Clinical Use of Tailored Computed Tomography to Prevent Poststernotomy Dehiscence

2021 ◽  
Author(s):  
Zihni M. Duman ◽  
Barış Timur ◽  
Çağdaş Topel ◽  
Timuçin Aksu
Keyword(s):  
Computed Tomography ◽  
Clinical Use ◽  
Hounsfield Units ◽  
Preoperative Risk ◽  
Tissue Density ◽  
Stability Group ◽  
Density Analysis ◽  
The Mean ◽  
Thorax Ct ◽  
Sternal Stability

Abstract Background Morphological and tissue density analysis of the sternum can be performed in the preoperative computed tomography (CT). The purpose of this study was to analyze morphology and tissue density of sternum in CT and effect for comparison sternal instability. Methods Patients with sternal instability (n = 61) and sternal stability (n = 66) were enrolled in this study. All of the patients were studied using same thorax CT procedure. All the measurements were performed by one specific cardiovascular radiologist. The Hounsfield units (HUs) were measured in axial sections of the sternum trabecular bone. Results Sternal instability group mean HU was 75.36 ± 13.19 and sternal stability group HU was 90.24 ± 12.16 (p < 0.000). HU is the statically significant predictor of sternal instability. Conclusion Our study showed a significant correlation between the mean HU value of sternum and sternal instability. We think that it is important to evaluate the existing thorax CT while performing preoperative risk analysis for sternal dehiscence.

scholarly journals Application of Computed Tomography (CT) Attenuation Values in Diagnosis of Transudate and Exudate in Patients with Pleural Effusion

2018 ◽  
Vol 11 (02) ◽  
pp. 19-25
Author(s):  
Keshab Sharma ◽  
PS Lamichhane ◽  
BK Sharma
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Ct Scan ◽  
Pleural Fluid ◽  
Pleural Effusions ◽  
Hounsfield Units ◽  
Fluid Analysis ◽  
Ct Attenuation ◽  
The Mean ◽  
Attenuation Values

Background: Pleural effusion is the pathologic accumulation of fluid in the pleural space. The fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Analysis of pleural fluid by thoracentesis with imaging guidance helps to determine the cause of pleural effusion. The purpose of this study was to assess the accuracy of computed tomography (CT) in characterizing pleural fluid based on attenuation values and CT appearance. Materials and Methods: This prospective study included 100 patients admitted to Gandaki Medical College and Teaching Hospital, Pokhara, Nepal between January 1, 2017 and February 28, 2018. Patients who were diagnosed with pleural effusion and had a chest CT followed by diagnostic thoracentesis within 48 hours were included in the study. Effusions were classified as exudates or transudates using laboratory biochemistry markers on the basis of Light’s criteria. The mean attenuation values of the pleural effusions were measured in Hounsfield units in all patients using a region of interest with the greatest quantity of fluid. Each CT scan was also reviewed for the presence of additional pleural features. Results: According to Light’s criteria, 26 of 100 patients with pleural effusions had transudates, and the remaining patients had exudates. The mean attenuation of the exudates (16.5 ±1.7 HU; 95% CI, range, -33.4 – 44 HU) was significantly higher than the mean attenuation of the transudates (11.6 ±0.57 HU; 95% CI, range, 5 - 16 HU), (P = 0.0001). None of the additional CT features accurately differentiated exudates from transudates (P = 0.70). Fluid loculation was found in 35.13% of exudates and in 19.23% of transudates. Pleural thickening was found in 29.7% of exudates and in 15.3% of transudates. Pleural nodule was found in 10.8% of exudates which all were related to the malignancy. Conclusion: CT attenuation values may be useful in differentiating exudates from transudates. Exudates had significantly higher Hounsfield units in CT scan. Additional signs, such as fluid loculation, pleural thickness, and pleural nodules were more commonly found in patients with exudative effusions and could be considered and may provide further information for the differentiation.

