Reliability of Manual Measurements Versus Semiautomated Software for Glenoid Bone Loss Quantification in Patients With Anterior Shoulder Instability

qua, 02/14/2024 - 08:00

Orthop J Sports Med. 2024 Feb 12;12(2):23259671231222938. doi: 10.1177/23259671231222938. eCollection 2024 Feb.


BACKGROUND: The presence of glenoid bone defects is indicative in the choice of treatment for patients with anterior shoulder instability. In contrast to traditional linear- and area-based measurements, techniques such as the consideration of glenoid concavity have been proposed and validated.

PURPOSE: To compare the reliability of linear (1-dimensional [1D]), area (2-dimensional [2D]), and concavity (3-dimensional [3D]) measurements to quantify glenoid bone loss performed manually and to analyze how automated measurements affect reliability.

STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3.

METHODS: Computed tomography images of 100 patients treated for anterior shoulder instability with differently sized glenoid defects were evaluated independently by 2 orthopaedic surgeons manually using conventional software (OsiriX; Pixmeo) as well as automatically with a dedicated prototype software program (ImFusion Suite; ImFusion). Parameters obtained included 1D (defect diameter, best-fit circle diameter), 2D (defect area, best-fit circle area), and 3D (bony shoulder stability ratio) measurements. Mean values and reliability as expressed by the intraclass correlation coefficient [ICC]) were compared between the manual and automated measurements.

RESULTS: When manually obtained, the measurements showed almost perfect agreement for 1D parameters (ICC = 0.83), substantial agreement for 2D parameters (ICC = 0.79), and moderate agreement for the 3D parameter (ICC = 0.48). When measurements were aided by automated software, the agreement between raters was almost perfect for all parameters (ICC = 0.90 for 1D, 2D, and 3D). There was a significant difference in mean values between manually versus automatically obtained measurements for 1D, 2D, and 3D parameters (P < .001 for all).

CONCLUSION: While more advanced measurement techniques that take glenoid concavity into account are more accurate in determining the biomechanical relevance of glenoid bone loss, our study showed that the reliability of manually performed, more complex measurements was moderate.

PMID:38352173 | PMC:PMC10863483 | DOI:10.1177/23259671231222938

PET KinetiX-A Software Solution for PET Parametric Imaging at the Whole Field of View Level

seg, 02/12/2024 - 08:00

J Imaging Inform Med. 2024 Jan 10. doi: 10.1007/s10278-023-00965-z. Online ahead of print.


Kinetic modeling represents the ultimate foundations of PET quantitative imaging, a unique opportunity to better characterize the diseases or prevent the reduction of drugs development. Primarily designed for research, parametric imaging based on PET kinetic modeling may become a reality in future clinical practice, enhanced by the technical abilities of the latest generation of commercially available PET systems. In the era of precision medicine, such paradigm shift should be promoted, regardless of the PET system. In order to anticipate and stimulate this emerging clinical paradigm shift, we developed a constructor-independent software package, called PET KinetiX, allowing a faster and easier computation of parametric images from any 4D PET DICOM series, at the whole field of view level. The PET KinetiX package is currently a plug-in for Osirix DICOM viewer. The package provides a suite of five PET kinetic models: Patlak, Logan, 1-tissue compartment model, 2-tissue compartment model, and first pass blood flow. After uploading the 4D-PET DICOM series into Osirix, the image processing requires very few steps: the choice of the kinetic model and the definition of an input function. After a 2-min process, the PET parametric and error maps of the chosen model are automatically estimated voxel-wise and written in DICOM format. The software benefits from the graphical user interface of Osirix, making it user-friendly. Compared to PMOD-PKIN (version 4.4) on twelve 18F-FDG PET dynamic datasets, PET KinetiX provided an absolute bias of 0.1% (0.05-0.25) and 5.8% (3.3-12.3) for KiPatlak and Ki2TCM, respectively. Several clinical research illustrative cases acquired on different hybrid PET systems (standard or extended axial fields of view, PET/CT, and PET/MRI), with different acquisition schemes (single-bed single-pass or multi-bed multipass), are also provided. PET KinetiX is a very fast and efficient independent research software that helps molecular imaging users easily and quickly produce 3D PET parametric images from any reconstructed 4D-PET data acquired on standard or large PET systems.

PMID:38343229 | DOI:10.1007/s10278-023-00965-z

AI-Based Approach to One-Click Chronic Subdural Hematoma Segmentation Using Computed Tomography Images

sab, 02/10/2024 - 08:00

Sensors (Basel). 2024 Jan 23;24(3):721. doi: 10.3390/s24030721.


