scholarly journals Anatomical siting of the splenic flexure using computed tomography

2017 ◽  
Vol 99 (3) ◽  
pp. 207-209 ◽  
Author(s):  
L Meecham ◽  
A Brookes ◽  
CAW Macano ◽  
T Stone ◽  
M Cheetham
Keyword(s):  
Computed Tomography ◽  
Colorectal Surgery ◽  
Vertebral Body ◽  
Splenic Flexure ◽  
Accurate Method ◽  
Observer Agreement ◽  
Ct Scans ◽  
Anatomical Site ◽  
Vertebral Level ◽  
Colorectal Surgeons

INTRODUCTION Often, left-sided colorectal surgery requires splenic flexure mobilisation (SFM) to allow a tension-free anastomosis to be carried out. This step is difficult and not without risk. We investigated a system of anatomical siting of the splenic flexure using computed tomography (CT). METHODS The Shrewsbury Splenic Flexure Siting (SSFS) system involves siting of the splenic flexure using the vertebral level (VL) as a reference point. We asked three surgical registrars (SRs) to analyse 20 CT scans of patients undergoing colonic resection to ascertain the anatomical site of the splenic flexure using the SSFS system. The distance from the centre of the vertebral body to the lateral edge (CVBL) of the splenic flexure was measured, as was the distance from the centre of the vertebral body to the inner abdominal wall (CVBI) along the same line, on axial images. RESULTS VL assessment demonstrated substantial inter-observer agreement with a kappa (κ) value of 0.742 (95% confidence interval (CI), 0.463–0.890). CVBL and CVBI demonstrated very strong inter-observer agreement (CVBL: κ = 0.905 (95% CI, 0.785–0.961); CVBI: 0.951 (0.890–0.979) (p<0.001). Overall, there was strong correlation between assessments by all three SRs across the three variables measured. CONCLUSIONS The SSFS system is an accurate method to site the splenic flexure anatomically using CT. We can use the SSFS system to develop a validated scoring system to help colorectal surgeons assess the difficulty of SFM.

scholarly journals Congenital Vertebral Malformations In French Bulldogs: X-Ray Vs Computed Tomography

2017 ◽  
Vol 74 (1) ◽  
pp. 123
Author(s):  
Lucia Madalina CORLAT ◽  
B. BLANCO ◽  
R. LUCERNA ◽  
P. J. GINEL ◽  
F. MIRO ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Vertebral Body ◽  
Ct Scans ◽  
Spinal Level ◽  
X Ray ◽  
Clinical Evolution ◽  
Important Impact ◽  
Degree Of Certainty ◽  
French Bulldog ◽  
Superposition Effect

Congenital vertebral malformations of the thoracolumbar area can have an important impact in the clinical evolution of French Bulldogs due to the instability it creates at the spinal level. The aim of this study is to show the differences between x-ray and CT scans in vertebral malformations of the French Bulldog. CT scans can offer a higher degree of certainty in the diagnosis of congenital vertebral malformations of the dogs. The VR model can offer a more thorough evaluation of the existing modifications of the vertebral body, allowing the examiner to circumvent the superposition effect than can be observed in the x-ray views and offering the chance to evaluate whether there is scoliosis or kyphosis present.

scholarly journals A Comparison of Intra-Observer and Inter-Observer Reliability of Plain Radiographs, Standard Computed Tomography Scans and Mobile Computed Tomography Scans in the Assessment of Distal Radius Fractures: A Cadaveric Study

2019 ◽  
pp. 53
Author(s):  
Sitthiphong Suwannaphisit ◽  
Saowapar Yoykaew ◽  
Chitchaya Suwanraksa ◽  
Varah Yuenyongviwat ◽  
Porames Suwanno ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Observer Agreement ◽  
Ct Scans ◽  
Radius Fractures ◽  
Plain Radiographs ◽  
Observer Reliability ◽  
Computed Tomography Scans ◽  
Mobile Ct

