Sella Turcica Dimensions and Morphology in a Yoruba Ethnic Population: A Computed Tomography Study

Background: Several sellar and parasellar pathologies affect the size and shape of sella turcica. A deviation from normal dimensions of sella turcica could be an indication of a pathological condition of the structure itself or the pituitary gland. Aim: This study was designed to assess the dimensions and morphology of the sella turcica of Yoruba ethnic population using cranial computed tomography (CT) images. Materials and Methods: This was a retrospective study involving 321 cranial CT images of the Yoruba subjects acquired in a tertiary health institution between January 2020 and April 2021. The sella turcica length, depth and anteroposterior diameter were measured using the digital calipers of the CT system while sella morphological shape was determined qualitatively by observing the floor of sella in the midsagittal slice and quantitatively by taking the ratio of superoinferior diameter to the transverse diameter. Result: In general, the mean and standard deviation value of sella turcica length was 12.2±`2.35mm. The mean sella length for males was 12.62`±2.50 and that for females was 11.69 ±`2.04mm. The result showed that males’ sella length differed significantly from that of females (t=3.635, p=0.000). A significant difference was noted between the sella depths of the two genders (p=0.032). The total mean anteroposterior diameter (APD) of sella turcica was 13.4`± 2.47mm. Male and female mean diameters were 13.6`± 2.45mm and 13.3±`2.17mm respectively. No significant difference was noted in sella length and APD across the age categories but sella depth showed a significant difference, which was noted to only exist between early adulthood (≤34 years) and late adulthood (≥65) (p=0.027). No statistically significant association was noted between sella shape and gender (c2=3.124, p=0.210) as well as age (c2=9.336, p=0.156). Conclusion: Only the mean sella length and depth differ significantly between male and female genders. Anteroposterior diameter is the same irrespective of gender. The sella turcica dimensions obtained from this study will serve as reference values for physicians in the assessment of sellar and parasellar pathologies in the study population. Key words: Computed tomography, sella turcica, morphology.

Prediction of the ureteric stone outcome by CT scan

Background and objective: Urolithiasis is prevalent in both developed and developing countries, which is attributed to changes in lifestyles. Management of ureteric stones is highly dependent on their characteristics such as volume, size, and density which can be determined based on the images obtained from CT scan. The present study was carried out to examine the association between the final outcomes of the stones and different stone parameters specified by CT scan. Methods: The present prospective cross-sectional study consisted of 100 patients who had been referred to the Radiology Department of Rizgary and Erbil Teaching Hospitals in Erbil, Kurdistan Region, Iraq, over six months in 2019 to undergo abdominal CT scan with clinical suspicion of ureteric stones. All patients underwent non-contrast MDCT scan, and the CT images were evaluated for the presence of ureteric stone, site of the stone, side, diameter in three planes, volume, and density. The outcome of the stone was correlated with each above variables. Results: Ureteric stones were more prevalent among the young and middle age group (25-64 years) with an approximate male-to-female ratio of 3.34:1. There were significant associations between stone outcomes (i.e. spontaneous passage or need for intervention) and the stone characteristics including volume (P <0.001), density (P <0.001)site (upper, mid and lower ureter) (P = 0.02), anteroposterior diameter (P <0.001), transverse diameter (P = 0.006), and superior inferior diameter (P <0.001). Conclusion: Upon the significant correlation between the spontaneous passage of ureteric stones and their characteristics (i.e., volume, density, site, anteroposterior diameter, transverse diameter, and superior inferior diameter), it is highly recommended that all patients with urolithiasis undergo CT scan examination in order to make the proper decision regarding stone management. Keywords: Ureteric stones; CT scan; Stone characteristics; Spontaneous passage.