This paper presents a computer vision-based approach to chronic subdural hematoma segmentation that can be performed by one click. Chronic subdural hematoma is estimated to occur in 0.002-0.02% of the general population each year and the risk increases with age, with a high frequency of about 0.05-0.06% in people aged 70 years and above. In our research, we developed our own dataset, which includes 53 series of CT scans collected from 21 patients with one or two hematomas. Based on the dataset, we trained two neural network models based on U-Net architecture to automate the manual segmentation process. One of the models performed segmentation based only on the current frame, while the other additionally processed multiple adjacent images to provide context, a technique that is more similar to the behavior of a doctor. We used a 10-fold cross-validation technique to better estimate the developed models' efficiency. We used the Dice metric for segmentation accuracy estimation, which was 0.77. Also, for testing our approach, we used scans from five additional patients who did not form part of the dataset, and created a scenario in which three medical experts carried out a hematoma segmentation before we carried out segmentation using our best model. We developed the OsiriX DICOM Viewer plugin to implement our solution into the segmentation process. We compared the segmentation time, which was more than seven times faster using the one-click approach, and the experts agreed that the segmentation quality was acceptable for clinical usage.

PMID:38339438 | PMC:PMC10857356 | DOI:10.3390/s24030721

Radiological measurements of lacrimal gland in thyroid eye disease

ter, 02/06/2024 - 08:00

Int Ophthalmol. 2024 Feb 6;44(1):11. doi: 10.1007/s10792-024-02991-4.


PURPOSE: Lacrimal gland enlargement is a common feature of thyroid eye disease (TED) and has been positively correlated with the clinical activity score. Although lacrimal gland volume is the preferred measure of lacrimal gland size, its calculation is not clinically translatable due to the expertise, time and advanced software required. The aim of our study is to determine whether the lacrimal gland volume in patients with TED undergoing magnetic resonance imaging (MRI) can be estimated using simpler lacrimal gland linear and area measurements.

METHODS: A retrospective review of 102 orbits (51 patients) with TED who underwent orbital MRI was conducted. The maximum length, width, and area of the lacrimal gland were measured in axial and coronal sections. Lacrimal gland volume was calculated by using a manual segmentation technique on all consecutive axial slices on commercially available software, OsiriX. All quantitative measurements were correlated with the lacrimal gland volume.

RESULTS: Mean age of participants was 59 ± 16 years, and 67% (n = 34) were females. With multivariate analyses, combined lacrimal gland axial and coronal areas strongly correlated with volume (r = 0.843, p < 0.01). Strong univariate predictors of volume included axial area (r = 0.704, p < 0.01) and coronal area (r = 0.722, p < 0.01), while moderate predictors included axial length (r = 0.523, p < 0.01), axial width (r = 0.521, p < 0.01), coronal length (r = 0.450, p < 0.01), and coronal width (r = 0.649, p < 0.01).

CONCLUSION: In patients with thyroid eye disease, lacrimal gland volume can be estimated using axial and coronal areas, which is simpler and more time efficient than calculating volumes.

PMID:38319433 | PMC:PMC10847191 | DOI:10.1007/s10792-024-02991-4


qui, 02/01/2024 - 08:00

World Neurosurg. 2024 Jan 30:S1878-8750(24)00155-4. doi: 10.1016/j.wneu.2024.01.133. Online ahead of print.


BACKGROUND: Cervical spondylotic myelopathy (CSM) is a prevalent cause of spinal cord dysfunction in adults, primarily from degenerative changes. The efficacy of treatment strategies, especially surgical approaches, remains debated.

OBJECTIVE: This study aimed to assess the long-term impact of posterior fusion laminectomy on the posterior longitudinal ligament (PLL) thickness, disc complex, and myelomalacia signal changes in CSM patients.

METHODS: A single-centre, prospective study from January 2020 to December 2021 included CSM patients without ossified posterior longitudinal ligament (OPLL). Magnetic resonance imaging (MRI) data from baseline, six, and twelve months postoperatively were collected. Measurements on the MRI were performed using the Osirix® MD software, focusing on the PLL width, myelopathic foci dimensions, and canal diameter.

RESULTS: Out of the 82 initially enrolled patients, 64 were considered for analysis. Postoperatively, a significant reduction in PLL width and myelopathic foci dimensions was observed, alongside a considerable increase in the canal diameter. Clinical outcomes based on the Modified Japanese Orthopaedic Association (mJOA) scale also showcased marked improvements post-surgery.

CONCLUSION: Posterior fusion laminectomy effectively reduces anterior pressure in CSM patients. This treatment may represent an optimal surgical approach for select CSM cases. Further, more extensive studies with extended follow-up are advocated.