scholarly journals ASSESSMENT OF JAW BONE DENSITY IN TERMS OF HOUNSFIELD UNITS USING CONE BEAM COMPUTED TOMOGRAPHY FOR DENTAL IMPLANT TREATMENT PLANNING

2021 ◽  
Vol 71 (1) ◽  
pp. 221-27
Author(s):  
Myra Ahmad ◽  
Yasir Ikram Ahmed ◽  
Farheen Qureshi ◽  
Muhammad Sharjeel Ashraf ◽  
Zubair Ahmed Khan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Density ◽  
Treatment Planning ◽  
Cone Beam Computed Tomography ◽  
Cone Beam ◽  
Hounsfield Units ◽  
Implant Placement ◽  
The Mean ◽  
Anterior Mandible ◽  
Implant Treatment

Objective: To assess jawbone density in terms of Hounsfield units using cone beam computed tomography fordental implant treatment planning in patients reporting to a local tertiary care dental hospital Study Design: Cross sectional study. Place and Duration of Study: Department of Periodontology and Oral Implantology, Fatima Memorial Hospital, Lahore, from Mar to Sep 2018. Methodology: A total of 100 patients who fulfilled the inclusion criteria and underwent implant placement wereincluded in the study. After ethical approval, informed and written consent, brief history was taken and a singleradiographer exposed and took cone beam computed tomography scan of all the subjects using PLANMECAmachine. A single investigator using PLANMECA software recorded jawbone density in terms of Hounsfieldunits. All data were presented as mean, SD and one way ANOVA was used. Multiple comparisons of the fourregions in the maxilla and mandible were performed with a Tukey test. An independent t-test was also used tocompare gender with age groups and bone density. Results: Total of 100 patients who underwent implant placement were included, 48 (48%) were males & 52 (52%) were females with the mean age of 28.53 ± 5.33 years. The mean jawbone density in terms of Hounsfield units using cone beam computed tomography in anterior maxilla was 709.75 ± 122.63 Hounsfield units, posterior maxilla was 299.66 ± 73.09 Hounsfield units, anterior mandible was 1093.34 ± 109.42 Hounsfield units and posterior mandible was 599.45 ± 135.55 Hounsfield units (p<.001). Conclusion: The anterior mandible and anterior...........

Computed Tomography Enhances Diagnostic Accuracy in Challenging Medial Coronoid Disease Cases: An Imaging Study in Dog Breeding Appeal Cases

2020 ◽  
Vol 33 (05) ◽  
pp. 356-362
Author(s):  
Jan Wennemuth ◽  
Bernd Tellhelm ◽  
Nele Eley ◽  
Kerstin von Pückler
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Working Group ◽  
False Negative ◽  
Imaging Study ◽  
Second Opinion ◽  
Substantial Agreement ◽  
Hounsfield Units ◽  
The Mean

Abstract Objectives The aim of this study was to determine the radiographic sensitivity in detecting medial coronoid disease (MCD), using computed tomography (CT) as reference in dogs presented for an official second opinion, and to compare the medial coronoid process (MCP) in fragmented and fissured MCP as well as those unaffected by MCD. Materials and Methods The data of dogs, presented for official second opinion radiographs and CT, were reviewed by three board-certified observers and in accordance with the International Elbow Working Group guidelines regarding MCD. Radiographic delineation, radiopacity and Hounsfield Units (HU) of the MCP were recorded additionally and the correlation between radiography and CT was investigated. Results Sensitivity and specificity of radiography compared with CT yielded values of 83.6% for the former and 83.5% for the latter. False-negative grading in radiography correlated significantly (p = 0.0001) with a present fissure line in CT. The mean delineation (p = 0.03) and mean HU of fragmented MCP (p = 0.0045) were significantly reduced compared with fissured MCP and no significant differences in measured HU for fissured MCP were detected in comparison to elbows unaffected by MCD. Conclusion The results of the present study show substantial agreement between radiography and CT in second opinion cases. However, sensitivity is reduced compared with not preselected cases. A present fissure line in CT was significantly associated with a false-negative grading in radiography. Therefore, CT imaging of the elbows is strongly recommended in cases of appeal.