ANATOMICAL AND MORPHOLOGICAL STUDY ON RADIAL HEAD AND ITS CLINICAL IMPLICATION

Introduction: The lateral forearm bone, Radius is a fundamental element for the physiological or prosthetic stability of the elbow and superior radio-ulnar joints. It also participates in elbow exion, supination & pronation. The knowledge of shape and size of the radius will be useful for the radial head prosthesis. The morphometric data may help orthopedic surgeons for reconstructive surgery. Aims & Objectives: To determine the morphometric parameters of proximal end of radius and to assess its clinical signicance. Methodology: A cross sectional morphometric study was conducted on sixty-six undamaged adult dry human Radii of unknown age and sex, in the Department of Anatomy, MJNMCH, by using a digital vernier caliper of accuracy of 0.01mm. Anteroposterior diameter, transverse diameter, medial height and lateral height and depth of superior articular facet were measured. Result: In the present study mean values (±standard deviation) of anteroposterior diameter, transverse diameter, medial height, lateral height of radial head and depth of superior articular surface were 16.86±2.92mm, 16.22±2.91mm, 8±1.7mm, 5.8±1.29mm and 1.1±0.3mm for the right side and 18.71±2.05mm, 18.14±2.1mm, 8.5±1.33mm, 6.15±0.9mm and 1.21±0.3mm for the left side respectively. The average values of anteroposterior and transverse diameter of radial head show signicant difference between right side and left side of radius. Conclusion: The knowledge of size and shape of radial head is necessary for creation of radial head prosthesis that should be automatically and biochemically correct so that the open be safely applied. The study was conducted to nd out some additional and relevant information on the morphometric parameters of radial head so that it can help in creation of radial head prosthesis.

A Cross Sectional Study to Assess Morphometry of Upper End of 80 Cadaveric Tibiae in a Tertiary Care Centre of Central India

BACKGROUND Osteoarthritis of knee joint is one of the major health problems, due to the evolution of erect posture. Upper weight bearing end of tibia is most vulnerable to damage in such patients. Total knee arthroplasty and unicompartmental arthroplasty are the most frequently done procedures, which require the use of adequate knee prosthesis. So, the present study was focused at providing morphometric data of upper articular end of tibia for designing the tibial component of prosthesis. METHODS The present study has been conducted in SAMC & PGI, Indore in the Department of Anatomy. 80 dry tibia bones were studied, of which 33 were right sided and 47 were left sided. Maximum anteroposterior (AP) length and width of upper surface of medial and lateral condyles and intercondylar area were measured with digital vernier caliper. RESULTS The average anteroposterior diameter was found to be greater than the transverse diameter for both the condyles and the intercondylar area, irrespective of side. Furthermore, the anteroposterior diameter and the transverse diameter of medial condyle was more than that of lateral condyle on both the sides. In intercondylar area, the anteroposterior diameter was found to be more on right side while transverse diameter was more on left side. CONCLUSIONS The present study demonstrates the accurate complete comparative measurements of all the parameters of upper surface of medial and lateral condyles and intercondylar area. The morphometric data obtained will provide guidelines for designing tibial component of knee prosthesis in central Indian population. Apart from clinical significance, the study has anthropological and medicolegal importance as well. KEYWORDS Morphometry, Upper End of Tibia, Knee Joint

Diagnostic Efficacy of Pelvic Ultrasound in Central Precocious Puberty in Girls: a Retrospective Cohort Study