Objective: Diagnosis of a distal end radius fracture relies on various imaging studies. However, the relative usefulness of these studies is still a matter of some controversy. The aim of this study was to compare the intra-observer and inter-observer reliability of plain radiographs, standard computed tomography (CT) scans and mobile CT scans in the assessment of distal radius fractures as categorized by the Fernandez classification method. The secondary objective was to compare the dosages of radiation between the different imaging modalities. Material and Methods: Sixteen fresh cadaveric wrist bones were used in this experimental study. The desired fractures were created in the bones to mimic Fernandez types I-V fractures and plain radiographs were taken in 4 views. Standard CT and mobile CT scans were also taken with the fractured bones in the same four positions. Interobserver reliability was assessed using Kappa statistics to determine the diagnostic consistency among the nine observers. Inter-observer agreement was assessed based on the Fernandez classification system diagnoses. Results: Overall, the inter-observer agreement was substantial for the Fernandez classifications (Kappa range 0.636 0.727) in all types of imaging. For intra-observer agreement, the analysis found higher agreement for both standard CT scans and mobile CT scans. The standard CT images imparted a higher average dose of radiation than both the mobile CT scans and the plain radiographs.Conclusion: The mobile CT scan can provide an alternative imaging method for precise diagnosis of distal end radius fractures, with the additional benefits of mobility and lower radiation exposure. 

Comparison of Lumbar Puncture with Computed Tomography Scan as an Indicator of Intracerebral Hemorrhage in the Preterm Infant

PEDIATRICS ◽  
1980 ◽  
Vol 66 (3) ◽  
pp. 432-437
Author(s):  
Gerald Silverboard ◽  
Anthony Lazzara ◽  
Peter A. Ahmann ◽  
James F. Schwartz
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Preterm Infant ◽  
Lumbar Puncture ◽  
Intraventricular Hemorrhage ◽  
Accurate Method ◽  
Ct Scans ◽  
Computed Tomography Scan ◽  
Tomography Scan

Computed tomography (CT) scan is the most accurate method for diagnosing intracerebral hemorrhage in the high-risk preterm infant. The present study was undertaken to evaluate lumbar puncture (LP) as a reliable means of diagnosing such hemorrhages. Forty eight infants less than 35 weeks gestation, requiring intensive care, were evaluated by CT scan at 48 to 96 hours of life, and serial LPs were performed. The initial LP preceded the CT scan by one to four hours and repeat LPs were done three and five days later if the initial CT scan revealed intracerebral hemorrhage. The initial LP was successfully performed in 28 of 48 infants. Of these 48 infants, 15 had hemorrhage by CT scan. The initial LP was consistent with the diagnosis on scan in eight of these 15. In the other seven infants, initial LP was normal in three, traumatic in one, and unsuccessful in three. The second LP was consistent with hemorrhage in four of the latter seven. Thus, in only eight of 15 infants, in whom CT scans revealed intracerebral hemorrhage, was the initial LP useful in confirming the diagnosis. Furthermore, LPs showed bloody cerebrospinal fluid in 10 of 18 infants whose CT scans were normal. At the present time LP cannot be considered a reliable means of identifying infants with subependymal-intraventricular hemorrhage.

scholarly journals Sex differences in the splenic flexure

2017 ◽  
Vol 99 (6) ◽  
pp. 456-458 ◽  
Author(s):  
AF Brookes ◽  
CAW Macano ◽  
T Stone ◽  
M Cheetham ◽  
L Meecham
Keyword(s):  
Vertebral Body ◽  
Splenic Flexure ◽  
Preoperative Assessment ◽  
Vertebral Level ◽  
Men And Women ◽  
Portal Venous Phase ◽  
Anatomical Difference ◽  
Male Patients ◽  
The Mean ◽  
Picture Archiving And Communication

