gastric Cancer. 2018 Sep;18(3):242-252

Authors: O'Brien S, Twomey M, Moloney F, Kavanagh RG, Carey BW, Power D, Maher MM, O'Connor OJ, Ó'Súilleabháin C

Abstract
Purpose: Surgical resection for gastric adenocarcinoma is associated with significant post-operative morbidity and mortality. The aim of this study was to assess the prognostic significance of sarcopenia in patients undergoing resection for gastric adenocarcinoma with respect to post-operative morbidity and survival.
Materials and Methods: A retrospective analysis was conducted on a cohort of consecutive patients who underwent surgical resection for gastric adenocarcinoma between 2008 and 2014. Patient demographics, radiological parameters, and pathological data were collected. OsiriX software (Pixmeo) was used to measure skeletal muscle area, which was normalized for height to calculate skeletal muscle index.
Results: A total of 56 patients (41 male, 15 female; mean age, 68.4 ± 11.9 years) met the inclusion criteria. Of these, 36% (20 of 56) of the patients were sarcopenic pre-operatively. Both sarcopenic and non-sarcopenic patient groups were equally matched with the exception of weight and body mass index (P=0.036 and 0.001, respectively). Sarcopenia was associated with a decreased overall survival (log-rank P=0.003) and was an adverse prognostic predictor of overall survival in multivariate analysis (hazard ratio, 10.915; P=0.001). Sarcopenia was a predictor of serious in-hospital complications in multivariate analysis (odds ratio, 3.508; P=0.042).
Conclusions: In patients undergoing curative resection for gastric cancer, there was a statistically significant association between sarcopenia and both decreased overall survival and serious post-operative complications. The measurement and reporting of skeletal muscle index on pre-operative computed tomography should be considered.

PMID: 30276001 [PubMed]

Subacromial space volume in patients with rotator cuff tear: The effect of surgical repair.

seg, 10/01/2018 - 09:47
Related Articles

Subacromial space volume in patients with rotator cuff tear: The effect of surgical repair.

Acta Orthop Traumatol Turc. 2018 Sep 26;:

Authors: Pepe M, Kocadal O, Gunes Z, Calisal E, Aksahin E, Aktekin CN

Abstract
OBJECTIVE: The aim of this study was to evaluate the effect of the rotator cuff tear repair on subacromial space volume.
METHODS: We retrospectively identified 21 eligible patients (5 males and 16 females; mean age: 56.4 (range; 46-71) years) who had shoulder arthroscopy for unilateral full-thickness small to medium rotator cuff tear and normal controlateral shoulder joint. The mean follow-up time was 16.1 (range; 12-25) months. Preoperative and postoperative 1 year bilateral shoulder MRIs and Constant scores were reviewed. Subacromial volume was calculated by using Osirix software. Pre-, postoperative and healthy side (contralateral control group) subacromial volumes were recorded. Paired sample and t-tests were used to compare the pre- and postoperative groups. Independent sample t-tests were used to compare the healthy and pre- and postoperative groups. The correlation between the changes in the subacromial volume and the shoulder Constant score were analyzed using Pearson correlation analyses.
RESULTS: The mean subacromial volume of the preoperative group was 2.95 cm3 (range; 1.53-4.23) and the postoperative group was 3.59 cm3 (range; 2.12-4.84). The volume increase was statistically significant (p < 0.05). The mean subacromial volume of the control group was 3.93 cm3 (range; 2.77-5.03), and the difference between the preoperative group and the control group was statistically significant. There was no significant difference found between the postoperative group and the control group (p = 0.156). There was no significant correlation found between the volume and the constant score changes (r = 0.170, p = 0.515).
CONCLUSION: The subacromial space volume significantly decreases in full-thickness rotator cuff tears smaller than 3 cm and the surgical repair increases the subacromial volume significantly.
LEVEL OF EVIDENCE: Level IV; Diagnostic Study.

PMID: 30268741 [PubMed - as supplied by publisher]

The utility of the Agatston calcium score in predicting carotid plaque vulnerability.

sab, 09/15/2018 - 09:44
Related Articles

The utility of the Agatston calcium score in predicting carotid plaque vulnerability.

