Leitor de feeds

Evaluation of aortic stent endoleaks in the renally impaired patient with ferumoxytol-enhanced MR angiography

PubMED - qua, 12/11/2024 - 08:00

Clin Imaging. 2024 Dec 5;118:110383. doi: 10.1016/j.clinimag.2024.110383. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate ferumoxytol-enhanced magnetic resonance angiography (FE-MRA) for assessment of endoleaks in patients with abdominal aortic aneurysms (AAA) and chronic kidney disease (CKD) status post endovascular aneurysm repair (EVAR).

METHODS: Of 1854 patients who underwent FE-MRA at a single institution between 03/21/2014 and 08/21/2023, 21 patients with a history of AAA and CKD status post EVAR were retrospectively identified (IRB #13-001341). Multiplanar pre- and post-contrast HASTE, T1-VIBE, and high-resolution breath-held 3D MRA sequences were obtained, where a dose of 4 mg/kg of Ferumoxytol was infused over six minutes. All examinations were performed on either a Siemens 3.0 T Prisma Fit, a Siemens 3.0 T TIM Trio, or a Siemens 1.5 T Avanto MRI scanner. Image post-processing was performed using OsiriX and Vitrea software for endoleak identification and display.

RESULTS: Twenty-six FE-MRA examinations were completed, where 24 were fully diagnostic and 2 were limited by metal artifact. Three patients underwent one follow-up examination, while one patient underwent two follow-up examinations. Endoleaks were identified in seven patients: one Type Ia, two Type Ib, and four Type II. The Type Ia endoleak patient received follow-up imaging two years after initial imaging. A Type II endoleak patient received follow-up imaging six months and one year after initial imaging. In both cases, the Type I and Type II endoleaks were reproducibly visualized. No contrast reactions occurred.

CONCLUSION: For patients with a history of AAA and CKD status post EVAR, FE-MRA is a safe, practical and effective imaging solution for evaluation of Type I and Type II endoleaks.

PMID:39662299 | DOI:10.1016/j.clinimag.2024.110383

Lacrimal gland enlargement in thyroid eye disease

PubMED - qui, 11/14/2024 - 08:00

Int Ophthalmol. 2024 Nov 14;44(1):431. doi: 10.1007/s10792-024-03352-x.

ABSTRACT

PURPOSE: This study aimed to investigate lacrimal gland (LG) enlargement in thyroid eye disease (TED) patients on magnetic resonance imaging (MRI).

METHODS: A retrospective review was conducted on TED patients who had undergone fat-suppressed contrast-enhanced T1-weighted MRI of the orbits. The lacrimal gland was segmented on OsiriX in consecutive axial and coronal slices to determine its volume. Enlargement was defined as a volume greater than 1100mm3, based on previous normative data. Asymmetric enlargement was defined if one side was enlarged but the contralateral side was not. Clinical data including presentation (active/inactive) and presence or absence of dysthyroid optic neuropathy was evaluated.

RESULTS: The study population consisted of 88 orbits from forty-four patients with a mean age of 53 ± 15 years, with 29 (65%) being female. Twelve patients (27%) had LG enlargement, with eight (18%) having bilateral enlargement and four (9%) having asymmetric enlargement. There was no significant difference in age (p = 0.17) or sex (p = 0.44) between the LG enlarged and non-enlarged groups. There was also no significant difference in the clinical activity (p = 0.46) or prevalence of dysthyroid optic neuropathy (p = 0.63) between the LG enlarged orbits and non-LG enlarged orbits.

CONCLUSION: Lacrimal gland enlargement may be observed in approximately thirty percent of TED patients, with asymmetric enlargement in approximately ten percent of cases.

PMID:39542958 | DOI:10.1007/s10792-024-03352-x

Sex estimation by CT image analysis of the rib cage in a Mediterranean population

PubMED - qua, 10/09/2024 - 07:00

Int J Legal Med. 2024 Oct 9. doi: 10.1007/s00414-024-03349-2. Online ahead of print.