Computed Tomography-Based Patient-Specific Instrumentation Loses Accuracy with Significant Varus Preoperative Misalignment

2020 ◽  
Author(s):  
Vicente Jesús León-Muñoz ◽  
Mirian López-López ◽  
Alonso José Lisón-Almagro ◽  
Francisco Martínez-Martínez ◽  
Fernando Santonja-Medina
Keyword(s):  
Computed Tomography ◽  
Deformity Correction ◽  
Patient Specific ◽  
Control Group ◽  
X Rays ◽  
Varus Alignment ◽  
Patient Specific Instrumentation ◽  
Conventional Instrumentation ◽  
The Mean ◽  
Valgus Alignment

AbstractPatient-specific instrumentation (PSI) has been introduced to simplify and make total knee arthroplasty (TKA) surgery more precise, effective, and efficient. We performed this study to determine whether the postoperative coronal alignment is related to preoperative deformity when computed tomography (CT)-based PSI is used for TKA surgery, and how the PSI approach compares with deformity correction obtained with conventional instrumentation. We analyzed pre-and post-operative full length standing hip-knee-ankle (HKA) X-rays of the lower limb in both groups using a convention > 180 degrees for valgus alignment and < 180 degrees for varus alignment. For the PSI group, the mean (± SD) pre-operative HKA angle was 172.09 degrees varus (± 6.69 degrees) with a maximum varus alignment of 21.5 degrees (HKA 158.5) and a maximum valgus alignment of 14.0 degrees. The mean post-operative HKA was 179.43 degrees varus (± 2.32 degrees) with a maximum varus alignment of seven degrees and a maximum valgus alignment of six degrees. There has been a weak correlation among the values of the pre- and postoperative HKA angle. The adjusted odds ratio (aOR) of postoperative alignment outside the range of 180 ± 3 degrees was significantly higher with a preoperative varus misalignment of 15 degrees or more (aOR: 4.18; 95% confidence interval: 1.35–12.96; p = 0.013). In the control group (conventional instrumentation), this loss of accuracy occurs with preoperative misalignment of 10 degrees. Preoperative misalignment below 15 degrees appears to present minimal influence on postoperative alignment when a CT-based PSI system is used. The CT-based PSI tends to lose accuracy with preoperative varus misalignment over 15 degrees.

scholarly journals Metacarpal Bony Dimensions Related to Headless Compression Screw Sizes

2019 ◽  
Vol 12 (S 01) ◽  
pp. S39-S44
Author(s):  
Michael Okoli ◽  
Kevin Lutsky ◽  
Michael Rivlin ◽  
Brian Katt ◽  
Pedro Beredjiklian
Keyword(s):  
Computed Tomography ◽  
Fracture Fixation ◽  
Ct Scans ◽  
Compression Screw ◽  
Metacarpal Head ◽  
Headless Compression Screw ◽  
Metacarpal Bones ◽  
Headless Compression Screws ◽  
The Mean ◽  
Distal Aspect

Abstract Introduction The purpose of this study is to determine the radiographic dimensions of the finger metacarpals and to compare these measurements with headless compression screws commonly used for fracture fixation. Materials and Methods We analyzed computed tomography (CT) scans of the index, long, ring, and small metacarpal bones and measured the metacarpal length, distance from the isthmus to the metacarpal head, and intramedullary diameter of the isthmus. Metacarpals with previous fractures or hardware were excluded. We compared these dimensions with the size of several commercially available headless screws used for intramedullary fixation. Results A total of 223 metacarpals from 57 patients were analyzed. The index metacarpal was the longest, averaging 67.6 mm in length. The mean distance from the most distal aspect of the metacarpal head to the isthmus was 40.3, 39.5, 34.4, and 31 mm for the index, long, ring, and small metacarpals, respectively. The narrowest diameter of the isthmus was a mean of 2.6, 2.7, 2.3, and 3 mm for the index, long, ring, and small metacarpals, respectively. Of 33 commercially available screws, only 27% percent reached the isthmus of the index metacarpal followed by 42, 48, and 58% in the long, ring, and small metacarpals, respectively. Conclusion The index and long metacarpals are at a particular risk of screw mismatch given their relatively long lengths and narrow isthmus diameters.