Ann Vasc Surg. 2018 Sep 10;:

Authors: Yoon WJ, Crisostomo P, Halandras P, Bechara CF, Aulivola B

Abstract
INTRODUCTION & OBJECTIVES: The utility of the Agatston calcium scoring method has been described extensively in the coronary circulation, but to date has not been investigated in the extracranial carotid domain. We sought to evaluate this calcium scoring method in its ability to predict carotid plaque vulnerability.
METHODS: We retrospectively reviewed all computed tomography angiogram (CTA) studies of the carotid arteries performed between March 2012 and March 2017 at a single institution. We identified 68 consecutive patients with 99 internal carotid arteries (ICAs) that met criteria for review. Total calcium was quantified by the Agatston scoring method using OsiriX software. Stenosis severity was determined using North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. The relation between Agatston score and degree of stenosis was evaluated using the Spearman's Rho coefficient (R).
RESULTS: Of 99 ICAs, 71 were asymptomatic and 28 were symptomatic. Baseline characteristics were comparable, with no significant difference in patient characteristics. There were significant differences in mean Agatston scores for asymptomatic versus symptomatic arteries (121.95±70.27 vs 34.83±47.77, p=0.0098, 50%-69% stenosis; 151.07±88.30 vs 71.59±77.27, p=0.0006, 70%-99% stenosis). In both asymptomatic and symptomatic groups, Agatston calcium score increased as severity of stenosis increased. Higher Agatston score is protective against symptoms ipsilateral to the carotid lesion.
CONCLUSIONS: Agatston calcium score may predict carotid plaque vulnerability, with higher scores associated with lower likelihood of developing symptoms ipsilateral to the carotid lesion. This score may be useful in predicting clinical behavior of carotid plaques.

PMID: 30213741 [PubMed - as supplied by publisher]

Role of CT and MRI in the design and development of orthopaedic model using additive manufacturing.

qua, 09/12/2018 - 09:08
Related Articles

Role of CT and MRI in the design and development of orthopaedic model using additive manufacturing.

J Clin Orthop Trauma. 2018 Jul-Sep;9(3):213-217

Authors: Haleem A, Javaid M

Abstract
Objective: To study the role of Computed tomography (CT) and Magnetic resonance imaging (MRI) for design and development of orthopaedic model using additive manufacturing (AM) technologies.
Methods: A significant number of research papers in this area are studied to provide the direction of development along with the future scope.
Results: Briefly discussed various steps used to create a 3D model by Additive Manufacturing using CT and MRI scan. These scanning technologies are used to produce medical as well as orthopaedic implants by using AM technologies. The images so produced are exported in different software like OsiriX Imaging Software, 3D slicer, Mimics, Magics, 3D doctor and InVesalius to produce a 3D digital model. Various criteria's achieved by CT and MRI scan for design and development of orthopaedic implant using additive manufacturing are also discussed briefly. AM model created by this process show exact shape, size, dimensions, textures, colour and features.
Conclusion: AM technologies help to convert the digital model into a 3D physical object, thereby improving the understanding of patient anatomy for treatment as well as for educational purpose. These scanning technologies have various applications to enhance the AM in the field of orthopaedic. In orthopaedic every patient model is a customised unit, sourced from the individual patient. 3D CAD data captured by these scanning technologies are directly exported in standard triangulate language (STL) format for printing by AM technologies. Crossestion of the physical model fabricated by this process shows a patient's anatomy if the model prepared by using the bone-like material.

PMID: 30202151 [PubMed]

The Calcaneal Crescent in Patients With and Without Plantar Fasciitis: An Ankle MRI Study.

sex, 08/31/2018 - 09:26

The Calcaneal Crescent in Patients With and Without Plantar Fasciitis: An Ankle MRI Study.

AJR Am J Roentgenol. 2018 Aug 30;:1-8

Authors: Finkenstaedt T, Siriwanarangsun P, Statum S, Biswas R, Anderson KE, Bae WC, Chung CB

Abstract
OBJECTIVE: The bundled, crescent-shaped trabeculae within the calcaneal tuberosity-which we term and refer to here as the "calcaneal crescent"-may represent a structural adaption to the prevailing forces. Given Wolff law, we hypothesized that the calcaneal crescent would be more robust in patients with plantar fasciitis, a syndrome in part characterized by overload of the Achilles tendon-calcaneal crescent-plantar fascia system, than in patients without plantar fasciitis.
MATERIALS AND METHODS: MR images of 37 patients (27 women and 10 men; mean age ± SD, 51 ± 13 years; mean body mass index [BMI, weight in kilograms divided by the square of height in meters], 26.8 ± 6.3) referred for workup of foot or ankle pain were retrospectively evaluated by two blinded readers in this study. Patients were assigned to two groups: group A, which was composed of 15 subjects without clinical signs or MRI findings of Achilles tendon-calcaneal crescent-plantar fascia system abnormalities, or group B, which was composed of 22 patients with findings of plantar fasciitis. The thickness and cross-sectional area (CSA) of the Achilles tendon, calcaneal crescent, and plantar fascia were measured on proton density (PD)-weighted MR images. The entire crescent volume was manually measured using OsiriX software on consecutive sagittal PD-weighted images. Additionally, contrast-to-noise ratio (CNR) as a surrogate marker for trabecular density and the mean thickness of the calcaneal crescent were determined on PD-weighted MR images. The groupwise difference in the morphologic measurements were evaluated using ANOVA with BMI as a covariate. Partial correlation was used to assess the relationships of measurements for the group with plantar fasciitis (group B). Intraclass correlation coefficient (ICC) statistics were performed.
RESULTS: Patients with plantar fasciitis had a greater CSA and volume of the calcaneal crescent and had lower CNR (i.e., denser trabeculae) than those without Achilles tendon-calcaneal crescent-plantar fascia system abnormalities (CSA, 100.2 vs 73.7 mm2, p = 0.019; volume, 3.06 vs 1.99 cm3, p = 0.006; CNR, -28.40 vs -38.10, p = 0.009). Interreader agreement was excellent (ICC = 0.85-0.99).
CONCLUSION: In patients with plantar fasciitis, the calcaneal crescent is enlarged compared with those without abnormalities of the Achilles tendon-calcaneal crescent-plantar fascia system. An enlarged and trabeculae-rich calcaneal crescent may potentially indicate that abnormally increased forces are being exerted onto the Achilles tendon-calcaneal crescent-plantar fascia system.

