Low filling ratio of the distal nail segment to the medullary canal is a risk factor for loss of anteromedial cortical support: a case control study

Background Anteromedial cortical support apposition (positive and/or neutral cortical relations) is crucial for surgical stability reconstruction in the treatment of trochanteric femur fractures. However, the loss of fracture reduction is frequent in follow-ups after cephalomedullary nail fixation. This paper aimed to investigate the possible predictive risk factors for postoperative loss of anteromedial cortex buttress after nail fixation. Methods A retrospective analysis of 122 patients with AO/OTA 31A1 and A2 trochanteric femur fractures treated with cephalomedullary nails between January 2017 and December 2019 was performed. The patients were classified into two groups according to the postoperative status of the anteromedial cortical apposition in 3D CT images: Group 1 with contact “yes” (positive or anatomic) and Group 2 with contact “No” (negative, loss of contact). The fracture reduction quality score, tip-apex distance (TAD), calcar-referenced TAD (Cal-TAD), Parker ratio, neck-shaft angle (NSA), and the filling ratio of the distal nail segment to medullary canal diameter in anteroposterior (AP) and lateral fluoroscopies (taken immediately after the operation) were examined in univariate and multivariate analyses. Mechanical complications were measured and compared in follow-up radiographs. Results According to the postoperative 3D CT, 84 individuals (69%) were categorized into Group 1, and 38 individuals (31%) were classified as Group 2. The multivariate logistic regression analysis showed that the poor fracture reduction quality score (P < 0.001) and decreasing filling ratio in the lateral view (P < 0.001) were significant risk factors for the loss of anteromedial cortical contact. The threshold value for the distal nail filling ratio in lateral fluoroscopy predicting fracture reduction re-displacement was found to be 53%, with 89.3% sensitivity and 78.9% specificity. The mechanical complication (varus and over lateral sliding) rate was higher in Group 2. Conclusions The fracture reduction quality score and the decreasing filling ratio of the distal nail to the medullary canal in the lateral view (a novel parameter causing pendulum-like movement of the nail) were possible risk factors for postoperative loss of anteromedial cortical support.

Do acetabular parameters measured on 2D imaging correlate with CT, and can lateral centre-edge angle predict femoral head coverage?

Aims The lateral centre-edge angle (LCEA) is a plain radiological measure of superolateral cover of the femoral head. This study aims to establish the correlation between 2D radiological and 3D CT measurements of acetabular morphology, and to describe the relationship between LCEA and femoral head cover (FHC). Methods This retrospective study included 353 periacetabular osteotomies (PAOs) performed between January 2014 and December 2017. Overall, 97 hips in 75 patients had 3D analysis by Clinical Graphics, giving measurements for LCEA, acetabular index (AI), and FHC. Roentgenographical LCEA, AI, posterior wall index (PWI), and anterior wall index (AWI) were measured from supine AP pelvis radiographs. The correlation between CT and roentgenographical measurements was calculated. Sequential multiple linear regression was performed to determine the relationship between roentgenographical measurements and CT FHC. Results CT-measured LCEA and AI correlated strongly with roentgenographical LCEA ( r = 0.92; p < 0.001) and AI ( r = 0.83; p < 0.001). Radiological LCEA correlated very strongly with CT FHC ( r = 0.92; p < 0.001). The sum of AWI and PWI also correlated strongly with CTFHC ( r = 0.73; p < 0.001). CT measurements of LCEA and AI were 3.4° less and 2.3° greater than radiological LCEA and AI measures. There was a linear relation between radiological LCEA and CT FHC. The linear regression model statistically significantly predicted FHC from LCEA, F(1,96) = 545.1 (p < 0.001), adjusted R2 = 85.0%, with the prediction equation: CT FHC(%) = 42.1 + 0.77(XRLCEA) Conclusion CT and roentgenographical measurement of acetabular parameters are comparable. Currently, a radiological LCEA greater than 25° is considered normal. This study demonstrates that those with hip pain and normal radiological acetabular parameters may still have deficiencies in FHC. More sophisticated imaging techniques such as 3D CT should be considered for those with hip pain to identify deficiencies in FHC. Cite this article: Bone Jt Open 2022;3(1):12–19.