ABSTRACT

Sexual dimorphism in the human species is key to the development of sex estimation techniques in the human skeleton. This dimorphism is manifested, as in other regions of the skeleton, in the bones that constitute the thoracic cage, according to the existing bibliography. In this aspect, the study of the human skeleton through 3D images has also proved to be useful for the development and validation of sex estimation methodologies for the reconstruction of the osteobiological profile.For this purpose, a sample of 240 thoracic CT scans of adult individuals was selected from a collection of 3D images belonging to the University of Granada, provided by the Castilla-La Mancha Health Service (SESCAM). Different measurements of the thoracic bones (ribs R2 to R5 width, sternum length and width, and clavicles width) have been taken with OsiriX software, with the aim of developing discriminant functions for sex estimation.The obtained results are positive, allowing sex estimation through 3D images of the thorax with up to 89.6% accuracy through discriminant functions, which shows the usefulness of image analysis for the reconstruction of the osteobiological profile.

PMID:39382593 | DOI:10.1007/s00414-024-03349-2

The Bony Nasal Cavity and Paranasal Sinuses of Big Felids and Domestic Cat: A Study Using Anatomical Techniques, Computed Tomographic Images Reconstructed in Maximum-Intensity Projection, Volume Rendering and 3D Printing Models

PubMED - sab, 09/14/2024 - 07:00

Animals (Basel). 2024 Sep 7;14(17):2609. doi: 10.3390/ani14172609.

ABSTRACT

This study aims to develop three-dimensional printing models of the bony nasal cavity and paranasal sinuses of big and domestic cats using reconstructed computed tomographic images. This work included an exhaustive study of the osseous nasal anatomy of the domestic cat carried out through dissections, bone trepanations and sectional anatomy. With the use of OsiriX viewer, the DICOM images were postprocessed to obtaining maximum-intensity projection and volume-rendering reconstructions, which allowed for the visualization of the nasal cavity structures and the paranasal sinuses, providing an improvement in the future anatomical studies and diagnosis of pathologies. DICOM images were also processed with AMIRA software to obtain three-dimensional images using semiautomatic segmentation application. These images were then exported using 3D Slicer software for three-dimensional printing. Molds were printed with the Stratasys 3D printer. In human medicine, three-dimensional printing is already of great importance in the clinical field; however, it has not yet been implemented in veterinary medicine and is a technique that will, in the future, in addition to facilitating the anatomical study and diagnosis of diseases, allow for the development of implants that will improve the treatment of pathologies and the survival of big felids.

PMID:39272394 | PMC:PMC11393894 | DOI:10.3390/ani14172609

Using computed tomography to evaluate anatomic landmarks in taiwanese trauma patients for insertion of resuscitative endovascular balloon occlusion of the aorta: A retrospective cohort study

PubMED - seg, 09/09/2024 - 07:00

Int J Surg. 2024 Sep 9. doi: 10.1097/JS9.0000000000002079. Online ahead of print.

ABSTRACT

BACKGROUND: Hemorrhage, particularly from non-compressible torso hemorrhage (NCTH) in the abdominopelvic region, is a leading cause of preventable trauma deaths. Resuscitative endovascular balloon occlusion of the aorta (REBOA), designed for aortic occlusion, has emerged as a tool for temporary hemorrhage control in recent years. However, attaining optimal REBOA placement in diverse demographic groups, such as Asian populations, may pose challenges owing to unique anatomical and physiological differences.

MATERIALS AND METHODS: This retrospective study analyzed trauma patients who underwent torso computed tomography (CT) at tertiary hospitals in Taiwan from January 2014 to January 2017. The OsiriX software was used to measure the endovascular lengths in the CT images.

RESULTS: Among the 223 patients, the median vascular lengths and body measurements were higher in males. The optimal fixed insertion length was identified as 47.5 cm for zone 1 with 99.43% accuracy and 25.5 cm with 82.1% accuracy for zone 3. The landmark-guided method showed 100% accuracy for zone 1 when using the mid-sternum and 94.6% for zone 3 with the umbilicus as the guide with the distance between the umbilicus, xiphoid process, and pubic ramus. External validation confirmed the accuracy of the landmark-guided method.

CONCLUSIONS: For zone 1 occlusions, a range of 44-48 cm insertion length cross-referenced with the mid-sternal landmark is recommended. For zone 3 occlusions, using the umbilicus as a guide with the distance between the umbilicus, xiphoid process, and pubic ramus provided the highest accuracy.