PMID: 30160979 [PubMed - as supplied by publisher]

A comparison of two different software packages for the analysis of body composition using computed tomography images.

qua, 08/29/2018 - 09:03

A comparison of two different software packages for the analysis of body composition using computed tomography images.

Nutrition. 2018 Jul 11;57:92-96

Authors: Rollins KE, Awwad A, Macdonald IA, Lobo DN

Abstract
OBJECTIVES: The analysis of body composition from computed tomography (CT) imaging has become widespread. However, the methodology used is far from established. Two main software packages are commonly used for body composition analysis, with results used interchangeably. However, the equivalence of these has not been well established. The aim of this study was to compare the results of body composition analysis performed using the two software packages to assess their equivalence.
METHODS: Triphasic abdominal CT scans from 50 patients were analyzed for a range of body composition measures at the third lumbar vertebral level using OsiriX (v7.5.1, Pixmeo, Switzerland) and SliceOmatic (v5.0, TomoVision, Montreal, Canada) software packages. Measures analyzed were skeletal muscle index (SMI), fat mass (FM), fat-free mass (FFM), and mean skeletal muscle Hounsfield Units (SMHU).
RESULTS: The overall mean SMI calculated using the two software packages was significantly different (SliceOmatic 51.33 versus OsiriX 53.77, P < 0.0001), and this difference remained significant for non-contrast and arterial scans. When FM and FFM were considered, again the results were significantly different (SliceOmatic 33.7 versus OsiriX 33.1 kg, P < 0.0001; SliceOmatic 52.1 versus OsiriX 54.2 kg, P < 0.0001, respectively), and this difference remained for all phases of CT. Finally, when analyzed, mean SMHU was also significantly different (SliceOmatic 32.7 versus OsiriX 33.1 HU, P = 0.046).
CONCLUSIONS: All four body composition measures were statistically significantly different by the software package used for analysis; however, the clinical significance of these differences is doubtful. Nevertheless, the same software package should be used if serial measurements are being performed.

PMID: 30153585 [PubMed - as supplied by publisher]

Using Stress Ultrasonography to Understand the Risk of UCL Injury Among Professional Baseball Pitchers Based on Ligament Morphology and Dynamic Abnormalities.

sab, 08/18/2018 - 07:06
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Using Stress Ultrasonography to Understand the Risk of UCL Injury Among Professional Baseball Pitchers Based on Ligament Morphology and Dynamic Abnormalities.

Orthop J Sports Med. 2018 Aug;6(8):2325967118788847

Authors: Shanley E, Smith M, Mayer BK, Bailey LB, Thigpen CA, Tokish JM, Kissenberth MJ, Noonan TJ

Abstract
Background: Ulnar collateral ligament (UCL) injury of the elbow is a common and debilitating problem seen frequently among elite baseball pitchers. Ultrasound is a useful diagnostic tool in evaluating UCL injuries.
Hypothesis: Evaluation with stress ultrasound of the elbow to measure the morphology of the UCL and the ulnohumeral joint space gapping is indicative of higher risk of UCL injury among professional baseball pitchers.
Study Design: Cohort study; Level of evidence, 2.
Methods: Ultrasound imaging was used to assess the medial joint laxity of the elbow of 70 asymptomatic professional baseball pitchers during spring training. Medial joint laxity and UCL morphology were assessed with OsiriX imaging software under 2 conditions-gravity valgus load and 5.5 lb of valgus load per a handheld dynamometer-with the shoulder in the maximal cocking position and the elbow in 90° of flexion. Two trials of resting position, elbow gapping, and UCL thickness were collected, measured, and averaged for data analysis. Intra- and interrater reliabilities were established and maintained, with intraclass correlation coefficients in the acceptable range for all measures (0.84-0.99). One-way analysis of variance was used to compare dominant variables between those pitchers who sustained a subsequent UCL injury and those who did not. A receiver operating curve was used to identify pitchers who, based on elbow gapping measures (by cut score), were at high risk versus low risk for UCL injury.
Results: Players who went on to injure the UCL (n = 7) displayed a significantly wider opening under 5.5 lb of applied stress (6.5 ± 1.2 vs 5.3 ± 1.2 mm, P = .01) when compared with pitchers without UCL injury history (n = 63); they also presented a trend toward wider dominant arm resting joint opening (4.9 ± 1.2 vs 4.0 ± 1.1 mm, P = .07). Professional pitchers with valgus stress ulnohumeral joint gapping ≥5.6 mm (area underneath the curve, 0.77; P = .02) of the dominant arm were at a 6-times greater risk of sustaining a UCL tear requiring reconstruction within a season.
Conclusion: Our data suggest that ultrasound evaluation of UCL morphology may be indicative of pitchers who are at risk of sustaining UCL injury and that it may improve player assessment.