scholarly journals Intraoperative cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy: a feasibility study

Urolithiasis ◽  
2021 ◽  
Author(s):  
R. A. Kingma ◽  
M. J. H. Voskamp ◽  
B. H. J. Doornweerd ◽  
I. J. de Jong ◽  
S. Roemeling
Keyword(s):  
Computed Tomography ◽  
Percutaneous Nephrolithotomy ◽  
Cone Beam Computed Tomography ◽  
University Hospital ◽  
Cone Beam ◽  
Cross Sectional ◽  
The Mean ◽  
Residual Stones ◽  
Residual Fragments

AbstractCone beam computed tomography (CBCT) provides multiplanar cross-sectional imaging and three-dimensional reconstructions and can be used intraoperatively in a hybrid operating room. In this study, we investigated the feasibility of using a CBCT-scanner for detecting residual stones during percutaneous nephrolithotomy (PCNL). Intraoperative CBCT-scans were made during PCNL procedures from November 2018 until March 2019 in a university hospital. At the point where the urologist would have otherwise ended the procedure, a CBCT-scan was made to image any residual fragments that could not be detected by either nephroscopy or conventional C-arm fluoroscopy. Residual fragments that were visualized on the CBCT-scan were attempted to be extracted additionally. To evaluate the effect of this additional extraction, each CBCT-scan was compared with a regular follow-up CT-scan that was made 4 weeks postoperatively. A total of 19 procedures were analyzed in this study. The mean duration of performing the CBCT-scan, including preparation and interpretation, was 8 min. Additional stone extraction, if applicable, had a mean duration of 11 min. The mean effective dose per CBCT-scan was 7.25 mSv. Additional extraction of residual fragments as imaged on the CBCT-scan occurred in nine procedures (47%). Of the follow-up CT-scans, 63% showed a stone-free status as compared to 47% of the intraoperative CBCT-scans. We conclude that the use of CBCT for the detection of residual stones in PCNL is meaningful, safe, and feasible.

Imaging findings of trichilemmal cyst and proliferating trichilemmal tumour

2021 ◽  
pp. 197140092110177
Author(s):  
Masaya Kawaguchi ◽  
Hiroki Kato ◽  
Natsuko Suzui ◽  
Tatsuhiko Miyazaki ◽  
Hiroyuki Tomita ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Hounsfield Units ◽  
Soft Tissue Density ◽  
Cutaneous Lesions ◽  
Imaging Characteristics ◽  
Trichilemmal Cyst ◽  
T1 Hyperintensity

Purpose The purpose of this study was to evaluate computed tomography and magnetic resonance imaging of benign trichilemmal cysts and proliferating trichilemmal tumours. Methods Nineteen histologically confirmed cutaneous lesions with trichilemmal keratinisation (12 trichilemmal cysts and seven proliferating trichilemmal tumours) were enrolled. Among them, 10 lesions (six trichilemmal cysts and four proliferating trichilemmal tumours) were examined by computed tomography, while 13 lesions (eight trichilemmal cysts and five proliferating trichilemmal tumours) were examined by magnetic resonance imaging. Computed tomography and magnetic resonance imaging characteristics were retrospectively reviewed. RESULTS Sixteen lesions (84%, 10 trichilemmal cysts and six proliferating trichilemmal tumours) occurred on the scalp. Lobulated margins were observed in five lesions (26%, three trichilemmal cysts and two proliferating trichilemmal tumours). With respect to computed tomography attenuation, calcification (>200 Hounsfield units) was observed in seven lesions (70%, five trichilemmal cysts and two proliferating trichilemmal tumours), hyperdense areas (≥80 and ≤200 Hounsfield units) in six (60%, three trichilemmal cysts and three proliferating trichilemmal tumours), and soft tissue density areas (<80 Hounsfield units) in nine (90%, five trichilemmal cysts and four proliferating trichilemmal tumours). On T1-weighted images, intratumoral hyperintensity was only observed in eight trichilemmal cysts but no proliferating trichilemmal tumours (100% vs. 0%, P<0.01). On T2-weighted images, hypointense rim and intratumoral hypointensity was observed in all 13 lesions (100%, eight trichilemmal cysts and five proliferating trichilemmal tumours), and linear or reticular hypointensity was observed in 10 (77%, six trichilemmal cysts and four proliferating trichilemmal tumours). Conclusion Trichilemmal cysts and proliferating trichilemmal tumours predominantly occurred on the scalp with calcification, and usually exhibited linear or reticular T2 hypointensity. Intratumoral T1 hyperintensity may be a useful imaging feature for differentiating trichilemmal cysts from proliferating trichilemmal tumours.

