Quantification of Tumor Blush of Highly Vascularized Tumors with Slow Feeding System: Representative Use for Giant Pituitary Adenomas

2021 ◽  
Author(s):  
Yoshikazu Ogawa ◽  
Kenichi Sato ◽  
Toshiki Endo ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Adenomas ◽  
Imaging Techniques ◽  
Cone Beam Ct ◽  
Three Dimensional ◽  
Region Of Interest ◽  
Operation Time ◽  
Preoperative Imaging ◽  
Ct Scanner ◽  
Cavernous Sinus Invasion ◽  
Giant Pituitary Adenomas

abstract Background Modern imaging techniques can identify adverse factors for tumor removal such as cavernous sinus invasion before surgery, but surgeries for giant pituitary adenomas often reveal discrepancies between preoperative imaging and intraoperative findings because pituitary adenomas have feeding arteries with narrow diameters. Current imaging methods are not suitable for tumors with not only large vascular beds but also slow arterial filling. Patients and Methods This prospective study recruited 13 male subjects and 9 female subjects with giant pituitary adenomas between November 2011 and 2018. All the patients were investigated with three-dimensional magnetic resonance (MR) imaging, bone image computerized tomography (CT), and digital subtraction angiography (DSA) using a C-arm cone-beam CT scanner with a flat-panel detector and 50% diluted contrast medium. Fine angioarchitecture was evaluated and the tumor blush was quantified using newly developed region of interest (ROI) analysis to establish surgical strategies. Results Seven patients demonstrated no or very faint tumor blushes. In these patients, feeding arteries run centripetally from the surface of the tumor. Fifteen patients showed significant tumor blushes, and the feeding arteries penetrated centrifugally from the inferoposterior pole to the upper pole of the tumor. All the patients were treated according to the angiographic information with successful hemostasis. The patients showed improvement and/or disappearance of the neurologic deficits. The faint and significant blush groups showed significant differences in intraoperative bleeding (p < 0.01) and operation time (p < 0.05). Conclusion Specialized evaluation focused on vascularization is required for successful therapy of giant pituitary adenomas.

scholarly journals Use of a three-dimensional printed anatomical model for tumor management in a pediatric patient

2020 ◽  
Vol 8 ◽  
pp. 2050313X2092760
Author(s):  
David Salazar ◽  
Trevor J. Huff ◽  
Justin Cramer ◽  
Lincoln Wong ◽  
Gabe Linke ◽  
...  
Keyword(s):  
Pediatric Patient ◽  
Clinical Education ◽  
Three Dimensional ◽  
Region Of Interest ◽  
Operation Time ◽  
Patient Specific ◽  
Anatomical Model ◽  
Three Dimensional Printing ◽  
Tumor Management ◽  
New Applications

The purpose of this study was to investigate the usage of an anatomical model to improve surgical planning of a complex schwannoma resection. As advancements in additive manufacturing continue to prosper, new applications of this valuable technology are being implemented in the medical field. One of the most recent applications has been in the development of patient-specific anatomical models for unique clinical education as well as for preoperative planning. In this case, a multidisciplinary team with expertise in research, three-dimensional printing, and medicine was formed to develop a three-dimensional printed model that could be used to help plan the reduction of a tumor from the cervical spine of a pediatric patient. Image segmentation and stereolithography creation were accomplished using Mimics and 3-matic, respectively. Models were developed on two different printer types to view different aspects of the region of interest. Reports from the operating surgeon indicated that the model was instrumental in the planning procedures of the operation and reducing operation time.

scholarly journals Imaging Artifacts of Nonadhesive Liquid Embolic Agents in Conventional and Cone-beam CT in a Novel in Vitro AVM Model

2021 ◽  
Author(s):  
Niclas Schmitt ◽  
Ralf O Floca ◽  
Daniel Paech ◽  
Rami A El Shafie ◽  
Ulf Neuberger ◽  
...  
Keyword(s):  
Cone Beam Ct ◽  
Three Dimensional ◽  
Region Of Interest ◽  
Cone Beam ◽  
Major Drawback ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Imaging Artifacts ◽  
Different Diameters