INTRODUCTION Anecdotally, surgeons claim splenic flexure mobilisation is more difficult in male patients. There have been no scientific studies to confirm or disprove this hypothesis. The implications in colorectal surgery could be profound. The aim of this study was to assess quantitatively whether there is an anatomical difference in the position of the splenic flexure between men and women using computed tomography (CT). METHODS Portal venous phase CT performed for preoperative assessment of colorectal malignancy was analysed using the hospital picture archiving and communication system. The splenic flexure was compared between men and women using two variables: anatomical height corresponding to the adjacent vertebral level (converted to ordinal values between 1 and 17) and distance from the midline. RESULTS In total, 100 CT images were analysed. Sex distribution was even. The mean ages of the male and female patients were 68.1 years and 66.7 years respectively (p=0.630). The mean vertebral level for men was 8.88, equating to the inferior half of the T11 vertebral body (range: 1–17 [superior half of T9 to inferior half of L2]), and 11.36 for women, equating to the inferior half of the T12 vertebral body (range: 4–16 [superior half of T10 to superior half of L2]). This difference was statistically significant (p=0.0001) and is equivalent to one whole vertebra. The mean distance from the midline was 160.8mm (range: 124–203mm) for men and 138.2mm (range: 107–185mm) for women (p<0.0001). CONCLUSIONS The splenic flexure is both higher and further from the midline in men than in women. This provides one theory as to why mobilising the splenic flexure may be more difficult in male patients.

scholarly journals Laparoscopic Approaches to Splenic Flexure Mobilization Tailored According to Disease- and Patient-Related Factors

2020 ◽  
Author(s):  
Melissa Kyriakos Saad ◽  
Elias Saikaly
Keyword(s):  
Colorectal Surgery ◽  
Splenic Flexure ◽  
Malignant Disease ◽  
Medical Literature ◽  
Laparoscopic Approach ◽  
Standard Approach ◽  
Surgical Approaches ◽  
Splenic Flexure Mobilization ◽  
Related Factors ◽  
Colorectal Surgeons

AbstractEarly in the 1990s, minimally invasive surgery manifested in laparoscopic surgery found its way to the field of colorectal surgery. Since then, a rising trend in utilizing laparoscopic approach in colorectal surgery, either for benign or malignant disease, is being noticed. In laparoscopic colorectal surgery, the most difficult and challenging step for colorectal surgeons is the mobilization of the splenic flexure. Laparoscopic mobilization of the splenic flexure is an area of debate, with no universally accepted gold standard approach. Multiple approaches have been described in the medical literature and no approach is considered the standard approach. Hence, colorectal surgeons should be familiar with all the different approaches and they should have the ability of utilizing a tailored splenic flexure mobilization approach modified according to patient- and disease-related factors. Herein, we review the different surgical approaches to laparoscopic splenic flexure mobilization that can be tailored to the surgeons needs according to patient- and disease-related factors.

scholarly journals Involvement of the proximal radial ulnar joint in partial radial head fractures: a novel three-dimensional computed tomography scan evaluation method

2017 ◽  
Vol 11 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Anne Couture ◽  
Jonah Hébert-Davies ◽  
Julien Chapleau ◽  
G. Yves Laflamme ◽  
Emilie Sandman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Radial Head ◽  
Evaluation Method ◽  
Radial Head Fracture ◽  
Geometric Model ◽  
Observer Agreement ◽  
Ct Scans ◽  
Level Of Evidence ◽  
Radial Head Fractures ◽  
Radial Tuberosity