scholarly journals AB1056 SYMPTOMATIC SCLEROSING MESENTERITIS REVEALING ERDHEIM-CHESTER DISEASE: A RARE CONDITION MEDIATED BY BRAF

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1818.1-1818
Author(s):  
J. Razanamahery ◽  
S. Humbert ◽  
A. Malakhia ◽  
J. F. Emile ◽  
F. Cohen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Sclerosing Mesenteritis ◽  
Fat Infiltration ◽  
Abdominal Computed Tomography ◽  
Erdheim Chester Disease ◽  
Mutational Status ◽  
The Mean ◽  
Kinase Pathway ◽  
Erdheim Chester ◽  
Chester Disease

Background:Sclerosing Mesenteritis (SM) refers to an entire spectrum of digestive inflammatory disorders. Diagnosis is based on imaging showing an increase of fat attenuation displacing bowel loops and is in most cases non-symptomatic. Several conditions (abdominal trauma/surgery, neoplasia, infectious and inflammatory diseases) are responsible for SM (1). Among neoplasia, Erdheim-Chester disease (ECD) is a rare clonal histiocytosis characterized by long bone involvement, peri-nephric fat infiltration and cardio-vascular involvement associated with compatible histology (2). Biopsy is mandatory to confirm tissue infiltration by histiocytes and detect somatic mutation. Almost 80% of ECDpatients harbor mutation in mitogen activated protein(MAP) kinase pathway especiallyBRAFV600Egene mutation in about 60% of cases(3). No series of patients presenting both pathologies has been reported. Furthermore, no correlation withBRAFmutation status has been described in patient harboring SM and ECD.Objectives:To describe the clinical, radiological and mutational status of patients harboring SM and ECD.Methods:We reviewed the database of patients with histiocytic disorders in Besancon University Hospital. Patient required one abdominal computed tomography showing sclerosing mesenteritis and clinical/histological features of ECD to fulfill the inclusion criteria. All biopsy samples were investigated for mutation ofMAPkinase pathway gene.Results:Four patients suffered from SM and ECD. The median age at the diagnosis of ECD was 68 years old (61-72). All patients described abdominal pain and the mean duration between first symptoms and diagnosis of ECD was 12 months (4-19). The mean CRP level at diagnosis was 40.75 mg/L (5-117). Two patients were found to have myeloid neoplasms (chronic myelomonocytic leukemia (#2) and essential thrombocythemia (#4)) concurrent with ECD diagnosis.Regarding abdominal computed tomography, all patients had a mesenteric mass associated with hyper-attenuated mesenteric fat and a “fat halo sign”. One patient (#2) had ascites and one had splenomegaly (#4) but no patient had enlarged lymph nodes. CT also demonstrated peri-nephric fat infiltration (“hairy kidney”) (4/4), vascular sheathing of aortic branches (3/4), adrenal hypertrophy (1/4) or ureter dilation (1/4). The mean SUVmaxof the mesentery was 7.5 (4.1-10.9) at diagnosis on (18F)- fluorodeoxyglucose-PET. Three patients underwent mesentery fat biopsy and all samples exhibited ECD histology. Regarding mutational status, 75% (3/4) patients hadBRAFV600Emutation.After initiation of therapies for ECD (targeted therapies for ¾ patients), all patients had improvement of digestive symptoms and decreased of SUVmaxon evaluation18FDG-PET during the follow up.Conclusion:ECD should be investigated in patient with symptomatic SM especially if it is associated with peri-nephric fat infiltration. This condition is rare and might be driven by BRAF gene.TABLE 2.Full term pregnancyMultiple gestationPreconception CZP exposureLabor complicationsMaternal infectionsNeonatal infections (< 6 m after birth)Congenital malformationsBreast-feedingNeonates, n/N15/152/155/150/151/150/150/156/15References:[1]Danford CJ, Lin SC, Wolf JL. Sclerosing Mesenteritis. Am J Gastroenterol. 2019 Jun;114(6):867–73.[2]Diamond EL, Dagna L, Hyman DM, Cavalli G, Janku F, Estrada-Veras J, et al. Consensus guidelines for the diagnosis and clinical management of Erdheim-Chester disease. Blood. 2014 Jul 24;124(4):483–92.[3]Haroche J, Cohen-Aubart F, Rollins BJ, Donadieu J, Charlotte F, Idbaih A, et al. Histiocytoses: emerging neoplasia behind inflammation. Lancet Oncol. 2017 Feb;18(2):e113–25.Disclosure of Interests:None declared

