The enlargement of the maxillary ostium after balloon sinuplasty evaluated by a novel measuring technique from 3D CBCT images

Our aim was to evaluate the effects of balloon sinuplasty on the size of the ostium in the maxillary sinuses in patients with chronic rhinosinusitis from cone beam computer tomography (CBCT) scans of the sinus. This is a blinded retrospective trial in patients who had undergone balloon sinuplasty of the maxillary sinus. CBCT scans were taken and SNOT-22 Quality of Life questionnaire completed before and 12 months after the operation. The size of the maxillary ostium was measured from the CBCT scans three-dimensionally. The association of changes in the SNOT-22 scores of the ostium was analysed. We discovered that the balloon sinuplasty increased the size of the maxillary ostium in all dimensions. The changes were statistically significant (p<0.05) in the axial diameter and the ostium area. The number of patent ostia increased after the intervention. The association between SNOT-22 score and ostium patency were statistically significant before the operation. Our conclusion is that the threedimensional measuring technique provides a reliable method to evaluate ostium dimensions. Balloon sinuplasty increased the size of the maxillary ostium and the result was maintained for 12 months after the operation.

Radiologic criteria of retropharyngeal lymph node metastasis in maxillary sinus cancer

Objective To determine the most appropriate radiologic criteria of metastatic retropharyngeal lymph nodes (RLNs) in patients with maxillary sinus cancer (MSC). Materials and methods We retrospectively evaluated 16 consecutive patients who underwent magnetic resonance imaging (MRI) before and after the treatment of locally advanced squamous cell carcinoma of the maxillary sinus. The minimal and maximal diameters of all RLNS were recorded. RLNs were classified as metastatic on the basis of the MRI follow-up (f/u). RLNs were considered non-metastatic if stable disease continued until the final MRI f/u and metastatic in cases with different evaluations (complete response, partial response, progressive disease) determined using Response Evaluation Criteria in Solid Tumours (RECIST) ver. 1.1. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to assess the accuracy of various criteria in the diagnosis of metastatic RLNs. Results Of the 34 RLNs in 16 cases observed on pretreatment MRI, 7 were classified as metastatic RLNs and 27 as non-metastatic RLNs. Using the radiologic criteria, metastatic RLNs tended to be diagnosed more accurately with the minimal axial diameter than with the maximal axial diameter (AUC; 0.97 vs. 0.73, p = 0.06). The most accurate size criterion of metastatic RLNs was a minimal axial diameter of 5 mm or larger, with an accuracy of 94.1% (32 of 34). Conclusions The most appropriate radiologic criterion of metastatic RLNs in MSC is a minimal axial diameter of 5 mm or longer.

Comparitive Study of Human Lymph Nodes

All the lymph nodes observed were typically bean shaped irrespective of their age or sex. The cervical lymph nodes were the largest of all the four groups in size. The mean maximum short axis axial diameter was 7.19mm (Range 5.67mm - 8.12mm). The mesentericl lymph nodes were the smallest of all the four groups in size. The mean maximum short axis axial diameter was 3.89mm (Range 2.7mm -6.lmm). The lymph nodes showed well defined deep cortical regions often containing large lymphoblasts and prominent endothelial cells in small blood vessels. The thickness of the deep cortex was however reduced when compared to its foetal counterpart. The mean thickness of the deep cortical region was 423 microns. To reconfirm the age related involution of the paracortical region, the mesenteric lymph nodes were observed. In sharp· distinction, axillary lymph nodes showed fewer germinal centres which were relatively smaller in size.Mean actual diameter of the germinal centre was77 microns also had had fewer and smaller germinal centres. Mean actual diameter of the germinal centre was 68 microns.

Does volume matter? Incorporating estimated stone volume in a nomogram to predict ureteral stone passage

Introduction: Recent studies have shown that software-generated 3D stone volume calculations are better predictors of stone burden than measured maximal axial stone diameter. However, no studies have assessed the role of formula estimated stone volume, a more practical and cheaper alternative to software calculations, to predict spontaneous stone passage (SSP). Methods: We retrospectively included patients discharged from our emergency department on conservative treatment for ureteral stone (≤10 mm). We collected patient demographics, comorbidities, and laboratory tests. Using non-contrast computed tomography (CT) reports, stone width, length, and depth (w, l, d, respectively) were used to estimate stone volumes using the ellipsoid formula: V=π*l*w*d*0.167. Using a backward conditional regression, two models were developed incorporating either estimated stone volume or maximal axial stone diameter. A receiver operator characteristic (ROC) curve was constructed and the area under the curve (AUC) was computed and compared to the other model. Results: We included 450 patients; 243 patients (54%) had SSP and 207 patients (46%) failed SSP. The median calculated stone volume was significantly smaller among patients with SSP: 25 (14–60) mm3 vs. 113 (66–180) mm3 (p<0.001). After adjusting for covariates, predictors of retained stone included: neutrophil to lymphocyte ratio (NLR) ≥3.14 (odds ratio [OR] 6, 95 % confidence interval [CI] 3.49–10.33), leukocyte esterase (LE) >75 (OR 4.83, 95% CI 2.12–11.00), and proximal stone (OR 2.11, 95% CI 1.16–3.83). For every 1 mm3 increase in stone volume, the risk of SSP failure increased by 2.5%. The model explained 89.4% (0.864–0.923) of the variability in the outcome. This model was superior to the model including maximal axial diameter (0.881, 0.847–0.909, p=0.04). Conclusions: We present a nomogram incorporating stone volume to better predict SSP. Stone volume estimated using an ellipsoid formula can predict SSP better than maximal axial diameter.

