Manual kidney stone size measurements in computed tomography are most accurate using multiplanar image reformatations and bone window settings

Computed tomography in suspected urolithiasis provides information about the presence, location and size of stones. Particularly stone size is a key parameter in treatment decision; however, data on impact of reformatation and measurement strategies is sparse. This study aimed to investigate the influence of different image reformatations, slice thicknesses and window settings on stone size measurements. Reference stone sizes of 47 kidney stones representative for clinically encountered compositions were measured manually using a digital caliper (Man-M). Afterwards stones were placed in a 3D-printed, semi-anthropomorphic phantom, and scanned using a low dose protocol (CTDIvol 2 mGy). Images were reconstructed using hybrid-iterative and model-based iterative reconstruction algorithms (HIR, MBIR) with different slice thicknesses. Two independent readers measured largest stone diameter on axial (2 mm and 5 mm) and multiplanar reformatations (based upon 0.67 mm reconstructions) using different window settings (soft-tissue and bone). Statistics were conducted using ANOVA ± correction for multiple comparisons. Overall stone size in CT was underestimated compared to Man-M (8.8 ± 2.9 vs. 7.7 ± 2.7 mm, p < 0.05), yet closely correlated (r = 0.70). Reconstruction algorithm and slice thickness did not significantly impact measurements (p > 0.05), while image reformatations and window settings did (p < 0.05). CT measurements using multiplanar reformatation with a bone window setting showed closest agreement with Man-M (8.7 ± 3.1 vs. 8.8 ± 2.9 mm, p < 0.05, r = 0.83). Manual CT-based stone size measurements are most accurate using multiplanar image reformatation with a bone window setting, while measurements on axial planes with different slice thicknesses underestimate true stone size. Therefore, this procedure is recommended when impacting treatment decision.

Use of modern energetic methods of bone tissue removal during endoscopic dacryocystorhinostomy

The article presents the results of surgical treatment of 22 patients with chronic dacryocystitis accompanied by proximal obstruction of the nasolacrimal duct. A new method of nasolacrimal anastomosis bone window during endonasal endoscopic dacryocystorhinostomy using ultrasound bone dissection is described. The questions of operation technique using SONOCA 185 ultrasound bone dissector and specific features of postoperative treatment are discussed. The obtained data allow to conclude that low temperature process of bone dissection with ultrasound cavitation gives a possibility of adequate bone window formation, reduces surgical trauma of bone structures, surrounding soft tissues and nasal cavity vessels as well as reduces the risk of bleeding and operation time needed for its stopping. It also enables better healing of soft tissues in shorter terms, provides anatomical and functional success of operation in 91 % of cases. Key words: chronic dacryocystitis; endonasal endoscopic dacryocystorhinostomy; ultrasound bone dissection; dacryostoma.

Logistic Regression Analysis of Relationship between Changes of Cerebrospinal Fluid and Communicating Hydrocephalus after Decompressive Craniectomy in Craniocerebral Injury under Computed Tomography Images

This paper aimed to explore the application value of CT imaging in the correlation analysis of communicating hydrocephalus (CH) after decompressive craniectomy (DC) of craniocerebral injury (CI). 410 patients with craniocerebral trauma who were admitted to the hospital from October 2015 to October 2019 were taken as subjects, among which 130 patients suffered from CH. All patients underwent craniocerebral CT examination, and logistic regression was applied to analyze the risk factors of hydrocephalus in CI and hydrocephalus after DC surgery. The results showed that the coma time (OR = 5.1283, P = 0.001 ), subarachnoid hemorrhage (SAH) (OR = 7.6543, P = 0.020 ), Glasgow Coma Scale (GCS) score no more than 8 points (OR = 3.5480, P = 0.001 ), intraventricular hemorrhage (OR = 2.2653, P = 0.003 ), cerebral contusion and laceration (OR = 1.036, P = 0.002 ), and subdural hemorrhage (OR = 2.4376, P = 0.001 ) were independent risk factors for CH. Bilateral DC (OR = 15.342, P = 0.023 ), second surgery (OR = 7.021, P = 0.004 ), bone window height (OR = 6.543, P = 0.041 ), and bone window area (OR = 1.035, P = 0.012 ) were independent risk factors for CH after DC surgery. It suggested that CT imaging technology could be utilized in the diagnosis of CI. The risk factors of CH included coma time, SAH, GCS score no more than 8, intraventricular hemorrhage, brain contusion, subdural hematoma, bilateral DC, bone window height, bone window area, and second surgery.