scholarly journals Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711879074 ◽  
Author(s):  
Robert C. Spang ◽  
Daniel B. Haber ◽  
Brendin R. Beaulieu-Jones ◽  
Kristen L. Stupay ◽  
George Sanchez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
National Football League ◽  
Treatment Method ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Specific Performance ◽  
Incomplete Healing ◽  
Bony Healing ◽  
The Mean ◽  
Career Performance

Background: Jones fractures result in subsequent dysfunction and remain an issue for athletes. Purpose: To (1) describe the epidemiology, treatment, and impact of Jones fractures identified at the National Football League (NFL) Scouting Combine on players’ early careers and (2) establish the value of computed tomography (CT) to determine bony healing after a fracture in prospective players. Study Design: Cohort study; Level of evidence, 3. Methods: All players who attended the combine between 2009 and 2015 were retrospectively reviewed to identify their history of Jones fractures. The playing position, treatment method, and number of missed collegiate games were recorded. The mean overall draft pick number, number of games started and played, snap percentage, and position-specific performance scores (fantasy score) over the first 2 years in the NFL were compared between players with fractures and controls. An imaging classification system was applied based on grading of each quadrant of the fifth metatarsal (plantar, dorsal, medial, lateral), with a score of 0 for not healed or 1 for healed. Results: Overall, the number of Jones fractures identified was 72 in 2285 athletes (3.2%), with all treated via intramedullary screw fixation. The mean overall draft pick number for players with fractures was 111.2 ± 67.9 compared with 99.0 ± 65.9 for controls ( P = .12). Performance scores for players with fractures were lower than those for controls across all positions, with a significant difference in running backs (2.6 vs 4.0, respectively; P < .001) and defensive linemen (1.4 vs 2.3, respectively; P = .02). The mean CT score was 2.5 ± 1.3. Of the 32 athletes who underwent imaging, 16 Jones fractures (50.0%) were healed or nearly healed, 12 (37.5%) were partially healed, and 4 (12.5%) showed little or no healing. The plantar cortex demonstrated the least healing (18/32; 56.3%), followed by the lateral cortex (15/32; 46.9%). Players with a mean score <1 were found to have fewer games started (2.7 ± 2.5) than those with 1 to 3 cortices healed (17.4 ± 10.4) or all cortices healed (8.7 ± 11.2). Conclusion: Based on CT, 50% of all players with a previous Jones fracture demonstrated incomplete healing. Moreover, position-specific performance scores over the first 2 years of a player’s career were lower across all positions for those with fractures compared with controls. Players with CT scores <1 were found to start fewer games and were drafted later than controls.

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