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One of the most commonly employed methods of treatment for Lumbar disc herniation with leg pain is epidural steroid injection. Of the three routes being deployed, inter-laminar approach is preferred as needle entry can be directed more closely to the assumed site of pathology, requiring less volume than the caudal route and it is less risky compared to the trans-foraminal approach. For effective placement of the spinal needle in the epidural space, use of C-arm is a must. But, the operation theatre and C-arm is not available in most of the health centers in the developing countries especially in rural settings. Time taken to set up is another issue. To improve the success rate of needle placement in “blind method” of ILESI, we have developed a technique of using digital X-ray of lumbo-sacral spine, which is available universally nowadays, to measure the depth of the epidural space and level of the targeted inter-vertebral space. Objective: To assess the effectiveness of measurements in plain roentgenograms of lumbo-sacral spine in guiding needle placement into epidural space. Methods: A prospective study was taken up in the Dept. of PMR, JNIMS during the period May 2017- Feb 2018. 56 consecutive clinically diagnosed prolapsed PIVD patients were enrolled. Lengths of spinous process and skin thickness were measured using a caliper. A 22G Quincke needle was advanced to the expected depth given by digital xray measurement. 1 ml of Iohexol dye was injected. Position of needle was checked by C-arm x-ray. Results: Out of the total 56 subjects, 46 (82.1%) completed the treatment program. Needle was placed at proper depth in 36 cases by using Xray measurement, giving success rate of 87.8%. Mean (SD) depth of epidural space from skin was found to be 3.82 (o.74) cm as measured from X-ray and actual measurement confirmed by fluoroscopy was 3.9 (0.81) cm (Pearson’s correlation coefficient =0.86). Conclusion: Measurement of depth of epidural space using plain X-ray of LS spine improves the success rate of blind MILESI from around 50% to 87.8%. This method of non-real time imaging is cost effective in developing countries where C-arm X-ray facilities are not available
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PURPOSE: There is debate concerning the observation of metabolite changes on MRS at the designated cortex during some tasks. The purpose of this study is to assess the change of the lactate content at the motor cortex during hand-grasping tasks with performing real-time fMRI-guided fMRS. MATERIALS AND METHODS: Seven healthy volunteers (23-28 years old) underwent realtime fMRI during right hand grasping tasks with using a 1.5 T system. After confirming the activating area, single voxel MRS was preformed at 1) the baseline, 2) during the task and 3) after the task on the activating cortex. The three consecutive spectra were compared for observing the changes of the lactate content by the tasks. The Cho/Cr, NAA/Cr and Lac/Cr ratios were calculated manually from those spectra. RESULTS: MRS during the tasks revealed the lactate peaks at the 1.33 ppm resonance frequency with great conspicuity at the activated area, which was identified on the real-time fMRI. After the task scan, the lactate peaks completely disappeared and the spectra recovered to the values of the baseline scan in all volunteers. At baseline, during the task and after the task, the Cho/Cr ratios were 0.81, 0.76 and 0.77, respectively, and the NAA/Cr ratios were 1.68, 1.65 and 1.72, respectively, and the Lac/Cr ratios were 0.28, 0.41 and 0.30, respectively. During the task, Lac was significantly increased by 46%. CONCLUSION: We observed prominent lactate peaks on MRS during hand-grasping tasks at the activated area, as was shown on the real-time fMRI. We suggest that fMRS can be used as a sensitive tool for observing the metabolite changes of the functioning brain.
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Hand , Hand Strength , Lactic Acid , Magnetic Resonance Imaging , Motor CortexABSTRACT
Objective To explore the methodology of sca nning, cutting and measuring normal cardiovascular structures by real-time three-dimensional echocardiography (RT-3DE) and it's clinical applications. Methods Conventional two-dimensional echocardiography (2-DE), RT-3DE and full volume three-dimensional echocardiography (FV-3DE)were performed in 20 normal volunteers to visualize normal cardiovascular structures in multiple orientations and cross sections both in static and dynamic fashions, and all echo images derived by three techniques were compared and analyzed.Results Technically satisfactory 2-DE, RT-3DE and FV-3DE images were obtained in all subjects. Compared with conventional 2-DE technique, RT-3DE has the advantages of instantly displaying three orthogonal planes and spatial relationships of any cardiac structure within a "piece of cake" images of a regional heart, while FV-3DE has the superiority in rapidly depicting three orthogonal planes and spatial relationships of any cardiac structure within a pyramid images of a whole heart. Conclusions Both RT-3DE and FV-3DE techniques can display cardiac structures unobtainable by 2-DE and are useful in reducing the subjectivity and blindness of 2-DE studies, which may enhance the diagnostic accuracy and work efficiency of echo laboratories and produce important clinical values.
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0.05 ), while defect dimensions by 2-D E were lower than those in surgical operation(P
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Objective To evaluate the ventricula r septal defect qualitatively and quantitatively by real-time three-dimensional echocardiography (RT-3DE).Methods RT-3DE were performed in 10 pig hearts with 22 ventricular septal defects in multiple orientations and cross sections. The diameters and areas of ventricular septal defects were measured both in RT-3DE and anatomic view. Echo images and parameters derived by RT-3DE were compared with anatomic view. Results Technically satisfactory RT-3DE images were obtained in all preparations. The location, size, morphology, and spatial relationships with surrounding cardiac structure of ventricular septal defects were displayed instantly. No significant differences were found between RT-3DE and anatomic measurements. Conclusions RT-3DE has advantages of instantly displaying the ventricular septal defects in anyplane and has important surgical and interventional implications.
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It is very important for pulmonary disease treatment to monitor the pulmonary function continuously. In this paper, the hardware of electrical impedance tomography (EIT) system is designed, and simulative model of human thorax is established for image reconstruction based on Landweber pre-iteration method. Compared with linear back projection, the method above results in the better image reconstruction with little trailing and increased speed of real-time reconstruction.