Background: Differentiating central precocious puberty (CPP) patients from normal cases and CPP-like patients “isolated premature thelarche (IPA) and isolated premature thelarche (IPT)” is important for beginning of treatment. Although the GnRH stimulation test is considered the gold standard for diagnosis of CPP, Because of its wide limitations, our study targets to evaluate pelvic sonography parameters as a contributory tool for CPP diagnosis.Methods: We consecutively enrolled 183 cases (93 CPP, 16 IPT, 12 IPA and 62 of age-matched normal controls) in our study over four years. All cases are classified by clinical and laboratory findings and are followed up for at least 2 years. Pelvic sonography parameters included uterine fundus, body and cervix anteroposterior diameter, fundus/cervix ratio, uterine length and transverse diameter, uterine volume, endometrial thickness, ovarian volumes and diameter of the largest follicle are evaluated in all classified groups. One-way ANOVA, post hoc and receiver operating characteristic (ROC) analysis was used to compare the study groups.Results: Our study found that all sonography parameters differ significantly between CPP and normal control cases, also a significant difference is found between CPP compared to IPT or IPA cases in all parameters except in cervix anteroposterior diameter, ovarian volumes and diameter of the largest follicle. In order of best parameters for differentiating CPP compared to study groups, uterine volume (a cut-off of 1.40 ml had a sensitivity of 75.27% and a specificity of 75.56%), transverse diameter (a cut-off of 13.5 mm had a sensitivity of 72.04% and a specificity of 71.11%) and F/C ratio (a cut-off of 0.98 had a sensitivity of 78.49% and a specificity of 70%) was selected. Our study also classified sonography parameters as in equal diagnostic value to uterine volume (as the best diagnostic parameter with area under the curve of 0.826) and not equal diagnostic value to uterine volume.Conclusions: Pelvic Sonography parameters may improve the diagnosis of CPP patients and can have a contributory role in distinguishing treatment needed patients from other patients. The best diagnostic parameter and its cut-off value could change according to different ethnicities and studies.

Reference Ranges for Vermis Biometry on Prenatal Ultrasound: Systematic Review and Meta-Analysis

Purpose To conduct a systematic review and meta-analysis of published nomograms for fetal vermis biometry. Materials and Methods A structured literature search was conducted to identify studies that reported normal measurements of the fetal vermis. A customized quality assessment tool was used to review the selected articles. Random effects meta-analysis was used to calculate normal ranges for vermian craniocaudal diameter, anteroposterior diameter, and surface area. Results A total of 21 studies were included for qualitative review and 3 studies were included for quantitative synthesis. The 3 included articles comprised a total of 10 910 measurements from gestational ages 17–35 weeks. The quality assessment demonstrated that there was generally poor reporting regarding maternal characteristics and neonatal outcomes. Except for one article with a large sample size, the mean number of fetuses per week of gestational age was 15.9, with the lowest number being 5. There was significant statistical heterogeneity. Non-visualization rates ranged from 0–35.4 %. The craniocaudal diameter (reported in 3 articles) increased from a mean of 7.90 mm (95 % confidence interval [CI] 7.42, 8.38) at 17 weeks to 21.90 mm (95 % CI 20.63, 23.16) at 35 weeks gestation. The anteroposterior diameter (reported in 2 articles) increased from 6.30 mm (95 % CI 5.42, 7.18) at 17 weeks to 15.85 (95 %CI 15.49, 16.21) at 32 weeks. Conclusion Reference ranges for vermis biometry across gestation based on meta-analysis of existing references are provided. However, because many of the underlying studies suffered from significant methodological issues, the ranges should be used with caution.

Morphometry of Dry Sub Axial Vertebra: A Nepalese Study

There is paucity in literature describing the morphology of sub-axial vertebra of the local population. Available studies are limited to the body, intervertebral disk, spinal canal and Torg’s ratio of the cervical vertebra. Therefore, the present study aims to document various morphological parameters of sub axial vertebra. Sixty-four dry sub-axial vertebrae of the Nepalese population were studied using Vernier Calipers calibrated to 0.1 mm accuracy. Paired parameters of pedicle, lamina, uncinate process, the distance of the apex of the uncinate process to intervertebral foramen and foramen transversarium were measured. Similarly, unpaired parameters including spinous process length, vertebral foramen anteroposterior width, vertebral foramen transverse diameter and Torg’s ratio were evaluated. Except the height of left lamina of C3 to C6 vertebrae, none of the parameters showed significant side differences. Significant higher values of C7 were noted against C3-C6 on vertebral body height, vertebral body anteroposterior diameter, spinous process length and vertebral foramen anteroposterior diameter. Population data of sub-axial vertebra available in literature showed mixed results with ours. Interestingly, our observations either compared to (lamina, uncinate process, anteroposterior diameter of spinal canal and Torg’s ratio) or were larger (Pedicle and spinous process) than the Indian study with pedicle axis length being largest among all the compared studies. The information of this study may be used as a reference database for our local setting and could be of value in preoperative planning and in designing implants.