PMID:39248313 | DOI:10.1097/JS9.0000000000002079

Prognostic value of body composition parameters by computed tomography in patients with lower extremity arterial disease: a single-center retrospective-prospective analysis

PubMED - qui, 09/05/2024 - 07:00

Int Angiol. 2024 Sep 5. doi: 10.23736/S0392-9590.24.05227-1. Online ahead of print.

ABSTRACT

BACKGROUND: In this study, we examine the associations between cross-sectional areas (CSAs) of skeletal muscle (SM), subcutaneous, visceral, and total adipose tissue (SAT, VAT, and TAT) measured by computed tomography (CT), and clinical outcomes in patients with lower extremity arterial disease (LEAD).

METHODS: Images obtained by lower extremity CT arteriography in 177 consecutive LEAD patients were retrospectively reviewed. The CSAs of SM, SAT, VAT, and TAT were determined at various body levels using OsiriX software. The outcomes measured were: target lesion revascularization (TLR), leg amputation, and composite endpoints.

RESULTS: A high prevalence of sarcopenia (45.2%), low SAT (48.0%), high VAT (44.6%), and high TAT (55.4%) was found among the patients studied. Patients who underwent leg revascularization had a lower SAT CSA at the third and fourth lumbar vertebrae (L3, L4), thigh, and calf compared to those who did not undergo vascular intervention. Compared to patients without a major adverse cardiovascular and limb event (MACLE), those with a MACLE had lower SM, SAT, VAT, and TAT values. Low SM and SAT CSAs were also associated with risk of TLR, MACLE, symptom severity, and impairment in functional status. These relationships remained statistically significant after adjustment for the presence of diabetes mellitus, hypertension, and chronic kidney disease, but disappeared after adjusting for smoking.

CONCLUSIONS: Low SM and SAT CSAs were related to symptom severity, impairment in functional status, and prognosis. Analysis of body component CSAs by CT seems to be a valuable method of stratifying LEAD patients.

PMID:39235281 | DOI:10.23736/S0392-9590.24.05227-1

Potential and Pitfalls of Postoperative Volumetric Assessment of Extent of Resection in High-Grade Glioma in Resource-Constrained Settings

PubMED - sab, 08/31/2024 - 07:00

Neurol India. 2024 Jul 1;72(4):756-762. doi: 10.4103/neurol-india.Neurol-India-D-23-00585. Epub 2024 Aug 31.

ABSTRACT

BACKGROUND: While literature suggests the need for routine postoperative volumetric estimation of the EOR and residual tumour volume (RTV) in all cases of gliomas, the utility and feasibility of this protocol in resource-constrained centers remain underinvestigated.

OBJECTIVES: Our objective was to study the feasibility of volumetric EOR in routine neurosurgical practice and determine correlation with surgeons' intraoperative estimation of EOR. The secondary objective was to determine the survival impact of EOR and RTV on survival.

METHODS AND MATERIALS: A prospective study of pathologically proven high-grade gliomas (WHO grades 3 and 4) in adults was conducted at a tertiary care center. Pre- and postoperative magnetic resonance imaging (MRI) was obtained for volumetric analysis using OsiriX software and manual segmentation. Overall survival and predictors were studied using Kaplan-Meier and Cox regression analysis.

RESULTS: Postoperative volumetry was feasible in 31% patients (n = 25) of study eligible patients (n = 84). The median EOR, CE-PTV, and CE-RTV were 79.1%, 69.8 cm3, and 8.7 cm3, respectively. There was a poor correlation of surgeons' intraoperative impression and volumetric data (P = 0.359). Interestingly, the EOR was not significantly associated with the survival time (P = 0.920), while tumor grade, molecular profile, Ki 67 score, and postoperative functional status showed statistically significant impact.

CONCLUSION: Logistic difficulties impede routine implementation of this protocol in developing countries. MRI volumetry is clearly more accurate than surgeons' intraoperative estimation of EOR. Notwithstanding the role of EOR in survival, our study reveals a perhaps bigger impact of tumor biology and postoperative functional status in this equation.

PMID:39216029 | DOI:10.4103/neurol-india.Neurol-India-D-23-00585