Automatic body region localization in 3D-CT images based on the improved YOLO model

Automatic body region localization in medical three-dimensional (3D)-CT images is a critical step of computerized body-wide Automatic Anatomy Recognition (AAR) system, which can be applied for radiotherapy planning and interest slices retrieving. Currently, the complex internal structure of human body and time consuming computation are the main challenges for the localization. Therefore, this paper introduces and improves the YOLO-v3 model into the body region localization for these problems. First, seven categories of body regions in a CT volume image I are defined based on the modification version of our previous work. Second, an improved YOLO-v3 model is trained to classify each axial slice into one of the seven categories. Then, the effectiveness of the proposed method is evaluated on 3D-CT images that collected from 220 subjects. The experimental results demonstrate that the slice localizing error is less than 3 NoS (Number of slices), which is competitive to the state-of-the-art methods. Beyond this, our method is simple and computationally efficient owing to its less training time, and the average computational time for localizing a volume CT images is about 3 second, which shows potential for a further application.

Standardised 3D-CT Lung Volumes for Patients with Idiopathic Pulmonary Fibrosis

Background: The assessment of lung physiology via pulmonary function tests (PFTs) is essential for patients with idiopathic pulmonary fibrosis (IPF). However, PFTs require active participation, which can be challenging for patients with severe respiratory failure, such as during acute exacerbations (AE) of IPF. Recently advances enabled to re-construct of 3-dimensional computed-tomography (3D-CT) images. Methods: This is a retrospective multi-center cohort study. This study established a standardisation method and quantitative analysis of lung volume (LV) based on anthropometry using three-dimensional computed tomography (3D-CT) images. The standardised 3D-CT LV in patients with IPF at diagnosis (n=140) and during AE (cohort1; n=61 and cohort2; n=50) and those of controls (n=53) were measured. Results: The standardised 3D-CT LVs at IPF diagnosis were less than those of control patients, especially in the lower lung lobes. The standardised 3D-CT LVs were correlated with forced vital capacity (FVC) and validated using the modified Gender-Age-Physiology (GAP) index. The standardised 3D-CT LVs at IPF diagnosis were independently associated with prognosis. During AE, PFTs were difficult to perform, 3D-CT analyses revealed reduced lung capacity in both the upper and lower lobes compared to those obtained at diagnosis. Lower standardised 3D-CT LVs during AE were independently associated with worse outcomes in independent two cohorts. Particularly, volume loss in the upper lobe at AE had prognostic values.Conclusion: A novel image quantification method for assessing pulmonary physiology using standardised 3D-CT-derived LVs was developed. This method successfully predicts mortality in patients with IPF and AE of IPF, and may be a useful alternative to PFTs when PFTs cannot be performed.

Integration of 3D Volumetric Computed Tomography Scan Image Data with Conventional Well Logs for Detection of Petrophysical Rock Classes