PMID:38302004 | DOI:10.1016/j.wneu.2024.01.133

Validating the use of clinical MSCT scans for cranial nonmetric sex estimation in a contemporary Indonesian population

qui, 02/01/2024 - 08:00

Int J Legal Med. 2024 Feb 1. doi: 10.1007/s00414-024-03176-5. Online ahead of print.


There is renewed interest in Asia for the development of forensic anthropological standards, partly due to the need for population-specific models to maintain high classification accuracies. At present, there are no known studies utilising morphoscopic standards specific to the Indonesian population. Craniometric analyses can often be time-consuming; morphoscopic assessments are quicker and are also known to be reliable and accurate. One of the most utilised morphoscopic standards for the estimation of skeletal sex is that of Walker (2008). Its application across population groups demonstrated reduced accuracies outside of the United States; population-specific predictive models would thus serve to improve the identification process of unknown skeletal remains. Digital imaging also allows for the validation of standards on a contemporary population and is an appropriate proxy to physical skeletal material.The present study quantifies the applicability of the Walker standard to a contemporary Indonesian population. A total of 200 cranial MSCT scans from a hospital in Makassar were analysed using OsiriX®. Scoring was performed in accordance with the Walker standard. Five univariate and nine multivariate predictive models were derived using single trait and multi-trait combinations. The best performing univariate model included the glabella, with a total classification accuracy of 82.0% and a sex bias of 14.6%. Classification accuracy with all traits considered was at 95.2% for females and 82.8% for males with a sex bias of 12.5%. These results provide forensic practitioners in Indonesia with an appropriate morphoscopic sex estimation standard, strengthening their capabilities in the field and improving judicial outcomes.

PMID:38300302 | DOI:10.1007/s00414-024-03176-5

Potent <em>in vivo</em> efficacy of oral gallium maltolate in treatment-resistant glioblastoma

ter, 01/30/2024 - 08:00

Front Oncol. 2024 Jan 15;13:1278157. doi: 10.3389/fonc.2023.1278157. eCollection 2023.


BACKGROUND: Treatment-resistant glioblastoma (trGBM) is an aggressive brain tumor with a dismal prognosis, underscoring the need for better treatment options. Emerging data indicate that trGBM iron metabolism is an attractive therapeutic target. The novel iron mimetic, gallium maltolate (GaM), inhibits mitochondrial function via iron-dependent and -independent pathways.

METHODS: In vitro irradiated adult GBM U-87 MG cells were tested for cell viability and allowed to reach confluence prior to stereotactic implantation into the right striatum of male and female athymic rats. Advanced MRI at 9.4T was carried out weekly starting two weeks after implantation. Daily oral GaM (50mg/kg) or vehicle were provided on tumor confirmation. Longitudinal MRI parameters were processed for enhancing tumor ROIs in OsiriX 8.5.1 (lite) with Imaging Biometrics Software (Imaging Biometrics LLC). Statistical analyses included Cox proportional hazards regression models, Kaplan-Meier survival plots, linear mixed model comparisons, and t-statistic for slopes comparison as indicator of tumor growth rate.

RESULTS: In this study we demonstrate non-invasively, using longitudinal MRI surveillance, the potent antineoplastic effects of GaM in a novel rat xenograft model of trGBM, as evidenced by extended suppression of tumor growth (23.56 mm3/week untreated, 5.76 mm3/week treated, P < 0.001), a blunting of tumor perfusion, and a significant survival benefit (median overall survival: 30 days untreated, 56 days treated; P < 0.001). The therapeutic effect was confirmed histologically by the presence of abundant cytotoxic cellular swelling, a significant reduction in proliferation markers (P < 0.01), and vessel normalization characterized by prominent vessel pruning, loss of branching, and uniformity of vessel lumina. Xenograft tumors in the treatment group were further characterized by an absence of an invasive edge and a significant reduction in both, MIB-1% and mitotic index (P < 0.01 each). Transferrin receptor and ferroportin expression in GaM-treated tumors illustrated cellular iron deprivation. Additionally, treatment with GaM decreased the expression of pro-angiogenic markers (von Willebrand Factor and VEGF) and increased the expression of anti-angiogenic markers, such as Angiopoietin-2.

CONCLUSION: Monotherapy with the iron-mimetic GaM profoundly inhibits trGBM growth and significantly extends disease-specific survival in vivo.

PMID:38288102 | PMC:PMC10822938 | DOI:10.3389/fonc.2023.1278157

Facial Anthropometric Analysis of Gender-Related Characteristics in Computed Tomography

seg, 01/29/2024 - 08:00

Ann Plast Surg. 2024 Jan 1;92(1S Suppl 1):S21-S26. doi: 10.1097/SAP.0000000000003761. Epub 2023 Dec 20.