Abstract Background A major drawback of liquid embolic agents (LEAs) is the generation of imaging artifacts (IA), which may represent a crucial obstacle for the detection of periprocedural hemorrhage or subsequent radiosurgery of cerebral arteriovenous malformations (AVMs). This study aimed to compare the IAs of Onyx, Squid and PHIL in a novel three-dimensional in vitro AVM model in conventional computed tomography (CT) and cone-beam CT (CBCT). Methods Tubes with different diameters were configured in a container resembling an AVM with an artificial nidus at its center. Subsequently, the AVM models were filled with Onyx 18, Squid 18, PHIL 25% or saline and inserted into an imaging phantom (n = 10/LEA). Afterwards CT and CBCT scans were acquired. The degree of IAs was graded quantitatively (Hounsfield units in a defined region of interest) and qualitatively (feasibility of defining the nidus)—Onyx vs. Squid vs. PHIL vs. saline, respectively. Results Quantitative density evaluation demonstrated more artifacts for Onyx compared to Squid and PHIL, e.g. 48.15 ± 14.32 HU for Onyx vs. 7.56 ± 1.34 HU for PHIL in CT (p < 0.001) and 41.88 ± 7.22 density units (DU) for Squid vs. 35.22 ± 5.84 DU for PHIL in CBCT (p = 0.044). Qualitative analysis showed less artifacts for PHIL compared to Onyx and Squid in both imaging modalities while there was no difference between Onyx and Squid regarding the definition of the nidus (p > 0.999). Conclusion In this novel three-dimensional in vitro AVM model, IAs were higher for the EVOH/tantalum-based LEAs Onyx and Squid compared to iodine-based PHIL. Onyx induced the highest degree of IAs with only minor differences to Squid.

scholarly journals Clinical application of multiple 3D-printed guide plates for precise reduction and fixation of comminuted patellar fractures

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052097208
Author(s):  
Zhi-Sheng Long ◽  
Fei-Peng Gong ◽  
Xie-Ping Dong ◽  
Jing-Tang Li
Keyword(s):  
Knee Joint ◽  
Articular Surface ◽  
Good Condition ◽  
Three Dimensional ◽  
Operation Time ◽  
Left Knee ◽  
Preoperative Imaging ◽  
Anatomical Landmarks ◽  
3D Printed ◽  
Patellar Fractures

Because of the lack of anatomical landmarks during reduction of multiple articular surfaces and fragments in comminuted patellar fractures, loss of bone fragments or aggravation of soft tissue and ligament injuries readily occurs. In the present case, we used multiple three-dimensional (3D)-printed guide plates to reduce and fix a comminuted patellar fracture. A 22-year-old man was hospitalized for 2 days because of left knee joint pain and limited movement caused by a traffic accident. Preoperative imaging revealed a comminuted fracture of the left patella (type 34-C3 according to the AO/OTA classification). Throughout a 2-year follow-up, the patient remained in generally good condition with no significant limitation of his left knee joint activity. Application of multiple 3D-printed guide plates is a safe and effective auxiliary technique for the treatment of comminuted patellar fractures. This novel technique can shorten the operation time, reduce the number of fluoroscopic procedures, and ensure fracture healing and recovery of knee joint function through reliable reduction of the articular surface.

scholarly journals Fractionated stereotactic radiotherapy for large and invasive non-functioning pituitary adenomas: long-term clinical outcomes and volumetric MRI assessment of tumor response

2015 ◽  
Vol 172 (4) ◽  
pp. 433-441 ◽  
Author(s):  
Giuseppe Minniti ◽  
Claudia Scaringi ◽  
Maurizio Poggi ◽  
Marie Lise Jaffrain Rea ◽  
Giuseppe Trillò ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Pituitary Adenomas ◽  
Three Dimensional ◽  
Fractionated Stereotactic Radiotherapy ◽  
Visual Field Defects ◽  
Radiation Induced ◽  
Giant Pituitary Adenomas ◽  
Low Toxicity ◽  
Magnetic Resonance Imaging Mri ◽  
Tumor Volume Reduction

ObjectiveWe describe the use of fractionated stereotactic radiotherapy (FSRT) for the treatment of large, invasive, nonfunctioning pituitary adenomas (NFPAs). FSRT is frequently employed for the treatment of residual or recurrent pituitary adenomas.Patients and methodsSixty-eight patients with a large residual or recurrent NFPAs were treated between April 2004 and December 2012, including 39 males and 29 females (median age 51 years). Visual defects were present in 34 patients, consisting of visual field defects (n=31) and/or reduced visual acuity (n=12). Forty-five patients had evidence of partial or total hypopituitarism before FSRT. For most of the patients, the treatment was delivered through 5–10 noncoplanar conformal fixed fields using a 6-MV linear accelerator to a dose of 45 Gy in 25 fractions.ResultsAt a median follow-up of 75 months (range 12–120 months), the 5- and 10-year actuarial local control were 97 and 91%, respectively, and overall survival 97 and 93%, respectively. Forty-nine patients had a tumor reduction, 16 remained stable, and three progressed. The relative tumor volume reduction measured using three-dimensional (3D) magnetic resonance imaging (MRI) was 47%. The treatment was well tolerated with minimal acute toxicity. Eighteen patients developed partial or complete hypopituitarism. The actuarial incidence of new anterior pituitary deficits was 40% at 5 years and 72% at 10 years. No other radiation-induced complications occurred.ConclusionsOur results suggest that FSRT is an effective treatment for large or giant pituitary adenomas with low toxicity.