Summary Core measurements are used for rock classification and improved formation evaluation in both cored and noncored wells. However, the acquisition of such measurements is time-consuming, delaying rock classification efforts for weeks or months after core retrieval. On the other hand, well-log-based rock classification fails to account for rapid spatial variation of rock fabric encountered in heterogeneous and anisotropic formations due to the vertical resolution of conventional well logs. Interpretation of computed tomography (CT) scan data has been identified as an attractive and high-resolution alternative for enhancing rock texture detection, classification, and formation evaluation. Acquisition of CT scan data is accomplished shortly after core retrieval, providing high-resolution data for use in petrophysical workflows in relatively short periods of time. Typically, CT scan data are used as two-dimensional (2D) cross-sectional images, which is not suitable for quantification of three-dimensional (3D) rock fabric variation, which can increase the uncertainty in rock classification using image-based rock-fabric-related features. The methods documented in this paper aim to quantify rock-fabric-related features from whole-core 3D CT scan image stacks and slabbed whole-core photos using image analysis techniques. These quantitative features are integrated with conventional well logs and routine core analysis (RCA) data for fast and accurate detection of petrophysical rock classes. The detected rock classes are then used for improved formation evaluation. To achieve the objectives, we conducted a conventional formation evaluation. Then, we developed a workflow for preprocessing of whole-core 3D CT-scan image stacks and slabbed whole-core photos. Subsequently, we used image analysis techniques and tailor-made algorithms for the extraction of image-based rock-fabric-related features. Then, we used the image-based rock-fabric-related features for image-based rock classification. We used the detected rock classes for the development of class-based rock physics models to improve permeability estimates. Finally, we compared the detected image-based rock classes against other rock classification techniques and against image-based rock classes derived using 2D CT scan images. We applied the proposed workflow to a data set from a siliciclastic sequence with rapid spatial variations in rock fabric and pore structure. We compared the results against expert-derived lithofacies, conventional rock classification techniques, and rock classes derived using 2D CT scan images. The use of whole-core 3D CT scan image-stacks-based rock-fabric-related features accurately captured changes in the rock properties within the evaluated depth interval. Image-based rock classes derived by integration of whole-core 3D CT scan image-stacks-based and slabbed whole-core photos-based rock-fabric-related features agreed with expert-derived lithofacies. Furthermore, the use of the image-based rock classes in the formation evaluation of the evaluated depth intervals improved estimates of petrophysical properties such as permeability compared to conventional formation-based permeability estimates. A unique contribution of the proposed workflow compared to the previously documented rock classification methods is the derivation of quantitative features from whole-core 3D CT scan image stacks, which are conventionally used qualitatively. Furthermore, image-based rock-fabric-related features extracted from whole-core 3D CT scan image stacks can be used as a tool for quick assessment of recovered whole core for tasks such as locating best zones for extraction of core plugs for core analysis and flagging depth intervals showing abnormal well-log responses.

Intracranial Brain Volume (ICV) Measurement in Epileptic Male Patient: A 3D CT Study

Objective: Intracranial volume (ICV) is one of the reliable indicators of neurodegenerative disease and premature brain size. Epilepsy is considered a neurological disorder. We aimed to measure ICV in epileptic male samples to identify the relation of ICV and epilepsy control status for their better treatment purpose. Methods: This retrospective study was done using CT images of age-matched control and epileptic male samples. All samples were collected from the archive of the Department of Radiology, Universiti Sains Malaysia (USM) from the 2010-2017 period. A total of 34 male samples were used for this study in two groups, control (n=17) and epileptic (n=17) groups. Control males were those who came for the CT scan and no disease was found. And epileptic male patients were those who came for routine checkups due to epilepsy. MITK 3M3 software was used for the ICV measurement. 2D CT images were converted to 3D CT images to measure intracranial brain volume (ICV) in each group. Two reviewers measured ICV and a reliability test was done between reviewers. Results: According to first reviewer, there is no significant (p=0.455) difference between control, (1287.82 (151.79) mm) and epileptic (1283.28 (65.48) mm) male groups. Results of second reviewer also showed no significant difference (p=0.400) between control (1299.58(144.81)) mm and epileptic (1283.88 (76.08)) groups. Average measurements also did not reveal any significant difference between groups, control is 1293.7 (144.81) mm and the epilepsy group is 1283.58 (69.90) mm (p=0.114). Reliability test results revealed an acceptable internal consistency level in control (97%, p<0.001) and epileptic (77%, p=0.003) groups. Conclusion: We concluded that epilepsy does not affect ICV in the male population. Further study is recommended to seek other indicators which might be affected by epilepsy in the male population. J MEDICINE 2021; 22: 95-99

Root and Canal Morphology of Maxillary Primary Molar using CBCT and 3D CT

The purpose of this study is to analyze morphological characteristics of maxillary primary molar’s root and root canal. 268 children aged 3 - 7 years (175 boys, 93 girls) who had CBCT (152 children) and 3D CT (116 children) taken in Seoul National University Dental Hospital from January 2006 to April 2020 were included. The number of roots and root canals were analyzed in 1002 teeth without any root resorption or periapical pathologies. Curvature, angulation, length of root and root canal, as well as cross-sectional shapes of the root canal were analyzed in 218 teeth. By using Mimics and 3-Matics software, volume, surface area, and volume ratio of root canal was analyzed in 48 teeth. More than half of maxillary primary molars have 3 roots and 3 root canals. The degree of symmetry of root canal type was about 0.63 (Cohen’s kappa coefficient). The most frequent shape of roots and canals was linear in 1st primary molars and curved in 2nd primary molars. Angulation, length of root and root canals was the largest on palatal roots. Most teeth showed ovoid or round shapes at apex. The largest root canal volume, surface area, volume ratio was found in the palatal roots.