BACKGROUND: In recent years, facial feminization surgery (FFS) has gained increasing popularity because of increases in transgender individuals and the acceptance of diversity in gender identity. However, there is still a scarcity of anthropometric research to guide evidence-based practices for FFS in Taiwan.

AIM AND OBJECTIVES: The purpose of this study was to provide a reference for surgeons to achieve optimal outcomes for patients undergoing FFS. The anthropometric analysis could help surgeons meet patients' specific requirements and improve patients' alignment with their gender identity.

MATERIALS AND METHODS: The study group consisted of 100 patients (50 males and 50 females) who had undergone cranial computed tomography at Chang Gung Memorial Hospital in Taiwan because of the indication of blunt injuries to the head and face with suspected skull and facial fractures. The computed tomography images were imported into the OsiriX image software to conduct an anthropometric evaluation. The parameters used in the measurements included 2 aspects: bone and soft tissue anthropometric analysis.

RESULTS: Anthropometric data were obtained from 50 males (age 32.6 ± 11.4 years) and 50 females (age 33.7 ± 10.3 years). The results for bone measurements showed that both the forehead bossing length and nasal bone width in the male group were significantly greater. The frontal angle in both bone and soft tissue in the male group was significantly smaller. The chin height and bigonial width in both bone and soft tissue in the male group were significantly greater. Although the average gonial angle was greater in the female group, the difference was not significant. For the measurements of lip projection, the results showed that there was no significant difference. Although this group of Asian males had more acute nasolabial angles, the difference was not statistically significant. However, the average nasofrontal angle among females was significantly more obtuse than among males.

CONCLUSION: The results revealed that Asian males tend to have more prominent superior orbital rims, wider nasal bones, and wider and taller mandibles compared with Asian females. Despite showing some trends, the gonial angle and lip projections did not reveal any significant differences, which is likely because of a large amount of variation.

PMID:38285991 | DOI:10.1097/SAP.0000000000003761

The size of the Hill Sachs defect increases during reduction of a first time shoulder dislocation in older adults: a pilot study in 20 cases

sex, 12/22/2023 - 08:00

J Exp Orthop. 2023 Dec 22;10(1):143. doi: 10.1186/s40634-023-00667-z.


PURPOSE: To evaluate if the size of Humeral Hill-Sachs Defects (HSDs) increases during reduction in the emergency department (ED) in subjects that have a first-time anterior shoulder dislocation.

METHODS: Subjects more than 18 years old presenting to the ED a first-time anterior shoulder dislocation were included. A computed tomography was performed prior to any reduction attempt (Pre-CT). The shoulder was reduced in the emergency room with intraarticular lidocaine; if two attempts failed, the shoulder was reduced under anaesthesia. A second CT was performed after reduction of the shoulder (Post-CT). CT were evaluated using the Osirix software. A 3-dimensional reconstruction of the humeral head was performed and the maximum width of the humeral defect, maximum depth of the humeral defect and total volume of the humeral defect were measured. The relative increase in size was calculated.

RESULTS: Twenty subjects were included in the study. All subjects presented HSDs in the Pre-CT that had a width of a median of 9.9(interquartile range:2.9)mm, a depth of 7.0(3.0]mm and a volume of 355(333)mm2. The HSD in the Post-CT had a width of 10.9(3.0)mm (an increase of 7.23[8.5]%, significant differences, p = 0.0001) a depth of 7.2(2.7)mm (an increase of 9.93[20.7]%, significant differences, p < 0.0001) and a volume of 469(271) mm2 (an increase of 27.5[26.9]%, significant differences, p < 0.0001). There were size increases larger than 25% in 15/20 (75%) of subjects.

CONCLUSION: Standard reduction manoeuvres performed in a first-time anterior shoulder dislocation increase the size of the HSD. This increase in size is larger than 25% in four out of five cases.

LEVEL OF EVIDENCE: IV, prospective cases series study.

PMID:38133843 | DOI:10.1186/s40634-023-00667-z

Anatomical and Three-Dimensional Study of the Female Feline Abdominal and Pelvic Vascular System Using Dissections, Computed Tomography Angiography and Magnetic Resonance Angiography

sex, 12/22/2023 - 08:00

Vet Sci. 2023 Dec 14;10(12):704. doi: 10.3390/vetsci10120704.