Background Partial radial head fractures (PRHF) can involve the proximal radioulnar joint (PRUJ) or be restricted to the ‘safe zone’ (SZ) during forearm rotation. The objective of the present study was to develop an assessment method for PRUJ involvement in radial head fractures using axial computed tomography (CT) scans. Methods The area of the radial head in contact with the PRUJ zone was identified, and defined on 18 cadaveric elbows CT scans; the quantitative relationship between PRUJ zone and radial tuberosity was established. Then, four evaluators validated it on PRHF CT scan axial views, classifying the fractures as involving the PRUJ or not. Results Using the radial tuberosity as the 0° of a 360° circle, the SZ was within 108° to 212° clockwise for a right elbow and counter clockwise for the left elbow. Fifty-five consecutive (30 men, 25 women, mean age of 49 years) partial radial head fracture CT scans were classified: four in the SZ only, three in the PRUJ zone and 48 in both the PRUJ and SZ. The kappa for the inter- and intra-observer agreement was 0.517 and 0.881, respectively. Conclusions Ninety-three percent of partial radial head fractures will involve the PRUJ and the geometric model developed allows their classification, potentially helping surgeons decide on optimal treatment. Level of evidence Retrospective basic science study. Level III: anatomic study, imaging

scholarly journals Role of iliac crest tangent in correct numbering of lumbosacral transitional vertebrae

2019 ◽  
Author(s):  
NESRİN GÜNDÜZ ◽  
GÜLÇİN DURUKAN ◽  
MEHMET BİŞLGİN ESER ◽  
AHMET ASLAN ◽  
ADNAN KABAALİOĞLU
Keyword(s):  
Computed Tomography ◽  
Disc Degeneration ◽  
Vertebral Body ◽  
Intervertebral Disc Degeneration ◽  
Iliac Crest ◽  
Observer Agreement ◽  
Transitional Vertebra ◽  
Lumbosacral Transitional Vertebra ◽  
Lumbosacral Transitional Vertebrae

Background and aim: Iliac crest tangent (ICT) has recently emerged as a reliable landmark to correctly number the lumbosacral transitional vertebrae (LSTV). We retrospectively evaluated the reproducibility and accuracy of ICT as a landmark in subjects without disc degeneration. Materials and methods: Fifty-eight patients with LSTV [19 female, 41 (26-52) years] and 55 controls without LSTV [23 female, 40 (26-55) years] who had undergone spinal computed tomography were included. The ICT was drawn on the coronal images, with the cursor in the sagittal view set to the posterior one third of the vertebral body located one level above the LSTV. When more than 1.25 vertebral body was counted below the ICT, the LSTV was considered as S1, otherwise as L5. The gold standard was counting the vertebrae craniocaudally. Results: The inter-observer agreement was good for determining ICT level (Cohen’s kappa=0.78, p<0.001). The rate of correct numbering by ICT in LSTV group was significantly lesser than controls (43.1% vs 96.4%, respectively, p<0.001). Patients with sacralization had significantly less correct numbering rate than lumbarization (33.3% vs 63.2%, respectively, p=0.03). Conclusion: ICT does not seem to be a reliable landmark for correct numbering of LSTV in patients with no intervertebral disc degeneration. Key words: computed tomography, iliac crest tangent, lumbosacral transitional vertebra

SPECIFIC CHARACTERISTICS OF BONE STRUCTURES ON CT-SCANS OF PATIENTS WITH SINONASAL INVERTED PAPILLOMAS

2019 ◽  
Vol 65 (4) ◽  
pp. 590-595
Author(s):  
Arkadiy Naumenko ◽  
Kseniya Sapova ◽  
Oleg Konoplev ◽  
Svetlana Astashchenko ◽  
Igor Chernushevich
Keyword(s):  
Computed Tomography ◽  
Tumor Recurrence ◽  
Inverted Papilloma ◽  
Ct Scans ◽  
Precise Localization ◽  
Sinonasal Inverted Papilloma ◽  
Bone Structures ◽  
Inverted Papillomas

Precise localization and excision of the originating site of a sinonasal inverted papilloma is essential for decreasing tumor recurrence. In this study we evaluated the use of preoperative computed tomography (CT) to pinpoint the attachment/origi-nating sites of the tumor.

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 Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

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