Kerley A-lines represent thickened septal plates between lung segments in patients with lymphangitic carcinomatosis: confirmation using 3D-CT lung segmentation analysis

Purpose Kerley A-lines are generally apparent in patients with pulmonary edema or lymphangitic carcinomatosis. There are two main thoughts regarding the etiology of Kerley A-lines, but no general agreement. Specifically, the lines are caused by thickened interlobular septa or dilated anastomotic lymphatics. Our purpose was to determine the anatomic structure represented as Kerley A-lines using 3D-CT lung segmentation analysis. Materials and methods We reviewed 139 charts of patients with lymphangitic carcinomatosis of the lung who had CT and X-ray exams with a maximum interval of 7 days. The presence of Kerley A-lines on X-ray was assessed by a radiologist. The A-lines on X-ray were defined as follows: dense; fine (< 1 mm thick); ≥ 2 cm in length, radiating from the hilum; no bifurcation; and not adjacent to the pleura. For cases with Kerley A-lines on X-ray, three radiologists agreed that the lines on CT corresponded with Kerley A-lines. The incidence of A-lines and the characteristics of the lines were investigated. The septal lines between lung segments were identified using a 3D-CT lung segmentation analysis workstation. The percentage of agreement between the A-lines on CT and lung segmental lines was assessed. Results On chest X-ray, 37 Kerley A-lines (right, 16; left, 21) were identified in the 22 cases (16%). Of these, 4 lungs with 12 lines were excluded from analysis due to technical reasons. Nineteen of the 25 lines (76%) corresponded to the septal lines on CT. Of these, 11 lines matched with automatically segmented lines (intersegmental septa, 4; intersubsegmental septa, 7) by the workstation. Two lines (8%) represented fissures. Four lines corresponded to the bronchial wall/artery (3 lines, 12%) or vein (1 line, 4%). Conclusion Kerley A-lines primarily represented thickened and continued interlobular septal lines that corresponded to the septa between lung segments and subsegments.

ITVT-07. Robotic alignment module Cirq for navigated brainstem tumor biopsies

BACKGROUND With the incorporation of the robotic alignment module Cirq (Brainlab, Germany) into our neurosurgical armamentarium, we aimed to know our baseline accuracy in stererotactic biopsies. We therefore retrospectively reviewed our data on biopsy accuracy for brain(stem) tumors using the non-robotic alignment instrument Varioguide (Brainlab, Germany). Because of unexpectedly large deviations from the intended target, we sought to improve our registration accuracy when we introduced Cirq. Intraoperative 3D CT with bone fiducials was added to the pre-operative 3D T1 MRI with skin fiducials. This made it possible to compare surgical devices as well as registration methods. AIMS To share our experience with the new robotic alignment module Cirq for navigated brain(stem) tumor biopsies and to evaluate its target accuracy with bone fiducial registration, as compared to the previously used Varioguide with skin fiducial registration. METHODS All patients (0–18 years old) that underwent a brain(stem) biopsy in our institution were included. Over 2018–2020, data were collected retrospectively (cohort Varioguide with 3D T1 MRI registration with skin fiducials). From 2021, data were collected prospectively (cohort Cirq with both 3D T1 MRI registration with skin fiducials and intraoperative CT registration with bone fiducials). For both cohorts, Euclidian distances were calculated between the intended target and the obtained target. For the prospective cohort, registration errors were calculated for bone versus skin fiducials. PRELIMINARY REUSLTS The deviation from the intended target was much smaller in the Cirq cohort versus the Varioguide cohort. Within the Cirq cohort, registration errors were submillimetric for bone fiducial registration as compared to several millimeters for skin fiducial registration. CONCLUSION: The Cirq robotic arm is convenient, safe and highly accurate, especially when combined with intraoperative 3D CT bone fiducial registration. Skin fiducial registration does not offer the level of precision that is mandatory in brainstem tumor biopsies.