This study describes the anatomical characteristics of the abdominal and pelvic vascular system of two healthy mature female cats via three-dimensional contrast enhanced computed tomography angiography, non-contrast enhanced magnetic resonance angiography and three-dimensional printing. Volume-rendering computed tomography angiography images were acquired from the ventral aspect using RadiAnt, Amira and OsiriX MD Dicom three-dimensional formats, and three-dimensional printing was obtained and compared with the corresponding computed tomography angiography images. Non-contrast enhanced magnetic resonance angiography was made using the time-of-flight imaging in ventral, oblique and lateral views. In addition, three cadavers with colored latex injection were dissected to facilitate the identification of the vascular structures. Three-dimensional computed tomography angiography showed the main vascular structures, whereas with the time-of-flight blood appeared with a high signal intensity compared with associated abdominal and pelvic tissues. Three-dimensional computed tomography angiography images and time-of-flight sequences provided adequate anatomical details of the main arteries and veins that could be used for future feline anatomical and clinical vascular studies of the abdomen and pelvis.

PMID:38133255 | DOI:10.3390/vetsci10120704

Predictors of periapical bone healing associated with teeth having large periapical lesions following nonsurgical root canal treatment or retreatment: A cone beam computed tomography-based retrospective study

sex, 11/17/2023 - 08:00

Int Endod J. 2023 Nov 17. doi: 10.1111/iej.13993. Online ahead of print.


AIM: Several factors influence the condition of the periapical tissues associated with root filled teeth. The primary objective of this study was to retrospectively evaluate the extent and speed of bone healing of large periapical lesions associated with nonsurgical root canal treatment or retreatment. The secondary objective was to analyse the relationship between the time to complete healing when analysed using cone beam computed tomography (CBCT) and other possible predictors that affect healing.

METHODOLOGY: Seventy-nine patients were treated during the years 2013-2020 with large periapical lesions of endodontic origin (10-15 mm) as observed on intraoral periapical radiographs (IOPAR) were included. IOPAR and CBCT were available before treatment and during the follow-up (IOPAR every 6 months and CBCT every 12 months). The volume of periapical lesions was calculated by OsiriX Lite software. Variables such as initial volume of the lesion, age, gender, type of treatment or type of root canal filling were compared to identify the differences between healed and unhealed lesions. Pearson's Chi-square test was used for categorical variables, the t-test for age and the Wilcoxon test for initial volume of the lesion. The association between time to healing and the variables was assessed using univariate analysis and multivariate analysis. The Wilcoxon test was used to observe the association of healing time with categorical variables and the correlation index was measured with the quantitative variables.

RESULTS: Of the 79 cases analysed, 60 lesions (76%) were completely healed as verified by CBCT in a mean healing time of 19 months, of which 60% healed fully between 12 and 18 months. Increase in age of patient and larger initial volume of the lesion were associated with a significantly longer healing time (p < .001). Gender, filling material and type of treatment did not have a significant effect on the healing process (p > .05).

CONCLUSIONS: Clinicians should be aware that periapical lesions in older patients and larger areas of bone loss take longer to heal. CBCT monitoring of large periapical lesions is critical and it can help clinicians in the decision-making process.

PMID:37974453 | DOI:10.1111/iej.13993

Clinical significance of sarcopenia in patients undergoing treatment for gastric cancer

qui, 11/16/2023 - 08:00

Rev Assoc Med Bras (1992). 2023 Nov 13;69(12):e20230568. doi: 10.1590/1806-9282.20230568. eCollection 2023.


OBJECTIVE: The aim of this study was to investigate the impact of sarcopenia on prognosis in patients with gastric cancer in order to explore the relationship between sarcopenia and postoperative complications as well as durations of hospital stay and intensive care unit.

METHODS: A total of 175 patients who visited the oncology clinic between 2017 and 2022 with respect to their radiological images, demographic data, and laboratory parameters were perused. The OsiriX software was used to measure the skeletal muscle area that was divided by the body height in order to obtain the skeletal muscle index.

RESULTS: A total of 50.28% of 175 patients (41 females and 134 males, with a mean age of 63.5 years) who met the inclusion criteria in the study were sarcopenic. Significant differences appeared between sarcopenic and non-sarcopenic patients with respect to durations of both hospital stay (p<0.01) and intensive care unit stay (p<0.01) (multivariate analysis). Furthermore, patients with sarcopenia had significantly frequent postoperative complications in comparison with those without sarcopenia. Among the patients with sarcopenia, decreased levels of hemoglobin and albumin as well as lymphocytes were encountered in terms of inflammatory markers; nevertheless, no significant differences were determined among other inflammatory markers.

CONCLUSION: In patients undergoing treatment for gastric cancer, sarcopenia increases postoperative complications and prolongs hospital and intensive care stays during the treatment process.

PMID:37971119 | DOI:10.1590/1806-9282.20230568