Three-Dimensional Imaging in Vascular Surgery

2015 ◽  
Author(s):  
Ram Gurajala ◽  
Milind Desai ◽  
Tara M. Mastracci
Keyword(s):  
Vascular Surgery ◽  
Treatment Planning ◽  
Complex Disease ◽  
Imaging Techniques ◽  
Noninvasive Imaging ◽  
Three Dimensional ◽  
Aortic Disease ◽  
Preoperative Imaging ◽  
Tomographic Images ◽  
Ct And Mri

Managing complex aortic disease is one of the major challenges facing vascular surgery. With the advent of endovascular technology over the last two decades, there has been a rapid adoption of minimally invasive techniques allowing for the treatment of more complex disease. For many aortic disorders, the endovascular approach has replaced open surgery. This increases the preoperative imaging demands as accurate preoperative imaging, intraoperative assistance, and stringent postoperative surveillance have all become imperative. In diagnosing and planning management of aortic disease, digital subtraction angiography, which was once considered to be the gold standard, has been replaced by noninvasive imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI). Although there are other noninvasive imaging techniques, such as duplex ultrasonography and echocardiography, images thus acquired do not provide an anatomic overview and the possibility of treatment planning. Additionally, the information collected is often operator dependent. CT and MRI allow imaging of the entire aorta and its branches in high resolution, as well as extraluminal structures that may impact care. Images are readily presented as two-dimensional tomographic images; however, analysis and treatment planning using these images can be time consuming and tedious. Thus, three-dimensional reformatting and visualization have evolved, enabling presentation of the vasculature in a more convenient and intuitive way. This review explores the role of CT and MRI in everyday clinical practice. This review contains 18 figures, 4 tables, and 26 references.

scholarly journals Initial clinical results with a fusion prototype for mammography and three-dimensional ultrasound with a standard mammography system and a standard ultrasound probe

2018 ◽  
Vol 59 (12) ◽  
pp. 1406-1413 ◽  
Author(s):  
Julius Emons ◽  
Marius Wunderle ◽  
Arndt Hartmann ◽  
Marcus Radicke ◽  
Claudia Rauh ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Three Dimensional ◽  
Region Of Interest ◽  
Clinical Results ◽  
3D Ultrasound ◽  
Breast Cancer Patients ◽  
Time Saving ◽  
Simultaneous Evaluation ◽  
Patients Experience ◽  
First Time

Background Combinations *Equal contributors. of different imaging techniques in fusion devices appear to be associated with improvements in diagnostic assessment. Purpose The aim of this study was to test the feasibility of using an automated standard three-dimensional (3D) ultrasound (US) device fused with standard mammography for the first time in breast cancer patients. Material and Methods Digital mammograms and 3D automated US images were obtained in 23 patients with highly suspicious breast lesions. A recently developed fusion machine consisting of an ABVS 3D US transducer from an Acuson S2000 machine and a conventional Mammomat Inspiration device (both Siemens Healthcare GmbH, Erlangen, Germany) were used for the purpose. The feasibility of the examinations, imaging coverage, and patients' experience of the procedure were examined. Results In 15 out of 19 patients, the region of interest (ROI) with the tumor marked in the mammogram was visible on US. The examination was experienced positively by the patients, with no unexpected pain or injury. The examination was time-saving and well tolerated. Conclusion In conclusion, we have shown initial clinical feasibility of an US/radiography fusion prototype with good localization and evaluation of the ROIs. The combined examination was well tolerated. The simultaneous evaluation with mammography and US imaging may be able to improve detection and reduce examiner-related variability.

scholarly journals The Comprehensive AOCMF Classification System: Mandible Fractures-Level 3 Tutorial

2014 ◽  
Vol 7 (1_suppl) ◽  
pp. 31-43 ◽  
Author(s):  
Carl-Peter Cornelius ◽  
Laurent Audigé ◽  
Christoph Kunz ◽  
Randal Rudderman ◽  
Carlos H. Buitrago-Téllez ◽  
...  
Keyword(s):  
Classification System ◽  
Imaging Techniques ◽  
Cone Beam Ct ◽  
Three Dimensional ◽  
Case Examples ◽  
Mandibular Arch ◽  
Level 3 ◽  
Mandible Fractures ◽  
The Individual ◽  
Trauma Sequelae