PMID: 30116762 [PubMed]

Influence of Age and Tooth Loss on Masticatory Muscles Characteristics: A Population Based MR Imaging Study.

ter, 08/07/2018 - 11:02

Influence of Age and Tooth Loss on Masticatory Muscles Characteristics: A Population Based MR Imaging Study.

J Nutr Health Aging. 2018;22(7):829-836

Authors: Daboul A, Schwahn C, Bülow R, Kiliaridis S, Kocher T, Klinke T, Mundt T, Mourad S, Völzke H, Habes M, Biffar R

Abstract
BACKGROUND: Aging is associated with a decline in masticatory muscles mass and performance. The present study aims to examine the differences in the cross-sectional areas of the masseter, medial and lateral pterygoid muscles in relation to age and the present dental status in a population-based magnetic resonance imaging study.
METHODS: This cross sectional study involved 747 subjects aged between 30-89 years (344 male, 403 female) who underwent both a whole body MRI and a full oral examination. The cross-sectional areas of the masseter, medial and lateral pterygoid muscles were measured from MRI images using the software Osirix. Dental and prosthetic status data from the oral examination were classified according to Eichner index. The method of generalized least squares, also called growth curve model, was used to examine the associations between the cross-sectional areas, age and tooth status.
RESULTS: The cross-sectional area of the lateral pterygoid muscle decreased substantially with age in women but did not depend on age in men. The medial pterygoid muscle depended on age but an effect modification by gender was uncertain. Masseter muscle was weakly associated with age but strongly associated with the number of teeth in both genders.
CONCLUSIONS: Our findings suggest that age has a heterogeneous effect on masticatory muscles. This indicates that age related changes to the masticatory muscles are muscle specific and are not consistent between the different muscles.

PMID: 30080228 [PubMed - in process]

Diffusion tensor imaging (DTI) and Tractography of the spinal cord in pediatric population with spinal lipomas: preliminary study.

sab, 08/04/2018 - 07:31
Related Articles

Diffusion tensor imaging (DTI) and Tractography of the spinal cord in pediatric population with spinal lipomas: preliminary study.

Childs Nerv Syst. 2018 Aug 02;:

Authors: Antherieu P, Levy R, De Saint Denis T, Lohkamp L, Paternoster G, Di Rocco F, Boddaert N, Zerah M

Abstract
PURPOSE: Diffusion tensor imaging (DTI) allows studying the micro and macro architecture. One of the major challenges in dysraphism is to know the morphologic organization of the spinal cord. In a preliminary work, spinal lipoma was chosen for analyzing the micro-architecture parameters and fiber morphology of the spinal cord by DTI with tractography.
METHODS: Twelve patients (0-8 years) related to spinal lipomas treated between May 2017 and March 2018 were included. Tractography reconstruction of the conus medullaris of 12 patients were obtained using the MedINRIA software. The diffusion parameters have been calculated by Osirix DTImap plugin.
RESULTS: We found a significant difference in the FA (p = 0.024) between two age groups (< 24 months old and > 24 months old). However, no significant differences in the mean values of FA, RD, and MD between the level of the lipoma and the level above were noted. The tractography obtained in each case was coherent with morphologic sequences and reproducible. The conus medullaris was deformed and shifted. Destruction or disorganization of fibers and any passing inside the lipomas was not observed.
CONCLUSIONS: Tractography of the conus medullaris in a very young pediatric population (0-8 years old) with a spinal lipoma is possible, reproductive, and allows visualization of the spinal cord within the dysraphism. Analysis of the FA shows that the presence of a lipoma seems to have an effect on the myelination of the conus medullaris. It is during the probable myelination phase that the majority of symptoms appear. Is the myelination per se the cause?

PMID: 30073389 [PubMed - as supplied by publisher]

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