Neuroanatomical MRI study: reference values for the measurements of brainstem, cerebellar vermis, and peduncles

Objectives: To set age-specific normal reference values for brainstem, cerebellar vermis, and peduncles measurements and characterize values’ variations according to gender, age, and age by gender interaction. Methods: 565 normal brain magnetic resonance examinations with normal anatomy and signal intensity of the supra- and infratentorial structures were categorized into six age groups (infant, child, adolescent, young adult, middle-age adult, and old aged adults). Patients with congenital malformations, gross pathology of the supra- or infratentorial brain, brain volume loss, developmental delay, metabolic disorders, and neuropsychological disorders (n = 2.839) were excluded. On midsagittal T1 weighted and axial T2 weighted images specific linear diameters and ratios of the brainstem, cerebellar vermis, and peduncles were attained. Two observers assessed a random sample of 100 subjects to evaluate the inter- and intraobserver reproducibility. Intraclass correlation coefficients, means ± standard deviation, one and two-way analysis of variance tests were used in the statistical analysis. Results: Good to excellent inter- and intraobserver measurements’ reproducibility were observed, except for the transverse diameter of the midbrain, the anteroposterior diameter of the medulla oblongata at the pontomedullary and cervicomedullary junctions, cerebellar vermis anteroposterior diameter, and thickness of the superior cerebellar peduncle. Age-specific mean values of the investigated measurements were established. A significant gender-related variation was recorded in the anteroposterior diameter of the basis pontis (p = 0.044), the anteroposterior diameter of the medulla oblongata at the cervicomedullary junction (p = 0.044), and cerebellar vermis height (p = 0.018). A significant age-related change was detected in all measurements except the tectal ratio. Age by gender interaction had a statistically significant effect on the tectal ratio, inferior, and middle cerebellar peduncles’ thickness (p = 0.001, 0.022, and 0.028, respectively). Conclusion: This study provides age-specific normal mean values for various linear dimensions and ratios of the posterior fossa structures with documentation of measurements’ variability according to gender, age, and their interaction. Advances in knowledge: It provides a valuable reference in the clinical practice for easier differentiation between physiological and pathological conditions of the posterior fossa structures especially various neurodegenerative diseases and congenital anomalies.

Radiation Protection: Do We Need to Scan the Whole Lumbar Spine in Suspected Lumbar Spine Stenosis?

Objectives: To test two hypotheses that the scan length could be reduced in patients younger than an age threshold below which lumbar stenosis in the two upper lumbar levels never occurs, and that an anteroposterior spinal canal diameter cut-off at the level of the L3 pedicles could rule out a congenital stenosis at the L1 and/or L2 levels. Methods: MR examinations of 55 healthy volunteers and 200 patients with suspected spinal canal stenosis were included. The anteroposterior diameter of the spinal canal was measured at each pedicle and each disk levels by two readers who also subjectively assessed the presence of stenosis. Results: Degenerative spinal canal stenosis never occurs at the upper two lumbar disk levels in patients younger than 55 years. The anteroposterior diameter of the spinal canal diminished from L1 to L3 in both healthy volunteers and patients. An anteroposterior diameter of the spinal canal at the L3 pedicles level ≥11 mm excluded a diameter <10 mm at L1 and/or L2 pedicles levels. Conclusion: A substantial reduction of the radiation dose from CT could be achieved by limiting the scan length from L3 to S1 in patients younger than 55 years provided that the anteroposterior diameter of the spinal canal is >11 mm at the L3 pedicles level.