This tutorial outlines the details of the AOCMF image-based classification system for fractures of the mandibular arch (i.e. the non-condylar mandible) at the precision level 3. It is the logical expansion of the fracture allocation to topographic mandibular sites outlined in level 2, and is based on three-dimensional (3D) imaging techniques/computed tomography (CT)/cone beam CT). Level 3 allows an anatomical description of the individual conditions of the mandibular arch such as the preinjury dental state and the degree of alveolar atrophy. Trauma sequelae are then addressed: (1) tooth injuries and periodontal trauma, (2) fracture involvement of the alveolar process, (3) the degree of fracture fragmentation in three categories (none, minor, and major), and (4) the presence of bone loss. The grading of fragmentation needs a 3D evaluation of the fracture area, allowing visualization of the outer and inner mandibular cortices. To document these fracture features beyond topography the alphanumeric codes are supplied with distinctive appendices. This level 3 tutorial is accompanied by a brief survey of the peculiarities of the edentulous atrophic mandible. Illustrations and a few case examples serve as instruction and reference to improve the understanding and application of the presented features.

Mitochondrial Reconstructions Based on Serial Thick Sections and HVEM

1975 ◽  
Vol 33 ◽  
pp. 286-287
Author(s):  
Jerome J. Paulin
Keyword(s):  
Imaging Techniques ◽  
Three Dimensional ◽  
Posterior Pole ◽  
Dimensional Structure ◽  
Stereo Imaging ◽  
Thin Sections ◽  
Anatomical Features ◽  
The Past ◽  
Cellular Components ◽  
Mitochondrial Reticulum

Within the past decade it has become apparent that HVEM offers the biologist a means to explore the three-dimensional structure of cells and/or organelles. Stereo-imaging of thick sections (e.g. 0.25-10 μm) not only reveals anatomical features of cellular components, but also reduces errors of interpretation associated with overlap of structures seen in thick sections. Concomitant with stereo-imaging techniques conventional serial Sectioning methods developed with thin sections have been adopted to serial thick sections (≥ 0.25 μm). Three-dimensional reconstructions of the chondriome of several species of trypanosomatid flagellates have been made from tracings of mitochondrial profiles on cellulose acetate sheets. The sheets are flooded with acetone, gluing them together, and the model sawed from the composite and redrawn.The extensive mitochondrial reticulum can be seen in consecutive thick sections of (0.25 μm thick) Crithidia fasciculata (Figs. 1-2). Profiles of the mitochondrion are distinguishable from the anterior apex of the cell (small arrow, Fig. 1) to the posterior pole (small arrow, Fig. 2).

Image formation analysis of thick biological specimens using three-dimensional power-spectra of through focus series

1994 ◽  
Vol 52 ◽  
pp. 124-125
Author(s):  
Karen F. Han
Keyword(s):  
Inelastic Scattering ◽  
Imaging Techniques ◽  
Mass Density ◽  
Relative Proportion ◽  
Three Dimensional ◽  
Power Spectra ◽  
Image Formation ◽  
Energy Filtering ◽  
Ewald Sphere ◽  
Nonlinear Imaging

The primary focus in our laboratory is the study of higher order chromatin structure using three dimensional electron microscope tomography. Three dimensional tomography involves the deconstruction of an object by combining multiple projection views of the object at different tilt angles, image intensities are not always accurate representations of the projected object mass density, due to the effects of electron-specimen interactions and microscope lens aberrations. Therefore, an understanding of the mechanism of image formation is important for interpreting the images. The image formation for thick biological specimens has been analyzed by using both energy filtering and Ewald sphere constructions. Surprisingly, there is a significant amount of coherent transfer for our thick specimens. The relative amount of coherent transfer is correlated with the relative proportion of elastically scattered electrons using electron energy loss spectoscopy and imaging techniques.Electron-specimen interactions include single and multiple, elastic and inelastic scattering. Multiple and inelastic scattering events give rise to nonlinear imaging effects which complicates the interpretation of collected images.

Microsurgical Management of Giant Pituitary Adenomas: A Series of 177 Cases

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
Sumit Sinha ◽  
B. Sharma ◽  
A. Mahapatra
Keyword(s):  
Pituitary Adenomas ◽  
Giant Pituitary Adenomas
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