Radiologic Criteria of Retropharyngeal Lymph Node Metastasis in Maxillary Sinus Cancer

Objective: To determine the most appropriate radiologic criteria of metastatic retropharyngeal lymph nodes (RLNs) in patients with maxillary sinus cancer (MSC).Materials and Methods: We retrospectively evaluated 16 consecutive patients who underwent magnetic resonance imaging (MRI) before and after the treatment of locally advanced squamous cell carcinoma of the maxillary sinus. The minimal and maximal diameters of all RLNS were recorded. RLNs were classified as metastatic on the basis of the MRI follow-up (f/u). RLNs were considered non-metastatic if stable disease continued until the final MRI f/u and metastatic in cases with different evaluations (complete response, partial response, progressive disease) determined using Response Evaluation Criteria in Solid Tumours (RECIST) ver. 1.1. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to assess the accuracy of various criteria in the diagnosis of metastatic RLNs. Results: Of the 34 RLNs in 16 cases observed on pretreatment MRI, 7 were classified as metastatic RLNs and 27 as non-metastatic RLNs. Using the radiologic criteria, metastatic RLNs tended to be diagnosed more accurately with the minimal axial diameter than with the maximal axial diameter (AUC; 0.97 vs. 0.73, p = 0.06). The most accurate size criterion of metastatic RLNs was a minimal axial diameter of 5 mm or larger, with an accuracy of 94.1% (32 of 34).Conclusions: The most appropriate radiologic criterion of metastatic RLNs in MSC is a minimal axial diameter of 5 mm or longer.

Comparison of Urinary Calculi Size Between Bone and Soft Tissue Window in Computed Tomography

Computed Tomography is an important technique for imaging the urinary calculi using cross sectional images. The size and site of the calculi are significant aspect that are necessary for treatment. Therefore, present study aims to compare diameters of calculi measured using bone and soft tissue window settings in CT and also determinesmost frequent site for occurrence of calculi in urinary system. This is a retrospective study including total of 126 patients (91 males, 35 females, age range: 20-50 years). The patients who had undergone non contrast enhanced computed tomography of Kidney Ureter and Bladder (NCCT KUB) and diagnosed with urinary calculi were included in study. For each calculus found on CT image, two diameters such as maximum diameter and perpendicular diameter was measured on coronal plane using soft tissue and bone window settings. Site of calculi was also noted.To compare diameters measured using soft tissue and bone window settings Wilcoxon signed ranks test was used.Mean of maximum diameter and perpendicular diameter of the calculi measured by soft tissue and bone window settings in CT was 0.74±0.5, 0.82 ±1.8 and 0.79 ± 0.5 ,0.67 ± 0.49 respectively. It was found that there was significant difference in diameters of calculi measured using soft tissue and bone window setting (p<0.0001). The study concludes that there was mean difference of0.08 cms and 0.12 cms for maximum axial diameter and perpendicular diameter respectively measured using soft tissue and bone window settings in CT. Calculi in kidneys was most common site in our study population.

GRANULOMETRIC STUDIES TO INTERPRET THE ORIGIN OF THE SEDIMENT TRAPPED WITHIN A POCKET ALONG THE PRAVARA RIVER BASIN, MAHARASHTRA, INDIA

Sediment populations may have characteristics associated with multiple sources. Grain size parameters will therefore reflect spatial as well as temporal variations in transport mechanism and flow direction along with the nature and energy flux of the transporting agents. Herein, the author has investigated a small watershed area along Mahalungi River in Maharashtra, India. Samples were collected from the surface and from litho-facies at various depths and were subjected to granulometric analysis. The sediment sizes were separated principally on the basis of their intermediate axial diameter and shape using microscope, sedigraph and pipette method appropriately. Bivariate relationships from textural parameters were obtained and Visher’s log-probability plots were constructed. Incorporation of all results of the analyses and a careful inspection of the geomorphic settings of the area lead us to the conclusion that the present deposits are part of the alluvial deposits of Pravara and haven’t descended from the footslope to form colluvial deposits. The fact that the silt population is found right at the footslope indicates that during the floods, flood waters must have entered and hit the amphitheater. As the flood water receded, the narrow outlet did not allow free retraction of the flow but created an eddy effect every time and gave a temporary ponding effect within the amphitheater.

Factors affecting the occurrence of proximal endoleak after endovascular abdominal aortic repair for abdominal aneurysms

Objective This retrospective study was performed to assess the clinical and radiological variables associated with proximal type IA endoleak (EL) in patients treated with elective endovascular repair for abdominal aortic aneurysms. Methods The chi-square test, t-test, and logistic regression analysis were performed as appropriate. A P value of <0.05 was considered statistically significant. Results The data of 79 patients were analyzed. No mortality occurred. During follow-up (median, 28.5 months; interquartile range, 12.8–43.0 months), 10 patients developed type IA EL. In the logistic regression analysis, undersizing of the endograft diameter by <10% significantly affected the occurrence of type IA EL. When the diameter was used for measurements, less oversizing was significantly associated with a higher risk of type IA EL. When the area was used for measurements, oversizing of >20% significantly affected the occurrence of type IA EL. Conclusion When sizing endografts, a discrepancy was noted between the measurements of the diameter and area of the proximal neck. The area might represent a more accurate measurement than the axial diameter to optimize the proximal sealing and lower the risk of developing type IA EL.