Impact of Multiparametric Stone Measurement in Noncontrast Computer Tomography on Ureterorenoscopic Stone Removal

<b><i>Purpose:</i></b> Low-dose computer tomography (NCCT) is the standard imaging modality for patients with acute flank pain with a suspicion of urolithiasis. The stone size is usually measured 2D by a radiologist. We compared 3D stone measurement using different windows to the 2D measurement and evaluated the clinical impact on ureterorenoscopic stone removal (URS). <b><i>Methods:</i></b> One hundred sixty-four patients (201 stones) with a preoperative NCCT, following a URS within 4 weeks, were included in this study. Stone location, number and size of stones, operating time, and laser lithotripsy were documented. Stones were measured in 3D using bone and soft tissue window. The maximum diameter was compared to the radiological report. The U test, Kruskal-Wallis, and regression were used for statistical analyses. <b><i>Results:</i></b> Almost two-thirds (64.68%; 130 stones) of stone measurements in 3D with the bone window were lower than the radiologist reports in 2D. One-third (34.83%; 70 stones) of stone measurements were higher and 0.5% (1 stone) reported the same size. Using the 3D soft tissue window, 81.09% (163 stones), 17.91% (37 stones), and 1% (2 stones) of stones were measured bigger, smaller, or had the same measurement results, respectively. In the clinical setting, we could calculate a cutoff for laser lithotripsy at a maximum stone diameter of 5.70 mm (<i>p</i> &#x3c; 0.01) with the 3D and 6.01 mm with the 2D measurements, respectively, and found a significant correlation between maximum stone diameter and operating time (<i>p</i> &#x3c; 0.01) and number of stones and operating time (<i>p</i> &#x3c; 0.01 with and <i>p</i> = 0.02 without laser). <b><i>Conclusion:</i></b> 3D stone measurement with bone window seems to be more accurate than 2D measurement, but 2D is sufficient for planning stone treatment.

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.

Low-Cost, Accurate, Effective Treatment of Hypertensive Cerebral Hemorrhage With Three-Dimensional Printing Technology

Background: Hypertensive intracerebral hemorrhage (HICH) is an acute, severe neurosurgical disease. Puncture drainage of the hematoma has gradually been accepted as a surgical treatment for HICH because of its minimally invasive nature. The precision of the puncture is extremely high because of particular physiological functions. This study was performed to explore the effect of a navigation mold created by three-dimensional printing (3DP) technology in the surgical treatment of HICH.Material and methods: We conducted a retrospective analysis of all consecutive patients with ICH treated with minimally invasive surgery using 3DP navigation or craniotomy to remove the hematoma through a small bone window at the Binzhou Medical University Hospital from June 2017 to March 2019. In total, 61 patients were treated with minimally invasive surgery using 3DP navigation (3DP group), and 67 patients were treated with craniotomy to remove the hematoma through a small bone window (craniotomy group). A comparative study of the two groups was conducted to assess the preoperative and postoperative conditions.Results: The duration of the surgery was significantly longer in the craniotomy group than in the 3DP group (3.27 ± 1.14 h vs. 1.52 ± 0.23 h). Postoperative complication rates were significantly lower in the 3DP group than in the craniotomy group (18.0 vs. 34.3%). Moreover, the rate of patients with a Glasgow Outcome Scale score ≥4 points was not statistically significantly different in the two groups.Conclusion: Minimally invasive surgery assisted by 3DP navigation to treat patients with HICH appears to be safe and effective. The 3DP technique may improve the individualization and accuracy of the surgery.